Roxana Mihaela Chiorescu

Iuliu Hațieganu University of Medicine and Pharmacy

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Dan Blendea

Iuliu Hațieganu University of Medicine and Pharmacy

Mihaela Mocan

Iuliu Hațieganu University of Medicine and Pharmacy

Sorin Pop

Iuliu Hațieganu University of Medicine and Pharmacy

Roxana-Daiana Lazar

Iuliu Hațieganu University of Medicine and Pharmacy

Cerasela Mihaela Goidescu

Iuliu Hațieganu University of Medicine and Pharmacy

Anca Daniela Fărcaș

Iuliu Hațieganu University of Medicine and Pharmacy

Mirela Anca Stoia

Clinical Emergency Hospital Bucharest

Giorgia Coșeriu

Iuliu Hațieganu University of Medicine and Pharmacy

Florin Petru Anton

Iuliu Hațieganu University of Medicine and Pharmacy

Gabriel Gușetu

Iuliu Hațieganu University of Medicine and Pharmacy

Cooperative Institutions

Iuliu Hațieganu University of Medicine and Pharmacy

Spitalul Clinic Județean de Urgență Cluj-Napoca

University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca

Clinical Emergency Hospital Bucharest

Massachusetts General Hospital

County Hospital

Harvard University

Institute of Cardiology

Spitalul Clinic CF Cluj-Napoca

Technical University of Cluj-Napoca

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Angiographic Anatomy of the Left Coronary Veins: Beyond Conventional Cardiac Resynchronization Therapy

Current Cardiology Reports (2025)

Iulia-Georgiana Zehan Csilla-Andrea Apetrei M P Moldovan Mihai G Andrei Patricia Schiop-Tentea

Coronary Vein

Great cardiac vein

10.1007/s11886-025-02204-z

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Left atrial appendage morphology and mitral annular plane systolic excursion predict stroke in patients with atrial fibrillation and high thromboembolic risk

European Heart Journal (2023)

Adriana Sarb Roxana-Daiana Lazar Iulia-Georgiana Zehan Calina P Schiop-Tentea Giorgia Coșeriu

Abstract Background Previous research has revealed a relationship between the morphology and function of the left atrial appendage (LAA) and the rate of thromboembolic events in patients with atrial fibrillation (AF). There is limited data on the impact of the left ventricular (LV) function on LAA thrombus formation. Emptying of the LAA depends on the active contraction of this structure as well as on the passive motion due to external compression from the LV base during ventricular diastole. Purpose Given these considerations the goal of this study was to investigate by transesophageal and transthoracic echocardiography the morphology and function of the LAA in relationship with the LV function and to assess the impact on incidence of stroke in a group of patients with AF with high thromboembolic risk who underwent TEE-guided direct current cardioversion. Methods We included 148 patients (age 65 ±11 yrs, 79men, median CHA2DS2-VASc score 4 (IQR 2-6), left ventricular ejection fraction 48±11%), who underwent transesophageal echocardiography before cardioversion. During a median follow-up period of 23 months (range 1-107) 34 patients developed stroke or TIA. Results The distribution of the four LAA morphologies (Figure 1) was: Cactus [47 (32%)], Cauliflower [30 (20%)], Windsock [38(26%)], and Chicken Wing [33 (22%)]. During the follow-up period stroke/TIA occurred significantly more frequently in patients with cactus or cauliflower LAA morphology vs. patients with windsock or chicken wing morphology (25 (35%) vs 9 (11%); p value=0.001). Patients who developed stroke or TIA had significantly lower MAPSE vs patients with event free survival (8±3 vs 12±3mm; p value=0.001). Kaplan-Meier survival curves for different categories of MAPSE and LAA morphology are shown in Figure 2. The significant relationship between MAPSE and stroke-free survival was retained in Cox multivariable analysis that included LAA morphology, CHA2DS2-VASc score and AF types. This association was present whether MAPSE was entered into the multivariable model as a continuous or dichotomized variable. Conclusions In patients with high thromboembolic risk, MAPSE predicts the occurrence of stroke independent of LAA morphology and CHA2DS2-VASc score. This phenomenon could be related to the impact LV diastole on LAA emptying.

Stroke

Atrial Appendage

10.1093/eurheartj/ehad655.469

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QRS voltage in precordial leads in patients with neurally mediated syncope

European Heart Journal (2020)

Dan Blendea Mircea Cimpeanu Mihaela Jelnean Roxana Mihaela Chiorescu Sorin Crişan

Abstract Background We have previously demonstrated that patients with neurally mediated syncope (NMS) who have an isolated QRS complex, of very low voltage (≤0.3mV cutoff), in one of the frontal leads on the 12-lead electrocardiogram have a threefold increase in the risk of syncope recurrence. The potential relationship between isolated low voltage (ILV) in precordial leads (Figure A) and recurrent NMS has not been yet explored. Purpose To prospectively evaluate whether the presence of ILV in the precordial leads predicts recurrence of NMS. Methods We included 135 patients with NMS (age 49±20) years, with a median of 4 syncopal episodes. During a median period of 15 months, 43 patients (32%) experienced recurrent syncope. The lowest QRS voltage (QRSmin) was determined separately for the frontal and precordial leads. The cutoff for precordial QRSmin that best discriminated between patients with recurrent and no recurrent syncope was ≤0.7mV (ROC curve AUC=0.65). Results Isolated low voltage in precordial leads was present in 49 (36%) of patients. The lead which displayed QRSmin in the precordial leads was V1 in 35 (71%) patients. The actuarial total syncope recurrence rate at 1 year was 26% (95% CI 16–42%) in patients with ILV in precordial leads, and 21% (95% CI 6–39%) in patients without ILV (log rank test P=0.043; Figure B). The significant relationship between the presence of ILV in precordial leads and syncope recurrence was retained in Cox multivariate analysis that included isolated very low voltage in frontal leads (≤0.3mV cutoff), as well as the number of syncopal episodes. Conclusions Isolated low QRS voltage in the precordial leads predicts recurrence of NMS independent of isolated low QRS voltage in the frontal leads. Figure 1 Funding Acknowledgement Type of funding source: None

Precordial examination

Cut-off

10.1093/ehjci/ehaa946.0705

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Current Insights and Future Directions in the Treatment of Heart Failure with Preserved Ejection Fraction

International Journal of Molecular Sciences (2023)

Roxana Mihaela Chiorescu Roxana-Daiana Lazar Alexandru Ruda Andreea Paula Buda Ştefan Chiorescu

Heart failure is a clinical syndrome associated with poor quality of life, substantial healthcare resource utilization, and premature mortality, in large part related to high rates of hospitalizations. The clinical manifestations of heart failure are similar regardless of the ejection fraction. Unlike heart failure with reduced ejection fraction, there are few therapeutic options for treating heart failure with preserved ejection fraction. Molecular therapies that have shown reduced mortality and morbidity in heart failure with reduced ejection have not been proven to be effective for patients with heart failure and preserved ejection fraction. The study of pathophysiological processes involved in the production of heart failure with preserved ejection fraction is the basis for identifying new therapeutic means. In this narrative review, we intend to synthesize the existing therapeutic means, but also those under research (metabolic and microRNA therapy) for the treatment of heart failure with preserved ejection fraction.

10.3390/ijms25010440

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Cardiovascular Risk Evaluation in Patients with Critical Leg Ischemia before Vascular Surgery

InTech eBooks (2018)

Mirela Anca Stoia Mihaela Mocan Cerasela Mihaela Goidescu Diana Larisa Hognogi Mocan Roxana Mihaela Chiorescu

Assessment of the role and investigation particularities (comparative and complementary aspects, hierarchies, preferential indication) adapted to the context of a global cardiovascular (CV) evaluation, including clinical elements, non-invasive and invasive imagistic examination in order to estimate the cardiovascular risk (CVR) and to define the revascularization therapeutic strategy in patients with critical leg ischemia (CLI). Complete and accessible evaluation involves accessible means of investigation like clinical exam, electrocardiogram, cardiac biomarkers, arterial, cardiac, and carotid ultrasonography which could be affordable in all cardiovascular departments. Non-invasive stress tests, coronary and arterial cervical angiography imaging leads in selected cases and where is possible to the identification of significant coronary and/or carotid lesions potential responsible for cardiac and cerebrovascular events after vascular surgery. The evaluation algorithm allows better risk stratification of patients with CLI in high and intermediate CVR. The "poly-arterial" status in patients with CLI changes the intervention management with a more intensive pre-operative medical treatment, while the coronary and the carotid arteries revascularization might precedes the peripheral arterial revascularization procedures, in order to reduce the CV risk status.

Carotid ultrasonography

10.5772/intechopen.78046

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Biomarkers of Inflammation in Left Ventricular Diastolic Dysfunction

Disease Markers (2019)

Mihaela Mocan Larisa Diana Mocan Hognogi Florin Petru Anton Roxana Mihaela Chiorescu Cerasela Mihaela Goidescu

Left ventricular diastolic dysfunction (LVDD) is an important precursor to many different cardiovascular diseases. Diastolic abnormalities have been studied extensively in the past decade, and it has been confirmed that one of the mechanisms leading to heart failure is a chronic, low-grade inflammatory reaction. The triggers are classical cardiovascular risk factors, grouped under the name of metabolic syndrome (MetS), or other systemic diseases that have an inflammatory substrate such as chronic obstructive pulmonary disease. The triggers could induce myocardial apoptosis and reduce ventricular wall compliance through the release of cytokines by multiple pathways such as (1) immune reaction, (2) prolonged cell hypoxemia, or (3) excessive activation of neuroendocrine and autonomic nerve function disorder. The systemic proinflammatory state causes coronary microvascular endothelial inflammation which reduces nitric oxide bioavailability, cyclic guanosine monophosphate content, and protein kinase G (PKG) activity in adjacent cardiomyocytes favoring hypertrophy development and increases resting tension. So far, it has been found that inflammatory cytokines associated with the heart failure mechanism include TNF- α , IL-6, IL-8, IL-10, IL-1 α , IL-1 β , IL-2, TGF- β , and IFN- γ . Some of them could be used as diagnosis biomarkers. The present review aims at discussing the inflammatory mechanisms behind diastolic dysfunction and their triggering conditions, cytokines, and possible future inflammatory biomarkers useful for diagnosis.

Proinflammatory cytokine

Endothelial Dysfunction

10.1155/2019/7583690

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Vulnerable Atherosclerotic Plaque: Is There a Molecular Signature?

International Journal of Molecular Sciences (2022)

Roxana Mihaela Chiorescu Mihaela Mocan Andreea-Ioana Inceu Andreea Paula Buda Dan Blendea

Atherosclerosis and its clinical manifestations, coronary and cerebral artery diseases, are the most common cause of death worldwide. The main pathophysiological mechanism for these complications is the rupture of vulnerable atherosclerotic plaques and subsequent thrombosis. Pathological studies of the vulnerable lesions showed that more frequently, plaques rich in lipids and with a high level of inflammation, responsible for mild or moderate stenosis, are more prone to rupture, leading to acute events. Identifying the vulnerable plaques helps to stratify patients at risk of developing acute vascular events. Traditional imaging methods based on plaque appearance and size are not reliable in prediction the risk of rupture. Intravascular imaging is a novel technique able to identify vulnerable lesions, but it is invasive and an operator-dependent technique. This review aims to summarize the current data from literature regarding the main biomarkers involved in the attempt to diagnose vulnerable atherosclerotic lesions. These biomarkers could be the base for risk stratification and development of the new therapeutic drugs in the treatment of patients with vulnerable atherosclerotic plaques.

Vulnerable plaque

Pathophysiology

Risk Stratification

Fibrous cap

10.3390/ijms232113638

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Cardiac Geometry and Function in Patients with Reflex Syncope

Journal of Clinical Medicine (2024)

Giorgia Coșeriu Patricia Schiop-Tentea Csilla-Andrea Apetrei Iulia-Georgiana Mindreanu Adriana-Daniela Sarb

Reflex syncope (RS) is the most prevalent form of syncope, yet its pathophysiology and clinical presentation are not well understood. Despite controversy, the ‘ventricular theory’ remains the most plausible hypothesis to explain RS in susceptible patients. Certain assumptions regarding the geometry and function of the heart are essential in supporting this theory. Given these considerations, the goal of this review was to try to integrate data on heart morphology and function in a phenotype of a patient susceptible to RS. Previous research suggests that a small left ventricle and atria, in addition to a normo- or hypercontractile myocardium, predispose to more syncopal events. These findings have been confirmed in different subsets of patients, including those with small heart and chronic fatigue syndrome, highlighting common pathophysiologic pathways in these subgroups of population. Heart geometry and function seem to play a role in different treatment strategies for RS patients, including the administration of medications, pacing, and possibly cardioneural ablation. In addition, parameters related to the geometry of the heart chambers and of the electrical activation of the heart seem to have predictive value for syncope recurrence. These parameters could be included in the future and improve the accuracy of predictive models for RS.

10.3390/jcm13226852

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Biomarkers of Volume Overload and Edema in Heart Failure With Reduced Ejection Fraction

Frontiers in Cardiovascular Medicine (2022)

Roxana Mihaela Chiorescu Roxana-Daiana Lazar Sándor-Botond Buksa Mihaela Mocan Dan Blendea

From a pathogenetic point of view, heart failure (HF) is characterized by the activation of several neurohumoral pathways with a role in maintaining the cardiac output and the adequate perfusion pressure in target organs and tissues. Decreased cardiac output in HF with reduced ejection fraction causes activation of the sympathetic nervous system, the renin angiotensin aldosterone system, arginine-vasopressin system, natriuretic peptides, and endothelin, all of which cause water and salt retention in the body. As a result, patients will present clinically as the main symptoms: dyspnea and peripheral edema caused by fluid redistribution to the lungs and/or by fluid overload. By studying these pathophysiological mechanisms, biomarkers with a prognostic and therapeutic role in the management of edema were identified in patients with HF with low ejection fraction. This review aims to summarize the current data from the specialty literature of such biomarkers with a role in the pathogenesis of edema in HF with low ejection fraction. These biomarkers may be the basis for risk stratification and the development of new therapeutic means in the treatment of edema in these patients.

Peripheral edema

Volume overload

10.3389/fcvm.2022.910100

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Severe Thrombocytopenia as a Manifestation of COVID-19 Infection

Journal of Clinical Medicine (2022)

Mihaela Mocan Roxana Mihaela Chiorescu Andrada Tirnovan Botond Sandor Buksa Anca Daniela Fărcaș

Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acute respiratory distress depending on the virus gateway, viral load, host immunity, and existing comorbidities. Some patients with COVID-19 infection can present hematological changes depending on the patient’s immune response and the severity of the infection. We present two different manifestations of thrombotic disorders related to COVID-19: one severe form of immune thrombocytopenia in a young woman with no comorbidities and a severe form of thrombocytopenia along with disseminated intravascular coagulation and acute urinary obstructive disease. Interestingly, both patients presented no signs of COVID-19 pneumonia. Failure to diagnose thrombocytopenia rapidly may lead to severe complications. Management with immunosuppressive corticosteroids in high doses should carefully balance the risk of bleeding versus deterioration due to infection.

2019-20 coronavirus outbreak

Pandemic

Betacoronavirus

10.3390/jcm11041088

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Citations (12)