Duke Treadmill Score in Prioritizing Patients for Coronary Angiography: Retrospective Study of a Croatian Regional Hospital

Aim of the study was to determine the potential of Duke Treadmill Score (DTS) in prioritizing patients for coronary angiography in a transitional country clinical setting.We analyzed 114 patients with suspected stable coronary artery disease who underwent exercise treadmill testing, and coronary angiography in Slavonski Brod General Hospital. DTS was calculated from treadmill test as: exercise time – (5 ST deviation in mm) – (4 exercise angina). Regarding the score, patients were grouped into three groups of risk for coronary artery disease: low risk, medium risk, and high risk patients. All patients underwent coronary angiography, and were grouped in accordance to the severity of the coronary artery disease into three groups: insignificant, significant, or severe coronary artery disease. All patients scored as high risk DTS had significant or severe coronary artery disease. Medium and low risk DTS patients had insignificant coronary artery disease in 50%, and 90% of cases, respectively. Medium risk patients with significant or severe coronary artery disease were significantly older, and had more frequent history of typical chest pain with higher number of episodes per week (P<0.05), whereas there were no differences regarding gender or presence of risk factors. There were no significant differences among medium risk patients regarding the severity of coronary artery disease in exercise time or ST deviation. However, the presence of limiting exercise angina in medium risk patients was significantly more related with significant and severe coronary artery disease (P<0.05). High risk DTS result showed great potential in stratifying patients for immediate coronary angiography. This scoring system may be used in prioritizing patients for coronary angiography in a transitional clinical setting

Treatment of a true CXA-OM bifurcation lesion using a one stent drug coated balloons provisional technique

Background: Provisional stenting is a favorable option for most bifurcation lesions, while two stent techniques show benefits in true bifurcation performed by experts. Using one stent and DCB in true bifurcation lesions still remains questionable.1,2 Case report: 76-year-old male presented with persisting chest pain. ECG showed no specific ischemic changes, while hsTnI was highly elevated. He had gone PCI LAD 14 years ago. Diagnosis: right coronary angiography revealed occlusion of RCA, while left coronary angiography revealed LLS of 20% in proximal LAD stent, 70% stenosis of mid LAD, and acute occlusion of secondary OM branch on bifurcation level, while CxA was stenosed 70-80%. Management: PCI CxA-OM2 was performed with DES Xience expedition 2,75/33mm in CxA-OM2 with POT 3,25/12mm proximally, then after rewiring and adequate lesion preparation a DEB Sequent please 2,5/25mm in CxA distally was performed. After two months we performed an elective PCI LAD and checked out the result of CxA bifurcation which was optimal. Conclusion: Using one stent and DCB in true bifurcation lesions still remains questionable. There are no data from a prospective study, while there are data from the observational study which enrolled 130 patients. DCB-only strategy was performed in 54% patients, 34.6% had at least one stent in the main branch, 8.5% had at least one stent in the side branch and 3.1% at least one stent in the main branch and side branch. Study follow up lasted for 9.8 months. The TLR rate was 4.5%, MACE was 6.1%, and no stent thrombosis was detected. This study suggested that the DCB+one stent, and DCB-only strategy was safe and effective in selected bifurcations, possibly allowing for an abbreviated antiplatelet regimen

Duke Treadmill Score in Prioritizing Patients for Coronary Angiography: Retrospective Study of a Croatian Regional Hospital

Aim of the study was to determine the potential of Duke Treadmill Score (DTS) in prioritizing patients for coronary angiography in a transitional country clinical setting.We analyzed 114 patients with suspected stable coronary artery disease who underwent exercise treadmill testing, and coronary angiography in Slavonski Brod General Hospital. DTS was calculated from treadmill test as: exercise time – (5 ST deviation in mm) – (4 exercise angina). Regarding the score, patients were grouped into three groups of risk for coronary artery disease: low risk, medium risk, and high risk patients. All patients underwent coronary angiography, and were grouped in accordance to the severity of the coronary artery disease into three groups: insignificant, significant, or severe coronary artery disease. All patients scored as high risk DTS had significant or severe coronary artery disease. Medium and low risk DTS patients had insignificant coronary artery disease in 50%, and 90% of cases, respectively. Medium risk patients with significant or severe coronary artery disease were significantly older, and had more frequent history of typical chest pain with higher number of episodes per week (P<0.05), whereas there were no differences regarding gender or presence of risk factors. There were no significant differences among medium risk patients regarding the severity of coronary artery disease in exercise time or ST deviation. However, the presence of limiting exercise angina in medium risk patients was significantly more related with significant and severe coronary artery disease (P<0.05). High risk DTS result showed great potential in stratifying patients for immediate coronary angiography. This scoring system may be used in prioritizing patients for coronary angiography in a transitional clinical setting

Patofiziološka povezanost katekolaminskog stresa kod pacijentice s Takotsubo kardiomiopatijom i kroničnim zatajenjem bubrega: prikaz slučaja

Abstract. Aim: Takotsubo cardiomyopathy is a transient dysfunction of the heart muscle that occurs in response to a stressful event. A working diagnosis is mostly made for acute ischemic heart disease due to similar clinical presentation and differential diagnostic doubts. Although it is a reversible disorder of cardiac contractility, mortality rate is similar to that of an acute coronary syndrome due to the development of complications. We report the case of a patient with chronic kidney disease and the consequent development of Takotsubo cardiomyopathy, a possible pathophysiological link that has not been reported in the significant number in literature so far. Case report: An 83-year-old patient on a chronic hemodialysis program, due to the development of anginal symptoms specific for the acute coronary syndrome and with a significant increase in cardiospecific enzymes, was transferred to the Coronary care unit for the necessary invasive cardiac treatment. Echocardiographic and coronarographic findings confirmed the diagnosis of Takotsubo cardiomyopathy, which was the first case in a patient on chronic hemodialysis program in our institution. Conslusions: According to available data, about 30 cases of Takotsubo cardiomyopathy have been reported so far, indicating that transient myocardial dysfunction is a rare cardiomyopathy in patients with chronic kidney disease. A small number of literature-recorded cases do not support the similar pathophysiological basis of increased sympathetic activity present in Takotsubo cardiomyopathy and chronic kidney disease.Sažetak. Cilj: Takotsubo kardiomiopatija prolazna je disfunkcija srčanog mišića koja nastaje kao odgovor organizma na stresorni događaj. Radna se dijagnoza većinom postavlja za akutnu ishemijsku bolest srca radi slične kliničke prezentacije i diferencijalnih dijagnostičkih dvojbi. Iako se radi o reverzibilnom poremećaju srčane kontraktilnosti, smrtnost je slična akutnom koronarnom sindromu uslijed razvoja komplikacija. Izvještavamo slučaj pacijentice s kroničnom bubrežnom bolesti i posljedičnim razvojem Takotsubo kardiomiopatije, moguće patofiziološke poveznice koja do sada literaturno nije zabilježena u značajnom broju. Prikaz slučaja: 83-godišnja pacijentica na programu kronične hemodijalize, uslijed razvoja anginoznih tegoba specifičnih za akutni koronarni sindrom te uz značajan porast kardiospecifičnih enzima, premještena je u koronarnu jedinicu radi potrebne invazivne kardiološke obrade. Ehokardiografski i koronarografski nalaz potvrdio je dijagnozu Takotsubo kardiomiopatije, što je ujedno prvi zabilježen slučaj u pacijenta na programu kronične hemodijalize u našoj ustanovi. Zaključci: Prema dostupnim podatcima, do sada je zabilježeno oko 30 slučajeva Takotsubo kardiomiopatije kod bubrežnih bolesnika, što pokazuje da je prolazna disfunkcija miokarda rijetka kardiomiopatija u pacijenata s kroničnom bubrežnom bolesti. Mali broj literaturno zabilježenih slučajeva ne ide u prilog sličnoj patofiziološkoj osnovi povećane simpatičke aktivnosti prisutne kod Takotsubo kardiomiopatije i kronične bubrežne bolesti