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Left ventricular thrombosis (LVT) is one of the most severe complications of acute myocardial infarction (AMI). LVT is commonly associated with an increased risk of cerebral or systemic embolization, which furthermore increases the morbidity and mortality of these patients. Management of LVT implies the administration of anticoagulants to achieve thrombus resolution and reduce the embolic risk. However, in the setting of an AMI, anticoagulants are added to already existing antiplatelet therapy, which increases the bleeding risk for this category of patients. Vitamin K antagonist (VKA) represents the main guideline recommendation for anticoagulation, but its multiple interactions are associated with an increased number of patients who are outside the therapeutic range and low compliance. Early studies that evaluate direct oral anticoagulants (DOAC) as an alternative for VKA show promising results, with reduced strokes and bleeding rates and faster thrombus resolution. Thus, in the near future, DOAC may represent a therapeutic option for treating LVT, but larger studies are needed to validate this approach.

Background/Objectives: The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation. Methods: We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months. Results: The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL. Conclusions: In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary–cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients. [ABSTRACT FROM AUTHOR]

Exercise-based cardiac rehabilitation (ExCR) programs are essential for patients diagnosed with cardiac diseases. Studies have shown that they aid in the rehabilitation process and may even facilitate a return to previous cardiorespiratory fitness. Also, patients who enroll and follow such programs have shown a lower rate of complications and mortality in the long run. The results vary depending on the type of program followed and the degree of debilitation the disease has caused. Therefore, in order to obtain optimal results, it is ideal to tailor each ExCR program to the individual profile of each patient. At the moment, the two most studied and employed training types are medium-intensity continuous training (MICT) and high-intensity interval training (HIIT). For most of the time, MICT was the first-choice program for patients with cardiovascular disease. In recent years, however, more and more studies have pointed towards the benefits of HIIT and how it better aids patients in recovering their cardiovascular fitness. Generally, MICT is more suited for patients with a severe degradation in functional capacity and who require a higher degree of safety (e.g., elderly, with a high number of comorbidities). On the other hand, while HIIT is more demanding, it appears to offer better outcomes. Therefore, this review aimed to summarize information from different publications on both types of training regimens in ExCR and assess their utility in current clinical practice. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a prevalent sleep disorder that impacts a considerable proportion of people around the world, and is often associated with other health conditions including obesity, diabetes and cardiovascular diseases. OSA is an important risk factor for developing hypertension as it leads to cyclical oxygen desaturation, sympathetic hyperactivity, poor sleep quality, frequent microarousals and daytime drowsiness. This review aims to present updated knowledge of the relationship and pathogenic association between sleep apnea and hypertension. [ABSTRACT FROM AUTHOR]

With advancements in screening, diagnosis, and treatment, cancer-related mortality is declining, and life expectancy for cancer patients is increasing by up to 30%. However, these patients often face increased cardiovascular risks due to hypertension, metabolic syndrome, and type 2 diabetes, as well as the cardiotoxic effects of cancer therapies. Chemotherapy drugs like anthracyclines, trastuzumab, and 5-fluorouracil can hurt the heart through oxidative stress, apoptosis, and mitochondrial dysfunction. This can cause heart failure, coronary heart disease, and arrhythmias, among other problems. Cardiovascular rehabilitation (CR) has emerged as a key strategy to mitigate these effects. Studies involving breast cancer patients and other cancer populations have demonstrated that CR programs, involving high-intensity interval training and moderate-intensity exercises, improve cardiorespiratory fitness and reduce cardiovascular risks in cancer patients. Despite challenges such as patient reluctance due to distance from specialized centers, telerehabilitation has proven to be a viable alternative. CR not only improves peak VO2 but also reduces systemic inflammation and promotes muscle mass gain while lowering mortality and healthcare costs associated with post-cancer therapy complications. Multidisciplinary involvement-integrating cardiologists, oncologists, psychologists, and nutritionists-enhances outcomes, improving both cardiac fitness and quality of life for cancer patients. Further research highlights the need for early intervention and customized CR programs to minimize cardiovascular toxicity and optimize patient recovery post-chemotherapy. [ABSTRACT FROM AUTHOR]

(1) Background: The aortic arch (AA) branching model is challenging, considering the multiple anatomical variations documented in existing research. The bovine aortic arch (BAA) is the most prevalent anatomical variation among these. This variant of AA branching has long been considered a nonsymptomatic malformation, having been discovered incidentally during imaging investigations for other causes. However, more recent studies have demonstrated that BAA shows a frequent association with coarctation of the aorta (CoA), thoracic aortic disease (TAD), and stroke. At the same time, given the current context of increasing activity in the fields of interventional and surgical procedures in the aorta and its branches, it is very important to know the medical–surgical implications of this anatomical variant. (2) Methods: We conducted a comprehensive review using PubMed and Embase, focusing specifically on randomized trials and cohort analyses that examined the medical–surgical implications of BAA. We assessed information related to studied groups, medical procedures, and study outcomes. Initially, we identified 8454 studies, and after rigorous evaluation, we narrowed down our review to 25 articles. (3) Discussions: The intervention consisted of assessing the risks associated with BAA through different imaging investigation methods such as computer tomographic angiography (CTA), magnetic resonance imaging (MRI), or ultrasonography (US). The following results were evaluated: the prevalence of the BAA, the importance of imaging investigations in establishing the diagnosis and the therapeutic management and monitoring the evolution of patients with the BAA, the association of the BAA with CoA, TAD, and stroke, and the potential risks of interventional treatment in patients with the BAA. (4) Conclusions: The prevalence of the BAA differs both between different ethnic groups and between genders. Advanced imaging methods such as CTA and 4D flow MRI allow detailed descriptions of supra-aortic vascular anatomy and information about blood flow velocities, direction, and turbulence in the AA. US remains an easy and valuable imaging investigation, with the potential to detect and correctly diagnose the BAA and its hemodynamic implications. Anatomical variations in the AA are associated with increased rates of TAD, CoA, and stroke, necessitating early diagnosis and increased supervision of patients with such incidentally observed abnormalities. In addition, there is a need to further develop and refine the surgical techniques used and personalize them to the individual characteristics of patients with the BAA. [ABSTRACT FROM AUTHOR]

In recent decades, chronic viral infection C (HCV) has posed a major public health challenge globally, considering the morbidity and mortality associated with this condition, as well as the difficulties related to diagnosis and treatment. Recently, significant advances in medical and pharmaceutical research have led to the development of new direct-acting antiviral therapies (DAAs), marking the beginning of a new era in HCV treatment. These treatments promise cure rates of over 90%, an improved safety profile, and a reduced duration of therapy compared to previous interferon-based regimens. This article aims to examine the evolution of HCV treatment, with a special focus on recent innovations in antiviral therapy. We will analyze the mechanisms of action of DAAs, their efficacy and safety, and their impact on populations with limited access to treatment. Additionally, we discuss the remaining challenges in the path to HCV eradication, including late diagnosis, barriers to treatment access, and the need for long-term monitoring of cured patients. By consolidating data from recent clinical studies and reviewing the specialized literature, this article provides a comprehensive perspective on the current landscape of HCV treatment, highlighting significant progress made and underlining the future directions needed to address remaining challenges. Finally, we reaffirm the importance of an integrated approach, encompassing prevention, early diagnosis, and universal access to innovative treatments, as a cornerstone in the fight against HCV. [ABSTRACT FROM AUTHOR]

Background. Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients’ point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9.

Background and Objectives: Assessment of the prothrombotic, proinflammatory, and functional status of a cohort of COVID-19 patients at least two years after the acute infection to identify parameters with potential therapeutic and prognostic value. Materials and Methods: We conducted a retrospective, descriptive study that included 117 consecutive patients admitted to Iasi Pulmonary Rehabilitation Clinic for reassessment and a rehabilitation program at least two years after a COVID-19 infection. The cohort was divided into two groups based on the presence (n = 49) or absence (n = 68) of pulmonary fibrosis, documented through high-resolution computer tomography. Results: The cohort comprises 117 patients, 69.23% females, with a mean age of 65.74 ± 10.19 years and abnormal body mass index (31.42 ± 5.71 kg/m2). Patients with pulmonary fibrosis have significantly higher levels of C-reactive protein (CRP) (p < 0.05), WBC (7.45 ± 7.86/mm3 vs. 9.18 ± 17.24/mm3, p = 0.053), neutrophils (4.68 ± 7.88/mm3 vs. 9.07 ± 17.44/mm3, p < 0.05), mean platelet volume (MPV) (7.22 ± 0.93 vs. 10.25 ± 0.86 fL, p < 0.05), lactate dehydrogenase (p < 0.05), and D-dimers (p < 0.05), but not ferritin (p = 0.470), reflecting the chronic proinflammatory and prothrombotic status. Additionally, patients with associated pulmonary fibrosis had a higher mean heart rate (p < 0.05) and corrected QT interval (p < 0.05). D-dimers were strongly and negatively correlated with diffusion capacity corrected for hemoglobin (DLCO corr), and ROC analysis showed that the persistence of high D-dimers values is a predictor for low DLCO values (ROC analysis: area under the curve of 0.772, p < 0.001). The results of pulmonary function tests (spirometry, body plethysmography) and the 6-minute walk test demonstrated no significant difference between groups, without notable impairment within either group. Conclusions: Patients with COVID-19-related pulmonary fibrosis have a persistent long-term proinflammatory, prothrombotic status, despite the functional recovery. The persistence of elevated D-dimer levels could emerge as a predictive factor associated with impaired DLCO. [ABSTRACT FROM AUTHOR]

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