Catalin Adrian Buzea

Beyond its typical synovio-entheseal manifestations, psoriatic arthritis (PsA) is a systemic immune-mediated disease that carries a substantial, independent risk of major adverse cardiovascular events (MACE). The complex interaction of chronic systemic inflammation, a high prevalence of traditional risk factors, and PsA treatment drugs results in this increased cardiovascular burden, which is commonly underestimated in cardiology practice. Adipokine balance, insulin signalling, and lipid metabolism are all impacted by cytokine-driven systemic inflammation, which promotes metabolic abnormalities and accelerated atherogenesis. PsA-specific therapy has a complex and significant effect on cardiovascular risk. While there is evidence that strong inflammation suppression with tumour necrosis factor-α (TNF-α) inhibitors may reduce cardiovascular risk, some medications, such as Janus kinase (JAK) inhibitors, should be carefully considered due to potential side effects. In order to outline the epidemiology and pathophysiology of the PsA-cardiovascular risk nexus, this narrative review synthesises recent data. It also offers a critical framework for managing cardiovascular risk in this susceptible group, advocating for a multidisciplinary approach that incorporates strict management of both inflammation and traditional risk factors to lessen the excessive burden of MACE.

Background/Objectives: Parkinson’s disease (PD) and hypertension are often coexistent conditions that interact in entwined ways at various levels. Cardiovascular autonomic dysfunction (CAD), a non-motor feature of PD occurring across all stages, alters blood pressure (BP) regulation. Methods: We conducted a cross-sectional study enrolling patients with PD and primary hypertension, without diabetes mellitus or other causes of secondary CAD, aiming to characterize BP profiles/patterns by ambulatory BP monitoring. We also sought associations between different CAD phenotypes and PD characteristics, disability, and cardiovascular comorbidities. Results: We included 47 patients with a median age of 71 years, PD duration of 9 years, and Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III score of 40. Diurnal and nocturnal BP values were within the reference range, but BP load was excessive. Almost one-third had neurogenic orthostatic hypotension (OH) and 80% were non-dippers. The overall burden of non-motor symptoms was significant in these phenotypes. Patients with neurogenic OH were more prone to constipation, anxiety, and urinary problems, whereas gustatory dysfunction, loss of libido, and erectile dysfunction were more frequently reported by non-dippers. No significant differences with regard to cognitive decline were identified in subjects with and without neurogenic OH. Neurogenic OH was symptomatic in 78% of the cases, whereas 56% of those with orthostatic symptoms did not have OH at repeated measurements. Conclusions: Neurogenic OH is an independent predictor of disability in patients with PD and hypertension, after adjusting for PD duration, Hoehn and Yahr stage, levodopa equivalent daily dose (LEDD), and Montreal Cognitive Assessment (MoCA) score.

Patients with severe mental illness (SMI) have a high risk for diabetes, dyslipidemia, and other components of metabolic syndrome. Patients with these metabolic comorbidities and cardiac risk facto...

Background and aims. In cancer patients sarcopenia may be a predictor for postoperative complications of curative or palliative surgery. Several indices including the total psoas area index (TPAI) are proposed for the diagnosis of this condition, but there is no validated cut-off point. Our study aimed to assess the role of TPAI as a marker for sarcopenia and to compare the utility of previously proposed cut-off values for predicting post-operative complications in patients with digestive cancers undergoing surgery. Methods. We retrospectively included all adult patients with digestive cancers admitted to a tertiary center for elective surgery between January and December 2019. Sarcopenia was considered based on TPAI evaluated on abdominal computed tomography (CT) and for analysis we used different cut-off points published by various authors. The primary endpoint was the occurrence of any complications as defined by the Clavien-Dindo classification. The secondary endpoints were fistula development, low– versus high-grade Clavien-Dindo post-operative complications, moderate or severe anemia at discharge, major bleeding, hypoalbuminemia at discharge, and decrease in albumin levels by at least 1g/dL. Results. We included 155 patients with a mean age of 64.78 ± 11.40 years, of which 59.35% were males; 58.06% developed postoperative complications. TPAI evaluated as a continuous variable was not a predictor for the development of post-operative complications neither in the general study sample, nor in the gender subgroups of patients. Sarcopenia defined by previously proposed cut-off values was not a predictor of the secondary end-points either. Conclusion. TPAI as a sole parameter for defining sarcopenia was not a predictor for postoperative complications in patients undergoing surgery for digestive neoplasia.

Antipsychotics represent the mainstay in the treatment of patients diagnosed with major psychiatric disorders. Hypertension, among other components of metabolic syndrome, is a common finding in the...

(1) Background: Parkinson’s disease and arterial hypertension are likely to coexist in the elderly, with possible bidirectional interactions. We aimed to assess the role of antihypertensive agents in PD emergence and/or progression. (2) We performed a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease who underwent treatment with drugs pertaining to one of the major antihypertensive drug classes (β-blockers, diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and calcium-channel blockers) prior to or after the diagnosis of parkinsonism were scrutinized. We divided the outcome into two categories: neuroprotective and disease-modifying effect. (3) We included 20 studies in the qualitative synthesis, out of which the majority were observational studies, with only one randomized controlled trial. There are conflicting results regarding the effect of antihypertensive drugs on Parkinson’s disease pathogenesis, mainly because of heterogeneous protocols and population. (4) Conclusions: There is low quality evidence that antihypertensive agents might be potential therapeutic targets in Parkinson’s disease, but this hypothesis needs further testing.

(1) Background: Cardiovascular autonomic dysfunction is a non-motor feature in Parkinson’s disease with negative impact on functionality and life expectancy, prompting early detection and proper management. We aimed to describe the blood pressure patterns reported in patients with Parkinson’s disease, as measured by 24-h ambulatory blood pressure monitoring. (2) Methods: We conducted a systematic search on the PubMed database. Studies enrolling patients with Parkinson’s disease undergoing 24-h ambulatory blood pressure monitoring were included. Data regarding study population, Parkinson’s disease course, vasoactive drugs, blood pressure profiles, and measurements were recorded. (3) Results: The search identified 172 studies. Forty studies eventually fulfilled the inclusion criteria, with 3090 patients enrolled. Abnormal blood pressure profiles were commonly encountered: high blood pressure in 38.13% of patients (938/2460), orthostatic hypotension in 38.68% (941/2433), supine hypertension in 27.76% (445/1603) and nocturnal hypertension in 38.91% (737/1894). Dipping status was also altered often, 40.46% of patients (477/1179) being reverse dippers and 35.67% (310/869) reduced dippers. All these patterns were correlated with negative clinical and imaging outcomes. (4) Conclusion: Patients with Parkinson’s disease have significantly altered blood pressure patterns that carry a negative prognosis. Ambulatory blood pressure monitoring should be validated as a biomarker of PD-associated cardiovascular dysautonomia and a tool for assisting therapeutic interventions.

Given the involvement of chronic inflammation in the pathophysiology of heart failure (HF) and the impact of inflammation on different leucocyte subpopulations, monocyte and lymphocyte counts were related to mortality in these patients. Our aim was to determine the utility of LMR in predicting medium-term all-cause mortality of heart failure patients. Patients with heart failure admitted to our clinic from January 2011 to December 2014 were included in this study. Patients with acute coronary syndromes, pulmonary embolisms, and in hospital mortality were excluded. Clinical, laboratory and echocardiographic parameters were recorded for all patients on admission. Survival status was assessed in January 2016. Our sample consisted of 612 HF patients, 337 (55.07%) female, with a mean age of 70.19 ± 11.18 years. Median (interquartile range) LMR was 2.88 (2.00; 4.04). LMR was inversely correlated with NT-proBNP levels (r = −0.463, p < 0.001), NYHA class (r = −0.423, p < 0.001), and length of hospital stay (r = −329, p < 0.001), and directly correlated to ejection fraction (r = 305, p < 0.001). Mortality rate was 28.69% during a median follow-up time of 3.7 (2; 5) years. In the entire study group, lower LMR predicted all-cause mortality with an AUC of 0.716 (95%CI 0.671–0.762), p < 0.001. Mortality was inversely proportional to LMR quartiles from 76 (50.33%) in first quartile to 15 (10.13%) in the fourth one, p for trend < 0.001. Patients in the first LMR quartile had an OR of 3.73 (95%CI 2.52–5.52), p < 0.001 for all-cause mortality. We therefore established the cut-off for adverse outcome at a LMR < = 2, the upper limit of the first quartile. In multiple logistical regression forward conditional method, LMR < = 2 was an independent predictor of mortality with a HR of 1.67 (95% CI 1.03–2.69), p = 0.035, after adjusting for age, sex, ejection fraction and NYHA class. LMR is an inexpensive, readily-available inflammation biomarker useful as an independent predictor of mortality in HF patients, with additional value alongside the classical prognostic parameters. We suggest the cut-off value of LMR < = 2 as an indicator of poor prognosis in HF patients.

G.A. Dan, A. Dan, A. Buzea, D. Sipciu, C. Adam; P-468 Atrial fibrillation worsens left ventricular function in patients with heart failure and controlled heart