Introduction: Pulmonary embolism (PE) is the most common cause of vascular death after myocardial infarction and stroke, being associated with high mortality and morbidity rates. The aim of this study was to assess the factors related to 1-year mortality in patients with acute pulmonary embolism who survived the acute event. Material and methods: In total, 104 patients who had survived the acute episode of pulmonary embolism and underwent a one-month follow-up after the acute event were included in the study. The patients were divided into two groups: Group 1 – patients who had survived at one year after being diagnosed with acute PE (80.76%, n = 84), and Group 2 – patients who had died after one year (19.23%, n = 20). Results: There were no differences between the 2 groups in relation to gender (p = 0.3), or cardiovascular risk factors (diabetes: p = 0.5, smoking: p = 0.3, hypertension: p = 1, hypercholesterolemia: p = 0.5, hypertriglyceridemia: p = 0.4). Patients who had deceased were significantly older (73.35 ± 9.37 years vs. 66.36 ± 11.17 years, p = 0.005) and had a higher weight compared to the survivors (85.8 ± 21.09 kg vs. 75.89 ± 22.69 kg, p = 0.03). Left ventricular ejection fraction, measured by cardiac ultrasound, was significantly lower in the deceased group compared to survivors (45.63 ± 8.9% vs. 52.86 ± 6.8%, p = 0.03). Multivariate analysis identified the hemodynamic instability (OR = 3.17, p = 0.007), the presence of left QRS axis deviation (OR = 4.81, p = 0.001), associated pulmonary pathologies (OR = 3.2, p = 0.02) as well as the presence of chronic kidney disease (OR = 5, p = 0.04) as the most powerful predictors of death at 1 year in patients with acute PE surviving the acute event. Conclusions: Factors associated with a higher mortality rate at 1 year in patients who had survived at 1 month following an acute pulmonary embolism episode included: older age, higher body weight, presence of associated pulmonary pathologies, chronic kidney disease, left axis deviation, low left ventricular ejection fraction, hemodynamic instability requiring inotropic support, cardiogenic shock at presentation or cardiac arrest during the acute phase.

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.

Despite of numerous treatment strategies developed in the last years, ischemic heart disease remains the leading cause of death around the world. Acute myocardial infarction (MI) causes irreversible destruction to the myocardial tissue, which is replaced by fibroblast cells, leading to the formation of a dense, collagenous scar, a non-contractile tissue, and often to heart failure. Stem cell therapy seems to represent the next therapeutic method for the treatment of heart failure caused by myocardial infarction. Several international trials proved the beneficial outcome of the intracoronary infusion of bone marrow-derived stem cells, improving left ventricular systolic function and clinical symptomatology. Many noninvasive imaging procedures are available to evaluate the beneficial properties of stem cell therapy. Most studies have demonstrated the role of multislice computed tomography (MSCT) in evaluating left ventricular parameters such as end-diastolic and end-systolic volumes and ejection fraction, or to quantify myocardial scar tissue. In this review we will discuss the usefulness of MSCT for the assessment of coronary arteries, new tissue regeneration, and evaluation of tissue changes and their functional consequences in subjects undergoing stem cell treatment following MI.

Ischemic heart disease morbidity and mortality are closely related to global and regional left ventricular function. The evaluation of left ventricular global function is a relevant part in the evolution of ischemic heart disease because it plays a significant role in prognosis prediction and patient management after revascularization. Regional function is also a critical part of the evolution, offering a possible and reliable mode for the assessment of myocardial disease. Currently several techniques for the evaluation of left ventricular parameters and function are in use. In this review we will discuss and compare currently available methods for the evaluation of global and regional left ventricular function such as 2D and 3D echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, and cardiac magnetic resonance imaging.Keywords: ischemic heart disease, echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, cardiac magnetic resonance imaging REVIEW DOI: 10.1515/jim-2017-0020 CARDIOLOGY // IMAGING Ischemic heart disease is the leading cause of death around the world. The morbidity and mortality rates are closely associated to regional and global left ventricular function in these patients. 1,2 The evaluation of global left ventricular (LV) function with noninvasive imaging tools has an important role in the therapeutic management and prognosis of patients with ischemic cardiac diseases. Several parameters have been proposed as illustrative for global left ventricular function such as volumes, ejection fraction, dimensions, end-diastolic pressure, contractility, and deformation parameters. Global systolic function is most often evaluated by measuring the difference in the end-diastolic and end-systolic volumes, determined in one, two and three dimensions, divided by the adequate end-diastolic volume. 3 Echocardiography is the most frequently used noninvasive technique for the analysis of LV parameters and function because of its accessibility, portability, and widely validated scale.

Coronary computed tomography angiography (CCTA) has evolved notably over the last decade, gaining an increased amount of temporo-spatial resolution in combination with decreased radiation exposure. The importance of CCTA is emerging especially in vulnerable and young patients who might not have developed a viable collateral vascular network to sustain the circulation to an infarction area during a major adverse coronary event. There are a few well-known markers by which a vulnerable plaque can be assessed and that can predict the subsequent events of sudden myocardial ischemia, such as an increased positive remodeling index (cut-off >1.4), low-attenuation plaque (cut-off <30 HU), plaque burden (cut-off >0.7), and napkin-ring sign (NRS). This manuscript presents a series of 3 clinical cases of young patients experiencing symptoms and signs of myocardial ischemia who underwent CCTA in order to assess the composition and functional characteristics of atherosclerotic plaques and their repercussion in developing an acute coronary syndrome.