Increased values of ICS, a new CTA marker of vascular calcification, are associated with a higher severity and complexity of PAD and a more depressed left ventricular function. High ICS values are also associated with increased i-IMT. Both can represent new surrogate markers of an increased atherosclerotic burden.

Cardiogenic shock remains the leading cause of death in patients hospitalized for acute myocardial infarction, despite many advances encountered in the last years in reperfusion, mechanical, and pharmacological therapies addressed to stabilization of the hemodynamic condition of these critical patients. Such patients require immediate initiation of the most effective therapy, as well as a continuous monitoring in the Coronary Care Unit. Novel biomarkers have been shown to improve diagnosis and risk stratification in patients with cardiogenic shock, and their proper use may be especially important for the identification of the critical condition, leading to prompt therapeutic interventions. The aim of this review was to evaluate the current literature data on complex biomarker assessment and monitoring of patients with acute myocardial infarction complicated with cardiogenic shock in the Coronary Care Unit.

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Background: Atherosclerosis has a systemic impact, producing gradual stenoses of the main vessels, and many imaging techniques have been developed in order to detect and quantify the atherosclerotic lesions. Peripheral artery disease has been shown to be associated with the presence of coronary heart disease, at the same time with carotid artery involvement. The utility of the carotid artery intima-media thickness (IMT) in predicting cardiovascular events caused by atherosclerosis, led to the idea that assessing the femoral artery IMT could have a similar impact. Study aim: We sought to determine the correlations between the femoral IMT, the degree of left ventricular systolic dysfunction and cardiovascular risk factors in patients with established diagnosis of ischemic heart disease. Material and methods: We prospectively included 27 patients with diagnosed ischemic heart disease. The ankle-brachial index (ABI) was assessed for the anterior and posterior tibial arteries. The left ventricular ejection fraction (LVEF) was determined by echocardiography. The femoral IMT was measured by peripheral vascular ultrasound, at the common femoral artery, 1 cm proximally from the bifurcation. The patients were divided into 2 groups: Group 1 – patients with IMT<0.9mm, and Group 2: patients with IMT >0.9 mm. Results: The mean age of the study population was 65.52 ± 11.44 years, and 77.77% were males. The mean glycemia levels were 99.89 ± 30.34 mg/dl, total cholesterol: 176.81 ± 43.09 mg/dl and the mean triglyceride level 140 ± 65.12mg/dl. The mean LEVF was 49.98% ± 12.73%, and femoral IMT 0.75 mm ± 0.25 mm. IMT significantly correlated with cholesterol levels (R = 0.383, p = 0.048), anterior and posterior tibial artery pressures (R = 0.450, p = 0.018, R = 0.418, p = 0.029 respectively) and ABI (R = 0.623, p = 0.005). There was no significant correlation between the LVEF and the IMT (R = −0.143, p = 0.475). There was a significant difference between the 2 groups regarding the minimum anterior tibial artery pressure (95.57 mmHg vs. 63.5 mmHg, p = 0.0011) and the minimum ABI (0.85 vs. 0.5, p = 0.015), and the femoral IMT (p = 0.0001). For patients with a femoral IMT >0.9 mm, a significant correlation was found between ABI and femoral IMT (R = −0.710, p <0.0001). Conclusion: The femoral intima-media thickness, assessed with peripheral vascular ultrasound, could be a new marker in evaluating the global cardiovascular risk in patients with ischemic heart disease. Femoral IMT could become a new marker for systemic atherosclerosis.

Introduction: Peripheral artery disease, a frequent consequence of atherosclerosis, is usually associated with concomitant ischaemic coronary artery disease and with a high rate of cardiovascular mortality. Material and methods: The study population consisted of 24 patients, admitted to our clinic with peripheral artery disease, 10 of them with critical limb ischaemia. In all cases, cardiovascular risk factors, left ventricular dysfunction and ejection fraction were analyzed. Peripheral Multislice Angio CT examination was used to determine the TASC class and to assess the peripheral arterial lesions. The Coronary Calcium Score and the Syntax Score were determined with angio CT of the coronary arteries. Results: Patients were between 39 and 84 years of age, and 54% were in Fontaine class 2B, 21% in Fontaine class 3 and 25% in Fontaine class 4. 12.5% of patients presented TASC class A, 33.3% TASC class B, and 54.2% TASC class C. Coronary Calcium Scores were between 0 and 100 in 16.6% of patients, between 100 and 400 in 41.8%, and >400 in 41.6% of patients. The SYNTAX Score was <22 in 54% of patients, between 22 and 32 in 37.5%, and >32 in 8.5% of patients. A significant correlation was found between the Coronary Calcium Score and the SYNTAX Score (r = 0.82, p = 0.03). The Syntax Score was 22.43 ± 3.2 in TASC A patients, 26.2 ± 5.4 in TASC B patients, 32.1 ± 2.3 in TASC C patients (p = 0.005). Conclusions: The severity of coronary artery disease characterized by the Syntax Score, by the presence of left main stenosis and segmental left ventricular hypokinesis presents significant correlation with the severity of peripheral artery disease, characterized by the TASC classification.