Browsing by Author "Ivanovic, Branislava (24169010000)"

Secondary metastatic deposits in the heart are generally rarely diagnosed antemortem. Malignant tumors of gynecologic origin commonly spread to the bones, lungs, local cervical region and the supra-clavicular lymph nodes, while gynecologic metastases to the thoracic region are rarely seen in clinical practice. We present a case of squamous cervical carcinoma that metastasized to the heart in 35-year old patient. The patient was admitted to cardiology department with complaints of retrosternal pain, dyspnea, fatigue, and cough. She informed the physicians that she had bilateral adnexectomy three years prior to admission. On physical examination patient was pale, febrile (38 °C), adynamic, with diminished breath sounds. Trans-thoracic echocardiogram showed aforeign mass of 42x64 mm extracardially proximal to the right atrium. Biopsy showed characteristics of metastatic deposits of squamous differentiation. These were the only metastases in this case. © 2018 EDIZIONI MINERVA MEDICA.

OBJECTIVE: The aim of our study was to define the relationship between the metabolic syndrome (MS), nondipping pattern, and their interaction on right ventricular (RV) structural and functional changes in untreated hypertensive patients. METHODS: This cross-sectional study included 318 recently diagnosed hypertensive patients. MS was defined by the presence of at least 3 National Cholesterol Education Program's Adult Treatment Panel III criteria. All patients underwent 24-h ambulatory blood pressure monitoring and a complete two-dimensional echocardiography examination. RESULTS: MS was found in 144 (45%) hypertensive patients and the nondipping pattern was detected in 147 (46%) patients. Hypertensive patients with MS had higher 24-h and night-time blood pressure levels in comparison with non-MS patients with the same nocturnal blood pressure pattern. RV wall thickness was significantly increased and RV diastolic function was significantly deteriorated in nondippers (with and without MS), but still more impaired in MS patients. MS, nondipping pattern, and their interaction had a huge impact on RV wall thickness, parameters of RV diastolic function (E/At, E/e′t, e′/a′t), as well as RV global function estimated by the myocardial performance index. Among the MS criteria, only fasting glucose level and abdominal obesity were associated independently with RV hypertrophy, diastolic, and global dysfunction. CONCLUSION: MS, nondipping pattern, and their interaction significantly impact RV structure, diastolic, and global function. Fasting glucose level and abdominal obesity are the most important MS criteria for RV remodeling in arterial hypertension. Copyright © Lippincott Williams & Wilkins.

OBJECTIVE: The aim of our study was to define the relationship between the metabolic syndrome (MS), nondipping pattern, and their interaction on right ventricular (RV) structural and functional changes in untreated hypertensive patients. METHODS: This cross-sectional study included 318 recently diagnosed hypertensive patients. MS was defined by the presence of at least 3 National Cholesterol Education Program's Adult Treatment Panel III criteria. All patients underwent 24-h ambulatory blood pressure monitoring and a complete two-dimensional echocardiography examination. RESULTS: MS was found in 144 (45%) hypertensive patients and the nondipping pattern was detected in 147 (46%) patients. Hypertensive patients with MS had higher 24-h and night-time blood pressure levels in comparison with non-MS patients with the same nocturnal blood pressure pattern. RV wall thickness was significantly increased and RV diastolic function was significantly deteriorated in nondippers (with and without MS), but still more impaired in MS patients. MS, nondipping pattern, and their interaction had a huge impact on RV wall thickness, parameters of RV diastolic function (E/At, E/e′t, e′/a′t), as well as RV global function estimated by the myocardial performance index. Among the MS criteria, only fasting glucose level and abdominal obesity were associated independently with RV hypertrophy, diastolic, and global dysfunction. CONCLUSION: MS, nondipping pattern, and their interaction significantly impact RV structure, diastolic, and global function. Fasting glucose level and abdominal obesity are the most important MS criteria for RV remodeling in arterial hypertension. Copyright © Lippincott Williams & Wilkins.

We aimed to determine left ventricular (LV) and right ventricular (RV) structure, function and mechanics, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). The study included 41 SSc patients and 30 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, 24-h Holter monitoring and complete two-dimensional echocardiography including strain analysis. The parameters of LV structure (interventricular septum thickness and LV mass index) and RV structure (RV wall thickness) were significantly higher in SSc patients. LV and RV diastolic function (estimated by mitral and tricuspid E/e′ ratio) was significantly impaired in SSc group comparing with the healthy controls. LV and RV longitudinal function was significantly deteriorated in SSc patients. LV circumferential strain was also significantly lower in SSc group, whereas LV radial strain was similar between the observed groups. All parameters of time and frequency domain of HRV were decreased in SSc patients. LV and RV cardiac remodeling parameters, particularly diastolic function and longitudinal strain, were associated with HRV indices without regard to the main demographic or the clinical and echocardiographic characteristics. Rodnan Skin Score was also independently associated with biventricular cardiac remodeling in SSc patients. LV and RV structure, function and mechanics, as well as autonomic nervous function, were significantly impaired in SSc patients. There is the significant association between biventricular cardiac remodeling and autonomic function in these patients, which could be useful for their everyday clinical assessment. © 2016, Springer-Verlag Berlin Heidelberg.

We aimed to determine left ventricular (LV) and right ventricular (RV) structure, function and mechanics, as well as heart rate variability (HRV), and their relationship, in patients with systemic sclerosis (SSc). The study included 41 SSc patients and 30 age-matched healthy volunteers. All the patients underwent clinical examination, serological tests, pulmonary function testing, 24-h Holter monitoring and complete two-dimensional echocardiography including strain analysis. The parameters of LV structure (interventricular septum thickness and LV mass index) and RV structure (RV wall thickness) were significantly higher in SSc patients. LV and RV diastolic function (estimated by mitral and tricuspid E/e′ ratio) was significantly impaired in SSc group comparing with the healthy controls. LV and RV longitudinal function was significantly deteriorated in SSc patients. LV circumferential strain was also significantly lower in SSc group, whereas LV radial strain was similar between the observed groups. All parameters of time and frequency domain of HRV were decreased in SSc patients. LV and RV cardiac remodeling parameters, particularly diastolic function and longitudinal strain, were associated with HRV indices without regard to the main demographic or the clinical and echocardiographic characteristics. Rodnan Skin Score was also independently associated with biventricular cardiac remodeling in SSc patients. LV and RV structure, function and mechanics, as well as autonomic nervous function, were significantly impaired in SSc patients. There is the significant association between biventricular cardiac remodeling and autonomic function in these patients, which could be useful for their everyday clinical assessment. © 2016, Springer-Verlag Berlin Heidelberg.

The aim of this study was to investigate the impact of nondipping arterial blood pressure pattern and the metabolic syndrome (MS), as well as their interaction, on left ventricular (LV) structural and function remodeling. The study included 352 never-treated hypertensive patients with and without MS. Nondipping pattern and MS, separately, as well as their interaction, significantly impacted LV structure, LV geometry pattern, systolic, diastolic and global function in hypertensive patients. Abdominal obesity was the only MS criterion which was simultaneously associated with LV hypertrophy, LV diastolic dysfunction and, LV global dysfunction. © Informa Healthcare USA, Inc.

The aim of this study was to investigate the impact of nondipping arterial blood pressure pattern and the metabolic syndrome (MS), as well as their interaction, on left ventricular (LV) structural and function remodeling. The study included 352 never-treated hypertensive patients with and without MS. Nondipping pattern and MS, separately, as well as their interaction, significantly impacted LV structure, LV geometry pattern, systolic, diastolic and global function in hypertensive patients. Abdominal obesity was the only MS criterion which was simultaneously associated with LV hypertrophy, LV diastolic dysfunction and, LV global dysfunction. © Informa Healthcare USA, Inc.

Background: We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). Methods: This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ® 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. Results: 2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (-24 ± 5 vs-27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. Conclusions: RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling. © 2014 Canadian Cardiovascular Society.

[No abstract available]

[No abstract available]

Background: Left atrial (LA) mechanics has been poorly investigated in women with subclinical hypothyroidism (SHT), and the effect of levothyroxine therapy on LA deformation and function is unknown. Aim: To investigate LA phasic function and mechanics assessed by two-dimensional echocardiography (2DE) and speckle tracking in women with SHT, and to estimate the influence of levothyroxine therapy on LA remodeling. Methods: We included 48 untreated women with SHT and 38 healthy control women of the same age. All the SHT patients received levothyroxine therapy and were followed for 1 year after euthyroid status was achieved. All the participants underwent laboratory analyses and complete 2DE examination. Results: Left atrial total emptying fraction was significantly lower in the SHT patients at the baseline in comparison with the controls. LA passive emptying fraction gradually decreased from the controls, throughout the treated SHT patients, to the untreated SHT patients. LA active emptying fraction was lower in the controls than in the untreated and the treated SHT participants. 2DE LA longitudinal strain and systolic strain rate gradually decreased from the controls to the untreated SHT patients, whereas LA early diastolic strain rate signi ficantly increased in the same direction. Late diastolic LA strain was lower in the controls than in the untreated and the treated SHT patients. Conclusion: Subclinical hypothyroidism significantly affects LA mechanics. Reservoir, conduit, and booster pump LA functions are all impacted by SHT. A 1-year levothyroxine therapy significantly improves, but does not completely restore LA phasic function and mechanics in the SHT patients. © 2014, Wiley Periodicals, Inc.

Background: We aimed to study the relationship between markers of oxidative lipid or protein damage and ventricular remodeling and the validity of 8-epi-prostaglandin F2α (8-epi-PGF2α) as an indicator of disease severity in patients with ischemic chronic heart failure (CHF). Patients and methods: We enrolled four groups of 12 patients with varying CHF according to the New York Heart Association (NYHA) classification and 25 controls. Urinary 8-epi-PGF2α and plasma malondialdehyde and protein thiol (P-SH) groups were correlated with echocardiographic indices of remodeling. The reliability of isoprostanes was analyzed by a receiver operating characteristics (ROC) curve. Results: NYHA class III and IV patients exhibited elevated 8-epi-PGF2α levels, increased malondialdehyde concentrations and decreased P-SH groups when compared to controls and NYHA I and II patients. 8-Epi-PGF2α and P-SH groups correlated significantly with indices of remodeling. The ROC curve drawn for 8-epi-PGF2α allowed us to differentiate NYHA class III and IV patients from NYHA class I and II patients with a sensitivity of 95.8% and specificity of 95.8% (cut off 0.84 ng/mg creatinine; area under curve 0.99; P < 0.001). Conclusions: Markers of oxidative damage are unlikely to play a significant role in early stages of CHF. However, they might become important in the course of CHF when their concentrations reach critical levels. Urinary 8-epi-PGF2α is a reliable indicator of symptomatic CHF. © 2008 W. S. Maney and Son Ltd.

Background: We aimed to study the relationship between markers of oxidative lipid or protein damage and ventricular remodeling and the validity of 8-epi-prostaglandin F2α (8-epi-PGF2α) as an indicator of disease severity in patients with ischemic chronic heart failure (CHF). Patients and methods: We enrolled four groups of 12 patients with varying CHF according to the New York Heart Association (NYHA) classification and 25 controls. Urinary 8-epi-PGF2α and plasma malondialdehyde and protein thiol (P-SH) groups were correlated with echocardiographic indices of remodeling. The reliability of isoprostanes was analyzed by a receiver operating characteristics (ROC) curve. Results: NYHA class III and IV patients exhibited elevated 8-epi-PGF2α levels, increased malondialdehyde concentrations and decreased P-SH groups when compared to controls and NYHA I and II patients. 8-Epi-PGF2α and P-SH groups correlated significantly with indices of remodeling. The ROC curve drawn for 8-epi-PGF2α allowed us to differentiate NYHA class III and IV patients from NYHA class I and II patients with a sensitivity of 95.8% and specificity of 95.8% (cut off 0.84 ng/mg creatinine; area under curve 0.99; P < 0.001). Conclusions: Markers of oxidative damage are unlikely to play a significant role in early stages of CHF. However, they might become important in the course of CHF when their concentrations reach critical levels. Urinary 8-epi-PGF2α is a reliable indicator of symptomatic CHF. © 2008 W. S. Maney and Son Ltd.

Background: Metabolic syndrome (MS) is a clustering of cardiovascular risk factors responsible for the development of target organ damage. The aim of this study was to determine the effect of the increasing number of MS risk factors on left ventricular function assessed by noninvasive methods. Material/Methods: The study included 204 subjects with MS and 76 controls with no MS risk factors. MS was defined by the presence of 3 or more of ATP-NCEP III criteria. MS subjects were grouped according to the number of criteria they fulfilled: 3 criteria (n=91), 4 criteria (n=65) and 5 criteria (n=48). All subjects underwent laboratory blood tests, complete 2-dimensional, pulse and tissue Doppler echocardiography. Echocardiography was used to assess systolic (LVEF, sseptal), diastolic function, by pulse-wave Doppler (E/A ratio) and tissue Doppler imaging (E/e'average), and global left ventricular function (Tei index). Appropriate time intervals for the estimation of the Tei index were obtained by tissue Doppler. Results: Transmitral E/A ratio decreased significantly and progressively from the 3 criteria to the 5 criteria group (0.82±0.25 vs. 0.79±0.24 vs. 0.67±0.14, p<0.001). The transmitral E/E'average ratio was significantly and gradually increased from the 3 criteria to the 5 criteria group (7.76±1.81 vs. 9.44±2.35 vs. 10.82±2.56, p<0.001). The left ventricle Tei index progressively increased from the 3 criteria to the 5 criteria group (0.43±0.11 vs. 0.48±0.10 vs. 0.54±0.12, p<0.001). Conclusions: The increasing number of MS criteria is associated with cardiac diastolic dysfunction. © Med Sci Monit, 2012.

Advanced cardiac imaging (ACI), including myocardial deformation imaging, 3D echocardiography and cardiac magnetic resonance, overcomes the limitations of conventional echocardiography in the assessment of patients with primary mitral regurgitation (MR). They enable a more precise MR quantification and reveal early changes before advanced and irreversible remodeling with depressed heart function occurs. ACI permits a thorough analysis of mitral valvular anatomy and MR mechanisms (important for planning and guiding percutaneous and surgical procedures) and helps to identify structural and functional changes coupled with a high arrhythmogenic potential, especially the occurrence of atrial fibrillation and heart failure development. The key question is how the data provided by ACI can improve the current management of primary MR. © 2022 Wiley Periodicals LLC.

Objectives: The aim of this study was to assess the performance of echocardiographic parameters to predict response to cardiac resynchronization therapy (CRT). Background: CRT reduces morbidity and mortality due to the proper selection of candidates for CRT. Methods: The 12-month trial was performed on 70 optimally medicated patients with standard inclusion criteria: NYHA class III or IV heart failure, left ventricular ejection fraction (LVEF) ≤ 35%, and QRS a 120 ms. All parameters were evaluated by conventional and tissue Doppler-based methods. Indicator of positive CRT response was more than 20% in improvement of LVEF. Results: LVEF increased >20% in 42 patients. Out of 43 tested baseline echocardiographic parameters, 12 showed statistical difference between responders and nonresponders. Out of these 12 parameters, six (LVSV, LVSI, LVFS, RVd, VPMR, and PISA) had modest to moderately good ability to predict LVEF response with sensitivity ranging from 62.2% to 82.4%, and specificity ranging from 56.5% to 81.2%. For those parameters, the area under the receiver-operating characteristic curve for positive response to CRT was a;circ0.76. Multivariate regression analysis resulted in selection of LVSI and LVFS as possible predictive independent parameters for a good response. The cutoff value for LVSI was 38.7 mL/m 2 (P = 0.045) and for LVFS was 13% (P = 0.032). Conclusions: Contribution of LVSI and LVFS is to be confirmed in larger trials. Simplicity of their assessment by conventional echocardiography could be an argument for adding them to the inclusion criteria for CRT in severe heart failure patients. © 2011, Wiley Periodicals, Inc.

Chronic infections may mimic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). We investigated which markers may help in the diagnosis and the prognosis of infections associated with proteinase 3 (PR3) and myeloperoxidase (MPO)-ANCA. In this study (1993-2008)-with an average follow-up of 5.1 years-we compared 66 AAV patients with 17 PR3 and/or MPO-ANCA-positive patients with protracted bacterial (11/17) or viral (6/17) infections. Seven of 17 patients had subacute bacterial endocarditis (SBE), while six of 17 patients had various autoimmune manifestations of chronic hepatitis C virus (HCV) infection. We determined ANCA, antinuclear antibodies, anti-PR3, anti-MPO, anticardiolipin (aCL), antibeta 2 glycoprotein I (β2-GP I), cryoglobulins, C3, and C4. Patients with infections were younger than AAV patients (p<0.01). There was no difference in frequency of renal and skin lesions. AAV patients more frequently had pulmonary and nervous system manifestations (p<0.01). Patients with infections more frequently had dual ANCA (high PR3, low MPO), aCL, anti-β2-GP I, cryoglobulins, and hypocomplementemia (pβ0.001). Immunosuppressive therapy (IST) was used in five 17 patients who had persistently high ANCA, cryoglobulinemia, and hypocomplementemia. There was no difference in frequency of lethality and renal failure in the two study groups. In patients who are PR3-and/or MPO-ANCA positive, SBE and HCV infection should be excluded. Although similar in renal and skin manifestations in comparison to AAV, only patients with infections developed multiple serological abnormalities. In patients with infections, concomitant presence of ANCA, cryoglobulins, and hypocomplementemia was associated with severe glomerulonephritis. The serological profile should be repeated after specific antimicrobial or surgical therapy, since some cases might require IST. © Clinical Rheumatology 2010.

This review summarizes current knowledge about echocardiographic modalities used to assess microvascular function and left ventricular (LV) systolic function in women with ischemia and no obstructive coronary arteries (INOCA). Although the entire pathophysiological background of this clinical entity still remains elusive, it is primarily linked to microvascular dysfunction which can be assessed by coronary flow velocity reserve. Subtle impairments of LV systolic function in women with INOCA are difficult to assess by interpretation of wall motion abnormalities. LV longitudinal function impairment is considered to be an early marker of subclinical systolic dysfunction and can be assessed by global longitudinal strain quantification. © 2022 Wiley Periodicals LLC.

To assess the presence of subclinical left ventricular myocardial dysfunction in subjects with high-normal blood pressure (BP) and untreated arterial hypertension, using three-dimensional (3D) echocardiography strain analysis. This cross-sectional study included 49 subjects with optimal BP, 50 subjects with high-normal BP, and 50 newly diagnosed untreated hypertensive patients matched by gender and age. All the subjects underwent 24 h blood pressure monitoring and complete two-dimensional and 3D echocardiography examination. The enrolled subjects were grouped according to 24 h systolic BP values, dividing the subjects with optimal BP from those with high-normal BP and the hypertensive patients (cut-off values were 120 and 130 mmHg, respectively). 3D global longitudinal strain was significantly lower in the high-normal BP group and the hypertensive patients, in comparison with the optimal BP group (-20.5 ± 3.3 vs. -18.7 ± 2.8 vs. -17.6 ± 2.7 %, p < 0.001). Similar results were obtained for 3D global circumferential strain (-18.6 ± 3 vs. -17.1 ± 2.9 vs. -16 ± 2.5 %, p < 0.001), as well for 3D global radial strain (49.4 ± 9.5 vs. 44.7 ± 8.1 vs. 43.5 ± 7.8 %, p = 0.002), and global area strain (-31.2 ± 4.8 vs. -28.7 ± 4.2 vs. -27.1 ± 4.5 %, p < 0.001). LV twist was increased in the hypertensive patients in comparison with the high-normal and the optimal BP groups (10.1° ± 2.4° vs. 10.8° ± 2.6° vs. 13.8° ± 3.1°, p < 0.01), whereas untwisting rate significantly and gradually decreased from the optimal BP group, across the high-normal BP group, to the hypertensive patients (-135 ± 35 vs. -118 ± 31 vs. -102 ± 27°/s, p < 0.001). 3D echocardiography revealed that the subjects with high-normal BP suffered subclinical impairment of LV mechanics similar as the hypertensive patients. © 2014 Springer Science+Business Media.

The aim of this study was to compare the right ventricular (RV) structure and diastolic function between normotensive and non-diabetic subjects with metabolic syndrome (MS), and new diagnosed diabetic and hypertensive patients. Study included 89 normotensive and non-diabetic subjects with MS which was defined by the presence 3 ATP-NCEP-III criteria, 45 diabetic and 117 hypertensive patients, as well as 76 controls with no MS criteria, matched for age and sex. All subjects underwent laboratory blood tests and complete two-dimensional echocardiography including pulsed and tissue Doppler. RV free wall thickness was similar between MS and diabetic patients, but significantly lower than in hypertensive patients (4.6±0.8 versus 4.3±0.7 versus 4.9±0.9mm; p<0.01). Tricuspid E/e′ ratio was similar between observed groups (5.3±1.2 versus 5.2±1.1 versus 5.7±1.2, p>0.05). RV systolic function evaluated by tissue Doppler (st) was similar between MS and diabetic participants, but still worse than in hypertensive patients (13.1±2.2 versus 13.5±2.5 versus 12.5±2.4, p<0.05). Global RV function estimated by Tei index was similar among MS and diabetic patients, and most impaired in hypertensive patients (0.47±0.09 versus 0.45±0.08 versus 0.52±0.1, p<0.01). Increased fasting glucose level, abdominal obesity and hypertension were independent predictors of biventricular hypertrophy, diastolic dysfunction and global dysfunction in whole population. RV structure and function gradually deteriorated from diabetic patients, across MS subject, to hypertensive patients. Normotensive and non-diabetic subjects with MS had similar level of RV impairment as diabetic patients which emphasize the synergic effects of MS components on cardiac damage. © 2014 Informa Healthcare USA, Inc.