Значимость субклинического гипотиреоза и заместительной терапии для развития сердечно-сосудистой патологии

Department of Internal Medicine, Discipline of Cardiology, Medical Clinic no. 3, Congresul III al Medicilor de Familie din Republica Moldova 17–18 mai, 2012, Chişinău, Republica MoldovaThis review presents the modern data concerning influence of subclinical hypothyroidism on morphology and functional state of myocardium and arterial vessels, traditional and “new” cardiovascular risk factors. The risk of clinically significant complications (cardiovascular diseases, disorders of hemostasis and changes in lipid exchange) connected with subclinical hypothyroidism is under research. The data on the effects of subclinical hypothyroidism substitution therapy are highlighted in the work В обзоре представлены современные сведения о влиянии субклинического гипотиреоза на морфологию и функциональное состояние миокарда и артериальных сосудов, а также некоторые классические и «новые» факторы риска атеросклероза. Обсуждается связанный с субклиническим гипотиреозом риск клинически значимых осложнений (сердечно-сосудистых, нарушений гемостаза и липидного обмена), а также данные об эффектах заместительной терапии субклинического гипотиреоза

Histological and morphometrical aspects of uterine arteries in uterine myoma

Catedra Obstetrică şi Ginecologie a USMF “ Nicolae Testemiţanu” Institutul Oncologic din MoldovaThe present study was designed to assess the vascular morphology of isolated uterine arteries in case of uterine fibromyoma. Our histological and morphometric findings demonstrated the increase in thickness in all layers of uterine artery wall, and there was a correlation between the degree of thickening and tumor size. These morphometric changes are supposed to contribute to the changes in the mechanical properties of the arterial walls as a result of adaptation of uterine arteries to haemodynamic and functional changes that occur in local blood circulation in women with uterine fibromyoma. Key words: uterine fibromyoma, uterine artery. Lucrarea prezentă a fost destinată studierii morfologiei vasculare a arterelor uterine izolate de la pacientele cu fibromiom uterin. Rezultatele histologice şi morfometrice au demonstrat o creştere a grosimii tuturor straturilor arterelor uterine, cu o corelaţie directă între gradul îngroşării şi dimensiunile tumorii. Aceste schimbări morfometrice pot fi responsabile de schimbările în proprietăţile mecanice ale pereţilor arteriali în rezultatul adaptării arterelor uterine la modificările hemodinamice şi funcţionale care au loc în circulaţia sanguină locală la pacientele cu fibromiom uterin. Cuvinte cheie: miom uterin, artera uterină

Electrocardiographic and echocardiographic changes in patients with thyreotoxic cardiopathy

Thyreotoxic cardiopathy represents a cardiac pathology, caused by the toxic influence of the thyroid hormones on the myocardium. The aim of this study is to determine the frequency of cardiovascular changes in patients with thyreotoxic cardiopathy according to the ECG and EchoCG results. The study included 72 patients with Graves’ disease and thyreotoxic cardiopathy, whose medical records have been analyzed. Such criteria, as heart rate, heart rhythm disorders, left ventricle hypertrophy, repolarization abnormalities (in ECG), ejection fraction, valve disorders, heart cavities dilation, left ventricle hypertrophy, impaired cardiac relaxation and pulmonary hypertension (in EchoCG) have been taken into consideration. The results showed a high percentage of patients with ECG disturbances (75%) and a high percentage of patients with EchoCG disturbances (100%). According to the ECG results, the disturbances included heart rhythm disorders (51.4%), left ventricle hypertrophy (36.1%) and repolarization abnormalities (53.3%). The most frequent heart rhythm disorders determined by ECG have been atrial fibrillation (19.5%), sinus tachycardia (13.9%), Guis’ fascicular blocks (13.9%) and extrasystoles (9.7%). The EchoCG examination of the patients identified valve disorders (94.4%), the left ventricle hypertrophy (52.8%), the left ventricle impaired relaxation (11.1%), the simultaneous dilatation of three cavities of heart (left atrium, right ventricle and right atrium) (26.4%) and pulmonary hypertension (52.8%). However, the influence of concomitant cardiovascular diseases (25%) on the obtained results cannot be excluded, since the moment of their appearance is unknown

Socio-Economic Variations Determine the Clinical Presentation, Aetiology and Outcome of Infective Endocarditis: a Prospective Cohort Study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) Registry.

Background Infective endocarditis (IE) is a life-threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors might influence its epidemiology, clinical presentation, investigation and management, and outcome, in a large international multi-centre registry

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results: As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43–3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06–2.13], p = 0.0210; 1-yr: HR 1.58[1.21–2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion: Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients

The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry

Aims: The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis (IE) and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of IE and data from the 2001 Euro Heart Survey. Methods and results: Patients (n = 3116) aged over 18 years with a diagnosis of IE based on the ESC 2015 IE diagnostic criteria were prospectively identified between 1 January 2016 and 31 March 2018. Individual patient data were collected across 156 centres and 40 countries. The primary endpoint is all-cause mortality in hospital and at 1 year. Secondary endpoints are 1-year morbidity (all-cause hospitalization, any cardiac surgery, and IE relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of IE. Conclusion: EURO-ENDO is an international registry of care and outcomes of patients hospitalized with IE which will provide insights into the contemporary profile and management of patients with this challenging disease

Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Purpose: High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods: Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results: As compared to &lt; 80&nbsp;yo patients, ≥ 80&nbsp;yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p &lt; 0.001), of surgery performed (37.0% vs. 75.5%, p &lt; 0.001), and a higher in-hospital (25.9% vs. 15.8%, p &lt; 0.001) and 1-year mortality (41.3% vs. 22.2%, p &lt; 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43–3.66]). By propensity analysis, 304 ≥ 80&nbsp;yo were matched to 608 &lt; 80&nbsp;yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p &lt; 0.0001) in ≥ 80&nbsp;yo. Overall mortality remained higher in ≥ 80&nbsp;yo (in-hospital: HR 1.50[1.06–2.13], p = 0.0210; 1-yr: HR 1.58[1.21–2.05], p = 0.0006), but was not different from that of &lt; 80&nbsp;yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion: Although mortality rates are consistently higher in ≥ 80&nbsp;yo patients than in &lt; 80&nbsp;yo patients in the general population, mortality of surgery in ≥ 80&nbsp;yo is similar to &lt; 80&nbsp;yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80&nbsp;yo patients

Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: a prospective cohort study

Abstract Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine &amp;gt; 2 mg/dL, congestive heart failure, vegetation length &amp;gt; 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles. </jats:sec

Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry (Infection, (2022), 50, 5, (1191-1202), 10.1007/s15010-022-01792-0)

In this article the “EURO-ENDO Investigators group” member U. Y. Sinan was incorrectly written as U.S. Yasar. The original article has been corrected

Characteristics, management, and outcomes of patients with left‐sided infective endocarditis complicated by heart failure: a substudy of the ESC‐EORP EURO‐ENDO (European infective endocarditis) registry

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