Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.

The myocardial performance index (MPI), defined as the sum of isovolumic contraction and relaxation times divided by ejection time, and N-terminal pro-brain natriuretic peptide (NTproBNP) have been utilised to express global left ventricular (LV) function. The ratio between early diastolic transmitral velocity (E, using pulsed Doppler) and early mitral annular diastolic velocity (Ea, using tissue Doppler imaging) has been proposed as the best Doppler predictor for evaluating LV filling pressures in a variety of cardiac diseases.

Introduction: N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. Aim: To assess the relationship between a new echocardiographyc parameter, E/(EaxSa), where Sa is the maximal systolic velocity of mitral annulus, and NTproBNP in patients with dilated cardiomiopathy (DCM). Material and methods: Fifty-eight consecutive patients (age 6313 years) with DCM, in sinus rhythm, referred for echocardiography, were analyzed simultaneously with NTproBNP. No patients were having inadequate echocardiographic images, paced rhythm, mitral prosthesis, severe mitral annular calcification or renal failure. E/Ea and E/(EaxSa) were assessed by conventional echocardiography and tissue Doppler imaging of lateral and medial mitral annulus. The average of the velocities from the medial and lateral site was used. Results: A statistically significant linear correlation was found between E/(EaxSa) and NTproBNP (r = 0.73, p 1200 pg/ml was 1.85 (sensitivity = 89%, specificity = 77%). Conclusions: E/(EaxSa) correlates strongly with plasma NTproBNP level and can be a simple, reproductible and accurate echocardiographic index in patients with DCM in sinus rhythm.

Spontaneous rupture of nonaneurysmal, noninfected atherosclerotic infrarenal aorta is rare. In most cases it is due to penetrating atherosclerotic ulceration (PAU) of the aorta. However, this disease predominantly affects thoracic aorta. PAU of the infrarenal aorta is a rare entity. A case of spontaneous rupture through an atheromatous plaque with spontaneous rupture of infrarenal abdominal aorta is reported. In our case the patient presented with gastro-intestinal complaints, probably due to adhesion of the duodenum to the anterior aortic wall. This could not be corrected by an endovascular procedure. Therefore, we elected to perform an open repair. The patient recovered uneventfully and was discharged from the hospital on 9-th postoperative day. At early follow up the GI symptoms faded away and the patient tolerated food well and gain weight. Unfortunately the patient passed away at the 28-th postoperative day from a stroke.

Popliteal artery aneurysms are the most common peripheral artery aneurysms. We present a case of rare combination of chronic aortic dissection type III and rupture of a giant popliteal aneurysm in 74 years old patient. We ligated the ruptured popliteal aneurysm with interposition of PTFE 8/5 prosthesis with a distal venous ‘cuff’. Postoperatively, the patient had palpable pedal pulses. He was discharged on the twenty-third postoperative day not on anticoagulant therapy because of the chronic aortic dissection type III, but on aspirin.

Elective stenting of de novo lesions in coronary arteries < 3 mm diameter is still controversial, because of high stent thrombosis and restenosis rate. The CarboStent has an optimised cellular design and improved thromboresistance and biocompatibility. We prospectively analyzed the safety, efficacy and 6 month angiographic patency after elective CarboStent placement for 23 consecutive de novo lesions (18 patients) in coronary arteries <3 mm. Thirteen lesions (57%) were type B2/C. Reference vessel diameter was 2.63 +/- 0.24 mm, diameter stenosis was 71.5 +/- 9.3% and the lesion length was 14.5 +/- 6.9 mm. Successful CarboStent placement was achieved for 22 lesions (96%). MLD increased to 2.61 +/- 0.2 mm and percent diameter stenosis decreased to 10 +/- 4.5%. No stent thrombosis occurred. Angiographic restenosis was found in 5 lesions (23%). Angiographic guided elective CarboStent placement in small coronary arteries seems feasible and safe, with good long term patency.

The purpose of our study is to describe the current clinical practice in Romania regarding the management of patients after myocardial infarction (MI). Data from 250 consecutive patients with a history of MI were prospectively collected in order to evaluate secondary prevention recommendations made by referring physicians. Analyzing the recommendations on lifestyle changes (smoking cessation, healthy food choices, overweight reduction, optimal physical activity, referral to a full rehabilitation program) and prophylactic drug therapies (antiplatelet drugs, beta blockers, statins, ACE inhibitors, oral anticoagulants) we concluded that secondary prevention after MI is far from optimal in Romania and the implication of cardiologists is poor. A considerable potential still exists to further reduce CHD mortality and morbidity by adequate secondary prevention recommendations.