Browsing by Author "Otašević, Petar (55927970400)"

In this article, the potential value of color Doppler in improving diagnostic accuracy of transesophageal echocardiography (TEE) in patients with incomplete obstruction of large pulmonary vessels is illustrated. We present an unusual case of massive pulmonary embolism that was unequivocally detected by color Doppler TEE both before and after pulmonary angiography, which failed to demonstrate filling defects in the pulmonary artery.

Introduction Paraoxonase 1 (PON1) is a multifunctional enzyme associated with high-density lipoprotein particles (HDL). It is a cellular antioxidant that hydrolyses oxidized macromolecules, especially low-density lipoproteins (ox-LDL). Because increased oxidative stress is believed to play a crucial role in the initiation and propagation of atherosclerosis, coding (Q192R and L55M) and promoter (C(-107)T) region polymerphisms of pon1 gene, that are responsible for catalytic efficiency, activity and the level of the enzyme, have been of great interest as a potential markers of susceptibility for atherogenesis. Objective The aim of the study was to assess possible association between these pon1 gene variants and clinical manifestations of the atherosclerosis and oxidative stress. Methods A total of 60 angiographically documented patients with manifested atherosclerotic disease and 100 control individuals were analyzed. Genomic DNA was isolated from the peripheral blood cells and genotyping was performed using polymerase chain reaction followed by the restriction fragment length polymorphism (PCR-RFLP) analysis. Results No significant difference in allele and genotype frequencies of all three examined polymorphisms was found between the atherosclerotic patients and healthy controls. The obtained results could not support an association of pon1 gene variants with the oxidative stress and atherogenesis. Conclusion These polymorphisms cannot be considered risk factors of atherosclerosis in Serbian population. A larger study is required in order to establish possible contribution of pon1 variants to atherosclerosis-related cardiovascular diseases.

Background/Aim. Decision-making by the Heart Team is an established way of making appropriate decisions regarding the management of patients with coronary artery disease. In clinical practice, it is not infrequent to see changes in decisions made by different Heart Teams. However, clinical implications regarding changes in the Heart Team decisions are not clear. The aim of this study was to determine clinical implications of change in the Heart Team decision in patients in whom surgical myocardial revascularization was advised first but consequently changed to percutaneous coronary intervention (PCI). Methods. We retrospectively analyzed data for 1,501 patients admitted to a single tertiary care high-volume center for coronary artery bypass grafting (CABG). In all patients, decisions were made by the Heart Team prior to admission. Upon admission, decisions were reevaluated by another Heart Team. The decision regarding the mode of revascularization was changed in 73 (4.86%) of patients. Propensity matching was made with patients from the same population who underwent CABG. Patients in both groups were followed for major adverse cardiac events (MACE) and total mortality for 12 months. Results. PCI and CABG groups were balanced with respect to demographic and clinical characteristics. All patients had two- and three vessel disease, with similar incidence of left main stenosis (26% in the PCI group and 30.10% in the CABG group). EuroSCORE II was similar between the groups (2.48 ± 2.38 vs. 2.36 ± 2.92). During the follow-up period, a total of 5 (6.80%) MACE in the PCI group and 12 (5.80%) MACE in the CABG group were observed (log rank 0.096, p = 0.757). A total of 6 (8.20%) patients died in the PCI group, and 15 (7.30%) patients died in the CABG group (log rank 0.067, p = 0.796). Conclusion. Our data indicate that patients in whom CABG was advised first but consequently changed to PCI have a prognosis similar to CABG patients over 12 months after the index procedure. © 2021 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

The reported incidence of mitral regurgitation in relapsing polychondritis ranges from 2 to 3% and is associated with aortic regurgitation. There are no reports that mitral regurgitation can be an isolated cardiac complication of relapsing polychondritis. This case report demonstrates that partial chordal rupture and consequent severe mitral regurgitation can be the only features of cardiac involvement in relapsing polychondritis.

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open-heart surgery, with an incidence between 8.9% and 39%. Studies have shown that even a slight increase in serum creatinine levels after cardiac surgery significantly affects the mortality and morbidity of these patients. Aim: This study sought to determine the predictors and incidence of acute kidney injury (AKI) in patients older than 70 years undergoing elective valvular surgery. Methods: Prospective study included 156 patients scheduled for elective cardiac surgery requiring cardiopulmonary bypass (CPB) at Dedinje Cardiovascular Institute between January and September 2019. Isolated valvular surgery was performed in 87 patients, while the remaining 69 patients underwent combined coronary and valvular surgery. The development and stage of CSA-AKI were diagnosed, according to Kidney Disease Improving Global Outcome (KDIGO) criteria. Predictors and incidence of CSA-AKI development were assessed using univariate binary logistic regression analysis. Results: The incidence of CSA-AKI was 17.3%. CSA-AKI stage 1 was diagnosed in 25 patients (16.02%). CSA-AKI stage 2 was noted in one patient (0.64%), as well as stage 3 (0.64%). In six patients (3.85%), renal replacement therapy (RRT) was required. Using univariate binary logistic analysis, the following parameters were identified as predictors for CSA-AKI development: duration of cardiopulmonary bypass (OR 1.01; CI 95% (1.01-1.02); P = .002), duration of aortic clamping (OR 1.02; CI 95% (1.01-1.03); P = .002), lactate levels during the intensive care unit (ICU) stay (OR 1.33; CI 95% (1.04-1.70); P = .026), duration of mechanical ventilation (MV) (OR 1.03; CI 95% (1.1-1.07); P = .014), the use of inotropic drugs (adrenaline, dobutamine) (OR 0.38: CI 95% (0.16-0.9); P = .026; and OR 0.23; CI 95% (0.1-0.56); P = .0019, respectively), and the use of diuretics (OR 0.24; CI95% (0.06-095); P = .041). Using Mann-Whitney U test for independent samples show that the group of patients who developed CSA-AKI had significantly longer duration of hospitalization (Z = -2.751); P = .006), prolonged ICU stay (Z = -4.160; P < .001), and need for prolonged mechanical ventilation (Z = -4.411; P < .001). Conclusion: Independent predictors for AKI development after valvular surgery in patients older than 70 years are prolonged mechanical ventilation and increased lactate values, while the use of diuretics after surgery reduces the incidence of AKI. Also, the development of CSA-AKI is associated with prolonged ICU stay and a longer duration of hospitalization. © 2022 Forum Multimedia Publishing, LLC.

Thrombosis of the prosthetic valve is a highly lethal medical emergency that requires immediate diagnosis and prompt therapy. Establishing the diagnosis may be difficult, despite numerous physical, echocardiographic, fluoroscopic, and angiographic signs, which have been described. We report a case of prosthetic aortic valve thrombosis diagnosed by Doppler echocardiography.

This study was designed to determine the relationship between histomorphometric features and contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy. Twenty-four consecutive patients (21 men, aged 43.4±8.7 years) with idiopathic dilated cardiomyopathy underwent dobutamine stress echocardiography. Wall motion score index, ejection fraction, cardiac power output and end-systolic pressure/volume ratio were used as indices of left ventricular contractility. Left ventricular endomyocardial biopsy specimens (3-5 per patient) were routinely processed and stained with Masson trichrome, interstitial fibrosis and myocyte diameter were calculated quantitatively. Myocyte diameter and interstitial fibrosis showed strongest correlation with change in wall motion score index (r=-0.667, p<0.001, and r=-0.567, p=0.004, respectively), followed by change in ejection fraction (r=-0.603, p=0.002, and r=-0.467, p=0.021, respectively). Interstitial fibrosis showed no correlation with change of cardiac power output and end-systolic pressure/volume ratio, whereas myocyte diameter was associated with change of both indices (r=-0.565, p=0.004, and r=-0.455, p=0.025). Contractile reserve elicited by high-dose dobutamine is strongly related to the degree of histological disruption in patients with idiopathic dilated cardiomyopathy. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Aim: To determine prognostic implications of the assessment of right (RV) vs. left ventricular (LV) contractile reserve with dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy. Methods and results: Forty-eight consecutive patients (41 male, NYHA class III/IV 13 patients, LV ejection fraction 19 ± 8%) were subjected to dobutamine stress echocardiography in incremental stages lasting 5 min each. Contractile reserve was defined as the difference between the values of LV ejection fraction and RV fractional area change obtained at peak dobutamine dose and the baseline values. Patients were followed for one year after enrollment for combined end-point of cardiac death, partial left ventriculectomy and hospitalization for congestive heart failure. During the follow-up 15/48 patients reached combined end-point. Patients who reached end-point had lower RV and LV contractile reserves (14 ± 5 vs. 8 ± 6%, p = 0.0014, and 9 ± 5 vs. 3 ± 2%, p < 0.001, respectively). Kaplan-Meier curves demonstrated that both LV and RV contractile reserves can identify patients with dismal prognosis (log rank = 17.02 and log rank = 14.66, respectively, p < 0.001 for both). Multivariate analysis identified dobutamine induced change in LV functional reserve as the only independent predictor of combined end-point (beta = -0.63, p = 0.0035). Conclusion: Both RV and LV contractile reserves can be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. It appears that dobutamine induced change in LV functional reserve may better identify patients with dismal prognosis. © 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Background: Although partial left ventriculectomy (PLV) may have beneficial clinical effects in patients with dilated cardiomyopathy (DCM), there are no reports on effects of PLV on myocardial histology. The objective of this study was to assess histological properties of the LV myocardium 1 year following PLV as compared to histology at the time of the operation. Methods: The study group consisted of 15 consecutive PLV survivors, predominantly male (13/15), aged 45±12 years. Surgical specimens and endomyocardial biopsies, taken 12 months postoperatively, were processed routinely and stained with Masson-trichrome. The following morphometric parameters were assessed semiquantitavely: (1) degree of hypertrophy and attenuation; (2) nuclear evidence of hypertrophy; (3) myofibrillar volume fraction; (4) degree of degenerative vacuolar changes; and (5) fibrosis volume fraction. Results: Both New York Heart Association (NYHA) functional class and ejection fraction (EF) improved 12 months following surgery as compared to preoperative values (2.40±0.69 vs. 3.33±0.49, p<0.001, and 33.21±12.05% vs. 20.21±9.07%, p<0.001, respectively). Morphometric analysis demonstrated postoperative decrease in the degree of attenuation as compared to preoperative values (1.40±0.51 vs. 2.47±0.64, p<0.01), as well as a decrease in fibrosis volume fraction (2.07±0.80 vs. 2.67±0.49, p<0.001) and nuclear hypertrophy (1.27±0.46 vs. 1.67±0.62, p<0.05). On the other hand, postoperative increase in myofibrillar volume fraction (1.87±0.61 vs. 1.40±0.61, p<0.01) was noted. Conclusion: One year postoperatively, PLV has favourable effects on myocardial morphology that parallels improvement in the patient's functional status and LV systolic function. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Introduction Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD) is poor. Objective We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG), history of myocardial infarction (MI), positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS) class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results Most patients were included based on abnormal ECG (48.4%). At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ± 1.29 to 4.63 ± 1.57 (p < 0.001). At the follow-up, the patients had significantly lower blood pressure (141 ± 19/85 ± 11 vs. 130 ± 12/80 ± 8 mmHg; p < 0.001) and most of them reported CCS class I (63.3%). The average weekly number of angina attacks was reduced from 2.82 ± 2.50 at Visit 1 to 1.72 0 ± 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ± 2.53 to 1.74 ± 1.47 tablets; p < 0.001 for all). Conclusion Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina. ©2016, Serbia Medical Society. All rights reserved.