CardioNET 2022 Book of Abstract

BOOK OF ABSTRACTS
CardioNET 2022
The 12th edition of the National Conference
with International Participation
Târgu Mureș, 29 June–1 July 2022
BOOK OF ABSTRACTS
CardioNET 2022
Vasculitis in Young Patients – Diagnostic and Therapeutic Challenge

Diana Popescu1,2, Petronela-Nicoleta Seritean-Isac1,2, Elena Rezus1,3, Ciprian Rezus1,2
1
“Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
2
Medical Clinic III, “Sf. Spiridon” Emergency County Clinical Hospital, Iași, Romania
3
Clinic of Rheumatology I, Clinical Hospital of Recuperation, Iași, Romania
Background: Takayasu arteritis, or the pulseless disease, is a rare vasculitis with unknown etiology, which affects the large and me-
dium vessels. With a prevalence of 2.6–6.4/million/year and a female predominance, the clinical manifestation of the disease occurs
frequently between the second and third decade of life, with a delay from onset until the first symptoms that can vary from months
to years. Case presentation: We present the case of a 22-year-old female patient who complained of an enlarged, painful mass in the
right latero-cervical region and increased fatigue that started two years prior. After ruling out infectious and malignant disorders,
as well as ear, nose and throat disease, the patient was referred to the rheumatology department for further investigations. Upon
admission, the patient was afebrile, in good general state, with an enlarged, solid mass in the right latero-cervical region, painful on
palpation, which could not be differentiated from the underlying planes. Clinical examination revealed the presence of a right carotid
murmur, decreased pulse amplitude in the right radial artery, and a 10-mmHg difference in blood pressure between the two arms.
Paraclinical examination revealed a concentric thickening of the common right carotid artery, which extended in the brachiocephalic
trunk, with a caliber asymmetry in the right internal carotid artery. Based on the criteria developed by the American College of Rheu-
matology in 1990, as well as the angiographical classification from 1991, the diagnosis of Takayasu arteritis type IIA was established.
The patient was prescribed immunosuppressants and corticosteroids, and she presented a slow favorable clinical course and evolution.
Conclusions: Takayasu arteritis is a rare disease with a potentially severe evolution, with possible death due to ischemia in vital organs
that may occur in absence of specific treatment. Therefore, early diagnosis and treatment in vital. Nevertheless, due to atypical initial
clinical presentation, the diagnosis can be delayed, as it was the case in the presented patient.
Ventricular Tachycardia with Recurrent Syncope – an Atypical

Presentation of Paraganglioma Catecholamine Crisis
Evelin Szabo1, Istvan Kovacs1,2, Nora Rat1,2, Monica Chitu1,2, Imre Benedek1,2, Theodora Benedek1,2
1
Clinic of Cardiology, Emergency Clinical County Hospital, Târgu Mureș,
2
University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade” of Târgu Mureș, Romania
Introduction: Pheochromocytomas arise from chromaffin cells of the adrenal medulla and extrarenal sympathetic paraganglia. They
produce excess catecholamines, epinephrine, and norepinephrine in a continuous or episodical manner. Their effect on the cardio-
vascular system can cause cardiac complications and serious, potentially lethal, arrhythmias, often in the setting of comorbid blood
pressure derangements, with various clinical manifestations including heart failure, myocardial infarction, and cardiomyopathy. Ar-
rhythmias are found in 10–20% of patients with pheochromocytomas. Catecholamine-induced arrhythmias are refractory to conven-
tional medical therapy. Without intervention, the condition can lead to severe complications (hypertensive crises, hypotensive shock).
Case Presentation: A 69-year-old male known with hypertension, permanent atrial fibrillation, and secondary pulmonary hyperten-
sion presented with constrictive chest pain with radiation in the interscapulovertebral region. These symptoms were associated with
two syncopal episodes and one monomorphic non-sustained ventricular tachycardia (NSVT). His serum electrolytes, liver and thyroid
function tests were within normal limits, with leukocytosis, and increased creatinine. The emergency coronary angiography did not
reveal significant coronary abnormalities. During hospitalization, his blood pressure was severely unstable, with remarkable blood
pressure fluctuation (from 260/130 mmHg to 60/40 mmHg) associated with multiple episodes of NSVT and VT cardioverted with 200 J
DC shock. Contrast computed tomography of the abdomen revealed an inhomogeneous, cystic, polylobate 7.3 cm × 7 cm × 7.2 cm mass
in the retroperitoneal, paraaortic, infrarenal region, and a provisional diagnosis of extra-adrenal pheochromocytoma was established.
The 24-h urinary metanephrine was 726 µg, normetanephrine 15,476 µg, noradrenalin 834, 88 µg, adrenaline and dopamine within
normal limits. Conclusions: Pheochromocytomas are uncommon tumors, and the intermittent nature of their symptoms often leads
to a delay in the diagnosis. Pheochromocytoma that initially presents with VT is rare and is reported only in a few isolated case reports.
We presented a rare case of paraganglioma complicated by a catecholamine crisis and VT. If patients present with symptoms of heart
failure, hypertensive crisis, and arrhythmia without coronary heart disease, valvular disease, or unknown etiology, paraganglioma
with catecholamine crisis should always be suspected.
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CardioNET 2022
Anatomical Barriers for Cardiac Resynchronization Therapy

Zsolt Parajko1, Kovacs Istvan1,2, Evelin Szabo1, Theodora Benedek1,2, Imre Benedek1,2
1
“George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
2
Clinic of Cardiology, Emergency Clinical County Hospital, Târgu Mureș, Romania
Background: Cardiac resynchronization therapy is an essential tool for patients suffering from heart failure in different types of
dilatative cardiomyopathy, with bundle branch block on the ECG. However, it is wildly used with significant benefits on the patients
in terms of quality of life and effort tolerability along with optimal medical therapy of heart failure. In spite of its benefits, unfor-
tunately, there are several factors that can influence its efficacy (etiology, lead position, device settings etc.) and in some cases, the
anatomical variance of the coronary sinus could create serious issues, even more could make impossible to advancing the left ven-
tricular lead, therefore the cardiac resynchronization. Case report: This case report describes a young female patient with complicated
sclerosis multiplex and a fibrous tissue in the coronary sinus, creating an almost sub-occlusive obstruction, making it impossible to
pass through the LV lead. In default of clinical guidelines, the solution is based on the resourcefulness of the operators. Conclusions:
This case underlines the importance of anatomical preparation with appropriate imaging investigation in order for the operator to be
prepared for the optimal interventional approach.
Different Risk Factors for the Same Type of

Acute Coronary Syndrome in Twins
Gerculy Renata1, Nora Rat1,2, Istvan Kovacs1,2,3, Monica Chitu1,2,3, Imre Benedek1,2,3, Theodora Benedek1,2,3
1
2
Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
3
Cardiomed Medical Center, Târgu Mureș, Romania
Cardiovascular risk factors are a widely studied area in scientific research. The influence of environmental factors on the development
of coronary artery disease has been proven. However, the interaction between environmental and genetic factors and its role in trigger-
ing an acute myocardial infarction has yet to be fully elucidated. Early coronary artery disease in patients with relevant family history
of coronary atherosclerosis suggests the influence of genetic predisposition, but the question that remains open is: can individual risk
factors and prevention strategies suppress the impact of genetic predisposition in patients with acute coronary syndromes? We present
the case of two brothers who presented with acute myocardial infarction at similar ages and were exposed to different cardiovascular
risk factors. One of the patients presented with a chronic systemic inflammatory disease, while the other presented with a modifiable
risk factor – chronic tobacco use. Genetic factors are not modifiable, but the implementation of preventive cardiovascular strategies in
association with gene sequencing could be an improved management option for these patients.
Aortic Stenosis Limits and Challenges

Oana Nicoleta Buliga-Finiș1,2, Anca Ouatu1,2, Evelina-Maria Gosav1,2, Petronela Nicoleta Isac-Serițean1,2, Dan Ștefan
Teodorescu1,2, Ciprian Rezuș1,2
1
Medical Clinic III, “Sf. Spiridon” Emergency Clinical Hospital, Iași, Romania
2
“Gr. T. Popa” University of Medicine and Pharmacy, Iași, Romania
Background and aim: Aortic stenosis, the most common valvular disease of the elderly, often represents the promotor of complica-
tions in this age group. Aortic stenosis and the increasing prevalence of intestinal angiodysplasia may lead to several complications,
especially in patients with mechanical valves. Material and Methods: We present the case of a 70-year-old female patient with an
aortic mechanical valve, which was placed for severe aortic stenosis, under treatment with chronic oral anticoagulants. The patient
presented with several comorbidities including cerebrovascular events, malignancy, thyroid and rheumatological associated pathol-
ogy. The patient presented to the emergency department for hematemesis, nausea, emesis, and an altered general state. Results: The
clinical and paraclinical examination confirmed the pre-existing conditions of the patient. The emergency digestive endoscopy and
computed tomography angiography that were performed in the emergency department due to the upper digestive bleeding with me-
lena ruled out active bleeding in the digestive tract. The clinical evolution of the patient was marked by the occurrence of a hematoma
in the superior-internal aspect of the left thigh and the installation of hemorrhagic shock, which required vasopressors. After specific
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CardioNET 2022
treatment, the patient presented favorable clinical and paraclinical evolution. Conclusions: The presence of aortic stenosis and hem-
orrhagic digestive disease in this clinical scenario suggest a diagnosis of Hyde syndrome. The specific triad, including aortic stenosis,
intestinal angiodysplasia, and von Willebrand syndrome, was confirmed by the upper digestive tract bleeding and the coagulopathy
that was enhanced by the need to continue the anticoagulant treatment.
The Link between Periodontopathogen Germs and the Severity of Acute

Coronary Syndromes – Study Based on Next-Generation Sequencing
Ioana-Patricia Rodean1,2, Vasile-Bogdan Halațiu1,2, Imre Benedek1,2, Theodora Benedek1,2
1
2
Background: Periodontal disease (PD) is a well-known inflammatory disease that increases cardiovascular risk and promotes the
development of acute coronary events. However, the link between periodontal pathogens and inflammatory biomarkers in patients
with acute coronary syndromes (ACS) has not been elucidated so far. Aim: The purpose of this study was to evaluate the correlation
between red and orange complex periodontal pathogens and inflammatory biomarkers in ACS patients. Material and Methods: Six-
teen patients with ACS and PD were enrolled in this study. For each patient, a complex dental examination was performed, including
a DNA sample from the periodontal pocket. Based on the presence of germs from the red and orange complex, the study population
was divided into two groups: the RC group included nine patients with periodontopathogen germs from the red complex; the ROC
group included seven patients with germs from the red and orange complex. In order to assess systemic inflammation, the follow-
ing biomarkers were determined: interleukin 6 (IL-6), endothelial/intravascular adhesion molecules (VCAM/ICAM), P-selectin,
metalloproteinase (MMP9), albumin (Ab), apolipoprotein B (ApoB), C reactive protein (CRP), alkaline phosphatase (AF), sST2,
and lymphocytes-to-monocytes ratio. Results: In patients with ACS, red complex germs, represented by Porphyromonas gingivalis,
Tannerella forsythia, and Treponema denticola, were more expressed than those of the orange complex (p = 0.0008). We found no
significant correlation between the two groups regarding the inflammatory status. Still, P-selectin was higher in the RC group (p =
0.005), and AF was more expressed in the ROC group both at baseline (p = 0.006) and on day 7 (p = 0.01). Also, in the ROC group, a
higher lymphocyte-to-monocyte ratio was observed compared to the RC group (3.2 ± 1.44 vs. 10.94 ± 12.75, p = 0.01). Conclusions:
The presence of periodontopathogen germs of the red complex in patients with ACS and PD is linked with increased blood vulner-
ability and worse long-term outcomes.
Correlation between Hemorheological Parameters

and Post-Infarction Heart Failure
Johanna Sándor-Kéri1, Nóra Raț1,2, István Benedek Jr1, Theodora Benedek1,2, Imre Benedek1,2
1
“George Emil Palade” University of Medicine, Pharmacy, Science, and Technology, Târgu Mureș, Romania
2
Background: Inflammation plays a key role in all stages of atherosclerosis, regardless of other well-known risk factors for coronary
heart disease. Inflammation can be associated with cardiovascular events in two ways: 1) promoting atherosclerosis as a chronic
process by damaging the endothelium; 2) promoting the release of acute phase proteins and cytokines that contribute to the develop-
ment of acute thrombosis. Recent studies have identified a number of associations with certain hemorheological parameters that may
provide information on the extent of inflammatory processes or may be associated with morbidity in acute coronary syndromes, such
as the platelet-lymphocyte ratio, which has been shown to be useful in the treatment of acute coronary syndromes. Aim: This study
investigated the relationships between pathological platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios in the assessment
of the risk of acute coronary syndrome. Results: The study analyzed the effect of altered hematologic parameters on (1) systemic in-
flammation, (2) nutritional status correlated with systemic inflammation, and (3) changes in left ventricular function after infarction.
Analyzing the hematological ratios, we found a statistically significant difference regarding the platelet-to-lymphocyte ratio (107.5
± 69.15 (87.64–127.4) vs. 513 ± 432.96 (273.3–752.7), p <0.0001, with increased values in the group of malnutrition patients. Analyz-
ing the neutrophil-to-lymphocyte ratio, we also found a statistically significant difference with its marked increase in patients with
nutritional deficiency: 3.82 ± 4.305 (2.583–5.056) vs. 7.740 ± 5.013 (4.964–10.520), p = 0.0001. Conclusions: The present study shows
a direct association between altered nutritional status and the onset of severe left ventricular dysfunction following acute myocardial
infarction in patients with increased inflammatory and altered bleeding parameters.
CardioNET 2022
Correlations between Inflammatory Status and

Mortality Post-Myocardial Infarction
Diana Opincariu1,2, Ioana Rodean1,3, Nora Rat1,2,3, Alexandra Stanescu3, Roxana Hodas1,3, Imre Benedek1,2,3, Theodora
Benedek1,2,3
1
2
3
Background: The role of systemic inflammatory response in the prognosis of cardiovascular patients has been established. However,
most risk prediction tools for acute myocardial infarction (AMI) do not include the systemic inflammatory response after the acute
event, nor the presence of multivessel disease, location of culprit lesions, and the left ventricular ejection fraction (LVEF). Aim: We
aimed to evaluate the accuracy of inflammatory biomarkers, in association with angiographical and echocardiographic parameters,
in predicting 1-year major adverse cardiovascular events (MACE) after revascularized AMI. Material and Methods: We conducted a
prospective cohort study which included 225 patients with AMI (STEMI + NSTEMI) who underwent percutaneous coronary interven-
tion (PCI) according to the current guidelines of the European Society of Cardiology, in which blood samples were drawn at one hour
following admission, to evaluate the serum levels of hs-CRP, IL-6, E-selectin, I-CAM, V-CAM, and MMP-9. Imaging markers included
the severity of coronary artery disease (CAD) assessed with invasive angiography and LVEF (during day 5). The primary end-point
of the study was the occurrence of MACE during a follow-up of 12 months, and the secondary end-point consisted in the presence of
acute phase complications during hospitalization for the index event. The study population was divided into two groups: Group 1 –
with MACE during follow-up (n = 56), Group 2 – without MACE (n = 134). Results: The MACE rate was 24.8% (n = 56). There were
no significant differences between groups in regard to IL-6, V-CAM, and E-selectin levels. The following inflammatory markers were
significantly higher in MACE patients: hs-CRP (11.1 ± 13.8 mg/L vs. 5.1 ± 4.4 mg/L, p = 0.03), I-CAM (452 ± 283 vs. 220.5 ± 104.6, p =
0.0003) and MMP-9 (2,255 ± 1,226 ng/mL vs. 1,099 ± 706.1 ng/mL, p = 0.0001). The most powerful predictor for MACE was MMP-9
of >1,155 ng/mL (AUC 0.786, p <0.001), even after adjustments for diabetes, LVEF, acute phase complications, and other inflammatory
biomarkers. Conclusions: Patients with increased serum inflammatory levels (hs-CRP, I-CAM, MMP-9) evaluated at one hour after
an AMI, with a LVEF, present a significantly higher risk of MACE at one year. The most powerful predictors for MACE in this clinical
scenario were increased I-CAM (>239.7 ng/mL) and MMP-9 (>1,155 ng/mL) levels, even after adjustments for clinical, biological, and
coronary artery disease severity.
The Impact of Early Mobilization on Scar Extension

and Evolution at One Month Post-Infarction
Aurelian Rosca1, Mihaela Ghircau Susca2, Roxana Hodas1, Theodora Benedek1,2
1
2
Background: Cardiac nuclear magnetic resonance (MRI) has a wide range of clinical applications. It currently plays a critical role in the
diagnosis of myocardial diseases and their classification. Cardiac MRI is the only imaging modality that allows accurate evaluation of
ventricular function and can provide accurate data about complete tissue characteristics in a single examination that does not require
the use of ionizing radiation. Objective: The present study aimed to investigate patients who have had a previous acute myocardial
infarction (AMI), in order to identify the differences between patients who mobilized early, at 1–2 days, versus patients who mobilized
late, after three days, through an MRI examination performed one month after the acute coronary event. Material and Methods: The
present study was a prospective observational study, which included 81 patients with AMI. All patients had cardiac MRI at one month
after the AMI through which we determined the ejection fraction, the percentage of necrosis, the necrosis area, the volume of myo-
cardial necrosis, and the degree of transmurality. The 81 patients included in the study were divided into two groups: Group 1 – 30
patients who mobilized early, on day 1–2 post-myocardial infarction, and Group 2 – 51 patients who were mobilized late, on day 3–4
post-myocardial infarction. Results: The study identified statistically significant differences between the two groups regarding the
cardiac MRI parameters. At one month after the AMI, the affected myocardial volume, cardiac remodeling, mass of infarcted tissue,
size of infarction, and degree of transmurality were significantly higher in patients with late mobilization (p <0.0001). Conclusions:
Patients mobilized early have a better evolution and a shorter extension of the myocardial scar at one month after the acute coronary
event, as evaluated by cardiac MRI examination, compared to late mobilized patients. The study proves the benefits of early mobiliza-
tion after myocardial infarction.
CardioNET 2022
Systemic and Local Inflammatory Biomarkers in the Acute Phase of

Myocardial Infarction, as Predictors of Post-Infarction Heart Failure
Botond Mátyás1, Imre Benedek1,2, Diana Opincariu1,2, Emanuel Blîndu1, Aurelian Roșca1, Theodora Benedek1,2
1
2
Background: It is a well-known fact that systemic inflammation plays a prominent role in the progression of atheromatous plaques,
which ultimately leads to an acute coronary event. Furthermore, inflammation also promotes ventricular remodeling and progression
towards heart failure after an acute myocardial infarction (AMI). Objectives: The aim of this study was to investigate the association
between left ventricular dysfunction and systemic inflammatory biomarkers in the first days after an AMI and their role in the early
identification of patients at high risk for post-infarction heart failure. Materials and Methods: In our study, we examined a total of
127 patients diagnosed with AMI, who were referred to the Department of Intensive Cardiovascular Care Unit of the Clinic of Cardiol-
ogy, Târgu Mureș County Clinical Emergency Hospital. All patients underwent coronary revascularization and evaluation of serum
level of NT-proBNP and inflammatory serum biomarkers (hs-CRP, IL-6, adhesion molecules). Based on the NT-proBNP level, the
study population was divided into two groups: Group 1 (n = 96), NT-proBNP <3,000 pg/mL and Group 2 (n = 31), NT-proBNP >3,000
pg/mL. Results: Serum levels of systemic inflammatory biomarkers were significantly higher in the group of patients with elevated
NT-proBNP levels (hs-CRP 12.33 ± 8.91 mg/L vs. 3.61 ± 6.75 mg/L, p <0.0001 and IL-6 27.63 ± 30.72 pg/mL vs. 8.69 ± 6.26 pg/mL, p
<0.0001). However, the levels of VCAM and ICAM cell adhesion molecules were not significantly different between the groups. Patients
in Group 2 had a significantly higher rate of major cardiovascular events and rehospitalizations in the first year after an acute coronary
syndrome (13.45%) compared to Group 1 (8.75%), p <0.05. Conclusions: Elevated serum biomarkers of left ventricular dysfunction are
strongly associated with systemic inflammation and left heart failure in the immediate post-acute period of AMI. Systemic inflamma-
tion has a greater effect on the clinical outcomes and progression of heart failure than local coronary inflammation expressed by cell
adhesion molecules.
Correlation between Biomarkers of Ventricular Dysfunction and

Inflammatory Biomarkers in Patients with Acute Myocardial Infarction
Bogdan Halațiu1,2, Andreea Buicu2, Roxana Hodas1, Theodora Benedek1,2
1
2
Background: Prolonged persistence of an inflammatory reaction in patients with myocardial infarction is associated with an increased
risk of complications and interferes with the ventricular remodeling process and subsequent ventricular disfunction. However, the role
of C-reactive protein or interleukin 6 as a predictor of left ventricular disfunction in myocardial infarction treated with percutaneous
coronary intervention (PCI) has not yet been fully elucidated. Aim: To investigate the correlations between serum biomarkers which
express the severity of left ventricular dysfunction and the serum biomarkers that express inflammatory status, in the immediate
post-infarction phase. Methods: The study included 123 consecutive patients with acute myocardial infarction admitted to the Car-
diology Clinic of the County Emergency Clinical Hospital of Târgu Mureș, Romania. According to the median value of the NT-proBNP
serum level, patients were divided into two groups: Group 1 – 92 patients with NT-proBNP levels <3,000 pg/mL, and Group 2 – 31 pa-
tients with NT-proBNP levels above 3,000 pg/mL. Inflammatory biomarkers, including high-sensitivity C-reactive protein (hs-CRP),
interleukin 6 (IL-6), E-selectin, intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and apolipoprotein
B (Apo B) were evaluated at h from admission. Results: Patients with ventricular dysfunction (Group 2), presented significantly higher
levels of inflammatory biomarkers hs-CRP (p <0.0001), IL-6 (p <0.0001), and E-selectin (p <0.0001). No statistical difference was
found between the two groups in terms of ICAM, VCAM, or Apo B. Conclusions: The analysis of NT-proBNP (expressing the severity
of left ventricular dysfunction) after myocardial infarction reveals a strong association between ventricular dysfunction and systemic
inflammatory status revealed by hs-CRP, IL-6, and E-selectin in the immediate phase following the acute coronary event.
CardioNET 2022
The Association between Altered Nutritional Status and Prolonged

Hospitalization in Patients with Acute Myocardial Infarction
Victoria Rus1, Tiberiu Nyulas1, Theodora Benedek1,2
1
2
Background: The presence of comorbidities and impaired nutritional status are among the most important factors affecting the length
of hospitalization (LOS) of a cardiovascular patient. A patient with an altered nutritional status has a higher risk of complications, poor
treatment effectiveness, and a worse prognosis. Recent studies have also shown that an altered nutritional status is associated with
an increase in the number of hospital days, a higher number of readmissions, and an increase in morbidity and mortality. Aim: To
evaluate how the depreciated nutritional status expressed by several validated instruments associates with the length of hospital stay
in patients with acute myocardial infarction. Materials and Methods: We conducted a prospective study that included 86 patients who
presented with myocardial infarction and were hospitalized in the cardiology department of the Emergency Clinical County Hospital
of Târgu Mureș, Romania. In all patients, initial characteristics, nutritional status assessment, body mass index and medical history
were recorded at admission. Laboratory data, indicators of inflammatory status (day 1 and day 5) were also collected, and the evalua-
tion of the nutritional status was performed by calculating the CONUT, PNI, and GNRI indices. Results: The comparison of the groups
according to the CONUT score showed that the length of stay in the cardiac critical care unit (CCCU) was significantly longer in the
group with impaired nutritional status (4.27 days vs. 2.85 days, p = 0.0015), as well as the total length of hospital stay, including the
immediate rehabilitation period (10.72 days vs. 7.95 days, p = 0.001). We obtained similar results when evaluating the sample accord-
ing to the GNRI and PNI scores: the length of stay in the CCCU (3.95 days vs. 2.93 days) and the total length of hospital stay (9.73 days
vs. 8.09 days) were significantly longer in the group with altered nutritional status (p = 0.0001). Conclusions: In our study, patients
with impaired nutritional status required longer observation periods in the intensive care unit as well as a longer duration of general
hospitalization than patients with normal nutritional status.
Study of Inflammatory Biomarkers in Patients with

Heart Failure and Acute Coronary Syndrome
Ioana Haja1, Andreea Luciana Buicu (Chiotoriu)1,2, Roxana Hodas1,2, Theodora Benedek1,2
1
2
Background: It is well known that heart failure (HF) is a disease with a major impact on the healthcare system, with a mortality of up
to 26.6% globally, while about 50% of people diagnosed with HF die approximately five years after the diagnosis. The disease mainly
affects people over the age of 60 and is also accompanied by an extremely high rate of hospitalization for decompensation of ventricu-
lar function. Aim: To highlight the role of different biomarkers currently used to assess HF patients and to identify those biomarkers
that have a stronger association with different clinical contexts leading to heart failure, such as acute coronary syndromes (ACSs).
Methods: The study included a total of 266 hospitalized patients with ACS of various types (unstable angina [UA], ST-segment eleva-
tion myocardial infarction [STEMI], non-ST-segment elevation myocardial infarction [NSTEMI]), in whom the diagnosis of HF was
established based on clinical and paraclinical data. We investigated the association between inflammatory biomarkers (hs-CRP, IL-6,
ICAM, VCAM) and the type of ACS in patients with confirmed laboratory (high NT-proBNP value) or based on imaging evidence (low
ejection fraction). Results: Patients with HF and acute myocardial infarction (AMI) presented significantly higher levels of inflam-
matory biomarkers compared to HF and UA (hs-CRP: p = 0.001, IL-6: p <0.0001). Patients with STEMI and HF presented significantly
higher levels of IL-6 compared to other types of ACS and HF. At the same time, ICAM appears to have a greater power of discrimination
between STEMI and other types of ACS associated with HF, having a value more than double in subjects with STEMI + HF (216.1 ± 149.6
vs. 448.2 ± 754.4, p <0.0001). Inflammatory biomarker analysis in patients with HF depending on the type of myocardial infarction
(STEMI or NSTEMI) revealed that only ICAM was significantly higher (two-fold higher) in STEMI compared to NSTEMI patients that
presented HF during the index hospitalization (214.6 ± 150.6 versus 448.2 ± 754.4, p <0.0001). Conclusions: Systemic inflammatory
status has a significant contribution in the development of left ventricular dysfunction after myocardial infarction. Serum biomarkers
expressing the degree of ventricular dysfunction (NT-proBNP and BNP) show a significant correlation not only with the inflamma-
tory status but also with the hemodynamic status of patients with myocardial infarction in the acute phase, as well as the severity of
angiographic lesions.
CardioNET 2022
Interrelation between CCTA Phenotype of Precursor Vulnerable

Plaques and the Type of Acute Coronary Syndrome They Trigger
Diana Opincariu1,2, Daniel Cernica1, Nora Rat1,3, Botond Matyas3, Emanuel Blindu3, Imre Benedek1,2,3, Theodora Benedek1,2,3
1
2
3
Background: Coronary computed tomography angiography (CCTA)-derived characteristics can provide data on the anatomy, topog-
raphy, composition, morphology, and vulnerability of coronary atherosclerotic lesions. The role of vulnerable plaques (VP) in causing
acute coronary syndromes (ACSs) is well established. However, there is scarce information regarding the relationship between plaque
characteristics and the type of ACS it triggers. Aim: We aimed to perform a comparative CCTA analysis of ACS precursor atherosclerotic
plaques, according to the type of ACS (unstable angina [UA], ST-segment elevation myocardial infarction [STEMI], non-ST-segment
elevation myocardial infarction [NSTEMI]) they had triggered, in regards to plaque anatomy, morphology, composition, and degree
of vulnerability. Material and Methods: We included 50 patients who underwent CCTA for stable angina, who presented ACS during a
follow-up of three years. At baseline, coronary plaque analysis was performed for atherosclerotic plaques that presented an interme-
diary degree of stenosis and at least one vulnerability marker, which became a culprit lesion during follow-up. The study population
was divided into three groups according to the type of ACS registered during follow-up: Group 1 – patients with UA (n = 28); Group 2
– patients with STEMI (n = 13); Group 3 – patients with NSTEMI (n = 9). Results: There were no significant differences between groups
in relation to age, body mass index, and gender. The time from baseline to the occurrence of the acute event was significantly higher
for NSTEMI patients, followed by UA and STEMI (391.5 ± 306.5 – API vs. 169.9 ± 177.4 – STEMI, vs. 472.1 ± 282.2 days, p = 0.0001).
The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). The remodeling and eccentricity index was
not significantly different between groups. STEMI precursor VPs presented the highest non-calcified (p = 0.01) and lipid rich volume
(p = 0.01). There were no differences between groups regarding the calcified and fibrotic volumes, or the incidence of CCTA-derived
vulnerability markers. VP that had triggered STEMI presented a significantly higher number of plaques with >2 vulnerability markers
per lesion compared to UA and NSTEMI (p = 0.01). Conclusions: STEMI precursor vulnerable plaques present a soft phenotype, with
non-calcified, lipid rich content, the most frequent vulnerability marker being the napkin ring sign. NSTEMI precursor lesions are
heterogeneous, with a low calcium content and the highest fibrotic volume, while VPs triggering UA are calcified, with a low lipid rich
volume and spotty calcifications. Funding: This work was supported by the “George Emil Palade” University of Medicine, Pharmacy,
Science and Technology of Târgu Mureș Research Grant number 510/13/17.01.2022
Feasibility of 3D Printed Models of Aortic Valves in

Guiding TAVI Procedures for Aortic Stenosis
Daniel Cernica1,2,3, Diana Opincariu1,2,3, Botond Mátyás1,2, Imre Benedek1,2,3, Emanuel Blîndu1,3, Theodora Benedek1,2,3
1
2
3
Background: Biomedical three-dimensional (3D) modeling represents a paramount in terms of advances in the cardiovascular imaging
field. It is an important emerging tool in pre-interventional planning and offers crucial information of spatial relationship. Further,
volumetric information collected using coronary computed tomography angiography (CCTA) and DICOM data is processed through
several steps to obtain 3D printed model. Aim: The aim of this study is to analyze the accuracy of replicating cardiovascular anatomi-
cal structures using different techniques, by conducting a comparative analysis of measurements achieved on CCTA images versus
measurements obtained with a specialized projection platform used to design models for 3D printing of various anatomical structures.
Materials and Methods: Twenty cardiovascular 3D printed models (n = 20, 1:1 ratio) were analyzed, including the aortic annulus, sinus
of Valsalva, ascending aorta, sinotubular junction, left ventricular outflow tract obstruction, and coronary arteries. The measurement
techniques used to evaluate the accuracy of the 3D printed models were as follows: digital planimetric measurement of CCTA scans us-
ing a digital caliper in a dedicated DICOM viewer and photogrammetry using specialized software to post-process and evaluate all the
digital 3D models. All measurements were made by a radiologist and a cardiologist. Results: The mean age of the study population was
72.43 ± 4.96 years, and 52% were males. The overall value for surface congruency/deviation of all 20 models obtained in planimetric vs.
photogrammetry measurements was -0.79065 mm. For further evaluation of valvular and perivalvular apparatus, anatomical struc-
tures were analyzed separately: the difference for the height of the coronary ostium on planimetric measurement vs. photogrammetry
CardioNET 2022
was –0.11 mm ± 0.09 mm, (p >0.05); the difference for the aortic annulus was –0.78 ± 0.28 mm, (p >0.20). Submillimetric differences
between the two measurements were observed in case of the left ventricular outflow tract, sinotubular junction, and Valsalva sinuses.
Conclusions: Three-dimensional printed models can be measured by various techniques. Individual techniques to analyze 3D models
can be affected by multifactorial chain of errors. The accuracy of each printed model depends on geometric complexity, on the level of
personnel training, and on feasible resources in each 3D printing lab. The high accuracy and quality of dataset processing is mandatory
in 3D models serving as guide in interventional procedures. Funding: This work was supported by the “George Emil Palade” University
of Medicine, Pharmacy, Science and Technology of Târgu Mureș Research Grant number 510/1/17.01.2022
Modern Technologies for Assessing Myocardial Fibrosis in Atrial Fibrillation

Emanuel Blîndu1,2, Botond Mátyás1,3, Istvan Kovacs1,2,3, Imre Benedek1,2,3, Theodora Benedek1,2,3
1
2
3
The patient with atrial fibrillation (AF) is a complex entity that involves a spot-on assessment of its burden based on the ischemic
and hemorrhagic risk following anticoagulant treatment, the contribution to developing heart failure, and on impaired quality of life.
There are plenty of trials that have shown that myocardial fibrosis plays a major role in developing and maintaining AF. The current
gold standard in diagnosing cardiac fibrosis is based on endomyocardial biopsy, but most often this is not a feasible procedure. Cardiac
magnetic resonance (CMR) is a noninvasive method accompanied by a lower risk of complications compared to biopsy, which can allow
the identification, assessment, and quantification of cardiac fibrosis and the characterization of structural remodeling. CMR is not only
used as a modern tool for AF management and treatment, but it also provides clues about stroke risk and left atrial appendage throm-
bosis. Also, the assessment of cardiac fibrosis is used for phenotyping the ideal patient most likely to benefit from catheter ablation.
Imaging Technologies Based on Artificial Intelligence

for Assessment of Epicardial Fat
Botond Mátyás1,2, Imre Benedek1,2, Diana Opincariu1,2, Emanuel Blîndu1,3, Aurelian Roșca3, Theodora Benedek1,2,3
1
2
3
Background: The epicardial adipose tissue plays a significant role in the progression of atheromatous disorders via release of adipokines,
which operate as endocrine mediators and may contribute to endothelial dysfunction. The coronary computed tomography angiography
(CCTA)-based pericoronary adipose tissue attenuation around the coronary arteries suggests coronary inflammation and is linked to
plaque vulnerability. The fat attenuation index (FAI) score is a new artificial intelligence (AI)-based criterion for measuring coronary
inflammation. Objectives: The goal of this study was to evaluate the differences in the FAI scores of patients who underwent advanced
techniques of CCTA examination and AI-based analysis for chest pain in the first months following a COVID-19 infection. Methods: The
study was carried out on 85 patients (mean age 62.20 ± 9.54 years) with chest pain and obstructive coronary plaques, divided into two
groups: Group 1 – 35 patients who had COVID-19 infection a few months prior to CCTA examination; Group 2 –50 patients, adjusted for
age and gender, who did not present COVID-19 infection prior to CCTA examination. Before the CCTA examination, demographic and
paraclinical characteristics, cardiovascular risk factors, and the development of signs and symptoms were monitored and assessed for
each patient. For each coronary artery, FAI and AI-based FAI scores were determined in all patients. Results: The average FAI score was
significantly different between the groups (12.98 ± 12.67 in Group 1 vs. 14.60 ± 10.22 in Group 2, p = 0.0028). However, a FAI sub-analysis
according to coronary distribution found that patients in Group 1 had considerably more inflammation in the right coronary arteries
than in the left, although the difference was not significant in Group 2. Right coronary FAI was 17.06 ± 16.48 in Group 1 compared to the
left coronary FAI of 9.67 ± 7.46 (p = 0.0027). In Group 2, this difference was not significant statistically (15.20 ± 9.84 vs. 12.80 ± 7.25,
p = 0.3004). Conclusions: COVID-19 infection is linked to a higher risk of coronary plaque vulnerabilization, which is reflected by the
increased inflammation of pericoronary fat, and this may be correlated with the distribution of plaques in the coronary territory. Plaques
located in the right coronary artery are more exposed to inflammatory injury in post-COVID patients. The novel, AI-based FAI score may
be a valuable tool in the noninvasive CCTA imaging for detecting the risk of acute coronary syndromes in post-COVID patients.
CardioNET 2022
The Impact of Inflammatory Response on the Extent of Myocardial Scar

Tissue Assessed with CMR in Patients with STEMI who Underwent pPCI
András Mester1,2, Nóra Rat1,3, Theodora Benedek1,3 Diana Opincariu1,4, Roxana Hodas1,3, Monica Chitu1,3, Imre Benedek1,3,4
1
2
Emergency Clinical County Hospital, Oradea, Romania
3
4
Introduction: The inflammatory response generated by an acute myocardial infarction (AMI) conducts the healing, scar forming,
and remodeling process of the left ventricle (LV). Cardiac magnetic resonance (CMR) can precisely detect the extent of the scar tissue
following an AMI. The aim of our study was to determine the relations between the acute inflammatory response and the extent of
the scar tissue following an ST-elevation MI (STEMI). Material and Methods: We included 200 patients with STEMI who underwent
primary percutaneous coronary intervention (pPCI). Serum inflammatory biomarkers (high-sensitivity C-reactive protein [hs-CRP],
interleukin 6 [IL-6]) were determined on day 1 and 5, and all patients underwent CMR at the 1-month follow-up for determination of
cardiac volumes, function, and extent of the myocardial scar. Results: Serum IL-6 levels significantly correlated with the extent of the
myocardial scar (r = 0.324, p = 0.01), high transmurality (r = 0.3, p = 0.01), and reduced LV ejection fraction (r = −0.3, p = 0.02). hs-
CRP levels determined on day 1 were not related to the extent of the scar, but those from day 5 (AUC = 0.635, p = 0.05), as well as IL-6
levels from day 1 (AUC = 0.685, p <0.001) were predictive of the infarct size. Conclusions: Serum IL-6 levels determined on day 1 and
hs-CRP levels determined on day 5 following a STEMI are independent predictors for the extent of myocardial scar and transmurality
in patients who underwent revascularization with pPCI.
Lesion-Associated Myocardial Ischemia Based

on Fusion Coronary CT Imaging
Alexandra Stanescu1,2, Andras Mester1, Diana Opincariu1,3, Imre Benedek1,2,3, Theodora Benedek1,2,3
1
2
3
Background: Multimodality assessment of coronary artery lesions has demonstrated superior effectiveness compared to the conven-
tional approach for assessing both the anatomical and functional significance of a coronary stenosis. Multiple imaging modalities can
be integrated into a fusion imaging tool to better assess myocardial ischemia and the vulnerable coronary plaques. The aim of the study
was to validate the hybrid CCTA/MRI imaging models developed in a previous study for the correlation between myocardial viability
and coronary plaques vulnerability. Material and Methods: We included 45 patients with recent history of myocardial infarction (MI)
and associated coronary lesions nearby the ischemic myocardial territory, which also included the quantitative analysis of inflamma-
tory biomarkers during the acute event. For all patients, we obtained hybrid CCTA/MRI images using a dedicated imaging platform
with special postprocessing software, and we calculated various cardiac CCTA-derived scores including the Duke Jeopardy Score, the
Syntax Score, and the Calcium Score. The study population was divided into three groups based on the vulnerability degree of coronary
plaques: Group 1 – no vulnerability markers (VM), n = 7; Group 2 – 1–2 VM, n = 28; Group 3 – >2 VM, n = 12. Results: The average
age of the study population was 60 years, and 77.70% were males. There were significant differences between the groups regarding
the infarcted myocardial mass with a mean value of 8.94 ± 5.25g in Group 1, 22.7 ± 7.9 g in Group 2, and 41.45 ± 6.9 g in Group 3 (p =
0.0001), and also regarding the level of hs-CRP and MMP9, which were higher in Group 3 (p = 0.007 and p = 0.03, respectively). The
Duke Jeopardy score was significantly associated with the vulnerability degree of the analyzed coronary plaques (p = 0.01). Conclusion:
Hybrid CCTA/MRI images can represent a feasible method to assess the impact of the coronary artery atherosclerotic plaques on the
subtended myocardium. In our study, the infarcted myocardial mass was significantly higher in MI patients who presented associated
non-culprit lesions with an increased vulnerability degree.
CardioNET 2022
Imaging Technologies for MINOCA Diagnosis during the COVID-19 Pandemic

Zsolt Parajko1, Istvan Kovacs1,2,3, Nora Rat1,2, Theodora Benedek1,2,3, Imre Benedek1,2,3
1
Clinic of Cardiology, Emergency Clinical County Hospital, Târgu Mureș, Romania A
2
Department of Cardiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania B
3
Introduction: Myocardial infarction in patients with non-obstructive coronary arteries (MINOCA) is a special form of acute coronary
syndrome with an insufficiently clarified etiology. The recent development of new imaging techniques (cardiac magnetic resonance
[CMR] and optical coherence tomography [OCT]) has led to a more complex interpretation of the basic mechanism of MINOCA patho-
physiology. On the other hand, the incidence of MINOCA increased significantly during the COVID-19 pandemic. Aim: The objective of
this study was to investigate the effects of the COVID-19 pandemic on the presentation rate and characteristics of patients with MINO-
CA. Material and Methods: The study included 80 patients who met the MINOCA criteria during 2019–2021, who were divided into two
groups: Group 1 – patients enrolled before the pandemic; Group 2 – patients enrolled during the pandemic. Emergency coronary angi-
ography was performed in all patients, and OCT was performed in selected cases. Cardiac MRI was performed one month after the acute
coronary event. Results: The average age of the enrolled patients was 62 vs. 58 years (p = 0.2), the proportion of male patients being
36.6% vs. 56.7% (p = 0.1). The proportion of patients with insignificant coronary lesions was 47.4% vs. 43.6% (p = 0.6), respectively,
patients without coronary lesions 57.7% vs. 42.3% (p = 0.7). The presence of a subintimal coronary artery dissection at OCT was found
in 29.4% vs. 70.6% (p = 0.04), and the phenomenon of “delayed wash out” in 20% vs. 37.1% (p = 0.057). Control MRI imaging in this
group of patients identified the presence of myocarditis in 18% vs. 57.14% (p = 0.008), the proportion of ischemic lesions being 45.4%
vs. 14.2% (p = 0.002). Conclusions: During the pandemic, the presence of myocarditis as a possible etiology of MINOCA increased sig-
nificantly, also with the presence of signs of endothelial dysfunction, which implies the presence of an inflammatory substrate in the
COVID era. Additional imaging acquisitions, such as OCT and CMR imaging, may play a key role in establishing the etiology of MINOCA.
FFR Technology for Therapeutic Decision in Difficult Cases

Dan Pasaroiu1,2, Constantin Tolescu2, Theodora Benedek1,2,3, Imre Benedek1,2,3
1
2
3
The challenge to choose the best therapy is noteworthy in patients who have complex coronary artery disease because the risk of
complications is significantly higher for these patients regardless of the revascularization strategy. Clinicians should have consistent
evidence to show that the management of patients is correct and not based solely on the visual estimation obtained from coronary
angiography. Fractional flow reserve (FFR) is a well-validated diagnostic tool with excellent reproducibility and repeatability, which
can selectively tailor revascularization on a lesion-to-lesion basis at the time of diagnostic angiography. FFR is defined as the ratio
of maximal myocardial blood flow in the presence of a stenosis to the maximal myocardial blood flow in the hypothetical case that
the same artery would be normal. Essentially, the combination of coronary angiography and FFR provides clinicians with crucial
information on the presence or absence of ischemia. A large body of evidence supports the use of FFR for guidance of revasculariza-
tion in different anatomical lesion settings such as left main disease, multivessel disease, bifurcation lesions, sequential stenoses,
intermediate stenoses, and diffuse atherosclerosis. A complete functional percutaneous revascularization strategy for patients with
multivessel disease consists of stenting of lesions that are ischemia-inducing while treating the lesions that are not ischemia-inducing
with optimal medical therapy. In fact, the latter are better deferred with good long-term clinical outcome. Funding: This work was
supported by the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș Research Grant
number 510/14/17.01.2022

CardioNET 2022 Book of Abstract

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BOOK OF ABSTRACTS

Vasculitis in Young Patients – Diagnostic and Therapeutic Challenge

Ventricular Tachycardia with Recurrent Syncope – an Atypical

Anatomical Barriers for Cardiac Resynchronization Therapy

Different Risk Factors for the Same Type of

Aortic Stenosis Limits and Challenges

The Link between Periodontopathogen Germs and the Severity of Acute

Correlation between Hemorheological Parameters

Correlations between Inflammatory Status and

The Impact of Early Mobilization on Scar Extension

Systemic and Local Inflammatory Biomarkers in the Acute Phase of

Correlation between Biomarkers of Ventricular Dysfunction and

The Association between Altered Nutritional Status and Prolonged

Study of Inflammatory Biomarkers in Patients with

Interrelation between CCTA Phenotype of Precursor Vulnerable

Feasibility of 3D Printed Models of Aortic Valves in

Modern Technologies for Assessing Myocardial Fibrosis in Atrial Fibrillation

Imaging Technologies Based on Artificial Intelligence

The Impact of Inflammatory Response on the Extent of Myocardial Scar

Lesion-Associated Myocardial Ischemia Based

Imaging Technologies for MINOCA Diagnosis during the COVID-19 Pandemic

FFR Technology for Therapeutic Decision in Difficult Cases

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