Browsing by Author "Stankovic, Ivan (57197589922)"

[No abstract available]

Coronary collateral circulation frequently develops in the presence of obstructive coronary lesions as an alternative source of blood supply. We present a case of rare direct communication between the circumflex and right coronary arteries in a 30-year-old male with continuity between the distal segments of the circumflex and right coronary artery and no coronary artery stenoses. Direct intercoronary connections may be seen in the absence of an occlusive coronary lesion, as a remnant of the fetal circulation in adult life. We present this case to increase awareness of this rare coronary variation and its clinical implications. © 2015 by Thieme Medical Publishers, Inc.

Guidelines aim at translating inclusion criteria of high-quality clinical landmark trials into indications for treatment recommendations in order to guarantee a solid evidence base for the clinical practice. In the field of cardiac resynchronization therapy (CRT), the inclusion criteria of landmark trials that impacted the current recommendations for patient selection were left ventricular ejection fraction <-35%3,4, <-40%5), New York Heart Association (NYHA) Class (I-II,1,5 II,4 II-III,2 III,3 II-IV,6 III-IV7,8), and QRS width (>-120ms,2,5 >-130ms,4,7,9 >-150ms3,10). Recommendations have been further influenced by study results showing a better response of patients with left bundle branch block (LBBB) than non-LBBBmorphology. 11 The suggested possible harm of CRT implantation in patients with QRS duration less than 130 ms by some studies12 has led to increasing the threshold for CRT implantation from 120ms in 2013 guidelines13 to 130ms in the 2016 edition of the European guidelines.14 While this approach ensures a strong evidence base for a certain treatment, it does not necessarily guarantee the optimal strategy for patient selection, as relevant or potentially favourable selection criteria might not have been tested. In the case of CRT, which has become an established treatment option for patients with heart failure, left ventricular (LV) dysfunction and conduction delays, still approximately one-third of the patients remain non-responders to this costlyand invasive therapy.15 One such potential selection criterion, which is not considered in current guidelines is mechanical dyssynchrony. This is in particular due to the disappointing results of studies that tested the additional predictive value of parameters derived from the timing of longitudinal myocardial velocity peaks as surrogate of mechanical dyssynchrony, which failed to show any additional value over conventional guideline criteria despite promising results from single-centre studies.16 In the meantime, however, there is growing evidence that advanced concepts such as the detection of specific motion patterns could be a potential guide for CRT candidate selection.17,18 The PREDICT-CRT trial investigated the association between CRT outcome and a novel parameter of mechanical dyssynchrony, characterized by a short septal contraction pulling the apex septally ['septal flash' (SF)] followed by a delayed lateral wall contraction which causes a lateral motion of the apex ['apical rocking' (ApRock)]. This specific pattern of contraction in addition to similar parameters which rely on the same phenomena, have been shown to be strongly associated with better survival and CRT response.17,19-26 In this study, we relate current CRT guideline recommendations for patient selection with patient outcome and investigate the potential additive prognostic value of echocardiographic markers of mechanical dyssynchrony. © 2018. For permissions.

Background: Electrocardiographic (ECG) indices, such as the morphology-voltage-P-wave (MVP) score, and echocardiographic parameters like left atrial volume index (LAVi), left atrial reservoir strain (LASr), and left atrial appendage (LAA) emptying velocity (LAAev) are associated with atrial fibrillation (AF) risk. However, the relationships between these markers remain incompletely understood. Aims: This study aimed to investigate correlations between the ECG MVP score and echocardiographic indices of LA size and function. Methods: In this prospective study, 60 patients in sinus rhythm, including 8 patients with paroxysmal AF, scheduled for transesophageal echocardiography underwent a 12‑lead ECG and transthoracic echocardiography within 30 min. Results: Significant correlations were observed between the mitral E/e’ ratio and LAVi (r = 0.30, p = 0.029), LASr (r = −0.42, p = 0.002), and LAAev (r = −0.29, p = 0.037). In comparison to patients with mid-high MVP scores, LAAev was significantly lower in those with low MVP scores (49 ± 21 vs. 61 ± 23 cm/s, p = 0.027). No significant differences were observed between the groups in LAVi (40 ± 20 vs. 42 ± 12 ml/m2, p = 0.187), LASr (26 ± 11 vs. 25 ± 10 %, p = 0.967), or mitral E/e’ ratio (8.2 ± 1.6 vs. 7.3 ± 1.3, p = 0.876). Additionally, patients with paroxysmal AF had significantly lower LASr and higher mitral E/e’ ratio compared to those without paroxysmal AF. Conclusions: While LAVi, LASr, and LAAev were all related to noninvasively assessed left ventiricular (LV) filling pressure, only LAAev was able to differentiate risk categories based on the MVP score. Our findings suggest that a multiparametric approach to evaluating LA and LAA function, and LV filling pressures may offer a more comprehensive assessment of AF risk than using individual parameters. © 2025 Elsevier Inc.

Cardiac ultrasound (CUS), either focused cardiac ultrasound (FoCUS) or emergency echocardiography, is frequently used in cardiovascular (CV) emergencies. We assessed correlations and discrepancies between CUS, clinical diagnosis and the autopsy findings in early deceased patients with suspected CV emergencies. We retrospectively analysed clinical and autopsy data of 131 consecutive patients who died within 24 h of hospital admission. The type of CUS and its findings were analysed in relation to the clinical and autopsy diagnoses. CUS was performed in 58% of patients - FoCUS in 83%, emergency echocardiography in 12%, and both types of CUS in 5% of cases. CUS was performed more frequently in patients without a history of CV disease (64 vs. 40%, p = 0.08) and when the time between admission and death was longer (6 vs. 2 h, p = 0.021). In 7% of patients, CUS was inconclusive. In 10% of patients, the ante-mortem cause of death could not be determined, while discrepancies between the clinical and post-mortem diagnosis were found in 26% of cases. In the multivariate logistic regression model, only conclusive CUS [odds ratio (OR) 2.76, 95% confidence interval (CI) 1.30–7.39, p = 0.044] and chest pain at presentation (OR 30.19, 95%CI 5.65 -161.22, p < 0.001) were independently associated with congruent clinical and autopsy diagnosis. In a tertiary university hospital, FoCUS was used more frequently than emergency echocardiography in critically ill patients with suspected cardiac emergencies. Chest pain at presentation and a conclusive CUS were associated with concordant clinical and autopsy diagnoses. © The Author(s), under exclusive licence to Springer Nature B.V. 2024.

The European Association of Cardiovascular Imaging (EACVI) is committed to maintaining the highest standards of professional excellence in all aspects of cardiovascular imaging. The mission of the EACVI is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging with a particular focus on education, training, scientific initiatives, and research. The EACVI established the Scientific Initiatives Committee (SIC) in December 2018. This committee has responsibility for surveys among imagers, patients' surveys and surveys including data from clinical practice. The current document describes the aims of the EACVI SIC and the creation of the international EACVI survey network. This document summarizes the EACVI's standards for the survey questions and standards for writing the papers with the results of the surveys. These are in accordance with previous recommendations and were approved by the EACVI SIC and the EACVI Board in 2019. © 2019 Published on behalf of the European Society of Cardiology. All rights reserved.

AimsContradicting reports have been published regarding the relation between a dobutamine-induced increase in either cardiac dyssynchrony or left-ventricular ejection fraction (LVEF) and the response to cardiac resynchronization therapy (CRT). Using apical rocking (ApRock) as surrogate dyssynchrony parameter, we investigated the dobutamine stress echocardiography (DSE)-induced changes in left-ventricular (LV) dyssynchrony and LVEF and their potential pathophysiological interdependence.Methods and resultsFifty-eight guideline-selected CRT candidates were prospectively enrolled for low-dose DSE. Dyssynchrony was quantified by the amplitude of ApRock. An LVEF increase during stress of >5% was regarded significant. Scar burden was assessed by magnetic resonance imaging. Mean follow-up after CRT implantation was 41 ± 13 months for the occurrence of cardiac death. ApRock during DSE predicted CRT response (AUC 0.88, 95% CI 0.77-0.99, P < 0.001) and correlated inversely with changes in EF (r =-0.6, P < 0.001). Left-ventricular ejection fraction changes during DSE were not associated with CRT response (P = 0.082). Linear regression analysis revealed an inverse association of LVEF changes during DSE with both, total scar burden (B =-2.67, 95CI-3.77 to-1.56, P < 0.001) and the DSE-induced change in ApRock amplitude (B =-1.23, 95% CI-1.53 to-0.94, P < 0.001). Kaplan-Meier analysis revealed that DSE-induced increase in ApRock, but not LVEF, was associated with improved long-term survival.ConclusionDuring low-dose DSE in CRT candidates with baseline dyssynchrony, myocardial contractile reserve predominantly results in more dyssynchrony, but less in an increase in LVEF. Dyssynchrony at baseline and its dobutamine-induced changes are predictive of both response and long-term survival following CRT. © 2013 The Author.

Aims To assess the level of transesophageal echocardiography (TOE) knowledge and skills of young cardiologists. Methods and results A European Association of Cardiovascular Imaging (EACVI) online study using the first fully virtual simulation-based software was conducted in two periods (9–12 December 2021 and 10–13 April 2022). All young cardiologists eligible to participate (<40 years) across the world were invited to participate. After a short survey, each participant completed two tests: a theoretical test to assess TOE knowledge and a practical test using an online TOE simulator to investigate TOE skills. Among 716 young cardiologists from 81 countries, the mean theoretical test score was 56.8 ± 20.9 points, and the mean practical test score was 47.4 ± 7.2 points (/100 points max each), including 18.4 ± 8.7 points for the acquisition test score and 29.0 ± 6.7 points for the anatomy test score (/50 points max each). Acquisition test scores were higher for four-chamber (2.3 ± 1.5 points), two-chamber (2.2 ± 1.4 points) and three-chamber views (2.3 ± 1.4 points) than for other views (all P < 0.001). Prior participation to a TOE simulation-based training session, a higher number of TOE exams performed per week, and EACVI certification for TOE were independently associated with a higher global score (all P < 0.001). Conclusion Online evaluation of young cardiologists around the world showed a relatively low level of TOE skills and knowledge. Prior participation to a TOE simulation-based training session, a higher number of TOE exams performed per week, and the EACVI certification for TOE were independently associated with a higher global score. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.

Aims: The European Association of Cardiovascular Imaging Scientific Initiatives Committee conducted a global survey to evaluate the impact of the 2019 coronavirus disease (COVID-19) pandemic on the mental well-being of cardiac imaging specialists. Methods and results: In a prospective international survey performed between 23 July 2021 and 31 August 2021, we assessed the mental well-being of cardiac imaging specialists ∼18 months into the COVID-19 pandemic. One-hundred-and-twenty-five cardiac imaging specialists from 34 countries responded to the survey. More than half described feeling anxious during the pandemic, 34% felt melancholic, 27% felt fearful, and 23% respondents felt lonely. A quarter of respondents had increased their alcohol intake and more than half reported difficulties in sleeping. Two-thirds of respondents described worsening features of burnout during the past 18 months, 44% considered quitting their job. One in twenty respondents had experienced suicidal ideation during the pandemic. Despite these important issues, the majority of participants (57%) reported having no access to any formal mental health support at work. Conclusion: The survey has highlighted important issues regarding the mental well-being of cardiac imaging specialists during the COVID-19 pandemic. This is a major issue in our sub-specialty, which requires urgent action and prioritization so that we can improve the mental health of cardiovascular imaging specialists. © 2022 Published on behalf of the European Society of Cardiology. All rights reserved.

Aims: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with hypertrophic cardiomyopathy (HCM). Methods and results: A total of 213 centres from 38 different countries (87% European) responded to the survey. One hundred twenty-one (57%) centres followed HCM patients in a general cardiology outpatient clinic and 85 (40%) centres in a specialized HCM/cardiomyopathy clinic. While echocardiography was the primary imaging modality, cardiovascular magnetic resonance (CMR) has become an important complementary tool. Cardiac anatomy, left ventricular (LV) systolic, and diastolic function were assessed according to current European guidelines and recommendations. To evaluate LV obstruction, 49% of the centres performed bedside provocation manoeuvres in every patient and 55% of the centres used exercise stress echocardiography. The majority of centres used the 5-year risk assessment of sudden cardiac death (SCD) calculated with the HCM Risk-SCD score. However, 34% of the centres also used extensive non-infarct late gadolinium enhancement on CMR and 27% the presence of LV apical aneurysm to help select patients for primary prevention implantable cardioverter-defibrillator therapy. Ninety-nine percent of the responding centres performed regular imaging follow-up of HCM patients. Conclusion: Most centres followed European guidelines and recommendations for the diagnosis and management of patients with HCM. The importance of bedside provocation manoeuvres and exercise stress echocardiography to diagnose LV outflow obstruction requires emphasis. Additional risk markers for SCD are used in many centres and might indicate the need for an update of current European recommendations. © 2021 Published on behalf of the European Society of Cardiology. All rights reserved.

Aims: The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey to evaluate current practice for the assessment and management of patients with suspected and confirmed chronic coronary syndromes. Methods and results: One-hundred and ten imaging centres from 37 countries across the world responded to the survey. Most non-invasive investigations for coronary artery disease were widely available, except cardiovascular magnetic resonance (available 40% centres). Coronary computed tomography angiography (CCTA) and nuclear scans were reported by a multi-disciplinary team in only a quarter of centres. In the initial assessment of patients presenting with chest pain, only 32% of respondents indicated that they rely on pre-test probability for selecting the optimal imaging test while 31% proceed directly to CCTA. In patients with established coronary artery disease and recurrent chest pain, respondents opted for stress echocardiography (27%) and nuclear stress perfusion scans (26%). In asymptomatic patients with coronary artery disease and an obstructive (>70%) right coronary artery stenosis, 58% of respondents were happy to pursue medical therapy without further testing or intervention. This proportion fell to 29% with left anterior descending artery stenosis and 1% with left main stem obstruction. In asymptomatic patients with evidence of moderate-to-severe myocardial ischaemia (15%), only 18% of respondents would continue medical therapy without further investigation. Conclusion: Despite guidelines recommendations pre-test probability is used to assess patients with suspected coronary artery in a minority of centres, one-third of centres moving directly to CCTA. Clinicians remain reticent to pursue a strategy of optimal medical therapy without further investigation or intervention in patients with controlled symptoms but obstructive coronary artery stenoses or myocardial ischaemia. © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.

Aims: The aim of this study is to analyse how current recommendations on left ventricular (LV) diastolic function assessment have been adopted. Identifying potential discrepancies between recommendations and everyday clinical practice would enable us to better understand and address the remaining challenges in this controversial and complex field. Methods and results: A total of 93 centres, mainly from tertiary care settings, responded to the survey. More than three-quarters (77%) of centres follow the 2016 ASE/EACVI recommendations for LV diastolic function evaluation in patients with preserved ejection fraction based upon e′, E/e′, tricuspid regurgitation velocity, and left atrial (LA) volume. These recommendations were generally preferred to the previous 2009 version. Many centres also consider strain assessments in the LV (48%) and left atrium (53%) as well as diastolic stress echocardiography (33%) to be useful as additional assessments of LV diastolic function. Echocardiographic assessments of LV diastolic function were used frequently to guide therapy in 72% of centres. Conclusion: There is widespread adoption of current recommendation on the evaluation of LV diastolic function and these are frequently used to guide patient management. Many centres now also consider LV and LA strain assessments useful in the clinical assessment of diastolic function. These may be considered in future recommendations. © 2021 The Author(s).

Background: We aimed to assess the relationship between echocardiographic characteristics and mortality in patients with chronic obstructive pulmonary disease (COPD). Methods: We prospectively studied 154 patients (mean age 71 ± 10 years, 71% male) with COPD. All patients underwent transthoracic Doppler echocardiography within 48 hours of hospital admission. Primary endpoint was all-cause mortality during a median period of 22 months. Results: Mildly elevated tricuspid regurgitation pressure and mitral E/e′ ratio were the most commonly encountered echocardiographic abnormalities, observed in 60% and 56% of patients, respectively. In Kaplan-Meier analysis of survival, left atrial enlargement, E/e′ ratio > 8, right atrial enlargement, right ventricular dilation, decreased tricuspid annular plane systolic excursion, decreased tricuspid annular systolic velocity, and elevated tricuspid regurgitation velocity were associated with all-cause mortality (p < 0.05 for all). In the Cox proportional hazards analysis, the mitral E/e′ ratio (hazard ratio 1.048; 95% confidence interval 1.001–1.096) remained an independent echocardiographic predictor of survival after adjustment for age, COPD severity, and other baseline echocardiographic parameters. Conclusions: Among patients with COPD, an abnormal mitral E/e′ ratio was an independent echocardiographic predictor of all-cause mortality. Echocardiographic evaluation of structural and functional cardiac abnormalities provides important prognostic information and should be used routinely in the assessment of patients with COPD. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:211–221, 2017;. © 2016 Wiley Periodicals, Inc.

[No abstract available]

Emergency echocardiography is a comprehensive diagnostic ultrasound examination of the heart done by cardiologists or adequately trained non-cardiologists who are able to independently perform and interpret the study. It is challenging and highly demanding procedure that should be performed by an experienced operator. Acute chest pain, acute dyspnea, hemodynamic instability, new murmur, syncope, chest trauma, and cardiac arrest are the main clinical situations in which emergency echocardiography is required. There are recommended standards for ultrasound equipment, execution, documentation, and interpretation, as well as for education and training of physicians performing echocardiography in the emergency setting. © 2023 CRC Press.

Aim: As a result of a higher prevalence of comorbidities, elderly adults are often underrepresented in clinical trials, and more often experience complications during percutaneous coronary intervention. Our aim was to evaluate clinical outcomes of patients older than 80 years, compared with their younger counterparts, when bioresorbable polymer biolimus A9 drug-eluting stent is used for their treatment. Methods: The prospective, observational e-Nobori registry was created to validate the safety and efficacy of bioresorbable polymer drug-eluting stent in unselected patients. The primary end-point of the study was freedom from target lesion failure defined as a composite of cardiac death, target vessel-related myocardial infarction and clinically-driven target lesion revascularization at 1 year. Results: There were 781 (7.8%) octogenarians, they were less frequently male (62% vs 77%; P < 0.0001) and more often presented as acute coronary syndrome (44% vs 39%; P = 0.0182). The index percutaneous coronary intervention success was lower in the elderly patients (98% vs 99%; P = 0.0398). One-year follow up was completed for 97% of the elderly patients and 99% of the younger patients. The difference in target lesion failure (3.33% vs 2.83%; log–rank P = 0.0114) was mainly driven by increased mortality in octogenarians (3.73% vs 1.47%; P < 0.0001). Elderly patients had more bleeding and vascular complications (2.67% vs 1.05%; P = 0.0001). Conclusions: Despite advanced age, multiple comorbidities and complexity of treated lesions, clinical outcomes are favorable in octogenarians treated by bioresorbable polymer biolimus A9 drug-eluting stent. Geriatr Gerontol Int 2016; 16: 1246–1253. © 2015 Japan Geriatrics Society

Aim: As a result of a higher prevalence of comorbidities, elderly adults are often underrepresented in clinical trials, and more often experience complications during percutaneous coronary intervention. Our aim was to evaluate clinical outcomes of patients older than 80 years, compared with their younger counterparts, when bioresorbable polymer biolimus A9 drug-eluting stent is used for their treatment. Methods: The prospective, observational e-Nobori registry was created to validate the safety and efficacy of bioresorbable polymer drug-eluting stent in unselected patients. The primary end-point of the study was freedom from target lesion failure defined as a composite of cardiac death, target vessel-related myocardial infarction and clinically-driven target lesion revascularization at 1 year. Results: There were 781 (7.8%) octogenarians, they were less frequently male (62% vs 77%; P < 0.0001) and more often presented as acute coronary syndrome (44% vs 39%; P = 0.0182). The index percutaneous coronary intervention success was lower in the elderly patients (98% vs 99%; P = 0.0398). One-year follow up was completed for 97% of the elderly patients and 99% of the younger patients. The difference in target lesion failure (3.33% vs 2.83%; log–rank P = 0.0114) was mainly driven by increased mortality in octogenarians (3.73% vs 1.47%; P < 0.0001). Elderly patients had more bleeding and vascular complications (2.67% vs 1.05%; P = 0.0001). Conclusions: Despite advanced age, multiple comorbidities and complexity of treated lesions, clinical outcomes are favorable in octogenarians treated by bioresorbable polymer biolimus A9 drug-eluting stent. Geriatr Gerontol Int 2016; 16: 1246–1253. © 2015 Japan Geriatrics Society

There is a growing trend of using ultrasound examination of the heart as a first-line diagnostic tool for initial patient evaluation in acute settings. Focus cardiac ultrasound (FoCUS) is a standardized but restricted cardiac ultrasound examination that may be undertaken by a range of medical professionals with diverse backgrounds. The intention of this core curriculum and syllabus is to define a unifying framework for educational and training processes/programmes that should result in competence in FoCUS for various medical professionals dealing with diagnostics and treatment of cardiovascular emergencies. The European Association of Cardiovascular Imaging prepared this document in close cooperation with representatives of the European Society of Anaesthesiology, the European Association of Cardiothoracic Anaesthesiology, the Acute Cardiovascular Care Association of the European Society of Cardiology and the World Interactive Network Focused On Critical Ultrasound. It aims to provide the key principles and represents a guide for teaching and training of FoCUS. We offer this document to the emergency and critical care community as a reference outline for teaching materials and courses related to FoCUS, for promoting teamwork and encouraging the development of the field. © 2017 The Author.

[No abstract available]

Ultrasound-based assessment of the heart with handheld ultrasound devices (HUDs) is an increasingly available imaging modality that may be used as an aid to rapid and accurate diagnosis of a variety of cardiac emergencies. Medical professionals using HUDs should receive appropriate training and must respect their weaknesses, as well as the limitations of focused cardiac examinations, to avoid potentially catastrophic errors in the emergency setting. Because examinations with current HUDs, owing to technical limitations, cannot replace a complete echocardiogram, they can only be reported as a complement to physical examination. Wide dissemination of HUDs and their use both by cardiologists and non-cardiologists becomes a reality. This trend is expected to grow in the near future. In this chapter, we describe the technical aspects of these miniature ultrasound devices, review their usefulness in the emergency setting, and discuss limitations, potential pitfalls, and future perspectives. © 2023 CRC Press.