Paula Cristina Morariu

Background/Objectives: We compared echocardiographic indices with galectin-3 and pentraxin-3 for discriminating established heart failure (HF). Methods: This exploratory cross-sectional secondary analysis included 131 coronary angiography patients: 69 with stage C HF and 62 without an established clinical HF syndrome. Patients with HF were clinically stable without symptoms at rest and were classified as New York Heart Association (NYHA) II or III at study evaluation. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP), the combined mitral Doppler index E/(Em × Sm), right ventricular systolic annular velocity, and both biomarkers were assessed using paired receiver operating characteristic comparisons and clinically adjusted logistic regression. Results: TAPSE/PASP had the highest numerical area under the curve (AUC 0.753; 95% confidence interval 0.671–0.835) and outperformed galectin-3 (AUC 0.500; Holm-adjusted p = 0.0012). Its AUC difference from pentraxin-3 was nonsignificant. E/(Em × Sm) and pentraxin-3 had AUCs of 0.654 and 0.631. TAPSE/PASP retained an association with HF in the joint adjusted model (odds ratio 0.55 per standard deviation; p = 0.0423); E/(Em × Sm) did not. Pentraxin-3 remained associated in its separate adjusted model (odds ratio 1.70; p = 0.0212). NYHA-class and ejection-fraction subgroup differences were nonsignificant after multiplicity correction. Conclusions: TAPSE/PASP discriminated established HF better than galectin-3 in this cohort. The separate pentraxin-3 association warrants further investigation of complementary inflammatory information. These exploratory findings, models, and derived thresholds require independent validation before clinical application.

Background/Objectives: In cardiovascular-kidney-metabolic (CKM) syndrome, left atrium (LA) involvement begins early: reservoir function declines before the chamber dilates, and the resulting atrial cardiomyopathy (ACM) precedes atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), and cardioembolic stroke. How ACM is distributed across CKM stages has not yet been characterized in routine clinical practice. ATRIO-CKM aims to characterize ACM non-invasively across the range of CKM stages in patients assessed in an internal medicine and cardiology department and to identify the parameters most strongly associated with ACM within CKM syndrome. Methods: Single-center, prospective, observational study with cross-sectional phenotyping at the index visit. We will enroll consecutive adults at their first assessment in our department (target, 200; minimum, 150). The primary objective is to estimate the stage-specific prevalence of ACM among participants in sinus rhythm without documented AF, who form the main cohort and are grouped as CKM with versus without ACM. Patients in sinus rhythm are phenotyped with 12-lead electrocardiogram (P-wave duration, Bayés interatrial block), echocardiography with speckle-tracking of the left ventricle (LV), LA (biplane reservoir, conduit, and contractile strain), and right ventricular (RV) free wall, and biomarkers including MR-proANP, Fetuin-A, FGF-23, and NT-proBNP, with cardiac magnetic resonance in an exploratory subset. Participants with AF documented at any time, including previously documented paroxysmal AF, are allocated to a separate established-AF cohort irrespective of the rhythm at the index visit. Results: We will report ACM prevalence by CKM stage with confidence intervals, the profile separating the two groups, LA volume index across three groups of increasing severity (no ACM, ACM in sinus rhythm, and established AF), and the parameters associated with ACM. Conclusions: Using only measurements already available in routine cardiology, ATRIO-CKM will describe how ACM is distributed across CKM stages and identify the parameters most strongly associated with ACM within CKM syndrome, as candidates for a classification index to be developed and validated in a larger cohort.

Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of major adverse limb events and mortality, particularly in patients with diabetes mellitus (DM). The Global Limb Anatomic Staging System (GLASS) standardizes anatomical assessment and supports revascularization planning. This study evaluated the association of anatomical complexity and diabetes with immediate technical success after infrainguinal endovascular treatment. Methods: This single-center retrospective study included 136 patients undergoing infrainguinal endovascular procedures for CLTI between May 2021 and May 2023, stratified into diabetic (n = 85) and non-diabetic (n = 51) groups. Anatomical complexity was assessed using GLASS. Technical success was defined as restoration of inline flow to the foot. Logistic regression and receiver operating characteristic analyses were performed. Results: Technical success was achieved in 74.3% of procedures, without significant differences between diabetic and non-diabetic patients (75.3% vs. 72.5%, p = 0.723). Success declined progressively from 86.3% in GLASS stage I to 75.5% in stage II and 53.1% in stage III (p = 0.003; trend p = 0.001). In multivariable analysis, GLASS FP (femoropopliteal) grade ≥2 (adjusted OR 8.068, 95% CI 3.018–21.562; p < 0.001) and tibioperoneal trunk occlusion (adjusted OR 4.874, 95% CI 1.271–18.687; p = 0.021) were independently associated with technical failure, whereas diabetes was not. The model showed good discrimination (AUC 0.820, 95% CI 0.744–0.897; p < 0.001). Conclusions: Anatomical complexity was associated with immediate technical success in CLTI, whereas no independent association with diabetes was detected in this cohort. GLASS may provide clinically relevant preprocedural risk stratification and support endovascular planning.

Background/Objectives: Retinal artery occlusion (RAO) represents an ischemic event of the anterior circulation, driven by impaired blood flow through the ophthalmic branches of the internal carotid artery. Atrial fibrillation (AF) is an increasingly recognized cardioembolic source in patients with RAO, yet its prevalence remains poorly characterized. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of AF in RAO patients and to summarize evidence on its incidence and association with this condition. Methods: Four databases were searched through April 2025, updated on 18 August 2026. Studies reporting AF prevalence, incidence, or association in adults with RAO were included. Pooled prevalence was estimated using the Freeman–Tukey double arcsine transformation with a random-effects model. Subgroup analyses, meta-regression, and sensitivity analyses were performed to explore heterogeneity. Results: Sixty-two studies were included in the qualitative synthesis, of which 58 reported AF prevalence data. Among the 36 studies comprising 139,222 patients, the pooled AF prevalence was 11.53% (95% CI: 9.41–13.82; I² = 99.2%; prediction interval: 2.00–26.9%). AF prevalence was significantly higher in patients aged ≥70 years (15.86%) and in central RAO cohorts (16.54%). Incident AF following RAO ranged from 10.5% to 41%, increasing progressively with monitoring intensity. The pooled odds ratio for the AF–RAO association was 1.56 (95% CI: 1.06–2.29). Conclusions: AF affects approximately one in nine patients with RAO, though with substantial uncertainty across populations (prediction interval 2.00–26.9%); the extent to which this exceeds the general-population estimates independent of age, cardiovascular risk profile, and geographic factors remains uncertain. These findings support cardiac rhythm surveillance following RAO diagnosis in selected patients, although its effect on clinical outcomes remains to be established prospectively.

Background and Objectives: Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral arterial disease and is associated with an increased risk of major amputation, particularly in patients with diabetes, in whom arterial disease frequently presents with distinct anatomical patterns. While global scores are widely used, the impact of lesion morphology on procedural outcomes is less clearly defined. This study aims to evaluate the distribution of lesion types (stenoses versus occlusions) and their association with the technical success of endovascular revascularization in CLTI, with a focus on differences between diabetic and non-diabetic patients. Materials and Methods: This retrospective study included 136 consecutive patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular revascularization at the Vascular Surgery Department of the “Sf. Spiridon” Clinical Emergency Hospital, Iași, Romania, between May 2021 and May 2023, comprising 85 (62.5%) diabetic and 51 (37.5%) non-diabetic patients. The mean age of the study population was 69.9 ± 9.7 years, and 38 (27.9%) patients were female. Baseline demographic characteristics and major comorbidities were broadly comparable between the two groups. Angiographic lesions were classified according to the degree of luminal narrowing as non-significant stenosis (Results: Diabetic patients had more frequent stenotic lesions (55.3% vs. 35.3%, p = 0.024) at the infrapopliteal level, whereas non-diabetic patients had more frequent occlusive lesions (96.1% vs. 83.5%, p = 0.028) at the femoropopliteal level. These differences were associated with procedural outcomes. Occlusive lesions, especially at key anatomical segments, were associated with an increased risk of technical failure, whereas stenotic lesions were more frequently associated with successful endovascular revascularization. Conclusions: Morphological characteristics of lesions play a critical role in determining the success of procedures in CLTI. Stenotic lesions in diabetic patients suggest a distinct vascular phenotype that may influence revascularization strategies. The results highlight the importance of detailed lesion assessment in planning interventions, beyond the use of conventional scores.

Central retinal artery occlusion (CRAO) is an acute ophthalmic emergency causing irreversible vision loss due to retinal ischemia. Inflammation is increasingly recognized as a contributor to vascular occlusions, but the relationship between systemic inflammatory biomarkers and structural retinal damage in CRAO remains unclear. This retrospective study included 37 patients with non-arteritic CRAO presenting within 168 h of symptom onset. Optical coherence tomography (OCT) classified ischemic severity as mild, moderate, or severe based on inner retinal morphology. Systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI), were calculated from admission blood tests, and associations were analyzed using ordinal logistic regression. Increasing severity correlated with higher NLR and SII values (p < 0.05). Univariable analysis showed significant associations for NLR, SII, neutrophil count, white blood cell count, and central macular thickness (CMT). Multivariable regression identified NLR (OR = 8.398, p = 0.007) and CMT (OR = 1.052, p = 0.001) as independent predictors of greater ischemic damage. Other indices were not significant. These findings indicate that NLR is the primary systemic inflammatory predictor of OCT-defined severity in acute CRAO, with CMT providing complementary structural information.

Atrial fibrillation (AF) frequently coexists with chronic coronary syndrome (CCS), reflecting shared cardiovascular risk factors and structural remodeling pathways. Identifying CCS patients at increased likelihood of AF remains clinically relevant, particularly when arrhythmia is silent or paroxysmal. Background: We hypothesized that established clinical and angiographic risk scores used in CCS may capture cumulative cardiovascular burden and could therefore assist in AF risk stratification. The biomarker-based ABC-stroke score was incorporated as a biological reference framework reflecting myocardial stress and injury. Methods: This prospective, single-center proof-of-concept study included 131 consecutive patients undergoing invasive coronary angiography for suspected myocardial ischemia. Patients were classified according to rhythm status, irrespective of AF subtype. Coronary artery disease severity was quantified using the Gensini and SYNTAX (PCI and CABG) scores. Global cardiovascular risk was assessed using Framingham, ASCVD, SCORE2, and SCORE2-OP. Correlation analyses, ROC curves, and multivariable logistic regression were performed to evaluate associations between risk scores, coronary complexity, and AF. Results: Clinical and angiographic risk scores differed significantly according to rhythm status and AF phenotype. Patients with AF exhibited higher global cardiovascular risk and greater coronary anatomical complexity compared with those in sinus rhythm. SYNTAX PCI and SYNTAX CABG demonstrated moderate discriminative performance for AF detection (AUC 0.745 and 0.760, respectively), with SYNTAX CABG remaining independently associated with AF in multivariable analysis. Significant correlations were observed between traditional cardiovascular risk scores and SYNTAX-derived measures of coronary complexity, whereas correlations with the Gensini score were weaker. The ABC-stroke reference model showed a strong discriminative signal, consistent with its biological proximity to AF-related myocardial stress. Conclusions: Established clinical and angiographic risk scores used in CCS are associated with the presence and phenotype of AF. These findings suggest that routinely available coronary risk assessment tools may serve as practical instruments for identifying CCS patients at increased likelihood of AF, potentially facilitating targeted rhythm screening and earlier risk stratification.