Abstract Funding Acknowledgements Type of funding sources: None. Background Left atrial (LA) dimension is a marker of LV filling pressure, reflecting the severity and chronicity of diastolic dysfunction. LA is a stable parameter that combines chronic cardiovascular conditions effects and acute increase in filling pressure in acute myocardial infarction. Patients with acute coronary syndrome and increased left atrial volume index (LAVI) have a worse long-term prognosis. In patients with hypertension and diabetes, an increase in the LA dimension predicts cardiovascular events. There are limiting data about the impact of LAVI on the outcome in diabetic hypertensive patients with ST-elevation myocardial infarction (STEMI). Purpose: of the study was to compare LAVI in diabetic and nondiabetic hypertensive patients admitted with STEMI. Methods: ninety-eight hypertensive patients admitted with STEMI were enrolled, sixty-seven with diabetes mellitus and thirty-one without diabetes. The patients with atrial fibrillation and significant valvular disease were not included in the study. The evaluation consisted in clinical examination, echocardiographic measurements, laboratory tests, and 12 leads electrocardiography. 2D Echocardiography area-length technique was used for LA volume measurement. The LA endocardial borders were traced in both the apical four- and two-chamber views, and the results were body surface area indexed. The cut of value was 34ml/m2. The Devereaux formula determined left ventricle mass index (LVMI), and the ranges were: 125 kg/m2 for males and 95 mg/m2 for females. Left ventricle ejection fraction (LVEF) was < 50% in all cases. Measurements were obtained in the first week after STEMI. The patients were divided into two groups: the first was between 40 and 60 years and the second was above 60 years. According to the age group, mean values (MV) and standard deviation (SD) were calculated, obtaining a comparison between diabetic and nondiabetic patients. Results: LAVI had higher values in diabetic patients: MV: 37.37 (SD: 3.39, CV: 9.07%) compare with nondiabetic patients: MV: 31.07 (SD: 2.67, CV 8.59%), p < 0.0001. Between 40-60 years LAVI MV were 36.43 +/- 3.21 in diabetic patients vs. 29.62+/-1.89 in nondiabetic patients (p = 0.0001); above 60 years of age LAVI MV were: 38.99 +/- 3.04 in diabetic patients and 31.14 +/- 2.8 in nondiabetics patients (p < 0.0001). In both group of age LAVI also correlated with body mass index, LVMI, LV volumes, LV diastolic dysfunction, LVEF, dyslipidemia and smoking. Conclusions: 1. In hypertensive patients admitted with STEMI, diabetes mellitus was an additional factor contributing to increased left atrium dimensions. 2. This study showed a correlation between LAVI and other factors involved in increasing LV filling pressure in hypertensive diabetic patients admitted with STEMI, underlying the importance of LA enlargement evaluation. Further studies with a larger number of patients are need to confirm these results.

A strong association between functional mitral regurgitation severity and all-cause mortality and hospitalization was found in patients with dilated cardiomyopathy and left ventricular systolic dysfunction, with or without an implanted device. Many studies revealed a bidirectional link between the decrease in functional mitral regurgitation severity and the response to cardiac resynchronization therapy. This emphasizes the importance to find methods for mitral regurgitation evaluation in heart failure patients after device implantation. In this complex pathology, adequate measurement remains a challenge for clinicians. Echocardiography is the key technique used to confirm the diagnosis and to assess the severity and prognosis. In this review, we discuss the echocardiographic challenges in the evaluation of functional mitral regurgitation after cardiac resynchronization therapy. An integrated approach including various criteria is strongly recommended. The assessment includes the integration of data from 2D/3D echocardiography imaging, as well as Doppler measures of severity. For quantifying the regurgitation degree, the vena contracta width and the parameters derived from the PISA method, effective regurgitant orifice area and regurgitant volume, are the most useful. There is also important to provide information about the left ventricle and right ventricle dimensions and ejection fraction, as well as the left atrium, right atrium dimensions and the pulmonary arterial systolic pressure.

Cardiotoxicity is the most important side effect of cancer therapy resulting in increased patient morbidity and mortality, therefore understanding its occurrence mechanism and a correct and early diagnosis are essential for patients at risk of irreversible heart failure. We present the case of a patient who developed cancer therapeutics-related cardiac dysfunction, emphasizing the importance of regular echocardiographic evaluation for early detection of subclinical cardiac dysfunction and further cardiac monitoring. More sensitive parameters should be used to predict cardiotoxicity because the probability of cardiac function recovery diminishes in time, despite optimal heart failure treatment.

Clinical study on a group of 48 patients over 3 months: 27 patients were recruited from ophtalmology and 21 recruited from cardiology, 25 % of these patients coming for routine check. Patients were investigated by ophthalmic, cardiologic examination, imaging and laboratory tests. The study demonstrated the need for interdisciplinary consultation for patients with vascular complaints in carotid territory and a close correlation between the vascular pathology and ophthalmology at this level.

Purulent pericarditis is rarely encountered in the antibiotherapy era, mainly in immunosupressed patients, after cardiac operations, in septicemia. Diagnosis of purulent pericarditis is based upon the analysis of pericardial drainage, obtained through pericardiocentesis or preferably, through a surgical approach. The reported case has following peculiarities: clinical signs of false acute surgical abdomen; altered clinical and biological response to infection; Optimal treatment is early, efficient pericardial drainage, with low risk of tissue contamination and of pericardial constriction; Surgical subxyphoid pericardial drainage is prefered in patients with affected general status. Antero-(lateral) thoracic approach with associated anterior pericardiectomy ensures an efficient pericardial drainage and prevents pericardial constriction, with low risks for pleural contamination.

Belu, E.1; Musetescu, R1; Bataiosu, C.1; Popescu, M.1; Cosulschi, M2; Florescu, N.1; Ionescu, D.-D.1 Author Information

Belu, E.; Musetescu, R.; Bataiosu, C.; Popescu, M.; Toader, D.; Mustafa, R.; Cosulschi, M.; Florescu, N.; Ionescu, D.-D. Author Information

Objective: Atrial fibrillation (AF) is associated with increased cardiovascular risk and the incidence of AF is higher in hypertensive patients. Different data suggest that dual chamber pacing may decrease the incidence of AF compared with VVI pacing. Methods: We have evaluated 78 hypertensive patients implanted in our centre in 2007: 24 with DDD pacing and 54 patients with VVI pacing. Patients with a previous history of atrial fibrillation were excluded from our analisys. The pacing indications were: sinus node disease (SND, 14%), atrioventricular (AV) block (55%), bradycardia-tachycardia syndrome (BTS, 11%) and AV block + sinus node disease (20%). The follow up period lasted for 2 years. Results: The mean age of the study group was 67 ± 8 years. The incidence of AF was: 14% after 1 year and 35% after 2 years of follow up. In patients with AF, New York Heart Association functional class of heart failure was higher than in patients without AF (p < 0.05). No significant differences have been observed between patients with complete AV block and those with SND regarding the incidence of atrial fibrillation (p>0.05). Conclusions: The incidence of atrial fibrillation was significantly lower in hypertensive patients treated with dual chamber devices than in pacients with ventricular pacemakers.

We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.

Cardiovascular disorders represented by congenital malformations, hypertension, aortic dilatation which can emerge in dissection or rupture and ischemic heart disease are common in Turner syndrome (TS) and life-threatening. Echocardiography and magnetic resonance imaging represent complementary diagnostic methods used to assess cardiovascular status. Unfortunately, normal reference ranges for cardiac and aortic measurements are established only in unselected TS patients, preventing a delineation between patients with and without cardiovascular pathology.We performed echocardiography in 15 patients with TS, aged 12-33 years (mean 21.8 years, standard deviation 6.37 years) without cardiovascular and renal malformations, hypertension or aortic dilatation and 30 normal controls; karyotype was 45,XO in 11 patients and 45,XO/46,XX in four patients. To minimize the influence of body size, ratios of aortic and cardiac chambers dimensions were calculated.As expected, we found smaller dimensions in TS versus controls but only the ascending aorta, left atrium and diastolic left ventricular diameters and the ratio diastolic/systolic left ventricular diameters reached statistical significance. Only aortic dimensions were entirely independent of age, height, weight and BMI with a 95% confidence interval of 14.28 - 25.32 (mean 19.8) mm for the aorta at the annulus and 95% CI 21.42 - 29.36 (mean 25.54) mm for the ascending aorta. The ratios ascending aorta/systolic left ventricular diameter (95% confidence interval 0.54 - 1.34; mean 0.94), aorta at the annulus/systolic left ventricular diameter(95% CI 0.44 - 0.92; mean 0.68) and aorta at the annulus/diastolic left ventricular diameter (95% CI 0.36 - 0.61; mean 0.49) are independent of age, height, weight and can also be reliable for detection of aortic dilatation.