Echocardiografic assasment of left ventricular funcion and pulmonary hypertension in COPD

Bolesti kardiovaskularnog sistema su vodeći uzrok smrtnosti među pacijentima sa poremećajem plućne funkcije. Poznato je da je plućna hipertenzija i posledična insuficijencija desne srčane komore često pratilac teške hronične opstruktivne bolesti pluća (HOBP). Međutim učestalost insuficijencije leve komore u poslednje vreme je predmet brojnih istraživanja i srčana insuficijencija je još uvek nedovoljno ispitana kod bolesnika sa HOBP. Cilj ove doktorske disertacije je ispitati funkciju leve komore i prisustvo plućne hipertenzije kod bolesnika sa HOBP. Materijal i metode : Istraživanjem je obuhvaćeno 120 ispitanika koji su prema GOLD kriterijumima podeljeni u četiri grupe po 30 bolesnika za svaki od četiri stadijuma bolesti. Svim bolesnicima je urađena spiropletizmografija i ehokardiografija. Rezultati : Analizom dobijenih vrednosti parametara (udarni volumen (SV) i njegov indeks (SVI), ejekciona frakcija (EF), frakcija skraćenja) sistolne funkcije miokarda leve komore dokazali smo da postoji sistolna disfunkcija miokarda leve komore kod bolesnika sa HOBP. Sa napredovanjem bolesti opadaju i vrednosti SV i SVI. Vrednosti ejekcione frakcije takođe opadaju sa porastom stepena HOBP. Analizom parametara dijastolne funkcije kod bolesika sa HOBP dokazali smo sa postoji dijastolna disfunkcija leve komore. Ispitivanjem transmitranog protoka i kontinuiranim i tkivnim doplerom registruju se smanjene srednje vrednosti vrednosti E/A i E'/ A'odnosa i u svim stadijumima bolesti. Ispitivanjem prisustva plućne hipertenzije dokazali smo da je sistolni pritisak u desnoj komori (RVSP) bio najniži u početnim stadijumima HOBP, postepeno raste sa težinom bolesti i najveći vrednosti se beleže u četvrtom stadijumu bolesti. Visoka prevalenca funkcionalnih promena na srcu koje smo dokazali u našem istraživanju treba da ukaže na potrebu ehokardiografije u otkrivanju ovih poremećaja u HOBP.Cardiovascular diseases are the leading cause of death among patients with impaired lung function. It is known that pulmonary hypertension and right heart failure are often companion of severe chronic obstructive pulmonary disease (COPD). Left ventricular dysfunction is still not well studied and it is the subject of numerous studies in patients with COPD in recent years. The aim of this dissertation is to examine the function of left ventricle and the presence of pulmonary hypertension in patients with COPD. Materials and Methods: The study included 120 patients who meet the GOLD criteria for COPD. They were divided into four groups of 30 patients for each of the four stages of the disease. All patients underwent echocardiography and spiropletismography. Results: Analysis of the obtained values of the systolic function parameters (stroke volume (SV) and it’s index (SVI), ejection fraction (EF), fractional shortening) show impaired systolic left ventricular function in patients with COPD. With disease progression SV and SVI decrease. With increased severity of COPD the values of ejection fraction decreases. We showed diastolic dysfunction of the left ventricle in COPD patients. Transmitral continuous flow Doppler and tissue Doppler recorded reduced values of the mean E / A and E '/ A' in all stages of the disease. Examining the presence of pulmonary hypertension, we have shown that the systolic pressure in the right ventricle (RVSP) was the lowest in the early stages of COPD, gradually increases with the severity of disease and the highest value was recorded in the fourth stage of the disease. The high prevalence of functional changes in the heart that we have proved in our research highlights the need for echocardiography in the detection of these disorders in COPD

Učinak dipping profila gestacijske hipertenzije na majčine simptome i fizikalne nalaze, porođajnu težinu i prijevremeni porođaj

The study aimed to determine if the non-dipping pattern of blood pressure (BP) influences preterm delivery in gestational hypertension (GH), but also maternal clinical findings and birth weight. Sixty women with GH, i.e. 30 women with a dipping BP profile (control group) and 30 non-dippers (study group), were included in the study. Echocardiography was performed in all subjects, as well as ambulatory blood pressure monitoring (ABPM) during third trimester. ABPM was repeated 6-8 weeks after delivery. Thirteen women with preterm delivery were classified as non-dippers and only four as dippers (p=0.01). The average and peak systolic and diastolic night-time BP had negative linear correlation with birth weight (p<0.0005). Total vascular resistance (p<0.0005) and mass index (p=0.014) were significantly higher as compared with women with term delivery, while ejection fraction (EF) (p=0.007) and circumferential systolic velocity (p=0.042) were significantly reduced in the preterm delivery group. Multivariate binary logistic regression identified the average night-time systolic BP, left ventricular mass index and EF as independent predictors of preterm delivery. Study results suggested a relationship of the non-dipping BP pattern in GH with preterm delivery, birth weight, and maternal clinical findings.Cilj ovoga istraživanja bio je utvrditi povezanost non-dipping profila krvnog tlaka (KT) s prijevremenim porođajem, porođajnom težinom novorođenčeta te kliničkim i ehokardiografskim parametrima kod žena s gestacijskom hipertenzijom (GH). Istraživanje je obuhvatilo 60 žena s GH, 30 s dipping profilom KT (kontrolna skupina) i 30 non-dippera (ispitna skupina). Sve žene podvrgnute su kompletnoj ehokardiografiji i 24-satnom ambulantnom praćenju krvnog tlaka (ambulatory blood pressure monitoring, ABPM) tijekom trećeg trimestra, a ABPM je ponovljen 6-8 tjedana nakon porođaja. Ukupno 17 žena imalo je prijevremeni porođaj. Trinaest žena s prijevremenim porođajem imalo je non-dipping profil KT, dok su samo četiri žene imale dipping profil KT (0,01). Prosječni i maksimalni sistolički i dijastolički noćni KT imali su negativnu linearnu korelaciju s porođajnom težinom (p<0,0005). Ukupna vaskularna rezistencija (p<0,0005) i indeks mase miokarda lijeve klijetke (p=0,014) bili su znatno viši u skupini žena s prijevremenim porođajem, dok su parametri sistoličke funkcije, tj. ejekcijska frakcija (EF) (p=0,007) i brzina cirkumferentnog skraćenja miokarda lijevog ventrikla (p=0,042) bili statistički značajno sniženi u skupini žena s prijevremenim porođajem. Multivarijatna regresijska analiza pokazala je da su prosječni noćni sistolički KT, indeks mase lijevog ventrikla i EF identificirani kao nezavisni prediktori prijevremenog porođaja. Rezultati istraživanja pokazali su da postoji povezanost između non-dipping profila KT s prijevremenim porođajem, porođajnom težinom novorođenčeta i poremećajem hemodinamskog statusa majke u GH

Echocardiografic assasment of left ventricular funcion and pulmonary hypertension in COPD

Bolesti kardiovaskularnog sistema su vodeći uzrok smrtnosti među pacijentima sa poremećajem plućne funkcije. Poznato je da je plućna hipertenzija i posledična insuficijencija desne srčane komore često pratilac teške hronične opstruktivne bolesti pluća (HOBP). Međutim učestalost insuficijencije leve komore u poslednje vreme je predmet brojnih istraživanja i srčana insuficijencija je još uvek nedovoljno ispitana kod bolesnika sa HOBP. Cilj ove doktorske disertacije je ispitati funkciju leve komore i prisustvo plućne hipertenzije kod bolesnika sa HOBP. Materijal i metode : Istraživanjem je obuhvaćeno 120 ispitanika koji su prema GOLD kriterijumima podeljeni u četiri grupe po 30 bolesnika za svaki od četiri stadijuma bolesti. Svim bolesnicima je urađena spiropletizmografija i ehokardiografija. Rezultati : Analizom dobijenih vrednosti parametara (udarni volumen (SV) i njegov indeks (SVI), ejekciona frakcija (EF), frakcija skraćenja) sistolne funkcije miokarda leve komore dokazali smo da postoji sistolna disfunkcija miokarda leve komore kod bolesnika sa HOBP. Sa napredovanjem bolesti opadaju i vrednosti SV i SVI. Vrednosti ejekcione frakcije takođe opadaju sa porastom stepena HOBP. Analizom parametara dijastolne funkcije kod bolesika sa HOBP dokazali smo sa postoji dijastolna disfunkcija leve komore. Ispitivanjem transmitranog protoka i kontinuiranim i tkivnim doplerom registruju se smanjene srednje vrednosti vrednosti E/A i E'/ A'odnosa i u svim stadijumima bolesti. Ispitivanjem prisustva plućne hipertenzije dokazali smo da je sistolni pritisak u desnoj komori (RVSP) bio najniži u početnim stadijumima HOBP, postepeno raste sa težinom bolesti i najveći vrednosti se beleže u četvrtom stadijumu bolesti. Visoka prevalenca funkcionalnih promena na srcu koje smo dokazali u našem istraživanju treba da ukaže na potrebu ehokardiografije u otkrivanju ovih poremećaja u HOBP.Cardiovascular diseases are the leading cause of death among patients with impaired lung function. It is known that pulmonary hypertension and right heart failure are often companion of severe chronic obstructive pulmonary disease (COPD). Left ventricular dysfunction is still not well studied and it is the subject of numerous studies in patients with COPD in recent years. The aim of this dissertation is to examine the function of left ventricle and the presence of pulmonary hypertension in patients with COPD. Materials and Methods: The study included 120 patients who meet the GOLD criteria for COPD. They were divided into four groups of 30 patients for each of the four stages of the disease. All patients underwent echocardiography and spiropletismography. Results: Analysis of the obtained values of the systolic function parameters (stroke volume (SV) and it’s index (SVI), ejection fraction (EF), fractional shortening) show impaired systolic left ventricular function in patients with COPD. With disease progression SV and SVI decrease. With increased severity of COPD the values of ejection fraction decreases. We showed diastolic dysfunction of the left ventricle in COPD patients. Transmitral continuous flow Doppler and tissue Doppler recorded reduced values of the mean E / A and E '/ A' in all stages of the disease. Examining the presence of pulmonary hypertension, we have shown that the systolic pressure in the right ventricle (RVSP) was the lowest in the early stages of COPD, gradually increases with the severity of disease and the highest value was recorded in the fourth stage of the disease. The high prevalence of functional changes in the heart that we have proved in our research highlights the need for echocardiography in the detection of these disorders in COPD

Left Atrial Strain as a Predictor of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension

Background and Objectives: There is emerging evidence of the usefulness of left atrial strain (LAS) in the assessment of diastolic dysfunction (DD). In this study we assess the sensitivity and specificity of LAS, to determine cut-off values and their association to DD with increased left atrial pressure (LAP) in patients with well-treated arterial hypertension. Materials and Methods: We performed a cross-sectional study on 180 subjects with well-treated arterial hypertension. All patients underwent transthoracic echocardiography. Patients were divided into two groups: a group without increased LAP and/or DD and a group with increased LAP DD. Results: In multivariate logistic regression, LAS proved to be the strongest statistically significant predictor of DD with increased LAP (OR 0.834, p 24.27% was significantly highly prevalent in the group of DD with increased LAP 78.9% when compared to the group without increased LAP 15.4%, p Conclusion: The findings of this study suggest that LAS could be a useful and highly sensitive and specific marker in the evaluation of DD. There is the potential for using LAS in everyday practice as a standard parameter in diastolic function assessment

Healthcare Service Quality from the Point of Healthcare Providers&rsquo; Perception at the Time of COVID-19

The pandemic of the Coronavirus 19 disease (COVID-19) has had significant impact on healthcare systems worldwide. The present study aims to investigate the service providers&rsquo; quality dimensions in public sector hospitals in the Republic of Serbia during the COVID-19 pandemic and to propose a sustainable model for healthcare improvement. The study was conducted from September 2021 to December 2021. A modified SERPERF quality measurement questionnaire was distributed to healthcare workers in nine secondary care public hospitals of the Serbian Autonomous Province of Vojvodina (APV). Six hundred one questionnaires were found to be complete in all aspects and compared to 528 questionnaires from the database of the Provincial Secretariat for Health Care obtained from healthcare workers before the COVID-19 outbreak. The present study suggests that supportive measures during the COVID-19 pandemic are effective and, from the providers&rsquo; perception, increase healthcare quality. Continual investment in healthcare would provide sustainable development of healthcare quality in the future, regardless of the pandemic conditions

Healthcare Service Quality from the Point of Healthcare Providers’ Perception at the Time of COVID-19

The pandemic of the Coronavirus 19 disease (COVID-19) has had significant impact on healthcare systems worldwide. The present study aims to investigate the service providers’ quality dimensions in public sector hospitals in the Republic of Serbia during the COVID-19 pandemic and to propose a sustainable model for healthcare improvement. The study was conducted from September 2021 to December 2021. A modified SERPERF quality measurement questionnaire was distributed to healthcare workers in nine secondary care public hospitals of the Serbian Autonomous Province of Vojvodina (APV). Six hundred one questionnaires were found to be complete in all aspects and compared to 528 questionnaires from the database of the Provincial Secretariat for Health Care obtained from healthcare workers before the COVID-19 outbreak. The present study suggests that supportive measures during the COVID-19 pandemic are effective and, from the providers’ perception, increase healthcare quality. Continual investment in healthcare would provide sustainable development of healthcare quality in the future, regardless of the pandemic conditions

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p p p Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity

Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19

Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p p p p p p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients