[show abstract][hide abstract] ABSTRACT: The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle) contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP) reduction but also normalize cardiovascular structure and function.
Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients.
The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A) ACE-inhibitor--Fosinopril and B) without ACE inhibitor--atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5 cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image.
After 9 months, BP in both groups was reduced in similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B: systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg). The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 +/- 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 +/- 0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 +/- 72 g vs. 307 +/- 77 g), while in group B patients, it was increased by 15 grams (323 +/- 79 g vs. 328 +/- 58 g. Diastolic function expressed through relation E/A was improved minimally in the group A, while it worsened by 0.1 in the group B. After 9 months, serious cardiovascular events were recorded (one infarction of myocardium and one hospitalization due to the unstable angina pectoris) in two patients of the group A, while four patients of the group B had serious CV events (1 cerebrovascular stroke and 3 hospitalizations due to unstable angina pectoris).
The results of our study showed that the application of Fosinopril in patients with the arterial hypertension and the left ventricle hypertrophy could efficiently block further progression of the intima-medial thickness of the common carotid artery, reduce the left ventricle mass, and improve diastolic function of the left ventricle.
Srpski arhiv za celokupno lekarstvo 01/2006; 134(3-4):106-13. · 0.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Myocardial ischemia which occurs in the absence of chest pain or its equivalents (silent myocardial ischemia) is common in patients with coronary artery disease. Silent myocardial ischemia may also be found in asymptomatic patients, particularly those with underlying risk factors. It is important for physicians to identify the existence of silent myocardial ischemia because it is predictive of increased cardiac risk. Objective: To evaluate the frequency and characteristics of silent myocardial ischemia in asymptomatic patients with multiple coronary risk factors ("high coronary risk" patients). Methods: Study group consisted of 360 male pts (age from 35 to 70 years) with multiple coronary risk factors free of previously diagnosed coronary artery disease. In study pts the most frequent risk factors for coronary artery disease were arterial hypertension (74%) and cigarette smoking (60%). In all pts maximal, or ST segment depression of ≥ 0.2 mV or symptom-limited exercise test was performed. In those with ST-segmant depression on exercise electrocardiogram, stress echocardiography was additionally performed in order to confirm myocardial ischemia. Results: Out of 360 patients 290 (81%) patients had neither ST-segment depression nor anginal pain during exercise stress testing, 52 (14%) patients had ischemic type of ST-segment depression on exercise electrocardiogram without chest pain and 18 (5%) patients had ischemic ST-segment depression and the first occurrence of chest pain (symptomatic myocardial ischemia). All patients with symptomatic myocardial ischemia had an echocardiographic marker for ischemia but out of 52 patients with asymtpomatic ST-segment depression 43 patients had echo markers for ischemia (silent miocardial ischemia), while in 9 patients stress echocardiography was without regional wall motion abnormality (false positive exercise electrocardiogram). Thus both types of myocardial ischemia were recorded in 61 (17%) "high coronary risk" patients (12% silent and 5% symptomatic myocardial ischemia). There were no significant difference in regard to magnitude and duration of ST-segment depression and exercise tolerance between patients with symptomatic and silent myocardial ischemia, but wall motion score index was bigger in patients with symptomatic than in those with silent myocardial ischemia (P<0.01). Conclusion: This study showed that in 12% of asymptomatic "high coronary risk" patients silent myocardial ischemia during exercise test was found. There were no differences between two types of myocardial ischemia in the exercise electrocardiogram but symptomatic ischemia had a higher degree of wall motion abnormality on stress echo than silent myocardial ischemia.
Medicine and Biology. 01/2004; 11127(616):107-112616.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to evaluate the frequency, some characteristics and prognostic significance of silent myocardial ischemia during early exercise testing in patients after myocardial infarction. In the group of 210 patients within three months after myocardial infarction submaximal or symptom-limited exercise test were performed. Out of 210 patients 88 (42%) had ischemic response on exercise electrocardiogram and 2D exercise echocardiogram. Out of 88 patients with ischemic response on exercise electrocardiogram and echocardiogram 54 (61%) had anginal pain or it's equivalents (symptomatic myocardial ischemia) and 34 (39%) had not ischemic symptoms (silent myocardial ischemia). Diabetes mellitus and arterial hypertension was more frequent in patients with silent than in patients with symptomatic myocardial ischemia. Level of exercise test and heart rate at the onset of both types of myocardial ischemia were not differ significantly. Duration of exercise testing was significantly bigger in patients with silent myocardial ischemia. The average magnitude and duration of ST-segment depression in both groups of pts with myocardial ischemia were similar. Before exercise test wall motion score index (WMSI) was similar in both groups of patients. After exercise stress echocardiography WMSI significantly rised in both groups, but more in patients with symptomatic ischemia, and after exercise test WMSI was significantly bigger in patients with symptomatic ischemia. During three years follow-up there were no significant differences in mortality, reinfarction and coronary artery by-pass surgery rate between patients with symptomatic and silent myocardial ischemia. This study showed that: silent myocardial ischemia, during early exercise testing was frequent finding in patients after myocardial infarction, especialy in those with diabetes mellitus and arterial hypertension; there were not significant differences in characteristics between silent and symptomatic myocardial ischemia on exercise electrocardiogram; and three years prognostic significance of both types of myocardial ischemia was similar.
[show abstract][hide abstract] ABSTRACT: Anti-citrullinated peptides antibodies (ACPA) are present in 80% of sera of rheumatoid arthritis (RA) patients with high specificity for diagnosis and prediction for the development of early erosive arthritis. A few studies have reported a low frequency ACPA in systemic sclerosis (SSc) patients with the presence of arthritis.
The aim of our study was to determine the frequency of ACPA in systemic sclerosis (SSc) patients, their correlation with clinical manifestations and radiographic features.
The study included 82 patients with SSc, mean age 54.4 years, 59 with the limited (ISSc) and 23 with the diffuse (dSSc) form of the disease. The control group included 28 healthy age and sex matched subjects. ACPA and rheumatoid factor (RF) were determined in all SSc patients and healthy subjects in whom standard radiography of hands and wrists was also done.
The presence of ACPA was detected in 11 (13.4%) of SSc patients. Their level was not increased in any of the controls. Positive RF was found in 15.9% of SSc patients. Arthritis was present in 17.1%, as well as marginal bone erosions. There was a statistically significant association between positive ACPA and arthritis (p < 0.0001) and positive ACPA and marginal bone erosions (p = 0.0002).
The research confirmed the correlation between ACPA with clinical signs of arthritis and radiographic damage of hand joints. ACPA is a useful diagnostic marker in the identification of SSc patients with arthritis and anatomic bone damage enabling the use of adequate therapy in order to prevent joint damage and poor quality of life.
Srpski arhiv za celokupno lekarstvo 140(5-6):350-4. · 0.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Regardless of other known factors, left ventricular hypertrophy is considered to be a significant factor which correlates with the risk of cardiovascular complications. In practice, it is very important to predict the outcome for every patient at the beginning of the treatment.
The aim of the study was to follow the predictive value of non-invasive parameters obtained at the beginning of the study in patients with essential arterial hypertension and left ventricular hypertrophy who were treated by regular therapy through a five year follow-up period.
Ninety patients (average age 55) with essential hypertension and left ventricular hypertrophy were examined. All patients were studied at baseline after temporary discontinuation of previous antihypertensive therapy. The follow-up period started at the baseline examination and lasted for five years. Adverse cardiovascular events occurred in 15 (16.7%) patients.
Non-invasive parameters were tested by stepwise multiple regression analysis. Three examined parameters had predictive value: QTc interval dispersion (beta = 0.325, p = 0.001), septal wall thickness (beta = 0.294, p = 0.003) and low increase of the heart rate during exercise testing (beta = -0.202, p < 0.04). For this model, adjusted R square = 0.203; F3,84 = 8.406, p < 0.0001.
In spite of regular medical treatment, patients with larger QTc dispersion, greater septum thickness and lower increase of heart rate during exercise testing showed worse outcome through the follow-up period. These patients should be recognized as early as possible and treated more aggressively.
Srpski arhiv za celokupno lekarstvo 140(9-10):571-6. · 0.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: Considering that dyslipidaemia is an important factor for cardiovascular diseases, target lipid levels are rarely reached in everyday clinical practice.
The objective of this study was to evaluate how often we achieve the treatment goals for the lipid parameters in the diabetic and non-diabetic patients after the previous myocardial infarction (MI).
The survey included 118 patients (84 males and 34 females), mean age 59.38 +/- 9.86 years, 34 (28.8%) of them diabetics, with the history of MI in the previous 3 years. The patients were selected from the database of multicentre prospective interventional study "Secondary prevention of coronary heart disease and cerebrovascular diseases", conducted in 2005 on 1,189 patients in Serbia. The patients were further followed in the period from 18 (5th visit) and 36 months (6th visit) after inclusion into the study from 2005-2008. Their lipid status, the use of lipid-lowering drugs, and the independent prognostic factors for major adverse coronary events were identified. In the beginning of the study, all patients were informed about the importance of lifestyle change and active approach to treatment. The accomplishment of secondary preventive measures was estimated on the basis of the European guidelines on secondary prevention of the coronary heart disease.
Three years after introduction of the preventive measures, diabetics had a higher prevalence of the target levels of the total cholesterol (21.2% vs. 7.6%) and HDL-cholesterol than non-diabetics (100% vs. 87.3%) (p < 0.05). Non-diabetics had significantly higher prevalence of the target levels of LDL-cholesterol than diabetics (19% vs. 3%) (p < 0.05). No significant differences were found in the prevalence of the treatment goals of triglycerides in diabetic (42.4%) and non-diabetic patients (60.8%) (p > 0.05). At the end of the study, after applying secondary prevention measures, 27.3% of diabetics did not use lipid-lowering drugs. The percentage of non-diabetics using no lipid-lowering drugs was lower (20.3%), but the difference was not statistically significant (p > 0.05). By using the method Enter Cox regression multivariant analysis, the change in the level of triglycerides, total and LDL-cholesterol were singled out as independent prognostic factors for major adverse coronary events.
Our study has shown high prevalence of increased plasma concentrations in the total, LDL-cholesterol and triglycerides and low plasma concentrations of HDL-cholesterol, as well as the insufficient use of lipid-lowering drugs in diabetic and non-diabetic patients with previous MI. Decreasing the total cholesterol and increasing the HDL-cholesterol are significant, decreasing of triglycerides and LDL-cholesterol does not suffice. Therefore, secondary prevention measures of cardiovascular events should be intensified, especially in patients with diabetes.
Srpski arhiv za celokupno lekarstvo 139(1-2):30-6. · 0.23 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG)]. Methods: Overall 719 consecutive CAD patients were involved in the study: WR (n=170), PTCA (n=226), CABG (n=323). HRQoL was estimated using the SF-36 questionnaire for total QoL and its two dimensions for physical and mental health [physical and mental component scores (PCS, MCS)]. Sexual dysfunction was assessed using the ASEX scale. Results: Significantly higher PCS, MCS and total SF-36, but lower ASEX score, were found in men compared with women. The ASEX score was significantly affected by age. Significantly higher PCS was found in PTCA group compared with that of CABG group. In multivariate analysis a significant positive association was obtained between PCS/MCS and male sex, between regular exercise, hyperlipoproteinemia, and permanent stress. ASEX was significantly positively associated with the age, CHF and non smoking. Conclusion: The results of this study have demonstrated significantly better HRQoL in men, younger CAD patients, patients who underwent PTCA and in patients without self-reported exposition to stress.
Central European Journal of Medicine · 0.26 Impact Factor