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Banovic M, Iung B, Putnik S, Mahendiran T, Vanderheyden M, Barbato E, Bartunek J. Asymptomatic Aortic Stenosis: From Risk Stratification to Treatment. Am J Cardiol 2024; 218:51-62. [PMID: 38432341 DOI: 10.1016/j.amjcard.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Our understanding of the natural history of aortic stenosis has significantly increased over the last decade. There have been considerable advances in the diagnosis and risk stratification of patients with aortic stenosis and in surgical and anesthetic techniques. In addition, transcatheter aortic valve replacement has established itself as a viable alternative to surgical management. Inevitably, these developments have raised questions regarding the merits of waiting for symptom onset in asymptomatic patients with severe aortic stenosis before offering treatment. Recent observational and randomized trial data suggest that early intervention in asymptomatic patients with severe aortic stenosis and normal left ventricular function may confer a prognostic advantage to a watchful waiting strategy. In this review, we highlight advances in the management and risk stratification of patients with asymptomatic severe aortic stenosis with particular consideration of recent findings supporting early valvular intervention.
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Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, Serbia.
| | - Bernard Iung
- Cardiology Department, Bichat Hospital APHP and Université Paris Cité, France
| | - Svetozar Putnik
- Belgrade Medical Faculty, University of Belgrade, Serbia; Cardiac-Surgery Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Thabo Mahendiran
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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2
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Zivkovic M, Tomovic S, Busic I, Zivic K, Vukcevic V, Wojakowski W, Binder RK, Banovic M. Acute Coronary Syndrome Following Transcatheter Aortic Valve Replacement. Curr Probl Cardiol 2024; 49:102016. [PMID: 37544628 DOI: 10.1016/j.cpcardiol.2023.102016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
Extending the indication of transcatheter aortic valve replacement (TAVR) to younger and lower-risk patients naturally results in longer life expectancy and survival rates after the intervention. The longer life expectancy of these patients leads to an increased possibility of future acute coronary events, necessitating the development of effective and appropriate treatment strategies. Acute coronary syndromes (ACS) in patients with previous TAVR procedures present with modified clinical characteristics when compared to the non-TAVR population. In populations with prior TAVR procedures, plaque rupture remains the main cause of ACS. However, unlike the non-TAVR population, there is an increased frequency of nonatherotrombotic mechanisms, like emboli and mechanical obstruction of coronary ostia by valve components. The main observation related to the treatment of ACS TAVR patients is the significantly lower percentage of patients undergoing invasive management. Furthermore, ACS in TAVR patients is associated with poor prognosis, higher long-term mortality rates, and higher incidence of MACE. It is surprising that considering this significant and increasingly recognized issue, there are only a few studies that have investigated ACS after TAVR. The scope of the present review is to address available data about ACS following TAVR, focusing on incidence, timing, mechanism, and causes. We also examined current knowledge regarding optimal invasive treatment and analyzed short and long-term clinical outcomes.
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Affiliation(s)
- Milorad Zivkovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sara Tomovic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Busic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Katarina Zivic
- Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Vladan Vukcevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ronald K Binder
- Department of Internal Medicine II, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia.
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3
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Banovic M, Putnik S, Iung B. Fostering heart team values: the fourth Belgrade Valve International Symposium. Eur Heart J 2023; 44:4300-4302. [PMID: 37571854 DOI: 10.1093/eurheartj/ehad494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
| | - Svetozar Putnik
- Belgrade Medical Faculty, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
- Department of Cardiac-Surgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia
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4
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Banovic M, Rajani R. Editorial: Advances in the imaging and treatment of valvular heart disease: "rising to the challenge". Front Cardiovasc Med 2023; 10:1276202. [PMID: 37745107 PMCID: PMC10513464 DOI: 10.3389/fcvm.2023.1276202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ronak Rajani
- Cardiovascular Directorate, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
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Banovic M, Iung B, Wojakowski W, Van Mieghem N, Bartunek J. Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications. Struct Heart 2023; 7:100201. [PMID: 37745683 PMCID: PMC10512009 DOI: 10.1016/j.shj.2023.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 09/26/2023]
Abstract
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
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Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bernard Iung
- University of Paris, Paris, France
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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6
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Banovic M. Understanding the Heart Failure Evolution as an Important Step toward Optimized Treatment. Cardiology 2023; 148:497-499. [PMID: 37562367 DOI: 10.1159/000533307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
- Belgrade Medical Faculty, Belgrade University, Belgrade, Serbia
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Dattani A, Brady EM, Alfuhied A, Gulsin GS, Steadman CD, Yeo JL, Aslam S, Banovic M, Jerosch-Herold M, Xue H, Kellman P, Costet P, Cvijic ME, Zhao L, Ebert C, Liu L, Gunawardhana K, Gordon D, Chang CP, Arnold JR, Yates T, Kelly D, Hogrefe K, Dawson D, Greenwood J, Ng LL, Singh A, McCann GP. Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis. Open Heart 2023; 10:e002441. [PMID: 37586847 PMCID: PMC10432628 DOI: 10.1136/openhrt-2023-002441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes. METHODS Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death. RESULTS Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%±3.1% vs 24.8%±2.4%, p=0.020), lower myocardial perfusion reserve (2.02±0.75 vs 2.34±0.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%±21% vs 77%±17%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log10renin: 3.27±0.59 vs 2.82±0.69 pg/mL, p<0.001) were found in diabetes. Multivariable Cox regression analysis showed diabetes was not associated with cardiovascular outcomes, but was independently associated with all-cause mortality (HR 2.04, 95% CI 1.05 to 4.00; p=0.037). CONCLUSIONS In patients with moderate-to-severe AS, diabetes is associated with reduced exercise capacity, increased diffuse myocardial fibrosis and microvascular dysfunction, but not cardiovascular events despite a small increase in mortality.
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Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aseel Alfuhied
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Christopher D Steadman
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Jian L Yeo
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Saadia Aslam
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marko Banovic
- Cardiology Department, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Hui Xue
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter Kellman
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Lei Zhao
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - Laura Liu
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - David Gordon
- Bristol Myers Squibb Co, Princeton, New Jersey, USA
| | | | - J Ranjit Arnold
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Damian Kelly
- Cardiology Department, Royal Derby Hospital, Derby, UK
| | - Kai Hogrefe
- Cardiology Department, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Dana Dawson
- Cardiovascular Medicine Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Greenwood
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Biomedical Imaging Sciences, University of Leeds, Leeds, UK
| | - Leong L Ng
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Iung B, Banovic M. Added value of heart valve clinics in the management of asymptomatic aortic stenosis. Heart 2023; 109:581-582. [PMID: 36702541 DOI: 10.1136/heartjnl-2022-322101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Bernard Iung
- Cardiology, Bichat -Claude-Bernard Hospital Cardiology Service, Paris, France
| | - Marko Banovic
- University Clinical Center of Serbia, Belgrade, Serbia
- Belgrade Medical School, Belgrade, Serbia
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9
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Banovic M, Poglajen G, Vrtovec B, Ristic A. Contemporary Challenges of Regenerative Therapy in Patients with Ischemic and Non-Ischemic Heart Failure. J Cardiovasc Dev Dis 2022; 9:jcdd9120429. [PMID: 36547426 PMCID: PMC9783726 DOI: 10.3390/jcdd9120429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/11/2022] [Accepted: 10/26/2022] [Indexed: 12/02/2022] Open
Abstract
It has now been almost 20 years since first clinical trials of stem cell therapy for heart repair were initiated. While initial preclinical data were promising and suggested that stem cells may be able to directly restore a diseased myocardium, this was never unequivocally confirmed in the clinical setting. Clinical trials of cell therapy did show the process to be feasible and safe. However, the clinical benefits of this treatment modality in patients with ischemic and non-ischemic heart failure have not been consistently confirmed. What is more, in the rapidly developing field of stem cell therapy in patients with heart failure, relevant questions regarding clinical trials' protocol streamlining, optimal patient selection, stem cell type and dose, and the mode of cell delivery remain largely unanswered. Recently, novel approaches to myocardial regeneration, including the use of pluripotent and allogeneic stem cells and cell-free therapeutic approaches, have been proposed. Thus, in this review, we aim to outline current knowledge and highlight contemporary challenges and dilemmas in clinical aspects of stem cell and regenerative therapy in patients with chronic ischemic and non-ischemic heart failure.
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Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, 11000 Beograd, Serbia
- Belgrade Medical School, 11000 Belgrade, Serbia
- Correspondence: (M.B.); (G.P.)
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Medical Faculty Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: (M.B.); (G.P.)
| | - Bojan Vrtovec
- Advanced Heart Failure and Transplantation Center, Department of Cardiology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
- Department of Internal Medicine, Medical Faculty Ljubljana, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Arsen Ristic
- Cardiology Department, University Clinical Center of Serbia, 11000 Beograd, Serbia
- Belgrade Medical School, 11000 Belgrade, Serbia
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10
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Banovic M, Rajani R. Do all patients with asymptomatic severe aortic stenosis need treatment? Expert Rev Cardiovasc Ther 2022; 20:787-793. [PMID: 36243000 DOI: 10.1080/14779072.2022.2137491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Although guidelines recommend a watchful waiting strategy for patients with asymptomatic severe aortic stenosis, there have been considerable advancements in surgical and anaesthetic techniques along with the success of transcatheter aortic valve replacement (AVR) as a viable alternative to surgical AVR. Inevitably, these developments have raised questions as to whether or not there is still merit in waiting for symptoms to ensue before treatment may offered to these patients. AREA COVERED The principal purpose of this paper is to review the data supporting earlier intervention in patients with asymptomatic severe aortic stenosis, and to project the implications these and other ongoing trials will have on indications for AVR in asymptomatic patients in the future. EXPERT OPINION The threshold for intervention in certain subgroups of asymptomatic patients with severe AS has already been lowered. The next frontier will inevitably be determining whether all patients with severe AS should undergo AVR irrespective of their symptomatic status.
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Affiliation(s)
- Marko Banovic
- University Clinical Center of Serbia, Belgrade, Serbia.,Belgrade Medical Faculty, Belgrade, Serbia
| | - Ronak Rajani
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, UK
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Boskovic N, Giga V, Dedic S, Ostojic M, Karadzic T, Rakocevic I, Aleksandric S, Petrovic O, Tesic M, Jovanovic I, Nedeljkovic I, Banovic M, Beleslin B, Djordjevic-Dikic A. Additive negative prognostic value of coronary flow reserve in patients with left bundle branch block without inducible ischemia and without known coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left bundle branch block (LBBB) can be isolated thing, but it is also often associated with underlying coronary artery disease (CAD). Stress echocardiography (SECHO) is widely used as an imaging method for the diagnosis of CAD. However, the diagnostic value of stress echocardiography in patients (pts) with LBBB is limited.
Purpose
To evaluate negative prognostic value of coronary flow reserve (CFR) in pts with LBBB without inducible ischemia and without known CAD.
Methods
This retrospective study included 224 pts (98, 43.8% male gender, average age 66±11 years) with LBBB and without known CAD. All the pts had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), Duke treadmill score, functional capacity (Metabolic Equivalents - METs) were recorded in all pts. Out of 224 pts, in 64 (29.5%) coronary flow reserve on the left anterior descending artery was assessed using pulsed Doppler echocardiography with adenosine in a dose of 140μcg/kg/body weight during 3 minutes. As the normal value we took value of CFR ≥2. Median follow up of the pts was 72 months (IQR 56.25–132 months) for the occurrence of MACE (cardiovascular death (CVD), non-fatal myocardial infarction (nfMI), coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI).
Results
Out of 224 pts, 6 (2.7%) had positive SECHO test, 2 pts (0.9%) had died due to non-cardiac causes and 11 pts (4.9%) were lost to follow up so they were excluded from further analysis. The remaining 204 pts were divided in 2 groups: 1. pts with only negative SECHO (n=144, 68.8%); 2. pts with negative SECHO and normal CFR (n=64, 31.2%). During the follow-up period 22 out of 205 pts (10.7%) had an adverse event (6 CVD, 6 nfMI, 5 CABG, 8 PCI). Between the two groups there was no significant difference in risk factors and parameters of the SECHO test. Pts with CFR had significantly lower rate of MACE compared to the pts with only SECHO test (2, 3.1% vs 20, 14.2%, p=0.018, respectively). Using the Cox regression analysis, univariate predictors of MACE were insulin dependent diabetes (HR 10.851 [95% CI 2.095–56.220], p=0.004), Duke score (HR 0.603 [95% CI 0.414–0.878], p=0.008), and MET (HR 0.393 [95% CI 0.209–0.737], p=0.004). In the multivariate analysis only the insulin dependent diabetes remained an independent predictor of MACE (HR 6.906 [95% CI 1.100–43.363], p=0.039). Using the Kaplan-Meier survival curve we see that the pts with SECHO test and CFR had shorter event-free time compared to the pts with SECHO test (136.3±3.6 months vs 149.8±2.9 months, Log Rank 4.022, p=0.045) (Figure 1).
Conclusion
Normal value of CFR has good negative prognostic value in pts with LBBB without inducible ischemia and without known CAD, while pts with insulin dependent diabetes have more pronounced risk for the occurrence of adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Boskovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - V Giga
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - S Dedic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - M Ostojic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - T Karadzic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - I Rakocevic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - S Aleksandric
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - O Petrovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Tesic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - I Jovanovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - I Nedeljkovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Banovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - B Beleslin
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - A Djordjevic-Dikic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
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12
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Banovic M, Boskovic N, Bojanic M, Nedeljkovic I, Jovanovic M, Penicka M, Bartunek J. Early aortic valve replacement improves exercise capacity in truly asymptomatic patients with severe aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Exercise capacity is a strong predictor of morbidity and mortality overall. In severe aortic stenosis (AS) ustained pressure overload during watchful waiting is associated with LV structural and functional deterioration and impaired clinical outcome both pre- and post aortic valve replacement (AVR). The effect of early surgical aortic valve replacement (SAVR) in asymptomatic patients with severe AS and normal left ventricular function on exercise capacity in unknown.
Aim
We investigated whether the early surgical AVR in truly asymptomatic patients with severe aortic stenosis and normal LVEF improves the exercise capacity.
Methods
This is a sub-analysis or the AVATAR trial (NCT02436655), which is international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area ≤1 cm2 with aortic jet velocity >4 m/s or a mean transaortic gradient ≥40 mm Hg), and with normal left ventricular function. Patients underwent cardiopulmonary exercise testing (supine bicycle, ramp protocol, 15 W/min) at the baseline and 12 months following the randomization. Patients who had positive exercise testing at baseline visit were excluded. We compared the value of workload (in WATs), VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope at the inclusion and at 12 months.
Results
Total of 157 patients (mean age, 67 years; 57% men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79). Mean LVEF and Vmax in early surgery and conservative treatment group were 70% and 4.5m/s and 69% and 4.5m/s, respectively. After 12 months in patients with conservative treatment there was a slight decrease in the values of workload, VO2 max, VO2 AT, VE/VCO2 and PETCO2 slope, but without statistical significance. However operated patients showed a significant increase in workload (115.4±38.4 watts at 12 months vs 104.8±42.2 at inclusion, p=0.038) and VO2 max (19.7±6.8 at 12 months vs 16.2±5.4 at the inclusion, p=0.048), while there was slight increase in the values of VO2 AT, VEVCO2 and PETCO2 but without statistical significance.
Conclusion
Early SAVR improve the functional capacity in asymptomatic patients with severe aortic stenosis and normal left ventricular ejection fraction
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Banovic
- Clinical center of Serbia , Belgrade , Serbia
| | - N Boskovic
- Clinical center of Serbia , Belgrade , Serbia
| | - M Bojanic
- Clinical center of Serbia , Belgrade , Serbia
| | | | - M Jovanovic
- Clinical center of Serbia , Belgrade , Serbia
| | - M Penicka
- Olv Hospital Aalst , Aalst , Belgium
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13
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Aleksandric S, Al-Lamee R, Djordjevic-Dikic A, Giga V, Tesic M, Banovic M, Zobenica V, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Davies J, Beleslin B. Diagnostic accuracy of instantaneous wave-free ratio at rest and during dobutamine provocation to assess myocardial bridging relevance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diastolic fractional flow reserve (d-FFR) during dobutamine provocation (DOB) was found to be a more reliable physiological index for the functional assessment of myocardial bridging (MB). However, d-FFR calculation is complicated and time-consuming, and therefore several authors have suggested the use of instantaneous wave-free ratio (iFR) to overcome these issues.
Purpose
The aim of our study was to assess diagnostic performance of d-FFR and iFR at rest and during DOB with exercise-induced myocardial ischemia as reference.
Methods
Twenty-four symptomatic patients (17 males, mean age 58±8 years) with MB and systolic compression ≥50% diameter stenosis on the left anterior descending (LAD) artery were included. Exercise stress-echocardiography test (SE), and both d-FFR and iFR in the distal segment of LAD at rest and peak DOB (30–50μg/kg/min), were performed in all patients. Optimal cut-off values and diagnostic performance of resting and hyperemic d-FFR and iFR were assessed using SE.
Results
Exercise-SE was positive for myocardial ischemia in 7/24 patients (29%). The area-under-the-receiver-operating-characteristic curve (ROC-AUC) for exercise-induced myocardial ischemia was 0.64 (95% CI: 0.400–0.885) for resting d-FFR, 0.62 (95% CI: 0.378–0.866) for resting iFR, 1.000 (95% CI: 0.999–1.000) for d-FFR at peak DOB, and 0.96 (95% CI: 0.895–1.000) for iFR at peak DOB. No significant difference in ROC-AUC was observed between d-FFR and iFR at peak DOB (p=0.243). The best cut-off value for both d-FFR and iFR at peak DOB was <0.76 with similar sensitivity and negative predictive values (100 vs. 100% for both), but lower specificity and positive predictive value for iFR in identifying MB associated with exercise-induced ischemia (94% vs. 82%; 88% vs. 70%, respectively). Compared with exercise-induced myocardial ischemia, the diagnostic accuracy of d-FFR and iFR at peak DOB was 96% (kappa=0.903, p<0.001) and 88% (kappa=0.731, p<0.001), respectively.
Conclusions
iFR during DOB provocation showed similar diagnostic accuracy as d-FFR to identify the functionally significant MB when compared with exercise-induced myocardial ischemia.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - R Al-Lamee
- Imperial College London , London , United Kingdom
| | | | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tomasevic
- Clinical Center Kragujevac, Clinic for Cardiology , Kragujevac , Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - J Davies
- Imperial College London , London , United Kingdom
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
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14
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Banovic M, Putnik S, Iung B, Bartunek J. Response by Banovic et al to Letter Regarding Article, "Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial". Circulation 2022; 146:e48-e49. [PMID: 35939543 DOI: 10.1161/circulationaha.122.060918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, Serbia (M.B., S.P.).,Cardiology Department (M.B.), University Clinical Center of Serbia, Belgrade
| | - Svetozar Putnik
- Belgrade Medical Faculty, Serbia (M.B., S.P.).,Cardiac Surgery Department (S.P.), University Clinical Center of Serbia, Belgrade
| | - Bernard Iung
- Cardiology Department, Bichat Hospital APHP and Universite Paris Cité, France (B.I.)
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Aalst, Belgium (J.B.)
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15
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Aleksandric S, Banovic M, Beleslin B. Challenges in Diagnosis and Functional Assessment of Coronary Artery Disease in Patients With Severe Aortic Stenosis. Front Cardiovasc Med 2022; 9:849032. [PMID: 35360024 PMCID: PMC8961810 DOI: 10.3389/fcvm.2022.849032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
More than half of patients with severe aortic stenosis (AS) over 70 years old have coronary artery disease (CAD). Exertional angina is often present in AS-patients, even in the absence of significant CAD, as a result of oxygen supply/demand mismatch and exercise-induced myocardial ischemia. Moreover, persistent myocardial ischemia leads to extensive myocardial fibrosis and subsequent coronary microvascular dysfunction (CMD) which is defined as reduced coronary vasodilatory capacity below ischemic threshold. Therefore, angina, as well as noninvasive stress tests, have a low specificity and positive predictive value (PPV) for the assessment of epicardial coronary stenosis severity in AS-patients. Moreover, in symptomatic patients with severe AS exercise testing is even contraindicated. Given the limitations of noninvasive stress tests, coronary angiography remains the standard examination for determining the presence and severity of CAD in AS-patients, although angiography alone has poor accuracy in the evaluation of its functional severity. To overcome this limitation, the well-established invasive indices for the assessment of coronary stenosis severity, such as fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR), are now in focus, especially in the contemporary era with the rapid increment of transcatheter aortic valve replacement (TAVR) for the treatment of AS-patients. TAVR induces an immediate decrease in hyperemic microcirculatory resistance and a concomitant increase in hyperemic flow velocity, whereas resting coronary hemodynamics remain unaltered. These findings suggest that FFR may underestimate coronary stenosis severity in AS-patients, whereas iFR as the non-hyperemic index is independent of the AS severity. However, because resting coronary hemodynamics do not improve immediately after TAVR, the coronary vasodilatory capacity in AS-patients treated by TAVR remain impaired, and thus the iFR may overestimate coronary stenosis severity in these patients. The optimal method for evaluating myocardial ischemia in patients with AS and co-existing CAD has not yet been fully established, and this important issue is under further investigation. This review is focused on challenges, limitations, and future perspectives in the functional assessment of coronary stenosis severity in these patients, bearing in mind the complexity of coronary physiology in the presence of this valvular heart disease.
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Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- *Correspondence: Srdjan Aleksandric
| | - Marko Banovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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16
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Banovic M, Putnik S, Penicka M, Doros G, Deja MA, Kockova R, Kotrc M, Glaveckaite S, Gasparovic H, Pavlovic N, Velicki L, Salizzoni S, Wojakowski W, Van Camp G, Nikolic SD, Iung B, Bartunek J. Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis: The AVATAR Trial. Circulation 2022; 145:648-658. [PMID: 34779220 DOI: 10.1161/circulationaha.121.057639] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Surgical aortic valve replacement (SAVR) represents a class I indication in symptomatic patients with severe aortic stenosis (AS). However, indications for early SAVR in asymptomatic patients with severe AS and normal left ventricular function remain debated. METHODS The AVATAR trial (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) is an investigator-initiated international prospective randomized controlled trial that evaluated the safety and efficacy of early SAVR in the treatment of asymptomatic patients with severe AS, according to common criteria (valve area ≤1 cm2 with aortic jet velocity >4 m/s or a mean transaortic gradient ≥40 mm Hg), and with normal left ventricular function. Negative exercise testing was mandatory for inclusion. The primary hypothesis was that early SAVR would reduce the primary composite end point of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure compared with a conservative strategy according to guidelines. The trial was designed as event-driven to reach a minimum of 35 prespecified events. The study was performed in 9 centers in 7 European countries. RESULTS Between June 2015 and September 2020, 157 patients (mean age, 67 years; 57% men) were randomly allocated to early surgery (n=78) or conservative treatment (n=79). Follow-up was completed in May 2021. Overall median follow-up was 32 months: 28 months in the early surgery group and 35 months in the conservative treatment group. There was a total of 39 events, 13 in early surgery and 26 in the conservative treatment group. In the early surgery group, 72 patients (92.3%) underwent SAVR with operative mortality of 1.4%. In an intention-to-treat analysis, patients randomized to early surgery had a significantly lower incidence of primary composite end point than those in the conservative arm (hazard ratio, 0.46 [95% CI, 0.23-0.90]; P=0.02). There was no statistical difference in secondary end points, including all-cause mortality, first heart failure hospitalizations, major bleeding, or thromboembolic complications, but trends were consistent with the primary outcome. CONCLUSIONS In asymptomatic patients with severe AS, early surgery reduced a primary composite of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure compared with conservative treatment. This randomized trial provides preliminary support for early SAVR once AS becomes severe, regardless of symptoms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02436655.
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Affiliation(s)
- Marko Banovic
- Belgrade Medical School, University of Belgrade, Serbia (M.B., S.P.).,Cardiology Department (M.B.), University Clinical Center of Serbia, Belgrade
| | - Svetozar Putnik
- Belgrade Medical School, University of Belgrade, Serbia (M.B., S.P.).,Cardiac-Surgery Department (S.P.), University Clinical Center of Serbia, Belgrade
| | - Martin Penicka
- Cardiovascular Center, OLV Hospital, Aalst, Belgium (M.P., G.V.C., J.B.)
| | - Gheorghe Doros
- Boston University School of Public Health, Department of Biostatistics, MA (G.D.)
| | - Marek A Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland (M.A.D.)
| | - Radka Kockova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (R.K., M.K.)
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (R.K., M.K.)
| | - Sigita Glaveckaite
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (S.G.)
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University of Zagreb School of Medicine and University Hospital Center Zagreb, Croatia (H.G.)
| | - Nikola Pavlovic
- University Hospital Center Sestre Milosrdnice, Zagreb, Croatia (N.P.)
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, Serbia (L.V.).,Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia (L.V.)
| | - Stefano Salizzoni
- Division of Cardiosurgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy (S.S.)
| | - Wojtek Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (W.W.)
| | - Guy Van Camp
- Cardiovascular Center, OLV Hospital, Aalst, Belgium (M.P., G.V.C., J.B.)
| | | | - Bernard Iung
- Cardiology Department, Bichat Hospital APHP and Universite de Paris, France (B.I.)
| | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, Aalst, Belgium (M.P., G.V.C., J.B.)
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17
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Aleksandric S, Djordjevic-Dikic A, Tesic M, Giga V, Dobric M, Banovic M, Boskovic N, Juricic S, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Beleslin B. Cut-off value of coronary flow velocity reserve obtained by transthoracic Doppler echocardiography during intravenous infusion of dobutamine for diagnosis of functional significant myocardial bridging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies showed that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during inotropic stimulation with dobutamine (DOB), in comparison to vasodilation with adenosine, provides more reliable functional evaluation of myocardial bridging (MB). However, the adequate cut-off value of CFVR during DOB for diagnosing functional significant MB has not been fully established.
Purpose
The purpose of the study was to evaluate the adequate cut-off value of TTDE- CFVR during DOB for diagnosis of functional significant MB.
Methods
This prospective study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery (LAD) and systolic compression ≥50% diameter stenosis. Exercise stress-echocardiography test (ExSE) and TTDE-CFVR in the distal segment of LAD during DOB infusion (DOB: 10–40μg/kg/min) were performed in all patients. Percent diameter stenosis (DS) of MB at end-systole and end-diastole were analyzed using quantitative coronary angiography.
Results
Exercise-SE was positive for myocardial ischemia in 22/79 (28%). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (1.94±0.16 vs. 2.78±0.53, p<0.001). ROC analysis identifies the optimal CFVR during peak DOB cut-off value <2.1 (AUC 0.985, 95% CI: 0.965–1.000, p<0.001), with a sensitivity of 96% and specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%, for identifying functionally significant MB associated with stress-induced myocardial ischemia. The categorical agreement between TTDE-CFVR at peak DOB and ExSE was high (kappa value = 0.877, p<0.001). Multivariate logistic regression analysis showed that percent DS at end-diastole was the only independent predictor of ischemic CFVR value <2.1 (OR: 1.136, 95% CI: 1.045–1.235, p=0.003).
Conclusion
A cut-off value <2.1 of CFVR during DOB infusion obtained by TTDE may adequate discriminate functional significant MB that induce myocardial ischemia which is caused by an incomplete diastolic MB-decompression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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18
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Banovic M, Putnik S, Binder R. Living the heart team live on stage in Serbia cardiac surgeons and cardiologists met at the second BELgrade Valve International Symposium. Eur Heart J 2021; 43:6-8. [PMID: 34528686 DOI: 10.1093/eurheartj/ehab527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marko Banovic
- Belgrade Medical School, Dr Subotica Starijeg 8, Belgrade, Serbia.,Cardiology Dpt, University Clinical Centre of Serbia, Pasterova 2, Belgrade, Serbia
| | - Svetozar Putnik
- Belgrade Medical School, Dr Subotica Starijeg 8, Belgrade, Serbia.,Cardiac-surgery Dpt, University Clinical Centre of Serbia, Pasterova 2, Belgrade, Serbia
| | - Ronald Binder
- Dpt of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, Wels 4600, Austria
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19
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Nedeljkovic-Arsenovic O, Banovic M, Radenkovic D, Rancic N, Polovina S, Micic D, Nedeljkovic I. Five-Year Outcomes in Bariatric Surgery Patients. ACTA ACUST UNITED AC 2020; 56:medicina56120669. [PMID: 33287109 PMCID: PMC7761683 DOI: 10.3390/medicina56120669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Abstract
Background and objectives: Obesity presents as a multifactorial, pandemic disease that arises as a consequence of unequal energy intake and energy consumption. Obesity adversely affects the quality of life, leading not only to disability, but also to various other disorders. Bariatric surgery is the most effective method for achieving significant and sustained weight loss in individuals with extreme obesity. The aim of this study was to examine how well surgically induced weight loss is maintained after five years of follow-up and its effects on cardiovascular risk factors and outcome. Materials and Methods: This is a retrospective cross-sectional study of 66 patients with morbid obesity, with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and obesity-related health conditions, aged 20 to 61 years, mostly women (77.3%) who underwent laparoscopic Roux-en-Y gastric bypass surgery. Results: Average follow-up was 6.42 years (95% CI 6.30–6.54 years) after surgery, with survival rate of 97% in operated individuals. There was a statistically significant reduction of weight and body mass index 6 months and 5 years after surgery in comparison to the initial values (p < 0.001). Of 62 patients who presented weight loss at the end of the follow-up period, 38 were able to maintain the amount of weight loss that was attained 6 months after surgery, while 24 patients regained weight compared to their postoperative weight at 6 months. Two patients reported no weight loss after treatment. Significant weight reduction was associated with better control of diabetes and increased self-reported physical activity at 6 months and 5 years after surgery, as well as with a reduction of the use of anti-diabetic and anti-hypertensive medications. Conclusions: Our research demonstrates a positive long-term impact of bariatric surgery on patients’ health conditions, significant and sustained weight loss, and decrease in BMI, which were associated with a reduction of co-morbidities and risk factors for cardiovascular diseases.
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Affiliation(s)
- Olga Nedeljkovic-Arsenovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Correspondence: (O.N.-A.); (N.R.)
| | - Marko Banovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Dejan Radenkovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, 11000 Belgrade, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
- Correspondence: (O.N.-A.); (N.R.)
| | - Snezana Polovina
- Department of Endocrinology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Faculty of Pharmacy, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Dragan Micic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
| | - Ivana Nedeljkovic
- Department of Cardiology, Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (M.B.); (D.R.); (D.M.)
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20
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Banovic M, Iung B, Brkovic V, Aleksandric S, Mitrovic P, Nedeljkovic I, Popovic D, Jaukovic M, Asanin M, Penicka M, Bartunek J. Gender specific differences in functional capacity in asymptomatic patients with isolated severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS.
Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo)
There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max
Conclusion
Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Banovic
- Clinical center of Serbia, Belgrade, Serbia
| | - B Iung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | - V Brkovic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - P Mitrovic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - D Popovic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Jaukovic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
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21
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Banovic M, Bojanic M, Nikolic SD. Perspectives in the Treatment of Heart Failure with Preserved Ejection Fraction: From Drugs to Devices. Curr Top Med Chem 2020; 20:266-271. [DOI: 10.2174/156802662004200304124916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Marko Banovic
- Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Milica Bojanic
- Belgrade Medical School, University of Belgrade, Belgrade, Serbia
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22
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Mujovic N, Marinkovic M, Nedeljkovic I, Banovic M, Markovic N, Potpara T. P1866Catheter-ablation of paroxysmal atrial fibrillation is associated with improvement of maximal cardiopulmonary exercise capacity. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Catheter-ablation (CA) of paroxysmal atrial fibrillation (AF) is associated with improvement in symptoms and quality of life (QoL), whilst the effects on functional capacity are underreported. We studied the change in cardiopulmonary exercise testing (CPET) indices of functional capacity from baseline to follow-up in patients undergoing their first CA for paroxysmal AF.
Methods
Consecutive patients who underwent their first CA for paroxysmal AF in our center during 2015, with a >12-month post-procedural follow-up were included. All patients completed the CPET and SF-36 (Short Form Health Survey) questionnaire to evaluate maximal functional capacity and QoL, respectively, at baseline (prior to CA) and 1 year post-CA. The follow-up 24h-Holter-monitoring was performed at 1, 3, 6 and 12 months after CA; finding of any atrial tachyarrhythmia lasting >30 sec was considered the arrhythmia recurrence.
Results
Study group consisted of 50 patients (the mean age 57±12 years, males 76%). The mean left ventricular ejection fraction and left atrial diameter were 61±8% and 41±6 mm, respectively. All patients were free of heart failure; the commonest comorbidities were hypertension (65%) and diabetes mellitus (21%). The follow-up CPET 1 year post CA demonstrated an improvement in maximal functional capacity compared to baseline values, with significant increase in maximal load (123±38 vs. 134±33 W, p=0.012), peak oxygen consumption (VO2max, 18±5 vs. 20±4 mL kg–1 min–1, p=0.001) and peak breathing equivalent (EQ-O2, 28±4 vs. 29±4, p=0.020). The AF-free patients (n=40) had a greater 1-year improvement in work time (22±129 vs. −71±123 sec, p=0.008) and maximal load (15±24 vs. −6±26 W, p=0.005) compared with those expiriencing AF recurrence post-CA (n=10). There was a significant correlation between the 1-year change in SF-36 score and the increase in maximal load (ρ=0.26, p=0.018) and between the 1-year change in SF-36 score and the prolongation of work time (ρ=0.27, p=0.017).
Conclusion
Our study suggests that CA of paroxysmal AF favourably affects the maximal functional capacity, especially in patients with stable sinus rhythm following the procedure. The increase in functional capacity is followed by QoL improvement. This should be considered in treatment decision-making.
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Affiliation(s)
- N Mujovic
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - M Marinkovic
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - I Nedeljkovic
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - M Banovic
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - N Markovic
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - T Potpara
- Clinic of Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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Boskovic N, Markovic F, Petrovic MT, Giga V, Jovanovic I, Dedic S, Banovic M, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A. P1511Promising prognostic value of negative stress echocardiography in patients with incomplete revascularization after successful primary PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The specific role of non-invasive functional testing in a risk stratification of patients with incomplete revascularization after primary percutaneous coronary intervention (pPCI) still needs to be evaluated. The aim of our study was to assess negative prognostic value of stress echocardiography (SECHO) after successful pPCI and incomplete revascularization of non-culprit lesions.
Methods
Our study consisted of 202 patients (mean age 59±10 years, male 142) successfully treated with pPCI, who performed SECHO according to Bruce protocol in order to assess residual ischemia in coronary artery with non-culprit lesion. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), achieved target heart rate (THR), heart rate recovery (HRR), wall motion score index (WMSI) and ejection fraction were interrogated in all patients. Slow HRR was defined as ≤18 beats/min. Median follow-up of the patients was 70 months (IQR 55–83 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction. We also assessed the independent predictors for the occurrence of the adverse events.
Results
Out of 202 patients, 42 (20.8%) had positive SECHO test, 4 patients (1.98%) had died due to non-cardiac causes and 7 patients (3.5%) were lost to follow-up. From the remaining 149 patients with negative SECHO, 13 (8.7%) had an adverse event (7 cardiovascular deaths and 6 non-fatal MI). Negative predictive value of SECHO test was 91.3%. Univariate predictors of adverse events were slow HRR (HR 4.343 [95% CI 1.473–14.011], p=0.008), and not achieved THR (HR 0.322 [95% CI 0.105–0.985], p=0.047). By multivariate analysis, only slow HRR remained independent predictor of adverse events (HR 3.324 [95% CI 1.013–10.906], p=0.048).
Conclusion
SECHO test has excellent negative prognostic value in patients with incomplete revascularization of non-culprit lesions after successful pPCI. Still, particular care should be taken to the patients with slow HRR and negative SECHO due to increased risk for the occurrence of adverse events.
Acknowledgement/Funding
Ministry of Education and Science of the Republic of Serbia (Grant No III41022)
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - F Markovic
- University Belgrade Medical School, Belgrade, Serbia
| | - M T Petrovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Jovanovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - M Banovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Dobric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
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Banovic M, Iung B, Putnik S, Nikolic S, Penicka M, Deja M, Bartunek J. Addressing the Treatment Dilemma in Asymptomatic Aortic Stenosis: The AVATAR Trial. JACC Cardiovasc Imaging 2019; 12:1896-1897. [PMID: 31488255 DOI: 10.1016/j.jcmg.2019.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
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25
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Abstract
Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the prevalence of diabetes is substantially increased in patients with aortic stenosis and those with diabetes have increased rates of progression from mild to severe aortic stenosis. There are good data supporting the hypothesis that aortic stenosis and diabetes mellitus are associated with diabetes mellitus being detrimental towards the quality of life and survival of patients. Thus, a thorough understanding of the pathogenesis of both of these disease processes and the relationship between them aids in designing appropriate preventive and therapeutic approaches. This review aims to give a comprehensive and up-to-date insight into the influence of diabetes mellitus on patients with degenerative aortic stenosis, as well as the prognosis and therapeutic approach to these patients.
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Affiliation(s)
- Marko Banovic
- 1 Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- 2 Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Lavanya Athithan
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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26
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Aleksandric S, Djordjevic-Dikic A, Dobric M, Stepanovic J, Giga V, Banovic M, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Saponjski J, Nedeljkovic M, Stankovic G, Ostojic M, Beleslin B. THE ROLE OF DOBUTAMINE IN THE HEMODYNAMIC ASSESSMENT OF MYOCARDIAL BRIDGING: CORRELATIONS BETWEEN STRESS-INDUCED MYOCARDIAL ISCHEMIA, FRACTIONAL FLOW RESERVE AND QUANTITATIVE CORONARY ANGIOGRAPHY MEASUREMENTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Nedeljkovic-Arsenovic O, Banovic M, Radenkovic D, Rancic N, Polovina S, Micic D, Nedeljkovic I. The Amount of Weight Loss Six Months after Bariatric Surgery: It Makes a Difference. Obes Facts 2019; 12:281-290. [PMID: 31104054 PMCID: PMC6696766 DOI: 10.1159/000499387] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bariatric surgery, especially Roux-en-Y gastric bypass (RYGB), has become the most frequently used therapy for morbid obesity. OBJECTIVES The aim of this study was to examine the effects of surgically induced weight loss on cardiopulmonary function 6 months after the procedure, as well as the effect of such an intervention on well-known risk factors for cardiovascular diseases. METHODS This is a cross-sectional study on 66 morbidly obese patients (BMI ≥40 or ≥35 kg/m2 with present comorbidities), comparing their cardiopulmonary function prior to and 6 months after RYGB surgery. RESULTS The substantial amount of weight loss (29.80 ± 13.27 kg) after RYGB surgery was associated with significant reduction of comorbidities, especially diabetes and sedentary lifestyle (p = 0.005 and p = 0.002, respectively). Regarding functional capacity, there was significant increase in peak oxygen uptake (VO2 peak, p = 0.003), duration of exercise testing, metabolic equivalents (exercise time and METs, p < 0.001), and in peak O2 pulse. These findings were particularly pronounced in a group of patients who had lost more than 18% of initial weight. CONCLUSIONS Reduction of body weight after RYGB surgery is associated with significantly improved cardiorespiratory function 6 months after surgery, especially in patients who lost more than 18% of their initial body weight. In addition, substantial decreases in body weight were also associated with a reduction of cardiovascular risk factors such as diabetes, smoking, hypertriglyceridemia, and sedentary lifestyle.
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Affiliation(s)
| | - Marko Banovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - Dejan Radenkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Digestive Surgery, Belgrade, Serbia
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Snezana Polovina
- Clinical Center of Serbia, Department of Endocrinology, Belgrade, Serbia
- Faculty of Pharmacy, University of Novi Sad, Novi Sad, Serbia
| | - Dragan Micic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Endocrinology, Belgrade, Serbia
| | - Ivana Nedeljkovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
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28
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Wright D, Bwye A, Banovic M, Baulch J, Wang C, Hair S, Hammond N, Coutts B, Kehoe M. First Report of Dickeya dianthicola in Potatoes in Australia. Plant Dis 2018; 102:PDIS01180094PDN. [PMID: 30102581 DOI: 10.1094/pdis-01-18-0094-pdn] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- D Wright
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - A Bwye
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - M Banovic
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - J Baulch
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - C Wang
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - S Hair
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - N Hammond
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - B Coutts
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
| | - M Kehoe
- DPIRD Diagnostic Laboratory Services, Department of Primary Industries and Regional Development, Western Australia
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Nedeljkovic I, Banovic M, Trifunovic D, Beleslin B, Stankovic G, Nedeljkovic M, Vukcevic V, Stojkovic S, Giga V, Djordjevic-Dikic A, Stepanovic J, Dobric M, Mehmedbegovic Z, Ostojic MC. P6504Combined exercise stress echocardiography and cardiopulmonary exercise test in assessment of diastolic function in patients successfully treated with primary percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Nedeljkovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - M Banovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - D Trifunovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - B Beleslin
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - G Stankovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - M Nedeljkovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - V Vukcevic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - S Stojkovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - V Giga
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - A Djordjevic-Dikic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - J Stepanovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - M Dobric
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - Z Mehmedbegovic
- School of Medicine, Belgrade University, Division of Cardiology, CCS, Belgrade, Serbia
| | - M C Ostojic
- Institute for Cardiovascular Diseases Dedinje, Cardiology, Belgrade, Serbia
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30
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Banovic M, Pusnik-Vrckovnik M, Nakou E, Vardas P. Myocardial regeneration therapy in heart failure: Current status and future therapeutic implications in clinical practice. Int J Cardiol 2018; 260:124-130. [DOI: 10.1016/j.ijcard.2018.01.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022]
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31
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Roguljic A, Juretic A, Spagnoli G, Sarcevic B, Banovic M, Oreskovic LB. PO-341 The role of cancer/testis antigens from MAGE-A family and NY-ESO-1 in ductal carcinoma in situ (DCIS). ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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32
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Banovic M, DaCosta M. Degenerative Mitral Stenosis: From Pathophysiology to Challenging Interventional Treatment. Curr Probl Cardiol 2018; 44:10-35. [PMID: 29731112 DOI: 10.1016/j.cpcardiol.2018.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 01/01/2023]
Abstract
Mitral stenosis (MS) is characterized by obstruction of left ventricular inflow as a result of narrowing of the mitral valve orifice. Although its prevalence has declined over the last decade, especially in developed countries, it remains an important cause of morbidity and mortality. The most often cause of MS worldwide is still postrheumatic mitral valve disease. However, in developed countries, degenerative or calcific changes cause MS in a siginificant proportion of patients. Although the range of treatment for mitral valve disease has grown over the years in parallel with transcatheter therapies for aortic valve disease, these improvements in mitral valve disease therapy have experienced slower development. This is mainly due to the more complex anatomy of the mitral valve and entire mitral apparatus, and the interplay of the mitral valve with the left ventricle which hinders the development of effective implantable mitral valve devices. This is especially the case with degenerative MS where percutaneous or surgical comissurotomy is rarely employed due to the presence of extensive annular calcification and at the base of leaflets, without associated commissural fusion. However, the last few years have witnessed innovations in transcatheter interventional procedures for degenerative MS which consequently hinted that in the future, transcatheter mitral valve replacement could be the treatment of choice for these patients.
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33
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Banovic M, Bartunek J, Nikolic SD, Vukcevic V, Aleksandric S, Iung B. Percutaneous Treatment of Aortic Valve Disease: Contemporary Overview and Future Trends. Curr Pharm Des 2017; 23:4687-4695. [DOI: 10.2174/1381612822666161018162022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Vladan Vukcevic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Srdjan Aleksandric
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, DHU FIRE, and Paris-Diderot University, Paris, France
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Popovic D, Damjanovic S, Djordjevic T, Martic D, Ignjatovic S, Milinkovic N, Banovic M, Lasica R, Petrovic M, Guazzi M, Arena R. Stress hormones at rest and following exercise testing predict coronary artery disease severity and outcome. Stress 2017; 20:523-531. [PMID: 28845719 DOI: 10.1080/10253890.2017.1368488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Despite considerable knowledge regarding the importance of stress in coronary artery disease (CAD) pathogenesis, its underestimation persists in routine clinical practice, in part attributable to lack of a standardized, objective assessment. The current study examined the ability of stress hormones to predict CAD severity and prognosis at basal conditions as well as during and following an exertional stimulus. MATERIALS AND METHODS Forty Caucasian subjects with significant coronary artery lesions (≥50%) were included. Within 2 months of coronary angiography, cardiopulmonary exercise testing (CPET) on a recumbent ergometer was performed in conjunction with stress echocardiography (SE). At rest, peak and after 3 min of recovery following CPET, plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and NT-pro-brain natriuretic peptide (NT-pro-BNP) were measured by immunoassay sandwich technique, radioimmunoassay, and radioimmunometric technique, respectively. Subjects were subsequently followed a mean of 32 ± 10 months. RESULTS AND DISCUSSION Mean ejection fraction was 56.7 ± 9.6%. Subjects with 1-2 stenotic coronary arteries (SCA) demonstrated a significantly lower plasma cortisol levels during CPET compared to those with 3-SCA (p < .05), whereas ACTH and NT-pro-BNP were not significantly different (p > .05). Among CPET, SE, and hormonal parameters, cortisol at rest and during CPET recovery demonstrated the best predictive value in distinguishing between 1-, 2-, and 3-SCA [area under ROC curve 0.75 and 0.77 (SE = 0.11, 0.10; p = .043, .04) for rest and recovery, respectively]. ΔCortisol peak/rest predicted cumulative cardiac events (area under ROC curve 0.75, SE = 0.10, p = .049). CONCLUSIONS Cortisol at rest and following an exercise test holds predictive value for CAD severity and prognosis, further demonstrating a link between stress and unwanted cardiac events.
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Affiliation(s)
- Dejana Popovic
- a Division of Cardiology , University of Belgrade , Belgrade , Serbia
- b Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | | | - Tea Djordjevic
- b Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - Dejana Martic
- b Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | | | - Neda Milinkovic
- b Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - Marko Banovic
- a Division of Cardiology , University of Belgrade , Belgrade , Serbia
| | - Ratko Lasica
- a Division of Cardiology , University of Belgrade , Belgrade , Serbia
| | - Milan Petrovic
- a Division of Cardiology , University of Belgrade , Belgrade , Serbia
| | - Marco Guazzi
- d Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology , I.R.C.C.S, Policlinico San Donato University Hospital , Milan , Italy
| | - Ross Arena
- e Department of Physical Therapy, College of Applied Health Sciences , University of Illinois Chicago , Chicago , IL , USA
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35
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Banovic M, Nedeljkovic I, Brkovic V, Aleksandric S, Stepanovic J, Jaukovic M, Giga V, Beleslin B, Petrovic M. P6199Predictive value of ve/vco2 slope in discovering hfpef during combined cardiopulmonary/stress-echocardiography testing in patients with hypertension and normal systolic and diastolic function at rest. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Popovic D, Damjanovic SS, Plecas-Solarovic B, Pešić V, Stojiljkovic S, Banovic M, Ristic A, Mantegazza V, Agostoni P. Exercise capacity is not impaired after acute alcohol ingestion: a pilot study. J Cardiovasc Med (Hagerstown) 2017; 17:896-901. [PMID: 25083719 DOI: 10.2459/jcm.0000000000000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The usage of alcohol is widespread, but the effects of acute alcohol ingestion on exercise performance and the stress hormone axis are not fully elucidated.We studied 10 healthy white men, nonhabitual drinkers, by Doppler echocardiography at rest, spirometry, and maximal cardiopulmonary exercise test (CPET) in two visits (2-4 days in between), one after administration of 1.5 g/kg ethanol (whisky) diluted at 15% in water, and the other after administration of an equivalent volume of water. Plasma levels of NT-pro-BNP, cortisol, and adrenocorticotropic hormone (ACTH) were also measured 10 min before the test, at maximal effort and at the third minute of recovery. Ethanol concentration was measured from resting blood samples by gas chromatography and it increased from 0.00 ± 0.00 to 1.25 ± 0.54‰ (P < 0.001). Basal echocardiographic and spirometric parameters were normal and remained so after acute alcohol intake, whereas ACTH, cortisol, and NT-pro-BNP nonsignificantly increased in all phases of the test. CPET data suggested a trend toward a slight reduction of exercise performance (peak VO2 = 3008 ± 638 vs. 2900 ± 543 ml/min, ns; peak workload = 269 ± 53 vs. 249 ± 40 W, ns; test duration 13.7 ± 2.2 vs. 13.3 ± 1.7 min, ns; VE/VCO2 22.1 ± 1.4 vs. 23.3 ± 2.9, ns). Ventilatory equivalent for carbon dioxide at rest was higher after alcohol intake (28 ± 2.5 vs. 30.4 ± 3.2, P = 0.039) and maximal respiratory exchange ratio was lower after alcohol intake (1.17 ± 0.02 vs. 1.14 ± 0.04, P = 0.04). In conclusion, we showed that acute alcohol intake in healthy white men is associated with a nonsignificant exercise performance reduction and stress hormone stimulation, with an unchanged exercise metabolism.
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Affiliation(s)
- Dejana Popovic
- aDivision of Cardiology, Faculty of Medicine, University of Belgrade, Visegradska 26 bDivision of Endocrinology, Faculty of Medicine, University of Belgrade, Dr Subotica 13 cFaculty of Pharmacy, University of Belgrade, Vojvode Stepe 450 dFaculty of Sport and Physical Education, University of Belgrade, Blagoja Parovica 156, Belgrade, Serbia eCentro Cardiologico Monzino, IRCCS fDepartment of Clinical Sciences and Community Health - Cardiovascular Section, University of Milan, Milano, Italy
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37
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Aleksandric S, Djordjevic-Dikic A, Beleslin B, Teofilovski-Parapid G, Stepanovic J, Banovic M, Ostojic M. Noninvasive measurement of coronary flow velocity reserve during inotropic stimulation as an additional tool for hemodynamic assessment of myocardial bridging. Int J Cardiol 2017; 229:64. [DOI: 10.1016/j.ijcard.2016.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
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38
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Petrovic M, Petrovic M, Milasinovic G, Vujisic Tesic B, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic I, Banovic M, Boricic-Kostic M, Petrovic J, Arena R, Popovic D. Gauging the response to cardiac resynchronization therapy: The important interplay between predictor variables and definition of a favorable outcome. Echocardiography 2017; 34:371-375. [PMID: 28075037 DOI: 10.1111/echo.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome. METHODS Seventy patients who received CRT were included. All patients met current guideline criteria for CRT. Forty-three echocardiographic parameters were evaluated before CRT and at 1, 3, 6, and 12 months. M-mode, 2D echocardiography, and Doppler imaging were used to quantify left ventricular (LV) systolic and diastolic function, mitral regurgitation, right ventricular systolic function, pulmonary artery pressure, and myocardial mechanical dyssynchrony. The following definitions of a favorable CRT response were used: left ventricular ejection fraction (LVEF) improvement more >5% acutely following CRT, LVEF improvement >20% at 12-month follow-up, and a LV end-systolic volume (LVESV) decrease >15% at 12-month follow-up. RESULTS For the LVEF improvement >5%, the best predictor was isovolumetric relaxation time (IVRT; P=.035). For improvement of LVEF >20%, the best predictors were left ventricular stroke index (LVSI; P=.044) and left ventricular fractional shortening (LVFS; P=.031). For the drop in left ventricular systolic volume (LVESV >15%), the best predictor was septal-to-lateral wall delay (ΔT) (P=.043, RR=1.023, 95% CI for RR=1.001-1.045). CONCLUSION The definition of a favorable CRT response influenced the optimal predictor variable(s). Standardization of defining a favorable response to CRT is needed to guide clinical decision making processes.
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Affiliation(s)
- Milan Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Goran Milasinovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Pacemaker Center, Clinical Center of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic Tesic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Trifunovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olga Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Banovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Jelena Petrovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dejana Popovic
- Clinic of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Congdon BS, Coutts BA, Renton M, Banovic M, Jones RAC. Pea seed-borne mosaic virus in Field Pea: Widespread Infection, Genetic Diversity, and Resistance Gene Effectiveness. Plant Dis 2016; 100:2475-2482. [PMID: 30686170 DOI: 10.1094/pdis-05-16-0670-re] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
From 2013 to 2015, incidences of Pea seed-borne mosaic virus (PSbMV) infection were determined in semi-leafless field pea (Pisum sativum) crops and trial plots growing in the Mediterranean-type environment of southwest Australia. PSbMV was found at incidences of 2 to 51% in 9 of 13 crops, 1 to 100% in 20 of 24 cultivar plots, and 1 to 57% in 14 of 21 breeding line plots. Crops and plots of 'PBA Gunyah', 'Kaspa', and 'PBA Twilight' were frequently PSbMV infected but none of PSbMV resistance gene sbm1-carrying 'PBA Wharton' plants were infected. In 2015, 14 new PSbMV isolates obtained from these various sources were sequenced and their partial coat protein (CP) nucleotide sequences analyzed. Sequence identities and phylogenetic comparison with 39 other PSbMV partial CP nucleotide sequences from GenBank demonstrated that at least three PSbMV introductions have occurred to the region, one of which was previously unknown. When plants of 'Greenfeast' and PBA Gunyah pea (which both carry resistance gene sbm2) and PBA Wharton and 'Yarrum' (which carry sbm1) were inoculated with PSbMV pathotype P-2 isolate W1, resistance was overcome in a small proportion of plants of each cultivar, showing that resistance-breaking variants were likely to be present. An improved management effort by pea breeders, advisors, and growers is required to diminish infection of seed stocks, avoid sbm gene resistance being overcome in the field, and mitigate the impact of PSbMV on seed yield and quality. A similar management effort is likely to be needed in field pea production elsewhere in the world.
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Affiliation(s)
- B S Congdon
- School of Plant Biology and Institute of Agriculture, Faculty of Science, University of Western Australia, Crawley, WA 6009, Australia
| | - B A Coutts
- Crop Protection Branch, Department of Agriculture and Food Western Australia, Perth, WA 6983, Australia
| | - M Renton
- School of Plant Biology and Institute of Agriculture, Faculty of Science, University of Western Australia
| | - M Banovic
- Crop Protection Branch, Department of Agriculture and Food Western Australia
| | - R A C Jones
- Institute of Agriculture, Faculty of Science, University of Western Australia and Crop Protection Branch, Department of Agriculture and Food Western Australia
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Aleksandric S, Djordjevic-Dikic A, Beleslin B, Parapid B, Teofilovski-Parapid G, Stepanovic J, Simic D, Nedeljkovic I, Petrovic M, Dobric M, Tomasevic M, Banovic M, Nedeljkovic M, Ostojic M. Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation. Int J Cardiol 2016; 225:37-45. [PMID: 27710800 DOI: 10.1016/j.ijcard.2016.09.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 09/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of hemodynamic relevance of MB using coronary flow velocity reserve (CFVR) measurements by transthoracic Doppler echocardiography (TTDE) with vasodilatative and inotropic challenges. METHODS This prospective study included forty-four patients with angiographic evidence of isolated MB of the left anterior descending coronary artery (LAD) and systolic compression of ≥50% diameter stenosis. All patients were evaluated by exercise stress-echocardiography (ExSE) test for signs of myocardial ischemia, and CFVR of the distal segment of LAD during iv.infusion of adenosine (ADO:140μg/kg/min) and iv.infusion of dobutamine (DOB:10-40μg/kg/min), separately. RESULTS Exercise-SE was positive for myocardial ischemia in 8/44 (18%) of patients. CFVR during ADO was significantly higher than CFVR during peak DOB (2.85±0.68 vs. 2.44±0.48, p=0.002). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (2.01±0.16 vs. 2.54±0.47, p<0.001), but not for ADO (2.47±0.51 vs. 2.89±0.70, p=0.168), respectively. Multivariable logistic analysis showed that CFVR peak DOB was the most significant predictor of functional significant MB (OR 0.011, 95%CI: 0.001-0.507, p=0.021). Receiver-operating characteristic curves have shown that TTDE-CFVR obtained by high-dose of dobutamine infusion is better than those by adenosine regarding to functional status of MB (AUC 0.861, p=0.004; AUC 0.674, p=0.179, respectively). CONCLUSIONS Non-invasive CFVR measurement by TTDE during inotropic stimulation, in comparison to vasodilation, provides more reliable functional evaluation of MB.
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Affiliation(s)
| | - Ana Djordjevic-Dikic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Branko Beleslin
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Biljana Parapid
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | | | - Jelena Stepanovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Dragan Simic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Petrovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Dobric
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Miloje Tomasevic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Kragujevac, School of Medicine, Kragujevac, Serbia
| | - Marko Banovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Milan Nedeljkovic
- Division of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Miodrag Ostojic
- University of Belgrade, School of Medicine, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia
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Banovic M, Nikolic SD, Putnik S. A Randomized Trial in Patients With Asymptomatic Severe Aortic Stenosis: A Future Has Begun! J Am Coll Cardiol 2016; 67:1970-1. [PMID: 27102516 DOI: 10.1016/j.jacc.2016.01.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
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Banovic M, Iung B, Bartunek J, Penicka M, van Camp G, Nikolic S, Putnik S. Response: Asymptomatic severe aortic stenosis: Cardiopulmonary exercise testing in "the world of AVATAR". Am Heart J 2016; 178:e3-4. [PMID: 27502872 DOI: 10.1016/j.ahj.2016.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marko Banovic
- Belgrade Medical School, Belgrade, Serbia; University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Guy van Camp
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | | | - Svetozar Putnik
- Belgrade Medical School, Belgrade, Serbia; University Clinical Centre of Serbia, 11000 Belgrade, Serbia
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Banovic M, Brkovic V, Nedeljkovic I, Nedeljkovic M, Popovic D, Djordjevic-Dikic A, Ristic A, Nikolic S, Beleslin B. Diabetes mellitus and coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries. Diab Vasc Dis Res 2016; 13:220-7. [PMID: 26993497 DOI: 10.1177/1479164115627107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND AIM Coronary flow reserve is impaired in asymptomatic patients with aortic stenosis and has a prognostic value. We investigated whether the type II diabetes mellitus additionally impairs microvascular circulation assessed by coronary flow reserve in patients with asymptomatic severe aortic stenosis, normal left ventricular ejection fraction and nonobstructed coronary arteries. METHODS A total of 128 patients, mean age of 66.35 ± 10.51 (58.6% males), with severe aortic stenosis and normal left ventricular ejection fraction were enrolled in this study. Patients with diabetes mellitus, those who were treated for diabetes mellitus or had documentation confirming the diagnosis of diabetes mellitus, were considered. All patients underwent coronary angiography and had no obstructive coronary disease (defined as having no stenosis >50% in diameter), standard transthoracic Doppler-echocardiographic study and adenosine stress transthoracic echocardiography for coronary flow reserve measurement. RESULTS Diabetes mellitus was present in 26 patients (20.31%). There was no significant difference in aortic stenosis severity between diabetic and non-diabetic patients [aortic valve area (0.81 ± 0.18 vs 0.85 ± 0.15 cm(2)) and Vmax (4.20 ± 0.57 vs 4.21 ± 0.48 m/s)]. Mean coronary flow reserve in diabetic patients was 1.98 ± 0.48, while mean coronary flow reserve in non-diabetic patients was 2.64 ± 0.54 (p < 0.01). Diabetes mellitus was independent predictor of coronary flow reserve [B = -0.636, 95% confidence interval (-0.916 to -0.368), p < 0.001]. CONCLUSION Diabetes mellitus additionally impairs coronary microvascular function in asymptomatic patients with severe aortic stenosis and nonobstructed coronary arteries.
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Affiliation(s)
- Marko Banovic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Voin Brkovic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Milan Nedeljkovic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Dejana Popovic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Arsen Ristic
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | | | - Branko Beleslin
- Departments of Non-Invasive Cardiology and Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia Belgrade Medical School, University of Belgrade, Belgrade, Serbia
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Banovic M, Iung B, Bartunek J, Asanin M, Beleslin B, Biocina B, Casselman F, da Costa M, Deja M, Gasparovic H, Kala P, Labrousse L, Loncar Z, Marinkovic J, Nedeljkovic I, Nedeljkovic M, Nemec P, Nikolic SD, Pencina M, Penicka M, Ristic A, Sharif F, Van Camp G, Vanderheyden M, Wojakowski W, Putnik S. Rationale and design of the Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR trial): A randomized multicenter controlled event-driven trial. Am Heart J 2016; 174:147-53. [PMID: 26995381 DOI: 10.1016/j.ahj.2016.02.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022]
Abstract
Aortic valve replacement (AVR) therapy is an obvious choice for symptomatic severe aortic stenosis (AS) patients as it improves symptoms, left ventricular function, and survival. The treatment decisions and indication for AVR in asymptomatic patients with severe AS and normal left ventricular ejection fraction are less well established and the subject of ongoing debate. Many efforts have been made to define the best treatment option in asymptomatic AS patients with normal left ventricular ejection fraction. Retrospective and observational data imply that elective AVR for asymptomatic severe AS may lead to improvement in outcomes in comparison to surgery performed after onset of symptoms. The AVATAR trial will aim to assess outcomes among asymptomatic AS patients randomized to either elective early AVR or medical management with vigilant follow-up. In the latter group, AVR would be delayed until either the onset of symptoms or changes in predefined echocardiographic parameters. To the best of the authors' knowledge, it will be the first large prospective, randomized, controlled, multicenter clinical trial that will evaluate the safety and efficacy of elective AVR in this specific group of patients.
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Martins Fernandes S, Badano L, Garcia Campos A, Erdei T, Mehdipoor G, Hanboly N, Michalski BW, Vriz O, Mo VY, Le TT, Ribeiro JM, Ternacle J, Yurdakul SELEN, Shetye A, Stoebe S, Lisowska A, Chinali M, Orabona M, Contaldi C, De La Chica JA, Codolosa JN, Trzcinski P, Prado Diaz S, Morales Portano JD, Ha SJ, Valente F, Joseph G, Valente F, Scali MC, Cordeiro F, Duchateau N, Fabris E, Costantino MF, Cho IJ, Goublaire C, Lam W, Galli E, Kim KH, Mariani M, Malev E, Zuercher F, Tang Z, Cimino S, Mahia P, De La Chica JA, Petrovic J, Ciobotaru V, Remsey- Semmelweiss E, Kogoj P, Guerreiro S, Saxena A, Mozenska O, Pontone G, Macaya Ten F, Caballero L, Avegliano G, Halmai L, Reis L, Trifunovic D, Gospodinova M, Makavos G, D'ascenzi F, Dantas Tavares De Melo M, Bonapace S, Kulkarni A, Cameli M, Ingvarsson A, Driessen MMP, Tufekcioglu O, Radulescu D, Barac A, Cioffi G, Almeida Morais L, Ledakowicz-Polak A, Portugal G, Naksuk N, Parato VM, Kovalova S, Cherubini A, Corrado G, Malev E, Wierzbowska-Drabik K, Lesevic H, Laredj N, Pieles GE, Generati G, Van Zalen JJ, Aquila I, Cheng HL, Lanzoni L, Asmarats Serra L, Kadrabulatova S, Ranjbar S, Szczesniak-Stanczyk D, Sharka I, Di Salvo G, Ben Kahla S, Li L, Hadeed HA, Habeeb HA, Toscano A, Granata F, Djikic D, Wdowiak-Okrojek K, Girgis HYA, Sharma A, Soro C, Gallego Page JC, Corneli M, Teixeira R, Roussin I, Lynch M, Muraru D, Romeo G, Ermacora D, Marotta C, Aruta P, Cucchini U, Iliceto S, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Colunga Blanco S, Velasco-Alonso E, Leon-Aguero V, Rodriguez-Suarez ML, Moris De La Tassa C, Edwards J, Braim D, Price C, Fraser AG, Salmani F, Arjmand Shabestari A, Szymczyk E, Kupczynska K, Peczek L, Nawrot B, Lipiec P, Kasprzak JD, Driussi C, Ferrara F, Brosolo G, Antonini-Canterin F, Magne J, Aboyans V, Bossone E, Bellucci BM, Fisher JM, Balekian AA, Idapalapati S, Huang F, Wong JI, Tan RS, Teixeira R, Madeira M, Almeida I, Reis L, Siserman A, Dinis P, Dias L, Ramos AP, Goncalves L, Wan FW, Sawaki DS, Dubois-Rande JLDR, Adnot SA, Czibik GC, Derumeaux GD, Ercan G, Tekkesin ILKER, Sahin ST, Cengiz B, Celik G, Demircan S, Aytekin SAIDE, Razvi NA, Nazir SA, Price N, Khan JN, Kanagala P, Singh A, Squire I, Mccann GP, Langel M, Pfeiffer D, Hagendorff A, Ptaszynska-Kopczynska K, Marcinkiewicz-Siemion M, Knapp M, Witkowski M, Musial WJ, Kaminski K, Natali B, D' Anna C, Leonardi B, Secinaro A, Pongiglione G, Rinelli G, Renard S, Michel N, Mancini J, Haentjens J, Sitbon O, Habib G, Imbriaco M, Alcidi G, Santoro C, Buonauro A, Lo Iudice F, Lembo M, Cuocolo A, Trimarco B, Galderisi M, Mora Robles J, Roldan Jimenez MA, Mancisidor MA, De Mora MA, Alnabelsi T, Goykhman I, Koshkelashvili N, Romero-Corral A, Pressman GS, Michalski BW, Kupczynska K, Miskowiec D, Lipiec P, Kasprzak JD, Montoro Lopez N, Refoyo Salicio E, Valbuena Lopez SC, Gonzalez O, Alvarez C, Moreno Yanguela M, Bartha Rasero JL, De La Calle M, Guzman Martinez G, Suarez-Cuenca JA, Merino JA, Gomez Alvarez EB, Delgado LG, Woo YM, Bang WD, Sohn GH, Cheong SS, Yoo SY, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Pineda V, Galian L, Teixido G, Gonzalez Allujas MT, Evangelista A, Garcia Dorado D, Zaremba T, Ekeloef S, Heiberg E, Engblom H, Jensen SE, Sogaard P, Rodriguez Palomares JF, Gutierrez L, Garcia G, Pineda V, Galian L, Teixido G, Gonzalez Allujas MT, Evangelista A, Garcia Dorado D, Dini FL, Galli F, Lattanzi F, Picano E, Marzilli M, Leao S, Moz M, Magalhaes P, Trigo J, Mateus PS, Ferreira A, Moreira JI, De Craene M, Legallois D, Labombarda F, Pellissier A, Sermesant M, Saloux E, Merlo M, Moretti M, Barbati G, Stolfo D, Gigli M, Pinamonti B, Sinagra G, Dores E, Matera A, Innelli P, Innelli P, Lopizzo A, Violini R, Fiorilli R, Cappabianca G, Picano E, Tarsia G, Seo J, Chang HJ, Heo R, Kim IC, Shim CY, Hong GR, Chung N, Melissopoulou MM, Nguyen V, Brochet E, Cimadevilla C, Codogno I, Vahanian A, Messika-Zeitoun D, Pontana F, Vassiliou V, Prasad S, Leclercq C, Samset E, Donal E, Lim DS, Bianchi G, Rossi F, Gianetti J, Marchi F, Cerone E, Nardelli A, Terrazzi M, Solinas M, Maffei S, Pshepiy A, Vasina L, Timofeev E, Reeva S, Zemtsovsky E, Brugger N, Jahren S, De Marchi SF, Seiler C, Jin CN, Tang H, Fan K, Kam K, Yan BP, Yu CM, Lee PW, Reali M, Silvetti E, Salatino T, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Tirado G, Nogales-Romo MT, Marcos-Alberca P, De Agustin A, Almeria C, Rodrigo JL, Garcia Fernandez MA, Macaya C, Perez De Isla L, Mancisidor M, Lara Garcia C, Vivancos R, De Mora M, Petrovic M, Vujisic-Tesic B, Trifunovic D, Boricic-Kostic M, Petrovic I, Draganic G, Petrovic O, Tomic-Dragovic M, Furlan T, Ambrozic J, Mohorko Pleskovic PN, Bunc M, Ribeiras R, Abecasis J, Andrade MJ, Mendes M, Ramakrishnan S, Gupta SK, Juneja R, Kothari SS, Zaleska M, Segiet A, Chwesiuk S, Kroc A, Kosior DA, Andreini D, Solbiati A, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Rota C, Guaricci AI, Pepi M, Pons Llinares J, Asmarats Serra L, Pericas Ramis P, Caldes Llull O, Grau Sepulveda A, Frontera G, Vaquer Segui A, Noris M, Bethencourt Gonzalez A, Climent Paya V, Martinez Moreno M, Saura D, Oliva MJ, Sanchez Quinones J, Garcia Honrubia A, Valdes M, De La Morena G, Terricabras M, Costabel JP, Ronderos R, Evangelista A, Venturini C, Galve E, Nemes A, Neubauer S, Rahman Haley S, Banner N, Teixeira R, Caetano F, Almeida I, Trigo J, Botelho A, Silva J, Nascimento J, Goncalves L, Tesic M, Jovanovic I, Petrovic O, Boricic-Kostic M, Dragovic M, Petrovic M, Stepanovic J, Banovic M, Vujisic-Tesic B, Guergelcheva V, Chamova T, Sarafov S, Tournev I, Denchev S, Ikonomidis I, Psarogiannakopoulos P, Tsirigotis P, Paraskevaidis I, Lekakis J, Pelliccia A, Natali BM, Cameli M, Focardi M, Bonifazi M, Mondillo S, Lima C, Assed L, Kalil Filho R, Mady C, Bochi EA, Salemi VMC, Targher G, Valbusa F, Rossi A, Lanzoni L, Lipari P, Zenari L, Molon G, Canali G, Barbieri E, Li L, Craft M, Nanda M, Lorenzo JM, Kutty S, Bombardini T, Sparla S, Di Tommaso C, Losito M, Incampo E, Maccherini M, Mondillo S, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Hui W, Meijboom FJ, Bijnens B, Dragulescu A, Mertens L, Friedberg MK, Sensoy B, Suleymanoglu M, Akin Y, Sahan E, Sasmaz H, Pasca L, Buzdugan E, Chis B, Stoicescu L, Lynce FC, Smith KL, Mete M, Isaacs C, Viapiana O, Di Nora C, Ognibeni F, Fracassi E, Giollo A, Mazzone C, Faganello G, Di Lenarda A, Rossini M, Galrinho A, Branco L, Timoteo AT, Rodrigues I, Daniel P, Rosa S, Ferreira L, Ferreira R, Polak L, Krauza G, Stokfisz K, Zielinska M, Branco LM, Galrinho A, Mota Carmo M, Teresa Timoteo A, Aguiar Rosa S, Abreu J, Pinto Teixeira P, Viveiros Monteiro A, Cruz Ferreira R, Peeraphatdit T, Chaiteerakij R, Klarich KW, Masia S, Necas J, Nistri S, Negri F, Barbati G, Cioffi G, Russo G, Mazzone C, Faganello G, Pandullo C, Di Lenarda A, Durante A, Rovelli E, Genchi V, Trabattoni L, Zerboni SC, Cattaneo L, Butti E, Ferrari G, Luneva E, Mitrofanova L, Uspensky V, Zemtsovsky E, Kasprzak JD, Rosner S, Karl M, Ott I, Sonne C, Ali Lahmar HM, Hammou L, Forsey J, Gowing L, Miller F, Ramanujam P, Stuart AG, Williams CA, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Patel NR, Raju P, Beale L, Brickley G, Lloyd GW, Fernandez-Golfin C, Gonzalez A, Rincon LM, Hinojar R, Garcia A, Megias A, Jimenez-Nacher JJ, Moya JL, Zamorano JL, Molon G, Canali G, Bonapace S, Chiampan A, Albrigi L, Barbieri E, Noris Mora M, Rodriguez Fernandez A, Exposito Pineda C, Grande C, Gonzalez Colino R, Macaya Ten F, Fernandez Vazquez X, Fortuny Frau E, Bethencourt Gonzalez A, Karvandi M, Blaszczyk R, Zarczuk R, Brzozowski W, Janowski M, Wysokinski A, Stanczyk B, Myftiu S, Teferici D, Quka A, Dado E, Djamandi J, Kresto L, Duka A, Kristo A, Balla I, Issa Z, Moiduddin N, Siblini G, Bulbul Z, Abid L, Abid D, Kammoun S, Rush E, Craft M, Goodwin J, Kreikemeier R, Cantinotti M, Kutty S, Zolaly MA, Khoshhal SQ, El-Harbi K, Tarawah A, Al-Hawsawi Z, Al-Mozainy I, Bakhoum SWG, Nabil MN, Elebrashy IN, Chinali M, Albanese S, Carotti A, Iacobelli R, Esposito C, Secinaro A, Moscogiuri G, Pasquini L, Malvezzi Caracciolo M, Bianchi RM, Caso P, Arenga F, Riegler L, Scarafile R, D'andrea A, Russo MG, Calabro' P, Simic DS, Peric VP, Mujovic NM, Marinkovic MM, Jankovic NJ, Shim A, Wejner-Mik P, Kasprzak JD, Lipiec P, Jain N, Kharwar R, Saran RK, Narain VS, Dwivedi SK, Sethi R, Chandra S, Pradhan A, Safal S, Marchetti MF, Cacace C, Congia M, Nissardi V, Ruscazio M, Meloni L, Montisci R, Gallego Sanchez G, Calero S, Portero JJ, Tercero A, Garcia JC, Barambio M, Martinez Lazaro R, Meretta AH, Perea GO, Belcastro F, Aguirre E, De Luca I, Henquin R, Masoli O. Poster session 2THE IMAGING EXAMINATIONP536Appropriate use criteria of transthoracic echocardiography and its clinical impact: a continuous challengeP537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratoryP538Exercise stress echocardiography appropriate use criteria: real-life cases classification ease and agreement among cardiologistsANATOMY AND PHYSIOLOGY OF THE HEART AND GREAT VESSELSP539Functional capacity in older people with normal ejection fraction correlates with left ventricular functional reserve and carotid-femoral pulse wave velocity but not with E/e and augmentation indexP540Survey of competency of practitioners for diagnosis of acute cardiopulmonary diseases manifest on chest x-rayASSESSMENT OF DIAMETERS, VOLUMES AND MASSP541Left atrium remodeling in dialysis patients with normal ejection fractionP542The prediction of postinfarction left ventricular remodeling and the role of of leptin and MCP-1 in regard to the presence of metabolic syndromeP543Ascending aorta and common carotid artery: diameters and stiffness in a group of 584 healthy subjectsAssessments of haemodynamicsP544Alternate echo parameters in patients without estimable RVSPAssessment of systolic functionP545Reduced contractile performance in heart failure with preserved ejection fraction: determination using novel preload-adjusted maximal left ventricular ejection forceP546Left ventricular dimensions and prognosis in acute coronary syndromesP547Time course of myocardial alterations in a murine model of high fat diet: A strain rate imaging studyP548Subclinical left ventricular systolic dysfunction in patients with premature ventricular contractionsP549Global myocardial strain by CMR-based feature tracking (FT) and tagging to predict development of severe left ventricular systolic dysfunction after acute st-elevation myocardial infarctionP550Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstructionP551The role of regional longitudinal strain assessment in predicting response to cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and left bundle branch blockP552Speckle tracking automatic border detection improves echocardiographic evaluation of right ventricular systolic function in repaired tetralogy of fallot patients: comparison with MRI findingsP553Echocardiography: a reproducible and relevant tool in pah? intermediate results of the multicentric efort echogardiographic substudy (evaluation of prognostic factors and therapeutic targets in pah)Assessment of diastolic functionP554Relationship between left ventricular filling pressures and myocardial fibrosis in patients with uncomplicated arterial hypertensionP555Cardiac rehabilitation improves echocardiographic parameters of diastolic function in patients with ischemic heart diseaseP556Diastolic parameters in the calcified mitral annulusP557Biomarkers and echocardiography - combined weapon to diagnose and prognose heart failure with and without preserved ejection fractionP558Diastolic function changes of the maternal heart in twin and singleton pregnancyIschemic heart diseaseP559Syntax score as predictor for the correlation between epicardial adipose tissue and the severity of coronary lesions in patients with significant coronary diseaseP560Impact of strain analysis in ergonovine stress echocardiography for diagnosis vasospastic anginaP561Cardiac magnetic resonance tissue tracking: a novel method to predict infarct transmurality in acute myocardial infarctionP562Infarct size is correlated to global longitudinal strain but not left ventricular ejection fraction in the early stage of acute myocardial infarctionP563Magnetic resonance myocardial deformation assessment with tissue tracking and risk stratification in acute myocardial infarction patientsP564Increase in regional end-diastolic wall thickness by transthoracic echocardiography as a biomarker of successful reperfusion in anterior ST elevation acute myocardial infarctionP565Mitral regurgitation is associated with worse long-term prognosis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary interventionP566Statistical significance of 3D motion and deformation indexes for the analysis of LAD infarctionHeart valve DiseasesP567Paradoxical low gradient aortic stenosis: echocardiographic progression from moderate to severe diseaseP568The beneficial effects of TAVI in mitral insufficiencyP569Impact of thoracic aortic calcification on the left ventricular hypertrophy and its regression after aortic valve replacement in patients with severe aortic stenosisP570Additional value of exercise-stress echocardiography in asymptomatic patients with aortic valve stenosisP571Valvulo-arterial impedance in severe aortic stenosis: a dual imaging modalities studyP572Left ventricular mechanics: novel tools to evaluate left ventricular performance in patients with aortic stenosisP573Comparison of long-term outcome after percutaneous mitral valvuloplasty versus mitral valve replacement in moderate to severe mitral stenosis with left ventricular dysfunctionP574Incidence of de novo left ventricular dysfunction in patient treated with aortic valve replacement for severe aortic regurgitationP575Transforming growth factor-beta dependant progression of the mitral valve prolapseP576Quantification of mitral regurgitation with multiple jets: in vitro validation of three-dimensional PISA techniqueP577Impaired pre-systolic contraction and saddle-shape deepening of mitral annulus contributes to atrial functional regurgitation: a three-dimensional echocardiographic studyP578Incidence and determinants of left ventricular (lv) reverse remodeling after MitraClip implantation in patients with moderate-to severe or severe mitral regurgitation and reduced lv ejection fractionP579Severe functional tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiographyP58015 years of evolution of the etiologic profile for prosthetic heart valve replacement through an echocardiography laboratoryP581The role of echocardiography in the differential diagnosis of prolonged fever of unknown originP582Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacementP583The significance and advantages of echo and CT imaging & measurement at transcatherter aortic valve implantation through the left common carotid accessP584Comparison of the self-expandable Medtronic CoreValve versus the balloon-expandable Edwards SAPIEN bioprostheses in high-risk patients undergoing transfemoral aortic valve implantationP585The impact of transcatheter aortic valve implantation on mitral regurgitation severityP586Echocardiographic follow up of children with valvular lesions secondary to rheumatic heart disease: Data from a prospective registryP587Valvular heart disease and different circadian blood pressure profilesCardiomyopathiesP588Comparison of transthoracic echocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patientsP589Incidence and prognostic significance of left ventricle reverse remodeling in a cohort of patients with idiopathic dilated cardiomyopathyP590Early evaluation of diastolic function in fabry diseaseP591Echocardiographic predictors of atrial fibrillation development in hypertrophic cardiomyopathyP592Altered Torsion mechanics in patients with hypertrophic cardiomyopathy: LVOT-obstruction is the topdog?P593Prevention of sudden cardiac death in hypertrophic cardiomyopathy: what has changed in the guidelines?P594Coronary microcirculatory function as determinator of longitudinal systolic left ventricular function in hypertrophic cardiomyopathyP595Detection of subclinical myocardial dysfunction by tissue Doppler ehocardiography in patients with muscular dystrophiesP596Speckle tracking myocardial deformation analysis and three dimensional echocardiography for early detection of chemotherapy induced cardiac dysfunction in bone marrow transplantation patientsP597Left ventricular non compaction or hypertrabeculation: distinguishing between physiology and pathology in top-level athletesP598Role of multi modality imaging in familiar screening of Danon diseaseP599Early impairment of global longitudinal left ventricular systolic function independently predicts incident atrial fibrillation in type 2 diabetes mellitusP600Fetal cardiovascular programming in maternal diabetes mellitus and obesity: insights from deformation imagingP601Longitudinal strain stress echo evaluation of aged marginal donor hearts: feasibility in the Adonhers project.P602Echocardiographic evaluation of left ventricular size and function following heart transplantation - Gender mattersSystemic diseases and other conditionsP603The impact of septal kinetics on adverse ventricular-ventricular interactions in pulmonary stenosis and pulmonary arterial hypertensionP604Improvement in right ventricular mechanics after inhalation of iloprost in pulmonary hypertensionP605Does the treatment of patients with metabolic syndrome correct the right ventricular diastolic dysfunction?P606Predictors of altered cardiac function in breast cancer survivors who were treated with anthracycline-based therapyP607Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis: a prospective tissue-doppler echocardiography studyP608Diastolic and systolic left ventricle dysfunction presenting different prognostic implications in cardiac amyloidosisP609Diagnostic accuracy of Bedside Lung Ultrasonography in Emergency (BLUE) protocol for the diagnosis of pulmonary embolismP610Right ventricular systolic dysfunction and its incidence in breast cancer patients submitted to anthracycline therapyP611Right ventricular dysfunction is an independent predictor of survival among cirrhotic patients undergoing liver transplantCongenital heart diseaseP612Hypoplasia or absence of posterior leaflet: a rare congenital anomaly of the mitral valveP613ECHO screening for Barlow disease in proband's relativesDiseases of the aortaP614Aortic size distribution and prognosis in an unselected population of patients referred for standard transthoracic echocardiographyP615Abdominal aorta aneurysm ultrasonographic screening in a large cohort of asympromatic volounteers in an Italian urban settingP616Thoracic aortic aneurysm and left ventricular systolic functionStress echocardiographyP617Wall motion score index, systolic mitral annulus velocity and left ventricular mass predicted global longitudinal systolic strain in 238 patients examined by stress echocardiographyP618Prognostic parameters of exercise-induced severe mitral valve regurgitation and exercise-induced systolic pulmonary hypertensionP619Risk stratification after myocardial infarction: prognostic value of dobutamine stress echocardiographyP620relationship between LV and RV myocardial contractile reserve and metabolic parameters during incremental exercise and recovery in healthy children using 2-D strain analysisP621Increased peripheral extraction as a mechanism compensatory to reduced cardiac output in high risk heart failure patients with group 2 pulmonary hypertension and exercise oscillatory ventilationP622Can exercise induced changes in cardiac synchrony predict response to CRT?Transesophageal echocardiographyP623Fully-automated software for mitral valve assessment in chronic mitral regurgitation by three-dimensional transesophageal echocardiographyP624Real-time 3D transesophageal echocardiography provides more accurate orifice measurement in percutaneous transcatheter left atrial appendage closureP625Percutaneous closure of left atrial appendage: experience of 36 casesReal-time three-dimensional TEEP626Real-time three-dimensional transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrilationP627Three dimensional ultrasound anatomy of intact mitral valve and in the case of type 2 disfunctionTissue Doppler and speckle trackingP629Left ventricle wall motion tracking from echocardiographic images by a non-rigid image registrationP630The first experience with the new prototype of a robotic system for remote echocardiographyP631Non-invasive PCWP influence on a loop diuretics regimen monitoring model in ADHF patients.P632Normal range of left ventricular strain, dimensions and ejection fraction using three-dimensional speckle-tracking echocardiography in neonatesP633Circumferential ascending aortic strain: new parameter in the assessment of arterial stiffness in systemic hypertensionP634Aortic vascular properties in pediatric osteogenesis imperfecta: a two-dimensional echocardiography derived aortic strain studyP635Assessment of cardiac functions in children with sickle cell anemia: doppler tissue imaging studyP636Assessment of left ventricular function in type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography: relation to duration and control of diabetesP637A study of left ventricular torsion in l-loop ventricles using speckle-tracking echocardiographyP638Despite No-Reflow, global and regional longitudinal strains assessed by two-dimensional speckle tracking echocardiography are predictive indexes of left ventricular remodeling in patients with STEMIP639The function of reservoir of the left atrium in patients with medicaly treated arterial hypertensionP640The usefulness of speckle tracking analysis for predicting the recovery of regional systolic function after myocardial infarctionP641Two dimensional speckle tracking echocardiography in assessment of left ventricular systolic function in patients with rheumatic severe mitral regurgitation and normal ejection fractionP642The prediction of left-main and tripple vessel coronary artery disease by tissue doppler based longitudinal strain and strain rate imagingP643Role of speckle tracking in predicting arrhythmic risk and occurrence of appropriate implantable defibrillator Intervention in patients with ischemic and non-ischemic cardiomyopathyComputed Tomography & Nuclear CardiologyP644Cardiac adrenergic activity in patients with nonischemic dilated cardiomyopathy. Correlation with echocardiographyP645Different vascular territories and myocardial ischemia, there is a gradient of association? Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nedeljkovic I, Banovic M, Stepanovic J, Giga V, Djordjevic-Dikic A, Trifunovic D, Nedeljkovic M, Petrovic M, Dobric M, Dikic N, Zlatar M, Beleslin B. The combined exercise stress echocardiography and cardiopulmonary exercise test for identification of masked heart failure with preserved ejection fraction in patients with hypertension. Eur J Prev Cardiol 2015; 23:71-7. [PMID: 26358991 DOI: 10.1177/2047487315604836] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is commonly associated with hypertension (HTN). However, resting echocardiography (ECHO) can underestimate the severity of disease. Exercise stress echocardiography (ESE) and the cardiopulmonary exercise testing (CPX) appeared to be useful tests in dynamic assessment of HFpEF. The value of combined exercise stress echocardiography cardiopulmonary testing (ESE-CPX) in the identification of masked HFpEF is still undetermined. OBJECTIVE The purpose of this study was to analyse the value of the combined ESE-CPX in the identification of masked HFpEF in patients with HTN, dyspnoea and normal resting left ventricular (LV) systolic and diastolic function. METHODOLOGY We studied 87 patients with HTN, exertional dyspnoea and normal resting LV function. They all underwent ESE-CPX testing (supine bicycle, ramp protocol, 15 W/min). ECHO measurements were performed at rest, and at peak load. Achievement of peak E/e' ratio>15 was a marker for masked HFpEF. RESULTS Increase of E/e'>15 occurred in 8/87 patients (9.2%) during ESE-CPX. Those patients had the lower peak VO2 (p = 0.012), the lower VO2 at anaerobic threshold (p = 0.025), the lower workload (p = 0.026), the lower peak partial pressure end tidal carbon dioxide (PetCO2) (p < 0.0001), and the higher VE/VCO2 slope (p < 0.0001) which was an independent multivariate predictor of HFpEF (p = 0.021), with the cut-off value of 32.95 according to the receiver-operator characteristic (ROC) curve (sensitivity (Sn) 100%, specificity (Sp) 90%). CONCLUSION The combined ESE-CPX test is feasible and reliable test that can unmask HFpEF and may become an important aid in the early diagnosis of HFpEF, excluding the other causes of exertional dyspnoea.
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Affiliation(s)
- Ivana Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Marko Banovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Jelena Stepanovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Vojislav Giga
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Danijela Trifunovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Milan Nedeljkovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Milan Petrovic
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Milan Dobric
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
| | - Nenad Dikic
- Outpatient Clonoc for Sport Medicine 'Vita Maxima', Belgrade, Serbia
| | - Milan Zlatar
- Cardiology Clinic, Clinical Center of Serbia, Serbia
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Serbia School of Medicine, University of Belgrade, Serbia
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Banovic M, Loncar Z, Behfar A, Vanderheyden M, Beleslin B, Zeiher A, Metra M, Terzic A, Bartunek J. Endpoints in stem cell trials in ischemic heart failure. Stem Cell Res Ther 2015; 6:159. [PMID: 26319401 PMCID: PMC4552990 DOI: 10.1186/s13287-015-0143-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite multimodal regimens and diverse treatment options alleviating disease symptoms, morbidity and mortality associated with advanced ischemic heart failure remain high. Recently, technological innovation has led to the development of regenerative therapeutic interventions aimed at halting or reversing the vicious cycle of heart failure progression. Driven by the unmet patient need and fueled by encouraging experimental studies, stem cell-based clinical trials have been launched over the past decade. Collectively, these trials have enrolled several thousand patients and demonstrated the clinical feasibility and safety of cell-based interventions. However, the totality of evidence supporting their efficacy in ischemic heart failure remains limited. Experience from the early randomized stem cell clinical trials underscores the key points in trial design ranging from adequate hypothesis formulation to selection of the optimal patient population, cell type and delivery route. Importantly, to translate the unprecedented promise of regenerative biotherapies into clinical benefit, it is crucial to ensure the appropriate choice of endpoints along the regulatory path. Accordingly, we here provide considerations relevant to the choice of endpoints for regenerative clinical trials in the ischemic heart failure setting.
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Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade Medical School, 11000, Belgrade, Serbia.
| | - Zlatibor Loncar
- Cardiology Department, University Clinical Center of Serbia, Belgrade Medical School, 11000, Belgrade, Serbia.
| | | | | | - Branko Beleslin
- Cardiology Department, University Clinical Center of Serbia, Belgrade Medical School, 11000, Belgrade, Serbia.
| | - Andreas Zeiher
- Cardiology Department, Goethe University of Frankfurt, 60590, Frankfurt, Germany.
| | - Marco Metra
- Cardiology Department, University of Brescia, 25123, Brescia, Italy.
| | | | - Jozef Bartunek
- Cardiovascular Center, OLV Hospital, 9300, Aalst, Belgium.
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Trifunovic D, Stankovic S, Marinkovic J, Beleslin B, Banovic M, Djukanovic N, Orlic D, Tesic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Stepanovic J, Djordjevic-Dikic A, Giga V, Ostojic M. Time-dependent changes of plasma adiponectin concentration in relation to coronary microcirculatory function in patients with acute myocardial infarction treated by primary percutaneous coronary intervention. J Cardiol 2014; 65:208-15. [PMID: 25012060 DOI: 10.1016/j.jjcc.2014.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/08/2014] [Accepted: 05/26/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE To analyze plasma adiponectin kinetics in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI) and its association with coronary flow reserve (CFR), an index of coronary microcirculatory function. METHODS A total of 96 consecutive patients with the first anterior STEMI treated by pPCI without heart failure were included. CFR was assessed on the 7th day after pPCI. Plasma adiponectin was measured on admission before pPCI, and on the 2nd and 7th day after pPCI. RESULTS Adiponectin concentration was the highest on admission, declined to the lowest level on the 2nd day, and rose on the 7th day remaining below admission values. Impaired coronary microcirculatory function (CFR<2) was observed in 41% of the patients. Adiponectin concentrations significantly positively correlated with CFR, and the strongest correlation was with the 2nd day adiponectin (r=0.489, p<0.001). In multivariate models, adiponectin concentrations were independent predictors of impaired CFR [on admission: odds ratio (OR) 0.175, confidence interval (CI): 0.047-0.654, p=0.010; 2nd day: OR 0.146, 95% CI: 0.044-0.485, p=0.002; 7th day: OR 0.198, CI: 0.064-0.611, p=0.005]. The best power to predict impaired CFR was the 2nd day adiponectin. Delta values of adiponectin (differences between adiponectin concentrations) did not correlate with CFR. CONCLUSIONS In patients with the first anterior STEMI treated by pPCI plasma adiponectin concentrations before and after pPCI are strongly associated with CFR. Our results support the hypothesis that low adiponectin, especially during the early post-pPCI period, carries the risk for impaired coronary microcirculatory function in STEMI patients.
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Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Centre of Serbia, School of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Banovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nina Djukanovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Dejan Orlic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bosiljka Vujisic-Tesic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Petrovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Nedeljkovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Stepanovic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislav Giga
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miodrag Ostojic
- School of Medicine, University of Belgrade, Belgrade, Serbia; Serbian Academy of Sciences and Arts, University of Belgrade, Belgrade, Serbia
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Trifunovic D, Stankovic S, Sobic-Saranovic D, Marinkovic J, Petrovic M, Orlic D, Beleslin B, Banovic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Stepanovic J, Djordjevic-Dikic A, Tesic M, Djukanovic N, Petrovic O, Vasovic O, Nestorovic E, Kostic J, Ristic A, Ostojic M. Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function. Cardiovasc Diabetol 2014; 13:73. [PMID: 24708817 PMCID: PMC4234386 DOI: 10.1186/1475-2840-13-73] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 12/13/2022] Open
Abstract
Background Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Methods In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. Results IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). Conclusion IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.
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Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, Clinical Centre of Serbia, Ul, Koste Todorovica 8, 11000 Belgrade, Serbia.
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Bartunek J, Behfar A, Dolatabadi D, Vanderheyden M, Ostojic M, Dens J, El Nakadi B, Banovic M, Beleslin B, Vrolix M, Legrand V, Vrints C, Vanoverschelde JL, Crespo-Diaz R, Homsy C, Tendera M, Waldman S, Wijns W, Terzic A. Reply: The C-CURE Randomized Clinical Trial (Cardiopoietic stem Cell therapy in heart failURE). J Am Coll Cardiol 2014; 62:2454-2456. [PMID: 24355591 DOI: 10.1016/j.jacc.2013.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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