rss_2.0Journal of Cardiovascular Emergencies FeedSciendo RSS Feed for Journal of Cardiovascular Emergencies of Cardiovascular Emergencies Feed of the Diagnosis-To-Needle Times for Patients Admitted to the Emergency Department with Acute ST-Segment Elevation Myocardial Infarction<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Coronary artery disease is one of the most common causes of death in the world. The outcome of patients with ST-elevation myocardial infarction is influenced by many factors, and the time elapsed from symptom onset to diagnosis and reperfusion have a critical role in this regard.</p> </sec> <sec><title style='display:none'>Aim</title> <p>The aim of this study was to investigate the differences in the diagnosis-to-needle times of patients with STEMI presenting to the hospital during and outside of working hours, and the effect of this relationship on in-hospital clinical events.</p> </sec> <sec><title style='display:none'>Methods</title> <p>This retrospective study analyzed the data of 50 patients admitted for emergency primary percutaneous coronary intervention. We assessed pain onset-to-diagnosis times and diagnosis-to-needle times, and evaluated their relationship with troponin values at admission and after 48 h.</p> </sec> <sec><title style='display:none'>Results</title> <p>The mean age of the patients was 55.64 ± 13.72 years. In total, 60% of the patients presented outside of working hours. Mean patient delay time from the onset of chest pain to seeking medical help was 2.64 ± 2.47 h. Mean troponin values were 4.39 ± 5.26 ng/ml at admission and 36.50 ± 12.95 ng/ml after 48 h. Mean post-angiography ejection fraction values were 47.36 ± 6.53%. We found a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours. We found a positive correlation between diagnosis-to-needle times and the troponin values of patients, and a statistically significant difference between pain onset-to-diagnosis times of patients who presented during and outside of working hours (p &lt; 0.05). Although the relationship between the diagnosis-to-needle time and troponin elevation after 48 h was strong (97%), the relationship between pain onset-to-diagnosis time and troponin elevation after 48 h was weak (8%), suggesting that the duration of surgical intervention is much more important than the time until the first medical contact.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>In this study, there was a statistically significant difference in the pain onset-to-diagnosis and diagnosis-to-needle times of patients who presented to the hospital during and outside of working hours.</p> </sec> </abstract>ARTICLEtrue Role of the Mechanical Characteristics and Microstructure of the Porcine Aortic Wall: Implications for Abdominal Aortic Aneurysm Rupture Risk<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title><p>Abdominal aortic aneurysm (AAA) represents the increase of the diameter of the aorta by more than 50% in the absence of surgical or endovascular intervention. The risk of rupture and, therefore, mortality is increased significantly in AAA. The role of the mechanical characteristics of the AAA wall is poorly studied.</p> <p>The <bold>aim</bold> of this study was to determine the mechanical properties of each layer of the porcine abdominal aorta for a better understanding of the role of the microstructural elements of the arterial wall in the development and risk of AAA rupture.</p></sec> <sec><title style='display:none'>Materials and methods</title><p>In this study, eight tubular segments of the abdominal porcine aorta were examined. From these segments, we processed 13 × 13 mm square samples for biaxial analysis and 15 × 5 mm samples for uniaxial analysis. At the biaxial analysis, the intact wall and each layer (intima, media, and adventitia) were stretched by 25% at a speed of 1% per s and we determined the mechanical characteristics of the samples at the point of failure.</p></sec> <sec><title style='display:none'>Results</title><p>In the circumferential axis, we found the adventitia (0.233 MPa) to be stronger than the media (0.182 MPa, p = 0.007), intima (0.171 MPa, p = 0.008), and the intact wall (0.192 MPa, p = 0.045). In the longitudinal axis, the adventitia (0.199 MPa) was stronger than the intima (0.117 MPa, p &lt;0.001) and the intact wall (0.156 MPa, p = 0.045), but there was no statistically significant difference compared to the media. Additionally, the adventitia had a greater stiffness than the other two layers (p &lt;0.05 for both layers and axes) and the intact wall (p &lt;0.05 for both axes). Stretching until failure, the adventitia was the strongest compared to the other layers and the intact wall (p &lt;0.001 for all), and it also presented better compliance, with the highest stretch ratio.</p></sec> <sec><title style='display:none'>Conclusions</title><p>The results indicate that the adventitia layer is the strongest and stiffest compared to the other two layers, being the last mechanical resistance structure of the arterial wall. It is crucial to avoid injuring and aggressively manipulating the adventitia during surgery to maintain the vascular wall's resistance structure. By taking the measures mentioned above, it is possible to prevent postoperative complications like anastomotic pseudoaneurysm and anastomotic rupture.</p></sec> </abstract>ARTICLEtrue Ratio – Risk of Amputation and Mortality in Patients with Limb-Threatening Ischemia – a Systematic Review<abstract> <title style='display:none'>Abstract</title> <p>Acute limb ischemia (ALI) and chronic limb-threatening ischemia (CLTI) are severe vascular conditions that can be lethal. The inflammatory response in these diseases, characterized by increased levels of neutrophils and platelets, highlights the importance of prompt management. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a useful biomarker during the COVID-19 pandemic and high NLR levels were found to be associated with an increased risk of ALI and other thromboembolic events. The aim of this systematic review was to analyze the prognostic role of the NLR regarding the risk of amputation and mortality in patients diagnosed with ALI and CLTI. We included 12 studies (five for ALI, with 1,145 patients, and seven for CLTI, with 1,838 patients), following the PRISMA guidelines. Treatment results were evaluated, including amputation and mortality. We found that high NLR values were consistently associated with an increased risk of amputation and/or mortality, with pooled odds ratios ranging from 1.28 to 11.09 in patients with ALI and from 1.97 to 5.6 in patients with CLTI. The results suggest that NLR may represent an important tool for informed decision-making in the management of these patients.</p> </abstract>ARTICLEtrue Appraisal of Medical System Performance for STEMI Management – a Comprehensive Analysis of Time Efficiency<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Time intervals related to ST-segment myocardial infarction (STEMI) revascularization are central determinants for patient outcomes. The current capability of the Romanian STEMI program to meet guideline-recommended time intervals is largely unknown.</p> </sec> <sec><title style='display:none'>Aims</title> <p>The present study aims to assess the ability of a regional STEMI network to obtain guideline-recommended time intervals for primary percutaneous coronary intervention (pPCI) and to measure the occurrence and the extent of time delays.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>This prospective study included 500 consecutive patients with STEMI at the “Prof. Dr. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania during a period of 14 months. Complete ischemic timelines were created using several key timepoints.</p> </sec> <sec><title style='display:none'>Results</title> <p>A secondary route (transfer from another hospital) was noted in most cases. The main time intervals were the following: patient delay 209 min, emergency medical system delay 66 min, and PCI center delay at 70 min, totaling an ischemic time of 6.4 h. A provisional stop at another hospital involved the addition of 113 min (1.8 h) until STEMI diagnosis and an additional 83 min (1.3 h) from diagnosis to revascularization, totaling a supplementary ischemic time of 3.1 h. In total, 41.5% of the patients were revascularized between 2 and 6 h from symptoms onset. The objective of revascularization in less than 120 min (from first medical contact) was accomplished in 35.5% of the patients. Prehospital thrombolysis was performed in 6.4% of the cases, although its potential benefits could have been expected in 64.5% of the patients.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Patients with STEMI arrive predominantly via secondary routes to the PCI center, which implies significantly increased ischemic times. The ambulance alert system and primary routes represent by far the most efficient, albeit still imperfect methods of pre-hospital approach. Prehospital thrombolysis did not compensate for the gaps existing in the performance of the current system.</p> </sec> </abstract>ARTICLEtrue Lock Syndrome – an Unusual Complication of Pacemaker Implantation Pediatric HeartMate 3 Ventricular Assist Device Implantation in Romania – a Case Report<abstract> <title style='display:none'>Abstract</title> <p>The use of ventricular assist devices as bridge-to-transplantation therapy has a critical role in the management of end-stage heart failure in pediatric patients without available compatible organ donors. The HeartMate 3 is an intracorporeal centrifugal flow pump with a fully magnetically levitated motor currently approved for the management of advanced refractory left ventricular failure in pediatric patients, with positive early outcomes. We report the case of a 17-year-old adolescent girl with end-stage heart failure secondary to dilated cardiomyopathy of idiopathic etiology, with multiple failed attempts of weaning from inotropic support (PEDIMACS 3 profile), who successfully received a HeartMate 3 left ventricular assist device as bridge-to-transplantation therapy with no significant adverse events during the early follow-up period. This paper presents the first case of pediatric ventricular assist device implantation in Romania.</p> </abstract>ARTICLEtrue Rare Case of Pyopneumopericardium Diagnosed by Coronary Angiography in a Patient Presented as STEMI<abstract> <title style='display:none'>Abstract</title> <p>Pyopneumopericardium is a rare pathology with a poor prognosis. Accurate diagnosis may be difficult and, in very rare cases, can mimic ST-elevation myocardial infarction (STEMI). We present the case of a 44-year-old man, with clinical, ECG, and ultrasound criteria of inferior STEMI. Emergency coronary angiography excluded obstructive coronary artery disease. However, a hydroaeric level image in the pericardium drew our attention. The chest computed tomography scan and Gastrografin study confirmed the diagnosis of pyopneumopericardium. An exploratory thoracotomy was performed to drain the liquid from the pericardium, without highlighting a fistulous path. The etiology of the pyopneumopericardium was detected by performing an upper endoscopy, which revealed a complex lesion suggestive for a foreign body perforation, which was treated with a covered esophageal stent. The outcome of the patient was unfavorable despite the complex treatment, with cardiac arrest and death occurring on the 14th day of hospitalization.</p> </abstract>ARTICLEtrue Neonatal Cardiovascular Emergencies: A Comprehensive Narrative Review on Assessment and Intervention Strategies<abstract> <title style='display:none'>Abstract</title> <p>The evaluation and management of congenital heart diseases (CHDs) in neonates are pivotal aspects of pediatric care given the substantial prevalence of this condition. This review emphasizes the urgency of timely recognition and intervention, as a notable proportion of affected neonates face critical illness shortly after birth. The multidisciplinary approach involving neonatologists, pediatricians, and obstetricians is essential to address the diagnostic and therapeutic challenges inherent in neonatal cardiac emergencies. The insights presented herein aim to guide medical practice, enhance early recognition, and ultimately improve outcomes for newborns grappling with critical heart conditions. Key proactive measures advocated include prenatal screening, facilitating early identification of potential cardiac anomalies. Advanced imaging techniques, such as fetal echocardiography, have a crucial role in enabling detailed examinations, contributing to the prenatal diagnosis of major CHDs. The review underscores the importance of preparing medical teams during the prenatal period for potential postnatal complications, emphasizing the necessity of a holistic approach to the care of neonates who survive critical episodes. Continued research and clinical advancements remain imperative to refine strategies and optimize care for this vulnerable patient population. The provided data serve as a valuable guide for healthcare professionals and could improve the outcomes of neonates confronting the challenges of CHD.</p> </abstract>ARTICLEtrue Risk of Death among Patients with Healthcare-associated Infections and Cardiovascular Diseases Admitted to the Intensive Care Unit in Romania<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title><p>Healthcare-associated infections (HAIs) can pose significant risks to patients with cardiovascular disease due to the compromised nature of their health and potential vulnerabilities. In order to reduce the incidence of HAIs and prevent the spread of antibiotic-resistant organisms, it is mandatory to develop surveillance systems.</p></sec> <sec><title style='display:none'>Methods</title><p>We undertook a retrospective case–control study of all patients presenting HAIs who were admitted to the intensive care unit (ICU) to assess risk factors associated with death among patients with cardiovascular disease.</p></sec> <sec><title style='display:none'>Results</title><p>Patients admitted to the ICU who died were more likely to present an infection with a multidrug-resistant bacterium, an infection with <italic>Acinetobacter baumannii</italic>, and to suffer from acute myocardial infarction. Among the patients enrolled in the study, a higher probability of death was also observed in association with certain Gram-negative pathogens such as <italic>Klebsiella pneumoniae</italic>, <italic>Acinetobacter baumannii</italic>, and <italic>Pseudomonas aeruginosa</italic>.</p></sec> <sec><title style='display:none'>Conclusion</title><p>The longer the patient remains admitted in the ICU, the higher the risk of acquiring an infection that can often become fatal. A nosocomial infection, particularly in patients with cardiovascular disease, also increases the length of hospitalization, which will lead to increased expenditure. For this reason, new prophylactic methods and therapeutic approaches are needed, and researchers’ efforts should be directed in this direction.</p></sec> </abstract>ARTICLEtrue of Artificial Intelligence in Cardiovascular Emergencies – Status Quo and Outlook<abstract> <title style='display:none'>Abstract</title> <p>Cardiovascular diseases are the leading cause of death, with many lives being affected by critical emergencies like heart attacks, strokes, and other acute conditions. Recognizing the early warning signs is crucial for highlighting the need for immediate medical attention, especially since a quick intervention may significantly improve short and long-term patient outcome. Artificial intelligence (AI) has become a key technology in healthcare, and especially in the cardiovascular field. AI, and in particular deep learning is well suited for automatically analyzing medical images, signals, and data. Its success rests on the availability of large amounts of curated data, and the access to high performance computing infrastructures for training the deep-learning algorithms. Thus, in cardiovascular care, AI plays a dynamic role in disease detection, predicting disease outcome, and guiding treatment decisions. This review paper details and discusses the current role of AI for the most common cardiovascular emergencies. It provides insight into the specific issues, risk factors, different subtypes of the diseases, and algorithms developed to date, followed by an outlook.</p> </abstract>ARTICLEtrue Implantable Cardioverter-Defibrillator Shocks in Ischemic Cardiomyopathy Compels Coronary Vascularization Reassessment<abstract> <title style='display:none'>Abstract</title> <p>The increasing number of patients with heart failure and implantable cardioverter-defibrillators (ICD) has led to a growing of the emergency presentations for ICD internal shocks. Appropriate shocks are sometimes caused by acute events in the course of disease and could be one of the earliest symptoms contributing to the diagnosis and timely treatment of these acute conditions. We present the case of a 64-year-old male patient with ischemic cardiomyopathy, ICD carrier, who presented to the emergency department for recurrent appropriate ICD shocks caused by episodes of polymorphic ventricular tachycardia and ventricular fibrillation. Even if he did not have chest pain, he was referred to cath lab, where the coronary angiography has shown a severe stenosis at the origin of the left anterior descending artery and a moderate stenosis at the proximal left circumflex artery. The percutaneous revascularization of both lesions resulted in the eradication of the sustained ventricular arrhythmias and the improvement of the clinical status. The case argues for the need for coronary vascularization assessment in ICD carrier patients with ischemic heart failure and adequate recurrent shocks, also emphasizing the importance of remote monitoring in early diagnosis of acute conditions in these patients.</p> </abstract>ARTICLEtrue Small-Diameter Vascular Xenografts as an Alternative to Autologous Vascular Grafting for Emergency Revascularization – a Preliminary Study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Autologous vascular arterial or venous graft are not available in 10-40% of patients, due to vascular pathologies, and the utility of decellularized biological scaffolds would be a solution for those cases. The purpose of this research was to obtain a functional acellular xenograft, prior to in-vivo testing as a vascular graft in an experimental animal.</p> </sec> <sec><title style='display:none'>Materials and method</title> <p>Two batches of carotid vasculo-nervous bundles were collected from porcine models from a local slaughterhouse. The arterial grafts were dissected and isolated, obtaining carotid arteries with a caliber of 5–6 mm and a length of approximately 10–12 cm. Two decellularization protocols were used, immersion (n = 10) and perfusion (n = 9). The resulting grafts underwent histological examination, DNA analysis, electrophoresis and spectrophotometry.</p> </sec> <sec><title style='display:none'>Results</title> <p>Due to severe tissue damage and friability, the batch that was decellularized using perfusion was not examined. The histological examination of grafts stained with hematoxylin-eosin and DAPI highlighted the absence of nuclei. Spectrophotometry revealed a 90% decellularization, and electrophoresis of revealed the migration band of the material extracted from the fresh tissue, as well as the absence of migration bands in the case of the material extracted from decellularized tissues.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>We successfully used the immersion protocol to obtain a functional acellular vascular graft, in contrast to perfusion decellularization, where intraluminal high pressures damage the extracellular matrix.</p> </sec> </abstract>ARTICLEtrue Severe Case of Hantavirus Cardiopulmonary Syndrome in a Patient Presenting as STEMI<abstract> <title style='display:none'>Abstract</title> <p>Hantavirus cardiopulmonary syndrome (HCPS) is a rare disease caused by Hantaviruses, that are transmitted from rodents to humans through aerosols. In some patients, HCPS can have a severe evolution, with rapid progression to respiratory distress and cardiogenic shock. We present the case of a 56-year-old female patient who was transferred to our hospital with ST-segment elevation myocardial infarction (STEMI) and acute respiratory distress syndrome (ARDS). The coronary angiography showed normal epicardial coronary arteries and the lung computed tomography (CT) raised the suspicion of tracheoesophageal fistula, which was soon refuted by an upper digestive endoscopy. Initially, the evolution was very severe, requiring mechanical ventilation, hemodynamic support, and broad-spectrum antibiotics. Later, sero-logical testing revealed an acute infection with Hantavirus Dobrava type. The patient lives in a rural environment, working in a wheat mill. Despite the severe presentation, the evolution was favorable, with complete remission of the pulmonary and myocardial damage after 2 weeks. We emphasize the importance of HCPS suspicion and specific testing in the early phase of the disease, as well as early admission to an intensive care unit, which is crucial in severe cases and can improve survival in a patient without any specific symptoms or a clear diagnosis.</p> </abstract>ARTICLEtrue Differences in the Level of Inflammation Between the Right and Left Coronary Arteries – a Coronary Computed Tomography Angiography Study of Epicardial Fat Attenuation Index in Four Scenarios of Cardiovascular Emergencies<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>The pericoronary fat attenuation index (FAI) is an emerging computed tomography-derived marker for measuring vascular inflammation at coronary vessels. It holds prognostic significance for major cardiovascular events and enhances cardiac risk assessment, complementing traditional risk factors and coronary artery calcium scores. However, the impact of local coronary circulation factors on pericoronary inflammation development in right versus left coronary arteries has not been clearly understood.</p> </sec> <sec><title style='display:none'>Objective</title> <p>This study aimed to investigate the regional differences in inflammation levels between the right and left coronary arteries in four clinical scenarios: acute coronary event in the follow-up period, post-COVID patients, recent percutaneous intervention, and unstable angina with significant lesions on native coronary arteries.</p> </sec> <sec><title style='display:none'>Methods</title> <p>The study included 153 patients (mean age 62 years, 70.5% male) who underwent clinically indicated coronary computed tomography angiography (CCTA). Vulnerable plaque features were analyzed to identify high-risk plaques. FAI and the FAI score, a score integrating risk factors and age, were calculated for each case at the left anterior descending artery (LAD), circumflex artery (LCX), and right coronary artery (RCA).</p> </sec> <sec><title style='display:none'>Results</title> <p>A total of 459 coronary arteries were analyzed. Both FAI and FAI scores were higher in the RCA (15.23 ± 11.97) compared to the LAD (10.55 ± 6.78) and (11.48 ± 6.5) LCX (p = 0.02). FAI values showed a significantly higher level at the RCA (−71.25 ± 7.47 HU) compared to the LCX (−76 ± 7.68 HU) and the LAD (−73.04 ± 8.9 HU, p &lt;0.0001). This trend persisted across all subgroups, including post-COVID CT scans (−75.49 ± 7.62 HU for RCA vs. −72.89 ± 9.40 HU for the LCX vs. −71.28 ± 7.82 HU for the LAD, p = 0.01) and patients with high-risk plaques (20.98 ± 16.29 for the RCA vs. 11.77 ± 7.68 for the LCX vs. 12.83 ± 6.47 for the LAD, p = 0.03).</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Plaques in different coronary areas show varied vulnerability and inflammation levels. The RCA, in particular, demonstrates greater inflammation susceptibility, with higher inflammation scores in areas surrounding the coronary plaques.</p> </sec> </abstract>ARTICLEtrue Inflamed Non-Calcified Coronary Plaques Sealed with Stents in Patients with Zero Calcium Score – a Case Series and Review of the Literature<abstract> <title style='display:none'>Abstract</title> <p>The modern management of coronary artery disease (CAD) uses coronary computed tomography angiography (CCTA) to enhance plaque evaluation and cardiovascular risk assessment. CCTA identifies high-risk plaques, and the latest CT technologies based on calculation of fat attenuation index (FAI) allow assessment of inflammation at the level of the target coronary artery. We present a series of case studies with chest pain and positive CCTA, in whom a significant stenosis was detected in the left anterior descendent coronary artery, and the existence of high-risk, inflamed plaques was documented even in the context of a zero calcium score. A severe narrowing of the left anterior descending artery, exhibiting the pattern of high-risk anatomy, was associated with a very high inflammation depicted by FAI analysis in all three cases, an association that may be extremely dangerous. In this case series, CCTA examination led to immediate stenting of the obstructive stenosis, sealing the dangerous plaque.</p> </abstract>ARTICLEtrue Inflammation and Coronary Calcification in an Acute Coronary Syndrome Successfully Treated with Cutting Balloon<abstract> <title style='display:none'>Abstract</title> <p>Complex coronary atherosclerosis may exhibit different phenotypes of coronary plaques, from non-calcified highly vulnerable atheroma to heavily calcified ones. Computed coronary tomography angiography (CCTA) may identify these different phenotypes and the recently introduced CCTA-based techniques for mapping coronary inflammation along the coronary arteries may provide useful additional information on cardiovascular risk. Here we present the case of a 68-year-old male patient with acute coronary syndrome in whom invasive coronary angiography and CCTA revealed a severe three-vessel disease with a heavily calcified lesion. Mapping of the CT fat attenuation index along the coronary arteries identified a high level of coronary inflammation, especially associated with the non-calcified lesions. All lesions were successfully revascularized by implantation of drug-eluting stents. A cutting balloon was used for the lesion identified by CCTA as heavily calcified, followed by stent implantation, with good results. In conclusion, CCTA, in association with novel techniques for mapping coronary inflammation, may represent an extremely useful tool for preparing complex interventions in multivessel diseases, helping preprocedural planning in high-risk patients.</p> </abstract>ARTICLEtrue Race Against Time: Coronary Computed Tomography Angiography Discovers a Highly Inflamed Plaque in 49-Year-Old Right Before STEMI<abstract> <title style='display:none'>Abstract</title> <p>In the modern management of coronary artery disease (CAD), cardiac computed tomography angiography (CCTA) has emerged as a pivotal diagnostic tool, offering detailed visualization of coronary artery lumens and atherosclerotic plaques. We present the case of a 49-year-old woman, with no prior cardiovascular history but with several risk factors, in whom CCTA identified a highly inflamed atherosclerotic plaque, which led immediately to an acute myocardial infarction. Significantly, this case spotlights the vital role of perivascular inflammation mapping in CCTA, crucial for identifying high-risk plaques. The case emphasizes the necessity for a comprehensive, multifaceted diagnostic approach in the evaluation and management of CAD, incorporating advanced techniques like perivascular inflammation mapping for a more accurate and predictive assessment.</p> </abstract>ARTICLEtrue Function and the Use of Vitamin K Antagonists or Direct Oral Anticoagulants in Atrial Fibrillation<abstract> <title style='display:none'>Abstract</title> <p>Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a five-fold increase in the risk for ischemic stroke. Therefore, lifelong use of anticoagulants is crucial to reduce the morbidity and mortality burden of AF. The incidence of AF in chronic kidney disease (CKD) is two to three times greater than in the general population, and there is a mutual aggravation of the two conditions as well as the presence of both an increased thromboembolic risk in CKD and an increased bleeding risk in severe CKD. The preservation of kidney function in patients with cardiovascular diseases is important, as the latter is the leading cause of death in patients with eGFR &lt;60 mL/min/1.73 m<sup>2</sup>. Similarly, kidney dysfunction is a serious limitation to the use of many cardiovascular drugs, including anticoagulants. Evidence is present for the faster progression of kidney disease with vitamin K antagonists, likely due to the vitamin K-related process of vascular calcification. Conversely, direct oral anticoagulants (DOACs) have been shown to reduce the progression of CKD and have a beneficial effect as far as the modulation of inflammation and oxidative stress are concerned in experimental models. Another less-discussed problem is the use of DOACs in advanced CKD.</p> </abstract>ARTICLEtrue Mechanical Augmentation of Human Saphenous Vein Graft By UV-A Irradiation in Emergency Vascular Reconstruction – Preliminary Results<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>In vascular reconstruction in arterial trauma, ruptured abdominal aortic aneurysm or ruptured aneurysmal arteriovenous fistula, the challenge no longer lies in the surgical procedure itself, but rather the prevention of intimal hyperplasia, thrombosis and aneurysm formation, in parallel with extending as long as possible the patency of the grafts.</p> </sec> <sec><title style='display:none'>The aim</title> <p>of this study is to present the preliminary findings of a novel non-ionizing radiation-based therapeutic method for stabilizing and strengthening the extracellular matrix of the venous wall, improving the biomechanical profile of the autologous graft used in myocardial and lower limb revascularization.</p></sec> <sec><title style='display:none'>Material and methods</title> <p>We developed the protocol and method for UV-A irradiation as a new method of mechanical augmentation of the resistance structure of the venous graft. Samples of the superficial femoral artery, superficial femoral vein, and great saphenous vein (GSV) were extracted from a 58-year-old patient who underwent above-the-knee amputation, and were prepared in 5 × 5 cm<sup>2</sup> patches. Additionally, we analyzed the samples biomechanically biaxially with the BioTester<sup>®</sup> 5000, in which we established a 25% equibiaxial stretch. The GSV sample was also treated by UV-A irradiation after being kept in riboflavin 5′-phosphate monosodium salt for 30 min.</p> </sec> <sec><title style='display:none'>Results</title> <p>After UV-A treatment of the GSV wall, we observed an important increase of Cauchy stress from 82 kPa to 131 kPa in the longitudinal axis and from 66 kPa to 115 kPa in the circumferential axis. Young’s modulus also changed after treating the GSV wall from 0.564 MPa to 1.218 MPa (longitudinal) and from 0.397 MPa to 0.709 MPa (circumferential). As a result of the therapy, we observed a considerable similarity of the mechanical behavior of the GSV wall to that of the artery wall.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>The photocrosslinking of collagen fibbers at the vein graft adventitia hardens and stiffens the venous wall, making it behave like the arterial wall after treatment. These preliminary ex vivo results on human vascular tissue may serve as the foundation for the development of new treatment approaches utilizing mechanical augmentation of the vein grafts.</p> </sec> </abstract>ARTICLEtrue Echocardiography for the Early Detection of Cardiac Dysfunction in Patients with Rheumatoid Arthritis<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Background</title> <p>Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease. Left atrial (LA) dysfunction is strongly linked to cardiovascular diseases, and the early detection of LA function in patients with RA is vital. Real-time three-dimensional echocardiography (RT-3DE) offers a noninvasive method to assess the structure and function of the LA.</p> </sec> <sec><title style='display:none'>Aim of the study</title> <p>To assess LA volumes and phasic function in patients with RA using 3D transthoracic echocardiography.</p> </sec> <sec><title style='display:none'>Materials and Methods</title> <p>This prospective case-control study included 162 subjects classified into two groups: Group 1 included 82 patients with RA, subdivided into an active RA group (n = 40) and an inactive RA group (n = 42), and Group 2 included 80 healthy matched controls. All study participants were examined using 2D and 3D transthoracic echo-cardiography.</p> </sec> <sec><title style='display:none'>Results</title> <p>Diastolic dysfunction was significantly greater in patients with moderate and severe disease activity than in patients with mild disease activity. RT-3DE analysis of RA groups showed significantly higher maximum, minimum, and pre-atrial LA volumes compared to controls (p &lt;0.01), and these volumes were significantly higher in the active RA group than in the inactive RA group (p &lt;0.01). We also found significantly lower LA passive ejection fraction (EF) and active EF in both RA groups than the control group (p &lt;0.01), and significantly lower total EF in the active RA group than the inactive RA group (p &lt;0.01).</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Patients with RA had increased 3D LA volumes and impaired mechanical function, especially in active RA. RT-3DE provides an accurate measurement of LA volumes and function, being a feasible and reproducible method in clinical applications.</p> </sec> </abstract>ARTICLEtrue