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  • 1
    Online Resource
    Online Resource
    The Challenges of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy and Persistent Left Superior Vena Cava: A Case Report and Concise Literature Review
    MDPI AG ; 2023
    In:  Biomedicines Vol. 11, No. 4 ( 2023-04-18), p. 1205-
    Details
    In: Biomedicines, MDPI AG, Vol. 11, No. 4 ( 2023-04-18), p. 1205-
    Abstract: Heart failure with reduced ejection fraction (HFrEF) is a chronic and debilitating disease, which requires extensive diagnostic and treatment resources in order to achieve an acceptable quality of life for the patient. While optimal medical treatment remains at the core of the disease’s management, interventional cardiology also plays a very important role. However, in very rare situations, interventionists might find cases especially challenging due to the presence of venous anomalies, such as persistent left superior vena cava (PLSVC), anomalies that may go undiscovered during the patient’s lifetime until venous cannulation is necessary. While these types of malformations also pose challenges in regards to standard pacemaker implantation, cardiac resynchronization (CRT) devices pose several additional challenges due to the complexity of the device and the necessity of finding an optimal position for the coronary sinus (CS) lead. We present the case of a 55-year-old male patient with advanced heart failure due to dilated cardiomyopathy (DCM) and LBBB who was a candidate for CRT-D therapy, describing the investigations that led to the discovery of the PLSVC as well as the technique and results of the intervention, while comparing our case to similar cases found in recent literature.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    URL: Article
    DOI: 10.3390/biomedicines11041205
    Language: English
    Publisher: MDPI AG
    Publication Date: 2023
    detail.hit.zdb_id: 2720867-9
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  • 2
    Online Resource
    Online Resource
    Single-Pass VDD Pacing Lead for Cardiac Resynchronization Therapy: A Reliable Alternative
    MDPI AG ; 2021
    In:  Micromachines Vol. 12, No. 8 ( 2021-08-18), p. 978-
    Details
    In: Micromachines, MDPI AG, Vol. 12, No. 8 ( 2021-08-18), p. 978-
    Abstract: (1) Background: Cardiac resynchronization therapy (CRT) systems can be simplified by excluding the atrial lead and using a Ventricular-Dual-Dual (VDD) pacing lead. Possible disadvantages might include atrial undersensing and Ventricular-Ventricular-Inhibition (VVI) pacing. Because literature data concerning these systems are scarce, we analyzed their benefits and technical safety. (2) Methods: this retrospective study compared 50 patients implanted with VDD–CRT systems (group A), mainly because of unfavorable venous anatomy concerning the complication rate, with 103 subjects with Dual-Dual-Dual (DDD)–CRT systems (group B) implanted during 2000–2016 and 49 (group C) during 2016–2020. To analyze the functional parameters of the devices, we selected subgroups of 27 patients (subgroup A) and 47 (subgroup B) patients with VDD–CRT in 2000–2016, and 36 subjects (subgroup C) with DDD–CRT implanted were selected in 2017–2020. (3) Results: There was a trend of a lower complication rate with VDD–CRT systems, especially concerning infections during 2000–2016 (p = 0.0048), but similar results were obtained after rigorous selection of patients and employment of an upgraded design of devices/leads. With a proper device programing, CRT pacing had similar results, atrial undersensing being minimal (p = 0.65). For VDD-systems, VVI pacing was recorded only 1.7 ± 2.24% of the time. (4) Conclusions: In patients with a less favorable venous anatomy, VDD–CRT systems may represent a safe alternative regarding complications rates and functional parameters.
    Type of Medium: Online Resource
    ISSN: 2072-666X
    URL: Article
    DOI: 10.3390/mi12080978
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2620864-7
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  • 3
    Online Resource
    Online Resource
    Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania
    MDPI AG ; 2021
    In:  Medicina Vol. 57, No. 5 ( 2021-05-03), p. 441-
    Details
    In: Medicina, MDPI AG, Vol. 57, No. 5 ( 2021-05-03), p. 441-
    Abstract: Background and Objectives: COVID-19 pandemic severely impacted public health services worldwide, determining a significant decrease of elective cardiovascular (CV) procedures, especially in patients with associated chronic diseases such as diabetes mellitus (DM). Materials and Methods: This study was first started in 2019 in the western of Romania, to analyze the differences regarding the implantations of intra-cardiac devices such as permanent pacemakers (PPM), cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillators (ICD) in 351 patients with and without DM and the situation was reanalyzed at the end of 2020. Results: of the first 351 patients with and without DM. 28.20% of these patients had type 2 DM (p = 0.022), exceeding more than twice the prevalence of DM in the general population (11%). Patients with DM were younger (p = 0.022) and required twice as often CRT (p = 0.002) as non-diabetic patients. The state of these procedures was reanalyzed at the end of 2020, a dramatic decrease of all new device implantations being observed, both in non-diabetic and in patients with type 2 DM (79.37%, respectively 81.82%). Conclusions: COVID-19 pandemic determined a drastic decrease, with around 75% reduction of all procedures of new intra-cardiac devices implantation, both in non-diabetics, this activity being reserved mostly for emergencies.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    URL: Article
    DOI: 10.3390/medicina57050441
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2088820-X
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  • 4
    Online Resource
    Online Resource
    Advantages of Intra-cardiac Polymer Coated Electrodes Leads in Patients with Diabetes Mellitus and Cardiovascular Implantable Electronic Devices
    Revista de Chimie SRL ; 2019
    In:  Materiale Plastice Vol. 57, No. 2 ( 2019-7-1), p. 39-44
    Details
    In: Materiale Plastice, Revista de Chimie SRL, Vol. 57, No. 2 ( 2019-7-1), p. 39-44
    Abstract: Diabetes mellitus (DM) and cardiovascular diseases (CVD) represent worldwide, major health problems. Frequently, diabetic patients may require therapy with implantable intra-cardiac electronic devices. In this article, we analysed the complications related to the presence of polymer-coated electrodes leads occurred among 351 patients, carriers of implantable electronic intra-cardiac devices: permanent pacemakers (PPM), cardiac resynchronisation therapy (CRT) or implantable cardioverter-defibrillators (ICD). Of all these patients, 99 (28.20%) had type 2 DM (p=0.022), double than the prevalence of DM in the general population (11%). Only two patients with PPM and DM had fractures of electrodes leads and one was diagnosed with right heart infective endocarditis, but no non-diabetic patient developed any complications related to the presence of polymer coated electrodes leads.
    Type of Medium: Online Resource
    ISSN: 0025-5289 , 2668-8220
    URL: Issue
    URL: Article
    DOI: 10.37358/MP.57.20.2
    DOI: 10.37358/MP.20.2.5349
    Language: English
    Publisher: Revista de Chimie SRL
    Publication Date: 2019
    detail.hit.zdb_id: 2487166-7
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  • 5
    Online Resource
    Online Resource
    Echocardiographic Parameters as Predictors for the Efficiency of Resynchronization Therapy in Patients with Dilated Cardiomyopathy and HFrEF
    MDPI AG ; 2021
    In:  Diagnostics Vol. 12, No. 1 ( 2021-12-24), p. 35-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 1 ( 2021-12-24), p. 35-
    Abstract: Cardiac resynchronization therapy (CRT) represents an increasingly recommended solution to alleviate symptomatology and improve the quality of life in individuals with dilated cardiomyopathy (DCM) and heart failure (HF) with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy (OMT). However, this therapy does have the desired results all cases, in that sometimes low sensing and high voltage stimulation are needed to obtain some degree of resynchronization, even in the case of perfectly placed cardiac pacing leads. Our study aims to identify whether there is a relationship between several transthoracic echocardiographic (TTE) parameters characterizing left ventricular (LV) performance, especially strain results, and sensing and pacing parameters. Between 2020–2021, CRT was performed to treat persistent symptoms in 48 patients with a mean age of 64 (53.25–70) years, who were diagnosed with DCM and HFrEF, and who were still symptomatic despite OMT. We documented statistically significant correlations between global longitudinal strain, posterolateral strain, and ejection fraction and LV sensing (r = 0.65, 0.469, and 0.534, respectively, p 〈 0.001) and LV pacing parameters (r = −0.567, −0.555, and −0.363, respectively, p 〈 0.001). Modern imaging techniques, such as TTE with cardiac strain, are contributing to the evaluation of patients with HFrEF, increasing the chances of CRT success, and allowing physicians to anticipate and plan for case management.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12010035
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662336-5
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  • 6
    Online Resource
    Online Resource
    Factors Influencing the Evolution of Pulmonary Hypertension in Previously Healthy Subjects Recovering from a SARS-CoV-2 Infection
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 22 ( 2021-11-12), p. 5272-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 22 ( 2021-11-12), p. 5272-
    Abstract: (1) Background: While the COVID-19 pandemic has been persisting for almost 2 years, more and more people are diagnosed with residual complications such as pulmonary hypertension (PH) and right ventricular dysfunction (RVD). This study aims to evaluate the course of PH and borderline PH (BPH) at 3 and 6 months after the acute COVID-19 infection and investigate if there are differences regarding its evolution between the patients from the first three waves of this disease. (2) Methods: We analyzed, by transthoracic echocardiography (TTE), the 3 and 6 months’ evolution of the echocardiographically estimated systolic pulmonary artery pressures (esPAP) in 116 patients already diagnosed with PH or BPH due to COVID-19 during the first three subsequent waves of COVID-19. (3) Results: We documented a gradual, statistically significant reduction in esPAP values, but also an improvement of the parameters characterizing RVD after 3 and 6 months (p 〈 0.001). This evolution was somewhat different between subjects infected with different viral strains and was related to the initial severity of the pulmonary injury and PH (adjusted R2 = 0.722, p 〈 0.001). (4) Conclusions: PH and RVD alleviate gradually during the recovery after COVID-19, but in some cases, they persist, suggesting the activation of pathophysiological mechanisms responsible for the self-propagation of PH.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10225272
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 7
    Online Resource
    Online Resource
    Cardiovascular Abnormalities and Mental Health Difficulties Result in a Reduced Quality of Life in the Post-Acute COVID-19 Syndrome
    MDPI AG ; 2021
    In:  Brain Sciences Vol. 11, No. 11 ( 2021-11-02), p. 1456-
    Details
    In: Brain Sciences, MDPI AG, Vol. 11, No. 11 ( 2021-11-02), p. 1456-
    Abstract: (1) Background: Post-acute COVID-19 syndrome, characterized by persisting symptoms up to 12 weeks after the acute illness, impairs numerous people’s physical and mental health. (2) Methods: 64 inpatients and 79 outpatients, aged under 55 years, with post-acute COVID-19, were evaluated by a transthoracic echocardiography (TTE), mental health examination, Quality of Life (QoL) questionnaire, post-COVID-19 functional status scale (PCFS) and Hospital Anxiety and Depression Scale (HADS). (3) Results: all inpatients had mild/moderate pulmonary injury during acute COVID-19, in contrast to 37.97% of outpatients. Inpatients who reported an average of 5 persisting symptoms, had, predominantly, level 3 PCFS and a median QoL of 62, compared to outpatients, who reported an average of 3 symptoms, level 1 PCFS and a median QoL score of 70. Increased pulmonary artery pressure was detected in 28.11% of inpatients, compared to 17.72% of outpatients, while diastolic dysfunction was diagnosed in 28.12% of inpatients, in comparison with 20.25% of outpatients (p = 0.02). Abnormal systolic function was assessed in 9.37% of inpatients, and 7.58% of outpatients. According to the HADS depression subscale, 46.87% of inpatients and 27.84% of outpatients had clinical depression. Concomitantly, anxiety was detected in 34.37% of inpatients and 40.5% of outpatients (4) Conclusions: cardiovascular and mental health difficulties were frequently detected in patients with post-acute symptoms of COVID-19, which correlated with the number and intensity of persisting symptoms and reduced QoL scores.
    Type of Medium: Online Resource
    ISSN: 2076-3425
    URL: Article
    DOI: 10.3390/brainsci11111456
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2651993-8
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  • 8
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    Online Resource
    The Impact of SARS-CoV-2 Pandemic on Patients Undergoing Radiation Therapy for Advanced Cervical Cancer at a Romanian Academic Center: A Four-Year Retrospective Analysis
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 6 ( 2022-06-17), p. 1488-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 6 ( 2022-06-17), p. 1488-
    Abstract: Background and Objectives: Throughout the COVID-19 pandemic, health systems worldwide adapted to support COVID-19 patients while continuing to provide assistance to patients with other potentially fatal illnesses. While patients with cancer may be at an elevated risk of severe COVID-19-related complications, their oncologic therapies generally cannot be postponed indefinitely without a negative effect on outcomes. Taking this into account, a thorough examination of the therapy management of various cancers is necessary, such as cervical cancer. Therefore, we aimed to develop a retrospective cohort study to measure the impact of the COVID-19 pandemic on the delivery of cancer care services for women diagnosed with cervical cancer staged IB2-IVA, necessitating chemo- and radiotherapy in Romania, as well as determine the difference in cervical cancer staging between the pandemic and pre-pandemic period. Materials and Methods: Using a multicentric hospital database, we designed a retrospective study to compare the last 24 months of the pre-pandemic period to the first 24 months of the SARS-CoV-2 pandemic to evaluate the variation in the proportion of women diagnosed with cervical cancer and the percentage of inoperable cases requiring chemotherapy and radiotherapy, as well as to detail their clinical presentation and other findings. Results: We observed that the likelihood of cervical cancer patients requiring radiation therapy at a later stage than before the pandemic increased by about 20% during the COVID-19 pandemic. Patients at an advanced FIGO stage of cervical cancer had a 3.39 higher likelihood of disease progression after radiotherapy (CI [2.06–4.21], p-value 〈 0.001), followed by tumor size at diagnosis with a hazard ratio (HR) of 3.12 (CI [2.24–4.00], p-value 〈 0.001). The factors related to the COVID-19 pandemic, postponed treatment and missed appointments, were also identified as significant risk factors for cervical cancer progression (HR = 2.51 and HR = 2.24, respectively). Conclusions We predict that there will be a considerable rise in cervical cancer cases over the next several years based on existing data and that expanding screening and treatment capacity will attenuate this with a minimal increase in morbidity and fatality.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12061488
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 9
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    Online Resource
    Evolution of Echocardiographic Abnormalities Identified in Previously Healthy Individuals Recovering from COVID-19
    MDPI AG ; 2022
    In:  Journal of Personalized Medicine Vol. 12, No. 1 ( 2022-01-04), p. 46-
    Details
    In: Journal of Personalized Medicine, MDPI AG, Vol. 12, No. 1 ( 2022-01-04), p. 46-
    Abstract: (1) Background: Although the infection with the SARS-CoV-2 virus affects primarily the lungs, it is well known that associated cardiovascular (CV) complications are important contributors to the increased morbidity and mortality of COVID-19. Thus, in some situations, their diagnosis is overlooked, and during recovery, some patients continue to have symptoms enclosed now in the post-acute COVID-19 syndrome. (2) Methods: In 102 patients, under 55 years old, and without a history of CV diseases, all diagnosed with post-acute COVID-19 syndrome, we assessed by transthoracic echocardiography (TTE) four patterns of abnormalities frequently overlapping each other. Their evolution was followed at 3 and 6 months. (3) Results: In 35 subjects, we assessed impaired left ventricular function (LVF), in 51 increased systolic pulmonary artery pressure, in 66 diastolic dysfunction (DD) with normal LVF, and in 23 pericardial effusion/thickening. All TTE alterations alleviated during the follow-up, the best evolution being observed in patients with pericarditis, and a considerably worse one in those with DD, thus with a reduction in severity (4) Conclusions: In patients with post-acute COVID-19 syndrome, several cardiac abnormalities may be assessed by TTE, most of them alleviating in time. Some of them, especially DD, may persist, raising the presumption of chronic alterations.
    Type of Medium: Online Resource
    ISSN: 2075-4426
    URL: Article
    DOI: 10.3390/jpm12010046
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662248-8
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  • 10
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    Online Resource
    The Impact of Metabolic Syndrome and Obesity on the Evolution of Diastolic Dysfunction in Apparently Healthy Patients Suffering from Post-COVID-19 Syndrome
    MDPI AG ; 2022
    In:  Biomedicines Vol. 10, No. 7 ( 2022-06-27), p. 1519-
    Details
    In: Biomedicines, MDPI AG, Vol. 10, No. 7 ( 2022-06-27), p. 1519-
    Abstract: (1) Background: Coronavirus disease 2019 (COVID-19) has a worse prognosis in individuals with obesity and metabolic syndrome (MS), who often develop cardiovascular complications that last throughout recovery. (2) Methods: This study aimed to analyze the evolution of diastolic dysfunction (DD), assessed by transthoracic echocardiography (TTE), in 203 individuals with and without obesity and/or MS diagnosed with post-COVID-19 syndrome. (3) Results: DD was frequently diagnosed in patients with MS and obesity, but also in those without obesity (62.71% and 56.6%, respectively), in comparison to 21.97% of subjects without MS (p ˂ 0.001). Almost half of the patients with obesity and MS had more severe DD (types 2 and 3). As for evolution, the prevalence and severity of DD, particularly types 1 and 2, decreased gradually, in parallel with the improvement of symptoms, progress being more evident in subjects without MS. DD of type 3 did not show a significant reduction (p = 0.47), suggesting irreversible myocardial damages. Multivariate regression analysis indicated that the number of MS factors, the severity of initial pulmonary injury, and protein C levels could explain DD evolution. (4) Conclusions: DD was commonly diagnosed in individuals with post-COVID-19 syndrome, particularly in those with MS and obesity. After 6 months, DD evolution, excepting that of type 3, showed a significant improvement, mostly in patients without MS.
    Type of Medium: Online Resource
    ISSN: 2227-9059
    URL: Article
    DOI: 10.3390/biomedicines10071519
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2720867-9
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