1
|
Obradovic S, Dzudovic B, Pruszczyk P, Djuric I, Subotic B, Matijasevic J, Benic M, Salinger S, Kos L, Kovacevic-Preradovic T, Mitevska I, Kafedzic S, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V. The timing of death in acute pulmonary embolism patients regarding the mortality risk stratification at admission to the hospital. Heliyon 2024; 10:e23536. [PMID: 38187278 PMCID: PMC10767379 DOI: 10.1016/j.heliyon.2023.e23536] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background The management of patients with acute pulmonary embolism (aPE) depends on the severity of aPE. The timing of death in various aPE risk subgroups is only partially known. Methods 1618 patients with an objectively established aPE diagnosis with computed tomography pulmonary angiography enrolled in the regional PE registry were included in the study. According to ESC criteria, patients were stratified at admission to the hospital in four risk strata. The timing of PE-related and non-PE-related deaths was analyzed regarding mortality risk. Results PE-related, and non-PE-related hospital death rates were 1.1 % and 1.5 % in low, 1.1 % and 4.8 % in intermediate-low, 8.1 % and 5.9 % in intermediate-high, and 27.7 % and 6.9 % in high-risk groups, respectively. The median time of PE-related and non-PE-related death across the PE mortality risk were: 4 (1.7-7.5) and 7.0 (4-14.7) days in low, 1.5 (1.0-9.5) and 11.5 (2.0-21.0) days in intermediate-low, 4.0 (2.0-9.0) and 9.0 (5.7-18.2) days in intermediate-high, 2.0 (1.0-4.75) and 7.0 (3.0-21.2) days in high-risk subgroups. 48.2 % and 17.1 % of patients who died in the high and intermediate-high risks died during the first hospital day. After the 6th hospitalization day, PE-related deaths were recorded in 43.9 % of deaths from intermediate-high and 17.9 % from high-risk subgroups. Conclusion PE-related mortality is prominent on the first hospitalization day in high and intermediate-high-risk PE. A substantial proportion of intermediate-high and high-risk patient's PE deaths occurred after the first 6 days of hospitalization.
Collapse
Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Ivica Djuric
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia
- School of Medicine, University of Novi Sad, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, Serbia
- School of Medicine, University of Nis, Serbia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina
- School of Medicine, University of Banja Luka, Bosnia and Herzegovina
| | - Irena Mitevska
- University Cardiology Clinic, Intensive Care Unit, Skopje, Macedonia
| | - Srdjan Kafedzic
- Clinic of Cardiology, University Clinical Center Zemun, Serbia
| | - Aleksandar Neskovic
- Clinic of Cardiology, University Clinical Center Zemun, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, Montenegro
- School of Medicine, University of Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, Montenegro
- School of Medicine, University of Podgorica, Montenegro
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, Serbia
- School of Medicine, University of Kragujevac, Serbia
| |
Collapse
|
2
|
Begic Z, Djukic M, Begic E, Aziri B, Mladenovic Z, Iglica A, Sabanovic-Bajramovic N, Begic N, Kovacevic-Preradovic T, Stanetic B, Badnjevic A. Left atrial strain analysis in the realm of pediatric cardiology: Advantages and implications. Technol Health Care 2024; 32:1255-1272. [PMID: 37840514 DOI: 10.3233/thc-231087] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.
Collapse
Affiliation(s)
- Zijo Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Milan Djukic
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim. Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Zorica Mladenovic
- Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Amer Iglica
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nirvana Sabanovic-Bajramovic
- Intensive Care Unit, Clinic for Heart, Blood Vessels and Rheumatism, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nedim Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Almir Badnjevic
- Verlab Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina
- Faculty of Pharmacy, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
3
|
Djuric I, Dzudovic B, Subotic B, Dzudovic J, Matijasevic J, Benic M, Salinger S, Mitevska I, Kos L, Kovacevic-Preradovic T, Simovic S, Miloradovic V, Savicic T, Bozovic B, Bulatovic N, Kafedzic S, Neskovic AN, Kocev N, Marinković J, Obradovic S. New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men. Diagnostics (Basel) 2023; 13:diagnostics13111829. [PMID: 37296681 DOI: 10.3390/diagnostics13111829] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. METHODS In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. RESULTS There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274-3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004-0.063); p = 0.013). CONCLUSION The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
Collapse
Affiliation(s)
- Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
| | - Irena Mitevska
- Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tanja Savicic
- Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
- School of Medicine Podgorica, University of Podgorica, 81000 Podgorica, Montenegro
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
- School of Medicine Belgrade, University of Belgrade, 11000 Beograd, Serbia
| | - Nikola Kocev
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| |
Collapse
|
4
|
Aziri B, Begic E, Stanetic B, Mladenovic Z, Kovacevic-Preradovic T. Sodium-glucose cotransporter-2 inhibitors: a swinging pendulum in the treatment of acute myocardial infarction. Minerva Cardiol Angiol 2023:S2724-5683.22.06200-7. [PMID: 37161919 DOI: 10.23736/s2724-5683.22.06200-7] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Sodium-glucose cotransporter-2 (SGLT2) inhibitors are integral in treating patients with heart failure, regardless of the existence of diabetes mellitus. In light of their benefits on the heart muscle, the question of their effect on acute coronary syndrome is raised, and a hypothesis as to whether they can be implemented in its treatment is proposed. The aim of the article was to indicate the potential of using SGLT2 inhibitors in the treatment of myocardial infarction (MI). EVIDENCE ACQUISITION A PubMed search for articles published between October 2017 and May 2022 was conducted using the following keywords: "SGLT2 inhibitors," "Acute Coronary Syndrome," "Treatment," "Prognosis." Reference lists of identified articles were searched for further articles. EVIDENCE SYNTHESIS Reports from clinical trials and animal studies thus far investigating mechanistic pathways of SGLT2 inhibitors' effect in relation to acute myocardial infarction were interplayed to extract relevant findings and analyze the safety of this therapy in acute coronary syndrome (ACS) patients. CONCLUSIONS SGLT2 inhibitors indicate beneficial effects in acute cardiovascular incident by various mechanisms, and early initiation of therapy may improve outcomes for AMI survivors.
Collapse
Affiliation(s)
- Buena Aziri
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina -
- Department of Cardiology, Prim. Dr. Abdulah Nakas General Hospital, Sarajevo, Bosnia and Herzegovina
| | - Bojan Stanetic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Zorica Mladenovic
- Department of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Tamara Kovacevic-Preradovic
- Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
- Department of Internal Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| |
Collapse
|
5
|
Ružičić DP, Dzudovic B, Matijasevic J, Benic M, Salinger S, Kos L, Kovacevic-Preradovic T, Mitevska I, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V, Djuric I, Obradovic S. Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER). BMJ Open Respir Res 2023; 10:10/1/e001559. [PMID: 37076250 PMCID: PMC10124252 DOI: 10.1136/bmjresp-2022-001559] [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] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. PATIENTS AND METHODS A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classified as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated. RESULTS The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not significantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate-risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001). CONCLUSION Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high-risk PE irrespective of sex and age.
Collapse
Affiliation(s)
- Dušan Predrag Ružičić
- Department of Internal Medicine and Invasive Cardiology, General Hospital Valjevo, Valjevo, Serbia
| | - Boris Dzudovic
- Clinic Of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
- School of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, Nis, Serbia
- School of Medicine, University of Nis, Nis, Serbia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Irena Mitevska
- Clinic of Cardiology, Intensive Care Unit, School of Medicine Skopje, University of Skopje, Skopje, North Republic of Macedonia
| | - Aleksandar Neskovic
- Clinic of Cardiology, Clinical Center Zemun, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
- School of Medicine, University of Podgorica, Podgorica, Montenegro
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
| |
Collapse
|
6
|
Obradovic S, Dzudovic B, Matijasevic J, Salinger S, Kos LJ, Benic M, Mitevska I, Kafedzic S, Kovacevic-Preradovic T, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V. The timing of death in acute pulmonary embolism patients regarding the mortality risk stratification at admission to hospital. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1866] [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 management of patients with acute pulmonary embolism (aPE) depend on the risk stratification at hospital admission. It is unknown when normotensive aPE patients with some other risk factors deteriorate.
Patients and methods
Patients with objectively established acute PE diagnosis enrolled in the regional PE registry from January 2015 to December 2021, were studied in this investigation. According to European Society od Cardiology criteria patients were stratified during admission to hospital in four risk stratums. The timing for death and the main reason for death were recorded. PE-related death was defined if patient has died because of cardiac arrest or obstructive shock if there is no another possible reason for that.
Results
In the REPER registry. Among 1541 patients (514 low risk, 366 intermediate-low risk, 472 intermediate-high risk and 189 high risk) with aPE, 101 (6.6%) have died primary from aPE and 64 (4.2%) have died from other reasons during the 30-day follow-up. PE-related death across the mortality risk groups were 0.8%, 1.1%, 8.5% and 28.5% in low-risk, intermediate-low, intermediate-high and high risk PE, respectively. Median time from hospital admission to PE related death was significantly longer in intermediate-high than in high risk patients 4.5 (2.0–9.0) vs 1.0 (1.0–4.5) days, p=0.001. In the high risk group 50.9% of patients died during the first 24 hours, 9.0% in the next 24 hours and 83.0% of patients died during the first 5 days from admission. In the intermediate-high risk group 17.5% died in the first 24 hours, 12.5% died in the next 24 hours and next 25% died till the fifth day. There was no difference in timing of non PE-related death between intermediate-high and high risk patients 9.5 (6.0–18.5) vs 7.0 (3.0–23.5) days, p=0.631.
Conclusion
There is significant delay in timing of death in intermediate-high compare to high risk PE patients, however, almost 50% of patients who died in the intermediate-high risk PE patients have died inside the first 5 days from hospital admission.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Obradovic
- Military Medical Academy of Belgrade, School of Medicine, University of Defense , Belgrade , Serbia
| | - B Dzudovic
- Military Medical Academy of Belgrade, School of Medicine, University of Defense , Belgrade , Serbia
| | - J Matijasevic
- Institute of Pulmonary Diseases Vojvodina , Novi Sad , Serbia
| | | | - L J Kos
- Clinical Center Banja Luka, Clinic of Cardiology , Banja Luka , Bosnia and Herzegovina
| | - M Benic
- Clinical Center Banja Luka, Clinic of Cardiology , Banja Luka , Bosnia and Herzegovina
| | - I Mitevska
- University Cardiology Clinic, Intensive Care Unit , Skopje , North Macedonia
| | - S Kafedzic
- Clinical Hospital Center Zemun, Clinic of Cardiology, Clinical Centre Zemun , Belgrade , Serbia
| | | | - A Neskovic
- Clinical Hospital Center Zemun, Clinic of Cardiology, Clinical Centre Zemun , Belgrade , Serbia
| | - B Bozovic
- Clinical Center of Montenegro, Clinic of Cardiology , Podgorica , Montenegro
| | - N Bulatovic
- Clinical Center of Montenegro, Clinic of Cardiology , Podgorica , Montenegro
| | - V Miloradovic
- University of Kragujevac Faculty of Medicine, Clinic of Cardiology , Kragujevac , Serbia
| |
Collapse
|
7
|
Bombardini T, Cortigiani L, Ciampi Q, Ostojic MC, Kovacevic-Preradovic T, Picano E. The prognostic value of stroke work/end-diastolic volume ratio during stress echocardiography. Acta Cardiol 2021; 76:384-395. [PMID: 32233739 DOI: 10.1080/00015385.2020.1746054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
BACKGROUND The ventricular stroke work (SW) refers to the work done by the left ventricle to eject the volume of blood during one cardiac cycle. The cath-lab relationship between SW and end-diastolic volume (EDV) is the preload-recruitable SW (PRSW). Recently a non-invasive single-beat PRSW (SBPRSW) has been proposed. However, the single beat formula needs mathematical skillness, and extra software. Aim of this study was to compare the non-invasive SBPRSW with the simpler non-invasive SW/EDVratio in the stress-echo lab. METHODS We studied 692 patients, age 62 ± 12 years, ejection fraction 50 ± 17%, with negative stress echo (SE)(exercise, n = 130, dobutamine, n = 124, dipyridamole, n = 438) and follow-up data. The PRSW was estimated at rest and at peak stress by the SBPRSW technique and compared with the SW/EDV. All patients were followed-up. Event rates were estimated with Kaplan-Meier curves. RESULTS SBPRSW and SW/EDV were linearly correlated at rest (r = 0.842, p < .001) and at peak stress (r = 0.860, p < .001). During a median follow-up of 20 months (first quartile 8, third quartile 40 months), 132 major events were registered: at receiver operating characteristic (ROC) analysis rest SBPRSW vs. SW/EDV (AUC 0.691 vs. 0.722) and peak stress (AUC 0.744 vs. 0.800) demonstrated both a significant prognostic power (all p < .001) with non-inferior survival prediction of the simpler SW/EDV ratio at Kaplan-Meier curves (Chi-square rest = 38, peak = 56) vs. SBPRSW (Chi-square rest = 14, peak = 42). CONCLUSIONS The data obtained with the non-invasive SBPRSW and by the simpler SW/EDV are highly comparable. PRSW with either SB or SW/EDV approach is effective in predicting follow-up events.
Collapse
Affiliation(s)
- Tonino Bombardini
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Miodrag C. Ostojic
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Tamara Kovacevic-Preradovic
- Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina
| | - Eugenio Picano
- Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy
| |
Collapse
|
8
|
Bombardini T, Zagatina A, Ciampi Q, Cortigiani L, D'Andrea A, Borguezan Daros C, Zhuravskaya N, Wierzbowska-Drabik K, Kasprzak J, De Castro E Silva Pretto J, Djordjevic-Dikic A, Beleslin B, Ostojic M, Kovacevic-Preradovic T, Picano E. Hemodynamic heterogeneity of inadequate cardiac output increase identified by 2-dimensional volumetric exercise echocardiography: slow, stiff or weak heart? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0037] [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: 11/15/2022] Open
Abstract
Abstract
Background
Two-dimensional (2-D) volumetric exercise stress echocardiography (ESE) provides an integrated view of preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) through end-systolic volume (ESV) changes.
Purpose
To assess the dependence of stroke volume (SV) and cardiac output (CO) upon LVCR EDV changes and heart rate (HR) during ESE.
Methods
We prospectively performed semi-supine bicycle or treadmill ESE in 1,344 patients (age 59.8±11.4 years; 550 female; ejection fraction = 62.5±8%) referred for known or suspected coronary artery disease in 20 quality controlled laboratories of 16 countries from 2016 to 2019. SV was calculated at rest and peak stress from raw measurement of LV EDV and ESV by biplane Simpson rule, 2-D echo. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values <2.0 identify a “weak” heart). Preload reserve was defined by an increase in LV EDV. Abnormal values (lack of EDV increase, peak EDV ≤ rest EDV) identify a “stiff” heart. Cardiac output was calculated as SV * HR (measured with standard EKG). HR reserve (stress/rest ratio) <1.85 identifies a “slow” heart with chronotropic incompetence.
Results
By selection, all patients had negative SE by wall motion criteria. Of the 1,344 patients included in the study, 448 belonged to the lowest tertile of CO increase. Of them 326 (73%) achieved HR reserve <1.85; 220 (49%) had a blunted LVCR and 374 (83%) a reduction of preload reserve, with 348 patients (78%) showing ≥2 abnormalities. The more the abnormal criteria, the worse the CO response, which was lowest in slow, stiff and weak hearts: see figure.
Conclusion
Patients with normal CO reserve during exercise usually have a fast, compliant and strong heart. Abnormal CO reserve is associated with heterogeneous hemodynamic responses, with slow, stiff and/or weak hearts. The clarification of underlying hemodynamic heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from a standard 2-D volumetric SE. Hearts with normal CO are all alike; every heart with abnormal CO is abnormal in its own way.
CO % changes in subsets (*p<0.001)
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- T Bombardini
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - A Zagatina
- State University Hospital, St. Petersburg, Russian Federation
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Cardioloy Division, Benevento, Italy
| | - L Cortigiani
- SAN LUCA Hospital, Cardioloy Division, Lucca, Italy
| | - A D'Andrea
- Monaldi Hospital, Second University of Naples, Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Napoli, Italy
| | | | - N Zhuravskaya
- State University Hospital, St. Petersburg, Russian Federation
| | | | | | | | | | - B Beleslin
- Clinical center of Serbia, Belgrade, Serbia
| | - M Ostojic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - T Kovacevic-Preradovic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - E Picano
- National Council of Research, Biomedicine Department, Pisa, Italy
| |
Collapse
|
9
|
Ostojic M, Arnautovic N, Nezic D, Borzanovic M, Ragus T, Nikolic A, Micovic S, Otasevic P, Djokic D, Ivanovic I, Stanetic B, Kovacevic-Preradovic T, Tasic N, Djajic V, Bojic M. Prediction of medium term mortality in diabetics with complex ischemic heart disease after first isolated coronary artery bypass grafting: comparison of FREEDOM, SYNTAX II and our formula. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1483] [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: 11/14/2022] Open
Abstract
Abstract
Background
Controversies exist how to predict medium term mortality (Mt) in diabetics (DM) with 3 vessel (3VD) and/or left main (LM) disease undergoing myocardial revascularization ranging from Syntax Score II (SSII) where DM was not predicative variable up to FREEDOM formula which was derived, just from population with DM (without LM), having DM patients (Pts) requirement of insulin as one of predicative variable.
Purpose
To compare predicative power of SSII, FREEDOM and formula developed in our institution in Pts post first isolated CABG with 3VD and/or LM with DM.
Methods
From our prospective data base of 2455 consecutive pts who had the first isolated CABG in the period 01/2012–12/2014 with complex Ischemic Heart Disease with 100% follow up of 4 years all-cause Mt we created by random sampling Training (1321; Mt:10.4%; DM 511; Mt:13.3%) and Validation (1134; Mt:10.0%; DM 414; Mt: 11.8%) sets. After deriving predicative formula (Cox regression) from training population we validated FREEDOM, SSII and Our Formula in 414 pts with DM from the Validation set.
Results
Characteristics of pts, our formula, predicating power by C Statistics, Calibration plots and Brier scores are presented in Picture 1.
Conclusions
FREEDOM formula designed just for DM pts with complex Ischemic Heart Disease without LM had the smallest standard error in the estimate, but moderate C statistics as Syntax Score II and our formula which may be used for pts with and without DM and 3VD and/or LM.
Picture 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of education, science and technology development, Republic of Serbia
Collapse
Affiliation(s)
- M Ostojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - N Arnautovic
- University Belgrade Medical School, Belgrade, Serbia
| | - D Nezic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - M Borzanovic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - T Ragus
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - A Nikolic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - S Micovic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - P Otasevic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - D Djokic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - I Ivanovic
- City Institute of Public Health, Institute of Public Health Republic of Serbia, Belgrade, Serbia
| | - B Stanetic
- University Clinical Centre of the Republic of Srpska, Faculty of Medicine Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - T Kovacevic-Preradovic
- University Clinical Centre of the Republic of Srpska, Faculty of Medicine Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - N Tasic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - V Djajic
- University Clinical Centre of the Republic of Srpska, Faculty of Medicine Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - M Bojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| |
Collapse
|
10
|
Kovacevic-Preradovic T, Stanetic B, Kos L, Malesevic G, Popovic-Pejicic S, Djordjevic-Dikic A, Wong N, Ostojic M. N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE IN THE PREDICTION OF REDUCED CORONARY FLOW VELOCITY RESERVE IN ASYMPTOMATIC TYPE 2 DIABETIC PATIENTS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30873-1] [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: 11/27/2022]
|
11
|
Salinger-Martinovic S, Dimitrijevic Z, Stanojevic D, Momčilović S, Kostic T, Koracevic G, Subotic B, Dzudovic B, Stefanovic B, Matijasevic J, Miric M, Markovic-Nikolic N, Nikolic M, Miloradovic V, Kos L, Kovacevic-Preradovic T, Srdanovic I, Stanojevic J, Obradovic S. Renal dysfunction as intrahospital prognostic indicator in acute pulmonary embolism. Int J Cardiol 2020; 302:143-149. [DOI: 10.1016/j.ijcard.2019.12.025] [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: 10/14/2019] [Revised: 12/08/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
|
12
|
Bombardini T, Pacini D, Potena L, Maccherini M, Kovacevic-Preradovic T, Picano E. Heart rate reserve during dipyridamole stress test applied to potential heart donors in brain death. Minerva Cardioangiol 2020; 68:249-257. [PMID: 32100982 DOI: 10.23736/s0026-4725.20.05093-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A blunted heart rate reserve (HRR) during dipyridamole stress echocardiography (DSE) is a prognostically unfavorable sign of cardiac autonomic dysfunction. Short-term adjustments of heart rate (HR) are thought to rise from changes in neural input to the heart. DSE is applied in potential heart donors to rule out underlying coronary artery disease and left ventricular dysfunction. The aim of this study is to assess HRR during DSE in brain death. METHODS We enrolled two groups: group 1 (N.=49, 22 men, 54.6±8.8 years) with patients in brain death enrolled in the nationwide marginal donor heart recruiting program; group 2 (N.=49, 18 men, 66.4±12.0 years) referred to DSE for suspected or known coronary artery disease. All underwent DSE (0.84 mg/kg in 6') by quality-controlled readers certified via web-based training (1487/CE Lazio-1). We assessed left ventricular contractile reserve (LVCR) as stress/rest ratio of force (systolic blood pressure/end-systolic volume). HRR was calculated as the peak/rest HR ratio from 12-lead EKG. RESULTS The two study groups were similar for prevalence of inducible ischemia (4/49 vs. 9/49, P=NS). Group 1 showed higher resting HR (group 1: 88.1±15.5 bpm vs. group 2: 66.5±11.5 bpm, P<0.01) and similar peak HR (group 1: 94.7±15.3 bpm vs. group 2: 89.5±19.3 bpm, P=0.144), with blunted HRR (group 1: 1.08±0.10 bpm vs. group 2: 1.36±0.31 bpm, P<0.01). HRR was unrelated to LVCR. CONCLUSIONS HRR is almost abolished and unrelated to LVCR in brain-dead patients during DSE. The modulation of neural input to the heart is essential to determine HRR, and plays no significant role in determining the inotropic response during DSE.
Collapse
Affiliation(s)
- Tonino Bombardini
- Clinical Center of the Republic of Srpska, Faculty of Medicine, University of Banja-Luka, Banja-Luka, Bosnia and Herzegovina -
| | - Davide Pacini
- Department of Cardiac, Thoracic, and Vascular Surgery, S. Orsola-Malpighi Polyclinic Hospital, Bologna University, Bologna, Italy
| | - Luciano Potena
- Department of Cardiac, Thoracic, and Vascular Surgery, S. Orsola-Malpighi Polyclinic Hospital, Bologna University, Bologna, Italy
| | | | - Tamara Kovacevic-Preradovic
- Clinical Center of the Republic of Srpska, Faculty of Medicine, University of Banja-Luka, Banja-Luka, Bosnia and Herzegovina
| | - Eugenio Picano
- Department of Biomedicine, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| |
Collapse
|
13
|
Salinger-Martinovic S, Dimitrijevic Z, Stanojevic D, Subotic B, Dzudovic B, Stefanovic B, Matijasevic J, Miric M, Markovic-Nikolic N, Nikolic M, Miloradovic V, Kos LJ, Kovacevic-Preradovic T, Srdanovic I, Obradovic S. P6465Are we calculated enough? Glomerular filtration rate as a predictor of intra-hospital prognosis in patients with pulmonary embolism. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1057] [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: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary embolism (PE) can lead to multi-organ damage including an acute renal dysfunction which is associated with adverse events and high long-term mortality rate.
Purpose
The aim of our study was to investigate the predictive role of renal dysfunction on intrahospital mortality risk in patients hospitalized due to PE. The study was performed in intensive care units of six university hospitals.
Methods
The prospective cohort study comprised 665 consecutive patients with acute PE which was confirmed using MDCT. All patients underwent echocardiography examination on admission and blood samples were collected for troponin I (TnI), B-type natriuretic peptide (BNP) and routine laboratory analyses.
Results
Based on estimated glomerular filtration rate (GFR), patients were divided into three groups: first with the GFR <30ml/min, second with GFR 30–60 ml/min, and third with GFR >60 ml/min. During hospitalization in the first group the overall incidence of death was recorded in 28 (45.9%), in the second in 42 (18.9%), and in the third in 30 (7.9%) patients (p<0.0001). Pulmonary embolism as a cause of death was recorded in the first group in 18 (29.5%) patients, in the second in 25 (11.3%) and in the third in 17 (4.5%) patients (p<0.0001). Fatal bleeding was recorded in the first group in 1 (1.6%), in the second in 1 (0.5%) and in the third group in 3 (0.8%) patients (p<0.05). There were no significant differences regarding major bleeding frequency among the groups. Multivariate analysis showed that age, comorbidities, hemodynamic status, TnI, and GFR were strongly associated with an overall mortality rate and with death due to PE, while the use of anticoagulation therapy influenced the fatal bleeding rate. After controlling for age, we found that GFR on admission had a significant effect on in-hospital survival. Compared with patients in the third group, those from the second group had more than 2 fold increased mortality risk [OR 2.17 (CI 1.301–3.625), p=0.001], and patients in the first group had 6 fold higher risk of mortality [OR 6.006 (CI 3.487–6.006)]. In the ROC analysis GFR showed significant predictive value for intra-hospital mortality risk in PE patients [AUC= 0.725, 95% CI (0.68–0.78), p<0.001]. The highest sensitivity (64%) and specificity (70%) had GFR “cutoff” value of 59.12/min.
Conclusion
Renal dysfunction, on admission, in patients with acute PE is strongly associated with high intrahospital mortality risk and fatal bleeding. The estimation of GFR in these patients is important not only for prediction of the outcome but also for the prevention of bleeding complications, regarding the optimal dosage of anticoagulants. Even though it seems that GFR calculation is not still the clinical routine in PE.
Collapse
Affiliation(s)
| | - Z Dimitrijevic
- Clinical Center of Nis, Clinic for nephrology, Nis, Serbia
| | | | - B Subotic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
| | - B Dzudovic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
| | - B Stefanovic
- Clinical center of Serbia, Clinic of cardiology, Belgrade, Serbia
| | - J Matijasevic
- Institute of Pulmonary Diseases Sremska Kamenica, Sremska Kamenica, Serbia
| | - M Miric
- Institute of Pulmonary Diseases Sremska Kamenica, Sremska Kamenica, Serbia
| | | | - M Nikolic
- Clinical Center Kragujevac, Clinic of cardiology, Kragujevac, Serbia
| | - V Miloradovic
- Clinical Center Kragujevac, Clinic of cardiology, Kragujevac, Serbia
| | - L J Kos
- Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - I Srdanovic
- Clinical Center of Vojvodina, Institute for Cardiovascular Diseases, Novi Sad, Serbia
| | - S Obradovic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
| |
Collapse
|
14
|
Stanetic B, Ostojic M, Kovacevic-Preradovic T, Kos LJ, Nikolic A, Bojic M, Campos C, Huber K. P4587Impact of diabetes mellitus on myocardial revascularisation method in the light of the 2018 ESC/EACTS guidelines: Results from the PROUST Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0973] [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: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Results of currently available randomized trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The 2018 ESC/EACTS guidelines on myocardial revascularization do not recommend PCI in patients with diabetes and SYNTAX score ≥23.
Purpose
We aimed to compare the all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics.
Methods
The study group comprised consecutive diabetics with angiographically proven three-vessel CAD (≥50% diameter stenosis) and/or unprotected left main CAD (≥50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG between 2008 and 2010. All-cause mortality was ascertained by telephone contacts and/or from Mortality Registries.
Results
Using the hospital data system, 5145 patients were screened and 4803 elected not to follow the inclusion criteria. Out of 342 included patients, 177 patients underwent PCI and 165 patients were referred for CABG. Patients with whom CABG was performed were significantly older (64.69±8.8 vs. 62.6±9.4, p=0.03), more often on insulin treatment (91/165=55.2% vs. 26/177=14.7%, p<0.01), had more complex anatomical characteristics i.e. higher SYNTAX scores (32.5 IQR (15) vs. 18.0 IQR (15), p<0.01) and with left main stenosis (70/165=42.4% vs. 7/177=4.0%, p<0.01), compared to patients treated with PCI. The cumulative incidence rates of all-cause death were significantly different between PCI and CABG at 4 years (16/177=9.0% vs. 26/165=15.7%, respectively, log-rank p=0.03). There was a higher incidence of all-cause mortality in PCI patients with intermediate (23–32) and high (≥33) SYNTAX scores compared with those with low (0–22) SYNTAX scores (6/32=18.8% vs. 6/124=4.8%, log-rank p=0.01; 4/21=19.1% vs. 6/124=4.8%, log-rank p=0.02, respectively). On the contrary, patients who underwent CABG displayed similar morality rates irrespective of the SYNTAX scores (SYNTAX 0–22: 5/34=14.7%; SYNTAX 23–32: 9/54=16.7%; SYNTAX ≥33: 12/77=15.6%; log-rank p=0.9). Finally, when compared with CABG, more deaths were observed following PCI with intermediate and high SYNTAX scores (intermediate SYNTAX (23–32) PCI: 6/32=18.8% vs. CABG: 26/165=15.8%, log-rank p=0.94; high SYNTAX (≥33) PCI: 4/21=19.1% vs. CABG 26/165=15.8%, log-rank p=0.87).
Conclusions
During a 4-year follow-up, CABG in comparison with PCI was associated with a higher rate of all-cause death, which can be accounted for by older age and comorbidities. In diabetics, our analysis is suggestive that PCI probably should be avoided in patients with SYNTAX ≥23, which is in concordance with the most recent guidelines. Individualized risk assessment as well as quantification of CAD by SYNTAX score remains essential in choosing appropriate revascularization method in patients with diabetes and complex CAD.
Acknowledgement/Funding
None
Collapse
Affiliation(s)
- B Stanetic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - M Ostojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - T Kovacevic-Preradovic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - L J Kos
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - A Nikolic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - M Bojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - C Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| |
Collapse
|
15
|
De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
|
16
|
Ostojic M, Stanetic BM, Kovacevic-Preradovic T, Boljevic D, Vulic D. Coronary stenosis and left ventricular function - Major prognostic factors in patients with ischemic heart disease: Has something changed in the era of "precision medicine"? Int J Cardiol 2019; 278:36-37. [PMID: 30545618 DOI: 10.1016/j.ijcard.2018.12.017] [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] [Received: 11/14/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Miodrag Ostojic
- Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia; Medical School University of Belgrade, Belgrade, Serbia; University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina; Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.
| | - Bojan M Stanetic
- Medical School University of Belgrade, Belgrade, Serbia; Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Medical School University of Belgrade, Belgrade, Serbia; Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Darko Boljevic
- Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Dusko Vulic
- Medical Faculty, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| |
Collapse
|
17
|
Kovacevic-Preradovic T, Stanetic B. Diagnosis and Treatment of Pulmonary Hypertension. SM 2017. [DOI: 10.18575/msrs.sm.e.17.10] [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: 11/24/2022] Open
|
18
|
Stanetic BM, Ostojic M, Campos CM, Marinkovic J, Farooq V, Kovacevic-Preradovic T, Huber K, Serruys PW. ApPropriateness of myocaRdial RevascularizatiOn assessed by the SYNTAX score II in a coUntry without cardiac Surgery faciliTies; PROUST study. Int J Cardiol 2017; 227:478-484. [DOI: 10.1016/j.ijcard.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
|
19
|
Müller A, Helbig I, Jansen C, Bast T, Guerrini R, Jähn J, Muhle H, Auvin S, Korenke GC, Philip S, Keimer R, Striano P, Wolf NI, Püst B, Thiels C, Fogarasi A, Waltz S, Kurlemann G, Kovacevic-Preradovic T, Ceulemans B, Schmitt B, Philippi H, Tarquinio D, Buerki S, von Stülpnagel C, Kluger G. Retrospective evaluation of low long-term efficacy of antiepileptic drugs and ketogenic diet in 39 patients with CDKL5-related epilepsy. Eur J Paediatr Neurol 2016; 20:147-51. [PMID: 26387070 DOI: 10.1016/j.ejpn.2015.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 05/26/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mutations in the CDKL5 gene cause an early-onset epileptic encephalopathy. To date, little is known about effective antiepileptic treatment in this disorder. METHOD Accordingly, the aim of this retrospective study was to explore the role of different antiepileptic drugs (AEDs) and the ketogenic diet (KD) in the treatment of this rare genetic disorder. We evaluated the efficacy in 39 patients with CDKL5 mutations at 3, 6 and 12 months after the introduction of each treatment. One patient was lost to follow-up after 6 and 12 months. RESULTS The responder rate (>50% reduction in seizure frequency) to at least one AED or KD was 69% (27/39) after 3 months, 45% (17/38) after 6 months and 24% (9/38) after 12 months. The highest rate of seizure reduction after 3 months was reported for FBM (3/3), VGB (8/25), CLB (4/17), VPA (7/34), steroids (5/26), LTG (5/23) and ZNS (2/11). Twelve patients (31%) experienced a seizure aggravation to at least one AED. Most patients showed some but only initial response to various AEDs with different modes of actions. SIGNIFICANCE Considering both age-related and spontaneous fluctuation in seizure frequency and the unknown impact of many AEDs or KD on cognition, our data may help defining realistic treatment goals and avoiding overtreatment in patients with CDKL5 mutations. There is a strong need to develop new treatment strategies for patients with this rare mutation.
Collapse
Affiliation(s)
- A Müller
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany
| | - I Helbig
- Department of Neuropediatrics, Christian-Albrechts-Univerisity of Kiel and University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Jansen
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany
| | - T Bast
- Epilepsieklinik für Kinder und Jugendliche, Epilepsiezentrum Kork, Germany
| | - R Guerrini
- Child Neurology Unit, A. Meyer Children's Hospital, University of Florence, Italy
| | - J Jähn
- Department of Neuropediatrics, Christian-Albrechts-Univerisity of Kiel and University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - H Muhle
- Department of Neuropediatrics, Christian-Albrechts-Univerisity of Kiel and University Medical Center Schleswig-Holstein (UKSH), Kiel, Germany
| | - S Auvin
- Service de Neurologie Pédiatrique et des Maladies Métaboliques, Hôpital Robert Debré, Paris, France
| | - G C Korenke
- Neuropädiatrie, Zentrum für Kinder- und Jugendmedizin, Klinikum Oldenburg, Germany
| | - S Philip
- Children's Hospital Birmingham, England, UK
| | - R Keimer
- Neuropädiatrie, Stauferklinikum Mutlangen, Germany
| | - P Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Institute Gaslini, University of Genova, Italy
| | - N I Wolf
- Child Neurology, VU University Medical Center, Amsterdam, Netherlands
| | - B Püst
- Neuropädiatrie, Kath. Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Ch Thiels
- Neuropädiatrie, Klinik für Kinder- und Jugendmedizin, Klinik der Ruhr-Universität, Bochum, Germany
| | - A Fogarasi
- Neurology Department, Bethesda Children's Hospital, Budapest, Hungary
| | - S Waltz
- Neuropädiatrie, Kinderklinik Amsterdamer Straße, Kliniken der Stadt Köln, Germany
| | - G Kurlemann
- Kinderklinik Münster, Neuropädiatrie, Germany
| | | | - B Ceulemans
- Department of Neurology-Child Neurology, University Hospital and University of Antwerp, Belgium
| | - B Schmitt
- University Children's Hospital Zurich, Switzerland
| | - H Philippi
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Germany
| | - D Tarquinio
- Rare Diseases Clinical Research Network, Boston Children's Hospital, USA
| | - S Buerki
- BC Children's Hospital, Department of Pediatrics, Vancouver, Canada
| | - C von Stülpnagel
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Paracelsus Medical University, Salzburg, Austria
| | - G Kluger
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Paracelsus Medical University, Salzburg, Austria.
| |
Collapse
|
20
|
Stanetic BM, Ostojic M, Huber K, Campos C, Kovacevic-Preradovic T, Serruys PW. APPROPRIATENESS OF MYOCARDIAL REVASCULARIZATION ASSESSED BY SYNTAX SCORE II IN A CENTRE WITHOUT ON-SITE CARDIAC SURGERY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61583-2] [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: 10/23/2022]
|
21
|
Mujanovic E, Bergsland J, Avdic S, Stanimirovic-Mujanovic S, Kovacevic-Preradovic T, Kabil E. Surgical treatment of left ventricular pseudoaneurysm. Med Arch 2014; 68:215-7. [PMID: 25568538 PMCID: PMC4240329 DOI: 10.5455/medarh.2014.68.215-217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 05/25/2014] [Indexed: 01/08/2023] Open
Abstract
Introduction: Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction, occurring in approximately 4% of patients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. Case report: In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.
Collapse
Affiliation(s)
| | - Jacob Bergsland
- BH Heart Center Tuzla, Tuzla, Bosnia and Herzegovina ; The Intervention Centre, Oslo University Hospital, Oslo Norway
| | - Sevleta Avdic
- BH Heart Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | - Emir Kabil
- BH Heart Center Tuzla, Tuzla, Bosnia and Herzegovina
| |
Collapse
|
22
|
Mujanovic E, Bergsland J, Avdic S, Stanimirovic-Mujanovic S, Kovacevic-Preradovic T, Kabil E. Surgical treatment of left ventricular pseudoaneurysm. Med Arh 2014; 68:215-217. [PMID: 25195357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction, occurring in approximately 4% of patients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. CASE REPORT In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.
Collapse
|
23
|
Kovacevic-Preradovic T, Jenni R, Oechslin E, Noll G, Seifert B, Attenhofer Jost C. Isolated Left Ventricular Noncompaction as a Cause for Heart Failure and Heart Transplantation: A Single Center Experience. Cardiology 2009; 112:158-64. [DOI: 10.1159/000147899] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 03/20/2008] [Indexed: 11/19/2022]
|
24
|
Kovacevic-Preradovic T, Zuber M, Jost CA, Widmer U, Seifert B, Schulthess G, Fischer A, Jenni R. Anderson-Fabry disease: long-term echocardiographic follow-up under enzyme replacement therapy. European Journal of Echocardiography 2008; 9:729-35. [DOI: 10.1093/ejechocard/jen129] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
25
|
Abstract
The occurrence of generalised tonic-clonic seizures (GTCS) was investigated in patients with absence epilepsy (AE), evaluating the opinion that ethosuximide does not protect against GTCS. Our retrospective study included 238 patients with absences and generalised 3-Hz spike waves (SW). We analysed the efficacy of antiepileptic drugs (AED) and the occurrence of GTCS before, during and after treatment. We surveyed family history, treatment delay and EEG findings. Family history of epilepsy was positive in 28%. Children with 3-Hz SW lasting >10 s suffered less frequently from GTCS (p=0.002). Photosensitivity (3-Hz SW during photic stimulation) recorded in 47 children was more frequent in juvenile AE (p=0.0001), but not associated with higher rates of GTCS. GTCS occurred in 27 children (11%) before treatment, in 14 (5.8%) during treatment and in 8 (4.8%) after tapering AED. Valproate and ethosuximide monotherapy were equally effective on absences, carrying the same low risk of GTCS during treatment (2 valproate, 1 ethosuximide). Most GTCS occurred on drug combinations considered effective against GTCS. Risk factors for relapses after tapering AED were photosensitivity (p=0.002) and GTCS during treatment (p=0.02). GTCS are rare in patients with typical AE. Our data do not support the current opinion that ethosuximide is inefficacious on GTCS in AE.
Collapse
Affiliation(s)
- B Schmitt
- University Children's Hospital, Clinical Neurophysiology, Zurich, Switzerland.
| | | | | | | |
Collapse
|