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Papers by András Mester

Research paper thumbnail of Acute-Phase Inflammatory Reaction Predicts CMR Myocardial Scar Pattern and 2-Year Mortality in STEMI Patients Undergoing Primary PCI

Journal of Clinical Medicine, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Magnitude of ST-segment Elevation Is Associated with Increased Acute Inflammatory Response and Myocardial Scar in Patients with Acute Myocardial Infarction Undergoing pPCI

Journal Of Cardiovascular Emergencies, 2021

Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the EC... more Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the ECG changes before and after primary percutaneous coronary intervention (pPCI) for ST segment elevation myocardial infarction (STEMI). The inflammatory response is a major component in scar formation and remodeling process of the myocardial tissue following myocardial infarction (MI). Cardiac magnetic resonance imaging (CMR) precisely quantifies the cardiac function and assesses the pattern of the myocardial scar tissue. The aim of the study was to evaluate the relations between the ISSTE score and: (1) acute inflammatory biomarkers and (2) extent of the myocardial scar determined by CMR in STEMI treated with pPCI. Material and methods: One hundred thirty STEMI patients were included in the study, who underwent pPCI in the first 12 hours from symptom debut. ISSTE-1 was calculated at presentation and 2 hours following pPCI (ISSTE-2). Inflammatory biomarkers were determined at admission and ...

Research paper thumbnail of Imaging Cardiovascular Inflammation in the COVID-19 Era

Diagnostics, 2021

Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and a... more Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate ...

Research paper thumbnail of Gastroenterological Perspectives on Acute Cardiac Care — the Management of Patients with Implanted Coronary Stents Following an Acute Coronary Syndrome

Journal Of Cardiovascular Emergencies

Cardiovascular and digestive diseases frequently share the same risk factors such as obesity, unh... more Cardiovascular and digestive diseases frequently share the same risk factors such as obesity, unhealthy diet, or several social behaviors, and the increasing prevalence of patients with overlapped cardiovascular and digestive symptoms is a challenging problem in the daily practice. Patients with gastro-esophageal reflux disease can exhibit various forms of chest pain that can be very similar to angina. Furthermore, antithrombotic therapies used for preventive or curative purposes in patients with cardiovascular diseases are frequently associated with gastrointestinal side effects including bleeding. At the same time, in patients with coronary stents presenting to the emergency department with chest pain, angina triggered by stent thrombosis or restenosis should be differentiated from angina-like symptoms caused by a gastrointestinal disease. The aim of this review was to present the complex inter-relation between gastroesophageal diseases and angina in patients on dual antiplatelet ...

Research paper thumbnail of Imaging Bioresorbable Vascular Scaffolds – at the Border between Science and Technology

Journal of Interdisciplinary Medicine

Research paper thumbnail of New Imaging-derived Biomarkers Based on Tridimensional CTA/MRI Hybrid Models for Complex Assessment of Myocardial Viability after Myocardial Infarction – the HYBRIDHEART Study

Journal of Interdisciplinary Medicine

Hybrid imaging represents a combination of two different imaging techniques resulting in a single... more Hybrid imaging represents a combination of two different imaging techniques resulting in a single image that contains all the information provided by the two investigations. Hybrid imaging tends to improve the accuracy of the diagnosis in many diseases. Coronary computed tomography angiography (CCTA) has unquestionable abilities in highlighting coronary artery diseases (CAD). Cardiac magnetic resonance imaging (MRI) also has a powerful predictive role in assessing the functionality of the myocardial tissue. The aim of the study is to develop new imaging markers for a complex evaluation of myocardial viability (MV) after an acute myocardial infarction (AMI), using hybrid technology. Material and methods: This study will enroll 100 patients at one month after an AMI. CCTA, MRI, 3D echocardiography, and blood tests will be performed in all patients. All the acquisitions will be processed using a supercomputer, and MV and other parameters will be assessed on hybrid images. A secondary o...

Research paper thumbnail of CTA Evaluation of Bioresorbable Scaffolds versus Metallic Coronary Stents – a Feasibility Study

Journal of Interdisciplinary Medicine

Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosi... more Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosis (ISR) evaluation in case of metallic coronary stents, due to the artifacts determined by stent struts, which alter in-stent plaque analysis. In case of bioresorbable scaffolds, stent strut resorption allows accurate evaluation of the vessel wall. Aim of the study: This study aims to compare the feasibility of CTA as a follow-up imaging method for ISR diagnosis following elective PTCA procedures, between bioresorbable scaffolds and metallic coronary stents. Material and methods: We conducted a prospective, observational study on 73 patients with elective PTCA procedures in their medical history, in whom 113 stents were assessed via CTA in order to diagnose ISR. Based on stent type, the patients were divided into two groups: Group 1 – patients with bioresorbable vascular scaffolds (BVS) (n = 30); and Group 2 – patients with bare metal stents (BMS) (n = 43). Plaque analysis was possible o...

Research paper thumbnail of CTA Assessment of Coronary Atherosclerotic Plaque Evolution after BVS Implantation – a Follow-up Study

Journal of Interdisciplinary Medicine

Background: Computed tomography angiography (CTA) occupies an important place in the evaluation o... more Background: Computed tomography angiography (CTA) occupies an important place in the evaluation of coronary atherosclerotic lesions, both before and after the implantation of bioresorbable stents (BVS), providing an accurate assessment of the treated lesions. Aim of the study: This study aims the prospective follow-up of atherosclerotic plaques electively treated with BVS implantation via CTA evaluation in terms of morphological and virtual histology aspects. Material and methods: This is a prospective observational study which enrolled 30 patients electively treated with BVS implantation, in whom CTA was performed after PTCA in order to assess the morphological and virtual histology aspects of coronary plaques. In order to evaluate the impact determined by pre- and post-implantation procedures, statistical analysis was performed among 6 subgroups. Results: After BVS implantation, a significant reduction was observed in terms of stenosis % (61.63 ± 12.63% in subgroup 1A vs. 24.41 ± ...

Research paper thumbnail of MINOCA Today – Are We There Yet?

Journal Of Cardiovascular Emergencies

Research paper thumbnail of In-stent Flow Hemodynamics and the Risk of STent Failure Following Bioresorbable Vascular ScAFFolds Implantation – the STAFF Study

Journal of Interdisciplinary Medicine

Background:Myocardial revascularization procedures have undergone important developments over the... more Background:Myocardial revascularization procedures have undergone important developments over the last decades, which led to a major shift in current clinical practice and therapeutic guidelines across the world. Bare metal and drug-eluting stents present several limitations, all centered on the concept of disturbed coronary hemodynamics after implantation, which can be surpassed by bioresorbable vascular scaffolds (BVS). BVSs are fourth-generation stents used in coronary revascularization procedures, but despite all the promising initial results published on their efficiency, several clinical trials have reported unsatisfactory results, and the main explanation was accredited to improper implantation method. Shear stress is a central element of intravascular homeostasis; it controls vascular remodeling, as well as the development, progression, and destabilization of atheromatous plaques. This studyaimsto assess the role of in-stent flow hemodynamics (evaluated by computational dete...

Research paper thumbnail of Anemia and Iron Deficiency in Heart Failure — Clinical Update

Journal of Interdisciplinary Medicine

Iron deficiency and anemia affect approximately half of the chronic heart failure patients and th... more Iron deficiency and anemia affect approximately half of the chronic heart failure patients and they are associated with increased hospitalization rate, lower functional capacity, lower quality of life, and higher mortality. The exact mechanism of iron deficiency in heart failure patients is still not fully understood. Current guidelines recommend ferritin as the most accurate serum biomarker for the diagnosis of iron deficiency. The use of erythropoiesis-stimulating agents is no longer recommended because of the lack of improvement on mortality or hospital readmission rate, and it was associated with a higher rate of thromboembolic events. Intravenous iron replacement therapy is safe and generally well tolerated, with fewer side effects compared to oral administration. Large randomized studies with ferric carboxymaltose demonstrated its effectiveness and superiority to oral administration, and it was associated with a decreased rate of hospitalization rate and worsening heart failur...

Research paper thumbnail of Modern Concepts in Regenerative Therapy for Ischemic Stroke: From Stem Cells for Promoting Angiogenesis to 3D-Bioprinted Scaffolds Customized via Carotid Shear Stress Analysis

International Journal of Molecular Sciences

Ischemic stroke is associated with a tremendous economic and societal burden, and only a few ther... more Ischemic stroke is associated with a tremendous economic and societal burden, and only a few therapies are currently available for the treatment of this devastating disease. The main therapeutic approaches used nowadays for the treatment of ischemic brain injury aim to achieve reperfusion, neuroprotection and neurorecovery. Therapeutic angiogenesis also seems to represent a promising tool to improve the prognosis of cerebral ischemia. This review aims to present the modern concepts and the current status of regenerative therapy for ischemic stroke and discuss the main results of major clinical trials addressing the effectiveness of stem cell therapy for achieving neuroregeneration in ischemic stroke. At the same time, as a glimpse into the future, this article describes modern concepts for stroke prevention, such as the implantation of bioprinted scaffolds seeded with stem cells, whose 3D geometry is customized according to carotid shear stress.

Research paper thumbnail of Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Journal Of Cardiovascular Emergencies

Background: The inflammatory response of the immune system plays a major role in the period follo... more Background: The inflammatory response of the immune system plays a major role in the period following an acute myocardial infarction (MI), as it coordinates the formation of the fibrous scar tissue that replaces the infarcted myocardial cells and ultimately leads to healing and remodeling of the affected zone. Along with other pro- and anti-inflammatory cytokines and acute phase proteins, interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the extent of the infarct size (IS) and may serve as predictors for remodeling and adverse left ventricular (LV) function. Material and methods: A single-center, non-randomized, observational prospective study was conducted, which included 75 patients with primary revascularized ST-elevation myocardial infarction (STEMI). High-sensitivity CRP (hs-CRP) serum levels were determined on day 1 and day 5 following the acute event. IL-6 was also determined on day 1. All patients underwent cardiac magnetic resonance imaging (CMR) at 1-mo...

Research paper thumbnail of Low-Density Carotid Plaques and the Risk of Stroke

Journal of Interdisciplinary Medicine

Ischemic stroke is the second cause of death worldwide, and at least a quarter of all ischemic st... more Ischemic stroke is the second cause of death worldwide, and at least a quarter of all ischemic strokes are associated with carotid atherosclerotic disease, the diagnosis of which relies primarily on imaging methods. Traditional risk assessment in carotid atherosclerotic disease has long been based on the measurement of stenosis severity, but there is strong evidence that only stenosis grading falls short in predicting near-future events. Moreover, numerous histopathologic studies gathered increasing evidence that plaque vulnerability depends on its composition and morphology, therefore, the new concept of “vulnerable plaque” analysis is necessary, independent of the carotid narrowing. Follow-up studies concluded that the presence of a large-lipid necrotic core and thin fibrous cap are significantly more likely to result in future ischemic events and thereby are hallmarks for unstable lesions. Under these conditions, magnetic resonance imaging (MRI) and multi-detector computed tomogr...

Research paper thumbnail of Magnetic Resonance Imaging of Myocardial Function Following Intracoronary and Intramyocardial Stem Cell Injection

Journal of Interdisciplinary Medicine

Stem cell-based therapy is a new therapeutic option that can be used in patients with cardiac dis... more Stem cell-based therapy is a new therapeutic option that can be used in patients with cardiac diseases caused by myocardial injury. Cardiac magnetic resonance imaging (MRI) is a new noninvasive imaging method with an increasingly widespread indication. The aim of this review was to evaluate the role of cardiac MRI in patients with myocardial infarction undergoing stem cell therapy. We studied the role of MRI in the assessment of myocardial viability, stem cell tracking, assessment of cell survival rate, and monitoring of the long-term effects of stem cell therapy. Based on the current knowledge in this field, this noninvasive, in vivo cardiac imaging technique has a large indication in this group of patients and plays an important role in all stages of stem cell therapy, from the indication to the long-term follow-up of patients.

Research paper thumbnail of Computed Tomography Assessment of Coronary Fistulas

Journal of Interdisciplinary Medicine

Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between th... more Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between the coronary arteries and other vascular structures or cardiac chambers and, in most cases, are detected incidentally. Regularly, they do not cause important pathological changes, but if the symptoms persist, they need to be treated. The hemodynamic impact depends on the localization and size of the fistulas. Noninvasive imaging techniques, such as magnetic resonance imaging and multislice computed tomography, are widely used for the detection of coronary anomalies. The presence of symptoms (angina, dyspnea) is the primary indication for the surgical or percutaneous closure of the communications; therefore, a systematic follow-up is indicated in all cases. We present four cases of coronary artery fistulas, without important hemodynamic complications, detected by multislice computed tomography coronary angiography.

Research paper thumbnail of Original research. Regional Wall Motion Abnormalities and Ventricular Function in Acute Peri-Myocarditis

Journal Of Cardiovascular Emergencies

Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflam... more Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflammation and effusion on the function of the left ventricle (LV) is still a controversial issue. The present study aimed to evaluate LV regional wall abnormalities in patients with acute peri-myocarditis, using 3D echocardiographic assessment of LV contractility. Material and methods: The study included 56 subjects divided into two groups: Group 1 - 28 subjects with acute peri-myocarditis and Group 2 - 28 healthy controls. All subjects underwent a complete clinical examination, including laboratory tests. 3D echocardiography was performed to assess the left ventricular end-diastolic (EDV) and end-systolic volumes (ESV), and to calculate specific indexes for global and regional ventricular contractility, such as the index of contraction amplitude (ICA) and the regional index of contraction amplitude (RICA) for each segment corresponding to the region affected by peri- myocarditis. Results: ...

Research paper thumbnail of Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

Journal Of Cardiovascular Emergencies

Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT),... more Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT), quantified either by thickness, assessed by transthoracic echocardiography, or by volume, assessed by cardiac computed tomography (CT), in the follow-up of patients with acute coronary syndromes (ACS). Method: One-hundred forty-four articles were screened, from which 56 were reviewed in full-text. From those, 47 studies were excluded for the following reasons: they did not meet the inclusion criteria; they were either reviews or meta-analyses; the study cohorts included only stable coronary artery disease patients; they did not state a clear and concise study design, endpoints, or follow-up. The final draft included nine studies for systematic evaluation. Results: Of the 2,306 patients included in the review, 170 underwent cardiac CT while the remaining 2,136 underwent transthoracic echocardiography for the measurement of EAT. The analysis found that the EAT thickness was significantly ...

Research paper thumbnail of Huge Vegetation on Aortic Valve in a Young Patient with Infective Endocarditis Caused by Enterococcus Faecalis

Journal of Interdisciplinary Medicine

Nothing to declare.

Research paper thumbnail of Computed Tomography Biomarkers of Vulnerable Coronary Plaques

Journal of Interdisciplinary Medicine, 2016

An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of t... more An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.

Research paper thumbnail of Acute-Phase Inflammatory Reaction Predicts CMR Myocardial Scar Pattern and 2-Year Mortality in STEMI Patients Undergoing Primary PCI

Journal of Clinical Medicine, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Magnitude of ST-segment Elevation Is Associated with Increased Acute Inflammatory Response and Myocardial Scar in Patients with Acute Myocardial Infarction Undergoing pPCI

Journal Of Cardiovascular Emergencies, 2021

Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the EC... more Background: The integrated ST segment elevation score (ISSTE) score objectively quantifies the ECG changes before and after primary percutaneous coronary intervention (pPCI) for ST segment elevation myocardial infarction (STEMI). The inflammatory response is a major component in scar formation and remodeling process of the myocardial tissue following myocardial infarction (MI). Cardiac magnetic resonance imaging (CMR) precisely quantifies the cardiac function and assesses the pattern of the myocardial scar tissue. The aim of the study was to evaluate the relations between the ISSTE score and: (1) acute inflammatory biomarkers and (2) extent of the myocardial scar determined by CMR in STEMI treated with pPCI. Material and methods: One hundred thirty STEMI patients were included in the study, who underwent pPCI in the first 12 hours from symptom debut. ISSTE-1 was calculated at presentation and 2 hours following pPCI (ISSTE-2). Inflammatory biomarkers were determined at admission and ...

Research paper thumbnail of Imaging Cardiovascular Inflammation in the COVID-19 Era

Diagnostics, 2021

Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and a... more Cardiac complications are among the most frequent extrapulmonary manifestations of COVID-19 and are associated with high mortality rates. Moreover, positive SARS-CoV-2 patients with underlying cardiovascular disease are more likely to require intensive care and are at higher risk of death. The underlying mechanism for myocardial injury is multifaceted, in which the severe inflammatory response causes myocardial inflammation, coronary plaque destabilization, acute thrombotic events, and ischemia. Cardiac magnetic resonance (CMR) imaging is the non-invasive method of choice for identifying myocardial injury, and it is able to differentiate between underlying causes in various and often challenging clinical scenarios. Multimodal imaging protocols that incorporate CMR and computed tomography provide a complex evaluation for both respiratory and cardiovascular complications of SARS-CoV2 infection. This, in relation to biological evaluation of systemic inflammation, can guide appropriate ...

Research paper thumbnail of Gastroenterological Perspectives on Acute Cardiac Care — the Management of Patients with Implanted Coronary Stents Following an Acute Coronary Syndrome

Journal Of Cardiovascular Emergencies

Cardiovascular and digestive diseases frequently share the same risk factors such as obesity, unh... more Cardiovascular and digestive diseases frequently share the same risk factors such as obesity, unhealthy diet, or several social behaviors, and the increasing prevalence of patients with overlapped cardiovascular and digestive symptoms is a challenging problem in the daily practice. Patients with gastro-esophageal reflux disease can exhibit various forms of chest pain that can be very similar to angina. Furthermore, antithrombotic therapies used for preventive or curative purposes in patients with cardiovascular diseases are frequently associated with gastrointestinal side effects including bleeding. At the same time, in patients with coronary stents presenting to the emergency department with chest pain, angina triggered by stent thrombosis or restenosis should be differentiated from angina-like symptoms caused by a gastrointestinal disease. The aim of this review was to present the complex inter-relation between gastroesophageal diseases and angina in patients on dual antiplatelet ...

Research paper thumbnail of Imaging Bioresorbable Vascular Scaffolds – at the Border between Science and Technology

Journal of Interdisciplinary Medicine

Research paper thumbnail of New Imaging-derived Biomarkers Based on Tridimensional CTA/MRI Hybrid Models for Complex Assessment of Myocardial Viability after Myocardial Infarction – the HYBRIDHEART Study

Journal of Interdisciplinary Medicine

Hybrid imaging represents a combination of two different imaging techniques resulting in a single... more Hybrid imaging represents a combination of two different imaging techniques resulting in a single image that contains all the information provided by the two investigations. Hybrid imaging tends to improve the accuracy of the diagnosis in many diseases. Coronary computed tomography angiography (CCTA) has unquestionable abilities in highlighting coronary artery diseases (CAD). Cardiac magnetic resonance imaging (MRI) also has a powerful predictive role in assessing the functionality of the myocardial tissue. The aim of the study is to develop new imaging markers for a complex evaluation of myocardial viability (MV) after an acute myocardial infarction (AMI), using hybrid technology. Material and methods: This study will enroll 100 patients at one month after an AMI. CCTA, MRI, 3D echocardiography, and blood tests will be performed in all patients. All the acquisitions will be processed using a supercomputer, and MV and other parameters will be assessed on hybrid images. A secondary o...

Research paper thumbnail of CTA Evaluation of Bioresorbable Scaffolds versus Metallic Coronary Stents – a Feasibility Study

Journal of Interdisciplinary Medicine

Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosi... more Background: Computed tomography angiography (CTA) presents important limits in in-stent restenosis (ISR) evaluation in case of metallic coronary stents, due to the artifacts determined by stent struts, which alter in-stent plaque analysis. In case of bioresorbable scaffolds, stent strut resorption allows accurate evaluation of the vessel wall. Aim of the study: This study aims to compare the feasibility of CTA as a follow-up imaging method for ISR diagnosis following elective PTCA procedures, between bioresorbable scaffolds and metallic coronary stents. Material and methods: We conducted a prospective, observational study on 73 patients with elective PTCA procedures in their medical history, in whom 113 stents were assessed via CTA in order to diagnose ISR. Based on stent type, the patients were divided into two groups: Group 1 – patients with bioresorbable vascular scaffolds (BVS) (n = 30); and Group 2 – patients with bare metal stents (BMS) (n = 43). Plaque analysis was possible o...

Research paper thumbnail of CTA Assessment of Coronary Atherosclerotic Plaque Evolution after BVS Implantation – a Follow-up Study

Journal of Interdisciplinary Medicine

Background: Computed tomography angiography (CTA) occupies an important place in the evaluation o... more Background: Computed tomography angiography (CTA) occupies an important place in the evaluation of coronary atherosclerotic lesions, both before and after the implantation of bioresorbable stents (BVS), providing an accurate assessment of the treated lesions. Aim of the study: This study aims the prospective follow-up of atherosclerotic plaques electively treated with BVS implantation via CTA evaluation in terms of morphological and virtual histology aspects. Material and methods: This is a prospective observational study which enrolled 30 patients electively treated with BVS implantation, in whom CTA was performed after PTCA in order to assess the morphological and virtual histology aspects of coronary plaques. In order to evaluate the impact determined by pre- and post-implantation procedures, statistical analysis was performed among 6 subgroups. Results: After BVS implantation, a significant reduction was observed in terms of stenosis % (61.63 ± 12.63% in subgroup 1A vs. 24.41 ± ...

Research paper thumbnail of MINOCA Today – Are We There Yet?

Journal Of Cardiovascular Emergencies

Research paper thumbnail of In-stent Flow Hemodynamics and the Risk of STent Failure Following Bioresorbable Vascular ScAFFolds Implantation – the STAFF Study

Journal of Interdisciplinary Medicine

Background:Myocardial revascularization procedures have undergone important developments over the... more Background:Myocardial revascularization procedures have undergone important developments over the last decades, which led to a major shift in current clinical practice and therapeutic guidelines across the world. Bare metal and drug-eluting stents present several limitations, all centered on the concept of disturbed coronary hemodynamics after implantation, which can be surpassed by bioresorbable vascular scaffolds (BVS). BVSs are fourth-generation stents used in coronary revascularization procedures, but despite all the promising initial results published on their efficiency, several clinical trials have reported unsatisfactory results, and the main explanation was accredited to improper implantation method. Shear stress is a central element of intravascular homeostasis; it controls vascular remodeling, as well as the development, progression, and destabilization of atheromatous plaques. This studyaimsto assess the role of in-stent flow hemodynamics (evaluated by computational dete...

Research paper thumbnail of Anemia and Iron Deficiency in Heart Failure — Clinical Update

Journal of Interdisciplinary Medicine

Iron deficiency and anemia affect approximately half of the chronic heart failure patients and th... more Iron deficiency and anemia affect approximately half of the chronic heart failure patients and they are associated with increased hospitalization rate, lower functional capacity, lower quality of life, and higher mortality. The exact mechanism of iron deficiency in heart failure patients is still not fully understood. Current guidelines recommend ferritin as the most accurate serum biomarker for the diagnosis of iron deficiency. The use of erythropoiesis-stimulating agents is no longer recommended because of the lack of improvement on mortality or hospital readmission rate, and it was associated with a higher rate of thromboembolic events. Intravenous iron replacement therapy is safe and generally well tolerated, with fewer side effects compared to oral administration. Large randomized studies with ferric carboxymaltose demonstrated its effectiveness and superiority to oral administration, and it was associated with a decreased rate of hospitalization rate and worsening heart failur...

Research paper thumbnail of Modern Concepts in Regenerative Therapy for Ischemic Stroke: From Stem Cells for Promoting Angiogenesis to 3D-Bioprinted Scaffolds Customized via Carotid Shear Stress Analysis

International Journal of Molecular Sciences

Ischemic stroke is associated with a tremendous economic and societal burden, and only a few ther... more Ischemic stroke is associated with a tremendous economic and societal burden, and only a few therapies are currently available for the treatment of this devastating disease. The main therapeutic approaches used nowadays for the treatment of ischemic brain injury aim to achieve reperfusion, neuroprotection and neurorecovery. Therapeutic angiogenesis also seems to represent a promising tool to improve the prognosis of cerebral ischemia. This review aims to present the modern concepts and the current status of regenerative therapy for ischemic stroke and discuss the main results of major clinical trials addressing the effectiveness of stem cell therapy for achieving neuroregeneration in ischemic stroke. At the same time, as a glimpse into the future, this article describes modern concepts for stroke prevention, such as the implantation of bioprinted scaffolds seeded with stem cells, whose 3D geometry is customized according to carotid shear stress.

Research paper thumbnail of Association Between Acute Inflammatory Response and Infarct Size in Stemi Patients Undergoing Primary PCI

Journal Of Cardiovascular Emergencies

Background: The inflammatory response of the immune system plays a major role in the period follo... more Background: The inflammatory response of the immune system plays a major role in the period following an acute myocardial infarction (MI), as it coordinates the formation of the fibrous scar tissue that replaces the infarcted myocardial cells and ultimately leads to healing and remodeling of the affected zone. Along with other pro- and anti-inflammatory cytokines and acute phase proteins, interleukin-6 (IL-6) and C-reactive protein (CRP) are associated with the extent of the infarct size (IS) and may serve as predictors for remodeling and adverse left ventricular (LV) function. Material and methods: A single-center, non-randomized, observational prospective study was conducted, which included 75 patients with primary revascularized ST-elevation myocardial infarction (STEMI). High-sensitivity CRP (hs-CRP) serum levels were determined on day 1 and day 5 following the acute event. IL-6 was also determined on day 1. All patients underwent cardiac magnetic resonance imaging (CMR) at 1-mo...

Research paper thumbnail of Low-Density Carotid Plaques and the Risk of Stroke

Journal of Interdisciplinary Medicine

Ischemic stroke is the second cause of death worldwide, and at least a quarter of all ischemic st... more Ischemic stroke is the second cause of death worldwide, and at least a quarter of all ischemic strokes are associated with carotid atherosclerotic disease, the diagnosis of which relies primarily on imaging methods. Traditional risk assessment in carotid atherosclerotic disease has long been based on the measurement of stenosis severity, but there is strong evidence that only stenosis grading falls short in predicting near-future events. Moreover, numerous histopathologic studies gathered increasing evidence that plaque vulnerability depends on its composition and morphology, therefore, the new concept of “vulnerable plaque” analysis is necessary, independent of the carotid narrowing. Follow-up studies concluded that the presence of a large-lipid necrotic core and thin fibrous cap are significantly more likely to result in future ischemic events and thereby are hallmarks for unstable lesions. Under these conditions, magnetic resonance imaging (MRI) and multi-detector computed tomogr...

Research paper thumbnail of Magnetic Resonance Imaging of Myocardial Function Following Intracoronary and Intramyocardial Stem Cell Injection

Journal of Interdisciplinary Medicine

Stem cell-based therapy is a new therapeutic option that can be used in patients with cardiac dis... more Stem cell-based therapy is a new therapeutic option that can be used in patients with cardiac diseases caused by myocardial injury. Cardiac magnetic resonance imaging (MRI) is a new noninvasive imaging method with an increasingly widespread indication. The aim of this review was to evaluate the role of cardiac MRI in patients with myocardial infarction undergoing stem cell therapy. We studied the role of MRI in the assessment of myocardial viability, stem cell tracking, assessment of cell survival rate, and monitoring of the long-term effects of stem cell therapy. Based on the current knowledge in this field, this noninvasive, in vivo cardiac imaging technique has a large indication in this group of patients and plays an important role in all stages of stem cell therapy, from the indication to the long-term follow-up of patients.

Research paper thumbnail of Computed Tomography Assessment of Coronary Fistulas

Journal of Interdisciplinary Medicine

Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between th... more Coronary artery fistulas, a rare anomaly, are represented by an abnormal communication between the coronary arteries and other vascular structures or cardiac chambers and, in most cases, are detected incidentally. Regularly, they do not cause important pathological changes, but if the symptoms persist, they need to be treated. The hemodynamic impact depends on the localization and size of the fistulas. Noninvasive imaging techniques, such as magnetic resonance imaging and multislice computed tomography, are widely used for the detection of coronary anomalies. The presence of symptoms (angina, dyspnea) is the primary indication for the surgical or percutaneous closure of the communications; therefore, a systematic follow-up is indicated in all cases. We present four cases of coronary artery fistulas, without important hemodynamic complications, detected by multislice computed tomography coronary angiography.

Research paper thumbnail of Original research. Regional Wall Motion Abnormalities and Ventricular Function in Acute Peri-Myocarditis

Journal Of Cardiovascular Emergencies

Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflam... more Introduction: Myocardial involvement in pericardial diseases and the effect of pericardial inflammation and effusion on the function of the left ventricle (LV) is still a controversial issue. The present study aimed to evaluate LV regional wall abnormalities in patients with acute peri-myocarditis, using 3D echocardiographic assessment of LV contractility. Material and methods: The study included 56 subjects divided into two groups: Group 1 - 28 subjects with acute peri-myocarditis and Group 2 - 28 healthy controls. All subjects underwent a complete clinical examination, including laboratory tests. 3D echocardiography was performed to assess the left ventricular end-diastolic (EDV) and end-systolic volumes (ESV), and to calculate specific indexes for global and regional ventricular contractility, such as the index of contraction amplitude (ICA) and the regional index of contraction amplitude (RICA) for each segment corresponding to the region affected by peri- myocarditis. Results: ...

Research paper thumbnail of Original research. The Assessment of Epicardial Adipose Tissue in Acute Coronary Syndrome Patients. A Systematic Review

Journal Of Cardiovascular Emergencies

Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT),... more Background: This systematic review seeks to evaluate the role of epicardial adipose tissue (EAT), quantified either by thickness, assessed by transthoracic echocardiography, or by volume, assessed by cardiac computed tomography (CT), in the follow-up of patients with acute coronary syndromes (ACS). Method: One-hundred forty-four articles were screened, from which 56 were reviewed in full-text. From those, 47 studies were excluded for the following reasons: they did not meet the inclusion criteria; they were either reviews or meta-analyses; the study cohorts included only stable coronary artery disease patients; they did not state a clear and concise study design, endpoints, or follow-up. The final draft included nine studies for systematic evaluation. Results: Of the 2,306 patients included in the review, 170 underwent cardiac CT while the remaining 2,136 underwent transthoracic echocardiography for the measurement of EAT. The analysis found that the EAT thickness was significantly ...

Research paper thumbnail of Huge Vegetation on Aortic Valve in a Young Patient with Infective Endocarditis Caused by Enterococcus Faecalis

Journal of Interdisciplinary Medicine

Nothing to declare.

Research paper thumbnail of Computed Tomography Biomarkers of Vulnerable Coronary Plaques

Journal of Interdisciplinary Medicine, 2016

An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of t... more An unstable plaque has a high risk of thrombosis and at the same time for a fast progression of the stenosis degree. Also, “high-risk plaque” and “thrombosis-prone plaque” are used as synonym terms for characterization of a vulnerable plaque. The imaging biomarkers for vulnerable coronary plaques are considered to be spotty calcifications, active remodeling, low-density atheroma and the presence of a ring-like attenuation pattern, also known as the napkin-ring sign. Computed cardiac tomography can determine the plaque composition by assessing the plaque density, which is measured in Hounsfield units (HU). The aim of this manuscript was to provide an update about the most frequently used biomarkers of vulnerability in a vulnerable plaque with the help of computed cardiac tomography.