<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Acute decompensated heart failure (ADHF) is a worldwide health problem, with poor prognosis and significant morbidity and mortality. Fluid overload is the primary reason for hospitalization in ADHF. The efficacy of diuretic monotherapy is suboptimal, with a substantial proportion of patients being discharged with residual congestion that portends a poor outcome. Accordingly, the loop diuretic monotherapy from the DOSE trial achieved a successful decongestion in less than 20% of patients. Although the concept of sequential nephron blockade has regained interest following the publication of several randomized clinical trials (RCTs), the optimal approach to combination diuretic therapy is still an area of uncertainty. The selection of an adequate approach remains difficult as comparisons between different trials cannot be made due to different diuretic doses used, timing of sequential blockade, differences in study cohorts or in definitions used to define decongestion. Moreover, a direct comparison of different combination therapies in large trials is lacking. Nonetheless, the approach to the combination diuretic therapy should rather take into account the patient phenotype, the suspected nephron segment responsible for diuretic resistance, and the anticipated electrolyte and acid–base disturbances in order to select diuretic agents with divergent effects. Herein, we review the molecular mechanisms of action of diuretic agents, highlight the most recent trials evaluating combined diuretic therapy in ADHF and identify clinical scenarios, apart from diuretic resistance, for optimal association of diuretics to counteract their anticipated adverse effects.</p>
</abstract>

A practical approach to sequential nephron blockade in acute decompensated heart failure

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Background</h3>
<p>The benefits of distal radial balloon aortic valvuloplasty were recently reported: same efficacy as the classical femoral approach, with no vascular complications. The long-term outcomes for these patients remain unknown.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>We retrospectively analyzed the long-term mortality and the impact of TAVI in a cohort of 30 patients who underwent distal radial (DR) BAV.</p>
</sec>
<sec>
<h3>Results</h3>
<p>The mean age was 78.3 ± 7.14 years and the median follow-up was 22.8 months. The indication for BAV was stable aortic stenosis in 70% of patients, while 23% of patients had concomitant acute heart failure symptoms and 6.6% of patients were in cardiogenic shock. A total of 16 patients (53.3%) received TAVI during follow-up after their BAV procedure while the remainder only received BAV. All-cause mortality was 20%, with only 1 death (6.3%) in the “BAV + TAVI” group compared to 5 deaths (35.7%) in the “BAV only” group (p = 0.089). All of the TAVI procedures were performed within 7 months after BAV. Cumulative incidence of TAVI was 40.0% at 5 months and 50.0% at 10 months. Cumulative incidence of death was 6.7% at 5 months, 13.3% at 10 months, 16.7% at 15 months, and 20.0% at 25 months. The probability of being alive without TAVI decreased from 53.3% at 5 months to 30.0% at 25 months.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>In the present study, we could show that half of the patients undergoing BAV eventually need TAVI, most of them within 5 months after BAV, and that BAV remains associated with high mortality after the procedure, with 35% of those undergoing isolated BAV dying during short-term follow-up.</p>
</sec>
</abstract>

Mortality after radial-only balloon aortic valvuloplasty: a long-term follow-up and a bridge-to-TAVI analysis

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Background</h3>
<p>Increased atrial elasticity is a marker of cardiovascular events. This study aimed to compare the parameters of elasticity and lipids in children with type 1 diabetes mellitus (TIDM) compared with controls and the effect of lipids on elasticity in children with diabetes.</p>
</sec>
<sec>
<h3>Method</h3>
<p>This case-control study was performed in 186 children aged 6 to 18 years. The aortic diameter was obtained from 3 cm above the aortic valve using M mode and was calculated as the distance between the medial edge of the anterior and posterior walls of the aorta at systole and diastole. AoS and AoD were recorded when the aortic wall was fully open. The parameters of aortic elasticity, aortic stiffness beta index, aortic tension, and elastic modulus of pressure were measured. Cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. For data analysis, SPSS 20 considers the applicable error to be 0.05.</p>
</sec>
<sec>
<h3>Results</h3>
<p>The participants were matched by sex and age. The right CHO, LDL, HDL, and MPI lipids, systolic, diastolic, and aortic systolic blood pressure were different among patients. The analysis also showed that ASβI (MWU = 1582.50, <italic>p</italic> &lt; 0.001) and PSEM (MWU = 1381.00 and <italic>p</italic> &lt; 0.001) were higher when AS (MWU = 1204 and <italic>p</italic> &lt; 0.001) and AoD (MWU = 1672.00 and <italic>p</italic> &lt; 0.001) and AoD (MWU = 1672.00 and <italic>p</italic> &lt; 0.001) were lower in patients than in controls. No lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>It was concluded that lipid profiles were different, and ASβI and PSEM were lower when AoS and AoD were higher in children with diabetes. None of the lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.</p>
</sec>
</abstract>

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Pulmonary agenesis is a rare malformation associated with congenital heart disease and may lead to a life-threatening condition and death without pre-planned surgical and medical support.</p>
<p>We report an unusual case of unilateral pulmonary agenesis in combination with total anomalous pulmonary venous connection, complete vascular ring, retroaortic, retroesophageal innominate vein, secondary atrial septal defect, which was prenatally identified by fetal ultrasound and magnetic resonance imaging, later confirmed by postnatal computed tomography.</p>
</abstract>

A case report of prenatal diagnostics and surgical correction of pulmonary agenesis associated with total anomalous pulmonary venous connection and vascular ring

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Objectives</h3>
<p>Myxomas are the most common primary tumors of the adult heart and should be considered in the differential diagnosis of intracavitary cardiac masses, along with thrombi and vegetations.</p>
</sec>
<sec>
<h3>Methods</h3>
<p>We report a case of a 64-year-old obese, hypertensive woman, who presented with dyspnea on moderate exertion as well as fatigue. The patient was admitted to our hospital after the discovery on transthoracic echocardiography of an intracardiac mass, which was highly suggestive for a left atrial myxoma.</p>
</sec>
<sec>
<h3>Results</h3>
<p>On admission, the patient presents no abnormalities on physical exam, with blood tests showing only slight deviations in the lipid profile. The ECG presents a normal sinus rhythm of 80/min with two premature ventricular contractions and a premature atrial contraction. Transthoracic echocardiography revealed the presence of a well-defined, pediculated, left atrial mass attached to the interatrial septum, measuring 25/17 mm, with no apparent interference in mitral valve motion. We supplemented our investigations with the use of transesophageal echocardiography which further defined the dimensions and location of the tumor, while also showing the presence of an atrial septal aneurysm associated to two small atrial septal defects measuring 6 mm and 7 mm respectively, with a left to right shunt. Cardiac CT examination confirmed the benign aspect of the mass and offered important anatomical elements, useful in preoperative planning. The patient was, therefore, admitted to our Cardiovascular Surgery department, where a successful surgical resection of the tumor was performed, without any local or systemic complications. The differential diagnosis of this mass included intracavitary thrombi, vegetations, as well as other histological subtypes of benign or malignant tumors, while the presence of an atrial septal defect, which represents a possible source of paradoxical emboli, provided an additional challenge.</p>
</sec>
<sec>
<h3>Conclusions</h3>
<p>This complicated case stands out due to its particular echocardiographic appearance and emphasizes the importance of a comprehensive evaluation in both the differential diagnosis and preoperative assessment.</p>
</sec>
</abstract>

Cardiac masses and the role of imaging in their diagnostic

<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec>
<h3>Introduction</h3>
<p>MELAS is a systemic hereditary condition that can present as hypertrophic or mixed hypertrophic and dilated phenotype cardiomyopathy in young individuals, although a late-onset form is also described in the literature. Genetic testing is essential for correct diagnosis and appropriate management.</p>
</sec>
<sec>
<h3>Case presentation</h3>
<p>We present the case of a 22-year-old male who was referred to our center after being diagnosed with NYHA class III heart failure with a mixed hypertrophic and dilated cardiomyopathy. His medical history included stroke episodes, seizures, progressive hypoacusis, neurocognitive impairment, and muscle atrophy. Lactic acidosis and elevated CK levels were also noted. The ECG revealed short PR interval and delta wave in lateral leads. TTE showed mildly dilated and hypertrophied LV and RV with severe biventricular systolic impairment. The CMR study was relevant for ring-like subepicardial fibrosis, predominantly in the medium and apical segments. Brain MRI showed multifocal supratentorial subcortical stroke-like lesions in both cerebral hemispheres, involving multiple vascular territories and following a migratory pattern. Genetic testing confirmed a pathogenic MT-TL1 mutation (m.324A>G) and the patient was diagnosed with MELAS. Further management included specific lifestyle recommendations and cascade genetic screening, as well as starting GDMT for HFrEF. Three months after discharge, his clinical status improved. However, the LVEF remained reduced. After careful consideration, an ICD was implanted for primary prevention.</p>
</sec>
<sec>
<h3>Conclusion</h3>
<p>A red-flag approach in this young patient, which took into consideration the stroke-like episodes, lactic acidosis, seizures, hypoacusis, myopathy, as well as the short PR interval, led to the correct diagnosis, further confirmed by using the appropriate genetic test. Failure to diagnose affects the patient’s prognosis, as their prognosis and clinical status are influenced by enforcing specific recommendations.</p>
</sec>
</abstract>

A rare cause of mixed hypertrophic and dilated phenotype cardiomyopathy – the MELAS syndrome

<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>From 2016 onwards, a group of cardiologists initially formed in 2013 took the initiative to regulate and standardize the rights of European citizens suffering from diverse cardiovascular conditions at the European level. Subsequently, the Romanian government embraced and incorporated these recommendations into law a year later. This process addressed several important new aspects, including stents, myocarditis, and various cardiomyopathies, with a focus on striking a balance between the individual’s right to drive a vehicle and the need to safeguard the lives of others. The Romanian law, however, is vague and states that “candidates or drivers from the indicated groups can be issued or renewed their driving licenses only after the condition in question has been effectively treated and subject to the opinion issued by the specialist cardiology doctor and, depending on a case, by performing a periodic medical check” but does not clearly specify how and for how long and to whom exactly the driver’s license should be suspended. Interestingly, Switzerland, despite not being an EU member, developed its own set of recommendations three years later, drawing strong inspiration from the German guidelines, which in turn personalized its indications (being the European country with the most publications in this field). A refinement of the refinement, one could say. The indications are clear, precise, and structured in a point-by-point fashion. The purpose of this review is to explore the Swiss guidelines on fitness to drive in cardiovascular diseases interactively, with discussions on fictitious cases, in the hope that doctors will be able to become more familiar with these rigid and often interpretable indications and implement them in their daily practice.</p>
</abstract>

Doctor, am I allowed to drive? A practical case-based guide on fitness to drive in cardiovascular diseases adapted from the Swiss model

AHEAD OF PRINT

Volume 34 (2024): Issue 1 (March 2024)

Volume 33 (2023): Issue 4 (December 2023)

Volume 33 (2023): Issue 3 (September 2023)

Volume 33 (2023): Issue 2 (June 2023)

Volume 33 (2023): Issue 1 (March 2023)

Volume 32 (2022): Issue 4 (December 2022)

Volume 32 (2022): Issue 3 (September 2022)

Volume 32 (2022): Issue 2 (June 2022)

Volume 32 (2022): Issue 1 (March 2022)

Volume 31 (2021): Issue 4 (December 2021)

Volume 31 (2021): Issue 3 (September 2021)

Volume 31 (2021): Issue 2 (June 2021)

Volume 31 (2021): Issue 1 (March 2021)

Romanian Journal of Cardiology

The Romanian Journal of Cardiology (RJC) is the official journal of the Romanian Society of Cardiology (Societatea Romana de Cardiologie) and is published quarterly.   The aim of the Romanian Journal of Cardiology was stated from the moment of its foundation in 1991: to provide an open forum for exchange of ideas and a strong connection between basic and clinical cardiology. The journal serves the interest of both practicing clinicians and researchers.   The Romanian Journal of Cardiology is an international, English language, peer-reviewed journal publishing original scientific articles in a wide range of basic, clinical, and experimental research areas. It covers all aspects of cardiology and its related specialties. The Journal publishes articles relevant to adult and pediatric cardiologists, cardiac surgeons, internists, and professionals from other areas of medicine interested in cardiovascular diseases.   The Romanian Journal of Cardiology publishes a diverse and high-quality selection of review articles, clinical trials, case reports, short communications, points of view, letters to the editor, editorials and Images in Cardiology. A letter of transmittal must accompany the submission of a manuscript, indicating that all the authors have contributed to the paper and that they have reviewed and agree with the content of the article.   The journal is based on independent and unbiased blind peer-reviewed principles. The Journal accepts for submission only unpublished papers that are not under review for publication elsewhere.   There is no charge for authors to submit articles to the Romanian Journal of Cardiology, which is an Open Access Journal. This allows the interested reader to search, access, download, or print the full-text articles and use them for any other lawful purpose.   All statements and opinions are solely the responsibility of the authors.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 

Romanian Journal of Cardiology

Volume 33 (2023): Issue 3 (September 2023)

Review

A practical approach to sequential nephron blockade in acute decompensated heart failure

Original Articles

Mortality after radial-only balloon aortic valvuloplasty: a long-term follow-up and a bridge-to-TAVI analysis

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

Case Presentation

A case report of prenatal diagnostics and surgical correction of pulmonary agenesis associated with total anomalous pulmonary venous connection and vascular ring

Cardiac masses and the role of imaging in their diagnostic

A rare cause of mixed hypertrophic and dilated phenotype cardiomyopathy – the MELAS syndrome

Physicians Corner

Doctor, am I allowed to drive? A practical case-based guide on fitness to drive in cardiovascular diseases adapted from the Swiss model

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