Browsing by Author "Velicki, Lazar (22942501300)"

Heart failure is recognized as a modern epidemic and despite advances in therapy and research, heart failure still carries an ominous prognosis and a significant socioeconomic burden. The main aim of this paper is to demonstrate how novel Decision Support System (DSS) and computational platform like INTELHEART can transform the future of healthcare and early diagnosis of heart failure. The main idea is integration of patient-specific data (i.e. demographic and physical characteristics, medical history, symptoms and signs) and results obtained using existing and novel diagnostic technologies into the cloud environment. Data will be used by different tools for machine learning and computational modelling, developing virtual patient population. Moreover, voice as a biomarker will be collected among participating patients, in order to create a VoiceHeart mobile app. INTELHEART represents a transformative advancement in heart failure care, aiming to make treatment more personalized, and proactive. This initiative centers on precision medicine, using AI-driven analysis and a powerful DSS alongside the cloud-based platform and VoiceHeart mobile app to assist both clinicians and patients. Additionally, it incorporates assessments of psychological resilience and emotional well-being, addressing the oftenoverlooked mental health factors essential to comprehensive heart failure management. © 2024 IEEE.

Heart failure is recognized as a modern epidemic and despite advances in therapy and research, heart failure still carries an ominous prognosis and a significant socioeconomic burden. The main aim of this paper is to demonstrate how novel Decision Support System (DSS) and computational platform like INTELHEART can transform the future of healthcare and early diagnosis of heart failure. The main idea is integration of patient-specific data (i.e. demographic and physical characteristics, medical history, symptoms and signs) and results obtained using existing and novel diagnostic technologies into the cloud environment. Data will be used by different tools for machine learning and computational modelling, developing virtual patient population. Moreover, voice as a biomarker will be collected among participating patients, in order to create a VoiceHeart mobile app. INTELHEART represents a transformative advancement in heart failure care, aiming to make treatment more personalized, and proactive. This initiative centers on precision medicine, using AI-driven analysis and a powerful DSS alongside the cloud-based platform and VoiceHeart mobile app to assist both clinicians and patients. Additionally, it incorporates assessments of psychological resilience and emotional well-being, addressing the oftenoverlooked mental health factors essential to comprehensive heart failure management. © 2024 IEEE.

Objectives. Heart rate variability (HRV) and haemodynamic response to exercise (i.e. peak cardiac power output) are strong predictors of mortality in heart failure. The present study assessed the relationship between measures of HRV and peak cardiac power output. Design. In a prospective observational study of 33 patients (age 54 ± 16 years) with chronic heart failure with reduced left ventricular ejection fraction (29 ± 11%), measures of the HRV (i.e. R-R interval and standard deviation of normal R-R intervals, SDNN) were recorded in a supine position. All patients underwent maximal graded cardiopulmonary exercise testing with non-invasive (inert gas rebreathing) cardiac output assessment. Cardiac power output, expressed in watts, was calculated as the product of cardiac output and mean arterial blood pressure. Results. The mean RR and SDNN were 837 ± 166 and 96 ± 29 ms, peak exercise cardiac power output 2.28 ± 0.85 watts, cardiac output 10.34 ± 3.14 L/min, mean arterial blood pressure 98 ± 14 mmHg, stroke volume 91.43 ± 40.77 mL/beat, and oxygen consumption 19.0 ± 5.6 mL/kg/min. There was a significant but only moderate relationship between the RR interval and peak exercise cardiac power output (r = 0.43, p =.013), cardiac output (r = 0.35, p =.047), and mean arterial blood pressure (r = 0.45, p =.009). The SDNN correlated with peak cardiac power output (r = 0.42, p =.016), mean arterial blood arterial (r = 0.41, p =.019), and stroke volume (r = 0.35, p =.043). Conclusions. Moderate strength of the relationship between measures of HRV and cardiac response to exercise suggests that cardiac autonomic function is not good indicator of overall function and pumping capability of the heart in chronic heart failure. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objective Diminished cardiac high-energy phosphate metabolism (phosphocreatine-to-AT P (PCr:AT P) ratio) and cardiac power with age may play an important roles in development of cardiac dysfunction and heart failure. The study defines the impact of age on PCr:AT P ratio and cardiac power and their relationship. Methods T hirty-five healthy women (young≤50 years, n=20; and old≥60 years, n=15) underwent cardiac MRI with 31P spectroscopy to assess PCr:AT P ratio and performed maximal graded cardiopulmonary exercise testing with simultaneous gas-exchange and central haemodynamic measurements. Peak cardiac power output, as the best measure of pumping capability and performance of the heart, was calculated as the product of peak exercise cardiac output and mean arterial blood pressure. Results PCr:AT P ratio was significantly lower in old compared with young age group (1.92±0.48 vs 2.29±0.55, p=0.03), as were peak cardiac power output (3.35±0.73 vs 4.14±0.81W, p=0.01), diastolic function (ie, early-to-late diastolic filling ratio, 1.33±0.54 vs 3.07±1.84, p<0.01) and peak exercise oxygen consumption (1382.9±255.0 vs 1940.3±434.4 mL/ min, p<0.01). Further analysis revealed that PCr:AT P ratio shows a significant positive relationship with early-to-late diastolic filling ratio (r=0.46, p=0.02), peak cardiac power output (r=0.44, p=0.02) and peak oxygen consumption (r=0.51, p=0.01). Conclusions H igh-energy phosphate metabolism and peak power of the heart decline with age. Significant positive relationship between PCr:AT P ratio, early-tolate diastolic filling ratio and peak cardiac power output suggests that cardiac high-energy phosphate metabolism may be an important determinant of cardiac function and performance. © 2018 Article author(s).

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2. The clinical presentation of this virus mainly manifests in the respiratory system but may also lead to severe complications in the cardiovascular system. The global burden of COVID-19 has led to an unprecedented need to gain further insight into patient outcomes, management, and clinical practice. This review aims to provide an overview of the current literature on heart failure (HF) hospitalizations, management, and care pathways for supporting patients during and beyond this pandemic. A literature review of five areas of interest was conducted and included: (i) HF hospitalization; (ii) recognizing the needs and supporting HF patients during COVID-19; (iii) supporting rehabilitation services; (iv) transitioning to a telehealth framework; and (v) the need for evidence. Patients with new-onset or existing HF are particularly vulnerable, but a significant reduction in HF hospital admissions has been reported. During these periods of uncertainty, the current care pathways for acute and elective cardiac patients have had to change with the relocation of HF services to protect the vulnerable and reduce transmission of COVID-19. Optimizing community HF services has the potential to reduce the pressures on secondary care during the recovery from this pandemic. Telemedicine and virtual health care are emerging technologies and overcome the risk of in-person exposure. Successful remote delivery of cardiac rehabilitation services has been reported during the pandemic. Delivery of a robust telehealth framework for HF patients will improve communication between clinician and patient. The reduction in HF admissions is a concern for the future and may result in unintended mortality. New-onset and current HF patients must understand their diagnosis and future prognosis and seek help and support using the appropriate platform when needed. Realigning HF services and the use of telemedicine and virtual health care has great potential but needs to be carefully understood to ensure engagement and approval in this population to overcome barriers and challenges. © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology

Aims: N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plays an important role in diagnosis and management of heart failure. The aim of the present study was to assess haemodynamic response to exercise and to evaluate the relationship between NT-proBNP, cardiac function, and exercise tolerance in chronic heart failure. Methods and results: A single-centre, cross-sectional pilot study recruited 17 patients with chronic heart failure with reduced left ventricular ejection fraction (age 67 ± 7 years) and 20 healthy volunteers (age 65 ± 12 years). The NT-proBNP was measured in the heart failure group. All participants completed maximal graded cardiopulmonary exercise stress testing coupled with gas exchange (using metabolic analyser for determination of exercise tolerance, i.e. peak O 2 consumption) and continuous haemodynamic measurements (i.e. cardiac output and cardiac power output) using non-invasive bioreactance technology. Heart failure patients demonstrated significantly lower peak exercise cardiac function and exercise tolerance than healthy controls, i.e. cardiac power output (5.0 ± 2.0 vs. 3.2 ± 1.2 W, P < 0.01), cardiac output (18.2 ± 6.3 vs. 13.5 ± 4.0 L/min, P < 0.01), heart rate (148 ± 23.7 vs. 111 ± 20.9 beats/min, P < 0.01), and oxygen consumption (24.3 ± 9.5 vs. 16.8 ± 3.8 mL/kg/min, P < 0.01). There was no significant relationship between NT-proBNP and cardiac function at rest, i.e. cardiac power output (r = −0.28, P = 0.28), cardiac output (r = −0.18, P = 0.50), and oxygen consumption (r = −0.18, P = 0.50), or peak exercise, i.e. cardiac power output (r = 0.18, P = 0.49), cardiac output (r = 0.13, P = 0.63), and oxygen consumption (r = −0.05, P = 0.84). Conclusions: Lack of a significant and strong relationship between the NT-proBNP and measures of cardiac function and exercise tolerance may suggest that natriuretic peptides should be considered with caution in interpretation of the severity of cardiac dysfunction and functional capacity in chronic heart failure. © 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

SUMMARY Introduction Chest pain (CP) diagnostics accuracy remains debatable for both general practitioners (GP) or emergency department (ED) physicians for patients in HEART score (HS) low-and intermediate-risk groups which prompted us to review our electronic database for all patients admitted via our center’s ED during 2014 to 2020 for CP and suspect acute coronary syndrome. Methods Patients were divided in function of low-or intermediate-risk HS and assessed during a three month follow up for angiogram results, major adverse cardiac events (MACE), lab results and echo parameters. Results Of 585 patients included, low-risk HS group (21,4%, 36% were women) had significant coronary disease on angiogram in 68%, while for intermediate-risk HS group (78.6%, with 32.6% women) it was for 18.4% of patients (p < 0,0005). Area under the ROC curve of HS in detecting patients with ischemic heart disease as a cause of CP was 0.771 (95% CI: 0.772–0.820) with best cut-off point HS was calculated at 3.5. Sensitivity and specificity were 89.2% and 57.6% respectively. Adjusting for sex, lab results and HS, AUROC curve of this model was 0.828 (95% CI: 0.786–0.869; p < 0,0005) with cut-off of 77.95. Sensitivity and specificity were 84.9% and 68% respectively. In the three-month follow-up post-discharge, there was a significant difference in MACE between groups (low-vs. intermediate-risk HS was 3.4 vs. 16.7% p < 0.05). Conclusion HS for our CP patients admitted via our ED by GP and ED physicians’ referral, provides a quick and reliable prediction of ischemic heart disease and MACE. © 2022, Serbia Medical Society. All rights reserved.

Aim: We sought the cardiopulmonary exercise testing (CPET) parameter that most accurately reflected therapeutic efficacy in patients with hypertrophic cardiomyopathy (HCM). Methods: Well-being questionnaire, N-terminal brain natriuretic peptide measurements, echocardiography, and CPET were performed in patients with symptomatic non-obstructive HCM during phase II, randomized, open-label multicentre study, before and after 16 weeks of traditional or sacubitril/valsartan treatment. Patients were followed 36 months after the initial CPET. Primary endpoints were changes in: 1) peak oxygen consumption (VO2); 2) VO2 at anaerobic threshold (AT); 3) oxygen pulse; 4) minute ventilation (VE)/carbon-dioxide (CO2) production slope; 5) VE/VCO2 at AT (VE/VCO2_AT); 6) VE/VCO2 nadir; 7) VE/VCO2 intercept; and 8) partial end-tidal pressure of carbon-dioxide (PETCO2) change during CPET. Results: Of 115 screened patients, 61 (52 ± 14 years, 43 % women) were included. Within subject therapy effects were detected only by the VE/VCO2 intercept and PETCO2 change, whereas the differences between medical regimens were detected by differences in VE/VCO2 nadir and VE/VCO2_AT changes after the treatment. The best predictors of the change in well-being were left ventricular outflow tract maximal gradient and VE/VCO2 intercept (B = 0.41,0.36; SE = 0.16,0.30; CI = 0.14–0.79, 0.15–1.14; p = 0.006,0.016, respectively). Adverse cardiac events were best predicted by the initial VE/VCO2 nadir. Conclusion: Ventilatory efficiency parameters outperform peak VO2 in gauging therapy effects in patients with HCM. © 2024 Elsevier Inc.