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ABSTRACT: Acute heart failure (AHF) is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population.
This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade) and were followed for one year after the discharge.
Mean age of the patients was 63.6 +/- 12.6 years and 59.4% were males. Acute congestion (43.8%) and pulmonary edema (39.1%) were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF) was 39.7% +/- 9.25%, while 44.4% of the patients had LVEF > or = 50%. At discharge, 55.9% of the patients received therapy with P-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blockers (ARB). The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS) and a higher tricuspid velocity.
One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity.
Vojnosanitetski pregled. Military-medical and pharmaceutical review 02/2011; 68(2):136-42. · 0.18 Impact Factor
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Zagorka B Jovanović, Bosiljka Vujisić Tesić,
Aleksandra M Pavlović,
Jasna J Zidverc Trajković,
Milija D Mijajlović,
Marija V Boririć Kostić,
Edita Z Cvitan,
Aleksandra P Radojicić,
Gordana Tomić,
Ana Sundić,
Nadezda M Sternić Covicković
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ABSTRACT: Transient global amnesia (TGA) could be related to acute ischemic disturbances in mesial parts of temporal lobes, which are important for memory. Incompetence of internal jugular vein (IJV) valve with venous congestion causes venous microthrombosis of hippocampus. The aim of this study was to investigate the frequency of IJV valve incompetence, as well as other hemodynamic and structural properties of cerebral circulation in TGA patients.
IJV valve competence was investigated in 40 TGA patients and 30 persons of the control group (matched by age and sex), as well as detection of microembolic signals and detection of right to left cardiopulmonal shunt, cerebral vasomotor reactivity and echocardiography by color triplex ultrasonography and transcranial doppler.
A significant difference in frequency of IJV valve incompetence was found between the TGA patients and the control persons (55% TGA vs. 30% controls; p < 0.001). We did not find a significant structural (plaques frequency) or hemodynamic (flow velocity, pulsatility index) differences on arteries of the neck and cerebral arteries between the TGA patients and the controls, except for the increased pulsatility index on the basilar artery (40% TGA vs. 16.6% controls; p < 0.01) and decreased vasomotor reactivity in TGA patients (50% TGA vs 26.6% controls;p < 0.001). Microembolic signals were detected very rarely (17.5% TGA patients vs. 13.3% controls; p > 0.05), as well as right to left cardiopulmonal shunt (15% TGA vs. 16.6% controls; p > 0.05), indicating that embolism was not important for pathogenesis of TGA. Transesophageal echocardiography confirmed it, because only one TGA patient had a potent foramen ovale.
We found a significantly increased frequency of IJV incompetence in the TGA patients, which confirmed the role of vein drainage disturbances in pathogenesis of TGA.
Vojnosanitetski pregled. Military-medical and pharmaceutical review 01/2011; 68(1):35-40. · 0.18 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in general population. The aim of the study was to compare all-cause mortality and cardiovascular mortality in patients with lone and idiopathic AF to correspondent mortality in general population of Serbia.
A longitudinal observational study included the patients with nonvalvular AF as the main indication for in-hospital and/or outpatient treatment in the Clinical Center of Serbia, during a period 1992-2007, if the latest date of first diagnosed AF was early January 2003; in that way, the total follow-up could last at least 5 years (minimum 1 year prospectively), or until death. Principles of oral anticoagulation, heart rhythm and frequency control during the study period were conducted according to the latest international guidelines for diagnosis and treatment of AF in the study period. Lone and idiopathic AF were defined as AF in patients without any underlying disease, younger than 60 years (lone AF) or older (idiopathic AF). To compare mortality of the study population with mortality of general population we used the standardized mortality ratio (SMR) and chi-square test with p < 0.05 as a level of statistical significance.
Out of 442 patients with AF and no underlying disease, aged 47 +/- 12.6 years, with mean follow-up of 11.5 +/- 7.2 years, 12 patients (2.7%) died: 7 patients of non-cardiovascular causes and 5 patients (1.1%) of cardiovascular death. When compared to the general population of Serbia, all-cause mortality and cardiovascular mortality in the patients with lone and idiopathic AF were not higher than in general population (p < 0.05).
All-cause mortality and cardiovascular mortality of patients with lone and idiopathic AF are similar to all-cause mortality and cardiovascular mortality in general population of Serbia.
Vojnosanitetski pregled. Military-medical and pharmaceutical review 02/2010; 67(2):132-5. · 0.18 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) increases the risk for ischemic stroke and other thromboembolic (TE) events. Aim of the study was to examine the relationship between clinical types of atrial fibrillation (AF) and (TE) events.
This longitudinal, observational study included patients with nonvalvular AF as main indication for in-hospital and/or outpatient treatment in the Cardiology Clinic, Clinical Center of Serbia during a period 1992-2007. The treatment of AF was based on the International Guidelines for diagnosis and treatment of AF, correspondent to given study period. Clinical types of AF were defined according to the latest ACC/AHA/ESC Guidelines for AF, from 2006. Diagnosis of central and systemic TE events during a follow-up was made exclusively by the neurologist and vascular surgeon.
During a follow-up of 9.9 +/- 6 years, TE events were documented in 88/1 100 patients (8%). In the time of TE event 46/88 patients (52.3%) had permanent AF. The patients with permanent AF were at baseline significantly older and more frequently had underlying heart disease and diabetes mellitus. Cumulative TE risk during follow-up was similar for patients with paroxysmal and permanent AF, and significantly higher as compared to TE risk in patients with persistent AF. However, multivariate Cox proportional hazard regression analysis with independent variables clinical types of AF at baseline and in the time of TE event, clinical and echocardiographic characteristics and therapy for prevention of TE complications at baseline and at the time of TE event, did not reveal independent predictive value of clinical type of AF for the occurrence of TE events during a follow-up.
TE risk in patients with AF does not depend on clinical type of AF. Treatment for prevention of TE events should be based on the presence of well recognized risk factors, and not on the clinical type of AF.
Vojnosanitetski pregled. Military-medical and pharmaceutical review 11/2009; 66(11):887-91. · 0.18 Impact Factor
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ABSTRACT: Aortic valve disease - stenosis and regurgitation are the cause of increased homodynamic stress of the left ventricle (LV) which then develops an adaptive mechanism of cardiac muscle hypertrophy. The aim of this study was to establish if aortic valve replacement procedure (AVR) reduces myocardial hypertrophy and if it does in what period of time.
Eighty-six patients who had been operated for AVR in the Clinical Centre of Serbia were included in this investigation. In the every patient the aortic valve had been replaced with a mechanical valve prosthesis. Transthoracic echocardiography examination (TTE) was performed in all of the patients before, and one week after the operation, while 22 patients were followed-up on a long-term basis. The LV mass was determined with the formula according to the Pen convention.
In the tested group there was significantly more male than female individuals (n = 57-66.3%, 29-337%). Twelve patients (14%) were operated for isolated aortic stenosis, 22 patients (25.6%) for aortic regurgitation, 48 patients (55.8%) for combined aortic valve disease, while 4 patients (4.7%0/) for endocarditis. Student t test did not show any significant difference in diastolic septal thickness before and after the operation (p = 0.88), while it did show that the difference in the LV mass before and after the operation was highly significant (p = 0.000). This test also showed that, taking the mass of 240 g as the border value for hypertrophy of LV, the reduction of LV mass between preoperative and early postoperative finding was not significant (p = 0.5), while the reduction in LV mass between late and early postoperative examination was statistically significant (p = 0.000). In 19 of 22 patients who were followed-up postoperatively over a long period (84 months after the operation) significant reduction of LV mass was registered. The mean time of the reduction was 27.5 months.
This study showed the presence of a significant reduction in the LV mass after AVR, and that the mean time required for this process was more than two years.
Vojnosanitetski pregled. Military-medical and pharmaceutical review 04/2007; 64(3):189-94. · 0.18 Impact Factor
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ABSTRACT: Sarcoidosis is a granulomatous disease that may involve multiple organ systems. Cardiac sarcoidosis may be a primary or a secondary process. Clinical manifestations of cardiac sarcoidosis include impulse conduction disorders, various arrhythmias, symptoms and signs of heart failure and even sudden death. The aim of the present paper was to assess the possibilities for echocardiographic detection of pathological changes in the hearts of patients with diagnosed systemic sarcoidosis.
The study group consisted of 31 patients with histological evidence of sarcoidosis obtained by biopsy of target organ (most frequently the lungs). There were 26 females and 5 males, aged from 38 to 74 years, mean age 53.67 +/- 9.48 years. The duration of sarcoidosis varied from 1 to 33 years, mean duration 6.56 years. All patients underwent Color Doppler echocardiographic examination with standard echocardiographic views.
Increased left ventricular end-diastolic diameter was registered in 6/31 patients (19%), while end-systolic dimension was increased in 2 patients (6%). However, left ventricular dimensions were more increased in the group of patients with sarcoidosis lasting 4 years or longer. Majority of patients with sarcoidosis (27/31 or 86%) had normal values of left ventricular systolic function. The diastolic function of the left ventricle was impaired in 19/31 patients (61%). Only one female patient had hypertrophied apical segments of interventricular septum (15-17 mm) and lateral left ventricular wall (14 mm), while basal segments of inferior, posterior and lateral left ventricular walls were thin and dyskinetic, but coronary angiography revealed normal findings. Laminar fibrosis within interventricular septal myocardium was identified in 14/31 sarcoidosis patients (45%), while granulations in ventricular septal myocardium were present in 10/31 patients (32%). Right ventricular systolic pressure over 30 mmHg was established in 5/31 patients (16%). Slight pericardial effusion was found in 4/31 patients (12%).
Echocardiography is a very useful method for obtaining important information on morphological and functional changes in myocardium of patients with sarcoidosis. However, neither of previously mentioned echocardiographic signs is specific for cardiac sarcoidosis. The diagnosis of cardiac sarcoidosis cannot be made solely on the basis of echocardiographic findings. Other diagnostic procedures, from clinical findings to endomyocardial biopsy, must be employed as well.
Medicinski pregled 02/2005; 58 Suppl 1:35-8.
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ABSTRACT: Cardiovascular manifestation of diabetes has remarkable therapeutic and prognostic implications. Diabetic cardiomyopathy is a distinct heart muscle disease in patients with well-controlled diabetes mellitus that cannot be ascribed to coronary artery disease, hypertension or any other known cardiac disease. It is characterized by left ventricular diastolic dysfunction that can be detected in 52-60% of well-controlled type II diabetic subjects using contemporary Doppler techniques. Pathophysiologically, hyperglycaemia causes myocardial necrosis and fibrosis, as well as the increase of myocardial free radicals and oxidants, which decrease nitric oxide levels, worsen the endothelial function and induce myocardial inflammation. Insulin resistance with hyperinsulinaemia and decreased insulin sensitivity are responsible for left ventricular hypertrophy. Clinical manifestations of diabetic cardiomyopathy are dispnoea, arrhythmias, atypical chest pain or dizziness. The treatment of diabetic cardiomopathy should be initiated as early as diastolic dysfunction is identified. Various therapeutic options include improving diabetic control with both diet and drugs (metformin and thiazolidinediones), use of ACE inhibitors, beta blockers and calcium channel blockers. Daily physical activity and reduction in body mass index may improve glucose homeostasis by reducing the glucose/insulin ratio, and the increase of both insulin sensitivity and glucose oxidation by the skeletal and cardiac muscles. Metformin and thiazolidinendiones are used to treat insulin resistance, but have different mechanisms of action. Metformin reduces free fatty amino acids effluvium from fat cells, thereby suppressing hepatic glucose production and indirectly improving peripheral insulin sensitivity and the endothelial function. In contrast, thiazolidinediones improve peripheral insulin sensitivity by reducing circulating free fatty amino acids, but also increasing production of adiponectin, which improves insulin sensitivity. Beta-adrenoceptor blocking agents are effective in preventing or reversing myocardial dilatation and remodelling, while ACE inhibitors facilitate blood flow through microcirculation in coronary vascular bed, fat and skeletal muscle, as well as improve insulin action at the cellular level.
Srpski arhiv za celokupno lekarstvo 135(9-10):576-82. · 0.19 Impact Factor
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ABSTRACT: Cardiac resynchronization therapy (CRT) is relatively new tool in treatment of chronic heart failure (HF), especially in dilated cardiomyopathy (DCM) with the left bundle branch block (LBBB).
The objective of our study was to assess the success of CRT in treatment of severe HF and the role of echocardiography in the evaluation of results of such therapy.
The group consisted of 19 patients, 13 males and 6 females, mean age 58.0 +/- 8.22 years (47-65 years) with CRT applied for DCM, severe HF (NYHA III-IV), LBBB and ejection fraction (EF) <35%. The mean follow up was 17 months (6.5-30). Standard color Doppler echocardiography examination was performed in all patients before and after CRT. The parameters of systolic and diastolic left ventricular function, mitral insufficiency and the right ventricular pressure were evaluated.
Following the CRT, statistically significant improvement of the end-systolic LV dimension, cardiac output, cardiac index, myocardial performance index (p < 0.01) and stroke index (p < 0.05) was recorded. The mean value of EFLV was increased by 10% and LV fractional shortening improved by 6% in 10/16 (62%) patients. CRT resulted in decreased MR (p < 0.01), prolonged LV diastolic filling time (p < 0.02) and reduced RV pressure (p < 0.05). Interventricular mechanical delay was shortened by 28% (18 msec)
CRT has an important role in improvement of LV function and correction of ventricular asynchrony. The echocardiography is a useful tool for evaluation of HF treatment with CRT.
Srpski arhiv za celokupno lekarstvo 134(11-12):488-91. · 0.19 Impact Factor
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ABSTRACT: Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve, left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiographic examination revealed a round tumour (5.8 x 4 cm) in the right ventricular free wall and two smaller cysts behind that tumour. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.
Srpski arhiv za celokupno lekarstvo 130(5-6):217-21. · 0.19 Impact Factor
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ABSTRACT: Diabetes mellitus is frequently accompanied by cardiac rhythm disorders. On the other hand, atrial fibrillation is the most frequent cardiac arrhythmia in adult population [1, 2]. According to some of the large epidemiological studies diabetes mellitus is among independent risk factors for development and persistence of atrial fibrillation [3]. Both diabetes mellitus and atrial fibrillation independently increase the risk of thromboembolism, especially of stroke [3-5]. It is obvious that rhythm control, i.e. restoration and maintenance of sinus rhythm, may be essential for prevention of thromboembolism in these patients.
The aim of this study is to analyse the impact of diabetes mellitus on rhythm control in patients with persistent atrial fibrillation.
We analysed the impact of diabetes mellitus and other clinical and echocardiographic parameters (age, gender, current arrhythmia duration, presence of previous episodes of persistent atrial fibrillation, cardiac and/or noncardiac diseases, left atrial diameter and left ventricular ejection fraction) on outcome of attempted cardioversion in patients with persistent atrial fibrillation admitted to Cardiologic Department of the Institute of Cardiovascular Diseases, Clinical Centre of Serbia, between January 1992 and December 1999. We also analysed retrospectively the impact of diabetes mellitus and other parameters listed above on the presence of previous episodes of atrial fibrillation in our patients, that at our opinion reflected the possibilities of sinus rhythm maintenance in these patients. All continuous parameters were expressed as mean value and standard deviation. Statistical significance of differences between variables was examined using Chi-square test. For identification of independent predictors of examined outcomes we used multiple logistic regression model with 95% of confidence interval. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) programme.
Of 378 patients with currently persistent atrial fibrillation, aged mean 53.98 +/- 11.69 years, there were 266 (70.4%) men. Diabetes mellitus was previously diagnosed in 27 (7.1%) patients, cardiac diseases in 223 (59.0%), noncardiac diseases in 47 (12.4%) and 140 (37.0%) patients had "lone" atrial fibrillation. Left atrial enlargement was noted in 224 (59.3%) patients, and reduced left ventricular ejection fraction in 82 (21.7%). Atrial fibrillation lasted 48 hours to 9 years, mean 8.5 +/- 18.14 months before cardioversion. While 43 patients had previous episodes of persistent AF for last 1-30 years, mean 10.5 +/- 7.3,335 patients never experienced AF before. There was a statistically significant difference in percent of diabetic patients (18.6%/43 vs. 5.7%/335, value of Chi-square test = 7.759, p < 0.01) in these two groups. We analysed the impact of diabetes mellitus on outcome of attempted cardioversion and on presence of previous episodes of AF reflecting the success in maintaining sinus rhythm. Multiple logistic regression models for all of 378 patients, with dependent variable being present in previous recurrent atrial fibrillations and independent variables of clinical and echocardiographic parameters as listed, identified diabetes mellitus to be an independent predictor of repeated atrial fibrillations with relative risk of 4.6 (CI 95%). When dependent variable in the same model was outcome of cardioversion (sinus rhythm is restored in 281/378 patients--74%) diabetes mellitus was not among independent predictors of successful cardioversion.
The relationship between atrial fibrillation and diabetes mellitus is not completely understood, including the impact of known complications of diabetes mellitus on electrophysiological properties of atrial myocardium and development of atrial fibrillation [6]. Besides being the independent risk factor for occurrence of atrial fibrillation, diabetes mellitus, according to our results, appears to influence the possibilities of maintaining sinus rhythm after cardioversion of permanent atrial fibrillation in diabetic patients. We found that patients with diabetes mellitus and persistent atrial fibrillation may be successfully converted to sinus rhythm like any other group of patients, but the presence of diabetes mellitus increases the risk of arrhythmia recurrence for 4.6 times compared to patients without diabetes mellitus. Obviously, diabetic patients need to be treated with more efficacious antiarrhythmics from the very beginning, including amiodarone, which successfully prevents recurrent atrial fibrillation in the majority of patients [7, 8].
We concluded that diabetes mellitus independently predicts the presence of recurrent atrial fibrillation but does not influence the possibility of sinus rhythm restoration. The relationship between atrial fibrillation and diabetes mellitus needs further investigation.
Srpski arhiv za celokupno lekarstvo 130(5-6):189-92. · 0.19 Impact Factor
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ABSTRACT: Primary pure cell seminoma of the mediastinum is a rare and potentially fatal lesion. Encroachment or invasion of adjacent structures is common, as are distant metastases. We present an unusual case of mediastinal seminoma with directly intracavitary invasion into the right atrium and extension to the left atrium. A 22-year-old male with right side chest pain, progressive cough, dyspnea, fever and right arm swelling lasting about a month is presented. Chest radiography on admission revealed a large mass in the anterior mediastinum. A cardiac ultrasonographic examination showed right atrial compression by the mass, with invasion of the right atrium wall. We also found polyp-like (about 2.5 cm in diameter) masses in left atrium near the area of the right pulmonary veins and a circumferential pericardial effusion. Percutaneous needle biopsy revealed mediastinal seminoma. To our knowledge, no similar case has been previously reported.
Srpski arhiv za celokupno lekarstvo 131(9-10):403-7. · 0.19 Impact Factor
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ABSTRACT: Tuberculous lymphadenitis is an uncommon form of extrapulmonary tuberculosis. We report on a case of isolated Cervicomediastinal tuberculous lymphadenitis without parenhimal involvement. A 49-year old woman was hospitalized with a four week history of night sweats and weight loss. Plain chest radiography disclosed mediastinal mass of the right side. Echocardiographic examination revealed a soft tissue mass below the ascending aorta and aortic arch causing moderate narrowing of the right ventricular outflow tract and the main pulmonary artery. Computed tomographic scanning showed soft tissue mass in the middle mediastinum surrounding the great vessels extending posteriorely with moderate compression of trachea. Histological examination of the cervical mass revealed caseating granuloma containing acid-alcohol fast bacillus. Antituberculous chemotherapy was started.
Srpski arhiv za celokupno lekarstvo 130(7-8):265-9. · 0.19 Impact Factor
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Jelena P Seferović-Mitrović,
Nebojsa M Lalić, Bosiljka Vujisić-Tesić,
Katarina Lalić,
Aleksandra Jotić,
Arsen D Ristić,
Vojislav Giga,
Milorad Tesić,
Natasa Milić,
Ljiljana Lukić,
Tanja Milicić,
Sandra Singh,
Petar M Seferović
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ABSTRACT: Several cardiovascular manifestations in patients with diabetes may be asymptomatic. Left ventricular diastolic dysfunction (LVDD) is considered to be the earliest metabolic myocardial lesion in these patients, and can be diagnosed with tissue Doppler echocardiography. Silent myocardial ischemia (SMI) is a characteristic and frequently described form of ischemic heart disease in patients with diabetes. Objective The aim of the study was to assess the prevalence of LVDD and SMI in patients with type 2 diabetes, as well as to compare demographic, clinical, and metabolic data among defined groups (patients with LVDD, patients with SMI and patients with type 2 diabetes, without LVDD and SMI).
We investigated 104 type 2 diabetic patients (mean age 55.4 +/- 9.1 years, 64.4% males) with normal blood pressure, prehypertension and arterial hypertension stage I. Study design included basic laboratory assessment and cardiological workup (transthoracic echocardiography and tissue Doppler, as well as the exercise stress echocardiography).
LVDD was diagnosed in twelve patients (11.5%), while SMI was revealed in six patients (5.8%). Less patients with LVDD were using metformin, in comparison to other two groups (chi2 =12.152; p=0.002). Values of HDL cholesterol (F=4.515; p=0.013) and apolipoprotein A1 (F=5.128; p= 0.008) were significantly higher in patients with LVDD.
The study confirmed asymptomatic cardiovascular complications in 17.3% patients with type 2 diabetes.
Srpski arhiv za celokupno lekarstvo 139(9-10):599-604. · 0.19 Impact Factor
