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Heart failure (HF) is determined by pathophysiologic changes in the left ventricle (LV) that occur before the onset of clinical symptoms; these changes can lead to mitral insufficiency that will maintain and favor ventricular dysfunction. An associated change in contractility occurs which will maintain the vicious circle. 252 patients with HF were included in this cross-sectional analysis. Patients were divided into two groups, Group I-S/V (n = 55) and Group II-CT (n = 197) to comparatively assess cardi-ac parameters according to the administered therapy and to determine their correlation with quality of life domains. 2D measurements were performed to determine ultrasound parameters. The WHOQOL-BREF questionnaire was used to assess the quality of life. When analyzing the mean values of the determined echocardiographic parame-ters, significant differences in LV ejection fraction (LVEF) (p < 0.03) Results: Analysing the mean values of the echocardiographic parameters determined, significant differences in LV ejection fraction (LV ejection fraction (LVEF) (p < 0.001) and right ventricular diameter (p = 0.030) were found between the two study groups. The incidence of aortic regurgitation and tricuspid regurgitation was higher in the I-S/V group (40% vs. 25%, p = 0.001, respec-tively 47% vs. 35%, p = 0.03). Mitral regurgitation was present in relatively similar per-centages. Testing the association of echocardiographic parameters with quality of life do-mains showed a significant association of LVEF with physical health and relationship with the environment (p = 0.002, r = 0.143, respectively p = 0.041, r = 0.129). Physical dimension and relationship with the environment are more affected in pa-tients with low LVEF. Routine echocardiographic evaluation is essential in the global as-sessment of the HF patient and may suggest a low quality of life with impaired physical dimension.

Assessing patients' quality of life is frequently used in medical research. Patients di-agnosed with heart failure (HF) have reduced exercise tolerance and reduced quality of life due to reduced heart pump function. The objectives of the study are (i) to assess quality of life and comorbidities in HF patients; (ii) to compare quality of life in the physical and psychological do-mains according to drug treatment followed and (iii) to identify predictors of the two domains as-sessed. Methods. A cross-sectional study was conducted between February 2023 and May 2024. A total of 169 patients with HF were included and were distributed into two groups: the HF -S/V group (N=64) who received treatment with sacubitril/valsartan and the HF -CT group (N=105) received treatment with conventional therapy. Two questionnaires were used to assess patients: the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF) questionnaire and the Charlson Comorbidity Index (CCI). Results: The values determined for physical and psy-chological health were significantly lower for Group HF - S/V (51.391 ± 22.232 vs. 61.79 ± 20.04, p=0.002, respectively 59.203 ± 16.871 vs. 64.933 ± 17.448, p=0.038). Approximately 25% of all re-cruited patients distributed in the 2nd CCI category (CCI score 3-4) have an overall poor and moderately poor perception of quality of life vs. 35.5% of patients distributed in the 3rd CCI cate-gory (CCI ≤ 5); 55% of them belong to the HF - S/V group. A good perception of health status is held by 29 (17.16% of the HF group) of the patients distributed in the 2nd CCI category and 28 (16.56%) have a low and moderate perception. Conclusions: The values for the Physical health domain are moderately low, while the values obtained for the psychological domain show that this domain is less affected. Predictors identified for physical health and psychological well-being are patient age, weight, CCI.

Dyspnea is defined by an increased laboured breathing, due to interactions of motor, sen-sory and metabolic nerve impulses, with increased airway resistance, caused by hypox-emia or hypercapnia. Chronic dyspnea presents various causes, respiratory disease, car-diovascular disease, skeletal disease, anaemia, obesity or even physical deconditioning, a condition that persists for more than 4–8 weeks. As for the rehabilitation program, it in-volves the patient’s re-education, the actual physical recovery, change in risk factors and psychological counselling, all leading to the definite improvement of the physical and mental condition, with positive consequences on the quality of life. The rehabilitation pro-gramme applied to increase exercise tolerance in patients with chronic dyspnea can be performed safely; it will also result in an increase in the quality of life of patients. There is a need to develop a strategy for a long-term approach to patients with chronic dyspnea, involving a multidisciplinary team for the constant follow-up of these patients using easi-ly reproducible, feasible and low-cost methods. Rehabilitation therapy in patients with chronic dyspnea uses a set of therapeutic measures, with the aim of restoring greater physical and mental capacity than before the programme.

Left ventricular non-compaction (LVNC) is a rare disease defined by morphological criteria, consisting of a two-layered ventricular wall, a thin compacted epicardial layer, and a thick hyper-trabeculated myocardium layer with deep recesses. Controversies still exist regarding whether it is a distinct cardiomyopathy (CM) or a morphological trait of different conditions. This review analyzes data from the literature regarding diagnosis, treatment, and prognosis in LVNC and the current knowledge regarding reverse remodeling in this form of CM. Furthermore, for clear exemplification, we report a case of a 41-year-old male who presented symptoms of heart failure (HF). LVNC CM was suspected at the time of transthoracic echocardiography and was subsequently confirmed upon cardiac magnetic resonance imaging. A favorable remodeling and clinical outcome were registered after including an angiotensin receptor neprilysin inhibitor in the HF treatment. LVNC remains a heterogenous CM, and although a favorable outcome is not commonly encountered, some patients respond well to therapy.

Diabetes exacerbates the progression of atherosclerosis and is associated with increased risk of developing acute coronary syndrome (ACS). Approximatively 25–30% of patients admitted for ACS have diabetes. ACS occurs earlier in diabetics and is associated with increased mortality and a higher risk of recurrent ischemic events. An increased proinflammatory and prothrombotic state is involved in the poorer outcomes of diabetic patients. In the past decade advancement in both percutaneous coronary intervention (PCI) and coronary artery by-pass graft (CABG) techniques and more potent antiplatelet drugs like prasugrel and ticagrelor improved outcomes of diabetic patients with ACS, but this population still experiences worse outcomes compared to non-diabetic patients. While in ST elevation myocardial infarction urgent PCI is the method of choice for revascularization, in patients with non-ST elevation ACS an early invasive approach is suggested by the guidelines, but in the setting of multivessel (MV) or complex coronary artery disease (CAD) the revascularization strategy is less clear. This review describes the accumulating evidence regarding factors involved in promoting increased incidence and poor prognosis of ACS in patients with diabetes, the evolution over time of prognosis and outcomes, revascularization strategies and antithrombotic therapy studied until now.

The incidence of the no-reflow (NR) phenomenon varies depending on the diagnostic criteria used. If just the angiographic criteria are considered (i.e., a degree of thrombolysis in myocardial infarction ≤2), it will be found that the incidence of NR is quite low; on the other hand, when the myocardial NR is taken into account (i.e., a decrease in the quality of myocardial reperfusion expressed by the degree of myocardial blush), the real incidence is higher. Thus, the early establishment of a diagnosis of NR and the administration of specific treatment can lead to its reversibility. Otherwise, regardless of the follow-up period, patients with NR have a poor prognosis. In the present work, we offer a comprehensive perspective on diagnostic tools for NR detection, for improving the global management of patients with arterial microvasculature damage, which is a topic of major interest in the cardiology field, due to its complexity and its link with severe clinical outcomes.

Adequate therapeutic intervention performed in the case of extradural spinal AVM and an inten-sive recovery program allow the amelioration of neurological manifestations in a very high percentage. With the ultimate goal of practicing a trade, a good biological recovery is needed for social recovery. The effectiveness of strategies for professional integration and reintegration de-pends largely on the patient’s experiences before the onset of the disease. The paper aims to re-view the treatment, the evolution of patients with extradural spinal AV and the possibilities of socio-professional reintegration. Methods and analysis. A case presentation of a patient diag-nosed with extradural spinal AV fistula is proposed, along with a review of the current literature on the treatment of this pathology, the evolution and the possibilities of vocational recovery. The studies will be analysed and selected in two stages, in the first stage the titles and abstracts, in the second stage, the articles with full text will be analysed, selected and a narrative synthesis of the included studies will be made. Summary case. The 51-year-old urban patient, a profes-sional driving instructor who underwent endovascular and surgical treatment for extradural spinal AV fistula, is hospitalized for a moderate motor deficit, such as paraparesis, back pain, mechanical pain in the knees and gait disorders. The objectives of recovery are represented by neuromotor recovery and socio-professional reintegration. Conclusions. Spinal EAVFs are rare lesions with a low risk of bleeding; the clinical manifestations are determined by the compres-sion of the bone marrow; these being significantly improved after the endovascular and surgical treatment. Studies show a good long-term prognosis, which is determined by the absence of re-currences. An essential role in the integration of patients with disabilities in the socio-professional life is the identification of their deficiencies and their reorientation according to the outstanding abilities, the stimulation of the preserved skills.

Sarcopenia or degeneration of skeletal muscle tissue with aging, is responsible for functional de-cline and loss of independence in older adults. The purpose of this article is to review the current definitions of sarcopenia, its potential causes, clinical consequences and the potential for prop-hylactic and curative intervention. Sarcopenia is recognized as a major clinical problem for the elderly, and the research in this area is growing exponentially. One of the most important recent developments has been convergence in the operational definition of sarcopenia that combines muscle mass, strength and muscle function. In 2010, the European Working Group on Sarcopenia in Oder People (EWGSOP) published a definition of sarcopenia aimed at promoting progress in the identification and care of the elderly. In early 2018 (EWGSOP2) he met again to update the original definition to reflect the scientific and clinical evidence that has been built over the past decade. The cause of sarcopenia is considered to be multifactorial: hormonal changes, neurologi-cal decline, sedentary / immobilization for a long period, chronic diseases, obesity, all these fac-tors contribute to the onset of sarcopenia. Prophylactic or curative interventions are essentially aimed at nutrition and exercise. Although pharmaceutical agents are developed that target seve-ral biological pathways, proper nutrition and specific physical exercises remain the gold stan-dard for therapy. Through this review, we want to draw attention to the need to implement complex analyzes of the elderly patient, regardless of the acute problem with which he presents himself at the consultation. These analyses should contain tests, measurements, questionnaires that identify in time a possible musculoskeletal degeneration. The results did not show any sig-nificant difference between the perception of sarcopenia, the way of approaching it and the prophylactic or therapeutic treatment. We focused on this pathology because sarcopenia is rela-tively newly observed, defined, it is not fully investigated and a clinical skill has not been for-med for the evaluation of the elderly patient.

The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls.