Browsing by Author "Vujisic-Tesic, Bosiljka D. (6508177183)"

Background: Does preoperative revascularization of the myocardium reduce cardiac risk in noncardiac surgery? The aim of this study was to evaluate the clinical effectiveness of preoperative cardioprotection by coronary artery revascularization in abdominal nonvascular surgery under general anesthesia. Materials and methods: The observational clinical study included 111 consecutive patients with angiographically verified coronary artery disease. Two stratification groups of patients were compared, those with coronary artery revascularization (34 patients, 30.6%) and those without coronary artery revascularization (77 patients, 64.9%), in relation to frequency of perioperative cardiac complications. The patients were followed up until the 30th postoperative day. During operation and in the following 72 postoperative hours, the patients were monitored by continuous ST-T segment recording. Twelve-lead electrocardiography was performed immediately after surgery and on postoperative days 1, 2, and 7 as well as 1 day before discharge. Serum troponin T levels were controlled at 6, 24, and 96 h postoperatively. Results: The number of patients with major cardiac complications was 0 (0.0%, n=34) in the revascularized myocardium group and 10 (12.9%, n=77) in the nonrevascularized myocardium group (P<.05). Three patients in the nonrevascularized myocardium group died of acute myocardial infarction, congestive heart failure, and malignant arrhythmias, respectively, with severe coronary artery stenosis verified angiographically. Conclusions: Preoperative cardioprotection by coronary artery revascularization significantly reduces morbidity and mortality in patients who have undergone abdominal nonvascular surgery. Patients with severe coronary artery stenosis and indication for coronary artery revascularization independently of noncardiac surgery should first undergo cardiosurgical intervention prior to elective abdominal nonvascular surgery. © 2008 Elsevier Inc. All rights reserved.

Background: Mitral annular calcification (MAC) has been suggested as a reliable, time-averaged marker of atherosclerosis and is associated with coronary artery disease, heart failure, ischemic stroke, and increased mortality. Data on the relationship between MAC and cardiovascular morbidity and mortality in atrial fibrillation (AF) are sparse, with the exception of the relationship between MAC and stroke. We investigated the association of MAC with cardiovascular morbidity, stroke, cardiovascular mortality, and all-cause death in a cohort of middle-aged patients with AF with a mean 10-year follow-up. Methods: This was an observational study of patients with nonvalvular AF between 1992 and 2007. Results: Of 1,056 patients, 33 (3.1%) had MAC; they were more likely to be older and female and to have a dilated left atrium, reduced left ventricular ejection fraction, permanent AF, hypertension, and/or diabetes mellitus (all P < .05). Total follow-up was 10,418.5 years (mean, 9.9 ± 5.9 years), and the mean age was 52.7 ± 12.2 years. In univariate analysis, MAC was associated with all-cause death, cardiovascular death, stroke, new cardiac morbidity (all P < .05), and the composite end point of ischemic stroke, myocardial infarction (MI), and all-cause death (P < .001). In multivariate analyses, MAC was related to all-cause death (hazard ratio [HR], 4.3; 95% CI, 1.8-10.0; P < .001), cardiovascular death (HR, 3.5; 95% CI, 1.2-10.4; P = .025), the composite end point (HR, 2.1; 95% CI, 1.0-4.3; P = .048), and new cardiac morbidity (HR, 2.4; 95% CI, 1.3-4.5; P = .005). There was no significant relationship between MAC and stroke or MI in the multivariate analyses. Conclusions: MAC is associated with increased cardiovascular morbidity, cardiovascular mortality, and all-cause mortality of patients with AF. MAC should be acknowledged as a marker of increased cardiovascular risk in middle-aged patients with AF. © 2011 American College of Chest Physicians.

Background: In order to evaluate the predictive value of echocardiograph parameters for mortality of hemodialysis patients and their relation to Kt/V and anthropometry, a prospective, single center study was analyzed post-hoc. Methods: This analysis encompassed 106 patients on maintenance hemodialysis monitored for 108 months from 1996 to 2004. spKt/V was calculated using the Daugirdas formula. Anthropometric measurements included mid-arm muscle measurements (MAMC) and percentage of body fat (%fat). Echocardiography included the estimations of left ventricular wall thickness, dimensions and volumes (EDV, ESV), systolic LV function (ejection fraction - EFLV, fractional shortening - VCF, stroke volume - SV) and diastolic LV function (E/A, VTI-A wave of transmitral flow velocity), left atrial diameter, as well as assessment of clinical and biochemical parameters. The Cox proportional hazard model was used to estimate predictive values of echocardiograph parameters. Results: Kt/V correlated significantly with left ventricular systolic and diastolic volumes and function, septal and posterior wall thickness and left atrium dimension. MAMC and %fat also correlated with many echocardiograph parameters. Multivariate Cox regression selected age [HR 1.07; CI (1.03-1.12); p<0.01], albumin [HR 0.88; CI (0.79-0.97); p<0.05] and left atrium dimension-binary [values > 4cm were marked as "1" and others "0"-HR 3.76; CI (1.56-9.03); p<0.01] as independent predictors of death. Conclusion: Left atrium dimension was the most important predictor of mortality among the echocardiograph parameters. Many of these parameters were related to Kt/V and anthropometric measurements and could be the combined consequence of hypervolemia and hypertension. © 2015 Informa Healthcare USA, Inc.

Study Objective: To analyze the clinical effectiveness of the β-1-aderenergic blocker, metoprolol. Design: Prospective, observational, clinical study. Setting: Operating room and intensive care unit of a tertiary-care teaching hospital. Patients: 111 ASA physical status II, III, and IV consecutive patients who were scheduled for open abdominal nonvascular surgery. Interventions: Patients were divided into two stratification groups: 83 (74.8%) of 111 received metoprolol, and 28 (25.2%) of 111 were controls. Within 24 to 96 hours, the drug was used parenterally in a dose of 5, 10, and 15 mg per 24 hours. Metoprolol cardioprotection was applied during the whole perioperative period, in the form of tablets in a dose of 25, 50, and 100 mg per 24 hours until the 30th postoperative day. Measurements: During surgery, and in the first 72 postoperative hours, patients were monitored by continuous ST-T segment monitoring. A 12-lead electrocardiogram was attached immediately after surgery; on postoperative days 1, 2, and 7; and one day before discharge from the hospital. Serum troponin-T level was controlled 6, 24, and 96 hours after surgery. Main Results: Postoperative mortality of cardiac etiology after 30 days of surgery was 1.2% (1/83) in the metoprolol group versus 7.1% (2/28) in the nonmetoprolol group (P < 0.05). The causes of death in these three patients were acute myocardial infarction, congestive heart failure, and malignant arrhythmias. Conclusions: Perioperative cardioprotection significantly reduced mortality until postoperative day 30 in patients having open abdominal nonvascular surgery with general anesthesia. © 2008 Elsevier Inc. All rights reserved.