Urine α-Glutathione S-Transferase, systemic inflammation and arterial function in juvenile type 1 diabetes.

BACKGROUND: Despite marked improvement in therapy and monitoring of patients with insulin-dependent (type 1) diabetes, diabetic nephropathy remains a serious complication, with subsequent end-stage renal disease in about 20% of cases. OBJECTIVE: To investigate in young patients with type 1 diabetes whether urine α-Glutathione S-transferase to creatinine ratio (α-GST:crea) relates to markers of systemic inflammation and subclinical vasculopathy. DESIGN: Children and adolescents (median age and diabetes duration 14 and 6years, respectively) with type 1 diabetes screened in a previous study for proximal tubular (urine α-GST:crea ratio) and renal (plasma creatinine, cystatin C glomerular filtration rate (GFR), and timed urine albumin excretion rate (AER)) function were, within the same timeframe, also investigated for vascular (blood pressure, carotid artery intima-media thickness (IMT) and compliance (CAC), brachial artery flow-mediated dilatation (FMD) and plasma cyclic guanosine monophosphate (cGMP) and inflammatory (C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α)) profiles. Exposure to environmental tobacco smoke (ETS) was assessed through questionnaire (n=67 respondents). RESULTS: None of the patients (n=69) had overt renal insufficiency. AER correlated with age (p=0.01, r=0.3), diabetes duration (p=0.02, r=0.3), FMD (p=0.04, r=-0.3, n=52), CAC (p=0.03, r=-0.3, n=62) and cGMP (p=0.01, r=-0.3, n=59). α-GST:crea was lower (p=0.03) in patients than in controls. α-GST:crea appeared to be particularly lower in older patients (p=0.004, r=-0.34 vs age), in those with worse diabetic control (p=0.03, r=-0.26 vs HbA1c), and in those with lower carotid artery elasticity (p=0.017, r=0.3 vs CAC). Although ETS had no direct significant impact on α-GST:crea, α-GST:crea correlated with FMD only in patients with ETS (r=0.5, p=0.009, n=13). α-GST:crea showed positive association with TNF-α (p=0.01, r=0.3). CONCLUSION: In children and adolescents with type 1 diabetes, lower levels of urine excretion of α-GST:crea appear to be associated with decreasing elasticity and endothelial vasomotor function of peripheral arteries, especially in patients with ETS. In contrast, higher levels of α-GST:crea are more common in patients with elevated markers of systemic inflammation. Large scale prospective studies are needed to clarify the meaning and mechanisms of this association

Aortic coarctation - modern concepts of approach and treatment

Spitalul Polivalent Novamed, Departamentul Cardiologie, Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Departamentul Pediatrie, IMSP Institutul Mamei şi CopiluluiIntroducere. Coarctaţia de aortă (CoA) poate fi diagnosticată la orice vârstă, dar în multe cazuri, pacienţii pot fi absolut asimptomatici până la vârsta pubertară. În alte cazuri nou-născuţii pot prezenta insufi cienţă cardiacă severă, acidoză sau şoc cardiogen după închiderea ductului arterial. Scopul. Studierea efi cacităţii utilizării stent-graftului dedicat de tip „BeGraft Bentley” în abordarea endovasculară a coarctaţiei de aortă la copii. Material şi metode. Pentru realizarea scopului studiului au fost analizate rezultatele implementării graft-stentului „BeGraft aortic Bentley”. Rezultate. În studiu au fost incluse şi rezolvate prin stentare 8 cazuri de CoA la pacienţi cu vârsta între 6 şi 32 ani; 5 pacienţi au fost de sex masculin, 3 – de sex feminin. Din 4 cazuri de valvulopatii asociate – 2 au fost cu PVM, 1 - stenoza VAo, 1 – bicuspidia Ao. MCC asociate: 2 pacienţi prezentau Canal arterial patent (CAP), 1 – Defect de sept atrial. Cauza de bază pentru care pacienţii au fost supuşi intervenţiei endovasculre - CoAo ( în toate 8 cazuri), 3 pacienţi au avut insuficienţă cardiacă. Hipertensiune arterială, care de-facto se dezvoltă la toţi paienţii, a fost prezentă în toate 8 cazuri, iar claudicaţia – s-a manifestat la 7 pacienţi. Complicaţiile poststentare, cel mai frecventă fi ind recoarctaţia, au lipsit la toţi, iar pseudoanevrismul s-a manifestat în 1 caz. Concluzii. 1. Abordarea endovasculară a CoAo este în prezent metoda de elecţie pentru tratamentul acesteia graţie ratei scăzute de complicaţii, timpului de spitalizare redus, inofensivităţii relative. 2. Stenturile aortice tip Bentley par a fi foarte promiţătoare, fiind uşor ajustabile, având o siguranţă şi protecţie maximă comparativ cu generaţiile mai vechi sau cu metoda clasică – prin dilatare cu balon. 3. Avantajul mare al graft-stenturilor Bentley este posibilitatea tratamentului simultan al CoAo şi CAP.Introduction. Coarctation of the aorta (CoAo) can be diagnosed at any age, but oftentimes, patients may be asymptomatic until pubescence. In other cases, newborns may undergo severe heart failure, acidosis, or cardiogenic shock after closing the arterial duct. The aim. Studying of the efficacy of „BeGraft Bentley” type stent-graft utilization in the endovascular approach of the CoAo. Materials and methods. Retrospective analysis of the „BeGraft aortic Bentley” stent-graft implantation results. Results. Totally 8 cases of CoA were included and solved in patients aged between 6 and 32 in the study; 5 patients were male, 3 - female. Of 4 cases of the associated valvular disease - 2 were presented with MVP, 1 - VAo stenosis, 1 - Ao bicuspids. The associated CHD: 2 patients were presented Patent Arterial Duct (PAD), 1 of them - Atrial septal defect. The baseline reason for patients undergoing endovascular intervention - CoAo (in all 8 cases), was associated with heart failure in 3 patients. Hypertension, which de facto develops in all patients, proved to be in all 8 cases, and claudication - manifested in 7 patients. The postoperative complications: the re-coarctation was absent in all patients, and the pseudoaneurysm manifested in one case. Conclusions. 1. The endovascular approach of CoAo is currently the method of choice for its treatment due to the low rate of complications, reduced hospitalization time, relative inoffensiveness. 2. Bentley type aortic stents appear to be very hopeful, being easily adjustable, with maximum safety and protection compared to elder generations or the classic method - by balloon expansion. 3. The great advantage of Bentley graft stents is the possibility of simultaneous treatment of CoAo and PAD

DISFUNCȚIA ENDOTELIALĂ PERIFERICĂ LA PACIENȚII CU INFARCT MIOCARDIC ACUT FĂRĂ SUBDENIVELAREA DE SEGMENT ST

Purpose: Evaluation of peripheral endothelial function using EndoPAT 2000 device in patients with non-ST-eleva-tion myocardial infarction (NSTEMI) and correlation with clinical characteristics of the patients.Material and methods: The study included 39 patients with NSTEMI, hospitalized in 2 PCI centers, in the period 03.2022-03.2023. At 72 hours after admission, peripheral endothelial function was assessed using the EndoPAT 2000 device. Patients were divided into 2 groups according to the presence of peripheral endothelial dysfunction (RHI <1.67). Statistical analysis of the data was performed using the t-test and the χ2 test. Results: The average value of the reactive hyperemia index (RHI) was 1.73 ± 0.47. Endothelial dysfunction was diag- nosed in 51,3% of NSTEMI patients. Group I included 19 patients with normal endothelial function (RHI>1.67), and group II – 20 patients with endothelial dysfunction (RHI<1.67). In the group of patients with endothelial dysfunction, twoor three-vessel disease prevailed (χ2=2.7, p=0.43) and a higher rate of coronary angioplasty was recorded (χ2=4.36, p=0.037). Conclusion: Peripheral endothelial dysfunction estimated by the EndoPat 2000 method is identified in 51,3% of patients with NSTEMI. The endothelial dysfunction correlated with severity of coronary lesions. Further studies are neededto assess the diagnostic and prognostic value of the method.Rezumat. Scop: Evaluarea funcției endoteliale periferice cu ajutorul dispozitivului EndoPAT 2000 la pacienții cu infarct miocardic fără supradenivelarea segmentului ST (NSTEMI) și corelarea cu caracteristicile clinice și paraclinice ale pacienților. Material și metode: În studiu au fost incluși 39 pacienți cu NSTEMI, spitalizați în 2 centre de angioplastie coronariană, în perioada 03.2022-03.2023. La 72 ore de la admitere, s-a evaluat funcția endotelială periferică cu ajutorul dispozitivului EndoPAT 2000. Ulterior, pacienții au fost divizați în 2 loturi în funcție de prezența disfuncției endotelialeperiferice (RHI <1.67). Analiza statistică a datelor s-a efectuat folosind testul t și testul χ2.Rezultate: Valoarea medie a indicelui hiperemiei reactive (RHI) a fost de 1.73 ± 0.47. Disfuncția endotelială a fost diagnosticată la 51,3% pacienți cu NSTEMI. Lotul I a inclus 19 pacienți cu funcția endotelială normală (RHI>1.67), iar lotul II – 20 pacienți cu disfuncție endotelială (RHI<1.67). În lotul pacienților cu disfuncție endotelială au predominat leziunile biși tricoronariene (χ2=2.7, p=0.43) și s-a înregistrat o rată mai mare a angioplastiei coronariene (χ2=4.36, p=0.037). Concluzie: Disfuncția endotelială periferică estimată prin metoda EndoPAT 2000 este identificată la 51,3% din pacienții cu NSTEMI. S-a determinat corelarea disfuncției endoteliale cu severitatea leziunilor coronariene. Pentru o apreciere mai concludentă a relevanței diagnostice și prognostice sunt necesare studii ulterioare

HLA, infections and inflammation in early stages of atherosclerosis in children with type 1 diabetes

This prospective study focuses on risk factors for arterial damage in children with type 1 diabetes (T1D). Eighty children and adolescents with T1D were investigated twice, approximately 2 years apart, for carotid artery intima-media thickness (cIMT) and compliance (CAC), flow-mediated dilatation (FMD) of the brachial artery, and plasma levels of matrix metalloproteinase (MMP)-8. All subjects were genotyped for HLA. The number of respiratory tract infections (RTI) during the past year was obtained by a questionnaire in 56 patients. cIMT progression, defined as percentage (%) change of cIMT from baseline, correlated inversely with the % changes of both CAC (p = 0.04, r = - 0.3; n = 62) and FMD (p = 0.03, r = - 0.3; n = 47). In multivariate analysis, RTI frequency correlated significantly with cIMT progression irrespective of age, diabetes duration, BMI, and HbA1c (p = 0.03, r = 0.3). When patients were divided in relation to RTI, the association of DQ2/8 with cIMT progression remained significant in patients with over three infections/year (p = 0.04, r = 0.3). During follow-up, the group of DQ2/8 patients with hsCRP > 1 mg/l showed significantly higher levels of plasma MMP-8 than the non-DQ2/8 group. The diabetes-risk genotype DQ2/8 and systemic inflammation contribute to pro-atherosclerotic vascular changes in children and adolescents with T1D.Peer reviewe

Клиническое наблюдение за лечением коарктации аорты с помощью приборов новогопоколения

Clinical Follow-up of the treatment of aortic coarctation with a new generation of deviceCoarctația de aortă (CAo) este o malformație congenitală critică, care necesită un tratament terapeutic urgent. Datele ecocardiografice și cele CT/RMN ale aortei furnizează informații despre localizarea, structura și extensia CAo precum și diametrele aortice, însă fenomenul diastolic „run-off” este considerat cel mai sugestiv pentru un diagnostic cert de CAo. CAo numără 5-7%, cu o prevalență de la 3 până la 10.000 de nou-născuți vii. Pe parcursul perioadei de 1 an de zile au fost rezolvate prin stentare 8 cazuri de CAo în cadrul Spitalului Polivalent Nova Med, care au fost evaluate clinico-paraclinic în dinamică. Rezultate. Vârsta pacienților incluși în cercetare a fost 18±0,05 ani. Toate cazurile au fost soluționate cu succes prin abordare endovasculară cu implantarea unui stent-graft dedicat tip ”BeGraft Bentley”. Concluzie. Abordarea endovasculară a coarctației de aortă în prezent este metoda de elecție pentru tratamentul acesteia, grație ratei scăzute de complicații, timpului de spitalizare redus, inofensivității relative.Клиническое наблюдение за лечением коарктации аорты с помощью приборов новогопоколени

Longitudinal ECG changes in tetralogy of Fallot and association with surgical repair

BackgroundECG abnormalities have been linked to adverse changes in right ventricular (RV) morphology and poor clinical outcomes in repaired Tetralogy of Fallot (rTOF). Our aim was to describe how ECG changes progress in early and intermediate follow-up and whether types of surgical strategy at the time of primary repair affected these changes.MethodsWe studied patients with rTOF born 2000–2018 operated at our institution. Seven time points in relation to primary repair, follow-up, and pulmonary valve replacement (PVR) were identified. Patients correct with valve sparing repair (VSR), trans-annular patch (TAP) including with a monocusp valve (TAP + M) and with at least 3 ECGs were included. PQ interval, QRS duration, dispersion, and fragmentation, QTc duration and dispersion, JTc as well as presence of a right bundle branch block (RBBB) were analyzed. Medical records were reviewed for demographic and surgical data.ResultsTwo hundred nineteen patients with 882 ECGs were analyzed with a median follow-up time of 12.3 years (8.4, 17) with 41 (19%) needing PVR during the study period. QRS duration increased at time of primary repair to discharge from 66 msec (IQR 12) to 129 msec (IQR 27) (p < 0.0001) and at 1- and 6- year follow-up but showed only a modest and temporary decrease after PVR. QTc increased at the time of primary repair as well as prior to PVR. PQ interval showed a small increase at the time of primary repair, was at its highest prior to PVR and decreased with PVR. Type of surgical repair affected mainly QTc and JTc and was consistently longer in the TAP + M group until PVR. In VSR, QTc and JTc were prolonged initially compared to TAP but were similar after 1 year. After PVR, there were no differences in adverse ECG changes between surgical groups.ConclusionsPQ interval and QRS duration best correspond to the assumed volume load whereas the relationship with QTc and JTc is more complex, suggesting that these represent more complex remodeling of the myocardium. Before PVR, QTc and JTc are longer in the TAP + M group which may be due to a longer surgical incision

Blood Pressure in 6-Year-Old Children Born Extremely Preterm

Background-Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. Methods and Results-We measured casual blood pressures (BPs) in a population-based cohort of 6-year-old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age-and sex-matched controls born at term (n=172). Measured BP did not differ, but sex, age-, and height-adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow-up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week-longer gestation. Conclusions-Six-year-old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow-up at older age is warranted.Peer reviewe

Fetal cardiac magnetic resonance imaging of the descending aorta in suspected left-sided cardiac obstructions

BackgroundSevere left-sided cardiac obstructions are associated with high morbidity and mortality if not detected in time. The correct prenatal diagnosis of coarctation of the aorta (CoA) is difficult. Fetal cardiac magnetic resonance imaging (CMR) may improve the prenatal diagnosis of complex congenital heart defects. Flow measurements in the ascending aorta could aid in predicting postnatal CoA, but its accurate visualization is challenging.ObjectivesTo compare the flow in the descending aorta (DAo) and umbilical vein (UV) in fetuses with suspected left-sided cardiac obstructions with and without the need for postnatal intervention and healthy controls by fetal phase-contrast CMR flow. A second objective was to determine if adding fetal CMR to echocardiography (echo) improves the fetal CoA diagnosis.MethodsProspective fetal CMR phase-contrast flow in the DAo and UV and echo studies were conducted between 2017 and 2022.ResultsA total of 46 fetuses with suspected left-sided cardiac obstructions [11 hypoplastic left heart syndrome (HLHS), five critical aortic stenosis (cAS), and 30 CoA] and five controls were included. Neonatal interventions for left-sided cardiac obstructions (n = 23) or comfort care (n = 1 with HLHS) were pursued in all 16 fetuses with suspected HLHS or cAS and in eight (27%) fetuses with true CoA. DAo or UV flow was not different in fetuses with and without need of intervention. However, DAo and UV flows were lower in fetuses with either retrograde isthmic systolic flow [DAo flow 253 (72) vs. 261 (97) ml/kg/min, p = 0.035; UV flow 113 (75) vs. 161 (81) ml/kg/min, p = 0.04] or with suspected CoA and restrictive atrial septum [DAo flow 200 (71) vs. 268 (94) ml/kg/min, p = 0.04; UV flow 89 vs. 159 (76) ml/kg/min, p = 0.04] as well as in those without these changes. Adding fetal CMR to fetal echo predictors for postnatal CoA did not improve the diagnosis of CoA.ConclusionFetal CMR-derived DAo and UV flow measurements do not improve the prenatal diagnosis of left-sided cardiac obstructions, but they could be important in identifying fetuses with a more severe decrease in blood flow across the left side of the heart. The physiological explanation may be a markedly decreased left ventricular cardiac output with subsequent retrograde systolic isthmic flow and decreased total DAo flow