Browsing by Author "Djurić, Predrag (52163459400)"

Background/Aim. Recently adopted technique, Transthoracic Doppler Echocardiography (TDE) enables the estimate of functional significance of coronary luminal narrowing. A multi-slice computed coronary angiography (MSCT), as one of the most important noninvasive methods, offers us a quite precise visualization of morphological characteristics of atherosclerotic changes in coronary arteries. We have tried to evaluate the most reliable noninvasive approach aimed at the detection of major stenosis on the left anterior descending artery (LAD) and the right coronary artery (RCA). Methods. This study involved 84 patients, with the previously detected atherosclerotic lesions on the LAD and/or RCA by MSCT. The coronary flow reserve (CFR) assessment by TDE with adenosine was obtained in LAD (n = 75); RCA (n = 61), resulting in 136 vessels subjected to the analysis. Invasive coronary angiography (ICA) was performed in all patients within 24 to 48 hours after the CFR as a reference technique. Results. The Cochrans Q test proved a significant statistical difference among these techniques in detection of a significant stenosis on the LAD and RCA (p < 0.01). Further analyses revealed a significant difference between the MSCT and CFR (p < 0.05), MSCT and ICA (p < 0.01), whereas we did not find a significant difference between the CFR and ICA (p > 0.05). The main discrepancies in results among the CFR, ICA and MSCT were noticed concerning intermediate and severe stenosis on the MSCT. The MSCT had a diagnostic accuracy for the LAD 66.67%, for the RCA 75.%, the CFR had for the LAD 90% and for the RCA 81.67%, in detection of significant stenosis. Where the consensus was reached between both techniques, diagnostic accuracy was improved for the LAD 97.33% and the RCA 90 %. Conclusion. Comprehensive noninvasive evaluation of both anatomical and functional imaging in coronary diseases makes the optimal approach for precise, noninvasive assessment of the coronary artery lesions in the coronary arteries. © 2019, Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. Previous studies have confirmed a positive correlation between homocysteine levels and a greater risk for acute coronary syndrome and stroke, but there are no available data to support an association between homocysteine and inflammatory markers and the severity of coronary artery disease according to the clinical SYNTAX score in patients with stable angina. The aim was to determine the association between homocysteine and inflammatory biomarker levels: interleukin (IL)-6, high sensitive C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR) and the severity of coronary artery disease according to clinical SYNTAX score. Methods. Eighty-two patients with stable angina pectoris (average age 65 ± 8 years, 28.9% females) underwent coronary angiography and were divided into three groups according to the clinical SYNTAX score: the group I < 22 (39 patients), the group II 23–32 (16 patients), the group III > 33 (27 patients). The severity and complexity of coronary artery disease were calculated by clinical SYNTAX score, multiplying the SYNTAX score with the modified ACEF score, based on the patients’ left ventricular ejection fraction, age and creatinine clearance (derived with Cockcroft–Gault equation). Results. Homocysteine levels were significantly higher in patients with high clinical SYNTAX score [the group I: median (interquartile range – IQR): 10.20 (3.97), the group II: 10.45 (5.77), the group III: 14.70 (7.50), p = 0.005]. Patients in the group III had significantly higher homocysteine levels compared to the group I (p = 0.001). We also found a positive association between inflammatory biomarkers (IL-6, hsCRP, fibrinogen, ESR) and the severity of coronary artery disease according to the clinical SYNTAX score (p = 0.017, 0.001, 0.032, 0.049 respectively). We detected significantly lower plasma levels of vitamin B12 in the group III and group II in comparison with the group I (the group I: median (IQR): 238 (160), the group II: 171 (160), the group III: 172 (102), p = 0.022), which indicates its important role in homocysteine metabolism. Conclusion. The elevated plasma levels of homocysteine, IL-6, hsCRP, fibrinogen, ESR were detected in patients with high clinical SYNTAX score (> 33). Our results showed that hyperhomocysteinemia and some inflammatory biomarkers can predict more severe and extensive coronary artery disease in stable angina patients. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

ence (WC), blood pressure (BP), serum triglyceride (TG), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were also compared between the two groups. Results. PDG patients had statistically significantly higher TNF-α values compared to the HCG patients (73 pg/mL vs. 55 pg/mL, p = 0.024). A trend towards higher levels of IL-8 and IL-1β and lower levels of E-selectin, VEGF-A, and IL-18 was registered in PDG patients but without statistical significance. Furthermore, PDG patients had higher values of BMI, WC, systolic BP, serum TG, FPG, and HbA1c when compared to HCG. Conclusion. The results of our study suggest the importance of inflammation and some inflammatory mediators in the pathogenesis of early glycoregulation disorder. We believe that the main goal of future studies should focus on anti-inflammatory therapy in prediabetes.; Background/Aim. Prediabetes is a condition that refers to the state of hyperglycemia not sufficiently high to reach the diagnostic values for type 2 diabetes mellitus (T2DM). This condition often precedes the appearance of T2DM. The association between the development of early glycoregulation disorders and the state of low-grade chronic inflammation is still not sufficiently well understood. The aim of the study was to assess the values of different inflammatory mediators and biomarkers in individuals with prediabetes. Methods. This cross-sectional, observational study included 60 respondents divided into two groups: the prediabetes group (PDG) with 31 patients and the healthy control group (HCG) with 29 respondents. Serum values of seven selected cytokines/biomarkers were compared between the two groups. Examined biomarkers were: interleukin (IL)-1β, IL-6, IL-8, IL-18, tumor necrosis factor (TNF)-α, E-selectin, and vascular endothelial growth factor (VEGF)-A. In addition, the values of body mass index (BMI), waist circumfer-ence (WC), blood pressure (BP), serum triglyceride (TG), fasting plasma glucose (FPG), and glycated hemoglobin (HbA1c) were also compared between the two groups. Re-sults. PDG patients had statistically significantly higher TNF-α values compared to the HCG patients (73 pg/mL vs. 55 pg/mL, p = 0.024). A trend towards higher levels of IL-8 and IL-1β and lower levels of E-selectin, VEGF-A, and IL-18 was registered in PDG patients but without sta-tistical significance. Furthermore, PDG patients had higher values of BMI, WC, systolic BP, serum TG, FPG, and HbA1c when compared to HCG. Conclusion. The results of our study suggest the importance of inflammation and some inflammatory mediators in the pathogenesis of early glycoregulation disorder. We believe that the main goal of future studies should focus on anti-inflammatory therapy in prediabetes. © 2024 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. The importance of chronic inflammation, endothelial dysfunction, certain cytokines, and selectins in the development of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVDs) is increasingly evident and supported by evidence. However, the role of chronic inflammation in the development of diastolic dysfunction (DD) in the early stages of cardiomyopathy in T2DM patients is insufficiently studied. The aim of this study was to examine the possible association of interleukin (IL)-1β, IL-1α, IL-6, and E-selectin with DD in T2DM patients with still preserved ejection fraction (EF). Methods. The research included a total of 74 subjects divided into two groups: a group with proven T2DM, i.e., diabetes group (DG) (n = 45), and a healthy control group (HCG) (n = 29). Echocardiographic parameters of DD and serum levels of IL-1β, IL-1α, IL-6 and E-selectin were compared between the two groups, and the correlation of echocardiographic parameters of DD and serum biomarkers was examined in both groups. Results. Subjects with T2DM had significantly different values of DD parameters compared to HCG but also higher values of IL-6 (19 pg/mL vs. 12 pg/mL, p = 0.002), E-selectin (2,036 pg/mL vs. 1,522 pg/mL, p < 0.001), and IL-1α (46 pg/mL vs. 37 pg/mL, p = 0.003). The majority of subjects who met the echocardiographic criteria of DD were from DG. In subjects with proven DD, significantly higher values of IL-6 (20.5 pg/mL vs. 16 pg/mL, p = 0.003) and IL-1β (15.0 pg/mL vs. 11.4 pg/mL, p = 0.036) were verified compared to subjects without DD. Conclusion. The results of our study indicate the presence of a connection between chronic inflammation and echocardiographic parameters with the onset of DD in the phases of preserved cardiac EF in patients with T2DM. © 2025 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Stent thrombosis (ST) in clinical practice can be classified according to time of onset as early (0–30 days after stent implantation), which is further divided into acute (< 24 hours) and subacute (1-30 days), late (> 30 days) and very late (> 12 months). Myocardial reinfaction due to very late ST in a patient receiving antithrombotic therapy is very rare, and potentially fatal. The procedure alone and related mechanical factors seem to be associated with acute/subacute ST. On the other hand, instent neoathero-sclerosis, inflammation, premature cessation of antiplatelet therapy, as well as stent fracture, stent malapposition, uncovered stent struts may play role in late/very late ST. Some findings implicate that the etiology of very late ST of baremetal stent (BMS) is quite different from those following druge-luting stent (DES) implantation. Case report. We presented a 56-year old male with acute inferoposterior ST segment elevation myocardial infarction (STEMI) related to very late stent thrombosis, 9 years after BMS implantation, despite antithrombotic therapy. Thrombus aspiration was successfully performed followed by percutaneous coronary intervention (PCI) with implantation of DES into the previously implanted two stents to solve the instent restenosis. Conclusion. Very late stent thrombosis, although fortunately very rare, not completely understood, might cause myocardial reinfaction, but could be successfully treated with thrombus aspiration followed by primary PCI. Very late ST in the presented patient might be con-nected with neointimal plaque rupture, followed by thrombotic events. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.