Andreea Marcu

University of Medicine and Pharmacy of Craiova

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Ionuț Donoiu

University of Medicine and Pharmacy of Craiova

Sebastian Militaru

University of Medicine and Pharmacy of Craiova

Octavian Istrătoaie

University of Medicine and Pharmacy of Craiova

Constantin Militaru

University of Medicine and Pharmacy of Craiova

Florentina Dumitrescu

Spitalul Clinic Dr. Victor Babes

Ioana Andreea Gheonea

University of Medicine and Pharmacy of Craiova

Maria Livia Iovănescu

University of Medicine and Pharmacy of Craiova

Cătălin Stoean

University of Craiova

C. Patru

University of Medicine and Pharmacy of Craiova

Ruxandra Stoean

University of Craiova

Cooperative Institutions

University of Medicine and Pharmacy of Craiova

University of Craiova

Clinical Emergency Hospital Bucharest

Carol Davila University of Medicine and Pharmacy

Institutul de Urgenţă pentru Boli Cardiovasculare "Prof.Dr. C.C. Iliescu"

Romanian Institute of Science and Technology

Institutul Național de Endocrinologie C.I. Parhon

University of Leeds

Universidad de Málaga

Spitalul Clinic Dr. Victor Babes

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Echocardiography Assessment of Cardiac Function in Adults Living with HIV: A Speckle Tracking Study in the Era of Antiretroviral Therapy

Journal of Clinical Medicine (2022)

Oana Mirea Mirela Manescu Sorina Iordache Andreea Marcu Ionuț Donoiu

Adults living with HIV (human immunodeficiency virus) infection (ALHIV) have high rates of cardiovascular events. New approaches are needed to detect subclinical cardiac dysfunction. We used conventional and speckle tracking echocardiography to investigate whether ALHIV display latent cardiac dysfunction. We analyzed 85 young subjects with HIV infection and free from cardiovascular risk factors (31 ± 4 years) and 80 matched healthy volunteers. We measured left ventricular (LV) layered global longitudinal strain, circumferential strain, peak longitudinal strain in the reservoir and contraction phases of the left atrium (LASr respectively LASct). In the HIV group, LV ejection fraction and s’ TDI (tissue doppler imaging) were slightly lower but still in the normal ranges. Layered longitudinal strain showed no significant difference, whereas circumferential global strain was significantly lower in the HIV group (−20.3 ± 3.9 vs. −22.3 ± 3.0, p < 0.001). LASr (34.3% ± 7.3% vs. 38.0% ± 6.9%, p < 0.001) was also lower in ALHIV and multivariate analysis showed that age (β = −0.737, p = 0.01) and infection duration (β = −0.221, p = 0.02) were independently associated with LASr. In the absence of cardiovascular risk factors, adults living with HIV display normal LV systolic function. Left atrial reservoir strain, is, however, decreased and suggests early diastolic dysfunction.

Subclinical infection

Speckle tracking echocardiography

10.3390/jcm11133792

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Citations (1)

[Problems of isoimmunization].

PubMed (1966)

S Lupşaiu Andreea Marcu S Halmoş G Havas

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Simultaneous papillary and medullary thyroid carcinoma, primary hyperparathyroidism and ACTH-independent Cushing syndrome- an intriguing puzzle of endocrine disorders

Endocrine Abstracts (2024)

Ana-Iolanda Badita Simona Jercălău Andrei Goldstein Andreea Marcu Oana Stănciulea

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

10.1530/endoabs.99.ep1166

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OC12.01: First trimester heart screening supported by artificial intelligence

Ultrasound in Obstetrics and Gynecology (2021)

Dominic Gabriel Iliescu Rodica Daniela Nagy C. Patru Cătălin Stoean Ruxandra Stoean

To investigate if artificial intelligence (AI) can support first trimester heart screening (FTHS) by alerting the obstetrician if the normal appearance of any of the key planes of the cardiac sweep is missing. Images from FTHS of fetuses aged 12-13+6 weeks have been collected and further processed to show only colour Doppler mode. Modern architectures of deep learning have been trained and validated to recognise five classes: four key planes of the cardiac sweep (atrioventricular flows in four-chamber view plane, the aorta in the left ventricular outflow tract plane, pulmonary artery, and arterial duct in the right ventricular outflow tract plane and the arterial arches in three-vessel plane) and other (the rest) non-informative images. We extracted frames showing each class of images from recorded video scans during general practice and labelled them accordingly for the machine learning approach. 7251 images from 326 US scans (80% of the images) were used for AI training. Once this stage is complete, the percent of correctly classified images from the remaining 20% test data was 95.56%. The accuracy is nevertheless very good, since usually, a certain plane appears several times in a cardiac sweep, hence, at this percent, the model will definitely identify at least one of its instances. The model was further applied to US movies, such as to simulate a real scenario of FTHS. It points out when each of the four planes is identified by displaying the label, alongside the probability of being certain on that label. The current results show great promise in the direction of artificial intelligence support for FTHS. To the best of our knowledge, there is no other pilot study to use computational intelligence for the identification of heart structures in scans from as early as the first trimester. This work was supported by a grant from the Romanian Ministry of Research and Innovation, CCCDI - UEFISCDI, project number 408PED/2020, PN-III-P2-2.1-PED-2019-2227, Learning deep architectures for the Interpretation of Fetal Echocardiography (LIFE).

Ventricular outflow tract

Outflow

Cardiac cycle

10.1002/uog.23860

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Fully penetrant genetic mutation results in wide familial variability: a cardiac magnetic resonance focused report

Romanian Journal of Cardiology (2021)

Maria Livia Iovănescu Andreea Marcu Cristian Militaru Octavian Istrătoaie Ioana Andreea Gheonea

Abstract Dilated cardiomyopathy (DCM) is a myocardial disorder characterized by ventricular dilation (LV or biventricular) and systolic dysfunction, with a broad etiological spectrum, comprising numerous genetic and non-genetic causes. Cardiac magnetic resonance (CMR) has become an important tool in guiding the etiological diagnosis in DCM. We present the case of a 37-years old man admitted to our department in order to investigate the diagnosis of DCM using CMR. Cine imaging showed mild left ventricular (LV) dilatation and moderate systolic (LV ejection fraction = 42%) dysfunction, but also apical hypertrabeculation meeting the criteria for non-compaction and late gadolinium enhancement (LGE) images revealed mid-wall fibrosis in the basal and midventricular segments of the inferior interventricular septum (IVS) – typical of non-ischemic DCM. Complete family history revealed the diagnosis of DCM in the mother of the patient and in the maternal grandfather, who had died at 87. After genetic testing of the index patient showed a pathogenic mutation in the TTN (titin) gene (c.79273A>T), cascade genetic testing followed, for his mother, sister, uncle and two cousins who all came back positive for the same mutation. CMR examination of the mother done 6 years prior demonstrated severe LV dilatation and systolic dysfunction (LV ejection fraction = 23%), LV non-compaction and mid-wall IVS fibrosis. CMR examination was performed for the other members of the family and discovered pathological findings in the uncle (normal LV volume and function, but focal mid-wall fibrosis in the inferior IVS) and the male cousin (LV non-compaction), while the female cousin had a normal exam. Using CMR and genetic testing, this case report proves the phenotypic heterogenicity of a completely penetrant titin mutation in the same family. Moreover, CMR is shown to be essential in DCM evaluation, having the ability to guide etiologic diagnosis and to detect alterations such as fibrosis and non-compaction in the absence of LV dilation or dysfunction.

Etiology

Myocardial fibrosis

10.47803/rjc.2021.31.1.129

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Intrafamilial Phenotypical Variability Linked to PRKAG2 Mutation—Family Case Report and Review of the Literature

Life (2022)

Andreea Marcu Radu Vătășescu Sebastian Onciul Viorica Rădoi Ruxandra Jurcuț

PRKAG2 syndrome (PS) is a rare, early-onset autosomal dominant phenocopy of sarcomeric hypertrophic cardiomyopathy (HCM), that mainly presents with ventricular pre-excitation, cardiac hypertrophy and progressive conduction system degeneration. Its natural course, treatment and prognosis are significantly different from sarcomeric HCM. The clinical phenotypes of PRKAG2 syndrome often overlap with HCM due to sarcomere protein mutations, causing this condition to be frequently misdiagnosed. The syndrome is caused by mutations in the gene encoding for the γ2 regulatory subunit (PRKAG2) of 5′ Adenosine Monophosphate-Activated Protein Kinase (AMPK), an enzyme that modulates glucose uptake and glycolysis. PRKAG2 mutations (OMIM#602743) are responsible for structural changes of AMPK, leading to an impaired myocyte glucidic uptake, and finally causing storage cardiomyopathy. We describe the clinical and investigative findings in a family with several affected members (NM_016203.4:c.905G>A or p.(Arg302Gln), heterozygous), highlighting the various phenotypes even in the same family, and the utility of genetic testing in diagnosing PS. The particularity of this family case is represented by the fact that the index patient was diagnosed at age 16 with cardiac hypertrophy and ventricular pre-excitation while his mother, by age 42, only had Wolff–Parkinson–White syndrome, without left ventricle hypertrophy. Both the grandmother and the great-grandmother underwent pacemaker implantation at a young age because of conduction abnormalities. Making the distinction between PS and sarcomeric HCM is actionable, given the early-onset of the disease, the numerous life-threatening consequences and the high rate of conduction disorders. In patients who exhibit cardiac hypertrophy coexisting with ventricular pre-excitation, genetic screening for PRKAG2 mutations should be considered.

Clinical phenotype

10.3390/life12122136

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S52 EXTRA-Meso Feasibility – a randomised feasibility study of exercise therapy in mesothelioma

Selina Tsim KG Blyth John Moore Andreea Marcu Zoe Merchant

Introduction

Malignant Pleural Mesothelioma (MPM) is associated with high symptom burden, cancer cachexia and poor health-related quality of life (HRQOL), even in those with good performance status (PS). Improving and maintaining HRQOL is a key goal in MPM management, and maximising systemic anti-cancer treatment (SACT) opportunity has never been more important. However, SACT uptake is typically low, often due to reduced physical fitness associated with MPM and advanced age at diagnosis. Exercise therapy is a rational approach to improving HRQOL and could maintain and/or improve fitness. There is evidence to support exercise therapy in other cancers, but there is limited evidence for the role of exercise therapy in MPM. EXTRA-Meso feasibility study is a prospective, randomised feasibility trial of exercise therapy versus standard care in patients with a diagnosis of MPM.

Methods

EXTRA-Meso Feasibility is currently recruiting from two UK centres (Glasgow and Manchester). Patients with a diagnosis of mesothelioma, ratified by a mesothelioma MDT; PS 0 - 2; clinical frailty score ≤5 and able/willing to provide informed written consent are eligible. Patients will be randomised 1:1 to intervention, where they receive a 12 week personalised exercise programme, after being assessed by a physiotherapist or qualified exercise professional with specific cancer training, or standard care (routine clinical follow-up). Baseline and follow-up assessments include functional fitness assessments and HRQOL questionnaires. Study flowchart is detailed in figure 1. The primary objective is to determine whether it is feasible to recruit and randomise 40 patients within 12 months. Secondary objectives include assessment of barriers to study recruitment and retention, and to determine the safety and tolerability of the exercise intervention and study assessments.

Results

The study opened to recruitment on 18^th January 2024, at the time of submission 19/40 patients had been enrolled and randomised. Preliminary results relating to study secondary objectives will be available for presentation at BTS Winter Meeting 2024.

Conclusion

Results of EXTRA-Meso feasibility will directly influence the study design of a future phase 3 randomised trial. Recruitment to date has met target recruitment rate, and if the current rate continues, a phase 3 study is likely to be feasible.

10.1136/thorax-2024-btsabstracts.58

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Intracardiac mass revealing a rare form of cardiomyopathy

BMJ Case Reports (2022)

Andreea Marcu Ionuţ Donoiu Ioana Andreea Gheonea Sebastian Militaru

We present the case of a woman with a 2-month history of exertional dyspnoea and fatigue in which echocardiography revealed a cavity-obliterating right ventricular mass. Further imaging evaluation using cardiac magnetic resonance showed a thrombotic mass as well as diffuse myocardial oedema and endomyocardial fibrosis (EMF) that involved both ventricles. In the absence of any other cause (including peripheral eosinophilia), the diagnosis of idiopathic EMF was established. This case highlights this uncommon disease in non-tropical areas.

Endomyocardial fibrosis

Rare disease

Peripheral edema

Restrictive cardiomyopathy

Cardiac magnetic resonance

10.1136/bcr-2022-249037

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HIV-HBV coinfection and liver fibrosis in long time monitored patients from the former Romanian pediatric HIV cohort – a small study single center experience

Romanian Journal of Infectious Diseases (2024)

Giorgiana-Nicoleta Lungu Florentina Dumitrescu Anca Duduveche Andreea Marcu Lucian-Ion Giubelan

The aim of this study was to determine the degree of liver fibrosis with the help of a non-invasive method - transient elastography - in a long term monitored HIV-HBV coinfected group of patients (from the former Romanian pediatric cohort) and to assess the implication of various factors as potential risk factors for the development of liver fibrosis. We have reviewed a total of 636 patients (Px) that were in the evidence of the HIV Department of the “Victor Babes” Hospital of Infectious Diseases of Craiova, from which we randomly selected a group of 37 patients that are monthly attending the HIV department. Mean age of the patients was 34.03±2 years old and they were monitored for a long period of time, mean duration of monitorization was 26.11±4.31 years. Patients have been split into group A (13 Px) with various degrees of liver fibrosis and group B (24 Px) without liver fibrosis; the mean value of liver stiffness was higher in group A vs group B 11.27±5.72 vs.4.93±0.98 kPa, p <0.0001. Mean value of nadir CD4 was lower in group A. No significant differences were found between the 2 groups related to the number of associated risk factors, duration of treatment with Zidovudine, Didanosine, Zalcitabine, Stavudine, non-nucleoside reverse transcriptase inhibitor or Ritonavir. Longer duration with Lamivudine alone was associated with group A, while dual therapy (Tenofovir based) was characteristic with group B. In conclusion in a prolonged monitoring of HIV-HBV coinfected patients (from the former Romanian pediatric HIV cohort) liver fibrosis is associated with longer use of Lamivudine and shorter use or Tenofovir.

Didanosine

Transient elastography

HBeAg

Hepatitis B

Stavudine

Nevirapine

10.37897/rjid.2024.1.2

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Deep Learning for the Detection of Frames of Interest in Fetal Heart Assessment from First Trimester Ultrasound

Lecture notes in computer science (2021)

Ruxandra Stoean Dominic Gabriel Iliescu Cătălin Stoean Vlad Ilie C. Patru