Daniela Maximov - Academia.edu (original) (raw)

Papers by Daniela Maximov

Endothelial dysfunction has been implicated in the pathological process of coronary artery diseas... more Endothelial dysfunction has been implicated in the pathological process of coronary artery disease as well as an adverse event after coronary drug eluting stent (DES) implantation. In this review, an overview will be given of the evidence to date regarding the effects of coronary DES on endothelial function obtained from both clinical and experimental studies. Stenting in general and DES seem to impair several aspects of endothelial function: provision of a permeable barrier function; modulation of adhesion, thrombosis and inflammation; and regulation of vascular tone. However, new insights show that the effects of DES can extend beyond the stent and peri-stent area: the vascular bed distal to the stent, starting with the distal conduit vessels up to the distal microvasculature, might be at risk. In addition, insight into the mechanism of DES induced endothelial dysfunction has been gained. To finalize this review, clinical complications and solutions of DES associated endothelial dysfunction will be discussed.

Dilated cardiomyopathy (DCM) is the most frequent form of non-ischemic cardiomyopathy; the cavity... more Dilated cardiomyopathy (DCM) is the most frequent form of non-ischemic cardiomyopathy; the cavity of the heart is enlarged and stretched (cardiac dilation) causing the heart to become weak and not pump normally. 1 Because the number of patients with DCM is increasing, new ...

European Journal of Heart Failure Supplements, Jun 1, 2008

Background: Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea)... more Background: Early diastolic transmitral velocity (E)/early mitral annular diastolic velocity (Ea) ratio has been proposed as the best Doppler predictor for evaluating left ventricular (LV) filling pressure. Purpose: To evaluate the relationship between a novel echocardiographic index, E/(Ea × Sa), and left ventricular end-diastolic pressure (LVEDP); Sa is the peak systolic mitral annular velocity. We measured this index at different sites of the mitral annulus and compared it with other Tissue Doppler parameters. Methods: Echocardiography was performed simultaneously with left heart catheterization in 110 consecutive patients in sinus rhythm. E, Sa, Ea and Aa (late mitral annular diastolic velocity) were determined at medial and lateral site, and average values obtained. E/Ea and E/ (Ea × Sa) were calculated (medial, lateral, average). LVEDP was measured with invasively fluid-filled catheter. Results: We demonstrated significant correlations between LVEDP and E/(Ea × Sa) lateral (r = 0.78, p b 0.0001), E/Ea average (r = 0.70, p b 0.0001), E/Ea lateral (r = 0.66, p b 0.0001), E/Ea medial (r = 0.60, p b 0.0001) and E/(Ea × Sa) medial (r = 0.60, p b 0.0001). E/(Ea × Sa) average had the strongest correlation with LVEDP (r = 0.80, p b 0.0001). An E/(Ea × Sa) average cutoff of 1.6 had 86% sensitivity and 85% specificity for detecting LVEDPN15 mmHg. Weaker correlations were found for Sa, Ea and Aa. E/(Ea × Sa) average was the best parameter to assess LVEDP in patients with normal LV ejection fraction (LVEF ≥ 50%) (r = 0.83, p b 0.0001), depressed LVEF (r = 0.76, p b 0.0001), regional dysfunction (r = 0.81, p b 0.0001), or E/Ea average between 8 and 15 (r = 0.67, p b 0.0001). Conclusions: E/(Ea × Sa) average was the best predictor of LVEDP in sinus rhythm patients, regardless of LVEF, particularly in those with E/ Ea average between 8 and 15 and in those with regional dysfunction.

Ejves Extra, Nov 1, 2005

Spontaneous rupture of nonaneurysmal, noninfected atherosclerotic infrarenal aorta is rare. In mo... more Spontaneous rupture of nonaneurysmal, noninfected atherosclerotic infrarenal aorta is rare. In most cases it is due to penetrating atherosclerotic ulceration (PAU) of the aorta. However, this disease predominantly affects thoracic aorta. PAU of the infrarenal aorta is a rare entity. A case of spontaneous rupture through an atheromatous plaque with spontaneous rupture of infrarenal abdominal aorta is reported. In our case the patient presented with gastro-intestinal complaints, probably due to adhesion of the duodenum to the anterior aortic wall. This could not be corrected by an endovascular procedure. Therefore, we elected to perform an open repair. The patient recovered uneventfully and was discharged from the hospital on 9-th postoperative day. At early follow up the GI symptoms faded away and the patient tolerated food well and gain weight. Unfortunately the patient passed away at the 28-th postoperative day from a stroke.

Ejves Extra, May 1, 2005

Popliteal artery aneurysms are the most common peripheral artery aneurysms. We present a case of ... more Popliteal artery aneurysms are the most common peripheral artery aneurysms. We present a case of rare combination of chronic aortic dissection type III and rupture of a giant popliteal aneurysm in 74 years old patient. We ligated the ruptured popliteal aneurysm with interposition of PTFE 8/5 prosthesis with a distal venous 'cuff'. Postoperatively, the patient had palpable pedal pulses. He was discharged on the twenty-third postoperative day not on anticoagulant therapy because of the chronic aortic dissection type III, but on aspirin.

Background and objectives: Recent studies showed that clopidogrel "low-responders" patients with ... more Background and objectives: Recent studies showed that clopidogrel "low-responders" patients with non-ST segment elevation acute coronary syndrome (NSTE ACS) are at high risk for development of new ischemic events. The assessment of "low-or non-responder" status to dual antiplatelet therapy (aspirin and clopidogrel) in patients undergoing percutaneous coronary intervention (PCI) with coronary stent placement for NSTE ACS may be a useful method in order to detect the high-risk patients for future cardiovascular (CV) ischemic events. Methods: We prospectively studied the platelet response to both aspirin and clopidogrel in 100 NSTE ACS consecutive patients undergoing PCI with stenting for NSTE ACS admitted in Timisoara Institute of Cardiovascular Diseases CathLab during the year 2010. A single blood sample was obtained just before PCI and analyzed by platelet aggregometry using both arachidonic acids (AA) and ADP as agonists to detect the responder or non-responder status to aspirin and clopidogrel, respectively. We used the multiple electrode aggregometry (MEA) performed with Multiplate® analyzer by Dynabyte, Munich, Germany in order to assess the post-treatment platelet reactivity. Patients were stratified into quartiles according to the AA-and ADP-induced platelet aggregation. Patients of the highest quartile (quartile 4) were defined as the "low-responders". Results: Ten recurrent cardiovascular (CV) events occurred during the 1-month follow-up. Clinical cardiovascular events were significantly associated with platelet response to clopidogrel [Quartile 4 vs.1, 2, 3: OR (95% CI) 19.8 (4.4-90.8; P<0.0001)]. Conclusions: The MEA assessment of AA-and ADP-induced platelet aggregation is a valuable method to identify the low-responders to dual antiplatelet therapy. The results correlated the values of area under curve (AUC) determined by MEA with the aspirin and clopidogrel low-responder status. The clopidogrel low-responders (quartile 4) were identified as the category of patients at high risk for recurrent cardiovascular ischemic events.

The International Journal of Cardiovascular Imaging, 2007

N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling... more N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. However this relationship was not validated in some categories of patients. Our aim was to evaluate the correlation between tissue Doppler velocities of the mitral annulus and NTproBNP levels in sinus rhythm patients. Methods Echocardiography was performed in 111 consecutive patients simultaneously with NTproBNP measurement. E/Ea and E/(Ea 9 Sa) were calculated (Sa is the maximal systolic velocity of mitral annulus); the average of the velocities of septal and lateral mitral annulus was used. Results Simple regression analysis demonstrated a significant linear correlation between E/(Ea 9 Sa) and NTproBNP (r = 0.71, P \ 0.0001), superior to E/Ea correlation (r = 0.58, P \ 0.0001). Significant but weaker correlations were found between NTproBNP and Sa, pulmonary artery systolic pressure, Ea, mitral E/A (early/late diastolic transmitral velocity), E wave, mitral E deceleration time and LV ejection fraction (LVEF). The optimal E/(Ea 9 Sa) cutoff for prediction of NTproBNP levels [ 900 pg/ml was 1.5 (sensitivity = 81%, specificity = 70%). Among analyzed parameters, E/ (Ea 9 Sa) was best correlated with NTproBNP levels in patients with LVEF C 50% (r = 0.80, P \ 0.0001), with depressed LVEF (\50%) (r = 0.66, P \ 0.0001), with regional wall motion abnormalities (r = 0.75, P \ 0.0001), and with E/Ea 8 to 15 (r = 0.58, P \ 0.0001). Conclusions E/(Ea 9 Sa) strongly correlates with NTproBNP, regardless of LVEF, and can be a simple and accurate echocardiographic index in patients in sinus rhythm, particularly in those with regional wall motion abnormalities or intermediate E/Ea.

International Journal of Cardiology, 2009

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JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Introduction: The novel Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has spread a... more Introduction: The novel Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) has spread across the globe generating a pandemic. Every affected country has tried its best to mitigate the virus's effects. Aim: This study was designed to implement the good clinical practice in the Institute of Cardiovascular Diseases Timisoara (ICDT) for Coronavirus Disease-2019 (COVID-19) infection by a retrospective search for patients with a possible COVID-19 infection before widespread testing was available in our country. Materials and Methods: The retrospective study was conducted on selected group of 19 patients admitted to the ICDT, who displayed radiological signs of possible SARS-CoV-2 infection, between September 2019 and May 2020 in collaboration with the Radiology Department. Patients have been followed-up regarding their clinical status and asked to participate in Immunoglobulin G (IgG) antibody testing at a local laboratory. The patients were divided based on the period they ...

Romanian Journal Of Internal Medicine, 2004

C-reactive protein (CRP) elevation after coronary stent implantation is a predictor for recurrenc... more C-reactive protein (CRP) elevation after coronary stent implantation is a predictor for recurrence. We prospectively evaluated the inflammatory response after dexamethasone eluting stent implantation in a native coronary artery by serial measurement of plasma level C-reactive protein.

la pacien]ii cu infarctmiocardic acut sau recent. Studiile experimentale [i clinice sugereaz \ c ... more la pacien]ii cu infarctmiocardic acut sau recent. Studiile experimentale [i clinice sugereaz \ c \ transplantul de celule stemdeoriginemedular \ areunefect benefic asupraproceselor

REZUMAT ® (Dynabyte, Germany) to assess the posttreatment platelet reactivity. Patients were stra... more REZUMAT ® (Dynabyte, Germany) to assess the posttreatment platelet reactivity. Patients were stratified into quartiles according to the ADP-induced platelet aggregation. Patients of the highest quartile (Q 4) were defined as the "low-responders". Results: Ten recurrent CV events occurred during the 1-month follow-up. Clinical CV events were significantly associated with platelet response to clopidogrel (Q4 vs. 1, 2, 3: OR (95% CI) 19.8 (4.4-90.8; P<0.001)). Conclusions: The MEA assessment of ADP and AA- induced platelet aggregation is a valuable method to identify the low-responders to dual antiplatelet therapy. The results correlated the values of the area under curve (AUC) determined by MEA with the clopidogrel low-responder status and with an increased risk of recurrent CV ischemic Introducere: Pacienţii cu sindroame coronariene acute fără supradenivelarea segmentului ST au risc inalt pentru apariţia de noi evenimente cardiovasculare (CV) ischemice. Determinarea stat...

REZUMAT MULTIPLE ELECTRODES AGGREGOMETRY A NEW METHOD TO ASSESS THE PLATELET REACTIVITY IN NON-ST... more REZUMAT MULTIPLE ELECTRODES AGGREGOMETRY A NEW METHOD TO ASSESS THE PLATELET REACTIVITY IN NON-ST ELEVATION ACUTE CORONARY SYNDROME PATIENTS Daniela Maximov1, Adina Ionac2, Alina Lupu1, Cristian Mornos2, Stefan I. Dragulescu2 Introduction: Non-ST segment elevation acute coronary syndrome (NSTE ACS) patients are at high risk for development of new cardiovascular (CV) ischemic events. Determination of lowor non-responder status to dual antiplatelet therapy in patients undergoing coronary stenting for NSTE ACS may be a useful method to detect the highrisk patients of this category. Material and methods: We prospectively studied the platelet response to clopidogrel and aspirin in 100 patients admitted in Timisoara Institute of Cardiovascular Diseases undergoing percutaneous coronary intervention (PCI) with stenting for NSTE ACS. A sample of whole blood was obtained before PCI and analyzed by multiple electrodes aggregometry (MEA), using ADP and arachidonic acid (AA) agonists to detect t...

Objectives:The aimof the study is to assess the safety and feasibility of autologous transplantat... more Objectives:The aimof the study is to assess the safety and feasibility of autologous transplantation by intracoronary infusion of bonemarrow stemcells into the infarct-related artery in patientswith acute and recentmyocardial infarction. Experimental and clinical studies suggest that transplantation of bonemarrowderived stemcells beneficially affects left ventricular (LV) remodelingprocesses after acutemyocardial infarction (AMI) and contributes to the regenerationof infarctedmyocardiumandneovascularizationof ischemic myocardium. Methods:We enrolled 4 patients with acute or recent (1 to 28 days), large myocardial infarction and successful reperfusion (percutaneous intervention (PCI) with stent implantation in AMI-related coronary artery) and LV ejection fraction< 40%. Bonemarrow AC133 cells wereharvested from theposterior iliac crest, isolated, washed, and resuspended for injectionby catheter. The cells were delivered by intracoronary injection into the infarct-related artery. Ba...

Introducere: Studii clinice [i experimentale sugereaz\ c\ transplantul autolog de celule stem med... more Introducere: Studii clinice [i experimentale sugereaz\ c\ transplantul autolog de celule stem medulare influen]eaz\ benefic procesul de remodelare ventricular\ postinfarct miocardic acut [i contribuie la regenerarea [i neovasculariza]ia miocardului ischemic. Obiectiv: Evaluarea siguran]ei [i fezabilit\]ii transplantului autolog de celule stem medulare AC133 + injectate intracoronarian la pacien]ii cu infarct miocardic acut sau recent. Metod\: Au fost nrola]i pacien]i cu reperfuzie tardiv\ [i implant de stent postinfarct miocardic acut sau recent ntins (frac]ie de ejec]ie a ventriculului stng <40%). Celulele AC133 + au fost injectate prin balon-cateter n artera responsabil\ de infarct. Perfuzia miocardic\ a fost evaluat\ prin scintigrafie miocardic\ (Technetiu-99m-sestamibi) efectuat\ ini]ial, la 3, 6 [i 12 luni. Frac]ia de ejec]ie (FE) global\ a ventriculului stng a fost evaluat\ ecocardiografic ini]ial, la 3, 6 [i 12 luni. Lotul cuprinde 9 pacien]i, urm\ri]i n medie 8±4 lu...

UNLABELLED C-reactive protein (CRP) elevation after coronary stent implantation is a predictor fo... more UNLABELLED C-reactive protein (CRP) elevation after coronary stent implantation is a predictor for recurrence. We prospectively evaluated the inflammatory response after dexamethasone eluting stent implantation in a native coronary artery by serial measurement of plasma level C-reactive protein. METHODS We investigated patients undergoing primary successful implantation of a single dexamethasone stent (Dexamet, Abbott Vascular Devices, Redwood City, CA, USA) in a native coronary artery. We analyzed plasma concentrations of CRP by immunoturbidimetric assay before stent implantation and 12, 24, 48 and 72 hours after the procedure. Patients on anti-inflammatory drugs or with evidences of inflammatory conditions were excluded. RESULTS Seventeen patients (mean age 62+/-9 years, 12 males) were enrolled. The presentation was unstable angina in 13 patients and stable angina in 4 patients. Eighteen stents were implanted as follows: 16 type B lesions (88%), 1 type C lesions (6%) and 1 type A ...

Introduction: Percutaneous transluminal coronary angioplasty with stent implantation is a very ef... more Introduction: Percutaneous transluminal coronary angioplasty with stent implantation is a very efficient method of revascularization. The major problem after stent implantation is in-stent restenosis. The in-stent restenosis rate has been significantly reduced along with the introduction of drug-eluting stents. However, even these drug-eluting stents can cause endothelial dysfunction in the adjacent stented area, but the severity of the endothelial lesions is much lower in DES implant than in BMS implant. Objective: The aim of this article is to present in a succinct way various recent studies about endothelial dysfunction produced by implantation of drug-eluting stents. Conclusions: First generation drug-eluting stents (paclitaxel and sirolimus) appears to have a lesser risk of stenosis compared to bare-metal stent. Recent researches showed that are also differences between drug-eluting stents types regarding vascular endothelial damage.

American Heart Journal, 2010

Background Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may... more Background Elevated left ventricular filling pressure after acute myocardial infarction (AMI) may be identified using clinical assessment, echocardiography, and B-type natriuretic peptide (BNP) levels. All of these predict outcome in this setting. There are, however, no data assessing their relative prognostic value. The current study addresses this. Methods Four hundred patients underwent detailed echocardiography and measurement of BNP levels after AMI (median 1 day). The study end points were (1) a composite of death, recurrent AMI, and/or admission to hospital with heart failure within 1 year and (2) all-cause mortality during medium-term follow-up (median 2.9 years). Results Both an elevated ratio of early transmitral flow to early mitral annulus velocity (E/e') and higher BNP levels were associated with an increased risk of an adverse event within the first year (odds ratio 6.14 for E/e' N15, P b .001; odds ratio 1.19 per 50-pg/mL increase in BNP, P b .001) and medium-term mortality (hazard ratio 4.67 for E/e' N15, P b .001; hazard ratio 1.10 per 50-pg/mL increase in BNP, P b .001). Among patients with BNP levels higher than the median or in the upper quartile, an E/e' ratio N15 identified a subgroup at greatest risk of mortality (P b .001 for both). Conclusions The E/e' ratio and BNP levels play important and complementary roles in the risk stratification of patients after AMI.