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Papers by Alexandra Stanescu

Research paper thumbnail of Assessment of lesion-associated myocardial ischemia based on fusion coronary CT imaging – the FUSE-HEART study

Introduction: Multimodality assessment of coronary artery lesions has demonstrated superior effec... more Introduction: Multimodality assessment of coronary artery lesions has demonstrated superior effectiveness compared to the conventional approach, for assessing both anatomical and functional significance of a coronary stenosis. Multiple imaging modalities can be integrated into a fusion imaging tool to better assess myocardial ischemia. Material and methods: The FUSE-HEART trial is a single center, prospective, cohort study that will assess the impact of a coronary artery stenosis on myocardial function and viability, based on advanced fusion imaging technics derived from Cardiac Computed Tomography Angiography (CCTA). Moreover, the study will investigate the correlation between morphology and composition of the coronary plaques and myocardial ischemia in the territory irrigated by the same coronary artery. At the same time, imaging parameters will be correlated with inflammatory status of the subjects. The trial will include 100 subjects with coronary lesions found on CCTA examinati...

Research paper thumbnail of P1709Sub-endothelial coronary artery dissection triggered by hypertension in patients with acute coronary syndromes and angiographically normal coronary arteries. An optical coherence tomography study

European Heart Journal

Coronary artery disease epidemiology and outcomes 345 [p=0.634], 0.2% vs. 0.3% CV death) and high... more Coronary artery disease epidemiology and outcomes 345 [p=0.634], 0.2% vs. 0.3% CV death) and high event risk cutoff of >8ng/L (64% vs. 61% of patients, 4.8% vs. 6.1% annual mortality [p=0.096], 2.7% vs. 3.4% CV death) showed an equivalent prognostic performance. Patients in the high event risk group had significantly more functionally relevant CAD than patients in the low event risk group (52% vs. 37%, p<0.001). The corresponding hs-cTnI cutoffs (low event risk: ≤3.4ng/L, high event risk: >3.4ng/L) provided analogous results. Conclusions: hs-cTn can be utilized for event risk stratification in symptomatic patients with known CAD and ruled out AMI. A cutoff of 8ng/L for hs-cTnT and 3.4ng/L for hs-cTnI stratified patients into low event risk and high event risk groups according to the ESC guidelines.

Research paper thumbnail of Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

Journal of Interdisciplinary Medicine, 2016

Myocardial viability plays an important role in preventing the development of left ventricular re... more Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT) during vasodilator stress test, associated with CT Coronary Angiography (CCTA) has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the ext...

Research paper thumbnail of Correlations Between Severity of Coronary Lesions and Epicardial Fat Volume in Patients with Coronary Artery Disease – a Multislice CT-based Study

Journal of Interdisciplinary Medicine, 2016

Background: Epicardial fat has been recently identified as a major player in the development of t... more Background: Epicardial fat has been recently identified as a major player in the development of the atherosclerotic process. Study aim: The aim of this study was to correlate the epicardial fat volume (EFV), determined by Multisclice CT, and the severity of the coronary lesions, expressed by the Coronary Calcium Score (CCS) and Syntax Score (SxS) in patients with established coronary artery disease (CAD). Material and methods: One-hundred-twenty-six patients underwent Multisclice 64 CT assessment of coronary lesions and epicardial fat quantification. Calculation of CCS was performed on all the three coronary vessels and was followed by determination of SxS according to guidelines. The patients were divided into 2 groups: Group 1 – patients with CCS >400 (n = 26), and Group 2 — patients with CaS <400 (n = 100). Results: The mean age of the study population was 65.32 years for Group 1 and 54 years for Group 2 (p <0.0001). However, patients >65 years of age had a high CCS i...

Research paper thumbnail of Characteristics of Neoatherosclerosis Within Implanted Coronary Stents in Patients with Acute Coronary Syndromes

Journal Of Cardiovascular Emergencies, 2016

Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. ... more Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. However, recent studies have suggested that an underlying progression of the atherosclerotic process called neoatherosclerosis, different from intimal proliferation, could be involved in ISR development. In this study the aim was to compare the characteristics of the neoatheromatous plaque evidenced by Multislice Angio Computed Tomography, Optical Coherence Tomography (OCT) and Virtual Histology Intravascular Ultrasound (VH-IVUS) with the characteristics of de-novo lesions in native coronary vessels of patients with ISR. Material and methods: This is a prospective single-center pilot study in which patients presenting with acute chest pain and having at least one symptomatic bare-metal stent (BMS) restenosis at six months to one year after BMS implantation, were enrolled. The characteristics of the neointimal tissue developed within the implanted stents using Acio CT, OCT and VH-IVUS wer...

Research paper thumbnail of Characteristics of Coronary Lesions in Small Vessel Disease Treated with Elective Stenting in Patients with Type 2 Diabetes Mellitus

Journal of Interdisciplinary Medicine, 2016

Background: The incidence of diabetes mellitus (DM) has suffered a dramatic increase and is a ser... more Background: The incidence of diabetes mellitus (DM) has suffered a dramatic increase and is a serious worldwide issue. Diabetes causes microvascular and macrovascular complications including coronary artery disease (CAD) that ultimately contributes to a high rate of cardiovascular morbidity and mortality. Study aim: The aim of this study was to assess the factors associated with the atherosclerotic involvement of small coronary arteries as compared to large vessel disease, in patients with type 2 diabetes mellitus undergoing percutaneous stent coronary angioplasty. Material and methods: Thirty-one patients who underwent Multislice 64 CT assessment of coronary lesions and stent implantation at the level of the significant coronary lesion were included in the study. CT-based Calcium Score was determined in all patients. Group 1 included patients with coronary lesions located on a vessel with a reference diameter above 3 mm (n = 24) and Group 2 included patients with a coronary lesion ...

Research paper thumbnail of Assessment of lesion-associated myocardial ischemia based on fusion coronary CT imaging – the FUSE-HEART study

Introduction: Multimodality assessment of coronary artery lesions has demonstrated superior effec... more Introduction: Multimodality assessment of coronary artery lesions has demonstrated superior effectiveness compared to the conventional approach, for assessing both anatomical and functional significance of a coronary stenosis. Multiple imaging modalities can be integrated into a fusion imaging tool to better assess myocardial ischemia. Material and methods: The FUSE-HEART trial is a single center, prospective, cohort study that will assess the impact of a coronary artery stenosis on myocardial function and viability, based on advanced fusion imaging technics derived from Cardiac Computed Tomography Angiography (CCTA). Moreover, the study will investigate the correlation between morphology and composition of the coronary plaques and myocardial ischemia in the territory irrigated by the same coronary artery. At the same time, imaging parameters will be correlated with inflammatory status of the subjects. The trial will include 100 subjects with coronary lesions found on CCTA examinati...

Research paper thumbnail of P1709Sub-endothelial coronary artery dissection triggered by hypertension in patients with acute coronary syndromes and angiographically normal coronary arteries. An optical coherence tomography study

European Heart Journal

Coronary artery disease epidemiology and outcomes 345 [p=0.634], 0.2% vs. 0.3% CV death) and high... more Coronary artery disease epidemiology and outcomes 345 [p=0.634], 0.2% vs. 0.3% CV death) and high event risk cutoff of >8ng/L (64% vs. 61% of patients, 4.8% vs. 6.1% annual mortality [p=0.096], 2.7% vs. 3.4% CV death) showed an equivalent prognostic performance. Patients in the high event risk group had significantly more functionally relevant CAD than patients in the low event risk group (52% vs. 37%, p<0.001). The corresponding hs-cTnI cutoffs (low event risk: ≤3.4ng/L, high event risk: >3.4ng/L) provided analogous results. Conclusions: hs-cTn can be utilized for event risk stratification in symptomatic patients with known CAD and ruled out AMI. A cutoff of 8ng/L for hs-cTnT and 3.4ng/L for hs-cTnI stratified patients into low event risk and high event risk groups according to the ESC guidelines.

Research paper thumbnail of Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

Journal of Interdisciplinary Medicine, 2016

Myocardial viability plays an important role in preventing the development of left ventricular re... more Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT) during vasodilator stress test, associated with CT Coronary Angiography (CCTA) has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the ext...

Research paper thumbnail of Correlations Between Severity of Coronary Lesions and Epicardial Fat Volume in Patients with Coronary Artery Disease – a Multislice CT-based Study

Journal of Interdisciplinary Medicine, 2016

Background: Epicardial fat has been recently identified as a major player in the development of t... more Background: Epicardial fat has been recently identified as a major player in the development of the atherosclerotic process. Study aim: The aim of this study was to correlate the epicardial fat volume (EFV), determined by Multisclice CT, and the severity of the coronary lesions, expressed by the Coronary Calcium Score (CCS) and Syntax Score (SxS) in patients with established coronary artery disease (CAD). Material and methods: One-hundred-twenty-six patients underwent Multisclice 64 CT assessment of coronary lesions and epicardial fat quantification. Calculation of CCS was performed on all the three coronary vessels and was followed by determination of SxS according to guidelines. The patients were divided into 2 groups: Group 1 – patients with CCS >400 (n = 26), and Group 2 — patients with CaS <400 (n = 100). Results: The mean age of the study population was 65.32 years for Group 1 and 54 years for Group 2 (p <0.0001). However, patients >65 years of age had a high CCS i...

Research paper thumbnail of Characteristics of Neoatherosclerosis Within Implanted Coronary Stents in Patients with Acute Coronary Syndromes

Journal Of Cardiovascular Emergencies, 2016

Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. ... more Introduction: In-stent restenosis (ISR) is traditionally associated with neointimal hyperplasia. However, recent studies have suggested that an underlying progression of the atherosclerotic process called neoatherosclerosis, different from intimal proliferation, could be involved in ISR development. In this study the aim was to compare the characteristics of the neoatheromatous plaque evidenced by Multislice Angio Computed Tomography, Optical Coherence Tomography (OCT) and Virtual Histology Intravascular Ultrasound (VH-IVUS) with the characteristics of de-novo lesions in native coronary vessels of patients with ISR. Material and methods: This is a prospective single-center pilot study in which patients presenting with acute chest pain and having at least one symptomatic bare-metal stent (BMS) restenosis at six months to one year after BMS implantation, were enrolled. The characteristics of the neointimal tissue developed within the implanted stents using Acio CT, OCT and VH-IVUS wer...

Research paper thumbnail of Characteristics of Coronary Lesions in Small Vessel Disease Treated with Elective Stenting in Patients with Type 2 Diabetes Mellitus

Journal of Interdisciplinary Medicine, 2016

Background: The incidence of diabetes mellitus (DM) has suffered a dramatic increase and is a ser... more Background: The incidence of diabetes mellitus (DM) has suffered a dramatic increase and is a serious worldwide issue. Diabetes causes microvascular and macrovascular complications including coronary artery disease (CAD) that ultimately contributes to a high rate of cardiovascular morbidity and mortality. Study aim: The aim of this study was to assess the factors associated with the atherosclerotic involvement of small coronary arteries as compared to large vessel disease, in patients with type 2 diabetes mellitus undergoing percutaneous stent coronary angioplasty. Material and methods: Thirty-one patients who underwent Multislice 64 CT assessment of coronary lesions and stent implantation at the level of the significant coronary lesion were included in the study. CT-based Calcium Score was determined in all patients. Group 1 included patients with coronary lesions located on a vessel with a reference diameter above 3 mm (n = 24) and Group 2 included patients with a coronary lesion ...