Browsing by Author "Vidaković, Radosav (13009037100)"

Introduction/Objective Revascularization in multivessel coronary artery disease (MVD) in patients with ST elevation myocardial infarction (STEMI) is a matter of debate. We sought to compare outcomes between revascularization strategies based on angiographic lesion severity or inducible ischemia. Methods In prospective study, first ever STEMI patients with MVD, defined as > 70% stenosis in non-culprit vessel, treated with culprit only primary PCI were randomized to: A. Complete revascularization of all non-culprit significant lesions during initial hospitalization; B. Complete revascularization after 30 days, or C. Revascularization based on non-invasive testing for inducible ischemia. The study explored occurrence of major adverse cardio-cerebral events (MACCE) (cardiac death, repeated MI, cerebrovascular event). Results The study enrolled 120 patients with door to balloon time within appropriate limits (A 51 ± 26 vs. B 47 ± 33 vs. C 44 ± 29 min, p = 0.604) The patients in group A underwent complete revascularization at 6 [4–7] days after primary PCI, while in the group B it was 35 [32–39] days. In group C, 16/43 (37.2%) patients underwent PCI at 82 [66–147] days after infarction (p < 0.001). The patients were followed for 2.7 ± 0.8 years. The events occurred less frequently in patients that underwent planned complete revas-cularization compared to those who underwent ischemia testing (7.8 vs. 20.9%, p = 0.040). Kaplan–Meier analysis favored complete delayed revascularization (MACCE A 8.8 vs. B 6.9 vs. C 20.9%, log rank p = 0.041). Conclusions Planned, angiography guided, complete revascularization after initial event may be favor-able strategy compared to single stress test for MVD in STEMI. © 2021, Serbia Medical Society. All rights reserved.

Objective: To assess the effect of surgical revascularisation on left ventricular (LV) systolic function in patients with viable and non-viable dysfunctional LV segments determined by low dose dobutamine stress echocardiography (DSE). Design: Prospective observational cohort study. Setting: Single tertiary care centre. Patients: Consecutive patients referred to surgical revascularisation (n=115). Interventions: DSE and surgical revascularisation. Main outcome measures: Functional recovery defined as increase in ejection fraction ≥5% 1 year after revascularisation in patients with and without viable myocardium (viability defined as improvement of contractility in ≥4 LV segments on DSE). Results: The mean age, ejection fraction and wall motion score index (WMSi) of patients were 59±9 years, 44±9% and 1.82±0.31, respectively. There was no difference between DSE positive and DSE negative patients for any of those parameters at baseline study (p>0.05 for all). After 12 months, the ejection fraction increased 11±1% in patients with viable myocardium vs 7±1% in patients without viable myocardium (p=0.002). Moreover, in patients with viable myocardium, the greatest increase of ejection fraction occurred 1 month after surgery (9±1%), whereas in those patients with negative DSE the ejection fraction increased more gradually (2±1% after 1 month, p=0.002 between groups for 1 month vs preoperative value), but still improved after 12 months follow-up (p<0.0001 in time for both groups). Conclusions: It appears that patients with LV dysfunction, but without viable myocardium, may also benefit from myocardial revascularisation. Functional recovery continuously occurs throughout the first year after surgical treatment.

Introduction Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. Objective We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. Methods A total of 433 consecutive patients who underwent primary PCI in 2011–2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients’ status was assessed by an office visit or telephone interview. Results Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n=217). Groups had similar total ischemic time (319±276 vs. 333±372 min; p=0.665), but TA+ group had higher maximum values of troponin I (39.5±30.5 vs. 27.6±26.9 ng/ml; p<0.001). The echocardiography revealed similar left ventricular volumes and systolic function, but TA+ group had significantly higher incidence of E/e’>15, as a marker of severe diastolic dysfunction (TA+ 23.1% vs. TA- 15.2%; p=0.050). During average follow-up of 14±5 months, major adverse cardiac/ cerebral events occurred at the similar rate (log rank p=0.867). Conclusion Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn’t influence the incidence of major adverse cardiovascular events. © 2016, Serbia Medical Society. All rights reserved.

Aim: Coronary bifurcation atherosclerosis depends on its angles, flow, and extensive branching. We investigate the ability of CT coronary angiography (CTCA) to determine atherosclerotic plaque characteristics of “true” bifurcation compared with intravascular ultrasound (IVUS) and the influence on side branch (SB) fate after percutaneous coronary intervention (PCI). Methods and results: The study included 70 patients with 72 “true” bifurcations. Most of the bifurcations were in the left anterior descending—diagonal (Dg) territory [50 out of 72 (69.4%)]. Longitudinal plaque evaluation at the polygon of confluence [carina and 5 mm proximal and distal in the main branch (MB)] showed that carina side MB and SB plaque had occurred with the lowest incidence with fibro-lipid structure (115 ± 63 HU and 89 ± 73 HU, p < 0.001 for all). Bland–Altman analysis showed a discrepancy in measuring mainly the lumen area between CTCA and IVUS in proximal MB [lumen 5.10, 95% CI (95% confidence interval, 4.53–5.68) mm2, p < 0.001; vessel −1.42, 95% CI (−2.63 to −0.21) mm2, p = 0.023], carina MB [lumen 3.74, 95% CI (3.37–4.10) mm2, p < 0.001; vessel −0.48, 95% CI (−1.45 to 0.48) mm2, p = 0.322], and distal MB [lumen 4.72, 95% CI (4.27–5.18) mm2, p < 0.001; vessel 0.62, 95% CI (−0.53 to 1.77) mm2, p = 0.283]. A significant correlation existed between average plaque density on CTCA with a percentage of calcified plaque on IVUS tissue characterization (proximal r = 0.307/p = 0.024, carina 0.469/0.008, distal 0.339/0.024, minimal lumen diameter 0.318/0.020). Circumferential plaque in the proximal MB segment remained an independent predictor of SB compromise [OR 3.962 (95% CI 1.170–13.418)]. Conclusion: Detection and characterization of atherosclerotic plaque by CTCA in non-left main “true” coronary bifurcations can provide useful information about bifurcation anatomy and plaque distribution that can predict outcomes after provisional stenting, thus guiding the interventional strategy to bifurcation PCI. 2023 Radunović, Vidaković, Timčić, Odanović, Stefanović, Lipovac, Krupniković, Mandić, Kojić, Tomović and Ilić.

Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: (1) identified risk factors, and (2) the type of the surgical procedure. On that basis, different scoring systems have been developed in order to accurately assess the perioperative cardiac risk and to improve the patient management. Importantly, patients with estimated high risk should be tested preoperatively by non-invasive cardiac imaging modalities. According to test results, they can proceed directly to planed surgery with the use of cardioprotective drugs (beta-blockers, statins, aspirin), or to myocardial revascularization prior to non-cardiac surgery. In this review, we discuss the role of clinical cardiac risk factors, laboratory measurements, additional non-invasive cardiac testing, and consequent strategies in perioperative management of patients undergoing noncardiac surgery.

Introduction Since clinical and electrocardiographic features of various cardiac disorders may overlap, the differential diagnosis of left ventricular (LV) dysfunction may be difficult even for the most experienced physicians. Recent advances in cardiac imaging may help clinicians to establish an accurate diagnosis and initiate adequate treatment. The aim of this case report is to raise awareness of a very short-lasting LV dysfunction during respiratory infections and to underline the importance of multimodality imaging in this clinical setting. Case outline A previously healthy 37-year-old male presented with atypical chest pain and ST-segment elevation in the inferolateral leads during severe mental stress and acute respiratory infection. Acute myocardial infarction, myocarditis, coronary vasospasm and stress cardiomyopathy were all considered as a differential diagnosis. A rapid onset of severe LV dysfunction and a complete recovery within 4 days was detected by echocardiography and further evaluated by multimodality imaging, including multi-slice computed tomography and cardiac magnetic resonance imaging. Conclusion Severe, but very short-lasting LV dysfunction may be triggered by various causes, including upper respiratory tract infections. Since the symptoms of respiratory infections may obscure those of LV dysfunction, myocardial dysfunction in these patients may go undetected with possible serious consequences. © 2019, Serbia Medical Society. 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.

Background/Aim. Percutaneous coronary interventions (PCI) in bifurcation lesions having more than 50% stenosis of both the main branch (MB) and the side branch (SB) remain challenging. Measurements of the vessel diameters and angles using quantitative coronary angiography (QCA) software have been used in evaluating PCI outcomes. We investigated potential effects of provisional stenting of the MB on SB coronary blood flow by determining quantitative vessel parameters in “true” non-left main coronary bifurcation lesions using conventional two-dimensional QCA. Methods. The study was prospective and conducted in a high-volume university PCI center. Study included patients with “true” native coronary artery bifurcations (Medina 1.0.1; 0.1.1; 1.1.1) treated with “provisional” stenting of the MB. Patients were excluded from the study if having left ventricular ejection fraction of less than 30%, having renal failure with creatinine clearance below 30 mL/kg/m2 or bifurcation lesions within the culprit artery causing myocardial infarction, grafted surgically or previously treated by PCI. QCA analysis included measurements of reference vessel diameters (RVD), diameter stenosis (DS) and bifurcation angles. Results. The study included 70 patients with 72 “true” non-left main bifurcations. Most of the bifurcations were located in the left anterior descending (LAD) – diagonal (Dg) territory. Compromise of the SB ostium defined as thrombolysis in myocardial infarction (TIMI) < 3 coronary flow occurred in 17/72 (23.6%) bifurcations. It was treated by either balloon angioplasty only of the SB ostium (9/17, 52.9%) or stent implantation [8/17 (47.1%)]. In a logistic regression analysis, including previously recognized predictors of SB compromise (bifurcation’s angles, RVD, DS and ratio of MB RVD to stent diameter ratio), only MB RVD to stent diameter ratio after PCI remained independent predictor of SB coronary flow compromise after stent implantation in the MB [OR 2.758 (95% CI 1.298–5.862); p = 0.008]. Conclusions. It appears that SB decreased coronary blood flow after “provisional” stenting in “true” non-left main bifurcations is associated with greater MB to stent diameter ratio. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.