From Classical Laboratory Parameters to Novel Biomarkers for the Diagnosis of Venous Thrombosis

Venous thrombosis is a common and potentially fatal disease, because of its high morbidity and mortality, especially in hospitalized patients. To establish the diagnosis of venous thrombosis, in the last years, a multi-modality approach that involves not only imaging modalities but also serology has been evolving. Multiple studies have demonstrated the use of some biomarkers, such as D-dimer, selectins, microparticles or inflammatory cytokines, for the diagnosis and treatment of venous thrombosis, but there is no single biomarker available to exclusively confirm the diagnosis of venous thrombosis. Considering the fact that there are some issues surrounding the management of patients with venous thrombosis and the duration of treatment, recent studies support the idea that these biomarkers may help guide the length of appropriate anticoagulation treatment, by identifying patients at high risk of recurrence. At the same time, biomarkers may help predict thrombus evolution, potentially identifying patients that would benefit from more aggressive therapies. This review focuses on classic and novel biomarkers currently under investigation, discussing their diagnostic performance and potential benefit in guiding the therapy for venous thrombosis

Prevalence of Cardiovascular Risk Factors Among Patients with Acute Myocardial Infarction and New Left Bundle Branch Block in North East Romania

The prevalence of coronary artery disease, a major contributor to cardiovascular disease, is related to the increasing prevalence of modifiable risk factors.The aim of our study was to determine the risk factors for acute myocardial infarction among patients from North East Romania.We evaluated patients with acute myocardial infarction with or without left bundle-branch block, hospitalized in Georgescu Institute of Cardiovascular Disease Iasi for three years. The results of our study show that patients with acute myocardial infarction and new left bundle branch block have a more recent history of hypertension, dyslipidemia and smoker status compared to patients without left bundle branch block. Nearly two thirds of patients included in the study (65.47%) had an elevated cholesterol level, with a high prevalence of dyslipidemia in patients with myocardial infarction and new left bundle branch block. More than two-thirds of patients with new left bundle branch block had a history of arterial hypertension (69.04% vs. 50.0%, p = 0.354), especially grade 2 hypertension, with a slight predominance in those with new left bundle branch block, but without statistically significant differences between the two groups (45.23% vs. 30.95%, p = 0.358). Early identification of modifiable risk factors is vital to set the strategy for prevention and special attention must be paid to smoking. An adequate control of cardiovascular risk factors would result in a significant reduction of coronary events in patients from the North East part of Romania. </jats:p

The Significance of New Left Bundle Branch Block Complicating Acute Myocardial Infarction

The aim of our study was to evaluate the impact of new LBBB on left ventricular systolic function and arrhythmic risk in patients with acute myocardial infarction and unicoronarian lesion. We prospectively studied the patients with acute myocardial infarction with and without LBBB and unicoronarian lesion after a mean of 16.51 � 2.41 months from the onset of acute coronary event. We observed a higher risk of ventricular premature beats and left ventricular systolic disfunction in patients with left bundle branch block. Also, the presence of left bundle branch block (F = 3.64; p [ 0.005; partly h2= 0.33) and the duration of the QRS complex (F = 4.17; p [ 0.005; partly h2= 0.36) was statistically significantly correlated with the value of left ventricular ejection fraction. Almost a double number of patients with left bundle branch block had an ejection fraction below 30%, despite an early revascularization. Patients with acute myocardial infarction and left bundle branch block represent a relatively small group but with an increased risk of malignant ventricular arrhythmias and left ventricular systolic dysfunction, and they should therefore benefit from a promptly and appropriately treatment in order to improve long term outcome. </jats:p

Long Term Assessment of the Biological Profile in Patients with Acute Myocardial Infarction and Left Bundle Branch Block

In order to study the impact of an acute coronary syndrome on the lifestyle changes of the patients, we prospectively studied the long term biological parameters of patients with myocardial infarction. After a median follow-up of 17 months, we noticed a significant improvement in the lipid profile of patients, both due to lifestyle changes and therapeutic compliance. Certainly, the occurrence of an acute coronary event has altered patients� attitudes about cardiovascular risk, motivating changing lifestyle and choosing the right therapy. </jats:p

Is There a Sex Difference of Cardiovascular Risk Factors in Patients with Acute Myocardial Infarction?

Conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, increase the risk of developing acute myocardial infarction. Primary prevention studies have shown that early detection and aggressive treatment of risk factors prevent cardiovascular events. In women, coronary artery disease appears up to 10 years later in life than in men. We analyzed the presence of conventional risk factors in patients with acute myocardial infarction and compared findings according to sex. We observed that more than 90% of patients included in the study had at least one of these risk factors, hypertension and diabetes predominated in women and smoking was more frequent in men. Because many of these risk factors are modifiable and amenable to treatment, an early detection and aggressive treatment can prevent cardiovascular events. </jats:p

Well-Known and Novel Serum Biomarkers for Risk Stratification of Patients with Non-ischemic Dilated Cardiomyopathy

Non-ischemic dilated cardiomyopathy encompasses a wide spectrum of myocardial disorders, characterized by left ventricular dilatation with systolic impairment and increased risk of sudden cardiac death. In spite of all the therapeutic progress that has been made in recent years, dilated cardiomyopathy continues to be an important cause of cardiac transplant, being associated with an enormous cost burden for health care systems worldwide. Predicting the prognosis of patients with dilated cardiomyopathy is essential to individualize treatment. Late gadolinium enhancement-cardiac magnetic resonance imaging, microvolt T-wave alternans, and genetic testing have emerged as powerful tools in predicting sudden cardiac death occurrence and maximizing patient’s selection. Despite all these new diagnostic modalities, additional tests to complement or replace current tools are required for better risk stratification. Therefore, biomarkers are an easy and important tool that can help to detect patients at risk of adverse cardiovascular events. Additionally, identifying potential biomarkers involved in dilated cardiomyopathy can provide us important information regarding the diagnostic, prognostic, risk stratification, and response to treatment for these patients. Many potential biomarkers have been studied in patients with dilated cardiomyopathy, but only a few have been adopted in current practice. Therefore, the aim of our review is to provide the clinicians with an update on the well-known and novel biomarkers that can be useful for risk stratification of patients with non-ischemic dilated cardiomyopathy

Well-Known and Novel Serum Biomarkers for Risk Stratification of Patients with Non-ischemic Dilated Cardiomyopathy

Non-ischemic dilated cardiomyopathy encompasses a wide spectrum of myocardial disorders, characterized by left ventricular dilatation with systolic impairment and increased risk of sudden cardiac death. In spite of all the therapeutic progress that has been made in recent years, dilated cardiomyopathy continues to be an important cause of cardiac transplant, being associated with an enormous cost burden for health care systems worldwide. Predicting the prognosis of patients with dilated cardiomyopathy is essential to individualize treatment. Late gadolinium enhancement-cardiac magnetic resonance imaging, microvolt T-wave alternans, and genetic testing have emerged as powerful tools in predicting sudden cardiac death occurrence and maximizing patient’s selection. Despite all these new diagnostic modalities, additional tests to complement or replace current tools are required for better risk stratification. Therefore, biomarkers are an easy and important tool that can help to detect patients at risk of adverse cardiovascular events. Additionally, identifying potential biomarkers involved in dilated cardiomyopathy can provide us important information regarding the diagnostic, prognostic, risk stratification, and response to treatment for these patients. Many potential biomarkers have been studied in patients with dilated cardiomyopathy, but only a few have been adopted in current practice. Therefore, the aim of our review is to provide the clinicians with an update on the well-known and novel biomarkers that can be useful for risk stratification of patients with non-ischemic dilated cardiomyopathy.</jats:p

Non-Vitamin K Antagonist Oral Anticoagulants and the Gastrointestinal Bleeding Risk in Real-World Studies

In the present study, we aimed to provide evidence from high-quality real world studies for a comprehensive and rigorous analysis on the gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs). We performed a systematic search of MEDLINE, EMBASE and PUBMED, and of 286 records screened, we included data from 11 high-quality real-world studies, coordinated by independent research groups over the last 3 years, that reported major GIB events in patients given NOACs or vitamin K antagonists for patients with nonvalvular atrial fibrillation. The lowest risk of gastrointestinal bleeding was with apixaban compared with warfarin (hazard ratio (HR) for GIB for apixaban ranging between 0.45 (95% confidence interval (CI) 0.34 to 0.59) and 1.13 (95% CI 0.79 to 1.63)). Apixaban was associated with a lower risk of GI bleeding than dabigatran ((HR ranging between 0.39 (95% CI 0.27 to 0.58) and 0.95 (95% CI 0.65 to 1.18)) or rivaroxaban ((HR ranging between 0.33 (95% CI 0.22 to 0.49) and 0.82 (95% CI 0.62 to 1.08)). The results of our study confirm a low or a similar risk for major GIB between patients receiving apixaban or dabigatran compared with warfarin, and apixaban appears to be associated with the lowest risk of GIB.</jats:p