40 research outputs found
BATIMETRIJSKA I GEOLOÅ KA 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 naÄinu prikaza batimetrijskih i geoloÅ”kih podataka s papirnatih karata u digitalne podatke i modele otvorio je moguÄnost manipulacije i analize podataka u digitalnome okruženju geografskih informacijskih sustava (GIS). U ovome radu analizirana su batimetrijska i geoloÅ”ka svojstva Jadranskoga mora s pomoÄu 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 ukljuÄuje statistiku dubina, izraÄun povrÅ”ine i volumena, hipsometrijsku krivulju i analizu heterogenosti batimetrijskih podataka unutar modela GEBCO 2020 na podruÄju Jadranskoga mora Äije je granice definirala MeÄunarodna organizacija za hidrografiju (IHO) te triju dijelova Jadranskoga bazena podijeljenih s obzirom na dubinu. Analiza geoloÅ”kih svojstava obuhvaÄa prostornu preraspodjelu sedimenata na temelju podataka EMODnet mreže i varijabilnost terena u kilometarskoj razluÄivosti na podruÄju Jadrana. Prema podatcima digitalnoga batimetrijskog modela GEBCO 2020 Jadransko je more plitko more s prosjeÄnom dubinom od 253 m i viÅ”e od 50 % povrÅ”ine pliÄe od 100 m. PovrÅ”ina Jadranskoga mora iznosi 138 516 km2 , a volumen 35 521 km3. Crte kojima je definirana varijabilnost terena poklapaju se s heterogenoÅ”Äu podataka na temelju kojih je izraÄunan model GEBCO i veÄim geomorfoloÅ”kim 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. MehaniÄka cirkulacijska potpora se koristi kao oblik lijeÄenja u skupini bolesnika s uznapredovalim zatajenjem srca. MehaniÄka crpka se kirurÅ”ki 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 mehaniÄke cirkulacijske potpore je volumno rasteretiti srce u terminalnom zatajenju i pomoÄi u održavanju protoka vitalnih organa održavajuÄi minutni volumen. Prisutna je Å”iroka paleta ureÄaja: od onih koji se mogu perkutano implantirati, ureÄaja za kratkoroÄnu potporu koji se mogu koristiti u operacijskoj sali, u laboratoriju za kateterizaciju kao i u jedinici intenzivnog lijeÄenja do potpuno implantibilnih ureÄaja za dugoroÄnu potporu. UreÄaji mogu biti koriÅ”teni kao terapija premoÅ”tenja do oporavka ili do transplantacije srca ili, u pojedinim sluÄajevima, ureÄaji predstavljaju definitivnu terapiju, npr. kod bolesnika u kojih je kontraindicirana transplantacija. Ovaj oblik lijeÄenja ne ukljuÄuje samo kardiokirurge, veÄ i kardiologe, anesteziologe kao i perfuzioniste. Pravilna trijaža bolesnika predstavlja kljuÄnu toÄku uspjeha u ishodu lijeÄenja volesnika s mehaniÄkom cirkulacijskom potporom. Prijeoperacijska stratifikacija rizika je iznimno važna u minimaliziranju stope perioperacijsakog mortaliteta. Istovremeni tehnoloÅ”ki razvoj, kao i multidisciplinarna suradnja konstruktora ureÄaja, znanstvenika, lijeÄnika i ostalog medicinskog osoblja dovest Äe do unaprijeÄenja cjelokupnog procesa lijeÄenja ove skupine bolesnika. Daljnji tehnoloÅ”ki razvoj ide u smjeru pojednostavljenja procesa implantacije, s manjim, efikasnijim, trajnijim i joÅ” viÅ”e pouzdanijim ureÄajima
Rezultati ugradnje Levitronix Centrimag mehaniÄke potpore srcu u KliniÄkom bolniÄkom 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 Ā± 11 years. Their ejection fraction and logistic EuroSCORE were 16 Ā± 2 % and 28 Ā± 7, respectively. The preoperative serum lactate and NT-pro-BNP concentrations were 1.7Ā±0.8 mmol/L and 9577 Ā± 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: LijeÄenje terminalne faze srÄanog popuÅ”tanja je revolucionarizirano uvoÄenjem mehaniÄke potpore srcu. Levitronix Centrimag je ureÄaj dizajniran u svrhu kratkoroÄne hemodinamske potpore prije nego Å”to trajnije rjeÅ”enje cirkulatornog problema postane moguÄe. Do sad se primijenjivao kao podrÅ”ka srcu do transplantacije srca, do oporavka srÄane funkcije ili do ugradnje trajnijeg oblika mehaniÄke potpore srcu. Metode: U periodu izmeÄu rujna 2008 i studenog 2009 Levitronix Centrimag je u naÅ”oj ustanovi ugraÄen u 6 bolesnika. U jednog bolesnika radilo se o postkardiotomijskom sindromu niskog minutnog volumena. U preostalih pet bolesnika ovaj je oblik mehaniÄke potpore srcu ugraÄen elektivno radi progresivnog kliniÄkog pogorÅ”anja bolesnika u terminalnoj fazi srÄanog popuÅ”tanja koje je postalo rezistentno na konzervativnu terapiju. Rezultati: Bolesnik u kojeg je indikacija za mehaniÄkom potporom srcu bila postavljena hitno u postkardiotomijskom srÄanom popuÅ”tanju bio je 65 godina star. Imao je ejekcijsku frakciju od 20% dok mu je logistiÄki 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. ProsjeÄna dob u skupini bolesnika u kojih je indikacija za mehaniÄku potporu srcu bila progresivna dekompenzacija srÄane funkcije bila je 46 Ā± 11 godinu. Navedeni bolesnici su imali prosjeÄnu ejekcijsku frakciju od 16 Ā± 2% dok im je logistiÄki EuroSCORE bio 28 Ā± 7. Prijeoperacijske vrijednosti serumskog laktata i NT-pro-BNP bile su 1.7Ā±0.8 mmol/L i 9577 Ā± 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 praÄenog sa bubrežnim zatajenjem ali bez potrebe za dijalizom. U treÄeg bolesnika radilo se o primarnoj hepatalnoj insuficijenciji. U prva dva bolesnika doÅ”lo je do poboljÅ”anja organskih funkcija nakon uspostave mehaniÄke potpore srcu, dok u treÄeg bolesnika nije doÅ”lo do promjene hepatalne funkcije buduÄi da ista nije bila uzrokovana malperfuzijom. Bolesnik u kojeg je mehaniÄka potpora srcu stavljena zbog postkardiotomijskog kardiogenog Å”oka je umro. Troje od pet bolesnika kod kojih je Levitronix Centrimag ugraÄen radi dekompenzacije kroniÄnog zatajenja srca su uspjeÅ”no transplantirani. Preostalo dvoje bolesnika je umrlo od septiÄnih komplikacija. U kohorti bolesnika u kojoj je mehaniÄka potpora srcu ugraÄena elektivno, dvoje bolesnika je zahtijevalo potporu oba ventrikula dok je u troje ugraÄena potpora samo lijevom. ZakljuÄak: Levitronix Centrimag pruža efikasnu hemodinamsku potporu bolesnicima sa kompromitiranom srÄanom funkcijom. Neophodno je zapoÄeti sa mehaniÄkom potporom srcu prije nego Å”to 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). ĪASPI 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 ĪASPI 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 ā 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 25ā84 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 28.6Ā±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