Browsing by Author "Ostojic, M. (34572650500)"

What is known and objective Premature discontinuation of clopidogrel in patients undergoing percutaneous coronary intervention is a significant risk factor for thrombotic adverse outcomes. However, recent studies indicate that even discontinuation of long-term use of clopidogrel may be associated with multiple adverse outcomes, that is, rebound phenomenon whose mechanism is not definitely clear. The aim of the study was to examine the effect of clopidogrel withdrawal in those on combined aspirin and clopidogrel therapy. Methods This prospective, multicenter study enrolled 200 patients who underwent coronary stent implantation and were on dual antiplatelet therapy (100 mg aspirin + 75 mg clopidogrel) 1 year after the stent placement. In all patients, we measured the platelet aggregation, by multiplate electrode aggregometry, using two agonists [adenosine diphosphate with PGE1 (ADPHS) and arachidonic acid (ASPI)] two times: on the day of cessation of clopidogrel and 90 days after clopidogrel was stopped. Results and discussion Following clopidogrel discontinuation, we registered an increase in ASPI values (P < 0·001), linear correlation between changes in ASPI and ADPHS values (P = 0·009) and significant difference in the values of ASPI first quartile of ADPHS compared with the other three (P < 0·001, P = 0·016, P < 0·001, I vs. II, I vs. III and I vs. IV quartile of ADPHS, respectively). What is new and conclusion Our findings show that cessation of clopidogrel causes loss of antiplatelet synergism with aspirin, leading to a weakening of the response to aspirin, which may be one explanation for the rebound after the clopidogrel cessation. Recent studies indicate that even discontinuation of long-term use of clopidogrel may be associated with multiple adverse outcomes, i.e. rebound phenomenon whose mechanism is not definitely clear. The aim of the study was to examine the effect of clopidogrel withdrawal in those on combined aspirin and clopidogrel therapy. Our findings show that cessation of clopidogrel causes loss of antiplatelet synergism with aspirin, leading to a weakening of the response to aspirin, which may be one explanation for the rebound after the clopidogrel cessation. © 2013 John Wiley & Sons Ltd.

What is known and objective Premature discontinuation of clopidogrel in patients undergoing percutaneous coronary intervention is a significant risk factor for thrombotic adverse outcomes. However, recent studies indicate that even discontinuation of long-term use of clopidogrel may be associated with multiple adverse outcomes, that is, rebound phenomenon whose mechanism is not definitely clear. The aim of the study was to examine the effect of clopidogrel withdrawal in those on combined aspirin and clopidogrel therapy. Methods This prospective, multicenter study enrolled 200 patients who underwent coronary stent implantation and were on dual antiplatelet therapy (100 mg aspirin + 75 mg clopidogrel) 1 year after the stent placement. In all patients, we measured the platelet aggregation, by multiplate electrode aggregometry, using two agonists [adenosine diphosphate with PGE1 (ADPHS) and arachidonic acid (ASPI)] two times: on the day of cessation of clopidogrel and 90 days after clopidogrel was stopped. Results and discussion Following clopidogrel discontinuation, we registered an increase in ASPI values (P < 0·001), linear correlation between changes in ASPI and ADPHS values (P = 0·009) and significant difference in the values of ASPI first quartile of ADPHS compared with the other three (P < 0·001, P = 0·016, P < 0·001, I vs. II, I vs. III and I vs. IV quartile of ADPHS, respectively). What is new and conclusion Our findings show that cessation of clopidogrel causes loss of antiplatelet synergism with aspirin, leading to a weakening of the response to aspirin, which may be one explanation for the rebound after the clopidogrel cessation. Recent studies indicate that even discontinuation of long-term use of clopidogrel may be associated with multiple adverse outcomes, i.e. rebound phenomenon whose mechanism is not definitely clear. The aim of the study was to examine the effect of clopidogrel withdrawal in those on combined aspirin and clopidogrel therapy. Our findings show that cessation of clopidogrel causes loss of antiplatelet synergism with aspirin, leading to a weakening of the response to aspirin, which may be one explanation for the rebound after the clopidogrel cessation. © 2013 John Wiley & Sons Ltd.

An enhanced risk of undesirable events has been described in individuals who take part in mainly high intensity physical activities. Underlying cardiac disorders are the most common cause of sudden death during sports activities. Left ventricular remodeling is associated with a long-term athletic training. Echocardiography is an easy, non-invasive and efficient way to the precise distinction between these exercise-induced changes, called " physiological" hypertrophy, that revert after detraining, and those of cardiac disorders or "pathological" hypertrophy. The identification of a cardiac disease in an athlete usually leads to his disqualification in an attempt to reduce the risk. On the other hand, a false diagnosis of a cardiac disease in an athlete may also lead to disqualification, thus depriving him of the various benefits from sports participation. Pronounced left ventricular dilatation and hypertrophy should always be suspected for underlying cardiac disease. Physiological left ventricular remodeling is associated with normal systolic and diastolic left ventricle function. Both global and regional left ventricle diastolic function should be evaluated. New echocardiographic techniques (tissue Doppler imaging, strain rate) have revealed "super - diastolic" left ventricle function in athletes, adding the new quality in differential diagnosis od athlete's heart syndrome. © 2011 Akadémiai Kiadó, Budapest.

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in termsof Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 mSv for the first operator, 33 mSv for the second operator/nurse and 12 mSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 mSv Gy-1 cm-2 for the first operator, 0.33 mSv Gy-1 cm-2 for the second operator/nurse and 0.16 mSv Gy-1 cm-2 for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practiceand may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values. ©The Author 2012. Published by Oxford University Press.

Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in termsof Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 mSv for the first operator, 33 mSv for the second operator/nurse and 12 mSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 mSv Gy-1 cm-2 for the first operator, 0.33 mSv Gy-1 cm-2 for the second operator/nurse and 0.16 mSv Gy-1 cm-2 for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practiceand may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values. ©The Author 2012. Published by Oxford University Press.

Aims: We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in the European Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results: Between 1 November 2018 and 31 December 2020, 10 162 patients with acute HF (AHF, 39%, age 70 [62–79], 36% women) or outpatient visit for HF (61%, age 66 [58–75], 33% women), with HF with reduced (HFrEF, 57%), mildly reduced (HFmrEF, 17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41 European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in the emergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most by a general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized for HF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation of GDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. After the AHF event or outpatient HF visit, use of any renin–angiotensin system inhibitor, angiotensin receptor–neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85% in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. Conclusion: Use and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohorts and registries including more primary care and general medicine and regions more local or outside of Europe and ESC-affiliated countries. © 2024 The Author(s). European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Coronary artery bifurcations are one of the largest challenges in interventional cardiology. Presented is the case of a patient in whom restenosis of a drug-eluting stent (DES) occurred as a consequence of guide wire re-crossing between the main vessel stent struts and the vessel wall in the proximal part of DES, and consequential balloon crushing of the proximal portion of the DES. Initially, the complication was not recognized because of a good angiographic result and absence of intravascular ultrasound (IVUS) guidance during the procedure. During the second procedure, IVUS analysis explained the mechanism of the DES failure. The problem was solved with the implantation of a new DES. © 2010 Urban & Vogel.