Comparison of efficiency of cardiogoniometry and exercise-ECG test in diagnostics of stable coronary artery disease in women

Cilj ovog istraživanja bio je ispitati učinkovitost kardiogoniometrije, novije, neinvazivne metode u dijagnostici koronarne bolesti u žena i usporediti je s ergometrijom, koristeći koronarografiju kao referentnu metodu. Metode i materijali: Riječ je o unicentričnom, prospektivnom istraživanju sastavljenom od serije slučajeva u koje su bile uključene žene sa simptomima stabilne angine pektoris kojima je učinjena koronarografija. Ergometrija, izvedena prema protokolu po Bruceu, kao i kardiogoniometrija izvedene su prije koronarografije. Klinički značajna koronarna bolest je definirana kao stenoza > 70% jedne ili više koronarnih arterija. Rezultati: U istraživanje je uključeno 114 uzastopnih bolesnica s medijanom dobi 64,0 (58,0- 71,0), od kojih su 32 (28,1%) imale koronarnu bolest. Kardiogoniometrija je pokazala ukupnu učinkovitost 74,6% s osjetljivošću 75,0% (95% CI 56,6-88,5%) i specifičnošću 74,4% (95% CI 63,6-83,4%). Ergometrija je pokazala ukupnu učinkovitost 45,1% s osjetljivošću 68,1% (95% CI 42,7-83,6%) i specifičnošću 36,6% (95% CI 25,2-50,3%). Kardiogoniometrija je pokazala veću učinkovitost u usporedbi s ergometrijom (p< 0,001). Patološki nalaz kardiogoniometrije je bio povezan s gotovo 9 puta većim rizikom koronarne bolesti (omjer rizika 8,7, 95% CI 3.4-22.3, p< 0,001), koji je ostao značajan i nakon prilagodbe za dob i hipokineziju. Zaključak: Kardiogoniometrija je neinvazivna metoda, jednostavna za korištenje i bez rizika komplikacija, koja je pokazala visoku učinkovitost u dijagnostici stabilne koronarne bolesti u žena i superiornost u odnosu na ergometriju. Kardiogoniometrija bi mogla postati dio dijagnostičkog algoritma za probir žena sa stabilnom koronanom bolesti te je pogodna za korištenje u primarnoj zdravstvenoj zaštiti, osobito u žena koje ne mogu podnijeti/izvršiti fizičko opterećenje.Aim of this study was to investigate the efficiency of cardiogoniometry, a novel, non-invasive method, in diagnosing coronary artery disease (CAD) in women and compare it with exercise- ECG test, by using coronary angiography as a reference method. Methods and materials: It was a single-centre, case-series study including consecutive female patients with stable angina pectoris symptoms undergoing coronary angiography. Exercise- ECG test, done according to the Bruce protocol, and cardiogoniometry were obtained prior to coronary angiography. Clinically significant CAD has been defined as one or more coronary lesions with > 70% stenosis. Results: Study included 114 consecutive female patients with median age of 64.0 (58.0-71.0), out of which 32 (28.1%) had CAD. Cardiogoniometry yielded a total accuracy of 74.6% with a sensitivity of 75.0% (95% CI 56.6 - 88.5%) and specificity of 74.4% (95% CI 63.6-83.4%). Exercise-ECG test yielded a total accuracy of 45.1% with a sensitivity of 68.1% (95% CI 42.7- 83.6%) and specificity 36.6% (95% CI 25.2-50.3%). CGM showed higher accuracy than exercise-ECG test (p< 0.001). Pathological cardiogoniometry was associated with almost 9 times higher risk for CAD (OR 8.7, 95% CI 3.4-22.3, p< 0.001), which remained significant after adjustment for age and hypokinesia. Conclusion: Cardiogoniometry is a non-invasive, easy-to-use and risk-free method which showed high efficiency in diagnosing stable CAD in women and is superior to exercise-ECG test. Cardiogoniometry could be introduced as a part of the diagnostic algorithm of screening women for stable CAD and is suitable for use in the primary setting, especially in women unable to undergo stress-testing

Comparison of efficiency of cardiogoniometry and exercise-ECG test in diagnostics of stable coronary artery disease in women

Cilj ovog istraživanja bio je ispitati učinkovitost kardiogoniometrije, novije, neinvazivne metode u dijagnostici koronarne bolesti u žena i usporediti je s ergometrijom, koristeći koronarografiju kao referentnu metodu. Metode i materijali: Riječ je o unicentričnom, prospektivnom istraživanju sastavljenom od serije slučajeva u koje su bile uključene žene sa simptomima stabilne angine pektoris kojima je učinjena koronarografija. Ergometrija, izvedena prema protokolu po Bruceu, kao i kardiogoniometrija izvedene su prije koronarografije. Klinički značajna koronarna bolest je definirana kao stenoza > 70% jedne ili više koronarnih arterija. Rezultati: U istraživanje je uključeno 114 uzastopnih bolesnica s medijanom dobi 64,0 (58,0- 71,0), od kojih su 32 (28,1%) imale koronarnu bolest. Kardiogoniometrija je pokazala ukupnu učinkovitost 74,6% s osjetljivošću 75,0% (95% CI 56,6-88,5%) i specifičnošću 74,4% (95% CI 63,6-83,4%). Ergometrija je pokazala ukupnu učinkovitost 45,1% s osjetljivošću 68,1% (95% CI 42,7-83,6%) i specifičnošću 36,6% (95% CI 25,2-50,3%). Kardiogoniometrija je pokazala veću učinkovitost u usporedbi s ergometrijom (p< 0,001). Patološki nalaz kardiogoniometrije je bio povezan s gotovo 9 puta većim rizikom koronarne bolesti (omjer rizika 8,7, 95% CI 3.4-22.3, p< 0,001), koji je ostao značajan i nakon prilagodbe za dob i hipokineziju. Zaključak: Kardiogoniometrija je neinvazivna metoda, jednostavna za korištenje i bez rizika komplikacija, koja je pokazala visoku učinkovitost u dijagnostici stabilne koronarne bolesti u žena i superiornost u odnosu na ergometriju. Kardiogoniometrija bi mogla postati dio dijagnostičkog algoritma za probir žena sa stabilnom koronanom bolesti te je pogodna za korištenje u primarnoj zdravstvenoj zaštiti, osobito u žena koje ne mogu podnijeti/izvršiti fizičko opterećenje.Aim of this study was to investigate the efficiency of cardiogoniometry, a novel, non-invasive method, in diagnosing coronary artery disease (CAD) in women and compare it with exercise- ECG test, by using coronary angiography as a reference method. Methods and materials: It was a single-centre, case-series study including consecutive female patients with stable angina pectoris symptoms undergoing coronary angiography. Exercise- ECG test, done according to the Bruce protocol, and cardiogoniometry were obtained prior to coronary angiography. Clinically significant CAD has been defined as one or more coronary lesions with > 70% stenosis. Results: Study included 114 consecutive female patients with median age of 64.0 (58.0-71.0), out of which 32 (28.1%) had CAD. Cardiogoniometry yielded a total accuracy of 74.6% with a sensitivity of 75.0% (95% CI 56.6 - 88.5%) and specificity of 74.4% (95% CI 63.6-83.4%). Exercise-ECG test yielded a total accuracy of 45.1% with a sensitivity of 68.1% (95% CI 42.7- 83.6%) and specificity 36.6% (95% CI 25.2-50.3%). CGM showed higher accuracy than exercise-ECG test (p< 0.001). Pathological cardiogoniometry was associated with almost 9 times higher risk for CAD (OR 8.7, 95% CI 3.4-22.3, p< 0.001), which remained significant after adjustment for age and hypokinesia. Conclusion: Cardiogoniometry is a non-invasive, easy-to-use and risk-free method which showed high efficiency in diagnosing stable CAD in women and is superior to exercise-ECG test. Cardiogoniometry could be introduced as a part of the diagnostic algorithm of screening women for stable CAD and is suitable for use in the primary setting, especially in women unable to undergo stress-testing

Percutaneous Coronary Intervention Registry in University Hospital Centre Sestre milosrdnice

Unatoč činjenici da je koronarna bolest srca (KBS) prvi uzrok smrtnosti, u Hrvatskoj ne postoji sveobuhvatni registar osoba koje boluju od KBS, a registre za perkutanu koronarnu intervenciju (PCI) imaju samo pojedini laboratoriji za kateterizaciju srca, koji se značajno razlikuju i nisu međusobno kompatibilni. Laboratorij za invazivnu i intervencijsku kardiologiju Kliničkog bolničkog centra Sestre milosrdnice 1. siječnja 2011. godine je oformio vlastiti registar za PCI. Ovaj registar dostupan je u elektroničkom obliku, s visokim stupnjem zaštite pristupa. U registar se upisuje 45 različitih podataka koji su podijeljeni u pet skupina: opći podaci, čimbenici rizika, simptomi i znakovi akutne bolesti, zahvat i utrošeni materijal te dijagnostički i terapijski nalaz. Osnovne razlike ovog registra, u odnosu na postojeće, jest model prema kojem je upis podataka za svakog bolesnika podijeljen između medicinskog tehničara, inžinjera medicinske radiologije i intervencijskog kardiologa, izrazita jednostavnost, kratko vrijeme potrebno za upis te istovremeno ispisivanje nalaza kateterizacije. Tek nakon što su ispunjeni svi traženi podaci intervencijski kardiolog upisuje dijagnozu i nalaz te se podaci zaključavaju. Na taj smo način osigurali da se u bazu podataka upisuju sve varijable vezane uz svaku pojedinačnu učinjenu intervenciju, mogu ispisati u Excel ekstenziji te implementirati u bilo koji registar. Nakon prve godine uporabe zaključili smo da je Registar značajno olakšao svakodnevni rad te da predstavlja nadopunu novih tehnologija uvedenih u liječenje KBS. Formiranje ovog Registra samo je korak prema zajedničkom cilju, formiranju nacionalnog registara PCI te sudjelovanju Republike Hrvatske u europskom registru bolesnika s akutnim koronarnim sindromom.Despite the fact that coronary heart disease (CHD) is the first cause of mortality, in Croatia there is no comprehensive registry of patiens with CHD, while the registries for percutaneous coronary intervention (PCI) are maintained only by specific cardiac catheterization laboratories, which greatly differ from each other and are not mutually compatible. Laboratory of Invasive and Interventional Cardiology of the University Hospital Centre Sestre milosrdnice established its own PCI registry from 1st January 2011. This registry is available in electronic format, with a high access protection level. The registry includes 45 different data which are divided into 5 groups: general data, risk factors, symptoms and signs of acute disease, procedure and materials used, and diagnostic and therapeutic results. The main differences of this registry compared to the existing registries is a model according to which the entry of data for each patient are divided between the medical technician, medical radiology engineer and interventional cardiologist, its utmost simplicity, short time required for the registration and writing the findings of catheterization at the same time. Only after all the required data have been filled in, the interventional cardiologist will enter a diagnosis and findings and the data are locked. In this way we have ensured that all the variables relating to each individual intervention performed are entered in the database, they can be written in Excel extension and implemented in any registry. After the first year of use, we have reached a conclusion that the Registry has greatly facilitated the daily work and that is complements the new technologies introduced in the treatment of CHD. The establishment of this Registry is only a step towards a common goal, establishment of the national PCI registry and participation of the Republic of Croatia in the European registry of patients with acute coronary syndrome

Utjecaj meteoroloških parametara i onečišćenja zraka na preglede u Hitnoj službi zbog kardiovaskularnih bolesti u gradu Zagrebu, Hrvatska

The aim of this study was to investigate whether nitrogen dioxide (NO2), ozone (O3), and certain meteorological conditions had an impact on cardiovascular disease (CVD)-related emergency department (ED) visits in the metropolitan area of Zagreb. This retrospective, ecological study included 20,228 patients with a cardiovascular disease as their primary diagnosis who were examined in the EDs of two Croatian University Hospitals, Sisters of Charity and Holy Spirit, in the study period July 2008-June 2010. The median of daily CVD-related ED visits during the study period was 28 and was the highest during winter. A significant negative correlation was found between CVD-related emergency visits and air temperature measured no more than three days prior to the visit, and the highest negative correlation coefficient was measured two days earlier (R=–0.266, p≤0.001). The number of CVD-related emergency visits significantly correlated with the average NO2 concentration on the same day (R=0.191, p<0.001). The results of multiple stepwise regression analysis showed that the number of CVD-related emergency visits depended on air temperature, and NO2 and O3 concentrations. The higher the air temperatures, the lower the number of daily CVD-related emergency visits (p<0.001). An increase in NO2 concentrations (p=0.005) and a decrease in O3 concentrations of two days earlier (p=0.006) led to an increase in CVD-related ED visits. In conclusion, the decrease in O3 concentrations and the increase in NO2, even if below the legally binding thresholds, could be associated with an increase in CVD-related emergency visits and a similar effect was observed with lower temperature measured no more than three days prior to the visit.Cilj istraživanja bio je ispitati imaju li dušikov dioksid (NO2), ozon (O3) i određene meteorološke prilike utjecaja na broj pregleda u Hitnoj službi (HS) zbog kardiovaskularnih bolesti (KVB) u gradu Zagrebu. U ovu retrospektivnu, ekološku studiju bilo je uključeno 20.228 bolesnika s primarnom dijagnozom jedne od kardiovaskularnih bolesti, pregledanih u HS-u dviju kliničkih bolnica: Sestre milosrdnice i „Sveti Duh“, u promatranom razdoblju od srpnja 2008. do lipnja 2010. Medijan dnevnih pregleda u HS-u zbog KVB-a tijekom promatranog razdoblja bio je 28, a najviše tijekom zime. Značajna negativna korelacija utvrđena je između broja pregleda u HS-u zbog KVB-a i temperature zraka do tri dana ranije, s najvećim negativnim koeficijentom korelacije dva dana ranije (R=-0,266, p=0,000). Broj pregleda u HS-u zbog KVB-a značajno korelira s prosječnim koncentracijama NO2 na isti dan (R=0,191, p=0,000). Rezultati stupnjevite regresijske analize pokazali su da broj pregleda u HS-u zbog KVB-a ovisi o temperaturi zraka i koncentraciji NO2 i O3. Što je viša temperatura zraka, to je manji broj pregleda u HS-u zbog KVB-a (p=0,000), a slično vrijedi i za koncentraciju ozona (p=0,006). Povećanje koncentracije NO2 povezano je s povećanjem broja pregleda u HS-u zbog KVB-a (p=0,005). Zaključno se može ustvrditi da povećanje koncentracije NO2 može biti povezano s povećanjem broja pregleda u HS-u zbog KVB-a, čak ako su navedene koncentracije unutar pravnoobvezujućih razina, sa sličnim utjecajem niže temperature zraka do tri dana ranije

Spontaneous pneumomediastinum and pneumopericardium in a young female: a case report

Spontaneous pneumomediastinum (SPM) is a rare condition in young adults, usually affecting young healthy males with underlying pulmonary disease, which can be extremely rarely complicated with pneumopericardium (SPP)

Rutinski dostupni biomarkeri kao prediktori razvoja sistoličke disfunkcije tijekom dugoročnog praćenja bolesnika s potpuno revaskulariziranim akutnim infarktom miokarda sa ST elevacijom

The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF <50% after 12 months. The study included 47 patients, median age 59±10 years, 74.5% of them men. Patients who developed systolic dysfunction (LVEF <50%) had significantly higher mean values of cTnT after 24 hours (5.11 vs. 2.82 μg/L, p=0.010) and peak values of CK (3375.5 vs. 1865 U/L, p=0.008). There was no significant relation between hsCRP and development of reduced LVEF (p=0.541). In conclusion, cTnT and CK could serve as long-term predictors of reduced left ventricular systolic function (<50%) in acute STEMI patients with normal systolic function at admission, single-vessel coronary disease and complete revascularization during primary PCI.Cilj istraživanja bio je utvrditi učinkovitost visokoosjetljivog C-reaktivnog proteina (hsCRP), kardijalnog troponina T (cTnT) i kreatin kinaze (CK) kao dugoročnih prediktora razvoja sistoličke disfunkcije u bolesnika sa STEMI-infarktom kojima je učinjena potpuna revaskularizacija tijekom primarne perkutane koronarne intervencije (PCI). Provedena je prospektivna studija kojom su evaluirani uzastopni bolesnici s akutnim STEMI-infarktom koji su imali urednu sistoličku funkciju kod prijma uz jednožilnu koronarnu bolest i koji su potpuno revaskularizirani tijekom primarne PCI. Uzorci krvi su prikupljani od prijma do 7. dana hospitalizacije. Primarni ishod bio je razvoj sistoličke disfunkcije lijevog ventrikla (LVEF <50%) nakon godinu dana. U istraživanje je bilo uključeno 47 bolesnika s medijanom dobi 59±10 godina i 74,5% su bili muškarci. Bolesnici koji su razvili sistoličku disfunkciju (LVEF <50%) su imali značajno više vrijednosti cTnT nakon 24 sata (5,11 prema 2,82 μg/L, p=0,010) i više maksimalne vrijednosti CK (3375,5 prema 1865 U/L, p=0,008). Nije utvrđena povezanost između hsCRP-a i razvoja sistoličke disfunkcije (p=0,541). Zaključak je da cTnT i CK mogu poslužiti kao dugoročni prediktori snižene sistoličke funkcije lijevog ventrikla (<50%) u bolesnika s akutnim STEMI-infarktom koji su imali urednu sistoličku funkciju kod prijma uz jednožilnu koronarnu bolest i koji su potpuno revaskularizirani tijekom primarne PCI

Percutaneous Coronary Intervention Registry in University Hospital Centre Sestre milosrdnice

Unatoč činjenici da je koronarna bolest srca (KBS) prvi uzrok smrtnosti, u Hrvatskoj ne postoji sveobuhvatni registar osoba koje boluju od KBS, a registre za perkutanu koronarnu intervenciju (PCI) imaju samo pojedini laboratoriji za kateterizaciju srca, koji se značajno razlikuju i nisu međusobno kompatibilni. Laboratorij za invazivnu i intervencijsku kardiologiju Kliničkog bolničkog centra Sestre milosrdnice 1. siječnja 2011. godine je oformio vlastiti registar za PCI. Ovaj registar dostupan je u elektroničkom obliku, s visokim stupnjem zaštite pristupa. U registar se upisuje 45 različitih podataka koji su podijeljeni u pet skupina: opći podaci, čimbenici rizika, simptomi i znakovi akutne bolesti, zahvat i utrošeni materijal te dijagnostički i terapijski nalaz. Osnovne razlike ovog registra, u odnosu na postojeće, jest model prema kojem je upis podataka za svakog bolesnika podijeljen između medicinskog tehničara, inžinjera medicinske radiologije i intervencijskog kardiologa, izrazita jednostavnost, kratko vrijeme potrebno za upis te istovremeno ispisivanje nalaza kateterizacije. Tek nakon što su ispunjeni svi traženi podaci intervencijski kardiolog upisuje dijagnozu i nalaz te se podaci zaključavaju. Na taj smo način osigurali da se u bazu podataka upisuju sve varijable vezane uz svaku pojedinačnu učinjenu intervenciju, mogu ispisati u Excel ekstenziji te implementirati u bilo koji registar. Nakon prve godine uporabe zaključili smo da je Registar značajno olakšao svakodnevni rad te da predstavlja nadopunu novih tehnologija uvedenih u liječenje KBS. Formiranje ovog Registra samo je korak prema zajedničkom cilju, formiranju nacionalnog registara PCI te sudjelovanju Republike Hrvatske u europskom registru bolesnika s akutnim koronarnim sindromom.Despite the fact that coronary heart disease (CHD) is the first cause of mortality, in Croatia there is no comprehensive registry of patiens with CHD, while the registries for percutaneous coronary intervention (PCI) are maintained only by specific cardiac catheterization laboratories, which greatly differ from each other and are not mutually compatible. Laboratory of Invasive and Interventional Cardiology of the University Hospital Centre Sestre milosrdnice established its own PCI registry from 1st January 2011. This registry is available in electronic format, with a high access protection level. The registry includes 45 different data which are divided into 5 groups: general data, risk factors, symptoms and signs of acute disease, procedure and materials used, and diagnostic and therapeutic results. The main differences of this registry compared to the existing registries is a model according to which the entry of data for each patient are divided between the medical technician, medical radiology engineer and interventional cardiologist, its utmost simplicity, short time required for the registration and writing the findings of catheterization at the same time. Only after all the required data have been filled in, the interventional cardiologist will enter a diagnosis and findings and the data are locked. In this way we have ensured that all the variables relating to each individual intervention performed are entered in the database, they can be written in Excel extension and implemented in any registry. After the first year of use, we have reached a conclusion that the Registry has greatly facilitated the daily work and that is complements the new technologies introduced in the treatment of CHD. The establishment of this Registry is only a step towards a common goal, establishment of the national PCI registry and participation of the Republic of Croatia in the European registry of patients with acute coronary syndrome