Abstract Introduction Syndecan-1 is a less studied molecule in heart failure (HF), but its increased serum levels in patients with acute HF may potentially reflect important myocardial pathological changes, such as fibrosis, inflammation, or endothelial dysfunction. Beyond its role as a cardiac biomarker, syndecan-1 could exhibit a promising role as a surrogate predictor of early kidney injury, as it seems that syndecan-1 levels are not influenced by a decreased creatinine clearance, but rather by ongoing damage to the glycocalyx of the renal endothelium. Additionally, syndecan-1 is involved in fibrotic processes, both myocardial and hepatic, via its extramembrane domain with a role in matrix metalloproteinase synthesis. Purpose The study aimed to highlight the potential use of syndecan-1 in clinical practice as a diagnostic and prognostic biomarker in acute HF, especially from the perspective of acute liver and kidney injury. Materials and methods We analyzed the serum levels of syndecan-1 in 100 patients presenting in emergency with acute HF, compared to 53 patients with chronic HF (control group). For further assessment, we used a small venous blood sample (2 mL) that was centrifuged in order to separate the serum. Quantification of syndecan-1 was performed by ELISA method, using dedicated kits. Acute kidney injury (AKI) was defined according to RIFLE criteria. The acute liver injury assessment was based on at least a 2-fold increase in transaminases (compared the reference values of the hospital laboratory). Results Syndecan-1 exhibited significantly higher mean serum levels among patients with acute HF compared to the control group. ROC analysis exhibited a consistent predictive value for syndecan-1, mirrored by its AUC of 0.898, showing a statistically significant performance (p < 0.05) in predicting acute HF. Syndecan-1 was also significantly correlated with the need for positive inotropic support and with the use of non-invasive ventilation mode. However, mortality rates (both during hospitalization and 30 days after discharge) were not substantially associated with its serum concentrations. Concerning its role of a dual biomarker, we revealed positive and significant correlations between elevated syndecan-1 and liver transaminases, a similar pattern being found for the correlation with serum urea and creatinine. Moreover, an increased syndecan-1 at admission was significantly and directly correlated with increased markers of liver and kidney injury occurring during hospitalization, from initially normal baseline values. Conclusions Syndecan-1 may be used as a surrogate cardiac biomarker in acute HF, as its serum levels are significantly higher in those patients, compared to controls with chronic HF. Syndecan-1 also emerged as an early predictor of liver and kidney injury in patients admitted for acute HF, even before the increase of the classic markers of organ dysfunction, such as serum creatinine or liver transaminases.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.

Abstract Background Cardiac rehabilitation (CR) is an essential pillar of the management of patients with heart failure (HF), regardless of the degree of systolic dysfunction, having both a therapeutic and prognostic role. The improvement of symptoms and functional status together with the improvement of quality of life are some of the arguments that support the referral of all HF patients to centers specialized in such integrative, multidisciplinary programs. Purpose We aimed to evaluate the impact of physical training on echocardiographic parameters (left ventricle global longitudinal strain [LV GLS], left atrial strain) among HF patients on a CR program. Methods We conducted a prospective cohort study on 105 patients with HF admitted to a single tertiary referral center. According to the functional class assessed by cardiopulmonary exercise testing (CPET), we divided patients into two groups: mild to moderate functional limitation (n=46) and moderate-severe functional limitation (n=59). Results We analyzed demographics, anthropometrics, clinical and paraclinical parameters, focusing on echocardiographic parameters of systolic function (ejection fraction, LV GLS) and atrial function (left atrial strain). Patients with HF in the second group had lower mean values of EF (p=0.046), LV GLS (p=0.021) and left atrial strain (p=0.039). After completing the CR program, patients in the second group had an improvement of the parameters compared to baseline values. LV GLS and left atrial strain values were statistically significantly correlated with serum NT-proBNP values (p=0.009), peak oxygen uptake (p=0.013), pain-free walking distance (p=0.034) and maximum walking distance (p=0.029). Left atrial strain also positively correlates with peak oxygen uptake (p=0.047). GLS value less than -8.9% is also a predictor for the persistence of severe functional limitation in HF patients (AUC=0.648 , p=0.041) (Figure 1). Conclusion(s) CR program improves systolic dysfunction in HF patients, with low GLS values being a negative predictor of functional status.

This paper aims to find new predictors of poor antihypertensive treatment adherence in the Romanian adult hypertensive population. Six hundred eighty hypertensive subjects identified in the SEPHAR IV survey were evaluated by a study questionnaire, including a 4-item Morisky Medical Adherence Score (MMAS-4), BP and anthropometric measurements, and laboratory workup. BP control was defined as <140/90 mmHg at both study visits (4 days apart). According to the MMAS-4 score, adherence was considered low (3-4p), moderate (1-2p) and high (0p). Statistical analysis was performed with SPSS Statistics 18.0 software at a significance level of p≤0.05. Of the total 680 hyper - tensive subjects, 461 were receiving antihypertensive treatment. According to BP control, treated hypertensives were further divided into two groups – controlled (181 subjects, 39.2%) and uncontrolled HTN (280 subjects, 60.8%). The mean age was 63.25±11.65 years and the female gender was more prevalent (61.1%). Distribution regarding residence was balanced (urban area – 51.5%). Low antihypertensive treatment adherence was recorded in 46 subjects representing 9.9% of the total group, with a significantly higher rate among uncontrolled hypertensive subjects [35 subjects (12.5%) vs. 11 subjects (6.1%); p=0.024]. Total cholesterol (AUC=0.659; CI=95%: 0.557–0.761; p=0.005) and LDL cholesterol (AUC=0.645; CI=95%: 0.537–0754; p=0.011) were statistically significant predictors of low treatment adherence. The MMAS-4 is a readily available tool that can be used in daily clinical practice. The lipid profile can be used to identify less adherent HT patients. Future research should establish a metabolic profile of the nonadherent patient and focus on developing strategies to increase adherence.

Abstract Funding Acknowledgements Type of funding sources: None. Cardiac rehabilitation (CR) plays an essential role in the management of patients with peripheral artery disease (PAD) [1]. Patients enrolment in an integrative and multidisciplinary program, can improve the functional status, quality of life, and long-term morbidity and mortality [2]. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a long-term mortality prognostic index in PAD [3], we enrolled two groups of patients: low and low-intermediate risk (group 1, n=45) versus high-intermediate and high risk (group 2, n=52). We analyzed demographics, clinical, and paraclinical parameters, focusing on novel inflammatory biomarkers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), white blood cells-to-MPV ratio (WMR) and lymphocyte-to-C-reactive protein ratio (LCR). The 6 months follow-up showed that a minimum 50% decrease compared to initial levels was associated with both short and long-term clinical and functional improvement. A decrease in NLR (p < 0.001), PLR (p = 0.028), WMR (p = 0.009) and LCR (p = 0.036) levels correlated positively with improved metabolic profile - low-density lipoprotein cholesterol (p= 0.015), triglycerides (p= 0.041) , fasting glucose (p=0.011) -, as well as improved exercise capacity - assessed through peak oxygen uptake (p = 0.008), pain-free walking distance (p = 0.024) and maximum walking distance (p = 0.032) at 6 months follow-up for group 1. Assessment of these inflammatory biomarkers had a statistically significant prognostic role in our study, being an accessible tool for clinical cardiologists in evaluating CR programs effectiveness in patients with PAD.

The present study analyzed etiologic profile of blood culture-positive infective endocarditis (IE) and possible differences between the main etiologies. Material and methods: An observational retrospective analysis was conducted in a regional hospital over 11-year period. A total of 58 consecutive patients diagnosed with infective endocarditis with positive blood cultures were included in the study. Diagnosis of IE was realized based on Duke modified criteria. All patients data was reviewed from electronic database and medical charts. Epidemiologic, clinical and laboratory parameters were analyzed. Afterwards, the main three determinant microorganisms were compared to identify differences in presentation or evolution. Results: Dominant etiology of IE was represented by: Enterococcus spp. (22.4%), S. aureus (18.9%), Viridans streptococci (17.2%), S. gallolyticus (10.3%) and coagulase-negative staphylococci (8.6%). Total in-hospital mortality remained high (24.1%), and no significative correlation was revealed between certain micro-organism and worsening disease course (p=0.259), or in-hospital death (p=0.343). No major baseline characteristic or evolution differences were observed between the main 3 etiologies. S. aureus infection presented a significative association with thrombocytopenia (p=0.049) and high levels of total bilirubin (p=0.008). Conclusions: Infective endocarditis is still a community-acquired disease, with peculiar etiologic distribution and increased prevalence of Enterococcus spp. infection. In-hospital mortality of the disease remains high, independent of the etiologic profile.

In order to establish more ef-ficient ways to prevent metabolic syndrome (MetS) in clinical settings, we need to thoroughly understand the physiopathology behind this cluster of risk factors for cardiometabolic diseases. The main point of focus concerning MetS still embraces the metabolic and secretory products of the abdominal adipose tissue. Our study aims to clearly define an adipokine pro-file for patients with MetS and assess possible correlations between obesity parameters, bio-chemical markers and adipokines. Material and methods: This is a cross-sectional study, elaborated over a period of two years, which involved 104 patients divided into 2 groups: with MetS and without MetS. Patients were considered as having MetS if they presented WC > 88 cm (women) / 104 cm (men) and more than one criterion of the following: glucose > 100 mg/dL, HDL < 40 mg/dL (men) / < 50 mg/dL (women), TG > 150 mg/dL, SBP/DBP > 130/85 mmHg. Dual-Energy X-ray Absorptiometry (DEXA) was performed to assess adipose tissue distribution. All patients underwent clinical and paraclinical evaluation, including the measurements of insulin, adiponectin and leptin. Results: Leptin levels present a strong and positive correlation with almost all obesity parameters evaluated, with or without MetS. The strongest correlation is observed for trunk fat percentage (without MetS: r=0.648, p<0.001; with MetS: r=0. 723, p<0.001). In the group of patients without MetS adiponectin level is not associated with fat percentages, whereas in the group of patients with MetS adiponectin reports a weak and positive correlation between total fat, arms fat and legs fat percentages. Adiponectin is negatively correlated with HOMA-IR and insulin in both groups, suggesting that insulin resistance is linked to the change in adiponectin levels. Patients that present MetS also report an association between HDL and adiponectin (r=0.280, p=0.02). Conclusions: Patients with MetS that did not follow prior treatment for any chronic disease and are characterized by similar adipose tissue percentage and distribution, report the fol-lowing: lower adiponectin levels than patients without MetS, but still a positive association with HDL; no modification in leptin levels compared to patients without MetS; negative correlation between adiponectin and insulin resistance; strong association between leptin and adipose tissue mass.

Adherence to healthy dietary patterns leads to improvements in metabolic health and prevents the risk of diabetes and obesity. Current guidelines underscore the im-portance of focusing on individualized dietary patterns in nutritional therapy of diabetics. The objectives of this study were to identify the dietary patterns in Romanian patients with Type 2 Diabetes Mellitus and to investigate the impact of these dietary patterns on associat-ed anthropometric and metabolic parameters. Material and methods: A total of 118 adults were included in this cross-sectional, observational study. Demographic and lifestyle data, information on current pathologies and associated co-morbidities, anthropometric measure-ments and biological markers were obtained. Dietary intake was assessed via the EPIC food frequency questionnaire. Results: We identified three dietary patterns by principal compo-nent analysis, defined as Prudent, Western and Traditional. We found that patients belong-ing to the Western pattern had higher waist-to-hip ratio, higher glycated hemoglobin A1c and were significantly younger compared to those in the Prudent pattern. Alcohol intake was significantly higher in the Western compared to the Prudent pattern. Conclusions: This study demonstrates that the Western pattern, characterized by high intake of meat and meat products, eggs and soft drinks, has negative metabolic consequences in Romanian adult p a-tients with T2DM, compared to the Prudent pattern. The Traditional pattern was closer to the Prudent one.

THE EFFECTS OF CARDIAC REHABILITATION ON RESTING HEART RATE AND BLOOD PRESSURE IN HEART FAILURE PATIENTS (Abstract): Our study analyzed the efficiency of cardiac rehabilitation programs (CRP) in decreasing resting blood pressure (RBP) and heart rate (RHR), two important prognosis tools for heart failure (HF) patients. Materials and methods: A retrospective cohort study was conducted in a regional hospital over a 3-year period. A total of 137 HF patients, who benefited from a physical based CRP with a mean duration of 10 days, were divided into 2 groups according to the severity of their symptoms. All the patients underwent physical and paraclinical evaluation, including cardiopulmonary testing before starting the rehabilitation. RHR and RBP were measured b e -fore and at the end of the program. Results: Most of the patients in this study were men (73.7%) and hypertensive (55.5%), while the mean age of study's participants was 65.24 +/- 9.76 years. A significant decrease was observed in the RHR after rehabilitation (81.37 +/- 8.65 bpm vs. 77.79 +/- 6.77 bpm, p = 0.004). Significant improvements were also observed in rest-ing systolic blood pressure (BP), the mean values decreasing with more than 4% after reha-bilitation (122.06 +/- 16.2 mmHg vs. 116.91 +/- 12.14 mmHg, p = 0.001). Mean diastolic BP al-so decreased at the end of the program (73.81 +/- 12.05 mmHg vs. 72.8 +/- 10.36 mmHg, p = 0.28). Though non-significant, age and baseline HR and BP appeared to be important thera-py response predictors. Younger patients and those who had higher HR and BP at the begin-ning of the program benefited most from CRP. Conclusions: A short term CRP proved to be efficient in reducing RHR and RBP of HF patients, while age, baseline HR and baseline BP may be potential therapy response predictors.

Obesity activates multiple pathways of metabolic syndrome (MetS), therefore the balance between adiponectin and leptin, hormones that are secreted by adipocytes, is of great interest in better managing and understanding this complex disease. The aim of our study was to characterize obesity phenotypes by circulating levels of adipokines and insulin, followed by a better understanding of the influence a lifestyle modification, like physical activity, may have upon the values of these biomarkers. Material and methods: Our cross-sectional study included 104 patients organized in 4 groups, based on BMI and metabolic syndrome (MetS): metabolically healthy obese (MHO), metabolically unhealthy obese (MUO), metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO). Unhealthy phenotypes were characterized by the presence of MetS and obesity by a BM1 >= 30 kg/m(2). All patients underwent insulin, adiponectin and leptin measurements, as well as MetS criteria investigations. After completion of the International Physical Activity Questionnaire, participants were graded with a low, moderate or high activity level. Results: All obesity parameters are significantly different between obese and non-obese patients, with leptin-adiponectin ratio (LAR) having the highest statistical power (p<0.001, eta(2)=0.15). Adiponectin, insulin, and HOMA-IR were statistically different between MHO and MUO, with no significance between MHNO and MUNO. Adiponectin levels are not significantly associated with a class that describes a specific physical activity level, whereas leptin levels are decreased in non-obese patients once they were more physically active (p=0.042). Relationship between physical activity level and obesity markers in obesity phenotypes did not conclude with any significant results. Conclusions: Adiponectin levels are higher in MHO phenotype than in MUO phenotype even though both groups present similar BM1 means, therefore we can consider adiponectin a possible biomarker for metabolic syndrome in obese patients. Also, adiponectin, LAR, insulin, and HOMA-IR levels do not change in physically active patients, whereas leptin values decrease significantly in non-obese subjects that engage in physical activity.

The present study analyzed the existence and quantification of inflammatory status and antiplatelet medication associated with intra-stent restenosis (ISR) in coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Material and methods: an observational cross-sectional study was conducted in a high-volume PCI centre over a 2-year period. A total of 235 consecutive patients diagnosed with angina or acute coronary syndrome treated by PCI were included in the study. Diagnosis of ISR was documented by coronary angiography and the patients were divided into groups (with and without ISR). All patients underwent clinical and laboratory examination, the administration of antiplatelet medication and the type of drug administered to each patient. Results: The mean time until ISR was 33 +/- 34 weeks. The lower use of single or dual antiplatelet therapy was associated with increased risk of ISR. Aspirin alone [ risk ratio (RR)=1.13; 95% confidence interval (95% CI): 0.882-1.462], clopidogrel alone (RR = 1.41; 95% CI: 0.879- 0.323), ticagrelor alone (RR = 1.98; 95% CI: 1.746-2.252) or dual antiplatelet therapy (DAPT) (RR = 0.82; 95% CI: 0.637-1.065) had a significant role in estimating the risk for ISR. Bare-metal stents (BMS) presented an associated risk of ISR higher as compared to drugeluting stents (DES) (0.88 vs. 0.74). Conclusions: Inflammatory status is associated with ISR; the type of stent used, time to ISR and antiplatelet medication were found to be associated with ISR.

Background and Aims: Recurrent restenosis despite DES or BMS treatment is relatively high and is still considered a challenge in interventional cardiology. Therefore, we aimed to determine a biomarker profile that may be considered as risk factor for intra-stent restenosis (ISR).

The oncological patient presents many pathophysiological particularities, including a hypercoagulable state, which causes frequent thromboembolic complications. Furthermore, the side effects of chemotherapy, laborious surgical interventions and the poor performance status favor the occurrence of deep vein thrombosis (DVT). The aim of this retrospective study is to identify the prevalence of paraneoplastic DVT in patients admitted in the Cardiology Department of the "Sf. Spiridon" County Clinical Emergency Hospital from Iasi and to establish the correlations between the DVT, type of neoplasia and certain particularities of the patients. Material and methods: The current retrospective study was conducted over a two-year period and enrolled 100 patients divided into two groups based on the presence or absence of a neoplasia (25 patients having a tumoral pathology and 75 patients without such a comorbidity). All study participants underwent a complete clinical examination and were assessed through biochemical and echocardiographic parameters. Results: Various tumor locations were identified in the 25 patients with a malignancy, the most prevalent being the colorectal cancer (6 cases, 24% of total), followed by the lung cancer (4 cases, 16%) and, with a similar occurrence, the brain, ovarian and breast cancer (2 cases each, 8%). Among the patients with neoplasia, 13 had a history of cancer (52% of cases from the neoplasia group), while for the remaining 12 patients it was a de novo diagnosis. Conclusions: Patients with DVT showed a significant cancer prevalence, either previously diagnosed or incidentally discovered. The increased risk of DVT in cancer patients is multifactorial and represents a diagnosis and therapeutic challenge. In our study, we recorded a slightly increased prevalence of cancer in women (56% vs. 44%), who had cervical cancer as the most common etiology (35.7%). On the other hand, male sex was associated with an increased frequency of colorectal cancer (36.4% of all cancers diagnosed in men), followed by lung cancer (27.3%).

Obesity is one of the most important risk factors for morbidity and mortality, especially when referring to cardiovascular diseases. Different obesity phenotypes are presented in the medical literature, each one describing a different cardiovascular risk profile. The most important phenotype that is directly linked to the obesity paradox (OP) is the metabolically healthy obese phenotype, characterizing individuals with a BMI ≥ 30 kg/m and no metabolic abnormalities. This phenotype strengthens the true existence of the OP. In the same time we need to consider all the possible influencers when concluding if the OP is real and worth taking into consideration by clinicians. Analyzing studies that mention the OP, we observed several limitations either of the study itself or of the BMI used to classify obese patients. These limitations are described in the present review and they are of great importance in understanding how the OP is defined and how it should be interpreted.

Porto-pulmonary hypertension (POPH), characterized by portal hypertension associated with high pulmonary vascular resistance (PVR), represents an important complication in liver cirrhotic (LC) patients. Our study aimed to determine the association between biological profile and pulmonary hypertension in a group of patients on the liver transplant awaiting list. Material and methods: The current 3-year prospective study analyzed 60 LC patients admitted for liver transplant evaluation and regular follow-up. All patients underwent biochemical evaluation and LC severity was evaluated by using MELD score and Child-Pugh class. Pulmonary hypertension was determined by standardized echocardiographic evaluation, most important markers being mean and systolic pulmonary artery pressure (mPAP, sPAP). Results: Mean age was 50.55 +/- 8.3 years, 83.3% males. sPAP was significantly higher in women (24.08 +/- 7.76 vs. 27.33 +/- 13.7 mmHg, p=0.040). The presence of ascites was directly correlated with the severity of pulmonary hypertension (p=0.033) while mPAP was higher in patients with autoimmune LC. mPAP correlated with MELD score (r=0.832, p=0.030), fibrinogen level (r=0.887, p=0.021) and bilirubin level (r=0.758, p=0.045). During the follow-up period, mPAP decreased significantly in patients that received liver transplant. However, mPAP was not a mortality risk factor for the awaiting liver transplant patients. Conclusions: Our study revealed that fibrinogen and total bilirubin levels, as parameters of cirrhosis severity, are in direct correlation with mPAP. Furthermore, refractory ascites in end-stage cirrhosis patients could be associated with a higher risk of pulmonary hypertension. Further larger studies on POPH incidence and follow-up in liver cirrhosis are warranted.

Background and Aims: Menopause is a significant risk factor for different cardiovascular diseases (CVD). However, in primary prevention, there is limited data regarding menopause and subclinical atherosclerosis. Thus, we aimed to determine the impact of menopause on subclinical atherosclerosis and CV risk in a group of asymptomatic female patients.

The effects of advanced liver diseases on heart function, like cirrhotic cardiomyopathy, hepato-pulmonary syndrome or porto-pulmonary arterial hypertension, are well known today. Cardiovascular Diseases (CVD) may affect the liver or increase a pre-existed liver disease in acute or chronic heart failure. The aim of this study was to evaluate the frequency of CV comorbidities in cirrhotic patients and to establish the influence on patients' outcome. Material and methods: The current prospective study was conducted over a 16-month period and included 105 patients diagnosed with liver cirrhosis (LC). Patients were extensively analyzed for the presence of CVD, both clinical and echo cardio graphic. Results: The main etiology of LC was viral C infection, followed by alcoholic exposure. Dilatative cardiomyopathy, high blood pressure, heart failure with reduced ejection fraction, arrhythmias and deep vein thrombosis were more prevalent in patients with viral liver disease. The valvular diseases were more frequent diagnosed in patients with a worse prognosis (31.4% vs. 25.7%, p=0.001), though there were no difference between patients with viral or alcoholic etiology. Conclusions: Our study confirmed that there is a high prevalence of different CVD in patients with LC, mostly in patients with viral etiology, and there is a great need for standardized protocols and guidelines for the initial approach, treatment and follow-up of the CV dysfunction in LC patients.

The purpose of our study was to describe and better understand the clinical aspects of cirrhotic patients from a cardiologic perspective, to observe the correlations between clinical and echocardiography findings and to evaluate the prognostic impact of cardiac involvement in the end stage liver disease. Material and methods: We enrolled for this study a number of 83 patients that were devised according to MELD and Child-Pugh score. All study participants underwent a complete clinical examination and were assessed by echocardiography focusing on chambers dimensions, walls thickness, E/A ratio, left ventricular ejection fraction and pulmonary artery systolic pressure (PAPs). Results: The most frequent cardiac sign was edemas (34.9%), which was not correlated with the MELD score (p=0.118) but had an influence on the mortality rate (p=0.043). PAPs was higher among patients with edemas (mean value 29.34 mmHg; p=0.001), dyspnea (34 mmHg; p=0.012) and heart murmurs (36 mmHg; p=0.001) also if left atrium dilation was present (28.81 +/- 10.02 vs. 22.13 +/- 8.95, p=0.002). Conclusions: The echocardiographic parameters assessed in cirrhotic patients were not predictors of mortality and were not influenced by the severity of liver cirrhosis.