17 research outputs found
Diet and Cardiovascular Health
Prehrana na razliÄite naÄine može utjecati na razvoj kardiovaskularnih bolesti. Nepravilni odabir namirnica, prevelik unos soli, ugljikohidrata, kolesterola i masti te prevelika koliÄina hrane, odnosno kalorijski unos pridonose razvoju i pogorÅ”anju bolesti. Incidencija pretilosti u svijetu je u porastu, a novija saznanja pokazuju da je uz smanjenje broja kalorija u borbi protiv pretilosti potrebno unositi hranu sa smanjenim potencijalom za njezin razvoj. Kardiovaskularni bolesnici imaju loÅ”e prehrambene navike te je za njih razvijen niz dijeta. Najdjelotvornijom se pokazala mediteranska prehrana s dodatkom ekstradjeviÄanskoga maslinova ulja i oraÅ”astih plodova koja se pokazala uÄinkovitom u smanjenju kardiovaskularne smrtnosti i kardijalnih dogaÄaja u primarnoj, kao i u sekundarnoj prevenciji. Osim nje uÄinkovita je DASH-dijeta koja ne samo da pomaže u regulaciji krvnog tlaka i smanjenju tjelesne težine nego i u sniženju razine ukupnog kolesterola u serumu. Daljnji povoljni uÄinak na regulaciju krvnog tlaka postiže se smanjenjem unosa soli na 6 g/dan ili manje. U kontroliranim studijama dokazano je da unos odreÄene vrste hrane utjeÄe na kardiovaskularno zdravlje. Konzumacija voÄa i povrÄa, ekstradjeviÄanskoga maslinova ulja, oraÅ”astih plodova i mahunarki, umjerena konzumacija ribe i morskih plodova, Äaja te male koliÄine alkohola pokazale su se korisnima u redukciji kardiovaskularnog rizika. Redovita, umjerena i pravilna prehrana jedan je od najvažnijih Äimbenika na koji možemo utjecati kako bismo znatno smanjili rizik od nastanka bolesti srca i krvnih žila.Our diet can affect the development of cardiovascular diseases in various ways. A wrong selection of foods, excessive intake of salt, carbohydrates, cholesterol and fat, as well as an excessive amount of food, i.e. of caloric intake can contribute to the development and worsening of the disease. Obesity is one of the major public health problems with increasing incidence worldwide. Recent findings indicate that in addition to the reduction in the number of calories, the selection of food with reduced potential for the development of obesity is crucial for weight control. Cardiovascular patients have poor eating habits and a series of diets has been developed for them, with different benefits. The most potent is the Mediterranean diet, supplemented with extra virgin olive oil and nuts, acting favourably on cardiovascular mortality and development of cardiac events both in primary and secondary prevention. The DASH diet used in the regulation of blood pressure and body weight has proved to be helpful in reducing the levels of total serum cholesterol. Further regulation of blood pressure can be achieved by reducing salt intake to 6 g or less per day. Guided exclusively on evidence and controlled studies based medicine, the impact of certain foods on cardiovascular health has been established. The benefit in reducing cardiovascular risk was found in the consumption of fruits and vegetables, extra virgin olive oil, nuts and legumes, moderate consumption of fish and seafood, tea, and small amounts of alcohol. We can actively work to reduce the risk of cardiovascular disease by controlling one of the most important factors and this is a regular, moderate and appropriate diet
How to Monitor Your Physical Activity?
Redovita tjelesna aktivnost u svakoj dobi povezana je sa sniženjem rizika od gotovo svih bolesti. MeÄutim, usprkos sve veÄoj svjesnosti o potrebi tjelesne aktivnosti, incidencija pretilosti, kao i kardiovaskularnih bolesti u porastu je. Uzrok tomu jest nedostatak adherencije i redovitog praÄenja tjelesne aktivnosti. Upravo u tome veliku nam pomoÄ posljednjih godina pruža razvoj mobilne tehnologije za praÄenje tjelesne aktivnosti. Njezina prednost utvrÄena je u brojnim kontroliranim studijama, kao i u svakodnevnom životu. Bez obzira na to o kojem se ureÄaju, programu ili mobilnoj aplikaciji za praÄenje aktivnosti radi, najbitnija je njihova redovita uporaba. Sustavnim praÄenjem svakodnevne aktivnosti, kao i trendova tjednih i mjeseÄnih aktivnosti postiže se bolja kontrola razlike izmeÄu uÄinjene i planirane aktivnosti. Time se zdravstvenim radnicima omoguÄava individualni pristup u odreÄivanju potrebne aktivnosti ovisno o dobi, kondiciji i eventualnim kroniÄnim bolestima.Regular physical activity at any age is connected with a reduced risk of almost all diseases. However, despite the increased awareness of the need for physical activity, the incidence of obesity and cardiovascular diseases is on the rise. The cause for this is the lack of adherence and regular tracking of physical activity. The development of mobile technology for tracking physical activity has been of great help in the last couple of years. The benefits of using such technology have been confirmed in numerous controlled studies, as well as in everyday life. No matter what device, programme or mobile application is used to track physical activity, regular usage is essential. Systematic tracking of daily, as well as weekly and monthly activity trends enables better control of variation between the planned and performed activity. As a result, healthcare professionals are provided with an individual approach to the determination of necessary activity, depending on age, physical condition and possible chronic diseases
Cardiotoxicity due to biological cancer therapy
KardiotoksiÄnost je sve ÄeÅ”Äa nuspojava onkoloÅ”kog lijeÄenja pa tako i novijih, bioloÅ”kih ciljanih lijekova. Posebno razvijena monoklonska protutijela ili inhibitori tirozin-kinaze blokiraju bilo receptore HER-2 bilo VEGF bilo pak aktivnost Abl-kinaze. MeÄutim, time se ometaju i molekularni mehanzimi kljuÄni za kardiovaskularno zdravlje. Anti-HER2 terapija najÄeÅ”Äe uzrokuju reverzibilnu sistoliÄku disfunkciju lijevog ventrikula, a blokadom VEGF receptora razvija se arterijska hipertenzija i poveÄava sklonost tromboembolijskim incidentima. Ranim prepoznavanjem i lijeÄenjem bolesnika u kojih se razvila kardiotoksiÄnost postiže se poboljÅ”anje kliniÄkih ishoda i kvalitete života, a time je Äesto moguÄe nastaviti specifiÄno lijeÄenja raka. Pri tome su kljuÄni multidisciplinarni pristup kardiologa i onkologa te redovito kardioloÅ”ko praÄenje.Cardiotoxicity has been increasingly reported as a side effect of oncologic treatment, including novel targeted biological therapy. Specific monoclonal antibodies or tyrosine kinase inhibitors have been developed for blockade of HER2 receptors, VEGF receptors, or Abl kinase activity. However, these actions also interfere with molecular mechanisms that are crucial for cardiovascular health. Anti HER2 therapy generally induces reversible systolic left ventricular dysfunction, whereas VEGF receptor blockade leads to development of arterial hypertension and increased susceptibility to thromboembolic events. In patients developing cardiotoxicity, better clinical outcome and quality of life can be achieved by early recognition and treatment, thus also enabling continuation of anti-cancer therapy in many cases. A multidisciplinary approach including cardiologists and oncologists, along with regular cardiologic follow up, is crucial for successful patient management
The magnitude and clinical implications of the interobserver variability of echocardiographic left ventricular ejection fraction measurement
The ejection fraction (EF) is the most commonly used echocardiographic measure of the systolic left ventricular (LV) function. Echocardiography has however several limitations in measuring LV volumes and EF since the formulas for quantifications are based on geometrical assumptions, the EF parameters (end-systolic and end-diastolic volumes) are preload dependent and adequate projections are not always possible to obtain. Previous studies have also shown correlation between different
echocardiographic techniques of obtaining EF and even correlation between echocardiography and other methods (MRI, SPECT, CT) but the data on interobserver and intraobserver variability remains scarce.1 In this study we examined the interobserver limits of agreement and the therapeutic implications of the uncertainty obtained by the result.
We examined 22 sequential patients referred to our echocardiography
laboratory for LV function assessment. All echocardiography studies were performed by two independent cardiologists blinded to the measurements of the other observer. 2D methods including the biplane Simpson method and āeyeballingā were conducted, while automatic and semiautomatic 2D and 3D methods were not allowed. Bland-Altman analysis was performed to determine the systematic bias and limits of
agreement (LOA) of EF between different observers (Figure 1).
Next the LOA were used to obtain new āconfidence intervalsā on a previously gathered set of echocardiograms of 171 heart failure patients. We recorded the number of patients that now had different treatment recommendations according to the current ESC guidelines on heart failure and device therapy i.e. the ānewā EF was 40%. McNemarās test was used to determine the statistical significance of the difference with a two-tailed P=0.05 taken as a threshold. The bias was calculated to be -2.3 with LOA (7.8 to -12.5) which is in agreement with
similar studies. The number of patients that received ānewā treatment recommendations was 99 for the lower LOA and 65 for upper LOA, P<0.001 for both groups. We therefore conclude that the interobserver variability of the EF measurement can lead to significantly different treatment strategies in patients with heart failure. Echocardiographic
methods introducing less variability (like automatic 3D techniques)
should be preferred in determining the EF
Vrijeme primjene trastuzumaba i rizik za razvoj srÄane disfunkcije u bolesnica sa ranim HER2 pozitivnim karcinomom dojke
Breast cancer is the most common malignant tumor in females in the world. Age is signifi cant risk factor and incidence increases rapidly after age of 35. Approximately one fourth of patients with breast cancer have tumors that overexpress HER2 protein or amplify the HER2/neu gene.Trastuzumab is a recombinant humanized monoclonal antibody that binds to a specific extracellular growth factor, human epidermal growth factor type 2 HER 2-neu or ErbB2, tyrosine kinase receptor
responsible for alterations in cellular metabolism and growth.Clinical studies have shown that trastuzumab given concurrently or following adjuvant chemotherapy improves disease-free survival (DFS) and overal survival (OS) in early-stage HER-2 positive breast cancer. HERA study (Herceptin in Adjuvant breast cancer) showed that one of fifty women treated with trastuzumab adjuvantly developes congestive heart failure during treatment.Mechanisms of trastuzumab induced cardiac dysfunction are not clear yet. Studies have shown that differences in timing of trastuzumab after chemotherapy an ddifferences in total dose of anthracyclines can explain differences in incidence of cardiac dysfunction. The aim of our study was to determine incidence of trastuzumab induced cardiac dysfunction in patients with HER2 positive early breast cancer and impact of time interval between administration of chemotherapy and trastuzumab on prevalence of cardiac dysfunction.
Follow up included 140 patients with early HER2 positive breast cancer treated with trastuzumab adjuvantly. Seventeen patients developed symptomatic cardiac dysfunction (12.1%) of which 6 developed severe congestive heart failure NYHA III/IV(4.2%) and 11 moderate NYHA II/III (7.9%).Patients who started trastuzumab therapy 11 to 20 days after finishing chemotherapy had 11% incidence of symptomatic heart failure, same as those patients who started trastuzumab 26 to 35
days after chemotherapy. There were no cardiac events if treatment was started 35 days after chemotherapy. Highest incidence of congestive heart failure was registered when trastuzumab was applied 21 to 25 days after adjuvant chemotherapy (22%). Time interval between cessation of adjuvant chemotherapy and fi rst trastuzumab application has a signifi cant impact on prevalence of trastuzumab induced cardiac dysfunction.Karcinom je najÄeÅ”Äi maligni tumor u žena u svijetu. Dob je znaÄajan riziÄni faktor i incidencija se poveÄava iznad dobi od 35 godina. Otprilike Äetvrtina bolesnica oboljelih od raka dojke ima tumor koji prekomjerno izražava HER2. Trastuzumab je rekombinantno humanizirano monoklonalno protutijelo koje se veže na humani epidermalni faktor rasta tip 2 HER2-neu ili ErbB2, tirozin kinazni receptor odgovoran za promjene u metabolizmu i rastu stanice. KliniÄke studije su pokazale
da davanje trastuzumaba konkomitantno s ili nakon adjuvantne kemoterapije produžuje period bez povrata bolesti (DSF) i ukupno preživljenje (OS) u ranog HER2 pozitivnog karcinoma dojke. Studija HERA (Herceptin in Adjuvant Breast Cancer) je pokazala da jedna od pedeset žena lijeÄenih trastuzumabom adjuvantno, razvija kongestivno zatajenje srca tijekom lijeÄenja. Mehanizmi nastanka trastuzumabom inducirane kardiotoksiÄnosti joÅ” nisu potpuno razjaÅ”njeni. Studije su
pokazale da razlike u vremenu zapoÄimanja terapije trastuzumabom nakon zavrÅ”ene adjuvantne kemoterapije i razlike u ukupnoj dozi antraciklina mogu objasniti razlike u incidenciji srÄanog zatajenja. Cilj naÅ”eg istraživanja je bio odrediti incidenciju trastuzumabom inducirane kardiotoksiÄnosti u bolesnica s ranim HER2 pozitivnim karcinomom dojke te odrediti utjecaj vremenskog intervala od zavrÅ”etka kemoterapije do poÄetka lijeÄenja trastuzumabom na pojavnost srÄanog zatajenja. PraÄenje je ukljuÄilo 140 bolesnica s ranim HER2 pozitivnim karcinomom dojke koje su lijeÄenje trastuzumabom adjuvantno. 17 bolesnica je razvilo simptomatsko srÄano zatajenje (12.1%) od kojih 6 teÅ”kog stupnja NYHA III/IV(4.2%) a 11 umjerenog NYHA II/III (7.9%).Bolesnice koje su zapoÄele lijeÄenje trastuzumabom 11 do 20 dana po zavrÅ”etku kemoterapije su imale incidenciju simptomatskog srÄanog zatajenja 11%, kao i bolesnice koje su zapoÄele terapiju trastuzumabom 26 do 35 dana nakon kemoterapije. U bolesnica koje su lijeÄenje zapoÄele 35 dana nakon kemoterapije nije zabilježeno kardijalnih dogaÄanja. NajviÅ”a incidencija kongestivnog zatajenja srca je zabilježena kada je terapija trastuzumabom zapoÄeta 21 do 25
dana nakon adjuvantne kemoterapije (22%). Vremenski interval izmeÄu zavrÅ”etka adjuvantne kemoterapije i prve aplikacije trastuzumaba ima znaÄajan utjecaj na pojavnost trastuzumabom induciranog srÄanog zatajenja
Nomogram s jednostavnim i rutinskim kliniÄkim i biokemijskim parametrima može biti prediktor patoloÅ”kog remodeliranja ventrikula u bolesnika sa STEMI-jem
Heart failure is the leading cause of morbidity and mortality worldwide, with
ischemic heart disease being one of the most important etiologic factors. Heart failure develops due to
ventricular remodeling, which leads to increases in left ventricular end-systolic and end-diastolic volumes.
In this prospective observational study, we included 101 patients with first episode of ST-segment
elevation myocardial infarction in whom percutaneous coronary intervention was conducted
within 12 h and Thrombolysis in Myocardial Infarction III flow was achieved. The aim was to determine
which clinical and biochemical parameters can help predict pathologic ventricular remodeling
1 year after myocardial infarction. We created a nomogram based on routinely used blood tests and
vital parameters which showed highest correlation with pathologic ventricular remodeling. The nomogram
included NTproBNP value 12 h after reperfusion, aspartate transaminase value 12 h after reperfusion,
systolic blood pressure value on admission, and culprit coronary artery. We performed ROC
analysis which yielded great predictive value of the nomogram. The area under curve was 0.907 (95%
CI 0.842-0.973). The nomogram value of -3.54 had 91.4% sensitivity and 74.0% specificity. We believe
that this nomogram, once validated, could offer a widely available, low-cost option that would
help identify patients at risk of developing pathologic left ventricular remodeling and achieve this at a
very early stage of myocardial infarction (12 h after reperfusion has been achieved).Zatajivanje srca je vodeÄi uzrok pobola i smrtnosti u svijetu, a ishemijska bolest srca je njegov najvažniji etioloÅ”ki Äimbenik.
Zatajivanje srca nastaje posljediÄno remodeliranju lijevog ventrikula, koje uzrokuje poveÄanje njegova volumena na
kraju sistole i dijastole. U ovom prospektivnom opservacijskom istraživanju ukljuÄili smo 101 bolesnika koji su imali prvu
epizodu STEMI i kojima je uÄinjena perkutana koronarna intervencija 12 sati od poÄetka bolova uz postignuti protok TIMI
III. Cilj istraživanja bio je utvrditi koji kliniÄki i biokemijski parametri mogu pomoÄi u predviÄanju nastupanja patoloÅ”kog
ventrikulskog remodeliranja godinu dana nakon preboljelog infarkta. Na temelju rezultata istraživanja stvoren je nomogram
koji je ukljuÄivao vitalne parametre i rutinske biokemijske nalaze koji su pokazali najbolju korelaciju s pojavom patoloÅ”kog
ventrikulskog remodeliranja. Nomogram ukljuÄuje vrijednost NTproBNP-a 12 sati nakon postignute reperfuzije, vrijednost
AST-a 12 sati nakon reperfuzije, vrijednost sistoliÄkog tlaka kod prijma te koronarnu arteriju okluzija koje je odgovorna za
nastanak infarkta miokarda. UÄinjena je ROC analiza koja je pokazala izvrsnu prediktivnu vrijednost nomograma. PovrÅ”ina
ispod krivulje (AUC) je bila 0,907 (95% CI 0,842-0,973). Vrijednost nomograma od -3,54 imala je osjetljivost od 91,4% i
specifiÄnost od 74,0%. MiÅ”ljenja smo da bi ovaj nomogram, jednom validiran, mogao ponuditi jeftinu i Å”iroko primjenjivu
metodu za rano prepoznavanje bolesnika koji Äe razviti patoloÅ”ko ventrikulsko remodeliranje nakon preboljelog infarkta
miokarda i to omoguÄiti veÄ u vrlo ranoj fazi bolesti odnosno 12 sati nakon postignute reperfuzije
Auxiliary diagnostic potential of ventricle geometry and late gadolinium enhancement in left ventricular non-compaction; non-randomized case control study
Background
There are still ambiguities existing in regard to left ventricular non-compaction (LVNC) diagnostic imaging. The aim of our study was to analyze diagnostic potential of late gadolinium enhancement (LGE) and ventricle geometry in patients with LVNC and controls.
Methods
Data on cardiac magnetic resonance imaging (CMR) studies for LVNC were reassessed from the hospitalās database (3.75 years; n=1975 exams). Matching sample of controls included cases with no structural heart disease, hypertrophic or dilative cardiomyopathy, arrhythmogenic right ventricular dysplasia or subacute myocarditis. Eccentricity of the left ventricle was measured at end diastole in the region with pronounced NC and maximal to minimal ratio (MaxMinEDDR) was calculated.
Results
Study included 255 patients referred for CMR, 100 (39.2%) with LVNC (prevalence in the studied period 5.01%) and 155 (60.8%) controls. Existing LGE had sensitivity of 52.5% (95%-CI:42.3ā62.5), specificity of 80.4% (95%-CI:73.2ā86.5) for LVNC, area under curve (AUC) 0.664 (95%-CI:0.603ā0.722);p1.10 had sensitivity of 95.0% (95%-CI:88.7ā98.4), specificity of 82.6% (95%-CI: 75.7ā88.2) for LVNC, AUC 0.917 (95%-CI:0.876ā0.948); p<0.001. LGE correlated with Max-Min-EDD-R (Rho=0.130; p=0.038) and there was significant difference in ROC analysis ĪAUC0.244 (95%-CI:0.175ā0.314); p<0.001. LGE also correlated negatively with stroke volume and systolic function (both p<0.05, respectively).
Conclusions
LGE was found to be frequently expressed in patients with LVNC, but without sufficient power to be used as a discriminative diagnostic parameter. Both LGE and eccentricity of the left ventricle were found to be relatively solid diagnostic landmarks of complex infrastructural and functional changes within the failing heart.
Keyword
Posttraumatic Stress Disorder after Acute Coronary Syndrome or Cardiac Surgery; Underestimated Reality
Osim somatskih posljedica akutnoga koronarnog sindroma u obliku razliÄitoga stupnja intolerancije
napora, radne nesposobnosti, simptoma kroniÄnog srÄanog zatajivanja, angine pektoris,
pojave razliÄitih aritmija i sl., moguÄ je veÄ u ranoj subakutnoj te u kroniÄnoj fazi u oboljelih osoba
razvoj niza psihosomatskih i psihiÄkih poremeÄaja, koji, ako se ne prepoznaju navrijeme i aktivno
ne lijeÄe, mogu pridonijeti nepovoljnom ishodu i poveÄanoj smrtnosti takve skupine bolesnika. Osim
povezanosti akutnoga koronarnog sindroma i kroniÄnog stresa, anksioznosti i depresije, on može biti
āokidaÄā za razvoj kasnijega posttraumatskoga stresnog poremeÄaja (PTSP) sa stopom prevalencije od
prosjeÄno 15-ak posto meÄu oboljelim osobama. ViÅ”e je istraživanja pokazalo da bolesnici sa simptomima
PTSP-a povezanog s prethodnim akutnim koronarnim sindromom, napose oni nelijeÄeni, imaju
poveÄanu smrtnost i veÄu stopu reinfarkta miokarda. BuduÄi da PTSP povezan s akutnim koronarnim
sindromom ili kardiokirurŔkom operacijom zna biti zanemaren i podcijenjen, svrha je ovog rada podizanje
svijesti o ovom problemu u svakodnevnoj kliniÄkoj praksi.In addition to the somatic consequences of acute coronary syndrome (ACS) that include different
levels of intolerance to exertion, incapacity for work, symptoms of chronic heart failure, angina
pectoris, the manifestation of various arrhythmias, etc., the development of a whole range of psychosomatic
and mental disorders is also possible already in the early subacute and chronic phases of the
disease, and if these mental disorders are not actively treated in a timely fashion they can contributed
to unwanted outcomes and increased mortality in this group of patients. ACS is associated with
chronic stress, anxiety, and depression and can be a trigger for later development of posttraumatic
stress disorder (PTSD) with an average prevalence rate of 15% in patients with ACS. Several studies
have shown that patients with symptoms of PTSD associated with ACS, especially if untreated, have
increased mortality and higher rates of myocardial reinfarction. Since PTSD associated with ACS or
cardiac surgery can be neglected or underestimated, the aim of this review was to raise awareness
about this issue that is present in everyday clinical practice