2008 RRC Sup

1-5 Cardiopatie ischemic A7
6-10 Insufcien cardiac A13

11-15 POSTER FORUM I A18
16-51 POSTER I A24
52-56 Aritmii I A65
57-61 Aritmii II A71
62-66 POSTER FORUM II A79
67-101 POSTER II A85
102-106 HTA Valvulopatii Cardiomiopatii A123
107-111 Cardiologie intervenional A131
112-116 POSTER FORUM III A138
117-151 POSTER III A144
152-156 Varia I A182
157-161 Varia II A189
Index autori A196
Index subiecte A201
Luni
22 septembrie 2008
Mari
23 septembrie 2008
Smbt
20 septembrie 2008
Duminic
21 septembrie 2008
Vol. XXIII,
Suplimentul A, 2008
Vol. XXII, Nr. 1, 2008
1-5 Ischemic cardiopathy A7
6-10 Heart failure A13
11-15 POSTER FORUM I A18
16-51 POSTER I A24
52-56 Arrhythmias I A65
57-61 Arrhythmias II A71
62-66 POSTER FORUM II A79
67-101 POSTER II A85
102-106 Arterial hypertension - Valvulopathies - Cardiomyopathies A123
107-111 Interventional cardiology A131
112-116 POSTER FORUM III A138
117-151 POSTER III A144
152-156 Varia I A182
157-161 Varia II A189
Authors index A196
Topics index A201
Monday,
September 22
nd
, 2008
Tuesday,
September 23
rd
, 2008
Saturday,
September 20
th
, 2008
Sunday,
September 21
st
, 2008
Vol. XXIII,
Suplimentul A, 2008
Preedinte: Radu Cplneanu
Preedinte ales: Dan Deleanu
Preedinte anterior: Carmen Ginghin
Vicepreedini: Marius Vintil
Ioan Mircea Coman
Secretar: Doina Dimulescu
Trezorier: Radu Ciudin
Membri: Eduard Apetrei
erban Blnescu
Carmen Bedeleanu
Ovidiu Chioncel
Mircea Cintez
Gheorghe Andrei Dan
Maria Dorobanu
Dan Gai
Bogdan Mut-Vitcu
Tiberiu Nanea
Mariana Rdoi
Anca Sglimbea
Gabriel Tatu-Chioiu
Drago Vinereanu
CONSILIUL DE CONDUCERE AL
SOCIETII ROMNE DE CARDIOLOGIE
ISSN: 1583-2996
Colegiul de redacie
Editura: Media Med Publicis
Publicitate: of ce@mediamed.ro
Distribuie: Revista Romn de
Cardiologie se distribuie membrilor Societii
Romne de Cardiologie
Abonamente: of ce@mediamed.ro
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Contact: Societatea Romn de Cardiologie
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Tel./Fax: +40.21.250 01 00, +40.21.250 50 86, +40.21.250 50 87;
E-mail: rscardio@rscardio.ro
Alexandru Cmpeanu - Bucureti
Mircea Cintez - Bucureti
Radu Ciudin - Bucureti
Radu Cristodorescu - Timioara
D. V. Cokkinos - Grecia
G. Andrei Dan - Bucureti
Dan Deleanu - Bucureti
Genevieve Derumeaux - Frana
Doina Dimulescu - Bucureti
Maria Dorobanu - Bucureti
tefan Iosif Drgulescu -
Timioara
Guy Fontaine - Frana
Bradu Fotiade - Bucureti
Alan Fraser - Anglia
Mihai Gheorghiade - USA
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Craiova
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erban Mihileanu - Frana
Nour Olinic - Cluj-Napoca
Fausto Pinto - Portugalia
Gian Luigi Nicolosi - Italia
Mariana Rdoi - Braov
Willem J. Remme - Olanda
Doina Rogozea - Bucureti
Michal Tendera - Polonia
Ion intoiu - Bucureti
Panagiotis Vardas - Grecia
Drago Vinereanu - Bucureti
Marius Vintil - Bucureti
Dumitru Zdrenghea - Cluj-Napoca
Colectivul de redacie
Redactor ef
Eduard Apetrei
Redactor ef adjunct
Carmen Ginghin
Redactori
Radu Cplneanu
Cezar Macarie
Redactor fondator
Costin Carp
Redactori asociai
Mihaela Rugin
Ruxandra Jurcu
Bogdan A. Popescu
Costel Matei
Revista Romn de Cardiologie | Vol. XXIII | Suplimentul A, 2008
ni mentelor cardiovasculare dup ajustarea pentru ali

factori de risc cardiovasculari (OR 0.72; 95%CI 0.57-
0.83, p=0.004) s-a dovedit de asemenea independent n
analiza multivariant.
Concluzie: Apolipoproteinele B i A-I pot f considerate
ca un mijloc de evaluare a riscului cardiovascular, va-
loarea lor predictiv find superioar celei obinute
prin evaluarea proflului lipidic convenional. Datele
obi nute sugereaz determinarea apolipoproteinelor n
prac tica clinic curent.

2. Expansiunea infarctului
miocardic acut la bolnavii cu
hipertrofie ventricular stng
preexistent fa de cei fr
hipertrofie ventricular
Camelia Nicolae, Nicolae Pun, Gabriela Gheorghe,
Irina Andrei, Sorin Vian, Conf. Adriana Ilieiu,
Prof. Tiberiu Nanea
Spitalul Clinic Caritas Acad. N. Cajal
Scop: Scopul studiului a fost de a evalua expansiunea
produs dup infarctul miocardic (IMA) la bolnavii cu
hipertrofe ventricular stng (HVS) preexistent fa
de cei fr hipertrofe.
Material i metod: Au fost inclui n studiu 88 bolnavi
cu IMA cu localizare antero-septal i HVS preexistent
i 84 bolnavi cu aceeai localizare a necrozei i fr HVS
preexistent. Criteriile de includere n studiu au fost:
primul infarct miocardic, infarct cu supradenivelare
de segment ST i localizare antero-septal V1V4,
dimensiuni normale a cavitii VS i prezena HVS.
Criteriile de excludere au fost: infarct miocardic sechelar
unul sau mai multe, insufcien cardiac clasa III-IV
NYHA, tulburri de ritm sau conducere, valvulopatii
moderate i severe, localizare nonanterioar a necrozei.
Au fost utilizai urmtorii parametrii: grosimea pereilor
VS, wall-stressul sistolic, proflul fuxului mitral, masa
ventriculului stng, viteza n tractul de ejecie al VS;
de asemenea, a fost comparat efciena trombolizei la
1. Valoarea apolipoproteinelor
A-I i B i a lipidelor plasmatice
ca factori de risc cardiovascular
Lucia Agoton-Coldea, Teodora Mocan, LD Rusu,
R Pais, DL Dumitrascu
Universitatea de Medicina si Farmacie Iuliu Hatieganu,
Clinica Medicala II, Cluj-Napoca
Obiectivele studiului: Evidene recente arat c rapor-
tul apolipoproteic (apo)B/apoA-I este un indicator mai
bun pentru riscul coronarian dect proflul lipidic con-
venional. Plecnd de la aceste date ne-am propus s
studiem dac apoB, apoA-I i raportul apoB/apoA-I
sunt factori de risc independeni pentru cardiopatia
ische mic i dac msurarea apolipoproteinelor este
supe rioar determ inrii fraciunilor lipidice plasmatice
n evaluarea riscului de evenimente coronariene.
Material i metod: S-a realizat un studiu transversal
n care au fost inclui 289 subieci, divizai n dou
gru puri: 144 subieci cu infarct miocardic vechi i 145
subieci fr cardiopatie ischemic, dar cu factori de
risc cardiovasculari. Au fost evaluai parametrii antro -
po metrici i factorii de risc cardiovasculari. Dozarea
frac iunilor lipidice s-a fcut prin metoda enzi ma tic,
iar a apoA-I i apoB a fost realizat prin imuno turbi-
dimetrie.
Rezultate: Valorile medii ale fraciunilor lipidice au
fost mai reduse la subiecii cu infarct miocardic dect
la su biecii fr cardiopatie ischemic: colesterolul total
(186.0648.11 vs. 206.9342.28 mg/dl, p=0.0001),
LDL-coles terolul (118.5742.95 vs. 129.5339.75
mg/dl, p=0.023), HDL-colesterolul (43.6412.32 vs.
50.4821.09 mg/dl, p=0.0008) i ale trigliceridelor
(145.3862.74 vs. 167.5682.11 mg/dl, p=0.01). Nivelul
plas matic al apoB a fost mai mare la subiecii cu infarct
mio cardic (1.120.57 vs. 0.860.27 g/l, p=0.0001), iar
cel al apoA-I mai redus (1.310.47 vs. 1.400.39 g/l,
p=0.101). Analiza multivariant indic faptul c nivelul
plasmatic a apoproteinei B peste valoarea de 1.7 g/l
este strns corelat cu prezena infarctului miocardic
(OR 3.96; 95%CI 2.87-5.02, p=0.001) independent de
alte cova riabile ca vrsta, fumatul, obezitatea, diabetul
zaharat, hipertensiunea arterial, fraciunile lipidice.
Efectul protectiv al apolipoproteinei A-I mpotriva eve-
CARDIOPATIE ISCHEMIC | ISCHEMIC CARDIOPATHY
CARDIOPATIE ISCHEMIC
ISCHEMIC CARDIOPATHY
Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
cele 2 grupuri de pacieni. Pentru obinerea propriu-

zis a lungimii segmentului expansionat a fost utilizat
o formul matematic original: L=2,68A, unde L
a reprezentat lungimea segmentului expansionat i
A=aria zonei anterioare a cavitii VS obinut pin
seciunea sagital la nivelul pilierilor.
Rezultate: Bolnavii cu HVS preexistent au fost
repartizai n grupa I, iar cei fara HVS n grupa a II-a.
ntre cele dou loturi de bolnavi nu au existat diferene
semnifcative privind caracteristicile generale cu
excepia grosimii pereilor VS, a masei miocardice,
prezenei semnelor de HVS pe electrocardiogram.
Cel mai important parametru ecocardiografc a constat
n lungimea segmentului expansionat care la grupul I a
prezentat valoarea de 13,881,31 mm, iar la grupul II a
nscris 17,061,21 mm, iar diferena a fost semnifcativ
statistic.
Parametrii ecocardiografci utilizai n studiu pentru
evaluarea tipului de hipertrofe au prezentat valori
diferite, semnifcativ statistic pentru cele 2 grupuri.
Proflul fuxului mitral a fost predominant de tip
relaxare ntrziat pentru grupul I (82%) i ntr-un
procent mult mai redus i pentru grupul II (60%) la
care s-a nregistrat o pondere mai mare a proflului
mitral tip restrictiv (35%). Efciena trombolizei nu a
infuenat lungimea segmentului expansionat.
Concluzii: HVS preexistent IMA cu supradenivelare
de segment ST i dimensiuni normale a cavitii VS
s-a asociat cu limitarea fenomenului de expansiune
a infarctului. Rezultatele studiului demonstreaz o
corelaie indirect ntre grosimea peretelui i lungimea
segmentului expansionat.

The expansion of myocardial
infarction in patients with pre-
existing left ventricular hypet-
rophy
Camelia Nicolae, Nicolae Pun, Gabriela Gheorghe,
Irina Andrei, Sorin Vian, Conf. Adriana Ilieiu, Prof.
Tiberiu Nanea
Acad. N. Cajal Caritas Hospital, Bucharest, Romania
Objectives: Te aim of the study was to assess the
expansion afer acute myocardial infarction in patients
with preexisting ventricular hypertrophy compared
with patients without hypertrophy
Methods: 88 patients with acute myocardial infarction,
anterior V1-V4 location and preexisting ventricular
hypertrophy and 84 patients with acute infarction,
same location, but without hypertrophy were selected
in the study. Te inclusion criteria was: frst myocardial
infarction with ST elevation, antero-septal location
V1-V4, normal lef ventricular cavity dimension and
preexisting lef ventricular hypertrophy . Patients were
excluded if any of the following occured: previous
myocardial infarction, class 3 or 4 NYHA heart failure,
rhythm or impulse conduction disturbances, moderate
or severe valvular heart disease, nonanterior infarct
location. Te following parameters were performed: lef
ventricular wall thickness, systolic wall-stress, mitral
fow profle, lef ventricular outfow velocity. Also was
compared the successfull of reperfusion. Te length
of infarct expansion was calculated with an original
mathematical formula: L=2,68A, were L=length of
infarct expansion, A=area of anterior ventricular cavity
which is obtained in parasternal short axis section at
papillary muscle level.
Results: Patients were included in group I with
hypertrophy and in group 2 without hypertrophy. Tere
was any diferences between the groups compared, except
for lef ventricular wall thickness, myocardial mass and
lef ventricular hypertrophy on electrocardiogram.
Te most signifcant echocardiographic parameter was
infarct expansion length which in the frst group was
13,881,31 mm and in the second 17,061,21 mm and
the diferences was signifcant. Te echocardiographic
parameters used to analize lef ventricular hypertrophy
characteristics were diferent within the groups. Te
mitral velocity profle was mainly delayed relaxation
type (82%) and 62% respectively with a more important
distribution of restrictive pattern in the second group.
Te successful of reperfusion did not infuence the
length of infarct expansion.
Conclusion: Preexisting lef ventricular hypertrophy
in acute myocardial infarction was associated with
limitation of infarct expansion. Te results of this
study demostrate an indirect correlation between the
thickness of ventricular wall and the length of infarct
expansion.

Suplimentul A, 2008
3. Enoxaparin, heparin
nefracionat sau ambele la
pacienii cu infarct miocardic
acut cu supradenivelare de
segment ST? Date din Registrul
RO-STEMI
G.P. Tatu-Chioiu
1
, M. Dorobanu
1
, M. Cintez
1
,
E. Craiu
2
, D.D.Ionescu
3
, C. Olariu
4
, C. Pop
5
,
C. Arsenescu-Georgescu
6
, A. Diaconeasa
1
,
R. Bugiardini
7
1
Bucureti
2
Constana
3
Craiova
4
Arad
5
Baia Mare
6
Iasi, Romania
7
Bologna, Italia, din partea investigatorilor Registrului
Romn pentru infarct miocardic acut cu supradenive-
lare de segment ST (RO-STEMI)
Introducere: 1. Studii recente au artat o mai bun evo-
luie la pacienii cu infarct miocardic acut cu supra deni-
velare de segment ST (STEMI), care au primit enoxa pa-
rin (Enox) pentru 8 zile comparativ cu cei care au pri-
mit heparin nefracionat (UH) timp de 48 ore. Aceas-
t diferen a fost suspectat ca find datorat efectului
rebound indus de suspendarea UH dup 48 ore.
2. Efectele dublei anticoagulri (UH urmat de Enox)
versus UH nu au fost nc evaluate.
Obiectiv: Compararea mortalitii intraspitaliceti i a
incidenei hemoragiilor cerebrale la pacienii nrolai
n Registrul romn pentru STEMI (RO-STEMI) trata i
fe cu UH+Enox, fe cu UH ca terapie asociat trombo-
lizei.
Metod: n perioada 1.01.2003-31.12.2007, un numr
de 2477 pacieni consecutivi nrolai n RO-STEMI,
n primele 6 ore de la debutul durerii toracice, au pri-
mit terapie fbrinolitic (Streptokinaza, tPA, rPA,
TNK+PA) asociat cu UH i Enox (UH 1000 UI/or,
48 ore urmat de Enox 1mg/Kgc pentru 8 zile, n=377),
Enox (30-40mg iv bolus urmat de 1mg/kcg pentru 8
zile, n=470) sau UH (1000 U.I./or timp de 72-96 ore,
n=1600). Toi pacienii au primit tratament aspirin
i/sau clopidogrel n afara contraindicaiilor.
Rezultate: Mortalitatea intraspitaliceasc a fost semni-
fcativ mai redus n subgrupul cu UH+Enox, compa-
rativ cu subgrupul cu UH (3,4% vs. 9,0%, p=0,0001). O
tendi spre mortalitate mai redus a fost inregistrat
i n subgrupul Enox (6,2%), comparativ cu subgrupul
UH (p=0,054). Dup ajustarea n funcie de vrst i
administrarea de aspirin i/sau clopidogrel, pacienii
tratai cu UH+Enox au avut un risc de deces de 1,61
ori mai sczut comparativ cu pacienii tratai cu UH
(95% CI, 0,21-0,72, p=0,003). Diferena ntre Enox i
UH nu a fost semnifcativ. Incidena hemoragiilor
cerebrale non-fatale nu a fost diferit la pacienii care
au primit terapie combinat cu UH+Enox (0,3%), sau
Enox (0,4%) sau UH (0,8%).
Concluzii: Datele din Registrul RO-STEMI sugereaz
faptul c o combinaie ntre UH (48 ore) i Enox pn
la 8 zile poate contribui pn la reducerea semnifcativ
a mortalitii intraspitaliceti la pacienii cu
STEMI i terapie trombolitic comprativ cu pacienii
tratai numai cu UH de 48 de ore.

Enoxaparin, unfractioned
heparin or both in patients
with ST-segment elevation
myocardial infarction? Data
from the RO-STEMI registry
G.P. Tatu-Chioiu
1
, M. Dorobanu
1
, M. Cintez
1
,
E. Craiu
2
, D.D.Ionescu
3
, C. Olariu
4
, C. Pop
5
,
C. Arsenescu-Georgescu
6
, A. Diaconeasa
1
1
Bucharest
2
Constana
3
Craiova
4
Arad
5
Baia Mare
6
Iasi, Romania
7
Bologna, Italy, on behalf of the Romanian registry for
ST-elevation myocardial infarction (RO-STEMI) inves-
tigators.
Background: 1. Recent studies showed a better out-
come in thrombolysed patients for ST-segment eleva-
tion myocardial infarction (STEMI) who also received
enoxaparin (Enox) for 8 days compared with pts
receiving unfractionated heparin (UFH) for 48 hours.
No study has investigated the efects of double anticoa -
gulation (Enox and UFH) versus UFH as ancillary the-
rapy for thrombolysis.
Objective: To compare in-hospital mortality and
incidence of non-fatal intracranial haemorrhage in
Suplimentul A, 2008
stresului oxidativ la pacientii cu sindroame coronariene

acute (SCA) fara supradenivelare de seg ment ST si
sindrom metabolic(SM) sau diabet zaharat (DZ) si la
pacientii cu SCA fara SM (SCA non SM) si fara DZ
(SCA non DZ).
Material si metoda: 172 pacienti (p) cu SCA fara supra-
denivelare de segment ST au fost inclusi intr-un studiu
pros pectiv pe o perioada de urmarire de 3 ani, lotul
find impartit in 3 grupuri in relatie cu asocierea SM
sau a DZ. Evaluarea bio-umorala s-a realizat initial, la
1 si 6 luni, evaluarea clinica, ecocardiografca s-a rea -
li zat initial, la 1, 6, 12, 24 si 36 luni. Au fost eva lua ti
ca markeri ai sindromului infamator nivelul seric al
proteinei C-reactive si nivelul plasmatic al fbri no ge-
nului iar ca markeri de stres oxidativ titrul de anti corpi
Anti ox-LDL si nivelul seric al statusului anti oxidant
total (TAS).
Rezultate:

SCA non MS
non DZ
SCA MS SCA DZ
6 luni
proteina C-reactiva >0,5mg/dl 6 (16.2%) 27 (35.5%)
p<0.05
25 (42.4%)
p<0.01
status antioxidant total <1.3
mmol/l
4 (10.8%) 21 (27.6%)
p<0.05
19 (32.2%)
p<0.05
3 ani
Fractia de ejectie a
ventriculului stang <40%
5 (13.5%) 23 (30.2%)
p<0.05
22 (37.3%)
p<0.05
Deces de cauza
cardiovasculara
2 (5.4%) 14 (18.4%)
p<0.05
15 (25.4%)
p<0.05
IMA/reinfarctizare 2 (5.4%) 18 (23.7%)
p<0.05
17 (28.8%)
p<0.05
Stroke 1 (2.7%) 4 (5.3%) 6 (10.2%)
AI cu reinternare 9(24.3%) 39
(51.3%)
p<0.025
33 (55.9%)
p<0.025
TOTAL (p) 37 76 59
SCA- sindroame coronariene acute fara supradenivelare
de segment ST, SM sindrom metabolic; DZ- diabet
zaharat; IMA infarct miocardic acut; AI- angina
instabila
Concluzii: In sindroamele coronariene acute fara supra-
denivelare de segment ST prezenta sindromului meta-
bolic sau a diabetului zaharat s-a asociat cu o incidenta
semnifcativ crescuta a sindromului infamator si a stre-
sului oxidativ la 6 luni si cu o incidenta semnifcativ mai
mare a disfunctiei sistolice de ventricul stang, decesului
de cauza cardiovasculara, infarctului miocardic acut si
anginei instabile cu reinternare la 3 ani. La pacientii cu
sindroame coronariene acute fara supradenivelare de
segment ST nu s-au inregistrat diferente semnifcative
intre grupul cu sindrom metabolic comparativ cu
grupul cu diabet zaharat la 3 ani de urmarire.

patients enrolled in the Romanian registry for STEMI
(RO-STEMI registry) receiving UFH and Enox versus
Enox as ancillary therapy for thrombolysis.
Methods: Between 1st January 2003 and 31st December
2007 a group of 2477 consecutive RO-STEMI patients
received fnbrinolytic therapy (streptokinase, tPA, rPA
or TNK-tPA) associated with UFH and Enox (n=377,
UFH 1000 U.I./hour, 48 hours followed by Enox 1mg/
kg bodyweight until day 8), Enox (n=470, 30-40 mg iv
bolus followed by 1mg/kg bodyweight for 8 days) or
UHF (n=1600, 1000 U.I./hour for 72-96 hours) within
6 hours from symptoms onset. All patients received
concomitant antiplatelets therapy with aspirin and/or
clopidogrel in the absence of contraindications.
Results: A signifcant lower in-hospital mortality was
seen in UFH and Enox patients as compared with UFH
subgroup (3,4% vs. 9.0%,p<0,0001). Tere was also a
trend toward a lower in-hospital mortality in the Enox
patients (6,2%) as compared with the UFH subgroup
(p=0,054). Afer adjustment for age, anyy clinical
confounder and antiplatelet therapy with aspirin and/
or clopidogrel, patients with Enox and UFH had a 1,61-
fold-lower risk of death (95% CI, 0.21-0.72, p=0,003,
UFH is the referent). Diference between Enox and
UFH were not signifcant. Te rates of non fatal
intracranial hemorrhage not difers among patients
treated with combination therapy (0,3%), Enox (0,4%)
and UHF (0,8%).
Conclusion: Te RO-STEMI registry data indicate that
combined anticoagulant therapy with UFH and Enox
reduces in-hospital mortality in patients undergoing
thrombolytic therapy.

4. Evaluarea comparativa a
prognosticului pacientilor cu
sindroame coronariene acute
fara supradenivelare de
segment st si sindrom
metabolic sau diabet zaharat
E. Bobescu
1,2
, M. Radoi
1,2
, A. Burducea
2
, Bianca Dusa
2
1
Universitatea Transilvania - Facultatea de Medicina
2
Spitalul Clinic Judetean de Urgenta, Clinica de Cardi-
ologie, Brasov, Romania
Scopul lucrarii: Evaluarea prognosticului, functiei sis-
tolice a ventriculului stang, sindromului infamator si a
Suplimentul A, 2008
Comparative evaluation of
prognosis in patients with non
st elevation acute coronary
syndrome and metabolic
syndrome or diabetes mellitus
E. Bobescu
1,2
, M. Radoi
1,2
, A. Burducea
2
, Bianca Dusa
2
1
Transilvania University - Faculty of Medicine
2
Clinic County Emergency Hospital- Clinic of
Cardiology, Brasov, Romania
Aims: Evaluation of prognosis, lef ventricular systolic
function, infammatory syndrome and oxidative stress
in patients with non ST elevation acute coronary syn-
drome (ACS) associated with metabolic syndrome
(MS) with diabetes mellitus(DM) in comparison with
patients with ACS and with non MS non DM ACS
patients.
Methods: 172 patients (pts) with non ST elevation acute
coronary syndrome were included in a prospective
study for a period of 3 years and divided in three groups
in relation with association of metabolic syndrome or
diabetes mellitus. Biologic evaluation were performed
initial and at 1, 6 months, clinical, electrocardiographic,
echocardiographic evaluation were performed initial
and at 1, 6, 12, 24 and 36 months. C-reactive protein
serum level and fbrinogen plasma level were determi-
nated as markers of infammatory syndrome. Anti
ox-LDL antibody titers and total antioxidant status
(TAS) serum level were measured for oxidative stress
eva luation.
Results:

ACS non MS
non DM
ACS MS ACS DM
6 months
C-reactive protein>0,5mg/dl 6 (16.2%) 27 (35.5%)
p<0.05
25 (42.4%)
p<0.01
Total antioxidant status <1.3
mmol/l
4 (10.8%) 21 (27.6%)
p<0.05
19 (32.2%)
p<0.05
3 years
Lef ventricular ejection
fraction <40%
5 (13.5%) 23 (30.2%)
p<0.05
22 (37.3%)
p<0.05
CV death 2 (5.4%) 14 (18.4%)
p<0.05
15 (25.4%)
p<0.05
AMI/reinfarctization 2 (5.4%) 18 (23.7%)
p<0.05
17 (28.8%)
p<0.05
Stroke 1 (2.7%) 4 (5.3%) 6 (10.2%)
UA with readmission 9(24.3%) 39 (51.3%)
p<0.025
33 (55.9%)
p<0.025
TOTAL (pts) 37 76 59
ACS - non ST elevation acute coronary syndrome, MS
metabolic syndrome; DM- diabetes mellitus; CV-car-
dio vascular; AMI-acute myocardial infarction; UA-
unstable angina
Conclusions: In non ST elevation acute coronary syn-
drome patients, presence of metabolic syndrome or
dia betes mellitus was associated with signifcant higher
incidence of infammatory syndrome and oxidative
stress at 6 months and with a signifcant increased inci-
dence of lef ventricular systolic dysfunction, cardio vas-
cular death, acute myocardial infarction and un sta ble
an gina with readmission at 3 years of follow up. It was
no signifcant diferences between non ST eleva tion acu-
te coronary syndrome with metabolic syn dro me and
with diabetes mellitus groups at 3 years of follow up.

5. Prognosticul pacienilor cu
infarct miocardic acut cu
supradenivelare de segment ST
n funcie de valoarea seric a
hs-CRP
Tudorascu M Raul Petrior,
Muetescu I Anca Emanuela,
Tudoracu I Diana Rodica, Ionescu M Dan Dominic
UMF Craiova, Centrul de Cardiologie Craiova
Introducere: S-a demonstrat c hs-CRP crete la pa-
cienii cu infarct miocardic acut cu supradenivelare de
segment ST, cretere care s-a dovedit a f corelat cu mor-
talitatea pe termen lung, ns puine studii au evaluat
prog nosticul pe termen scurt al acestor pacienii. Ne-
am propus s evalum prognosticul pe termen scurt al
pacienilor cu infarct miocardic cu supradenivelare de
segment ST pe baza scorului de risc TIMI i s stabilim
corelaia acestuia cu nivelul seric al hs-CRP.
Scop: Lotul a fost constituit dintr-un numr de 45 pacien-
i internai n Centrul de Cardiologie Craiova cu diag-
nosticul de infarct miocardic acut cu supradenivelare
de segment ST. La acetia s-au notat toate datele nece-
sare pentru calculul scorului TIMI (vrsta, istoricul de
angin, diabet zaharat, TA, frecvena cardiac, clasa
Killip, greutatea, supradenivelarea de segment ST, blo-
cul complet de ramur stng, timpul pn la iniie rea
tra ta mentului), s-a calculat acest scor pentru fecare pa-
cient i s-a dozat nivelul seric al hs-CRP.
Suplimentul A, 2008
Rezultate: S-a constatat c la majoritatea pacienilor

ana lizai scorul TIMI s-a corelat cu nivelul seric al hs-
CRP la internare i astfel prognosticul pe termen scurt
al acestor pacieni poate f infuenat de nivelul seric al
aces tei proteine de faz acut.
Concluzii: Prognosticul pe termen scurt al pacienilor
cu IMA cu supradenivelare de segment ST evaluat prin
sco rul TIMI pare a f infuenat de nivelul seric al hs-
CRP.

The prognosis of ST segment
elevation acute myocardial
infarction patients in terms of
the serum concentrations of
hs-CRP
Tudorascu M Raul Petrior,
Muetescu I Anca Emanuela,
Tudoracu I Diana Rodica, Ionescu M Dan Dominic
UMF Craiova, Centrul de Cardiologie Craiova
It has been demonstrated that hs-CRP levels increase
in patients with ST-segment elevation acute myocardial
infarction, an increase witch has been proved to corre-
late with long term mortality; however, very few studies
have evaluated the short term prognosis for these pa-
tients. We have undertaken to evaluate the short term
prog nosis for ST-segment elevation MI patients based
on the TIMI risk score and to establish its correlation
with the serum level of hs-CRP.
Te study group consisted in 45 patients brought to the
Cardiology Centre of Craiova and diagnosed with ST-
segment elevation acute MI. For these patients all the
necessary data for calculating the TIMI risk score were
collected (age, angina history, diabetes mellitus, TA,
heart rate, Killip class, weight, ST-segment elevation, lef
bundle branch block, time until treatment initiation).
Tis score was calculated for each patient and the
seru m hs-CRP level was measured.
It was found that the TIMI score of most of the patients
studied correlates with the hs-CRP serum level on ad-
mi ssion and thus the short term prognosis of these pa-
tients can be infuenced by the serum level of this acu te
phase protein.
Te short term prognosis of ST segment elevation AMI
patients assessed through the TIMI score appears to be
infuenced by hs-CRP serum levels.

INSUFICIEN CARDIAC | HEART FAILURE

dyne.sec.cm (-4), p <0,01). Mortalitatea a fost de 18,75%
(3 pacieni) toi find diabetici.
Concluzii: Bioimpedana toracic este o metod rapid,
efcient i relativ iefin de urmrire a pacienilor insta-
bili hemodinamic. Poate f efectuat n dinamic la
patul bolnavului i permite adaptarea tratamentului cu
Levosimendan la parametri hemodinamici i corelarea
dozelor cu efectul inotrop pozitiv. Toi parametrii hemo-
dinamici urmrii au prezentat corelaii statistice.

7. Eficiena tratamentului
antiaritmic cu flecainida n
fibrilaia atriala
R.Bolohan, Veronica Indries, Mihaela Mihai, Mihaela
B.Leustean,V.Greere, G.Hila, I.Moscaliuc, D Nita,
G.Cristian
Centrul Clinic de Urgen de Boli Cardiovasculare al
Armatei Bucureti
Am studiat prospectiv in perioada ianuarie 2004-mai
2008 efcienta tratamentului antiaritmic cu fecainida
in fbrilatia atriala.
Lotul de studiu a cuprins 60 pacienti (42 barbati (70%)
i 18 femei (30 %) cu virsta medie 54 ani (45-75 ani).
54 pacienti (90%) (lot A) au prezentat fbrilatie atri al
paroxistic repetitiv iar 6 pacieni (10%) (lot B) au avut
fbrilatie atriala persistenta la care s-a realizat conversia
electrica sau chimica la ritm sinusal.
S-a urmarit disparitia sau rarirea semnifcativa a epi-
soadelor de fbrilatie atriala (lot A) si pastrarea ritmului
sinusal (lot B).
Rezultate: - 51 pacienti din lotul A (95 %) au pre zen-
tat o evolutie semnifcativ favorabila (33 pa cien ti - 61%
nu au mai prezentat episoade de fbri la tie atriala, la 18
pacienti-34 % s-a obtinut rarirea con sis tenta a crizelor
de fbrilatie atriala)
-5 pacienti din lotul B (83 %) pastreaza ritmul sinu-
sal.
Concluzii: Flecainida este un antiaritmic cu foarte buna
efcienta proflactica a recidivei fbrilatiei atriale (com-
parabila cu amiodarona) (cu mult mai putine reactii
6. Evaluarea efectului hemo-
dinamic al Levosimendanului
prin bioimpedan toracic la
pacienii cu IMA
O. Istrtoaie, R. Mustafa, A. Giuc, C. Militaru,
D.D. Ionescu
Centrul de Cardiologie Craiova. UMF Craiova
Introducere: Efectele inotrop pozitive ale Levosimen-
danului sunt cunoscute n IMA, dar variaiile n dina-
mic ale debitului btaie, volumului telediastolic i ale
rezistenelor vasculare pulmonare i sistemice n IMA
cu insufcien cardiac nu sunt pe deplin elucidate.
Bioimpedan toracic permite evaluarea n dinamic
a acestor parametrii.
Material i metod: Bioimpedana toracic a fost efec-
tuat n primele 24 ore i dup 72 ore de la admi nistrarea
de Levosimendan la 16 pacieni inter nai consecutiv n
USTIC, cu diagnosticul de IMA i insufcien car diac
clasa II i III Killip n perioda martie 2004 martie
2008. Parametrii hemodinamici urmrii au fost
volumul btaie, fracia de ejecie a VS, indexul cardiac
(IC), volumul telediastolic al VS, indexul de rezisten
vascular sistemic (IRVS) i indexul rezistenei vascu-
lare pulmonare (SSVRI). Compararea fraciei de ejecie,
a volumului telediastolic al VS i debitului btaie au fost
efectuate prin ecocardiografe transtoracic cu un sis-
tem SONOS 5500, conform protocolului nainte i dup
administrarea de Levosimendan. Vrsta medie a lotului
de fost de 62,4 ani, dominnd sexul masculin prin cei
10 pacieni. Localizarea anterioar a fost prezent la 9
pacieni, 3 dintre acetia aveau infarct infero-latero-
posterior i 4 pacieni cu infarct n H.
Rezultate: Levosimendan a produs la pacienii cu IMA
i insufcien cardiac clasa II i III Killip creterea frac-
iei de ejecie n medie de la 31, 6% pn la 42,7% dup
72 ore (p <0,01), creterea volumului btaie de la 48
3ml la 59 6 mL (p <0,03), augmentarea indexului
cardiac de la nivelul de 2,2 l/minut iniial pn la 3,1 l/
minut la 72 ore (p <0,01), reducerea presiunii la nivelul
capilarului pulmonar de la 22 1 mm Hg to 16 3
mm Hg (p <0,03), scderea semnifcativ a rezistenei
vasculare sistemice de la 1214 +/- 276 to 932 +/- 282
INSUFICIEN CARDIAC
HEART FAILURE
Suplimentul A, 2008
adverse). Difcultatea tratamenului consta in inexis-

tenta fecainidei pe piata farmaceutica din Romnia.

The efficacy of antiarrhythmic
treatment with flecainide in
atrial fibrillation
R.Bolohan, Veronica Moldovan, Mihaela Mihai, Mi-
haela B.Leustean,V.Greere, G.Hila, I.Moscaliuc,
D Nita, G.Cristian
Armys Emergency Clinical Center of Cardiovascular
Diseases, Bucharest
We prospectively studied between January 2004 and
May 2008 the ef cacy of antiarrhythmic treatment with
fecainide in atrial fbrillation.
Material and method: we evaluated 60 patients (42 men
(70%) and 18 women (30%) with mean age 54 years
old (45-75 years). 54 patients (90%) (Group A) were
diagnosed with recurrent paroxysmal atrial fbrillation
and 6 patients (10%) (Group B) had persistent atrial
fbrillation and were treated with electrical or chemical
conversion to sinus rhythm.
Our aim was signifcant fewer or no more episodes
of atrial fbrillation (Group A) and maintaining sinus
rhythm in Group B.
Results: - 51 patients from Group A (95%) showed
a signifcant favorable evolution (33 patients (61%)
didnt present other episodes of atrial fbrillation, 18
patients (34%) showed signifcant fewer episodes of
atrial fbrillation)
- 5 patients from Group B maintained sinus rhythm.
Conclusions: Flecainide is a very ef cient antiarrhyth-
mic drug in prophylaxis of recurrences of atrial fbri-
lla tion (comparable with amiodarone, but with fewer
ad ver se reactions). Te dif culty of the treatment is
absen ce of fecainide on the Romanian market.

8. Diferene morfologice i
funcionale vasculare n IC
uman de etiologii diverse
Ilinca Savulescu- Fiedler, Roxana Nicoleta Siliste,
Mihaela Gherghiceanu, Ion I. Bruckner
Spitalul Clinic Colea, Bucureti
Premisa teoretic: afectarea vascular, manifestat ca
disfuncie endoteliala, este difuza in insufcienta car-
diaca (IC). Nu se cunoate dac afectarea endotelial
este diferit n IC cu afectare diferita a functiei sistolice.
Studiul isi propune aprecierea afectarii endoteliale
in IC de etiologii diferite, ca si in IC prin disfunctie
sistolica sau diastolica. Material si metoda: 15 pacienti
cu diagnostic clinic de IC, de etiologii diferite (lot de
studiu) si 11 pacienti fara diagnistic de IC (lot martor).
Toti pacientii au suferit o interventie chirurgicala in
sfera abdominala, prilej cu care s-a recoltat un frag-
ment vascular din radacina mezenterului. n funcie
de valoarea fractiei de ejectie pacienii au fost mprii
n dou categorii: IC cu FE normal (ICFEN- 9 pacien-
ti), sau IC cu FE sczut (ICFES- 6 pacienti). Tuturor
pacientilor li s-au evaluat, funcia endotelial (ecogra-
fc) si aparenta morofologica endoteliala. Frag mentul
vas cular recoltat a fost analizat morfologic prin micro-
scopie optica i microscopie electronica.
Re zul tate i discutii: Etiologia IC a fost divers: diabet
zaha rat (DZ) 6 cazuri; boal coronarian 5 cazuri;
val vu lopatii 3 cazuri; hipertensiune arterial izolata
1 caz. Valoarea medie a vasodilatatiei fux-mediate in
artera brahiala (DFM) a fost net scazuta la pacientii cu
IC (4,93%), comparativ cu cei din lotul control (6,65%).
Cele mai mici valori ale DFM s-au inregistrat la pacientii
cu DZ (3,56%). Valoarea DFM a fost net inferioara
la cei cu ICFES (1,625%) comparativ cu pacientii cu
ICFEN (6,55%). Examinarea in microscopie optica a
structu rilor vasculare releva modifcari morfologice
doar la pacientii cu IC. Modifcarile de structura endo-
teliala au fost diferite si au vizat celula endoteliala insasi
(vacuole, elongare etc.), celulele musculare netede
vas culare (modifcari fenotipale, vacuolizari etc.), ma-
tricea extracelulara, membrana bazala. Modifcarile
electro no micro sco pice s-au semnalat doar la pacientii
cu IC. La acestia, scorul mediu de a ctivare endoteliala
(Masuda) a fost 2, iar valoarea medie a DFM a fost
1,53%, mult sub media lotului (4,93%). La pacientii cu
IC fara activare endoteliala valoarea medie a DFM a
fost 6,69% (superioar valorii medii a lotului). 44,44%
Suplimentul A, 2008
INSUFICIEN CARDIAC
HEART FAILURE
dintre pacieni cu diagnostic de ICFEN si 83,3% din cei
cu ICEFS aveau activare endoteliala. Examinarea ultra-
struc tu rala evidentiaza variate modifcari endo teliale
(nuclei eucro matici, vacuole endoteliale, contacte intre
celulele endo teliale si celulele musculare netede, modi-
fcari matri ceale etc).
Concluzii: Studiul desfurat arat c: DFM a fost mai
mic la pacienii cu IC dect la lotul control; valoarea
DFM a fost diferit n IC de etiologii diferite; valoarea
DFM a variat n funcie de gradul de afectare a funciei
sistolice. Prezena activrii endoteliale coreleaz cu
valoarea DFM la nivelul arterei brahiale. Examinarea
ultrastructurala relev anumite modifcri endoteliale,
cu relevanta necunoscuta, doar la pacienii afai n IC.

9. Practica medical n
ngrijirea pacienilor cu
insuficien cardiac ntr-un
centru teriar de urgen
comparaie cu registrul
european Euro Heart Survey
Maria-Corina Bornoiu, Miruna Chiru, Ana Gabriela
Fruntelat, Maria Dorobanu
Spitalul Clinic de Urgen, Bucureti
Premize i obiective: Studiile privind insufciena car-
diac sugereaz faptul c tratamentul standard, bazat
pe dovezi nu este folosit n msura n care ar trebui.
De aceea, am investigat felul n care sunt tratai i eva-
luai pacienii cu insufcien cardiac ntr-o clinic de
cardiologie de urgen; totodat centru teriar, din Bucu-
reti. Am plecat de la analiza unui grup de pacieni cu
insufcien cardiac internai n clinica noastra dup
fa de raportare a cazului folosit n EuroHeart Failure
Survey II (EHS-HF II), n acelai mod n care au fost
analizai pacienii din registrul european, pentru a
vedea realitatea ngrijirii insufcienei cardiace la noi
com parativ cu media din Europa. Obiectivele au fost
evaluarea caracteristicilor pacienilor, a etiologiei, trata-
mentului i evoluiei insufcienei cardiace la pacienii
internai n Clinica de Cardiologie a Spitalului de Urgen-
Bucureti n relaie cu rezultatele studiului EHS-HF
II.
Metode: Un grup de 55 pacieni internai n Clinica de
Cardiologie a Spitalului Clinic de Urgen Bucureti
pentru insufcien cardiac acut sau insufcien car-
diac cronic decompensat au fost nregistrai ntr-
o baz de date construit pe baza fei de raportare a
cazului din EHS-HF II. Au fost inclui pacieni con-
secutivi care s-au internat prin camera de gard n
secia de Cardiologie. Pacienii au fost clasifcai n: insu-
fcien cardiac acut (ICA) i insufcien cardiac
cronic decompensat (ICCD). Rezultate: Dintre pa-
cien tii studiai, 67.3% au avut ICCD i numai 32.7%
ICA. Cele mai frecvente condiii subiacente la pacienii
studiai au fost boala ischemic (80%), cu 36.4% seche-
lari de infarct miocardic, hipertensiunea arterial
(65.5%) i, pentru cei cu insufcien cardiac acut,
boala valvular (63.6%). Aderena la ghidurile actuale
se men ine i n studiul nostru cu inhibitorii enzimei de
con ver sie a angiotensin ei i spironolacton prescrise la
peste 70% dintre pacieni la externare. Beta-blocantele
ns sunt subutilizate n Romnia find prescrise doar la
54.5% dintre pacieni. Digitala este extrem de utilizat
n Romnia, cu aproape 70% dintre pacieni primind
digoxin la externarea din spital.
Concluzii: O treime dintre pacienii studiai au avut
insufcien cardiac acut (de novo), similar cu raportul
European. O treime dintre pacieni au avut sindrom
coro narian acut. Fracia de ejecie a ventriculului stng
evaluat ecocardiografc nu a fost diferit ntre clasele
clinice de insufcien cardiac, i a fost conservat la
peste jumtate dintre pacieni, aspect raportat i de
stu diul EHS-HF II i de alte studii similare. Jumtate
dintre pacienii admii cu insufcien cardiac decom-
pensat se afau sub tratam ent cu diuretice, beta-blo-
cante i/sau inhibitori de enzim de conversie i o trei-
me erau digitalizai. La externare, prescripia de inhi -
bitori, diuretice i digoxin a crescut semnifcativ, dar
beta-blocantele au rmas sub-utilizate.

INSUFICIEN CARDIAC
HEART FAILURE
Suplimentul A, 2008
10. Anxietatea, depresia i

calitatea vieii la pacienii cu
insuficien cardiac i
hipertensiune arterial
Rodica Avram, Simona Tman, Claudiu Popa,
Dorina Jejeran, Tudor Ciocrlie, Florina Prv,
Mihai Balint, Victor Moga
Clinica de Cardiologie, Spital Clinic Judeean de
Urgen Timioara
Scopul lucrrii: Este de presupus ca la pacienii cardiaci
s existe un grad de afectare psihic, n legtur cu
simptomatologia clinic i limitarea funcional, posibil
ns i cu o calitate a vieii alterat. Ne-am propus
identifcarea anxietii, depresiei i evaluarea calitii
vieii la pacienii (p) cu i fr insufcien cardiac i
corelarea cu parametrii clinici.
Material i Metod: Am studiat un numr de 63
pacieni nediagnosticai cu boal psihiatric, internai
de urgen i subclasifcai n 2 loturi: insufcien
cardiac (IC) cu alterarea funciei sistolice (FE<40%)
40p. i hipertensiune arterial (HTA) 23p. S-au
nregistrat datele demografce i de ncadrare clinic-
paraclinic n grade de severitate. Pentru evaluarea
psihiatric s-au utilizat scalele Hamilton (HAM) pentru
anxietate (notat cu 18, 25, 30) i depresie (medie
18) respectiv scala HADS de anxietate i depresie n
spital (7-10 i 11), calitatea vieii (Q-OL), respectiv
evaluarea subiectiv a acesteia (S-QC), suportul social
(S-SS), starea de sntate i calitatea ngrijirii (S-HS) s-
au apreciat prin scala OMS (cotaii 1-10).
Rezultate: n lotul global s-au nregistrat prin cele 2
teste: anxietate la 34,91% i anume moderat (notat
18-25) la 12p. (19,04%), sever (>25) la 10p. (15,87%) i
respectiv 42,86% prin HADS; depresia s-a confrmat la
31,74% i respectiv la 28,7% din p. Gradul de severitate
al HTA se coreleaz cu patologia psihiatric (p<0,0001)
dar i cu calitatea vieii (S-QC i S-HS p<0,01).
ncadrarea clinic a IC se coreleaz cu S-QC (p<0,005),
cu S-SS (p<0,05), FE vs. S-QC (p<0,01), respectiv vs.
S-SS (p<0,0001), iar testul de mers 6 minute vs. S-SS
- p<0,01, respectiv vs. S-QC - p<0,001. Valori nalt
semnifcative (p<0001) au rezultat de asemenea n
relaia Q-OL vs. diabet zaharat, fumat, PCR.
Concluzii: Anxietatea i depresia sunt prezente la peste
1/3 din p., corelate mai ales cu severitatea HTA. Datele
subiective privind calitatea vieii i suportul social
sunt modifcate mai ales n relaie cu gravitatea clinic
i alterarea FE n IC. Incidena patologiei psihiatrice,
relaia cu calitatea vieii justifc cercetarea i aciunea
asupra factorilor psiho-sociali.

Anxiety, depression and quality
of life in hypertensive and heart
failure patients
Rodica Avram, Simona Tman, Claudiu Popa,
Dorina Jejeran, Tudor Ciocrlie, Florina Prv,
Mihai Balint, Victor Moga
Clinica de Cardiologie, Spital Clinic Judeean de
Urgen Timioara
Aim: It is assumed that there is a degree of psychiatric
disease in cardiac patients, in connection with clinical
symptoms and functional limitation, but possible with
a poor quality of life, too. We tried to identify anxiety,
de pre ssion and quality of life in patients (p.) with or
with out heart failure and the correlation with clinical
para meters.
Material and Method: We studied a number of 63 p.
with out a previous psychiatric diagnosis, emergency
admi tted and sub classifed in two lots: cardiac failure
with altered systolic function (EF <40%) 40p. and
hyper tension (HT) 23p. We recorded demographic
data and clinical para clinical data into grades of seve-
rity. For psychiatric evaluation we used Hamilton scales
(HAM) for anxiety (noted 18, 25, 30) and depre ssion
(medium 18), the HADS scale for anxiety and depre ss-
ion in hospital (7-10, 11), respectively; the quality of
life (S-QC), social support (S-SS), health state and qua-
li ty of health care (S-HS) were evaluated through OMS
scale (noted 1-10).
Results: In the global lot recorded through 2 tests:
an xie ty in 34.91% as follows - moderate (noted 18-
25) in 12p. (19.04%), severe (>25) in 10p. (15.87%)
and 42.86% respectively though HADS, depression in
31.74% and 28.7% p, respectively. Te hypertensions
gra de of severity correlates with psychiatric pathology
(p<0,0001), but also with the quality of life (S-QC and
S-HS p<0,01). Clinical classifcation of HF correlates
with S-QC (p<0,005), with S-SS (p<0,05), EF vs. S-QC
(p<0,01) and vs. S-SS (p<0,0001), and the 6 minutes walk
test vs. S-SS - p<0,01, vs. S-QC p<0,001, respectively.
Suplimentul A, 2008
INSUFICIEN CARDIAC
HEART FAILURE
Conclusions: Anxiety and depression are present in
more than 1/3p., with a strong correlation with the
hyper tensions severity. Subjective data regarding the
quality of life and social support are in relation with
clinical severity and the alteration of EF in heart failure
p. Te prevalence of psychiatric pathology, correlation
with the quality of life, justifes the research and action
on psycho social factors.
POSTER FORUM I
changes. Two months earlier the patient was inserted
a VVI pacemaker (through the right subclavian vein)
for low rhythm atrial fbrillation, with ought incidents.
Present cardiac examination reveals: BP = 110/73 mm
Hg, right heart failure decompensation signs, atrial
fbri llation with SVF 60 beats/min on EKG. Trans-
thoracic and transesophagial echocardiographic exami-
nation pinpoint a right intracavitary mass, 32/38 mm,
extremely mobile, foating between right ventricle
and atrium, through the tricuspid valve, attached to
the distal extremity of the electrostimulation catheter
(placed on the lateral wall of the right ventricle). Te
clinical hypothesis of pulmonary thromboembolism
(originating in the catheter thrombosis) was confrmed
through pulmonary perfusion scintigraphy (lacunar
images in both pulmonary area s, mainly in the lef
inferior lobe). Due to advanced patients age, therapeutic
approach consisted in continuous heparin infusion,
800 IU/h, 14 days, followed by oral anticoagulation,
resulting in complete thrombus dissolution. We note as
favoring prothrombotic factors the presence of cardio-
megaly, atrial fbrillation and congestive heart failure in
this case.

12. Corelaii ntre variabilitatea
tensiunii arteriale i prezena
sindromului metabolic
C. Matei, Ioana Pop, Mihaela Rugin,
Carmen Ginghin, E. Apetrei
Clinica de Cardiologie, Institutul de Boli Cardiovascu-
lare, Prof. Dr. C.C. Iliescu Bucureti
Obiective: Scopul principal al acestui studiu a fost
evaluarea variabilitii tensiunii arteriale (TA) obinut
prin nregistrarea ambulatorie continu la pacienii
hipertensivi cu sau fr sindrom metabolic (SMet).
Drept scop secundar am urmrit corelaiile ntre
variabilitatea TA i indicele de rigiditate arterial AASI
(ambulatory arterial stifness index).
Metod: Un grup de 195 pacieni (pt.) hipertensivi
(47% brbai, cu vrsta >21 ani, vrsta medie 57,9 ani)
11. Tromboza a cateterului de
stimulare caz clinic
M.D.Datcu, Viviana Aursulesei, Irina Costache,
D. Iliescu, Georgeta Datcu
Universitatea de Medicina si Farmacie Gr.T. Popa Iasi,
Clinica I Medicala Cradiologica C.I.Negoita Iasi
Bolnavul S.Gh. 84 ani, se adreseaz pentru dureri tora-
cice i dispnee, ambele la eforturi minime, nsoite de
vertij n special la schimbrile brute ale poziiei. Este
la dou luni de la implantarea unui pacemaker VVI
pen tru fbrilaie atrial cu ritm lent (fr incidente).
Bilan ul clinic i investigarea cordului arat: TA 110/73
mmHg, semne clinice de insufcien cardiac dreap-
t, RVS 60/min cu atriile n fbrilaie.Examenul eco-
car diografc (transtoracic i transesofagian) pune n
eviden o imagine de mas intracavitar dreapt de
32/38 mm, extrem de mobil, fotant ntre VD i AD
prin valva tricuspid, ataat de extremitatea distal
a cate terului de stimulare (plasat pe peretele lateral al
VD). Suspiciunea clinic de tromboembolism pul mo-
nar (sursa tromboza pe cateter) a fost confr ma t de
scintigram a pulmonar (imagini lacunare n am be le
arii pulmonare, predominent n lobul infe rior stng)
Dat find vrsta bolnavului, se opiniaz pen tru hepa-
rino terapie 800 UI/or, 14 zile, care a dus la dis pa riia
ima ginii descrise.(continuat cu trata ment anti coagu-
lant oral) Subliniem prezena facto rilor favo ri zani:
car dio megalie, atriile n fbrilaie, insuf cien t car diac
con ges tiv.

Electrostimulation catheter
thrombosis case presentation
M.D. Datcu, Viviana Aursulesei, Irina Costache,
D. Iliescu, Georgeta Datcu
Universitatea de Medicina si Farmecie Gr. T. Popa
Iasi, Clinica I Medicala Cardiologica C. I. Negoita Iasi
Patient S. Gh., 84 years old, was admitted in the hospital
for thoracic pain and exertion dyspneea, on minimal
physic activities, with vertigo due to sudden positional
Suplimentul A, 2008
POSTER FORUM I
evaluai prin monitorizare ambulatorie a tensiunii
arteriale (MATA) timp de 24 ore au fost investigai clinic
i biologic n privina existenei sindromului metabolic
dup criteriile Federaiei Internaionale de Diabet
(IDF). Pentru MATA am folosit un sistem BR-102
(Schiller AG, Elveia). Variabilitatea TA a fost calculat
pentru fecare pacient, find defnit ca valoarea deviaiei
standard fa de medie a valorilor TA nregistrate; a fost
aleas o valoare cut-of de 17mmHg pentru a defni
limita normalului (limita superioar a intervalului
de confden 95% a valorii medii a variabilitii TA
msurate n ntreg lotul). n mod asemntor au fost
defnite valorile normale ale variabilitii diurne i
nocturne de 17mmHg, respectiv 13,5mmHg. Analiza
statistic a fost efectuat cu programul EpiInfo 2000
(CDC, Atlanta), versiunea 3.3.2.
Rezultate: n lotul de studiu nu au existat diferene
semnifcative ntre cele 2 sexe n privina variabilitii
TA. Pacienii au fost mprii n 2 grupuri n funcie
de absena (grupul A, n= 131) sau prezena (grupul B,
n= 64) sindromului metabolic. Nu au existat diferene
semnifcative statistic ntre cele dou grupuri n ceea
ce privete vrsta, sexul, antecedentele cardiovasculare.
Valoarea variabilitii TA nu a avut diferene semni-
fcative legate de prezena sindromului metabolic (16,2
5 n grupul A fa de 16,4 4,7 n grupul B); varia bi-
litatea TA a fost comparabil indiferent de grupul de
vrst n care s-a fcut analiza. De asemenea, nu au
existat diferene semnifcative ntre cele dou grupuri
ntre variabilitatea diurn i respectiv cea nocturn.
Am obinut o corelaie nalt semnifcativ ntre indicele
de rigiditate arterial (AASI) obinut la monitorizarea
ambulatorie continu i variabilitatea TA (r= 0,98,
p<0.01), corelaie ce nu este infuenat nici ea de
prezena sindromului metabolic.
Concluzii: Prezena sindromului metabolic asociat
hipertensiunii arteriale nu infueneaz variabilitatea
tensiunii arteriale. Aceasta se coreleaz foarte bine,
independent de prezena sindromului metabolic, cu
modifcarea rigiditii arteriale exprimat prin indicele
AASI.

Correlations between blood
pressure variability and pres-
ence of metabolic syndrome
Aims: Te main objective of this study was the
evaluation of the blood pressure (BP) variability from
ambulatory blood pressure monitoring of hypertensive
patients (pts.) with or without metabolic syndrome
(MetSyn). As secondary objective we choose the
correlations between BP variability and ambulatory
arterial stifness index (AASI).
Methods: One hundred ninety-fve hypertensive
patients (47% male, age >21years, medium age 57.9
years) underwent a 24-hour ambulatory blood pressure
monitoring (ABPM) in our Cardiology Department
were evaluated regarding medical history, renal function
and presence of metabolic syndrome (International
Diabetes Foundation criteria). Te device used for
ABPM was BR-102 (Schiller AG, Switzerland). Blood
pressure variability was calculated for each patient and
represents the standard deviation of the mean of BP
values over the 24-hour recording; we choose as cut-of
value for normal BP variability 17mmHg (upper limit
of the 95% CI interval of BP variability of all pts. in our
group). Te same was done for diurnal and nocturnal
BP variability; normal values were 17mmHg and
13,5mmHg, respectively. Statistical analysis was done
with EpiInfo 2000 statistical sofware package, version
3.3.2.
Results: In our study group there was no signifcant
diference of BP variability between men and women.
Te patients were divided in two groups according to
absence (group A, 131 pts.) or presence (group B, 64
pts.) of MetSyn. Tere were no statistically signifcant
diferences between this groups regarding age, sex,
history of important cardiovascular diseases. Blood
pressure variability has had no signifcant diferences
between the two groups (16.2 5 in group A and 16.4
4.7 in group B); BP variability was comparable no matter
the age group the analysis was done. In the mean time,
there werent signifcant diferences between groups
regarding nocturnal and diurnal BP variability. A
highly signifcant correlation index between AASI and
BP variability was observed (r= 0.98, p< 0.001), also
POSTER FORUM I Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
independent of the presence of metabolic syndrome.

Conclusions: Te presence of the metabolic syndrome
associated to hypertension does not infuence blood
pressure variability. Instead, BP variability it is very
well correlated to changes of arterial stifness refected
by the ambulatory arterial stifness index, independent
of metabolic syndrome presence.

13. Estimarea functiei sistolice
si diastolice prin doppler tisu-
lar la voluntari sanatosi
Oana Mihailescu, Cati Istrate, Ovidiu Chioncel,
Cezar Macarie
Institutul de Boli Cardiovasculare Prof.Dr.C.C.Iliescu
Scop: Evaluarea velocitatilor miocardice sistolice si
diastolice si a paternului specifc al velocitatilor maxime
sistolice (Vmx) si diastolice(E) prin Doppler tisular,
la voluntarii sanatosi, pentru obtinerea unor scale ale
normalului. In paralel evaluarea functiei diastolice prin
metoda conventionala la nivelul fuxului mitral.
Metoda: S-au studiat 64 de voluntari sanatosi (fara
afectare cardiovasculara, fara diabet zaharat, obezitate).
S-au masurat: velocitatea maxima a umplerii diastolice
precoce (E) si velocitatea maxima a umplerii diastolice
tardive prin contractie atriala, cu Doppler pulsat
pozitionat la varful cuspelor mitrale in sectiunea
apical 4 camere (metoda conventionala) si velocitatile
sistolice si diastolice prin Doppler tisular (V mx septal,
Vmx lateral, Eseptal si E lateral, raport E/Es si E/E l)
in sectiunea apical 4 si 2 camere, cu esantionul Doppler
pulsat plasat in segmentul bazal, la 1 cm de inelul
mitral.
Raportul E/Ea este folosit pentru estimarea presiunii
de umplere a ventriculului stang, chiar si in conditii
difcile de evaluare (tahicardie sinusala), find relativ
independent de presarcina sau fractia de ejectie a
ventriculului stang.
Rezultate: din lotul studiat de 64 de voluntari, 43 sunt
barbati si 21 sunt femei varsta medie este 35,89 8,1,
media valorilor undei E este de 71,35 13,8 cm/s, media
valorilor undei A de 68,4 11,5 cm/s, media valorilor
undei Es de 7,5 1,3 cm/s, iar media undei El de 8,1
1,3 cm/s, media Vmx septal 6,8 1,3 cm/s, Vmx lat 7,6
1,7 cm/s, iar rapoartele E/Es cu media 8,62,8 si E/El
de 7,9 2,5.
S-au constatat: coefcient de corelatie Es cu El de
0,791 semnifcativ statistic (p=0,001), coefcient de
corelatie VMS cu VML de 0,883 semnifcativ statistic
(p=0,001), coefcient de corelatie El cu VML de 0,850 si
El cu VMS de 0,789 semnifcative statistic, (p=0,001),
coefcient de corelatie Es cu VMS de 0,635 si Es cu VML
de 0,704, semnifcative statistic (p=0,001) coefcient de
corelatie E/Es cu E/El de 0,857 semnifcativ statistic
(p=0,001).
Un procent de 13,9% din voluntari au raportul E/
El mai mare decat valorile din literatura (care sunt
considerate normale), iar 58,13% din voluntari au
raportul E/Es mai mare decat valorile considerate
normale. 18,6% din voluntari au raportul E/Es mai mare
decat media + deviatia standard si 13,9% au raportul E/
El mai mare decat media +deviatia standard.
Concluzii: Media velocitatii maxime laterale este mai
mare decat velocitatea maxime septale si media undei
Elat este mai mare decat media Eseptal. Velocitatile
diastolice ( El, Es) se coreleaza cu velocitatile sistolice
(Vmx lat, Vmx septal), iar velocitatile maxime sistolice
la nivelul peretelui lateral scad cu varsta, mai pregnant
decat velocitatile maxime de la nivelul septului.
9,3% din voluntari au ambele rapoarte (E/El si E/Es)
peste limita normala, aratand disfunctie diastolica, in
timp ce valorile undelor E si A sunt in limite normale.
Din lotul studiat se poate afrma importanta estimarii
velocitatilor sistolice si diastolice prin Doppler tisular,
find net mai sensibile in detectarea disfunctiei
diastolice fata de metoda clasica (undele E, A, raport
E/A), precum si importanta estimarii velocitatilor atat
la nivelul peretelui lateral cat si septal.

Assesment of diastolic and sys-
tolic ventricular function by
tissue doppler on healthy vol-
untaries
Oana Mihailescu, Cati Istrate, Ovidiu Chioncel,
Cezar Macarie
Aims: Te aim of the study was to evaluate diastolic
and systolic velocities, particular patterns of maximal
systolic velocities (Vmx) and diastolic velocities (E) by
Doppler tissue imaging (DTI) on healthy voluntaries
Suplimentul A, 2008
POSTER FORUM I
for assessment of normal scales, comparative with con-
ventional methods for assessment diastolic function.
Methods: 64 healthy voluntaries (without any
cardiovascular disease, diabetes mellitus, and obesity)
were referred for an echocardiogram. It was measured
early diastolic flling with maximal velocity (E), late
diastolic flling by atrial contraction (A) on transmitral
fow with Doppler pulsate, maximal systolic velocities
(Vmx) and diastolic velocities (E) by tissue Doppler, on
lateral wall and interventricular sept, in 4 chambers and
2 chambers view. E/E ratio was measured for assessment
of lef ventricular flling in dif cult conditions such
sinusal tachycardia, because of its relative independence
with preload or ejection fraction.
Results: In this lot, 64 healthy voluntaries, 43 men and
21 women, mean age was 35,89 8,1, the average for
E velocity was 71,35 13,8 cm/s, the average for A
velocity was 68,4 11,5 cm/s, average for Es 7,5 1,3
cm/s and for El 8,1 1,3 cm/s, the average for Vmx
septal was 6,8 1,3 cm/s and mean for Vmx lat was 7,6
1,7 cm/s.
Te E/Es ratio had the average 8,62,8 and E/El
ratio had the average 7,9 2,5.
Te correlation coef cient between Es and El was
0.791 statistical signifcant (p=0,001), the correlation
coef cient between systolic velocity Vmx septal and V
mx lateral was 0.883 statistical signifcant (p=0,001).
Te correlation coef cient between El and Vmx
lateral was 0.850 and El with Vmx septal 0.789, both
stati stical signifcant (p=0,001), the correlation coef -
cient between Es with Vmx septal was 0.635 and Es
with Vmx lateral 0.704 statistical signifcant (p=0,001).
Te correlation coef cient between E/Es and E/El ratio
was 0.857 statistical signifcant (p=0,001).
13.9% form voluntaries had E/El ratio signifcantly
higher comparative with normal range from literature
and 58.13% from voluntaries had E/Es ratio higher
comparative with normal range from literature. 18.6%
from voluntaries had E/Es ratio signifcantly higher
comparative with mean + standard deviation and
13.9% had E/El ratio signifcantly higher comparative
with mean + standard deviation.
Conclusion: Te average of the maximal systolic lateral
velocities was higher comparative with the average of
maximal systolic septal velocities and the average of
Elateral was higher comparative with the average of
Eseptal. Diastolic velocities ( El, Es) was signifcantly
correlated with systolic velocities (Vex lat, Vex septal)
and maximal systolic lateral velocities decreased with
age, signifcantly higher comparative with maximal
systolic septal velocities. 9.3% from voluntaries had
both E/El and E/Es ratio above normal range, revealed
diastolic dysfunction, when the velocities E and A
was normal. So, is important to asses the systolic
and diastolic velocities by tissue Doppler, because of
higher sensibility for diastolic dysfunction comparative
with conventional methods for assessment diastolic
function, as well the assessment of both lateral and
septal velocities.

14. Potenialele atriale tardive
i riscul de fibrilaie atrial
la hipertensivii cu disfuncie
diastolic
Musetescu Rodica, Toader Despina, Popescu Monica,
E. Belu, D.-D. Ionescu
Centrul de Cardiologie Craiova
Disfuncia diastolic din hipertensiunea arterial este
caracterizat printr-o presiune de umplere crescut.
PHiRes este o metod care analizeaz potenialele
atriale tardive de la fnalul undei P, reprezentnd
depolarizarea tardiv a miocardului atrial, locul n care
i au originea aritmiile prin reintrare.
Scop: folosirea potenialelor atriale tardive (PAT) ca
marker al afectrii structurale a miocardului atrial la
pacienii hipertensivi cu disfuncie diastolic i contrac-
tilitate sistolic prezervat a ventriculului stng.
Metode: 44 de pacieni hipertensivi cu vrste cuprinse
ntre 48 i 80 de ani au fost evaluai prin: examinare clinic
clasa funcional NYHA I-III; electrocardiograma
cu 12 derivaii: criteriile Cornell pentru hipertrofa
ventricular stng (HVS) i suprasolicitarea atrial
(SA), ecocardiografa transtoracic: criterii pentru HVS
septul interventricular >13 mm, peretele posterior al
VS >12 mm ( msurate n modul M), indexul volumului
atriului stng >20 ml/m
2
; criterii pentru disfuncia
dias tolic folosind fuxul Doppler transmitral, fuxul
venos pulmonar, tissue Doppler la nivelul lateral al
inelului mitral n sectiunea 4 camere apical, velocitatea
propagrii fuxului (VPF) n modul M precum i cri-
terii pentru potenialele atrial e tardive folosind electro-
cardiograma de nalt rezoluie: durata undei P cu
semnal mediat (SAPWD) >140 ms, rdcina ptrat
medie (RMS 40) >3,5 V, integrala undei P >800 V,
POSTER FORUM I Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
cu fltrele setate ntre 250-400 Mhz, nivelul zgomotului

<0,3V (tinta).
Rezultate: 1. Pattern-urile fuxului de umplere la
pacienii hipertensivi au fost : 45,47% relaxare anormal,
18,18% pseudonormal, 22,72% restrictiv i 13,63%
normal. 2. Distributia prezenei PAT la hipertensivii
cu disfunctie diastolic era: cu relaxare anormal: HVS
58,3%, SA 60%, p <0,05; cu pattern pseudonormal:
HVS 66%, SA 80%, p <0,05; cu pattern restrictiv: HVS
87,5%, SA 90%, p <0,05 3. Potenialele atriale tardive la
pacienii hipertensivi cu un pattern normal al fuxului
transmitral dar cu modifcri la examinarea tissue
Doppler sau n modul M erau prezente la 33% dintre
subieci.
Concluzii: 1. A fost descoperit o corelaie ntre pre-
zena potenialelor atriale tardive i disfuncia dias to-
lic la pacienii hipertensivi cu hipertrofe ven tricu lar
stng i cu atriul stng dilatat, probabil dato rit pre-
siunii crescute din atriul stng din timpul dias tolei.
2. Potenialele atriale tardive erau prezente n sta diile
precoce de disfuncie diastolic evideniat prin ima-
gistic tissue Doppler i n modul M, dar erau mai
evidente la pacienii cu pattern pseudonormal i res-
trictiv al fuxului de umplere.

15. Efectul exercitiului fizic
acut asupra adiponectinei si
leptinei la pacientii suprapon-
derali
D. Pop, D. Zdrenghea, G. Bodisz, D. Petrovai
Universitatea de Medicina si Farmacie \Iuliu Hatie-
ganu\, Spitalul Clinic de Recuperare- Cardiologie,
Cluj-Napoca
Premise: La pacientii supraponderali nivelul
adiponectinei este scazut, iar cel al leptinei este
crescut. In schimb efectul exercitiului fzic asupra
nivelurilor plasmatice ale adiponectinei si leptinei este
controversat.
Scop: Studierea efectului exercitiului fzic asupra
nivelelor plasmatice ale adiponectinei si leptinei la
pacientii normali si supraponderali.
Material si metoda: Am studiat 79 subiecti, 42 barbati,
37 femei cu varsta de 59+/- 9 ani, impartiti in 2 grupuri.
Grupul I a fost format din 19 pacienti cu un indice de
masa corporala <25kg/(m)
2
si grupul II format din
60 pacienti supraponderali (IMC25kg/(m)
2
). Toti
pacientii au fost supusi unui test de efort maximal
limitat de simptom pe bicicleta, conform protocoalelor
clasice (efort mediu 103+/- 27ws). Probele din sange
venos au fost recoltate inainte de exercitiu (Proba I ) si
la 30 de minute dupa intreruperea efortului (Proba II);
nivelele de adipolectina si leptina au fost determinate
utilizand metoda ELISA.
Rezultate: Sunt reprezentate in tabel. In repaus adipo-
nectina este semnifcativ scazuta iar leptina cres cuta
la pacientii supraponderali. In schimb in timpul exer-
citiului valorile plasmatice ale celor doua adipo ki ne
nu au diferit semnifcativ de cele inregistrate in timpul
repausului la ambele grupuri, chiar daca adipo nec-
tina a ramas la un nivel scazut iar leptina a sca zut
pana la limita semnifcatiei statistice la pacientii supra-
ponderali. In ceea ce priveste barbatii si femeile, date-
le sunt similare pentru barbati, insa dupa exercitiu
fe mei le supraponderale au inregistrat o reducere
semni fca tiva a valorilor leptinei. De asemenea, in
repaus nivelele de adiponectina au fost mai crescute la
femeile supraponderale (p=0,01). Aceasta sugereaza ca
femeile supraponderale pot f protejate in comparatie
cu barbatii si exercitiul fzic poate aduce un benefciu
supli mentar.
Concluzie: Exercitiul fzic acut are un efect nesem ni-
fcativ asupra nivelelor de adiponectina si leptina, dar
adiponectina de repaus este crescuta iar leptina semni-
fcativ scazuta in timpul exercitiului la femeile supra-
ponderale si ar putea avea un efect benefc la aceasta
categorie de subiecti. Pacienti Adiponectina I (ng/ml)
Adipo nectina II (ng/ml) p Leptina I (pg/ml) Leptina
II (pg/ml) p IMC<25kg/(m)
2
(19p) 143559120
1112410203 NS 72167428 44773949 NS Barbati
(10p) 1441410320 93558180 NS 39294193
356532989 NS Femei (9p) 142908815 13088.812794
NS 10868.89097 5393.35020 NS IMC25kg/(m)2
(60p) 5889.16278 5590.16400 NS 9235.810988
8013.911449 p=0.05 Barbati (27p) 3697.43710
4988.15239 NS 7123.610542 7129.413862 NS Femei
(33p) 7498.77420 5930.97318 NS 10749.311329
8747.89524 p=0.02

Suplimentul A, 2008
POSTER FORUM I
The effect of acute exercise
upon adiponectin and leptin in
overweight subjects
D. Pop, D. Zdrenghea, G. Bodisz, D. Petrovai
Universitatea de Medicina si Farmacie \Iuliu Hatie-
ganu\, Spitalul Clinic de Recuperare- Cardiologie,
Cluj-Napoca
Background: Adiponectin is decreased and leptin
increased in overweight subjects. In turn, exercise
has controversial efect upon adiponectin and leptin
plasmatic levels.
Purpose: To study the efect of acute exercise upon
plasmatic levels of adiponectin and leptin in normal
and overweight subjects.
Method: We studied 79 subjects, 42 males and 37
females, aged 569 years, divided in two groups. Group
I consisted of 19 patients with body mass index <25 kg/
(m)
2
and group II consisted of 60 overweight subjects
(BMI 25 kg/ (m)
2
). All subjects were submitted to a
maximal symptom limited exercise stress testing on
cycloergometer, upon classical protocols (mean efort
103 27 Ws). Venous blood samples were obtained
before exercise (sample I) and at 30 minutes afer the
efort was stopped (sample II); adiponectin and leptin
levels were determined, using ELISA method.
Results: Are exposed in the table. At rest adiponectin
is signifcantly decreased and leptin increased in
overweight subjects. In turn, during exercise the values
of the two adipokines were not signifcantly diferent
from those registered at rest in both groups, even if the
adiponectin remained at a low level and leptin decreased
at the limit of signifcance in overweight subjects.
Considering men and women, the data are similar for
men but, afer exercise overweight women registered a
signifcant reduction of the leptin values. Also at rest
adiponectin levels are more increased in overweight
women (p=0.01). Tis suggests that overweight women
can be protected in comparison with men and exercise
could add a supplementary benefce.
Conclusion: Acute exercise has little efect upon adi-
po nectin and leptin levels, but rest adiponectin is
increased and leptin signifcantly decreased during
exer cise in overweight women and could be benefcial
to this category of subjects. Patients Adiponectin I
(ng/ml) Adiponectin II (ng/ml) p Leptin I (pg/ml)
Leptin II (pg/ml) p BMI<25kg/(m)2 (19p) 143559120
1112410203 NS 72167428 44773949 NS Males (10p)
1441410320 93558180 NS 39294193 356532989
NS Females (9p) 142908815 13088.812794 NS
10868.89097 5393.35020 NS BMI25kg/(m)2
(60p) 5889.16278 5590.16400 NS 9235.810988
8013.911449 p=0.05 Males (27p) 3697.43710
4988.15239 NS 7123.610542 7129.413862 NS Fe-
ma les (33p) 7498.77420 5930.97318 NS 10749.3
11329 8747.89524 p=0.02
21
POSTER I
ventriculului stng n subgrupurile cu HRV sczut i,
respectiv normal. HRV s-a modifcat ntre cele dou
nregistrri doar la 4 pacieni (la 3 de la sczut la
normal), ambele nregistrri AECG find efectuate n
condiii de stabilitate clinic. Evaluarea HRV prin dou
nregistrri AECG n comparaie cu doar o singur
moni torizare AECG s-a corelat ceva mai bine cu sc-
derea clasei NYHA (r= 0,28 vs. r= 0,18) i creterea frac-
iei de ejecie (r= 0,25 vs. r= 0,19).
Concluzii: Dei a fost efectuat pe un lot mic de pacieni,
studiul de fa a artat faptul c mai multe nregistrri
AECG la pacienii cu CMD, n special la cei fr aritmii
simptomatice, cresc ansele pentru un tratament mai
agresiv al aritmiilor. Variabilitatea ritmului sinusal nu
s-a modifcat semnifcativ pe perioada de urmrire, dar
valoarea prognostic a acesteia rmne crescut.

Use of multiple ambulatory
ECG recordings in dilated
cardiomiopathy. Is it useful?
Purpose: Te aim of the study was the evaluation of
informations provided by serial 24-hours ambulatory
ECG monitoring (AECG) in patients with dilated car-
diomyopathy (DCM).
Method: A subgroup of 30 patients (mean age 59.9
10.6 years, 83.3% men), diagnosed with DCM in our
Department, with more than one 24-hours AECG recor-
ding, were selected for the present study. Te device
used for 24 hours ECG monitoring was MT-100 and the
sofware used for ECG analysis was MT-200 (Schiller
AG, Switzerland). For each patient, only frst and last
recording during follow-up were analyzed. Te mean
time interval between recordings was 1411 months.
Te follow-up period (clinical events, pacemakers and/
or ICD implantations, etc) was 1812 months. Heart
rate variability (HRV) was assessed for both recordings
16. Este util monitorizarea
ambulatorie ECG n dinamic
la pacienii cu cardiomiopatie
dilatativ?
Obiectiv: Scopul acestui studiu a fost evaluarea infor-
ma iilor obinute prin monitorizare ambulatorie Holter
ECG 24 ore (AECG) repetat la pacienii cu cardio mio-
patie dilatativ (CMD).
Metod: Pentru studiul de fa, a fost selectat un sub-
grup de 30 pacieni (vrst medie 59,910,6 ani, 83,3%
brbai), diagnosticai cu CMD n clinica noastr, la
care s-a efectuat mai mult de o nregistrare ambulatorie
ECG (AECG) pe 24 ore. Aparatul utilizat pentru moni-
torizarea Holter ECG 24 ore a fost MT-100 i soful
utilizat pentru analiz a fost MT-200 (Schiller AG,
Elveia). Pentru fecare pacient au fost analizate doar
pri ma i ultima nregistrare din perioada de urmrire.
Intervalul mediu ntre nregistrri a fost de 1411 luni.
Perioada de urmrire (evenimente clinice, implantul de
stimulator cardiac i/sau defbrilator intracardiac etc.) a
fost de 1812 luni. La 15 pacieni a fost evaluat varia-
bilitatea ritmului cardiac (HRV) n ambele nre gis trri
i a fost clasifcat ca normal sau sczut utiliznd 2
parametrii: HRV index i pNN50. Analiza statistic a
fost realizat cu EpiInfo 2000, versiunea 3.3.2.
Rezultate: Prima monitorizare Holter ECG a artat
arit mii ventriculare semnifcative i a determinat nce-
perea proflaxiei cu amiodaron la 5 dintre pacieni,
3 dintre acetia avnd indicaie IIb pentru AECG. La
15 din cei 30 pacieni indicaia pentru ambele AECG
a fost evaluarea aritmiilor n insufciena cardiac (indi-
caie de clas IIb). Implantarea de stimulator cardiac
a fost efectuat dup prima monitorizare la 4 pacien-
i i dup a doua monitorizare la 2 pacieni. n lotul
studiat a fost necesar implantarea unui singur defbri-
lator intracardiac. Pe perioada de urmrire nu s-a
nre gistrat nici un deces n lotul studiat. Nu a existat
nici o diferen n ceea ce privete fracia de ejecie a
Suplimentul A, 2008
25
POSTER I
in 15 patients and was classifed as normal or low HRV
using 2 parameters: HRV index and pNN50. Statistical
analysis was done using EpiInfo 2000 statistical package,
version 3.3.2.
Results: Te frst AECG monitoring shows signifcant
ventricular arrhythmia and determined starting of
amio darone prophylaxis in 5 patients, 3 of them with
class IIb indication for AECG. In 15 of 30 patients
the indication for both AECG was the evaluation of
arrhythmia in heart failure (class IIb). Pace-maker
implantation was considered afer the frst AECG in 4
pa tients and afer the second AECG in other 2 patients.
Only one ICD implantation was necessary in our group
of patients. None of the patients died during follow up.
Tere was no diference in the lef ventricular ejection
fraction between low and normal HRV subgroups.
HRV did change between evaluations in 4 patients (3
from low to normal), both AECG exams in clinically
stable condition. Evaluation of HRV by two AECG
com pared to only one has a slightly better correlation
to NYHA class decrease of (r= 0.28 vs. r= 0.18) and
ejection fraction increase (r= 0.25 vs. r= 0.19).
Conclusions: Despite the small series of patients in the
present study, we showed that multiple AECG recor-
dings in patients with DCM, especially without sympto-
matic arrhythmias, increase the chance for a more
aggre ssive attitude in treating arrhythmias. Heart rate
variability does not change signifcantly during follow-
up, but its prognostic value is high.

17. Monitorizarea ambulatorie
a tensiunii arteriale la pacientii
diabetici hipertensivi
E. Badila, D. Bartos, C. Tirziu, S. Ghiorghe,
M. Dorobantu
Spitalul Clinic de Urgenta Bucuresti
Obiectiv: Aprecierea utilitatii monitorizarii ambulatorii
automate a tensiunii arteriale (MAATA) in controlul
valorilor tensionale la pacientii diabetici hipertensivi
apparent bine controlati prin masurarea TA la cabinet.
Metoda: In studiu au fost inclusi 62 pacienti hipertensivi
diabetici. Fiecare subiect era tratat si aparent bine
controlat (TA <130/80 mmHg) prin masurarea TA
la cabinet. Pentru monitorizarea ambulatorie a TA
am utilizat un aparat ABPM-04, Meditech, Ungaria.
Tensiunea arteriala a fost masurata la intervale de 20
min in perioada 06:00 22:00h si la 30 min interval in
perioada noptii. Am defnit hipertensiunea la MAATA
atunci cand media valorilor TA a fost >125/80 mmHg.
Rezultate: Din totalul pacientilor diabetici hipertensivi
inclusi in studiul nostru, 67.7% au avut media valorilor
presionale la MAATA peste limita (>125/80 mmHg).
Media valorilor TA sistolice pe intreg lotul a fost de
141+/-10 mmHg iar media TA diastolice a fost 88+/-
7 mmHg. Prevalenta pattern-ului non-dipping printre
pacientii nostrii a fost de 64.5%. Din totalul subiectilor
inclusi, 30.6% au prezentat un pattern cu risc inalt de
tip riser (media TA nocturna mai mare decat media TA
diurna).
Concluzii: Pacientii diabetici cu hipertensiune arte ria-
la trebuie evaluati prin monitorizare ambulatorie auto-
mata a TA cu scopul stabilirii controlului optim al valo-
rilor presionale. Doua treimi din pacientii inclusi in
stu diul nostru au avut valorile TA peste limita, desi TA
la cabinet era bine controlata. O treime dintre pacienti
au asociat un pattern de tip riser, asociat cu un risc car-
diovascular foarte inalt.

Ambulatory blood pressure
monitoring in diabetic
hypertensive patients
E. Badila, D. Bartos, C. Tirziu, S. Ghiorghe,
M. Dorobantu
Emergency Hospital Bucharest, Bucharest, Romania
Purpose: To assess the usefulness of ambulatory blood
pressure monitoring (ABPM) in the control of blood
pressure (BP) values in diabetic hypertensive patients
with apparently well controled of ce blood pressure.
Methods: 62 hypertensive and diabetic patients were
included in our study. Each subject was treated and
the blood pressure was apparently well controlled
(of ce BP <130/80 mmHg). For the ambulatory BP
monitoring, we used an automatic Meditech ABPM-
04 device. BP was measured at 20 min intervals from
06:00 to 22:00h and at 30 min intervals at night. We
defned ambulatory hypertension as a mean BP higher
than 125/80 mmHg.
Results: From all hypertensive diabetic patients inclu-
POSTER I Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
26
ded in our study, 67.7% had 24 h mean BP values over
limits (>125/80 mmHg). Te 24 h mean systolic BP in
all groups was 141+/-10 mmHg and the diastolic BP
was 88+/-7 mmHg. Te prevalence of non-dipping
pattern among our patients was 64.5%. 30.6% of the
patients presented a high risk riser pattern (night time
BP above daytime mean).
Conclusions: Diabetic hypertensive patients should be
evaluated by ambulatory blood pressure monitoring
in order to estabilish the optimal control of BP values.
Two third of our patients had BP over limits despite
well controled of ce BP. One third presented a riser
pattern associated to a very high cardiovascular risk.

18. Este utila dozarea pro-BNP
plasmatic pentru stratificarea
riscului cardiovascular la
pacientii hipertensivi?
C. Tirziu
1
, E.Badila
1
, D. Bartos
1
, S. Ghiorghe
1
,
R. Tirziu
2
1
Spitalul Clinic de Urgenta, Bucuresti
2
CMDTAAcad. St. Milcu, Bucuresti
Scopul studiului a fost de a testa utilitatea clinica a do-
za rii plasmatice a proBNP-lui in vederea stratifcarii
ris cului cardiovascular la pacientii cu hipertensiune
arte riala.
Metoda: Am evaluat un lot de 45 de pacienti cu hiper -
tensiune arteriala esentiala fara insufcienta car dia ca
sau alte afectiuni concomitente dovedite a se core la
cu cresterea valorilor plasmatice ale pro-BNP. Fie care
pacient a fost evaluat astfel: a). clinic prin inre gis-
trarea circumferintei taliei si indicelui de masa cor po-
rala (IMC); b). biologic prin determinarea valo rilor
plas matice ale glicemiei, colesterolului total, tri gli ce ri -
delor, creatiniei (si clearenceul la creatinina), pro-BNP
(ELECSYS 2010, Roche); si c). imagistic prin inre gis-
trarea ECG, ecocardiografe, determinarea eco grafca
a indicelui intima-medie carotidian (IIM) si moni to-
rizarea 24 ore a TA (ABPM Meditech).
Rezultate: Valoarea proBNP-lui plasmatic s-a corelat
liniar pozitiv (r= 0,523) cu valoarea colesterolului total
si s-a corelat dupa o relatie patratica (r=0,517) cu nivelul
trigliceridelor serice. Nu am identifcat corelatie intre
pro-BNP si circumferinta taliei sau IMC. De asemenea
nu s-a inregistrat legatura semnifcativa statistic intre
pro-BNP si prezenta ecocardiografca a HVS (coefcient
Pearson 0,23) sau a disfunctiei diastolice (coef cient
Pearson 0,21), si nici cu valorile creatininei plasmatice
sau a IIM. Am identifcat o corelatie moderata pozitiva
liniara intre pro-BNP si TAS medie (r=0,607) si TAD
medie (r=0,596) dar fara concordanta intre valorile
pro-BNP si variatia diurnal a TA.
Concluzie: La pacientii cu HTA valoarea plasmatica
a pro-BNP se coreleaza cu valorile colesterolului total
si trigliceridelor dar nu am identifcat corelatii semni-
fcative intre valorile acestuia si atingerea de organe tinta.
Consideram ca dozarea pro-BNP plasmatic este utila in
aprecierea controlului valorilor tensionale (corelatie cu
valorile tensionale obtinute la monitorizarea in 24 de
ore) dar nu isi dovedeste utilitatea privind stratifcarea
riscului cardio-vascular la pacientii cu hipertensiune
arteriala.

19. Tratamentul hipertensiunii
rezistente prin adaugarea unei
doze mici de spironolactona
E. Badila, C. Tirziu, S. Ghiorghe, D. Bartos,
M. Dorobantu
Obiectiv: Aprecierea efcientei clinice si hemodinamice
a adaugarii unei doze mici de spironolactona, antagonist
al aldosteronului, in tratamentul hipertensiunii arte-
riale rezistente.
Metoda: Studiul a inclus 26 pacienti cu HTA rezis-
tenta. Efcienta clinica a adaugarii unei doze mici de
spironolactona (25 mg/zi) a fost apreciata prin masu-
rarea TA la cabinet si prin monitorizarea ambulatorie
auto mata a TA (ABPM-04, Meditech, Ungaria). Ef-
cien ta hemodinamica a fost apreciata non-invaziv
prin bioimpedanta electrica toracica (Hotman, Hemo
Sapiens Inc). Pentru fecare pacient am determinat TA
la cabinet, media TAS, media TAD, presiunea pulsului
(PP), TA medie (TAM), stroke systemic vascular resis-
tance index (SSVRI), total arterial compliance index
(TACI), stroke index (SI).
Rezultate: redate in tabel.
Concluzii: Adaugarea unei doze mici de spironolactona
este efcienta in controlul hipertensiunii rezistente. Re-
Suplimentul A, 2008
2I
POSTER I
ducerea rezistentei periferice reprezinta probabil un
me canism important al efcientei spironolactonei in
HTA rezistenta. Utilizarea metodei bioimpedantei elec-
trice toracice in managementul hipertensiunii rezis -
tente permite identifcarea noninvaziva a ano ma liilor
hemodinamice prezente la acesti pacienti.

Inainte de
spironolactona
Dupa
spironolactona
p
Media TAS mmHg 164,612,5 129,56,3 0.01
Media TAD mmHg 92,310,4 76,45,3 0.01
TAM mmHg 116,49,6 94,25,3 0.01
PP mmHg 72,112,1 53,14,2 0.01
SI ml/m2 34,88,4 39,810,5 ns
SSVRI dyn.sec.cm-5.m2 251,640,5 184,571,4 0.01
TACI 0,540,2 0,750,2 ns

Management of resistant
hypertension by adding a low
dose spironolactone
E. Badila, C. Tirziu, S. Ghiorghe, D. Bartos,
M. Dorobantu
Emergency Hospital Bucharest
Objective: To assess the clinical and hemodynamical
efectiveness of aldosterone antagonist spironolactone
in the treatment of resistant hypertension.
Method: 26 patients with resistant hypertension
were included. Te clinical efectiveness of adding a
low dose spironolactone (25 mg/day) was assess by
of ce and ambulatory blood pressure monitoring
(ABPM) (Meditech, Hungary). Te hemodinamycal
efectiveness was assess non-invasively by electric
thoracic bioimpedance (ETB) (Hotman, HemoSapiens
Inc). We measured of ce blood pressure, mean systolic
BP, mean diastolic BP, pulse pressure (PP), mean arterial
pressure (MAP), stroke systemic vascular resistance
index (SSVRI), total arterial compliance index (TACI),
stroke index (SI).
Results: see table.
Conclusions: A low dose spironolactone is ef cacious
in the control of resistant hypertension. Reduction of
peripheral resistance is probably an important mecha-
nism of efectiveness of spironolactone in resistant hy-
pertension. Te use of ETB in management of resistant
hypertension allows non-invasive identifcation of
under lying hemodinamic abnormalities in these
patien ts.

Before
spironolactone
Afer
spironolactone
p
SBP mmHg 164,612,5 129,56,3 0.01
DBP mmHg 92,310,4 76,45,3 0.01
MAP mmHg 116,49,6 94,25,3 0.01
PP mmHg 72,112,1 53,14,2 0.01
SI ml/m2 34,88,4 39,810,5 ns
SSVRI dyn.sec.cm-5.m2 251,640,5 184,571,4 0.01
TACI 0,540,2 0,750,2 ns

20. Agregarea plachetar la
vechi i diabet zaharat tip 2
Silvia Filimon
IMSP Institutul de Cardiologie, Chiinu, Republica
Moldova
Scop: determinarea particularitilor agregrii plache-
tare la pacienii cu infarct miocardic vechi i diabet za-
harat tip 2. Material i metode: 100 pacieni, inclui n
studiu, cu vrsta medie 58,880,92 ani, dintre care 51
brbai i 49 femei, au fost divizai n dou grupuri: Gru-
pul I- de baz a inclus 50 pacieni cu infarct miocardic
vechi (IMV) i diabet zaharat tip 2 (DZ tip 2), care pri-
meau terapie standard pentru pacienii cu cardiopatie
ischemic (CPI) (-adrenoblocante, inhibitori ai enzi-
mei de conversie a angiotensinei-II, antiagregante,
nitra i) i terapie hipoglicemic oral cu Glibenclamid
i Grupul II- de referin a inclus 50 pacieni cu IMV
fr DZ tip 2, care primeau terapie standard pentru
CPI. Terapia antiagregant a fost suspendat cu 7 zile
nainte de investigaie. Agregarea plachetar (AP) a
fost studiat prin metoda fotometric Born/OBraen
(1962), care permite aprecierea gradului i vitezei
agregrii plachetare. n calitate de inductor al agregrii
a fost utilizat adenozindifosfat (ADF (Germania) n con-
centraie de 0,1 i 0,5 Mol. Paralel a fost apreciat AP
prin metoda propus de Gabassov Z.A. i coaut.(1989),
care permite nregistrarea razei medii a agregatelor.
Protocolul explorrii a inclus determinarea timpului
agregrii maximale prin dou metode (T%- metoda
Born i TR- metoda Gabassov n secunde (s), gradului
de agregare (H%) n procente (%), razei agregatelor
(HR) n uniti optice (u.o) i indicelui de agregare
(A)conform formulei: A= (Umax/Uo)
2
- 1 unde A-
indi cele de agregare; Umax- valoarea maximal a razei
agregatelor; Uo- valoarea iniial a razei agregatelor.
Rezultate: Analiza rezultatelor studiului a relevat unele
particulariti ale agregrii plachetare la pacienii cu
Suplimentul A, 2008
28
IMV i DZ tip 2. La aceti pacieni s-a nregistrat o raz
iniial a agregatelor mai mare la concentraia 0,1 Mol
ADF- 4,840,19 u.o comparativ cu pacienii cu IMV
fr DZ tip 2- 3,660,12 u.o (p<0,01), o raz maximal
a agregatelor mai mare la concentraia 0,1 Mol ADF-
6,170,21 u.o versus 4,630,13 u.o (p<0,01) i un indice
de agregare mai mare la concentraia 0,1 Mol ADF-
0,650,05 versus 0,550,04 (p<0,05). Aceste deosebiri
au fost determinate i la concentraia 0,5 Mol ADF.
Raza iniial i maximal a agregatelor au fost mai mari
n grupul pacienilor cu IMV i DZ tip 2- 4,840,19 u.o.
versus 3,890,19 u.o. (p<0,05) i 6,370,21 u.o.- versus
5,060,13 u.o.- (p<0,01), cu un indice mai mare de
agregare n grupul celor cu IMV i DZ tip 2- 0,760,06
versus 0,650,05 (p<0,05). Deosebiri importante ntre
grupuri referitor la timpul agregrii maximale dup
metoda Born i Gabassov la concentraia 0,1 i 0,5 Mol
ADF i gradul de agregare maximal la concentraia 0,5
Mol ADF n-au fost determinate.
Concluzii: La pacienii cu IMV i DZ tip 2 parametrii
agregrii plachetare (raza iniial i maximal a agre-
gatelor i indicele de agregare) sunt mai mari comparativ
cu pacienii cu IMV fr DZ tip 2, ceea ce explic riscul
crescut de complicaii trombotice la aceast categorie
de pacieni.

21. Utilizarea tecii
stabilizatoare n ablaia prin
radiofrecven a sindromului
de preexcitaie n boala Ebstein
Mihaela Grecu, Andrei Lozba, Tudor Georgescu,
Ctlina Arsenescu Georgescu
Institutul de Boli Cardiovasculare Iai Prof. Dr. George
I. M. Georgescu
Introducere: Anomalia anatomic a aparatului valvular
tricuspidian face difcil ablaia prin radiofrecven a
sindromului de preexcitaie n boala Ebstein. Exist
puine date privind aportul tecii stabilizatoare n men-
inerea cateterului de ablaie.
Obiective: Pacient de 50 ani, cu boal Ebstein demons-
trat ecocardiografc (valva tricuspid septal inserat
cu 35 mm apical fa de planul inelului mitral, cu
regurgitare grad II i VD atrializat 50%), cu crize de
palpitaii refractare la antiaritmice clasa Ia, Ic si III
a fost supus studiului electrofziologic endocavitar.
Mappingul endocavitar bidimensional deceleaz pre-
zena de cale accesorie unic cu conducere rapid bidi-
rec ional (PRA 220 ms) situat n poriunea lateral
a miocardului ventricular atrializat. Stimularea atrial
induce tahicardia ortodromic clinic cu aspect de bloc
de ram drept, cu interval HV alungit la 63 ms, cu VA
274 ms la nivel hisian i 60 ms la nivel lateral drept.
Identifcarea punctului de ablaie s-a realizat pe criterii
exclusiv electrofziologice. Instabilitatea cateterului de
ablaie a impus utilizarea unei teci stabilizatoare Preface
ce a permis meninerea cateterului n punctul de ablaie
cu succes unde s-a nregistrat, n derivaie bipolar,
un potenial atrial de amplitudine mic, urmat de un
potenial ventricular cu amplitudine mare cu fuziune
continu n derivaii bipolare. Odat identifcat inseria
anterograd a cii accesorii n ritm sinusal, s-a indus
tahicardia ortodromic, n timpul creia s-a confrmat
coincidena inseriei retrograde a cii accesorii cu
inseria anterograd, n poziia lateral a miocardului
ventricular atrializat. Postablaie se documenteaz con-
ducere atrioventricular normal, dar cu tulburare de
conducere infrahisian cu interval HV alungit (63ms)
i QRS cu aspect de BRD cu durat de 150 ms, frecvent
ntlnit n boala Ebstein. Stimularea ventricular fnal
pune n eviden dispariia conducerii retrograde pe
cale accesorie (PW retrograd 450 ms, cu conducere
retro grad decremental i concentric). La 3 luni
postprocedural pacientul este asimptomatic, n absena
medicaiei antiaritmice i menine aspectul de BRD.
Concluzie: Ablaia clasic prin radiofrecven a sin-
dromului de preexcitaie n boala Ebstein poate f
labo rioas din motive anatomice. Utilizarea tecii stabi-
lizatoare pentru cateterul de ablaie poate contribui la
succesul procedural.

Suplimentul A, 2008
29
POSTER I
The utility of stabilizing sheath
in the radiofrequency catheter
ablation of the preexcitation
syndrome in Ebsteins anomaly
Mihaela Grecu, Andrei Lozba, Tudor Georgescu,
Cardiovascular Diseases Institute Prof. Dr. George I.
M. Georgescu Iasi
Background: Te anatomical malformation of the
tricuspid valve apparatus makes dif cult the radio-
frequency ablation of the preexcitation syndrome in
Ebsteins anomaly. Tere are few data concerning the
usefulness of the stabilizing sheath in maintaining the
position of the ablation cathether.
Method: A 50 year old patient, with an echocardiographic
diagnosis of Ebsteins anomaly (apical displacement
of the septal tricuspid valve leafet of 35mm from the
mitral annulus, 2nd degree tricuspid regurgitation
and 50% atrialized right ventricle), with palpitations
uncontrolled by class Ia, Ic and III antiarrhytmic
drugs was referred to an electrophysiological study.
Te two-dimensional endocavitary mapping reveals
the presence of an unique accessory pathway with fast
bidirectional conduction, with an absolute refractory
period of 220ms, located in the lateral side of the
atrialized ventricular myocardium. Atrial stimulation
induces the clinical orthodromic tachycardia, with
right bundle branch block pattern, with a prolonged
HV interval of 63ms and a VA interval of 274ms at
the His bundle level and of 63ms at the right lateral
level. Te location of the ablation site was made solely
on electrophysiologial criteria. Te instability of the
ablation catheter has imposed the use of a Preface
stabilizing sheath that allowed the succesful maintaining
of the catheter at the ablation site, where was recorded,
in a bipolar lead, a low amplitude atrial potential, follo-
w ed by a high amplitude ventricular potential with
con ti nuous fusion in bipolar leads. Once identifed the
atrial insertion of the accessory pathway during sinus
rythm, orthodromic tachycardia was induced, during
which the coincidence of the retrograde insertion
of the accessory pathway with the anterograde one
was proved, as located in the lateral side of the atria-
lized ventricular myocardium. Postablation, the atrio-
ventricular conduction was normal, but there was
present an infra His conduction delay ( HV interval
of 63ms) with right bundle branch block pattern (QRS
duration of 150ms), a common fnding in Ebsteins
anomaly. Te fnal ventricular stimulation evidentiated
the disappearance of the retrograde conduction over
the accessory pathway. Afer 3 months of follow-up the
patient is asymptomatic, doesnt require antiarrhytmic
drugs, while maintaining the right bundle branch block
pattern.
Conclusions: Te classical radiofrequency ablation of
the preexcitation syndrome in Ebsteins anomaly could
be dif cult due to anatomical peculiarities. Te use
of the stabilizing sheath for the ablation catheter may
contribute to the success of the procedure.

22. Diabetul zaharat i
insuficiena cardiac acut
- elemente de epidemiologie
descriptiv
Monica Bengu
1
, O. Chioncel
2
, C. Macarie
2
1
Secia de cardiologie, Spitalul Judeean Focani
2
lare C.C.Iliescu Bucureti
Introducere: Exist pn n prezent date limitate lega te
de particularitile clinice i prevalena diabetului zaha-
rat (DZ) n insufciena cardiac acut (ICA). Diabetul
zaharat reprezint un factor cheie n fziopatolgia ICA
alturi de congestie, injurie miocardic i sindrom
cardio-renal. Evidenele epidemiologice legate de ICA
pro vin din registre i trialuri mari (ADHERE, OPTI-
MIZE HF, EHFS II, EFICA) i arat c prevalena DZ la
pacienii spitalizai cu ICA este mare i variaz n func-
ie de forma clinic a ICA.
Obiective: Evaluarea prevalenei DZ i a tulburrilor de
glicoreglare la pacienii cu insufcien cardiac acut i
evaluarea caracteristicilor clinice n cazul asocierii DZ-
ICA.
Material i metod: Studiul, observaional, de cohort
prospectiv folosete date din Registrul Romn de Insu-
fcien cardic acut. Sunt nrolai consecutiv pacieni
internai n secii de cardiologie din ar cu diagnosticul
de ICA. Pacienii sunt ncadrai n 3 forme clinice de
ICA: insufcien cardiac decompensat, edem pul mo-
nar acut i oc cardiogen. Sunt folosite criteriile ADA
1997 pentru clasifcarea glucometabolic (IFG, DZ).
In cazul pacienilor diabetici este menionat tipul DZ
Suplimentul A, 2008
80
(cu noscut sau nou descoperit) i tratamentul folosit
anterior internrii pentru controlul glicemiei.
Rezultate: In intervalul noiembrie 2007-februarie 2008
au fost nrolai consecutiv 400 pacieni cu diagnosticul
de ICA cu vrsta medie 67.1 ani (SD 12.6), 41.3% femei
i 58.8% barbai. Din totalul pacienilor, 68.75% au fost
spitalizai pentru insufcien cardiac decompensat;
24.75% cu edem pulmonar acut i 6.5% cu diagnosticul
de oc cardiogen.
Prevalena DZ la pacienii cu ICA a fost de 31.8%
(21.3% DZ cunoscut i 10.5% DZ nou descoperit),
ocupnd a treia poziie n ierarhia factorilor de risc cardio-
vascular dup HTA (50.8%) si dislipidemie (33.3%).
Prevalena tulburrilor de glicoreglare la internare la
pa cienii nondiabetici (hiperglicemii tranzitorii peste
110 mg%) a fost de 25.75%. Astfel, prevalena DZ i
a tulburrilor de glicoreglare n grupul pacienilor cu
ICA a fost de 57.55%. Prevalena DZ a fost diferit
n cele trei forme clinice de ICA. La pacienii cu ICA
decompensat prevalena DZ a fost de 27.64% (18.55%
DZ cunoscut i 9.09% DZ nou descoperit); la cei cu EPA
prevalena DZ a fost de 40.40% (26.26% DZ cunoscut i
14.14% DZ nou descoperit). In cazul pacienilor cu oc
cardiogen prevalena DZ a fost de 42.31% (30.77% DZ
cunoscut i 11.54% DZ nou desoperit).
Caracteristici clinice: In rndul pacienilor diabetici
48.82% erau fr tratament antidiabetic la internare,
26.77% aveau tratament cu insulin, 7.09% biguanide,
10.24% foloseau asocieri.
Concluzii: Studiul aduce date legate de prevalena
DZ la pacienii spitalizai cu ICA i prezint o serie
de caracteristici clinice ale asocierii DZ-ICA, unele
re zul tate find comparabile cu cele din studiile mari.
Nu m rul pacienilor inclui n acest studiu este mic,
Regis trul Romn de Insufcien cardic acut este n
des f urare.

Diabetes mellitus and acute
heart failure-descriptive
epidemiological data
Monica Bengu
1
, O. Chioncel
2
, C. Macarie
2
1
Secia de cardiologie, Spitalul Judeean Focani
2
lare C.C.Iliescu Bucureti
Background: Till now, there is limited data concerning
clinical features and prevalence of diabetes mellitus
in acute heart failure. Diabetes mellitus represents
a key factor in acute heart failure physiopathology,
like congestion, myocardial injury and cardio-renal
syndrome. Tere is epidemiological data regarding
acute heart failure from registries and clinical trials
(ADHERE, OPTIMIZE HF, EHFS II, EFICA) showing
that diabetes prevalence is increased in patients hospi-
talized with acute heart failure, and prevalence is not the
same in diferent clinical form of acute heart failure.
Objectives: Tis study, observational cohort study,
used data from the Romanian Registry of Acute Heart
Failure and its goals are prevalence evaluation of dia-
betes mellitus and glucometabolic impairement in pa-
tients with acute heart failure and clinical features eva-
luation in these patients.
Methods: Between November 2007-february 2008, 400
patients hospitalized with acute heart failure were enro-
lled consecutively in three clinical forms of acute heart
failure: decompensated heart failure, pulmonary oede-
ma and cardiogenic shock. Criteria used for gluco meta-
bolic classifcation was made according to the ADA
1997 (for impaired fasting glucose, diabetes melli tus).
Results: 400 patients were enrolled consecutively with
diagnosis of acute heart failure, 41.3% women and
58.8% men, age 67.1 (SD 12.6). 68.75% patients were
hos pitalized with decompensated heart failure, 24.75%
with pulmonary oedema and 6.5% with cardio genic
shock. Te prevalence of diabetes mellitus in these
patients was 31.8%, third position afer arterial hyper-
tension (50.8%) and dislipidemia, as cardiovascular
risk factors. Prevalence of glucometabolic impairement
in non diabetic patients (transitory increasing in plasma
glu cose above 110 mg%) was 25.75%.
Te prevalence of diabetes mellitus varied in diferent
clinical forms of acute heart failure. In patients with
decompensated heart failure the prevalence of diabetes
was 27.64%; in patients with pulmonary oedema 40.40%
and in patients with cardiogenic shock the prevalence
of diabetes mellitus was 42.31%. Regarding diabetic
treatment, 57.55% of patients were without treatment,
26.77% used insulin, 7.09% biguanide and 10.24% used
associations.
Conclusions: Tis study brings new data concering
romanian experience. Some of the results are similar
with data recorded in large clinical trials and registries
in the feld of acute heart failure.

Suplimentul A, 2008
81
POSTER I
23. Efectele hipertrofiei ven-
triculare stngi induse de
constricia de aort asupra
fenomenelor electrice i meca-
nice ale cordului de obolan
Alina Scridon, R.C. Serban, M. Perian, Dan Dobreanu
Disciplina de Fiziologie, UMF Targu Mures
Introducere: Ca rspuns la o larg varietate de stimuli
- me canici, hemodinamici, hormonali, miocardul se
adap teaz necesitilor crescute prin hipertrofa mio ci-
telor. Mecanismele implicate n hipertrofa fzio logi c,
precum i n cea patologic sunt puin nelese. Rezul-
tatele unor studii au sugerat posibilitatea ca cuplul exci-
taie-contracie s fe alterat n hipertrofa car diac.
Scopul studiului: A fost acela de a nelege bazele
electro-mecanice implicate n hipertofa cardiac.
Material i metod: Treizeci de obolani Wistar au fost
distribuii n dou grupuri: grupul control i grupul cu
constricie aortic. Pentru grupul de studiu s-a efectuat
intervenia chirurgical pentru realizarea constriciei
aortei abdominale. Dup patru sptmni, obolanii
din ambele grupuri au fost anesteziai i sacrifcai. Au
fost msurai o serie de parametrii electrici i respectiv
mecanici. Pentru a investiga posibilul rol al alterrii
cuplului excitaie-contracie, am comparat activitatea
mecanic i electric, nregistrate simultan la muchii
papilari normali i hipertrofai.
Rezultate: Masele cardiace au fost mai mari pentru
grupul de obolani cu constricie de aort cu 270,7%
(p<0,05). Durata potenialului de aciune (APD) la
obolanii cu constricie de aort a fost mai mare dect
la sobolanii din lotul control: APD90 (1371.5msec
vs 1001msec, p=0,002), APD75 (78,20.8msec vs
59,80,4msec, p=0,006), APD50 (70,80,7msec vs
55.70.3msec, p=0,003) i APD25 (49.40.4msec vs
44.80.3msec, p=0,004). AC a crescut la obolanii
operai de la 485,42mN la 6524mN (p=0,003), TAC
de la 1260,1msec la 1670,5msec (p=0,004), iar T1/2R
de la 880,5msec la 1190,7msec (p=0,006).
Discuii: La grupul de obolani operai s-a obinut o
alungire semnifcativ a tuturor fazelor PA. Totui,
cele mai semnifcative modifcri s-au produs pe baza
re polarizrii. Aceast modifcare explic apari ia arit-
miilor cardiace n contextul hipertrofei mal adap tati-
ve. Alungirea APD asociat cu hipertrofa mio car dic
poate f un factor important implicat n alun gi rea du-
ratei contraciei. ntruct amplitudinea con trac iei n
muchiul papilar de obolan este foarte puin mo di fcat
de alungirea depolarizrii dincolo de o anumi t valoare,
este posibil ca, odat atins aceast valoa re, alungirea n
continuare a duratei PA s nu mai infuen eze tensiunea
dezvoltat. Acest fapt ar putea explica lipsa de corelaie
dintre durata PA i parametrii contraciei, n contextul
hipertrofei patologice.

24. Nivelul de cunoastere al
factorilor de risc
cardiovasculari la femeile cu
sindrom metabolic
Nicoleta Calomfirescu, Marius Calomfirescu, Carmen
Ginghina
1
ARDES
2
Medicover
3
UMF carol Davila, Clinica de Cardiologie Institutul de
Boli Cardiovasculare Prof. Dr. CC Iliescu
Scop: Se accepta ca o buna cunoastere a factorilor de
risc cardiovasculari si un bun nivel de informare al
pacientilor referitor la bolile cardiovasculare imbuna-
tatesc aderenta la tratament. Calitatea informatiei si
a surselor de informare sunt criterii importante ale
acestui proces. Ne-am propus sa stabilim nivelul de
cunoastere al factorilor de risc cardiovasculari al unui
grup de femei care vin in ambulatorul de specialitate.
Material si metoda:149 de femei selectate aleator,
intr-o populatie de paciente ce au venit in ambulator
in perioada iunie-septembrie 2006. La toate femeile s-a
masurat tensiunea arteriala sistolica si diastolica , HDL
colesterol, glicemia si trigliceridele. Obeziatatea a fost
evaluata prin masurarea circumferintei abdominale.
Toate femeiele incluse in studiu au completat un
chestionar legat de valorile normale ale factorilor de risc
cardiovasculari si de principalele surse de informare.
Rezultate: Virsta medie a fost de 52,4 cu o deviatie
standard de 10,2. Utilizind criteriile NCEP-ATP III,
91 dintre ele (61,9%) aveau sindrom metabolic. Majo-
ritatea aveau un nivel mediu de educatie (42,85%) si
doar 36,73% studii universitare.55% dintre femei pri-
misera inaintea acestei vizite medicale un material
infor mational legat de bolile cardiovasculare si in 55%
din cazuri el a fost primit tot intr-o unitate medicala
Suplimentul A, 2008
82
sub forma unei brosuri. Majoritatea cunosteau valorile
target ale factorilor de risc cardiovasculari:61% pentru
circumferinta abdominala, 59% pentru tensiunea
sistolica si diastolica, 57% pentru HDL colesterol si
trigliceride. Toate femeiele din studiu aveau circum-
ferinta abdominala mai mare decit normalul dar in rest
valorile parametrilor masurati erau la tinta.
Concluzii: O buna informare referitoare la factorii de
risc cardiovasculari este necesara dar nu sufcienta in
clinica practica, masuri active din partea medicilor si
pacientilor sunt necesare.

The awarenesslevel of
cardiovascular risk factors
values in women with
metabolic syndrom
Nicoleta Calomfirescu, Marius Calomfirescu,
Carmen Ginghina
Asociatia Romana ptr. Dezvoltarea Educatiei in Sana-
tate (ARDES), Medicover, UMF Carol Davila, Clinica
de Cradiologie Fundeni
Purpose: It is accepted that the awareness of cardio-
vascular risk factors and a good level of patient s infor-
mation link with cardiovascular disease improve the
adherence to treatment. Te information quality and
sources are very important criterion in this process.
We want to establish the awareness level link with
cardiovascular factors in a women group who came at
a routine medical examination in an ambulatory care
settings.
Material and methods: 149 women randomly selected
among a patient population who came in an ambulatory
care setting between june - september 2006. In all women
we measured sistolic and diastolic blood pressure
and HDL cholesterol, glicemia and triglycerides were
measured in the whole group. Obesity was assessed
by abdominal circumference. All women answer to a
questionnaire about the right values of cardiovascular
risk factors and how are the major sources of medical
information.
Results: Te mean age was 52,4 with standard devia-
tion 10,26. Based on NCEP-ATPIII criterion, 91
(61,9%) had metabolic syndrom.Most of them have a
me dium level of education(42,85%) and only 36,73%
had university degree. 55% received before the current
visit a medical material link cardiovascular risk factors,
and in 55% they received it in a medical setting as a
written brochure (in 55%, too). Most of them know
the right value of cardiovascular risk factors measured:
61% for abdominal circunference, 59%for sistolic and
diastolic bloood pressure value, 57% for either HDL
cholesterol and tryglicerides. All hypertensive women
have the current value at target level, but whole group
have an abdominal circumference higher than normal.
Conclusions: A good information level about cardio-
vascular disease factors is necessary but it is not enough
in clinical practice, active measures from both parts
doctors and patients are needed.

25. Solutiile e-health:
forta motrice a viitoarelor
strategii de preventie
Carmen Ginghina
Scop: In ultimii ani strategiile sistemelor de sanatate in
domeniul cardiologiei au virat dinspre interventional
spre preventie. Rezultatele programelor de preventie
apar dupa multi ani, deci e nevoie de strategii efciente
pentru aplicarea teoriei in practica. E-health este
un concept dezvoltat in ultimii ani, dar cu o crestere
importanta. Scopul studiului nostru epidemiologic,
statistic si IT este de stabili daca e- helath pot reprezenta
solutii pentru strategiile de preventie.
Metode: Am analizat date din EuroStat, EuroHeart
Survey despre distributia epidemiologica si consecintele
fnanciare ale afectiunilor cardiovasculare.Pe de alta
parte am analizat oprtunitatile, costurile si bene fciile
sistemelor de e-health.
Rezultate: Solutiile e-health sunt un instrument
important pentru: educatie, cercetare, CIS (sisteme
cardio logice informatizate), networking, stabilind o
legatura puternica intre furnizorii de servicii medicale
si pacienti. Oamenii tineri cu virste intre 35-45 de ani
sunt navigatori frecventi pe internet, deci segmentele
de educatie si cercetare pot f foarte folositoare din acest
Suplimentul A, 2008
88
POSTER I
punct de vedere. Acuratetea si veridicitatea informatiei
medicale sunt insa subiecte delicate. Tehnicile imagistice
(ecografa, MRI, angiografa) sunt frecvent folosite in
cardiologie, iar urmarirea pacientilor necesita stocarea
multor informatii, respectiv imagini. La sfrsit, dar nu
pe ultimul loc, networking-ul insemna sa motivezi
oame nii in directia potrivita. Concluzii: Coroborind
datele din toate aceste perspective, solutiile e- health
pot f forta motrice a strategiilor preventive.

E-health solutions:
the driving force for future
preventions strategies
Carmen Ginghina
Purpose: In the last few years health strategies in
cardiology feld shif from interventional to prevention
Preventions results will appear afer a long period of
time, so, good strategies to put theory in practice, are
needed. E-health is a concept developed in the last
few years but with an important growth. Te purpose
of our epidemiological, statistical and IT research
is to establish if e-health can be a good solution for
preventions strategi es.
Methods: We analyzed statistical data from EuroStat,
EuroHeartSurvey about fnancial and epidemiological
distribution of cardiovascular diseases across Europe.
At the other side we analyze e-health opportunities,
costs and benefts. Results E-health is a useful tool
for: education, research, CIS (cardiology information
system), networking, a strong link between healthcare
providers and patients. Young people with age between
35-45 years old are frecquent fyers on internet, so
education and research can be very useful from this
point of view. Informations accuracy and truth is a
very delicate issue. Imagining (echo, MRI, angyogram)
are used ofen in cardiology, and a patient follow-up
need a lot of written and imaging information, so CIS
is essen tial. At least but not the last, networking means
to share and motivate people in the right direction as
Heart Char ter does.
Conclusions: Tinkig from all this perspective e-health
is the driving force for future preventions strategies.

26. Aplicaia n practic a
ghidurilor ESC n clasificarea
clinic i identificarea
factorilor de precipitare a
cazurilor de insuficien
cardiac acut
A. Frigy, Ildiko Kocsis, E. Caraca
Clinica Medical IV, Tg. Mure
Clasifcarea clinic i identifcarea factorilor de preci-
pitare a cazurilor de insufcien cardiac acut (ICA)
este important att pentru luarea unor deci zii tera-
peutice corecte, ct i pentru prevenirea recuren elor.
Pacieni i metod. ntr-un interval de 6 luni toi
pacienii admii cu ICA (25 femei, 57 brbai, vrst
medie 65.59 ani) au fost introdui ntr-o baz de date
complex, n care am registrat conform ghidului ESC
din 2005 clasifcarea clinic a cazurilor, respectiv
facto rii precipitani ai decompensrii acute.
Rezultate: Distribuia cazurilor conform claselor clini-
ce a fost urmtoarea: decompensarea insufcienei car-
diace cronice - 39, ICA hipertensiv - 21, edem pulmo-
nar acut - 6, oc cardiogen - 7, debit cardiac crescut - 3,
ICA de ventricul drept - 6 cazuri. Distribuia pacien-
ilor n funcie de severitate clinic a fost: cald i
uscat - 4, cald i umed - 71, rece i uscat - 0, rece
i umed - 7 pacieni. Cei mai frecveni factori de preci-
pitare au fost (primii cinci): complian sczut - 27,
criz hipertensiv - 12, tratament cronic suboptimal -
10, infecie -7, diagnostic greit - 6 cazuri.
Concluzii: Majoritatea cazurilor intr in clasele clinice
cu anse terapeutice mai bune (tensiune arterial ps-
trat). Analiza factorilor de precipitare a decelat, c
multe cazuri pot f prevenite printr-o ngrijire mai
aten t, respectiv prin ameliorarea cooperrii pacient-
medic-familie.

Suplimentul A, 2008
81
Practical application of ESC
guidelines in the clinical
classification and the
identification of precipitating
factors of acute heart failure
cases
A. Frigy, Ildiko Kocsis, E. Caraca
Clinica Medical IV, Tg. Mure
Classifcation of acut heart failure (AHF) cases and the
identifcation of precipitating factors is important for
early and adecvate therapeutic decisions and prevention
of recurrences.
Patients and methods: In a 6 month period, all patients
(25 women, 57 men, mean age 69,59 yrs) admitted with
AHF were introduced into a complex database, con-
taining data about the classifcation (clinical, clinical
seve rity) and precipitating factors of the acute decom-
pensation, according to the ESC guidelines from 2005.
Results: Te distribution of cases regarding clinical
classifcation was: acute decompensated heart failure -
39, hypertensive AHF 21, acute pulmonary oedema
- 6, cardiogenic shock -7, high output AHF - 3, acute
right heart failure - 6 patients. Classifcation of patients
according to clinical severity was: warm and dry: 4,
warm and wet: 71, cold and dry: 0, cold and wet:
7 patients. Te most frequent precipitating factors were
(the frst fve): lack of compliance - 27, hypertensive
crisis -12, suboptimal chronic treatment - 10, infection
-7, missed diagnosis 6 patients.
Conclusions: Te majority of cases felt into categories
with a better therapeutic chance (preserved blood pre-
ssure). Analysis of precipitation factors revealed that a
lot of cases can be prevented by a more careful patient
mana gement and by enhancing the patient physician
family cooperation.

27. Extinderea calcificarilor
valvulare aortice la pacientul cu
hipertensiune arteriala corelata
cu velocitatea fluxului
transvalvular
Aura Popa, Aurora-Maria Vladaia, Bogdan Popescu,
Carmen Ginghina
Institutul de Boli Cardiovasculare Prof. Dr. C.C. Ili-
escu, Bucuresti
Rezumat: Rolul important al calcifcarilor valvulare
aortice neobstructive (CVA) n morbiditatea si mor-
talitatea cardiovasculara este cunoscut. Datele privind
factorii care determina extinderea CVA, inter relatia lor
cu velocitatea fuxului transvalvular aortic sunt putine
si discordante.
Obiective: -analiza factorilor care determina extin-
derea calcifcarilor valvulare aortice la pacientii cu hi-
per tensiune arteriala; - analiza posibilei asocieri intre
exten sia CVA si velocitatea fuxului transvalvular aortic
la pacientii fara stenoza aortica.
Metoda: Esantionul de studiu a fost reprezentat din
66 pacienti (36 barbati si 30 feme), cu varsta intre
52-79 ani, media 65 6 ani, care au fost evaluai Eco-
Doppler. Depozitul calcar este defnit astfel: minim <2
mm; mediu: 2-5 mm; semnifcativ: >5 mm. Criteriile
de prezen a calcifcrilor valvulare aortice extinse:
1) cel puin o calcifcare semnifcativ; 2) cel puin 2
calcifcri medii. In lotul nostru au fost 8 pacieni
(12%) cu calcifcri semnifcative i 36 de pacieni
(55%) fr calcifcri valvulare; restul de 22 de pacieni
(33%) nu au criterii de CVA constituind grupul cu CVA
nesemnifcative.
Rezultate: Un sfert din velocitile fuxului transval-
vular aortic s-au defnit prin velociti crescute; velo-
ci tatea maxima a fost semnifcativ mai crescut la
pa cienii cu calcifcri valvulare semnifcative (135
45 mm/sec) versus cei cu calcifcri nesemnifcative
(116 23 mm/sec) sau cei fr calcifcri valvulare
(113 21 mm/sec). Fluxul aortic semnifcativ crescut
a fost la pacienii cu CVA semnifcative fa de cei
fr calcifcri. Am identifcat vrsta ca find singura
variabil independent asociat cu CVA avansate. CVA
semnifcative i genul feminin au fost identifcate ca
variabile independente pentru creterea fuxului trans-
valvular aortic.
Concluzii: Prevalena CVA printre pacientii hiper ten-
sivi este ridicat i n relaie clar cu vrsta. CVA sem-
Suplimentul A, 2008
85
POSTER I
nifcative se asociaz cu creterea velocitii fuxului n
ciuda deschiderii nerestrictive a cuspelor aortice.

28. Afectarea cardiaca in
limfoamele maligne
non-hodgkin la copil
diagnostic ecocardiografic
Mandric Cristina, Dimitriu A.G, Miron Ingrith
Universitatea de Medicina si Farmacie Iasi
Scopul lucrarii: obiectivarea rolului major al ecocardio-
grafei in diagnosticul si monitorizarea afectarii car-
diace in limfomul malign non-hodgkin (LMNH).
Metoda: Pacienti: 38 copii, varsta cuprinsa intre 3
luni- 17ani cu LMNH, pe o perioada de 5 ani. Toti
pacientii- evaluati clinic, electrocardiografc, radiologic
si ecocardiografc.
Rezultate: Afectarea cardiaca - 6 cazuri (15,8%); 5
cazuri limfom-T-, 1 caz limfom B; semne clinice de
de but: astenie, dispnee, sindrom de vena cava supe rioa-
ra. ECG: microvoltaj QRS si unda T. Rx. torace: afec-
tare mediastinala(5cazuri) si efuziune pleu rala dreap-
ta importanta(1). Eco aspecte: efuzie pericar dice(4),
tamponada cardiaca(2); tumora pericardica (1). 2
cazuri mase intracardiace; caz1- masa tumorala ce
umple atriul drept,cu baza de implantare spre VCS, caz2
masa tumorala ce se extinde de la peretele late ral AD
spre valva septala tricuspida, la care se aso ciaza efuziune
pericardica masiva; modifcarile eco din cazul 1 a fost
confrmat ulterior la necropsie. In cazul 2 si la toate
cazurile cu efuziune pericardica la debut, modifcarile
eco au revenit la normal dupa chimioterapie.
Concluzie: Incidenta mare a afectarii car diace in
LMNH determina necesitatea evaluarii eco in toate
cazurile, chiar si in absenta simptomatologiei clinice,
pentru a preveni aparitia tamponadei cardiace sau a
altor urgente cardiace. Echo este o metoda cruciala de
inves tigatie in diagnosticul si monitorizarea afectarii
cardiace de LMNH.

29. Studiu privind incidenta si
prevalenta sindromului
coronarian acut la pacientii cu
stenoza aortica degenerativa
care prezinta asociat si stenoze
carotidiene
Dan Delia, Calin Pop
Spitalul Judetean de Urgenta Baia Mare, Facultatea de
Medicina. Universitatea de Vest Vasile Goldis- Arad
Introducere: Creterea grosimii intim-medie la nivel
carotidian (IMT), stenozele carotidiene (CAS) i calci-
ferea inelului mitral (MAC) sunt legate de pato logia
cardiovascular. Legtura ntre riscul de dezvol tare
a sindromului coronarian acut (SCA) i IMT, CAS i
MAC, la pacienii cu stenoz aortic dege nerativ nu
este nc bine stabilit. Noi am evaluat rela ia dintre
IMT, CAS, MAC i SCA la un grup de pacieni cu
stenoz aortic degenerativ, pentru a vedea dac
acetia sunt factori independeni de risc.
Metod: Populaia de studiu a constat n 72 de pacieni
de ras caucazian, cu stenoz aortic degenerativ,
evideniat ecocardiografc, care nu au avut afeciuni
manifeste cardiovasculare. Aceti pacieni au fost
eva luai clinic, ecocardiografc, prin ultrasonografe
Doppler la nivelul arterelor carotide i biologic, iar
apari ia SCA a fost diagnosticat conform metodelor
n vi goare (clinic, EKG i enzimatic).
Rezultate: Pe o perioad de urmrire de 1 an, 18 pa-
cieni (25%) au dezvoltat SCA, iar prezena steno zelor
carotidiene a fost documentat la 9 din ei (50%), com-
parativ cu doar 12 pacieni (22,2%) din lotul martor
( p=0.049), n timp ce calciferea de inel mitral a fost
prezent la 17 pacieni (94,44%) din lotul SCA, fa
de 44 (81,48%) la lotul martor, dar fr atingerea sem-
nifcaiei statistice (p=0.21). Prezena CAS, dar nu i
a IMT sau a MAC se asociaz cu o cretere de 3.5 ori
a riscului de SCA la pacienii cu stenoz aortic dege-
nerativ, dup ajustarea n funcie de sex , vrst i
varia bile clinice (OR = 3.58; 95% CI, p= 0.049).
Concluzii: Pacienii cu stenoze aortice degenerative,
care prezint asociat i CAS au un risc crescut de a
dezvolta SCA i necesit controlul strict al riscului
cardiovascular global precum i o dispensarizare medi-
cal intensiv.
Suplimentul A, 2008
86
Cuvinte cheie: stenoza aortic degenerativ, stenoza
carotidian, sindrom coronarian acut

30. Blocul atrio-ventricular
de gradul I - indicaie de
cardiostimulare electric
permanent?
Cristina Moisa, Mihaela Grecu, Simona Moruzi,
Cristian Sttescu, Ctlina Arsenescu-Georgescu
Institutul de Boli Cardio - Vasculare Prof. dr. George
I.M. Georgescu Iai
Introducere: Blocul atrioventricular de gradul I marcat
(PR 0.30 sec) poate determina fenomene clinice de
insufcien cardiac, expresia pseudo- sindromului de
pacemaker, chiar si la pacieni cu funcie sistolic VS
normal.
Material si metod: Prezentm cazul unui pacient,
brbat, 68 ani, diagnosticat cu BAV gr. I (PR 0,36 sec.)
cu 4 ani anterior, cu agravare progresiv prin alungirea
marcat a intervalului PR, simptomatic prin astenie
i dispnee la eforturi moderate de 6 luni. Examenul
clinic la internare deceleaz pulsaii ample ale venelor
jugulare, fr semne de decompensare cardiac stng
sau dreapt. Electrocardiografc se evideniaz BAV
gr. I marcat (PR 0.56 sec), fr scurtare semnifcativ
dup administrare de atropin, cu complex QRS fn i
super poziia undei P peste unda T a ciclului cardiac
precedent. La examenul ecocardiografc se remarc
dimensiunile normale ale cavitilor cardiace, profl
Doppler transmitral cu unda E unic prin fuziunea E-
A, expresie a pierderii sincronismului atrioventricular,
cu regurgitare mitral gradul II, dar cu funcie sistolic
VS normal (FEVS 62%). Monitorizarea Holter ecg
/24 ore deceleaz BAV gr. I permanent i BAV gr. II tip
Mobitz I intermitent, frecventa sinusal variind intre
60 si 130/min.
S-a practicat cardiostimularea electric permanent
tip VDDR cu optimizarea intervalului A-V, cu reducerea
regurgitrii mitrale la gradul I, ameliorare clinic a
fenomenelor de insufcien cardiac i creterea tole-
ranei la efort, scderea spontan a frecvenei rit mului
sinusal de la 80/min la 65/min i normalizarea aspec-
tului ecocardiografc al fuxului transmitral.
Concluzii: Cardiostimularea electric permanent re-
pre zint o alternativ de corecie a fenomenelor clinice
de insufcien cardiac la pacienii cu alungire marcat
a intervalului PR.

First-degree atrio-ventricular
block - an indication for
cardiac pacing ?
Cristina Moisa, Mihaela Grecu, Simona Moruzi,
Cristian Sttescu, Ctlina Arsenescu-Georgescu
Institute of Cardiovascular Diseases Prof. dr. George
I.M. Georgescu Iai
Introduction: Marked frst degree A-V block (PR
0,30 sec) can produce heart failure similar to the pace-
maker syndrome, even in the presence of normal LV
function.
Methods: We present the case of 68-old patient with
frst degree A-V block and progressive and marked
prolongation of PR interval in the last 4 years, with
astenia and exertional dyspnoea in the last 6 months,
pulsations of jugulars veins, but without congestive
signs in the moment of clinical examination. Te
electrocardiogramm reveals marked frst degree A-
V block (PR 0.56 sec), PR interval does not shorten
appropiately on atropin, with narrow QRS complex
and superimposed P wave and T wave of the precedent
cardiac cycle. Transthoracic echocardiography shows
normal dimensions of cardiac chambers, pulsed-wave
Doppler transmitral fow with single E wave (fusion
between E and A waves) due to loss of A-V synch-
rony, moderate mitral regurgitation, but normal LV
sistolic function (FEVS 62%). 24-hours Holter moni-
toring reveals permanent frst degree A-V block and
intermitent type I- second degree A-V block, with
spontaneus rate of sinus node between 60-130 bpm.
We proceed to permanent dual chamber pacing
VDDR with A-V delay optimisation, for reducing
mode rate mitral regurgitation to mild, with clinical
impro vement of heart failure, spontaneus reduction of
sinus rhytm up to 65 bpm and transmitral fow norma-
lisation.
Conclusion: Cardiac pacing can be a therapeutic
resource with benefts in regression of clinical heart
failure in patients with marked prolongation of PR
interval.

Suplimentul A, 2008
8I
POSTER I
31. Modificari
electrocardiografice in
diselectrolitemii
Daniela Crisu, Viviana Aursulesei, Ileana Antohe,
Georgeta Datcu, M.D. Datcu
Universitatea de Medicina si Farmacie Gr.T. Popa
Iasi, Clinica I Medicala Cardiologica, Spitalul Clinic de
Urgenta Sf. Spiridon Iasi
Introducere: Electrocardiograma este o metoda
utila pentru recunoasterea tulburarilor electrolitice,
permitand aprecierea severitatii diselectrolitemiei si
urmarirea efcientei terapeutice.
Obiectiv: Scopul lucrarii a fost de a identifca modi f-
carile electrocardiografce si evolutia acestora in cateva
cazuri de diselectrolitemii.
Metoda: Sunt prezentate cazurile a 4 pacienti la care
tulburarile electrolitice severe survenite pe boala car-
diaca organica sau pe cord indemn au determinat
mo difcari clinice si electrocardiografce care puteau
preta la confuzii de diagnostic. Determinarea seriata a
electrolitilor serici a aratat o corelare a severitatii diselec-
trolitemiei cu modifcarile electrocardiografce. Trata-
mentul tulburarilor electrolitice a necesitat si decelarea
cau zei, normalizarea diselectrolitemiei corelandu-se cu
evolutia clinica si electrocardiografca.
Concluzii: Corelatiile dintre modifcarile electro car-
diografce si tulburarile electrolitice sunt cu atat mai
bune cu cat acestea survin mai brusc si sunt mai severe.
Aso cierea modifcarilor electrocardiografce deter mi-
nate de o cardiopatie organica le pot masca pe cele
deter minate de diselecterolitemii.

Electrocardiographic changes
in ellectrolitic abnormalities
(case presentation)
Daniela Crisu, Viviana Aursulesei, Ileana Antohe,
Georgeta Datcu, M.D. Datcu
Background: Electrocardiography is a simple and
useful diagnostic test for ellectrolitic abnormalities,
allowing their severity and therapeutic corrections
assess ment.
Aim: Te aim of the study was to pinpoint electro-
cardiographic dynamic changes in diverse ellectrolitic
abnormalities.
Method: Four case presentations are depicted (3 pa-
tients with organic cardiac disease) with ellectro litic
abnormalities, responsible for clinic and/or electro-
cardiographic changes, generating diagnostic dif cu-
lties.
Conclusions: Correlations betwen electrocardiographic
and ellectrolitic changes depend on the suddeness and
severity of ellectrolitic abnormalities. Electrocar dio-
graphic changes due to an organic cardiac diseases can
hide dysellectrolitic abnormalities.

32. Afectarea cardiaca la
pacientul arteriopat
Irina Costache, M.D. Datcu, Viviana Aursulesei, Irina
Girleanu, Anca Marandiuc
Scop: evaluarea patologiei cardiovasculare asociate
ntl nite la pacienii diagnosticai cu arteriopatie oblite-
rant membrele inferioare (AOMI) stadiul II-IV.
Material si metod: studiul a cuprins un numar de 127
pacieni cu AOMI stadiul II-IV, internai n Clinica I
Cardiologie Iai, n perioada ianuarie 2005- martie 2008,
n vederea depistrii unei eventuale patologii asociate.
Evaluarea cardiac a fost efectuat: clinic (ascultaia
cordului i a arterelor carotide n vederea depistrii
unor sufuri cu caracter ateromatos, msurarea tensiunii
arteriale) i prin metode de monitorizare non-invaziv:
nregistrarea 24 ore a valorilor tensiunii arteriale
(ABPM), electrocardiogram i ecocardiografe (M
mode, 2D, Doppler).
S-a urmrit: prezena semnelor de hipertrofe ventri-
cular stang, tulburari de ritm sau de conducere, pre-
zena modifcarilor de ischemie pe ECG, funcia sistolic
(FE<50%) i funcia diastolic (E/A<1). Rezultate:
85,8% din pacienii internai cu AOMI au prezentat
afec tare cardiac concomitent, 85% au asociat HTA
i la 24,4% s-au ascultat sufuri la nivel carotidian.
nregis trarea ECG a evideniat faptul c: 37,7% dintre
Suplimentul A, 2008
88
pacieni aveau aritmii cardiace din care 25,9% fbrilaie
atrial i 1,33% extrasistolie ventricular i la 42,5% din
pacieni s-au nregistrat tulburri de conducere, 25,1%
bloc de ram drept, 17,3% bloc de ram stng i 56,6%
asociau modifcri ischemice. Ecocardiografa a evaluat
modifcrile aterosclerotice de la nivelul valvelor aortic
i mitral, 59% avnd afectare valvular degenerativ la
nivel aortic i numai 26,7% la nivel mitral. 53,5% dintre
pacieni asociau hipertrofe ventricular stng, 50,3%
disfuncie diastolic i 33% disfuncie sistolic.
Concluzii: majoritatea pacienilor arteriopai prezint
afectare cardiac concomitent, fapt care atest ideea
c ateroscleroza este o afeciune cu caracter sistemic,
iar pacienii diagnosticai cu AOMI ar trebui tratai ca
orice pacient cu afectare coronarin.

Cardiac involvement in
patients with peripheral
arterial disease
Irina Costache, M.D. Datcu, Viviana Aursulesei, Irina
Girleanu, Anca Marandiuc
Purpose: evaluation of cardiovascular disease in patien-
ts diagnosed with peripheral arterial disease (PAD) sta-
ge II-IV.
Material and methods: we studied 127 patients
diagnosed with PAD stage II-IV, admitted in Iasi
Cardiology Clinic I , between January 2005- March 2008,
for angiographic examination and cardiac evaluation in
order to fnd other associated pathologies. Te patients
were evaluated: clinically (heart and carotide arteries
auscultation in order to fnd abnormal murmurs) and
non-invasive cardiac monitoring by: 24 hours regis-
tered arterial tension (ABPM), electrocardiogram,
echo cardiography (M mode, 2D, Doppler). We search
for the presence of lef ventricular hypertrophy, cardiac
arrhy thmia or conduction abnormalities, and presence
of ischemic lesions on ECG. Diastolic and systolic
dysfunc tions were evaluated by conventional Doppler
echo cardiography: LVEF<50% (systolic dysfunction)
and E/A<1 (abnormal LV relaxation- diastolic dysfun-
ction). Results: 85,8% patients with PAD had cardiac
involvement, 85% had arterial hypertension, and 24,4%
carotidian murmurs. ECG registration revealed that
37,7% of patients had cardiac arrhythmia: 25,9% atrial
fbrillation, 1,33% ventricular extrasistoles, and 42,5%
conduction abnormalities, lef ventricular brunch
block 17,3%, right ventricular brunch block 25,1% and
with ischemic abnormalities 56,6%. Echocardiographic
we evaluated atherosclerotic valvular disease: 59% of
patients had aortic atherosclerotic disease and only
26,7% had mitral atherosclerotic involvement. 53,5%
of patients associated lef ventricular hypertrophy and
50,3% diastolic dysfunction and 33% systolic dysfunc-
tion.
Conclusion: the majority of patients with PAD had
cardiac involvement, which supports the idea that athe-
rosclerosis is a systemic disease and patients diagnosed
with PAD should be treated as an equivalent to a coro-
nary disease.

33. Factori care influenteaza
dilatarea aortei ascendente
la pacientii cu valve aortice
bicuspide
Madalina Iancu, Marinela Serban, Ioana Ghiorghiu,
Ruxandra Jurcut, Ileana Craciunescu, Aneida Hodo,
Carmen Ginghina
Institutul de Boli Cardiovasculare Prof. Dr. C. C. Ili-
escu, Bucuresti
Premise: Bicuspidia aortica (BAV) reprezinta cea mai
frecventa malformatie congenitala cardiaca, find intal-
nita la 1-2% din populatia generala. Dilatarea aortei
as cen dente asociata bicuspidiei este o manifestare feno-
tipica cu severitate inalta, din cauza riscului crescut de
disectie aortica.
Scopul lucrarii: Studiul actual isi propune sa evalueze
principalii factori asociati prezentei dilatarii aortice
la pacientii cu valve aortice bicuspide; se evalueaza in
principal infuenta hipertensiunii arteriale sistemice
(HTA) si a altor factori de risc cardio-vascular, precum
si a valvulopatiilor aortice asociate.
Metoda: Grupul de studiu a inclus 60 pacienti cu BAV
(68% barbati, varsta medie 38 ani), internati in clinica
noastra in perioada 2003-2007 (5 ani). Diametrul aortei
ascendente a fost masurat prin ecografe transtoracica,
la 3 cm desupra inelului aortic, in telediastola, iar valo-
Suplimentul A, 2008
89
POSTER I
rile obtinute au fost indexate pe suprafata corporala.
Valoarea cut-of pentru dilatarea aortei ascendente a
fost considerata 21 mm/m
2
. Pacientii cu coarctatie de
aorta si HTA secundara au fost exclusi din studiu (9
cazuri).
Rezultate: Privind legatura dintre hipertensiunea
arteriala sistemica si dilatarea aortica, dintre cele 51
cazuri analizate, au fost 19 (37%) cazuri cu dilatare de
aorta ascendenta fara HTA, 10 pacienti (20%) cu HTA
fara dilatare de aorta ascendenta, 5 pacienti (10%) cu
HTA si dilatare aortica si 17 pacienti (33%) fara HTA
sau dilatarea aortei ascendente.
Diametrul mediu al aortei ascendente a fost de 21
mm/m
2
la normotensivi si de 19,6 mm/m
2
la pacientii
hipertensivi; prezenta HTA nu s-a corelat cu prezenta
dilatarii aortice (p=0,235, Fisher); nici severitatea HTA
nu s-a corelat cu diametrul aortei ascendente (p=0,53,
Kendalls tau).
Prezenta dilatarii aortice nu a fost semnifcativ dife-
rita intre subgrupurile de pacienti cu unul sau mai
multi factori de risc cardiovascular (sex masculin, fu-
mat, diabet, obezitate, dislipidemie) versus pacientii
fara nici un factor de risc (p=1, Chi-square). Diametrul
aortei ascendente a crescut cu varsta (p=0,08), dar
dependenta a fost slaba (r2=0,13, regresie lineara).
Privind valvulopatiile asociate, cea mai frecventa a
fost insufcienta aortica, prezenta in 30 cazuri (59%),
urmata de leziunea mixta (insufcienta si stenoza
aortica) la 4 pacienti (7%) si stenoza aortica in 2 cazuri
(4%); diametrul aortei ascendente a fost mai mare la
pacientii cu regurgitare aortica (diametrul me diu 20,7
mm/m
2
), fata de pacientii fara insufcienta aor tica
(diametrul mediu 18,6 mm/m
2
); intr-un model de
corelatie bivariata, severitatea regurgitarii aortice s-a
corelat semnifcativ cu diametrul aortic (p<0,05, Spear-
man). Dilatarea aortei ascendente a fost prezenta si la
pacientii cu valve aortice normofunctionale in 7 cazuri
din 15 (47%), comparativ cu pacientii cu afectare val-
vulara (19 cazuri din 36 valvulopatii, respectiv 53%).
Concluzii: 1. Dilatarea aortei ascendente in BAV nu
este infuentata de prezenta sau severitatea HTA, nici
de prezenta celorlaltor factori de risc cardiovascular.
2. Dilatarea aortei ascendente in BAV apare inde-
pendent de coexistenta leziunilor valvulare aortice, dar
este agravata cand acestea sunt prezente.
3. Severitatea insufcientei aortice se coreleaza cu gra-
dul dilatarii aortei ascendente.

Factors that influence
ascending aorta dilatation
in patients with bicuspid
aortic valves
Madalina Iancu, Marinela Serban, Ioana Ghiorghiu,
Ruxandra Jurcut, Ileana Craciunescu, Aneida Hodo,
Carmen Ginghina
Prof. Dr. C. C. Iliescu Institute of Cardiovascular
Diseases, Bucharest
Background: Bicuspid aortic valves (BAV) are the most
common congenital malformation, occurring 1-2% of
the population. Aortic dilatation is a severe associated
entity, due to the risk of aortic dissection.
Objective: To assess the main factors associated with
the presence of ascending aorta dilatation in patients
with BAV. Te main studied determinants are systemic
hypertension and other cardiovascular risk factors and
associated aortic valvular diseases.
Methods: Te study group included 60 patients with
BAV (68% men, mean age 38), referred to our clinic
over a 5-years period (2003-2007). Te measurement
of ascending aorta diameter was done by TTE at 3 cm
above the aortic ring at end-diastole and normalized
to body surface area. Te cut-of size for dilatation
was considered 21mm/m
2
. Patients with secondary
hypertension associated with aortic coarctation were
excluded from study (9 cases).
Results: Regarding systemic hypertension infuences
on aortic dilatation, from the analyzed 51 cases, there
were 19 (37%) cases with ascending aorta dilation,
10 pts (20%) with systemic hypertension, 5 (10%)
with dilation and hypertension and 17 (33%) without
hypertension or aortic dilatation. Te mean diameter
of ascending aorta was 21 mm/m
2
in normotensive pa-
tients and 19, 6 mm/m
2
in hypertensive pts.; the pre-
sence of hypertension did not correlate with the pre-
sence of aortic dilation (Fishers Test, p=0.235); nor
the severity of hypertension correlated with the aortic
diameter (p=0.53, by Kendalls tau).
Te presence of aortic dilatation was not signifcantly
diferent between the subgroup of patients with one or
more atherosclerotic risk factor (masculine sex, smo-
king, diabetes, obesity, dyslipidemia), versus patients
without any atherosclerotic risk factors (p=1 by Chi-
square).
Suplimentul A, 2008
10
Ascending aorta diameter increased with age
(p=0.08), but the dependency was weak (r
2
=0.13 by li-
near regression).
From associated aortic valvular lesions, the most
frequent was aortic regurgitation, in 30 cases (59%),
follo wed by mixed aortic valve disease (aortic insuf -
ciency and stenosis) in 4 pts. (7%), and aortic stenosis
in 2 pts. (4%). Ascending aorta diameter was larger in
pts. with aortic insuf ciency (mean diameter 20,7 mm/
m2) versus those without aortic regurgitation (mean
diameter 18,6 mm/m
2
). In a bivariate correlation model
by Spearman, the severity of aortic insuf ciency was
correlated with asceding aorta size ( p<0,05). Ascending
aorta dilatation was also present in pts. with normal
functioning aortic valves in 7 cases from 15 pts. (47%),
comparative with patients with aortic valvulopaties
(19 aortic dilatations from 36 aortic valvular lesions,
respectively 53%).
Conclusions: 1. Ascending aorta dilatation in
BAV is not inuenced by the presence or by the
severity of systemic hypertension, nor by the
other cardiovascular risk factors.
2. Aortic dilatation in BAV appears irrespective of the
presence of aortic valvular diseases, but it is aggravated
when those are associated.
3. Aortic insuf ciency severity correlates with the
degree of ascending aorta dilatation.

34. Infarctul de miocard cu
und Q i blocul de ram drept
Radu Grigore
1
, Cristina uescu
2
,
Ileana Grigore
3
1
Spitalul de Urgen Sf. Apostol Andrei Galai
2
Centrul de diagnostic i tratament N. Kretzulescu
Bucureti
3
Centrul de diagnostic i tratament municipal Galai
Clasic, pentru c BRD altereaz numai poriunea ter-
minal a QRS i cum unda Q n IM altereaz numai
por iu nea iniial a QRS se accept c BRD nu inter-
fereaz cu diagnosticul de IM cu und Q. Pe inima
nor mal poriunea iniial a QRS este generat de
ven triculul stng, contibuia ventriculului drept find
nesem ni fcativ. Totui cnd ventriculul stng pierde
esut miocardic n IM, dar i n alte stri patologice
care schimb raportul de fore electrice ntre cei doi
ventri culi, ponderea ventricului drept n depolarizarea
poriu nii iniiale a QRS nu este de ignorat. Au fost
des crise unde Q fals negative n special n IM inferior
i unde Q fals pozitive n IM anteroseptal (RBBB
depen dent Q wave). A fost descris diminuarea undei
Q de necroz dup by pass aortocoronarian n IM.
Infuenele vectoriale ntre BRD i undele Q pot s
mascheze sau s simuleze IM acut. S-au descris unde
Q n precordialele drepte n IM acut care au aprut pe
complexele ventriculare cu BRD intermitent.
Observaii personale: 1. F. 78 ani cu BAV Wenckebach,
fr unde Q de necroz; dup 4 luni fbrilaie atrial
lent, 40/min cu BRD intermitent. Complexele cu BRD
sunt cu necroz anteroseptal care dispare pe complexele
fr BRD. Este un caz cu und Q de necroz dependent
de BRD. 2. M. 70 ani cu IM vechi anteroseptal i BRD
(QRV1 i QSV2); dup 10 zile este cu edem pulmonar
acut i cu BAV cu alt morfologie cu rR n V1 i Rrn
V2 fr unde Q de necroz. Este posibil ca undele Q de
necroz s fe anulate de undele R ale unui IM posterior
acut. 3. M. 72 ani, cu IM vechi anterior i inferior,
bypass aortocoronarian. Este cu fbrilaie atrial lent
i BRD intermitent n precordiale. Dup o extrasistol
ventricular apare BRD care diminu undele Q de
necroz de la 0.08 sec n V1-V4 la 0.03- 0.04 sec. 4.
M. 71 ani, cu IM vechi anterior. Dup un an undele
QS anterioare (de 0.08 sec) dispar, se nscrie BRD cu
qR V1-V3 (0.04-0.03 sec). Este posibil ca BRD s f
contribuit la diminuarea undelor Q de necroz. 5. F. 81
ani cu IM vechi anteroseptal. Pe aceeai ECG apariia
BRD a diminuat lrgimea undei Q de necroz de la 0.08
n V1 la 0.04 sec i dispariia undei Q de necroz n
V2. 6. F. 63 ani, este cu IM vechi posterior i IM acut
anteroseptal mascat de BRS. BRD intermitent demasc
IM anteroseptal.
Concluzii: Interferenele ntre BRD i unda Q de
necroz pun diferite probleme de diagnostic electro car-
diografc.

Suplimentul A, 2008
11
POSTER I
Myocardial infarction with Q
wave and right bundle branch
block
Radu Grigore
1
, Cristina uescu
2
,
Ileana Grigore
3
1
County Hospital Sf. Apostol Andrei Galati
2
Center of diagnosis and treatment N. kretzulescu
Bucuresti
3
Center of diagnosis and treatment Galati
Classic, because RBBB alters only terminal position of
QRS and also the Q wave in MI alters only the initial
portion of QRS, it accepts that RBBB does not interfere
with the diagnosis with Q wave. On the normal heart
the initial portion of QRS is generated by the lef ven-
tricle, the contribution of right ventricle being insi g-
nifcant. However when the lef ventricle looses myo-
cardial tissue in MI and in other pathological states,
which changes the ratio of electrical forces between
the two ventricle, the weight of right ventricular in the
depolarization of initial portion of QRS is not to be
ignored. Tere were described false negative Q waves
especially in the inferior MI and false positive Q waves
in MI anteroseptal (RBBB dependent Q wave). Tere
was described the diminution of the necrosis Q wave
afer aortocoronarian bypass in the inferior MI. Te
vectorial infuences between RBBB and Q waves can
mask or simulate an acute MI. Tere were described
Q waves in right precordial in acute MI and these Q
waves have appeared on the ventricular complexes with
intermittent RBBB.
Personal observations: 1. F. 78 years old with AVB
Wenckebach without the necrosis Q waves; afer four
months slow atrial fbrillation 40/min with intermittent
RBBB. Te complexes with RBBB are with anteroseptal
necrosis which disappear on the complexes without
RBBB. Tis is a case with RBBB dependent Q wave.
2. M. 70 years old with old anteroseptal MI and RBBB
(QRV1 and QSV2). Afer 10 days the patient is with
acute pulmonary edema and with RBBB with other
morphology, rRV1 and RrV2 without necrosis Q waves.
It is possible that the necrosis Q waves are canceled by R
wave of a posterior acute MI. 3. M. 72 years old with old
anterior and inferior MI and bypass aortocoronarian.
Tere is a slow atrial fbrillation and intermittent RBBB.
In the precordials afer a ventricular extrasystole; RBBB
appear which diminishes the necrosis Q waves of QS
(0.08 sec) in V1-V4 to 0.03-0.04 sec. 4. M. 71 years
old with old anterior MI. Afer one year the anterior
QS waves (0.08 sec) disappear and it inscribes RBBB
with qR V1-V3 (0.04-0.03 sec). It is possible that RBBB
contributes to the diminishing of the necrosis Q waves.
5. F. 81 years old with old MI anteroseptal. On the same
ECG the appearance of RBBB have diminished the
width of necrosis Q wave from 0.08 sec in V1 to 0.04
sec and the disappearance of the necrosis Q wave in V2.
6. F. 63 years old with old MI posterior and acute MI
anteroseptal masked by LBBB. Te intermittent RBBB
unmasks anteroseptal MI.
Conclusions: Te interferences between RBBB and
the necrosis Q wave put various problems of electro-
cardiography diagnosis.

35. Evaluarea percepiei
modificrii stilului de via la
pacientul cu boala coronariana
aterosclerotica - studiu pe 500
de cazuri
Horaiu Rus, Codru Ciurea
Facultatea de Medicin. Universitatea Transilvania
Braov
Introducere: Recomandarile privind modifcarea stilu-
lui de viata sunt esentiale in managementul modern al
pacientului cu boala coronariana ischemica (BCI).
Obiectiv: Evaluarea gradului de educatie la pacientii
cu BCI in relatie cu recomandarile privind modifcarea
stilului de viata.
Material si metoda: Am evaluat 500 de pacienti cu
BCI privind gradul lor de instructie in ceea ce priveste
recomandarile privind modifcarea stilului de viata.
Am considerat ca si variabile: varsta, sexul, greutatea,
prezenta diabetului si a tratamentului medicamentos.
Statistica Pearson.
Rezultate: Majoritatea p. cu BCI. (90%), relateaza pre-
zenta unui grad de instructie medicala in ceea ce pri-
veste modifcarea stilului de viata. Recomandarea de
mo di fcare a regimului alimentar a fost raportata cel
mai frevent (80%), urmata de reducerea aportului de
sare (52%), reducerea consumului de alcool (35%) si
incu ra jarea antenamentului fzic.(30%). Recomandarile
pri vind modifcarea stilului de viata au fost raportate
Suplimentul A, 2008
12
cel mai frecvent de pacientii mai tineri de 60 ani (odd
ratio OR 1,51; 95% interval de cofdenta IC 1,22-1,84),
la persoa nele supraponderale i obeze (IMC 30 kg/
m
2
) n raport cu normoponderalii i subponderalii (OR
1,72; 95% IC, 2,15-3,45), i la cei tratai medicamentos
(OR 2,28;95% IC, 2,22-3,38).
Concluzie: Pacienii cu boala coronariana ischemica si
vrsta mai mare de 60 ani, cei care nu sunt supraponderali
i obezi, i cei fr un tratament medicamentos, relateaz
un grad mai redus de instrucie privind modifcarea
stilului de via.

Evaluation of degree of
perception concerning life
style modification
500 patients study
Horaiu Rus, Codru Ciurea
Facultatea de Medicin. Universitatea Transilvania
Braov
Background: Recomandations regarding the life
style changing are essential in the management of the
patients with ischemic heart disease(IHD).
Objectiv: Evaluate the degree of education in patients
with IHD in relation with lifestyle management.
Matherial and method: We interogate 500 patients with
IHD regarding their degree of education concerning life
style management. We consider as variables: age, sex,
weight, presence of diabetes, and medical treatement.
Stastistics Pearson anlysis.
Rezultats: Most of patients with IHD (90%), report
the presence of medical instruction concerning the
importance of life style management. Recomandation of
changing the eating habits was reported most frecquently
(80%) ,followed salt intake by (52%), reduction of
alcohol intake (35%) and encouraging of sport training
(30%). Life style changing recomandations were repor-
ted more frequently in pacients younger than 60 years
old (odd ratio OR 1,51; 95% confdence interval IC
1,22-1,84), in obese and overweight patients (IMC 30
kg/m
2
) in relation with normal and underweight pa-
tients (OR 1,72; 95% IC, 2,15-3,45), and in medically
trea ted patients(OR 2,28;95% IC, 2,22-3,38).
Conclusion: Pts. over 60 years, with IHD, whitout
obe sity and those without medical therapy are shown
to be less instructed regarding life style changing reco-
mandations.

36. B-type natriuretic peptide
(BNP) dincolo de capcane in
insuficienta cardiaca congestiva
(ICC)
Daniela Toporan, Cristina Tanaseanu, Marius Vintila
Clinica de Medician interna si Cardiologie, Spitalul de
Urgenta Sf. Pantelimon UMF Bucuresti
Background: Nivelul BNP reprezinta o cale comuna
pentru multiple stari patologice cardiovaculare ca
ischemia, aritmiile, fbroza, hipertrofa cardiaca, dis-
functia endoteliala. Dincolo de aceste capcane clinice,
BNP este utilizat ca un marker solid de prognostic la
pacientii cu ICC.
Obiectiv: A fost evaluat benefciul clinic al masuratorilor
BNP deopotriva la internare, la externare si ca predictor
prognostic pe termen scurt (30 zile) la pacientii cu ICC.
Metoda. 340 de pacienti internati in clinica cu ICC
clasele I-IV NYHA, varsta medie 75 ani, sex maculin
59%, au fost inclusi in studiu. 53% dintre pacienti au
fost in clasa IV NYHA, 22% in clasa III, 14% in clasa
II si 11% in clasa I. Tuturor li s-a masurat fractia de
ejec tie a ventriculului stang (FEVS) prin metoda canti-
tativa 2D biplan Simpson si li s-a examinat fuxul
Doppler transmitral pentru o completa evaluare a
functiei sistolo-diastolice a VS. Au fost exclusi pacien-
tii cu disfunctie diastolica izolata, insufcienta cardiaca
dreapta si hiperteniune pulmonara primitiva.In cazu-
rile cu FE 45% a fost determinat nivelul BNP, valori
sem nifcative find considerate cele >600pg/ml. ICC a
avut boala coronariana ischemica ca boala de baza in
56% din cazuri.
Rezultate: S-a inregistrat o relatie inversa intre nivelul
BNP si valoarea FEVS, de la o valoare medie de 420 pg/
ml pentru o FE de 45% la o valoare medie de 11300pg/
ml pentru o FE de 18% (p<0.001). Scaderea mai lenta
a nivelului BNP sub tratament maximal conventional
s-a asociat cu o durata mai lunga a spitalizarii (>14
zile) si cu un status instabil al acestor cazuri (mai multe
evenimente cardiace ischemice, hipotensiune severa,
dis functie renala si o mai lenta regresie a simptomelor
si semnelor de ICC). Decesul s-a instalat in 3 cazuri
Suplimentul A, 2008
18
POSTER I
cu valori constant crescute ale BNP in ciuda terapiei
adec vate. O valoare a BNP >1000 pg/ml la pacientii
exter nati si corect tratati s-a asociat cu o evolutie nefa-
vora bila si cu o rata a mortalitatii de 13% la 30 de zile,
com pa rativ cu o rata de 5% a mortalitatii in cazurile cu
BNP <1000pg/ml la externare (p <0.001).
Concluzii: Valoarea BNP s-a corelat strans cu severitatea
clinica a ICC (clasa NYHA ) si a fost direct infuentata
de FEVS, cu o valoare dovedita si de incredere pentru
stratifcarea riscului cardiac. BNP este un instrument
util pentru monitorizarea clinica a raspunsului tera-
peutic ca si un predictor prognostic puternic pentru
evo lutia clinica pe termen scurt la pacientii cu ICC in
toate stadiile de boala.

B-type natriuretic peptide
(BNP) beyond pitfalls in
congestive heart failure (CHF)
Daniela Toporan, Cristina Tanaseanu, Marius Vintila
Clinic of Internal medicine and Cardiology, St. Panteli-
mon Emergency Hospital, Bucharest
Background: BNP levels represent a fnal common
pathway for many cardiovascular pathologic states, as
ischemia, arrhythmias, fbrosis, cardiac hypertrophy,
coronary endothelial dysfunction. Beyond these clinical
pitfalls, BNP has been used as a solid prognostic
marker for patients with CHF.
Objective: Te clinical beneft of BNP measurements,
both on admission, on discharge and on short-term
prognostic outcome prediction in patients hospitalized
with CHF, was evaluated.
Methods: 340 patients admitted in our clinic with
CHF, NYHA (New York Heart Association) functional
class I-IV,mean age 75 yrs., men 59 %, were included
in this study. 53% of patients were in class IV NYHA,
22% were in class III, 14% met class II and 11 % class
I. All patients underwent a measurement of ejection
fraction (EF) by the quantitative 2D (biplane Simpson)
method and a Doppler examination of mitral infow
for a complete, systolic and diastolic lef ventricular
function (LVF) evaluation. Patients with isolated dias-
tolic dysfunction, right-heart failure or primary pul-
mo nary hypertension were excluded. In cases with EF
45% at echocardiography the BNP level was deter-
mined on admission, on discharge and at 30 days of
follow-up and was correlated with the severity of LV
systolic dysfunction and with clinical outcome. A signi-
fcant value >600pg/ml was consider for an important
cardiac disorder. HF had, as underlying disease, 56%
coronary artery disease.
Results: Tere was an inverse relationship between
BNP level and lef ventricular ejec tion fraction, from a
mean value of 420 pg/ml for 45% EF to a mean value of
11300 pg/ml for 18% EF (p<0.001). Slower decreased
of BNP levels under maximal conventional treatment
was associated with a longer duration of hospitalization
(>14 days) and with an unstable status of these cases
(more ischemic heart events, severe hypotension, renal
dysfunction and a slower regression of symptoms and
signs of HF). Fatal outcome in terms of death occurred in
three patients with constant high BNP despite adequate
therapy. Persistent high BNP value at discharge (>1000
pg/ml) in correct and maximal treated patients was
correlated with an adverse short-term outcome con-
sisted in re-hospitalization for worsening heart fail ure
and severe ventricular arrhythmia, also with a higher
cardiovascular mortality rate (13%) within 30 days
afer discharge, respect of those with lower BNP levels
at discharge (<1000 pg/ml) and a better outcome (5%
mortality rate at 30 days, p<0.001).
Conclusions: BNP correlates well with the clinical seve-
rity of CHF (NYHA class) and is closely related to lef
ven tricular ejection fraction, with a proved and reliable
value for risk stratifcation. Furthermore, BNP may
provide an additional tool for estimation and clinical
monitoring of treatment responsiveness as well as a
strong prog nostic predictor with regard to short-term
adverse cli nical events in patients with CHF at all stages
of disea se.

37. Controlul tensiunii
arteriale la pacientii
hipertensivi cu boala ischemica
coronariana cronica
M.Dumitrescu, M Albu, G Badea, M.Bolog, A.Calota,
E. Pacuraru, F.Romanoschi, M Tudose, G.Ursu, M.
Maxim
Spital Prof. Dr. Agrippa Ionescu - Bucuresti
Introducere: Boala coronariana ischemica (BCI) este
una din principalele cauze de morbiditate si mortalitate
Suplimentul A, 2008
11
la pacientii hipertensivi. Controlul tensiunii arteriale
(TA) este esential in imbunatatirea prognosticului car-
dio vascular. Totusi, exista insufciente informatii des-
pre proflul clinic al pacientilor hipertensivi cu BCI in
practica curenta.
Obiective si metoda: Au fost inclusi in studiu pacienti
de ambele sexe, 18 ani, hipertensivi si coronarieni
cunos cuti. Au fost exclusi din studiu pacientii cu sin-
drom coronarian acut in ultimele trei luni. Datele
obtinute sunt corelate cu controlul valorilor TA. Un
bun control al TA a fost considerat la valori <140/90
mmHg (<130/80 mmHg in cazul diabeticilor).
Rezultate: Au fost studiati 1455 pacienti (65.815.2
ani; 27.56 %femei). TA sistolica a fost 143.627.9
mmHg si TA diastolica 81.821.3 mmHg. 55.12 %
din pacientii inclusi in studiu au avut indexul de masa
corporala intre 25-29.9 kg/ m2 si 29% 30 kg/ m2.
70.79% din pacienti au prezentat dislipidemie , 35.5%
diabet zaharat, 55.7% erau fumatori sau fosti fumatori.
Hipertrofa ventriculara stanga a fost evidentiata la
49.7% din pacienti, insufcienta cardiaca in 28.7% din
cazuri , boala arteriala periferica 15.1%, afectare renala
in 12% si stroke in 8%. 98% din pacienti utilizau cel
putin un antihipertensiv, cel mai frecvent inhibitorul
enzimei de conversie a angiotensinei (85%). 67% din
pacienti erau tratati cu beta blocant, 44.4% calcium
blocant, 35% diuretic, 12,8 %blocant de receptor de
angio tensina si 4% alfa blocant. TA a fost controlata
in 40.5% din cazuri. Factorii predictivi pentru lipsa de
control a valorilor TA au fost circumferinta taliei (>102/
88 cm, barbat /femeie) (OR 1.59, 95% CI 1.25-2.02),
sexul feminin (OR 1.43, 95% CI 1.08-1.90), diabetul
zaharat (OR 0.22, 95% CI 0.17-0.29), consumul excesiv
de alcool (OR 0.58, 95% CI 0.38-0.88) aportul excesiv
de sare (OR 0.61, 95% CI 0.48-0.77).
Concluzii: Desi rata de control a valorior TA la hiper-
tensivii cu BCI studiati este oarecum mai buna decat
datele publicate in literatura, controlul TA este extra-
ordinar de modest in aceasta populatie cu risc inalt
cardiovascualar. Factorii predictivi pentru lipsa de con-
trol a valorilor TA au fost circumferinta taliei, sexul
femi nin, diabetul zaharat, consumul excesiv de sare
si alcool. Este decisiva identifcarea precoce a acestor
pacienti cu risc inalt, ce impun o abordare agresiva.

Blood pressure control in the
hypertensive patients with
chronic ischemic heart disease
M.Dumitrescu, M Albu, G Badea, M.Bolog, A. Calota,
E. Pacuraru, F.Romanoschi, M Tudose, G.Ursu,
M. Maxim
Prof. Dr. Agrippa Ionescu Hospital-Bucharest
Introduction: Chronic ischemic heart disease is one
of the main causes of morbidity and mortality in the
hypertensive patients. Blood pressure (BP)control is
crucial to improve cardiovascular prognosis. However,
there is scarce information about the clinic profle of
hypertensives with chronic ischemic heart disease in
clinical practice.
Objectives and methods: Patients of both sexes, 18
years, with an established diagnosis of hypertension
and chronic ischemic heart disease were included in
the study. Patients with an acute coronary syndrome in
the three months before the inclusion were excluded.
We report the data related to the BP control. A good
BP control was considered <140/90 mmHg (<130/80
mmHg for diabetics).
Results: A total 1455 patients (65.815.2 years;27.56
%women)were studied. Systolic BP was 143.627.9
mmHg and diastolic BP 81.821.3 mmHg. 55.12 % of
patients included in the study had a body mass index
between 25-29.9 kg/ m
2
and 29% 30 kg/ m2. 70.79%of
the patients had dyslipidemia, 35.5% diabetes and 55.7%
were current smokers or ex- smokers. Lef ventricular
hypertrophy was detected in 49.7% of patients, heart
failure in 28.7%, peripheral arterial disease in 15.1%,
renal impairment in 12% and stroke in 8%. 98% of
patients were taking at least one anti hypertensive
drug, being angiotensinconverting enzyme inhibitors
the most frequent (85%).67% of the patient were
taking beta blockers, 44.4%calcium antagonists, 35 %
diuretics, 12,8 % angiotensin receptor blockers and 4%
alpha blockers. BP was controlled in 40.5% of patients.
Predictive factors of no BP control were increased waist
circumference (>102/88 cm, male/ female)(OR 1.59,
95% CI 1.25-2.02), female gender (OR 1.43, 95% CI
1.08-1.90), diabetes(OR 0.22, 95% CI 0.17-0.29), exce-
ssive alcohol intake (OR 0.58, 95% CI 0.38-0.88) and
excessive salt intake(OR0.61, 95% CI 0.48-0.77).
Conclusions: Although BP control rates in hypertensives
with chronic ischemic heart disease is slightly better to
those published in general hypertensive patients stu-
Suplimentul A, 2008
15
POSTER I
dies, BP control is remarkably poor in this high-risk
popu lation. Predictor of no BP control were increased
waist circumference, female gender , diabetes, excessive
alcohol intake and excessive salt intake. Terefore, it is
important the early identifcation of these patients for a
more aggressive approach.

38. Afectarea cardiovascular
subclinic n sindromul
metabolic
S.I. Dumitrescu
1
, I. Tintoiu
1
, C. Manole
2
, R. Orosan
2
,
M. Vicol
2
, V. Greere
1
, I. Raduta
1
, I. Moscaliuc
1
,
G. Neagoe
1
, V.A. Voicu
3
1
Armatei, Bucureti, Romnia
2
Centrul Medical STS, Bucureti, Romnia
3
Academia Romn, Bucureti, Romnia
Scop: Am urmrit afectarea cardiovascular subclinc
la indivizii diagnosticai cu sindrom metabolic conform
criteriilor IDF, prin determinarea valorilor urmtorilor
markeri: vasodilataia mediat de fux la nivelul arterei
brahiale (FMD), grosimea complexului intim-medie
la nivelul arterelor carotide (IMT), masa ventriculului
stng indexat la suprafaa corporal (LVMI), timpul
de decelerare al undei E (EDT), timpul de relaxare izo-
volu metric (IVRT) i indicele de performan mio car-
dic (Tei).
Metode: n cadrul unui program de prevenie primar
cardiovascular am realizat screeningul a 179 subieci
cu urmtoarele caracteristici: vrsta 45.4 8.8 ani,
47.5% brbai, BMI 27.04.8 kg/m2, circumferina taliei
(WC) 94.414.1 cm, fumtori 31.3%, diabetici 10.1%,
ten siunea arterial sistolic/diastolic (BP) 129.319.4 /
79.611.5 mmHg, glicemia 92.528.9 mg/dl, colesterol
total (TC) 213.242.1 mg/dl, LDL-colesterol 135.737.8
mg/dl, HDL-colesterol 47.512.8 mg/dl, trigliceride
(TG) 151.8120.7 mg/dl. Conform criteriilor IDF 2005,
68 (38%) dintre persoanele din lotul studiat au fost
diag nosticate cu sindrom metabolic. Dup colectarea
da telor de ecografe cardiac i vascularar (IMT, FMD,
LVMI, EDT, IVRT, Tei) am realizat analiza statistic.
Rezultate: Indivizii cu sindrom metabolic au n pro-
porie semnifcativ mai mare afectare subclinic fa de
restul grupului 80.8% vs. 62.1% (p=0.013), rezul tat
calculat pentru prezena uneia sau mai multor valo ri
anormale ale markerilor studiai, care analizai indi-
vidual n cele dou subgrupuri sunt deasemenea diferii:
valori anormale ale FMD 73.53% vs. 41.44% (p<0.001),
IMT 30.88% vs. 14.41% (p=0.014), Tei index 44.12% vs.
26.13% (p=0.020), IVRT 25.00% vs. 10.81% (p=0.021),
EDT 25% vs. 11.71% (p=0.035), LVMI 23.53% vs.
10.81% (p=0.039). Analiza statistic a riscului pentru
ca o persoan cu sindrom metabolic s aib afectare car-
dio vascular subclinic a indicat urmtoarele rezul tate
semnifcative: FMD anormal OR 3.92 (CI 95% 2.03
7.57), IMT anormal OR 2.65 (CI 95% 1.265.55),
indice Tei anormal OR 2.23 (CI 95% 1.174.23), IVRT
anormal OR 2.75 (CI 95% 1.226.19), EDT anor mal
OR 2.51 (CI 95% 1.135.57), LVMI anor mal OR
2.53 (CI 95% 1.115.76). Alte diferene semni fca tive
statis tic ntre datele ecografce obinute la cele 2 sub gru-
puri sunt ilustrate n tabel.
SINDROM
METABOLIC +
SINDROM
METABOLIC -
p
Media
Deviatia
std.
Media
Deviatia
std.
FMD (%) 6.04 3.19 8.50 4.11 <0.001
IMT (mm) 0.74 0.17 0.65 0.16 <0.001
LVMI g/m2 107.61 28.05 87.48 25.67 <0.001
IVRT (ms) 90.54 15.40 84.01 12.84 0.003
Tei 0.52 0.08 0.50 0.06 0.032
IVCT (ms) 66.72 6.94 69.98 8.90 0.011
EDV/BSA
(ml/m
2
)
60.22 12.62 54.57 10.77 0.002
ESV/BSA
(ml/m
2
)
23.55 7.00 20.65 6.33 0.005
Tabel 1. IVCT = timpul de contractie izovolumetric,
EDV = volum telediastolic (ml), ESV= volum telesistolic
(ml), BSA=aria suprafeei corporale (m
2
)
Concluzii: Lucrarea noastr atrage atenia asupra ris-
cului adiional pe care l genereaz sindromul metabolic
i demonstreaz prezena extensiv a afectrilor sub-
clinice produse de acesta.

Suplimentul A, 2008
16
Subclinical cardiovascular
disease in metabolic syndrome
SI. Dumitrescu
1
, I. Tintoiu
1
, C. Manole
2
, R. Orosan
2
,
M. Vicol
2
, V. Greere
1
, I. Raduta
1
, I. Moscaliuc
1
,
G. Neagoe
1
, V. A. Voicu
3
1
Center for Cardiovascular Disease of Army, Bucharest,
Romania
2
STS Medical Center, Bucharest, Romania
3
Romanian Academy, Bucharest, Romania
Purpose: To explore the presence of subclinical cardio-
vascular impairment assessed by evaluation of brachial
artery Flow Mediated Dilatation (FMD), carotid artery
Intima Media Tickness (IMT), lef ventricular mass
indexed to BSA (LVMI), E wave deceleration time
(EDT), iso-volumetric relaxation time (IVRT) and myo-
car dial performance index (Tei) in individuals with
meta bolic syndrome (MS) identifed according to IDF
criteria.
Methods: We assessed 179 persons in a cardiovascular
primary prevention program: age 45.4 8.8 years,
47.5% males, BMI 27.04.8 kg/m
2
, waist circumference
(WC) 94.414.1 cm, smoking 31.3%, diabetes 10.1%,
blood pressure (BP) 129.319.4 / 79.611.5 mmHg,
blood glucose 92.528.9 mg/dl, total cholesterol (TC)
213.242.1 mg/dl, LDL-cholesterol 135.737.8 mg/dl,
HDL-cholesterol 47.512.8 mg/dl, triglycerides (TG)
151.8120.7 mg/dl. According to IDF 2007 criteria, 68
persons (38%) had metabolic syndrome. Afer collecting
data from the vascular and cardiac ultrasound exam,
we performed the statistical analysis.
Results: Te individuals with MS had signifcantly more
subclinical abnormalities as compared with the group
without MS 80.8% vs. 62.1% (p=0.013) calculation
for the presence of one or more abnormal values of
our markers, which also were diferent independently:
abnormal FMD 73.53% vs. 41.44% (p<0.001), abnormal
IMT 30.88% vs. 14.41% (p=0.014), abnormal Tei
index 44.12% vs. 26.13% (p=0.020), abnormal IVRT
25.00% vs. 10.81% (p=0.021), abnormal EDT 25% vs.
11.71% (p=0.035), abnormal LVMI 23.53% vs. 10.81%
(p=0.039). Te risk analysis for the persons with MS
to sufer from subclinical organ damage yielded signi-
fcant results for: abnormal FMD OR 3.92 (CI 95%
2.037.57), abnormal IMT OR 2.65 (CI 95% 1.26
5.55), abnormal Tei index OR 2.23 (CI 95% 1.17
4.23), abnormal IVRT OR 2.75 (CI 95% 1.226.19),
abnormal EDT OR 2.51 (CI 95% 1.135.57), abnormal
LVMI OR 2.53 (CI 95% 1.115.76). Other signifcant
dife rences between echo data are reported in table 1.
METABOLIC
SYNDROME +
METABOLIC
SYNDROME -
p
Mean
Std.
Deviation
Mean
Std.
Deviation
FMD 6.04 3.19 8.50 4.11 <0.001
IMT 0.74 0.17 0.65 0.16 <0.001
LVMI 107.61 28.05 87.48 25.67 <0.001
IVRT 90.54 15.40 84.01 12.84 0.003
Tei 0.52 0.08 0.50 0.06 0.032
IVCT 66.72 6.94 69.98 8.90 0.011
EDV/BSA 60.22 12.62 54.57 10.77 0.002
ESV/BSA 23.55 7.00 20.65 6.33 0.005
Table 1. IVRT iso-volumetric relaxation time (ms),
IVCT iso-volumetric contraction time (ms), EDV=end
diastolic volume (ml), ESV=end systolic volume (ml),
BSA=body surface area (m
2
)
Conclusions: Our study promotes the need to consider
the additional risk generated by the metabolic syndrome
substantiating the subclinical disease it triggers.

39. Dincolo de SCORE:
afectarea subclinic la
indivizii cu risc mic
S.I. Dumitrescu
1
, I. Tintoiu
1
, C. Manole
2
, R. Orosan
2
,
M. Vicol
2
, V. Greere
1
, I. Raduta
1
, I. Moscaliuc
1
,
G. Neagoe
1
, V.A. Voicu
3
1
Armatei, Bucureti, Romnia
2
Centrul Medical STS, Bucureti, Romnia
3
Academia Romn, Bucureti, Romnia
Scop: Am urmrit afectarea cardiovascular subclinc
la indivizii ncadrai n clasa de risc sczut conform
criteriilor SCORE, prin determinarea valorilor urm-
torilor markeri: vasodilataia mediat de fux la nive lul
arterei brahiale (FMD), grosimea complexului inti m-
medie la nivelul arterelor carotide (IMT), masa ven tri-
culului stng indexat la suprafaa corporal (LVMI),
timpul de decelerare al undei E (EDT), timpul de re-
laxare izovolumetric (IVRT) i indicele de perfor man-
miocardic (Tei) i am evaluat diferenele dintre sub-
grupul cu afectare subclinic fa de cel fr afectare
sub clinic.
Metode: n cadrul unui program de prevenie primar
cardiovascular am realizat screeningul a 179 subieci
pe care i-am ncadrat n clasele SCORE de risc mare, me-
Suplimentul A, 2008
1I
POSTER I
diu i mic. Grupul cu risc mic a cuprins 119 persoane
cu urmtoarele caracteristici: vrsta 41.3 6.1 ani,
33.6% brbai, BMI 26.13.8 kg/m
2
, circumferina talia
(WC) 90.312.6 cm, fumtori 23.5%, diabetici 3.3%,
ten siunea arterial sistolic/diastolic (TAS/TAD)
124.116.2/77.211.1 mmHg, glicemie 87.521.1 mg/
dl, coles terol total (TC) 20942.7 mg/dl, LDL-colesterol
134.737.4 mg/dl, HDL-colesterol 48.312.3 mg/dl,
trigli ceride (TG) 129.296.7 mg/dl. Dup colectarea
date lor de ecografe cardiac i vascularar (IMT, FMD,
LVMI, EDT, IVRT, Tei) am realizat analiza statistic.
Rezultate: Afectarea cardiovascular subclinic dovedi-
t prin una sau mai multe valori anormale ale markerilor
urmrii a fost prezent la 57% din indivizii clasifcai
ca avnd risc sczut, valorile anormale ale FMD find
cele mai frecvente42%, urmate de cele ale indicelui
Tei21.8%, prelungirea EDT12.8% i IVRT9.2%,
pre zena aterosclerozei carotidiene8.4%, cea mai rar
ntl nit find hipertrofa de ventricul stng4.2%. Am
gsit urmtoarele diferene semifcative statistic ntre
sub grupul cu afectare subclinic fa de cel fr afectare
sub clinic: BMI 27.03.5 vs. 24.94.0 kg/m
2
(p=0.003),
WC 93.411.3 vs. 86.413.4 cm (p=0.002), HDL-C
45.710.2 vs. 51.914.2 mg/dl (p=0.006), raportul
TC/HDL-C 4.81.1 vs. 4.21.1 (p=0.005), TA sistolic
129.617.3 vs. 11612 mmHg (p<0.001) i diastolic
80.111.8 vs. 73.38.5 mmHg (p<0.001). Aceste dife-
ren e sunt sugestive pentru prezena sindromului meta-
bo lic la indivizii cu afectare subclinic observaie con-
fr mat semnifcativ statistic de analiza riscului pen tru
valori anormale ale EDT (OR 3.429, CI 95% 1.133
10.375) i FMD(OR 3.119, CI 95% 1.3687.113). Alte
di fe rene semnifcative statistic sunt ilustrate n tabelul
1.
Afectare subclinic+ Afectare subclinic - p
EDV/BSA 56.810.6 52.98.8 0.0360
ESV/BSA 21.14.7 19.53.3 0.0401
EDT 182.131.3 163.918.2 0.0003
E 0.680.1 0.740.1 0.0002
IVRT 86.112.5 76.57.5 <0.0001
Tei 0.500.06 0.460.04 <0.0001
IMT 0.660.16 0.570.10 0.0005
FMD 6.02.8 11.83.3 <0.0001
Tabel 1. EDV= volum telediastolic (ml), ESV= volum
tele sistolic (ml), BSA=aria suprafeei corporale (m
2
), E
= velo citatea undei E transmitrale (m/s), EDT=timpul
de decelerare al undei E, IVRT= timpul de relaxare iso-
volumetric (ms), IMT= grosimea complexului inti m-
medie la nivelul arterelor carotide (mm), FMD= vaso di-
lataia mediat de fux la nivelul arterei brahiale (%).
Concluzii: Studiul nostru arat necesitatea distinciei
dintre ncadrarea n clasa de risc mic SCORE i absena
afectrilor cardiovasculare subclinice i pledeaz pentru
rafnarea instrumentelor de stratifcare a riscului n
sensul detectrii i corelrii cu afectarea subclinic.

Beyond risk SCORE: subclini-
cal cardiovascular impairment
in low risk individuals
SI. Dumitrescu
1
, I. Tintoiu
1
, C. Manole
2
, R. Orosan
2
,
M. Vicol
2
, V. Greere
1
, I. Raduta
1
, I. Moscaliuc
1
,
G. Neagoe
1
, V. A. Voicu
3
1
Center for Cardiovascular Disease of Army, Bucharest,
Romania
2
STS Medical Center, Bucharest, Romania
3
Romanian Academy, Bucharest, Romania
Purpose: To investigate the presence of subclinical
cardio vascular impairment assessed by evaluation
of brachial artery Flow Mediated Dilatation (FMD),
carotid artery Intima Media Tickness (IMT), lef ven-
tricular mass indexed to BSA (LVMI), E wave dece-
leration time (EDT), iso-volumetric relaxation time
(IVRT) and myocardial performance index (Tei) in
low risk individuals, categorized by the SCORE classi-
fcation and to examine the diferentiation bet ween
this subgroup and those without markers of subclinical
injury.
Methods: We assessed 179 persons in a primary pre ven-
tion program separating them into low, medium and
high risk groups according to SCORE classifcation.
Te low risk group encompassed 119 individuals with
the following characteristics: age 41.3 6.1 years,
33.6% males, BMI 26.13.8 kg/m
2
, waist circumference
(WC) 90.312.6 cm, smoking 23.5%, diabetes 3.3%,
blood pressure (BP)124.116.2/77.211.1 mmHg,
blood glucose 87.521.1 mg/dl, total cholesterol (TC)
20942.7 mg/dl, LDL-cholesterol 134.737.4 mg/dl,
HDL-cholesterol 48.312.3 mg/dl, triglycerides (TG)
129.296.7 mg/dl. Afer recording the vascular and car-
diac ultra sound data (IMT, FMD, LVMI, EDT, IVRT,
Tei) we performed the statistical analysis.
Results: Subclinical cardiovascular impairment as
esta blished by one or more abnormal values of our
markers is present in 57% of the individuals from the
Suplimentul A, 2008
18
low risk group, abnormal FMD being prevalent42%,
followed by abnormal Tei index21.8%, abnormal
relaxation (prolonged EDT12.8%, IVRT9.2%), caro-
tid atherosclerosis8.4%, LV hypertrophy 4.2%. Te
signifcant diferences in the subgroups with vs. with-
out subclinical impairment are: BMI 27.03.5 vs.
24.94.0 kg/m2 (p=0.003), WC 93.411.3 vs. 86.413.4
cm (p=0.002), HDL-C 45.710.2 vs. 51.914.2 mg/
dl (p=0.006), TC/HDL-C ratio 4.81.1 vs. 4.21.1
(p=0.005), systolic BP 129.617.3 vs. 11612 mmHg
(p<0.001), diastolic BP 80.111.8 vs. 73.38.5 mmHg
(p<0.001). Tese diferences are suggestive for the pre-
sence of metabolic syndrome on individuals with sub-
clinical disease, confrmed by the risk analysis with
signi fcant correlations for abnormal EDT (OR 3.429,
CI 95% 1.13310.375) and for abnormal FMD (OR
3.119, CI 95% 1.3687.113). Additionally, signifcant
diferences between echo data are reported in table 1.
Subclinical injury + Subclinical injury - p
EDV/BSA 56.810.6 52.98.8 0.0360
ESV/BSA 21.14.7 19.53.3 0.0401
EDT 182.131.3 163.918.2 0.0003
E 0.680.1 0.740.1 0.0002
IVRT 86.112.5 76.57.5 <0.0001
Tei 0.500.06 0.460.04 <0.0001
IMT 0.660.16 0.570.10 0.0005
FMD 6.02.8 11.83.3 <0.0001
Table 1. EDV=end diastolic volume (ml), ESV=end
systolic volume (ml), BSA=body surface area (m
2
),
E=trans-mitral E wave velocity (m/s), EDT=E wave
dece le ration time (ms), IVRT iso-volumetric relaxation
time (ms), Tei=myocardial performance index, FMD
fow mediated dilatation (%).
Conclusions: Our study prompts the necessary distinc-
tion between low risk SCORE categorization and the
absence of subclinical disease and advocates the need
to improve the risk assessment tools in order to detect
the subclinical atherosclerosis.

40. Rolul ultrasonografiei
carotidiene in evaluarea
riscului cardiovascular n
sindromul metabolic
F. Mitu
1
, M. Mitu
2
, M. Turiceanu
3
1
Universitatea de Medicina Gr. T. Popa Iasi
2
Spitalul Clinic de Recuperare Iasi
3
Spitalul de Urgenta Moinesti
Sindromul metabolic este o entitate clinic n prezent
bine defnit, cu prevalen n continu ascensiune.
Prezena sa crete semnifcativ riscul cardiovascular.
Identifcarea sindromului metabolic determin ncadra-
rea pacientului n grupa de risc cardiovascular cres cut,
la care sunt indicate metode de determinare a atero-
sclerozei n stadiul subclinic. Ultrasonografa caro ti-
dian reprezint o metod imagistic recomandat
n practica clinic pentru determinarea modifcrilor
atero sclerotice la nivel carotidian, n vederea depistrii
indivizilor cu modifcri aterosclerotice, n present
find recomandat n evaluarea celor cu risc crescut.
Obiectivul lucrrii a fost studierea relaiei dintre modi-
fcrile atersoclerotice evideniate la ultraso nografe
carotidian la pacienti cu multipli factori de risc cardio-
vascular i prezena sindromului metabolic.
Material i metod: Au fost inclui n studiu 144 pa-
cieni (84 B/60 F) cu afeciune cardiovascular stabil
(angin pectoral, infarct miocardic, boal arterial
peri feric, hipertensiune arterial), la care s-au evaluta
fac torii de risc clasici (fumatul, hipercolesterolemia,
diabe tul zaharat, obezitatea). Pentru defnirea obezitii
s-a deter minat indicele de mas corporeal (IMC=G/
T2) i s-a msurat perimetrul abdominal. Au fost consi-
derai ca avnd sindrom metabolic cei cu IMC 30 i
care asociau cel puin dou din urmtoarele modifcri:
HTA, diabet zaharat, hipercolesterolemie. Examinarea
prin ultrasonografe carotidian a inclus msurarea
gro simii intim-medie (GIM), detectarea plcilor atero-
sclerotice i a stenozelor.
Rezultate: Obezitatea a fost prezent la 77 pacieni
(53,5%), iar sindromul metabolic la 46 pacieni. Nu s-
a demonstrat o relaie semnifcativ ntre IMC crescut
i GIM sau prezena plcilor carotidiene. In schimb,
perimetrul abdominal mrit (peste 102 cm la brbai
i 88 cm la femei) s-a asociat cu o cretere a GIM
semnifcativ statistic (0,930,09 vs 0,910,06, p=0,01).
HTA este mai frecvent la valori ale GIM mai mari
de 0,8 mm (63,8% vs 21,6%, p=0,05), iar la GIM1,1
Suplimentul A, 2008
19
POSTER I
toi pacienii erau hipertensivi. Hipercolesterolemia,
hipertrigliceridemia i diabetul zaharat nu s-au
asociat cu modifcri semnifcative ale GIM sau ale
prezenei placilor aterosclerotice carotidiene la acest
lot. La grupa de pacieni cu sindrom metabolic defnit
prin dou componente asociate obezitii GIM nu a
variat semnifcativ (0,910,20 vs 0,900,20); la grupa
cu sindrom metabolic la care au fost prezente trei
componente alturi de obezitate, valoarea GIM este mai
mare dar fr a atinge pragul de semnifcaie statistic
(0,920,21 vs 0,890,20). Determinarea fbrinogenului
la lotul studiat a relevat o asociere direct i semnifcativ
statistic cu GIM (p=0,01).
Concluzii: La pacienii obezi cu sindrom metabolic,
GIM crescut, ca marker de ateroscleroz, se coreleaz
mai bine cu perimetrul abdominal dect cu IMC. La
lotul studiat, GIM este mai puin infuenat de fecare
component izolat a sindromului metabolic, ns mai
accentuat de asocierea tuturor componentelor (obe-
zitate, HTA, hipercolesterolemie, diabet zaharat). Pare
a exista o relaie strns ntre fbrinogen ca marker al
infamaiei i modifcrile endoteliale carotidiene de
ateroscleroz.

Role of carotid ultrasound
examination in the assessment
of cardiovascular risk in
metabolic syndrome
F. Mitu
1
, M. Mitu
2
, M. Turiceanu
3
1
University of Medicine Gr. T. Popa Iasi
2
Rehabilitation Hospital Iasi
3
Emergency Hospital Moinesti
Te presence of metabolic syndrome increases cardio-
vascular risk and is an indication for further assessment
for asymptomatic atherosclerotic disease.
Purpose: Te study of the relationship between athero-
sclerotic alterations pointed out at carotid ultrasound
examination at patients with cardiovascular risk factors
and the presence of the metabolic syndrome.
Methods: 144 patients (84 male/60 female) with stable
cardiovascular disease (angina, chronic myo cardial
infarction, and arterial hypertension) were inves ti ga-
ted. Classical risk factors (smoking, diabetes melli tus,
hypercholesterolemia, obesity) were assessed. Obe sity
was considered at a body-mass index (BMI) 30 and a
waist circumference (WC) 102 cm at male and 88 cm
at female. Te metabolic syndrome was consi dered in
the presence of obesity and at least two of the following:
arterial hypertension, diabetes mellitus, hyper choles-
terolemia or hypertrigliceridemia. Ultrasound exa mi-
nation of the extra cranial carotid arteries included
mea surement of intima-media thickness (IMT) and
detec tion of carotid plaques.
Results: 77 patients were obese and 46 had metabolic
syn drome. Tere was not a signifcant relation bet-
ween BMI and IMT or carotid plaques. A raised WC
was correlated with a signifcant increase of IMT
(0.930.19 mm vs 0.910.16 mm, p=0.01). Arterial
hyper tension was more frequent at an IMT > 0.08 mm
(63.8% vs 21.6%, p=0.05) and at an IMT1.1 mm all
pa tients were hypertensive. Hypercholesterolemia,
hyper tri gliceridemia and diabetes mellitus were not
asso ciated with signifcant alterations of IMT or the
pre sence of carotid plaques. Patients with metabolic
syndro me defned by two components associated to
obesity did not show a signifcantly greater value of
IMT (0.910.20 mm vs 0.900.20 mm); patients with
metabolic syndrome with three components associated
to obesity had an increased IMT but not statistically
relevant (0.920.21 mm vs 0.890.20 mm). Tere is a
signifcant correlation between serum fbrinogen and
IMT at the study group (p=0.01).
Conclusions: In metabolic syndrome, an increased
IMT is better correlated with WC than with BMI. IMT
is less infuenced by each component of the metabolic
syndrome (except arterial hypertension) but seems to
increase in the presence of all. Tere is a strong relation
between fbrinogen as an infammation marker and
IMT.

41. Predictori de remodelare
pozitiva ventriculara stanga
dupa angioplastia coronariana
M. Serban, I.S. Craciunescu, IA. Ghiorghiu,
M.E. Iancu, S. Vasile, G. Pampu, A. Hodo, M. Postu,
D. Deleanu, C. Ginghina
Institutul de Boli Cardiovasculare Prof. Dr. C. C. Ili-
escu, Bucuresti, Romania
Premise: Dintre pacientii cu disfunctie sistolica de
ventricul stang (VS) post-infarct miocardic, o categorie
Suplimentul A, 2008
50
din ce in ce mai mare benefciaza de angioplastie
trans luminala percutana (PTCA), in scopul atenuarii
simpto matologiei, dar si pentru ameliorarea functiei
ven triculare stangi.
Scopul lucrarii: Acest studiu evalueaza modifcarile
functiei sistolice ale VS dupa PTCA si factorii predictivi
pentru o buna recuperare a acesteia.
Metoda: Studiul a evaluat prospectiv 172 pacienti
inro lati consecutiv (79,7% barbati, varsta medie 61,7
ani), cu boala coronariana aterosclerotica si disfunctie
sistolica de VS, care au avut indicatie de PTCA cu stent.
Functia sistolica a fost evaluata ecocardiografc, fractia
de ejectie (FE) si indexul de cinetica parietala (WMI)
au fost determinati la momentul procedurii si reevaluati
dupa 6 luni. Au fost masurate, de asemenea, diametrele
VS, telesistolic (ESLVD) si telediastolic (EDLVD).
Rezultate: 94 pts. (54.6%) au avut o recuperare a frac-
tiei de ejectie de cel putin 5% (cresterea medie a FE
a fost 11.7 4.1 %.). Imbunatirea WMI, defnita prin
amelorarea kineticii regionale in cel putin 2 segmente
adicente a fst identifcata la cel putin 56 pts. (32.5%).
Ameliorarea functiei sitolice a fost insotita de o des-
crestere semnifcativa a diametrelor ventriculare stan gi
(descresterea medie pentru EDLVD : 6.3 2.2, des-
cres terea medie a ESLVD: 3.8 0.79). In analiza multi-
variata, predictorii independenti ai cresterii FE au fost
revascularizarea miocardica completa (HR 4.33, 95%CI
1.63 10.5, p = 0.003), FE initiala (HR 5.2, 95% CI 2.7
18.6, p <0.001), clasa NYHA initiala (HR 2.86, 95%
CI 1.18 7.16, p = 0.009) si ESLVD (HR 2.73, 95% CI
1.17 6.4, p = 0.02).
Concluzii: Pacientii cu risc crescut, in clasa functionala
NYHA avansata si cu disfunctie severa de VS benefciaza
cel mai mult de manevrele de PTCA. Revascularizarea
completa contribuie, de asemena, la o recuperare mai
buna a functiei VS la acesti pacienti.

Predictors for left ventricular
positive remodeling after
percutaneous transluminal
coronary angioplasty
M. Serban, I S. Craciunescu, I A. Ghiorghiu,
M.E. Iancu, S. Vasile, G. Pampu, A. Hodo, M. Postu,
D. Deleanu, C. Ginghina
Prof. Dr. C. C. Iliescu Institute of Cardiovascular Dis-
eases, Bucharest, Romania
Background: Tere is an increasing category of patients
with lef ventricle (LV) systolic dysfunction afer myo-
cardial infarction, which benefciate from elective percu-
taneous transluminal coronary angioplasty (PTCA), in
order to relieve symptoms, but also to improve LV func-
tion.
Objective: Te study was designed to evaluate the chan-
ges in systolic function afer PTCA and the prediction
factors for recovery.
Methods: Te study evaluated prospectively 172 conse-
cutive patients (79.7% men, mean age 61.7 years old)
with CAD and LV systolic dysfunction, who underwent
elective PTCA. Systolic function was evaluated by
echocardiography and ejection frac tion (EF) and wall
motion index (WMI) were determi ned at the time of
the procedure and afer 6 month of follow-up. End-
systolic (ESLVD) and end-diasto lic (EDLVD) LV diame-
ters were also recorded.
Results: 94 pts. (54.6%) had a recovery of EF with at
least 5% (mean increase in EF was 11.7 4.1 %.). Te
improvement of WMI, defned by the increased kinetic
in at least two adjacent segments was registered in 56
pts. (32.5%). Improvement in systolic function was
asso ciated with a signifcant decrease in LV diameters
(mean decrease for EDLVD of 6.3 2.2, mean decrease
of ESLVD of 3.8 0.79). At multivariate analysis, the
inde pendent predictors of EF recovery were complete
revas cularization (HR 4.33, 95%CI 1.63 10.5, p =
0.003), initial EF (HR 5.2, 95% CI 2.7 18.6, p <0.001),
ini tial NYHA class (HR 2.86, 95% CI 1.18 7.16, p =
0.009) and ESLVD (HR 2.73, 95% CI 1.17 6.4, p =
0.02).
Conclusion: High-risk patients with increased NYHA
class and severe LV dysfunction benefciate the most
from PTCA maneuvers. Complete revascularization
also contributes to a better recovery of LV function in
these patients.

Suplimentul A, 2008
51
POSTER I
42. Activitatile homocistein
tiolactonazica si esterazica ale
paraoxonazei-1 la pacienti cu
insuficienta cardiaca
E Moldoveanu
1
, DS Marta
1
, M Serban
2
, I Serban
3
,
G Manea
1
, N Radulescu
4
,T. Kosaka
5
1
Institutul National de Cercetare-Dezvoltare in Dome-
niul Patologiei si Stiinelor Biomedicale Victor Babes,
Bucuresti
2
Universitatea de Medicin i Farmacie Carol Davila,
Bucuresti
3
Institutul de Boli Cardiovasculare CC Iliescu, Bucur-
esti
4
Sisteme Informatice pentru Automatizri - SIAT SA,
Bucuresti
5
Afresa Pharma Corporation, Osaka, Japonia
Scop: Homocisteina plasmatica (Hcy) este un factor de
risc pentru bolile cardiovasculare si are o valoare pre-
dictiva pentru mortalitate, independenta de alti factori de
risc traditionali la pacientii cu boli coronariene. Efectele
nocive ale hiperhomocisteinemiei se exercita prin mai
multe mecanisme din care un loc central ocupa stresul
oxidativ, inductia factorilor proinfamatori si formarea
unui metabolit homocistein tiolactona (HcyTL).
HcyTL este un compus cu reactivitate mare care are
capa citatea de a reactiona cu proteinele, modifcandu-
le activitatea fziologica si are o actiune toxica asupra
celulelor. Recent s-a aratat ca paraoxonaza-1 (PON1),
o enzima cu proprietati antioxidante si antiaterogene
are in plus fata de activitatea esterazica si o activitate
homo cistein tiolactonazica (HcyTL-azica), HcyTL
find substratul ei natural.
Am presupus ca PON1 prin activitatile esterazica
si HcyTL-azica joaca un rol important in insufcienta
cardiaca, sindrom complex in evolutia caruia sunt
implicate stresul oxidativ si infamatia. Obiectivul aces-
tui studiu este determinarea activitatilor esterazice si
HcyTL-azice ale PON1 si corelarea lor cu doi markeri
ai infamatiei, mieloperoxidaza (MPO) si fosfolipaza
A2 asociata LDL (LpPLA2).
Metode: Am masurat la 100 de pacienti cu insufcienta
cardiaca si la 20 de martori activitatile esterazice si
HcyTL-azice ale PON1, MPO si LpPLA2 prin metode
spectrofotometrice. Evaluarea bazala a pacientilor a
inclus: examinarea clinica, ECG cu 12 derivatii, esti-
marea clasei functionale NYHA, ecocardiografe trans-
toracica si teste de laborator de rutina.
Rezultate: Activitatatea esterazica si cea HcyTL-azica
a PON1 au fost semnifcativ mai scazute la pacientii cu
insufcienta cardiaca [(47.4712.36(U) / 14.364.43(U/
L)] comparativ cu martorii [(88.113.1(U) / 20.37
6.2(U/L)].
Concluzii: Activitatatea esterazica si cea HcyTL-azica a
PON1 sunt scazute la pacientii cu insufcienta cardiaca
si se coreleaza negativ, semnifcativ statistic, cu markerii
de infamatie investigati (MPO si LpPLA2). Activitatea
HcyTL-azica poate reprezenta un mecanism natural de
protectie cardiovasculara.

Homocysteine thiolactonase/
esterase activity of paraoxonase
1 in heart failure patients
E Moldoveanu
1
, DS Marta
1
, M Serban
2
, I Serban
3
,
G Manea
1
, N Radulescu
4
, T. Kosaka
5
1
Victor Babes National Institute of Pathology and
Biomedical Sciences - Bucharest, Romania
2
Carol Davila Medical School, Bucharest
3
CC Iliescu Institute of Cardiovascular Disease, Bu-
charest
4
SIAT SA, Bucharest
5
Afresa Pharma Corporation, Osaka, Japan
Purpose: Plasma homocysteine (Hcy) is a risk factor
for cardiovascular disease and predicts mortality inde-
pendently of traditional risk factors in patients with
coronary artery disease. Hyperhomocysteinemia exerts
its adverse efects through multiple mechanisms, oxi-
dative stress, induction of proinfammatory factors and
formation Hcy metabolite, homocysteine thiolactone
(HcyTL) having a central role. HcyTL is a highly
reactive compound which has the ability to modify
proteins, decreasing their physiologic activities and
having toxic efects on cells. Recently it was shown that
paraoxonase 1 (PON1), an enzyme with antioxidant
and antiatherogenic properties, also has homocysteine
thiolactonase (HTLase) activity, HcyTL being its phy-
siologic substrate.
We presumed that PON1 esterase/ HTLase activities
play an important role in heart failure (HF), a complex
syndrome in which oxidative stress and infammation
are implicated in disease evolution. Our objectives
were to determine PON1 esterase/ HTLase activities
Suplimentul A, 2008
52
and to correlate both activities with two infammatory
markers myeloperoxidase (MPO) and lipoprotein-
associated phospholipase A2 (LpPLA2).
Methods: We measured PON1 esterase, PON1 HTLase,
PLA2-LDL and MPO activities (spectrophotometric
methods) in 100 patients with ischemic HF and 20
controls. Baseline evaluation for patients included
clinical examination, 12-lead ECG, estimation of
NYHA functional class, transtoracic echocardiography
and routine laboratory tests.
Results: Both PON1 esterase/ HTLase activities were
signifcantly lower in HF patients [(47.4712.36(U) /
14.364.43(U/L)] than in controls [(88.113.1(U) /
20.376.2(U/L)].
Conclusions: PON1 esterase/ HTLase activities are de-
crea sed in HF patients and are statistically signifcant
inverse associated with markers of infammation
(MPO, PLA2-LDL). PON1 esterase/ HTLase activities
might represent a natural mechanism of cardiovascular
protection.

43. Riscul aritmogen al testului
de efort
Adina Malai, R. Rosu, D. Zdrenghea, E. Bogdan
Universitatea de Medicina si Farmacie Iuliu Hatiega-
nu, Spitalul Clinic de Recuperare- Cardiologie, Cluj-
Napoca
Scop: In ultimii douazeci de ani indicatia efectuarii
testului de efort s-a largit, acesta find folosit atat in scop
diagnostic, cat si in evaluarea pacientilor cu afectiuni
cardiovasculare. In aceeasi perioada, prevalenta
tulburarilor de ritm a crescut semnifcativ, la pacientii
cardiaci, sustinand reevaluarea riscului aritmogenic al
testului de efort.
Metoda: Au fost studiate 1110 teste de efort consecutive,
indicate in scop diagnostic sau de evaluare. Au fost
exclusi subiectii care au prezentat tulburari de ritm
in repaus, imediat inaintea testului. In acest studiu
au fost luate in considerare ca tulburari de ritm atat
tahiaritmiile (cu exceptia tahicardiei sinusale), cat si
tulburarile de conducere in timpul testului de efort si
in urmatoarele 10 minute, si au fost corelate cu (unii)
factori de risc cardiovascular, etiologia boli cardiace si
performanta ventriculului stang.
Rezultate: Grupul studiat a constat din 1110 pacienti,
589 femei si 521 barbati, in varsta de 55,25 +/-9,78
ani, diagnosticati cu cardiopatie ischemica (64,1%),
cardiomiopatie dilatativa (4,1%), alte boli cardio vas-
culare (8,92%) si subienti sanatosi (22,88%). Un numar
de 421 pacienti a fost adresat la testul de efort in scop
diagnostic. Tulburarile de ritm au fost inregistrate in
timpul testului de efort in 21,2% din cazuri si dupa
efort in 13,0% din cazuri, iar tulburarile de conducere
in timpul si dupa efort au aparut la 2,2%. In timpul
efortului tulburarile de ritm au fost reprezentate de
extrasistole ventriculare (13%), tahicardie ventriculara
(1,1%), extrasistole supraventriculare (6,7%) si fbri la-
tie atriala (0,4%). Extrasistolele ventriculare in timpul
efortului nu au fost semnifcativ mai frecuente la pa-
cientii cu cardiopatie ischemica (13% vs 12%, p=0,14),
exceptand infarctul miocardic vechi (24,5% vs 10,7%,
p<0,000013) si au aparut la 48% din pacientii cu FEVS
<40% (vs 11,7% pacienti fara antecedente de infarct
miocardic, p<0,0000068). Corelatia cu performanta
ven triculara stanga a fost sustinuta si de incidenta
mare a extrasistolelor ventriculare aparute la pacientii
cu cardiomiopatie dilatativa (71,1%). S-au gasit de ase-
menea corelatii intre aparitia EV si dislipidemie (8,7%
vs 20%, p<0,00000...), fumat (12,1% vs 15,8%, p<0,15),
hipertensiune (10,8% vs 19,7%, p<0,00048), obezitate
(29,1% vs 9,8%, p<0,0000). Pre zenta EV imediat dupa
efort este considerata a avea un risc aritmogenic crescut.
EV postefort au fost mai frecvent intalnite la pacientii
coronarieni (7% vs 1%, p<0,000), dfslipidemie
(19,6% vs 8,1%, p<0,000) si hipertensiune (6% vs 0%).
Procentul mic de pacienti care a prezentat tahicardie
ventriculara nu ofera posi bilitatea vreunei corelatii. In
ceea ce privaste extra sis tolele supraventriculare, singura
corelatie a fost cea cu FEVS (25% la pacientii cu FEVS
<40% vs 7% la cei cu FEVS >40%, p <0,000012), ceea
ce sugereaza ca ele reprezinta un semn al performantei
sistolice scazute si al cresterii presiunii medii atriale.
Concluzie: Riscul aritmogen al testului de efort este
mic, find reprezentat in special de extrasistolele ven-
triculare, corelate cu functia sistolica, infarctul mio-
cardic vechi si factorii de risc cardiovasculari. In schimb,
nu s-a inregistrat nici un deces de cauza aritmica in
timpul testului de efort.

Suplimentul A, 2008
58
POSTER I
Arrhythmogenic risk of
exercise stress testing
Adina Malai, R. Rosu, D. Zdrenghea, E. Bogdan
Universitatea de Medicina si Farmacie Iuliu Hatiega-
Napoca
Background and purpose: In the last two decades the
indication of exercise stress testing (ET) enlarged, being
used for diagnostic purposes and the evaluation of the
great majority of cardiovascular patients. In the same
period, the prevalence of arrhythmias signifcantly
increa sed in cardiovascular patients, supporting a
reeva luation of the arrhythmogenic risk of exercise
stress testing.
Methods: Tere were studied 1110 consecutively exer-
cise stress tests, indicated for diagnosis or evaluation.
Tere were excluded the subjects with arrhythmias at
rest, immediately before ET. In the present study there
were took into account tachyarrhythmias (except sinus
tachycardia), but also conduction disturbances during
and ten minutes afer the ET and they were corre-
lated with (some) cardiovascular risk factors, etiolo gy
of cardiovascular disease and lef ventricular perfor-
mance.
Results: Te studied group consisted in 1110 patients,
589 females and 521 males, aged of 55,25 +/- 9,78
years, diagnosed with ischemic heart disease (64,1%),
dilated cardiomyopathy (4,1%), other cardiovascular
disease (8,92%) and healthy subjects (22,88%). A num-
ber of 421 of all patients were addressed to ET for
diagnostic reason. Arrhythmias were registered dur ing
ET in 21,2% of all cases and afer efort in 13,0% and
conduction disturbances during ET and afer efo rt
in 2,2%. During exercise the arhythmias were repre-
sented by ventricular premature beats (VPB) in 13%,
ventricular tachycardia in 1,1%, supraventricular extra-
systoles 6,7% and atrial fbrillation 0,4%. VPB werent
signifcantly more frequent in ischemic heart disease
(13,1% vs 12,8%, p=0,14), except old myocardial infar-
ction (24,5% vs 10,7%, p<0,000013) and they were
regis tered in 48% of the patients with LVEF <40%
(vs 11,7% patients without old myocardial infarction,
p<0,0000068). Te correlation with lef ventricular
perfor mance was also supported by the high incidence
of VPB seen in dilated cardiomyopathy (71,1%). For
VPB correlations were also registered with dyslipidemia
(8,7% vs 20%, p<0,00000...), smoking (12,1% vs 15,8%,
p<0,15), hypertension (10,8% vs 19,7%, p<0,00048),
obesity (29,1% vs 9,8%, p<0,0000). Te presence of
VPB immediate afer exercise is considered to have
an increased arrhythmogenic risk. VPB were more
frequent registered in patients with ischemic heart
di sease (7% vs 1%, p<0,000..), dyslipidemia (19,6%
vs 8,1%, p<0,000) and hypertension (6% vs 0%).
Te small percent of the patients who presented ven-
tricular tachycardia doesnt ofer the possibility of any
corre lation. In case of supraventricular extrasystoles,
the only correlation was registered with LVEF (25%
in patients with LVEF<40% vs 7% in LVEF>40%,
p<0,000012), which suggests that they represent a sign
of depressed lef ventricular systolic performance and
increased mean atrial pressure. Conclusion: Te arrhy-
th mogenic risk of ET is low, being represented mainly
by ventricular premature beats, correlated with lef ven-
tricular performance, old myocardial infarction and
some cardiovascular risk factors. In turn, no cardiac
arrhy thmic death was registered during exercise stress
testing.

44. Scorul Grace si
evenimentele cardiovasculare
dupa infarctul miocardic acut
cu supradenivelare de ST
intr-un segment populational
din sectorul 3 al Capitalei
Gabriela Silvia Gheorghe, Irina Mariella Andrei,
Mariana Bulandra, Irina Chivu
1
, Sorin Visan
1
,
Adriana Mihaela Iliesiu, Ioan Tiberiu Nanea
Clinica Medicala Caritas, Bucuresti
1
medici rezidenti
medicina interna
Introducere: Scorul Grace a fost elaborat pentru a
estima riscul de moarte cardio-vasculara la 6 luni dupa
un sindrom coronarian acut
Scop: aprecierea valorii prognostice a scorului Grace la
bolnavii cu infarct miocardic acut cu supradenivelare
de segment ST, intr-un segment populational din sec-
torul 3 al Capitalei
Material si metoda: Au fost luati in studiu 110 bolnavi
care au supravietuit dupa un infarct miocardic acut
cu supradenivelare de segment ST (STEMI) la care
Suplimentul A, 2008
51
s-au notat parametrii inclusi in scorul Grace (varsta,
ante cedentele de insufcienta cardiaca, antecedentele
de infarct miocardic, alura ventriculara in repaus, ten-
siunea arterial sistolica, creatinina serica la internare,
efectuarea angioplastiei coronariene in spital). Bolnavii
au fost clasifcati in functie de localizarea infarctului,
timpul scurs de la debutul simptomelor pana la inter-
nare, tratamentul fbrinolitic, antecedentele de diabet
zaharat. Lor li s-a aplicat un chestionar telefonic la 6
luni de la eveniment, care a inclus reinternariea, apa-
ritia fenomenelor de insufcienta cardiaca, aparitia cri-
zelor anginoase si decesul cardiovascular. Datele au fost
analizate statistixc cu testul Student.
Rezultate: Au ramas in studiu 60 bolnavi care au putut
f contactati telefonic, 51,18% barbati, cu varsta medie
75,5 (55-83). 34,8% au avut STEMI antero-septal,
34,8 % inferior si 30,1% anterior intins. La 85,7% s-a
efec tuat tromboliza, 40% dintre acestia avand semne
ECG de reperfuzie. 2% bolnavi au fost trimisi pentru
angio plastie primara. 12,5% au avut antecedente de
infarct miocardic, 39,7% au avut istoric de insufcienta
cardiaca, 2,5% creatinina serica peste 2 mg/% si 15,3%
au avut tensiunea arteriala sistolica intre 80-99,9 mmHg.
Scorul Grace a fost in medie 130, realizat mai ales prin
varsta inaintata a bolnavilor. Acest scor corespunde
unei mortalitati cardio-vasculare la 6 luni de 5,8%.
Mortalitatea la 6 luni in grupul studiat a fost de 1,8% iar
recurenta ischemiei, reinternarile, insufcienta cardiaca
au fost prezente la 30%.
Concluzii: In grupul studiat scorul Grace are valoare
prog nostica limitata in aprecierea riscului de deces
cardiovascular la 6 luni la bolnavii STEMI tratati cu
terapie ce vizeaza dezobstructia coronariana. Acest fapt
poate f explicat prin prevalenta scazuta in grupul stu-
diat a bolnavilor cu antecedente de infarct miocardic,
insufcienta cardiaca si insufcienta renala cronica.

Grace score and the
cardio-vascular events after
acute myocardial infarction
with ST segment elevation in
the community
Gabriela Silvia Gheorghe, Irina Mariella Andrei,
Mariana Bulandra, Irina Chivu
1
, Sorin Visan
1
,
Adriana Mihaela Iliesiu, Ioan Tiberiu Nanea
Clinica Medicala Caritas, Bucuresti
1
medici rezidenti
medicina interna
Background: Grace score estimates the risk of 6 months
of post discharge death in patients with acute coronary
syndromes.
Purpose: to evaluate the prognostic value of Grace
Score in the patients (pts) with acute myocardial infarc-
tion with ST segment elevation (STEMI).
Method: We studied 110 pts who survived afer a
STEMI and we noted the criteria of Grace score (age,
history of heart failure, old myocardial infarction, ven-
tricular frequency at the admission, systolic arterial
pressure, serum creatinine at the admission, in hospital
angioplasty).
Pts were classifed according to STEMI localization,
time between symptoms and admission, fbrinolitic the-
rapy, history of diabetes mellitus. 6 months afer STEMI
they were asked by phone about rehospitalization, new
symptoms of heart failure, new symptoms of angina
cardio-vascular death. Statistical analysis was made by
Student test.
Results: 60 pts answered to the phone call, 51,18%
men, 75,5 (55-83) years old. 34,8% had antero-septal
STEMI, 34,8 % inferior and 30,1% anterior. 85,7 % pts
were thrombolized , from whom 40 % had ECG signs
of reperfusion. 2% pts performed primary angioplasty.
12,5% had old myocardial infarction, 39,7% history
of heart failure, 2,5 % serum creatinine above 2 mg/%
and 15,3% had systolic arterial pressure between
80-99,9 mmHg. Grace score was 130 in the whole
group, especially due to the old age of the pts. Tis
score presume a 6 months cardio-vascular mortality
of 5,8%. In the study pts the mortality was 1,8 % and
the recurrence of ischemia, rehospitalizations, new
symptoms of heart failure occurred in 30 % pts.
Conclusions: In this study, Grace Score has little prog-
nostic value regarding the risk of 6 months cardiovascular
death in pts with STEMI treated with fbrinolitics. Tis
Suplimentul A, 2008
55
POSTER I
fact may be due to the reduced prevalence of pts with
old myocardial infarction, chronic heart failure and
chronic renal failure in the study group.

45. Modificri ale evoluiei
leziunilor valvulare cardiace
ntlnite n practica medical a
ultimilor ani
Ionescu Simona Daniela, Manea Paloma,
Artenie Romeo, Rezu Ciprian, Tnase Daniela Maria,
Ouatu Anca
Clinica a III-a Medical Cardiologic I.Enescu, Uni-
versitatea de Medicin i Farmacie Gr.T. Popa, Iai
Obiectivul i metoda: Studiul prospectiv al aspectelor
evolutive determinate de leziunile valvulare cardiace a
artat apariia unor modifcri semnifcative. n perioa-
da 1.01.2003-31.12.2007 au fost internai n Clinica a
III-a Medical Cardiologic 780 pacieni cu leziuni val-
vulare cardiace reumatismale i 1031 pacieni cu leziuni
valvulare aterosclerotice.
Rezultate: Pentru leziunile valvulare reumatismale
maxim de frecven a fost de 363 pacieni n 2003 i
minim 58 pacieni n 2007; vrsta medie de descoperire
a fost de 31,3 ani i au predominat la sexul feminin ( 512
F/268 B sau 65,6% / 34,4%). S-au exprimat dominant
prin boal mitral, stenoz mitral i insufcien aor-
tic iar circumstanele de descoperire au fost repre-
zen tate de tulburri de ritm 530 pacieni (68%),
insu fcien cardiac II-IV NYHA 694 pacieni (89%),
tromboembolism 148 pacieni (19%), endocardit
infec ioas 7 pacieni (0,87%).
Pentru leziuni aterosclerotice minim de frecven
a fost de 124 pacieni 2003 i maxim de 412 pacieni
n 2007; vrsta medie de descoperire a fost de 74,5 ani,
cu exprimare relativ egal pe sexe: 563 F/486 B (54,6%
/ 45,4%) i manifestare dominant ca stenoz aortic
insufcien mitral. Circumstanele de descoperire
au fost: insufciena cardiac II-IV NYHA 814 pacieni
(79%), tulburri de ritm 278 pacieni (27%), angin
pec toral 381 pacieni (37%), infarct miocardic 217
pacieni (21%), endocardit infecioas 8 pacieni
(0,77%).
Concluzii: Leziunile valvulare aterosclerotice au deve-
nit prioritare. Leziunile reumatismale au diminuat sem-
nifcativ prin dispariia cazurilor de RAA. Vrsta de
exprimare a celor dou etiologii determin circumstane
deosebite evolutive i terapeutice. Leziunile valvulare
aterosclerotice snt nsoite de ateroscleroz vascular
cu prognostic sever. Endocardita infecioas compli-
c ambele tipuri, dar mai frecvent etiologia reumatis-
mal.

Modification of heart valvular
diseases evolution seen in
medical practice of the last
years
Ionescu Simona Daniela, Manea Paloma,
Artenie Romeo, Rezu Ciprian, Tnase Daniela Maria,
Ouatu Anca
3rd Medical Cardiology Clinic I. Enescu, University
of Medicine and Pharmacy Gr. T. Popa, Iasi
Objective and method: Te prospective study of
evolutive aspects determined by heart valvular diseases
has shown the apparition of signifcant modifcations.
Between 1st January 2003 and 31st December 2007,
780 patients with rheumatismal heart valvular diseases
and 1031 patients with atherosclerotic valvular diseases
have been hospitalised in the 3rd Medical Cardiology
Clinic.
Results: Tere was a maximum of 363 patients in
2003 and a minimum of 58 patients in 2007, sufering
of rheu matismal valvular disease; the average age was
31,3 years, most of them beeing women 512 and 268
men (65,6% / 34,4%).Te majority of them sufered of
mi tral disease, mitral stenosis and aortic regurgitation.
Te circum stances of discovery were represented by rhy-
thm distur bances: 530 patients (68%), heart failure
II-IV NYHA: 694 patients (89%), tromboembolism:
148 patients (19%), infective endocarditis: 7 patients
(0,87%).
Tere was a minimum of 124 patients (in 2003) and
a maximum of 412 patients (in 2007) sufering of athe-
rosclerotic diseases.Te average age was 74,5 years, with
almost equal ratio of sexes ( 563 women and 468 men
54,6% / 45,4%). Te dominant manifestations were
aortic stenosis mitral regurgitation. Te circum stan-
ces of discovery were heart failure II-IV NYHA 814
patients (79%), rhythm disturbances 278 patien ts
(27%), angina pectoris 381 patients (37%), myo car-
Suplimentul A, 2008
56
dial infarction 217 patients (21%), infective endo car-
ditis 8 patients (0,77%).
Conclusions: Atherosclerotic valvular diseases have
become a priority. Rheumatismal valvular diseases have
diminished semnifcatively because of disaperance of
rheumatic fever. Te age of manifestation of the two
ethiologies determine special evolutive and therapeutical
circumstances.Te atherosclerotic valvular diseases are
associated with vascular atherosclerosis, sever outcome.
Te infective endocarditis aggravates both types of
diseases, but more frecquently the rheumatismal ethio-
lgy.

46. Aspecte ecocardiografice
n sindromul metabolic
(rezultate preliminare)
Ctlina Lionte, L. orodoc, O.R. Petri,
Victoria orodoc, Cristina Bologa, Gabriela Anton,
Marilena Spiridon, D. Tesloianu, P. Scripcariu
Clinica Medical, Spitalul Clinic de Urgene Sf. Ioan
Iai
Scop: Studiu prospectiv pentru evaluarea structurii
i funciei cardiace la pacieni cu sindrom metabolic
(SM), fr istoric de boal cardiovascular, analiznd
para metrii ecocardiografci.
Material i metod: n ultimele 6 luni am efectuat un
screening de boal cardiovascular folosind ecocardio-
grafa la 155 pacieni, 63% femei, divizai ntr-un grup
cu SM (n=85, vrsta: 51+/-3.7 ani) i fr SM (n=70,
vrsta: 50+/-3.5 ani) folosind criteriile ATP III-NCEP
de defnire ale SM. Dimensiunile i grosimea pere ilor
ventricolului stng (VS) au fost msurate prin eco-
car diografe mod M. Grosimea esutului adipos sub-
epicardic (GSE), component a grsimii viscerale ce
nconjur cordul i vasele coronare s-a msurat prin
ecocardiografe mod M n seciune parasternal ax
lung i scurt. S-au msurat valorile maxime la aceste
niveluri i media a fost folosit pentru analiza statistic.
S-au mai calculat indexul masei VS, fracia de ejecie a
VS. Funcia diastolic a VS s-a evaluat prin velocitatea
undei E, velocitatea undei A i raportul E/A pe fuxul
transmitral, prin ecocardiografe Doppler. A fost de
asemenea calculat indexul Tei, ce refect global, att
funcia diastolic, ct i cea sistolic a VS.
Rezultate: Nu s-au gsit diferene semnifcative ntre
grosimea relativ a pereilor, indexul masei VS, sau frac-
ia de ejecie a VS ntre cele 2 grupuri. Att raportul
E/A, ct i indicele Tei au fost semnifcativ diferite
(p<0.001), ntre grupul cu SM (0.67+/-0.12 i respectiv
0.34+/-0.05) i cel fr SM (0.87+/-0.23 i 0.28+/-0.08).
Pacienii cu SM au avut o grosime semnifcativ (< p
0.001) mai mare a GSE comparativ cu subiecii din
grupul fr SM (5.2 1.6 i 3.3 1.5 mm).
Concluzii: Pacienii cu SM pot avea disfucnie dias-
tolic n lipsa hipertrofei VS sau a disfunciei sisto lice,
ceea ce poate explica parial morbiditatea cardio vas-
cular crescut asociat SM. S-a demonstrat exis tena
unei relaii ntre GSE i SM. Evaluarea GSE n eco car-
diografile de rutin este util n predicia existen ei SM
i a riscului su cardiovascular asociat.

Echocardiography findings
in metabolic syndrome
(preliminary results)
Catalina Lionte, L. Sorodoc, O.R. Petris, Victorita
Sorodoc, Cristina Bologa, Gabriela Anton, Marilena
Spiridon, D. Tesloianu, P.Scripcariu
Medical Clinic, Sf.Ioan Clinic Emergency Hospital Iasi
Aim: prospective study to assess cardiac structure and
function in patients who have metabolic syndrome
(MS) but no history of cardiovascular disease by ana ly-
zing echocardiography fndings.
Material and method: In the past 6 months we per-
for med screening for cardiovascular disease using
echo car diography in 155 patients, 63% women, divi-
ded into MS (n=85, age: 51+/-3.7 years) and non-MS
(n=70, age: 50+/-3.5 years) groups based on the cri-
teria for MS according to ATP III-NCEP. Te lef ven-
tricular (LV) wall thickness and dimension were mea-
sured by M-mode echocardiography. Tickness of the
subepicardial adipose tissue (SAT), a component of vis-
ceral fat surrounding the heart and coronary vessels,
was measured using M-mode echocardiography in para-
sternal long and short axis views. Maximum values at
any site were measured, and the average value was used
for statistical analyses. LV mass index, and LV ejection
frac tion (LVEF) were calculated. LV diastolic function
was assessed by E velocity, A velocity, and the ratio of E
Suplimentul A, 2008
5I
POSTER I
to A (E/A) by the transmitral fow with Doppler echo-
cardiography. Te Tei index, which refects both LV
dias tolic and systolic function, was also calculated.
Results: Tere were no diferences in relative wall thick-
ness, LV mass index, or LVEF between the two groups.
However, both the E/A and Tei index were signifcantly
diferent between the MS (0.67+/-0.12 and 0.34+/-0.05,
respectively) and non-MS (0.87+/-0.23 and 0.28+/-
0.08) groups (p <0.001). Te patients with MS had signi-
fcantly higher SAT thickness compared to the subjects
in the non-MS group (5.2 1.6 and 3.3 1.5 mm, <p
0.001).
Conclusion: Tese results indicate that patients with
MS can have cardiac diastolic dysfunction even if they
have neither LV hypertrophy nor systolic dysfunc tion,
and may partially explain the increased cardio vas cu lar
morbidity and mortality associated with MS. A rela-
tionship between SAT thickness and MS was de mons-
trated. Assessment of SAT thickness in routine echo-
car diography examinations is useful in predicting the
existence of MS and its associated cardiovascular risk.

47. Fibrilatia atriala in
insuficienta cardiaca acuta:
factor de prognostic pe
perioada internarii
Lucica Grigorica, O. Chioncel, A. Carp, Ileana Tepes,
Rodica Cioranu, Iulia Kulcsar, E.Stoica, C. Macarie
Institutul de Boli Cardiovasculare C.C. Iliescu Bucur-
esti
Premize: Insufcienta cardiaca si fbrilatia atriala
sunt conditii patologice cu factori de risc si etiologici
comu ni si o incidenta crescuta dupa varsta de 60 ani.
Intre cele doua exista o relatie reciproca: insufcienta
car diaca reprezinta unul dintre cei mai puternici pre-
dictori pentru fbrilatia atriala, iar fbrilatia atriala poate
determina sau agrava o insufcienta cardiaca.
Scop: Autorii si-au propus sa analizeze intr-o cohorta
de pacienti cu insufcienta cardiaca acuta rolul fbrilatiei
atriale ca atat ca factor precipitant, cat si ca factor agra-
vant al actualului episod de insufcienta cardiac acuta.
Material si metoda: Lotul studiat a cuprins 481 de pa-
cienti internati cu diagnosticul de insufcienta car diaca
acuta in sectia Cardiologie I a Institutului de Boli Cardio-
vasculare Prof. Dr. C. C. Iliescu Bucuresti, in perioada
1 ianuarie 2006 31 martie 2007. Diagnosticul de insu-
fcienta cardiaca a fost sustinut conform criteriilor
Fra mingham, iar forma clinica de prezentare a fost sta-
bilita conform recomandarilor Societatii Europene de
Cardiologie din Ghidul de Insufcienta Cardiaca Acuta
din 2005.
Rezultate: Varsta medie a lotului studiat a fost de
67, 4 6, 2 ani. Lotul a cuprins preponderent barbati
(60,3%). Principala forma de prezentare a fost insu-
fcienta cardiaca cronica decompensata (82,8%), majo-
ritatea pacientilor prezentand semne si simptome se-
ve re de insufcienta cardiaca (92 % dintre pacienti au
avut insufcienta cardiaca clasa III si IV NYHA). Insu f-
cienta cardiaca acuta de novo a reprezentat 16,1% din
totalul cazurilor cu insufcienta cardiaca acuta. Aproxi-
mativ 1/3 dintre pacienti au avut fractia de ejectie a
ventriculului stang prezervata (FE >50%). Cel mai
frecvent factor precipitant l-a reprezentat ischemia
miocardica (34,5%), urmat de criza hipertensiva si non-
complianta la tratament (25,5%). In urma analizarii
traseului ECG efectuat la internare fecarui pacient,
autorii au constatat prezenta fbrilatiei atriale in 39,5%
dintre cazuri, ritmul sinusal find evidentiat la 53,2%
dintre subiecti. In 8,5% din cazuri fbrilatia atriala a
fost considerata ca find singurul factor precipitant al
insufcientei cardiace acute. Prevalenta fbrilatiei atriale
a crescut cu severitatea clasei functionale NYHA: 11,2
% in clasa II si respectiv 17,5% si 58% in clasele III si
IV NYHA. Frecventa acestei tulburari de ritm este mai
mare la pacientii cu insufcienta cardiaca acuta cu fractie
de ejectie prezervata comparativ cu cei cu disfunctie
sistolica de ventricul stang: 44,2%, comparativ cu 35,4%.
Prevalenta creste cu varsta, fbrilatia atriala regasindu-se
la 72,3% dintre pacientii peste 65 ani. Nu s-au constatat
diferente semnifcative intre cei cu insufcienta cardiaca
cronica decompensata vs insufcienta cardiaca acuta de
novo (38% vs 40 %). Fibrilatia atriala a fost predictor de
mortalitate in cohorta studiata (OR 3,5). Mortalitatea
in lotul cu fbrilatie atriala a fost de 8,7%, in conditiile
in care mortalitatea generala in lotul studiat a fost de
5,2 %. Factorii care au infuentat mortalitatea in lotul
cu fbrilatie atriala au fost: varsta inaintata (>70 ani),
forma severa de insufcienta cardiaca (clasa NYHA IV,
socul cardiogen, edemul pulmonar acut) si disfunctia
sistolica severa de ventricul stang. Durata medie a
spitalizarii nu a fost infuentata semnifcativ de prezenta
fbrilatiei atriale (7,3 4,2 zile in lotul cu fbrilatie atriala
vs 6,4 3,9 zile in lotul fara fbrilatie atriala). Optiunea
Suplimentul A, 2008
58
de tratament in majoritatea cazurilor a fost controlul
ritmului cardiac cu digitala si beta blocante, conversia
chimica sau electrica find recomandata in mai putin
de 3% dintre situatii.
Concluzii: Fibrilatia atriala este aritmia cu prevalenta
cea mai mare in cohorta studiata. Insufcienta cardiaca
poate f declansata sau agravata de fbrilatia atriala, in
timp ce insufcienta cardiaca poate f factor determinant
al fbrilatiei atriale. Prognosticul pacientilor cu insuf-
cienta cardiaca acuta si fbrilatie atriala este determinat
de varsta inaintata, severitatea insufcientei cardiace si
a disfunctiei sistolice de ventricul stang.

Atrial fibrillation in the acute
heart failure: factor of
prognostic on the admission
Lucica Grigorica, O. Chioncel, A. Carp, Ileana Tepes,
Rodica Cioranu, Iulia Kulcsar, E.Stoica, C. Macarie
Institute of Cardiovascular Disease Prof. Dr. C. C.
Iliescu Bucharest
Background: Heart failure and the atrial fbrillation is
a pathologically condition with factors of risk and eti-
o logical common and with incidence breeded afer the
age of 60 years. Between one and there exist a reci pro cal
relation: heart failure represents one of the most strong
predictor for atrial fbrilation, and the atrial fbri la tion
can cause or aggravates a cardiac insuf ciency.
Aim. Te authors analysed the role of atrial fbrillation:
precipitant or agravant factor for the patients with acute
heart failure.
Material and metod: Te authors evaluated 481 hos pi-
talized consecutive with acute heart failure admi tted
to the frst Department of Cardiology of the Ins titute
of Cardiovascular Disease Prof. Dr. C. C. Ilie scu Bu-
charest, between 01.01.2006 31.03.2007. Def nitions
and classifcation of the acute heart failure was in
con formity with recommendation of the acute heart
failure guideline of the European Society of Car diology.
(2005).
Results: Median age was 67, 4 6, 2 years, the mas-
culine gender was preponderant (60, 3%). Te most
frequent clinical form was acute decompensate heart
failure - 82, 8 %. In our group, was a high prevalence
of worse NYHA functional class: 92% NYHA III and
NYHA IV). 15,% % of patients was hospitalized with
de novo acute heart failure and one third of patients
and 36,6 % of patients was hospitalized with acute heat
failure with preserved ejection fraction (EF >50%).
Te most frequent precipitant factor was myocardial
ischemia (34.5%), followed by hypertensive creases
and treatment non- compliance (25, 5%). Te initial
admission ECG fnds: atrial fbrillation in the 39, 5%
patients and normal sinusal rhythm in the 53, 2%
patients. Te atrial fbrillation was the only precipitant
factor for the actual acute heart failure episode in 8, 5%
cases. Te prevalence of atrial fbrillation was higher
in the group with severe NYHA functional class:
11,2% - NYHA II, 17,5% - NYHA III, 58% - NYHA
IV.Te prevalence of atrial fbrillation was higher in
the group with acute heart failure with preserved lef
ventricular systolic function vs. lef ventricular systolic
dysfunction: 44, 2%, vs. 35, 4%. Te prevalence is also
higer in the older patients: 72,3% for the patients older
than 65 years. No signifcant diferences between acute
decompensated heart failure vs de novo acute heart
failure (38 % vs 40%).Atrial fbrillation was a predictor
factor for mortality in our study (OR 3, 5).
Te mortality in the group with atrial fbrillation
was of 8, 7%, in the conditions which in the general
mor tality in the lot was of 5,2%. Te prognostic factors
for in hospital mortality were: the age ( >70 years),
seve re heart failure (class IV NYHA cardiogen schock,
acut pulmonary edema) and the severe lef ventricular
sisto lic disfunction. Median lenght of stay wasnt
signi fcant infuenced by the atrial fbrillation vs the
group without atrial fbrillation: 7,3 4,2 days vs 6,4
3,9 days. Heart rate control was the most frequent
treat ement methode (beta blockers and dygoxin); the
control rythm (electrical or chimical conversion was
performed <3%).
Conclusions: Te atrial fbrillation is the most frequent
arrhythmia in our cohorte. Atrial fbrillation can cause
or agravatted heart failure and heart failure was a
strong predictor factor for the atrial fbrillation. Several
factors have been identifed are associated with higher
mortality in the group with atrial fbrillation: older age,
severe heart failure and lef ventricular systolic dys-
function.

Suplimentul A, 2008
59
POSTER I
48. Aspecte particulare de
diagnostic in miocardite acute
Alina Simion, S. Huidu, I. Stanca, R.C. Popescu,
A.Popescu, L. Ionescu, L. Arama, E. Floares,
A. Albulescu, D. Dimulescu
Spitalul Universitar de Urgenta Elias, Bucuresti
Introducere: Miocardita reprezinta o boala infamatorie
a miocardului, cu un spectru larg de manifestari clinice
la prezentare, de la forme asimptomatice sau fruste,
pana la forme fulminante si deces. Diagnosticul se
bazeaza pe criterii histologice, imunologice. Conform
criteriilor Dallas (1987), miocardita este caracterizata
prin infltrat infamator la nivelul miocardului, cu
ne croza si/sau degenerescenta cardiomiocitelor adia-
cente, atipica pentru leziune-ischemie caracteristica
bolii coronariene. Incidenta este greu de apreciat dato-
rita problemelor frecvente de diagnostic diferential,
pa cientii prezentand deseori la debut tablou de sin-
drom coronarian acut. Aspectele evolutive pot orien ta
ulterior diagnosticul, in cele mai multe cazuri pacien tii
prezentand remisiunea modifcarilor ECG si a tulbu-
rarilor de cinetica parietala, in contextul absentei unor
modifcari patologice coronarografce. Cei mai mul ti
pacienti se recupereaza complet, fara disfunctie car-
diaca reziduala, in timp ce 20% evolueaza spre cardio-
miopatie dilatativa.
Obiective: urmarirea caracterelor clinice si evolutive
ale pacientilor cu miocardita, in vederea identifcarii fac-
torilor cu valoare prognostica. Material si metoda: A fost
realizat un studiu in care au fost analizate retrospectiv
16 cazuri de miocardita diagnosticate in perioada 2005-
2007 in Clinica de Cardiologie a Spitalului Universitar
de Urgenta Elias, pentru care au fost disponibile datele
clinice. Au fost urmarite date referitoare la varsta, sex,
antecedente personale si heredo-colaterale, factorii
de risc cardiovascular (fumat, HTA, diabet zaharat,
disli pidemie, obezitate), date de laborator, ECG, test
de efort, ecocardiografe, coronarografe, scintigrafe
miocardica, RMN.
Rezultate: Varsta medie a pacientilor a fost 43 ani, cu
predominanta sexului masculin (10 cazuri). Simpto-
mele de debut au fost similare in majoritatea cazurilor:
subfebra, transpiratii, dureri toracice anterioare, pal-
pitatii, fatigabilitate, dispnee. Un singur caz a prezentat
sincopa la debut. Sindromul infamator a fost prezent
la 6 pacienti, iar leucocitoza la 7 pacienti. Aritmia
extra sistolica ventriculara a fost prezenta in 3 cazuri,
in timp ce tulburari de conducere AV au prezentat 2
pa cienti, iar BRS major 1 caz. Troponina a prezentat
valori de pana la 1ng/ml la 5 pacienti, si de peste 1ng/
ml la 4 pacienti. Enzimele de citoliza miocardica au
fost crescute la mai putin de 2 ori valoarea normala
la 6 pacienti. Cinci pacienti au prezentat maxim 2
factori de risc cardiovascular. Doua cazuri au prezentat
afectare tranzitorie usoara a functiei renale. Din punct
de vedere imagistic, jumatate din pacienti au prezentat
tulburare de cinetica la ecocardiografe, cu remisiune
completa, in timp ce doua cazuri au evoluat spre CMD,
scintigrafa miocardica evidentiind la acesti pacienti
tulburari de perfuzie miocardica, in restul cazurilor
in care s-a efectuat, find normala. Toti pacientii care
au fost explorati angiografc au prezentat coronare epi-
cardice normale. Testele serologice au fost efectuate la
doi pacienti, evidentiind etiologia cu Chlamidia Tracho-
matis in unul din cazuri, iar in celalalt find negative.
Concluzii: Miocardita reprezinta unul dintre cele mai
controversate diagnostice. Aceasta entitate este rareori
recunoscuta la debut, fziopatologia este putin inteleasa,
nu exista criterii unanim acceptate de diag nostic, iar
tratamentul genereaza inca numeroase con tro verse.
Miocardita trebuie suspicionata la pacien ti tineri, in
general fara sau cu putini factori de risc cardio vascular,
care prezinta de obicei un tablou clinic sugestiv de
infectie virala, cu sindrom infamator pre zent, cu
mo di fcari enzimatice, ECG, tulburari de cine tica re-
gre sive in totalitate, si coronare epicardice nor male
in majoritatea cazurilor. Deoarece biopsia endo mio-
car dica este o metoda invaziva, cu anumite riscuri, si
care presupune prezenta unei echipe complexe, testele
sero logice sunt rareori concludente, iar RMN desi
pre zinta inalta sensibilitate si specifciate este rareori
dispo nibila, diagnosticul de certitudine este greu de
stabilit, numeroase cazuri sunt incorect incadrate in
spec trul altor entitati patologice, iar o parte dintre
CMD idiopatice ar putea avea in realitate un punct
de plecare miocarditic.

Suplimentul A, 2008
60
Particular aspects of diagnostic
in acute myocarditis
Alina Simion, S.Huidu, I. Stanca, R.C. Popescu,
A. Popescu, L. Ionescu, L. Arama, E. Floares,
A. Albulescu, D. Dimulescu
Emergency Universitary Elias Hospital, Bucharest
Introduction: Myocarditis is an infammatory disease,
with a large spectrum of clinical manifestation at pre-
sentation, from asymptomatic to fulminant forms and
death. Diagnostic is based on histologic, imunologic
criteria. Correspondig with Dallas criteria (1987), myo-
carditis is characterized by infammatory infltrate in
myocardium, with necrosis and/or degeneration of
adya cente myocytes, not typical of ischemic damage
associated with coronary artery disease. Incidence is
hard to appreciate because of frequent diferential diag-
nostic problems, pacients ofen presenting at onset with
clinical aspects of acute coronary syndrom. Evolution
can than suggest the diagnostic, almost patients
presentig remission of ECG changes and of contractility
abnormalities, in the absence of coronarography abnor-
malities. Majority of patients recovers completly, with-
out residual cardiac dysfunction, but 20% of pa tients
evoluate to dilated cardiomopathy.
Objectives: clinical and evolutive characteristics of
patients with myocarditis, for identifcation of factors
with prognostic value. Matherial and method: We
annalized retrospective 16 patients with myocarditis
diagnosed between 2005-2007 in Cardiology Clinic of
Emergency Universitary Elias Hospital, for which we
have disponible information. We utilized information
about age, sex, personal and heredo-colateral ante-
cedents, cardiovascular risk factors (smoke, HTA, dia-
betus mellitus, dyslipidemia. obesity, laboratory para -
meters, ECG, exercise ECG, ecocardiography, coro naro-
graphy, myocardial scintigraphy, MRI.
Results: Median age was 43 years old, predominant
males (9 patients). Onset symptoms were similar:
fever, sweats, chest pain, palpitations, fatigue, dyspnea.
One case had syncope at onset. Infammatory synd-
rom was present in 6 patients, and 7 patients had
leuco citosis. Ventricular extrasystolic arhytmia was
pre sent in 3 cases, 2 patients had atrioventricular con-
duc tion abnormalities, LBBB one case. Troponin was
up to 1 ng/ml at 5 patients, and over 1 ng/ml at 4 pa-
tients. Myocardial necrosis enzyms were up to 2 folds
normal value in 6 patients. 5 patients had up to 2 cardio-
vascular risk factors. 2 cases presented mild transient
abnormality of renal function. Half of patients had
contractility abnormalities at echocardiography, with
complete remission, and 2 cases evoluated to dilated
cardiomiopathy, myocardial scintigraphy presentig
myocardial perfusion anomalies, the other patients
having normal scintigraphy. All angiographyc explored
patients, had normal epicardial coronary arteries.
Serological tests were disponible in 2 cases, one case
was positive for Chlamidia Trachomatis, and the other
one was negative.
Conclusions: Myocarditis is one of the most challen-
ging diagnoses. Te entity is rarely recognized at
onset, pathophysiology is poorly under stood, there
are no commonly diagnostic criteria, and treatment
is still a source of controversions. Myocarditis must
be suspicioned in young patients without or with little
car dio vascular risk factors, with clinical aspects of viral
infection, with infammatory syndrom, abnormal myo-
cardial enzyms, ECG, contractility, total regresive, and
normal coronary arteries at most patients. Because
endomyocardial biopsy is an invasive method, with
risks, which needs complex team, serological tests are
rarely concludent, and MRI although has high sen-
sibility and specifcity is rarely disponible, diagnostic
of myocarditis is hard to establish, many cases are
erronate considered like other pathologic entities, and
a part of idiopathyc dilated cardiomiopathy may have a
myocarditic substrate.

49. Aderena populaiei la
programele de prevenie a
cardiopatiei ischemice prin
antrenament fizic
Corneliu Zeana
1
, Cornel Diaconescu
2
,
Ivona Rileanu
3
, Ctlina Constantin
4
1,4
Spitalul de Urgenta Floreasca Bucuresti
2
Medic Familie, Rm Valcea
3
MF Iasi
Motivare: sedentarismul este un important factor de
risc pentru cardiopatia ischemic, iar antrenamentul
fzic reprezint o metoda de prevenie dovedit efcient.
Recomandarea este prevzut n toate ghidurile de
practic.
Obiectiv: Verifcarea msurii n care populaia noastr
Suplimentul A, 2008
61
POSTER I
este avizat asupra rolului preventiv al efortului fzic i
gradul de aderen la programe.
Material, metod. Studiu efectuat pe baz de chestionar
i de discuii pe un lot de 480 de subieci (264F,216M),
ntre 50 i 69 ani, fr invaliditi motorii i fr insu-
fcien cardiac manifest.
Rezultate: 88% nu au primit informaii consistente
privind rolul efortului fzic n prevenirea cardiopatiei
ischemice. Sursa principal de informare a fost: 1.
Radioul, emisiunile de sntate, 2. Presa, 3. TV, 4.
Medicul. Marea majoritate a medicilor de familie (86%)
nu explic i nu insist asupra acestui factor, nu urm-
resc modul n care se efectueaz antrenamentul fzic,
rezultatele obinute etc, n schimb, toi pacienii pleac
de la medic cu o reet de medicamente. 36% primesc
i unele recomandri dietetice.
Mai puin de 1% din intervievai cunosc existena
unor structuri organizaionale ca Sportul pentru toi
(Min Tineretului i Sportului), Federaia Romn de
Atletism Seniori sau altele.
92% nu i-au pus problema unor exerciii fzice regu-
late i intense, consider c activitatea n gospodrie,
deplasrile i plimbrile sunt sufciente.
Dup ce au primit informaii privitor la benefciile
antr e namentului fzic, o treime s-au artat dornici s
participe la programe de antrenament. Impedimente:
lipsa bazelor sportive adecvate i mai ales accesul la
aceste baze. Doar 7 M i 3 F practic un regim de antre-
nament corespunztor atandardelor.
Concluzii: 1. Participare foarte redus a populaiei la
programele de antrenament fzic.
2. Medicii cunosc foarte puin aceast problem,
defcitul de pregtire din facultate find n principal
legat de lipsa programelor i a catedrelor de cardiologie
preventiv. 3. Medicii de familie nu sunt remunerai
pentru activiti de cardiologie preventiv. 4.n Romania
exist un enorm defcit de baze de antrenament dedicate
meninerii sntii populaiei. 5. Casa de Asigurari de
Sntate ar trebui s suporte o parte (important) din
costurile reclamate de antrenamentul fzic (accesul la
bazine de not i alte baze sportive, n acelai regim cu
medicamentele.

The attitude of Romanians
toward ischemic cardiopathy
prevention by physical
training
Corneliu Zeana, Cornel Diaconescu, Yvona Raileanu,
Catalina Constantin
Te sedentary life is one of the most important risk fac-
tors for coronary heart disease. All the guidelines stress
on the importance of the physical training.
Objective: To check the Romanian population adhe-
rence to the physical activity programs of value in the
ischemic cardiopathy prevention.
Material, method: Questionnaire and personal dis cu-
ssion with 480 subjects (264F,216M) aged 50-69 years,
with no motor disabilities or heart failure necessitating
drug treatment.
Results: 88% are not aware of the role of physical trai-
ning on the prevention of the ischemic heart disease.
Te family doctor does not insist on this topic, but
invariable prescribes drugs. Afer discussion, more
than 1/3 are willing to be involved in physical activity
programs. Declared impediments: mainly the rarity of
the sportive bases, or, if they exists, almost inaccessible
to seniors.
Conclusions: 1. In Romania there is a very low adhe-
rence to the physical activity programs for the preven-
tion of the ischemic heart disease (and not only)2. Phy-
cians are not prepared in this respect and are not remu-
nerated for preventive activities. 3. Tere is an imme-
nse defcit in sportive bases : swimming pools, sportive
parks etc. 4. Te Health Security System (CNAS) sho-
uld support physical activity programs, at least for the
seco ndary prevention of the myocardial infarction.

Suplimentul A, 2008
62
50. Peptidele cardiace in timpul
exercitiului izometric la
pacientii cu disfunctie
diastolica
D T. Zdrenghea, M. Ilea, D. Petrovai
Universitatea de Medicina si Farmacie Spitalul Clinic de
Recuperare Cardiologie, Cluj-Napoca
Premise: La pacientii cu insufcienta cardiaca, peptidele
cardiace (PC) cresc in timpul exercitiului dinamic,
imbu natatind astfel posibilitatile de diagnostic si eva-
luare a pacientilor atat cu disfunctie sistolica cat si
diastolica a VS. In schimb, PC au fost mai putin stu-
diate in timpul exercitiului izometric iar datele cu pri-
vire la efectul handgrip la pacientii cu disfunctie dias-
tolica izolata sunt insufciente. Material si metoda: Au
fost studiati 43 de pacienti cu insufcienta cardiaca (p)
apartinand claselor NYHA II-III cu functie sistolica a
VS pastrata, dar cu disfunctie diastolica evaluata prin
echo Doppler- fux transmitral, fux venos pulmonar,
viteza propagata doppler M color. Toti pacientii au fost
supusi unui test handgrip (cu mana dominanta) la 50%
din contractia voluntara maximala, timp de 3 minute.
PC au fost determinate inainte si dupa handgrip din san-
gele venos (proANP, VN<1900fmol/ml; proBNP, VN
<250 fmol/ml). Rezultate: Studiul a inclus 23 barbati si
20 femei cu varsa cuprinsa intre 47-76 ani, 18 dintre
ei cu cardiopatie ischemica si 25 cu hipertensiune arte-
riala. Relaxarea anormala a fost inregistrata la 30p, iar
pseudonormalizarea sau restrictia la 13 p. In repaus
proBNP (1239.3884.8fmol/ml) dar nu proANP
(1306.9153fmol/ml) a fost crescut la pacientii cu insu-
f cien ta cardiaca cu functie sistolica a VS pastrata. Valo-
rile ambelor peptide au fost semnifcativ crescute la
pacientii cu pseudonormalizare sau restrictie (proBNP
1856170fmol/ml; proANP 1521143fmol/ml) in
comparatie cu relaxarea anormala (proBNP 962
78 fmol/ml, proANP 1228110fmol/ml, p<0.05). In
tim pul exercitiului pentru intregul grup proANP-ul
a cres cut (1364.85137fmol/ml) si proBNP a scazut
(1155.4984.3fmol/ml) nesemnifcativ (p>0.05), suge-
rand ca exercitiul izometric genereaza un grad mai redus
de intindere a miocardului atrial sau ventricular. Datele
au fost similare cand am analizat separat pacientii cu
relaxa re anormala (proBNP 897.983fmol/ml; proANP
1244120fmol/ml, p>0.05) si cu pseudonormalizare
sau restrictie (proBNP 1759167fmol/ml; proANP
1719127fmol/ml, p>0.05). Datele demonstreaza ca
in timpul unui efort izometric chiar si de instensitate
crescuta, disfunctia VS este un stimul mai putin
puternic decat disfunctia diastolica pentru cresterea
nivelelor PC.
Concluzie: Pacientii cu insufcienta cardiaca cu dis-
functie diastolica a VS si functie sistolica pastrata,
exer citiul izometric nu creste nivelul PC, sugerand ca
efortul izometric moderat este bine tolerat la aceasta
categorie de pacienti.

Cardiac peptides during iso-
metric exercise in patients with
diastolic dysfunction
D T. Zdrenghea, M. Ilea, D. Petrovai
Universitatea de Medicina si FarmacieIuliu Hatiega-
Napoca
Background and purpose: In heart failure patients,
cardiac peptides (CP) increase during dynamic exer ci-
se, improving the diagnostic and evaluation in patients
with either systolic or diastolic LV dysfunction. In
turn, during isometric exercise CP were less studied
and data are lacking about the efect of handgrip in
pa tie nts with isolated diastolic dysfunction. Methods:
Tere were studied 43 heart failure patients (p), NYHA
II-III class, with preserved LV systolic function, but
with diastolic dysfunction determined through echo
Doppler - transmitral fow, pulmonary venous fow,
Doppler M color propagated velocity. All patients
were submitted to a handgrip test (dominant hand)
at 50% of the maximal voluntary contraction, for
three minutes. Before and afer handgrip, CP were
deter mined using venous blood samples (proANP, vn
<1900 fmol/ml; proBNP vn<250fmol/ml). Results:
Te study included 23 males and 20 females aged 47-
76 years, 18 with ischemic heart disease and 25 with
hyper tension. Abnormal relaxation was registered in
30 p and pseudonormalization or restriction in 13p. At
rest proBNP (1239.3884.8fmol/ml) but not proANP
(1306.9153fmol/ml) was increased in heart failure
patients with preserved LV systolic function. Te values
of both cardiac peptides were signifcantly increased
in patients with pseudonormalization or restriction
Suplimentul A, 2008
68
POSTER I
(proBNP 1856170fmol/ml; proANP 1521143fmol/
ml) in comparison with abnormal relaxation (proBNP
96278fmol/ml, proANP 1228110fmol/ml, p<0.05).
During exercise, for the whole group, proANP in-
creased (1364.85137fmol/ml) and proBNP de crea-
sed (1155.4984.3fmol/ml) insignifcantly (p>0.05),
su gg es ting that isometric exercise results in a lesser
de gree of ventricular and atrial stretching efect. Te
data were similar when we considered separa tely
patients with abnormal relaxation (proBNP 897.9 83
fmol/ml; proANP 1244120fmol/ml, p>0.05) and with
pseudonormalization or restriction (proBNP 1759
167fmol/ml; proANP 1719127fmol/ml, p>0.05).
Te data prove that during isometric efort even severe,
LV dysfunction is a less strong stimulus than systolic
dysfunction for increasing the cardiac peptides.
Conclusion: In heart failure patients with LV diastolic
dysfunction and preserved LV systolic function, iso-
metric exercise doesnt increase cardiac peptides level,
suggesting that moderate isometric efort can be safe in
this category of patients.

51. Obezitatea, sTNFR- I si
polimorfismul genetic al ACE
la pacientii cu insuficienta
cardiaca
O. Penciu, D. Pop, D T. Zdrenghea, L. Procopciuc,
M. Cebanu
Universitatea de Medicina si Farmacie Cluj-Napoca,
Spitalul Clinic de Recuperare Cardiologie
Material si metoda: casexia este considerata facor de
risc la pacientii cu insufcienta cardiaca, iar prin con-
trast, obezitatea ar trebui considerata factor de pro-
tectie. In schimb, obezitatea se coreleaza cu gradul
de infamatie care este in relatie cu nivelul ACE si al
angiotensinei II. Acestea depind semnifcativ de poli-
mor fsmul genetic al ACE, mutatia genetica DD find
corelata cu nivele crescute ale ACE. Astfel, este impor-
tant sa se studieze relatia dintre obezitat e, receptorul
solubil I al factorului de necroza tumorala (sTNFR- I),
ca o expresie a infamatiei la pacientii cu insufcienta
car diaca si polimorfsmul ACE.
Metode: Au fost studiati 36 de pacienti cu insufcienta
cardiaca apartinand claselor NYHA III-IV, 20 barbati
si 16 femei cu varsta de 71.39.22. La toti pacientii,
poli morfsmul genetic ACE a fost determinat utilizand
metoda PCR si de asemenea nivelele plasmatice ale
sTNFR-I (ELISA; VN<3 pg/ml), indicele de masa cor-
porala (IMC) si fractiunile lipidice serice.
Rezultate: Nivelele TNFR-I au fost crescute la pacientii
cu insufcienta cardiaca (228.13106.12 pg/ml), chiar
mai crescute la pacientii obezi cu insufcienta cardi a-
ca (250.4280.84 pg/ml) in comparatie cu pa cien tii
nor mo ponderali (210.94108.81 pg/ml), p <0.05,
de monstrand relatia dintre obezitate si infama tie la
aceas ta categorie de pacienti. Distributia polimorfs-
mu lui genetic al ACE a fost dupa cum urmeaza: muta-
tia DD 47.22% (17 p), ID 22.22% (8 p), II 30.55 % (11
p). Nivelul plasmatic mediu al sTNFR-I la pacientii
cu mutatie DD (237.2286.53 pg/ml) nu a diferit sem-
nifcativ fata de valoarea medie inregistrata la pacientii
fara aceasta mutatie (248.80100.45 pg/ml), p>0.05. In
schimb pacientii cu mutatie DD au avut un IMC cres-
cut (33.858.49% vs 28.644.27%, p<0.05) si nivele
plas matice crescute ala fractiunilor lipidice. (TCo-
171.7342.78 mg%; LDL-Co-105.6628.62 mg%;
TG-152.13127.12 mg% vs TCo-147.6638.42 mg%;
LDL-Co-98.726.66 mg%; TG-92.9425.97 mg%).
Deoa rece mutat ia DD, prin intermediul nivelelor ACE
si ale angiotensinei II favorizeza infamatia, iar nivelele
crescute ale fractiunilor lipidice, reduc gradul de infa-
matie, estimata prin intermediul sTNFR-I, pro ba bil
obezitatea reprezinta cel mai important factor care con-
tribuie la cresterea sTNFR-I si a infamatiei la pacien tii
nostri.
Concluzie: La pacientii cu insufcienta cardiaca, obe-
zitatea reprezinta un factor mai important in favo ri-
zarea infamatiei decat nivelele ACE, exprimate prin
polimorfsmul genetic al ACE.

Obesity, sTNFR- I and ACE
genetic polymorphism in heart
failure patients
O. Penciu, D. Pop, D T. Zdrenghea, L. Procopciuc,
M. Cebanu
Background and purpose: Cachexya is considered a
risk factor in heart failure patients and conversely obe-
Suplimentul A, 2008
61
sity has to be a protective one. In turn, obesity correlates
with the degree of infammation, witch is also in
relationship with ACE and angiotensin II levels. Tese
depend signifcantly by ACE genetic poly morphism, DD
genetic mutation being correlated with increased levels
of ACE. Tus, it is important to study the relationship
between obesity, soluble tumor necrosis factor receptor
I (sTNFR- I) as an expression of infammation in heart
failure patient, and ACE poly morphism. Methods:
Tere were studied 36 heart failure patients NYHA III-
IV class, 20 males and 16 females aged 71.39.22 years.
In all patients ACE genetic polymorphism was deter-
mined through PCR methods, but also sTNFR-I plas-
matic levels (ELISA; nv <3 pg/ml), body mass index
(BMI) and serum lipid fractions.
Results: sTNFR-I levels were increased in heart failure
patients (228.13106.12 pg/ml) and even more increased
in obese heart failure patients (250.4280.84pg/ml) in
comparison with nonobese patients (210.94108.81 pg/
ml), p<0.05, proving the relationship between obesity
and infammation in this category of patients. Te ACE
genetic polymorphism distribution was as follow: DD
mutation 47.22% (17 p), ID 22.22% (8 p), II 30.55 %
(11 p). Te sTNFR-I mean plasmatic level in patients
with DD mutation (237.2286.53 pg/ml) was not
signi fcantly diferent from the mean value registered
in patients without this mutation (248.80100.45 pg/
ml), p>0.05. In turn, patients with DD mutation have
an increased BMI (33.858.49% vs 28.644.27%,
p<0.05) and increased serum lipid fractions (TCo-
171.73 42.78 mg%; LDL-Co-105.6628.62 mg%; TG-
152.13127.12 mg% vs TCo-147.6638.42 mg%; LDL-
Co-98.726.66 mg%; TG-92.9425.97 mg%). Because
the DD mutation, through ACE and angiotensin II
level promote infammation, but increased serum lipi-
ds decrease the degree of infammation, estimated
throu gh sTNFR-I, probably obesity represents the
most important factor in increasing sTNFR-I and infa-
mmation in our patients.
Conclusion: In heart failure patients obesity represents
a more important factor to promote infammation
than ACE levels, estimated through ACE genetic poly-
morphism.
ARITMII I
Rezultate: In timpul perioadei de urmrire, recurena
FA a fost nregistrat la 18 pacieni din grupul A i la
36 pacieni din grupul B (85,7%vs.40,9%, p=0,0004).
In grupul B pacienii cu FA recurent au avut o durat
mai mare a undei P fltrate (168,1527,0msec vs.
150,417,1msec, p=0,031) i RMS 20 mai mic (3,22,1
V vs. 5,83,5V, p=0,008). Ceilali parametri ai ECG
de nalt rezoluie la nivel atrial la pacienii cu FA re-
curent nu au fost diferii statistic fa de cei ai pa cien-
ilor care se afau n ritm sinusal dup 6 luni (RMS P:
7.6 2.8 V vs. 8.0 2.6 V, p = 0.72; RMS 40: 5.7
1.4 V vs. 6.3 3.4 V, p = 0.54; RMS 30: 5.0 1.7 V
vs. 5.9 3.8 V, p = 0.45; Pint: 943.7 243.8 Vsec vs.
965.3 268.0 Vsec, p = 0.8).
Concluzii: Recurena FA la 6 luni dup cardioversie
este semnifcativ mai mare la pacienii cu ECG de nal-
t rezoluie la nivel atrial la care unda P nu este sepa-
rat de complexul QRS prin linie izoelectric, ca i la
pa cienii cu durat mai lung a undei P fltrate i RMS
20 mai mic. De vreme ce toi pa cienii au avut un inter-
val PR normal, pattern-ul ECG de nalt rezoluie n
care P nu e separat de QRS prin linie izoelectric poate
f echivalent cu o durat lung a undei P fltrate.

53. Factorii predictivi ai
aparitiei fibrilatiei atriale dupa
bypass aorto-coronarian la
pacientii tratati cu betablocante
R.M.Christodorescu, M. Cocora
1
, S. Ursoniu
2
,
S. Dragan
1
, M. Popa
1
, A. Gheorghiu
1
, D. Darabantiu,
D. Lighezan, M.Tomescu
Clinica de Cardiologie ASCAR,
1
Institutul de Boli
Cardiovasculare Timisoara,
2
Disciplina de Sanatate
Publica,Universitatea de Medicina si Farmacie Timiso-
ara
Premize si obiective: Efectele defavorabile ale fbri la-
tiei atriale (FA) instalate postoperator dupa by-pass
aor to coronarian ca si efcienta preventiei acestora cu
beta blocante (BB) este bine documentata, motiv pen-
tru care BB sunt administrate de rutina. Scopul lucra-
52. Are valoare predictiv ECG
de nalt rezoluie la nivel atrial
n recurena fibrilaiei atriale
persistente dup cardioversie
Constantin Militaru, Mirela Manescu, Cristina Radoi,
Anda Ungureanu, Dan-Dominic Ionescu
Fibrilaia atrial este o aritmie comun a crei prevalen
crete odat cu vrsta (5% din pacienii cu vrsta peste
69 ani au fbrilaie atrial). Recurena acestei aritmii
dup cardioversie este frecvent, n special la pacienii
cu anomalii electrice i anatomice. S-a demonstrat c
para metri modifcai ai ECG de nalt rezoluie pre zic
riscul fbrilaiei atriale la pacienii cu diverse boli car-
dio vasculare, ns valoarea lor predictiv n recu rena
fbrilaiei atriale dup cardioversie nu a fost clar sta-
bilit.
Metod: La 109 pacieni cu boal coronarian i vrsta
60,19,6 ani s-a efectuat ECG standard 12 derivaii i
ECG de nalt rezoluie la nivel atrial n prima or dup
cardioversia reuit a fbrilaiei atriale persistente. Toi
pacienii au avut un interval PR >0,12sec. Toate ECG
de nalt rezoluie la nivel atrial s-au inregistrat la un
zgomot de fond sub 1V .Pe baza morfologiei semnalului
dintre sfritul undei P i nceputul complexului QRS,
pacienii au fost mprii n 2 grupuri: grupul A- 21
pacieni pe a cror ECG de nalt rezoluie unda P nu
este separat de complexul QRS prin linie izoelectric
i grupul B-88 pacieni pe a cror ECG de nalt rezo-
luie unda P este separat de complexul QRS prin linie
izo electric evident. Parametri msurai n grupul B
au fost: durata undei P fltrate n msec (Pdur), rd cina
medie ptrat a undei P (RMS P), RMS ai ulti milor 40, 30
si 20 V (RMS40, RMS30 si RMS20) i integrala undei
P (Pint) n V/sec. Niciunul dintre aceti parametrii nu
a fost luat n consideraie n grupul A. Toi pacienii au
fost urmrii lunar timp de 6 luni Analiza statistic a
inclus comparaia celor dou grupuri n ceea ce privete
rata recurenei FA i testul Student pentru parametri
ECG de nalt rezoluie la pacienii din grupul B, cu i
fr FA recurent; pentru ambele teste un p<0,05 a fost
considerat semnifcativ.
ARITMII I Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
rii a fost cercetarea incidentei FA survenite post by-

pass aorto-coronarian la pacienti (P) tratati cu BB si
importanta factorilor de risc clinic si ecocardiografci
pentru aparitia FA.
Metode: La 203 P recrutati in serie in sectia de chirurgie
cardiaca, Institutul de Boli Cardiovasculare Timisoara
intre ianuarie 2005 si decembrie 2007, incidenta FA
postoperatorii a fost cercetata in functie de factorii
de risc clinic si ecocardiografci de FA. P au fost tratati
preoperator cu 4 BB, metoprolol, bisoprolol, carvedilol
si betaxolol, instituiti sau continuati dupa internare si
postoperator. Rezultatele au fost analizate in functie
de factorii de risc clinic si ecocardiografci pentru tot
lotul de 203 p. Urmarirea postoperatorie s-a facut pana
la externare, in medie 7.71.9zile. Pentru identifcarea
predictorilor s-a efectuat analiza univariata si multi-
variata cu ajutorul programului STATA 9.2.
Rezultate: FA a aparut postoperator la 46 p(22.6%).
Analiza univariata releva faptul ca dintre toti factorii
de risc analizati varsta inaintata, FEVS si dimensiunile
AS se asociaza semnifcativ cu incidenta crescuta de FA
postoperator (pentru toti factorii de risc p<0.002). Din
analiza multivariata se confrma ca varsta inaintata(O
R:1.08,95%CI:1.04-1.13, p<0.001), FEVS (OR:0.95,95%
CI:0.91-0.98,p=0.008), si dimensiunile AS(OR:1.76,95%
CI:1.09-2.82,p=0.019) se asociaza cu incidenta crescuta
a FA postoperator.
Concluzii: Studiul confrma ca varsta, FEVS si dimen-
siunile AS sunt predictori ai incidentei FA postoperator.
De aceea examenul clinic si ecocardiografc sunt utili in
stratifcarea riscului postoperator de FA.

Predictors of postoperative
atrial fibrillation after coronary
artery bypass graft surgery
in patients treated with
betablockers
R.M.Christodorescu, M. Cocora
1
, S. Ursoniu
2
,
S. Dragan
1
, M. Popa
1
, A. Gheorghiu
1
, D. Darabantiu,
D. Lighezan, M. Tomescu
Clinica de Cardiologie ASCAR,
1
Institutul de Boli
Cardiovasculare Timisoara,
2
Disciplina de Sanatate
Publica,Universitatea de Medicina si Farmacie
Timisoara
Background and objectives: Te detrimental efects
of atrial fbrillation (AF) afer coronary artery bypass
graf surgery (CABG) and the protective efects of beta-
blockers (BB) in AF prevention are well established.
Te aim of the present study was to determine the
inci dence of AF afer CABG and to identify the post-
operative clinical and ecocardiographic predictors of
AF in a cohort of coronary patients(p) treated with
beta blockers.
Methods: In 203 p,consecutively recruited between
January 2005 and December 2007 in the Cardiovascular
surgery department,Te Cardiovascular Institute Timi-
soara the incidence of AF was monitored according
to relevant clinical and ecocardiographic data.Te pa-
tients were treated with 4 BB, metoprolol, bisoprolol,
car vedilol si betaxolol, started before admission and
continued afer surgery. Te results were analysed
according to the risk factors for the entire cohort. Te
follow-up was done until discharge, mean interval
7.71.9days. Te statistical analysis was performed
with the programme STATA 9.2.
Results: Postoperative AF occured in 46 p(22.6%). By
uni variate analysis older age, lower EF and larger LA
were signifcantly associated with a higher incidence
of post CABG-AF ( for all the risk factors p<0.002).
In the logistic regression model we confrmed that
age (OR:1.08,95%, CI:1.04-1.13, p<0.001), EF (OR:
0.95,95%, CI:0.91-0.98, p=0.008), and LA dime nsion
(OR: 1.76,95%, CI:1.09-2.82, p=0.019) were inde pen-
dent predictors of post CABG-AF.
Conclusions: Te present study suggests that age, EF
and LA dimension in p treated with BB are independent
predictors of post CABG-AF. Terefore the clinical and
echocardiografc data may be useful in preoperative risk
stratifcation for the occurrence of post CABG-AF.

Suplimentul A, 2008
ARITMII I
54. Performanta pe termen
lung a sondelor de stimulare
permanenta plasate la nivelul
septului interatrial
Calin Siliste, Margulescu Andrei Dumitru,
Sisu Roxana Cristina, Cinteza Mircea,
Vinereanu Dragos
Cardiologie, Spitalul Universitar de Urgenta Bucuresti,
UMF Carol Davila Bucuresti
Context: Plasarea sondelor la nivelul septului inter-
atrial (SIA) reprezinta o alternativa la stimularea cla-
sica a auriculului drept (AuD), in special datorita re du-
cerii fbrilatiei atriale pe termen lung. In acelasi timp
insa stimularea SIA poate f grevata de difcultati teh-
nice, respectiv de praguri de stimulare mai mari si de
instabilitate pe termen lung a sondelor implantate.
Obiective si Metoda: Obiectivele studiului au fost veri-
fcarea a 2 ipoteze: 1) implantarea SIA nu este inferioara
implantarii AuD din punct de vedere al parametrilor
de stimulare (impedanta, sensing, prag stimulare) la 1
luna, 6 luni si 1 an de urmarire; 2) stimularea SIA ofera
un sincronism interatrial superior implantarii AuD
(evaluat pe baza duratei undei P stimulate). Studiul a
fost retrospectiv pe 14 pacienti (70 +/- 12 ani): 7 pacienti
stimulati la nivelul SIA postero-inferior (grup 1) si un
grup de control (grup 2) format din 7 pacienti similar ca
varsta, mod de stimulare si parametrii ecocardiografci,
stimulati la nivelul AuD. Stimulatoarele cardiace au fost
de tip unicameral AAI (4 pacienti) si bicameral DDD
(10 pacienti). Sondele utilizate au fost de tip Medtronic
5076-52.
Rezultate: Unda P masurata in ritm sinusal (RS) in
cazul grupului 1 a fost superiora fata de grupul 2 (110
ms vs. 83 ms, p = 0.003). Cresterea duratei undei P
stimulate fata de P in RS a fost inferioara in cazul gru-
pului 1 fata de grupul 2 (10 ms vs. 76 ms, p = 0.03); in
con secinta, durata undei P stimulate a fost inferioara in
cazul grupului 1 fata de grupul 2 (127 ms vs 167 ms, p =
0.05). Aceste date sugereaza resincronizare interatriala.
Evolutia parametrilor de stimulare (sensing, impedanta,
prag stimulare) a fost similara in cele 2 loturi la 1 luna,
6 luni si un an dupa implantare: Implantare Luna 1
Luna 6 Luna 12 SIA AuD SIA AuD SIA AuD SIA AuD
Impedanta (ohm) 1131 727 722 528 665 518 431 570
Prag (V) 0.9 1.1 0.7 0.5 0.6 0.5 0.7 0.6 Amplitudine
unda P (mV) 2.6 3.7 3 3.2 0.7 0.6 2.4 2.8
Concluzie: Implantarea unei sonde atriale cu fxare
acti va la nivel SIA este o alternativa implantarii AuD
in privinta parametrilor de stimulare pe termen lung.
Implan tarea SIA ar putea f superioara implantarii AuD
in privinta parametrilor electrici de resincronizare inte-
ratriala.

Long-term performance of
permanent atrial stimulation
leads implanted at interatrial
septum
Siliste Calin, Margulescu Andrei Dumitru, Sisu
Roxana Cristina, Cinteza Mircea, Vinereanu Dragos
Cardiology, University and Emergency Hospital of Bu-
charest, UMPh Carol Davila Bucharest
Background: Lead implantation at interatrial septum
(IAS) level is an alternative to the classical right atrial
appendix (RAA) pacing site, mainly because of the long
term decrease in the incidence of atrial fbrillation.
Meanwhile, IAS pacing can be associated with technical
dif culties, high stimulation thresholds, and long-term
lead instability.
Objectives and Method: Te objectives of this study
were to check the following 2 hypothesis: 1) Pacing
para meters (impedance, sensing, pacing threshold) of
IAS implantation is not inferior to RAA implantation
afer 1, 6, and 12 months of follow-up; 2) IAS pacing
ofers better interatrial synchronicity compared with
RAA pacing (as assessed by P wave duration). Te stu-
dy was retrospective on 14 patients (70 +/- 12 years): 7
pa tients paced at postero-inferior IAS level (group 1)
and a control group (group 2) of 7 patients paced at
RAA level, with similar age, pacing modes, and echo-
car dio graphical parameters. Cardiac pacemakers were
single-chamber AAI mode (4 patients) and dual-cham-
ber DDD mode (10 patients). Te atrial leads were Med-
tronic 5076-52 (active fxation).
Results: Te measured P wave in sinus rhythm (SR) in
group 1 was longer than in group 2 (110 ms vs. 83 ms,
p = 0.003). Te increase of the duration of the paced P
wave as compared with the duration of the P wave in
SR was smaller in group 1 than in group 2 (10 ms vs. 76
ms, p = 0.03); consequently, the duration of the paced
P wave was smaller in group 1 compared with group 2
Suplimentul A, 2008
Te evolution of pacing parameters of the 2 groups at

1, 6 and 12 months of follow-up was similar: Implant
Month 1 Month 6 Month 12 IAS RAA IAS RAA IAS
RAA IAS RAA Impedance (ohm) 1131 727 722 528 665
518 431 570 Treshold (V) 0.9 1.1 0.7 0.5 0.6 0.5 0.7 0.6
P wave amplitude (mV) 2.6 3.7 3 3.2 0.7 0.6 2.4 2.8
Conclusion: Te implantation of active-fxation atrial
leads at IAS level is an alternative to RAA pacing site,
by having similar long-term pacing parameters. IAS
pa cing can be superior to RAA pacing possibly by
impro vement of interatrial synchronicity electrical pa-
ra meters.

55. Implantarea unei sonde de
defibrilare cu fixare activa la
nivelul tractului de ejectie al
ventriculului drept, prin vena
cava superioara stanga
persistenta
Siliste Calin, Vinereanu Dragos,
Margulescu Andrei Dumitru, Cinteza Mircea
Cardiologie, Spitalul Universitar de Urgenta Bucuresti;
Context: Vena cava superioara stanga (VCSS) reprezinta
o anomalie congenitala rara care poate determina dif-
cultati in implantarea sondelor de defbrilare si obti-
nerea unor praguri de defbrilare acceptabile. Rapoartele
precedente au descris implantari ale acestor sonde la sau
adiacent apexului ventriculului drept (VD). Raportam
un caz in care implantarea unei sonde de defbrilare
subtiri, cu fxare activa s-a realizat la nivelul tractului
de ejectie al VD (TEVD).
Prezentare de caz: Un pacient in varsta de 72 de ani, cu
infarct miocardic anterior vechi, insufcienta car diaca
clasa II NYHA, disfunctie ventriculara stanga seve ra
(fractie ejectie 25%), anevrism apical important calci-
fcat, fbrilatie atriala cronica si tahicardie ventriculara
monomorfa instabila hemodinamic, a fost internat in
vederea implantarii unui defbrilator automat intern
(DAI) monocameral. Prin abord cefalic stang, o sonda
de defbrilare dublu-coil cu fxare activa (St. Jude Medi-
cal, Riata 1580-65 cm) a fost introdusa printr-o VCSS
anterior necunoscuta (confrmata prin febografe ulte-
rioara) care drena in sinusul coronar. Sonda a fost plasata
la nivelul TEVD septal folosind un ghid in forma de J
larg. Regiunea apicala a fost evitata intentionat datorita
riscului de perforare asociat mai ales cu acest tip de
sonda. Amplitudinea undei R, pragul de stimulare
si impedanta de stimulare au fost 13.4 mV, 0.9 mV la
0.4 ms si 539 Ohm, respectiv. Sonda a fost conectata
la un DIA monocameral (St. Jude Medical, Epic VR V-
197). Fibrilatia ventriculara a fost indusa si convertita
cu succes la ritm sinusal printr-un soc unic de 20J
intre coil-ul distal si carcasa DIA (protocol de inductie
unica); impedanta de defbrilare a fost 57 Ohm. Dupa
o luna, pozitia sondei si parametrii acesteia au ramas
stabili.
Concluzie: Acest caz reprezinta prima raportare a
implan tarii unei sonde dublu-coil, subtiri, cu fxare
activa, la nivelul TEVD prin VCSS persistenta.

Right ventricular outflow
tract implantation of an active
fixation defibrillation lead
through persistent left
superior vena cava
Siliste Calin, Vinereanu Dragos,
Margulescu Andrei Dumitru, Cinteza Mircea
Cardiology, University and Emergency Hospital of
Bucharest, UMPh Carol Davila Bucharest
Background: Persistent lef superior vena cava (LSVC)
is a rare congenital anomaly which can add dif culties
in placing defbrillation leads and achieving good def-
brillation thresholds. Previous reports described pla ce-
ment of leads at or near the right ventricular (RV) apex.
We report a case of implantation of a thin acti ve fxation
defbrillation lead into the RV outfow tract (RVOT).
Case report: A 72-year-old male with an old anterior
myocardial infarction, NYHA class II, severe lef
ventricular systolic dysfunction (ejection frac tion
25%), large calcifed apical aneurism, chronic atrial
fbri llation, and hemodinamically unstable mono-
mor phic ventricular tachycardia, was admitted for
implan tation of single chamber internal cardioverter-
def bri lla tor (ICD). By lef cephalic venothomy, a
dual-coil active fxation defbrillation lead (St. Jude
Suplimentul A, 2008
ARITMII I
Medical, Riata 1580-65 cm) was advanced through a
previously unknown persistent LSVC (confrmed by
subsequent fe bo graphy), draining into the coronary
sinus. Te lead was placed into the septal RVOT using
a single stylet sha ped like a large rounded J. Te apical
region was deli berately avoided because of the risk for
perforation, espe cially with this type of lead. R wave,
pacing thre shold, and pacing impedance were 13.4
mV, 0.9 mV at 0.4 ms, and 539 Ohms, respectively. Te
lead was connec ted to a single chamber ICD (St. Jude
Medical, Epic VR V-197). Ventricular fbrillation was
induced and successfully terminated with a 20J shock
between the distal coil and the can (one induction
protocol); the def bri llation impedance was 57 Ohms.
One month later, the lead position and parameters
remained stable.
Conclusion: To the best of our knowledge, this is the
frst report of a dual-coil, active fxation defbrillation
lead of thin type succesfully implanted into the RVOT
through a persistent LSVC.

56. Restaurarea ritmului si-
nusal dupa izolarea peretelui
posterior al atriului stang in
fibrilatia atriala persistenta:
de cine depinde?
Mariana Floria, Valentin Ambarus
1
, Ciprian Rezus
1
,
Jacques Jamart
2
, Mark La Meir
2
, Luc De Roy
2
Clinica II Medical, Spitalul Clinic Judeean de Urgene
Sfntul Spiridon Iai
1
Clinica II Medical, UMF Iai, Romnia
2
Cliniques Universitaires UCL de Mont-Godinne, Yvoir,
Belgium
Premize: La pacientii cu fbrilatie atriala (FA) persis-
tenta refractara restaurarea ritmului sinusal (RS) se
poate face printr-o tehnica ablativa minim invaziva.
Scop: Evaluarea parametrilor care infuienteaza restau-
rarea RS la pacientii (pac) supusi izolarii epicardice a
venelor pulmonare in FA persistenta.
Metode: Am evaluat suprafata si volumul atriului stang
(AS) ecocardiografc (EEL) si computer-tomografc
(CTEL), prin metoda elipsoidului, inainte si dupa abla-
tia toracoscopica la pac cu FA persistenta. Functia meca-
nica atriala a fost deasemenea evaluata prin Doppler
transmitral. Am analizat factorii de care depinde res-
taurarea RS la 3 luni postprocedura.
Rezultate: La cei 40 de pac inclusi in studiu FA a fost
continua cu o durata medie de 17 luni (54.5 11.7 ani,
80% B, IMC=27.353.7kg/m
2
). Evaluarea la 5.3 5.1
luni a obiectivat RS stabil la 31 de pac. S-a obtinut deci
controlul adecvat al ritmului, la cei mai multi cu adaus
de medicatie antiaritmica, la 77.5% din pac. S-a observat
o reducere semnifcativa a volumului si suprafetei AS la
pac convertiti si ramasi in RS: EEL=5931ml, CTEL =
8443ml si 25.79.7mm
2
vs. EEL=4816ml, CTEL =
6222ml si 20 5.6mm
2
(p<0.05). Mai mult, o con trac-
tie mecanica efcienta demonstrata de prezenta undei A
la Doppler transmitral s-a constatat la 29 din cei 31 de
pac. Restaurarea RS a fost de 100% la femei si de 83%
la barbati la o suprafata a AS sub 20 mm2. Conversia la
RS nu a depins de varsta, IMC sau volumul AS.
Concluzii: Izolarea peretelui posterior al AS prin tora-
coscopie dreapta pare efcienta la pacientii cu FA per-
sistenta. Remodelarea atriala inversa si conversia la RS
depinde de sex si suprafata AS.

Restoration of sinus rhythm
following isolation of left atrial
posterior wall in persistent
atrial fibrillation: it depends
by who
Mariana Floria, Valentin Ambarus
1
, Ciprian Rezus
1
,
Jacques Jamart
2
, Mark La Meir
2
, Luc De Roy
2
Clinica II Medical, Spitalul Clinic Judeean de Urgene
Sfntul Spiridon Iai
1
Clinica III Medical-Cardiologic, UMF Iai, Romnia
2
Cliniques Universitaires UCL de Mont-Godinne, Yvoir,
Belgium
Background: Sinus rhythm (SR) could be restored
follow ing minimal invasive thoracoscopic approach
in refractory persistent atrial fbrillation (AF) patients
(pts).
Aim: We assessed the parameters that can infuence
the restoration of SR in pts undergoing an epicardial
Suplimentul A, 2008
iso lation of the pulmonary veins for persistent AF.

Methods: We evaluated lef atrial (LA) surface and
vo lu me by echocardiography (EEL) and computer-
tomo graphy (CTEL) with the ellipsoid method, before
and afer right thoracoscopic ablation, in refractory
per sistent AF. Mechanical LA function by transmitral
Doppler was either assessed. We analyzed by who de-
pen ds the restoration of stable SR at 3 months (M) afer
ablation.
Results: Te mean duration of continued AF before
pro cedure, in 40 pts (54.5 11.7 years, 80% men,
BMI=27.353.7kg/m
2
), was 17 M. At the time of
echo cardiographic evaluation (5.3 5.1 M afer inter-
vention), 31 pts were in SR. An adequate rhythm control,
with addition of antiarrhythmic drugs in most of them,
could thus be obtained in 77.5% of pts. We observed
a signifcant reduction of LA volume and surface in
pts who converted and remained in SR, respectively
EEL=5931ml, CTEL=8443ml and 25.79.7mm
2

vs. EEL=4816ml, CTEL=6222ml and 20 5.6mm
2

(p<0.05). Moreover, 29 pts out of 31 in SR had an ef cient
mechanical contraction of the LA, demonstrated by the
presence of an A wave on transvalvular mitral Doppler.
Te restoration of SR was 100% in women and 83% in
men for pts with LA surface <20 mm
2
. However, it was
not depend on age, BMI or LA volume.
Conclusions: Right thoracoscopic approach for isola-
tion of the LA posterior wall seems to be ef cien tly for
persistent refractory AF ablation. A clear morphological
reverse remodeling and the recovery of a stable SR de-
pend on sex and LA surface.
I1
ARITMII II
fost estimata prin fractia de ejectie (EF) si prin viteza
sistolica longitudinala medie (STDE) iar cea diastolica
prin viteza diastolica longitudinala medie (ETDE), E/
Ea si E/Vp.
Rezultate: Sincronismul contractiei si functia sistolica
si diastolica VS nu au fost semnifcativ diferite, pentru
cele 2 situsuri de implantare, la baseline (1) si in urma-
rire la 6 luni (2). In acelasi timp nu au existat modi fcari
semnifcative ale sincronismului si functiei intre cele
2 vizite pentru ambele situsuri de stimulare. Situs sti-
mulare STP (ms) SDS (ms) MxS (ms) SDD (ms) MxD
(ms) APD (ms) Inter (ms) EF (%) STDE (cm/s) ETDE
(cm/s) E/Ea E/Vp Apical1 9054 4119 7939 2921
1710 3835 7342 568 40.9 5.51.8 148 2.61
Apical2 9255 3521 4949 6277 1611 3325 4366
526 40.9 4.91.9 175 2.50.9 Septal1 17298 4716
8738 4225 5742 4216 13135 5410 4.21.2
4.81.8 138 1.30.7 Septal2 16476 4022 5750
3418 3542 4320 6157 486 4.40.9 5.11.7 147
1.60.5
Concluzii: Nu exista diferente majore pe termen scurt
si mediu, in functia sistolica si diastolica VS si sincro-
nismului, pentru cele 2 situsuri de implantare, la pa-
cientii cardiostimulati permanent. De aceea situsul de
implantare adecvat ar putea depinde de caracteristicile
individuale ale pacientilor.

Similar short- and mid- term
effects on cardiac synchrony
and function, between apical
and septal right ventricular
permanent pacing
R. Sisu, A. Margulescu, C. Siliste, M. Cinteza,
D. Vinereanu
University of Medicine Carol Davila, Bucharest,
Romania
Background: Pacing at the apex of right ventricle is
the most used technique for pacemaker implantation,
being simple and giving stable lead position and stable
57. Cardiostimularea
permanenta septala versus
apicala ventricul drept - efecte
similare pe termen scurt si
mediu asupra functiei
ventriculare stangi si
sincronismului
R. C. Sisu, A. D. Margulescu, C. Siliste, M. Cinteza,
D. Vinereranu
Spitalul Universitar de Urgenta Bucuresti
Premisele teoretice: Stimularea permanenta la nivelul
apexului ventriculului drept (VD) este cea mai utilizata
tehnica de stimulare find accesibila, avand o pozitie
a electrodului si prag stimulare stabile. La pacientii
stimulo dependenti, acest situs de stimulare ar putea
induce un asincronism important de contractie si conse-
cutiv disfunctie ventriculara stanga. In acest context,
stimularea septala VD, printr-o activare posibil mai
fziologica ar putea f o alternativa mai buna.
Scopul studiului: La pacientii cu cardiostimulare per-
manenta s-au comparat pentru cele 2 situsuri de stimu-
lare, efectele pe termen scurt si mediu asupra functiei
cardiace si sincronismului, prin ecocardiografe conven-
tionala si doppler tisular.
Metoda: Au fost inclusi 40 pacienti (738 ani, 19 bar-
bati), 20 stimulati apical si 20 septal VD afati la 114
luni de la implantare. 24 dintre ei au fost urmariti la 6
luni de la includere (13 stimulati apical). Masuratorile
doppler tisular s-au facut la nivelul celor 6 segmente
bazale VS si bazal VD. Pentru fecare segment s-au
masu rat velocitatile sistolice si diastolice si timpul
debut QRS - velocitate maxima sistolica si diastolica.
Asin cro nismul intraventricular a fost cuantifcat prin
intar zierea miscarii sept-perete posterior VS (STP),
devia tia standard (sistolica - SDS si diastolica - SDD)
si diferenta maxima (sistolica - MxS si diastolica -
MxD) a timpilor miocardici VS. Asincronismul inter-
ven tricular a fost cuantifcat prin intarzierea fux aor-
tic-fux pulmonar (APD) si diferenta maxima intre
seg men tele bazale VS si VD (Inter). Functia sistolica a
ARITMII II Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
I2
threshold. However, in pacing-dependent patients, this
site might cause signifcant asynchrony, inducing lef
ventricular dysfunction. Terefore, septal right ven tri-
cular pacing, by using more physiological electrical acti-
vation pathways, might be a better alternative.
Purpose: To compare short- and mid- term efects on
cardiac synchrony and function, by conventional and
tissue Doppler echocardiography, between the two
pacing sites, in chronically implanted patients.
Methods: 40 pacing-dependent patients (738 years,
19 men), 20 paced at the apex and 20 at the septal
level (age-matched), were studied 114 months afer
implan tation. For 24 of them (13 paced at the apex), a 6
months follow up visit was performed. Tissue Doppler
measurements were made from 6 lef ventricular basal
myocardial segments, and one right ventricular seg-
ment. For each segment, peak systolic and diastolic
velo cities, and time-to-peak systolic and diastolic velo-
cities were measured. Intra-ventricular synchrony was
asse ssed from septal-to-posterior wall motion delay
(STP), standard deviation (systolic - SDS, and diastolic
- SDD), and maximal diference (systolic - MxS, and
dias tolic - MxD) of the lef ventricular myocardial ti-
min gs. Inter-ventricular synchrony was assessed from
the aorto-pulmonary fow delay (APD), and maximal
dife rence between any lef ventricular segment and the
right ventricular segment (Inter). Systolic function was
assessed from ejection fraction (EF), and mean longi-
tudinal systolic velocity (STDE); diastolic function
from mean longitudinal diastolic velocity (ETDE), E/
Ea ratio, and E/Vp ratio.
Results: Cardiac synchrony and function were not
signi fcantly diferent between the two pacing sites at
base line (1), and afer 6 months follow-up (2) (table).
Mean while, there were no signifcant changes in syn-
chrony and function between the two visits for both
pacing sites. STP (ms) SDS (ms) MxS (ms) SDD (ms)
MxD (ms) APD (ms) Inter (ms) EF (%) STDE (cm/s)
ETDE (cm/s) E/Ea E/Vp Apical1 9054 4119 7939
2921 1710 3835 7342 568 40.9 5.51.8 148
2.61 Apical2 9255 3521 4949 6277 1611 3325
4366 526 40.9 4.91.9 175 2.50.9 Septal1 17298
4716 8738 4225 5742 4216 13135 5410
4.21.2 4.81.8 138 1.30.7 Septal2 16476 4022
5750 3418 3542 4320 6157 486 4.40.9 5.11.7
147 1.60.5
Conclusion: Tere are no major diferences during
short- and mid- term follow up, for cardiac synchrony
and function, between the two pacing modalities in
chro nically implanted patients. Terefore, appropriate
pacing site should depend on individual patient charac-
teristics.

58. Reprezinta testul mesei
nclinate o investigaie util n
predicia recurenelor pe
termen scurt (6 luni) la
pacienii cu sincope
vasovagale?
Dr. Daniel Gherasim, Dr. Razvan Ticulescu,
Dr. Irina Marin
Bucuresti
Scop: Testul mesei nclinate intr n protocolul curent
de evaluare a bolnavilor cu suspiciune de sincop vaso-
vagal. Scopul lucrarii este de a investiga daca exist un
marker de predicie a recurenelor derivat din rspunsul
la test.
Metoda: Din 725 pacieni consecutivi care au efectuat
testul mesei nclinate ntre 1997 2007, am selecionat
pe cei testai pe parcursul anului 2007, pentru care am
avut date complete de identifcare si contact. Au fost
realizate 54 de teste, la pacieni cu vrsta intre 7 si 84
de ani, 23 find de sex masculin si 31 femei, protocolul
folosit constnd in nclinarea mesei la 70 grade, timp
de 30 de minute, rspunsul find considerat pozitiv la
dezvoltarea sincopei. Toi pacientii care au efectuat
testul au fost chestionai telefonic la 6 luni, indiferent
de rspunsul obinut la test.
Rezultate: Testul a fost pozitiv la 6 dintre pacienti
(11,1%), distribuii egal pe sexe (3 barbati si 3 femei), 2
raspunsuri find de tip mixt si 4 de tip cardioinhibitor
(1 de tip II A si 3 de tip II B, conform clasifcarii VASIS).
Niciunul dintre pacienii cu test pozitiv nu a repetat
sincopa n interval de 6 luni. Dintre cei cu test negativ,
3 pacieni (2 femei si un barbat) au repetat sincopa in
intervalul amintit. Ca o caracteristica comun, toti 3
descriseser mai mult de 2 episoade sincopale pna la
efectuarea testului mesei nclinate.Vrsta celor care au
repetat sincopa a fost cuprinsa intre 18 si 76 de ani.
Suplimentul A, 2008
I8
ARITMII II
Concluzie: In predictia recurenelor pe termen scurt,
rezultatul pozitiv la testul mesei nclinate nu are semni-
fcaie. Este posibil ca alte elemente, cum ar f numarul
episoadelor sincopale la prezentare, s fe mai utile
in predicia recurentelor. Studiul este prospectiv si
isi propune s inregimenteze un numr mai mare de
subieci si pe o perioad mai ndelungat de urmrire
pentru a trage o concluzie mai clar.

Syncope recurrence at 6
months can be predicted by
head-up tilt testing in patients
with vasovagal syncope?
Dr. Daniel Gherasim, Dr. Razvan Ticulescu,
Dr. Irina Marin
Institute of Cardiovascular Disease Prof.Dr.C.C.Iliescu
Bucharest
Background: Head-up tilt testing is widely used in the
evaluation of patients with suspected vasovagal syncope.
Te aim of the study was to prospectively analyze if we
can fnd a marker for recurrence of syncope from tilt
test results.
Methods: We included the patients referred for head-up
tilt testing in 2007, from 725 patients which performed
the tilt-testing between 1997 and 2007.
Te identifcation and contact data were colected for all
patients in 2007.
Te protocol used consisted in tilting the table at 70
for 30 minutes.A positive response was noted in patients
which developed syncope.Te test was performed in
54 patients, with distribution of age between 7 and 84
years, 23 being males and 31 females.
Results: Te test was positive in 6 patients (11,1%), 3
males and the same number of females.Te positive
responses were classifed (VASIS classifcation) as type
I mixed (2 patients), type II A (one patient) and type II
B (cardioinhibition with asystole in 3 patients).None of
the patients with positive response have a reccurence
during follow-up. Tree of the patients with negative
response (2 females and one male) at tilt testing have
a reccurence in 6 month. All of them described at least
2episodes of syncope in the past.Te age of patients
with reccurence varied between 18 and 76 years.
Conclusions: In patients with vasovagal syncope, a
posi tive response at tilt testing is not a marker for reccu-
rences.Te number of syncopes at admission is possible
to corelate with risk of recurrence. More patients and a
longer follow-up are needed for better conclusions.

59. Importana localizrii
electrocardiografice a cilor ac-
cesorii atrioventriculare n tac-
tica studiului electrofiziologic
Andrei Lozb, Mihaela Grecu,
Institutul de Boli Cardiovasculare Prof. Dr. George
I.M. Georgescu Iai
Introducere: Studiul i-a propus s puna n eviden
valoarea localizrii cilor accesorii la pacienii cu
sindrom Wolf Parkinson White n tactica studiu-
lui electrofziologic endocavitar i a ablaiei prin radio-
frecven. n acest scop a fost propus o diversitate de
algoritmi, din care au fost selectai 2, a cror acuratee
a fost testat prin compararea cu rezultatele obinute
prin mapping endocavitar.
Material si metod: Lotul de studiu a fost format din
103 pacieni cu aspecte electrocardiografce sugestive
pentru un sindrom de preexcitaie evaluai n cadrul
Laboratorului de Electrofziologie al Institutului de Boli
Cardiovasculare Prof. Dr. George I. M. Georgescu
Iai, supui studiului electrofziologic n perioada 2002
2007. Localizarea cilor accesorii s-a fcut prin ana-
liza electrocardiogramelor de suprafa 12 derivaii n
repaus, ct i n timpul tahicardiei prin reintrare atrio-
ventricular. Rezultatul a fost comparat cu localizarea
cilor accesorii prin studiu electrofziologic endocavitar.
Pentru identifcarea localizrii cii accesorii manifeste
pe electrocardiograma de repaus ( 82 cazuri) s-a folosit
un algoritm bazat pe polaritatea complexului QRS in
5 derivatii (DII, DIII, aVL, V1, V2). n cazul cilor
acce sorii oculte, a fost evaluat aspectul undelor P
retro grade (morfologie i polaritate) n derivaiile DI,
DII, DIII, aVF i V1 pe traseele electrocardiografce
din timpul episoadelor de tahicardie (21 cazuri). Loca-
lizarea endocavitar a preexcitaiei s-a fcut prin mapp-
ing la nivelul inelelor tricuspidian i mitral n poziie
anteroposterioar, oblic anterior stng i oblic anterior
drept, urmrindu-se intervalul AV minim, timpul de
activare endocavitar ca i aspectul QS al depolarizrii
Suplimentul A, 2008
I1
ventriculare n derivaia unipolar i avnd ca reper
punctul de succes al aplicaiilor de curent de radio-
frecven.
Rezultate: n total, utilizarea celor 2 algoritmi n
ambele situaii de ci accesorii a dus la o estimare pre-
cis a localizarii preexcitaiei in 90/103 cazuri (87.4%).
Loca lizarea ventricular a cailor accesorii manifeste a
fost corect n 90% din cazuri (att ci drepte ct i ci
stngi), iar corelaia exact cu localizarea endocavitar
n 73 /82 cazuri (89%) din care 41/44 cazuri (93.2%) pen-
tru cile accesorii drepte i 32/38cazuri (84.2%) pentru
cile accesorii stngi. Localizarea cilor accesorii oculte
a fost corect n 17 /21 cazuri (80.9%). Localizarea ci-
lor accesorii manifeste se realizeaz cu acuratee mai
mare pentru cile accesorii drepte. Eroarea de localizare
a cilor accesorii manifeste i oculte a fost de maxim un
sfert de cadran.
Concluzii: Aplicarea algoritmilor de localizare a cilor
accesorii pe electrocardiograma de suprafa este o
moda litate simpl, rapid i precis de localizare a cilor
accesorii, permind mappingul intit endocavitar, ceea
ce duce la scurtarea timpului de realizare a procedurii
i a timpului de iradiere.

The importance of the electro-
cardiographic localization of
the atrioventricular accessory
pathways in the tactics of the
electrophysiological study
Andrei Lozb, Mihaela Grecu,
Cardiovascular Diseases Institute Prof. Dr. George
I.M. Georgescu Iai
Introduction: Te aim of the study was to underline
the value of the localization of the accessory pathways
in patients with Wolf Parkinson White syndrome
in the tactics of the electrophysiological study and
radiofrequency ablation.In this purpose, a multitude of
electrocardiographical algorithms was proposed, from
which only 2 were selected and their accuracy was
tested through comparison with the results obtained
from the endocavitary mapping.
Material and method: Te study was performed on
a group of 103 patients with electrocardiographical
aspects suggestive of preexcitation syndrome evalua-
ted in the Electrophysiological Laboratory of the Car-
diovascular Diseases Institute Prof. Dr. George I.M.
Georgescu Iai that underwent electrophysiological
studies between 2002 and 2007. Te localization of
the accessory pathways was made through the analyze
of the resting 12 lead electrocardiograms and the
electrocardiograms recorded during the tachycardia
episodes. Te result was compared to the localization
of the accessory pathways through endocavitary electro-
physiological study. An algorithm based on the QRS
polarity in 5 leads (DII, DIII, aVL, V1 and V2) was used
for the location of the manifest accessory pathways (82
cases). In the case of occult accessory pathways, there
was analized the aspect of the retrograde P waves
(morphology and polarity) in the leads DI, DII, DIII,
aVF and V1 on the electrocardiograms recorded during
episodes of tachycardia (21 cases). Te endocavitary
localization of the preexcitation was made through
mapping at the levels of the tricuspid and mitral
annulus, in anteroposterior, right anterior oblique, lef
anterior oblique, by observing the shortest AV interval,
the endocavitary activation time, QS aspect of the
ventricular depolarization in unipolar leads, and the
successful ablation site.
Results: Te use of the 2 algorithms in the 2 types of
accessory pathways led to an accurate estimation of the
localization of preexcitation in 90/103 cases (87.3%).
Te ventricular localization of manifest accessory
path ways was accurate in 90% cases (both for right
and lef pathways) and the exact correlation with the
endo cavitary localization was in 73/82 cases (89%),
41/44 cases (93.2%) for right pathways and 32/38 cases
(84.2%) for lef pathways. Te localization of the occult
pathways was correctly assessed in 17/21 cases (80,9%).
Te localization of manifest accessory pathways is more
accurate for the right sided pathways. Te localization
on the surface electrocardiogram of manifest and occult
accessory pathways is made with an error of an quarter
of a quadrant.
Conclusions: Te use of the algorithms for the loca-
lization of the accessory pathways is an easy, fast and
accurate tool for their localization, thus allowing the
targeted endocavitary mapping, that leads to the shor-
tening of the procedural time and of the radiation expo-
sure time.

Suplimentul A, 2008
I5
ARITMII II
60. Prezentare orala
Ablatia prin curenti de
radiofrecventa folosind
sistemul de maping non
contact ensite: experienta
a sase ani
R.Bolohan, R.Alexandru
1
, L.Chiriac,
Veronica Indries, Mihaela Mihai, Mihaela B. Leustean,
D. Nita, G. Cristian
Centrul Clinic de Urgenta de Boli Cardiovasculare al
Armatei Bucuresti
1
Medtronic Romania
Din mai 2002 functioneaza in cadrul Laboratorului de
electrofziologie al Centrului Clinic de Urgenta de Boli
Cardiovasculare al Armatei Bucuresti primul sistem de
maping noncontact din Romania. Prezentam activitatea
celor sase ani in care am efectuat ablatie prin curenti de
radiofrecventa folosind sistemul de maping noncontact
EnSite.
Am realizat 45 de ablatii prin curenti de radiofrec ven-
ta in perioada mai 2002-mai 2008; 28 barbati (62,2%)
si 17 femei(37,8%), cu media de virsta de 48 ani (26-69
ani).
Lotul de studiu a cuprins: -futter atrial postincizional
(dupa interventie chirurgicala pe cord deschis)- 8 pa-
cienti (17,7%)
- tahicardie automatic atriala dreapta- 3 pac.(6,7%)
- futter atrial +tahicardie automatica AD- 3 pac
(6,7%)
- futter atrial +focar extrasistolic AD- 4 pac (8,8%)
- futter atrial +tahicardie paroxistica supraven-
tri culara prin reintrare intrajonctionala- 8 pac
(17,8%)
- futter atrial- 19 pac (42,3%) (5 pac si cu fu-
tter 1:1)
Rezultate: La 39 de pacienti (86,6%) procedura a fost
efcienta; 3 pacienti (6,7%) au necesitat repetarea pro-
cedurii, la 3 pacienti (6,7%) terapia ablativa a fost ine-
fcienta la distanta.
Flutter atrial cu circuit deplasabil am observat la 9
pacienti (20,1%)
Concluzii: 1. Avantaje: evidentierea circuitelor elec tri-
ce, a focarelor extrasistolice, vizualizarea zonelor de
ablatie, scurtarea timpului de ablatie si a timpului de
expu nere radiologica, la pacientii cu cavitati mari, cu
zone anevrismale, cu circuite atipice, cu circuite profun-
de, cu ablatii anterioare inefciente, ablatia tulburarilor
de ritm asociate si numar mic de sonde
2. Dezavantaje: manevrabilitatea difcila a sondelor
in jurul balonului, timp suplimentar pentru procedurile
de pregatire ale balonului, pretul.

Radiofrequency ablation
using ensite non contact
mapping system: experience
of 6 years
R. Bolohan, R. Alexandru
1
, L. Chiriac,
Veronica Indries, Mihaela Mihai, Mihaela B. Leustean,
D. Nita, G.Cristian
Armys Emergency Clinical Center of Cardiovascular
Diseases, Bucharest
1
Medtronic Romania
Since May 2002 we have the frst non contact
mapping system from Romania in our Laboratory of
Electrophysiology of Armys Emergency Clinical Cen-
ter of Cardiovascular Diseases from Bucharest. We
would like to present our 6 years activity when we
pe r for med radiofrequency ablation using EnSite Non-
contact Mapping System.
We realized 45 radiofrequency ablations between
May 2002 and May 2008, 28 men (62.2%) and 17 women
(37.8%), mean age 48 years old (26-69 years old).
Material: Te patients were diagnosed with:
- Postincisional atrial futter (afer open heart sur ge-
ry) - 8 patients (17.7%)
- Right atrial automatic tachycardia -3 patients
(6.7%)
- Atrial futter and right atrial automatic tachycardia
3 patients (6.7%)
- Atrial futter and right atrial ectopic beats- 4
patients (8.8%)
- Atrial futter and supraventricular intranodal re-
entry tachycardia- 8 patients (17.8%)
- Atrial futter -19 patients (42.3%) (among them
there were 5 patients with 1:1 atrial futter
Results: Te procedure was ef cient to 39 patients
(86.6%). 3 patients (6.7%) needed the repetition of the
ablation and at 3 patients (6.7%) the radiofrequency
ablation wasnt ef cient for long time.
Suplimentul A, 2008
I6
We observed 9 patients (20.1%) with moving circuit
atrial futter
Conclusions: 1. Advantage: the possibility to see elec-
trical circuits, ectopic foci and ablation zone, shorter
ablation time and radiological exposure time, the
possibility of ablation for patients with large cavities,
aneurismal zone, atypical or deep circuits or in case of
inefective prior ablation, the possibility of ablation for
patients with associated rhythm disturbances and the
use of a small number of catheters.
2. Disadvantage: the dif culty to move the catheters
on all sides of the balloon, the need of an extra time for
preparing the balloon and the price of the procedure.

61. Insuficienta cardiaca si
fibrilatia atriala -
caracteristici generale si
factori de prognostic
Ileana epe Piser, Mdlina Patrichi, Rodica Cioranu
Stnescu, Iulia Kulcsar, A. Carp, E. Stoica,
O. Chioncel, C.Macarie
Bucureti
Fibrilatia atriala (FiA) este cea mai frecventa aritmie
cardiaca intalnita in cardiologia clinica, in special la
pacientii cu insufcienta cardiaca. Prevalenta acesteia
creste odata cu gradul de disfunctie a ventriculului
stang si severitatea simptomelor insufcientei cardiace.
Dezvoltarea FiA la pacientii cu insufcienta cardiaca
duce la cresterea mortalitatii.
Scopul studiului: Analiza caracteristicilor generale si a
factorilor de prognostic la pacientii cu fbrilatie atriala si
insufcienta cardiaca cu disfunctie sistolica, comparativ
cu pacientii cu fbrilatie atriala si insufcienta cardiaca
cu fractie de ejectie prezervata a ventriculului stang.
Materiale si metode: Grupul de studiu a inclus 463 de
pacienti internati cu diagnosticul de fbrilatie atriala
si insufcienta cardiaca, clasa III-IV NYHA, admisi la
Sectia 1 de Cardiologie a Institutului C.C. Iliescu, in
perioada ianuarie 2004- decembrie 2007. Criteriile de
excludere au fost: boli valvulare severe, cardiomiopatie
hipertrofca obstructiva, cardiomiopatie restrictiva,
pericardita, stadiu avansat de neoplazie, pacemaker,
creatinina ser> 3 mg/ dl.
Fractia de ejectie prezervata a fost considerata >=
50%. Datele au fost analizate folosind un program
SPSS.
Rezultate: Incidenta fbrilatiei atriale la pacientii cu
insufcienta cardiaca clasa III-IV NYHA a fost 34,2%.
La internare, 57,12% din pacienti au fost cu clasa III
NYHA, 42,8% cu clasa IV NYHA. La externarea , 14%
din pacienti au fost cu clasa II NYHA, 79% cu clasa III
NYHA si 7% din pacienti au fost cu clasa IV NYHA.
In functie de valoarea fractiei de ejectie a ventri cu-
lului stang, pacientii au fost impartiti in doua grupuri:
69,5% cu fractie de ejectie < 50% si 30,5% cu fractie de
ejectie >=50%.
Varsta medie a grupului de studiu a fost de 68,13 ani.
Reprtitia pe sexe a fost de 38,1% sex feminin si 61,9%.
Sex masculin. In grupul cu fractie de ejectie prezervata
au predominat barbatii 81,7% vs 42% femei. Varsta
medie a grupului cu fractie de ejectie prezervata a fost
de 67,2 ani iar in cel cu disfunctie sistolica de VS a fost
de 66,02 ani. Etiologia ischemica, diabetul zaharat si
cardio miopatiile au fost mai frecvente la pacientii cu
dis functie sistolica VS comparativ cu grupul cu frac tia
de ejectie prezervata: 36% vs 18%, 25% vs 22%% vs 4%.
in timp ce hipertensiunea a fost mai frecvent intalnita la
pacientii cu fractie de ejectie pre zervata (67% vs 58%).
Prevalenta obezitatii (22,9%) si dislipidemiei (42%)
a fost similara in ambele grupuri. Consumul de alcool
a avut o frecventa de 13% la pacientii cu fractie de
ejectie prezervata in comparatie cu 21% la pacientii
cu disfunctie sistolica a ventriculului stang. Nivelul
mediu al ureei a fost mai ridicat in grupul cu disfunctie
sistolica 68+-32 mg/ dl vs 57+-14 mg/ dl, iar valoarea
medie a sodiului plasmatic a fost mai scazut in grupul
cu disfunctie sistolica 134+-19 mmol/ l vs 139+-8,2
mmol/ l. Valoarea medie a BNP-ului a fost de 650 pg/
dl, fara diferente intre cele doua grupuri. Au existat mai
multi pacienti cu un QRS complex >120 ms in grupul
cu FE<50%,(26%) decat in grupul cu FE>50%. (9,7%).
Accidentul vascular cerebral a fost mai des intalnit
la pacientii cu disfunctie sistolica de ventricul stang
(13,6% vs 6,8%). Durata medie a spitalizarii la pacientii
cu disfunctie sistolica de ventricul stang a fost de 6,2 zile
iar la cei cu fractie de ejectie prezervata a fost de 5,51
zile. Analiza mortalitatii si a variabilelor asociate cu
aceasta a fost realizata pe un subgrup, care a inclus 256
de pacienti internati intre ianuarie 2004 si octombrie
2006. Perioada medie de supervizare a fost de 709+481
zile (de la 8 luni la 56 de luni). Mortalitatea generala a
fost de 43,1%. Analiza univariata a aratat ca factorii de
risc pentru mortalitate au fost genul masculin, fractia
Suplimentul A, 2008
II
ARITMII II
de ejectie si valoarea BUN. Analiza multivariata a aratat
ca barbatii prezinta o mortalitate mai ridicata decat
femeile (semnifcatia statistica p=0,001) si ca disfunctia
sistolica (FE VS <40%) a crescut riscul mortalitatii de
4,29 ori (p=0,003). ACEI si beta-blocantii la externare
au fost factori de protectie (p=0,003, respectiv p=0,004),
care au scazut mortalitatea de 4-5 ori.
Concluzii: 1) In grupul de pacienti cu insufcienta
car diaca, fbrilatia atriala este mai frecventa la cei cu
disfunctie sistolica de ventricul stang.
2) Studiul furnizeaza date epidemiologice, carac-
teristici clinice si biologice la pacientii cu insufcienta
cardiaca si fbrilatie atriala.
3) La aceasta categorie de pacienti s-a constatat o
mortalitate crescuta pe termen lung. Factorii de prog-
nostic negativi in analiza multivariata au fost genul
masculin si disfunctia sistolica si factorul de protectie a
fost tratamentul cu ACEI si BB.

Heart failure and atrial
fibrillation - general
characteristics and
prognosis factors
Ileana epe Piser, Mdlina Patrichi, Rodica Cioranu
Stnescu, Iulia Kulcsar, A. Carp, E. Stoica,
O. Chioncel, C. Macarie
Bucureti
Atrial fbrillation (AF) is the most common sustained
cardiac arrythmia encountered in clinical cardiology,
particularity in patients with heart failure. Its
prevalence increases with the degree of lef ventricular
dysfunction and severity of heart failure symptoms.
Te development of AF in patients with heart failure
has been shown to result in increased mortality.
Aims: Analysis of the general characteristics and prog-
nosis factors in patients with atrial fbrillation and
heart failure with systolic dysfunction comparative
with patien ts with atrial fbrillation and heart failure
with preserved lef ventricle ejection fraction.
Material and methods: Te group of study included
463 patients successive hospitalized with diagnosis of
atrial fbrillation and heart failure, NYHA class III-
IV, admited in Cardiology 1ST Department of C.C.
Iliescu Institute, between January 2004- December
2007.
Exclusion criteria were: severe valvular diseases,
hyper trophic obstructive cardiomyopathy, restrictive
cardio myopathy, pericarditis, advanced stage neoplasia,
pace maker, serum creatinine >3 mg/ dl.
Preserved ejection fraction was considered > =50%.
Data were analysed using a SPSS program.
Results: Te incidence of atrial fbrillation in patients
with heart failure NYHA class III- IV, was 34,2%. At
admission, 57,12% of patients were with NYHA class
III, 42,8% with NYHA class IV. At discharge of hospi-
tal, 14% of patients were with NYHA class II, 79%
were with NYHA class III and 7% of patients were with
NYHA class IV. According to ejection fraction value of
lef ven tricle, patients were separated in 2 groups: 69,5%
with ejec tion fraction <50% and 30,5% with ejection
frac tion>=50%. Te mean age of the study group was
68,13 years.
Te gender separation was 38,1% of female gender
and 61,9% of male gender. In the group with preserved
ejection fraction were mainly 81,7% males vs. 42%
females. Median age of the group with preserved
ejection fraction was 67,2 years and 66,02 years in the
group with systolic dysfunction. Etiologic factors of
the heart failure had a higher prevalence of ischemic
cardiac disease, diabetus mellitus and cardiomyopathy
in patients with systolic dysfunction comparative with
preserved lef ventricle ejection fraction: 36% vs 18%,
25% vs 22%, 16 vs 4%. Hypertension was more frequent
in patients with preserved ejection fraction (67% vs
58%). Obesity (22,9%) and dislipidemy (42%) pre valen-
ce was similar in the both groups. Te alco hol intake
had a frequency of 13% in patients with preser ved ejec-
tion fraction in comparison with 21% in patients with
lef ventricular systolic dysfunction. Mean blood urea
nitrogen level was higher in the group with systolic
dysfunction 68+-32 mg/ dl vs. 57+-14 mg/ dl and the
mean value of serum sodium was lower in the group
with systolic dysfunction 134+-19 mmol/l vs. 139+-
8,2mmol/l. Te mean value of BNP was 650 pg/ dl, with
no diferences between the two groups. Tere were
more patients with an QRS complex >120 ms in the
group with EF <50% than in the group with EF >50%.
(26% vs 9,7%). Te stroke was more frequent in patients
with lef ventricular systolic dysfunction (13,6% vs
6,8%). Te mean hospitalisation duration in patients
with lef ventricular systolic dysfunction was 6,2 days
and in those with preserved ejection fraction was 5,51
days. Mortality analysis and variables associated with
Suplimentul A, 2008
I8
mortality was realized on a secondary group which
included 256 patients hospitalized between January
2004- October 2006. Median supervising period was
709+481 days (from 8 months to 56 months). Overall
mortality was 43,1%. Univariable analysis has shown
that the risk factors for mortality were male gender, ejec-
tion fraction and BUN value. Te multivariable analy-
sis has shown that males present a higher mortality
than females (statistical signifcance p=0,001) and that
sys tolic dysfunction (FE VS <40%) increased mortality
risk 4,29 times( p=0,003). ACEI and beta- blockers at
dis charge were protection factors(p=0,003, respectively
p=0,004) which decreased the mortality 4-5 times.
Conclusions: 1) In the group of patients with heart
failu re, atrial fbrillation is more frequent in those with
lef ventricular systolic dysfunction.
2) Tis study shows epidemiologic data, clinical and
bio lo gical characteristics in patients with heart failure
and atrial fbrillation.
3) It was found an increased long term mortality.
Nega tive prognosis factors in multivariable analysis
were masculine gender and systolic dysfunction and
pro tection factor was the treatment with ACEI and
BB.
I9
POSTER FORUM II
Concluzii: Menopauza afecteaza nivelul tensiunii arte-
riale. Cresterea presiunii arteriale dupa menopauza
pare sa se coreleze cu cresterea prevalentei altor factori
de risc CV majori (diabet, dislipidemie). Desi un numar
mare dintre femeile hipertensive la menopauza urmea-
za tratament, controlul valorilor tensionale este foarte
scazut si fara diferenta semnifcativ statistica in compa-
ratie cu populatia adulta a Romaniei.
Factori risc
Femei la menopauza
(n=150)
Lotul global
(2017)
p
Hipertensiunea
Prevalenta
Constientizarea
Tratati
Controlati
(% din toti hipertensivii)
66.6% 45% <0.01
73% 54.4% <0.01
61% 39% <0.01
12% 7.8% ns
Media TAS mmHg 145.725.0 137.623.4 <0.01
Media TAD mmHg 88.514.4 83.113.1 <0.01
Obezitatea viscerala 65.3% 37%
Fumat 14% 29% <0.01
Diabet zaharat 12% 5% <0.01
TAG 16% 14% ns
Dislipidemie 64% 46% <0.01
Sindrom metabolic 58% 21% <0.01

Prevalence of major
cardiovascular risk factors in
postmenopausal women.
Data from SEPHAR study.
M. Dorobantu
1
, E. Badila
1
, S. Ghiorghe
1
,
R. O. Darabont
2
, G. Datcu
3
, M. R. Luca
4
1
Emergency Hospital Bucharest
2
Universitary Hospital Bucharest
3
Sf. Spiridon Hospital Iasi
4
Bios Diagnostic;
Aim: of this aub study was to assess the prevalence of
major cardiovascular risk factors in postmenopausal
women in Romania.
Methods: Missing the recent epidemiological data
about the major CV risk factors, was the reason for
star ting in 2005 a national study (SEPHAR) which had
the main goal to assess these parameters. Te study has
involved 2017 adult subjects (a representative sample
62. Prevalenta factorilor de risc
cardiovasculari majori la
femeile la menopauza.
Date din studiul SEPHAR
M. Dorobantu
1
, E. Badila
1
, S. Ghiorghe
1
,
R. O. Darabont
2
, G. Datcu
3
, M. R. Luca
4
1
2
3
Spitalul Sf. Spiridon Iasi
4
Bios Diagnostic
Obiectiv: a fost aprecierea prevalentei factorilor de risc
cardiovasculari majori la femeile la menopauza din
Romania.
Metoda: In 2005, in Romania s-a desfasurat studiul
SEPHAR, primul studiu epidemiologic care a avut ca
scop aprecierea prevalentei hipertensiunii arteriale si
a altor factori de risc CV majori in populatia adulta
a tarii noastre. Au fost inclusi 2017 subiecti cu varsta
cuprinsa intre 18-85 ani, esantion reprezentativ pentru
populatia adulta a Romaniei. Examinarea fecarui indi-
vid a constat intr-un chestionar completat de catre o asis-
tenta, masurarea tensiunii arteriale, masuratori antro-
pometrice si teste de laborator. In acest sub-studiu din
SEPHAR am analizat prevalenta factorilor de risc CV
majori la femeile la menopauza. Obezitatea viscerala
a fost defnita la valori ale circumferintei abdominale
>102 cm la barbati si >88 cm la femei. Diabetul zaharat
a fost considerat cand glicemia 126 mg/dl; valoarea
intre 100-126 mg/dl a fost interpretata ca toleranta alte-
rata la glucoza. Sindromul metabolic a fost defnit in
acord cu criteriile NCEP ATP III. Menopauza a fost
apreciata dupa istoricul pacientei de sangerari mens-
truale.
Rezultate: Dintre cei 2017 subiecti inclusi in SEPHAR
au fost identifcate 150 femei la menopauza. Distributia
pe grupe de varsta a fost urmatoarea: 35-44 ani - 4% ; 45-
54 ani -30.6%; 55-64 ani - 41.3%; 65 ani - 24% femei.
In functie de aria de resedinta, au fost 62.6% femei in
mediu urban si 37.3% in mediu rural. Prevalenta facto-
rilor de risc CV majori la femeile la menopauza este
redata in tabel. Prevalenta hipertensiunii in popu latia
adulta a Romaniei a fost 45%.
POSTER FORUM II Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
80
for the Romanian adult population, range age 18-85
yrs). Te examination consisted of a nurse-completed
que s tio nnaire, blood pressure (BP) measurement, anth-
ro pometrical measurements and laboratory tests. In this
sub study from SEPHAR we analyzed the pre valence
of major risk factors in postmenopausal women. Te
visceral obesity was defned as waist circumference
>102 cm in males and >88 cm in females. Diabetes was
considered when glycemia 126mg/dl; a value between
100 and 126 mg/dl was impairing fasting glucose
(IFG). Te metabolic syndrome was defned in accord
with NCEP ATP III criteria. Te menopausal status was
assessed using patients history of menstrual bleeding.
Results: Tere were 150 women in postmenopausal
status from 2017 included subjects. Te age distribution
was: 35-44 yrs-4%; 45-54 yrs-30.6%; 55-64 yrs-41.3%;
65 yrs-24% females. Depending of area of resi dence,
there were 62.6% females in urban area and 37.3% in
rural area. Te prevalence of risk factors in post meno-
pausal women is showed in the table. Te pre va lence
of hypertension in adult population in Romania was
45%.
Conclusions: Te menopause afects blood pressure
levels. Te BP rise afer the menopause seems to be corre-
lated with increase of other cardiovascular risk factors
(diabetes, dyslipidemia). Despite a higher number of
hypertensives treated in postmenopausal women, the
control of BP is very low and without signifcant dife-
rence in comparison with general adult population in
Romania.
Risk Factors
Menopausal
women (n=150)
Global sample
(2017)
p
Hypertension
Prevalence
Awareness
Treated
Controlled
(% of all hypertensives)
66.6% 45% <0.01
73% 54.4% <0.01
61% 39% <0.01
12% 7.8% ns
Mean SBP mmHg 145.725.0 137.623.4 <0.01
Mean DBP mmHg 88.514.4 83.113.1 <0.01
Visceral obesity 65.3% 37%
Smoking 14% 29% <0.01
Diabetes mellitus 12% 5% <0.01
IFG 16% 14% ns
Dyslipidemia 64% 46% <0.01
Metabolic syndrome 58% 21% <0.01

63. Complicatii
intraprocedurale in ablatia
prin radiofrecventa
G. Ivanica, S. Pescariu, C.T. Luca, Eugenia Venescu,
Al. Gheorghiu, Alina Ivanica, A. Ivanica, St.I. Dra-
gulescu,
Institutul de Boli Cardiovasculare Timisoara
Obiectiv: Punerea in evidenta a complicatiilor intra- si
postprocedurale legate de ablatia prin radiofrecventa.
Material si metoda: 2100 de pacientii internati in
cadrul Institutului de Boli Cardiovasculare Timisoara,
in perioada 1998-2008, care au fost supusi procedurilor
de ablatie prin radiofrecventa pentru diverse tipuri de
tahiaritmii.
Rezultate: Monitorizarea intra- si postprocedurala a
evidentiat aparitia urmatoarelor complicatii:
- deces 0 cazuri;
- perforatii cardiace cu tamponada 2 cazuri
(0,095%) (care au necesitat drenaj, respectiv tora-
co tomie exploratorie);
- bloc atrioventricular total permanent 2 cazuri
(0,095%) (1 pacient cu tahicardie prin reintrare
intranodala, respectiv 1 pacient cu tahicardie ven-
triculara idiopatica stanga, de tract de ejectie de
ventricul stang subaortic);
- hematom la locul de punctie cu anemie secun-
dara, care a necesitat drenaj chirurgical 1 caz
(0,047%);
- fstula arterio-venoasa la locul punctiei 0 cazu-
ri;
- endocardita infectioasa postprocedurala 0 ca-
zuri;
- pneumotorax 0 cazuri.
Concluzie: Ablatia prin radiofrecventa reprezinta o
pro cedura terapeutica curativa pentru un numar mare
de tahiaritmii supraventriculare si ventriculare, care se
insoteste de o rata scazuta a complicatiilor peri pro ce-
durale.

Suplimentul A, 2008
81
POSTER FORUM II
Intraprocedural Complications
During Radiofrequency
Ablation
Al. Gheorghiu, Alina Ivanica, A. Ivanica, St.I. Dra-
gulescu
Timisoara Institute of Cardiovascular Diseases
Aims of the study: To observe the periprocedural com-
plications related to radiofrequency ablation.
Methods: We observed 2100 patients treated in Timi-
soara Institute of Cardiovascular Diseases, from 1998
to 2008, who were submitted to ablation procedures for
diferent types of tachyarrhythmias.
Results: Periprocedural surveillance led to the following
observations:
- there was no death among the patients observed;
- cardiac perforation and tamponade 2 cases
(0,095%) (the patients needed drainage and explo-
rative torachotomy, respectively);
- third-degree atrioventricular block 2 cases
(0,095%) (1 patient with atrioventricular nodal
reentrant tachycardia and 1 patient with idiopathic
ventricular tachycardia).
- puncture site hematoma and secondary anemia,
requiring surgical drainage 1 case (0,047%);
- puncture site arteriovenous fstula 0 cases;
- postprocedural infective endocarditis 0 cases;
- pneumothorax 0 cases.
Conclusion: Radiofrequency ablation is a cura tive the-
rapeutic procedure for a large range of supra ventricular
and ventricular arrhythmias, with a low rate of peri-
procedural complications.

64. Valoarea prognostic a
HbA1c la pacienii diabetici
cu IMA
Sorina Magheru, Alina Iacobescu, F. Maghiar,
M. Popescu
Universitatea din Oradea
Introducere: Numeroasele cercetri experimentale
i date de laborator au subliniat semnifcaia valorilor
HbA1C asupra echilibrului glicemic pe perioada ulti-
melor 6-8 sptmni. MOTOCU, JEBELEANU au do-
zat cromatografc HBA1C la diabetici, constatnd c
aceas ta refect fdel statusul glicemic din ultimele 8
spt mni, diabeticii prezentnd valori duble fa de
nor mal. Astfel, acest parametru este deosebit de util
n supra vegherea de durat a controlului metabolic n
DZ.
Material i metod: Hb glicozilat A1c (VN=6%) a
fost determinat la 202 pacieni diabetici, inclusiv la cei
20 pacieni de cazuri nou depistate cu DZ, precum i la
cei 52 pacieni nondiabetici care prezentau la internare
valori mari ale glicemiei, toi internai pentru infarct
miocardic avut.
Rezultate: Cei 182 de pacieni diabetici cunoscui cu
DZ tip 2 aveau toi Hb glicozilat A1c la valori crescute,
cu o valoare medie de 11,11,4% (8-15%). 52 pacieni
aveau Hb A1c peste 13% ceea ce denot un control
meta bolic defcitar major i prelungit. La cei 20 pacieni
nou depistai cu diabet, Hb glicozilat A1c a nregistrat
valori peste valoarea normal, cu o valoare medie de
14,31,7% (11-16%). 14 pacieni aveau Hb A1c >13%
deci i aceti pacieni aveau un control metabolic def-
citar. Cei 52 pacieni nondiabetici cu valori mai mari ale
glicemiei la internare aveau Hb glicozilat A1c n limite
normale cu o valoare medie de 5,3%0,3 (5-6%).
Concluzii: Sindromul coronarian acut (IMA) se insta-
leaz cu precdere la diabeticii cu echilibru metabolic
neco respunztor, manifestat prin glicemie jeun ridi-
cat i valori crescute ale HbA1c. Hemoglobina glico-
zilat a fost la cei mai muli pacieni diabetici peste 13%
ceea ce dovedete un control metabolic defcitar, major
i prelungit, care poate f cauza debutului unui accident
coronarian major.

Suplimentul A, 2008
82
65. Stratificarea riscului de
deces intra-spitalicesc al
pacientilor cu insuficienta
cardiaca acuta: o estimare
intr-adevar utila in practica?
A.O. Petris, M.D. Datcu, Dana Crisu, L. Slatineanu,
Maria Stoenescu, Georgeta Datcu, D. Iliescu
Universitatea de Medicina si Farmacie Gr. T. Popa
Iasi, Romania
Introducere: Un registru al insufcientei cardiace
acute (ICA) a identifcat valoarea tensiunii arteriale
sis to lice (SBP), nivelul ureei serice (BUN, mg/dl) si a
crea tininei serice (Scr, mg/dl) ca predictori utili in stati-
fca rea riscului de deces intra-spitalices al acestui tip de
pacienti (pts). OBIECTIV. Verifcarea utilitatii aces tui
sis tem de trei variabile in predictia mortalitatii pacien-
tilor suferind de un sindrom cu o mortalitate redutabila
pre cum si identifcarea altor variabile cu potential rol
prog nostic.
Metoda: Am utilizat datele introduse con secutiv intr-
un registru local de insufcienta cardia ca acuta a pacien-
tilor internati in perioada iunie 2005-ianuarie 2007
in unitatea de terapie intensiva coronarieni (CCU) a
unui spital universitar din Iasi (Romania). Au fost iden-
tifcati pacientii cu risc inalt, intermediar si inalt pe
baza valorilor de departajare pentru nivelul BUN 43
mg/dl, pentru Scr - 2, 75 mg/dl si pentru SBP 115
mmHg. Pacientii au fost incadrati in 5 grupuri: 1. insu-
fcienta cardiaca decompensata (DHF); 2. insufcienta
cardiaca hipertensiva (HHF); 3. edem pulmonar acut
(APE); 4. soc cardiogen (CS) si 5. insufcienta cardiaca
a ventriculului drept (RHF).
Rezultate: Lotul a cuprins 106 pts cu ICA: DHF 25
pts (23.6%), HHF 16 pts (15.1%), APE 19 pts (17.9%),
CS 30 pts (28.3%) and RHF 16 pts (15.1%). Valoa-
rea medie a BUN a fost 69.83+/-50.69 mg/dl, valoa-
rea medie a creatininei derice 1.52+/-0.82 mg/dl
(clearance-ul creatininei calculat cu formula Cock-
crof-Gault 65.0+/-32.37 ml/min si antecedente
pato lo gice renale la 19.6% din pacientii intregului
lot), iar valoarea medie a SBP 117.08+/-39.85 mmHg.
Morta litatea intraspitaliceasca a fost mare pentru
DHF 36.0%, pentru HHF 31.3%, pentru APE 15.8%,
pentru CS 70.0% iar pentru RHF 37.5%. Mortalitatea
intraspitaliceasca la pacientii cu BUN <43 mg/dl a
fost 37.93%, cu BUN 43 mg/dl 40.54%. In cazul
pa cientilor cu BUN <43 mg/dl si SBP 115mmHg
mortalitatea intraspitaliceasca a fost 15.62% (un
risc relativ redus, comparativ cu intregul lot analizat),
iar pentru pacientii cu BUN <43 si SBP <115 mmHg
mor talitatea intraspitaliceasca a fost 50.0%, un risc
inter mediar. In cazul pacientilor cu BUN 43 mg/dl si
SBP 115 mmHg mortalitatea intraspitaliceasca a fost
23.07%, iar pentru pacientii cu BUN 43 si SBP <115
mmHg mortalitatea intraspitaliceasca a fost 59.52%.
In acest ultim subgrup, in cazul celor cu Scr <2.75 mg/dl
mortalitatea intraspitaliceasca a fost 54.28%, un risc
mult mai inalt find intalnit in cazul celor cu Scr 2.75
mg/dl 85.71%. Supravietuirea a fost strans corelata (p
0.01, 2-tailed) cu clasa NYHA, clasa hemodinamica,
tensiunea arteriala sistolica (ziua 0), diureza (ziua 0),
nivelul initial al sodiului sericl, nivelul initial al ureei
serice, nivelul initial al creatininei serice si nivelul
initial al glicemiei. Variabilele ecocardiografce strans
corelate cu prognosticul au fost FEVS, pletora venei cave
inferioare si gradientul presional trans-tricuspidian.
Concluzii: Cei trei predictori ai prognosticului (BUN,
Scr, SBP) sunt utili in cursul practicii curente din CCU
pentru identifcarea riscului redus si inalt al mortalitatii
intraspitalicesti la pacientii cu insufcienta cardiaca
acuta. Riscul intermediar nu este insa identifcat adecvat
prin acesti predictori, refectand probabil infuenta pozi-
tiva asupra prognosticului al mentinerii unei SBP 115
mmHg.

The three nodes risk
stratification of in-hospital
mortality for patients with
acute heart failure:
this is really useful?
A.O. Petris, M.D. Datcu, Dana Crisu, L. Slatineanu,
Maria Stoenescu, Georgeta Datcu, D. Iliescu
Universitatea de Medicina si Farmacie Gr. T. Popa
Iasi, Romania
Background: A large acute heart failure (AHF) registry
had identifed systolic blood pressure (SBP), blood ureea
nitrogen (BUN, mg/dl) and serum creatinine (Scr, mg/
dl) as emerging predictors useful in risk stratifcation
for in-hospital mortality of this patients (pts). AIMS.
Suplimentul A, 2008
88
POSTER FORUM II
To verify the utility of this three clinico-biological
vari ables in prediction of mortality in this life-threa-
tening syndrome and to detect some more prognosis
variables.
Methods: From the local AHF registry we use the
anonymised data related to all consecutives pts with
diagnosis of AHF admitted between June 2005 and
January 2007 in our coronary care unit (CCU) of an
university hospital from Iasi (Romania). Low, inter me-
diate and high risk were identifed using this cut-point
values for BUN 43 mg/dl, for Scr - 2, 75 mg/dl and for
SBP 115 mmHg.
Results: Tere were 106 pts with AHF: decompensated
heart failure (DHF) 25 pts (23.6%), hypertensive heart
failure (HHF) 16 pts (15.1%), pulmonary oedema
(APE) 19 pts (17.9%), cardiogenic shock (CS) 30 pts
(28.3%) and right ventricular heart failure (RHF)
16 pts (15.1%). Te mean BUN value for all pts was
69.83+/-50.69 mg/dl, the mean serum creatinine value
1.52+/-0.82 mg/dl (creatinine clearance calculated
with Cockcrof-Gault equation 65.0+/-32.37 ml/
min and renal failure his tory in 19.6% of all pts), and
the SBP mean value was 117.08+/-39.85 mmHg. Te
in-hospital mortality was high for DHF 36.0%, for
HHF 31.3%, for APE 15.8%, for CS 70.0% and for RHF
37.5%. In-hospital mortality in pts with BUN <43 mg/
dl was 37.93%, with BUN 43 mg/dl 40.54%. For the
patients with BUN <43 mg/dl and SBP 115mmHg
in-hospital mortality was 15.62% (relatively a low
risk compared with the all lot), and for pts with BUN
<43 and SBP <115 mmHg in-hospital mortality was
50.0%, an intermediate risk. For the patients with BUN
43 mg/dl and SBP 115mmHg in-hospital mortality
was 23.07%, and for pts with BUN 43 and SBP <115
mmHg in hospital mortality was 59.52%. If this last
sub-group had a Scr level <2.75 mg/dl in-hospital
mortality was 54.28%, but a higher risk had the pts
with Scr 2.75 mg/dl in-hospital mortality 85.71%.
In-hospital survival was strong correlated (p 0.01, 2-
tailed) with NYHA class, hemodynamic class, SBP (day
0), diuresis (day 0), initial serum sodium level, initial
BUN level, initial serum creatinine level and initial
plasma glucose level.
Conclusion: Tis three emerging predictors of prog-
nosis (BUN, Scr, SBP) are useful in current CCU
practice for identifcation of the low and high risk of
in-hospital mortality in AHF pts. Te intermediate
risk identifcation 2 and 3 is not so adequate, refecting
probabley the favorable infuence of SBP 115mmHg.

66. Evaluarea disfunctiei
endoteliale la pacientii cu
insuficienta cardiaca cronica
Liliana Slatineanu, Viviana Aursulesei,
Antoniu Petris, Georgeta Datcu
Scop: Relatia dintre disfunctia endoteliala si insufcienta
cardiaca a fost deja stabilita. Obiectivul acestui studiu a
fost de a evalua disfunctia endoteliala prin doua me to-
de diferite (dozarea endotelinei-1 plasmatice si de ter -
minarea vasodilatatiei mediate de fux, cu ajuto rul eco-
grafei vasculare) si cuatifcarea relatiilor exis tente cu
modifcarile morfologice si hemodinamice la pacientii
cu insufcienta cardiaca cronica (ICC).
Material si metoda: Lotul studiat a inclus 71 de pacienti
cu ICC clasa II IV NYHA de cauza ischemica si/sau
alcoolica, cu fractie de ejectie (FE) sub 40%. Distributia
lotului a fost simetrica pe sexe: 36 de barbati (50,7%)
si 35 de femei (49,3%). Au fost exclusi pacientii cu
insufcienta renala cronica, boli autoimune, ciroza
hepatica si afectiuni neoplazice. Ecocardiografc am
masurat o serie de parametri, dintre care mentionam
dimensiunile cavitatilor cardiace, regurgitarile valvu-
lare, fractia de ejectie si de scurtare (FS), presiunea
sis tolica in artera pulmonara. Cu ajutorul acetora am
cal culat debitul cardiac. La toti pacientii s-a determinat
endo telina-1 (ET-1) plasmatica (ELISA), s-au efectuat
testele hematologice si biochimice uzuale, radiografe
tora cica si electrocardiograma. Utilizand ecografa vas -
culara s-a evaluat vasodilatatia mediata de fux (FMD)
si cea independenta de endoteliu.
Rezultate: ET-1 plasmatica a fost crescuta la toti pacientii
din lotul studiat (5,2775 2,65 fmol/ml). Valoarea ET-
1 s-a corelat cu clasa NYHA de ICC (p<0,000002) si
cu FE (p<0,001). FS a fost foarte scazuta la 87,32% din
pacien ti (valoarea a fost intre 5-15%) iar relatia cu ET-1
a fost semni fca tiva statistic si de tip invers (r = -0,3911,
p<0,001). Rezultate asemanatoare am obtinut coreland
ET-1 cu volu mul terminaldiastolic si terminalsistolic(p
<0.026, respectiv, p<0.001), presiunea sistolica in artera
pulmonara (p<0,0001, r = 0,71) si debitul cardiac (p
< 0,0234). FMD a fost scazuta la toti pacientii din lotul
studiat (7.574 0.8%), mai ales in sublotul de femei
(6.54 0.57%) fata de cel de barbati (8.61 0.48%).
Vasodilatatia independenta de endoteliu a avut o va loare
Suplimentul A, 2008
81
medie de 12.86 1.3% (14.611.01% - sublotul de barbati
si 11.181.45% in cel de femei). Valoarea ET-1 plasmatice
nu s-a corelat cu FMD sau vasodilatatia independenta de
endoteliu (p>0.21, respectiv, p>0 .28). In schimb, FMD a
prezentat o relatie semnifcativa sta tistic cu FE (p<0.016) si
FS (p<0.03). Datele nostre sugereaza absenta unei corelatii
intre FMD si presiunea sis tolica in artera pulmonara
(p>0,29) si debitul cardiac (p>0,27).
Concluzii: La pacientii cu insufcienta cardiaca cronica
endotelina-1 plasmatica este crescuta si vasodilatatia
mediate de fux scazuta dar nu exista o relatie semni-
fcativa statistic intre acesti doi parametri. Parametrii
hemodinamici se coreleaza cu valoarea ET-1, nu si cu
FMD. Ecografa vasculara certifca existenta disfunctiei
endoteliale dar nu si gradul afectarii hemodinamice
la pacientii cu ICC. Prin dozarea ET-1 plasmatice se
poate evalua atat disfunctia endoteliala cat si gravitatea
clinica si statusul hemodinamic in ICC.

Evaluation of endothelial
dysfunction in patients with
congestive heart failure
Liliana Slatineanu, Viviana Aursulesei, Antoniu Petris,
Georgeta Datcu
Background: Te relation between endothelial dys-
function and heart failure has already been established.
We simultaneously evaluated the endothelial dysfunc-
tion by two independent methods (plasma endothelin-
1 and vascular ultrasound (fow-mediated dilatation
- FMD) in order to quantify their correlation with the
morphological and haemodynamic alteration of the
heart.
Materials and Methods: We included 71 pa tients with
NYHA class II - IV ischemic and/or alcoholic con-
gestive heart failure. Te ejection fraction was lower
than 40%. Te sex distribution was 36 men (50.7%)
and 35 women (49.3%). We excluded patients who
sufered from chronic renal failure, malignancies, sys-
temic autoimmune disorders, liver cirrhosis. Te echo-
cardiography evaluated the chambers dimensions, val-
vular regurgitations, ejection and shortening fraction,
systolic pulmonary artery pressure, cardiac output.
All patients were assessed for endothelin-1, usual he-
ma tological and biochemical tests, chest X-ray and
electro cardiogram. Te vascular echography eva luated
FMD and endothelium-independent dila tation of the
brachial artery.
Results: Te plasma level of endothelin-1 was increased
in all patients (5,2775 2,65 fmol/ml). Te value of ET-
1 was associated with NYHA class of congestive heart
failure (p<0,000002). All patients had a low ejection
fraction (EF) (<40%) and it was strongly associated with
high level of plasma ET-1 (p<0,001). Te shortening
fraction (SF) was very low at 87,32% of patients (value
was beetween 5% and 15%) and the relation with ET-
1 was signifcant (r = -0,3911, p<0,001). Te same
rela tion was beetween ET-1 and telediastolic and
tele systolic lef ventricular volume (p<0.026, respec ti-
vely, p<0.001), regional kinetics alteration (p<0.023),
systolic pulmonary arterial pressure (p<0,0001, r =
0,71) and cardiac output (p < 0,0234). Te FMD was
decreased in all the studied patients (7.574 0.8%)
more in women (6.54 0.57%) than in men (8.61
0.48%). Te endothelium-independent dilatation was
12.86 1.3% (14.611.01% in men and 11.181.45%
in women). Te value of ET-1 was not associated with
FMD or endothelium-independent dilatation (p>0.21,
respectively, p>0.28). FMD was strongly associated
with EF (p<0.016) and SF (p<0.03). Our results indicate
nonrelation beetwen FMD and systolic pulmonary
arterial pressure (p>0,29) and cardiac output (p>0,27).
Conclusions: Te plasma level of endothelin-1 is
high and fow-mediated dilatation is decreased in all
patients with congestive heart failure but there was no
correlation beetwen plasma concentration ET-1 and
FMD. Te relation beetwen haemodynamic para meters
and plasma level ET-1 was signifcant but not with FMD.
Te vascular echography did not assess haemodynamic
status of heart failure patients. Te plasma levels of ET-
1 were correlated with clinical and haemodynamical
status in congestive heart failure.
85
POSTER II
rativ cu 4.6% la brbai (p>0.05), PCI 5.3 % la femei si
13.8% la brbai (p<0.05).
Concluzie: la femeile in postmenopauza cu cardiopatie
ischemica prevenia secundara medicamentoasa este
similara cu cea utilizat la brbai, exceptand aspirina
si IECA care sunt subutilizate.

Drug secondary prevention in
postmenopausal women with
cardiovascular disease
A. Sitar-Taut, M. Cebanu, D. Zdrenghea, D. Pop
Universitatea de Medicina si Farmacie Iuliu Hatieganu
Cluj-Napoca
Background and purpose: It is known that women
with cardiovascular disease are under treated, inclu-
ding drug treatment. Tis aspect was less studied
with respect to drugs used for secondary prevention.
Methods: In an urban Romanian community there was
studied a representative sample of 150 postmenopausal
women with ischaemic heart disease. We considered
the secondary prevention by drugs. Te results were
com pared with those registered in a similar sample of
150 men aged >55 years with ischaemic heart disease.
Te study was carried out using general practitioners
fles.
Results: In according to 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 (p<0.05), ACEI in
69.1% and 79.8 %( p>0.05), beta blockers in 69.1%
and 74.3 % (p>0.05) and statins in 48.9% and 48.6%
(p>0.05). Even if they dont represent preventive drugs,
a signifcant percent of the patients were treated with
nitra tes (36.2% women, 43.1% men p>0.05) and with
calcium channel blockers (31.9% women and 19.3%
men p<0.05). Te results show that antiplatelet drugs
are underused in ischaemic patients, but especially in
women. Te use of other preventive drugs categories is
close to that reported in the literature for East Europe,
but if the utilization of beta blockers and statins is
67. Prevenia secundara
medicamentoasa la femeile
in postmenopauza cu boala
cardiovasculara
A. Sitar-Taut, M. Cebanu, D. Zdrenghea, D. Pop
Universitatea de Medicina si Farmacie Iuliu
HatieganuCluj-Napoca
Scop: este bine cunoscut ca femeile cu boala cardio-
vasculara sunt subtratate (incluznd terapia medica men-
toasa). Acest aspect a fost mai puin studiat referitor la
drogurile care sunt utilizate pentru prevenie secundara.
Metoda: intr-o comunitate urbana din Romnia, a fost
studiat, din punct de vedere al preveniei secundare
medicamentoase, un lot reprezentativ de 150 femei
in postmenopauza, cunoscute cu boala ischemica car-
diac. Rezultatele au fost comparate cu cele obinute pe
un ean tion similar de brbai cu vrsta peste 55 ani, cu
boala ische mic. Studiul s-a desfurat utiliznd fsele
medi cilor de familie.
Rezultate: in concordan cu literatura, au fost consi-
derate ca fcnd parte din categoria drogurilor de pre-
venie antiagregantele plachetare, statinele, betablo can-
tele si IECA. Aspirina a fost utilizata la 56.4% dintre
femei, respectiv la 72.5% dintre brbai (p<0.05), IECA
la 69.1% si 79.8 %( p>0.05), betablocantele in 69.1% si
74.3 % (p>0.05), iar statinele in 48.9% si 48.6% (p>0.05).
Chiar daca nu reprezint droguri de prevenie, un pro-
cent important de pacieni au fost tratai cu nitrai
(36.2% femei, 43.1% brbai p>0.05) si blocante de
canale de calciu (31.9% femei si 19.3% brbai p<0.05).
Rezultatele arata ca antiagregantele plachetare sunt
subutilizate la pacienii ischemici, mai ales la femei.
Procentul utilizrii celorlalte categorii de medicamente
este apropiat de cel raportat in literatura pentru Europa
de Est, dar daca utilizarea betablocantelor si statinelor
este aproximativ egala pentru brbai si femei, IECA
sunt mai puin utilizate la femei. Cel mai ridicat pro-
cent de utilizare a medicaiei preventive la femei a fost
nregistrat post infarct miocardic (betablocante-85.7%,
statine-50%, aspirina-60.7%, IECA-75%). n schimb,
revascularizarea miocardica prin PCI si CABG este
redus la ambele sexe, n special la femei 1.1% compa-
POSTER II Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
86
almost equal in men and women, ACEI are less used
in women. Te maximum use of preventive drugs in
women was registered afer 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 p>0.05, PCI 5.3 % in women and 13.8% in men
p<0.05.
Conclusion: In postmenopausal women with ischae-
mic heart disease the secondary prevention by drugs
is similar with that applied in men, except aspirin and
ACEI, which are underused

68. Rigiditatea arteriala si
factorii de risc in
hipertensiunea arteriala
esentiala
Viviana Aursulesei, Georgeta Datcu, M. D. Datcu
Obiectiv: studiul si-a propus caracterizarea relatiei
intre velocitatea undei pulsatile (PWV) parametru recu-
noscut ca factor de risc cardiovascular independent si
marker al afectarii subclinice de organ si alti factori de
risc la pacientii cu hipertensiune arteriala esentiala.
Deoarece evaluarea este limitata in practica, studiul
propune testarea infuentei unui marker surogat de
rigiditate arteriala (RA) IVS/PP (raportul index volum
sistolic/presiunea pulsului).
Material si metoda: au fost inclusi 147 de pacienti 92
hipertensivi (varsta medie 60,72 6,4, 57,6% femei, fara
diabet zaharat) si un lot martor de 55 normotensivi.
PWV carotida-femurala (Complior) a fost urmarita
bazal si prin studiu farmacodinamic pentru defnirea
rela tiei NO rigiditate arteriala (RA) la nivel central: vaso-
dilatatia NO dependenta/independenta au fost studiate
prin administrarea de Ventolin spray (DPWVC-F %
= BRC-F), respectiv NTG sublingual (DPWVC-F %
= NRC-F). IVS a fost determinat ecocardiografc, PP
peri feric masurat din TA brahiala, PP aortic estimat
Complior. Relatiile cu factorii de risc au fost evaluate
bazal si dupa tratament (6, 12 luni).
Rezultate: 1. PWV se coreleaza cu parametrii hemo-
dinamici TA sistolica, PP aortic si periferic (p <0,05)
indiferent de momentul determinarii. 2. Rela tia
NORA este evidenta la 12 luni de tratament pentru
BRC-F cu valorile normale ale TA sistolice (r=0,23;
p=0,02), PP central (r=0,45; p<0,03) si frecventa car-
diaca (p=0,04). 3. PWV este determinata in mod
inde pendent de decadele de varsta (r=0,46; p<0,001)
si de sexul masculin (p<0,02), dar si de IMC (r=0,32;
p<0,05). Nu exista corelatii evidente (p>0,05) pentru
ceilalti factori de risc traditionali. 4. Relatia NORA este
infuentata in mod independent de sex inainte de trata-
ment (ANCOVA), iar IMC se coreleaza cu NRC-F (r =
-0,35; p=0,001); ambele componente ale relatiei NORA
sunt dependente de valoarea HDL (p<0,03) si BRC-F
de valoarea LDL (p=0,04). 5. Atat PWV cat si relatia
NORA centrala sunt corelate cu numarul factorlor
de risc (t-test). 6. IVS/PP este invers corelat cu TA sis-
tolica, PP periferic (p<0,0001), PP aortic si gradul TA
(p=0,001) si este infuentat de numarul factorilor de
risc (p=0,04) inainte si dupa tratament.
Concluzii: 1. PWV este corelat cu multipli factori ai
pro flului de risc in hipertensiunea arteriala esentiala.
2. IVS/PP subliniaza relatia RA cu parametrii hemo-
dinamici. 3. Relatia NORA cu factorii de risc tradi-
tionali accentueaza valoarea sa de marker surogat a
ris cului cardiovascular. 4. Metoda Complior este utila
pentru defnirea mai completa a riscului pacientului
hipertensiv in evolutie.

Arterial stiffness and risk
factors in essential arterial
hypertension
Objective: our study follows the characterization of
relation between pulse wave velocity (PWV) recog-
nized as independent cardiovascular risk factor and
marker of subclinical organ damage and other risk
factors in patients with essential arterial hypertension.
Te methodology for evaluation is limited in clinical
prac tice, so the study tests another surrogate marker
Suplimentul A, 2008
8I
POSTER II
of arterial stifness (AS) stroke volume index/pulse
pressure ratio (ISV/PP).
Material and methods: we studied 147 patients 92
hyper tensives (mean age 60.726.4, 57.6% females,
with out diabetes) and 55 matched normotensives.
Caro tid-femoral PWV (Complior) was evaluated in a
basal manner and using pharmacodynamic study for
defning central NOAS relation: NO dependent/inde-
pen dent vasodilation were studied using Ventolin
spray (DPWVC-F % = BRC-F) and sublingual NTG
(DPWVC-F % = NRC-F) respectively. ISV was deter-
mined by echocardiography, peripheral PP afer blood
pressure measurement, aortic PP estimated with
Complior. Te relations with risk factors were evalua-
ted in a basal moment and afer 6, 12 months of antihy-
pertensive treatment.
Results: 1. PWV is related with hemo dynamic para me-
ters: systolic blood pressure (SBP), peripheral and aortic
PP (p <0.05), irrespective the moment of determination.
2. Te relation NOAS is evident afer 12 months of treat-
ment for BRC-F with normal values of SBP (r=0.23,
p=0.02), with aortic PP (r=0.45, p<0.03) and heart
rate (p=0.04). 3. PWV is independently determined
by decades of age (r=0.46, p<0.001) and male gender
(p<0.02), but also by BMI (r=0.32, p<0.05). Tere are
no correlations with other conventional risk factors. 4.
Te relation NOAS is independently infuenced by gen-
der before treatment (ANCOVA) and BMI is related
with NRC-F (r = -0.35, p=0.001); both components of
NOAS relation depend on HDL values (p<0.03) and
BRC-F depends on LDL (p=0.04). 5. PWV and central
NOAS relation are both infuenced by number of risk
factors (t-test). 6. ISV/PP is inversely correlated with
SBP and peripheral PP (p<0.0001), aortic PP and BP
grading (p=0. 001) and number of risk factors (p=0.04)
before and afer treatment.
Conclusions: 1. PWV is closely related with many risk
factors in essential arterial hypertension. 2. ISV/PP
supports the relation between AS and hemodynamic
para meters. 3. NOAS relation with other conventional
risk factors confrms the value of parameter as a surro-
gate marker of cardiovascular risk. 4. Complior method
is useful for a more complete defnition of cardiovascular
risk in hypertensive patients during evolution.

69. Influenta sindromului
metabolic asupra rigiditatii
arteriale
Obiectiv: sindromul metabolic (SM) se caracterizeaza
printr-un risc crescut de morbiditate si mortalitate
cardiovasculara. Rigiditatea arteriala coexistenta ar
putea f partial responsabila pentru acest tip de evolutie.
Studiul nostru a investigat modul in care factorii de
risc din SM infuenteaza rigiditatea arteriala centrala si
periferica.
Material si metoda: studiul a inclus 73 de pacienti con-
secutivi cu SM defnit conform criteriilor NCEP-ATP
III si un lot martor (43 de subiecti). Pacientii au fost
impartiti in subloturi in functie de tipul si numarul
factorilor defnitorii pentru SM (72% hipertensiune
arteriala, 36% obezitate abdominala, 41% HDL-coles-
terol scazut, 47% trigliceride crescute, 39% valori modi-
fcate ale glicemiei la testul de toleranta la glucoza). Rigi-
ditatea arteriala a fost evaluata prin metoda Com plior
(velocitatea undei pulsatile PWV carotida-femu rala si
caro tida-radiala, presiunea centrala a pul sului estimata
PP), IVS/PP index volum sistolic/PP si indexul de rigi-
ditate (evaluat ecografc).
Rezultate: 1. valorile PWV cresc cu numarul factorilor
aso ciati in SM (dupa ajustarea infuentei altor factori,
inclusiv factorii de risc cardiovasculari ANCOVA).
Exis ta o diferenta semnifcativa intre valorile PWV
si ale indexului in SM comparativ cu lotul martor
( +17,02%, p<0,03; PWV carotida-radiala +10,9%,
p=0,02; index +7,89%, p<0,05). 2. Circumferinta ab-
do mi nala si TA sistolica sunt corelate in mod indepen-
dent cu PWV carotida-femurala (p<0,001) si cu IVS/
PP (p<0,04). 3. Indexul este puternic infuentat de
nivelul de HDL-colesterol (t-test), inclusiv dupa adau-
ga rea infuentei valorilor modifcate ale glicemiei. 4.
Numai PWV carotida-femurala este infuentata de
frec venta cardiaca la pacientii cu SM (valoare prag de
90/min, t-test); valorile acidului uric nu se coreleaza cu
parametrii de rigiditate arteriala in studiul nostru.
Concluzii: 1. SM infuenteaza parametrii de rigiditate
arte riala, posibil prin activare simpatica. 2. PWV pare sa
fe cel mai util parametru pentru studiul infuentei SM.
3. Asocierea componentelor din SM are efect sinergic
Suplimentul A, 2008
88
asupra rigiditatii arteriale, dar la nivel individual efectul
independent este inconstant.

The effects of metabolic
syndrome on arterial stiffness
Viviana Aursulesei, Georgeta Datcu, M. D. Datcu,
Objective: metabolic syndrome (MS) is characterized
by an increased risk of cardiovascular morbidity and
mortality. Te coexistent arterial stifness might be
responsible at least in part for this type of evolution. We
investigated how the clustering of the risk factors of the
MS determine central or peripheral arterial stifening.
Methods and materials: we studied 73 consecutive
patients with MS according NCEP-ATP III criteria
and 43 matched control subjects. Te patients were
categorized according to the type and number of traits
of the MS (72% arterial hypertension, 36% abdominal
obesity, 41% low HDL-cholesterol, 47% high trygli-
cerides, 39% abnormal oral glucose tolerance). Arterial
stifness was assessed using Complior method (carotid-
femoral and carotid-radial pulse wave velocity PWV,
estimated central pulse pressure PP), ISV/PP stroke
volume index/pulse pressure and index (carotidian
ultrasound).
Results: 1. PWV values increased with number of
traits of MS afer adjusting for confounders factors
and other cardiovascular risk factors (ANCOVA). It is
a signifcant diference between PWV and index in
MS as compared with control subjects (carotid-femo ral
PWV +17.02%, p< 0.03; carotid-radial PWV +10.9%,
p=0.02; index +7.89%, p<0.05). 2. Waist circum fe rence
and systolic blood pressure were inde pen dently related
with carotid-femoral PWV and ISV/PP (p<0.001,
p<0.04 respectively). 3. index is stron gly infuenced
by HDL-cholesterol level (t-test) and also afer adding
abnormal glucose values. 4. Only carotid-femoral PWV
in relation with traits of MS is infuenced by heart rate
(cut-of value 90 b/min, t-test); uric acid values have
no correlations with arterial stifness parameters in our
study.
Conclusions: 1. MS has infuence on arterial stifness
parameters, possibley via sympathetic activation. 2.
PWV seems to be the most useful parameter for study.
3. Te clustering of MS components have a synergistic
action on arterial stifness, even though the individual
MS components have not a constant independent
efect.

70. Profilul clinic si angiografic
la pacientii cu arteriopatie
obliteranta a membrelor
inferioare
M.D. Datcu, Viviana Aursulesei, D. Iliescu,
Irina Costache, Liliana Slatineanu
Obiective: 1. defnirea notiunii de pacient vulnerabil
in arteriopatia obliteranta a membrelor inferioare
(AOMI) in functie de statusul clinic si factorii de risc
cardio-metabolic. 2. stabilirea de corelatii clinico-angio-
grafce.
Material si metoda: analiza retrospectiva a unui lot
de 1432 de pacienti consecutivi, internati in perioada
2002-2008, cu diagnostic stabilit de AOMI. Protocolul
de diagnostic a cuprins anamneza, bilant clinic arte rial
(29% stadiul II B Leriche) si al factorilor de risc con-
ventionali (varsta medie 56,44,5 ani, 87,3% barbati,
81,6% fumatori, 37,8% diabetici, 4,3% obezi, 42,7%
disli pidemie, 39% hipertensivi, 19,7% factor genetic
cunoscut, 23,8% criterii NCEP-ATP de sindrom meta-
bolic, 22% antecedente de revascularizatie+amputatie,
25,7% antecedente de afectare cardiovasculara, 58% 2
factori de risc), explorare angiografca (82% tromboze:
45,4% artera femurala superfciala-AFS, 7,4% artera
femurala profunda-AFP, 11% arterele iliace, 4,3%
artera poplitee, 26,2% arterele gambei, 5,7% obstructie
completa a axului arterial al membrului inferior), 18%
stenoze (unice sau etajate, 77% AFS). Indicele glezna-
brat (IGB) a fost efectuat la 627 pacienti (43.7%).
Afectarea vasculara in alte teritorii a fost apreciata
clinic si prin bilant ecografc vascular (placi de aterom,
grosimea intima-medie carotidiana IMT la 582
pacienti-40,6%), ecg si ecocardiografc.
Rezultate: 1. Clinic pot f detasate urmatoarele sub-
grupuri: 43% AOMI fara afectare arteriala manifesta in
Suplimentul A, 2008
89
POSTER II
alte teritorii; 27,8% AOMI+boala coronariana; 13,5%
AOMI+afectare cerebrovasculara; 15,7% afectare arte-
riala multipla. 2. Nivelul glicemiei, TA sistolica, fumatul
reprezinta factori independenti de predictie a afectarii
clinice severe in AOMI (ANCOVA); in sublotul cu diabet
zaharat relatia cu asocierea de factori de risc/afectare
clinica manifesta in alte teritorii este semnifcativa
statistic (p<0,05). 3. IGB <0,5 se coreleaza cu leziunile
angiografce tip tromboza extinsa/stenoze etajate, iar
IGB + IMT>0,9 mm cu subgrupurile clinice (t-test).
4. Leziunile angiografce tip tromboza caracterizeaza
stadiile III-IV, diabetul zaharat, asocierea fumat + HTA
(t-test), iar stenozele izolate stadiul II, dislipidemia
IMT>0,9 mm.
Concluzii: 1. AOMI in populatia studiata este frecvent
o boala sistemica; determinarea IGB si IMT creste
acuratetea evaluarii clinice. 2. Diagnosticul se stabileste
tardiv si este corelat cu stadiul clinic avansat si cu leziuni
angiografce extinse. 3. Proflul cardio-metabolic este
slab controlat in momentul diagnosticului. 4. Este
necesara implementarea unui sistem integrat de pre-
ventie, depistare activa si tratare agresiva a bolii arteriale
periferice.

Clinical and angiographic
profile of patients with lower
extremity arterial disease
M.D. Datcu, Viviana Aursulesei, D. Iliescu,
Irina Costache, Liliana Slatineanu
Objectives: 1. to identify the vulnerable patient with
peripheral (lower extremity) arterial disease PAD accor-
ding to the clinical status and cardio-metabolic risk
factors. 2. to establish clinical and angiographic corre-
lations.
Material and methods: retrospective analysis of a
cohort including 1432 consecutive patients, hospitalized
between 2002-2008, with certain diagnosis of PAD. Te
diagnosis protocol included history interview, clinical
arterial exam (29% stage II B Leriche), conventional
risk factors profle (mean age 56.44.5 years, 87.3%
males, 81.6% active smokers, 37.8% diabetes, 4.3%
obese, 42.7% dyslipidemia, 39% arterial hypertension,
19.7% genetic factor, 23.8% NCEP-ATP criteria for
metabolic syndrome, 22% prior revascularization +
amputation, 25.7% prior cardio vascular morbidities,
58% 2 risk factors), angiography (82% thrombosis:
45.4% superfcial femoral artery-SFA, 7.4% profunda
femoral artery-PFA, 11% iliac arteries, 4.3% popliteal
artery, 26.2% calf arteries, 5.7% occlusion of lower
limb arteries), 18% stenosis (unique/multiple, 77% of
SFA). Ankle-brachial index (ABI) was evaluated in 627
patients (43.7%). Arterial disease in other territories
was evaluated by clinical exam, vascular ultrasound
(atheroma plaques, intima-media thickness IMT in 582
patients-40.6%), ecg and echocardiography.
Results: 1. Tere are some clinical subgroups: 43% PAD
without other manifest cardiovascular disease; 27.8%
PAD+coronary disease; 13.5% PAD+cerebrovascular
disease; 15.7% multiple arterial disease. 2. Glycemic
values, systolic blood pressure, active smoking are
independent predictors of severe clinical PAD (ANCO-
VA); in diabetic patients it is a signifcant corre lation
with associated risk factors/manifest clinical arterial
disease in other territories (p<0.05). 3. ABI<0.5 is
related with extensive thrombotic lesions/multiple
ste nosis; ABI + IMT>0.9 mm is related with clinical
subgroups (t-test). 4. Angiographic thrombotic lesions
are associated with stages III-IV, diabetes, smoking +
arterial hypertension (t-test) and unique stenosis with
stage II, dyslipidemia IMT>0.9 mm.
Conclusions: 1. PAD in the studied cohort is ofen a
systemic disease; using ABI and IMT the accuracy
of clinical evaluation is higher. 2. Tere is a tardive
diagnosis for PAD, related with advanced clinical status
and extensive angiographic lesions. 3. Cardio-metabolic
profle has a poor control at the moment of diagnosis.
4. It is strongly necessary to create an integrated system
for prevention, active detection and aggressive therapy
for PAD.

Suplimentul A, 2008
90
71. Putem evalua prin ecografie
vasculara modificarile functiei
endoteliale la pacientii cu
insuficienta cardiaca?
Georgeta Datcu
Scop: Multe studii publicate pana in prezent in litera-
tura au demonstrat existenta unei relatii puternice
intre disfunctia endoteliala si insufcienta cardiaca.
Obiectivul acestui studiu a fost de a evalua disfuncia
endotelial prin ecografe vasculara (o metoda nu foarte
scumpa, relativ usor de efectuat, dar desi stan dardizata
inca nevalidata pentru aceasta categorie de pacienti) la
pacienii cu insufcien cardiac cronic (ICC).
Material i metod: Lotul de studiu a inclus 71 de
pacieni cu ICC (clasa II-IV NYHA) avnd vrsta medie
de 72,07 3,2, din care 50,7% barbai i 49,3% femei.
Toi pacienii au avut fracia de ejecie (FE) sub 40%.
Criteriul de selecie a fost cardiomiopatie dilatativ
ische mic i/sau alcoolic. Au fost exclui pacienii cu
valvulopatii, cardiopatii congenitale sau alte afeciuni
care ar f putut infuena rezultatele (hipertensiune arte-
rial, infarct miocardic acut, angina pectorala, accident
vascular cerebral recent, dislipidemie, diabet zaharat).
La toi pacienii s-au efectuat o serie de determinri
hematologice i biochimice uzuale, electrocardiograma,
radiografa toracic. Ecocardiografc s-au msurat di-
men siunile cavitilor cardiace, fracia de ejecie (FE),
fracia de scurtare (FS), presiunea n artera pulmonar,
regur gitrile valvulare. Am evaluat debitul cardiac
(DC), indexul cardiac (IC) i rezistena vascular sis-
te mic (RVS). Prin ecografe vascular am evaluat
vaso dilataia dependent (FMD) i independent de
endo teliu (EID). Msurtorile s-au efectuat la nivelul
arterei brahiale. Cu ajutorul formulelor de calcul am
deter minat complianta si distensibilitatea.
Rezultate: FMD a fost sczut la toi pacienii cu
ICC (7,5740.8%), mai ales n lotul de femei fa de
brbai (6.540.57%, versus 8.610.48%). Vasodilataia
independent de endoteliu a avut o valoare medie de
12.861.3% (14.611.01% la brbai i 11.181.45%
la femei). Presiunea arterial medie a fost de 97.43
6.78mmHg. FMD s-a corelat cu FE (p<0.017) i FS
(p<0.002). EID a prezentat o relaie semnifcativ sta-
tistic cu DC (p<0.005) i IC (p<0.012). RVS se coreleaz
invers cu EID (p<0.017). Distensibilitatea a sczut
pro gresiv cu creterea clasei NYHA (de la clasa IV:
1.020.11 kPa% la clasa II: 1.570.17 kPa%, p<0.05).
Com pliana a avut o evoluie asemntoare (p<0.01).
Att compliana ct i distensibilitatea s-au corelat
cu vasodilataia dependent de endoteliu, aceasta
pre zentnd variaii semnifcative n relaie cu FE
(p<0.005). Parametrii hemodinamici generali (DC, IC,
RVS) si presiunea sistolica in artera pulmonara nu au
pre zentat relatii semnifcative statistic cu vasodilatatia
depen denta si independenta de endoteliu. Pe alta parte,
com plianta si distensibilitatea arteriala s-au corelat cu
RVS (p<0.05, respectiv, p<0.047) si, la un nivel mediu,
cu DC si IC (valori ale p intre 0.06 si 0.088).
Concluzii: Rezultatele studiului au demonstrat c dis-
funcia endotelial este prezent la toi pacienii cu
insu fcien cardiac. Vasodilataia mediat de fux se
coreleaz att cu parametrii elastici arteriali ct i cu
seve ritatea clinica a afeciunii. Paramentrii elastici arte-
riali pot f utilizati in evaluarea hemodinamica a pa-
cientilor cu insufcienta cardiaca.

We can to evaluate endothelial
function used vascular
ultrasound in heart failure?
Georgeta Datcu
Objective: Many studies indicate un strong relation
between endothelial dysfunction and heart failure. Te
aim of the study was to evaluate endothelial function
by vascular ultrasound (the method not expensive
and relatively easy to perform) in chronic heart failure
(CHF) patients.
Matherial and methods: We enrolled 71 patients (mean
age 72,07 3,2, 50,7% men and 49,3% women) with CHF
(II-IV NYHA class). Te selection criteria were ischemic
or alcoholic dilatative cardiomyopathy with ejection
fraction lower than 40%. We excluded patients who
sufered from valvulopathies, congenital heart diseases
Suplimentul A, 2008
91
POSTER II
and other conditions which could infuence the results
(hypertension, acute myocardial infarction, stroke,
dysli pidemias, pectoral angina, diabetes mellitus).
All patients were assessed with usual hematologic
and biochemical tests, electrocardiogram, chest X-
ray. Te echocardiographic assessment evaluated the
heart chambers dimensions, lef ventricular ejection
frac tion (EF) and shortening fraction (SF), systolic
pul mo nary artery pressure, valvular regurgitation.
We deter mined cardiac output (CO), cardiac index
(CI), systemic vascular resistance (SVR). Te vas-
cular echo graphy evaluated the parameters of the bra-
chial artery. Flux mediated vasodilation (FMD) and
endothelial independent vasodilation (EID) was mea-
sured by vascular ultrasound in the brachial artery. We
determined compliance and distensibility.
Results: Te fow mediated dilatation was decreased for
all the studied patients (7,5740,8%), more in women
(6,540.57%) than in men (8,610.48%). Te fow
inde pendent dilatation was 12.861.3% (14.611.01%
in men and 11.181.45% in women). Mean arterial
pre ssure was 97,436,78 mmHg. FMD was correlated
with EF (p<0.017) and SF (p<0.02). EID was correlated
with CO (p<0.005) and CI (p<0.012). SVR is inversely
correlated with EID (p<0.017). Te distensibility
pro gressively decreases with the aggravation of the
heart failure (from class IV: 1.020.11 kPa% to class
II: 1.570.17 kPa%, p<0.05). Te compliance had the
same trend (p<0.01). Both compliance and disten sibi-
lity correlated with fow mediated dilatation which pre-
sen ted signifcant variation according to the ejection
frac tion (p<0.005). Haemodynamic parameters (CO,
CI, SVR) and systolic pulmonary artery pressure was
not correlated with FMD and EID. Compliance and
disten sibility was correlated with SVR (p<0.05, respec-
tively, p<0.047) and, medium level, CO and CI (p beet-
ween 0.06 and 0.088).
Conclusions: Te pre sent data indicate that fux-me-
diated vasodilation and endothelial independent vaso-
dila tion can be used to evaluate heart dysfunction and
to appreciate haemodynamic state of chronic heart
failu re patients. Te elastic parameters can be used for
haemodynamic evaluation of patients with heart failu-
re.

72. Comorbiditatile pacientului
cu boala vasculara periferica
Irina Costache, M.D. Datcu, Viviana Aursulesei,
Irina Girleanu, Anca Marandiuc
Scop: evaluarea comorbiditilor ntlnite la pacienii
cu arteriopatie obliterant membrele inferioare (AOMI)
i implicaiile prognostice ale acestora.
Metod i material: studiul a cuprins 127 pacieni cu
AOMI stadiul II-IV, internai n Clinica I Cardiologic
Iai, n perioada ianuarie 2005-martie 2008, n vederea
explorrii arteriografce. Diagnosticul de AOMI a fost
presupus clinic i confrmat paraclinic prin indicele
glez n bra i angiografe sau angioRM a arterelor
mem brelor inferioare. Evaluarea comorbiditilor a
vizat: 1. afeciunea cardiac - hipertensiunea arterial,
cardiopatia ischemic (istoric de infarct miocardic acut
sau angin pectoral), insufcien cardiac, cardio-
miopatia dilatativ alcoolic- evaluate prin ECG i
eco car diografe; 2. asocierea diabetului zaharat; 3. afec-
tarea renal aterosclerotic- clearance de creatinin; 4.
afec tarea cerebrovascular (istoric de AVC sau AIT); 5.
profl lipidic.
Rezultate: 86,6% din pacienii internati cu AOMI
au prezentat afeciuni asociate care susin ideea ca
pacien tul arteriopat este un plurivascular: HTA 85%,
disli pidemie 70%, diabet zaharat 33%, afectare renal
atero sclerotic 53,5%. Din totalul pacienilor inclui n
stu diu 56,6% aveau afectare coronarian i 4,7% aveau
istoric de AVC i AIT.
Concluzii: pacientul arteriopat este un plurivascular
i necesit o evaluare complex i atent sub aspectul
factorilor de risc aterosclerotici i a afectrii n cadrul
acestora a organelor int (cord, creier, rinichi). Aso-
cierea acestor comorbiditi are un impact negativ
asupra prognosticului i evoluiei acestor pacieni.

Suplimentul A, 2008
92
Comorbidities in patients with
peripheral arterial disease
Irina Costache, M.D. Datcu, Viviana Aursulesei,
Irina Girleanu, Anca Marandiuc
Purpose: the evaluation of co-prevalence of athero-
sclerotic vascular disease in patients with peripheral
arterial disease and the impact on patients prognosis.
Method and material: we enrolled data from 127 pa-
tients with lower extremity peripheral arterial disease
stage II-IV, admitted in Iasi Cardiology Clinic I, bet-
ween January 2005-March 2008, for angiographic
explo ration. Diagnosis of peripheral arterial disease
(PAD) was presumed clinically and confrmed by ankle
brachial index and angiographic or angioRM explo-
rations of lower extremity arteries. Te assessment of
comorbidities involved: 1. cardiac diseases- arterial
hypertension, cardiovascular arterial disease (history
of acute myocardial infarction or angina), heart failu-
re, alcoholic cardiomiopathy evaluated by ECG and
echocardiography; 2. diabetes mellitus; 3. renal func-
tion evaluated using serum creatinine clea rance; 4.
cerebrovascular disease (history of stroke or transient
ischemic attack); 5. lipids abnormalities.
Results: 86.6% of patients with PAD had comorbidities
which support the idea that the patient with PAD has
a plurivascular disease. PAD patients were more likely
to have widespread atheromatous disease in multiple
vascular beds (72,4%). Hypertension was associated
in 85% of cases, dyslipidemia in 70% of cases, diabetes
in 33% of cases and impaired renal function in 53,5 of
cases. We found that from 127 men with PAD 56.6%
had coronary artery disease and 4,7% had an ischemic
cere bral infarction.
Conclusion: the patient with PAD needs a complex
and careful evaluation of atherosclerotic risk factors
and target organs damage (heart, brain, and kidney).
Te association between comorbidities has a negative
impact on the prognosis and subsequent evolution of
the patient.

73. Severitatea emboliei
pulmonare la pacienii
spitalizai cu tromboz venoas
profund a membrelor
inferioare studiu retrospectiv
Mihai Balint, Rodica Avram, Florina Prv,
Claudiu Popa, Tudor Ciocrlie
Universitatea de Medicin i Farmacie Victor Babe
Timioara, Clinica de Cardiologie, Spital Clinic
Judeean de Urgen, Timioara
Scopul lucrrii: Am efectuat un studiu retrospectiv
privind existena unei relaii ntre gradul de extindere
a trombozei venoase profunde (TVP) a membrelor
inferioare, factorii de risc asociai i severitatea emboliei
pulmonare (EP) la pacieni internai.
Material i metod: Studiul retrospectiv a inclus 288
de pacieni (cu vrste ntre 24 i 89 de ani) cu TVP
a membrelor inferioare dintre care 78 (27%) cu EP,
spitalizai n Clinica de Cardiologie n ultimii 6 ani.
Diagnosticul s-a pus pe baza tabloului clinic, a modi-
fcrilor electrocardiografce, pe datele de eco car-
diografe i ultrasonografe Doppler vascular pentru
TVP i, respectiv, pe informaiile furnizate de explo-
rrile imagistice (radiografe toracic, scintigrafe de
per fuzie pulmonar i, mai recent, angiotomografa
com puterizat de tip multislice) pentru EP.
Rezultate: Am nregistrat 151 pacieni (52,43%) cu
TVP gambier (grupul A), 132 pacieni (45,83%) cu
TVP iliofemural (grupul B) i 5 pacieni (1,73%) cu
TVP extins la ntreg membrul inferior (grupul C). Am
remarcat predominena sexului feminin, indiferent de
localizarea TVP (72,18% n grupul A, 65% n grupul
B i 80% n grupul C). Cei 78 de pacieni internai cu
EP au cuprins 52 de femei (66,67%) i 26 de brbai
(33,33%), TVP iliofemural ca substrat morfopatologic
find mai frecvent (51,28%) dect cea gambier
(43,58%). EP pe fond de TVP gambier a fost ntlnit
predominant la pacieni tineri (vrst medie 37,110,3
ani) care au avut intervenii chirurgicale fr protecie
prealabil cu anticoagulant (7 cazuri), graviditate (5
cazuri), obezitate (5 cazuri), tumori maligne avansate
(4 cazuri), dar i la cei vrstnici (peste 65 de ani), cu
obezitate (5 cazuri), imobilizare prelungit la pat (4
cazuri) i cu tumori maligne (4 cazuri). EP pe fond
de TVP iliofemural a fost mai frecvent la pacienii
vrstnici cu imobilizare prelungit la pat (10 cazuri),
Suplimentul A, 2008
98
POSTER II
obezitate (8 cazuri), intervenii chirurgicale neprotejate
cu anticoagulant (6 cazuri), neoplazii (6 cazuri), pe
cnd pacienii tineri (vrsta medie 40,62,5 ani) au fost
afectai prin obezitate (7 cazuri), intervenii chirurgicale
neprotejate cu anticoagulant (5 cazuri) i neoplazii (2
cazuri). Au decedat 18 pacieni prin cord pulmonar
acut, 6 (33,33%) cu TVP gambier i 12 (66,67%) cu
TVP iliofemural, avnd condiii favorizante neoplazii
(6 cazuri), imobilizare prelungit la pat (6 cazuri),
obezitate (4 cazuri) i intervenii chirurgicale anterioare
(2 cazuri). Jumtate dintre pacienii decedai aveau
asociat i patologie cardiac sever.
Concluzii: Sexul feminin, neoplaziile, imobilizarea
prelungit la pat, obezitatea, interveniile chirurgicale
neprotejate prin anticoagulare i patologia cardiac
sever constituie factori de risc n strns legtur cu
prognosticul defavorabil n EP. Aceste condiii par s fe
la fel de importante ca i localizarea topografc a TVP,
impunnd ca o necesitate proflaxia cu anticoagulant a
EP.

Severity of pulmonary
embolism in hospitalized
patients with lower limb
deep vein thrombosis
a retrospective study
Mihai Balint, Rodica Avram, Florina Prv,
Claudiu Popa, Tudor Ciocrlie
University of Medicine and Pharmacy Victor Babe
Timioara, Cardiology Clinic, Emergency County
Hospital, Timioara
Introduction: We explored the relationship between
deep vein thrombosis (DVT) spreading degree, asso-
ciated risk factors and pulmonary embolism (PE) in
hospitalized pacients.
Materials and methods: Tis retrospective study
included 288 patients (age 24 to 89 years) admitted
for DVT, 78 of them (27%) for PE and all of them
hospitalized in Cardiology Clinic during last 6 years.
Diagnosis was based on clinical features, electro-
cardiographic changes, echocardiographic and vascu-
lar Doppler ultrasonography data for DVT and, res-
pectively, on informations provided by chest X-ray
exa mination, perfusion lung scintigraphy and, lately,
multislice chest CT scan for PE.
Results: We recorded 151 patients (52,43%) with calf
DVT (group A), 132 patients (45,83%) with iliofemural
DVT (group B) and 5 patients (1,73%) with total lower
limb DVT (group C). We noted the preponderance of
women irrespective of DVT spreading degree (72,18%
in group A, 67,88% in group B and 80% in group C).
Te 78 patients admitted for PE consisted of 52 women
and 25 men. Te iliofemural DVT as underlying base
was more frecquent (51,28%) than calf DVT (43,58%).
Calf DVT related PE was recorded in young patients
(mean age 37,110,3 ani) who sufered unprotected by
anticoagulation surgical procedures (7 cases), pregnancy
(5 cases), obesity (5 cases), advanced malignant tumors
(4 cases) and in elderly (over 65 years) with obesity (5
cases), prolonged bed immobilization (4 cases) and
malignancy (4 cases). Iliofemural DVT related PE was
nore frecquent in elderly with prolonged bed immo-
bilization (10 cases), obesity (8 cases), unprotected
by anticoagulation surgical procedures (6 cases), neo-
plasic disease (6 cases), while young patients (mean
age 40,62,5 ani) were afected by obesity (7 cases),
unprotected by anticoagulation surgical procedures (5
cases) and neoplasic disease (2 cases). 18 patients died
by acute cor pulmonale, 6 of them (33,33%) having calf
DVT and 12 (66,67%) iliofemural DVT, associated with
malignancy (6 cases), prolonged bed immobilization
(6 cases), obesity (4 cases) and surgical procedures (2
cases). Half of death patients were sufering associated
severe cardiac disease.
Conclusions: Women, malignancy, prolonged bed
immo bilization, obesity, unprotected by anticoagulation
surgical procedures and severe cardiac disease are risk
factors associated to poor prognosis in PE and they
seem to have the same importance as DVT location.
Terefore in these circumstances PE prophylactic the-
rapy becomes necessary.

Suplimentul A, 2008
91
74. Acuratetea ecocardiografiei
ultraportabile in evaluarea
patologiei cardiace studiu
comparativ cu ecocardiografia
standard
Sorin Giusca, Ruxandra Jurcut, Razvan Ticulescu,
Dafina Dumitru, Aurora Vladaia, Oana Savu,
Ramona Cazacu, Carmen Ginghina
Departamentul de Cardiologie, Institutul de Boli Car-
diovasculare Prof. Dr. C. C. Iliescu , Bucuresti
Obiective: Dezvoltarea tehnologica din ultimele decade
a permis miniaturizarea ecocardiografelor ceea ce a dus
mai departe la o crestere a portabilitatii. Obiectivul stu-
diului nostru a fost evaluarea rolului clinic si educa tio-
nal a unui aparat ecocardiografc ultraportabil (EcUP)
utilizat de catre un medic rezident cardiolog in ana liza
diferitelor aspecte morfologice ale cordului.
Materiale si metode: 56 de pacienti consecutivi inter-
nati in Departamentul de Cardiologie al Institutului
de Boli Cardiovasculare Prof Dr C. C. Iliescu au fost
examinati de catre medici rezidenti cu nivel 1 de prega-
tire (criterii ASE) utilizand un EcUp cu sof dedicat
eva luarii cordului capabil de redare imagini in mod B.
Stan dardul de aur pentru comparatie a fost examenul
eco cardiografc efectuat de catre medici specialisti cu
nivel 3 de pregatire in ecocardiografe utilizand aparate
cu dotari standard (ESD). Au fost analizati mai multi
parametri: tulburari de cinetica segmentare (TCS),
modi fcari la nivelul valvei mitrale (MVM), modifcari
la nivelul valvei aortice (MVA), prezenta lichidului peri-
car dic (LP), dilatarea si hipertrofa de ventricul stang
(VS). Analiza statistica a presupus determinare coef-
cientului kappa de corelatie (k), sensibilitatii (Sn), speci-
fcitatii (Sp), valorii predictive negative (VPN) si pozi-
tive (VPP) pentru fecare dintre parametrul studiat
Rezultate: Pe baza ecogenicitatii, examinarile cu EcUp
si ESD au fot posibile la 52 dintre cei 56 de pacienti (26
femei, varsta medie 6011.95 ani). Analiza TCS a aratat
o corelatie moderata (k=0,56) cu evaluarea stan dard.
Corelatii substantiale au fos evidentiate in cazul ana-
lizei MVM (k=0,72), MVA (k=0,76) si LP (k=0,65). In
cazul dilatarii de VS corelatia a fost excelenta (k=0,81),
evaluarea hipertrofei VS avand o corelatie substan tiala
(k=0,67). Sp foarte bune s-au inregistrat in cazul eva-
laurii valvulopatiilor si efuziunii pericardice (MVM -
97,4%, MVA - 100% si LP - 100%) cu rezultate totusi
infe rioare in cazul Sn si VPN. O evaluare hemodinamica
completa a valvelor prostetice si native precum si a
hiper tensiunii pulmonare nu a fost posibila datorita
limitarilor tehnice.
Concluzii: EcUp este un instrument util in evaluarea in
salon a pacientilor din punct de vedere al dimensiunilor
si grosimii peretilor ventriculari, functiei sistolice a ven-
tricului stang si a valvulopatiilor semnifcative. Totusi,
pre zinta limitari tehnice in ceea ce priveste analiza
hemo dinamica, un element important in practica car-
diologica. Nu in ultimul rand, EcUp se poate dovedi un
dispozitiv util in pregatirea medicilor rezidenti cardio-
logi daca este combinat cu ESD.

Accuracy of hand-held
echocardiography for bedside
diagnostic evaluation in a
tertiary cardiology center
comparison with standard
echocardiography
Sorin Giusca, Ruxandra Jurcut, Razvan Ticulescu,
Dafina Dumitru, Aurora Vladaia, Oana Savu,
Ramona Cazacu, Carmen Ginghina
Department of Cardiology, Institute of Cardiovascular
Diseases Prof.dr.C.C.Iliescu, Bucharest, Romania
Objectives: Te technological advancement seen in
recent decades has made possible the development of
compact, miniaturized and battery-powered echocar-
diographic systems. Te aim of our study was to assess
the clinical and educational role of a basic hand-held
echocardiographic device (HHE) used by a trainee in
car diology in evaluating diferent morphological ele-
ments of the heart.
Methods: 56 consecutive patients (pts) admitted in
our Cardiology Department had an echocardiographic
exam performed by cardiology trainees with a level 1
train ing in echocardiography (ASE criteria) using a
4th type HHE with B-mode potential only. Te gold
standard for comparison was an echocardiography per-
formed by level 3 echocardiographers using a stan dard
echocardiography device (SED). Several para meters
were analyzed: the presence of wall motion abnor ma-
lities (WMA), aortic valve abnormalities (AVA), mitral
Suplimentul A, 2008
95
POSTER II
valve abnormalities (MVA), the presence of peri cardial
efusion (PE), as well as the presence of a dila ted or
hypertrophied lef ventricle (LV). Te Kappa coef -
cient of correlation between the two methods (k) was
determined, along with the sensitivity (Sn), speci fcity
(Sp), negative predictive value (NPV) and positive
predictive value (PPV) for each of the analyzed para-
meters.
Results: Based on pts echogenicity, both HHE and
SED examinations were possible in 52 of the 56 pts
(26 women, mean age 60.011.9 years). Tere was
a moderate correlation in the assessment of WMA
(k=0.56) with a substantial agreement for MVA (k=0.72),
AVA (k=0.76) and PE (k=0.65). Tere was excellent
agree ment for LV chamber dilatation identifcation
(k=0.81), with substantial agreement for LV walls hyper-
trophy (k=0.67). Valvular and pericardial disease were
determined by HHE with good Sp (MVA - 97.4%, AVA
-100% and PE - 100%), although the Sn and NPV were
lower. A complete hemodynamic evaluation of patients
with native or prosthetic dysfunctional valves, as well
as pulmonary hypertension, was not possible using
HHE due to its technical limitations in determining
hemo dynamic parameters.
Conclusions: Bedside evaluation using HHE is helpful
for assessing LV chamber and walls dimensions, LV
systolic function, and signifcant valvular disease. For
technical reasons, the method has limitations regarding
hemodynamic assessment, an important issue in the
cardiology tertiary center. In a University Cardiology
Hospital, HHE may be very useful as a teaching instru-
ment in echocardiography for cardiology trainees if
combined with SED.

75. Tratamentul hipertensiunii
arteriale i riscul de accident
vascular cerebral
Floridor Adam, Anca Popa, Raluca Ciomag,
Crina Sinescu
Clinica de Cardiologie, Spitalul Clinic de Urgenta
Bagdasar, Bucuresti
Obiectiv: Numeroase studii confrma importanta de-
tec tarii si tratamentului hipertensiunii arteriale in pre-
venirea bolilor cerebrovasculare. Studiul de fata anali-
zeaza prevalenta hipertensiunii tratate si netratate la
pa cientii cu accident vascular cerebral.
Material si metoda: Au fost luati in studiu121 de pa-
cienti cu varste intre 46 si 85 de ani admisi in clinica de
cardiologie a spitalului Bagdasar-Arseni in perioada
februarie 2002-decembrie 2007 pentru diverse patologii
cardiace (cardiopatie ischemica, insufcienta cardiaca
con gestiva, hipertensiune arteriala) care dezvolta un
acci dent vascular cerebral in cursul spitalizarii sau care
au un istoric recent de accident vascular cerebral, avand
internari anterioare intr-o clinica de neurologie.
Rezultate: Din totalul pacientilor, 67 erau hipertensivi
cunoscuti (55,37%), restul neavand istoric de hiper ten-
siune (44,63%). Din totalul celor cu istoric de hiper ten-
siune 23 de pacienti (34,32%) erau tratati iar 44 (65,68%)
erau netratati. Din cei fara istoric de hiperten siu ne 17
pacienti (31,48%) erau hipertensivi nou desco pe riti,
res tul find normotensivi. Rezulta o prevalenta tota la a
hipertensiunii de 69,42% la pacientii cu accident cere-
bral. Dintre hipertensivi doar 23 (27,38%) erau tratati,
res tul find netratati inaintea episodului acut.
Concluzii: Pacientii cu accident cerebral au o preva-
lenta mare a hipertensiunii arteriale. Aproape trei sfer-
turi dintre hipertensivi sunt netratati inaintea episo-
dului acut cerebral. Aceste date readuc in prim plan
importanta preventiei primare a accidentului vascular
cerebral prin tratamentul antihipertensiv.

76. Rezultatele postinfarct
miocardic ale terapiei cu
Irbesartan la pacientii cu
DZ tip 2 si hipertensivi
Dr. Doina Rosu
1
, L. Vasiluta
1
, D. Pascut
1
, Alina Feiler
1
,
Deliana Tanasie
2
1
Spitalul Clinic Judetean de Urgenta Timisoara
2Spitalul Clinic Municipal Timisoara
Scopul lucrarii: DZ tip2 si HTA sunt doi dintre fac-
torii de risc cei mai agresivi de crestere a riscului de
eve ni mente cardiovasculare atat pre cat si postinfarct
mio cardic; pentru scaderea riscului este obligatoriu
con trolul metabolic si al HTA.
Terapia cu sartani prin inhibarea sistemului reni na-
angiotensiva (excesiva postinfarct) poate reali za pro-
tectia dubla cardiaca si vasculara (previne remo delarea
ven triculara si proliferarea neointimala excesiva endo-
teliala) si controlul valorilor TA.
Suplimentul A, 2008
96
Material si metoda: S-au luat in studiu un numar de
83 pacienti(P) cu DZ tip 2 si hipertensivi care au fost
inter nati in T.I. Coronarieni la S. C. J. U. Timisoara
timp de 2 ani si care au fost diagnosticati cu infarct mio -
cardic acut cu insufcienta cardiaca KILLIP I-III, find
trombolizati cu Streptokinaza/Reteplaza.
La toti P din studiu s-a administrat terapia combinata
standard postinfarct la care s-a adaugat Irbesartan intre
ziua 4 si ziua 14 in doze progresiv crescande (75mg-
300 mg) pana la atingerea tintei terapeutice pentru con-
trolul valorilor tensionale (TA <130/80mmHg).
S-au dispensarizat si evaluat periodic P la 1 luna, 6
luni, 1 an, 2 ani prin examene clinice si paraclinice: ECG
de repaus, Holter ECG / 24h, test de efort, ecocardio-
grafe, analize de laborator.
Designul studiului: S-au impartit cei 83 P in 4 loturi
astfel: Lot 1: 24 M <60 ani; Lot 2: 27 M >60 ani; Lot 3:
10 F <60 ani; Lot 4: 22 F >60 ani. Parametrii urmaritii
au fost: 1. mortalitatea de cauza cardiovasculara la 1
luna si la 2 ani (endpoint primar); 2. morbiditatea CV
la 2 ani (end-point secundar, composit), hospitalizarea
pen tru IC, aritmii, recurenta ischemiei active IMA/
angi na instabila, stroke.
Rezultate:
Evenimente C-V M<60ani M>60ani F<60ani F>60ani Global
Mortalitate CV la o luna 8,3% 11,11% 10% 9,09% 9,6%
Mortalitate CV la 2 ani 20,83% 25,92% 20% 27,27% 24,09%
Hospitalizare pentru
insufcienta cardiac la
2 ani
37,5% 44,44% 30% 31,8% 36,14%
Aritmii la 2 ani 29,16% 48,14% 30% 50% 39,75%
Recurenta infarctului/
angina instabila la 2 ani
12,5% 18.5% 10% 13,6% 14,44%
Stroke la 2 ani 8,3% 7,4% 0% 13,6% 8,4%
Concluzii: 1. Mortalitatea nu difera in functie de sex
la aceeasi categorie de varsta, dar creste cu varsta la
ambe le sexe. 2. Controlul valorilor TA postinfarct, nu
infu enteaza evolutia spre insufcienta cardiaca si stro-
ke pro babil datorita micro si macroangiopatiei ce au o
pon dere superioara, dar pare probabil sa aibe un rol in
ameliorarea ischemiei cardiace. 3. Recurenta ischemiei
active/ reinfarctului in proportie relativ mica poate f
explicata prin dispensarizarea medicala activa si prin
tra tamentul conbinat efectuat (incepand cu reper fuzia
miocardica prin tromboliza). 4. Procentul de hospi-
talizare pentru insufcienta cardiaca mai mare la bar bati
comparativ cu femeile (la ambele intervale de vars ta)
poate f explicat prin diferenta de factori de risc, acestia
find mai agregati la genul masculin. 5. Rata des tul de
mare de aritmii poate f datorata tulburarilor hidro-elec-
tro litice si metabolice, neuropatiei autonome car diace,
episoadelor de ischemie silentioasa si a exis tentei unei
cardiomiopatii diabetice. 6. Terapia cu sarta ni post-
infarct miocardic pare sa amelioreze evolutia la acest
grup de pacienti diabetici si hipertensivi, dar nece sita a
f con frmata pe loturi mai mari de pacienti.

77. Urmarirea evenimentelor
cardiovasculare postinfarct
miocardic la pacientii cu
insuficienta cardiaca manifesta
si disfunctie autonoma
vegetativa
Dr. Doina Rosu
1
, L. Vasiluta
1
, D. Pascut
1
,
Deliana Tanasie
2
1
Spitalul Clinic Judetean de Urgenta Timisoara
2
Spitalul Clinic Municipal Timisoara
Scopul lucrarii: Corelat cu marimea unui IMA apare
un grad de disfunctie VS (exprimat prin FEVS) si
disfunctie autonoma vegetativa(exprimat prin heart
rate variability-HRV). Imbalanta tonusului vegetativ
este data de cresterea activitatiii Simpaticului (sau
scaderea Parasimpaticului) si este relevant la cel putin
7 zile dupa un IMA, putand persista 1 an. Vom analiza
relevanta evenimentelor CV ulterioare unui IMA in
functie de FEVS si HRV. Vom evalua ecocardiografc
(Apical 4C, 2C) VTD, VTS si FEVS. Prin monitorizare
ECG Holter 24/ore vom evalua HRV prin 2 parametrii:
1) deviatia standard a intevalelor RR SDNN (apreciaza
tonusul vegetativ global) si 2) barorefex sensitivity
BRS (apreciaza raspunsul vegetativ dupa adminstrarea
i.v. de fenilefrina sau nitroglicerina, masurandu-se
valorile intervalului RR /valorile TA sistolice). Datele
din literatura stabilesc ca valorile SDNN <70 msec si
BRS <4 msec/mmHg ca find semnifcative pentru o
HRV scazuta. (alterare evidenta a tonusului autonom).
Material si metoda: 184 P, 62+-22 de ani, cu IMA cu
IC clasa Killip I-III si fara diabet zaharat, internati in
T.I. Coronarieni-SCJU Timisoara, trombolizati cu
Strepto kinaza/Rapilysine, ulterior tratati cu terapie stan-
dard. Dupa faza acuta IMA, s-a efectuat in ziua 7-10
evaluarea ecocardiografca FEVS si determinarea HRV,
repetata la 3luni, 1an si 2 ani. P au fost divizati in 4 lo-
turi: Lot1: 92P cu FE<30% din care 58P (63%) cu HRV
Suplimentul A, 2008
9I
POSTER II
sca zuta si 34P(37%) cu HRV normala; Lot 2: 92P cu Fe
>30% din care 51P(55%) cu HRV scazuta si 41P \(45%
cu HRV normala). Astfel s-au format Lot 3: 109 P cu
HRV scazuta indiferent de FE format (indi ferent de FE)
si Lot 4: 75 P cu HRV normal (indiferent de FE).
Parametri urmariti Lot1 Lot2 Lot3 Lot4
Mortalitatea la 3 luni 11,9% 7,6% 12,8% 5,66%
Mortalitatea la 1 an 15,67% 7,6% 16,5% 8%
Mortalitatea la 2 ani 21,7% 19% 25,68% 12%
Hospitalizare la 2 ani pt. IC 35,8% 30% 33% 32%
Aritmii la 2 ani 26,8% 20,6% 28% 17,3%
Recurenta ischemiei la 2 ani 14,1% 12,24% 15,59% 12%
P s-au urmarit si evaluat in functie de urmatorii para-
metrii: mortalitate la 3 luni si 2 ani, hospitalizarea pt IC
agravata (defnita ca scaderea ecocardiografca cu mai
mult de 10% a FEVS), prezenta aritmiilor, recurenta
ische miei/infarctului.
Concluzii: 1. HRV scazuta postIMA este un predictor
inde pendent pentru mortalitatea la 3 luni si un an si
arit mica (la fel ca si FEVS), iar asocierea cu o FEVS
<30% amplifca acest risc. 2 HRV nu s-a corelat sem-
ni fcativ statistic fata de FE referitor la cresterea spi-
ta lizarii pt IC, recurenta ischemiei si mortalitatea la
2 ani. Analizarea cazurilor a relevat ca HRV scazuta
la un pacient postIMA, nu se coreleaza neaparat cu
intin derea si localizarea infarctului, varsta sau sex,
find un parametru care se necesita a f determinat
individual, neputand f predictibil; in schimb FEVS se
coreleaza foarte bine cu intinderea infarctului. Totusi
chiar si pa cientii cu FEVS buna pot avea un prognostic
rezervat. 3. Evoultia nefavorabila la acesti pacienti este
infuentata de aparitia disfunctiei autonome care face
ca riscul acestor pacienti sa fe comparabil cu riscul
diabeticilor. Din acest motiv, evolutia pacientilor care
prezinta dis functie autonoma nu este in totalitate
legata de FEVS. 4. Desi este o metoda simpla si iefina,
limitarea aplicarii sale (indicatie de clasa II b in ghiduri)
deriva din faptul ca se aplica de obicei la pacientii in
ritm sinusal, (oricum P cu fbrilatie atriala si tahicardii
ventriculare au un risc crescut de evenimente CV). De
asemenea HRV poate f infuentat de IC preexistenta,
noi episoade ischemice, infectii, tulburari HE si EAB,
interferente medicamentoase (dar nu e infuentat de
betablocante).
5. Determinarea celor 2 markeri (FEVS si HRT), pe
langa alte metode neinvazive utilizate (test de efort, po-
tentiale tardive, alternanta ST, dispersia QT etc.) cuan-
ti fca P cu risc crescut si stabileste indica tiile inva zive
de coronaroangiografe si studiu electro fzio logic (la
ne vo ie implant de implantabil cardioverter defbrilator
ICD).

The influence of cardiac
performance and heart
rate variability over
post-myocardial infarction
evolution
Dr. Doina Rosu
1
, L. Vasiluta
1
, D. Pascut
1
, Alina Feiler
1
,
Deliana Tanasie
2
1Academic County Emergency Hospital Timisoara
2Municipal Clinical Hospital Timisoara
Objective: Te severity of lef ventricular dysfunction
(LVEF) and vegetative dysfunction (heart rate varia bi-
lity- HRV) is directly proportional with the extension
of the MI. Vegetative tonus imbalance, which can be
caused by an increase in sympathetic activity or a de-
crease of parasympathetic activity, becomes relevant
at least 7 days afer an AMI and can last over a year.
We shall analyze post-AMI cardiovascular events using
LVEF and HRV as parameters. We shall evaluate EDV,
ESV and LVEF through echocardiography (Apical 4C,
2C). HRV will be evaluated using ECG Holter 24h
moni toring as follows: 1) RR standard deviation SDNN
(global vegetative tonus evaluation) and 2) barorefex
sensitivity BRS (evaluates vegetative response afer
intra venous administration of fenilefrine and nitrogly-
cerine by measuring RR intervals and Systolic BP le-
vels). Current data suggests that SDNN under 70 msec
and BRS <4 msec/mmHg correlate with low HRV. (clear
alteration of vegetative tonus).Material and methode:
184 P, with ages 6122 years, by sex 110M and 74F,
with AMI and HF Killip I-III, non diabetic, admitted
in the Intensive Care-Coronary Unit of Emergency
County Hospital Timisoara .All the patients received
thrombolytic therapy (streptokinase/reteplase), afer
which standard treatment was administered. Afer
the acute faze of the AMI, in the 7th-10th day, there
has been done an echocardiographic evaluation of the
LVEF and the HRV, repeated afer 3 months, 1 year and
2 years. Te patients have been divided in 4 groups:
Group 1: 92P with EF<30% from which 58P (63%)
with lowered HRV and 34P(37%) with normal HRV;
Group 2: 92P with EF>30% from which 51P(55%) with
lowe red HRV and 41P (45% with normal HRV). Tese
patients have also been regrouped in Group 3: with
109 P with lowered HRV and Group 4: with 75P with
normal HRV, both regardless of the LVEF.
Suplimentul A, 2008
98
Followed Cardiac Events Group 1 Group 2 Group 3 Group 4
Mortality at 3 months 11,9% 7,6% 12,8% 5,66%
Mortality at 1 year 15,67% 7,6% 16,5% 8%
Mortality at 2 years 21,7% 19% 25,68% 12%
Hospitalisation for CI in 2 years 35,8% 30% 33% 32%
Arithmyas in 2 years 26,8% 20,6% 28% 17,3%
Te recurence of the ischemya
in 2 years
14,1% 12,24% 15,59% 12%
Te patients have been folowed up and evaluated by
the next parameteres: mortality at 3 months,1 and 2
years, hospitalization for aggravated HF (defned by the
echografc lowerage with more than 10% of the LVEF),
the presence of the arithmyas, the recurrence of the
ischemia/infarct.
Conclusions: 1. Post AMI lowered HRV is an indepen-
dent predictor for the mortality at 3 months and 1 year,
and for the arrhythmias at 2 years (LVEF as well), and
the association between HRV and LVEF <30% amplifes
this risk. 2. Statistically HRV has not been signifcantly
corelated with the EF regarding the higher rate of the
admittance for HF, recurrent ische mya and mortality
at 2 years (probably enhanced HRV afer life style
changes,including physical efort).Te ana lisys of the
cases revealed that the lowering of the HRV at a patient
afer an AMI ,does not necessarily correlate with the
extention and localization of the infarct, age or sex,
because it is a parameter that needs to be individually
determined, and it is not pre dictable; meanwhile, LVEF
correlates very well with the extention of the infarction.
Still, even the patients with preserved LVEF can have
a reserved prognosis. 3. Te unfa vorable evolution of
this patients is infuenced by the autonom dysfunction,
which makes these patients risk comparable with that
of the diabetic patients. For this reason, the evolution
of the patients with vegetative dysfunction is not
completely related with LVEF. 4. Although it is a simple
and cheap method, the limitation of its applicability
(Class II b indication in the guides) comes from
the fact that is usually used on patients with sinusa
rhythm(patients with AF and VT have a higher risk
for cardio-vascular events). Also, HRV can be infu en-
ced by pre-existent HF, new ischemic episodes, infec-
tions, hidroelectrolithic balance and acid-base balance
changes, drug related interferences (but it is not infu-
enced by the beta blockers) 5. Te determination of the
2 markers (LVEF and HRV), next to other non-invasive
tests (efort test, late potentials, ST segment alternance,
QT range) quantifes the patients with a higher risk and
establishes the indication for invasive coronarography
(lowered HRV probably means a bad reperfusion)and
electrophysiological studies (if needed defbrillator car-
dioverter implant ICD).

78. Tahicardii polimorfe
asociate disfunciei de nod
sinusal modalitate de debut
n displazia aritmogen de
ventricul drept la vrstnic
Mihaela Grecu, Andrei Lozba, Mircea Balasanian,
Cristian Statescu, Catalina Arsenescu Georgescu
Institutul de Boli Cardiovasculare Iai Prof. Dr. George
I. M. Georgescu
Introducere: Displazia aritmogen de ventricul drept
(DAVD) este o cardiomiopatie caracterizat prin infl-
trarea grsoas a peretelui ventricular drept avnd ca
expresie clinic sincope, tahiaritmii ventriculare sau
moarte subit, aprute la pacieni tineri. Pna n prezent
au fost publicate doar cazuri sporadice de DAVD cu
debut clinic tardiv, dup 65 ani.
Obiective: Prezentm evoluia unui pacient de 67 ani,
cu episoade paroxistice recente de fbrilaie atrial (FAP)
pe fond de bradicardie sinusal, care ne-a fost adresat
pentru un episod lipotimic survenit n repaus, nsoit
de palpitaii cu ritm rapid, cu durat de peste o or.
Suspiciunea clinic a fost de futter atrial cu conducere
atrioventricular 1:1 avnd n vedere antecedentele
de disfuncie de nod sinusal i FA. n criz prezenta
tahicardie de complex larg, cu aspect de BRS, 220/
min, cu criterii morfologice de tahicardie ventricular
(TV), ce a impus cardioversie electric. Monitorizarea
Holter a evideniat ritm sinusal bradicardic 34-80/min,
cu QRS cu aspect de bloc de ram drept permanent, cu
episoade scurte de FAP, numeroase ESV sistematizate
i episoade de TV nesusinut. Poteniale ventriculare
tardive prezente. Ecocardiografc s-a observat VD dila-
tat (41mm) i hipertrabeculat, asociind disfuncie sis-
tolic i anevrism al peretelui lateroinferior al VD. Coro-
narografa a exclus etiologia ischemic a TV. Studiul
electro fziologic endocavitar a ridicat suspiciunea pre-
zenei unui substrat stuctural ventricular drept, DAVD,
ntruct stimularea ventricular programat, realizat
n fbrilatie atrial persistent, a indus TV cu origine
dreapt, dar cu morfologie diferit de cea a tahicardiei
clinice, cu degradare hemodinamic, cu rspuns la stimu-
lare overdrive. Inducia de TV susinut cu caracter
poli morf a reprezentat un criteriu major de diagnostic
al DAVD. Datorit indisponibilitii unui defbrilator
implantabil, s-a optat pentru terapia combinat, aso-
ciind Amiodarona unui cardiostimulator de tip VVI.
Suplimentul A, 2008
99
POSTER II
La 6 luni post procedural pacientul este asimptomatic,
n ritm ventricular stimulat, fr tahiaritmii susinute
la monitorizarea Holter.
Concluzii: DAVD poate se poate manifesta tardiv
printr-un spectru larg de tahiaritmii (fbrilaie atrial,
tahicardie ventricular polimorf, bradicardie sinusal),
dei clasic debutul su este n decadele 2-4 de via.
Cardiostimularea electric permanent n combinaie
cu medicaia antiaritmic poate reprezenta o soluie
tera peutic la pacientul vrstnic.

Polymorphic tachycardias
associated with sick sinus
syndrome a type of onset in
arrhythmogenic right
ventricular dysplasia in
aged persons
Mihaela Grecu, Andrei Lozba, Mircea Balasanian,
Cristian Statescu, Catalina Arsenescu Georgescu
Cardiovascular Diseases Institute Prof. Dr. George I.
M. Georgescu Iasi
Introduction: Arrhytmogenic right ventricular dyspla-
sia (ARVD) is a cardiomyopathy characterized by fatty
infl tration of right ventricular (RV) wall, with clinical
mani festations such as syncopes, ventricular tachyar-
rhyt mias and sudden death, appearing especially in
young patients. Tere have been reported sporadic ca-
ses of ARVD with late onset (afer 65 years of age).
Objectives: Tere is presented the evolution of a 67 year
old patient, with recent episodes of paroxysmal atrial
fbrillation (PAF) appearing on sinus bradycardia (SB),
that was referred to us for an episode of lipothymia
during rest, associated with fast rate palpitations, with
a duration of over an hour. Te clinical hypotesis was
atrial futter with 1:1 atrioventricular conduction, due
to the history of sick sinus syndrome and PAF. Te ECG
recorded during the episode revealed broad complex
tachycardia 220/min, lef bundle branch block aspect,
with morphological criteria for ventricular tachycardia
(VT), that imposed electrical DC cardioversion. Te
Holter monitoring revealed SB 34-80/min, per manent
right bundle branch block, short episodes of PAF,
frequent systematized premature ventricular beats and
episodes of non sustained VT. Late ventricular po ten -
tials were present. Ecocardiography revealed a dila ted
(41 mm) and hypertrabeculated RV, asso cia ted with
systolic dysfuction and an aneurysm of the infero-
lateral wall of the RV. Te coronarography exclu ded the
ischemic etiology of the VT. Te endocavitary electro-
physiological study indicated the suspicion of a RV
structural substrate (ARVD), because the programmed
ventricular stimulation, performed during PAF, has
induced VT with RV origin, with diferent morphology
than that of the clinical tachycardia, with haemodynamic
instability, supressed by overdrive stimulation. Te
induction of polymorphic VT represented a major crite-
rium for ARVD. Due to the indisponibility of an ICD,
the therapeutic solution was the association between
amiodarone and VVI pacing. Afer 6 months of follow-
up, the patient is asymptomatic, in ventricular paced
rhythm, without sustained arrhytmias revealed by
Holter monitoring.
Conclusions: ARVD could have a late onset charac te-
rized by a multitude of tachyarrhytmias (AF, poly mor-
phic VT, SB), in spite of its classical onset in the 2nd
4th decade. Te association between permanent pacing
and antiarrhytmic drugs could be a therapeutic option
in aged patients.

79. Studiu asupra factorilor
clinici cu valoare predictiva
pentru rezultatul testului de
inclinare la pacientii cu risc de
sincopa vaso-vagala
C. David, C. Podoleanu, M. Dorgo, E. Carasca
Clinica Medicala nr 4, UMF Targu Mures, *Ospedali
dei Tigulio, Lavagna (GE), Italia
Introducere: Desi sincopa neurocardiogena este con-
side rata a f mai frecventa la tineri decat la varstnici,
exista putine studii care au urmarit efectul varstei si
severitatii simptomatologiei asupra rezultatului testu-
lui de inclinare (TI). Scop: Scopul acestui studiu este ur-
marirea corelatiei intre rezultatul TI si aspectele clinice
sugestive pentru sincopa neurocardiogena.
Metode: Au fost inclusi 84 de pacienti (36 barbati si
48 femei; varsta medie de 34.412 ani) cu sincopa re-
Suplimentul A, 2008
100
curenta si cu o probabilitate mare a etiologiei me dia te
nervos inaintea efectuarii testului. Criteriile de pro ba bi-
litate mare, pretest, au fost urmatoarele: (1) cel putin 2
episoade sincopale; (2) absenta bolii car dia ce orga nice
si traseu ECG normal; (3) varsta <65 ani; (4) isto ric
tipic de sincopa mediata nervos, fac tori declan satori
plus semne premonitorii; si (5) durata scurta a simpto-
mato logiei si recuperare rapida.
Rezultate: 65 de pacienti au avut un rezultat pozitiv al
TI potentat cu nitroglicerina. In grupul de pacienti cu
varsta <35 ani, timpul mediu pana la sincopa a fost de
16,58 min inainte de administrarea nitroglicerinei si
dupa 4,21 min, iar in grupul cu varsta >35 ani, timpul
mediu pana la sincopa a fost de 13,15 min inaintea
administrarii nitroglicerinei iar dupa aceasta 4,11
min. Intervalul de timp intre ultimul episod sincopal si
initierea TI mai mic de 4 saptamani a fost corelat cu un
raspuns pozitiv.
Concluzii: Severitatea simptomatologiei si timpul mediu
pana la sincopa nu au avut valoare predictiva in studiul
nostru pentru rezultatul TI insa varsta pacientilor s-a
dovedit a f un factor predictiv important. Pacientii cu
sincopa de etiologie neprecizata trebuie testati cat mai
curand fata de momentul ultimului episod sincopal
pentru a creste rata raspunsului pozitiv la TI.

Study over clinical factors with
predictive value for the
head-up tilt test (hutt)
results in patients with
neurocardiogenic syncope
C. David, M. Dorgo, C. Podoleanu, E. Carasca
Clinica Medicala III Targu-Mures
Background: Although neurocardiogenic syncope is
thought to be common in the young and rare in the
elderly, there are few data evaluating the efects of age
and symptom burden on the outcome of HUTT. Te aim
of this study is to investigate the correlation between the
result of the HUTT and the clinical fndings suggestive
for neurocardiogenic syncope.
Methods: 84 patients (36 men and 48 women; mean
age of 34.4 +/- 12 years) with recurrent syncope and
high pretest likelihood of neurally mediated syncope
were included. Te following were considered as high
pre test likelihood criteria: (1) at least two syncopal
epi sodes; (2) no structural heart disease and normal
base line ECG; (3) age <65 years; (4) a typical history
of neurally mediated syncope, triggering factors plus
pre monitory signs; and (5) short duration of symptoms
and fast recovery.
Results: 65 patients had a positive HUTT with nitro-
glycerin challenge. In the group aged <35 years, the
mean time to syncope was 16,58 min and afer nitro-
glycerin 4,21 min, while in the group >35 years, the
mean time to syncope was 13,15 min before nitro-
glycerin and 4,11 min afer.
Conclusions: Te time interval between the last syn-
copal episode and baseline HUTT test bellow 4 weeks
was correlated with positive response. None of the
measures of symptom burden or mean time to syncope
predicted HUTT outcome in our study but the age of
the patient strongly predicted HUTT outcome and pa-
tients with syncope of unknown origin must be tilted
nearest as possible to the last syncope to increase the
positive responses of HUTT.

80. Studiu asupra corelatiei
intre hipotensiunea ortostatica
si indexul diurn la pacientii
hipertensivi
C. Chebut, C.Podoleanu, M. Dorgo, E. Carasca
Introducere: Pacientii hipertensivi prezinta diferite
mo dalitati de variatie a tensiunii arteriale (TA) atat
in decurs de 24 de ore, find clasifcati in functie de
indexul diurn (ID) in dipperi si non-dipperi, cat si in
timpul unui stress ortostatic.
Scop: Scopul acestui studiu a fost evaluarea corelatiei
intre comportamentul TA la pacientii hipertensivi
expusi unui stress ortostatic si ID.
Metode: Au fost inrolati 67 de pacienti hipertensivi (43
barbati, varsta medie 62 11,9 ani). La toti pacientii
s-a monitorizat TA ambulator pe parcursul a 24 de ore.
In functie de ID ei au fost impartiti in 2 grupe: non-
dipperi (ID <10%, 22 pacienti) si dipperi (ID >10%, 45
pacienti). Toti pacientii au efectuat testul de inclinare
Suplimentul A, 2008
101
POSTER II
(TI) fara potentare cu nitroglicerina (5 minute in pozitie
decliva, 10 minute in pozitie ridicata la 60). TI a fost
efectuat sub terapie medicamentoasa hipotensiva.
Rezultate: Hipotensiunea ortostatica, defnita ca o
scadere a TA sistolice cu 20 mmHg a fost evidentiata
la 17 pacienti (25%) si a fost prevazuta de modelul ten-
sional diurn non-dipper: odds ratio (OR) 2,86 cu inter-
val de confdenta 95% [1,021-11,622], p <0,05. Nu am
gasit nici o diferenta semnifcativa intre cresterea frec-
ventei cardiace in grupurile studiate.
Concluzii: In studiul nostru, pacientii hipertensivi cu
afectarea scaderii tensionale nocturne (model non-di-
pper) au fost mai predispusi la dezvoltarea unei hipo-
tensiuni ortostatice comparativ cu cei care au pre zentat
o scadere normala sau exagerata a TA nocturne.

Study over the correlation
between orthostatic
hypotension and diurnal index
in hypertensive patients
C. Chebut, M. Dorgo, C. Podoleanu, E. Carasca
Background: Hypertensive patients show diferent
blood pressure (BP) variation patterns during 24 hours,
classifed according to diurnal index (DI) into dipper or
non-dipper, as well as during orthostatic stress. Te aim
of our study was to asses whether there is a relationship
between the behavior of the BP in hypertensive patients
exposed to orthostatic stress and the DI.
Methods: 67 hypertensive patients were enrolled (43
men, mean age 6211,9 years). All patients underwent
ambu latory blood pressure monitoring for 24 hours.
Accor ding to the DI they were classifed into two grou-
ps: non-dippers (DI<10%, 22 patients) and dippers
(DI>10%, 45 patients). Abbreviated head-up tilt test
(HUTT) without nitroglycerin stimulation (5 minutes
in the supine position, 10 minutes in the upright posi-
tion at 60) was performed to all patients. Te HUTT
was performed under pharmacological therapy for
hyper tension.
Results: Orthostatic hypotension, defned by a systolic
BP reduction of 20 mmHg or more was found in 17
(25%) patients and was predicted by the non-dipper
diurnal BP pattern: odds ratio (OR) 2,86 with 95% conf-
dence intervals [1,021-11,622], p<0,05. Tere was no
signifcant diferences between the heart rate increase
in the study groups.
Conclusions: In our study, hypertensive patients with
impaired nocturnal fall of the BP (non dipper pattern)
were more prone to develop orthostatic hypotension
when compared to those with normal or exaggerated
noc turnal fall in the BP.

81. Studiu asupra eficientei
clinice a unui protocol de test
de inclinare cu durata redusa
pentru diagnosticul sincopei
vaso-vagale
M. Pop, C.Podoleanu, M. Dorgo, E. Carasca
Introducere: Protocoalele testului de inclinare (TI)
difera in principal prin durata stimularii ortostatice cat
si prin unghiul de inclinare.
Scop: Scopul studiului nostru a fost compararea efca-
citatii a doua protocoale (P) pentru TI a caror diferenta
a constat in durata fazei pasive.
Metode: 84 de pacienti cu sincopa de etiologie nepre-
cizata au fost evaluati in mod egal folosind protocolul
P1 (42 pacienti, varsta medie 34,6 12,1 ani) care a
cons tat intr-o faza de relaxare in pozitie decliva, urmata
de o faza de inclinare la 70 timp de 30 de minute fara
medicatie ulterior potentare cu nitroglicerina si proto-
colul P2 (42 pacienti, varsta medie 35,2 11,8 ani) ce
difera prin durata mai scurta a fazei fara medicatie, 20
de minute. 2 grupe de control formate din voluntari
sana tosi, fara istoric de sincopa, au efectuat TI dupa
aceleasi protocoale.
Rezultate: TI a fost pozitiv la 32 (77%) pacienti care
au urmat protocolul P1 versus 30 (72%) pacienti cu
pro tocol P2. Nu au existat diferente semnifcative intre
timpul mediu pana la sincopa fara potentare cu nitro-
gli cerina: 17,2 11,2 minute folosind protocolul P1
versus 18,3 11,7 minute cu protocol P2, p=NS. Dupa
stimularea cu nitroglicerina timpul mediu pana la sin-
copa nu a prezentat diferente semnifcative intre cele
2 pro tocoale, find 4,3 0,9 minute cu protocolul P1
Suplimentul A, 2008
102
si 4,1 1,1 minute pentru protocolul cu durata mai
scurta, p=NS. Incidenta unui raspuns pozitiv la TI dupa
stimulare cu nitroglicerina a fost mai mare folo sind
protocolul P2 cu durata mai scurta: 26 din 32 pacienti
(80%) versus 17 din 30 pacienti (55%).
Concluzii: Ambele protocoale si-au dovedit efcienta in
diagnosticarea sincopei vasovagale, iar protocolul mai
scurt ar putea f o alternativa atractiva pentru o practica
clinica zilnica incarcata.

Study over the clinical
efficacy of a shorter headup
tilt test(hutt) protocol in
diagnosing vasovagal syncope
M. Pop, M. Dorgo, C. Podoleanu, E. Carasca
Background: Te head-up tilt testing (HUTT) pro-
tocols difer mainly through the duration of the ortho-
static stimulation as well as by the tilt angle. Te aim
of our work was to compare the ef cacy of two HUTT
protocols that difer through the duration of the passive
phase.
Methods: 84 patients with syncope of unknown origin
were equally assigned either to the P1 protocol (42 pa-
tients, mean age 34,612,1 years) which consisted of a
15 minutes resting phase in supine position followed
by a 30 minutes drug-free phase at 70 degrees and sub-
lingual nitroglycerine challenge or to the P2 protocol
(42 patients, mean age 35,211,8 years) which difered
by a shorter drug-free phase, of 20 minutes. Two con-
trol groups of healthy volunteers, with no his tory of syn-
cope underwent the same protocols.
Results: HUTT was positive in 32 (77%) patients afer
the P1 protocol vs. 30 patients (72%) afer the P2 proto-
col. Tere were no signifcant diferences between the
mean time to syncope without nitroglycerine challenge:
17,211,2 minutes during P1 protocol vs. 18,311,7
minutes for P2 protocol, p=NS. Te mean time to
syncope afer nitroglycerine challenge showed either no
signifcant diferences between the two protocols, being
4,30,9 minutes for P1 protocol and 4,11,1 minutes
for the abbreviated protocol, p=NS. Te incidence of
positive HUTT response with nitroglycerine challenge
was higher for the shorter protocol: 26 of 32 patients
(80%) vs. 17 of 30 (55%).
Conclusions: Both protocols proved clinical ef cacy
in diagnosing vasovagal syncope and the shorter pro-
tocol could be an attractive alternative in daily busy
prac tice.

82. Eficienta tratamentului cu
bandaj elastic compresiv in
prevenirea hipotensiunii
ortostatice progresive la
pacientii varstnici
C. Podoleanu, R. Maggi
1
, M. Brignole
1
, E. Carasca
Clinica Medicala nr 4, UMF Targu Mures,
1
Ospedali dei
Tigulio, Lavagna (GE), Italia
Introducere: Hipotensiunea ortostatica progresiva apa-
re frecvent la persoanele varstnice in cursul ortosta tis-
mului.
Scop: Acest studiu si-a propus sa evalueze efcienta
com presiunii extrinseci prin bandaj elastic la nivelul
mem brelor inferioare si abdomenului in prevenirea
hipotensiunii ortostatice si a simptomatologiei aces-
teia.
Metode: 21 de pacienti (varsta medie 70,11 ani) afectati
de hipotensiune ortostatica progresiva simptomatica
au efectuat testul de inclinare in 2 etape: cu si fara com-
presie prin bandaj elastic a membrelor inferioare (pre-
siunea compresiei =40-60mmHg) si a abdomenului
(pre siunea compresiei =20-30mmHg) intr-o maniera
incru cisata randomizat. Bandajul membrelor inferioa-
re a fost folosit 10 minute, find urmat de un bandaj ab-
do minal aditional pentru inca 10 minute. Simpto mele
au fost evaluate folosind un chestionar cu 7 punc te
con form Scorului Simptomelor Specifce (SSS) inain te
si dupa o luna de terapie cu ciorapi compresivi elas tici
(indicati la toti pacientii indiferent de rezultatul stu-
diului de inclinare).
Rezultate: In grupul de control, ten siu nea arteriala
sistolica (TAS) masurata a scazut de la 12518mmHg,
imediat dupa inclinare, la 11225 mmHg dupa 10 mi-
nute de bandajare placebo a mem brelor inferioare si la
106 25mmHg dupa 20 de minute in ciuda unui ban daj
abdominal aditional placebo. Valorile cores pondente
in cazul terapiei active au fost 129 19 mmHg, 127
17mmHg (p-0,003 versus control) si 127 21mmHg
Suplimentul A, 2008
108
POSTER II
(p-0,002 versus control). In grupul activ, 90% din pa-
cienti au ramas asimptomatici, versus 53% in grupul
de control (p-0,02). Scorul mediu al chestionarului SSS
in timpul lunii anterioare evaluarii a fost 35,212,1, iar
ameteala, slabiciunea si palpitatiile au reprezentat 64%
din scorul total. Scorul SSS a scazut la 22,511,3 dupa
o luna de terapie (p-0,01).
Concluzii: Bandajul compresiv al membrelor inferioare
este efcient in evitarea scaderii ortostatice a TAS si in
reducerea simptomelor la pacientii varstnici afectati de
hipotensiune ortostatica progresiva.

Study over the efficacy of
compression bandage of legs
and abdomen in preventing
progressive orthostatic
hypotension in elderly patients
C. Podoleanu, R. Maggi, M. Brignole, E. Carasca
Background: Progressive orthostatic hypotension can
occur in elderly people during standing. Tis study
sought to assess the ef cacy of compression bandage of
legs and abdomen in preventing hypotension and sym-
ptoms.
Methods: Twenty-one patients (70,11 years) afected
by symptomatic progressive orthostatic hypotension
underwent 2 tilt-test procedures, with and without
elastic bandage of the legs (compression pressure 40 to
60 mm Hg) and of the abdomen (compression pressure
20 to 30mm Hg) in a randomized crossover fashion. Leg
bandage was administered for 10 min and was followed
by an additional abdominal bandage for a further 10
min. Symptoms were evaluated by a 7-item Specifc
Sym ptom Score (SSS) questionnaire before and afer 1
month of therapy with elastic compression stockings of
the legs (prescribed in all patients irrespective of the
results of the tilt study).
Results: In the control arm, systolic blood pressure
decreased from 12518 mm Hg immediately afer tilting
to 11225 mm Hg afer 10 min of sham leg bandage
and to 10625 mm Hg afer 20 min despite the addition
of sham abdominal bandage. Te corresponding values
with active therapy were 12919 mm Hg, 12717 mm
Hg (p -0.003 vs. control), and 12721 mm Hg (p -0.002
vs. control). In the active arm, 90% of patients remai-
ned asymptomatic, versus 53% in the control arm (p
-0.02). During the month before evaluation, the mean
SSS score was 35.212.1 with dizziness, weakness, and
palpitations accounting for 64% of the total score. Te
SSS score decreased to 22.511.3 afer 1 month of thera-
py (p -0.01).
Conclusions: Lower limb compression bandage is efec-
tive in avoiding orthostatic systolic blood pressure de-
crease and in reducing symptoms in elderly patients
afected by progressive orthostatic hypotension.

83. Semnificatia analizei
turbulentei de frecventa
cardiaca pe perioada scurta si
a variabilitatii de frecventa
cardiaca la pacientii cu
insuficuenta cardiaca
V.D. Moga, Viviana Ivan, M.Turcan, Mariana Moga, T.
Ciocarlie, Ana Maria Dan, Rodica Avram
Universitatea de Medicina si Farmacie V. Babes
Timisoara. Clinica de Cardiologie Spitalul Clinic de
Urgenta Nr 1 Timisoara
Departamentul de Informatica. Clinica de Cardiologie
Spitalul Clinic de Urgenta Nr 1
Scopul lucrarii: Noi metode de analiza a aritmiilor
si a consecintelor hemodinamice ale acestora au fost
aplicate in stratifcarea riscului, in special la pacienti
dupa infarct miocardic. Acest studiu investigheaza
gradul de relevanta a analizei turbulentei de frecventa
cardiaca (HRT) pe perioada scurta, in comparatie cu
variabilitatea de frecventa cardiaca, in caracterizarea
mecanismelor de reglare la pacientii cu insufcienta
cardiaca.
Turbulenta de frecventa cardiaca, refecta sensibi li-
litatea barorefexa, este o metoda noua de analizare a
aritmiilor si de evaluare a riscului, in special la pacienti
dupa infarct miocardic.
Debutul turbulentei (TO) refecta diferenta (in %)
dintre suma celor doua intervale RR normale care ur-
meaza (RR1 si RR2) si suma celor doua intervale RR
Suplimentul A, 2008
101
nor male (RR-1 si RR-2) care preced contractia ventri cu-
lara preamtura.
TO: [(RR1+RR2)-(RR-1+RR-2)]/(RR-1+RR-2)*100
TO>0 semnifca decelerare, TO <0 semnifca accele-
rare a ritmului sinusal. HRT este considerat, inde pen-
dent de alti factori de risc predictivi, cel mai puter nic
factor de risc predictive, legat de ECG.
Variabilitatea de frecventa cardiaca refecta controlul
sistemului norvos autonom.
Material si Metoda: Studiul a fost efectuat in Clinica de
Cardiologie a Spitalului de Urgenta Timisoara, Romania.
Grupul de studiua fost alcatuit din 26 de pacienti cu
insufcienta cardiaca, 16 barbati si 10 femei, cu varsta
medie 58 ani. Din monitorizarea Holter ECG pe24 ore
(CARDIOSPY- ECG HOLTER SYSTEM LABTECH
Ltd), am calculate urmatorii parametrii: intervale RR
medii, frecventa cardiaca medie, parametrii domeniului
de frecventa cardiaca si debutul turbulentei. Debutul
turbulentei a fost comparat cu parametrii de frecventa
joasa si foarte joasa. Parametrii de frecventa inalta au
fost, de asemenea analizati.
Concluzii: Debutul turbulentei (TO) a fost -2,4, refec-
tand accelerarea nodului sinusal. LF/HF (marker al echi-
librului autonom) a fost 1,2 , refectand activitate simpa-
tico crescuta. Consideram ca HRT este un factor de
risc predictive independent la pacientii cu insufcienta
car diaca.

The Significance of Short-Term
Heart Rate Turbulence and
Heart Rate Variability Analysis
in Patients with Heart Failure
V.D. Moga
1
, Viviana Ivan
1
, M.Turcan
2
,
Mariana Moga
2
, T. Ciocarlie
2
, Ana Maria Dan
2
,
Rodica Avram
1
1
University of Medicine and Pharmacy V. Babes
Timisoara. Cardiology Clinic Emergency Hospital No.1
Timisoara Romania
2
Informatic Department. Cardiology Clinic Emergency
Hospital No1. Timisoara, Romania
New methods for the analysis of arrhythmias and their
hemodynamic consequences have been applied in risk
stratifcation, in particular to patients afer myocardial
infarction. Tis study investigates the suitability of
short-term heart rate turbulence (HRT) analysis in
comparison to heart rate variability as to characterise
the regulatory mechanisms between patients with con-
gestive heart failure.
Heart rate turbulance, refecting barorefex sensi-
tivity, is a new method for the analysis of arrhytthmias
and risk assessment, in particular to patients afer myo-
cardial infarction.
Turbulence Onset (TO): refects the diference (in
%) between the sum of the two normal RR intervals
following (RR1 and RR2) and the sum of the two
normal RR intervals preceding (RR-1 and RR-2) the
premature ventricular contraction.
TO=[(RR1+RR2)-(RR-1+RR-2)]/(RR-1+RR-2)*100
TO> 0 means deceleration, TO <0 means accele ra-
tion of the sinus rhythm. HRT is considered to be an
inde pendent of other risk predictors - the most power-
ful ECG-related risk predictor.
Heart rate variability refects the control of the auto-
nomic nervous system.
Method: Te study was performed in the Cardiology
Clinic of the Emergency Hospital Timioara, Romania.
Te study group consist of 26 patients with heart failure,
16 men and 10 women, with mean age 58 yrs. Afer In
24 hour ECG Holter monitoring (CARDIOSPY ECG
HOLTER SYSTEM LABTECH Ltd) we have calculated
the following parameters: mean RR intervals, mean
heart rate, frequency doman parameters and turbulence
onset. Turbulence onset was compared to very low and
low frequency parameters. High frequency parameter
was also analyzed.
Conclusions: Turbulence onset (TO) was 2.4 refec-
ting acceleration of the sinus node. LF/HF (marker of
the autonomic imbalance) was 1.2 refecting high sym-
pathetic activty. We consider that HRT to be an inde-
pendent risk predictor in patients with heart failure.

Suplimentul A, 2008
105
POSTER II
84. Scleroza aortica - un posibil
marker nou pentru evaluarea
riscului cardiovascular
Radu A. Sascu, Cristian Sttescu, Flavia Antoniu,
I.M. Georgescu, Iai
Introducere: Scleroza aortica valvulara, considerata
un stadiu initial de afectare valvulara in cadrul stenozei
aor tice, nu este o conditie benigna, fara semnifcatie
clinica, ci se asociaza cu un risc cardiovascular crescut.
Asocierea sclerozei valvulare aortice cu ateroscleroza
cu diverse localizari nu este intamplatoare si se explica
in parte prin coexistenta unor factori de risc comuni,
care predispun la aceste afectiuni.
Premis: Prezenta sclerozei valvulare aortice nu se aso-
ciaza numai cu o prevalenta crescuta a bolii cardiace
ische mice, ci si cu extensia importanta a leziunilor vas-
culare la nivel coronarian.
Metod: Am analizat un lot de 65 pacienti cu scle ro za
valvulara aortica (varsta medie 64,5+/-3,2 ani), docu-
mentata ecocardiografc. S-a determinat preva len ta
prin cipalilor factori de risc cardiovasculari si pre zen ta
bolii aterosclerotice coronariene (clinic si angio gra fc).
Datele obtinute au fost comparate cu cele ale unui lot
de persoane fara scleroza aortica. S-a cons ta tat pre-
valenta crescuta a HTA (45/16, p<0,001) si a fuma tu-
lui (35/16, p<0,001) la pacientii cu scleroza aor tica,
pre cum si valori statistic mai mari ale lipidelor seri ce.
Nu s-au inregistrat diferente semnifcative intre cele
doua grupuri in privinta prevalentei diabetului zaha rat
si obezitatii. Prevalenta bolii coronariene mani fes tata
clinic: fara angina pectorala (23/17), angina pec to rala
de efort (24/16), angina pectorala instabila (13/10),
infarct miocardic (5/2). Din lotul cu scleroza aortica 50
pacienti au efectuat coronarografe, care a evi dentiat:
32% - leziuni unicoronariene, 43% - leziuni bicoro-
na riene, 25% - leziuni tricoronariene. 30 pacienti au
bene fciat de angioplastie coronariana cu stent, iar 5
de bypass aortocoronarian. In lotul martor, au efectuat
coronarografe 35 pacienti - 45% leziuni unicoronariene,
38% leziuni bicoronariene, 17% leziuni tricoronariene.
Concluzii: Prezenta sclerozei aortice in populatia cu-
noscuta cu risc cardiovascular crescut are efect aditiv
asupra acestui risc. Se remarca o asociere semnifcativa
a sclerozei valvulare aortice cu factorii de risc cardio-
vascular si cu boala cardiaca ischemica.

Aortic valvular sclerosis -
a possible new marker for the
assessment of cardiovascular
risk
Radu A. Sascu, Cristian Sttescu, Flavia Antoniu,
Cardiovascular Diseases Institute Prof. Dr. George I.M.
Georgescu, Iai
Introduction: Te aortic valvular sclerosis, considered
an initial stage of valvular damage in aortic stenosis, is
not a benigne condition, without clinical signifcance
and it is associated with an elevated cardiovascular risk.
Te association between aortic valvular sclerosis and
atherosclerosis in not random and it can be explained
by common risk factors for both of these conditions.
Hypothesis: Te valvular aortic sclerosis is not only
associated with an elevated prevalence of coronary
disease, but also with an important extension of the
coronary lesions.
Methode: We analized 65 patients with aortic valvular
sclerosis (median age 64,5 +/- 3,2 years), documented
by echocardiography. We determined the prevalence of
the main cardiovascular risk factors and the presence
of the atherosclerotic coronary disease (clinically and
angiographically). Te data we obtained were compared
with those of 45 persons without aortic sclerosis. We
noticed the elevated prevalence of hypertension (45/16,
p<0,001) and smoking (35/16, p<0,001) in patients
with aortic sclerosis ang a signifcantly higher level of
serum lipids. We didnt notice any signifcant diference
for diabetes mellitus and obesity. Te prevalence of
the clinically manifested coronary disease: without
angina (23/17); stable angina (24/16); unstable angina
(13/10), myocardial infarction (5/2). 50 patients with
aortic sclerosis had done a coronarography: 32% had
one vessel disease, 43% two - vessel disease, 25% three
vessel disease. 30 patients had a percutaneous coronary
intervention and 5 of them a coronary aortic bypass
graf. In the other arm of our study, 35 patients had a
coronarography: 45% had one - vessel disease, 38% two
- vessel disease, 17% three - vessel disease.
Conclusions: Te prevalence of aortic sclerosis in the
elevated cardiovascular risk patients has an aditional
efect on this risk. We noticed an elevated association
between the aortic valvular sclerosis, cardiovascular
risk factors and coronary artery disease.

Suplimentul A, 2008
106
85. Upgrade-ul de la
cardiostimularea VVI la cea
DDD doar un beneficiu
hemodinamic ?
Cristian Sttescu, Radu A. Sascu, Flavia Antoniu,
I.M. Georgescu, Iai
Introducere: Importanta hemodinamic a mentinerii
sistolei atriale a fost recunoscut de la nceputul seco-
lului XX si multe studii au dovedit obinerea unui debit
cardiac mai mare n urma pacing-ului sincron atrio-
ventricular (DDD) dect a celui ventricular uni cameral
(VVI). Dei meninerea secvenei normale de acti-
vare atrioventricular are un rol important n selec ia
modului de stimulare, numeroi pacieni sunt cardio-
stimulai n regim VVI/VVIR.
Material i metod: Upgrade-ul de la modul VVI la
DDD este indicat la pacienii care dezvolt simptome
cauzate de dissincronia atrioventricular, cum ar f
sind romul de pacemaker. n aceste condiii n Institu-
tul de Boli Cardiovasculare Prof. Dr. George I.M.
Geor gescu Iai, pe o perioad de 18 luni, am efectuat
5 astfel de proceduri. S-a implantat un electrod atrial
intro dus prin puncia venei subclaviculare ipsilateral,
care ulterior s-a poziionat prin fxare activ pe peretele
lateral al atriului drept. Nu au existat complicaii proce-
durale. Dup restaurarea sincroniei AV i efectua rea
programrii individualizate a intervalului AV pacienii
au fost evaluai att ecocardiografc (indexul cardiac)
ct i prin chestionarul de apreciere a calitii vieii la 1
i respectiv 6 luni de la upgrade.
Rezultate: Hemodinamic, indexul cardiac a crescut cu
18% la 1 lun, respectiv 21% la 6 luni. n termeni de
cali tate a vieii s-au nregistrat benefcii cu atingerea
pra gului de semnifcaie statistic n ceea ce privete
simpto matologia, calitatea somnului, funciile cognitive
i tolerana la efort.
Concluzii: Upgrade-ul de la VVI la DDD duce la o ame-
liorare semnifcativ a calitii vieii pe lng un bene-
fciu hemodinamic cert, generate de resta bi lirea sin cro-
niei atrioventriculare. Ca metod tera peutic tre buie
con siderat atunci cnd o impune simpto mato logia
pa cientului.

Upgrade from VVI pacing to
DDD only beneficial
haemodynamic effects ?
Cristian Sttescu, Radu A. Sascu, Flavia Antoniu,
Cardiovascular Diseases Institute Prof. Dr. George I.M.
Georgescu, Iai
Introduction: Te haemodynamic importance of atrial
systole has been recognized since the begining of 20th
century and many studies have demonstrated a higher
car diac output with atrioventricular synchronous pa-
cing (DDD) than with ventricular stimulation (VVI).
How ever normal atrioventricular activation sequen ce
should be the frst choice on the selection of pacing
mode, a signifcant number of patients have received
ventricular pacemakers (VVI/VVIR).
Methods: Up grade from VVI to DDD is indicated at
patients with sym ptoms caused by atrioventricular
dyssynchrony, i.e. pacemaker syndrome. During a 18
months pe riod, in Cardiovascular Diseases Institute
Prof. George I.M. Georgescu Ive maded 5 procedures
of this kind. An atrial lead was implanted via ipsilateral
sub cla vian vein, and then positioned on the lateral
right atrial wall, by active fxation. Tere were no
post operative complications. Afer restoration of AV
syn chrony and programming of an individualised AV
delay, the follow-up was performed at 1 and 6 months
by echo cardiography (cardiac index) and with the
quality of life assessment questionnaire.
Results: By haemo dyna mics, the cardiac output was
raised with 18% at 1 month and with 21% at 6 months.
Te results of quality of life questionnaire showed a
statistically signifcant diference in symptoms, sleep
quality, cognitive func tion and physical ability.
Conclusion: Upgrade from VVI to DDD lead to sig ni-
fcant improvements in quality of life and haemo dyna-
mical benefcial efects, because of the restoration of
AV synchrony. As a therapeutic method it should be
con sidered when patient symptoms ask.

Suplimentul A, 2008
10I
POSTER II
86. Probleme de diagnostic
cito-histologic pe biopsii
pericardice
Liliana Parascan
1
, Vasile R
1
, Moldovan H
1
,
Iosifescu A
1
, Radulescu B
1
, Cosa F
1
, Vasilescu A
1
,
Candea V
1
, Laky D
2

1
Institutul de Boli Cardiovasculare Prof. Dr. C. C.
Iliescu- Bucuresti - Romania
2
Universitatea de Medicina Semmelweiss Budapesta
- Ungaria
Scop: Studiul anatomo-clinic efectuat in Clinica noastra
a fost realizat pentru a oferi o sinteza asupra tuturor
cazurilor de afectiuni ale pericardului (generic denumite
pericardite) analizate citologic si/sau histologic.
Material si metode: S-au efectuat 204 citologii din lichi-
dul pericardic colorate MGG si cupe histologice colorate
clasic (HE si VG) din fragmentele de pericard recoltate
de catre chirurgi (Iliescu V., Vasile R., Moldovan H.,
Iosi fescu A., Cosa F., Baila S., Radulescu B., Cornea A.,
Ro ta reasa B., Vasilescu A., Stiru O., Somacescu T., Mi-
ha l cescu D.) in perioada 1999-2008.
Rezultate: Din totalul de 195 de examene histologice
ale pericardului s-au dovedit a f: pericardite cronice:
nespecifce 90 (49 barbati si 51 femei); specifce de tip
TBC 4 (3 B si 1 F); pericardite acute 21 (14 B si 7 F),
deter minari neoplazice in numar de 38 (13 B, 25 F);
peri cardite constrictive: 23 (12 B, 11 F); pericardite
exsu dative: 6 (3 B, 3 F); pericardite hemoragice: 27 (14
B, 13 F). Din punct de vedere al predominantei unui sex
sau altul, in pericarditele cronice a predominat sexul
feminin iar in pericarditele neoplazice, cel feminin.
Analiza pe grupe de varsta este redata in tabele. In cazul
citologiilor din lichidele pericardice s-a obtinut in 95%
din cazuri concordanta cito-histologica acolo unde am
primit si lichid pericardic pe langa biopsia pericardica.
Concluzii: Majoritatea pericarditelor examinate sunt
pericarditele cronice nespecifce; urmeaza ca frecventa
cele de natura neoplazica apoi cele hemoragice, find
urmate de pericarditele constrictive si de cele acute; peri-
carditele edematoase (exsudative) si cronice specifce de
tip TBC au fost italnite arareori. In ciuda unui numar
mare de etiolgii, exista doar cateva forme anatomice ale
intere sarii pericardice.

Cyto-histological diagnosis
problems on pericardium biop-
sies
Liliana Parascan
1
, Vasile R
1
, Moldovan H
1
,
Iosifescu A
1
, Radulescu B
1
, Cosa F
1
, Vasilescu A
1
,
Candea V
1
, Laky D
2

1
Iliescu- Bucuresti - Romania
2
Universitatea de Medicina Semmelweiss Budapesta
- Ungaria
Aim: An atomoclinical study was carried out in our clinic
to ofer a synthesis about all the cases with pericardial
disease cytologically and / or histopathologically exa-
mined.
Material ad methods: Were efectuated cytological
exams from pericardial fuid MGG stained and classic
histologically stained (HE, VG) from pericardial bio-
psies harvested by surgeons (Iliescu V., Vasile R.,
Moldo van H., Iosifescu A., Cosa F., Baila S., Radulescu
B., Cornea A., Rotareasa B., Vasilescu A., Stiru O.,
Somacescu T., Mihalcescu D.) between 1999-2008.
Results: From a total of 195 cases, histological exams
of pericardium were: fbrinous and serofbrinous
peri car ditis: 90 cases (49 male, 51 female); caseous
peri carditis: 4 cases (3 male, 1 female); purulent or
supu rative pericarditis: 21 cases (14 male, 7 female);
chylous efusions containing malignant mediastinal
neo plasms: 38 cases (13 male; 25 female); constrictive
pericarditis: 23 cases (12 male, 11 female); hemorrhagic
pericarditis: 27 cases (14 male, 13 female); serous
pericarditis: 6 cases (3 male, 3 female). As for sex varia-
bility, male predominance in the fbrinous and sero-
fbrinous pericarditis and female predominance in
ma lig nant mediastinal neoplasms with metastasis in
peri cardium.
Conclusions: Te majority of pericardium cases from
total are fbrinous and serofbrinous pericarditis; the
next (by number) is the serosanguineous efusions in
the frame of malignant mediastinal neoplasms: afer
them are hemrrohagic and purulent or suppurative
pericarditis; the serous and caseous pericarditis are rare.
Despite the large number of etiologies of pericardial
disease, there are relatively few anatomic forms of
pericardial involvement.

Suplimentul A, 2008
108
87. Caracterizarea
hemodinamicii pulmonare la
pacientii cu ciroza si
hipertensiune portala
Ioana Tudor, Adriana Gurghean, D. Spataru,
I. Bruckner
Spitalul Clinic Coltea, Bucuresti
Scop: evaluare noninvaziva a hemodinamicii pulmo-
nare la pacientii cu ciroza si hipertensiune portala
(HTPo).
Metoda: 51 pacienti cu ciroza si HTPo, varsta 59 8
ani, barbati/femei = 1,3. Etiologia cirozei: alcoolica 43%,
post virala 29%, mixta 22%, alte 6%. Clasa Child-Pugh:
A 37%, B 41%, C 22%; grup martor format din 57 per-
soa ne pentru a stabili o valoare maxima normala pentru
indexul cardiac si dimensiunea atriului stang; ecocar-
diografe 2D si Doppler; am evaluat presiunea sistolica
in artera pulmonara (PAPs), presiunea medie in artera
pul monara (PAPm), rezistenta vasculara pulmonara
(RVP), indexul cardiac (IC), indexul de volum al atriu-
lui drept (IVA) si dimensiunea atriului stang (AS).
Am considerat hipertensiune pulmonara (HTP) cand
PAPm 25 mmHg si PAPs 35 mmHg; RVP crescuta
240 dyn.s.cm-5, 240 > RVP de granita 120 dyn.
s.cm-5 si RVP scazuta <120 dyn.s.cm-5 (80dyn.s.cm-
5 = 1 unitate Wood); sindrom hiperdinamic cand IC
>1,8 L/min./m2; hipervolemie cand IVA 30ml/m2;
presiune capilara pulmonara (PCP) crescuta cand AS
>4 cm. Am considerat hipertensiune porto-pulmonara
(HTPP) cazurile cu HTP, RVP crescuta sau de granita
si PCP normala.
Rezultate: 1. HTP a fost prezenta in 27% din cazurile cu
HTPo; 7% din cazurile cu HTP au avut HTPP usoara.
2. Nu am putut caracteriza hemodinamica pulmonara
la 29% din cazurile cu HTP ( nu am putut masura RVP
in 64% din cazuri, IVA in 21% din cazuri si IC in 7%
din cazuri). 3. HTPP a fost prezenta in 2% din toate ca-
zu rile cu HTPo.
Concluzii: 1. HTPP este o complicatie rara a HTPo si
atunci cand e prezenta este de severitate usoara. 2. Eco-
cardiografa poate caracteriza hemodinamica pulmo-
nara la pacientii cu HTPo dar cu anumite limite impu-
se in special de difcultatea de a masura RVP. 3. Rezul-
tatele trebuiesc confrmate prin alte metode (cateterism
cardiac).

Characterization of pulmonary
hemodynamic in patients
with cirrhosis and portal
hypertension
Ioana Tudor, Adriana Gurghean, D. Spataru,
I. Bruckner
Coltea Clinical Hospital, Bucharest, Romania
Purpose: a noninvasive evaluation of pulmonary hemo-
dynamic in patients with cirrhosis and portal hyper-
tension.
Method: 51 pts. with cirrhosis and portal hypertension,
aged 598 years old, males/females=1.3.Etiology of
cirr hosis: alcohol 43%, viral 29%, mixt 22%,others 6%.
Child-Pugh classifcation: A 37%, B 41%, C 22%; con-
trol group (N=57) for established a cut-of value for
cardiac index and lef atrium; echocardiography 2D
and Doppler; we evaluated systolic pulmonary arte rial
pressure (sPAP), mean pulmonary arterial pre ssu re
(mPAP), pulmonary vascular resistance (PVR), car diac
index (CI), right atrial volume index (RAVI), lef atri-
um dimension (LA).We considered pulmo na ry arte rial
hyper tension (PAH) when mPAP 25 mmHg and sPAP
35 mmHg; high PVR 240 dyn.s.cm-5, 240 >high
normal PVR 120 dyn.s.cm-5 and low PVR <120 dyn.
s.cm-5 (80 dyn. s.cm-5=1 Wood unit); hyperdinamic
syndrome when CI>1.8L/min/m
2
; volume overload
when RAVI 30ml/m
2
; high pulmonary capillary wed-
ged pressure (PCWP) when LA >4 cm.We consi dered
portopulmonary hypertension (PPHT) cases with PAH,
high or high-normal PVR and normal PCWP.
Results: 1.PAH was present in 27% from cases with
cirrhosis; 7% from cases with PAH had mild porto-
pul monary hypertension. 2.We cannot characterized
pulmonary hemodynamic in 29% from cases with PAH
(failure to measured PVR in 64%, RAVI in 21%, CI in
7%). 3.PPHT was present in 2% from all cases with cirr-
hosis and portal hypertension.
Conclusions: 1.PPHT is a rare complication of por tal
hypertension; in all cases it was mild in severity. 2. Echo-
cardiography can evaluate pulmonary hemo dynamic
in pts. with portal hypertension but it has some limits,
specially in measurement of PVR. 3.Te results must be
confrmed by other method (cardiac catheterism).

Suplimentul A, 2008
109
POSTER II
88. Efectele nebivololului
comparativ cu metoprololul
asupra nivelelor de dimetil
arginina asimetrica la bolnavii
hipertensivi cu diabet zaharat
Adriana Toadere
Spitalul Clinic Judetean Oradea, Universitatea din
Oradea
Introducere: Adenil dimetil arginina asime trica
(ADMA) este un inhibitor endogen al nitric-oxid
sintetazei iar nivelele ridicate ale acesteia contribuie la
accentuare disfunctiei endoteliale. Nivele ridicate ale
ADMA au fost detectate in hipertensiunea arteriala,
dia betul zaharat, dislipidemie precum si la bolnavii cu
insufcienta renala. Exista evidente clinice care converg
spre concluzia ca nivelele plasmatice ridicate ale ADMA
constituie un factor de risc independent pentru bolile
cardiovasculare si este un predictor puternic pentru
progresia bolii renale. Lucrarea isi propune sa evalueze
efectele nebivololului comprativ cu metoprololul asu-
pra nivelelor circulante de ADMA la bolnavii hiper-
tensivi cu diabet zaharat.
Material si metoda: S-au luat in studiu 80 de bolnavi
hipertensivi, cu varste cu prinse intre 40-60 ani si valori
ale glicemiei a jeun >20 mg/dl. La includerea in studiu
s-au determinat nivelele circulante ale ADMA utilizand
metoda Elisa. Bolnavii au fost impartiti ulterior in
2 loturi. Bolnavilor din pri mul lot li s-a administrat
nebivolol in doza de 10 mg/zi iar bolnavilor din lotul al
doilea metoprolol in doza de 50 mg/zi. Dupa o perioada
de urmarire de 6 luni in care s-au monitorizat lunar
valorile tensionale,s-au reevaluat nivelele circulante ale
ADMA.
Rezultate: Valorile medii ale ADMA, inregistrate in cele
2 loturi de bolnavi au fost de 3.21 0.49 mol/l Valorile
tensionale s-au redus cu aproximativ 15 mmHg pentru
tensiunea arteriala sistolica si aproximativ 10 mmHg
pentru tensiunea arteriala diastolica in ambele loturi de
bolavi. In schimb, in lotul tratat cu nebivolol, nivelele
circulante ale ADMA nu s-au modifcat fata de valorile
initiale, pe cand in lotul bolnavilor tratati cu metoprolol
acestea au fost semnifcativ mai mari decat la includerea
in studiu (4.12 0.3 mol/l). In ceea ce priveste nivelele
glicemiei, acestea au cresut in lotul tratat cu metoprolol
cu aproximativ 20 5 mg/dl comparativ cu lotul tratat
cu nebivolol 10 2 mg/dl.

Effects of nebivolol
compared with metoprolol in
hypertensive patients with
diabetes mellitus
Adriana Toadere
Spitalul Clinic Judetean Oradea, Universitatea din
Oradea
Introduction: Asymmetric dimetil arginine (ADMA)
is an endogen inhibitor of nitric oxide synthetase and
high levels of ADMA contributes to the augmentation
of endothelial dysfunction.High levels of ADMA were
described in arterial hypertension, diabetes melli tus,
dyslipidemia as well as in patients with renal insu-
f ciency. Tere are clinical evidences that suggest high
levels of ADMA to be an independent risk factor for
cardiovascular desease and a powerfull predic tor for
the progression of idney desease.Te aim of this stu-
dy was to evaluate the efects of nebivolol com pared
with metoprolol in hypertensive patients with dia betes
mellitus.
Material and method: A number of 80 hyper ten sive
patients, age between 40-60 years and levels of glycemia
>120 mg/dl were enrolled in the study. At the inclusion
were assessed the circulating levels of ADMA by Elisa
method. Te patients were divided in two groups. First
group received nebivolol 10 mg/day and the second
group received metoprolol 50 mg/day.Te follow up
period was 6 month in which were recorded monthly
the values of blood pressure.At the end of follow up
period the levels of ADMA were re-evaluated.
Results: Median values of ADMA in the two groups
were 3.21 0.49 mol/l. Blood pressure values were re-
du ced with 15 mmHg for the systolic blood pressure
and with 10 mmHg for diastolic pressure.In group treat-
ed with nebivolol ADMA levels did not difer from the
baseline compared with the group treated with meto p-
rolol in which levels of ADMA were signifcant higher
(4.12 0.3 mol/l) at the end of follow up period. Te
levels of glycemia in the group treated with meto prolol
increased from the baseline with 20 5 mg/dl in com-
parison with nebivolol group in which the dife rence
from the baseline was higher with only 10 2 mg/dl.

Suplimentul A, 2008
110
89. Relaia dintre strain-ul
longitudinal al atriului stng i
torsiunea/detorsiunea
ventriculului stng. Studiu
prin ecocardiografie speckle-
tracking la subieci normali
B. A. Popescu
1,2
, D. Muraru
2
, C. C. Beladan
2
,
A. Teodorescu
2
, M. Hiru
2
, O. Savu
2
, C. Ginghin
1,2
1
Universitatea de Medicin i Farmacie
Carol Davila Bucureti
2
Iliescu, Bucureti
Premise: Att funcia normal a ventriculului stng
(VS), ct i cea a atriului stng (AS) sunt deopotriv
impor tante pentru umplerea VS la presiuni normale.
Stu diile anterioare au subliniat rolul torsiunii (torVS)
i detorsiunii VS (detorVS) pentru o suciune i
umple re diastolic VS efciente, ns relaia acestora
cu parametrii de strain atrial nu a fost nc studiat.
Obiective: Evaluarea parametrilor de deformare a
atriu lui stng - strain () i strain-rate (Sr) i rela ia
acestora cu parametrii de tor/detorVS i cu indicii con-
ven io nali de funcie diastolic.
Metod: Am nrolat prospectiv 58 de subieci normali
(vrsta medie 3612, interval 18-73 ani, 17 brbai).
S-au efectuat examinri ecocardiografce complete. Au
fost nregistrate seciuni de ax scurt VS la nivel bazal i
apical pentru evaluarea of ine a torsiunii i detorsiunii
prin ecocardiografe speckle-tracking (STE) cu ajutorul
unui sofware dedicat (2D strain, EchoPac). LVtor a
fost defnit ca diferena maxim ntre unghiurile de
rotaie la nivel apical i bazal, normalizat la diametrul
longitudinal telediastolic al VS. Prin scderea n fe-
care moment a ratei de rotaie apicale i bazale (de
sens contrar), au fost msurate timpul pn la velo ci-
tatea maxim de torsiune (TVMT) i timpul pn la
velocitatea maxim de detorsiune diastolic (TVMD).
Parametrii de strain longitudinal al AS au fost eva-
luai cu acelai sofware din seciunea apical 4 came-
re, msurnd valoarea maxim global de strain AS
() i strain rate (SrS, SrE i SrA) i timpul de la vr ful
undei R (ECG) la fecare valoare maxim (T, TSrS,
TSrE,TSrA). Intervalele de timp sistolice au fost norma-
lizate la intervalul R (ECG) - momentul nchiderii val-
vei aortice, iar cele diastolice la durata diastolei.
Rezultate: Att parametrii de tor/detor VS, ct i
and Sr ai AS au fost obinui cu acuratee la 54 subieci
(93%). Valoarea AS maxim a fost 3611%, iar SrS,
SrE i SrA au fost: 1,50,4 s-1; -20,6 s-1; -1,70,5
s-1. TorVS maxim a fost 2,30,7/cm. AS a avut o
core laie invers cu TVMT (p <0,03), n timp ce SrE
and SrA s-au corelat direct cu TVMT (p=0,01). De ase-
menea, a existat o strns corelaie ntre TsrE, TSrA
i TVMD (p<0,0001 pentru ambele). Timpul de dece-
lerare a undei D de la nivelul fuxului venos pulmo nar
(TDD) i raportul E/A al fuxului transmitral au avut
o relaie invers cu TSrE (p=0,001; p=0,037). TSrE s-
a corelat direct i cu velocitatea maxim a un dei A a
fu xului transmitral (p=0,009), a undei A de la ni velul
ine lului mitral lateral (p=0,001) i a undei Ar a fuxului
venos pulmonar (p=0,04). Vrsta a avut o infuen
semni fcativ nu numai asupra unor indici ai funciei
diasto lice VS, dar a avut i o corela ie invers cu AS
(p=0,013), SrS (p=0,019) i o relaie semni fcativ direc-
t cu SrE (p=0,003).
Concluzii: STE este util pentru evaluarea tor/detor
VS i a strain-ului AS. Exist o legtur strns ntre
para metrii de strain AS i tor/detor VS, subliniind
rolul complementaritii strain-ului AS i al deformrii
torsionale VS pentru umplerea efcient a VS i pentru
o performan cardiac normal.

Relationship of left atrial strain
with left ventricular torsion
and untwisting. A speckle-
tracking echocardiography
study in normal subjects
B A. Popescu
1,2
, D. Muraru
2
, C C. Beladan
2
,
A. Teodorescu
2
, M. Hirsu
2
, O. Savu
2
, C. Ginghina
1,2
1
Carol Davila University of Medicine, Bucharest,
Romania
2
Institute of Cardiovascular Diseases, Bucharest,
Romania
Background: Normal lef ventricular (LV) mechanics
and lef atrial (LA) function are both important
for LV flling at normal pressures. Previous studies
have emphasized the role of LV torsion (LVtor) and
untwisting for efective diastolic suction and LV flling,
Suplimentul A, 2008
111
POSTER II
but their relation to atrial strain parameters has not
been studied.
Purpose: To assess atrial strain () and strain-rate (Sr)
and their relationship with LV tor/untwisting para me-
ters and with conventional indices of diastolic func-
tion.
Methods: We studied prospectively 58 normal sub-
jects (age 3612, range 18-73 years, 17 men) who
under went a comprehensive echocardiogram. LV ba-
sal and apical short-axis loops were stored for of ine
assess ment of LVtor and untwisting by speckle tra ck-
ing echo cardiography (STE) with dedicated 2D stra-
in sof ware (EchoPac). LVtor was defned as the peak
dife rence between rotation angles at the apex and base,
normalized for LV diastolic longitudinal length. By sub-
tracting rotation rates at each time point of both planes,
time to peak LV torsional velocity (TPTV) and time
to peak untwisting velocity (TPUV) were measured.
Longi tudinal LA strain parameters were assessed with
the same 2D strain sofware from apical 4 chamber ima-
ges by measuring peak values of average segmental
and Sr (SSr, ESr and ASr) and time intervals from R
(ECG) wave to each peak (T, TSSr, TESr,TASr). Sys-
tolic intervals were normalized to peak R (ECG)-aortic
valve closure time and diastolic intervals were corrected
to diastolic duration.
Results: LVtor/untwisting parameters and atrial and
Sr were reliably derived in 54 subjects (93%). Peak LA
was 3611%, while SSr, ESr and ASr were: 1.50.4 s-1;
-20.6 s-1; -1.70.5 s-1. Peak LVtor was 2.30.7/cm.
LA was inversely related to TPTV (p <0.03), while
ESr and ASr correlated well with TPTV (p=0.01). TESr
and TASr correlated strongly with TPUV (p<0.0001
for both). Pulmonary venous fow D wave deceleration
time and mitral E/A ratio were inversely related to
TESr (p=0.001; p=0.037). TESr was also directly related
to peak velocity of mitral A wave (p=0.009), A lateral
(p=0.001) and pulmonary venous Ar wave peak velocity
(p=0.04). Age infuenced not only several diastolic
func tion indices, but it was also inversely related to
LA (p=0.013), SSr (p=0.019) and directly with ESr
(p=0.003).
Conclusions: STE is feasible for assessing LV torsion/
unt wisting and LA strain. Tere is a close association
bet ween parameters of LA strain and LV torsion/unt-
wisting, highlighting the complementary role of LA
strain and LV torsional deformation for efective LV fll-
ing and normal cardiac performance.

90. Istmul cavo-tricuspidian -
observatii anatomice utile
ritmologului
Cismaru Gabriel-laurentiu, Cismaru Cosmin-andrei,
Mihut Calin
UMF Iuliu Hatieganu, Cluj-Napoca
Rezumat: Istmul cavo-tricuspidian (ICT) este de mare
interes pentru ritmologul interventionist, find crucial
in ablatia futter-ului. ICT este delimitat de: valva
lui Eustachio, insertia valvei tricuspide si ostiumul
sinusului coronar.
Scop: Ablatia prin cateter a futter-ului atrial se bazeaza
pe identifcarea unor puncte de reper in interiorul atriu-
lui drept in timpul procedurii de ablatie. Acestea pot f
insa mascate, greu de intuit in timpul procedurii. Des-
crierea anatomica a ICT poate ajuta cardiologul inter-
ven tionist in tehnica de abla tie.
Materiale si metoda: Am examinat 26 inimi (16 barbati
si 10 femei, varsta medie de 65 ani) utilizand metodele
clasice macroscopice de evaluare a elementelor anato-
mice. Am masurat urmatoarele repere: valva lui Eusta-
chio (VE), valva tricuspida(VT)- diametru longi tudinal
si transversal la nivelul insertiei, diametrul sinusului
co ro nar(SC), lungimea ICT, grosimea ICT, unghiul for-
mat de ICT cu vena cava inferioara (VCI), diametrul
1= VCI-SC, diametrul 2=VT-SC.
Rezultate: Valva lui Eustachio=29,5mm, valva tricus-
pi da=28,5 respectiv 18mm; sinusul coronar=8,6mm;
lun gimea ICT=24,5mm cu variatii intre 19-30mm;
gro simea ICT=12mm; unghiul format cu VCI~90, dia -
metru 1=10,5mm; diametrul 2=17mm. Se constata obs-
ta cole anatomice in calea cateterului de ablatie: val va lui
Eustachio proeminenta, recese adanci subeusta chiene.
Concluzie: Exista variatii considerabile in ceea ce pri-
veste dimensiunea ICT si grosimea ICT cu implicatii
in procedura de ablatie. Exista confguratii particul are
ale ICT cu obstacole anatomice in calea cateterului. Cu-
noasterea acestor variatii poate contribui la succesul
tera piei de ablatie.

Suplimentul A, 2008
112
91. Prevalena factorilor de
risc cardiovascular la pacienii
protezai aortic inclui n
programul comprehensiv de
recuperare
Dana Emilia Velimirovici
1
, Maria Rada
1
, Delia Ber-
ceanu Vduva
1
, Simona Drgan
1
, D. Gai
1
, Adriana
Schnabel
3
, Georgiana Manca
1
, I. Gogoa
2
, Silvia
Manca
1
1
2
Universitatea de tiine Agricole i Medicin Veterinar
a Banatului
3
Spitalul Clinic Municipal Timioara, Romnia
Scop: stabilirea infuenei programelor de recuperare
cardiovascular asupra prevalenei factorilor de risc
cardiovascular la pacienii protezai aortic n funcie de
etiologia valvulopatiei aortice.
Material i metod: au fost inclui n studiu 76 pacieni
pro tezai pentru valvulopatie aortic de etiologie diver-
s. Factorii de risc cardiovascular evaluai la inclu dere
i la 6 luni postoperator au fost: TA 140/90 mmHg,
IMC 30 kg/m
2
, CT 200 mg/dl, diabet zaharat tip
2, condiia de fumtor i ex fumtor. Pacienilor li s-a
recomandat respectarea msurilor de prevenie secun-
dar, inclusiv antrenament fzic sau desfurarea de
acti viti fzice zilnice n mod regulat n funcie de tole-
rana individual la efort, precum i de rezultatele test-
rii la efort, insistndu-se asupra edinelor de mers pe
jos. Prelucrarea statistic: media deviaie standard, %
lot, testul t nepereche.
Rezultate: la lotul inclus n studiu se remarc prevalena
etio logiei degenerative (61,84%) secondat de cea
reu matismal. Incidena sexului masculin a fost de
63,15%. La loturile randomizate n funcie de etiologia
val vulopatiei se remarc o prevalen crescut a celor
trei factori de risc majori tradiionali (hipertensiune,
hiper colesterolemie i condiia de fumtor), ndeosebi
la cei cu etiologie degenerativ. Benefciul msurilor de
prevenie secundar asupra dinamicii evoluiei facto-
rilor de risc cardiovascular cuantifcat la 6 luni de la
includerea n studiu, indic o ameliorare nesemni fca-
tiv a prevalenei hipertensiunii i obezitii n rn dul
pacienilor randomizai comparativ cu valorile post ope-
ratorii, n schimb prevalena hipercoles tero lemiei scade
de la 28,94% la 18,30% (p<0,005), iar cea a statusului de
fumtor de la 32,89% la 21,12% (p <0,005).
Concluzii: este evident prevalena crescut a celor trei
factori de risc majori tradiionali, ndeosebi la pacienii
valvulari aortici cu etiologie degenerativ. Acest stu diu
demonstreaz benefciul major programelor de recu-
perare cardiovascular i n special al msurilor de pre-
venie secundar asupra prevalenei factorilor de risc
cardiovascular, n principal a hipercolesterolemiei i a
statusului de fumtor la 6 luni de la randomizare modi-
fcnd riscul cardiovascular al valvulopatiilor aortice.

Prevalence of cardiovascular
risk factors on patient with
aortic valve replacement
included in comprehensive
rehabilitation program
1
, Maria Rada
1
,
Delia Berceanu Vaduva
1
, Simona Dragan
1
, D. Gaita
1
,
Adriana Schnabel
3
, Georgiana Mancas
1
, I. Gogoasa
2
,
Silvia Mancas
1
1
University of Medicine & Pharmacy Victor Babes
2
University of Agricultural Sciences of Banat
3
Clinical Municipal Hospital, Timisoara, Romania
Objective: to establish the infuence of cardiovascular
rehabilitation program on cardiovascular risk factors
prevalence in patients with aortic valve replacement
depending on the etiology of aortic valvulopathy.
Materials and methods: 76 patients with aortic valve
replacement for aortic valvulopathy of diverse etio-
logies where included in the study. Te evaluated car-
dio vascular risk factors at the study admission time
and 6 month afer surgery were as follows: BP 140/90
mmHg, BMI 30 kg/m
2
, TC 200 mg/dl, type 2 diabetes
mellitus, smoking and ex-smoking state. Patients were
recomanded to respect secondary prevention mea sures,
including exercise programs or regular daily phy sical
activity depending on the limits of individual efort
tole rance and on the results at the efort test, with an
accent to walking sessions. Statistical analysis: average
standard deviation, % lot, student t test.
Results: in the studied lot we remark the prevalence
of degenerative etiology (61.84%) and secondly the reu-
matismal etiology of the aortic valvulopathy. 63.15%
of patients were man. We remark a higher preva lence
Suplimentul A, 2008
118
POSTER II
of the three traditional major risk factors (hyper ten-
sion, hypercholesterolemia and smoking condi tion),
espe cialy in aortic degenerative lesions. Te beneft
of secondary prevention measures on dinamics of car-
dio vascular risk factors evolution, quantifed afer 6
mon ths from study admission, indicate a poor impro ve-
ment of hypertension and obesity prevalence com pared
to early post surgery values, on the other han hand
pre valence of hypercholesterolemia decreased from
28.94% to 18.30% (p<0.005), and the prevalence of smo-
ker condition from 32.89% to 21.12% (p<0.005).
Conclusions: there is an evidence of higher prevalence
for the three traditional major risk factors, especially for
aortic valvular patients with degenerative lesions. Tis
study demonstarte the major beneft of cardiovascular
reabilitation programes and especially of secondary
pre vention measures on cardiovascular risk factor
pre valence, frst in rank for hypercholesterolemia and
smoking status 6 months afer randomisation, impro-
ving the cardiovascular risk score in patients with aor-
tic valvulopathy.

92. Fluxul retrograd in venele
pulmonare poate realiza
diagnosticul diferential intre
tahicardiile atrio-ventriculare
ortodromice si tahicardiile prin
reintrare in nodul
atrioventricular
Adriana Alexandrescu, R. Vatasescu, N. Dumitrescu,
Maria Dorobantu
Rezumat: Este difcil de realizat diagnosticul diferential
intre tahicardia atrioventriculara ortodromica (TRAV)
si tahicardia prin reintrare in nodul atriventricular
(TRNAV) in absenta studiului electrofziologic invaziv.
Totusi activarea succesiva intai a ventriculilor si apoi
a atriilor in TRAV comparativ cu activarea aproape
concomitanta a ventriculilor si a atriilor in TRNAV
poate avea consecinte hemodinamice distincte.
Obiectiv: Evaluarea fuxului venos pulmonar, fuxului
transmitral si transaortic in timpul tahicardiilor supra-
ventriculare cu complexe QRS inguste in scopul iden-
tifcarii unor parametrii ecocardiografci care sa per-
mita diagnosticul neivaziv al tipului de tahicardie cat si
semnifcatia hemodinamica a acesteia.
Metoda: Cei 22 de pacienti care au fost supusi unui
studiu electrofziologic in vederea ablatiei, au fost eva-
luati ecocardiografc in timpul tahicardiilor induse in
labo ratorul de studiu electrofziologic precum si in
timpul ritmului sinusal. S-a masurat viteza maxima
(AR) si durata fuxului venos pulmonar retrograd, du-
ra ta umplerii diastolice mitrale, durata intre debutul
umplerii diastolice mitrale si unda R si debitul bataie.
Pe baza datelor electrofziologice, 10 din pacientii exa -
mi nati au prezentat forma atrioventriculara de tahi-
cardie, restul de 12 pacienti au prezentat tahicar die prin
reintrare in nodul atrioventriculular.
Rezultate: Fluxul venos pulmonar s-a caracterizat prin
inregistrarea unei singure unde si anume ceea de fux
sistolic retrograd. Viteza maxima a fuxului retrograde
in arterele pulmonare la pacientii cu TRNAV a fost
sem ni fciativ mai mica decat la pacientii cu TRAV
(30,54,89 cm/s vs 36,201,03 cm/s, p<0,002). Totusi,
nu a fost posibila identifcarea unei valori limita care
sa poata face diferentierea clara intre cele 2 tipuri de
tahi cardii datorita lotului redus de pacienti. Durata
umplerii diastolice a VS nu a fost semnifcativ diferita
intre cele doua grupuri de tahicardii (12619,8ms in
grupul cu TRNAV si in grupul cu TRAV 113,2ms13,7,
p=NS). Debitul bataie a fost redus in ambele tipuri de
tahicardie (de la 716,4ml la 33,53,26ml in TRNAV si
de la 709ml la 34,83,48ml in TRAV, p=NS).
Concluzii: Pacientii cu tahicardie atrioventriculara
ortodromica au o viteza a fuxului retrograd mai mare
com parativ cu lotul pacientilor cu tahicardie prin
reintrare in nodul atrioventricular. Totusi, identifcarea
unei va lori limita care sa poata face diagnosticul
diferential intre cele doua tipuri de tahicardii, necesita
un lot mai nu meros de pacienti.

Suplimentul A, 2008
111
93. Valoarea NT-proBNP n
evaluarea prezenei disfunciei
de ventricul drept i a
severitii hipertensiunii
pulmonare la pacienii cu
insuficien cardiac
moderat-sever
Adriana Gurghean
1
, Bianca Malmare
1
, Ioana Tudor
1
,
Anca Mihailescu
1
, Luminita Varzaru
1
, Ioana Pop
2
,
Minerva Muraru
1
, I. Bruckner
1
1
Clinica de Cardiologie, Spitalul Clinic Colea,
Bucureti, Romnia
2
Clinica de Cardiologie, Institutul de Boli Cardiovas-
culare Prof. Dr. C.C. Iliescu, Bucureti, Romnia
Obiective: Scopul acestui studiu a fost evaluarea core-
laiilor dintre valorile NT-proBNP i prezena disfunciei
de ventricul drept (VD) i severitatea hipertensiunii
pul monare (HTP) la pacienii cu insufcien cardiac
moderat-sever
Metod: Am evaluat un lot de o sut trei pacieni (pt.)
cu insufcien cardiac clasa III-IV NYHA (55% br-
bai, vrsta cuprins ntre 25 i 92 de ani, virsta medie
65.6 ani) la care s-au dozat valorile NT pro-BNP seric
si s-a efectuat o evaluare ecocardiografc n care s-au
urmrit n special parametrii funciei VD si ai HTP.
Analiza statistic a fost efectuat prin utilizarea coef-
cientului de corelaie Pearson si testul Mann-Whit ney
U Statistica versiunea 7.
Rezultate: Pacienii au fost mpriti n dou grupuri:
grupul A cu pacienii (53.3%pt.) care asociau disfuncie
de VD si grupul B cu pacieni cu funcie sistolic
normal VD. (46.7%pt.). Am evaluat funcia sistolic
a VD utilizand modul M (TAPSE valoare normal
>18 mm) si Imagistica prin Tissue Doppler (unda S inel
tricuspidian valoare normal >10 cm/s) si hiper ten-
siunea pulmonar utilizand regurgitarea tricus pi dian
pentru PAP sistolic si timpul de accelerare n artera
pulmonar pentru PAP medie. Disfuncia de VD a fost
prezent la 56% pt. din grupul A, 81.4% pt. din grupul
A prezentau HTP sistolic (PAPs >35 mmHg) si toi
pt. din grupul A prezentau valori ale presiunii medii
pul monare peste normal (PAPm >25 mmHg). In ceea
ce priveste evaluarea funciei VD a existat o corelaie
semni fcativ statistic ntre examinarea n M-mode si
TDI (p<0.001, r=0.59) i nu a existat nici o corelaie
ntre severitatea PAPs si PAPm si funcia VD (p =
0,861, r = 0,293 si respectiv, p = 0,392, r = 0,129). A
existat o corelaie semnifcativ statistic ntre valorile
NT-proBNP si funcia sistolic a VD evaluat atat prin
TDI (p=0.0331, r=-0.3114) cat si prin M-mode, res-
pectiv (p=0.0228, r=-0.3317), dar nu a existat nici o
corelaie ntre valorile NT-proBNP si severitatea hiper-
tensiunii pulmonare, evaluat prin presiunile sistolice
(p = 0,7818, r = -0,0420) si, respectiv, medii (p = 0,5032,
r = -0,1105)
Concluzii: Prezena disfunciei ventriculului drept s-a
asociat cu valori semnifcativ mai mari ale valorilor NT-
proBNP la pacienii cu insufcien cardiac. Valorile
NT-proBNP

The prognostic value of NT-
proBNP for right ventricular
dysfunction and pulmonary
hypertension severity in
patients with moderate to se-
vere heart failure
Adriana Gurghean, Bianca Malmare, Ioana Tudor,
Anca Mihailescu, Luminita Varzaru, Ioana Pop,
Minerva Muraru, I. Bruckner
Clinic of Cardiology, Coltea Clinical Hospital,
Bucharest, Romania
Aims: To evaluate the relationship between the NT-
proBNP values and the presence of right ventricular
(RV) dysfunction and the severity of pulmonary arte-
rial hypertension (PAH) in patients with moderate to
severe heart failure.
Method: One hundred and three patients (pts.) with
heart failure NYHA III-IV (55% male, age 25-92 years,
mean age 65.6 years) having a NT pro-BNP assessment
in our Department were evaluated by echocardiography.
A special attention was directed towards the parameters
of RV systolic function and pulmonary hypertension.
Statistical analysis was done with Statistica sofware
programme, version 7, using Pearson correlation coef -
cient and the Mann-Whitney U test.
Results: Te pts. were divided in two groups: Group A
with pts. with RV dysfunction (53.3%pts.) and group
Suplimentul A, 2008
115
POSTER II
B with pts. without RV dysfunction (46.7%pts.). We
evaluated the right ventricular systolic function by using
M-mode (TAPSE normal value >18mm) and Tissue
Doppler Imaging (S annular tricuspid wave normal
value >10cm/s) and the pulmonary hypertension by
using the tricuspid regurgitation for systolic PAH and
the acceleration time in pulmonary artery for mean
PAH assessment. RV dysfunction was present in 56%
pts. from group A, 81.4% pts. from group A had systolic
pulmonary arterial hypertension (sPAH >35mmHg)
and all of the pts. from group A had mean pulmonary
arterial hypertension above normal limit (mPAH >25
mmHg). Regarding the RV function assessment, there
was a statistically signifcant correlation between the
M-mode and TDI evaluation (p<0.001, r=0.59) and
there was no correlation between the severity of sPAH
and mPAH and RV function (p = 0,861, r = 0,293 and p
= 0,392, r = 0,129 respectively). Tere was a statistically
signi fcant correlation between the NT-proBNP values
and RV systolic function assessed by TDI (p=0.0331,
r=-0.3114) and by M-mode, respectively (p=0.0228, r=-
0.3317), but there was no correlation between the NT-
proBNP values and the severity of pulmonary arterial
hyper tension, evaluated both by systolic (p = 0,7818, r
= -0,0420) and mean values (p = 0,5032, r = -0,1105),
respectively.
Conclusions: Te presence of right ventricular dysfunc-
tion was associated with signifcantly greater values of
NT-proBNP in patients with heart failure. NT-proBNP
correlated with right ventricular dysfunction regar dless
of the severity of heart failure. NT-proBNP did not
correlate with the severity of pulmonary arterial hyper-
tension.

94. Manifestari in tahicardii ale
cailor nodale
Al. Gheorghiu, Alina Ivanica, A. Ivanica,
St. I. Dragulescu
Institutul de Boli Cardiovasculare Timisoara
Obiectiv: Punerea in evidenta a tahicardiilor legate de
prezenta cailor nodale multiple (slow-fast, slow-slow,
fast-slow) si a tahicardiilor in care caile nodale intervin
in mod secundar.
Material si metoda: In perioada 1998-2008, in cadrul
Institutului de Boli Cardiovasculare Timisoara, au fost
ablatati un numar de 850 de pacienti cu tahicardii al
caror mecanism de aparitie implica prezenta cailor
nodale multiple, dupa cum urmeaza:
- tahicardii prin reintrare intranodala de tip slow-
fast - 846 pacienti (99,5%);
- tahicardii prin reintrare intranodala de tip slow-
slow - 12 pacienti (1,4%);
- tahicardii prin reintrare intranodala de tip fast-
slow - 9 pacienti (1,05%);
- tahicardii cu dublu raspuns ventricular - 3 pacien-
ti (0,35%);
- tahicardii jonctionale reciproce cu alternanta ciclu
scurt - ciclu lung - 35 pacienti (4,1%);
- dubla tahicardie - 22 pacienti (2,5%).
Pacientii au fost ablatati dupa cum urmeaza:
- calea (cai) lenta - 842 pacienti (99%);
- calea rapida - 13 pacienti (1,5%).
Rezultate: Rata de succes a procedurilor efectuate a fost
de 99,5% (846 pacienti), inregistrandu-se recidive doar
in cazul a 0,5% (4 pacienti) dintre pacientii tratati.
De asemenea, s-au inregistrat urmatoarele compli-
catii:
- deces 0 cazuri.
- bloc atrioventricular total permanent 1 caz
(0,11%);
- bloc atrioventricular gradul II tip Mobitz I tran-
zitor 2 cazuri (0,23%);
- tamponada cardiaca 0 cazuri;
- hemoragii la locul de punctie 0 cazuri;
- endocardita infectioasa postinterventie 0 ca-
zuri.
Concluzie: Manifestarile tahicardiilor sunt multiple si
implica mecanisme diverse, care necesita confrmare
prin studiul electrofziologic. Ablatia prin radiofrecventa
in tahicardiile al caror mecanism implica prezenta
cailor nodale multiple vindeca pacientul cu pretul unei
rate scazute a complicatiilor periprocedurale.

Suplimentul A, 2008
116
Aspects of Tachycardias
Involving Atrioventricular
Nodal Pathways
Al. Gheorghiu, Alina Ivanica, A. Ivanica,
St. I. Dragulescu
Timisoara Institute of Cardiovascular Diseases
Aims of the study: To underline some aspects of mul-
ti ple atrioventricular nodal pathways related tachy car-
dias (slow-fast, slow-slow, fast-slow) and aspects of
tachy cardias in which nodal pathways are secondary
invol ved.
Methods: From 1998 to 2008 there were 850 patients
admitted in Timisoara Institute of Cardiovascular Di-
seases and treated by means of radiofrequency ablation
for tachycardias involving the presence of multiple
atrio ventricular nodal pathways:
- slow-fast atrioventricular nodal reentrant tachy-
cardia - 846 patients (99,5%);
- slow-slow atrioventricular nodal reentrant tachy-
- fast-slow atrioventricular nodal reentrant tachy-
- double ventricular response tachycardia - 3 pa-
tients (0,35%);
- long cicle-short cicle alternating junctional reci-
procating tachycardia - 35 patients (4,1%);
- double tachycardia - 22 patients (2,5%).
Te patients were ablated as follows:
- slow pathway(s) ablation - 842 patients (99%);
- fast pathway ablation - 13 patients (1,5%).
Results: Te ablation success rate was 99,5% (846
patients) and only in 0,5% of the patients treated (4
cases) the tachycardia relapsed.
We also, observed the following complications:
- permanent third-degree atrioventricular block 1
case (0,11%);
- transient second-degree Mobitz I atrio ventri cular
block 2 cases (0,23%);
- cardiac tamponade 0 cazuri;
- puncture site haemorrhage 0 cazuri;
- postprocedural infective endocarditis 0 cazuri.
Conclusion: Tachycardias have multiple features and
involve complex mechanisms, which necessitate con-
fr mation by means of electrophysiological study. Ra-
dio frequency ablation in tachycardias involving the
pre sence of multiple atrioventricular nodal pathways
cure the pacient and has a low rate of periprocedural
com pli cations.

95. Aprecierea calitii vieii
prin intermediul
chestionarului duke activity
status index la pacienii
valvulari aortici operai
Maria Rada
1
, Dana Velimirovici
1,2
, Simona Drgan
1,2
,
Adriana Schnabel
3
, M. Berceanu
1
, F. Cobzariu
1
,
V. Ionescu
1
, Florentina Tecar
2
, Silvia Manca
1,2
1
2
Institutul de Boli Cardiovasculare
3
Spitalul Clinic Municipal, Timioara, Romnia
Scop: stabilirea benefciilor programelor postoperatorii
de recuperare cardiovascular, asupra ameliorrii capa-
citii funcionale i implicit a calitii vieii la pacienii
valvulari aortici operai, aceasta find n prezent o m-
sur relevant a efcacitii oricrui tratament.
Material i metod: pentru aprecierea calitii vieii
s-a utilizat chestionarul Duke Activity Status Index
(DASI), ce se adreseaz n general populaiei adulte cu
patologie cardiovascular. Indexul Duke este msu rat
pe o scala semicontinu care permite scoruri posi bile
ntre 0 i 58,2. Scorurile maxime indic o bun funcio-
na litate fzic, iar un scor de 0 puncte refect incapa-
citatea pacientului de a-i desfura activitile zilnice
de baz.
Cei 82 pacieni eligibili pentru studiu, au fost rando-
mizai n dou grupe:grupa de antrenament (A)-43
pacieni i grupa de control (B)-39 pacieni. Pacienii
ambelor grupe, au completat chestionarele pentru eva-
luarea calitii vieii la includere n studiu i la 3 luni
(fnalul fazei II de recuperare cardiovascular).
Rezultate: pentru a realiza o mai bun cuantifcare a
scorurilor acestea au fost grupate astfel: 0-18; 19-26; 27-
32; 33-42; 43-50; 51-58. Dei la includere predomin
pacienii cu scoruri DASI mici, 24,39% (scor 0-18), la 3
luni se remarc o cretere a procentului celor ncadrai
n scoruri DASI mai nalte, 52,05% (scor 51-58), de-
mons trnd ameliorarea semnifcativ a capacitii
func io nale la pacienii protezai aortic. Dup 3 luni
Suplimentul A, 2008
11I
POSTER II
de antrenament fzic pacienii i-au mbuntit scorul
DASI cu 66,78% (de la 27,85 la includere la 46,45
la fnalul fazei II). La pacienii grupei de control se
remarc o mbuntire mai puin semnifcativ a sco-
rului, 35,65% (de la 25,52 la includere la 34,62 la 3 luni).
Analiznd difereniat n funcie de sex evoluia scorului
DUKE cele mai evidente mbuntiri se semnaleaz
la grupa de antrenament la pacienii de sex masculin,
de la 32,8 la 52,3, (p <0,001), comparativ cu cei de sex
feminin unde aceast ameliorare a fost de la 22,9 la 33,8
(p <0,01).
Concluzii: scorul DASI, care refect starea fzic i
autoaprecierea strii de sntate, are o evoluie mai
favorabil la pacienii inclui n programe de reabi litare
cardiovascular comparativ cu cei sedentari. Antre na-
mentul fzic a contribuit la creterea capacitii de efort
i concomitent la mbuntirea calitii vieii apre ciat
prin starea fzic. Analiznd n funcie de sex evo luia
scorului DASI cele mai evidente mbuntiri sunt
remarcate la pacienii de sex masculin inclui n pro-
gramul de recuperare cardiovascular.

Physical training efficiency
on life quality evaluation by
duke activity status index
questionnaire in patients after
aortic valve replacement
Maria Rada
1
, Dana Velimirovici
1,2
, Simona Drgan
1,2
,
Adriana Schnabel
3
, M. Berceanu
1
, F. Cobzariu
1
,
V. Ionescu
1
, Florentina Tecar
2
, Silvia Manca
1,2
1
University of Medicine and Pharmacy Victor Babes
2
Institute of Cardiovascular Diseases
3
Objective: to establish the beneft of postoperatory
cardiovascular rehabilitation program on functional
capacity and on quality of life for patients afer aortic
valve replacement.
Materials and methods: we used the Duke Activity
Status Index (DASI) questionnaire to assess the quali ty
of life; DASI was developed generally for adults with
cardiovascular pathology. Duke index is evalua ted on
a semi continuous scale with possible scores bet ween
0 and 58.2. Maximal scores indicate a good phy sical
capacity, and a score of 0 points refects the inability to
carry out usual activities of daily living. 82 patients were
divided in 2 groups: training group (A) 43 patients
and control group (B)-39 patien ts. Te two groups of
patients completed a self-adminis tered questionnaire
to determine the quality of life, at the time of inclusion
and afer 3 months (the end of phase II of cardiovascular
rehabilitation).
Results: to obtain a better quantifcation, scores were
grouped as fallows: 0-18; 19-26; 27-32; 33-42; 43-50;
51-58. Albeit there is a predominance of low DASI
scores at study admission time- 24,39% (score 0-18),
afer 3 months we remark a proportion of the patients
with higher DASI scores -52,05% (score 51-58),
demonstrating a signifcant improvement of functional
capacity in patients with aortic valve replacement.
Afer 3 months of physical training the patients impro-
ved their DASI score with 66.78% (from 27.85 at stu dy
admission time to 46.45 at the end of phase II RC). In
the control group, we remark a less signifcant impro-
vement of the score- 35.65% (from 25.52 at the time
of inclusion to 34.62 afer 3 months). Gender dife ren-
tiated analyze for DUKE score discloses the most evi-
dent improvement for male training group, from 32,8
to 52,3, (p<0,001), versus female training group with an
improvement from 22,9 to 33,8 (p<0,01).
Conclusions: DASI score that refect physical condition
and health self-esteem have a more favorable evolution in
patients that participate to cardiovascular rehabilitation
programs versus sedentary subjects. Physical training
contributes to the increase of functional capacity and
quality of life. Gender diferentiated analyze for DASI
evolution scores discloses the most obvious progress in
male patients included in cardiovascular rehabilitation
program.

Suplimentul A, 2008
118
96. Tromboza intracardiaca
dreapta - cazuri clinice
integrate
AG Tase, SM Marinescu, D Blajan, R Mihalache,
M Mihaila, A Radulescu, G Stanciulescu,
C Trache, O Tetiu
Universitatea din Pitesti, Spitalul Judetean de Urgenta
Arges, Pitesti
Introducere: In ultimul timp am intalnit in practica
noastra clinica un numar de cazuri de tromboza car-
diaca dreapta, la diverse grupe populationale dupa cri-
terii de varsta, gen, mediu, in variate contexte clinice,
cu tromboze asociate in alte teritorii vasculare.
Metoda: Din cadrul acestui portofoliu, am selectionat
patru cazuri de tromboza cardiaca dreapta cu evolutie
accelerata, de diversitate demografca (30 ani urban,
55 ani rural, 27 ani rural, 60 ani rural), cu tablouri
clinico-biologice nespecifce la care examenul eco-
cardiografc a fost decisiv pentru diagnostic. Au mai
fost efectuate si alte investigatii imagistice (CT, RMN
etc.) si biochimice specifce.
Contextul clinic a fost variat, de la administrarea de
contraceptive si calatorii lungi cu autocarul, la infectii
respiratorii recidivante sau sarcom fbroblastic de pe-
rete toracic. Trombozele au fost prezente si in alte teri-
torii (vena saphena magna, vena cava inferioara, artera
pul monara etc.)
Rezultate: Examenul ecocardiografc s-a efectuat pre-
coce si a avut relevanta diagnostica.
Tratamentul farmacologic antitrombotic maximal a
fost instituit imediat. Majoritatea pacientilor studiati
sunt supravietuitori (75%).
Pacientii selectionati nu au suferit interventie chirur-
gicala, din diverse motive. Cazuistica este relevanta
pentru succesul terapiei farmacologice.
Similaritatile, respectiv contrastele observate la aces-
te cazuri constituie lectii clinice traite, utile pentru pa-
cientii care vor urma. La Congres vor f prezentate fl-
mele video ecocardiografce.
Concluzii: Consideram ca, datorita severitatii si tren-
dului ascendent al prevalentei acestei patologii, tema
este de actualitate. De asemenea, dorim ca prin aceasta
lucrare sa contribuim la optimizarea diagnosticului si
tratamentului acestei boli.

Right intracardiac thrombosis
- integrated clinical cases
AG Tase, SM Marinescu, D Blajan, R Mihalache,
M Mihaila, A Radulescu, G Stanciulescu, C Trache,
O Tetiu
University of Pitesti, Arges County Emergency Hospital,
Pitesti
Intro: In the last time we have met in our clinical practice
a number of cases with right cardiac thrombosis, in
diferent populational groups concerning age, gender,
medium criteria, in various clinical contexts, with asso-
ciated thrombosis in other vascular territories.
Method: From this portfolio of patients, we selected four
cases of right cardiac thrombosis with accelerated evo-
lution, with demographic diversity (30 years urban,
55 years rural, 27 years rural, 60 years rural), with
non-specifc clinical and biological patterns in which
the echocardiographic examination was decisive for
the diagnosis. Tere were also performed other ima-
ging (CT, MRI, etc.) and specifc biochemistry inves-
tigations.
Te clinical context was various, ranging from contra-
ceptives administration and long bus trips, to iterative
respiratory infections, or thoracic wall fbroblastic
sar coma. Te thrombosis were also detected in other
terri tories (vena saphena magna, inferior vena cava,
pul monary artery, etc.)
Results: Echocardiographic examination was perfor-
med early and proved diagnostic relevance.
Te maximal antithrombotic pharmacological treat-
ment was initiated immediately.
Te main part of the patients studied are survivors
(75%).
Te selected patients did not undergo surgery, from
various reasons.
Te case portfolio is relevant for the success of the
pharma cological therapy.
Te similarities and contrasts, respectively, observed
in these cases, are living clinical lessons, useful for the
ongoing patients.
In the Congress will be presented the video echocar-
diographic movies.
Conclusions: We consider that, because of severity and
ascending trend of this pathology prevalence, this issue
is actual. By this paper, we also intend to contribute in
optimizing diagnosis and treatment of this disease.

Suplimentul A, 2008
119
POSTER II
97. Preventia primara la
subiectul asimptomatic cu risc
inalt - Euroaspire III Romania
follow-up
Avram C
1
, Craciun L
2
, Iurciuc S
2
, Avram CA
2
,
Sarau CA
2
, Iurciuc M
2
, Gaita D
2
1
Universitatea de Vest Timioara, Facultatea de
Educaie Fizic i Sport
2
Institutul de Boli Cardiovasculare Timisoara, UMF V.
Babes Timisoara
Premise stiintifce: Numeroase studii tiinifce, porni-
nd de la studii observaionale i trialuri controlate ran-
do mizate susin efciena interveniilor de schimbare a
stilului de via (fumatul, dieta i exerciii fzice), trata-
mentului hipertensiunii arteriale, hiperlipidemiei i
diabetului zaharat, precum i utilizarea selectiv a terapiei
medicamentoase proflactice (aspirina, beta blocante,
IECA, ageni hipolipemiani i anticoagulante). Toate
aceste msuri pot reduce morbiditatea i mortalitatea la
cei cu boli coronariene i de asemenea pot reduce riscul
dezvoltrii acestei afeciuni.
Obiective: Obiectivul principal al acestui studiu este
acela de a creste standardul preventiei cardiovasculare
prin intensifcarea interventiilor de schimbare a stilului
de viata, controlul adecvat al factorilor de risc si opti-
mizarea tratamentului proflactic pentru a reduce riscul
de aparitie a bolilor cardiovasculare la subiectii cu risc
inalt. Un alt obiectiv al protocolului acestui studiu este
acela de a evalua efcienta tratamentului pacientilor din
EuroAspire III prin optimizarea medicatiei conform
ghidurilor actuale.
Material si metoda: Pacientii au fost inclusi in studiu
ince pand cu noiembrie 2007 find evaluati initial in
cadrul studiului EUROASPIRE III Romania. Crite riile
de includere in studiu au coincis cu cele din stu diul
EUROASPIRE III Romania, lotul de pacienti asimpto-
matici cu risc crescut: barbati si femei sub 80 ani, ne-
diag nosticati cu boala coronariana sau alte afectiuni
atero sclerotice, care in momentul includerii in studiu
erau sub medicatie antihipertensiva si/sau medicatie
hipo lipemianta si/sau terapie antidiabetica (medicatie
antidiabetica sau doar dieta), cuprinsi in intervalul de
timp de 6 luni - 3 ani de la momentul initierii terapiei.
Pacientii au fost evaluati la includerea in studiu,
urmand sa fe reevaluati periodic la interval de 6 luni
din punct de vedere clinic si biologic la nivelul cabi-
netelor de medicina de familie si medicina interna de
ambulator (6 centre medicale). Recomandarile in ceea
ce priveste schimbarea stilului de viata, modifcarea
facto rilor de risc si prescrierea medicatiei au fost facute
in colaborare cu specialistul cardiolog, nefrolog si dia-
betolog conform ghidului European de preventie a
bolilor cardiovasculare (2007).
Rezultate si concluzii: Din numarul total de pacientii
eligibili (503 pacienti) doar 345 pacienti au putut f
inclusi in EUROASPIRE III Romania Follow-Up (rata
de raspuns 68 %) datorita compliantei scazute a pacien-
ti lor cu risc crescut la masurile de preventie primara a
bolii coronariene. Analiza fnala, preconizata in iulie
2009 ne va arata in ce masura tratamentul optim al
fac to rilor de risc si recomandarile de schimbare a stilu-
lui de viata reduc mortalitatea i morbiditatea cardio-
vas culara la subiecii cu risc nalt.

Primary prevention in high
risk asimtomatic patients -
Euroaspire III Romania
follow-up
Avram C
1
, Craciun L
2
, Iurciuc S
2
, Avram A
2
,
Sarau CA
2
, Iurciuc M
2
, Gaita D
2
1
University of West Timioara, Romania
2
Victor Babe University of Medicine and Pharmacy
Timioara, Romania
Introduction: Many scientifc studies shows demons-
trated the ef ciency of lifestyle changing interventions
(smoking, diet and physical activity), treatment of
arterial hypertension, hyperlipemia and diabetes
melli tus and also using prophylactic therapy (aspirin,
beta-blockers, ACEI, hypolipemiant agents and anti coa-
gulants). All of these measures can reduce the morbi-
dity and mortality in patients with coronary heart di-
seases and also can prevent development of athero scle-
rotic disease.
Objectives: Te main objective of this study is to raise
the standard of preventive cardiology through lifestyle
intervention, good control of other risk factors and
optimal use of prophylactic drug therapies in order to
reduce the risk of developing cardiovascular disease
in high risk individuals. One key point in the follow-
up protocol is to asses the ef ciency of treatment in
EuroAspire III patients through optimizing the medi-
Suplimentul A, 2008
120
cation according to current guidelines, so that every
patient receives the appropriate cardiovascular pre ven-
tive treatment.
Material and methods: Patients were included in the
study started with November 2007 afer they were
eva luated at baseline in EUROASPIRE III Romania.
Inclusion criteria were the same as in the EUROASPIRE
III Romania - high risk asymptomatic patients: men
and women under 80 years old without coronary heart
disease or other atherosclerotic disease treated with
anti hypertensive and/or hypolipemiant and/or anti-
dia betic drugs at inclusion and between 6 months to 3
years from the initiation of therapy.
Te patients were evaluated at baseline and they were
clinically and biologically reevaluated at every 6 months
by the investigators (6 medical centres). Changing life-
style intervention, management of risk factors and
drugs recommendations were made in collaboration
with specialist doctors (cardiologist, diabetologist and
nephro logists) according to European prevention of
cardio vascular diseases guideline (2007).
Results and conclusions: From 503 eligible patients,
just 345 patients could be included in EUROASPIRE
III Romania Follow-Up (response rate of 68 percent)
because of low rate compliance at primary prevention
mea sures in high risk asymptomatic patients.
Te fnal results expected in July 2009 will show us
the ef ciency of cardiovascular risk factors treatment
and recommendations of life style changing in reducing
cardio vascular mortality and morbidity in high risk
asymptomatic patients.

98. Eficiena monitorizrii
holter la pacienii diabetici
versus nondiabetici cu infarct
miocardic acut
Sorina Magheru, Alina Iacobescu, F. Maghiar, M.
Popescu
Introducere: Durerea precordial este principalul simp-
tom al bolii ischemice coronariene dup care se evalueaz
tipul i efcacitatea tratamentului. Studiile populaionale
au artat c ntre 20-60% dintre infarctele de miocard
acute nonfatale nu sunt recunoscute de pacient, find
descoperite numai la nregistrrile electrocardiografce
ulterioare sau decelate postmortem.
Material i metod: Monitorizarea Holter s-a efectuat
la 116 pacieni diabetici i la 98 pacieni nondiabetici.
Rezultate: n studiul nostru, n timpul monitorizrii
Holter, alungirea intervalului QTc s-a gsit la 29 pacieni
diabetici (14,3%) fa de 3 nondiabetici (1,5%) (p<0,001).
Tulburrile de ritm au fost detectat la un numr aproape
egal de pacieni diabetici i nondiabetici (44 versus 40
pacieni) fr a exista diferene semnifcative (p>0,05).
La pacienii diabetici s-au ntlnit mai multe cazuri de
fbrilaie atrial i TV nesusinut. Ischemia silenioas
detectat prin nregistrri Holter a fost semnifcativ mai
frecvent la pacienii diabetici find prezent la 35,6%
fa de nondiabetici la care a fost prezen n proporie
de 28,4% (p<0,05). nregistrrile Holter la DZ tip 2
ntre 40-70 de ani, a relevat o subdenivelare ischemic
ST-T la 36% din DZ fa de 17% dintre coronarieni non-
diabetici.
Concluzii: Monitorizarea Holter a pus n eviden apa-
riia la bolnavii cu IMA a unor episoade de subdenivelare
de segment ST asimptomatice, i care nu se evideniau
pe ECG de repaus.

99. Scderea tensiunii
arteriale produs de clonidin
n corelaie cu activitatea AC I.
Studii in vivo.
Alina Iacobescu, Sorina Magheru, F. Maghiar
Introducere: Clonidina este un antihipertensiv cu efect
agonist asupra receptorilor alfa2 adrenergici. Meca nis-
mul de aciune nu este bine cunoscut, dar se pare c
efectul hipotensor este produs prin aciunea la nivel
cen tral, ceea ce duce la scderea tonusului simpatic.
Material i metod: Am examinat 100 de pacieni care
au primit tratament cu clonidin i au fost mprii n
dou grupuri: grupul 1, 50 de pacieni, au primit cloni-
din oral n doz de 0.3 mg pe zi; grupul 2, 50 de pacieni,
au primit clonidin oral n doz de 0.3 mg pe zi; dup
care au primit concomitent cu clonidin tratament cu
indometacin, 150 mg/zi, timp de 3 zile, dup care, nc
3 zile s-a continuat tratamentul cu clonidin, dup care
s-au prelevat probele sangiune. S-au urmrit zilnic
Suplimentul A, 2008
121
POSTER II
valorile TA i activitatea AC din hematii la pacienii cu
terapie oral.
Rezultate: La grupul 1 clonidina scade activitatea
tota l a AC din hematii cu 26% din care AC I scade
cu 66%, iar activitatea AC II cu 14%; valorile TA au
sczut de la 20015 mmHg la 14010 mmHg. La
grupul 2 pretratamentul cu indometacin reduce efectul
inhibitor al clonidinei asupra AC I. Activitatea total
a AC din hematii scade cu 18% din care AC I scade
cu 42%, iar AC II cu 8%. Efectul hipotensor este redus
cu 30%, valorile TA scznd de la 200 10 mmHg la
160 5 mmHg. Rezultatele nostre arat c clonidina
scade predominant activitatea AC I i mai puin a AC
II. Scderea activitii AC I se produce concomitent cu
scderea valorilor TA la toi pacienii luai n studiu.
Scderea n paralel a valorilor TA i a activitii AC I
sugereaz o posibil implicare a a acestei enzime n
mecanismul de aciune a clonidinei.
Concluzii: Clonidina, prazosinul, rezerpina i hidrala-
zina scad activitatea AC I i valorile TA, dar ultimele
dou cresc concomitent activitatea AC II. Se observ, din
studiile de mai sus, c scderea valorilor TA se produce
n paralel cu scderea activitii AC I. Aceast corelaie
sugereaz posibila implicare a AC I n mecanismul de
aciune a acestor droguri.

100. Pericardita asociat
sclerodermiei studiu
retrospectiv pe 10 ani
F. Maghiar, Alina Iacobescu, Sorina Magheru, M.
Popescu
Introducere: Prezent clinic la aproximativ 10% din
pacienii cu sclerodermie, pericardita este depistat la
autopsie la pn la 50% din cazuri.
Are ca mecanism acumularea de celule infamatorii i
formarea n exces a colagenului care duce la ngroarea
pericardului i formarea de aderene. Rareori apare un
revrsat pericardic important.
Material i metod: Pe parcursul celor 10 ani am iden-
tifcat 15 pacieni care au prezentat semne clinice de
peri cardit asociate afeciunii de baz: sclerodermia.
Toi aceti pacieni au fost femei, iar vrsta medie a fost
de 52.3 ani.
Rezultate: Pacientele, cunoscute cu sclerodermie s-au
prezentat la medic pentru dispnee inspiratorie la efor-
turi moderate i tabloul insufcienei cardiace drep te.
S-a ridicat problema diagnosticului diferenial cu hiper-
ten siunea pulmonar, prezent deseori la pacienii
cu sclerodermie, dar ecografa cardiac a tranat diag-
nosticul.
Astfel ecocardiografc 8 paciente au prezentat hiper -
tensiune pulmonar uoar, iar 6 au prezentat hiper-
tensiune pulmonar moderat. Toate pacientele au pre-
zentat lichid pericardic, ntre 300-500 ml.
Pacientele au benefciat de tratament imunosupresor
i au fost supravegheate medical pn la remiterea lichi-
dului.
n urmtorul an, 8 paciente au prezentat din nou
simptomatologia clinic de pericardit, confrmat prin
prezena lichidului pericardic, iar alte 6 paciente au
dezvoltat pericardit constrictiv, diagnosticat ecocar-
dio grafc i radiologic. Aceste 6 paciente au decedat
ntr-un an de la diagnosticul pericarditei constrictive.
n urmtorii 5 ani, alte 4 paciente au prezentat
pericardit constrictiv, 3 decednd n anul urmtor,
iar a patra la 2 ani de la diagnosticul de pericardit cons-
trictiv.
Nici unul dintre decese nu s-a datorat leziunilor peri-
cardice, ce condiiilor asociate n contextul afeciunii
auto imune.
Concluzii: Pericardita n sclerodermie a aprut la pa-
cienii urmrii de noi, n fazele evoluate ale afeciunii
i adeseori apariia pericarditei constrictive prevestete
exitusul, avnd valoarea prognostic negativ.

101. Sindromul de efuzie
pericardic n tuberculoza
pulmonar
F. Maghiar, Sorina Magheru, Alina Iacobescu,
M. Popescu
Introducere: Un loc aparte n cadrul pericarditelor bac-
teriene l ocup pericardita tuberculoas. Dei n rile
dezvoltate incidena pericarditei tuberculoase este n
scdere, reprezentnd 0-8% din totalul pericarditelor,
la noi n ar pericardita tuberculoas cunoate o recru-
descen.
Suplimentul A, 2008
122
Material i metod: n studiul realizat de noi am diag-
nosticat 470 pacieni cu pericardit tuberculoas. Dintre
acetia, 290 (61.70%) au fost brbai i 180 (38.30%) au
fost femei. Vrsta medie a fost de 52, 8 ani (ntre 31 i
69 de ani). Durata medie de spitalizare a fost de 19 de
zile.
Rezultate: La examenul ecocardiografc 329 (70%)
dintre pacieni prezentau revrsat pericardic n canti-
tate medie/mare iar 141 (30%) dintre pacieni pre zen-
tau deja semne de pericardit constrictiv. Toi pa-
cien ii au primit tratament simptomatic antialgic, 123
(26.17%) pacieni necesitnd tratament cu opiace. Toi
pa cienii au primit tratament antiinfamator, din tre
care 131 (27.87%) pacieni, toi cu pericardit constric-
tiv, au primit corticoterapie pentru controlul simpto-
ma to logiei. Toi pacienii au urmat schema standard de
tera pie antituberculoas.
Dintre cei 329 de pacieni cu revrsat pericardic n
momentul diagnosticrii 129 (39,21%) au dezvol tat pe-
ricardit constrictiv n urmtorul an de dispen sarizare.
Ali 20 (6,08%) de pacieni au fost diagnosticai cu
peri cardit constrictiv la un an pn la trei ani de
la reactivarea procesului tuberculos. Dintre cei 290
(61,70%) de pacieni cu pericardit constrictiv n mo-
mentul diagnosticrii sau la care aceasta s-a dezvoltat
pe parcursul perioadei de urmrire 115 (39.65%) au
fost supui pericardectomiei, obinndu-se ameliorarea
semnelor de congestie venoas sistemic.
Concluzii: Diagnosticul de pericardit TBC s-a stabilit
n contextul clinic de impregnare bacilar, alturi de
diag nosticul pozitiv de pericardit. Complicaia cea
mai frecvent a pericarditei tuberculoase, n statistica
noas tr, a fost pericardita constrictiv. Studiul nostru
a dovedit c asocierea corticoterapiei la medicaia speci-
fc tuberculostatic nu duce la scderea incidenei
compli caiilor. n cazul pericarditei constrictive conse-
cutiv pericarditei tuberculoase, lucrarea de fa a
artat c, cu ct este mai scurt timpul de la debutul
simpto matologiei pn la pericardectomie, cu att mai
bune sunt rezultatele.
128
HTA VALVULOPATII CARDIOMIOPATII |
ARTERIAL HYPERTENSION - VALVULOPATHIES - CARDIOMYOPATHIES
IR mai mare (0.75 +/- 0.11 vs 0.58 +/- 0.12, p=0.03) si cu
RVSM mai inalt (2.53 +/- 0.13 vs 1.22 +/- 0.2, p=0,01).
In acelasi grup, AIT a fost semnifcativ mai frecvent la
pacienii cu VTD mai crescut (27.3 +/- 2,8 cm/s vs
18.2 +/- 2.1 cm/s, p=0.03). AIC a fost asociat semni-
fcativ cu RVSM mai mare (2.51 +/- 0.18 vs 1.12+/-0.22,
p=0.01).
Concluzii: Grosimea mai mare a stratului IM si nive-
lul mai ridicat al VTD si al RVSM par sa aib o predic-
tibilitate buna asupra unui prognostic mai sever pe ter-
men mediu (un an) in ceea ce privete evenimentele car-
dio vasculare la pacienii hipertensivi, mai ales la cei cu
SM. Mai mult, IR crescut are o valoare prognostica mai
puternica pe termen mediu pentru incidena sindroa-
melor coronariene acute fara supradenivelare de seg-
ment ST, la pacienii hipertensivi cu SM.

Linking ultrasound assessment
of the extracranial cerebral
circulation to the
cardiovascular events in
hypertensive patients with or
without metabolic syndrome
Adrian Gavrila
l
, Ruxandra Jurcut
2
, Rodica Musetescu
3
,
Cristian Searpe
1
, Vaieriu Sbrceal
1
, Carmen Ginghina
2
1
University Hospital C.F. , Craiova, Romania
2
Institute of Cardiovascular Diseases, Bucharest, Roma-
nia
3
Cardiology Center, Craiova, Romania
Te aim of the study was to estimate how the ultrasound
para meters of the carotid arteries correlate with prog-
nostic of hypertensive patients with or without meta-
bolic syndrome (MS).
Material and methods: 30 hyper ten sive patients (pts)
(mean age= 58.2+/-7.6 years, 53.3% males) -group 1-
and 30 hypertensive pts with MS, matched for age and
sex (mean age=59.8+/-7.3 years, 56.6% males) -group
2. Vascular ultrasound para meters performed were:
102. Corelatiile dintre
explorarea ecografica a circu-
latiei cerebrale extracraniene si
evenimentele cardiovasculare
la pacienii hipertensivi cu sau
fara sindrom metabolic
Adrian Gavrila
l
, Ruxandra Jurcut
2
, Rodica Musetescu
3
,
Cristian Searpe
1
, Vaieriu Sbrceal
1
, Carmen Ginghina
2
1
Spitalul Universitar C.F. Craiova
2
Institutul de Boli Cardiovasculare Bucureti
3
Rezumat: Scopul studiului a fost de a analiza felul in
care parametrii ecografci ai arterelor carotide se core-
leaz cu prognosticul pacienilor hipertensivi cu sau
fara sindrom metabolic (SM).
Material si metode: 30 pacieni hipertensivi (vrsta me-
die - 38.2 +/- 7.6 ani, 33,3% brbai) -grupul 1, iar 30
pa cieni hipertensivi cu SM, cu caracteristici similare
in ceea ce privete distribuia pe sexe si vrsta (vrsta
medie = 39.8+/- 7.3 ani 56.6% brbai) grupul 2. Para-
metrii de ecografe vasculara evaluai au fost: grosimea
stratului intima-medie (IM) in arterele carotide comune
(ACC), velocitatea telediastolica (VTD) in arterele caro-
tide interne (ACI), indicele de rezistenta (IR) in ACI,
raportul dintre velocitatile sistolice maxime (RVSM) in
ACI si ACC. Toti pacientii au fost urmrii timp de un an
cu scopul de a depista urmtoarele complicatii: angina
instabila (AI), infarct miocardic fara supradenivelare
de segment ST (IMFSD), accident ischemic cerebral
tran zitor (AIT), accident ischemic cerebral constituit
(AIC).
Rezultate: In grupul 1, AI a fost semnifcativ asociata
cu VTD mai mare (28.2+/- 2.7 cm/s vs 16.1 +/-1.7 cm/
s, p=0,02). In acelai grup, AIT a fost prezent intr-o
proporie semnifcativ mai mare la pacienii cu o gro-
sime mai mare de IM (1 +/- 0.3 mm vs 0.4 +/- 0.2 mm,
p=0.01). In grupul 2, AI a fost semnifcativ asociata cu
IR mai crescut (0.74 +/- 0.09 vs 0.59 +/- 0.11, p=0.04).
IMFSD a fost semnifcativ mai frecvent la pacienii cu
HTA VALVULOPATII CARDIOMIOPATII
Suplimentul A, 2008
121
thick ness of intima-media layer (IML) in common
caro tid arteries (CCA), end diastolic velocity (EDV)
in internal carotid arteries (ICA), resistance index(RI)
in ICA, peak systolic velocity ratio(PSVR) in ICA and
CCA. All pts were evaluated during one year in order
to detect the following complications: unstable angina
(UA), non-ST-segment-eievation myocardial infarc-
tion (NSTEMI), transient ischemic stroke(TIS) ische-
mic stroke(IS).
Results: In group 1, UA was signifcantly associate with
higher EDV(28.2+/-2.7 cm/s vs 16.1+/-l,7 cm/s, p=0.02).
In the same group TIS was found in a signifcantly higher
proportion at pts with greater thickness of IML(l+/-
0.3mm vs 0.4+/-0.2mm, p=0.01). In group 2, UA was
signifcantly associated with a greater RI (0.74+/-0.09
vs 0.59+/-0.11, p=0,04). NSTEMI was signifcantly
more frequent at pts with greater RI (0.75+/-0.11 vs
0.58+/-0.12, p=0,03) and with higher PSVR (2.53+/-
0.13 vs 1.22+/-0.2, p=0.01). In the same group TIS
was found in a signifcantly higher proportion at pts
with a higher EDV (27.3+/-2.8cm/s vs 18.2+/-2.1cm/s
p=0.03), IS was signifcantly associated with a greater
PSVR (2.51+/-0.18 vs 1.12+/-022, p=0,01)
Conclusions: Greater thickness of IML and higher level
of EDV and of PSVR seem to predict a worse mid term
outcome (one year) concerning cardiovascular events
at hypertensive pts, especially with MS.
Moreover, higher RI appears to have mote powerful
mid term prognostic value for incidence of acute co-
ro nary syndromes without ST-segment elevation at
hy per tensive pts with MS.

103. Rolul stresului oxidativ
in dezvoltarea complicatiilor
cardiace la bolnavii
hipertensivi
Campeanu A
1
, Bolohan M., Olinescu R., Dusceac D.,
Nanea T.
Universitatea de Medicina si Farmacie Carol Davila
Bucuresti, Spitalul Clinic Caritas
Introducere: Date recente sugereaza ca stresul oxidativ
(SO) este implicat in disfunctia endoteliala, formarea
si activarea placii aterosclerotice si poate contribui la
dezvoltarea complicatiilor la pacientii cu hipertensiune
esentiala (HT). Este inca in discutie implicarea SO in
dez voltarea diferitelor tipuri de complicatii cardiace la
pacienti hipertensivi.
Scop: Evaluarea statusului plasmatic oxidant si antioxi-
dant la pacienti (pts) cu HT cu sau fara complicatii car-
diace.
Metoda: La 229 pts (varsta 62.767.68 ani) cu HT, 77
pts fara complicatii (HT-C), 50 pts cu hipertrofe ven -
triculara stanga (HVS+) evaluati ECG sau ecocar dio gra-
fc, 50 pts cu boala cardiaca ischemica stabila (CAD+)
si 52 pts cu insufcienta cardica cronica (ICC+) si la
35 subiecti sanatosi (varsta 59.0511.44 ani) (grupul
C), ce nu primeau antioxidanti sau beta blo can te, s-au
recol tat probe de sange pentru deter mi na rea coles tero-
lu lui(mg/dl), prooxidantii plasma tici (lipid pero xi daza
LPx(mol/l), indexul de activare a leu co ci telor PMN
LAI) si antioxidantii (grupari tiol SH (mol/l), capa-
ci tatea antioxidanta totala AO(UI), si ceru lo plas mina
- CP(mol/l)).
Ana liza sta tistica s-a realizat folosind testul student-t.
Rezultate: Valorile parametrilor SO plasmatic sunt pre-
zentate in tabel:
Grup C HT-C HVS+ CAD+ ICC+
LPx
2,41
0,35
4,42
1,37*
5,20
1,29*/**
5,03
1,43*/**
5,0
1,33*/**
LAI
26,21
3,16
39,67
8,06*
40,52
5,85*
45,40
9,44*/**
47,70
9,97*/**
AO
22,74
1,99
16,47
2,31*
15,18
1,90*/**
14,97
2,37*/**
14,75
2,28*/**
SH
416,6
14,38
354,15
54,34*
346,88
49,61*
334,68
57,93*/**
329,55
57,93*/**
CP
116,2
10,21
127,98
30,23*
136,9
28,21*/**
140,97
41*/**
153
41,18*/**
Colesterol
216.3
33.1
230.4
40.9
224
43.5
241.2
71.9
225.2
36.7
*p<0.0001 vs. control ** p<0.05 vs. HT-C
Nivelele LPx, marker al speciilor reactive de oxigen,
sunt semnifcativ crescute la toti pts cu HT, dar se inre-
gistreaza cresteri mai importante la cei cu compli catii
car diace. Nivelele de LAI si SH nu sunt modifcate sem-
nifcativ la pts cu HVS.
Concluzii: Rezultatele sugereaza ca:
1. Un status oxidativ semnifcativ este prezent la toti
pts cu HT si este semnifcativ mai important la pts cu
com plicatii cardiace.
2. SO are un rol important in dezvoltarea si progresia
ICC si CAD, dar probabil joaca un rol mai putin impor-
tant in HVS.

Suplimentul A, 2008
125
The role of oxidative stress
in development of cardiac
complications in patients with
essential hypertension
Campeanu A., Bolohan M., Olinescu R., Dusceac D.,
Nanea T.
Caritas Hospital
Background: New evidences suggest that oxidative
stress (OS) is involved in endothelial dysfunction, athe -
ro sclerotic plaque formation and activation and may
contribute to the development of cardiovascular com -
pli c a tions in essential hypertension (EH). Te impli ca-
tio ns of OS in development of diferent types of cardiac
complications in patients with EH are still under de-
bate.
Te aim was to evaluate plasma prooxidant and antio-
xidant parameters in patients (pts) with EH with or
with out diferent cardiac complications.
Methods: In 229 pts (age 62.767.68 years) with EH, 77
pts without complications (HT-C group), 50 pts with
lef ventricular hypertrophy (LVH+ group) evaluated
by ECG or echocardiographical criteria, 50 pts with
stable coronary artery disease (CAD+ group), and 52
pts with chronic heart failure (CHF+ group) and in
35 heal thy subjects (age 59.0511.44 years) (C group)
with out antioxidants or beta blockers agents blood
sam ples were drawn to determine cholesterol (mg/
dl), plas ma prooxidants (lipid peroxides -LPx(mol/
l), poly morphonucleare leukocytes activation index-
LAI)) and antioxidants (thiol compounds-SH(mol/l),
total anti oxidants capacity-AO(UI) and ceruloplasmin
-CP(mol/l)) levels. Statistical analysis- student t test.
Results: Te values of plasma OS parameters are pre-
sen ted in table:
Group C HT-C LVH+ CAD+ CHF+
LPx
2,41
0,35
4,42
1,37*
5,20
1,29*/**
5,03
1,43*/**
5,0
1,33*/**
LAI
26,21
3,16
39,67
8,06*
40,52
5,85*
45,40
9,44*/**
47,70
9,97*/**
AO
22,74
1,99
16,47
2,31*
15,18
1,90*/**
14,97
2,37*/**
14,75
2,28*/**
SH
416,6
14,38
354,15
54,34*
346,88
49,61*
334,68
57,93*/**
329,55
57,93*/**
CP
116,2
10,21
127,98
30,23*
136,9
28,21*/**
140,97
41*/**
153
41,18*/**
Cholesterol
216.3
33.1
230.4
40.9
224
43.5
241.2
71.9
225.2
36.7
*p<0.0001 vs. control ** p<0.05 vs. HT-C
LPx levels, markers of reactive oxygen species are
signifcantly increased in all pts with EH, more impor-
tant in those with cardiac complications.
LAI and SH levels are not signifcantly changed in
pts with LVH.
Conclusions: Te results suggest that:
1. A signifcant oxidative state is present in all pa-
tients EH and is signifcantly more important in pts
with cardiac complications.
2. OS has an important role in development and
pro gression of CAD and CHF, but perhaps has a less
important role in LVH

104. Corelaii ntre SAECG i
parametrii tissue Doppler la
pacientul hipertensiv
Despina Toader, Rodica Musetescu, E. Belu,
D.D. Ionescu
Introducere: Alterarea presiunii de umplere la pacientul
hiper tensiv poate f evaluat folosind ecocardiografa
tissue Doppler. Electrocardiografa cu amplifcare de
sem nal (PHiRes) identifc prezena potenialelor atria-
le tardive (PAT) la sfritul undei P, care reprezint de-
po la rizarea ntarziat a miocardului atrial, de unde se
pot declana aritmii prin reintrare.
Scopul studiului: existena unei posibile corelaii ntre
prezena PAT ca marker de leziune miocardic atria l
stng i parametrii Tissue Doppler de cretere a pre-
siunii de umplere la pacientul hipertensiv.
Metod: 44 pacieni hipertensivi cu vrste cuprinse ntre
48-80 ani au fost evaluai prin: examen clinic: NYHA
I-IV, ECG 12 derivaii: criteriile Cornell de hipetrofe
de ventricul stng (HVS), suprasolicitare de atriu stng
(SAS); ecocardiografe transtoracic: crite rii de HVS:
SIV >13 mm, PPVS >12 mm dilatare AS: indexul de
volu m AS >20 ml/m
2
, aspectul fuxului Doppler trans-
mi tral: velocitile E, A, eco tissue Doppler folosind ine-
lul mitral lateral: Sm, Em, Am; raportul E/Em (marker
de cretere a presiunii de umplere); PHiRes: criterii de
prezen a PAT: durata undei P (SAPWD) > 140ms,
r d cina medie patratic (RMS40) >3,5 V, integrala
undei P >800V, folosind fltre de 250-400 MHz, zgo-
mot de fond <0,3 V(target).
Suplimentul A, 2008
126
Rezultate: 1. Modifcri ale parametrilor Tissue Dopp-
ler: HVS(+): Sm <7 cm/s - 63,33%, Em <5 cm/s -73,33%,
E/Em >14 -76,66%. SAS(+): Sm <7 cm/s - 62,06%,
Em <5 cm/s - 85,71%, E/Em >12 -75,86%; p <0,05. 2.
Prezena PAT la pacienii hipertensivi cu Sm <7 cm/s a
fost: HVS(+) 63,15% i dilarare AS(+) 66,66%; la cei cu
Em<5cm/s: HVS(+) 81,81% i dilatare AS 85,71% iar n
ca zul E/Em>14: HVS(+) 86,95% i dila ta re AS 90,90%;
p<0,05l.
Concluzii: 1. Pacienii hiperten sivi cu PAT prezente au
velociti sczute msurate prin tissue Doppler: Sm <7
cm/s, Em <5 cm/s, E/Em >14, ceea ce indic o corelaie
ntre presiunile de umplere i alterrile structurale ale
AS, cu posibilitatea apariiei aritmiilor prin reintrare.
2.Corelaia a fost mai evident la pacienii cu HVS i
SAS, datorit unor presiuni de umplere mai mari.

Correlation between PHiRes
and tissue Doppler imaging
parameters in hypertensive
patients
Despina Toader, Rodica Musetescu, E. Belu,
D.-D. Ionescu
Craiova Cardiology Center
Background: An increased flling pressure in hyper-
tensive patients can be evaluated using tissue Doppler
imaging parameters. PHiRes is a method which reveals
late atrial potentials at the end of P wave representing
late depolarizarion of atrial myocardium, were reentry
arrhythmias can start.
Purpose: We studied a potential correlation between
the presence of late atrial potentials (LAP) as a marker
of lef atrial myocardium damage and tissue Doppler
imaging parameters of increased flling pressure.
Methods: 44 hypertensive patients aged 48-80 years
were evaluated by: clinical examination: NYHA class
I-III, 12 ECG leads: Cornell criterias for lef ventricular
hypertrophy (LVH) and lef atrial dilatation (LAD),
transtoracic echocardiography: criterias for LVH: inter-
ventricular septum>13mm, lef ventricular posterior
wall >12mm and LAD: lef atrial volume index >20ml/
m
2
, transmitral Doppler echocardiography: early (E)
and late (A) diastolic velocities, tissue Doppler imaging
using lateral corner of mitral annulus in four apical
chamber view: peak systolic (Sm), early (Em), late (Am)
diastolic velocities; E/Em ratio which is a marker of
diastolic flling pressure were calculated; LAP criterias
usig P wave high ECG resolution: signal averaged P
wave duration (SAPWD) >140ms, root mean square
(RMS 40) >3,5V, integral of Pwave >800V, flters
250-400 MHz, noise level <0,3V(target). Results:1.
Changes in tissue Doppler parameters: LVH(+):
Sm<7cm/s-63,33%, Em<5cm/s -73,33%, E/Em>14 -
76,66%. LAD(+):Sm< 7cm/s 62,06%, Em <5cm/s
-85,71%, E/Em >12 -75,86%; p<0,05. 2. Te presence
of LAP in hypertensive patients with Sm <7cm/s was:
LVH(+) 63,15% and LAD(+) 66,66%; in those with
Em<5cm/s: LVH(+)81,81% and LAD 85,71% and in
case of E/Em>14: LVH(+) 86,95% and LAD 90,90%;
p<0,05l.
Conclusions: 1. Hypertensive patients with LAP had
reduced velocities measured with tissue Doppler ima-
ging: SM <7 cm/s, Em <5 cm/s and increased E/Em >14.
Tis revelead the link between an increased flling pre-
ssure and structural damage of lef atrium which may
lead to reentry arrhythmias. 2. Correlation was more
obvious in hypertensive patients with lef ventricular
hyper trophy and dilated lef atrium probably due to an
increased flling pressure.

105. Relaia dintre detorsiunea
ventriculului stng, parametrii
de funcie diastolic i
presiunile de umplere la
pacienii cu stenoz aortic
A. Teodorescu
1
, B. A. Popescu
1,2
, C. C. Beladan
1
,
D. Muraru
1
, D. Deleanu
1
, F. Antonini-Canterin
3
,
G. L. Nicolosi
3
, C. Ginghina
1,2

1
Iliescu, Bucuresti;
2
Universitatea de Medicin i Farmacie Carol Davila
Bucureti;
3
A.R.C., A. O. Santa Maria degli Angeli, Pordenone,
Italia
Premise: La pacienii cu stenoz aortic (SA) strns i
fracie de ejecie (FE) ventricular stng (VS) normal,
disfuncia diastolic este frecvent. Contribuia torsiu-
Suplimentul A, 2008
12I
nii i detorsiunii la umplerea VS precoce i la fenome-
nul de suciune diastolic a fost demonstrat, ns acest
lucru nu a fost studiat la pacienii cu SA.
Obiectiv: Evaluarea detorsiunii VS i a relaiei acesteia
cu parametrii de funcie diastolic i presiunile de
umplere VS la pacieni cu SA strns i FEVS pstrat,
comparativ cu subieci normali.
Metod: Am studiat 28 de pacieni consecutivi cu SA
strns (658 ani, 21 brbai), FEVS pstrat (637%),
fr leziuni coronariene semnifcative i 30 de subieci
normali (4310 ani, 6 brbai). Tuturor subiecilor li s-
a efectuat o examinare ecocardiografc complet care
a inclus i msurarea prin Doppler tisular a unor para-
metrii de funcie diastolic (E a fost calculat ca media
valorilor E msurate la nivel septal i lateral din fereas-
tr apical patru camere). Pentru cuantifcarea rotaiei i
torsiunii VS prin ecocardiografe speckle tracking au fost
nregistrate din inciden parasternal ax scurt seciuni
la nivelul bazei i apexului VS, imaginile find ulterior
analizate of-line cu ajutorul unui sofware dedicat
(2D strain, EchoPac). Detorsiunea a fost evaluat prin
msurarea ratei maxime de rotaie diastolic apical
i a ratei maxime de detorsiune (calculat ca diferena
dintre ratele maxime de rotaie diastolic apical i baza-
l pe curba de velociti de torsiune). Au fost de ase-
menea msurate intervalele de timp de la vrful undei
R (ECG) la momentul atingerii acestor velociti maxi-
me, intervalele de timp find apoi corectate la intervalul
RR.
Rezultate: A existat o diferen de vrst ntre lotul de
pacieni cu SA i lotul control (p<0,001). In lotul de
pacieni clasa NYHA a fost 2,00,4, aria indexat a val-
vei aortice a fost 0,370,11 cm
2
/m
2
i gradientul me diu
5520 mm Hg. Volumele VS i FEVS au fost similare
ntre cele dou loturi (p>0,50). Nu au existat diferene
semni fcative ntre cele dou loturi n ceea ce privete
raportul E/A (p=0,70) i E/Vp (p=0,20). Pacienii cu
SA au avut volume atriale stngi mai mari (p=0,036) i
raport E/E semnifcativ mai mare fa de lotul control
(p<0,001). Rata maxim de detorsiune i timpul pn la
atingerea acesteia au fost similare ntre loturi (p>0,10).
Rata maxim de rotaie diastolic apical i timpul
pn la atingerea acesteia au fost semnifcativ crescute
n lotul pacienilor cu SA (p=0,007; p=0,005). n cadrul
pacienilor cu SA timpul pn la atingerea ratei maxi-
me de rotaie diastolic apical i timpul pn la atin-
gerea detorsiunii maxime s-au corelat semnifcativ cu
E/E (r=0,43; p=0,03 i respectiv r=0,40; p=0,04).
Concluzii: La pacienii cu SA strns i FEVS pstrat
rotaia apical diastolic este ntrziat i corelat sem-
ni fcativ cu presiunile de umplere VS. Parametrii de
detorsiune s-au corelat de asemenea cu presiunile de
umplere VS. Aceste rezultate subliniaz rolul rotaiei
diasto lice apicale i al detorsiunii n umplerea VS la
pacienii cu SA strns i FEVS pstrat.

The relationship between left
ventricular untwisting and pa-
rameters of diastolic function
and filling pressures in patients
with aortic stenosis
A. Teodorescu
1
, B. A. Popescu
1,2
, C. C. Beladan
1
,
D. Muraru
1
, D. Deleanu
1
3
,
G. L. Nicolosi
3
, C. Ginghina
1,2

1
Romania
2
Romania
3
A.R.C., A.O. Santa Maria degli Angeli, Pordenone,
Italy
Background: In patients (pts) with severe aortic
stenosis (AS) and normal lef ventricular ejection frac-
tion (LVEF) diastolic dysfunction is frequently found.
Te contribution of LV torsion and untwisting to LV
suction and early diastolic flling was previously demons-
trated, but this was not yet studied in pts with AS.
Purpose: To assess LV untwisting and its relationship
with parameters of diastolic function and flling pre-
ssures in pts with AS and preserved LVEF, compared to
normal subjects.
Methods: We studied 28 consecutive pts with severe
AS (658 yrs, 21 men), preserved LVEF (637%) and
without signifcant coronary artery disease and 30
normal subjects (4310 yrs, 6 men). A comprehensive
echocardiogram was performed in all, including TDI-
derived parameters of LV diastolic function (E was
calculated as the average of E values measured at the
septal and lateral sites, apical 4-chamber view). Te
parasternal basal and apical short-axis planes were
recorded to quantify basal and apical LV rotation and
LV torsion by speckle tracking echocardiography using
dedicated sofware (2D strain, EchoPac). Untwisting
was assessed by measuring peak apical diastolic rota-
Suplimentul A, 2008
128
tion rate and peak untwisting rate (calculated as the net
dife rence between peak diastolic apical and basal rota-
tion rates on the torsional velocity curve). Time inter-
vals from peak R wave (ECG) to each of them were mea-
sured and normalized to the RR interval.
Results: Pts with AS were older than normal subjects
(p<0.001). In pts, NYHA class was 20.4, indexed
aortic valve area was 0.370.11 cm
2
/m
2
and mean trans-
valvular gradient 5520 mm Hg. LV volumes and LVEF
were similar in pts and in normals (p>0.50 for all).
Tere were no signifcant diferences between groups
regarding E/A (p=0.70) and E/Vp ratios (p=0.20). Pts
with AS had higher lef atrial volumes (p=0.036) and
E/E ratios (p<0.001). Peak untwisting rate and time
to peak untwisting rate were similar between groups
(p>0.10). Peak apical diastolic rotation rate and time
to peak apical diastolic rotation rate were increased in
pts vs normals (p=0.007; p=0.005). In pts with AS time
to peak apical diastolic rotation rate and time to peak
untwisting rate had signifcant correlations with E/E
(r=0.43; p=0.03 and r=0.40; p=0.04 respectively).
Conclusions: In pts with severe AS and preserved LVEF
apical diastolic rotation was delayed and signifcantly
related to LV flling pressures. Untwisting parameters
were also related to LV flling pressures. Tese fndings
support the role of apical diastolic rotation and of
LV untwisting in LV flling in pts with severe AS and
normal LVEF.

106. Utilitatea scintigrafiei
miocardice si a
ecocardiografiei in
diagnosticul precoce al
cardiomiopatiei diabetice
incipiente la pacientii cu diabet
zaharat tip 2
R. Artenie
1
, Anca Artenie
2
, Simona Ionescu
1
,
G. Ungureanu
2
1
Spitalul Clinic de Urgene Sf. Spiridon Iai-Clinica a
III-a Medical-cardiologica
2
Spitalul Clinic Dr. C.I.Parhon Iai-Clinica a IV-a
Medical
Cardiomiopatia diabetica este una dintre cele mai frec-
vente complicatii ale diabetului zaharat (DZ) a carei
incidenta depinde de durata si severitatea DZ. Lucrarea
a avut ca scop evaluarea funciei sistolice i diastolice
ven triculare stngi (VS) la pacienii cu diabet zaharat
tip 2 (DZ) n corelaie cu tipul de tratament al DZ,
utili zind ecografa cardiac transtoracic si scintigrafa
miocardica.
Material i metod: Studiul s-a efectuat pe 42 de pacieni
diabetici tip 2: Lot A-20 pacienti insulinonecesitanti si
lot B-22 pacienti tratati cu antidiabetice orale, cu virste
cuprinse intre 42-58 ani, durata a bolii de 5-15 ani, fara
semne de afectare coronariana pe EKG standard si valori
tensionale normale. Ecocardiografc au fost urmariti
38 de parametri dintre care 12 au fost utilizai pentru
aprecierea funciei sistolice i 18 au fost utilizai pentru
aprecierea funciei diastolice a VS. Perfuzia miocardica
a VS a fost evaluata prin scintigrafe miocardica de
perfuzie (SPECT) cu 99mTc MYOVIEW-(16 mCi in
repaus) combinata cu testul la dipiridamol (20mCi).
De asemenea, am determinat proflul glucidic, HbA1,
am efectuat EKG standard si de efort si am dozat micro-
albu minuria (test RIA).
Rezultate: Toti pacientii aveau asociata polineuropatie
diabetica iar 16 pacienti aveau retinopatie si MA. HbA1a
fost de: la lot A -9.80.8% respectiv lot B:10.20.6%.
Testul de efort a fost pozitiv pentru ischemie si tulbu-
rari de ritm la 55% dintre pacienti din ambele loturi.
Ecocardiografa a aratat: Fracia de ejecie a VS a avut
valori 60% la 11 pacieni (5 din lot a si 6 din lot B), a
fost cuprins ntre 50% i 60% la 20 pacieni (12 din
Suplimentul A, 2008
129
lot A si 8 lot B) i a avut valori ntre 40% i 50% la
11 pacieni (5 din lot A si 6 din lot B). Valorile mean
systolic ejection rate au fost cuprinse ntre 221 ml/s i
515 ml/s, iar cele ale mean velocity of circumferential
shortening ntre 0,9 circ/s i 1,8 circ/s. Raportul undelor
E i A mitrale (E/A) a fost >1 la 10 pacieni i <1 la 23
pacieni. Timpul de relaxare isovolumic (TRIV) al VS
a fost <70 ms la 17 pacieni, >100 ms la 15 pacien i i
a avut valori normale la 10 pacieni. Timpul de dece-
leraie al undei E (EDT) a fost 150 ms la 18 pacieni i
cu valori normale la 10 pacieni.Imaginile scintigrafce
miocardice au aratat modifcari la 28 de pacienti : 16 cu
ischemie la dipiridamol si 12 cu necroza miocardica(13
pacienti din lotul A (5 respectiv 8) si 15 pacientidin
lotul B (8 respectiv 7) incluzind toti pacientii cu micro-
albuminurie.
Concluzii: 1. Disfunctia diastolica a VS se corelea za
direct cu controlul glicemic si prezenta micro albu mi-
nuriei la pacientul cu diabet zaharat tip 2. 2. Nu exis-
ta diferente intre tipurile de tratament (insulina sau
antidiabetice orale) si aparitia cardiomiopatiei diabe-
tice. 3. Ecocardiografa si scintigrafa miocardica de per-
fuzie reprezinta metode neinvazive si utile de diagnostic
precoce a cardiomiopatiei diabetice.

The utility of myocardial
scintigraphy and
echocardiography in earlier
diagnosis of diabetic
cardiomiopathy in tipe 2
diabetic melitus patients
R. Artenie
1
, Anca Artenie
2
, Simona Ionescu
1
,
G. Ungureanu
2
1
Emergency Hospital Sf. Spiridon Iai the IIIrd
Medical Cardiologic Clinic
2
Clinic Hospital DR. C. I. Parhon Iai the IVth
Medical Nefrologic Clinic
Diabetic cardiomiopathy is one of the common compli-
cation of the type 2 diabetes mellitus (DM) witch is
increased in proportion to the duration and severity of
the diabetes.
Te aim of the study: was to reveal the deterioration of
the systolic and diastolic function of the lef ventricle
(LV) in patients with DM, in correlation with treatment
of DM, using myocardial scintigraphy and transtoracic
echocardiography.
Material and method: our study was performed on 42
type 2 DM patients: group A - 20 patients with IDDM
and group B - 22 patients with NIDDM (anti dia betic
therapy), with age between 42-58 years, du ra tion of
the disease of 5-15 years, without sign of coro nary
disease on EKG, and normal values of blood pre ssure.
Te ecocardiographic evaluation determined 38 para-
meters. From these parameters, 12 were used for the
measurement of the systolic function of the LV and 18
were used for the determination of the diastolic function
of the LV. Te myocardial perfusion of the LV was eva-
luated through myocardial scintigraphy with 99mTc
MYOVIEW-16 mCi (SPECT) method combined with
Dipiridamol test (20 mCi). Also we have studied the
glycemic profle, HbA1, electrocardiography standard
and efort test and microalbuminuria MA (RIA
method).
Results: All patients had associated peripheric neuro-
pathy and 16 patients had retinopathy and presence of
MA. Te HbA1 were: group A-9.80.8% respectively
group B:10.20.6%. On the efort test 55% reveal
ische mic lesions or arrhythmia on both groups. Echo-
cardiography show: the ejection fraction (EF) of the LV
was 60% in 11 patients (5 in group A and 6 in group
B), between 50% and 60% in 20 patients (12 in group
A and 8 in group B) and between 40% and 50% in 11
patients (5 in group A and 6 in group B). Te values of
mean systolic ejection rate was between 221 ml/s i 515
ml/s and the values of mean velocity of circumferential
shortening was between 0,9 circ/s i 1,8 circ/s. Te
ratio of the E and A waves at the mitral valve was >1
in 10 patients and <1 in 23 patients. Te LV isovolumic
relaxation time (IVRT) was <70 ms in 17 patients,
>100 ms in 15 patients and had normal values in 10
patients. Te E wave deceleration time (EDT) was 150
ms in 18 patients and had normal values in 10 patients.
Myocardial scitigraphic images show abnormalities
in 28 patients: 16 patients with dipiridamol-induced
ischemia and 12 patients with myocardial necrosis -
(13 patients (5 respectively 8) in group A, 15 patients
(8 respectively 7) group B) included all patients with
MA.
Suplimentul A, 2008
180
Conclusions: 1. Tere is a direct correlation between the
diastolic dysfunction of the LV and metabolic control
of type 2 DM and the presence of microalbuminuria.
2. Tere is no dependence on the class of antidiabetic
therapy (drugs or insulin) in development of diabetic
cardio miopathy. 3. Te echocardiography and myocar-
dial scintigraphy examination represent an useful and
noninvasive methods for an earlier diagnosis of diabetic
cardiomiopathy.
CARDIOLOGIE INTERVENIONAL | INTERVENTIONAL CARDIOLOGY

cu 224 pacieni cu BMS corespunztori vrstei i sexului.
Au fost folosite 268 SES n 260 leziuni, versus 298 BMS
n 278 leziuni. Perioada medie de urmrire a fost de
226 20 vs. 209 18 zile. Prevalena factorilor de risc
cardiovascular majori a fost n grupul SES versus BMS:
diabet zaharat 26% vs. 11%, p=0.0001; hipertensiune
arterial 79% vs. 72%, p=0.062; hipercolesterolemie
90% vs. 79%, p=0.001. 52% vs. 40% pacieni (p=0.005)
au asociat cel puin 3 factori de risc, iar 16% vs. 3.5%
pacieni au prezentat patru factori de risc majori. 71%
vs. 43% pacieni (p=0.0001) au avut infarct miocardic
n antecedente. 8% vs. 0.3% (p=0.001) din stenturi au
fost utilizate pentru restenoz intra-stent. Vasul int
a fost IVA la 66% vs. 45% pacieni (p =0.003); artera
circumfex la 12% vs. 24% (p=0.012); i ACD la 20%
vs. 31% (p=0.05). 71% vs. 41% (p= 0.0001) din leziuni
au avut RVD 3 mm, iar 88% vs. 51% (p= 0.0001) au
fost leziuni mai lungi de 15 mm. MLD pre- i post pro-
cedural a fost 0.40.2 mm vs. 0.50.2 mm (ns), i res-
pectiv, 2.70.2 mm vs. 2.80.3 mm (ns); n mod similar,
acute gain a fost 2.30.3 mm vs. 2.20.2 mm (ns). n
grupul SES s-au suspectat 3 cazuri de restenoz clinic
con frmate angiografc la 2 pacieni (0.9%), iar n gru-
pul BMS au fost suspicionate 20 cazuri de reste noz
cli nic confrmate angiografc la 16 pacieni (7.0%)
(p=0.001). 2.7% pacieni din grupul SES au avut MACE
compa rativ cu 8.9% din grupul BMS (p= 0.007).
Concluzii: Spre deosebire de pacienii din grupul BMS,
pacienii care au benefciat de SES au avut mai frec vent
diabet zaharat, mai mult de 3 factori de risc cardio-
vascular majori, n principal leziuni de IVA, leziu ni
pe vase mici i/sau mari. Restenoza intra-stent ghi dat
clinic a fost redus de la 7% la 1%, cu o scdere semni-
fcativ a MACE.

107. Stenturile active
farmacologic sunt mai bune
dect cele metalice simple la
pacienii cu diabet zaharat,
factori de risc cardiovascular
multipli i leziuni dificile
C Stoicescu, A Burlacu, V Vintila, C Udroiu,
N Florescu, O Pirvu, M Cinteza, D Vinereanu
Spitalul Universitar Bucuresti
Context: Rezultatul pe termen mediu la pacienii cu
intervenii coronariene percutane (PCI) este infuenat
de restenoza intra-stent, care reprezint principalul
neajuns al PCI. Studiile clinice recente au dovedit o sc-
dere a incidenei restenozei de la 25% la mai puin de
10% consecutiv utilizrii stenturilor active farmacologic
cu sirolimus (sirolimus eluting stents, SES). Cu toate
acestea, restenoza SES din viaa real comparativ cu
cea a pacienilor similari la care s-a folosit BMS nu a
fost ntocmai raportat.
Metode: Am efectuat un studiu de registru controlat
(studiu case control) pe o perioad de 44 luni, care
a inclus toi pacienii la care s-a utilizat 1 stent activ
farmacologic cu sirolimus, n comparaie cu un grup de
pacieni de control, la care s-a implantat 1 stent metalic
simplu (BMS). Fiele standard de raportare a cazului
au cuprins datele clinice i demografce, tipul leziunii
responsabile (culprit), complicaiile procedurale i
tratamentul. Pentru evaluarea diametrului de referin
al vasului (reference vessel diameter, RVD) i diametrului
minim al lumenului vasului (minimal lumen diameter,
MLD) s-a utilizat angiografa coronarian cantitativ
(QCA). End-pointul primar a constat n restenoza
clinic (defnit clinic i/sau prin test ECG de efort);
atunci cnd s-a suspectat restenoza clinic, s-a repetat
angiografa coronarian. Obiectivele secundare au fost
evenimentele cardiace adverse majore (MACE, major
adverse cardiac events) defnite ca: decesul din cauz
cardiac, infarctul miocardic, revascularizarea leziunii
int (TLR, target lesion revascularization) sau angina
recurent.
Rezultate: n studiul nostru au fost inclui 448 pacieni:
224 pacieni cu SES (58 10 ani, 75% brbai), comparai
CARDIOLOGIE INTERVENIONAL
INTERVENTIONAL CARDIOLOGY
Suplimentul A, 2008
Drug eluting stents are better

than bare metal stents in
pacients with diabetes mellitus,
multiple cardiovascular risk
factors, and difficult lesions
N Florescu, O Pirvu, M Cinteza, D Vinereanu
Background: Medium-term outcome of patients with
percutaneous coronary interventions (PCIs) is related
to in-stent restenosis, which represents the main
drawback for PCIs. Recent clinical studies have shown
a decrease of restenosis rate from 25% to less than 10%,
using sirolimus eluting stents (SES). However, real-
life SES restenosis, by comparison with similar patients
receiving BMS, has not been enough reported.
Methods: We performed a controlled registry study
(case control study) over a period of 44 months, inclu-
ding all patients who received 1 sirolimus eluting
stent, comparing them to a control group of patients
who received 1 bare metal stent (BMS). Clinical and
demo graphical data, type of culprit lesion, procedural
compli cations, and treatment were documented into
stan dard case report fles. Quantitative coronary angio-
graphy was used to evaluate reference vessel diameter
(RVD) and minimal lumen diameter (MLD). Primary
end-point was the clinical restenosis (defned clinically
and/or by ECG exercise test); when clinical restenosis
was suspected, coronary angiography was repeated.
Secondary end-points were major adverse cardiac
events (MACE), defned as cardiac death, myocardial
infarc tion, target lesion revascularization, or recurrent
angina.
Results: 448 patients were included into the controlled
registry study: 224 SES patients (5810 years, 75%
males), compared to 224 age- and sex-matched BMS
patients. 268 SES were used in 260 lesions, versus (vs.)
298 BMS used in 278 lesions. Mean follow-up period
was 22620 vs. 20918 days. Major cardiovascular risk
factors prevalence was: diabetes mellitus 26% vs. 11%,
p=0.0001; arterial hypertension 79% vs. 72%, p=0.062;
hypercholesterolemia 90% vs. 79%, p=0.001, in SES
and BMS groups, respectively. 52% vs. 40% patients
(p=0.005) associated at least 3 risk factors, and 16%
vs. 3.5% patients had four major risk factors. 71% vs.
43% patients (p=0.0001) had previous myocardial
infarc tion. 8% vs. 0.3% (p=0.001) stents were used for
intrastent restenosis. Target vessel was LAD in 66%
vs. 45% patients (p=0.003); lef circumfex in 12% vs.
24% (p=0.012); and RCA in 20% vs. 31% (p=0.05).
71% vs. 41% (p= 0.0001) were lesions with RVD 3
mm, and 88% vs. 51 % (p= 0.0001) were lesions longer
than 15 mm. Te MLD pre- and post- procedure was
0.40.2 mm vs. 0.50.2 mm (ns), and 2.70.2 mm vs.
2.80.3 mm (ns), respectively; similarly, acute gain was
2.30.3 mm vs. 2.20.2 mm (ns). 3 cases of clinical
restenosis were suspected in the SES group, confrmed
by coronary angiography in 2 patients (0.9%), whereas
20 cases of clinical restenosis were suspected in the
BMS group, confrmed by coronary angiography in 16
patients (7.0%) (p=0.001). 2.7% patients from the SES
group had MACE, compared with 8.9% from the BMS
group (p= 0.007).
Conclusions: By comparison with patients receiving
BMS, patients who beneft from SES had more diabetes
mellitus, more than 3 major cardiovascular risk factors,
mainly LAD lesions, small and/or long vessel lesions.
Clinically-driven in-stent restenosis was reduced
from 7% to less than 1%, with a signifcant decrease of
MACE.

108. Tromboza intra-stent: un
eveniment rar, influenat de
tratamentul antiagregant
plachetar combinat pe termen
lung
N Florescu, O Parvu, M Cinteza, D Vinereanu
Context: Tromboza intra-stent este o complicai rar,
dar extrem de sever. Date recente sugereaz c folo si-
rea stenturilor active farmacologic (drug eluting stents,
DES) poate crete riscul de tromboz intra-stent, n
condiiile n care tratamentul antiplachetar combinat
este ntrerupt prematur (<6 luni), dup cum este nc
recomandat n multe din ghidurile actuale. Romania se
af ntr-o situaie unic n Europa, avnd n vedere c
pe baza programului naional de clopidogrel susinut
de guvern, pacienii cu cel puin un stent au dreptul s
Suplimentul A, 2008
primeasc tratament antiagregant plachetar combinat,
gratuit pentru cel puin 9 luni.
Obiective: 1) evaluarea prevalenei trombozei intra-
stent (tromboz acut n primele 24 ore de la intervenie;
trom boz subacut, ntre 24 ore i 30 zile; tromboz
tardiv, peste 30 zile; i tromboz foarte tardiv, dup
mai mult de un an) n cadrul unui amplu studiu de tip
case-control; 2) evaluarea relaiei dintre tromboza intra-
stent i durata tratamentului antiplachetar combinat.
Metode: A fost efectuat un studiu de tip case-control pe
o perioad de 44 luni (2003-2007), care a inclus pacieni
la care s-a implantat cel puin un DES, comparativ cu
un grup de control avnd pacieni la care s-a folosit
cel puin un stent metalic simplu (bare metal stent,
BMS). Rezultate. Au fost inclui n studiu 950 pacieni:
475 pacieni cu 578 DES implantate (268 Cypher, 152
Endeavor, 122 XienceV i 36 Taxus) urmrii pe o
perioad de 23321 zile, n comparaie cu 475 pacieni
cu 598 BMS, umrrii pe o perioad similar, de 22819
zile. Toi pacienii au primit continuu aspirin. Toi
pacienii au primit clopidogrel pe o perioad de 9 luni;
49% pacieni din grupul DES i 15% din grupul BMS
(p<0.0001) au primit clopidogrel pentru mai mult de
9 luni. Periprocedural, 2.6% pacieni din grupul DES
versus 2.1% din grupul BMS (ns) au primit inhibitori
de receptor GP Iib/IIIa. Tromboza intra-stent acut i
subacut a fost documentat angiografc la 0,9% ver sus
1,9% pacieni din grupul DES i respectiv BMS (ns).
Tromboza intra-stent tardiv i foarte tardiv docu-
mentat, nu a survenit n nici unul din cele dou gru-
puri. n primele 30 zile a survenit un singur deces n
grupul DES (FV urmat de disociaie electromecanic
dar nu datorat trombozei stentului), i un deces n
gru pul BMS (datorat trombozei subacute a stentului).
n primele 9 luni, a survenit numai 1 singur moarte
subi t, i aceea n grupul DES, iar dup 1 an s-au notat
dou mori subite, n acelai grup DES.
Concluzii: Tromboza intra-stent tardiv i foarte tar-
div, defnit sau probabil, nu a survenit n nici un
caz, probabil datorit faptului c toi pacienii au primit
tra tament antiplachetar combinat pentru cel puin 9
luni dup implantarea stentului (de fapt, jumtate din
pacienii cu DES au primit acest tratament pentru mai
mult de un an).

In-stent thrombosis: rare event,
influenced by long-term
combined antiplatelets
treatment
C Stoicescu, V Vintila, N Florescu, M Cinteza,
D Vinereanu
Background: In-stent thrombosis is a rare but extre-
mely severe complication. Recent data suggest that use
of drug eluting stents (DES) may increase the risk of in-
stent thrombosis, if combined antiplatelets treatment is
stopped too early (<6 months), as still recommended by
many of the current guidelines. Romania is in an unique
situation in Europe because, based on the national clo-
pidogrel program supported by the government, pa-
tients with at least one stent are entitled to receive free
of charge combined antiplatelets treatment for at least
9 months.
Aims: 1) to assess prevalence of in-stent thrombosis
(acute thrombosis in the frst 24 hours from the inter-
vention; subacute thrombosis between 24 hours and 30
days; late thrombosis afer more than 30 days; and very
late thrombosis afer more than one year) in a large
national case-control study; 2) to assess relation bet-
ween stent thrombosis and duration of the combined
antiplatelets treatment.
Method: A case control study was conducted over a
period of 44 months (2003-2007), including patients
who received at least one DES, compared with a control
group comprising patients who received at least one
bare metal stent (BMS).
Results: 950 patients were included into the study:
475 patients with 578 implanted DES (268 Cypher,
152 Endevour, 122 XienceV, and 36 Taxus), followed
for 23321 days, compared with 475 patients with
598 implan ted BMS, followed for a similar period, of
22819 days. All patients received aspirin continuously.
All patients received clopidogrel for 9 months; 49% of
patients from the DES group and 15% of patients from
the BMS group (p<0.0001) received clopidogrel for
more than 9 months. Periprocedural, 2.6% patients
from the DES group versus 2.1% from the BMS group
(ns) received GP IIb\\IIIa receptor inhibitors. Acute and
subacute in-stent thrombosis was documented angio-
graphically in 0.9% versus 1.9% of patients from DES
and BMS groups, respectively (ns). Documented late
Suplimentul A, 2008
in-stent thrombosis and very late in-stent thrombosis

did not occur in any of the two groups. In the frst 30
days, there was one death occurring into the DES group
(VF, followed by electro-mechan ical dissociation,
not due to stent thrombosis), and one death into the
BMS group (due to subacute stent thrombosis). In the
frst 9 months, there was only 1 sudden cardiac death,
occurring in the DES group, while afer 1 year there
were two sudden cardiac deaths occurring in the DES
group.
Conclusion: Defnite and probable late and very late
in-stent thrombosis did not occur in any of the cases,
probably related to the fact that all patients receive com-
bined antiplatelets treatment for at least 9 months afer
stent implantation (in fact, half of the patients with DES
received it for more than one year).

109. Angioplastia coronariana
percutana la pacientii cu
anevrism apical de ventricul
stang
Calin C., Teodorescu A., Beladan C., Savu O., Deleanu
D., Ginghina C.
Institutul de Boli Cardiovasculare Prof. Dr. C.
C.Iliescu Bucuresti
Mortalitatea pacientilor cu anevrism de ventricul stang
(VS) post infarct miocardic este de 6 ori mai mare decat a
pacientilor fara anevrism, chiar in conditiile unei fractii
de ejectie VS (FEVS) comparabile. Anevrismectomia
si revascularizarea chirurgicala reprezinta interventia
recomandata la majoritatea pacientilor simptomatici,
existand putine date despre rolul angioplastiei percu-
tane coronariene transluminale in managementul pa-
cien tilor cu anevrism VS constituit.
Metode: Am studiat retrospectiv 33 de pacienti (25
barbati) cu anevrism apical VS, cu varsta medie 6210
ani, cu o valoare medie a FEVS de 377%, selectati
retro spectiv din baza noastra de date. Au fost exclusi
pa cientii supusi unor interventii de revascularizare chi-
rur gicalaanevrismectomie. 18 pacienti au fost tratati
con ser vator (grupul 1), in cazul celorlalti 15 pacienti
(gru pul 2) efectuandu-se angioplastie coronariana per-
cu ta na la nivelul arterei responsabile de infarct (arte ra
interventriculara anterioara) intr-un interval de 136
sapta mani postinfarct. Au fost analizati parametri clinici
(cla sa func tional NYHA) si ecocardiografci (FEVS, dia-
metru atriu lui stang, dimensiunile anevrismului VS,
insu f cienta mitrala). Inter valul mediu dintre infarctul
mio cardic acut si eva luarea initiala a fost intre 3 si 40 de
sapta mani, simi lar pentru cele doua grupuri. In grupul
tratat inter ventional am considerat evaluarea dinaintea
inter ven tiei ca evaluare initiala. A doua evaluare a fost
efec tuata la un interval mediu de 126 saptamani de la
prima.
Rezultate: In cadrul evaluarii initiale cele doua grupuri
au fost comparabile, fara diferente semnifcative, in
ceea ce priveste varsta, factorii de risc cardiovascular,
clasa NYHA, FEVS, dimensiunile atriului stang si seve-
ritatea insufcientei mitrale. Dimensiunile anevris mu-
lui VS au fost semnifcativ mai mari in grupul 1 (37.5%
din volumul telediastolic VS grup 1, 31% - grup 2,
p=0.046). La a doua evaluare nu au fost identi fcate dife-
rente semnifcative intre grupuri din punct de vedere
al FEVS, severitatii insufcientei mitrale, dimen siunile
atriu lui stang si dimensiunile anevrismului VS, existand
insa diferente semnifcative ale clasei functionale NYHA
(2.27 grup 1, 2.83 grup 2, p=0.01) in favoarea grupu-
lui revascularizat interventional.
Concluzii: Tratamentul combinat medical si interven-
tional la nivelul arterei responsabile de infarct in cazul
pacientilor cu anevrism apical VS a fost asociat cu o
ameliorare semnifcativa a clasei functionale, desi nu
a avut impact asupra FEVS, severitatii insufcientei mi-
trale sau dimensiunii anevrismului. Aceste rezultate
nece sita confrmare prin studii ulterioare.

110. Coronarografia
computerizat 64-multislice
la pacieni cu probabilitate
intermediar i joas de boal
coronarian
Florina Parv, Rodica Avram, Balint Mihai,
Victor Dan Moga, Ciocarlie Tudor, Popa Claudiu
Clinica de Cardiologie, Spitalul Clinic de Urgen
Judeean Nr. 1 Timioara
Scopul lucrrii: Angiocoronarografa tomografc com-
pu te rizat este o tehnic imagistic nou n plin ascen-
siune cu potenial alternativ la metodele nonin vazive
Suplimentul A, 2008
pentru boala coronarian. Metoda prezint o mare
acuratee n diagnosticul leziunilor coronariene steno-
zante sau nu, precum i determinarea ncrcrii cu
calciu a plcilor aterosclerotice. Evaluarea utilitii coro-
narografei computerizate 64-multislice n detectarea
sau excluderea bolii coronariene la pacieni cu proba-
bilitate intermediar i joas.
Material i metod: S-a luat n lucru un lot de 19
pacieni simptomatici, cu durere toracic non-angi-
noas sau cu angin atipic, la care s-au efectuat ECG,
enzimele cardiace, test de efort la ergociclu i s-au notat
factorii de risc clasici (hipertensiune, diabet, fumat,
obezitate, antecedente de boal coronarian prematur,
dislipidemie), pacienii find mprii n dou grupe:
cu probabilitate joas: 4 (21,05 %) i intermediar 15
(78,94%).
Rezultate: La 8 (42,10%) pacieni (5 femei, 3 brbai)
cu vrsta medie 54,75 7,99 cu biomarkeri cardiaci
negativi, fr modifcri ischemice electrice i cu test de
efort negativ s-a efectuat coronarografe computerizat
64-multislice (Siemens Sensation Somatom 64). Pacien-
ii cu frecven cardiac peste 65 b/min au primit meto-
prolol/atenolol nainte de expunere. Boala corona rian
semni fcativ a fost defnit n prezena a cel puin unei
stenoze coronariene 50%. 2 pacieni au prezentat scor
calcic > 700 i leziuni coronariene peste 75% care au fost
confr mate prin coronarografe clasic i sancionate
cu tra tament invaziv (1 pacient cu PTCA i stent i
un pacient cu by-pass aorto-coronarian), 5 pacieni au
prezentat leziuni sub 50% i scor calcic ntre 0-357 i 3
pacieni au prezentat coronare normale angiografc i
cu scor calcic 0. n total au fost detectate 16 leziuni: 7 pe
ADA, 3 pe diagonala I, 5 pe ACX i 1 pe ACD. Pacienii
cu leziuni coronariene non-stenozante, care iniial
erau considerai cu risc sczut au fost rencadrai ntr-
o clas superioar de risc i au benefciat de tratament
specifc.
Concluzii: Dei studiul e restrns la un numr mic de
cazuri este printre primele din Romnia care arat c
angiocoronarografa computerizat 64-multislice este o
metod util la pacieni simptomatici cu probabilitate
joas sau intermediar pretest de boal coronarian.
Un rezultat negativ CT exclude prezena unei afectri
coronariene semnifcative.

64-Slice computed tomography
in patients with low and inter-
mediate probability of coronary
heart disease
Florina Parv, Rodica Avram, Balint Mihai,
Victor Dan Moga, Ciocarlie Tudor, Popa Claudiu
Cardiology Clinic, Emergency County Hospital Nr. 1
Timioara
Aim: Computed tomographic coronary angiography
is a new noninvasive coronary imaging technique with
a very good diagnostic accuracy in coronary lesio ns
either calcifed or no, and ofer independent prog nos-
tict direct information, too. To assess the utility of this
method to rule out coronary heart disease in pa tients
with low and intermediate probability of coro nary
disease.
Material and Method: We studied 19 symptomatic
patients with non-anginal chest pain and atypical
angina in which we performed ECG, cardiac biomar-
kers, exercise test and noted classical risk factors (hyper-
tension, diabetes mellitus, cigarette smoking, obe sity,
family history of premature coronary disease, dislipi-
demia). Patients were divided in two groups, with low
4 (21.05 %) and intermediate 15 (78.94%) probability
risk.
Results: In 8 (42.10%) patients (5 women, 3 men)
with average age 54.75 7.99 with negative cardiac bio-
markers, no ischemic ECG changes and negative exer-
cise test we performed 64-multislice cardiac comu ted
tomography (Siemens Somatom Sensation 64). Patients
with heart rate over 65 bpm received metoprolol/ate-
nolol before exposure. Signifcant coronary disease was
defned in presence of at least one coronary ste nosis
50%. 2 patients (25%) presented an Agatston calcic
score (CAC) over 700 and signifcant coronary lesions
>75%, confrmed at clasic angiography and con se cutive
inva sive treated (one woman with PCI and stent and
one man with aorto-coronary by-pass), 5 patients
(62.5%) presented lesions < 50% and a CAC score bet-
ween 0-357 and 3 (37.5%) patients had normal coro-
nary arteries. We detected an amount of 16 lesions: 7
on LAD, 3 on I-st diagonale, 5 on ACX and 1 on RCA.
Pa tien ts with nonobstructive lesions considered initia-
lly with low risk were reconsidered in a superior risk
class and appropriate treated.
Conclusions: Tis small study, but one from the frst in
Romania, suggests that 64-multislice cardiac computed
Suplimentul A, 2008
tomography is useful in symptomatic patients with low

or intermediate pretest probability of having signifcant
coronary artery disease. A negative CT result may rule
out a signifcant coronary lesion.

111. Stenturile active
farmacologic versus stenturile
inerte n Registrul de Angio-
plastii al Institutului de Boli
Cardiovasculare C.C. Iliescu
urmrire la 1 an
Rami-Mihail Chreih, Dan Deleanu, Lucian Zarma,
Carmen Ginghin
Institutul de Boli Cardiovasculare C.C. Iliescu
Bucureti, Romnia
n Octombrie 2006 s-a iniiat Registrul de Angioplastii
al Institutului C.C. Iliescu find inclui, consecutiv,
toi pacientii crora li s-a efectuat angioplastie n Depar-
tamentul de Cardiologie Intervenional al Institutului
de Boli Cardiovasculare C.C. Iliescu.
Scopul lucrrii: Acest studiu compar rezultatele angio-
plastiei cu stent pe termen scurt i pe termen lung (1
an) ale pacienilor crora li s-au implantat stenturi acti-
ve farma cologic (DES drug eluting stents) versus cele
ale pacienilor crora li s-au implantat stenturi iner te
(BMS Bare Metal Stents).
Materiale i metode: Rezultatele au fost defnite ca
find complicaii peri-procedurale (embolizare dis tal,
fe no men slow-fow/no-refow, ocluzie acut de seg-
ment coronarian, ocluzie de vas colateral, perforare
co ro na rian, oc indus de procedur, AVC, reacii aler -
gice, necesitatea cardiostimulrii), complicaii la nive -
lul lo cului de puncie (hematom necesitnd trans fuzie
sau cur chirurgical, fstul arterio-venoas, pseudo-
ane vrism, ocluzie/disecie vascular ce a nece sitat inter-
ven ie, infecie), complicaii precoce (infarct/reinfarct
mio cardic, AVC, insufcien renal acut, deces intra-
spita licesc) i complicaii tardive (infarct/reinfarct
mio car dic, AVC, insufcien renal acut, agra varea
angi nei, agravarea dispneei, restenoz/tromboz intra-
stent, reacie de hipersensibilitate/alergie, deces). n
plus, complicaiile tardive au fost completate cu date
sepa ra te privind decesul de cauz cardiovascular,
dece sul de cauz non-cardiovascular, revascularizarea
vasu lui int (target vessel revascularization TVR) i
revas cularizarea leziunii int (target lesion revas cula-
rization TLR).
ntre octombrie 2006 i aprilie 2007, 631 pa cieni au
fost supui angioplastiei coronariene. 44 pacieni nu au
fost inclui n studiu, acetia find supui angioplastiei cu
balon. Pentru a elimina posibilele erori, 65 pacieni au
fost exclui, lor findu-le efectuat angioplastie primar/
de salvare/facilitat (primary/res cue/facilitated PCI),
toi pacienii crora li s-au implan tat stenturi active
farmacologic au fost supui angio plastiei. S-a obinut,
astfel, un grup de 522 pacieni (86 n grupul DES i 436
n grupul BMS).
Cele dou grupuri, obinute dup mprirea n
funcie de stenturile implantate, au prezentat distribuii
similare ale datelor demografce, permind comparaia
fr a f necesare ajustri statistice.
Rezultate: Evaluarea a relevat o tendin care favo ri-
zeaz grupul celor cu stenturi active, cu toate c pute-
rea statistic a acestei comparaii este mic din cauza
procentului sczut de stenturi active farmacologic im-
plantate (p= 0.104). n ceea ce privete complicaiile
tar dive, procentul total a fost de 1.16% (1 pacient) n
grupul DES vs. 2.75% (12 pacieni) n grupul BMS,
o privire mai detaliat artnd c TVR a interesat 1
pacient n grupul DES vs. 10 pacieni n grupul BMS,
TLR a interesat 1 pacient n grupul DES vs. 8 pacieni
n grupul BMS. Toi pacienii din grupul DES au fost
n via la controlul dup 1 an de la implantarea sten-
turilor, n timp ce 4 pacieni din grupul BMS au murit
din cauze cardiovasculare. Complicaile precoce au fost,
de asemenea, mai frecvent ntlnite n grupul BMS (4
pacieni vs. 0), ca i cele la locul de puncie (6 pacieni
vs. 2). Complicaiile periprocedurale au fost relevate la
2 pacieni din grupul DES i la 8 din grupul BMS.
Concluzii: Nu exist o diferen semnifcativ statistic
la 1 an ntre pacienii crora li s-au implantat stenturi
active farmacologic i cei crora li s-au implantat sten-
turi inerte. Aceast concluzie ar putea f datorat att
procentului sczut de stenturi active farmacologic
implan tate (procentul TVR i TLR artnd o diferen
net, dar fr putere statistic), ct i faptului c trom-
boza tardiv intra-stent poate depai limita de 1 an i s
apar la un moment mai ndeprtat.

Suplimentul A, 2008
DES versus BMS in C.C. Ilies-
cu Institute for Cardiovascular
Disease PCI Registry 1 year
follow-up
Rami-Mihail Chreih, Dan Deleanu, Lucian Zarma,
Carmen Ginghin
C.C. Iliescu Institute for Cardiovascular Diseases
Bucharest, Romania
In October 2006 a PCI registry was started and has inclu-
ded all consecutive patients that, since, underwent PCI
in C.C. Iliescu Institute for Cardiovascular Disease
Interventional Cardiology Department.
Background: Tis study aims at comparing short-term
and long-term results (1 year) in patients that under-
went bare metal stent (BMS) implantation in oppo-
sition to those that underwent drug-eluting stent (DES)
implantation.
Materials and methods: Te results were defned as
peri-procedural complications (distal embolisation, no-
fow/slow-fow phenomenon, acute segment closure,
side-branch occlusion, coronary perforation, shock
induced by procedure, stroke, allergic reactions, pacing
requirement), percutaneous arterial complications
(haema toma requiring transfusion or surgery, AV fstu-
la, false aneurysm, vascular occlusion/dissection requi-
ring intervention, infection), early complications (myo-
cardial infarction/reinfarction, stroke, renal failure,
death prior to discharge), and late complications (myo-
cardial infarction/reinfarction, stroke, renal failure,
angina aggravation, dyspnoea aggravation, in-stent
reste nosis/thrombosis, hypersensibility/allergy, death).
Further more late complications were completed with
sepa rate data concerning death of cardiovascular cause,
death of non-cardiovascular cause, target vessel revas-
cularization (TVR), and target lesion revascu larization
(TLR).
Between October 2006 and April 2007, 631 patients
underwent PCI. 44 patients were not included in this
study, as they underwent balloon coronary angioplasty.
To eliminate bias 65 patients were excluded because they
were subject to primary/rescue/facilitated PCI, as all
patients that underwent DES implantation underwent
only elective PCI. A 522 patient group was obtained (86
in DES group and 436 in BMS group).
Te two groups obtained afer separation according
to stent criteria showed similar distribution of demo-
graphic data values, therefore allowing a comparison
without any statistical adjustments.
Results: Te endpoint assessment revealed a trend
that favors the DES group although the statistical
power of the comparison is quite low due to the small
percen tage of DES implanted (p= 0.104). Regarding
late complications, the total percentage was 1.16% (1
patient) in the DES group vs. 2.75% (12 patients) in the
BMS group, a more detailed look showing TVR was 1
patient in the DES group vs. 10 patients in the BMS
group, TLR was 1 patient in the DES group vs. 8 patients
in the BMS group. All the patients in the DES group
were alive at the 1 year follow-up, while 4 patients from
the BMS group died from cardiovascular causes. Te
early complications were also found more frequently
in the BMS group (4 patients vs. none), as were the
percu taneous arterial complications (6 patients vs. 2
patients). Periprocedural complications count was 2 for
the DES group and 8 for the BMS group.
Conclusions: Tere is no signifcant diference at the 1
year follow-up mark between patients that were under-
went PCI with DES implantation and those that under-
went BMS implantation. Tis conclusion may be due to
the low percentage of DES implanted (TVR and TLR
counts showing a diference, but without statis tical
signifcance), as well as to the fact that late stent throm-
bosis may elude the 1 year follow-up mark and may
emerge at a later time.
POSTER FORUM III

internare au forme mai severe de IC. Prognosticul
acestor pacienti este mai grav, ei avand o mortalitate la
1 an semnifcativ mai mare.

Diastolic blood pressure
prognostic factor ni patients
with congestive heart failure
Dan Darabantiu, Mirela Tomescu, Daniel Lighezan,
Ruxandra Christodorescu, Florica Pascu,
Horea Branea
Cardiology Clinic ASCAR City Hospital Timisoara
Premises and purpose: Systolic blood pressure is a
known prognostic factor in patients (P) with congestive
heart failure (CHF). Te prognostic role of diastolic
blood pressure (DBP) is better established in coronary
heart disease P, but less evaluated in CHF. Te purpose
of this study was to determine the prognostic value of
DBP in P with CHF.
Material and method: We have recruited from our
CHF Registry Timisoara 244 P with CHF due to lef
ventricular systolic dysfunction (LVEF 40%), which
had follow-up data for at least 3 months. Te median
DBP for the whole groups has been 80 mmHg. Accor-
ding to this, P were divided into 2 groups: group 1
(n=124) with DBP 80 mmHg and group 2 (n=120) with
DBP >80 mmHg. We compared the clinical, bio logical
and echocardiographic parameters and the clinical evo-
lution afer discharge between the 2 groups.
Results: Tere were no diferences concerning mean age
(65 8 years in both groups) and gender distribution.
From the clinical parameters at admission, NYHA class
was signifcantly higher in group 1 (3 0,6 vs. 2,7
0,7, p < 0,0001), while BP values (164 25 mm Hg vs
126 22 mm Hg and 99 10 mmHg vs 73 9 mmHg),
weight (82 16 kg vs 75 16 kg) and ejection fraction
(36 4% vs 33 6%) were signifcantly higher in group
2. Ischemic heart disease was present in 75 P in group
1 and 86 P in group 2 (p=0.07), while hypertension
in 49 and 96 P respectively (p<0.0001). Mean follow-
up period was 16 14 months in group 1 and 14 10
112. Tensiunea arteriala
diastolica factor de
prognostic la pacientii cu
insuficienta cardiaca congestiva
Dan Darabantiu, Mirela Tomescu, Daniel Lighezan,
Horea Branea
Clinica de Cardiologie ASCAR Spital Municipal Timiso-
ara
Premize si obiective: Tensiunea arteriala sistolica este
un factor de prognostic cunoscut la pacientii (P) cu
insufcienta cardiaca congestiva (ICC). Rolul prognostic
al TA diastolice (TAD)mai bine stabilit la pacientii
cu cardiopatie ischemica, find mai putin evaluat in
ICC. Obiectivul acestui studiu a fost de a determina
importanta prognostica a TAD la P cu ICC.
Material si metoda: Din registrul de IC Timisoara
au fost recrutati 244 P consecutivi internati cu ICC
prin disfunctie sistolica VS (FEVS 40%), pentru care
au existat date de urmarire pe o perioada de minim 3
luni. Pentru intregul grup mediana TAD a fost de 80
mmHg. In functie de aceasta P au fost impartiti in 2
grupe: grupul 1 (n=124) cu TAD 80 mmHg si grupul
2 (n=120) cu TAD > 80 mmHg. Au fost comparati
parametrii clinici, biologici, ecocardiografci si evolutia
clinica dupa externare.
Rezultate: Intre cele 2 grupe nu au existat diferente
privitor la varsta medie (65 8 ani in ambele grupe) si
distributia pe sexe. Dintre parametrii clinici la internare,
clasa NYHA a fost semnifcativ mai mare in grupul 1 (3
0,6 vs. 2,7 0,7, p < 0,0001), iar valorile TA (164 25
mm Hg vs 126 22 mm Hg si 99 10 mmHg vs 73 9
mmHg), greutatea (82 16 kg vs 75 16 kg) si fractia
de ejectie 36 4% vs 33 6%) semnifcativ mai mari
in grupul 2. Cardiopatia ischemica a fost prezenta la
la 75 P din grupul 1 si 86 P din grupul 2 (p=0,07), iar
HTA la 49 respectiv 96 P (p< 0,0001). Perioada medie
de urmarire a fost de 16 14 luni in grupul 1 si 14
10 luni in grupul 2 (p=0,2). Mortalitatea la 1 an a fost
38% in grupul 1 (28 decese din 73 P urmariti) si 20% in
grupul 2 (16 decese din 80 P urmariti) (p=0,02).
Concluzii: Pacientii cu ICC si TAD 80 mmHg la
Suplimentul A, 2008
POSTER FORUM III

months in group 2 (p=0,2). One-year mortality rate
was 38% in group 1 (28 deaths from 73 P) and 20% in
group 2 (16 deaths from 80 P)(p=0.02).
Conclusions: Te patiens with CHF and DBP 80
mmHg at admission have more severe heart failure.
Tese patients prognosis is worse, their one year
mortality being signifcantly higher

113. Variatiile de tensiune
arteriala la pacienti spitalizati
pentru edem pulmonar acut
cardiogen analizate in raport
cu semnele de ischemie
miocardica si functia sistolica
de ventricul stang
Darabont R., Costache I., Homoceanu A.,
Vinereanu D.
Obiective: Contributia cresterii tensiunii arteriale (TA)
la aparitia edemului pulmonar acut cardiogen (EPAC)
are semnifcatii controversate, de la epifenomen la
factor inductor specifc in forme clinice particulare.
Scopul nostru a fost sa comparam pattern-ul tensiunii
arteriale atat in prezenta cat si in absenta semnelor de
ischemie miocardica acuta pe durata spitalizarii pentru
edemul pulmonar acut cardiogen.
Metoda: Au fost evaluati retrospectiv 95 de pacienti cu
EPAC (varsta medie: 70 +/-11 ani ). Dintre acestia 82
nu au fost diagnosticati cu afectiuni valvulare severe
sau cu cardiomiopatie idiopatica si au fost impartiti in
2 loturi, lotul A, fara semne de ischemie miocardica (18
pacienti), si lotul B, cu angina pectorala tipica si/sau cu
modifcari electrocardiografce sau ecocardiografce
sugerind ischemia (64 de pacienti). S-au analizat si
comparat valorile TA la internare, dupa primele 24 de
ore si la externare, precum si valorile fractiei de ejectie
a ventriculului stang, evaluate prin metoda elipsoidului
monoplan, in primele 72 de la internare.
Rezultate: Valoare medie pentru fractia de ejectie de
ventricul stang a fost de 47,5% in lotul A si de 36,9% in
lotul B (p<0,001). In lotul A, 78,5% dintre pacienti au
avut fractia de ejectie >40%, iar in lotul B doar 20% au
prezentat o functie sistolica normala saucvasinormala.
Valorile TA in ambele loturi sunt prezentate in
urmatorul tabel. Aritmiile acute, cronice si tulburarile
de conducere au avut aceeasi frecventa in ambele loturi
(CI: 0,49-4,11) Tensiunea Arteriala Grup A Grup B
Valoarea p test t Student TA la internare 187 209 0,047
TA in primele 24 de ore 136 148 0,072 TA la externare
130 140 0,060 Variatia TA in primele 24 de ore 50 101
0,007.
Concluzii: Majoritatea pacientilor fara semne de ische-
mie miocardica acuta au functia sistolica a ventriculului
stang pastrata, indeplinind criteriile de edem pulmonar
acut cardiogen hipertensiv. Amplitudinea cresterii TA
nu a fost in mod semnifcativ mai mare la aceasta cate-
gorie de pacienti, raspunsul la tratament a fost similar
la externare. Insa variatia TA in primele 24 de ore a fost
mai putin ampla, sugerand o vasoconstrictie reziduala
mai puternica la cei cu edem pulmonar acut cardiogen
hiprtensiv, adesea invocata in patogeneza EPAC cu
functie sistolica conservata

Blood pressure patterns in
patients hospitalised for acute
cardiogenic pulmonary
oedema with and without
current signs of myocardial
ischemia
Darabont R., Costache I., Homoceanu A.,
Vinereanu D.
Objectives: Te signifcance of the blood pressure
(BP) rise in the acute cardiogenic pulmonary oedema
(ACPO) is still controversial, from epiphenomenon
to specifc inductor factor in some particular clinical
forms. Our main purpose was to compare the BP
pattern in the presence and in the absence of current
signs of myocardial ischemia, during the hospitalization
for ACPO.
Methods: A series of 95 patients with ACPO were
retrospectively evaluated (mean age: 7011 y). 82 had no
severe valvular disease, nor idiopathic cardiomiopathy
and were devided in group A, without manifestations
POSTER FORUM III Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
of myocardial ischemia (18 patients) and group B,

with tipical angina and/or electrocardiographic and/
or echocardiographic anomalies supporting ischemia
(64 patients). Te mesurements of BP at admission, in
the frst 24h and at discharge and the values of the lef
ventricular ejection fraction (LVEF), evaluated by the
area-length method, in the frst 72h were recorded and
comapared.
Results: Te average LVEF was 47.5% in group A and
36.9% in group B (p<0.001). In group A, 78.5 % had
LVEF 40%, while in group B only 20% presented a
relatively preserved lef ventricular systolic function.
Te values of BP in both groups are illustrated in the
table. Acute and cronic arrythmia or conduction
disturbances had the same rate of occurrence in the
two groups (CI: 0,49-4,11). Blood pressure Group
A Group B p-value Students t test BP at admission
187 209 0,047 BP in the frst 24h 136 148 0,072 BP at
discharge 130 140 0,060 Variation of BP in the frst 24h
50 101 0,007
Conclusions: Te majority of patients without current
signs of myocardial ischemia had residual preserved
lef ventricular systolic function, fulflling the criteria of
hypertensive ACPO. Te amplitude of BP rise was not
signifcantly greater in this cathegory of patients, and
the response to treatment was similar before discharge.
However, the variation of BP in the frst 24h was less
ample, suggesting a stronger remanent vasoconstriction
in the hypertensive ACPO.

114. Vitamina e crete rezerva
funcional coronarian n
insuficiena cardiac
Popovici M, Cobe V, Popovici I, Ivanov V, Ciobanu N,
Moraru I, Todira M, Ciobanu L
IMSP Institutul de Cardiologie, Chiinu, Moldova
Scopul: Evaluarea rezervei funcionale coronariene
n insufciena cardiac experimental, precum i a
efectului administrrii vitaminei E.
Material i metode: Insufciena cardiac (IC) s-a
re produs la obolanii albi de laborator prin trecerea
acestora de la un regim acvatic ad libitum (lot martor) la
unul mbogit n fuor (0,5% NaF timp de 3 sptmni),
dup ce pe parcursul a 2 sptmni s-a administrat
vitamina E (i/p 50 mg/kg lot de studiu) sau volume
echivalente de soluie fziologice (lot de referin).
Rezerva funcional coronarian (RFC) s-a estimat n
cadrul perfuziei cordului izolat izovolumetric (metoda
Langendorf) la valori constante de frecven cardiac
(4,5 Hz) prin determinarea valorii incrementului
fuxului coronarian (FC, ml/min) la aciunea factorilor
vaso relaxani naturali carbacolului (Cb, 10-6 M),
H2O2 (10-6 M), bradichininei (Br, 10-6 M), sau a nitro-
glicerinei, donorului de NO (Ng, 10-7 M), inclusiv n
condiiile inhibiiei NOSec prin L-NAME (10-6 M).
Rezultate: Reactivitatea coronarian endoteliu inde-
pendent atestat n proba cu Ng a fost pstrat n IC
(FC: + 24,82% vs + 27,22%, martor), efect care nu a
fost abolit prin L-NAME. RFC endoteliu dependent
la aciunea Cb s-a notat mai mult ca dublu redus
(incre mentul FC: +11,31% vs +23,82 martor), iar
aciu nea L-NAME a anihilat coronarodilataia mai
con si derabil n lotul martor (-80% vs 65%), fapt ce
indic incompetena endoteliului n sensul eliberrii
de NO. FC la administrarea Br a crescut la cote de
circa 1/2 din nivelul incrementului martor, iar H2O2
a indus o coronarodilataie similar. L-NAME a abolit
n proporie de circa 52% efectul Br n lotul martor i
numai de aproximativ 25% efectul acesteia n IC, punnd
n eviden oportunitatea factorului cu aciunea hiper-
polarizant (H
2
O
2
) n controlul RFC n insufciena
cardiac, lund n consideraie c mediatorii de baz
ai Br sunt NO i H
2
O
2
. Vitamina E a majorat cu 433%
FC la stimularea parasimpatic, efect datorat creterii
expresiei i/sau activitii NOSec, ntruct aciunea
L-NAME a abrogat cooronarodilataia n proporii
inerente lotului martor (-75%). De menionat la aceas-
t conotaie i majorarea dubl a FC consecvent aciu-
nii Br, incrementul constituind 84% din valoarea de
referin, iar coronarodilataia indus de H2O2 a cres-
cut cu circa 10%, efect congruent capacitii vitaminei
E de a crete expresia SOD i posibil legat de creterea
expresiei receptorilor miocitari K+.
Concluzii: 1. Factorul cu aciune hiperpolarizant,
H
2
O
2
, joac un rol compensator important n controlul
RFC a cordului afectat n condiiile diminurii coronaro-
dilataiei dependente de NO. 2. Vitamina E crete FC
la aciunea Cb, Br i a H
2
O
2
, efect plauzibil determinat
de expresia n sus a NOSec, a SOD i a receptorilor
miocitari piramidinici ai H
2
O
2
i poate f acceptat
drept un adjuvant al terapiei IC n sensul ameliorrii
rezervei funcionale coronariene.

Suplimentul A, 2008
POSTER FORUM III

Vitamin e increases the
coronary functional reserve
in heart failure
Popovici M, Cobet V, Popovici I, Ivanov V, Ciobanu N,
Moraru I, Todiras M, Ciobanu L
Institute of Cardiology, Chisinau, Moldova
Aim: Evaluation of the coronary functional reserve in
heart failure, as well as of the vitamin E administration
induced efect.
Material and methods: Te heart failure (HF) was
reproduced on white rats thereby of drinking water
regimen ad libitum (control series) enriching by NaF
(0,5% during 3 months) afer that among of the 2
months have been administered vitamin E (50 mg/kg,
i/p study series) or equivalent volumes of physiologic
solu tion (reference series). Coronary functional reserve
(CFR) was estimated during isolated isovolumic heart
perfusion (according to Langendorf method) at con-
stant cardiac frequency (4,5 Hz) measuring the incre-
ment level of the coronary fux (CF) consequently to
the natural vasorelaxing factors action: carbachol (Cb,
10-6 M), H2O2 (10-6 M), bradykinin (Br, 10-6 M) or
to the nitroglycerine, NO donor, action, (Ng, 10-7 M),
inclusively in conditions of the NOSec inhibition by L-
NAME (10-6 M).
Results: Te Ng induced endothelium independent coro-
nary response was maintained in HF (CF: + 24,82%
vs + 27,22% in control), an efect which was not
abolished by L-NAME. CFR endothelium dependent
con sequently to Cb action was doubly reduced (CF
incre ment: +11,31% vs +23,82 in control), and L-
NAME more evidently annihilated the control croro-
na roconstriction (-80% vs 65%), indicating the
endo the lium incompetence concerning NO release.
Due to Br administration the CF increased as from
con trol ratio, but H
2
O
2
induced coronarodilation was
simi lar. L-NAME blunted by 52% the Br induced efect
in con trol series and only by approximately 25% - in
HF, under lying the opportunity of the factor having
hyper po la ri zing action (H
2
O
2
) in the CF control in HF
in regard that NO and H
2
O
2
are the main mediators
of the brady kinin. Vitamin E increased by 433% CF
on para sympathetic stimulation due to enhancement of
the NOSec expre ssion (or/and its activation) inasmuch
L-NAME abro gated coroanrodialtion correspondingly
to con trol ratio (-75%). To be noted in this context
that Br induced a double CF increase (increment
measuring 84% from reference value), but H2O2 indu-
ced coronarodilation raised by almost 10%, an efect
congruent to the vitamin E capacity to augment SOD
expression and perhaps also due to smooth myocyte
receptor K+ expression rise.
Conclusions: 1. H
2
O
2
, the factor with hyperpolarizing
action plays an important compensator role in the
CFR control in HF in the conditions of NO-dependent
coronarodilation depletion. 2. Vitamin E increases the
CF consequently Cb, Br and H
2
O
2
action, an efect
presumably due to up expression of NOSec, SOD and
of H
2
O
2
-piramidinic myocyte receptor and might be
accepted as an adjuvant of HF therapy concerning the
coronary functional reserve improvement.

115. Impactul fibrilaiei
atriale asupra vrstnicilor cu
insuficien cardiac
Mirela Tomescu, D. Darabaniu, D. Lighezan,
Minodora Andor, D. Brbat, I. Gyalai
Universitatea de Medicin i Farmacie V. Babe,
Timioara, Romnia
Registrul Timioara de Insufcien Cardiac
Premize: Insufciena cardiac reprezint o problem
major de sntate, deoarece prevalena sa crete cu
vrsta, iar prognosticul este sever. Fibrilaia atrial
agra veaz simptomele de insufcien cardiac, dar nu
exist date sufciente privind infuena sa asupra prog-
nosticului insufcienei cardiace.
Obiective: Am cercetat rata mortalitii n 2 grupuri de
pacieni vrstnici cu insufcien cardiac: un grup cu
ritm sinusal, cellalt grup cu fbilaie atrial, pentru a
verifca dac la aceast categorie de pacieni fbrilaia
atrial fbrilaia atrial se asociaz cu o mortalitate mai
mare.
Metode: Studiul retrospectiv cuprinde 240 pacieni
cu vrste 70 ani (vrsta medie 786 ani), 90 brbai
i 150 femei, internai prima oar pentru insufcien
car diac i cuprini n registrul de insufcien cardiac
Timi oara. Pacienii au fost mprii n 2 grupuri:
gru pul I (n= 116) de pacieni cu ritm sinusal, i
grupul II (n= 124) de pacieni cu fbrilaie atrial.
Am analizat urmtorii parametrii: durata spitalizrii,
POSTER FORUM III Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
parametrii clinici i biologici, terapia la externare, rata

reinternrilor i deceselor la 12 luni. Metode de analiz
statistic: media DS, testul Student nepereche, testul
exact Fisher.
Rezultate: Perioada medie de urmrire a fost de 12
3 luni. Etiologia insufcienei cardiace a fost ischemic
la 63% (n=151 pacieni) i neischemic la ceilali 37%
(n=89 pacieni). Pacienii cu fbrilaie atrial au avut
clase NYHA superioare (2,90,6 vs 2,60,7, p=0,0002),
spitalizri mai lungi (13,95 zile vs 114 zile, p <0,0001)
i au primit mai frecvent digoxin (82% vs 23%, p
<0,0001). FEVS a fost similar n ambele gru puri (32
4% ), i, cu excepia digoxinei, terapia la externare a fost
de asemenea similar. Dup 12 luni, rata reinternrilor
a fost de 24% n grupul I i 35% n grupul II (p>0,1), iar
rata de mortalitate a fost de 9% n grupul I i de 14% n
grupul II (p>0,3).
Con cluzii: Prezena fbrilaiei atriale la vrstnicii cu
insu fcien cardiac crete severitatea simptomelor
de insufcien cardiac i durata spitalizrilor, dar nu
crete semnifcativ rata reinternrilor i mortalitatea la
un an.

Impact of atrial fibrillation
in elderly patients with heart
failure
Mirela Tomescu, D. Darabaniu, D. Lighezan,
Minodora Andor, D. Brbat, I. Gyalai
University of Medicine and Pharmacy V. Babe,
Timioara, Romnia
Timioara Heart Failure Registry
Background: Heart failure is a major public health
pro blem, as its prevalence is increasing with age and
its prognosis is poor. Atrial fbrillation aggravates the
symptoms of heart faiure, but there are no available data
regar ding its infuence on prognosis in heart failure.
Objective: We investigated the mortality rate in 2 groups
of elderly patients with heart failure: one with sinus
rhythmus and one with atrial fbrillation. We wanted
to determine if atrial fbrillation in these category of
patients was associated with a higher mortality rate.
Methods: Te retrospective study included 240 patien-
ts 70 years old ( mean age 786 years), 90 males and
150 females, frst hospitalized for heart failure and
recruited in the Timisoara HF Registry. In regard to
the presence of persistent atrial fbrillation, we divided
the lot into 2 groups: group I (n= 116 ) included patients
with sinus rhythm and group II (n= 124) patients with
atrial fbrillation. We analysed following parameters:
duration of hospitalization, clinical and biological
parameters, discharge therapy, and the readmission
and death rates at 12 months. Statistics: mean SD,
unpaired Student`s test and Fisher`s exact test.
Results: Mean follow-up period was 12 3 months.Te
etiology of heart failure was ischemic in 63 % (n=151
patients ) and nonischemic in 37% (n=89 patients) . Te
patients with atrial fbrillation had a higher NYHA class
(2,9 0,6 vs 2,6 0,7, p=0,0002), a longer duration of
hospitalization (13,9 5 days vs 11 4 days, p< 0,0001)
and a higher prescription rate of digoxin (82% vs 23%,
p <0,0001). LVEF was similar in both groups (32 4%),
and, excepting digoxin, discharge therapy was also
similar. At 12 months, the readmission rate was 24% in
group I and 35% in group II (p>0,1), and the mortality
rate was 9% in group I and 14% in group II (p>0,3).
Conclusion: Te presence of atrial fbrillation in
elderly patients with heart failure increases the seve rity
of heart failure symptoms and the duration of hospi-
talization, but it does not increase signifcantly one year
readmission rate and mortality.

116. Disparitia conducerii
sustinute pe calea lenta este un
predictor mai bun pe termen
lung al succesului dupa
ablatia cu radiofrecventa
pentru TRAVN tipica
Vatasescu Radu, Iorgulescu Corneliu,
Ieremciuc Isabela, Dorobantu Maria
Spitalul clinic de Urgenta Bucuresti
Premize: Obiectivul procedural optim al eliminarii
substra tului in timpul ablatiei cu radiofrecventa (RF)
de cale lenta (CL) nu poate f obtinut intr-un pro cent
substantial de cazuri cu TRAVN (tahicardie reintra-
nta atrio-ventriculara nodala) tipica. Endpoint-ul sub-
Suplimentul A, 2008
POSTER FORUM III

optimal dar acceptabil in practica curenta e ste modi-
fcarea substratului - persistenta dualitatii fziologice
a NAV (DFNAV) cu nu mai mult de 2 ecouri dupa
admi nistrare de isoproterenol.
Obiective: evaluarea procentului de pacienti cu rezultat
suboptimal dupa ablatia cu RF de CL si identifcarea in
cadrul acestui subgrup de pacienti a unui parametru
electrofziologic mai bine corelat cu modifcarea semni-
fcativa a substratului fziologic.
Metode: am analizat 40 cazuri consecutive de pacienti
intens simptomatici (varsta medie 4517 ani, 23 femei,
perioada de urmarire 2010 luni) care au efectuat
ablatie cu RF pentru TRAVN forma tipica. Succesul
periprocedural acut a fost defnit ca lipsa inductibilitatii
aritmiei inclusive dupa administrare de isoproterenol,
cu eliminarea sau modifcarea substratului. DFNAV
a fost defnita ca persistenta saltului de conducere iar
conducerea sustinuta pe calea lenta (sustained slow
pathway conduction - SSPC) ca PR> RR inaintea punc-
tului de Wenckebach anterograd. Persistenta DFAVN si
a SSPC a fost determinate inainte si dupa ablatie.
Rezultate: Inainte de ablatie SSPC a fost prezent la
90% (36) iar DFNAV la 85% (34) dintre pacienti. Succe-
sul procedural acut a fost obtinut la toti pacientii.
Sub stratul a fost eliminat la 82,5% dintre pacienti iar
DFNAV a persistat la 17,5% (7) dintre pacienti. Au fost
2 recurente in subgrupul cu DFNAV persistenta. SSPC
a persistat dupa ablatie doar la pacientii cu recurente.
Concluzii: SSPC este mai bine corelat cu modifcarea
semnifcativa a substratului si este un predictor mai
bun al absentei recurentelor dupa ablatia cu RF de CL
pentru TRAVN

Disappearance of sustained
slow pathway conduction
(SSPC) is a better predictor for
long term success after
radiofrequency ablation for
typical AVNRT
Ieremciuc Isabela, Dorobantu Maria
Background: Te optimum endpoint of substrate eli-
mination during radiofrequency (RF) slow pathway
(SP) ablation cannot be obtained in a substantial per-
cent of the patients with typical AVNRT. Suboptimal
but acceptable post procedural endpoint is substrate
modi fcation currently defned as persistence of dual
AV node physiology (DAVNP) with no more than two
echoes afer isoproterenol administration.
Objective: To evaluate the percentage of patients with
a suboptimal result afer RF SP ablation and to identify
in this group an electrophysiological parameter that
is better correlated with signifcant substrate modi fca-
tion.
Methods: We retrospectively analyzed 40 con secu-
tive highly symptomatic patients (mean age 45 17
years, 23 female, mean follow-up 2010 months) who
under took RF SP ablation for typical AVNRT. Acute
procedural success was defned as lack of indu cibi lity of
arrhythmia with substrate elimination or modi

f ca tion
despite isoproterenol administration. DAVNP was iden-
tifed as by AH jump and sustained slow pathway con-
duction (SSPC) as PR>RR before anterograde Wencke-
bach point. Te persistence of DAVNP and SSPC was
determined before and afer ablation. Results: Befo re
ablation SSPC was present in 90% (36) and DAVP in
85% (34) of the patients. Acute procedural success was
obtained in all the patients. Te substrate was eli mi-
nated in 82,5% of the patients and DAVN persis ted in
17,5% (7). Tere were 2 recurrences, all in the group
with persistent DAVN. SSPC was present afer abla tion
only in patients with recurrences.
Conclusion: SSPC is better correlated with signifcant
substrate modifcation and it is a better predictor for
lack of recurrences afer RF SP ablation for typical
AVNRT.

111
POSTER III
118. Reproductibilitatea
comparativa a testelor de
evaluare ultrasonografica
noninvaziva a functiei
vasculare
Andrea Ciobanu, Stefania Magda, Claudiu Stoicescu,
Mircea Cinteza, Dragos Vinereanu
Context: Masurarea functiei vasculare prin metode
ultrasonografce reprezinta o metoda indicata de catre
ghidurile actuale pentru evaluarea riscului cardio-
vascular. Dar, pentru a-si dovedi utilitatea clinica, masu-
ratorile efectuate trebuie sa fe reproductibile. Cu toate
aceastea, pana in prezent nu exista sufciente date cu
privire la reproductibilitatea comparativa a inregistrarii
si masurarii multiplilor parametri de functie vasculara.
Metoda: 15 pacienti (48+/-15 ani, 6 barbati) au fost
eva luati de catre 2 observatori prin ecografe vasculara
(e-tracking, wave intensity analysis) la nivelul arterei
carotide comune drepte (determinarea grosimii intima-
medie IMT, a indicelui de augmentare AIx, si a para-
metrilor de interactiune ventriculo-arteriala, frst peak
FP, second peak SP, negative area NA, indicele
de rigiditate , modulul elastic Young EP, complianta
arteriala AC, viteza undei pulsului WS) si la nivelul
arterei brahiale drepte (vasodilatatia mediata de fux
FMD), folosindu-se un ecograf Aloka 5500SSD, si
prin metoda COMPLIOR pentru determinarea vitezei
undei pulsului (PWV). Reproductibilitatea intra- si
inter observator a fost evaluata intr-o prima sedinta, in
cadrul careia s-au efectuat 3 determinari consecutive,
in ordinea: observator 1 observator 2 observator 1.
Repetabilitatea metodei a fost apreciata printr-o a patra
examinare dupa 1 saptamana (observato r 2).
Rezultate: Reproductibilitatea comparativa (coefcien-
tul de corelatie) a inregistrarii si masurarii principalilor
parametri de functie vasculara este prezentata in tabe-
lul 1. Cei mai reproductibili parametri sunt PWV, IMT,
si parametrii de rigiditate arteriala. Para metru Varia-
bili tatea intraobservator Variabilitatea inter obser vator
Repetabilitatea IMT 0.96 0.95 0.96 AIx 0.95 0.63 0.48
FP 0.83 0.82 0.66 SP 0.68 0.71 0.45 NA 0.85 0.98 0.67
117. Monitorizarea
parametrilor
ecocardiografici la pacientii
tratati cu antraciclinice
Dimitriu A.G, Mandric Cristina, Miron Ingrith
Universitatea de Medicina si Farmacie Iasi
Scopul lucrarii: Evaluarea celor mai importanti para-
metri ai functiei sistolice si diastolice a ventriculului
stang (VS), stabilirea celor predictivi pentru disfunctia
pre coce aparuta la copii tratati cu antracicline.
Metoda: 124 pacienti (3luni-19 ani), tratati cu antra ci-
cline, grup mar tor-40 copii sanatosi. Doza medie cumu-
lativa de antra cicline-320 mg/m
2
Echocardiografa Do-
pp ler (Eco) a evaluat cei mai importanti parametric ai
func tiei sis tolice si diastolice, intervalul dintre exa me-
ne iind sta bilit in functie de doza cumulative antraci cli-
nica. Para metri sistolici (FSVS,FEVS) au fost compa rati
cu cei dias tolici ai functiei VS (E, A, E/A, DT, IVRT,
IVCT) la toti pa cientii; in 64 cazuri a fost evaluat si
indexul Tei.
Rezultate: modifcari eco sugestive-63 cases-51%
(manifestari clinice).Cele mai importante modifcari
eco au fost evidentiate la o doza cumulativa >350 mg/m
2
,
in special disfunctie diastolica, deasemenea, cu debut
precocet; disfunctia sistolica-scaderea FEVS (19%);
Disfunctie diastolica: tulburari de relaxare-raport E/
A<1 (17%) sau tulburari de complianta- raport E/A>
2,5 (31%), cresterea timpului de deeceleratie a undei E-
DT (35%) si a trimpului de relaxare izovolumica TRIV
(28%). Indicele Tei, crescut in 30 cazuri: 21 cazuri valori
intre 0.39-0.62, 9 cazuri >0.62.
Concluzii: Parametrii diastolici eco si indicele Tei
permit o detectare precoce a cardiotoxicitatii antra ci-
clin-induse, frecvent nediagnosticate sau nesuspectate
cilinic, in special deca FEVS este in limite normale

Suplimentul A, 2008
115
POSTER III
0.80 0.80 0.95 EP 0.84 0.83 0.95 AC 0.84 0.80 0.91 WS
0.89 0.88 0.95 FMD 0.82 0.90 0.89 PWV 0.98 0.98 0.95
Concluzie: Evaluarea ultrasonografca a functiei vascu-
lare are o variabilitate intra- si inter- observator si o
repetabilitate buna, similara cu a altor metode eco-
grafce.

The comparative
reproductibility of the
noninvasive ultrasound
vascular function evaluation
methods
Andrea Ciobanu, Stefania Magda, Claudiu Stoicescu,
Mircea Cinteza, Dragos Vinereanu
Background: Ultrasound vascular function measure-
ment is recommended by the present guidelines for the
cardiovascular risk evaluation. Tese measurements
must be reproductible, in order to be clinically appli-
cable. However, until now, there is not enough data
avai lable regarding the comparative reproductibility of
the acquisition and measurement of diferent vascular
function parameters.
Method: 15 patients (age 4815 years, 6 men) had vas-
cular ultrasound evaluations (e-tra cking, wave-inten-
sity analysis) performed by 2 observers, of the right
common carotid artery (mea surement of intima-me-
dia thickness- IMT, augmen tation index AIx, and
the ventriculo-arterial interac tion parameters, frst
peak FP, second peak SP, negative area NA,
beta stifness index, Young elastic module EP, arte-
rial com pliance AC, wave speed WS), and of the
right brachial artery (fow mediated dilation FMD),
using an Aloka 5500SSD ultrasound machine. Also,
the pulse wave velocity (PWV) was evaluated using the
COMPLIOR method. Intra- and interobserver repro-
duct ibility was assessed in the frst examination, when
three consecutive acquisitions were made: 1st observer
2nd observer 1st observer. Te repeatibility of the
method was evaluated one week later, during the 4th
exami nation (2nd observer).
Results: Te comparative reproductibility (the corre la-
tion coef cient) of the most important vascular func-
tion parameters is shown in the table 1. Te most repro-
ducible parameters are PWV, IMT and arterial stifness
parameters. Parameter Intraobserver variability Inter-
observer variability Repeatibility IMT 0.96 0.95 0.96
AIx 0.95 0.63 0.48 FP 0.83 0.82 0.66 SP 0.68 0.71 0.45
NA 0.85 0.98 0.67 beta 0.80 0.80 0.95 EP 0.84 0.83 0.95
AC 0.84 0.80 0.91 WS 0.89 0.88 0.95 FMD 0.82 0.90
0.89 PWV 0.98 0.98 0.95
Conclusion: Ultrasound vascular function evaluation
has a good intra- and interobserver variability, and a
good repeatibility, similar to other ultrasound metho-
ds.

119. Prevalena sindromului
metabolic la pacienii vrstnici
cu accident vascular cerebral
ischemic
Ctlina Clin, Dana Micu, Valentin Chioncel,
Crina Sinescu
Spitalul Clinic de Urgen Bagdasar-Arseni
Obiectiv: Scopul acestui studiu a fost s identifce pre-
valena sindromului metabolic (SM) la pacienii vrst-
nici cu accident vascular cerebral ischemic (AVCI).
Metod: A fost un studiu retrospectiv n care am ana-
lizat 237 pacieni vrstnici (vrsta 65 ani) internai
n ultimii 4 ani (grup 1) pentru boal cardiac acut
compli cat cu AVCI. Acetia au fost comparai cu 276
pacieni vrstnici (grup 2) fr istoric pozitiv de boal
cardiac sau cerebrovascular AVCI a fost pus n
eviden prin examinare CT cerebral, iar SM a fost def-
nit conform ultimelor ghiduri. Distribuia bazat pe
sex a fost similar n ambele grupuri.
Rezultate: Prevalena SM a fost semnifcativ mai mare
n grupul 1 vs. grupul 2 (43.6% vs. 21.2%, p <0.001).
Proflul aterogenic a fost mai sever alterat n grupul 1
fa de grupul 2: LDL-colesterol >130 mg/dl: 41.3%
vs. 20.6%, p <0.05; HDL-colesterol: femei <50 mg/dl:
45.3% vs. 23.8%, p <0.05; brbai <40 mg/dl: 46.5% vs.
25.2% - p <0.05; TGL >150 mg/dl: 40.2% vs. 19.3%, p
<0.05. Pacienii din grupul 1 au avut valori mai mari
ale acidului uric seric (7.22.4 mg/dl vs. 5.71.4 mg/
dl). Incidena SM la pacienii cu AVC a crescut cu
IMC: 23.4% pentru normoponderali; 33.4% pentru
supraponderali i 56.8% pentru obezi.
POSTER III Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
116
Concluzii: Prevalena SM este semnifcativ mai mare
la pacienii vrstnici cu AVCI. Aceasta este n relaie
direct cu proflul aterogenic, obezitatea i valorile mari
ale acidului uric seric.

Prevalence of metabolic
syndrome in elderly patients
with acute ischaemic stroke
Ctlina Clin, Dana micu, Valentin Chioncel,
Crina Sinescu
Aim: Te aim of this study was to identify the prevalence
of metabolic syndrome (MS) in elderly patients (pts)
who presented an acute ischaemic stroke (AIS).
Method: Tis was a retrospective study. We analyzed
237 elderly pts (age 65 years) hospitalized in the last
4 year (group 1) for acute cardiac disease complicated
with AIS. Tey were compared with 276 elderly pts
(group 2) without positive history for cardiac or cardio-
vas cular disease AIS was proved by CT-scan and MS
was defned in according with the last guidelines. Te
distri bution based by gender was similary in the both
groups.
Results: Prevalence of MS was signifcantly higher in
group 1 vs. group 2 (43.6% vs. 21.2%, p <0.001). Te
athe ro genic profle was more alterated in group 1 than
in group 2: LDL-cholesterol >130 mg/dl: 41.3% vs.
20.6%, p <0.05; HDL-cholesterol: females <50 mg/dl:
45.3% vs. 23.8%, p <0.05; TGL >150 mg/dl: 40.2% vs.
19.3%, p <0.05. Pts from group 1 had higher values
of plas ma uric acid (7.2 2.4 mg/dl vs. 5.7 1.4 mg/
dl). Inci dence of MS in pts with AIS increased with
BMI: 23.4% for normal weight; 33.4% for overweight
(supraponderal) and 56.8% for obese.
Conclusions: Te prevalence of MS is signifcantly
higher in elderly pts with AIS. It is in directly relationship
with atherogenic profle, obesity and the higher value
of plasma uric acid.

120. Anergia cutanat - marker
de prognostic n insuficiena
cardiac
D. P. Petcu
1
, Denisa Babeanu
1
, Laura Bogdan
1
,
Florescu Cristina
1
, Coriolan Petcu
2
1
Centrul de Cardiologie Craiova,
2
Institutul de Boli Cardiovasculare C.C. Iliescu
Bucuresti /Chirurgie Cardiovasculara
Introducere: Insufcienta cardiaca reprezinta o cauza
importanta de morbiditate si mortalitate. Mortalitatea
in IC severa (clasa III-IV NYHA) este de 20-40% pe an.
Prognosticul este infuentat de numerosi factori clinici
si paraclinici. Anergia cutanata a fost mai putin studiata
ca factor de prognostic pana in prezent.
Scop: Prezentul studiu isi propune sa demonstreze o
legatura intre anergia cutanata la pacientii cu ICC clasa
III-IV NYHA si prognosticul bolii.
Material si metode: Am studiat un lot de 35 de pacienti
cu ICC clasa III-IV NYHA internati in CCC in perioada
1.11.2007-30.04.2008. Testele cutanate au fost efectuate
cu candidina 0,1 ml IDR, cu citire ulterioara la 48 de
ore. Anergia a fost considerata induratia cu diametru<2
mm. Subiectii normali, fara IC (n=20), au prezentat o
induratie cu diametrul >2mm.
Pacientii luati in studiu au fost divizati in doua loturi:
pacienti cu IC de etiologie ischemica si pacienti cu IC
de etiologie idiopatica. Au fost studiate date biochimice
si hemodinamice specifce bolnavilor cu IC. Pacientii
studiati au primit tratament conform recomandarilor
ghidurilor actuale.
Rezultate si concluzii: Grupul total al IC a fost divizat
in anergici (45%) si nonanergici (55%). 57% din anergici
aveau etiologie ischemica iar 43% etiologie idiopatica.
Marea majoritate a anergicilor aveau preponderent IC
clasa IV NYHA, varsta mai inaintata, Na seric scazut,
colesterol, TG si LDL serice scazute. S-a observat o rela-
tie lineara intre valorile Nt pro BNP, factorii infa ma-
torii si modifcarile hemodinamice (FE%).
Testele cutanate ar putea reprezenta o alternativa mai
putin costisitoare la alte teste hemodinamice folosite in
predictia prognosticului pacientilor cu insufcienta car-
diaca.

Suplimentul A, 2008
11I
POSTER III
Skin test anergy- predicting
factor in advanced heart
failure
D. P. Petcu
1
, Denisa Babeanu
1
, Laura Bogdan
1
,
Florescu Cristina
1
, Coriolan Petcu
2
1
Craiova Cardiology Center
2
C.C. Iliescu Institute of Cardiovascular Diseases,
Bucharest/Cardiovascular Surgery
Background: Heart failure (HF) is an important cause
of morbidity and mortality. Te mortality in patients
with NYHA class III-IV HF is about 20-40 %/year. Te
prognostic depends on many clinical and biochemical
factors. Skin anergy was less studied before as a prog-
nostic marker.
Te endpoint of this study is to set a relationship
between skin anergy in patients with NYHA class III-
IV and the prognosis of their disease.
Methods: We studied a group of 35 patients admitted
with NYHA class III-IV HF within the Craiova Cardio-
logy Center between 1.11.2007 30.04.2008. Te skin
test was done with candidine 0,1 ml injected intra der-
mally and were read 48 hours later.Anergy was defned
as induration <2 mm. Te normal subjects (20) had
indu rations >2mm.Te studied patients were divided
in 2 groups according to HF etiology: ischemic HF and
idiopathic HF. Biochemical and hemodynamic data,
specifc for HF, were studied. Tese patients were treat-
ed according to HF guidelines.
Results and conclusions: Te entire group of HF was
divided in anergic (45 %) and non-anergic (55%) sub-
groups. 57% of anergic patients had ischemic HF and
43% had idiopathic HF. A higher proportion of patients
in the anergic group were classifed as NYHA class IV
rather than NYHA class III, they were older, had lower
serum sodium and lower plasmatic lipid values. We
deter mined a relationship between NT proBNP levels,
infamatory factors and hemodynamic changes (EF%).
Skin tests could be a less expensive choice compa-
ratively to other haemodinamic tests for predicting the
prognosis in patients with advanced HF.

121. Relatia dintre doza de
diuretic de ansa si prognosticul
pacientilor cu insuficienta
cardiaca acuta pe perioada
spitalizarii
Eugenia Nechita, Lucica Grigorica
Spitalul Clinic de Urgenta Sf. Apostol Andrei Galati
Diureticele de ansa reprezinta prima linie de tratament in
insufcienta cardiaca congestiva. Desi utilizarea acestora
ame lioreaza semnifcativ simptomele pacientilor, uti-
li zarea lor este limitata de alterarea functiei renale,
acti varea neurohormonala, agravarea prognosticului
pa cien tilor. Scopul studiului a fost acela de a evidentia
in ce mod dozele de furosemid pot infuenta evolutia
pa cientilor cu insufcienta cardiaca acuta pe perioada
inter narii. End-point-urile studiului au fost: durata
spitalizarii, pierderea in greutate, modifcarea fu nctiei
renale si mortalitatea pe perioada internarii.
Material si metoda: Studiul a fost retrospectiv, obser-
vational care a cuprins pacienti internati consecutiv cu
diagnosticul de insufcienta cardiaca acuta in pe rioa da
01.08. 31.12.2007 in sectia de cardiologie a Spit alului
Clinic de Urgenta Sf. Apostol Andrei Galati.
Rezultate: Lotul a cuprins 78 de subiecti, predominant
de sex masculin (62,3 %).Varsta medie a lotului studiat
a fost de 69,1 4,5 ani. Cea mai frecventa forma clinica
de prezentare a fost insufcienta cardiaca cronica
decom pensate (79% dintre cazuri). Am remarcat frec-
venta crescuta a cazurilor cu edem pulmonar acut
(10%). Proportia pacientilor cu fractie de ejectie a
ven tri culului stang prezervata (FE >50%) a fost de
34,5 %. Durata medie de spitalizare a fost de 9 2,3
zile, iar mortalitatea generala a fost de 7,2 %. 81,6%
dintre pacienti au necesitat diuretic parenteral, iar 10%
diuretic per os. Durata medie de spitalizare a fost semni-
fcativ mai mare in grupul pacientilor care au primit
furo semid injec tabil: 11 2,4 zile vs 7 zile in grupul
celor cu furosemid per os. Nu au existat diferente
semni fcative statistic in ceea ce priveste mortalitatea
gene rala pe perioada spitalizarii intre cele doua gru-
puri: 7,4% vs 7% (mai mare in lotul cu furosemid injec-
tabil). S caderea medie in greutate a fost de 3,4 0,5
Kg si nu s-a corelat cu doza zilnica de furosemid. O
doza de furosemid mai mare de 320 mg/zi s-a corelat
cu o du rata a spitalizarii mai mare (131,2 zile) si o
mort ali tate usor crescuta comparative cu media lotului:
Suplimentul A, 2008
118
7,8%. Nu s-au constatat corelatii semnifcative statistic
intre doza maxima de diuretic si nivelul creatininei.
Crea tinia medie la internare a fost de 1,26 0,4 mg.dl,
28 % dintre pacienti avand creatinina >1,3 mg/dl. La
externare 15 % dintre pacientii internati cu disfunctie
renala mentineau creatinina >1,2 m g/dl.
Concluzii: Dozele mari de furosemid s-au corelat cu
spitalizare prelungita si o usoara crestere a mortalitatii
pe perioada spitalizarii, dar nu s-au corelat cu nivelul
scaderii ponderale si cu valoarea creatininei.

The relation among the dose
of diuretic of ansa and the
prognostic of hospitalized
patients with cardiac acute
failure
Eugenia Nechita, Lucica Grigorica
Emergences Hospital Sf. Apostol Andrei Galati
Te loop diuretics represent the frst line of treatment
of cardiac congestive failure. Although these utilization
improves signifcantly the symptoms of the patients,
their utilization is limitated of the alteration of renal
function, the neurohormonal activation , the severity
prognostic of the patients.
Aim: How the furosemid doses infuenced the evo lution
of hospitalized patients with acute heart failure. Te end
points of this study it was: the period of hos pi talization,
loss of weight, renal function and in hospital general
mortality.
Material and metod: Tis study was retrospective,
observational contained patients consecutive admitted
with acute heart failure in the period 01.08. 31.12.2007
in Cardiology Department of the Emergence Hospital
Sf. Apostol Andrei Galati.
Results: Our retrospective study evaluated 78 of sub-
ject, predominantly male (62, 3%). Median age was 69,
1 4, 5 years. Te most frequent clinical form was acute
decompensate heart failure (79% cases). We obser ved
a high frequency of acute pulmonary oedema (10%).
Te proportion of the patients with preserved lef
ventricular ejection fraction (FE > 50%) was of 34, 5
%. Te median length stay was 9 2, 3 days, and gene-
ral mortality was 7, 2 %. 81, 6 % among patients requi-
red parenteral loop diuretic, and 10% diuretic per os.
Te median length stay was higher in the group with
pare nteral diuretic treatment vs. per os diuretic: 11
2, 4 days vs. 7 days. Te parenteral diuretic utilization
infuenced non-signifcantly the in hospital mortality:
mor tality was 7, 4% in the group with intravenous
furo semide vs. 7% in the group without parenteral
furosemide. Median weight loss: 3, 4 0,5 Kg. Te
furosemide dose was not correlated with weight loss.
A relation between furosemide doses >320 mg/dl
and length stay and mortality. Correlation between
maxi mal dose of furosemide and creatinine level was
not statistical signifcant. Median creatinine level at
admi ssion was 1, 260, 4 mg/dl; the seric creatinine
was higher (>1, 3 mg/dl) for the 28 % patients. 15 %
pa tients leave hospital with renal dysfunction (level of
seric creatinine >1, 2 mg/dl).
Conclusions: Te high intravenous furosemide doses
was correlated with long lenght stay and higer in-
hospital mortality vs group with per os furosemide;
was not statistical signifcant correlation between the
level of weight loss and the level of seric creatinine.

122. Strategii terapeutice
n fibrilaia atrial nou
diagnosticat
Mihaela Bolog, Mihaela Dumitrescu, Elena Pcuraru,
Florentina Romanoschi, Gabriela Badea, Gina Ursu,
Mihai Tudose
Spitalul militar de urgen Agrippa Ionescu
Scop: Analiza strategiilor terapeutice aplicate i evoluia
intraspitaliceasc a bolnavilor cu fbrilaie atrial nou
diagnosticat.
Metoda: Analiza retrospectiv a foilor de observaie ale
bolnavilor spitalizai in perioada aprilie 2005-aprilie
2008. Au fost selecionate cazurile care, erau pentru
prima oara diagnosticate cu fbrilaie atrial.
Rezultate: Din cei 56 bolnavi internai cu fbrilaie atrial
nou diagnosticat 18 au fost femei (32,1%) cu vrsta
medie 64 ani si 38 barbati (67,9%) cu vrsta medie 58,5
ani. 31 de bolnavi (55,3%) prezentau fbrilaie atrial
cu debut recent (<7 zile), iar la ceilali 25 de bolnavi
(44,6%) anamneza nu a putut identifca cu certitudine
mo mentul instalrii fbrilaiei atriale. Frevena ventri-
cular medie a fost de 140 btai/minut, un singur
bol nav prezentnd fbrilaie atrial cu rspuns lent(
Suplimentul A, 2008
119
POSTER III
frecvena cardiac 45b/minut).Toi bolnavii au primit
de la internare tratament anticoagulant (heparin cu
greu tate moleculara mic), iar 50 de bolnavi( 89,2%)
aveau, sau s-a asociat, aspirina. La bolnavii cu fbrilaie
atrial cu debut recent (31 bolnavi) s-a optat pentru
cardioversie farmacologic (cu cordarone 21 bolnavi,
37,5% si cu propafenon 10 bolnavi 17,8%). 25 de
bolnavi (80,6%) din cei 31cu debut recent s-au convertit
in ritm sinusal in cursul spitalizarii iniiale . La cei la
care debutul fbrilaiei atriale a fost incert s-a urmarit
controlul frecvenei cardiace (betablocant, digital sau
asocialia dintre ele). Dintre acetia, 13 bolnavi (52%)
s-au convertit spontan in ritm sinusal. Un bolnav a
necesitat cardioversie electrica de urgen si un bolnav
a fost trimis pentru implantare de pacemaker.
Concluzii: Rata conversiei la ritm sinusal a bolnavilor
cu fbrilaie atrial nou diagnosticat a fost de 69,6%
(39 de bolnavi) dintre care 25 bolnavi au fost convertii
chimic, (cu cordarone 21 bolnavi, 37,5% si cu pro pa-
fenon 10 bolnavi, 17,8%), 13 bolnavi 23,2% s-au con-
vertit spontan si 1 bolnav a fost convertit electric. 17
bol navi (30,4%) au fost externati in fbrilaie atrial
urmand ca decizia de conversie la ritm sinusal sa fe
apreciat ulterior.

Therapeutic strategies in first
detected atrial fibrillation
Mihaela Bolog, Mihaela Dumitrescu, Elena Pacuraru,
Mihai Tudose
Emergency Military Hospital Agrippa Ionescu
Background: Analysis of therapeutic strategies and
intra-hospitaly evolution of patients with frst detected
atrial fbrillation
Methods: Retrospective analysis of the medical records
of the patients hospitalized between April 2005-April
2008. Tere were selected and analyzed only the cases
with frst detected atrial fbrillation
Results: From the 56 patients (0,88%/3years with frst
detected with atrial fbrillation 18 were women (32,1%)
aged 64 years old and 38 were men (67,9%) aged 58,5
years old. 31 patients (55,3%) had recent onset atrial
fbrillation (<7 days), and for the other 25 de patients
(44,6%) anamnesis could not identifed the date of the
debut of the atrial fbrillation. Te average ventricular
rate was 140 beats /minute, only one patient had slow
rate atrial fbrillation (45b/minut). All patients received
from the admission fractionated heparin and 50 pa-
tients (89,2%) had before or received now aspirin in
asso ciation. Patients with recent onset atrial fbrillation
(31 patients) were submitted to chemical cardioversion
(with cordarone 21 patients, 37,5% and with propa fe-
none 10 patients 17,8%). 25 patients (80,6%) of the 31
with recent onset atrial fbrillation converted to sinusal
rhythm. Tose patients in witch the debut of the atrial
fbrillation was uncertain, were submitted to rate con-
trol therapy (beta-blocker, digitalis or association). Of
those 13 patients (52%) converted to sinusal rhythm.
One patient needed emergency electrical cardioversion
and one patient (with slow response atrial fbrillation)
had pace maker implantation.
Conclusions: Te rate of conversion to sinus rhythm
in patients with frst detected atrial fbrillation was
69,6% (39 patients): 25 patients were chemicaly cardio-
verted (with cordarone 21 patients, 37,5% and with
propafenone 10 patients 17,8%), 13 patients 23,2% con-
verted spontaneously si 1 patient was electricaly cardio-
verted. 17 patients (30,4%) remained in atrial fbri lla-
tion, the decision of cardioversion beeing postponed to
a latter moment.

123. Factori demografici si
condiii asociate fibrilaiei
atriale nou diagnosticate
Scop: Analiza factorilor demografci si/sau a condiiilor
asociate fbrilaiei atriale nou diagnosticate (la prima
prezentare).
Metod: Analiza retrospectiva a foilor de observaie ale
bolnavilor spitalizai in perioada aprilie 2005-aprilie
2008. Au fost selecionate cazurile care erau pentru
prima oar diagnosticate cu fbrilaie atrial.
Rezultate: Din cele 6312 internri/3 ani au fost diag-
nosticai pentru prima oar cu fbrilaie atrial 56
bolnavi (0,88%/3 ani ). Au fost 18 femei (32,1%) cu
vrsta medie 64 ani si 38 brbati (67,9%) cu vrsta
me die 58,5 ani. Au prezentat boli structurale cardiace
48 bolnavi (85,7%): HTA 32 bolnavi (57,1%), insuf-
cien cardiac 9 bolnavi (16%), boal cardiac ische-
mic 9 bolnavi (16%), cardiomiopatie dilatativ 4
bol n avi (7,1%), valvulopatiii 3 bolnavi(5,3%), cardio-
mio patie hipertrofc 2 bolnavi (3,5%), sindrom de
preexci taie 1 bolnav (1,7%), boal de nod sinusal 1
Suplimentul A, 2008
150
bol nav (1,7%). Ali factori predispozani sau/si condiii
asociate: hipertiroidie 3 bolnavi, pneumopatie acut 2
bol navi, tumor mediastinal 2 bolnavi, trombembolie
pul monar 1 bolnav, hernie gastric transhiatal volu-
minoas 1 bolnav, consum alcool (in absena altor
etiologii posibile) 2 bolnavi, fr cauz/factori precipi-
tani 1 bolnav. Sindromul metabolic (defnit conform
criteriilor NCEP-ATP III si AHA/NHLBI) au prezentat
15 bolnavi (26,7%). Fracia de ejectie medie (estimat
eco cardiografc) a fost de 48%. Dimensiunile atriului
stng (media diametrului cel mai mare) a fost de 44
mm.
Concluzii: Sexul masculin (67,9%), hipertensiunea arte-
rial 57,1%) i sindromul metabolic (26,7%) reprezint
factorii cel mai frecvent asociai fbrilaiei atriale nou
diagnosticate.

Demographics and associated
condition in first detected
atrial fibrillation
Mihaela Bolog, Mihaela Dumitrescu, Elena Pacuraru,
Mihai Tudose
Emergency Military Hospital Agrippa Ionescu
Background: Identifcation of the demographic factors
and associated condition in frst detected atrial fbrilla-
tion.
Methods: Retrospective analysis of the medical records
of the patients hospitalized between April 2005 - April
2008. Tere were selected and analyzed only the cases
with frst detected atrial fbrillation.
Results: From the 6312 hospitalization /3 years 56
patients (0,88%/3years) were frst detected with atrial
fbri llation 18 were women (32,1%) aged 64 years old
and 38 men (67,9%) aged 58,5 years old. Underlying
heart disease had 48 patients (85,7%): hypertensive heart
di sease 32 patients (57,1%), cardiac failure 9 patients
(16%), coronary artery disease 9 patients (16%), dilated
car dio myopathy 4 patients (7,1%), valvular heart
disease 3 patients (5,3%), hypertrophic cardiomyopathy
2 pa tients (3,5%), preexcitation syndrome 1 patient
(1,7%), sick sinus syndrome 1 patient (1,7%). Other
pre disposing or associated condition: hyperthyroidism
3 patients, acute pneumionitis 2 patients, mediastinal
tumor 2 patients, pulmonary thromboembolism 1
pa tien ts, transhiatal gastric hernia voluminoasa 1 pa-
tient, alcohol consumption (in absence of other etio-
logies) 2 patients, none 1 patients. Metabolic syndrome
(NCEP-ATP III and AHA/NHLBI criteria) presented
15 patients (26, 7%). Lef ventricular ejection fraction
(esti mated by echocardiography) was 48%. Lef atrial
dimension (the average of the longest diameter mea-
sured by echocardiography) was 44 mm.
Conclusions: Masculine sex (67, 9%), hypertensive
heart disease 57, 1%) and metabolic syndrome (26,
7%) were the most frequent factors associated with frst
detec ted atrial fbrillation.

124. Cuantificarea disfunctiei
cardiovasculare si
aterosclerozei precoce in
poliartrita reumatoida
Stefania Magda, Andrea Ciobanu, Claudiu Stoicescu,
Gabriela Udrea, Mircea Cinteza, Dragos Vinereanu
Spitalul Universitar de Urgenta, Bucuresti
Context: Poliartrita reumatoida (PAR) induce frecvent
complicatii cardiovasculare, determinate probabil de
fenomenele de ateroscleroza precoce in context de
infamatie sistemica cronica. Tratamentul antiinfamator
ar putea reduce aceste complicatii, insa prevalenta bolii
cardiovasculare la pacientii cu PAR corect tratata este
insufcient cunoscuta. Studiul nostru are drept obiectiv
principal evaluarea prevalentei afectarii cardiace si
vasculare subclinice, precum si a mecansimelo r inter-
actiunii ventriculo-arteriale la pacientii cu PAR corect
tratata.
Metoda: Au fost evaluati prospectiv 20 de subiecti (55
6.8 ani, 2 barbati), 13 pacienti cu PAR seropozitiva tratata,
asimptomatici din punct de vedere cardiovascular, si 7
subiecti normali. Durata medie a PAR: 12.7 9 ani. Toti
pacientii cu PAR se afau in tratament cronic ( 3.9 2.4
ani) cu Metotrexat Sulfasalazina sau corticosteroizi.
S-au determinat parametrii de functie cardiaca prin
eco

cardiografe standard si tissue Doppler, GIM si
indici de rigiditate arteriala la nivel carotidian prin e-
tracking, wave intensity analysis (ecograf ALOKA
5500 SSD), functia endoteliala prin metoda dilatatiei
mediate de fux la nivelul arterei brahiale drepte (FMD)
si viteza undei pulsului carotido-femurala, prin metoda
Complior.
Suplimentul A, 2008
151
POSTER III
Rezultate: Cele 2 loturi au fost similare ca varsta, sex
si distributie a factorilor de risc clasici. Durata medie
a PAR: 12.7 9 ani. Valoarea medie a VSH in lotul
cu PAR a fost de 41 13.7 iar in lotul de control 22
18.2 (p=ns). Nu s-au inregistrat diferente semnifcative
statistic intre cele 2 loturi pentru functia cardiaca sau
vasculara (tabel 1 si 2). Tabelul 1 Parametrii de functie
sistolica si diastolica Parametru Lot PAR Lot normali
FEVS (%) 59 5 58 3.5 TRIV (msec) 94 8.2 95.1
10.4 Vp (cm/s) 57 21.5 57 9.3 Sm (cm/s) 6.1
1.4 5.3 0.8 E/Em 8.8 2.6 11.1 3.2 E/Vp 1.3 0.8
1.2 0.1 Tabelul 2 Parametrii de rigiditate arteriala,
disfunctie endoteliala si PWV Parametru Lot PAR Lot
normali IMT (mm) 5.8 1.6 7.3 0.9 AC (mm2/kPa)
0.7 0.2 0.9 0.3 Indice de rigiditate 9.7 3 7.4 1.8
Primul peak sistolic 7 2.8 5.6 2.3 FMD (%) 10.7
3.3 10.9 3.4 PWV carotido-femurala (m/s) 9.5 1.8
10.2 1.6
Concluzie: PAR corect tratata, cu infamatie sistemica
controlata, nu determina disfunctie cardiaca si vasculara
subclinica.

The quantification of
cardiovascular disfunction
and early atherosclerosis in
rheumatoid arthritis
Stefania Magda, Andrea Ciobanu, Claudiu Stoicescu,
Gabriela Udrea, Mircea Cinteza, Dragos Vinereanu
University Emergency Hospital Bucharest, Clinical
Hospital Dr. I. Cantacuzino, Bucharest
Context: Rheumatoid arthritis (RA) induces frequently
cardiovascular complications, probably related to early
atherosclerosis determined by chronical systemic infa-
mmation. Antinfammatory treatment might reduce
these complications, but the prevalence of cardio vas-
cular disease in patients with correctly treated RA is
insuf ciently known. Te main purpose of our study is
to determine the prevalence of subclinical cardiac and
vascular disease and to evaluate the mechanisms of ven-
triculo-arterial interaction in patients with correctly
treated RA.
Methods: We evaluated prospectively 20 subjects (55
6.8 yrs, 2 men), 13 patients with seropositive treat-
ed RA, without any cardiovascular symptoms and 7
normal subjects. All patients with RA were chro ni cally
treated with (3.9 2.4 yrs) Methotrexate Sulfa salasine
or corticosteroids. We determined the para meters of
cardiac function through standard and tissue Doppler
echocardiography, IMT and arterial stif ness at the
level of the carotid artery through e-tracking, wave
intensity analysis (ultrasound ma chine ALOKA 5500
SSD), endothelial function through fow mediated
dilation at the level of the right bra chial artery (FMD)
and carotido-femoral pulse wave velocity using the
Complior method.
Results: Te age, sex and classical risk factor distribution
were similar in the 2 subgroups ca varsta, sex si distribu-
tie a factorilor de risc clasici. Mean duration of RA: 12.7
9 yrs. Mean value of ESR in the RA subgroup was 41
13.7 (mm/h) and in the control subgroup 22 18.2
(p=ns). No statistical signifcant diferences were noted
between the 2 subgroups regarding the cardiac and
vascular function. (table 1 and 2). Table 1 Parameters
of systolic and diastolic function Parameter RA group
Control group LVEF (%) 59 5 58 3.5 IVRT (msec)
94 8.2 95.1 10.4 Vp (cm/s) 57 21.5 57 9.3 Sm
(cm/s) 6.1 1.4 5.3 0.8 E/Em 8.8 2.6 11.1 3.2
E/Vp 1.3 0.8 1.2 0.1 Table 2 Parameters of arterial
stifness, endothelial function and PWV Parametru RA
group Control group IMT (mm) 5.8 1.6 7.3 0.9 AC
(mm2/kPa) 0.7 0.2 0.9 0.3 stifness index 9.7 3
7.4 1.8 First systolic peak 7 2.8 5.6 2.3 FMD (%)
10.7 3.3 10.9 3.4 Carotid-femoral PWV (m/s) 9.5
1.8 10.2 1.6
Conclusion: Correctly treated RA, with controlled sys-
te mic infammation doesnt induce subclinical car diac
and vascular disfunction.

125. Influenta varstei si a
sexului in selectarea pacientilor
pentru revascularizare
coronariana interventionala
(PCI) in Romania
Udroiu Cristian, Deleanu Dan, Mot Stefan,
Vinereanu Dragos
Spitalul Universitar de Urgenta Bucuresti, Institutul de
Cardiologie CC Iliescu, Institutul Inimii Cluj Napoca
Argument: Cu mai putin de 500 de angioplastii coro-
nariene percutane (PCI) la un milion de locuitori,
Suplimentul A, 2008
152
Romania este in continuare o tara cu un volum mic
de proceduri interventionale coronariene, raportat
la restul Europei. Aceasta, in conditiile in care morbi-
ditatea cardiovasculara in Romania este una dintre
cele mai mari din Europa, iar selectia pacientilor
pentru PCI a devenit o problema difcila. Plecand de la
raporta rile facute la Registrul European de PCI, unde
Romania ocupa locul trei ca nivel de raportare, am
urmarit criteriile de selectie si performantele tehnice
ale utilizarii PCI in Romania versus Europa.
Metoda: Registrul PCI este un registru populational
prospectiv al Societatii Europene de Cardiologie, parte
a programului Euro Heart Survey, bazat pe rapor tarile
a peste 220 de centre, din peste 30 de tari euro pene.
Raportarea se face sub format electronic stan dard, si
include in prezent peste 24.000 pacienti, realizand o
imagine de ansamblu a cardiologiei interventionale in
Europa.
Rezultate: Analiza statistica a fost efectuata pe 23.765
pacienti, dintre care 2894 (12.17%) au fost raportati din
Romania (1 aprilie 2008). In Romania pacientii tineri
si barbatii au fost mai frecvent selectati pentru PCI.
De asemenea in Romania frecventa factorilor de risc
la pacientii cu PCI este semnifcativ mai ridicata decat
in Europa, iar istoricul de infarct miocardic este mai
frecvent (vezi tabelul). In Romania procedurile elective
sunt mai frecvente (60.8% vs 50.26%), cu rezolvarea
de obicei a unui singur vas (87.04% vs 74.84%), si cu
mai putine stenturi pe procedura. Doar 24.14% din
stenturile utilizate in Romania au fost stenturi active
(39.87% in Europa). Medicatia la externare a fost
optimizata in Romania.
Concluzii: Selectia pacientilor pentru PCI intr-o tara
cu nivel scazut de resurse, se restrange la pacientii tineri
si de sex masculin, la pacientii cu multiplii factori de
risc si cu istoric de boala cardiaca ischemica. Frec venta
urgentelor si a PCI pentru boala coronariana multi-
vas culara este redusa. Pentru cei care benefciaza de o
dila tare coonariana percutana medicatia este optima.
Romania versus Europa VARIABILA ROMANIA
EUROPA P VARSTA MEDIE (ANI) 59.33 64.32 ns
VARSTA >65 ANI (%) 31.62 48.08 <0.05 BARBATI
(%) 77.88 73.74 <0.05 HTA (%) 78.45 69.21 <0.05
FUMATORI (%) 67.86 52.86 <0.05 DISLIPIDEMIE (%)
75.2 61.06 <0.05 ISTORIC IM (%) 46.23 33.76 <0.05

126. Cardiomiopatie dilatativa
la un pacient cu fibrilatie
atriala permanenta si sindrom
de preexcitatie intermitent: re-
versibilitate completa prin ab-
latie cu radiofrecventa si
terapie de resincronizare
Balanescu Serban, Dorobantu Maria
Rezumat: Pacient in varsta de 49 de ani, cunoscut
cu fbrilatie atriala permanenta si boala Basedow, se
prezinta cu fenomene de insufcienta cardiaca clasa IV
NYHA. Examenul fzic indica staza pulmonara, matitate
cardiaca marita, fbrilatie atriala cu ritm rapid (160
bpm), valori tensionale normale. Electrocardiograma
arata fbrilatie atriala cu AV foarte rapida, QRS ingust,
intermitent cu unda delta prezenta. Ecocardiografa
arata dilatare a VS si AS, fractie de ejectie a VS 25%
si prezenta asincroniei inraventriculare (SPWMD 130
ms). Examenul biochimic infrma o disfunctie tiroidiana
iar arterele coronare au fost normale angiografc. Stu-
diul electrofziologic arata o cale accesorie medio sep-
tala dreapt by-stander cu conducere inter mitenta,
fara implicare intr-o aritmie clinica. Se con si dera ca
impli cate in patogenia cardiomiopatiei fbri latia atriala
cu AV rapida necontrolabila terapeutic si prezenta asin-
croniei intraventriculare posibil cau zata de activarea
VS i prin calea accesorie. Se decide implan tarea de
cardiostimulator biventricular i abla ia cu radio-
frecven a cii accesorii i nodului atrio- ven tricular.
La o luna postimplant pacientul se prezinta asimpto-
matic, iar repetarea ecocardiografei arata redu cerea
dimensiunilor VS si FE 47%.

Suplimentul A, 2008
158
POSTER III
Dilative cardiomyopathy in a
patient with permanent atrial
fibrillation and intermittent pre
excitation syndrome: complete
reversal with radiofrequency
ablation and resynchronization
therapy
Balanescu Serban, Dorobantu Maria
49 years patient, with a known history of permanent
atrial fbrillation and Basedow disease, was presented
in class IV NYHA heart failure. Physical exam found
pulmonary rales, enlarged cardiac area, atrial fbrillation
with a rapid ventricular response (160 bpm), and
normal blood pressure. ECG showed rapidly conducted
atrial fbrillation with a narrow QRS and intermittent
delta wave. Echocardiography showed dilated LV and
LA, LV ejection fraction 25% and the presence of intra-
ventricular asynchrony (SPWMD of 130 ms). Blood tests
have infrmed dysthyroidy and the coronary arteries
were normal on angiography. Electrophysiological
study showed a by-stander midseptal right sided acce-
ssory pathway, with no involvement in a clinical arrhy-
thmia. Te etiology of the cardiomyopathy were consi-
dered to be rapidly conducted atrial fbrillation and
LV intraventricular asynchrony possibly due to LV
acti vation via the accessory pathway. A biventricular
pace maker implantation was decided followed by
AV node and accessory pathway radiofrequency abla-
tion. A month later the patient was asymptomatic and
echocardiography has shown reduction of LV dimen-
sion and an ejection fraction of 47%.

127. Depasirea compensarii
functiei radiale miocardice la
pacientii diabetici tip II fara
disfunctie cardiaca clinica
studiu de urmarire pe 5 ani
Vlad Vintila, Claudiu Stoicescu, Alan Fraser,
Dragos Vinereanu
Spitalul Universitar de Urgenta, Bucuresti
Studii ecocardiografce efectuate la pacienti diabetici
tip 2 fara boala cardiovasculara manifesta au sugerat ca
dis functia longitudinala miocardica este compensata
printr-o crestere a functiei contractile radiale, cu
mentinerea fractiei de ejectie globale a VS. Evolutia in
timp a acestei compensari nu a fost evaluata.
Metoda: 27 pacienti cu DZ tip II (18 B si 9 F, varsta
medie 638 ani) au fost reanalizati dupa 56.50.7 luni
dupa evaluarea initiala, cand au fost comparati cu un lot
de control similar ca varsta si sex. Functia ventriculara
longitudinala si radiala au fost evaluate cu ajutorul
tehnicilor de Doppler tisular. Modifcarile au fost com -
parate cu proflul de risc, fractia de ejectie a fost ma-
su rata prin tehnica Simpson modifcata. Acceleratia
izo vo lumetrica a fost masurata ca un indice de functie
con tractila.
Rezultate: Atat functia sistolica longitudinala (medie
a 4 segmente bazale, imagini apicale), cat si cea radiala
au scazut cu 13% la 5.61.3 cm/s (p<0.001) si respectiv
4.91.4 cm/s (p<0.025). Functia sistolica radiala, initial
crescuta, a inregistrat valori similare fata de valorile de
control obtinute la evaluarea initiala. Acceleratia lon-
gitudinala izovolumetrica (segmente bazale) a scazut
cu 37% la 0.980.51 m/s2 (p<0.001), in timp ce acce lera-
tia radiala (segment bazal posterior) a scazut cu 96%
la 1.040.53 m/s
2
(p<0.001).Fractia de ejectie me die in
lotul studiat a scazut cu 9% (p<0.01). Functia dias tolica
longitudinala masurata prin velocitatea precoce e a
scazut cu 20% to -4.81.2 cm/s (p<0.001), dar func tia
ra diala a ramas neschimbata (-6.12.1 cm/s). Si alti para-
metri de functie diastolica longitudinala au demons trat
agravare, precum cresterea presiunii de umplere a VS
(E/e) (+ 26%, p<0.05), scadere a vitezei de propagare a
fuxului transmitral (- 26%, p <0.001). Evolutia functiei
sistolice longitudinale a fost prezisa de inaltime, durata
diabetului, presiunea pulsului, creatinina si colesterolul
total (r2=0.56, F=4.75, p<0.01), in timp ce functia
sistolica radiala a foat prezisa doar de valoarea sa initiala
Suplimentul A, 2008
151
(r2=0.39, F=8.811, p<0.01)( regresie liniara treptata).
Functia contractila longitudinala (IVA) a fost prezisa
de valoarea sa initiala, varsta, presiu nea pulsului, coles-
terolul total, HbA1c si tratamentul cu insulina age
(r2=0.71, F=5.34, p<0.001; regresie liniara inversa), in
timp ce functia contractila radiala a fost prezisa doar
de durata diabetului (r2=0.25, F=5.03, p<0.05). Pentru
func tia diastolica longitudinala nu s-a identifcat nici
un model predictiv, iar functia diastolica radiala a
fost prezisa de valoarea sa initiala (r2=0.39, F=8.81, p
<0.01).
Concluzii: Dupa 5 ani pacientii diabetici tip II cu
disfunctie cardiaca subclinica au pierdut compensarea
sistolica radiala initiala. Velocitatile diastolice radiale
nu au scazut, dar alti parametri ai functiei diastolice au
demonstrat scaderea progresiva a acesteia. Schimbarile
au demonstrat progresia catre insufcienta cardiaca cu
fractie de ejectie prezervata.

128. Evaluarea ecocardiografica
3D a remodelarii ventriculare,
sincronismului de contractie si
hemodinamicii fluxului
intracavitar in cardiomiopatia
dilatativa
Benedek Theodora, Sarbu Alexandru,
Struczuy Melinda, Madaras Szilrd, Chitu Monica,
Benedek Imre
Universitatea de Medicin i Farmacie Trgu Mure-
Clinica de Cardiologie
Introducere: Ecocardiografa 3D, bazata pe afsarea
3D in timp real si codifcata color, poate reprezenta o
alternativa pentru evaluarea geometriei VS si sincro-
nismului de contractie in vederea unei analize complexe
a remodelarii ventriculare in cardiomiopatia dilatativa
Material si metoda: Gr.1: 22 pacienti cu CMD idio-
patica; gr.2: 20 pacienti-grup control. Utilizand
sofware-ul QLab Philips Sonos 7.500, au fost efectuate
analiza 3D a geometriei si cineticii ventriculare si a fost
evaluat gradul de sincronism al contractiei. Au fost
determinate curbele volumetrice ale fecarui segment
in timpul ciclului cardiac precum si hartile polare ale
timpului scurs de la debutul pana la atingerea contractiei
maxime. Hemodinamica intraventriculara a fost eva-
luata analizand fuxurile Doppler la 3 nivele (bazal,
median si apical ) de-a lungul a 3 axe longitudinale. Au
fost determinati timpii de accelerare precum si timpii
de decelerare.
Rezultate: In gr.1 analiza computerizata 3D a geometriei
VS a evidentiat o dilatare a VS mai pronuntata cu 25%
in regiunea apicala decat in restul cavitatii VS. Trombul
apical a fost prezent la 87% din pacientii cu CMD. 8
pacienti au prezentat dissincronism de contractie
intre sept si peretele lateral. Curbele volumetrice de
con tractie a segmentelor apicale au fost cu 67% mai
apla tizate comparativ cu grupul II; in timp ce pentru
segmentele mijlocii procentul scade la 37% (p<0.001).
Analiza Doppler a fuxurilor a evidentiat o reducere
progesiva a velocitatilor de la baza spre apex cu o
medie de 0,48 la pacientii cu CMD comparativ cu 25%
in grupul control (p=0,001.) In gr.1, aceasta reducere a
fost de 2.2 ori mai pronuntata in jumatatea apicala this
a VS (0.33 m/sec) decat in cea bazala (0.15 m/sec). In
gr.2 reducerea a fost distribuita uniform -0.13 m/sec vs
0.12 m/sec, iar diferenta dintre decelerarea fuxului in
zona apicala si cea bazala a VS a fost 0.25 m/sec in gr.1
coparativ cu -0.01 in gr.2 (p=0,002).
Concluzii: Ecocardiografa 3D poate reprezenta o me-
to da alternativa pentru evaluarea modifcarilor arhi-
tectonice ale VS in cursul procesului de remodelare
in CMD, evidentiind modifcari mai exprimate in
zona apicala. Analiza vitezelor de fux prin doppler evi-
dentiaza o decelerare mai pronuntata a fuxului in zona
apicala cauzata probabil de modifcarile geometriei
VS care sunt mai pronuntate la apex, reprezentand o
posibila cauza pentru localizarea apicala a trombilor in
apex la pacientii cu CMD.

Suplimentul A, 2008
155
POSTER III
Computerized 3D
echocardiographic evaluation
of left ventricular remodelling,
contraction synchronism and
intracavitary flow
haemodynamics in dilated
cardiomyopathy
Benedek Theodora, Sarbu Alexandru, Struczuy Me-
linda, Madaras Szilrd, Chitu Monica, Benedek Imre
University of Medicine and Pharmacy-Departament of
Cardiology
Introduction: Computerized 3D echocardiography
could represent an alternative to evaluate LV geometry
and contraction synchronism for a complex analysis
of ven tricular remodelling in dilated cardiomyopathy,
based on a live 3D colour-coded display.
Materials and methods: Gr.1: 22 patients with idio-
pathic DCM, gr.2: 20 patients control group. Using
QLab sofware Philips Sonos 7.500, computerized 3D
echo cardiography analysis of ventricular geometry,
con tractility and contrraction synchronicity were per-
formed. Volumetric curve of each myocardial seg ment
during the cardiac cycle and polar map of time delay
from onset till the maximum contraction were obtained.
Intracavitar haemodynamics was evaluated using
Do ppler mapping of fow velocities at 3 levels (basal,
median and apical) along 3 longitudinal axes, and fow
acceleration and decelerations were calculated.
Results: In gr.1 3D computherised analysis of LV geo-
metry revealed dilatation of LV cavity with 25% more
pronounced in LV apical region than in the rest of
the LV cavity. Apical thrombus was present in 87%
pa tients with DCM. Eight patients had contractility
dissynchronism between lateral and septal wall. Te
volumetric curve of contraction for apical segments was
67% more applatized in gr.1 compared with gr.2, while
only 37% for medioventricular segments (p<0.001).
Doppler mapping of LV fow velocities showed a
gradual decrease of fow velocities from basis to apex
with 0.48 average in DCM patients compared with only
25% in control group (p=0.001). In gr.1, this decrease
was 2.2 times more pronounced in the apical half of the
LV (0.33 m/sec decrease) than in the basal half, (0.15
m/sec decrease). In gr.2 this decrease was uniformly
distributed -0.13 m/sec vs 0.12 m/sec. Diference
between fow deceleration in apical and basal half of
the LV was 0.25 m/sec in gr.1 compared with -0.01 in
gr.2 (p=0,002).
Conclusions: Computerized 3D echocardiography
could represent an alternative method to evaluate LV
archi tectonic modifcations during the remodeling pro-
cess in DCM. Tis method identifed modifcations of
LV architectonics more expressed at the apex. Doppler
mapping of LV fow velocity showed a more pro noun-
ced decrease of LV fow in the apical region, pro bably
caused by modifcations of LV geometry more pro-
nounced in the apical half, representing a possible cause
for apical localization of LV thrombus in DCM.

129. Metode inovative de
tratament interventional: laser,
stentare, transplant de celule
stem si efectul acestora in
tratamentul bolilor aortoiliace
Monica Chitu, Melinda Struczuy, Theodora Benedek,
Istvn Kovcs, Alexandru Sarbu, Istvan Benedek, Imre
Benedek
Clinica de Cardiologie Trgu Mure
Scop: Procedurile intervenionale dobndesc un rol
din ce n ce mai important n tratamentul bolilor arte-
riale obstructive periferice (BAOP). Asocierea angio-
plastiei cu balon (PTA) cu angioplastia laser i cu
implan tarea de stenturi intraarteriale, duce la rezultate
net favorabile, putnd reprezenta o alternativ a trata-
mentului chirurgical la aceti bolnavi.
Material i metod: Au fost efectuate 116 inter venii
la nivel aorto-iliac la 116 pacieni. Leziunile au fost
ncadrate n funcie de clasifcarea TASC astfel: TASC D
n 29.41% cazuri, TASC C n 20.59% cazuri, TASC B n
29.41% cazuri i TASC A n 20.59% cazuri. Angiopastia
laser a fost aso ciat la 14 intervenii (10 la nivelul axului
iliac i 4 cazuri de angioplastie iliac). 88 de stenturi au
fost implantate, iar n 2 cazuri s-a realizat transplant de
celule stem.
Rezultate: Succesul tehnic nregistrat a fost de
98.44%(127 leziuni) si a fost defnit pentru PTA si
stentare ca refa cerea permeabilitii arteriale in absenta
diseciei inti male; iar pentru laser a fost depirea
Suplimentul A, 2008
156
leziunii si vapo rizarea materialului trombotic cu crearea
unui tunel de cel puin 20%. Utilizarea angioplastiei
laser a crescut succesul tehnic de la 95.34% la 98,44%
(p=0.15). Rata permeabilitii primare a fost de 96.61%
la 6 luni, 93.06% la 1 an, 89.98% la 18 luni i 88.4% la 2
ani, Rata permeabilitii secundare a fost de 98.04%, pe
ntreaga perioada de urmrire. Utlizarea angioplastiei
laser in cazurile TASC D a condus la o rata mai mare
de succes tehnic O analiza separata pentru pacienii din
grupul TASC D a evideniat ca permeabilitatea primara
a fost superioara in grupul cu laser dect in cel doar cu
implantare de stent dei cele in care s-a folosit laserul
erau leziuni mai complexe (permeabilitate primara la
24 luni fara laser 56,82%, laser 77,14%. p=0.41). Analiza
factorilor care infueneaz permeabilitatea pe termen
lung arata importanta clasei TASC si a statusului clinic,
inrgistrandu-se rate mai bune de permeabilitate primara
la pacienii cu TASC A si B comparativ cu cei cu TASC
C si D (permeabilitatea primara la 24 luni: TASC AB
97.14%, TASC CD 80.73%, p=0.051) Ambele cazuri cu
trans plant de celule stem au evideniat mbuntiri ale
statusului clinic.
Concluzii: Angioplastia axului iliac este sigur i ef-
cien t n tratamentul stenozelor i ocluziilor la acest
nivel. Extinderea indicaiilor angioplastiei iliace i la
ca zuri mai complexe (TASC D i C), duce la rezultate
bune privind permeabilitatea, rata de supravieuire i
pstrarea viabilitii membrului pe perioada de urm-
rire.

Effect of complex intervention-
al treatment - laser, stenting
and stem cells - on short and
long term patency in aortoiliac
diseases
Monica Chitu, Melinda Struczuy, Theodora Benedek,
Istvan Kovacs, Alexandru Sarbu, Istvan Benedek, Imre
Benedek
Cardiology Targu Mures
In the last years the interventional procedures have
become one of the most important therapeutic choice
in the management of Peripheral Arterial Obstructive
Diseases (PAOD). Association between these procedures
(Percutaneous transluminal angioplasty, stenting and
excimer laser) could represent an alternative for surgery
in our experience.
Material and method: were performed in 116 patients
with iliac or aortoiliac obstructive diseases. Lesion type
was TASC D in 29.41% cases, TASC C in 20.59% cases,
TASC B in 29.41% cases and TASC A in 20.59% cases.
Laser angioplasty was associated in 14 cases, 88 iliac
stents were implanted and in 2 cases we performed
STEM cell implantation.
Results: Technical success was achieved in 127 lesions
(98.44% of lesions), defned for PTA and stenting as
restored arterial patency with residual stenosis <30%,
in absence of intimal dissection, and for laser techni cal
success was defned as crossing the lesion and debul-
king the atherothrombotic material with at least 20%
channel created. Use of laser angioplasty in cases of
technical failure increased the technical success from
95.34% up to 98,44% (p=0.15). We recorded a global
primary patency rate of 96.91% at 6 months, 93.06%
at 1 year, 89.98% at 18 months and 88.34% at 2 years,
maintained to the 5th year of follow-up. Global Primary
assisted patency rates and secondary patency rates were
98.04% during all the follow-up period. Addition of
laser therapy in dif cult TASC D cases led to increase
of technical success. A separate analysis of only TASC
D cases note that in time, primary patency was superior
for the laser group than for the stent group, eventhough
laser cases were the most dif cult ones (primary patency
at 24 months: stent 56,82%, laser 77,14%. p=0.41). We
analysed the infuence of diferent factors on long term
patency rates, like TASC class and clinical status. Based
on TASC classifcation, we recorded superior patency
rates for TASC A and B compared with TASC C and D
class (primary patency at 24 months: TASC AB 97.14%,
TASC CD 80.73%, p=0.051). Both cases with stem
cell transplantation showed improvmenet of clinical
status.
Conclusions: Iliac angioplasty appears to be safe and
efective in iliac stenoses or occlusions. We extended
indications for iliac interventions to complex cases
(TASC C and TASC D) showing good patency and
survival rates on the follow-up period.

Suplimentul A, 2008
15I
POSTER III
130. Controlul tensiunii
arteriale la pacienii cu
insuficien cardiac
congestiv i diabet zaharat
Dana Mincu, Ctlina Clin, Valentin Chioncel,
Crina Sinescu
Obiectiv: Scopul acestui studiu a fost s evalueze con-
trolul tensiunii arteriale (TA) la pacienii cu insufcien
cardiac congestiv (ICC).
Metod: Am examinat 315 pacieni care au fost grupai
n funcie de istoricul de diabet zaharat (DZ): pacieni
nondiabetici i pacieni diabetici.
Rezultate: Am obinut dou grupuri de pacieni: 54%
nondiabetici i 46% diabetici. Istoricul pozitiv de HTA
a fost regsit la 34% dintre pacienii nondiabetici i la
40% dintre diabetici. Valoarea medie a TA a fost de 131
28 / 79 14 mmHg la nediabetici i de 134 26 / 70
11 mmHg la diabetici. Valoarea target a TA de control
(<140/90 mmHg) nu a fost nregistrat la 43% dintre
pacienii nondiabetici, iar cea de <130/85 mmHg la 66%
dintre pacienii diabetici (p <0,001). Pacienii au fost
tratai cu IECA (72%), betablocante (40%), diuretice
(75%), blocante de calciu (7.5%) i inhibitor de recep-
tor AT1 (3.2%) n ambele grupuri (p = ns). Combinaie
de antihipertensive a fost utilizat la 50% dintre ne-
diabetici i la 43% dintre diabetici, iar combinaie de
minimum trei medicamente la 34% dintre diabetici i
respectiv 30% dintre nondiabetici (p = ns).
Concluzii: Controlul TA la pacienii cu ICC nu a fost
satisfctor n peste 40% din cazurile de nondiabetici,
respectiv 60% din cele de diabetici. Aceste concluzii
indic un potenial ridicat al mbuntirii tratamen-
tul i prognosticul valorilor ridicate ale TA n special la
pacienii cu ICC i DZ.

Control of blood pressure in
patients with congestive heart
failure and diabetes mellitus
Dana Mincu, Ctlina Clin, Valentin Chioncel,
Crina Sinescu
Aim: Te aim of this study was to evaluate the level
of blood pressure (BP) control among congestive heart
failure (CHF) patients (pts).
Methods: We examinated 315 pts. Tey were divided
according to there history of diabetes mellitus (DM):
nonDM pts and DM pts.
Results: We found 54% nonDM pts and 46% DM pts.
Positive history of arterial hypertension (AH) was at
34% of nonDM pts and 40 % DM pts. Te mean value
of BP was 131 28/ 79 14 mmHg in nonDM pts
and 134 26/ 70 11 mmHg in DM pts. Target BP
control (<140/90 mmHg) were not registered in 43% of
nonDM pts and <130/85 mmHg in 66% of DM pts (p
<0,001). Te pts were treated by ACE inhibitors (72%),
beta blockers (40%), diuretics (75%), calcium blockers
(7.5%) and AT1 receptor inhibitors (3.2%) in the both
groups. Te combination of two antihypertensive drugs
was used by 50% of nonDM pts and by 43% of DM
pts; combination of three drugs by 34% and by 30%
respectively.
Conclusion: Control of BP in pts with CHF was not
satisfactory in more than 40% in nonDM pts and in
more than 60% in DM pts. Tere is a big potential to
improve the treatment and prognosis of high BP in pts
with CHF and DM.

131. Prognosticul pe termen
lung la pacienii obezi cu
insuficienta cardiaca
Stoica E, Chioncel O, Carp A, Tepes Piser I,
Stanescu Cioranu R, Kulcsar I, Saraolu A., Macarie C
Institutul de Boli Cardiovasculare Prof. Dr. CC.
Iliescu
Obiectiv: Evaluarea impactului pe termen lung al
obezitii asupra evoluiei pacienilor cu insufcienta
cardiaca.
Suplimentul A, 2008
158
Material si metode: Au fost inclui 280 pacieni internai
in anul 2004 cu diagnosticul de insufcienta cardiaca.
Urmrirea s-a efectuat timp de 4 ani (48 12 luni).
Au fost analizai factori clinici (etiologia insufcientei
cardiace, clasa funcionala, asocierea cu ali factori
de risc. IMC. talia abdominala), electrocardiografei
(pre zenta H VS, prezenta tulburrilor de ritm si de
con ducere), ecocardiografci (FE, funcia diastolica,
pre zenta HVS, PAP sistolica) si de laborator (Hb. crea-
tini na, acid uric, leucocite). Evenimentele urmrite au
fost decesele totale, decesele de cauza cardiovasculara,
reinter narile pentru agravarea insufcientei cardiace; de
ase menea s-au urmrit si interveniile efectuate pentru
revas cula rizare miocardica si cardiostimulare.
Rezultate: Dintre pacienii analizai au fost 160 pacieni
cu IMC >25 kg/m
2
(57,1%). In timpul urmririi pa-
cienilor s-au produs 91 decese (32,5%) si 80 decese car-
diovasculare (28,6%), iar reintemari pentru agravarea
insufcientei cardiace s-au efectuat la 159 pacieni
(56,8%); de asemenea revascularizari miocardice s-au
efectuat la 34 pacieni (12,1%) si cardiostimulare per-
manenta la 40 pacieni (14,3%). La pacienii obezi s-
a observat asocierea intr-o proporie semnifcativ mai
mare a celorlati factori de risc (HTA, dislipidemie,
diabet zaharat), iar etiologia insufcientei cardiace a
fost intr-o proporie mai marc cea hipertensiva (62,5%
din pacienii cu acest tip de insufcienta cardiaca au fost
obezi). Dintre parametrii studiai obezitatea s-a asociat
mai frecvent doar cu hipertrofa ventriculara stnga
apre ciata ecocardiografc - RR - 1,3 (l,l-l,59)(p -0,002).
La pacienii obezi IC a fost intr-o proporie mai mare
cu FE prezervat (FE - 39,489,89% vs 33,209,3%).
In ceea ce privete prognosticul, la pacienii obezi s-
au produs mai puine decese de orice cauza (35% vs
42,5% dintre pacienii cu IMC < 25 kg/m
2
) (p - 0,002),
cat si de cauza cardiovasculara (22,5% vs 36,67%). IMC
>25 kg/m avnd chiar rol protector asupra dece sului
cardio vascular - RR -0,8 f (0.69 - 0,95) ( p - 0,009), iar
decompensarile cardiace au fost prezente in aceeai
proporie. Pacienii cu sindrom metabolic au avut
aceleai caracteristici - predominenta IC cu FE prezer-
vate, etiologie hipertensiva si pronostic mai bun.
Concluzii: Dintre pacienii internai pentru insufcienta
cardiaca o marc proporie sunt obezi. Insufcienta car-
diaca la pacienii obezi si la cei cu sindrom metabolic
este predominent cu fracie de ejectie prezervat.
Prognosticul pe termen lung in insufcienta cardiaca
(decese, decese cardiovasculare) este mai bun la pacien-
ii obezi (IMC >25 Kg/m
2
) fata de cei cu IMC <25 kg/
m
2
.

Long term prognosis at heart
failure obese patients
Stoica E, Chioncel O, Carp A, Tepes Piser I,
Stanescu Cioranu R, Kulcsar I, Saraolu A, Macarie C
Institutul de Boli Cardiovasculare Prof. Dr. C.C.
Iliescu
Objective: Evaluation of long term impact of obesity
on heart failure patients evolution.
Methods: We included in this study 280 patients
admitted for heart failure in 2004. Follow-up duration
was of 4 years (4812 month).We analyzed clinical fac-
tors (heart failure cause, NYHA functional class, pre sen-
ce of cardiovascular risk factors, BMI, abdo minal waist),
ECG characteristics (LVH, rhythm distur ban ces), echo-
cardiographic features (LVEF, dias tolic function, LVH,
systolic PAP) and lab test results (haemoglobin, serum
creatinine, uric acid, WBC counts). We analyzed the
following events: total number of deaths, cardivascular
deaths, admissions for heart failure aggravation; as well
myocardial revascularization and pacemaker implan-
tations.
Results: 160 of these patients had a BMI above 25 kg/
m
2
(57,1%). Tere were 91 deaths (32,5%), 80 cardio vas-
cular deaths (28,6%) and admissions for heart failure
aggra vation at 159 patients (56,8%); myocardial revas-
cu larization at 34 patients (12,1%) and pacemaker
implan tation at 40 patients (14,3%). Other risk factors
(hyper tension, dyslipidemia, diabetes mellitus) are
asso ciated in a greater proportion at obese patients.
Heart failure cause was more frequent hypertension
(62,5% of the patients with this heart failure etiology
were obese). Obesity was associated only with echocar-
diographic LVH - odds ratio of 1,3 (1,1-1,59) (p -
0,002). At obese patients type of heart failure wass espe-
cially with preserved LVEF ( LVEF of 39,489,89% vs
33,209,3% at patients with BMI <25 kg/ m
2
). Tere
were fewer all cause death (35% vs 42,5%) (p - 0,002)
and cardiovascular death (22,5 vs 36,7%)(p-0,009) at
the patients with BMI above 25 kg/ m
2
- RR of cardio-
vas cular death - 0,81 (0,69-0,95); admissions for heart
failure aggravation was at the same proportion. Tere
were the same characteristics at the patients with meta-
bolic syndrome - greater proportion of preserved LVEF
heart failure, of hypertensive cause of heart failure and
a better prognosis.
Conclusions: A great proportion of patients admitted
with heart failure are obese. Heart failure at obese pa-
tients and at patients with metabolic syndrome is main-
ly with preserved LVEF.
Suplimentul A, 2008
159
POSTER III
Heart failure long term prognosis is better at the patients
at the patients with BMI above 25 kg/m
2
.

132. Statinele reduc nivelul
hidroperoxizilor lipidici
circulani i acumularea
LDLoxi n celulele endoteliale
Victoria Ivanov
1
, I. Popovici, V. Cobe, L. Ciobanu,
S. Costin
2
, M. Popovici
1
1
IMSP Institutul de Cardiologie, Chiinu, (R. Moldova)
2
Departamentul de Biologie Molecular i Structural al
Institutului Inimii i Plmnului Max-Planck Insti-
tute, Bad Nauheim (Germania)
Modifcarea oxidativ a lipidelor circulante se implic
n disfuncia endotelial cu apariia ulterioar a atero-
sclerozei. Hidroperoxizii lipidici (HPL), produsul pri-
mar al peroxidrii acizilor grai, i dialdehida malo nic
(DAM), produsul secundar al acestui proces, sunt bio-
markerii serici ai oxidrii. Ptrunderea i acumularea
LDL oxidat (LDL oxi) n spaiul subendotelial activeaz
procesele de infamaie i disfuncia endotelial care
pre cede iniierea procesului ateromatos Statinele po-
sed efecte endotelio-protective, posibil mediate de pro-
prietile lor antioxidante.
Obiectiv: Determinarea efectelor tratamentului cu
sta tine asupra biomarkerilor serici ai oxidrii HPL i
DAM, ct i asupra coninutului de LDLoxi intracelular
n cultur.
Material i metode: n studiu au fost inclui 96 de
pacieni (63 brbai i 33 femei) cu vrste cuprinse ntre
42 i 74 ani (media 57,01,4), cu hipercolesterolemie
primar i risc cardiovascular foarte nalt, nalt i
moderat, crora timp de 12 luni li s-a administrat
Pravastatina n doz standard 40mg/zi. Iniial, apoi
la 6 i 12 luni de tratament acestora li s-au determinat
markerii serici al oxidrii: HPL timpurii, intermediari i
tardivi, precum i DAM prin spectrofotometrii, uznd
reactivele frmei Dia Sys Diagnostics Systems GmbH
(Germania).
Cercetrile in vitro s-au efectuat asupra celulelor
endoteliale, apreciind gradul asimilrii LDL coleste-
rolului peroxidat n acestea dup incubarea culturii de
celule endoteliale cu peroxid de hidrogen (H2O2) n
concentraia de 0,1 mmol i cu LDL colesterol conjugat
direct cu fuorocrom rou n doza de 0,01 mg/nl mediu
de cultur. Culturile erau a f fxate i cercetate la
micro scopul cu laser. La fel s-a apreciat i asimilarea
lipo proteinelor peroxidate ntr-o cultur similar, n
care se suplimenta Fluvastatin, n dozele de 4 i 40 mg
comparaia trasndu-se cu celulele din cultura de con-
trol.
n rezultatul tratamentului cu Pravastatin s-a fcut
observat reducerea treptat a concentraiei tuturor ti-
pu rilor de HPL. Astfel, dac iniial HPL timpurii deter-
minate n plasm erau de de 0,960,04 un/ml, n a 6-a
lun au cobort la 0,900,03 (p<0,05), iar n a 12-a lun
de medicaie pn la 0,690,06 u/l (p<0,01), diferenele
cu iniialul constituind 28,1%. HPL intermediare s-au
redus de la 0,55 0,05 iniial la 0,440,05 u/l (p<0,05)
ctre a 12 lun de tratament, diminuarea constituind
20%. HPL tardive au descrescut de la 0,240,02 pn
la 0,160,02 u/l (p<0,01) spre sfritul tratamentului,
ceea ce constituie o scdere fa de iniial cu 33,3%.
Sub tratamentul cu statine se observ i o tendin de
descretere a concentraiei DAM din plasm, dar aceas-
ta ar f statistic nesemnifcativ.
Datele investigaiei in vitro au constatat o acumulare
de mai mult de 96% a LDLox n celulele endoteliale
tratate cu H
2
O
2
comparativ cu celulele din cultura de
control. Intr-o cultur similar n care s-a adugat Flu-
vastatina n doza de 4mg s-a redus esenial la 75,723,5
(p<0,01) coninutul de LDLox intracelular fa de
146,122,3 n cultura celulelor endoteliale expuse aciu-
nii H
2
O
2
. Doza de 40mg de Fluvastatin a redus can-
titatea de LDLoxi pn la la 60,910,7 (p<0,01), ceea
ce constituie o descretere cu 58,3% (p<0,01) fa de
celu lele expuse H
2
O
2
.
Concluzie: Prava- i Fluvastatina realizeaz efecte
anti oxi dative marcate ce se manifest prin diminuarea
pro gre siv a HPL pe tot parcursul administrrii in vivo,
pre cum i inhibarea acumulrii de LDLoxi n celulele
endoteliale in vitro.

Suplimentul A, 2008
160
Statins reduce the levels of
circulations lipid
hydroperoxides and
accumulation of oxidized LDL
in endothelial cells
Victoria Ivanov
1
, I. Popovici, V. Cobe, L. Ciobanu,
S. Costin
2
, M. Popovici
1
1
IMSP Institutul de Cardiologie, Chiinu, (R. Moldova)
2
Departamentul de Biologie Molecular i Structural al
Institutului Inimii i Plmnului Max-Planck Insti-
tute, Bad Nauheim (Germania)
Oxidative modifcation of circulating lipids contributes
to endothelial dysfunction, which are hallmark featu-
res of atherosclerosis. Lipid hydroperoxides (LH) are a
primary product of fatty acid peroxidation, and malo-
n dialdehyde (MDA) which is more advanced product
of this process, are a serum biomarker of oxidation.
Penetration and accumulation of oxidized LDL
(LDLox) in subendothelial layer activates infammation
and endothelial dysfunction with ulterior development
of atherosclerosis. Statins have endothelio-protective
efects, possible mediated by antioxidants proprieties
of these drugs.
Te aim of this study was evaluation of efects of treat-
ment with statins on serum biomarkers of oxidation,
LH and MDA, and on the rate of intracellular LDLox
accumulation in the endothelial cells (EC) culture.
Methods: Tis study focused on the analysis of 96 pa-
tients 63 men and 33 women 42 to 74 years of age
(mean age was 57,01,4 years) with primary hyper-
cho lesterolemia and considerable cardiovascular risk,
which administrated for 12 month 40mg/die of Pravas-
tatin. We evaluated LH levels in serum samples collec-
ted from patients at baseline and at the 6 and12-month
period. Te levels of LH and MDA (measured as thio-
barbituric acid reactive substances) were measu red
spectrophotometrically with reactives Dia Sys Diag-
nostics Systems GmbH (Germany).
In vitro investigation was efectuated on culture
of EC with determination of levels of assimilation of
LDLox afer incubation of the culture with H2O2 in
con centration of 0,1 mmol/l and with conjugated with
fuo rocrom red LDL cholesterol (0,01 mg/nl) in cul ture,
with ulterior fxation and laser microscopy. Te similar
culture was supplemented with 4 and 40mg of Fluvas-
tatin and compared with EC of the control culture.
Results: Pravastatin progressively reduced the con-
centrations of all types of LP. Early LP was initially
0,960,04 un/ml an 6 month 0,900,03 (p<0,05), at
12 month 0,690,06 u/l (p<0,01), diference of initial
28,1%. Intermediate LP was reduced from 0,55 0,05
initial at 0,440,05 u/l (p<0,05) at the end of the study,
that mean 20%. Late LP diminution with 33%, baseline
0,240,02 end of treatment 0,160,02 u/l (p<0,01). We
observed a tendency to decrease of concentration of
MDA, but statistic non signifcantly.
Te obtained in vitro data showed an accumulation of
more than 96% of LDLox in EC incubated with H
2
O
2
in
comparison with control EC. In similar culture treated
with 4 mg of Fluvastatin we observed an essential redu-
cing 75,723,5 (p<0,01) levels of intracellular LDLox
vs 146,122,3 culture exposed on H
2
O
2
. 40mg of Fluvas-
tatin reduced quantity of LDLox at 60,910,7 (p<0,01),
that is a reduction of 58,3% (p<0,01) vs EC exposed
H
2
O
2
.
Conclusion: Prava- and Fluvastatin realized an impor-
tant antioxidative efects, manifested by progressive
reducing of LP in vivo and inhibition of accumulation
LDLox in EC in vitro.

133. Caractere clinice,
demografice si de tratament
ale pacientilor cu sindroame
coronariene acute-studiu
prospectiv
Dr Nadia Necula, Dr O. Chioncel , Dr A Carp, Dr
Rodica Stanescu, Dr Ileana Tepes, Dr Iulia Kulcser, Dr
E Stoica, Dr L.Zarma, Dr D Deleanu, Dr M. Postu, Dr
Platon, Dr A. Bucsa, Prof Dr Cezar Macarie
Bolile cardiovasculare reprezint prima cauz de mor-
talitate pe plan mondial, find raspunztoare de 1/3
din totalul deceselor. Situaia este mai alarmant cu
ct vrsta de apariie a acestor evenimente este din
ce in ce mai mic. Pacienii cu sindrom coronarian
acut prezint risc crescut imediat i pe termen lung de
infarct miocardic recurent i deces de cauz cardiac.
Obiectivul studiului a fost identifcarea factorilor de
risc care pot f responsabili de incidena crescut a mor-
biditii i mortalitii sindroamelor coronariene acute,
precum i evaluarea caracteristicilor clinice, paraclinice
i terapeutice a acestor pacieni.
Suplimentul A, 2008
161
POSTER III
Material si metoda: Am efectuat un studiu prospectiv
pe un lot de 120 de pacieni internai consecutiv n
Clinica de Cardiologie I a Institutului C.C Iliescu cu
diag nosticul de sindrom coronarian acut in perioada
1.01.2008 -1.06.2008.
Rezultate i discuii: Din lotul studiat 79 (65,83%) au
fost pacienti de sex masculin, 41 (34,16%) au fost de sex
feminin. Din acest lot 12,5% sau incadrat in grupa de
varst 20-40 ani, 33,33 % in grupa 41-60 ani, iar 54,16%
au avut varste peste 61 ani.
n lotul studiat 62,5% dintre pacienti erau fumatori,
68,33 % erau hipertensivi cunoscuti, 26,66 % diabetici,
65% dislipidemici. Din istoricul pacienilor inclui n
lot s-a remarcat istoric familial de boli cardio-vasculare
n 25% din cazuri, infarct miocardic cunoscut n ante-
cedente n 40% cazuri, CABG n 10 % din cazuri, PCI +
stent n antecedente n 23,33 % din cazuri.
De asemeni am putut observa afectarea atero scle-
rotic i a altor teritorii dect cel coronarian, precum
arteriopatie periferic (8,33%), AVC (13,33%), retenie
azotat (12,5%).
Din punct de vedere al evalurii clinice i paraclinice
a pacienilor inclui n lot am constatat prezenta sem-
nelor i simptomelor de insufcien cardiac n 29,16%
cazuri, cu disfuncie sistolic a ventriculului stng
evaluat ecocardiografc n 33,33 % cazuri, prezer varea
acesteia n 66,66% cazuri si valori crescute ale tropo-
ninei serice n 46,6% cazuri.
91,66% dintre pacienii internai cu sindrom coro-
narian acut au benefciat de evaluare angiografc coro-
narian, dintre care 63,33% au necesitat angioplastie i
implantare de stent, 15,83% au primit indicaie de revas-
cularizare chirurgical. 4,16 % dintre pacientii inclui
n lot au decedat pe parcursul internrii ca urmare a
complicaiilor aprute postinfarct miocardic.
In studiul efectuat am putut constata ca 75% dintre
pacientii inclui n lot primeau tratament betablocant la
domiciliu, fa de 87,5% ci au primit la externare, 75%
primeau tratament cu antiagregant plachetar inainte de
internare fa de 100% ci au primit la externare, 65%
dintre cei inclui n lot primeau terapie hipolipemiant
fa de 79,16% cai au primit la externare.
Concluzii: n urma studiului efectuat am constatat
incidena crescut n lotul studiat a factorilor de risc
cardiovasculari care includ dislipidemia, fumatul, hiper-
tensiunea arterial sistolic, factorii socio-economici,
indicele de mas corporal, nivelul de activitate fzic.
Incidena sindroamelor coronariene acute a fost mult
crecut la pacienii cu vrsta peste 60 ani, ns este de
luat n seam frecvena destul de mare i n lotul celor
tineri.

134. Verificarea aplicrii
strategiilor de prevenie
secundar n dou cabinete de
medcin de familie cu ajutorul
bazelor de date pe suport
electronic - Medprax
Preg Zoltan, Kikeli Pal Istvan, Laszlo Mihaly-Imre,
Hubatsch Mihaela
UMF Targu Mures, Romania
Introducere: Prevenia secundar a bolilor cardiovas-
culare, urmrirea pacienilor cu boal cardiovascular
manifest este o prioritate strategic n prevenirea
eveni mentelor fatale cardiovasculare principala cauz
de mortalitate n Romnia. Scopul lucrrii este iden ti-
fcarea situaiei actuale a preveniei secundare n 2 cabi-
nete de medicin de familie din Trgu Mure.
Scop: Datele din fele pacient a 2500 de pacieni au
fost transpuse pe fe pacient structurate i introduse n
sistemul Medprax. Cu ajutorul modului de prelucrare
statistic a programului am evaluat i am identifcat
pacienii diagnosticai cu boli cardiovasculare, de ase-
menea am evaluat conformitatea tratamentel or medi-
camentoase recomandate cu cele ale ghidurilor de prac-
tic medical actuale.
Rezultate: Numrul pacienilor diagnosticai cu car-
dio patie ischemic a fost de 439 dintre acetia au
bene fciat de tratament medicamentos 238 pacieni.
Clasele de medicamente prescrise au fost urmtoarele:
anti agregante plachetare 46,6%, betablocante 48,32%,
calciu blocante 29,83%, IEC 72,69%, nitrai 54,2%, sta-
tine 15,55%. Numrul pacienilor diagnosticai cu insu-
fcien cardiac a fost 114 dintre acetia au bene fciat
de tratament medicamentos 67. Clasele de medicamente
prescrise au fost urmtoarele: IEC 83,58%, betablocante
32,84%, digitalic 14,93%, antialdosteronice 19,4%, diu-
re tice de ans 23,88%
Concluzii: 1. Bazele de date pe suport electronic per-
mit identifcarea i urmrirea strii de sntate, a inter-
veniilor terapeutice la nivel populaional. 2. Per mit
evaluarea strategiilor terapeutice i urmrirea com-
plian ei la ghidurile terapeutice. 3. Tratamentul pres-
cris pentru bolnavii cardiovasculari nu corespunde stra-
tegiilor de prevenie secundar.

Suplimentul A, 2008
162
135. Profilul clinic al
pacientilor in faza de
screening pentru
hipercolesterolemie familiala
A. Selaru, R. Creih, M. Ghionea, Mihaela Marin,
Oana Andrei, Alexandra Gherghina,
Raluca Tecuceanu, I.M. Coman.
Institutul de Boli Cardiovasculare Prof.C.C.Iliescu
Bucuresti
Obiectiv: Analiza caracteristicilor clinice a pacientilor
selectionati in cadrul proiectului Strategii noi in con-
duita diagnostica si terapeutica a hipercolesterolemiei
familiale prin screening-ul molecular al mutatiilor genei
receptorului LDL in perioada 01.01.2007-31.04.2008.
Material si metoda: Lot de 105 pacienti selectionati
conform criteriilor Dutch Lipid Network pentru suspi-
ciunea de hipercolesterolemie familiala (HF). Acestea
au fost: (1) prezenta hipercolesterolemiei; (2) prezenta
bolii cardiace ischemice, a afectarii cerebrovasculare
sau periferice vasculare premature (barbate <55 ani,
femei <60 ani); (3) semne obiective de HF (arc cor-
neean, xantoame tendinoase) si (4) istoric familial de
hiper coles terolemie, afectare cardiovasculara prema-
tura sau prezenta la rude de semne obiective de HF. Pe
baza acestor criterii pacientii au fost clasifcati in func-
tie de risc crescut/probabil/posibil de HF.
Rezultate: Varsta medie in lotul stuiat a fost de 54.12
ani, fara diferente intre sexe (53.52 ani in lotul feminin
si 54.56 ani in cel masculin).
In urma analizei statistice a caracteristicilor clinice
s-a constatat prezenta a doua categorii de pacienti:
1. Pacienti cu hipercolesterolemie dar fara afectare
cardiovasculara ( 24,76 %).
2. Pacienti cu hipercolesterolemie si afectare cardio-
vasculara (75,24 %), din care:
- Boala cardiaca ischemica au prezentat 98,73 %;
- Boala cerebrovasculara au prezentat 8,86 %;
- Boala vasculara periferica au prezentat 11,39 %;
Dintre pacienti cu boala cardiaca ischemica:
- Angina pectorala si/sau test de efort pozitiv au
prezentat 93,59%;
- Istoric de infarct miocardic au prezentat 29,49%;
- Leziuni coronariene angiografc documentate au
prezentat 46,15%;
- Istoric de revascularizare miocardica prin PTCA
au prezentat 10,26%.
- Istoric de revascularizare miocardica prin CABG
au prezentat 16,67%.
Dintre pacientii cu boala cerebrovasculara:
- Istoric de accident vascular cerebral au prezentat
85,71%;
- Leziuni carotidiene documentate angiografc au
prezentat 28,57%;
- Istoric de revascularizare carotidiana prin PTA au
prezentat 28,57%.
Dintre pacienti cu boala periferica vasculara:
- Claudicatie intermitenta au prezentat 77,78%;
- Leziuni periferice documentate angiografc au
prezentat 22,22%;
- Istoric de revascularizare periferica prin PTA au
prezentat 11,11%.
Concluzii: Din lotul de pacienti dislipidemici selec-
tio nati pentru faza de screening pentru HF, o pro-
portie semnifcativa (circa 75 %) au prezentat boala
car diaca ischemica, afectare cerebrovasculara sau vas-
culara periferica prematura. Astfel, la un pacient cu
dislipidemie, afectarea cardiovasculara prematura (si in
special prezenta leziunilor coronariene), creste semni-
fcativ riscul relativ de hipercolesterolemie familiala.
A. Criterii de includere:
a) Istoric familial:
- rude de gradul I cu boala cardiovasculara pre ma-
tura cunoscuta (barbati<55 ani, femei <60 ani)
sau
- rude de gradul I cu LDL col >160 mg/dl (1p)
- rude de gradul I cu xantoame la nivelul tendoanelor
si/sau arc cornean sau
- copii <18 ani cu LDL col >95% din valoarea cores-
punzator varstei (2p)
b) Criterii clinice:
- boala cardiovasculara prematura (barbati <55 ani,
femei <60 ani) (2p)
- boala cerebrovasculara si arteriala periferica pre-
ma tura (femei<60 ani sau barbati<55 ani)(1p)
c) Examen fzic:
- xantoame tendinoase (6p)
- arc cornean inainte de 45 de ani (4p)
d) Nivel seric al colesterolului:
- LDLcolesterol >/= 330 mg/dl (8p)
- LDLcolesterol intre 252-229 mg/dl (5p)
B. Criterii de excludere:
a) Diabet zaharat cu debut inainte de diagnosticul
hipercolesterolemiei.
b) Hipotiroidie sub tratament.
Suplimentul A, 2008
168
POSTER III
c) Ciroza biliara primitiva.
Astfel, pe baza scorului obtinut in protocolul anterior,
pacientii considerati eligibili pentru a intra in studiu au
fost subimpartiti in trei subloturi:
- sublotul I: pacienti cu HF certa (> 8 p);
- sublotul II: pacienti cu HF probabila (scor 6-8);
- sublotul III: pacienti cu HF posibila (scor 3-5).

136. Impactul schimbrilor
de strategie trombolitic i a
medicaiei concomitente la
cu supradenivelare de segment
ST n Romnia. Registrul
RO-STEMI
Tatu-Chitoiu G.P., Dorobantu Maria, Cintez M,
Craiu Elvira, Ionescu D.D., Datcu D.M., Petris A,
Olariu C, Vladoianu M, Bugiardini R i investigatorii
RO-STEMI.
Introducere: Registrul romn pentru infarctul miocar-
dic acut cu supradenivelare de segment ST (RO-
STEMI) a nrolat 10378 pacieni (pts) din 28 centre
ntre 1.01.2000 31.12.2007.
Obiectiv: Evaluarea impactului adus de modifcrile de
strategie trombolitic i de medicaie concomitent la
pacienii nrolai n RO-STEMI.
Metod: Mortalitatea intraspitaliceasc i rata de
utilizare a anticoagulantelor, antiagregantelor plache-
tare, beta-blocantelor (BB), inhibitorilor enyimei de
con versie a angiotensinei (ACEIs) i statinelor au fost
evaluate la 2786 pts. RO-STEMI tratati cu trombolitice
(streptokinaz, tPA, rPA, TNK-tPA) n primele 6 ore
de la debutul STEMI ntre 1.01.2003-31.12.2007.
Rezultate: Datele principale pot f urmrite n tabel.
A fost evideniat o cretere progresiv i intens sem-
ni fcativ statistic a fost nregistrat n utili zarea trom-
bo liticelor fbrin specifce, a statinelor, a combi naiei
aspirin-clopidogrel i a combinaiei heparin nefrac -
io nat 1000 i.u. pentru 48 ore urmat de enoxa parin
1 mg/kgcorp pn n ziua a 8 -a (de la 0,0% la 28,97%).
Pro centajul de pacieni tratai cu ACEIs a rmas ne-
schimbat. O tendin global de redu cere a morta li t ii
intraspitaliceti a fost nregis trat la limita semnifca iei
statistice (probabil datorit numrului relativ redus de
pacieni).
Concluzie: n ultimii 5 ani n Romnia Au fost nregis-
trate modfcri majore n strategia trombolitic i n
medicaia concomitent la pacienii cu STEMI tratai
n primele 6 ore. Aceste schimbri par a conduce spre
o reducere a mortaklitii intraspitalicesti la aceti pa-
cieni.
2003 2004 2005 2006 2007 p trend
Pacieni 417 761 427 753 428 /
Litice fbrin
specifce
20.86% 36.66% 45.19% 42.09% 50.23% < 0.0001
Beta-blocante 69.54% 79.76% 80.79% 83.39% 79.20% < 0.0001
Statine 73.86% 75.68% 77.51% 86.85% 89.48% <0.0001
ACEIs 76.01% 78.71% 78.68% 80.87% 77.57% 0.374
Aspirin &
Clopidogrel
12.47% 24.96% 43.55% 53.78% 69.15% <0.0001
Heparin 78.41% 66.09% 77.51% 42.89% 42.75% <0.0001
Heparin &
Enoxaparin
0.00% 0.00% 0.00% 32.27% 28.97% /
Mortalitate 11.96% 9.32% 8.19% 9.03% 6.54% 0.088

Impact of changes of
throm bo lytic strategy and of
concomitant therapy in
patients with ST-elevation
myocardial infarction in
Romania. The RO-STEMI
registry
G P. Tatu-Chitoiu
1
, M. Dorobantu
1
, M. Cinteza
1
,
E. Craiu
2
, DD. Ionescu
3
, DM Datcu, A. Petris,
C. Olariu, M. Vladoianu, R. Bugiardini
7
- , on behalf
of the Romanian registry for ST-elevation myocardial
infarction (RO-STEMI) investigators
Background: Te Romanian registry for ST-segment
elevation myocardial infarction (RO-STEMI) enrolled
10378 consecutive patients (pts) from 28 centres bet-
ween 1.01.2000 31.12.2007.
Objective: To assess the impact of changes in throm bo-
lytic strategy and in administration of the concomitant
therapy in RO-STEMI pts treated between 1.01.2003
31.12.2007.
Methods: Te in-hospital mortality and the rates of the
anticoagulants,antiplatelets agents, beta-blockers (BB),
Suplimentul A, 2008
161
angiotensin converting enzyme inhibitors (ACEIs) and
statins using were assessed in 2786 consecutive RO-
STEMI pts treated with thrombolytics (streptokinase,
tPA, rPA, TNK-tPA) within the frst 6 hours afer the
STEMI onset between 1.01.2003-31.12.2007.
Results: Te main data can be seen in table. A pro-
gressively and strongly statistically signifcant increase
of using of the fbrin specifc thrombolytics, of statins,
of combination aspirin-clopidogrel and of combination
unfractionated heparin 1000 i.u. for 48 hours followed
by enoxaparin 1 mg/kg bodyweight until day 8 (from
0,0% to 28,97%) was seen within the mentioned time
interval. Te percentage of patients receiving ACEIs
remained practically unchanged. A global trend toward
a progressively decrease of the in-hospital mor tality
was recorded at the limit of signifcance (pro bably due
to the relatively low number of pts).
Conclusions: Major changes regarding the thrombolytic
strategy and the concomitant therapy in STEMI pts treat-
ed within the frst 6 hours were recorded in Roma nia
for the last 5 years. Tese changes seem to lead toward a
decrease of the in-hospital mortality in STEMI pts.
2003 2004 2005 2006 2007 p trend
Patients 417 761 427 753 428 /
Fibrin-specifcs
lytics
20.86% 36.66% 45.19% 42.09% 50.23% < 0.0001
Beta-blockers 69.54% 79.76% 80.79% 83.39% 79.20% < 0.0001
Statins 73.86% 75.68% 77.51% 86.85% 89.48% <0.0001
ACEIs 76.01% 78.71% 78.68% 80.87% 77.57% 0.374
Aspirin &
Clopidogrel
12.47% 24.96% 43.55% 53.78% 69.15% <0.0001
Heparin 78.41% 66.09% 77.51% 42.89% 42.75% <0.0001
Heparin &
Enoxaparin
0.00% 0.00% 0.00% 32.27% 28.97% /
Mortality 11.96% 9.32% 8.19% 9.03% 6.54% 0.088

137. Relaia dintre concentraia
plasmatica a BNP si extensia
aterosclerozei coronare in
infarctul miocardic acut
Balanescu S, Scafa Udriste A, Niculescu R, Onut R,
Gainoiu E, Caimac L, Constantinescu D,
Arvanitopol S, Fruntelata A, Dorobantu M.
Clinica de Medicina Interna si Cardiologie, Spitalul
Clinic de Urgenta Bucureti
Premise: Concentraia serica a BNP a fost recunoscuta
ca unul dintre indicatorii prognostici importani in
insufcienta cardiaca cronica si in sindroamele corona-
riene acute. Pana in prezent nu s-a apreciat relaia
dintre valoarea BNP seric si severitatea aterosclerozei
coronare la pacienii fara insufcienta cardiaca.
Scop: Determinarea corelaiei dintre nivelul plasmatic
al BNP si severitatea angiografca a aterosclerozei coro-
nare la pacienii cu IMA cu supradenivelare de segment
ST (STEMI).
Metode: Au fost inrolati 88 pacieni (78 M, 10 F)
fara insufcienta cardiaca in antecedente, in vrsta de
51.6+/-11 ani internai cu STEMI, in primele 12 ore de
la debutul durerii si avnd in clasa Killip I la prezentare.
Fracia de ejectie (FEVS) la internare inainte de adminis-
trarea oricrei terapii de reperfuzie a fost de 45.8+/-
7.1%. BNP seric a fost determinat la internare, la 24h
si la 30 zile. La aceleai intervale de timp s-au msurat
FEVS, diametrele atriului stng, timpul de relaxare
isovolumica (IVRT) si velocitatea undelor de umplere E
si A. Severitatea aterosclerozei coronare a fost apreciata
prin coronarografe si cuantifcata in procente de ste-
noza luminala de ctre doi observatori neinformati
despre valorile BNP sau rezultatele ecocardiografce.
Toi pacienii au fost tratai cu o metoda de reperfuzie
fe tromboliza sistemica (n=45; 51.1%), fe angioplastie
de urgenta - primara sau de salvare (n=43; 48.9%).
Rezultate: Nivelul BNP a fost mai mare la pacienii
cu boala coronarian trivasculara (medie: 110 vs 41.9
pg/ml; p=0.034). Concentraia BNP a fost mai mare
inca de la internare atunci cnd artera responsabila
de infarct a fost IVA (medie: 88.7 vs 29.5; p=0.044).
Pre zenta embolizarilor distale s-a asociat cu un nivel
crescut al BNP la 24h (medie: 362.1 vs 204 pg/ml;
p=0.021). A existat o corelaie intre numrul total de
ste noze coronare >50% si nivelul BNP seric (p=0.017;
IC 95% ==1.53-2.85). Prezenta calcifcarilor coronare
apreciate fuoroscopic s-au corelat de asemenea cu
nivelul BNP inca de la internare (medie: 133.3 vs 38.3
pg/ml; p=0.0005). Indicatorii necrozei miocardice
apreciai prin nivelul Tnl si a mioglobinei la 24h au
fost direct proporionali cu BNP. A existat o corelaie
invers proporionala intre nivelul BNP seric si FEVS si
diametrul transversal al AS si direct proporionala BNP
indexul scorului de cinetica.
Concluzii: La pacienii cu STEMI fara semne de insu-
fcienta cardiaca la internare concentraia BNP seric
este corelata cu severitatea aterosclerozei coronare apre-
ciata angiografc. Creterea nivelului BNP seric se poa-
te datora severitii leziunii miocardice ischemice in
tim pul procesului acut, in absenta disfunctiei sistolice
semni fcative.

Suplimentul A, 2008
165
POSTER III
138. Reactivitatea coronarian
endotelinic n impactul
ischemic
Popovici M, Cobe V, Popovici I, Ivanov V, Ciobanu N,
Moraru I, Todira M, Ciobanu L
IMSP Institutul de Cardiologie, Chiinu, Moldova
Scopul: evaluarea in vitro a rspunsului coronarian din
cadrul fenomenului ischemie-reperfuzie la stimularea
receptorilor endotelinici.
Material i metode: Cordul izolat de obolan s-a perfuzat
n regim izovolumetric dup metoda Langendorf fr
recirculaie la frecven de contracie cardiac constant
(electrostimulare - 4,5 Hz). Dup o perioad de 30 min
de ischemie global jetul aortic retrograd s-a iniiat la
aceleai valori de presiune (perioada de reperfuzie).
Endotelina-1 (ET-1), agonistul receptorilor ETA, BQ-
3020 i agonistul receptorilor ETB, Sarafatoxina (Sf),
s-au administrat n concentraia de 5 x 10-7 M nainte
de episodul de ischemie sau dup 30 min de reperfuzie.
Valoarea fuxului coronarian (FC) s-a msurat dup
volumul de perfuzat refuat de la cord (ml/min), iar pre-
siunea sistolic dezvoltat de ventriculul stng (PSVS)
a fost evaluat prin intermediul autografului Linear-
corder MARK VII W3101 (Germania).
Rezultate: Administrarea preischemic a ET-1 i a BQ-
3020 a indus o coronaroconstricie relevant, care s-a
manifestat prin reducerea FC cu 292% (p <0,05) i,
respectiv, cu 34%2% (p<0,01). Stimu larea receptorilor
endo telinici ETB a generat coronaro di la ta ie, rezultnd
o cre terea a FC cu 162 % (p >0,05). Pe fondalul admi-
nis trrii ET-1 sau a BQ-3020 PSVS a crescut n pro-
porii similare (cu circa 22 mmHg), fapt ce ar semni fca
efectul inotrop pozitiv al stimulrii recep to rilor endo -
telinici ETA. Aciunea coronaro dila ta toare a ago nis tu-
lui ETB s-a impus, de asemenea, prin majorarea PSVS
(incrementul constituind 172%), mecanism mediat
prin fenomenul coronarian Gregg. n perioada de reper-
fuzie ET-1 a generat o coronaroconstricie mai puter-
nic dect cea indus preischemic (+403%), de vreme
ce efectul BQ-3020 s-a meninut la cota preische mic,
fapt ce ar pune n eviden disfuncia recepto rilor ETB,
can tonai pe endoteliu. ntr-adevr, efectul coro naro di-
lata tor postischemic al Safrotoxinei s-a diminuat pn
la 1/3 din nivelul preischemic. Remarcabil, c la aceast
etap de reperfuzie restabilirea PSVS s-a apreciat la
cote de circa 88-96% din nivelul preischemic. Mai
mult, dac n faza preischemic se reproducea activarea
recep torilor ETA sau ETA sau ETA/ETB (prin ET-1),
atunci gradul de redresare a funciei contractile a mio-
cardului se arat net micorat, probabil din cauza unei
precondiionri de efort premergtoare perioadei de
ischemie.
Concluzie: 1. La impactul ischemic tranzitoriu endo-
teliul coronarian se arat mai receptiv dect miocardul,
fapt ce se impune printr-o tripl atenuare a efectului coro-
narodilatator de la stimularea receptorilor endotelinci
ETB n faza de reperfuzie, fenomenul constatat a cauzat
creterea cu mai mult de 10% a conoraconstriciei ine-
rente aciunii ET-1.

Endothelinic coronary reactiv-
ity in the ischemic impact
Aim: Te in vitro evaluation of the coronary response
on endothelinic receptors stimulation afer ischemia-
reperfusion
Material and methods: Isolated rat heart was perfused
izovolumically by Langendorf method without recir-
culation at constant cardiac frequency (electro stimu-
lation 4,5 Hz). Afer a 30 min period of total ischemia
the retrograde aortic jet was initiated on the same pre-
ssure values (reperfusion period). Endothelin-1 (ET-
1), ETA receptor agonist, BQ3020, and ETB recep tor
agonist, Sarafatoxin (Sf), were administered in con-
centration of 5 x 10-7 M before ischemic episode or
afer 30 min of reperfusion. Te coronary fux (CF)
value was measured as perfusating volume refuxed
from heart (ml/min). Te systolic pressure developed
by lef ven tricle (LVSP) was evaluated using the recorder
MARK VII WR3101 (Germany).
Results: Te preischemic action of ET-1 and of BQ3020
relevantly induced a coronaraconstriction manifested
by CF reduction by 292% (p<0,05), and respectively,
by 34%2% (p<0,01). Te endothelinic receptor ETB
stimulation caused a coronarodilation resulting in a CF
raise by 162 % (p>0,05). During ET-1 and BQ3020
administration the LVSP increased similarly (by almost
22 mm Hg), an evidence presumably due to inotropic
efect of endothelinic ETA receptor stimulation. Te
coronarorelaxing action of the ETB agonist also led
to LVSP enhancement (172%) whose mechanism
is mediated by the Greggs phenomenon. During
Suplimentul A, 2008
166
reperfusion period ET-1 realized a coronaroconstriction
stronger than preischemic value (+403%), but the
BQ3020 induced efect has remained at preischemic
level, a fact very likely indicating the dysfunction of
ETB receptor placed on endothelium. Indeed, the
Sf induced postischemic coronarodilatator efect
decreased till a 1/3 from preischemic level. Remarkably,
in this reperfusion period the LVSP restoration has
been attested at 89-96% from preischemic level. More
than that, when ETA or ETB or ETA/ETB (thereby ET-
1) receptors were activating in preischemic phase, then
the degree of the myocardium contractile function
redressing was notably reduced, perhaps due to an
efort preconditioning before ischemic event.
Conclusions: 1. Te coronary endothelium is more
receptive to a transient ischemic impact that is
manifested by 3-fold blunting of endothelinic ETB
receptor stimulation induced coronarodilation in
reperfusion, a phenomenon causing the ET-1 induced
coronaroconstriction elevation by more than 10%.

139. Evaluarea prognosticului
pacientilor diabetici cu
sindroame coronariene acute
Laura Arama, I. Stanca, Daniela Popescu, S. Barsan,
Luminita Ionescu, Roxana Coralia Popescu,
Simona Huidu, Andreea Caterina Popescu,
Doina Dimulescu
Spitalul Universitar de Urgenta Elias Clinica de
Cardiologie
Obiective: Evaluarea prognosticului pacientilor diabe-
tici cu sindroame coronariene acute pe termen scurt si
mediu.
Material si metoda: Studiul retrospectiv a fost realizat
in Clinica de Cardiologie a Spitalului Universitar de
Urgenta Elias, pe un lot de 214 pacienti cu diagnosticul
de sindrom coronarian acut cu sau fara supradenivelare
de segment ST, inrolati in oridinea internarii, in perioada
aprilie 2005-ianuarie 2006. Dintre acestia 40,6% au fost
diabetici. Intraspital s-au urmarit evenimentele cardio-
vasculare (angina recurenta, reinfarctarea si decesul de
cauza cardiovasculara), in timp ce la 1 an s-au urmarit:
clasa NYHA a insufcientei cardiace, clasa Canadiana a
anginei pectorale, recurenta unui eveniment coronarian
acut, decesul de cauza cardiovasculara, accidetul vas-
cular cerebral si aparitia insufcientei renale.
Rezultate: Pacientii au fost impartiti in doua loturi
diabetici si nondiabetici.Diabetul zaharat s-a dove-
dit predictor puternic defavorabil pentru evolutia
intra spital, lucru cuantifcat prin rata crescuta a eveni-
mentelor cardiovasculare. Intraspital pacientii diabetici
au prezentat angina recurenta de 1,8 ori mai frecvent
(p=0,003), reinfarctare de 2,25 ori mai frecvent (p
>0,05), si au decedat de 3,5 ori mai frecvent (p=0,05).
Nu s-a observat diferenta semnifcativa statistic in cele
doua loturi, in ceea ce priveste sangerarile intraspital.
La 1 an diabetul nu a infuentat semnifcativ statistic nici
unul dintre parametrii urmariti: insufcienta cardiaca
clasa III/IV NYHA 34,3% vs. 40,9%, angina de repaus
34,3% vs 27, 3%, mortaliatea cardiovasculara la diabetici
a fost de 14,9%, vs. 13,3% la nondiabetici, accidentele
vas culare cerebrale 11,4% vs. 6,8%, insufcienta renala
nou aparuta 14,7% vs. 13,6%,.
Concluzie: Diabetul zaharat s-a dovedit factor de prog-
nostic defavorabil, indiferent de vechimea bolii, pentru
evolutia intraspital, dar nu si pentru evolutia la 1 an.

Endothelinic coronary
reac ti vity in the ischaemic
impact
Aim: Te in vitro evaluation of the coronary response
on endothelinic receptors stimulation afer ischaemia-
reperfusion
Material and methods: Isolated rat heart was perfu-
sed izovolumically by Langendorf method with out
recirculation at constant cardiac frequency (electro-
sti mulation 4,5 Hz). Afer a 30 min period of total
ischaemia the retrograde aortic jet was initiated on the
same pressure values (reperfusion period). Endothelin-
1 (ET-1), ETA receptor agonist, BQ3020, and ETB
receptor agonist, Sarafatoxin (Sf), were administered in
concentration of 5 x 10-7 M before ischaemic episode
or afer 30 min of reperfusion. Te coronary fux (CF)
value was measured as perfusating volume refuxed
from heart (ml/min). Te systolic pressure developed
by lef ventricle (LVSP) was evaluated using the recorder
MARK VII WR3101 (Germany).
Suplimentul A, 2008
16I
POSTER III
Results: Te preischaemic action of ET-1 and of BQ3020
relevantly induced a coronaraconstriction manifested
by CF reduction by 292% (p<0,05), and respectively,
by 34%2% (p<0,01). Te endothelinic receptor ETB
stimulation caused a coronarodilation resulting in a CF
raise by 162 % (p>0,05). During ET-1 and BQ3020
administration the LVSP increased similarly (by almost
22 mm Hg), an evidence presumably due to inotropic
efect of endothelinic ETA receptor stimulation. Te
coronarorelaxing action of the ETB agonist also led
to LVSP enhancement (172%) whose mechanism is
mediated by the Greggs phenomenon. During reper-
fusion period ET-1 realized a coronaroconstriction
stron ger than preischaemic value (+403%), but the
BQ3020 induced efect has remained at preischaemic
level, a fact very likely indicating the dysfunction of
ETB receptor placed on endothelium. Indeed, the Sf
induced postischaemic coronarodilatator efect decrea-
sed till a 1/3 from preischaemic level. Remarkably, in
this reperfusion period the LVSP restoration has been
attested at 89-96% from preischaemic level. More than
that, when ETA or ETB or ETA/ETB (thereby ET-1)
recep tors were activating in preischaemic phase, then
the degree of the myocardium contractile function
redre ssing was notably reduced, perhaps due to an
efort preconditioning before ischaemic event.
Conclusions: 1. Te coronary endothelium is more
re cep tive to a transient ischaemic impact that is mani-
fested by 3-fold blunting of endothelinic ETB recep tor
stimulation induced coronarodilation in reper fusion, a
phenomenon causing the ET-1 induced corona rocon-
striction elevation by more than 10%.

140. Corelaia dintre vrst i
raspunsul hemodinamic la
testul mesei inclinate la
pacientii cu sincopa vasovagala
Daniel Gherasim, Razvan Ticulescu, Irina Marin,
Liliana Florea, Carmen Ginghina
Institutul de Boli Cardiovasculare Prof Dr. C.C. Ili-
escu Bucharest
Scop: La pacientii cu suspiciunea de sincopa vasovagala,
testul mesei inclinate poate da tipuri diferite de raspuns.
Scopul lucrarii este de a investiga daca exista o corelatie
intre tipul de raspuns si varsta, sugerand mecanisme
fziopatologice diferite.
Metode: Am inclus 725 pacieni consecutivi (55% br-
bai) cu sincop de cauz probabil vaso-vagal, la care
s-a efectuat testul mesei nclinate n Institutul de Boli
Cardio vasculare Prof. Dr. C.C. Iliescu ntre 1997-
2007. Distribuia pe grupe de vrst (grupe de cate 10
ani) a lotului studiat a fost relativ egal, cu excep ia
vrste lor extreme. Protocolul folosit a constat n ncli-
narea mesei timp de 30-40 minute la 70 grade, pn la
apa riia simptomelor nsoite de modifcri ale ten siu-
nii arteriale sau frecvenei cardiace sau pn la apa riia
sincopei.
Rezultate: Testul a fost pozitiv la 10,26% dintre pacieni.
Cele mai frecvente tipuri de rspuns au fost: tipul I
(mixt)-36% i tipul III (vasodepresor)-33%. Incidena
cea mai mare a testului pozitiv a fost n intervalul de
vrst 61-70 ani (36%). La acest interval de vrst,
tipurile I i III de rspuns cumulate au reprezentat
86,48% din totalul rspunsurilor pozitive. Tipul de
rspuns II b (cardioinhibitor cu asistol) a fost cel mai
frecvent n intervalul de vrst 11-20 ani. n medie, sin-
copa s-a instalat n minutul 17,73. Doar doi pacieni au
prezentat sincopa dup minutul 30. Doi pacieni care au
prezentat rspuns de tip cardioinhibitor i care au fost
cardios timulai au repetat testul, prezentnd reacie de
tip III (vasodepresor).
Concluzii: este posibil s existe o reacie specifc fe-
crei vrste la testul mesei nclinate, hipotensiunea
predo minnd la vrstele mai naintate, n timp ce asis-
tola find mai frecvent la vrstele tinere.

Age and Hemodynamic
Responses to Tilt Testing in
Those With Vasovagal Syncope
Daniel Gherasim, Razvan Ticulescu, Irina Marin,
Liliana Florea, Carmen Ginghina
Institutul de Boli Cardiovasculare Prof Dr. C.C.
Iliescu Bucharest
Background: in those with suspected neurocardioge-
nic syncope, tilt testing demonstrates diferent hemo-
dynamic responses. We sought to determine wheter are
age-related diferences in tilt testing results, refecting
difering underlying pathophysiology.
Suplimentul A, 2008
168
Methods and results: we included 725 consecutive
patients (55% men) with suspected neurally mediated
syncope, which had a tilt test in IBCV Prof. Dr C. C.
Iliescu between 1997-2007. Te distribution by age of
the lot (10 years groups) in study was relatively equi-
table, with the exception of the extreme ages. Te pro-
tocol used consisted in tilting the table at 70 for 30-40
miutes, until the onset of symptoms, accompanied by
changes in blood pressure and cardiac freguency or of
the syncope.
Results: Te test was positive in 10,26% of patients.Te
most frequent pattern of responses were type I (mixt)-
36% and type III (vasodepresor)-33%. A positive test
was most frequent in the group of age between 61-70
yaers (36%). In this interval of age type I and type II
cumulated 81,48% of the positives tests. Te II b reac-
tion (syncope with asystole) was the most frequent one
between 11-20 years (42,5%). Te average minute of the
syncope was 17,73. Only two patients had a syncope
afer 30 minutes. Two patinents with cardioinhibitor
res ponse which were cardio-stimulated repeted the tilt
test, and they have a positive response type III.
Conclusions: there appear to be distinct pathophy-
siologies underlying in diferent groups of age in tilt
table test, hypotension predominating in older ages,
while asystole is the most frequent pattern of response
in younger ones.

141. Indicatiile stenturilor
active farmacologic pentru
leziunile off-label sunt la fel
de sigure si eficiente ca si
indicatiile pentru leziunile
clasice
C. Stoicescu, N. Florescu, D. Vinereanu
Context: Folosirea stenturilor active farmacologic
(DES), in afara indicatiilor aprobate a fost putin studiata
de-a lungul timpului. Date recente pun la indoiala
siguranta folosirii acestor tipuri de stenturi in leziuni
(of-label), altele decat cele pentru care au indicatie,
sugerand o crestere a mortalitatii si a infarctului non-
fatal. OBIECTIV. S-au urmarit frecventa, siguranta si
efca citatea DES pentru indicatiile of-label
Material si metoda: In cadrul unui studiu de registru,
am inclus toti pacientii care au primit cel putin un
stent activ farmacologic pentru o perioda de 54 luni
(incepand cu 2003). Pacientii au fost impartiti in doua
loturi: lotul of - label defnit ca lot in care s-au folosit
stenturi pentru: leziuni de trunchi comun stang (TCS),
restenoze intrastent, leziuni ostiale, bifurcatii ori ocluzii
totale, sau la pacientii cu un vas de referinta (RVD) <2.5
mm sau >3.75 mm in diametru, sau leziuni cu lungime
>30 mm; si lotul clasic defnit ca lot in care s-au
folosit stenturi pentru indicatiile aprobate. Obiectivul
primar a fost restenoza clinica (defnita pe baza simpto-
melor clinice si/sau a testului ECG de efort). In caz
de suspiciune clinica de restenoza, pacientului i s-a
repe tat coronarografa. Obiectivele secundare au fost
repre zentate de evenimentele cardiace adverse majore
(MACE), defnite ca moarte de cauza cardiaca, infarct
de miocard, reinterventie pe leziunea / vasul tinta si
angi na pectorala recurenta.
Rezultate: 476 pacienti inclusi in studiu, cu 559 de
leziuni; 26.3% au fost leziuni of-label (TCS 2.3%; ISR
7.7%; ostiu 1.1%; bifurcatii 0.4%; ocluzii totale 3.9%;
RVD <2.5 mm 8.1%; RVD >3.75 mm 3.6%; lungime
>30 mm 3.2%). Perioada medie de urmarire a fost de
22620 zile. Nu a fost nici o diferenta intre cele doua
grupuri pentru prevalenta factorilor majori de risc
cardiovasculari. A fost un caz de restenoza in grupul
of-label vs. 2 cazuri in grupul clasic (p=ns); 0.8%
din pacientii of-label au avut MACE vs. 2.9% din
grupul clasic (p=ns).
Concluzii: Folosirea DES pentru leziuni of-label este
obisnuita. Comparata cu indicatiile clasice, folosirea
DES pentru leziuni of-label este sigura si efcienta,
nefind asociata cu cresterea ratei restenozei sau a
MACE.

DES indications for off-label
lesions are safe and efficient as
indications for classical lesions
C Stoicescu, N Florescu, D Vinereanu
Background: Limited data exist regarding use of drug-
eluting stents (DES) outside of approved indications in
Suplimentul A, 2008
169
POSTER III
real-world settings. Safety concerns have arisen from
recent reports that suggested increased mortality and
nonfatal myocardial infarction (MI) with DES usage
for of-label indications.
Aim: We performed a retro spective analysis of our
local registry in order to deter mine the frequency,
safety, and efectiveness of DES for of-label indications
in percutaneous coronary interv ention (PCI).
Methods: Within a registry study, we included all
patients who received at least one pharmacological acti-
ve stent, for a 54 months period (since 2003). We com-
pared two groups: of-label group, defned as use of
stents in lef main coronary artery disease, restenotic
lesio ns (ISR), ostial, bifurcated, or totally occluded
lesio ns, or in patients with a reference-vessel diameter
(RVD) <2.5 mm or >3.75 mm, or a lesion length >30
mm, and classical group, defned as use of stents in
appro ved indications. Primary end-point was the clini-
cal restenosis (defned clinically and/or by ECG exer-
cise test); when clinical restenosis was suspected, coro-
nary angiography was repeated. Secondary end-points
were major adverse cardiac events (MACE), def ned as
cardiac death, myocardial infarction, target lesion revas-
cularization, or recurrent angina. Results. 476 patients
were included into the registry study with 559 lesions;
26.3% were of-label lesions (TCS 2.3%; ISR 7.7%;
ostial 1.1%; bifurcations 0.4%; total occlusion 3.9%;
RVD <2.5 mm 8.1%; RVD >3.75 mm 3.6%; length >30
mm 3.2%). Mean follow-up period was 22620 days.
Tere were no diferences between the two groups for
the prevalence of major cardiovascular risk factors.
Tere was 1 case of restenosis in the of-label group,
vs. 2 cases in the classical group (p=ns); 0.8% patients
from the of-label group had MACE, compared with
2.9% from the classical group (p= ns). Conclusions.
Of-label use of drug-eluting stents is common.
Te utilization of DES for non-approved indications
(of-label lesions) proved to be ef cacious and safe,
when compared with a control cohort for classical
indications. Of-label use of DES was not associated
with increased rates of restenosis and MACE.

142. Eficiena antrenamentului
fizic n aprecierea calitii vieii
la pacienii valvulari aortici
operai prin intermediul
chestionarului Short Form 36
1
, Maria Rada
1
,
Simona Drgan
1
, D.M. Duda-Seiman
1
, C. A. Saru
1
,
M. Berceanu
1
, FI. Cobzariu
1
, V. Ionescu
1
,
Nadia Cornu
2
, Silvia Manca
1
1
2
Spitalul Clinic Municipal Timioara, Romnia
Scop: aprecierea ameliorrii calitii vieii la fnalul
fazei II de recuperare cardiovascular prin intermediul
ches tionarului Short Form 36 (SF 36) la pacienii
valvulari aortici operai, acesta find unul din cele mai
utilizate chestionare actuale de evaluare a calitii vieii
la pacienii cu intervenii chirurgicale cardiace.
Material i metod: monitorizarea efectelor progra-
mului de recuperare cardiac asupra calitii vieii la
cei 82 pacieni inclui n studiu s-a efectuat prin inter-
mediul scorului celor dou componente fzic (PCS-
36) i mental (MCS-36) la includere n studiu i la 3
luni (fnalul fazei II de recuperare cardiovascular).
Cal cularea punctajului celor dou componente s-a
efectuat electronic prin accesarea site-ului www.sf-
36.org/demos/SF-36html. Pentru cuantifcarea punc ta-
jul obinut s-a utilizat un scor original cu limite ntre
0 i 100, 0 cel mai slab i 100 cel mai bun posibil status
de sntate. Pacieni eligibili pentru studiu, au fost
randomizai n dou grupe: grupa de antrenament (A)-
43 pacieni i grupa de control (B)-39 pacieni.
Rezultate: la debutul studiului componenta fzic
(PCS-36) prezint valori mai reduse comparativ cu
cea mental (MCS-36) att la pacienii protezai aortic
inclu i n program de reabilitare cardiac ct i la cei
din grupa de control, datorit decondiionarii fzice
secundare bolii existente preoperator. Dup faza II
de recuperare cardiovascular la grupa A s-a obinut
o evoluie favorabil a componentei PCS -36 (de la o
valoare medie de 33,6716,2 la 60,4523, p<0,0001).
n contrast la grupa B ameliorarea PCS-36 a fost mai
puin evident, de la 28,8218,2 la 44,4525,1 la 3 luni
(p<0,001). n ceea ce privete componenta MCS-36, la
grupa A s-au obinut rezultate mai semnifcative din
puncte de vedere statistic, de la 47,3127,5 la 62,3532,4
(p<0,01), comparativ cu grupa B unde aceast cretere
a fost de la 41,322,41 la 51,324,2 (p<0,05).
Suplimentul A, 2008
1I0
Concluzii: n prezent scopul programelor de reabilitare
cardiac nu este doar prelungirea duratei de via, ci
obinerea unei vieii de o calitate superioar, mbu-
ntirea calitii viei find vzut din ce n ce mai
mult ca unul din principalele obiective ale programelor
de recuperare cardiovascular. Dei ambele grupe au
bene fciat de modifcarea stilului de via, conform
recomandrilor ghidului, pacienii care au benefciat
de antrenament fzic individualizat i standardizat i-
au mbuntit semnifcativ starea fzic i statusul
funcional, precum i starea mental, comparativ cu
grupa de control.

Physical training efficiency
on life quality evaluation by
Short Form 36 questionnaire
in patients after aortic valve
replacement
1
, Maria Rada
1
,
Simona Drgan
1
, D.M. Duda-Seiman
1
, C. A. Saru
1
,
M. Berceanu
1
, FI. Cobzariu
1
, V. Ionescu
1
,
Nadia Cornu
2
, Silvia Manca
1
1
University of Medicine & Pharmacy Victor Babes
2
Objective: evaluation of life quality amelioration at the
end of phase II of cardiovascular rehabilitation, using
Short Form 36 questionnaire (SF 36) for patients afer
aortic valve replacement, SF 36 is the most used ques-
tionnaire for evaluation of life quality for patients afer
cardiac surgery.
Methods and materials: monitoring of cardiac rehabi-
litation program efects on life quality for 82 study
included patients was performed by assessing the two
questionnaire components physical (PSC36) end mental
(MCS-36) at admission and afer 3 months (the end
of phase II of cardiovascular rehabilitation). Synopsis
estimation of the two components was efectuated
on internet site www.sf-36.org/demos/SF-36html. To
quantify obtained data, an original score with limits
between 0 and 100 was utilized: 0-the powerless and
100 the best possible health condition. Study eligible
patients were divided in two groups: training group (A)
43 patients and control group(B) 39 patients.
Results: at the beginning of the study, the physical
component (PCS-36) had lower score comparative to
the mental score (MCS-36) in patients with aortic valve
replacement included in cardiovascular rehabilitation
program, and also in the control group, because of
phy sical decoditioning secondary to preoperatory
disease. Afer phase II of cardiac rehabilitation pro-
gram we remark a favorable evolution of the PCS-36
com po nent (from an average value of 33,6716,2 to
60,4523, p<0,0001). Contrarily, PCS-36 amelioration
on B-group was less obvious: from 28,8218,2 to
44,4525,1 afer 3 months (p<0,001). Regarding the
MCS-36 component, A-group patients had obtained
more signifcant statistical results from 47,3127,5 to
62,3532,4 (p<0,01), compared to the B-group from
41,322,41 to 51,324,2 (p<0,05).
Conclusions: the actual purpose of cardiac rehabi lita-
tion program is not only life prolongation, but also
to enhance the quality of life that becomes one of the
lead ing goal. Altrought in both groups lifestyle chan-
ges accor ding to guideline recommendations were pre-
served, pa tients who beneft from individual and stan-
dardized phy sical training had a signifcant impro ve-
ment of phy sical condition and functional capacity, also
of mental condition, compared to the control group.

143. Modele experimentale de
cardioplegie pe cord izolat i
perfuzat Langendorff
M. Perian, Marieta David, Crina Manole, D. Dobreanu
Disciplina de Fiziologie U.M.F. Targu Mures
Scopul lucrrii: Datorit continuei perfecionri a
tehnicilor de chirurgie cardiac, cercetrile privind
obinerea unor protocoale optime de cardioplegie sunt
de un interes deosbit.
Studiul nostru i-a propus s realizeze o comparaie
ntre dou protocoale diferite de cardioplegie folosind
soluia Sabax.
Material i metod: Am folosit dou loturi de cte 15
obolani Whistar cu greutate medie de 280g. Dup
anes tezie general cu ketamin-xilazin s-a prelevat
cordul. La primul lot cordul a fost oprit i pstrat n
soluie cardioplegic Sabax la +5 grade Celsius. Dup
3 ore de cardioplegie s-a nceput perfuzia cu soluie
Suplimentul A, 2008
1I1
POSTER III
Krebs-Henseleit la 37 grade i s-au nregistrat electro car-
diograma i fora de contracie a ventricolului stng.
La cel de-al doilea lot, dup prelevare cordul a fost
oprit i perfuzat continuu cu soluie Sabax la +15
grade celsius. Dup 3 ore s-a perfuzat cu soluie Krebs-
Henseleit la 37 grade i s-au nregistrat aceiai para me-
trii. Am urmrit de asemenea rata de apariie a arit mii-
lor ventriculare ce au necesitat stimulare overdrive sau
defbrilare.
Rezultate i concluzii: La primul lot inducia cardio-
plegiei a fost rapid (n medie 1 minut i 37 secunde),
revenirea complet s-a nregistrat la 17 minute (+/- 3
min) iar rata de apariie a aritmiilor ce au necesitat
pacing overdrive sau defbrilare a fost de 63 %. n cazul
celui de-al doilea lot, inducia a fost mai lent, probabil
i datorit temperaturii mai ridicate, timpul de revenire
nu a fost infuenat semnifcativ, ns rata de apariie a
arit miilor ce au necesitat stimulare overdrive sau def-
brilare a fost de doar 35%.

Experimental models of
cardioplegia in isolated
Langendorff hearts
M. Perian, Marieta David, Crina Manole, D. Dobreanu
Disciplina de Fiziologie U.M.F. Targu Mures
Objective: Considering the continous developpment
of cardiac surgery techniques, the researches for opti-
mal protocols of cardioplegia are of high interrest at
this moment. Our study is providing a comparison bet-
ween two diferent cardioplegia protocols using Sabax
solution.
Methods: Two groups of 15 Whistar male rats were
used in the study. Afer general anesthesia with Keta-
mine+Xylasine the hearts were prelevated from thoracic
cavity. In the frst group, the heart was stopped and
kept in cold (+5 Celsius degrees) Sabax solution. Afer
3 hours of cardioplegic arrest, the hearts were perfused
with Krebs-Henseleit solution at 37 Celsius degrees.
ECG and lef ventricle contractile force were recorded.
In the second group, afer cardioplegic arrest the hearts
were continously perfused with Sabax cardioplegic
solution at +15 Celsius degrees. Afer 3 hours a perfusion
with Krebs-Henseleit at +37 degrees was established.
Contractile force and ECG were recorded. We also
monitored the occurence of ventricular arrhythmias
necssitating overdrive suppresion or defbrillation.
Results and conclusions: In the frst group the induc-
tion of cardioplegic arrest was quick (1 min. and 37
secs. mean), the full recovery was noticed at about 17
minutes (+/- 3min) and the arrhythmic events rate was
at 63%. In the second group the cardioplegic arrest
occured later, probably also because of higher tempe-
rature, the full recovery time had no signifcant dife-
rence from the frst group, but the arrhythmias rate was
only 35 %.

144. Protectia Miocardica
utilizand Acizi Grasi Omega-3
in Cardioplegia Cristaloida
Hipotermica
Cristina Goga, Marcel Perian, Marieta Gabriela David,
Dan Dobreanu
Universitatea de Medicina si Farmacie Targu Mures,
Disciplina Fiziologie
Obiective: Studiul nostru evalueaza infuenta AGPN
omega-3 asupra disfunctiei contractile si a vulnera bili-
tatii la aritmii a miocardului de sobolan in cardioplegia
(CP) cristaloida hipotermica.
Material si metoda: Sobolani Wistar (greutate medie
350g), masculi, in varsta de 12 saptamani au benefciat
de o dieta cu etil-esteri de AGPN omega-3 (Omacor 5g/
Kg hrana standard) (DAG, n=15) sau de o dieta standard
(DS, n=15) pentru 30 de zile. Muschii papilari izolati,
prelevati din ventricolul stang, au fost supusi la 30 de
minute CP cristaloida cu solutie St. Tomas Hospital
No.2, rece (T= 8oC) urmata de 30 de minute de reperfu-
zie. Forta maxima a contractiei izometrice stimulate cu
o frecventa de 1Hz si potentialele intracelulare au fost
inregistrate inaintea inducerii CP si la 20 de minute de
la reperfuzie.
Rezultate: DAG a ameliorat recuperarea functiei con-
trac tile postcardioplegie, forta maxima a contractiei
izo metrice find superioara celei din grupul DS (+dF,
p=0,041). Intre cele doua grupuri nu au existat dife-
rente semnifcative ale timpului de dezvoltare a fortei
maxime (+dt) si ale vitezei de dezvoltare a fortei maxime
(+dF/dt). AG omega-3 au determinat redu cerea vitezei
de depolarizare (dV/dt, p=0,0019) si scur tarea duratei
Suplimentul A, 2008
1I2
potentialului de actiune (APD) prin redu cerea APD
la 50 % din repolarizare (APD50, p=0,0292) si 90%
(APD90, p=0,0215).
Discutii: Rezultatele sugereaza ca AG omega-3 ame-
lioreaza functia contractila a miocardului postcar dio-
plegie, prin augmentarea +dF, posibil prin stimularea
mecanismelor de eliberare a Ca2+ din reticolul sarco-
plasmic. In cursul cardioplegiei AG omega-3 au redus
APD, prin scurtarea duratei repolarizarii, asociata cu
diminuarea susceptibilitatii miocardului la aritmii. AG
omega-3 au stabilizat electric miocardul prin alterarea
activitatii canalelor ionice: inhibarea INa+, responsabila
de reducerea dV/dt, inhibarea ICa2+,L si scurtarea
APD50 si augmentarea IK, resposabila de scurtarea
APD90. Mecanismul modularii activitatii electrice a
miocardului in cursul CP cristaloide hipotermice este
similar efectelor antiaritmice asociate ischemiei si
reperfuziei miocardice.

145. Functia cardiaca
longitudinala supranormala
la sportivii de anduranta in
comparatie cu sportivii de
rezistenta, determinata de
optimizarea interactiunii
ventriculo-arteriale
M. Florescu, I. Petcu, M. Radu, C. Palombo,
M. Cinteza, A. Lautaru, D. Vinereanu
Context: Adaptarea cardiaca la sportivii de performanta
difera in functie de tipul de antrenament fzic. Astfel,
antrenamentul de anduranta se asociaza cu hipertrofe
ventriculara stanga (HVS) excentrica si cu o functie
cardiaca supranormala, in timp ce antrenamentul de
rezistenta determina HVS concentrica fara a creste
performanta cardiaca. Tipul de HVS per se nu poate
explica diferenta de adaptare cardiaca, astfel incat, alte
mecanisme, ca de exemplu o interactiunea ventriculo-
arteriala diferita, ar putea f implicate.
Obiective: 1) Sa analizeze diferenta de functie car-
diaca in HVS determinata de cele doua tipuri de antre-
nament, de anduranta si de rezistenta; si 2) Sa evalueze
mecanismele interactiunii ventriculo-arteriale si efec-
tele acesteia asupra functiei cardiace.
Metode: Au fost inrolati 69 de subiecti barbati (varsta
medie 214 ani): 26 sportivi de anduranta (SA), 10
sportivi de rezistenta (SR) si un lot de control de 33 de
subiecti sedentari de aceeasi varsta (C). Functia cardiaca
a fost evaluata prin ecocardiografe conventionala si prin
Doppler tisular: functia sistolica globala prin calcularea
fractiei de ejectie (FE), functia radiala prin masurarea
velocitatilor peretelui posterior, iar functia longitudinala
sistolica (STDE) si diastolica (ETDE) prin masurarea
mediei velocitatilor a 6 segmente ventriculare bazale.
Rigi ditatea arteriala a fost estimata prin calcularea
indexului de augmentare (AIx) si a velocitatii undei
pul su lui (PWV); functia endoteliala prin vasodilatatia
media ta de fux (FMD) la nivelul arterei brahiale; iar
interac tiunea ventriculo-arteriala prin amplitudinea
undei de compresie (CW), deteriminata prin analiza
de wave intensity. De asemenea, au fost masurati
NT-proBNP, markerii de fbroza miocardica (procola
genul de tip I amino-terminal) si markerii de stres
oxi dativ (SO) (concentratia de carbonil in proteinele
plasmatice).
Rezultate: Desi ambele loturi de sportivi au avut HVS
semnifcativa in comparatie cu C, SA au avut o functie
longitudinala mai buna (tabel), dar cu o functie radiala
similara, asociata cu o functie arteriala si endoteliala aug-
mentata si un SO scazut, cu optimizarea interactiunii
ventriculo-arteriale. NT-proBNP si markerii de fbroza
miocardica nu au variat intre grupuri. Concluzii. Desi
atat SA, cat si SR prezinta HVS fziologica, antrena-
mentul de anduranta se asociaza cu o functie cardia ca
longitudinala supranormala determinata de opti mi-
zarea interactiunii ventriculo-arteriale. STDE (cm/
s) ETDE (cm/s) AIx (%) PWV (m/s) FMD (%) CW
(mmHg.m.s-3x103) OS (nmol/mg) SA 120.9 17.40.3
-10.97 7.12.4 16.76.9 37.121.5 0.259071 SR
100.8 13.70.4 0.0796 8.52 12.54.5 17.114.5
0.5490,9 C 10.11 15.80.2 -2.211 8.81.1 144.1
17.613.4 0.4280.88 p (ANOVA) <0.0001 <0.0001
<0.001 <0.0001 <0.009 <0.0001 <0.0001 P(SA vs SR)
<0.0001 <0.0001 <0.009 <0.0001 <0.025 <0.01 <0.0001

Suplimentul A, 2008
1I8
POSTER III
Better longitudinal function in
endurance-trained athletes in
comparison with
strength-trained athletes,
related to optimized
ventriculo-arterial interaction
M. Florescu, I. Petcu, M. Radu, C. Palombo,
M. Cinteza, A. Lautaru, D. Vinereanu
Background: Cardiac adaptation difers according to
the type of exercise training. Tus, endurance exercise
training is associated with eccentric LVH and better
cardiac function, whereas strength exercise training
induces concentric LVH and no diference in cardiac
performance. Te type of hypertrophy alone can not
explain these diferences, therefore, other mechanisms,
such as diferent ventriculo-arterial interaction might
be involved.
Aims: 1) To assess diferences in cardiac function indu-
ced by endurance- and strength- training. 2) To iden-
tify mechanisms of ventriculo-arterial interaction, and
their efects on cardiac function in both type of ath-
letes.
Methods: 69 male (214 years) subjects were enrolled:
26 endurance-trained athletes (EA), 10 strength-trained
athletes (SA), and a control group (C) of 33 age-matched
sedentary subjects. Cardiac function was assessed by
conventional and tissue Doppler echo: global systolic
function from EF, short-axis function from PW, and
long-axis systolic (STDE) and diastolic (ETDE) function
from mean 6 basal segments velocities; arterial stifness
from augmentation index (AIx) and carotido-femural
pulse wave velocity (PWV); endothelial function from
fow mediated dilatation (FMD); and ventriculo-arterial
interaction from amplitude of the compression wave
(CW) from the carotid wave intensity recordings. NT-
proBNP, markers of myocardial fbrosis, and markers
of oxidative stress (OS) were measured.
Results: Both groups of athletes had signifcant, but
simi lar, LVH; however, EA had better longitudinal func-
tion (table), whereas short-axis function was similar,
associated with augmented arterial and endothelial
function and lower OS, with improved ventriculo-
arterial. NT-proBNP and markers of myocardial fbrosis
were not diferent between the groups.
Conclusions: Although both EA and SA have phy sio-
logical LVH, endurance exercise is associated with better
longitudinal function, due to optimized ventriculo-
arterial interaction. STDE (cm/s) ETDE (cm/s) AIx
(%) PWV (m/s) FMD (%) CW(mmHg.m.s-3x103)
OS (nmol/mg) EA 120.9 17.40.3 -10.97 7.12.4
16.76.9 37.121.5 0.259071 SA 100.8 13.70.4
0.0796 8.52 12.54.5 17.114.5 0.5490,9 C 10.11
15.80.2 -2.211 8.81.1 144.1 17.613.4 0.4280.88
p (ANOVA) <0.0001 <0.0001 <0.001 <0.0001 <0.009
<0.0001 0.001 p (EA vs SA) <0.0001 <0.0001 <0.009
<0.0001 <0.025 <0.01 <0.0001

146. Factorii de risc si
bolile cardiovasculare la
femeile varstnice
M. Cebanu, D T. Zdrenghea, A. Sitar-Taut, D. Pop, D.
Petrovai
Premise: La femeile in varsta factorii de risc si bolile
cardiovasculare devin egale ca frecventa sau chiar mai
frecvente decat la barbati. In Romania, acest aspect nu a
fost studiat pana acum, chiar daca riscul si mortalitatea
prin afectiuni cardiovasculare sunt foarte ridicate.
Material si metoda: In Cluj-Napoca, Romania a fost
studiat un lot reprezentativ de 250 de femei cu varsta
>65 de ani, comparativ cu un un lot similar de barbati.
Factorii de risc cardiovascular au fost evaluati utilizand
atat date privind prevalenta bolilor cardiovasculare
extra se din fsele medicilor de familie, precum si pe
date obtinute pe baza examinarilor clinice, ECG si de
labo ra tor (lipide serice, glicemie).
Rezultate: Valorile medii ale tensiunilor sistolica si
dias to lica si ale glicemiei nu au fost semnifcativ dife-
rite la femei comparativ cu barbatii, dar valoarea
me die a colesterolului plasmatic (218.6754.12 vs
197.2145.18mg%) si a trigliceridelor (148.0577.98
vs 125.7173.29mg%)au fost semnifcativ mai cres cute
la femei (p<0.05). Prevalenta factorilor de risc cardio-
vascular a fost mai mare la femei decat la barbati,
exceptand fumatul, care s-a intalnit de aproape doua
ori mai frecvent la barbati (18.1%) decat la femei (7.4%)
p<0.05. Dislipidemia (colesterol crescut, trigliceride
cres cute sau ambele) a fost inregistrata la 48.5% dintre
Suplimentul A, 2008
1I1
femei si la 32.3% dintre barbati (p<0.05), diabetul
zaharat la 21.2% vs 15.9% (p>0.05), hipertensiunea la
91.3% vs 84.5% (p>0.05), obezitatea la 29.5% vs 20.5
% (p<0.05). Prevalenta bolilor cardiovasculare a fost
aproximativ egala la femei (62.1%) si barbati (57.8%)
p>0.05, prevalenta cardiopatiei ischemice find semni-
fcativ mai crescuta l a femei (55.7% vs 47.4%, p<0.05),
spre deosebire de accidentul vascular cerebral (16.3%
vs 19.9%, p>0.05) si bolile arteriale periferice (4.5%
vs 10%, p<0.05) care inregistreaza o prevalenta mai
crescuta la barbati. Infarctul miocardic vechi (femei
5.7% vs barbati 12% p<0.05) a fost intalnit de doua ori
mai frecvent la barbati, insa angina pectorala a fost mai
frecventa la femei (21.2% vs 12.7% p<0.05). Prevalenta
insufcientei cardiace (9.8% la femei si 11.2% la barbati,
p>0.05) si a aritmiilor (femei 23.5%, barbati 22.7%,
p>0.05) a fost apropiata in cele doua grupuri.
Concluzie: Factorii de risc si bolile cardiovasculare
inregistreaza o prevalenta crescuta in randul femeilor
varstnice in Romania. Factorii de risc cardiovascular, cu
exceptia fumatului sunt mai frecventi decat la barbati,
insa prevalenta bolilor cardiovasculare este similara la
femeile varstnice si la barbati, ceea ce impune adoptarea
unor masuri energice si rapide de preventie secundara.

Cardiovascular risk factors and
disease in old women
M. Cebanu, D T. Zdrenghea, A. Sitar-Taut, D. Pop, D.
Petrovai
Background and purpose: In old women cardiovascular
risk factors and disease become equal or more frequent
than in men. In Romania, this aspect wasnt studied
until now, even if the cardiovascular risk and mortality
are very high.
Methods: In the urban community of Cluj-Napoca,
Romania a representative sample of 250 women aged
>65 years was studied in comparison with an equal
sample of aged men. Te cardiovascular risk factors
were registered as well as the prevalence of cardio vas-
cular disease using general practitioners fles, but also
cli ni cal, ECG and laboratory examination (serum lipi-
ds, glycemia).
Results: Te mean values of systolic and diastolic blood
pressure and glicemia were not signifcantly diferent in
women in comparison with men, but mean cholesterol
(218.6754.12 vs 197.2145.18mg%) and triglycerides
(148.0577.98 vs 125.7173.29mg%) were signi fcantly
increased in women (p<0.05). Te car dio vascular
risk factors were more prevalent in women than in
men except smoking habit, more than double in men
(18.1%) than in women (7.4%) p<0.05. Dys lipidemia
(high cholesterol, triglycerides or both) was registered
in 48.5% of women and 32.3% of men (p<0.05), diabetes
mellitus in 21.2% vs 15.9% (p>0.05), hypertension in
91.3% vs 84.5% (p>0.05), obesity in 29.5% vs 20.5 %
(p<0.05), Te prevalence of cardiovascular disease
was close in women (62.1%) and men (57.8%) p>0.05,
ischemic heart disease being signifcantly more prevalent
in women (55.7% vs 47.4%, p<0.05), but stroke (16.3%
vs 19.9%, p>0.05) and peripheral arterial disease (4.5%
vs 10%, p<0.05) in men. Old myocardi al infarction
(women 5.7% vs men 12% p<0.05) was double in men,
but stable angina was dominant in women (21.2% vs
12.7% p<0.05). Te prevalence of heart failure (9.8% in
women and 11.2% in men, p>0.05) and of arrhythmias
(women 23.5%, men 22.7%, p>0.05) was very close in
both groups.
Conclusion: Te cardiovascular risk and disease are
very high in Romanian old women. Cardiovascular risk
factors, except smoking, are more prevalent in women,
but the prevalence of cardiovascular disease is the same
in old women and men and imposes strong and urgent
secondary prevention measures.

147. Predictori clinici si
paraclinici ai mortalitatii la
pacientii cu disectie acuta
de aorta
Cati Istrate, Oana Andrei, Monica Bengus,
Oana Mihailescu, Horatiu Moldovan,
Bogdan Radulescu, Andrei Iosifescu, Razvan Vasile,
Serban Bubenek, Daniela Filipescu, Ovidiu Chioncel,
Cezar Macarie
Bucuresti Romania
Scop: analizarea parametrilor clinici si paraclinici si
relatia acestora cu mortalitatea intraspitaliceasca la pa-
cientii cu disectie de aorta in perioada ianuarie 2004-
februarie 2008.
Suplimentul A, 2008
1I5
POSTER III
Material si metoda: lotul urmarit a inclus 135 pacientii
internatii consecutiv cu diagnosticul de disectie de
aorta, in perioada ianuarie 2004-iunie 2008 in Insti-
tutul de Boli Cardiovasculare CC Iliescu. Au fost ana-
li zate: tipul de disectie, patologia asociata, tabloul
clinic la internare, tehnica de diagnostic, tratamentul
initial, parametrii ecocardiografci (aorta la inel, aorta
ascendenta, aorta la crosa, aorta descendenta, aorta
abdominala, FE a VS, prezenta regurgitarii aortice) si
relatia acestora cu mortalitatea intraspitaliceasca.
Rezultate: varsta medie in lotul de studiu a fost de
59,5 +/-13,54, 29,6% (40 pts) au fost femei si 70,3%(95
pts) barbati. Din cei 135 pacienti cu disectie de aorta,
67,4% (91 pts) au avut disectie de tip A iar 32,6 %(44
pts) disectie tip B.
La 87,40%(118 pts) debutul a fost cu durere toracica,
6,66% (9 pts) cu durere abdominala, 21,48 % (29 pts)
au prezentat la debut tablou clinic de tamponada care
s-a asociat cu o mortalitate semnifcativ mai mare
(51,72%), 17,03 % au prezentat la debut sincopa,
23,07% au avut ischemie periferica acuta la prezentare,
3,7% accident vascular cerebral, iar 37,77% au avut la
internare creatinina mai mare de 1,2 mg/dl.
Din punct de vedere al patologiei asociate, 4,44% (6
pts) din cei urmariti au avut sindrom Marfan, 1,53%(2
pts) ectazie anulo-aortica, 6,66%(9 pts) diabet zaharat iar
90,37 % erau hipertensivi. Mortalitate intraspitaliceasca
generala a fost de 34 % (46pts); 31,86 % (29 pts) in
disectia de tip A si 38,63 % (17pts) in disectia de tip B.
In ceea ce priveste mortalitatea in functie de tipul de
disectie si interventia chirurgicala rezultatele au fost
21,66 % decese la pacientii cu disectie de tip A operati si
66,66% la pacientii cu disectie de tip A neoperati versus
51,61 % decese la pacientii operati cu disectie de tip B si
7,6 % la pacientii cu disectie de tip B neoperati.
De asemenea mortalitatea intraspitaliceasca a fost
mai mare la pacientii cu tamponada la internare(51,72%
vs 29,24%), sincopa (60,86% vs 28,57%), ischemie peri-
ferica acuta (38,70%) si accident vascular cerebral
(75%).
Concluzii: Disectia de aorta este asociata cu mortalitate
generala crescuta. Majoritatea pacientilor cu disectie de
aorta erau hipertensivi iar modalitatea de prezentare a
fost variabila, tamponada cardiaca, sincopa, ischemia
periferica si accident vascular cerebral asociindu-se cu
mortalitate intraspitaliceasca semnifcativ mai mare.
Alte variabile asociate cu mortalitate ridicata au fost
sexul feminin, varsta si creatinina de 1,2 mg/dl la inter-
nare. Interventia chirurgicala precoce a scazut morta-
litatea in disectiile de tip A dar nu si in cele de tip B.

Clinical and paraclinical
predictors of mortality in
patients with acute aortic
dissection
Cati Istrate, Oana Andrei, Monica Bengus, Oana Mi-
hailescu, Horatiu Moldovan, Bogdan Radulescu, An-
drei Iosifescu, Razvan Vasile, Serban Bubenek, Daniela
Filipescu, Ovidiu Chioncel, Cezar Macarie
Institute of Cardiovascular Diseases Prof.
Dr.C.C.Iliescu, Bucharest Romania
Aim: analysis clinical and paraclinical characteristics
and relation with in hospital mortality in patients with
acute aortic dissection between January 2004-February
2008.
Material and method: the group of study included
135 patients successively hospitalized with acute aortic
dissection diagnoses between January 2004-February
2008 in the Institute of Cardiovascular Diseases C.C.
Iliescu. It was analyzed: type of dissection, associated
disease, clinic presentation, imaging techniques, ini tial
treatment, echocardiography parameters(aortic annu-
lus, ascending aorta, descending aorta, abdominal aor-
ta, ejection fraction of LV, aortic regurgitation) and
their relation with in hospital mortality.
Results: mean age in the study group was 59,5+/-
13,54 and the gender separation was 29,6 %(40 pts)
female gender and 70,3% (95 pts) male gender. From
the group of 135 patients with acute aortic dissection,
67,4% (91 pts) had type A dissection and 32,6% (44
pts) had type B dissection. 87,40% (118 pts) had chest
pain on admission, 21,48% (29 pts) had pericardial
tamponade and was associated with a higher mortality
rate (51,72%), 17,03% had syncope on admission,
23,07% had acute peripheral diseases, 3,7% had stroke
and 37,77 % had a higher serum creatinine than 1,2
mg/dl.
From the associated pathology point of view, 4,44%
(6 pts) had Marfan syndrome, 1,53% (2 pts) annulo-
aortic ectasia, 6,66 %(9 pts) had diabetus mellitus, and
90,37 % high blood pressure.
Overall mortality was 34% (46 pts), 31,86% (29 pts)
in patients with type A and 38,63% (17 pts) in patients
with type B dissection. Regarding type of dissection and
surgical intervention mortality the results were 21,66
% deceases on patients with type A dissection who
sufered an surgical intervention and 66,66 % deceases
Suplimentul A, 2008
1I6
on patients with type A dissection with no surgical
inter vention versus 51,61% deceases on patients with
type B dissection who sufered an surgical intervention
and 7,6% on patients with type B dissection with no
surgical intervention.
Also in hospital mortality was higher in patients with
tamponade in the moment of admission in hos pital
(51,72% vs 29,24%), syncope(60,86% vs 28,57%) and
acute peripheral disease ( 38,70%) and stroke (75%).
Conclusions: Acute aortic dissection is associated
with high overall mortality. Majority of patients with
acute aortic dissection had high blood pressure and
the presentation method was diferent like pericardial
tamponade, syncope, acute peripheral diseases and
stroke in association with a higher rate of in hospital
mortality. Early surgical intervention decreases the
mortality in type A dissection but not in type B.

148. Parkinsonismul indus de
trimetazidin (T)
Conf Dr Corneliu Zeana
Spitalul de urgen Floreasca Bucureti
Trimetazidina este larg utilizat n Romnia, dei nu se
adreseaz fondului patologic al bolii coronariene. Stu-
dii efectuate pe grupe de pacieni au artat c T indu-
ce un sindrom extrapiramidal n 25-43% din cazu ri i
c n cazurile de boal Parkinson preexistent se nre-
gistreaz agravri.
Caracterul studiului: clinic.
Obiectiv: verifcarea potenialului efectelor adverse ale
T asupra sistemului extrapiramidal.
Material i metod: 1. Se prezint 4 cazuri de de fracturi
de col femural i humeral produse prin cdere la bolnavi
care au dezvoltat Parkinsonism sub administrare de
trimetazidin.
2. Studiu pe 68 pacieni tratai cu T , sub aspectul
Parkinsonismului.
Rezultate: doi din cei patru pacieni cu fracturi osoase
au decedat ca urmare a complicaiilor.
Cu o excepie, boala Parkinson preexistent a fost
agravat dup administrarea T. Apariia unui sindrom
extrapiramidal de novo sub T s-a observat la un sfert
din cazuri.
n toate cazurile a fost vorba de pacieni peste 60 de
ani.
Discuii: T acioneaz la nivel metabolic nu numai
asu pra miocardului ci i asupra altor celule i esuturi,
sistemul nervos find vulnerabil
Concluzii: 1. Administrarea trimetazidinei poate indu-
ce un sindrom Parkinsonian, ndeosebi la vrst nici. 2.
Frecvena ridicat (un sfert din cazuri) a Par ki n so nis-
mului trimetazidinic restrnge indicaiile adminis trrii
acestui medicament.

Extrapyramidal side effects of
trimetazidine
Conf. Dr. Corneliu Zeana
Emergency Hospital Floreasca Bucharest
Trimetazidine is largely used in Romania. In the lite-
rature, it was reported a 25-43% of side efects on the
extrapyramidal system in the form of Parkinson disea-
se.
Aim of the study: to verify the potential harmful efect
of trimetazidine on the extrapyramidal system. Clinical
study.
Material and method: 1. Four cases of bone fracture,
consequence of the gait and movement disturbances
that appeared under trimetazidine administration.
3. Clinical follow up of 68 patients treated with tri-
metazidine.
Results: Two of the four patients with bone fractures
died because of complications. With one exception, a
preexistent Parkinson disease worsened under trime-
tazidine. More than 20% of pateints developed an extra-
pyramidal syndrome (tremor, muscular rigidity, Noika
sign, gait and walk troubles).
Discussion: Trimetazidine disturb not only the metabo-
lism of the cardiac cells, but acts also on the central ner-
vous system.
Conclusions: 1. trimetazidine induces rather frecvently
an extrapyramidal syndrome.
2. Tis side efect is frecvently encountered so that the
administration of trimetazidine should be restrained.

Suplimentul A, 2008
1II
POSTER III
149. Determinarea velocitatilor,
deformarii si ratei deformarii
miocardice la indivizi normali
utilizand Vector Velocity
Imaging
Ruxandra Jurcut
1
, Gabriel Pintea
2
, Sorin Giusca
1
,
Frank Rademakers
3
, Jan Dhooge
3
, Jens-Uwe Voigt
3
,
Carmen Ginghina
1
1
Departamentul de Cardiologie, Institutul de Boli
Cardiovasculare Prof.dr.C.C.Iliescu, Romania
2
Policlinica Promedica, Braila, Romania
3
Laboratory of Cardiovascular Imaging and Dynamics,
Catholic University Leuven, Leuven, Belgium
Obiectiv: Vector Velocity Imaging (VVI) este o tehnica
ecocardiografca noua care masoara velocitatile si defor-
marea miocardica pe baza principiului speckle track-
ing, nefind dependenta de unghiul de insonatie al ultra-
sunetelor. Nu au fost inca publicate valorile normale
pentru aceasta tehnica. Scopul studiului nostru a fost
determinarea valorilor de referinta normale pentru
indicii de velocitate si deformare miocardica la nivelul
ventricului stang (VS) utilizand VVI si investigarea
paternului de distributie a deformarii la acelasi nivel.
Materiale si metode: Au fost efectuate examinari
ecocardiografce la 90 de indivizi sanatosi (67 barbati,
varsta medie 41.69.1ani, limite 24-66 ani). Datele au
fost achizitionate la 60-80 frame pe secunda. Velcitatile
miocardice longitudinale (V) si indicii de deformare
(strain, S) si rata deformarii (strain rate, SR) s-au obti-
nut din sectiunile apical 4, 3 si 2 camere. Strain-ul post-
sistolic a fost defnit ca diferenta dintre S postsistolic
maxim si S sistolic maxim. Parametrii de deformare
radiala si circumferentiala s-au cuantifcat in incidenta
parasternal ax scurt la nivelul muschilor papilari ai VS.
Rotatia torsiunea au fost evaluate utilizand incidenta
parasternal ax scurt la nivel bazal si apical.
Rezultate: Dintr-un total de 1620 de segmente, 206 au
fost excluse din analiza datorita unei delimitari inadec-
vata in cursul examinarii VVI (fezabilitate 87.2%).
De for marea miocardica longitudinala (-16.35.0% la
baza, -19.55.8% la nivel mediu so -21.66.5% la ni-
vel apical, p ANOVA<0.001) a prezentat un gra dient
baza-apex. Deformarea longitudinala post-sis to li ca
a fost scazuta (media globala VS 1.62.0%). Para me-
trii de deformare radiala au fost: V=3.40.5 cm/s,
S=32.911.7%, SR=1.90.4 s-1. Parametrii de defor-
mare cir cum ferentiala inregistrati au fost: V=4.10.3
cm/s, S=16.17.2%, SR=1.40.5 s-1. Rotatia ba za la a
fost in sen sul acelor de ceasornic (-3.52.7), in timp
ce ro ta tia api cala a fost in sens invers acelor de ceasor-
nic (7.44.5), cu o valoare medie a torsiunii VS de
1.280.31/cm.
Concluzii: VVI este o noua tehnica ecocardiografca
cu fezabilitate clinica buna. Aceste valori normale de
referinta vor putea f utilizate drept etalon in evaluarea
prin aceasta metoda a pacientilor cu diferite afectiuni
miocardice.

Velocity vector imaging
derived left ventricular systolic
myocardial deformation and
torsion parameters in healthy
adults
Ruxandra Jurcut
1
, Gabriel Pintea
2
, Sorin Giusca
1
,
Lieven Herbots
3
, Frank Rademakers
3
,
Jens-Uwe Voigt
3
, Jan Dhooge
3
, Carmen Ginghina
1
1
Department of Cardiology, Institute of Cardiovascular
Diseases Prof.dr.C.C.Iliescu, Romania
2
Policlinica Promedica, Braila, Romania
3
Laboratory of Cardiovascular Imaging and Dynamics,
Catholic University Leuven, Leuven, Belgium
Purpose: Velocity vector imaging (VVI) is a new
echo cardiographic technique which measures myo-
cardial velocity and deformation based on speckle
tracking, independent of ultrasound beam angle.
Lef ventricle (LV) deformation is known to be a 3-
dimensional process, consisting of longitudinal, radial
and circumferential deformation, as well as torsion.
Te aim of our study was to describe normal reference
values for myocardial deformation and torsion indices
in the lef ventricle (LV) using VVI.
Methods: Echocardiography was performed in 90
healthy volunteers (67 males, mean age 41.69.1 years,
limits 24-66 years). Data was acquired with a frame
rate of 60-80 fps. Longitudinal myocardial deformation
indices strain (S) and strain rate (SR) were derived from
apical 4, 3 and 2-chamber views. Postsystolic strain was
defned as the diference between postsystolic peak strain
and systolic peak strain. Radial and circumferential
Suplimentul A, 2008
1I8
deformation para meters were measured in a parasternal
short axis view at lef ventricular papillary muscles
level. Rotation (rot) and torsion (tor) parameters were
derived using the parasternal short axis views at basal
and apical levels.
Results: From a total of 1620 segments, we excluded
206 segments from analysis due to inaccurate track ing
during VVI evaluation (87.2% feasibility). Lon gi tudinal
myocardial S (-16.35.0% at base, -19.55.8% at mid and
-21.66.5% at apical level, p ANOVA<0.001) presented
a base-to-apex gra dient. Te longitudinal postsystolic
strain was low (overall LV mean 1.62.0%). Mean LV
radial indi ces were: V=3.40.5 cm/s, S=32.911.7%,
SR=1.90.4 s
-1
. Mean LV circumferential indices were:
V=4.10.3 cm/s, S=16.17.2%, SR=1.40.5 s
-1
. Basal
rot was clockwise (-3.52.7), while apical rot was
counterclockwise (7.44.5), with LV tor of 1.280.31/
cm.
Conclusions: VVI is a new echocardiographic tech-
nique with good clinical feasibility. Tese nor mal
reference values will allow comparison in pati ents with
various myocardial diseases when eva luated using this
method.

150. EUROASPIRE III
Romania Follow-up
prevalena factorilor de risc
cardiovascular la subiectul
asimptomatic cu risc
Craciun L
1
, Avram C
2
, Iurciuc S
1
, Avram CA
1
,
Sarau CA
1
, Iurciuc M
1
, Mancas S
1
, Gaita D
1
1
Institutul de Boli Cardiovasculare Timisoara, UMF V.
Babes Timisoara
2
Universitatea de Vest Timioara, Facultatea de
Educaie Fizic i Sport
Premise: Studiile EUROASPIRE I (1995/1996) si II
(2000/2001) au indicat o prevalenta crescuta a stilului
de viata nesanatos, factorilor de risc modifcabili si
tratamentului inadecvat al acestora.
Obiective: Obiecivul principal al acestui studiu l repre-
zint determinarea prevalenei factorilor de risc cardio-
vascular i realizarea unei imagini obiective a preveniei
cardiovasculare practicate n Romania la subiectul
asimptomatic cu risc. De asemenea studiul urmrete
s evalueze n ce msur sunt respectate recomandrile
europene privind prevenia cardiovascular la pacienii
cu risc cardiovascular crescut precum i optimizarea
tratamentului in acord cu ghidul actual de prevenie a
bolilor cardiovasculare (2007).
Material si metod: Au fost inclui n studiu 345 de
pacienti cu vrsta de 58+ 9 ani din care 39% brbai,
evaluai iniial n cadrul studiului EUROASPIRE III Ro-
mania. Criteriile de includere au fost: subieci asimpto-
matici afai sub tratament antihipertensiv i/sau hipol-
ipeminat i/sau antidiabetic, iar vrsta peste 80 de ani
i diagnosticul de boala aterosclerotica n atecedente
au fost criterii de excludere. Evaluarea la includere si
cele 3 evaluri consecutive la inteval de 6 luni au con-
stat n examen clinic (nlime, greutate circumferina
abdominal, valori tensionale, frecven cardiac) i
paraclinic (glicemie a jeun, hemoglobina glicozilata
la pacienii diabetici, lipidograma complet, albu-
minurie calitativ/cantitativ, proteina C reactiv inalt
senzitiv, concentratia monoxidului de carbon n aerul
expirat i determinarea indicelui glezn-bra).
Rezultate si concluzii: Rezultatele acestui studiu vor
furniza o imagine comprehensiv asupra msurilor
de identifcare a factorilor de risc i a managementu-
lui acestora la indivizii cu risc cardiovascular crescut.
Rezul tatele pariale indic o prevalen crescut a fac-
torilor de risc cardiovasculari: 78% dintre pacieni sunt
hipertensivi, 60% prezint dislipidemie i 18,4% au dia-
bet zaharat, n timp ce 37,9% au asociat doi, respectiv
6,15% trei dintre factorii de risc enumerati anterior.
27,1% dintre pacieni au indicele de masa corporal
peste 30 kg/m
2
, n timp ce 51,2% dintre femei respec-
tiv 21% dintre brbai prezint obezitate de tip central
(circumferin abdominal >80 cm la femei i >94 cm
la brbai). Prevalena sindromului metabolic conform
criteriilor Federaiei Internaionale de Diabet (IDF), este
de 42% ceea ce confera acestor pacieni un risc cardio-
metabolic crescut. Efciena tratamentului la pacienii
cu diabet zaharat (diet i/sau medicaie antidiabetic)
s-a dovedit a f sczut - doar la jumtate dintre acetia
s-a reuit meninerea hemoglobinei glicozilate la nive-
lul recomandat de ghidurile actuale (HbA1c <6,5%).
n ceea ce privete fumatul, 13% dintre pacieni sunt
fum tori activi, avnd un nivel de monoxid de carbon
de peste 10 ppm n aerul expirat. Dintre factorii de risc
mai recent descrii, remarcm prezena sindromului
infamator (proteina C reactiv peste 5 mg/l) la 20%
dintre pacieni.
Rezultatele fnale ale studiului EUROASPIRE III
Romania Follow-up (Iulie 2009) vor arta n ce msur
Suplimentul A, 2008
1I9
POSTER III
sunt implementate recomandrile europene actuale de
pre venie cardiovascular primar i totodat vor per-
mite evaluarea efcienei programelor de prevenie din
prac tica clinic, n scopul reducerii mortalitalitii i
morbi ditii de cauz cardiovascular.

EUROASPIRE III Romania
Follow-up Prevalence of
cardiovascular risk factors in
asymptomatic high risk
patients
Craciun L
1
, Avram C
2
, Iurciuc S
1
, Avram CA
1
,
Sarau CA
1
, Iurciuc M
1
, Mancas S
1
, Gaita D
1
1
Victor Babe University of Medicine and Pharmacy
Timioara, Romania
2
University of West Timioara, Romania
Introduction: EUROASPIRE I (1995/1996) and II
(2000/ 2001) studies indicated a high prevalence of un-
heal thy lifestyle, cardiovascular risk factors and their
ina de quate treatment.
Objectives: Te main objective of this study is to
empha size the prevalence of cardiovascular risk fac-
tors and to achieve an objective image of practicing
cardio vascular prevention in Romanian asymptomatic
high risk patients. As well, the study will evaluate the
implementation of European recommendation of car-
diovascular prevention in high risk patients and will
try to optimize their treatment according with the gui-
delines of cardiovascular disease prevention (2007).
Material and methods: 345 patients (58+ 9 years, 39%
men) evaluated at baseline in EUROASPIRE III Roma-
nia were included. Inclusion criteria were: asympto-
matic high risk patients with antihypertensive and/or
hypolipemiant and/or antidiabetic treatment. Exclu-
sion criteria were: age over 80 years and atherosclerotic
diseases. Te evaluations (at baseline and another 3
reevaluation in 6 months interval) consists in clini-
cal examination (height, weight, waist circumference,
blood pressure, heart rate) and paraclinic examination
(fasting plasma glucose and HbA1c - in diabetic pa-
tients, blood lipids, qualitative/quantitative microalbu-
minuria, high sensitive C-reactive protein, breathing
CO concentration and ankle-brachial index)
Results and conclusions: Te results of this study will
show us a comprehensive image about cardiovascular
risk factors management in asymptomatic high risk
patients. Partial results indicate a high prevalence of
cardiovascular risk factors: 78% of patients are hyper-
tensive, 60% are dyslipidemic and 18,4% are diagnosed
with diabetes while 37.9% associates 2 respective 6.15%
associates 3 from the previous risk factors. 27.1% from
patients have BMI>30 kg/m
2
while 51.2% of women and
21% of men have central obesity (waist circumference
>80 cm in women and >94 cm in men). Te prevalence
of metabolic syndrome according to IDF criteria is 42%
which add a high cardiometabolic risk to these patients.
Te ef ciency of treatment in diabetic patients was poor,
just a half of them reached the target of HbA1c (<6.5%)
according with current guidelines. Just 13% of patients
were active smokers with breathing CO concentration
over 10 ppm. Regarding more recent cardiovascular
risk factors, infammatory syndrome was found in 20%
of patients (CRP>5mg/l).
Finale results of EUROASPIRE III Romania Follow-
up study (July 2009) will show us the level of imple-
mentation of the current European guidelines for pri-
mary prevention and also they will evaluate the ef -
ciency of prevention programmes in clinical practice for
redu cing the cardiovascular mortality and morbidity.

151. Infectiile dupa implantul
unui dispozitiv antiaritmic-
complicatii oricand posibile ?
Mirela R. Petre, Mihaela Mihaila, Ion Bostan, Cristian
Capraru, Radu Ciudin
Institutul de Boli Cardiovasculare Prof.dr.C.C.Iliescu,
UMF Carol Davila- Bucuresti
Tratamentul infectiilor asociate implantari unui dispo-
zitiv antiaritmic ramane o provocare.
Material si metoda: In acest studiu am analizat tipul,
momentul de aparitie si tratamentul complicatiilor
infectioase dupa implantul unui dispozitiv antiaritmic
la toti pacientii ce au primit aceasta procedura la Insti-
tutul de Boli Cardiovasculare Prof.Dr.C.C.Iliescu, in
intervalul septembrie 1995- aprilie 2008. In aceasta
perioada au fost 4900 de implanturi de dispozitiv
cardiac. Am inclus 36 pac. si am analizat retrospectiv a
datele obtinute din foile de observatie.
Suplimentul A, 2008
180
Rezultate: In total 36 pac., cu varsta cuprinsa intre 15
si 85 ani (mediana 70,1 ani), 18 pac. de sex masculin
(50%), au fost internati cu diagnosticul de infectie aso-
ciata unui dispozitiv antiaritmic. Rata de aparitie a
infectiilor dupa implantul unui PM/ICD a fost 0,73%.
In clinica noastra toti pacientii au primit proflaxie cu
antibiotic timp de 3-5 zile postimplant.
Dispozitivele antiaritmice au fost pacemaker de tipul
VVI (28 pac.), DDD (3 pac.), AAI (1 pac.) , si respectiv
ICD pentru 3 pac. (1 pac. primind IDC+CRT). Indicatia
initiala de cardiostimulare a fost: BAV de grad II sau III
(61.1%), boala de nod sinusal (27.8%), TV/ FiV (8.3.%),
hipersensibilitatea sinus carotidian (2,8%).
Infectiile au aparut dupa implantul primar de
pacemaker (25 pac.), repozitionarea sondei (5 pac.),
schimbarea generatorului (3 pac.), interventie ptr.
hematom local (2 pac). si up-gradarea sistemului (1
pac.). Un debut tardiv al infectiei- dupa 30 zile au
avut 24 pac. (66,6%).
Simptomatologia si semnele clinice au fost: infectia
buzunarului/ sondei la 16 pac. (44,4 %), eroziunea
buzu narului 14 pac. (38,9 %), endocardita infectioasa
asociata dispozitivului la 9 pac. (25%). 3 pac. cu
endo cardita aveau si infectie de buzunar/ sonda de
stimulare.
La examenul bacteriologic s-au identifcat: staflo co-
cul auriu (50%), staflococul auriu meticilino-rezistent
(21,3%), germeni gram negativ (21,3%), staflcocul epi-
der midis (7,4%).
Pentru cei 27 pac. cu infectie localizata doar la nivelul
buzunarului/ sondei durata tratamentului antibiotic a
fost in medie de 10 zile. Explantarea pacemaker-ului s-a
realizat la 16 pac., cu reimplantarea unui nou dispozitiv
contralateral (11 pac.), profund subpectoral (4 pac.)
sau in acelasi loc (1pac.). Mediana duratei de spitalizare
a fost de 13,2 zile (3-35 zile). Pe durata urmaririi (482
zile) 6 pac. au avut recaderei.
Pacientii cu endocardita au primit tratament anti-
biotic pe o durata medie de 30 zile. Extragerea totala a
sistemul de pacing s-a efectuat chirurgical la 5 pac. (4
pac. necesitand valvuloplastie tricuspidiana, iar 1 pac.
by-pass aortocoronarian). Generatorul de puls a fost
implantat la nivelul peretelui abdominal cu electrozi
de stimulare epicardici. In cazul a 2 pac. extragerea
sondelor endocavitare s-a facut percutan, prin tractiune
manuala. Nu s-au inregistrat complicatii in caz de
extractie percutana a sondei.Un pacient a decedat prin
sepsis. Mediana duratei de spitalizare a fost de 45 zile
(17-90 zile). Pe parcursul monitorizarii ulterioare (210
zile) nu s-au inregistrat recaderi.
Concluzii:
1) Rata de aparitie a infectiilor asociate dispozitivelor
antiaritimice in clinica noastra a fost 0,73%, mult sub
cea raportata in literatura de specialitate.
2) Aparitia infectiei este oricand posibila in evolutia
pacientilor cu PM/ICD, asociata sau nu procedurii de
implant.
3) Tratamentul infectiilor asociate dispozitivelor de
pacing este complex, difcil si individualizat.

Infections post antiarrhythmic
devices implant-
Always possible ?
Mirela R. Petre, Mihaela Mihaila, Ion Bostan,
Cristian Capraru, Radu Ciudin
Institute of Cardiovascular Diseases Prof.
dr.C.C.Iliescu , UMF Carol DavilaBucharest
Treatment of antiarrhythmic devices implant related
infections remains always a challenge.
Material and method: In this study we have analyzed
type, timing and treatment of infectious following
antiarrhythmic devices implants in all patients receiving
such procedure at Institute of Cardiovascular Diseases
Prof.dr.C.C.Iliescu, between September 1995- April
2008. In this period there were 4900 cardiac devices
implants.
We have included 36 patients. It was a retrospective
review of the medical records.
Results: A total of 36 patients, aged between 15 and
85 years (median 70,1 years), 18 males (50%), were
admitted with infection associated to antiarrhythmic
devices. Infection occurrence rate in pts with a pace-
maker/ICD implant was 0,73%.
All patients have received a prophylactic adminis tra-
tion of antibiotics for 3-5 days following there implant
procedure.
Antiarrhythmic devices used were pacemakers: VVI
(28 pts), DDD (3 pts.), AAI (1 pt.) and ICD for 3 pts.
(1 pt. received an ICD+ CRT). Initial pacing indication
was: second and third degree AVB (61.1%), sick sinus
synd rome (27.8%), TV/VF (8.3%), carotid sinus hyper-
sensitivity (2,8%).
Infections occurred post primary implant procedure
for 25 pts., lead repositioning for 5 pts., box-change for
Suplimentul A, 2008
181
POSTER III
3 pts., local hematoma for 2 pts. and system upgrade
for 1 pt.
Late onset infection - occurred more that 30 days
post implant- in 24 pts. (66,6%).
Clinical signs and symptoms observed were pocket/
lead infection for 16 pts. (44,4 %), pocket erosion for 14
pts.(38,9 %), device-related endocarditis in 9 pts. (25%).
3 pts with endocarditis also had pocket/ lead infection.
Te microbiology exam has identifed: Staphylococcus
aureus (50%), MRSA (21,3%), gram-negative bacilli
(21,3%) and Staphylococcus epidermitis (7,4%).
For 27 pts. with infection localized only at the
pocket/ lead, antibiotic treatment with a median of 10
days was given. Pacemaker removal was underwent in
16 pts. and reimplanting of a new device on the con-
tra lteral side (11 pts.), subpectoral (4 pts.) or on the
same side (1pt.) was performed. Te average duration
of hospitalization was 13,2 days (3- 35 days). Median
follow-up for possible side efects was 482 days, 6 pts.
having relapse of infection.
Patients with endocarditis were treated with a median
of 30 days of antibiotics. Total pacing system removal
was done surgically in 5 pts. (4 pts. required a tricuspid
valvuloplasty and 1 pt. CABG). Te pulse generator was
placed in an abdominal site with epicardial leads.
2 pts. underwent percutaneous lead extraction with
use of manual extraction. Tere were no complications
in the cases of transvenous lead removal. One patient
died with sepsis.Te average duration of hospitalization
was 45 days (17-90 days). In the follow-up (210 days),
there was no relapse.
Conclusions:
1) Tere was a reduced occurrence rate of antia-
rythmic devices related infections in our Institute
(0,73%), much lower than in the literature.
2) Occurrence of infection is anytime possible
du ring pacemaker and ICD pts follow-up, implant or
non implant related.
3) Treatment of infections caused by pacing devices
is complex, dif cult and individualized.
182
VARIA I
cinetic parietal i BNP seric la 24 h (BNP vs. FEVS:
R2=0,19; p<0,001 i BNP vs indexul scorului de
cinetic segmentar: R2=0,67; p<0,0001). Mortalitatea
la un an de urmrire a fost de 2,3% la aceast populaie
cu risc sczut dup STEMI (clasa Kilip I, tratai cu
reperfuzie).
Concluzie: La pacienii cu STEMI fr semne de
insufcien cardiac, concentraia seric de BNP se
coreleaz cu amplitudinea necrozei miocardice. Acest
rezultat sugereaz c severitatea leziunii ischemice
acute este refectat i de nivelul seric al BNP.

153. Evaluarea efectelor acute
ale radioterapiei asupra functiei
cardiace prin analiza
deformarii miocardice la
pacientele cu cancer mamar
stang
R.O. Jurcut
1
, K. Erven
2
, J. Ector
4
, C. Weltens
2
,
W. Van den Bogaert
2
, H. Wildiers
3
, J. Dhooge
4
,
F. Rademakers
4
, J.U.Voigt
4
1
lare Prof.dr.C.C.Iliescu, Bucuresti, Romania
2
Departamentul de Oncologie si Radiologie
3
Departament Oncologie Medicala
4
Departamentul de Cardiologie, Spitalul Universitarl
Gasthuisberg, Leuven, Belgium
Obiectiv: Radioterapia in cancerul mamar stang poate
conduce la disfunctie miocardica pe termen lung. Efec-
tele precoce ale acesteia asupra functiei miocardice nu
au fost inca evaluate. Imagistica prin Doppler miocardic
(IDM) s-a dovedit o metoda sensibila pentru cuantifcare
modifcarilor subclinice ale functiei miocardice. Acest
studiu isi propune evaluarea modifcarilor incipiente ale
functiei miocardice regionale induse de radioterapie.
Metode: Au fost examinate 20 de femei (varsta
55,313,2 ani) cu cancer mamar stang. Toate pacientele
au primit radioterapie la nivel mamar cu unde fotonice
152. Corelaia dintre
concentraia seric a BNP i
extensia necrozei miocardice n
STEMI
Blnescu ., Scafa Udrite A., Constantinescu D.,
Onu R., Ginoiu E., Fruntelat A., Dan M., Teodor-
escu C., Tatu-Chioiu G., Dorobanu M.
Clinica de Medicin Intern i Cardiologie, Spitalul
Clinic de Urgen Bucureti
Scop: Am determinat relaia dintre nivelul seric al BNP
i amploarea necrozei miocardice la pacienii (pts) cu
infarct miocardic acut cu supradenivelare de segment
ST (STEMI).
Metode: Am nrolat 88 pts (78 brbai, 88,6%) n vrst
de 51,6+/-11 ani cu STEMI internai in primele 12 h
de la debutul durerii. Au fost selectai numai pts care
aveau clasa Killip I la internare i nu aveau istoric de
insufcien cardiac. Toi pacienii au primit tratament
de reperfuzie prin tromboliza (n=45; 51,1%) sau
angioplastie primar (n=43; 48,9%). Fracia de ejecie
(FEVS) msurat la internare nainte de administrarea
oricrei terapii de reperfuzie a fost de 45,8+/-7,1%.
Concentraia seric a BNP a fost msurat la internare,
la 24h i la 30 zile de la debutul IMA. CK i CK-MB
au fost apreciate la fecrae 6h ptr 3 zile, n timp ce
mioglobina i troponina I (TnI) au fost determinate la
intrare i la 24h. Reperfuzia miocardic apreciat prin
reducerea supradenivelrii segmentului ST cu >50%
(pe lng criteriile angiografce utilizate la cei care au
suferit PCI primar) a fost observat la 72 pts (81,8%).
Rezultate: Concentraia BNP seric s-a corela cu nivelul
plasmatic al TnI, mioglobinei, CK i CK-MB nc de
la intrare, n primele 12 h de la debutul simptomelor.
Corelaia cea mai puternic s-a remarcat pentru valorile
serice determinate la 24 h: BNP vs. TnI (R2=0,59;
p<0.001; CI 95%=9,03-13,05) i BNP vs. mioglobina
(R2=0,55; p<0,001; CI 95%=0,79-1,2). Valoarea BNP
la 24 h s-a corelat cu amploarea necrozei miocardice
exprimat prin creterea maxim a CK (R2=0,56;
p<0,001; CI 95%=0,05-0,07) i a CK-MB (R2=0,58;
p<0,001; CI 95%=0,43-0,63). S-a remarcat o corelaie
strns ntre valoarea FE a VS, indexul scorului de
Suplimentul A, 2008
188
VARIA I
tangentiale sau la nivel toracic cu campuri electronice
directe. Doza totala a fost de 50 Gy in 25 de fractiuni.
La 12 paciente, nodulii limfatici interni mamari si
supraclaviculari mediali au fost de asemenea iradiati.
Pe baza histogramelor de doza-volum, doza medie
la nivelul cordului a fost de 5,94,2 Gy. Au fost deter-
minate valorile vitezei (V), strain rate-ului (SR) si
strain-ului (S) maxim sistolic la nivelul celor 18 seg-
mente ale ventricului stang (VS)(6 bazale, 6 medii si 6
apicale). Doza cumulata de radiatii la nivelul fecarui
seg ment miocardic a fost calculata pe baza unui volum
3D specifc fecarei paciente obtinut pe baza datelor de
computer tomograf utilizate pentru planifcarea trata-
mentului.
Rezultate: Datele conventionale si IDM au fost obtinute
la toate pacientele inainte si dupa radioterapie. Pe baza
datelor de planifcare ale radioterapiei, 163 (45,2%)
segmente ale VS au fost incluse in campul de radioterapie,
cu o medie de 83 segmente per pacienta (limite 3-18).
Dimensiunile VS, fractia de ejectie, excursia sistolica
a inelului mitral si parametrii conventionali ai functie
diastolice nu s-au modifcat dupa radioterapie. Pe de
alta parte, o reducere semnifcativa a S (de la -21.36.6%
la -18.47.0%, p<0.001) si a SR (de la -1.400.46s-1 la
-1.230.39s-1, p<0.001) a fost evidentiata la nivelul
segmentelor miocardice ce au primi o doza cumulativa
mai mare de 5 Gy, dar nu si la nivelul celorlalte seg-
mente (-22.26.3% la -21.06.1% si -1.430.37s-1 la
-1.380.33s-1, amandoua NS).
Concluzii: Spre deosebire de evaluarea ecocardiografca
conventionala, s-a evidentiat o reducere a parametrilor
de deformare miocardica imediat dupa incetarea radio-
terapiei pentru cancer mamar stang. Sunt necesare stu-
dii pentru evaluarea relatiei dintre aceste modifcari pre-
coce si disfunctia miocardica pe termen lung.

Acute radiation effects on
cardiac function detected by
strain rate imaging in
left-breast cancer patients
R.O. Jurcut
1
, K. Erven
2
, J. Ector
4
, C. Weltens
2
,
W. Van den Bogaert
2
, H. Wildiers
3
, J. Dhooge
4
,
F. Rademakers
4
, J.U.Voigt
4
1
Deparment of Cardiology, Institute of Cardiovascular
Diseases, Bucharest, Romania
2
Department of Radiation Oncology
3
Department of Medical Oncology
4
Deparment of Cardiology, University Hospital Gast-
huisberg, Leuven, Belgium
Purpose: Radiotherapy for lef-sided breast cancer
can be associated with long-term cardiac dysfunction.
Early efects on myocardial function have not yet been
described. Doppler Myocardial Imaging (DMI) has
been shown to be a sensitive echocardiographic tool
for quantifying subtle changes in regional cardiac
function. Tis study investigates the occurrence of early
radiation-induced changes in regional cardiac function
using DMI.
Methods: We examined 20 women (age 55.313.2
years) with lef-sided breast cancer. All patients received
radiotherapy to the breast or chest wall by respectively
tangential photon beams or direct electron felds. Dose
prescription was 50 Gy in 25 fractions. In 12 patients,
the internal mammary and medial supraclavicular
lymph nodes were also irradiated.Based on the dose-
volume histograms, the mean heart dose was 5.94.2
Gy. Standard echocardiography and DMI data were
obtained before and afer radiotherapy. Peak systolic
longitudinal velocity (V), strain rate (SR) and strain
(S) were measured in all patients for the 18 (6 basal,
6 mid and 6 apical) lef ventricular (LV) segments.
For each patient, the cumulative radiation dose to the
diferent myocardial segments was calculated using a
patient-specifc 3D cardiac volume obtained from the
treatment planning computer tomography datasets.
Results: Conventional and DMI data could be obtained
in all patients before and afer radiotherapy. Based on
the radiotherapy planning data, 163 (45.2%) LV myo car-
dial segments were included in the radiotherapy feld,
with an average of 83 segments/patient (limits 3-18).
LV dimensions, ejection fraction, mitral annulus plane
systolic excursion and conventional parameters of
VARIA I Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
181
diastolic function did not change afer radiotherapy. In
contrast, a signifcant reduction in S (from -21.36.6%
to -18.47.0%, p<0.001) and SR (from -1.400.46s-1
to -1.230.39s-1, p<0.001) was found afer treatment
at the level of myocardial segments irradiated with
a cumulative dose above 5 Gy, but not in the other
segments (-22.26.3% to -21.06.1% and -1.430.37s-
1 to -1.380.33s-1, respectively, both NS).
Conclusions: In contrast to conventional echocardio-
graphy, myocardial deformation parameters allowed
the detection of regional decrease in myocardial defor-
mation immediately afer the end of radiotherapy for
lef breast cancer. Further follow up is ongoing to assess
the relation between these early changes and long term
dysfunction.

154. Modificari ale functiei
diastolice si deformarii
miocardice asociate cu
nivelul seric al BNP la pacienti
cu functie sistolica a
ventriculului stang normala
I Craciunescu
1
, C. Revnic
1
, M. Serban
1
, M. Iancu
1
,
D. Muraru
1
, A. Craciunescu
2
, V. Uscatescu
3
, R. Jurcut
1
,
B A. Popescu
1
, C. Ginghina
1
1
Iliescu
2
Spitalul Clinic Colentina
3
Institutul Clinic Fundeni
Peptidul natriuretic tip B (BNP) reprezinta nu numai
un puternic factor de prognostic cardiovascular, dar si
un marker de insufcienta cardiaca (IC).
Obiectiv: Scopul studiului este de a identifca modif-
carile nivelelor serice de BNP la pacienti cu functie
sistolica normala a ventriculului stang (VS) si fara insu-
fcienta cardiaca clinic manifesta.
Metoda: Am analizat 24 de pacienti cu boala coro na-
riana ischemica, confrmata prin coronarografe, fara
IC clinica si cu fractie de ejectie a VS (FE-VS) normala
(FE-VS 50%). S-au dozat nivelele serice ale BNP la toti
pacientii, la momentul efectuarii ecocardiografei. Pa-
cientii au fost investigati prin ecocardiografe standard
si 2D strain imaging. FE-VS a fost calculata prin
metoda Simpson. Au fost evaluati urmatorii parametri
ai functiei diastolice: velocitatea de propagare a fuxului
prin valva mitrala la mod M color (Vp), raportul E/A
la nivelul valvei mitrale si timpul de decelerare a undei
E (TDE), velocitatea miocardica septala diastolica pre-
coce (Em) si raportul E/Em. Analiza 2D strain a fost
efec tuata of ine cu un sofware dedicat (ECHOPAC)
pe imagini achizitionate din 3 sectiuni parasternale
(ax scurt la nivelul valvei mitrale, muschilor papilari si
api cal) si 3 sectiuni longitudinale (apical 4-camere, 2-
camere si 3-camere). S-au calculat strain global (S) si
strain rate global (SR) longitudinal (L), circumferential
(C) si radial (R) prin media valorilor segmentare.
Rezultate: Valoarea medie a BNP seric a fost de 169 pg/
ml. Nivelul seric al BNP s-a corelat cu FE-VS (r=-0.51,
p=0.02) si strainul longitudinal global (r= -0.54, p=0.01).
Nu s-au inregistrat asocieri semnifcative statistic intre
nivelul seric de BNP si S circumferential sau radial,
si nici cu SR longitudinal, radial sau circumferential.
BNP nu s-a corelat cu valorile E mitral, Em si Vp, dar
s-a corelat cu E/Em si E/Vp (r=0.41, p=0.04; respectiv,
r=0.39, p=0.047). Nu au existat corelatii semnifcative
intre nivelul seric al BNP si aria atriului stang, volumele
end-diastolice si end-sistolice ale VS. 11 pacienti din
grupul de studiu au avut istoric de infarct miocardic
mai vechi de o luna. Corelatia a fost mai puternica intre
BNP si SL global la pacientii cu infarct miocardic (BNP
mediu 250.0 pg/ml, SL global mediu 13.31%, r= -
0.65) in comparatie cu pacientii fara infarct miocardic
(BNP mediu 110.36 pg/ml, SL global mediu -15.2%, r=
-0.41).
Concluzie: Valorile serice ale BNP se coreleaza cu FE-
VS, strainul longitudinal global si parametri de functie
diastolica la pacientii cu FE-VS prezervata si fara IC
clinic manifesta.

Suplimentul A, 2008
185
VARIA I
Changes in diastolic function
and myocardial deformation
associated with serum levels of
BNP in patients with preserved
systolic left ventricle function
I Craciunescu
1
, C. Revnic
1
, M. Serban
1
, M. Iancu
1
,
D. Muraru
1
, A. Craciunescu
2
, V. Uscatescu
3
, R. Jurcut
1
,
B A. Popescu
1
, C. Ginghina
1
1
Iliescu
2
Spitalul Clinic Colentina
3
Background: B-type natriuretic peptide (BNP) repre-
sents not only a powerful predictor for cardiovascular
outcome, but also a marker of heart failure (HF).
Purpose: To investigate the signifcance of changes in
BNP levels in patients (pts) with normal lef ventricular
(LV) systolic function and without clinical HF.
Methods: We analyzed 24 patients with coronary artery
disease confrmed by angiography, without clinical
HF and normal lef ventricle ejection fraction (LV-EF
50%). Serum levels of BNP, drawn at the time of echo-
cardiography, were available for all pts. Standard echo-
cardiography and 2D strain were performed. LVEF was
calculated by Simpsons method. Diastolic function
para meters were evaluated: color M-mode Doppler fow
velocity propagation (Vp), mitral E/A ratio and E-wave
decelaration time (EDT), early diastolic myocardial
velocity at the septal site (Em), as well as the E/Em
ratio. 2D strain analyses were performed on loops
acqui red from 3 parasternal short-axis views (mitral
valve, papillary muscles and apical levels), as well as on
3 apical views (4-chamber, 2-chamber, long axis). We
calcu lated global longitudinal (L), circumferential (C)
and radial (R) strain (S) and strain rate (SR) values as
the average of segmental values.
Results: Mean values of BNP levels was 169 pg/ml.
Serum levels of BNP correlated with LVEF (r= - 0.51,
p=0.02) and global LS (r= -0.54, p=0.01). Tere was no
correlation between BNP levels and CS or RS, and also
longitudinal, circumferential or radial SR. Tere were
no correlations between BNP and mitral E, Em, and
Vp, but BNP correlated with E/Em and E/Vp (r=0.41,
p=0.04; r=0.39, p=0.047). No signifcant correlations
were found between BNP levels and lef atrial area, LV
end-diastolic and end-systolic volumes. 11 pts from the
study group had a history of old myocardial infarction
(> 1 month). Correlation was stronger between BNP
and global LS in patients with myocardial infarction
(mean BNP 250.0 pg/ml, mean global LS 13.31%, r=
-0.65), compared to those without previous myocardial
infarction (mean BNP 110.36 pg/ml, mean global LS
-15.2%, r= -0.41).
Conclusion: BNP levels correlate with LVEF, global
longi tudinal strain and diastolic function parameters
even in pts without clinical HF and with preserved
LVEF.

155. Evaluarea functiei
ventriculului stang la pacienti
cu infarct miocardic in
antecedente prin strain rate
imaging
Evaluarea corecta a functiei ventriculului stang (VS)
dupa un eveniment coronarian acut este esentiala pen-
tru prognosticul si evolutia ulterioara a pacientului.
Progresele recente in cuantifcarea functiei VS utilizand
metode ecografce noi, precum two-dimensional (2D)
strain imaging contribuie la o evaluare obiectiva si mai
precisa.
Obiectiv: Scopul studiului este de a caracteriza functia
VS prin parametrii de strain, la pacienti cu infarct mio-
cardic (IM) in antecedente si de a-i compara cu para-
metrii conventionali de evaluare a functiei VS.
Metoda: Au fost evaluati 32 de pacienti cu IM in ante-
cedente (varsta medie 57,39,1 ani, 27 barbati) utilizand
un sofware dedicat de analiza a strain bidimensional
(ECHOPAC). S-au calculat of ine parametrii de strain
(S) si strain rate (SR) radial (R), circumferential (C) si
longitudinal (L) pe imagini achizitionate in trei sectiu-
ni parasternale ax scurt (la nivelul valvei mitrala, al
muschilor papilari si la nivel apical) si in trei sectiuni
longitudinale (apical 4-camere, 2-camere si 3-camere).
Fractia de ejectie a VS (FE-VS) a fost calculata prin
meto da Simpson. Indexul de kinetica a peretilor VS
(wall motion score index WMSI) a fost calculat ca
medie a scorurilor date de evaluarea estimativa vizuala
a kineticii fecarui segment al VS.
Rezultate: Valorile medii pentru FE-VS si WMSI au fost
51,5 9.5% si, respectiv, 1.88 0.7. FE-VS s-a corelat
cu S longitudinal (r=0.48, p=0.004) si SR longitudinal
Suplimentul A, 2008
186
(r=0.45, p=0.007), precum si cu S circumferential
(r=0.33, p=0.03) si SR circumferential (r=0.31 p=0.04).
Asocierea intre FE-VS si S si SR radial nu a atins semni-
fcatia statistica. Tabelul integreaza valorile medii ale SL,
SR-L, SC, SR-C, SR, SR-R in segmentele normokinetice,
hipokinetice, akinetice si diskinetice. Doar S si SR longi-
tudinal si circumferential au diferit semnifcativ intre
grupe, in timp ce diferentele de S si SR radial nu au fost
semnifcative statistic.
SL SR-L SC SR-C SR SR-R
Segm.
normokinetice
-16.9892 -1.1081 -18.57 -1.41 33.36 1.77
Segm.
hipokinetice
-16.3478 -.9978 -16.02 -1.35 40.45 1.99
Segm. akinetice -15.2806 -.9890 -13.05 -1.30 30.36 1.76
Segm.
diskinetice
-4.1120 -.3800 -11.15 -1.20 25.96 1.65
p-value
(ANOVA)
0.000 0.002 0.003 0.03 0.13 0.31
Concluzie: Evaluarea vizuala a kineticii parietale este
bazata mai mult pe magnitudinea miscarii miocardice si
mai putin pe ingrosarea parietala, astfel ca modifcarile
de deformare in sens radial pot f subestimate. Corelatia
intre FE-VS si strainul longitudinal, precum si lipsa
unei asocieri semnifcative cu strainul radial refecta
importanta crescuta a straturilor longitudinale in func-
tia globala a VS, precum si cresterea compensatorie a
functiei radiale, consecutiv afectarii ischemice a func-
tiei longitudinale.

Characterization of left ventric-
ular function in patients with
previous myocardial infarction
by strain rate imaging
Accurate assessment of lef ventricular (LV) function
afer a coronary event is essential for patient mana ge-
ment. Recent advances in quantifcation of LV function
using advanced echocardiographic metho ds such as
2D strain imaging contribute to a more precise and
objective evaluation.
Purpose: To characterize LV strain parameters in pa-
tients (pts) with previous myocardial infarction (MI)
and to compare them with conventional parameters of
LV systolic function.
Methods: We evaluated 32 pts with previous MI (age
57.3 9.1 y; 27 men) using dedicated 2D strain sofware
(ECHOPAC) to calculate radial (R), longitudinal (L)
and circumferential (C) strain (S) and strain rate (SR)
in 3 apical views and 3 short axis views. LVEF was
calculated by Simpsons method. Wall motion score
index (WMSI) was calculated as the average of scores
assigned by visual assessment to every LV segment.
Results: Mean values for LVEF and WMSI in the study
group were 51.5 9.5% and 1.88 0.7, respectively.
LVEF correlated with longitudinal S and SR (r=0.48,
p=0.004; r=0.45, p=0.007 respectively) and with circum-
ferential S and SR (r=0.33, p=0.03; r=0.31 p=0.04
respectively). Correlations between LVEF and RS and
R-SR did not reach statistical signifcance. Te table
summarizes mean values of LS and L-SR, CS and C-SR,
RS and R-SR in normokinetic, hypokinetic, akinetic
and dyskinetic segments. Only longitudinal and
circumferential S and SR difer signifcantly between
groups, while RS and R-SR did not.
Conclusion: Visual assessment of wall kinetics is based
more on the magnitude of myocardial movement and
less on that of wall thickening, therefore deformation
changes in the radial direction may be underestimated.
Te correlation between LV-EF and LS, as well as the
lack of association with RS, may refect the higher
importance of longitudinal layers in global LV systolic
function and consecutive raising in radial function,
compensatory to ischemic longitudinal dysfunction.
LS L-SR CS C-SR RS R-SR
Normokinetic -16.9892 -1.1081 -18.57 -1.41 33.36 1.77
Hypokinetic -16.3478 -.9978 -16.02 -1.35 40.45 1.99
Akinetic -15.2806 -.9890 -13.05 -1.30 30.36 1.76
Diskinetic -4.1120 -.3800 -11.15 -1.20 25.96 1.65
p-value
(ANOVA)
0.000 0.002 0.003 0.03 0.13 0.31

Suplimentul A, 2008
18I
VARIA I
156. Dissincronismul rotaiei
apicale i bazale: un posibil
mecanism de alterare precoce a
funciei ventriculare stngi
D. Muraru
1
, B. A. Popescu
1,2
, A. Teodorescu
1
,
C. C. Beladan
1
, O. Savu
1
, C. Ginghin
1,2
1
Iliescu, Bucureti
2
Universitatea de Medicin Carol Davila, Bucureti
Premise: Torsiunea i detorsiunea ventriculului stng
(VS) reprezint componente importante ale unei per-
formane cardiace normale. Sincronismul contrac iei
regionale VS este la fel de important pentru o func ie
cardiac normal. Datele despre diferenele de timp
ntre momentul de rotaie maxim a apexului VS n
raport cu cel bazal i infuena acestora asupra para me-
trilor de funcie VS sunt n prezent limitate.
Obiective: Analiza variabilitii intervalului de timp
dintre rotaia maxim apical (RAM) i bazal (RBM)
i evaluarea corelaiei acesteia cu diveri parametri de
funcie sistolic i diastolic VS.
Metod: Au fost nrolai consecutiv 60 subieci normali
(vrsta: 3612, interval 18-73 ani, 17 brbai). Toi
subiecii au fost supui unei examinri ecocardiografce
complete, incluznd seciuni de ax scurt VS la nivel
apical i bazal pentru evaluarea rotaiei VS. Torsiunea
VS (torVS) a fost defnit ca diferenta maxim ntre
unghiurile de rotaie la nivel apical i bazal, normalizat
la lungimea diastolic a VS. Detorsiunea VS a fost
cuantifcat prin msurarea velocitii maxime de
detorsiune derivate prin scderea n fecare moment a
ratei rotaiei de la cele dou nivele. Au fost msurate
intervalul de la vrful undei R (ECG) la vrful rotaiei
maxime apicale (TRAM) i bazale (TRBM) i diferena
ntre ele (TAB).
Rezultate: Torsiunea VS a fost 185, iar torsiunea
nor malizat a fost de 2,4 0,7/cm. Fracia de ejecie
VS a fost 623%. RAM a fost de 13 5, n timp ce
RBM a fost de -6 3. TRAM a fost de 33138 ms iar
TRBM a fost de 33249 ms. Diferena medie ntre cele
dou intervale de timp a fost de 3532 ms. Douzeci
i patru de subieci (40%, grupul 1) au avut o diferen
semni fcativ de timp ntre RAM i RBM (35 ms).
Evalua rea comparativ a celor dou grupuri, grupul 1
(TAB35 ms) i grupul 2 (TAB<35 ms, 36 subieci) a
artat o reducere semnifcativ a torsiunii VS (p=0,02)
i a detorsiunii VS (p=0,03) n grupul 1. Mai mult, au
existat diferene semnifcative n privina parametrilor
de funcie diastolic ntre cele dou grupuri (velocitatea
de propagare a fuxului -Vp a fost redus i raportul
E/Vp crescut n grupul 1, p=0,008 pentru ambele;
timpul de decelerare a undei E a fost mai lung n
grupul 1, p=0,003). Intre cele dou loturi nu au existat
diferene semnifcative de vrst, frecven cardiac,
FEVS, volume i mas VS i RAM (p>0,20 pentru
toate), dei RBM a fost mai mic n grupul 1 (p=0,02).
A existat o tendin la atingerea torsiunii maxime VS
dupa nchiderea valvei aortice (p=0,05) n grupul 1.
Dife renele menionate ntre cele dou grupuri s-au
meninut i cnd TAB a fost corectat la RR (ECG).
Concluzii: O diferen de timp crescut ntre atin ge-
rea rotaiei maxime apicale i bazale infueneaz per-
formana sistolic i diastolic a VS. Pierderea sincro-
nismului apico-bazal al rotaiei VS poate repre zenta un
mecanism de alterare precoce a funciei ventriculare
stngi.

Differences in timing of peak
apical and basal rotation: a
possible mechanism for early
alterations in left ventricular
mechanics
D. Muraru
1
, B. A. Popescu
1,2
, A. Teodorescu
1
,
C. C. Beladan
1
, O. Savu
1
, C. Ginghin
1,2
1
Institute of Cardiovascular Diseases, Bucharest, Roma-
nia
2
Carol Davila University of Medicine, Bucharest, Roma-
nia
Background: Lef ventricular (LV) twisting and unt-
wisting are important components of normal cardiac
per formance. Synchronicity of regional LV contraction
is also important for normal cardiac function. Limited
information exists regarding the apex vs base diference
in rotational timing and its infuence on cardiac func-
tion parameters.
Purpose: To analyze the heterogeneity in timing of peak
apical rotation (PAR) relative to peak basal rotation
(PBR) and to assess its correlation with parameters of
LV systolic and diastolic function.
Suplimentul A, 2008
188
Methods: Sixty normal subjects were consecutively
en rolled (age: 3612, range 18-73 years, 17 men). A
com prehensive echocardiogram was performed in all,
including parasternal basal and apical LV short-axis
views to assess rotation at each level. LV torsion (LVtor)
was defned as the peak diference between rotation
angles at the apex and base, normalized for LV diastolic
longitudinal length. LV untwisting was quantifed
by measuring peak untwisting velocity derived by
subtracting rotation rates at both planes for each time
point. Time intervals from peak R wave (ECG) to PAR
(TTPAR) and PBR (TTPBR) and the diference between
them (TAB) were also measured.
Results: LVtor was 185 and normalized LVtor was
2.4 0.7/cm. LV ejection fraction (EF) was 623%.
PAR was 13 5, while PBR was -6 3. TTPAR was
33138 ms and TTPBR was 33249 ms. Mean time
diference between TTPAR and TTPBR was 3532
ms. 24 subjects (40%, group 1) had a signifcant time
diference between PAR and PBR (35 ms). Comparative
evaluation between group 1 (TAB35 ms) and group
2 (TAB<35 ms, 36 subjects) showed signifcantly
reduced LVtor (p=0.02) and untwisting (p=0.03) in
group 1. In addition, signifcant diferences regarding
diastolic function indices were found between groups
(fow velocity propagation Vp was lower and E/Vp
ratio was higher in group 1, p=0.008 for both; E-wave
deceleration time was longer in group 1, p=0.003). Of
note, there were no diferences between groups in age,
heart rate, LVEF, LV volumes and LV mass or PAR
(p>0.20 for all), yet PBR was lower in group 1 (p=0.02).
LV torsion tended to peak afer aortic valve closure in
group 1 (p=0.05). All of the above diferences between
groups held also true when the TAB corrected to the
RR interval (ECG) was used in analyses.
Conclusions: Increased time diference between peak
apical and peak basal rotation infuences both systolic
and diastolic LV performance. Loss of synchronicity
in apical-basal rotation may be a mechanism for early
alterations in LV mechanics.
189
VARIA II
E/Vp (1,76 vs 1,95, p=0,5). Prevalena blocului
de ramur stng nu a fost semnifcativ diferit ntre
grupuri. Volumele telesistolic (5823 ml/m
2
vs 11455
ml/m
2
, p=0,006) i telediastolic VS (8523 ml/m
2
vs
15677 ml/m
2
p=0,036) au fost semnifcativ mai mari
n grupul 2. Diametrul maxim latero-septal al VS, m-
surat n telediastol din seciunea apical 4 camere (ca
msur a sfericitii cavitii) a fost semnifcativ mai
mare n grupul 2 (305 mm/m
2
vs 3810 mm/m
2
,
p=0,014). Fracia de scurtare VS a fost semnifcativ mai
mic (187% vs 122%, p=0,007), n timp ce fracia de
ejec ie VS i strain-ul global longitudinal au fost doar
uor sczute n grupul 2 (3212% vs 266%; -114 vs
-72, p=0,08 pentru ambele).
Concluzii: Rotaia apical inversat observat la pacien-
ii cu CMDNI se asociaz cu remodelare VS marcat
(dimensiuni i form) i reducere important a funciei
sistolice VS. STE permite evaluarea rotaiei i torsiunii
VS, facilitnd studierea mecanismelor disfunciei VS la
pacienii cu CMDNI.

Left ventricular rotation and
torsion in patients with dilated
cardiomyopathy: could left
ventricular remodeling explain
changes in torsional dynamics?
B. A. Popescu
1,2
, C. C. Beladan
2
, A. Teodorescu
2
,
D. Muraru
2
, D. Deleanu
2
3
,
G. L. Nicolosi
3
, C. Ginghin
1,2
1
Romania
2
Romania
3
Italy
Background: During systole, the apex of the lef
ventricle (LV) rotates counterclockwise (when viewed
from the apex), whereas the base rotates clockwise,
creating a torsional deformation of the LV, due to the
157. Influena remodelrii
ventriculare asupra rotaiei i
torsiunii ventriculare stngi
la pacienii cu cardiomiopatie
dilatativ non-ischemic
B. A. Popescu
1,2
, C. C. Beladan
2
, A. Teodorescu
2
,
D. Muraru
2
, D. Deleanu
2
3
,
G. L. Nicolosi
3
, C. Ginghin
1,2
1
Universitatea de Medicin i Farmacie Carol Davila,
Bucureti
2
Iliescu, Bucureti
3
Italia
Premise: Contracia sistolic a fbrelor miocardice orien-
tate helicoidal determin rotaia antiorar a apexului i
rotaia orar a bazei (privite dinspre apex), genernd
micarea de torsiune. Dilatarea ventricular stng
(VS) conduce la orizontalizarea fbrelor musculare obli-
ce, infuennd, cel puin teoretic, torsiunea VS.
Scop: Evaluarea rotaiei i torsiunii VS i a relaiei dintre
parametrii de torsiune i de remodelare VS la pacienii
cu cardiomiopatie dilatativ non-ischemic (CMDNI),
cu ajutorul ecocardiografei speckle-tracking (STE).
Metod: Au fost nrolai prospectiv 27 de pacieni con-
secutivi cu istoric documentat de CMDNI (4914 ani,
22 brbai). Toi pacienii au fost supui unei examinri
ecocardiografce complete. Au fost achiziionate sec-
iu ni de ax scurt la nivelul bazei i apexului VS n
sco pul cuantifcrii rotaiei VS cu ajutorul unui sof-
ware dedicat (2D strain, EchoPac). Strain-ul global
longi tudinal a fost evaluat din seciuni apicale (4, 3, 2
camere) cu ajutorul STE.
Rezultate: Au fost identifcate 2 tipuri de rotaie apical
i au fost constituite 2 grupuri de studiu: grupul 1 (rotaie
apical orientat normal, 11 pacieni) i grupul 2 (rotaie
apical inversat, 16 pacieni). Nu au existat diferene
semnifcative ntre grupuri n ceea ce privete vrsta
(p=0,2), suprafaa corporal (BSA, p=0,4), clasa NYHA
(p=0,6), raportul E/E (147 vs 179, p=0,3), velocitatea
de propagare a fuxului transmitral Vp (p=0,3), raportul
VARIA II Revista Romn de Cardiologie, Vol. XXIII
Suplimentul A, 2008
190
helically oriented myofbers. As the LV dilates, the orien-
tation of the oblique fbers changes to a more transverse
direction, which may cause alterations in LV torsion.
Purpose: To assess LV rotation and torsion and the
rela tionships between LV torsion parameters and LV
remo deling in pts with non-ischemic dilated cardio-
myo pathy (NIDCM), using Speckle Tracking Echo car-
dio graphy (STE).
Methods: Twenty-seven consecutive patients (pts) with
NIDCM (age: 4914 years, 22 men) were prospectively
en rolled. A documented history of NIDCM was avai-
lable in all pts. A comprehensive echocardiogram was
per formed in all. Te parasternal basal and apical
short-axis planes were recorded to quantify basal and
api cal LV rotation using a commercially available STE
sof ware (2D strain, EchoPac). Global longitudinal
strain was assessed from apical views (4-, 2-chamber,
and long-axis) by STE.
Results: We found 2 patterns of LV apical rotation and
formed 2 groups accordingly: group 1 (normally dire-
cted apical rotation, 11 pts), and group 2 (reversed apical
rotation, 16 pts). Tere were no diferences between
groups regarding age (p=0.2), body surface area (BSA,
p=0.4), NYHA class (p=0.6), E/E ratio (147 vs 179,
p=0.3), fow velocity propagation Vp (p=0.3), E/Vp ratio
(1.76 vs 1.95, p=0.5). Te prevalence of lef bundle
branch block was not signifcantly diferent between
grou ps. LV end-systolic (5823 ml/m
2
vs 11455 ml/
m
2
, p=0.006) and end-diastolic volumes (8523 ml/m
2

vs 15677 ml/m
2
p=0.036) were higher in group 2. LV
maximal septal-lateral diameter, measured at end-dias-
tole from the apical 4-chamber view (as a measure of
cavi ty sphericity) was also increased in group 2 (305
mm/m
2
vs 3810 mm/m
2
, p=0.014). LV fractional
shortening was signifcantly lower (187% vs 122%,
p=0.007), while LVEF and global longitudinal strain
were marginally lower in group 2 (3212% vs 266%;
-114 vs -72, p=0.08 for both).
Conclusions: Reversed apical rotation observed in pts
with NIDCM is associated with marked LV remodeling
(size, shape) and marked reduction in parameters
of LV systolic function. STE allows assessment of LV
rota tion and torsion, facilitating new insights into
the mechanisms of LV dysfunction in the setting of
NIDCM.

158. Modificarea prevalenei
factorilor de risc
cardiovascular prin programul
comprehensiv de recuperare la
pacienii protezai aortic cu i
fr by- pass aorto-coronarian
Maria Rada
1
, Dana Velimirovici
1,2
,
1
, Simona Dragan
1,2
, D. Gaita
1,2
,
Adriana Schnabel
3
, D.M. Duda Seiman
4
,
Georgiana Mancas
1
, Silvia Mancas
1,2
1
2
Institutul de Boli Cardiovasculare
3
Spitalul Clinic Municipal, Timioara, Romnia
Scop: stabilirea impactului programului comprehensiv
de recuperare cardiovascular asupra prevalenei facto-
rilor de risc cardiovascular la pacienii cu protez aortic
cu i fr by-pass aorto-coronarian concomitent.
Material i metod: au fost inclui n studiu 96 pa-
cien i din care 76 au fost protezai aortic (grupa A),
iar 20 au necesitat pe lng nlocuirea valvei aortice
i revascularizare miocardic prin by-pass aorto-coro-
narian (grupa B). La lotul studiat se remarc predo-
minena sexului masculin (63,54%), iar vrsta medie a
pacienilor a fost 687ani. Am studiat prevalena fac to-
rilor de risc cardiovascular: TA 140/90 mmHg, IMC
30 kg/m
2
, CT 200 mg/dl, diabet zaharat tip 2, con-
diia de fumtor i ex fumtor. Faza II a programului de
recu perare cardiovascular, n care antrenamentul fzic
deine un rol important, a avut o durat de 12 spt-
mni, din care primele 2 sptmni n spital cu edine
zilnice (30 min/zi) i urmtoarele 10 sptmni n
ambu lator, 3 edine/sptmn (30 min/edin), cu
inten sitate de 70-80% din frecvena cardiac maxim
atins la testul de efort. Ulterior (faza III) s-a insistat
asupra edinelor de mers pe jos. S-a urmrit efciena
msu rilor de prevenie secundar prin evaluarea preva-
lenei factorilor de risc la 6 luni postoperator. Prelu-
crarea statistic: media deviaie standard, % lot, testul
t nepereche.
Rezultate: studiul demonstreaz c pacienii valvulari
aortici i cu boal coronarian asociat (grupa B) au
o prevalen mai crescut a factorilor de risc studiai
comparativ cu pacienii grupei A. La 6 luni de la
randomizare prevalena hipercolesterolemiei a sczut
de la 40% la 23,52% (p<0,001) la grupa B, comparativ
Suplimentul A, 2008
191
VARIA II
cu grupa A (de la 28,94% la 18,30%, p<0,005). Dup
6 luni de randomizare prevalena fumtorilor activi a
fost de 21,12% la grupa A versus 11,76% la grupa B. Se
remarc o scdere statistic semnifcativ a prevalenei
fumatului la ambele grupe avnd n vedere c la
includere n studiu prevalena fumtorilor activi a fost
de 32,89% la grupa A i de 35% la grupa B.
Concluzii: leziunea valvular aortic asociat cu boal
coronarian se nsoete de o prevalen mai nalt a
factorilor de risc cardiovasculari comparativ leziunea
valvular aortic izolat. Hipertensiunea arterial,
hiper colesterolemia i fumatul, prin prevalen, modi-
fc riscul cardiovascular al valvulopatiilor aortice. Pro-
gramul comprehensiv de recuperare a determinat o
ame liorare a prevalenei factorilor majori de risc cardio-
vascular.

Amelioration of cardiovascular
risk through comprehensive
cardiac rehabilitation program
in patients with aortic valve
replacement with and without
CABG
Maria Rada
1
, Dana Velimirovici
1,2
,
1
, Simona Dragan
1,2
, D. Gaita
1,2
,
Adriana Schnabel
3
, D.M. Duda Seiman
4
,
Georgiana Mancas
1
, Silvia Mancas
1,2
1
University of Medicine and Pharmacy Victor Babes
2
Institute Of Cardiovascular Diseases
3
Municipal Clinical Hospital, Timisoara, Romania
Objective: to establish the impact of comprehensive
cardiovascular rehabilitation program on prevalence
of risk factors in patients with aortic valve replacement
with and without associated CABG.
Methods and materials: 96 patients where included in
the study, from which 76 with aortic valve replacement
(group A) and 20 with aortic valve replacement and
associated CABG (group B). Te prevalence of man was
63.54% and the average age was 687 years. We studie the
prevalence of the following cardiovascular risk factors:
BP 140/90 mmHg, BMI 30kg/m
2
, TC 200 mg/dl,
type 2 diabetes mellitus, smoking and ex-smoking
con di tion. Phase II of cardiovascular rehabilitation
pro gram emphasizes the importance of safe physical
activity and consisted of 12 weeks of exercise training:
the frst 2 weeks- in hospital with daily sessions (30min/
day), and the next 10 weeks -outpatient rehabilitation
with three sessions per week (30min/session), with an
efort level (target heart rate) between 70-80% from the
maximum heart rate achieved during the efort test.
It subsequently was emphasized the importance of
walking sessions (phase III RC). Te purpose of the
study was to determine the efectiveness of secondary
cardiac prevention programs, by evaluating risk factors
prevalence 6 months afer surgery. Statistical analysis:
average standard deviation, % lot, student t test.
Results: this study demonstrate that aortic valvular
patients with associated coronary artery disease
(group B), had a higher prevalence of studied risk
factors, compared to the A- group. Six months afer
randomization, the prevalence of hypercholesterolemia
decrease from 40% to 23,52% (p<0,001) in B- group and
from 28,94% to 8,30% ( p<0,005) on A- group, and the
prevalence of active smokers was 21,12% on A-group
versus 11,76% on B- group. We remark a signifcant
statistical decrease in prevalence of smoking in both
groups, considering the prevalence of active smokers of
32,89% in A- group and of 35% in B- group at the time
of inclusion.
Conclusions: aortic valve lesions associated with
co ro nary artery disease have a higher prevalence of
car diovascular risk factors than isolated aortic valve
lesio ns. Arterial hypertension, hypercholesterolemia
and smoking modify through their prevalence the car-
dio vas cular risk profle of patients with aortic valvulo-
pathy. Comprehensive cardiovascular rehabili ta tion
pro gra ms lead to improvement of major cardio vascular
risk factors prevalence.

159. Corelaii ntre activitatea
AC I din hematii i valorile
tensiunii arteriale
Alina Iacobescu, Sorina Magheru, F. Maghiar
Introducere: Activatorii AC I cresc valoarea TA, iar
inhi bitorii izoenzimei o scad, am studiat existana unei
posibile corelaii dintre valorile TA i activitatea AC I. n
Suplimentul A, 2008
192
acest sens a fost efectuat un studiu pe un numr relativ
mare de pacieni cu hipertensiune arterial, respectiv
pe voluntari cu valori mici ale tensiuni arteriale i pe
voluntari cu valori normale ale tensiunii arteriale.
Material i metod: Cercetrile au fost efectuate in vivo.
Am inclus 3 loturi de pacieni dup cum urmeaz: Lotul
A, 200 de voluntari sntoi, cu valori ale TA sistolice
ntre 110 i 140 mmHg i valori ale TA diastolice ntre 70
i 90 mmHg; Lotul B, 200 de pacieni afai n eviden
de cel puin 5 ani pentru hipertensiune arteriala form
moderat sau sever, respectiv cu valori ale TA la debut
ntre 160 i 200 mmHg TA sistolic respectiv ntre 100
i 120 mmHg, afai n eviden de cel puin 5 ani. Lotul
C, 200 pacieni cu valori ale tensiunii arteriale sistolice
sub 110 mmHg i valori ale tensiunii arteriale diastolice
sub 70 mmHg. La toi aceti pacieni s-au determinat
valorile TA n condiii standard i activitatea AC din
hematii.
Rezultate: La pacienii din lotul B, valorile activitii
AC I sunt de 3 ori mai mari dect la cei din lotul martor,
A, iar la cei cu valori TA mici sunt de 3 ori mai mici
comparativ cu lotul martor. n cazul activitii AC II
acest fapt nu este att de pronunat, valorile n lotul
C find la nivelul a 75% din activitatea lotului martor,
iar n lotul pacienilor hieprtensivi sunt cu 50% mai
mari dect n lotul martor. Activitatea AC I la pacienii
hipertensivi este de 0.6, adic de 3 ori valoarea din lotul
martor. Creterea activitii AC la pacienii din lotul B
s-a produs predominant prin creterea activitii AC I.
n lotul C, cu valori sczute ale TA, activitatea AC I este
0.07, de 3 ori mai sczut dect valoarea medie din lotul
martor, si de peste 8 ori mai sczut dect activitatea
AC I din lotul pacienilor hipertensivi. Activitatea
total a AC la voluntarii din acest lor este 0.75, find de
1.44 ori mai mic dect n lotul martor i de 2.5 ori mai
mic dect n lotul pacienilor hipertensivi. Scderea
activitii AC n acest caz s-a produs prin activitatea
sczut a AC I la bolnavii cu TA sczut.
Concluzii: Existena corelaiei ntre activitatea AC I
i valorile TA sugereaz implicaia AC n modifcrile
tensiunii arteriale i patogeneza HTA, ca i implicaia
inhibitorilor sau activatorilor enzimei n terapia hiper-
tensiunii sau hipotensiunii arteriale.

160. Tulburrile de
contractilitate miocardica
secundare bolilor inflamatorii
pericardice influeneaz sau nu
hemodinamica si performanta
VS?
Benedek Imre, Benedek Theodora, Sarbu Alexandru,
Chitu Monica, Matei Claudia
Clinica de Cardiologie Trgu Mure
Introducere: In pericardite extensia procesului infa-
mator de la nivelul pericardului la miocardul adia cent
poate duce la alterarea cineticii parietale, afec tnd seg-
mente afate in contact cu pericardul infa mat.
Ace st studiu utilizeaz ecocardiografa 3D compu te r-
i za ta pentru a evalua tulburrile de cinetica ale mio car-
du lui asociate pericarditelor.
Material si metode: 15 pacieni cu pericardita cronica,
la care eco 2D a evideniat prezenta pericardului ingro-
sat (4.2 mm, +/-0.5 mm) si coleciei pericardice (5.6
mm +/- 3,2 mm), localizata la nivel lateral (7 pac-
46.66%), inferior (5 pac-33.33%) si apical (3 pac-20%.
S-a efectuat ecocardiografe 3D cu un aparat Philips
7.500, computerizata pri n prelucrare cu soful QLab.
Au fost determinate curbele volumetrice ale fecrui
segment in timpul ciclului cardiac precum si hrile
polare ale timpului scurs de la debutul pana la atingerea
contraciei maxime. Coronarografa a fost efectuata in
11 cazuri pentru a exclude prezenta bolii coronariene
la cazurile cu durere toracica nespecifca si modifcri
ECG. Hemodinamica intraventriculara a fost evaluata
analiznd fuxurile doppler la 3 nivele (bazal, median si
apical ) dea lungul a3 axe. Au fost determinai timpii de
accelerare precum si timpii de decelerare.
Rezultate: tulburrile de contractilitate au fost def-
nite ca un aspect plat al curbei volumetrice cu o dife-
rena intre vol maxim si minim sub 3,5ml, precum
si ntrzierea in cretere contraciei peste 50 msec
Fracia de ejectie calculata prin eco 3D a fost nomala
in toate cazurile, (avg. 53.4% +/- 4.2%). Tulburrile
de contractilitate au fost localizate la nivelul peretelui
lateral in 6 cazuri (40%), inferior in 5 cazuri (33.33%),
apical in 3 cazuri (20%) si lateroapical la 1 caz (6,66%),
in concordanta cu localizarea pericardului infamat
(p=0.001). Diferena de timp intre volumul maxim
Suplimentul A, 2008
198
VARIA II
si minim din timpul contraciei a fost de 375 msec
in segmentele cu tulburri de cinetica comparativ cu
323 in restul miocardului. (p=0.002). intarzierea in
augmentarea contraciei a fost 57 msec in segmentele
cu tulb de cinetica comparativ cu segmentele care se
contracta normal. Toi pacienii explorai invaziv au
prezentat coronare normale. Mappingul Doppler nu
a evideniat modifcri - scdere a vitezelor de fux
uniform distribuita - 0.12 msec in zona bazala si 0.13
msec in zona apicala. (p=0.002)
Concluzii: extensia procesului infamator de la peri-
card la miocard poate infuenta contractilitatea mio-
cardica, evideniata utiliznd ecocardiografa 3D baza-
ta pe evaluarea obiectiva-cantitativa a parametrilor de
contractilitate. Totui acestea nu infueneaz per for -
manta VS exprimata prin fracia de ejectie si nici para-
metrii hemodinamici intracavitari. Studii supli mentare
sunt necesare pentru a elucida impactul pro ceselor
inlamatorii asupra funciei VS.

Myocardial contractility
disorders caused by pericardial
inflammatory diseases
influences or not left ventricu-
lar haemodynamics and
performance?
Benedek Imre, Benedek Theodora, Sarbu Alexandru,
Chitu Monica, Matei Claudia
CardiologyTargu Mures
Introduction: In pericarditis, extension of infammatory
process from the pericardium to myocardium could
lead to alteration of wall motion, involving segments
located in contact with the diseased pericardial layer.
Tis study use Computerized 3D echocardiography
(C3DE) for evaluation of myocardial motion disorder
associated with pericarditis.
Materials and methods: 15 pts with chronic peri-
carditis, in whom 2D echo showed presence of thick
pericardium (4.2 mm, +/-0.5 mm) and pericardial fuid
(5.6 mm +/- 3,2 mm), located at the level of lateral (7
pts-46.66%), inferior (5 pts-33.33%) and apical seg-
ments (3 pts-20%). C3DE was performed with Philips
7.500 machine and QLab sofware. Volumetric curve
of each myocardial segment during cardiac cycle and
polar map of time delay from onset till the maximum
contraction were obtained. Coronarography was perfor-
med in 11 cases to exclude presence of CAD in cases with
nonspecifc chest pain and ECG changes. Intracavitar
haemodynamics was evaluated using Doppler mapping
of fow velocities at 3 levels (basal, median and apical)
along 3 longitudinal axes, and fow acceleration and
decelerations were calculated.
Results: Contractility disorder (CD) was defned as a
fat type of the volumetric curve, with the diference
between the maximum and minimum volume less
than 3.5 ml, and a spot on the time delay polar map
located at the same segment, representing a delay in
contraction augmentation more than 50 msec. LVEF
calculated by C3DE was normal in all cases (avg. 53.4%
+/- 4.2%). CD was revealed by C3DE located at the
level of lateral segment in 6 cases (40%), inferior in
5 pts (33.33%), apical in 3 pts (20%) and lateroapical
in 1 patient (6,66%), in accordance with the location
of the pericardial infammation (p=0.001). Time dife-
rence between maximum and minimum volume
du ring contraction was 375 msec in segments with
CD compared with 323 in the rest of the segments
(p=0.002). Delay in contraction augmentation was 57
msec in segments with CD compared with normal
contracting segments. In all cases coronary angiography
showed normal coronary arteries. Doppler mapping of
fow velocities in the LV cavity showed no perturbance
of intracavitary fow (gradual decrease of fow velocity
from basis to apex uniformly distributed on the
longitudinal axis 0.12 msec in the basal half and 0.13
msec in the apical half- p=0.002)
Conclusions: Extension of the infammatory process
from the pericardium to the myocardial layer could
infuence myocardial contractility, which was identifed
in this study using C3DE, based on objective evaluation
and quantifcation of contractility parameters. However,
these did not infuence LV performanced expressed
by LVEF or the intracavitary fow hemodynamics.
Further studies are required to elucidate the impact of
infammatory process on LV performance.

Suplimentul A, 2008
191
161. Estimarea prin vasodilata-
tie mediata de flux (FMD) a
prognosticului evenimentelor
cardiovasculare postoperatorii
la pacienii cu boala arteriala
periferica
Stoica A
1
, Uscatescu V
2
, Constantinescu I
2
,
Ginghina. G
1
1
Iliescu
2
Obiectiv: Aprecierea disfunctiei endoteliale prin vaso-
dilatatia mediata de fux (FMD) la pacienii operai
pentru boala arteriala periferica.
Material si metoda: Acest studiu a analizat posibili
markeri de risc pentru evenimente cardiovasculare la
30 pacieni programai pentru intrerventie chirurgicala
de revascularizare vasculara periferica. Factorii de risc
analizai au fost: disfunctia endoteliala estimata prin
vasodilatatia mediata de fux (FMD), teste de infamatie
(fbrinogen, numr leucocite), severitatea bolii vasculare
periferice evaluata prin indice glezna-brat, factorii
de risc clasici ai aterosclerozei (vrsta, fumat, diabet
zaharat, hipertensiune arteriala, sindrom metabolic,
dislipidemie), fracia de ejectie a ventriculului stng
ecocardiografc si tipul interveniei chirurgicale.
Pacienii au fost urmrii timp de 30 zile postoperator
pentru apariia de evenimente cardiovasculare (deces
de cauza cardiovasculara, infarct miocardic, angina
instabila, AVC).
Rezultate: La cei 30 pacieni inclui in studiu s-au
efectuat mai multe tipuri de intervenii: by-pass aorto-
bife mural la 9 pacieni (26,7%), by-pass femuro-popli-
teu la 19 pacieni (63,3%), amputatie la 1 pacient
(3,3%) si by-pass axilo-femural la 2 pacieni (6,7%). S-
au produs evenimente cardiovasculare postoperatorii
la 3 pacieni (la 2 pacieni infarct miocardic si la 1
pacient angina instabila). Valoarea FMD preoperatorie
a fost cuprinsa intre 5,26 si 12,5% (valoare medie - 8.34
1.87%;). La pacienii cu evenimente cardiovasculare
FMD a fost semnifcativ mai mic (6.93 2.65% vs
8.49 1,76% la cei fara evenimente cardiovasculare;
p - 0.05), in timp ce vasodilatatia independenta de
endo teliu (dup administrare de nitroglicerina) a fost
similara la cele doua grupuri (12.74 1.77 % vs 14.08
2.32%). Dintre ceilali factori de risc studiai, apariia
eveni mentelor cardiovasculare a fost corelata doar cu
numrul leucocitelor (121133.3 3917.06 /mm
3
la
pacienii cu evenimente cardiovasculare vs 8197.04
1584.52/ mm3 la cei fara evenimente cardiovasculare;
p -0.002).
Concluzii: Vasodilatatia mediata de fux (FMD) este o
metoda utila pentru aprecierea preoperatorie a riscului
de evenimente cardiovasculare la pacienii programai
pentru revascularizare periferica.

Prognosis of postoperative
cardiovascular events at
patients with peripheral arterial
disease estimated by flow
mediated vasodilatation (FMD)
Stoica A
1
, Uscatescu V
2
, Constantinescu I
2
,
Ginghina. G
1
1
Iliescu
2
Objective: Endothelial function assessment by fow
mediated vasodilatation (FMD) at patients with peri-
pheral arterial disease undergoing nonemergent vas-
cular surgery.
Methods: We studied possible risk markers of post-
ope rative cardiovascular events at 30 consecutive pa-
tients with peripheral arterial disease proposed for
nonemergent vascular surgery. Risk markers inclu ded
endothelial function assessed by brachial artery fow-
mediated dilation (FMD). fbrinogen, white blood
cells (WBC), severity of PAD according to ABI, athero-
sclerosis risk factors (age, smoking, diabe tes mellitus,
hypertension, metabolic syndrome, dyslipi demia), lef
ventricular systolic function (LVEF), type of surgical
intervention. Patients were followed for cardiovascular
events (cardiac death, acute myocardial infarction, un-
stable angina, stroke) 30 days afer surgery.
Results: A total of 30 patients were included in the
study and underwent a vascular intervention, inclu-
ding aortobifemoral by-pass - 9 patients (26,7%),
femo ral-popliteal by-pass - 19 patients (63,3%), limb
Suplimentul A, 2008
195
VARIA II
ampu tation - 1 patient (3,3%), axilo-femoral by-pass
- 2 patients (6,7%). Tree patients (9,9%) had post-
operative cardiovascular events (myocardial infarction
- two patients; unstable angina - one patient). Pre ope-
rative endothelium dependent fow-mediated dilation
was between 5.26 and 12.5 and the mean value was 8.34
1.87%; at the patients with a postoperative cardio-
vascular event FMD was signifcantly lower (6.93
2.65%) than in those without an event (8.49 1,76%;
p - 0.05), whereas endothelium-independent vaso dila-
tion to nitroglycerin was similar in both groups (12.74
1.77 % vs 14.08 2.32%). Of the other outcome mea-
sures studied (age, smoking, diabetes mellitus, hyper-
tension, metabolic syndrome, dyslipidemia. WBC
counts, fbrinogen, LVEF, type of surgical intervention)
cardio vascular events were correlated only with WBC
counts (121133.3 3917.06 /mm3 vs 8197.04 1584.52/
mm
3
; p - 0.002).
Conclusions: Flow mediated vasodilatation may be a
useful method for postoperative cardiovascular events
estimation at patients with peripheral arterial disease
undergoing a nonemergent vascular surgery.
INDEX AUTORI | AUTHORS INDEX

Bolog Mihaela 37, 122, 123
Bologa Cristina 46
Bolohan M. 103
Bolohan R. 7, 60
Bornoiu Maria-Corina 9
Bostan I. 151
Branea H. 112
Brignole M. 82
Bruckner I 8, 87, 93
Bubenek S. 147
Bucsa A. 133
Bugiardini R. 3, 136
Bulandra Mariana 44
Burducea A. 4
Burlacu A. 107, 108
C
Calin C. 109
Calin Catalina 119, 130
Calmac L. 137
Calomfrescu M. 24, 25
Calota A. 37
Campeanu A. 103
Candea V. 86
Capraru C. 26, 151
Carasca E. 79, 80, 81, 82
Carp A. 47, 61, 131, 133
Cazacu Ramona 74
Cebanu M. 51, 67, 146
Chebut C. 80
Chioncel O. 13, 22, 47, 61, 131, 133
Chioncel Valentin 119, 130
Chiriac L. 60
Chiru Miruna 9
Chitu Monica 128, 129, 160
Chivu Irina 44
Christodorescu Ruxandra 53, 112, 115
Cinteza M. 3, 54, 55, 57, 107, 108, 118, 124, 136, 145
Ciobanu Andreea 118, 124
Ciobanu Lucia 114, 132, 138
Ciobanu N. 114, 138
Ciocarlie T. 73, 83, 110
Ciocrlie Tudor 10
Ciomag Raluca 75
Cismaru C.A. 90
Cismaru G.L. 90
Ciuca A. 6
A
Adam F. 75
Agoston Coldea Lucia 1
Albu M. 37
Albulescu A. 48
Alexandrescu Adriana 92
Alexandru R. 60
Ambarus V. 56
Andor Minodora 115
Andrei Irina Mariella 2, 44
Andrei Oana 135, 147
Aneida Hodo 33
Antohe Ileana 31
Anton Gabriela 46
Antonini-Canterin F. 105, 157
Antoniu Flavia 84, 85
Apetrei E. 12, 16
Arama Laura 48, 139
Arsenescu Georgescu Catalina 3, 21,30, 59, 78, 84, 85
Artenie Anca 106
Artenie R. 45, 106
Aursulesei Viviana 11, 31, 32, 66, 68, 69, 70, 71, 72
Avram C.A. 97, 150
Avram Rodica 10, 73, 83, 110
B
B.A.Popescu 27, 89,105, 154, 155, 156, 157
Babeanu Denisa 120
Badea Gabriela 37, 122, 123
Badila E. 16, 18, 19, 62
Balanescu S. 126, 137, 152
Balasanian M. 78
Balint M. 10, 73, 110
Barbat D. 115
Barsan S. 139
Bartos D. 16, 18, 19
Beladan C.C. 89, 105, 109, 156, 157
Belu E. 14, 96, 104
Benedek I. 128, 129, 160
Benedek Teodora 128, 129, 160
Bengus Monica 22, 147
Berceanu M. 95, 142
Bobescu Elena 4
Bodisz G. 15
Bogdan E. 43
Bogdan Laura 120
Suplimentul A, 2008
INDEX AUTORI
AUTHORS INDEX
Ciudin R. 151
Ciurea C. 35
Cobet V. 132, 138
Cobzariu F. 95, 142
Cocora M. 53
Coman I.M. 135
Constantin Catalina 49
Constantinescu D. 137, 152
Constantinescu I. 161
Cornu Nadia 142
Cosa F. 86
Costache I.
Costache Irina 11, 32, 70, 72, 113
Costin S. 132
Craciun L. 97, 150
Craciunescu A. 154, 155
Craciunescu I. 33, 41, 154, 155
Craiu Elvira 3, 136
Creih R.M. 111, 135
Cristian G. 7, 60
Crisu Daniela 31, 65
D
Dan Ana Maria 83
Dan Delia 29
Dan M. 152
Darabantiu D. 53, 112, 115
Darabont Roxana 62, 113
Datcu Georgeta 11, 31, 62, 65, 66, 68, 69, 71
Datcu M.D. 11, 31, 32, 65,68, 69, 70, 72, 136
David C. 79
David Marieta Gabriela 143, 144
Deleanu D. 41, 105, 109, 111, 125, 157
Diaconeasa A. 3, 136
Diaconescu C. 49
Dimitriu A.G. 28, 117
Dimulescu Doina 48,139
Dobreanu D. 23,143, 144
Dorgo M. 79, 80, 81
Dorobantu Maria 3, 9, 17, 19, 62, 92, 116, 126, 136, 137,
152
Dragan Simona 53, 91, 95, 142, 158
Dragulescu S.I. 38, 39, 63, 94
Duda-Seiman D.M. 142, 158
Dumitrascu D.L. 1
Dumitrescu Mihaela 37, 122, 123
Dumitrescu N. 92
Dumitru Dafna 74
Dusa Bianca 4
Dusceac D. 103
F
Feiler Alina 76, 77
Filimon Silvia 20
Filipescu Daniela 147
Floares E. 48
Florea Liliana 140
Florescu Cristina 120
Florescu M. 145
Florescu N. 141
Floria Mariana 56
Fraser Alan 127
Frigy A. 26
Fruntelata Ana 9, 137, 152
G
Gainoiu E. 137, 152
Gaita D. 91, 97, 150, 158
Gavrila A. 102
George Gabriela 2
Georgescu T. 21
Gheorghe Gabriela Silvia 44
Gheorghiu A. 53
Gheorghiu Al. 63, 94
Gherasim D. 58, 140
Gherghiceanu Mihaela 8
Gherghina Alexandra 135
Ghionea M. 135
Ghiorghe S. 19,16,18,62
Ghiorghiu Ioana 33, 41
Ginghina Carmen 16, 12, 24, 25, 27, 33, 41, 74, 89,102,
105, 109, 111, 140, 149, 154, 155, 156, 157, 161
Girleanu Irina 32, 72
Giusca S. 74, 149
Goga Cristina 144
Gogoasa I. 91
Grecu Mihaela 21, 30, 59, 78
Greere V. 7, 38, 39
Grigore Ileana 34
Grigore R. 34
Grigorica Lucica 47, 121
Gurghean Adriana 87, 93
Gyalai I. 115
H
Herbots L. 149
Hila G. 7
Hirsu M. 89
Hodo A. 41
Homoceanu A. 113
Hooge J. D. 149
INDEX AUTORI
AUTHORS INDEX
Suplimentul A, 2008
Hubatsch Mihaela 134

Huidu S. 48
Huidu Simona 139
I
Iacobescu Alina 64, 99, 98, 100, 101, 159
Iancu Madalina 33, 41, 154, 155
Ieremciuc Isabela 116
Ilea M. 50
Iliescu D 11,65, 70
Iliesiu Adriana 2, 44
Imre Laszlo Mihaly 134
Indries Veronica 7, 60
Ingrith Mandric 28
Ionescu D.D. 3, 6, 5, 14, 52, 96, 104, 136
Ionescu Daniela Simona 45, 106
Ionescu Luminita 48, 139
Ionescu V. 95, 142
Iorgulescu C. 116, 126
Iosifescu A 86, 147
Istrate Cati 13, 147
Istratoaie O. 6
Iurciuc M. 97, 150
Iurciuc S. 97, 150
Ivan Viviana 83
Ivanica Alina 63, 94
Ivanica G. 63, 94
Ivanov Victoria 114, 132, 138
J
Jamart J. 56
Jejeran Dorina 10
Jurcut Ruxandra 33, 74, 102, 149, 153, 154, 155
K
Kikeli Pal Istvan 134
Kocsis Ildiko 26
Kosaka T 42
Kovacs I. 129
Kulcsar Iulia 47, 61, 131, 133
L
Laky D. 86
Lautaru A. 145
Leustean Mihaela B. 7, 60
Lighezan D. 53, 112, 115
Lionte Catalina 46
Lozba A. 21, 59, 78
Luca C.T. 94, 63
Luca M.R. 62
M
Macarie C. 13, 22, 47, 61, 131, 133, 147
Magda Stefania 118, 124
Maggi R. 82
Magheru Sorina 64, 98, 99, 100, 101, 159
Maghiar F. 64, 98, 99, 100, 101, 159
Malai Adina 43
Malmare Bianca 93
Mancas Georgiana 91, 158
Mancas Silvia 91, 95, 142, 150, 158
Mandric Cristina 28, 117
Manea G. 42
Manea Paloma 45
Manescu Mirela 52
Manole C. 38, 39, 143
Marandiuc Anca 32, 72
Margulescu A.D. 54, 55, 57
Marin Irina 58, 140
Marin Mihaela 135
Marta D.S. 42
Matei C. 12, 16
Matei Claudia 160
Maxim M. 37
Meir M.La 56
Mihai Mihaela 7, 60
Mihaila Mihaela 151
Mihailescu Anca 93
Mihailescu Oana 13, 147
Mihut C. 90
Militaru C. 6, 52
Mincu Dana 119, 130
Miron Ingrith 117
Miscaliuc I. 7
Mitu F. 40
Mitu Magda 40
Moga Mariana 83
Moga V. 10, 83, 110
Moisa Cristina 30
Moldovan H. 86, 147
Moldoveanu E. 42
Moraru I. 114, 138
Moruzi Simona 30
Moscaliuc I. 38, 39
Mot S. 125
Muraru D. 89, 105, 154, 155, 156, 157
Muraru Minerva 93
Musetescu Anca 5
Musetescu Rodica 14, 96, 102, 104
Mustafa R. 6
Suplimentul A, 2008
INDEX AUTORI
AUTHORS INDEX
N
Nanea T. 44, 103
Neagoe G. 38, 39
Nechita Eugenia 121
Necula Nadia 133
Nicolae Camelia 2
Nicoleta Calomfrescu 24, 25
Nicolosi G.L. 105, 157
Niculescu R. 137
Nita D. 7, 60
O
Olariu C. 3, 136
Olinescu R. 103
Onut R. 137
Onut R. 152
Orosan R. 38, 39
Ouatu Anca 45
P
Pacuraru Elena 37, 122, 123
Pais R. 1
Palombo C. 145
Pampu G. 41
Parascan Liliana 86
Parv Florina 10, 73, 110
Pascu Florica 112, 115
Pascut D. 76, 77
Patrichi Madalina 61
Paun N. 2
Penciu O. 51
Perian M. 23, 144
Pescariu S. 63, 94
Petcu C. 120
Petcu D.D. 120
Petcu I. 145
Petre Mirela 151
Petris A. 65, 66, 136
Petris O.P. 46
Petrovai D. 15, 50, 146
Pintea G. 149
Pirvu O. 107, 108
Platon P. 133
Podoleanu C. 79, 80, 81, 82
Pop C. 3, 29
Pop D. 15, 51, 67
Pop Ioana 12, 16, 93
Pop M. 81
Popa Anca 27, 75
Popa C. 10, 73, 110
Popa M. 53
Popescu A. 48
Popescu Andreea Caterina 139
Popescu Daniela 139
Popescu M. 64, 98, 100, 101
Popescu Monica 14, 104
Popescu Roxana Coralia 48, 139
Popovici I. 114, 132, 138
Popovici M. 114, 132, 138
Postu M. 41
Preg Zoltan 134
Procopciuc L. 51
R
Rada Maria 91, 95, 142, 158
Rademakers F.
Radoi Cristina 52
Radoi Maria 4
Radu M. 145
Radulescu B. 86, 147
Radulescu N. 42
Raduta I. 38, 39
Raileanu Ivona 49
Revnic C. 154, 155
Rezus C. 45, 56
Romanoschi Florentina 37, 122, 123
Rosu Doina 76, 77
Rosu R. 43
Roy L De. 56
Rugina Mihaela 12, 16
Rus H. 35
Rusu L.D. 1
S
Saraolu A. 131
Sarau C.A. 97, 142, 150
Sarbu A. 128, 129
Sascau R.A. 84, 85
Savu O. 74, 89, 109, 156
Savulescu-Fiedler Ilinca 8
Sbarcea V. 102
Scafa Udriste A. 137, 152
Schnabel Adriana 91, 95, 158
Scridon Alina 23
Scripcariu P. 46
Searpe C. 102
Selaru A. 135
Serban I. 42
Serban Marinela 33, 41, 42, 154, 155
Serban R.C. 23
INDEX AUTORI
AUTHORS INDEX
Suplimentul A, 2008
Siliste C. 54, 55, 57

Siliste Roxana Nicoleta 8
Simion Alina 48
Sinescu Crina 75, 119, 130
Sisu Roxana Cristina 54, 57
Sitar-Taut A. 67, 146
Slatineanu Liliana 65, 66, 70, 71
Sorodoc L. 46
Sorodoc Victorita 46
Spiridon Marilena 46
Stanca I. 48, 139
Stanescu Rodica Cioranu 47, 61, 131, 133
Statescu C. 30, 78, 84, 85
Stoenescu Maria 65
Stoica A. 161
Stoica E. 47, 61, 131, 133
Stoicescu C. 107, 108, 118, 124, 127, 141
Strucsuy Melinda 128, 129
Sutescu Cristina 34
Szilard M. 128
T
Tamasan Simona 10
Tanase Daniela Maria 45
Tanaseanu Cristina 36
Tanasie Deliana 76, 77
Tatu-Chitoiu G. 3, 136, 152
Tecar Florentina 95
Tecuceanu Raluca 135
Teodora Mocan 1
Teodorescu A. 89, 105, 109, 156, 157
Teodorescu C. 152
Tepes Piser Ileana 47, 61, 131, 133
Tesloianu D. 46
Ticulescu R. 58, 74, 140
Tintoiu I. 38, 39
Tirziu C. 16, 18, 19
Tirziu R. 18
Toader Despina 96, 14, 104
Toadere Adriana 88
Todiras M 114, 138
Tomescu Mirela 53, 112, 115
Toporan Daniela 36
Tudor Ioana 87, 93
Tudorascu Diana 5
Tudorascu M.R.P 5
Tudose M. 37, 122, 123
Turcan M. 83
Turiceanu M. 40
U
Udrea Gabriela 124
Udroiu C. 107, 108, 125
Ungureanu Anda 52
Ungureanu G. 106
Ursoniu S. 53,
Ursu G. 37, 122, 123
Uscatescu V. 154, 155, 161
V
Vaduva Delia Breceanu 91, 158
Varzaru Luminita 93
Vasile R. 86, 147
Vasile S. 41
Vasilescu A. 86
Vasiluta L. 76, 77
Vatasescu R. 92, 116, 126
Velimirovici Dana Emilia 91, 95, 142, 158
Venescu Eugenia 63, 94
Vicol M. 38, 39
Vinereanu D. 54, 55, 57, 107, 108, 113, 124, 125, 127,
141, 145
Vintila M. 36
Vintila V. 107, 108, 127
Visan S. 2, 44
Vladaia Aurora Maria 27, 74
Vladoianu M. 136
Voicu V.A. 38, 39
Voight J-U 149
Z
Zarma L. 111, 133
Zdrenghea D. 15, 43, 50, 51, 67, 118, 146
Zeana C. 48, 149
INDEX SUBIECTE | TOPICS INDEX

11.01 Ecografe de stress
11.02 Ecografe transesofagiana
12.00 Electrocardiografe 31
13.00 Epidemiologie si preventie 67, 69
13.01 Ateroscleroza 35
13.02 Factori de risc 24, 37, 38, 39, 51, 62, 67, 91,
146, 158
13.03 Programe preventive 134, 135, 150, 152
14.00 Fiziologie, fziopatologie cardiovasculara
8, 23, 144
15.00 Functie cardiaca 47, 71, 149
15.01 Functie sistolica 41, 113, 145, 160
15.02 Functie diastolica 13, 154
15.03 Insufcienta cardiaca congestiva 10, 14, 26,
36, 42, 66, 71, 93, 112
15.04 Diagnostic, prognostic 9, 61, 65, 112, 131,
153
15.05 Agenti inotropi
15.06 Inhibitori ai enzimei de conversie
16.00 Hipertensiune 68, 75, 102
16.01 Tratament 18, 19, 76, 88
16.02 Monitorizare ambulatorie 12, 17, 40, 130
16.03 Fiziopatologie 80, 99, 103, 113, 159
17.00 Reabilitare
18.00 Test de efort 15, 43, 50
19.00 Valvulopatii 33, 45
19.01 Valvulopatii aortice 27, 147
19.02 Valvulopatii mitrale
19.03 Endocardita
19.04 Proteze valvulare
19.05 Valvuloplastie
20.00 Altele 1, 2, 6, 7, 11, 20, 22, 32, 70, 72, 97,
100, 101, 114, 120, 123, 132, 143, 148, 151
01.00 Accidentul vascular cerebral
02.00 Aritmii 11, 30, 32, 90, 94
02.01 Mecanism 79, 81, 82
02.02 Electrocardiografe
02.03 SAECG, Monitorizare Holter 14, 52, 58, 96,
104, 140
02.04 Variabilitate RR, QT 83
02.05 Testare electrofziologica 60, 116, 127
02.06 Pacemakere 54, 57, 85, 126
02.07 Aritmii supraventriculare 56, 115
02.08 Aritmii ventriculare 78
02.09 Sindrom WPW 59
02.10 Moarte subita, resuscitare
02.11 Antiaritmice
02.12 Cardioversie, Defbrilare 55, 63, 122
03.00 Boli ale miocardului si pericardului
03.01 Cardiomiopatie hipertrofca
03.02 Cardiomiopatie dilatativa 16
03.03 Miocardita 48
03.04 Tumori 28, 86
04.00 Cardiologie interventionala
04.01 Coronarografe
04.02 Angioplastie 125, 141
04.03 Stenturi 107, 111, 125
04.04 Restenoza 108, 109
04.05 Alte proceduri
05.00 Cardiologie nucleara
06.00 Cardiopatii congenitale 21
07.00 Cardiopatie ischemica 49, 133, 138
07.01 Angina pectorala stabila, instabila 4, 110
07.02 Infarct miocardic acut 3, 34, 119, 137
07.03 Perioada postinfarct 77
07.04 Prognostic, stratifcarea riscului 5, 29, 44,
64, 98, 139
07.05 Unitate coronariana, monitorizare
07.06 Tromboliza
07.07 Tratament 136
08.00 Chirurgie cardiovasculara
08.01 Cardiopatie ischemica 53
08.02 Valvulopatii 95, 142
08.03 Protectie miocardica
08.04 Aorta, artere periferice 161
09.00 Circulatie pulmonara 87
09.01 Hipertensiune pulmonara
09.02 Embolism pulmona 73
10.00 Computere in cardiologie 25
11.00 Ecocardiografe 46, 74, 84, 89, 92, 105,
106, 117, 118, 124, 128, 155, 16, 157

2008 RRC Sup

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2008 RRC Sup

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1-5 Cardiopatie ischemic A7

6-10 Insufcien cardiac A13

ni mentelor cardiovasculare dup ajustarea pentru ali

cele 2 grupuri de pacieni. Pentru obinerea propriu-

stresului oxidativ la pacientii cu sindroame coronariene

Rezultate: S-a constatat c la majoritatea pacienilor

INSUFICIEN CARDIAC | HEART FAILURE

adverse). Difcultatea tratamenului consta in inexis-

10. Anxietatea, depresia i

independent of the presence of metabolic syndrome.

cu fltrele setate ntre 250-400 Mhz, nivelul zgomotului

rii a fost cercetarea incidentei FA survenite post by-

Te evolution of pacing parameters of the 2 groups at

iso lation of the pulmonary veins for persistent AF.

CARDIOLOGIE INTERVENIONAL | INTERVENTIONAL CARDIOLOGY

Drug eluting stents are better

in-stent thrombosis and very late in-stent thrombosis

tomography is useful in symptomatic patients with low

POSTER FORUM III

POSTER FORUM III

of myocardial ischemia (18 patients) and group B,

POSTER FORUM III

parametrii clinici i biologici, terapia la externare, rata

POSTER FORUM III

INDEX AUTORI | AUTHORS INDEX

Hubatsch Mihaela 134

Siliste C. 54, 55, 57

INDEX SUBIECTE | TOPICS INDEX

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