BATIMETRIJSKA I GEOLOŠKA SVOJSTVA JADRANSKOGA MORA

Advance in the visualization of the bathymetric and geological data from charted to digital maps and models opened the possibility to analyse data within Geographic Information System (GIS) functionalities. In this paper, bathymetric and geological properties of the Adriatic Sea were analysed using the General Bathymetric Chart of the Ocean (GEBCO) 2020 digital bathymetric model (DBM) and data from the European Marine Observation and Data Network (EMODnet). The bathymetric analysis includes depth statistics, area and volume calculation, hypsometry, and analysis of the heterogeneity of bathymetric data from the GEBCO 2020 DBM within the limits of the Adriatic defined by the International Hydrographic Organization (IHO) and 3 sub-basins delineated according to the bathymetry. The geological analysis includes seabed substrate map from EMODnet data and kilometre-scale seabed variability in the Adriatic. The GEBCO 2020 DBM shows that the Adriatic Sea is a shallow sea with a mean depth of -253 metres and over 50% of area shallower than 100 metres. The area of the Adriatic Sea is 138 516 km2 with a total volume of 35 521 km3. Patterns describing morphological variability coincide with the heterogeneity of the underlying source data of the GEBCO 2020 digital bathymetry model and major structures in the Adriatic Sea.Napredak u načinu prikaza batimetrijskih i geoloških podataka s papirnatih karata u digitalne podatke i modele otvorio je mogućnost manipulacije i analize podataka u digitalnome okruženju geografskih informacijskih sustava (GIS). U ovome radu analizirana su batimetrijska i geološka svojstva Jadranskoga mora s pomoću podataka digitalnoga batimetrijskoga modela General Bathymetric Chart of the Ocean (GEBCO) 2020 i Europske mreže za nadgledanje i prikupljanje podataka o moru (EMODnet). Batimetrijska analiza uključuje statistiku dubina, izračun površine i volumena, hipsometrijsku krivulju i analizu heterogenosti batimetrijskih podataka unutar modela GEBCO 2020 na području Jadranskoga mora čije je granice definirala Međunarodna organizacija za hidrografiju (IHO) te triju dijelova Jadranskoga bazena podijeljenih s obzirom na dubinu. Analiza geoloških svojstava obuhvaća prostornu preraspodjelu sedimenata na temelju podataka EMODnet mreže i varijabilnost terena u kilometarskoj razlučivosti na području Jadrana. Prema podatcima digitalnoga batimetrijskog modela GEBCO 2020 Jadransko je more plitko more s prosječnom dubinom od 253 m i više od 50 % površine pliće od 100 m. Površina Jadranskoga mora iznosi 138 516 km2 , a volumen 35 521 km3. Crte kojima je definirana varijabilnost terena poklapaju se s heterogenošću podataka na temelju kojih je izračunan model GEBCO i većim geomorfološkim strukturama u Jadranu

Kratkotrajna potpora cirkulaciji i izmjeni plinova u krvi

Heart failure continues to be an ever-growing public health concern. The continued aging of the population has contributed to the increasing incidence and prevalence of heart failure. Mechanical circulatory support is used to treat patients with advanced heart failure. A mechanical pump is surgically implanted to provide pulsatile or non-pulsatile flow of blood to supplement or replace the blood flow generated by the native heart. The main purpose of a mechanical circulatory support is to unload the failing heart and help maintain forward cardiac output and vital organ perfusion. A big variety of devices exists: from the percutaneous and short-term support, which can be used in the operating room or the cath-lab and afterwards in the intensive or coronary care units, to the internal and long-term devices, which can be used as a bridge-to-recovery or cardiac transplant, or as definitive therapy in patients with contraindication to cardiac transplant. This treatment involves not only the cardiac surgeons, but also the cardiologists, anaesthesiologists, intensivists and perfusionists. Appropriate patient selection represents the critical determinant of successful outcomes with the VAD therapy. The predictive risk stratification is extremely important for achieving the minimal peri-operative mortality rate. As VAD technology progresses, the collaboration of multidisciplinary teams composed of engineers, scientists, physicians, and nurses will continue to refine the technology and improve patient care and operation outcomes. Advances in device design will allow for an easier implantation and create smaller, more efficient, durable, and reliable units.Zatajenje srca s porastom incidencije i prevalencije u sve starijoj populaciji polako postaje javno zdravstveni problem. Mehanička cirkulacijska potpora se koristi kao oblik liječenja u skupini bolesnika s uznapredovalim zatajenjem srca. Mehanička crpka se kirurški implantira kako bi osigurala, bilo pulsatilni, bilo nepulsatilni protok krvi koji služi kao supplement ili kao zamjena protoku krvi kojeg bi trebalo generirati srce. Glavni cilj i namjena mehaničke cirkulacijske potpore je volumno rasteretiti srce u terminalnom zatajenju i pomoći u održavanju protoka vitalnih organa održavajući minutni volumen. Prisutna je široka paleta uređaja: od onih koji se mogu perkutano implantirati, uređaja za kratkoročnu potporu koji se mogu koristiti u operacijskoj sali, u laboratoriju za kateterizaciju kao i u jedinici intenzivnog liječenja do potpuno implantibilnih uređaja za dugoročnu potporu. Uređaji mogu biti korišteni kao terapija premoštenja do oporavka ili do transplantacije srca ili, u pojedinim slučajevima, uređaji predstavljaju definitivnu terapiju, npr. kod bolesnika u kojih je kontraindicirana transplantacija. Ovaj oblik liječenja ne uključuje samo kardiokirurge, već i kardiologe, anesteziologe kao i perfuzioniste. Pravilna trijaža bolesnika predstavlja ključnu točku uspjeha u ishodu liječenja volesnika s mehaničkom cirkulacijskom potporom. Prijeoperacijska stratifikacija rizika je iznimno važna u minimaliziranju stope perioperacijsakog mortaliteta. Istovremeni tehnološki razvoj, kao i multidisciplinarna suradnja konstruktora uređaja, znanstvenika, liječnika i ostalog medicinskog osoblja dovest će do unaprijeđenja cjelokupnog procesa liječenja ove skupine bolesnika. Daljnji tehnološki razvoj ide u smjeru pojednostavljenja procesa implantacije, s manjim, efikasnijim, trajnijim i još više pouzdanijim uređajima

Rezultati ugradnje Levitronix Centrimag mehaničke potpore srcu u Kliničkom bolničkom centru Zagreb

Background: The management of end stage heart failure has been revolutionized by the use of mechanical circulatory support. The Levitronix Centrimag ventricular assist device (VAD) is designed for short-term cardiac assistance as a bridge to a more permanent solution to the hemodynamic problem. It has been used as bridge-to-transplantation, bridge-to-bridge, bridge-to-recovery, and bridge-to-decision. Methods: In the period between September 2008 and November 2009, six patients received mechanical cardiac assistance with the Levitronix Centrimag device at our institution. In one patient, the indication was postcardiotomy cardiogenic shock. In the remaining five patients, the device was implanted electively, due to progressive decompensation of chronic heart failure unresponsive to medical therapy. Results: The patient having received a biventricular assist device (BIVAD) in the postcardiotomy setting was 65 years of age. His ejection fraction and EuroSCORE were 20 % and 25, respectively. His NT-pro-BNP was 9,428 pg/ml and his pre-implantation lactate was 8.8 mmol/L. The mean age in the group of patients, in whom the VAD was placed due to decompensated severe heart failure (DSHF ), was 46 ± 11 years. Their ejection fraction and logistic EuroSCORE were 16 ± 2 % and 28 ± 7, respectively. The preoperative serum lactate and NT-pro-BNP concentrations were 1.7±0.8 mmol/L and 9577 ± 3674 pg/ml, respectively. Of these, three patients had evidence of end organ dysfunction. The low cardiac output was responsible for acute renal failure, requiring renal replacement therapy in one patient. Neurocognitive dysfunction and renal failure not requiring dialysis was seen in another. The third patient had long standing primary hepatic insufficiency. A reversal of end organ dysfunction was seen in the former two patients, whereas the hepatic insufficiency was not caused by hemodynamic compromise and was, therefore, not relieved by circulatory support. The single patient, who had suffered from postcardiotomy cardiogenic shock, died shortly after receiving mechanical circulatory support. Three of five patients, in whom Levitronix Centrimag was placed electively, were successfully transplanted. The remaining two died of septic complications. In the cohort of patients, in whom ventricular assistance was placed due to DSHF , two required BIVAD placement, and three left ventricular assist devices (LVAD). Conclusion: The Levitronix Centrimag VAD is useful in supporting circulation in patients with acute decompensation of congestive heart failure. It may also be used in patients with postcardiotomy shock. It is an imperative for the device to be placed before irreversible organ dysfunction occurs as the aftermath of malperfusion.Uvod: Liječenje terminalne faze srčanog popuštanja je revolucionarizirano uvođenjem mehaničke potpore srcu. Levitronix Centrimag je uređaj dizajniran u svrhu kratkoročne hemodinamske potpore prije nego što trajnije rješenje cirkulatornog problema postane moguće. Do sad se primijenjivao kao podrška srcu do transplantacije srca, do oporavka srčane funkcije ili do ugradnje trajnijeg oblika mehaničke potpore srcu. Metode: U periodu između rujna 2008 i studenog 2009 Levitronix Centrimag je u našoj ustanovi ugrađen u 6 bolesnika. U jednog bolesnika radilo se o postkardiotomijskom sindromu niskog minutnog volumena. U preostalih pet bolesnika ovaj je oblik mehaničke potpore srcu ugrađen elektivno radi progresivnog kliničkog pogoršanja bolesnika u terminalnoj fazi srčanog popuštanja koje je postalo rezistentno na konzervativnu terapiju. Rezultati: Bolesnik u kojeg je indikacija za mehaničkom potporom srcu bila postavljena hitno u postkardiotomijskom srčanom popuštanju bio je 65 godina star. Imao je ejekcijsku frakciju od 20% dok mu je logistički EuroSCORE bio 25. Prijeoperacijski NT-pro-BNP bio je 9428 pg/ ml dok su serumske vrijednosti laktata prije implantacije Centrimaga bile 8.8 mmol/L. Prosječna dob u skupini bolesnika u kojih je indikacija za mehaničku potporu srcu bila progresivna dekompenzacija srčane funkcije bila je 46 ± 11 godinu. Navedeni bolesnici su imali prosječnu ejekcijsku frakciju od 16 ± 2% dok im je logistički EuroSCORE bio 28 ± 7. Prijeoperacijske vrijednosti serumskog laktata i NT-pro-BNP bile su 1.7±0.8 mmol/L i 9577 ± 3674 pg/ml. U troje bolesnika bila je evidentna kompromitacija funkcije nekog od ostalih organskih sustava. U jednog bolesnika se radilo o akutnom renalnom zatajenju ovisnog o hemodijalizi, u drugog o neurokognitivnoj disfunkciji praćenog sa bubrežnim zatajenjem ali bez potrebe za dijalizom. U trećeg bolesnika radilo se o primarnoj hepatalnoj insuficijenciji. U prva dva bolesnika došlo je do poboljšanja organskih funkcija nakon uspostave mehaničke potpore srcu, dok u trećeg bolesnika nije došlo do promjene hepatalne funkcije budući da ista nije bila uzrokovana malperfuzijom. Bolesnik u kojeg je mehanička potpora srcu stavljena zbog postkardiotomijskog kardiogenog šoka je umro. Troje od pet bolesnika kod kojih je Levitronix Centrimag ugrađen radi dekompenzacije kroničnog zatajenja srca su uspješno transplantirani. Preostalo dvoje bolesnika je umrlo od septičnih komplikacija. U kohorti bolesnika u kojoj je mehanička potpora srcu ugrađena elektivno, dvoje bolesnika je zahtijevalo potporu oba ventrikula dok je u troje ugrađena potpora samo lijevom. Zaključak: Levitronix Centrimag pruža efikasnu hemodinamsku potporu bolesnicima sa kompromitiranom srčanom funkcijom. Neophodno je započeti sa mehaničkom potporom srcu prije nego što se pojave ireverzibilne disfunkcije ostalih organskih sustava

Antithrombotics in heart failure

Heart failure is a common clinical condition associated with high morbidity and mortality rate despite significant improvements in pharmacotherapy and implementation of medical procedures. Patients with heart failure are at an increased risk of developing arterial and venous thrombosis, which contribute to the high rate of adverse events and fatal outcomes. Many heart failure patients routinely receive antithrombotic therapy due to the presence of a specific indication for its use, like ischemic heart disease or atrial fibrillation. However, there is no solid evidence to support the routine use of antithrombotic agents in all heart failure patients. This article reviews the evidence for using antithrombotic therapy in heart failure patients

Postoperative atrial fibrillation is associated with high on-aspirin platelet reactivity

BACKGROUND: Atrial fibrillation (AF) contributes to a prothrombotic state through platelet activation. It is unclear whether increased platelet aggregability in patients with AF is caused by the underlying cardiovascular condition rather than the arrhythmia per se. We investigated the effect of postoperative atrial fibrillation (POAF) on platelet reactivity after coronary artery bypass grafting (CABG). ----- METHODS: This study is a post hoc analysis from a randomized controlled trial (ClinicalTrials.gov: NCT01159639) based on patients undergoing elective primary CABG. Patients were dichotomized according to POAF. Postoperative platelet function testing with arachidonic acid as the platelet agonist (ASPI test) was used to define high on-aspirin platelet reactivity (HAPR). ΔASPI presented the difference between pre- and postoperative ASPI test values. To account for the isolated effect of POAF on platelet reactivity, a propensity score analysis was applied. ----- RESULTS: Overall incidence of POAF was 23% (92 of 398 patients). HAPR was detected in 54% (214 of 398) of patients. HAPR was more prevalent among patients with POAF when compared with patients without POAF (64.1% versus 50.7%; odds ratio [OR], 1.74; 95% confidence interval [CI], 1.08-2.82; p = 0.023). The propensity score model produced a subcohort of patients that was well balanced for comorbidities. When compared with the matched group without POAF, the POAF group maintained its prevalence for HAPR (64.1% versus 45.7%; OR, 2.13; 95% CI, 1.18-3.85; p = 0.012) and had greater ΔASPI values (15.0 [IQR, 0.0-36.0] vs 8.0 [IQR, -5.5-19.5]; p = 0.030). ----- CONCLUSIONS: The main finding of our study indicates there is added platelet activation in patients with POAF after CABG before and after controlling for pathologic conditions through propensity matching. The present study does not prove a causal association between POAF and HAPR

Bioelectrical Impedance Analyzes Offers Clinically Relevant Appraisal of Body Composition, but Fails to Recognize Nutritional Risk or Differences between Surgery and Percutaneous Coronary Interventions Treatments – A Non-Randomized Cohort

Our aim was to evaluate the adipose tissue percentage content appraised with BIA in patients recently treated for cardiovascular disorders by means of surgery or percutaneous coronary interventions. Study included 208 consecutive patients, in age range 25–84 years, 176 male and 32 female. There were 108 (51.9%) percutaneous coronary interventions and 100 (48.1%) operations. Adipose tissue share appraised by BIA in our settings was 28.6±6.7% with significant differences in relation with gender (p<0.001) and no relations with the age of patients. Intermediate levels of correlations were found in relation to the body mass index (Rho: 0.521, p<0.001), waist-circumference (Rho: 0.450; p<0.001) and hip-circumference (Rho: 0.393; p<0.001). ROC-analyzes revealed diagnostic cutoff point of BIA at 29.5% for predicting the obesity (AUC=0.761; p<0.001) and 27% for metabolic syndrome (AUC=0.715; p<0.001). There were no relations of BIA to nutritional status, laboratory or echocardiography diagnostic. BIA offered clinically relevant appraisal of anthropometrically and metabolic related risks from cardiovascular continuum. Diagnostic yields solely on impedance analyze bases seem limited, particularly in investigational settings with composited endpoints

Connections between nutritional status and proton pump inhibitor therapy in patients scheduled for cardiovascular rehabilitation after treatment for ischaemic and valvular heart disease

BACKGROUND: Multiple and yet uncertain connections exist between cardiovascular diseases and the nutritional status of patients, particularly in relation to cardiovascular treatments. Proton pump inhibitors (PPI) are among the most commonly used group of drugs. ----- AIM: To analyse utilisation of PPI in association with nutritional risk of patients scheduled for rehabilitation after treatment for ischaemic and valvular heart disease. ----- METHODS: Retrospective analyses on a consecutive sample of patients, which included drug utilisation of PPI and nutritional risk screening, using a standardised NRS-2002 tool. The patients (n = 536) were divided into groups based on previous cardiovascular treatments and use of PPI. ----- RESULTS: Nearly half of the patients (244, 46.1%) had PPI in their chronic therapy despite the clinically negligible prevalence of conditions that are their fundamental indications. The odds for using PPI in patients with increased nutritional risk, estimated by logistic regression, were 3.34 (95% confidence intervals [CI] 2.26-4.94), p 3: positive likelihood-ratio (LR) 2.35 (95% CI 2.10-2.60); negative LR 0.46 (95% CI 0.4-0.6); area under the curve (AUC) 0.720; p 6.36% (positive LR 2.22 [95% CI 2.00-2.50]; negative LR 0.41 [95% CI 0.30-0.50]; AUC 0.707; p < 0.001). ----- CONCLUSIONS: Utilisation of PPI was found to be of relatively high prevalence and significantly associated with parameters of nutritional risk screening. Furthermore, it was in correlation with the age of patients and the existence of chronic kidney disease, which are well-established predispositions for poor nutritional status. Nutritional risk seems to be additionally negatively challenged by utilisation of PPI due to gastric malabsorption and anaemia

Amyloidosis of the Aortic Root in a Patient with Polyarteritis Nodosa

Amyloidosis results from the deposition of insoluble fibrillar proteins in various tissues. Cardiac symptoms, when present, are usually related to congestive heart failure or arrhythmias. Amyloid involvement of the aortic root is exceedingly rare. We describe a case of aortic root amyloidosis in a patient with a long-standing history of polyarteritis nodosa