43 research outputs found
Myocardial bridge stenting complicated by coronary artery perforation and midLAD right ventricle fistula formation in NSTEMI patient
Myocardial bridging (MB) is defined as a coronary artery that tunnels through the myocardium, under the overlying muscle bridge. It almost exclusively affects the left anterior descending artery (LAD), especially the middle part (midLAD)
Antikoagulantna terapija u bolesnika s fibrilacijom atrija i kroniÄnom renalnom insuficijencijom
Aim: To investigate the efficacy and safety profile of oral anticoagulants and determine
the best treatment for patients with atrial fibrillation (AF) and chronic kidney disease (CKD ).
Methods and materials: A systematic assessment of literature from Pubmed/MEDLINE was performed
in search of studies evaluating the efficacy, safety, pharmacokinetics, and pharmacodynamics
of direct oral anticoagulants (DOACs) and warfarin in patients with CKD .
Results: According to guidelines, DOACs are the treatment of choice for patients with CKD 1ā3
(Crcl ā„ 30 mL/min) due to their high efficacy, better safety profile, and fewer food/drug and drug/
drug interactions than warfarin. For patients with CKD 4 (Crcl 15-29 mL/min), there are no such
strong recommendations as to which group of anticoagulants is the better choice, and for those with
CKD 5 (Crcl <15 mL/min), the choice is currently narrowed to warfarin or apixaban. However, there
seem to be more negative effects of warfarin, including accelerated CKD progression and increased
risk of bleeding compared to DOACs.
Conclusion: Considering their superior safety profile and the possibility of apixaban, rivaroxaban,
and edoxaban to achieve an adequate anticoagulant effect even in severe kidney disease, DOACs seem
to be a better option for anticoagulant treatment of patients with AF and CKD .Cilj: istražiti uÄinkovitost i sigurnost svakog pojedinog antikoagulantnog lijeka i odrediti najbolju terapijsku opciju za
bolesnike s fibrilacijom atrija (AF) i kroniÄnom bubrežnom boleÅ”Äu (CKD -om).
Metode i materijali: Napravljen je pregled literature dostupne na Pubmedu/MEDLINE u u potrazi za istraživanjima o
uÄinkovitosti, sigurnosti, farmakokinetici i farmakodinamici izravnih oralnih antikoagulansa (DOAC) i varfarina u bolesnika
s CKD -om.
Rezultati: DOAC-i su terapija izbora za bolesnike s CKD 1-3 (Crcl ā„ 30 mL/min) zahvaljujuÄi visokoj uÄinkovitosti,
dobrom sigurnosnom profilu i manje interakcija s lijekovima i hranom. Za bolesnike s CKD 4 (Crcl 15 - 29 mL/min) ne
postoje tako snažne preporuke koji antikoagulantni lijek je najbolja opcija, a izbor antikoaguacije za bolesnike s CKD 5 (Crcl
<15 mL/min) trenutno je ograniÄen na varfarin i apiksaban. MeÄutim, Äini se da postoji viÅ”e negativnih aspekata varfarina
nego DOAC-a, ukljuÄujuÄi ubrzanu progresiju CKD -a i poviÅ”en rizik krvarenja.
ZakljuÄak: S obzirom na njihov dobar sigurnosni profil i moguÄnost ostvarivanja zadovoljavajuÄeg antikoagulantnog
uÄinka apiksabana, rivaroksabana te apiksabana i u teÅ”kom CKD -u, DOAC-i bi mogli biti bolja terapijska opcija za bolesnika
s AF-om i CKD -om
Razlike prema spolu u bolesnika s akutnim zatajivanjem srca primljenih na hitni prijam
Little is known about gender-associated differences in characteristics and survival of acute heart failure patients. The increasing incidence calls for investigating the possibilities of improved management. The purpose of the study was to determine gender-associated differences
among emergency department acute heart failure patients in order to improve treatment quality and survival. A prospective observational study on 22,713 patients was conducted at the University Hospital Center Emergency department during 2010 and included 726 consecutive acute heart failure patients. The most common cause of acute heart failure was worsening of chronic heart failure. Females suffered more frequently from hypertensive acute heart failure and males from acute heart failure associated with acute coronary syndrome. Females were older, with higher body mass index, atrial fibrillation, urinary tract infections, hypertension history, hypertension at admission, and SAPS II score at admission. Males had a higher frequency of ST-elevation myocardial infarction and dilated cardiomyopathy, confirmed by ultrasound as lower ejection fraction and left ventricle dilatation with reduced ejection fraction. Males were more frequently smokers with a history of chronic obstructive pulmonary disease. The importance of treating hypertension and atrial fibrillation in women and acute coronary syndrome and chronic obstructive pulmonary disease in men should be emphasized. Aggressive identification and management of all possible heart failure etiologies should be recommended in the emergency department.Malo toga je poznato o spolno-zavisnim razlikama u znaÄajkama i preživljenju bolesnika s akutnim zatajivanjem srca. RastuÄa incidencija obvezuje na ispitivanje moguÄnosti poboljÅ”anog lijeÄenja. Svrha ove studije je bila utvrditi spolno-zavisne razlike u bolesnika s akutnim zatajivanjem srca u hitnom prijmu radi poboljÅ”anja kvalitete lijeÄenja i preživljenja. Prospektivna opservacijska studija na 22.713 bolesnika je provedena u hitnom prijmu SveuÄiliÅ”nog bolniÄkog centra tijekom 2010. godine i ukljuÄila je 726 uzastopnih bolesnika s akutnim zatajivanjem srca. NajuÄestaliji uzrok akutnog zatajivanja srca bilo je pogorÅ”anje kroniÄnog zatajivanja srca. Žene su uÄestalije bolovale od hipertenzivnog akutnog zatajivanja srca, a muÅ”karci od akutnog zatajivanja srca udruženog s akutnim koronarnim sindromom. Žene su bile starije, s viÅ”im indeksom tjelesne mase, atrijskom fibrilacijom, infekcijama mokraÄnog sustava, anamnezom hipertenzije, hipertenzijom kod prijma i viÅ”im zbirom SAPS II. pri prijmu. MuÅ”karci su imali viÅ”u uÄestalost srÄanog infarkta s ST-elevacijom i dilatacijske kardiomiopatije, ultrazvuÄno potvrÄenu sniženom izbaÄajnom frakcijom i dilatacijom lijeve klijetke sa smanjenom izbaÄajnom frakcijom. MuÅ”karci su uÄestalije bili puÅ”aÄi s anamnezom kroniÄne opstruktivne bolesti pluÄa. Treba naglasiti važnost lijeÄenja hipertenzije i atrijske fibrilacije u žena te akutnog koronarnog sindroma i kroniÄne opstruktivne bolesti pluÄa u muÅ”karaca. Agresivnu identifikaciju i lijeÄenje svih moguÄih etiologija zatajivanja srca treba preporuÄiti u hitnom prijmu
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
Serum concentration of HDL particles predicts mortality in acute heart failure patients
Clinical studies have shown that assessing circulating concentrations of high-density lipoprotein (HDL) particles by nuclear magnetic resonance (NMR) spectroscopy is superior to HDL-cholesterol in predicting cardiovascular risk. We tested the hypothesis that circulating concentrations of HDL particles predict 3-month mortality of patients with acute heart failure (AHF). Out of 152 included patients, 52% were female, additionally the mean patient age was 75.2āĀ±ā10.3 years, and three-month mortality was 27%. Serum lipoprotein profile at admission was determined by NMR spectroscopy. Univariate logistic regression analyses revealed a significant inverse association of total (odds ratio (OR) 0.38 per 1-SD increase, 95% confidence interval (CI) 0.23-0.60, pā<ā0.001) and small HDL particle concentrations (OR 0.35 per 1-SD increase, 95% CI 0.19-0.60, pā<ā0.001) with 3-month mortality, whereas concentrations of large HDL particles (pā=ā0.353) or HDL-cholesterol (pā=ā0.107) showed no significant association. After adjustment for age, sex, mean arterial pressure, low-density lipoprotein cholesterol, glomerular filtration rate, urea, and N-terminal pro-brain natriuretic peptide, both the total and small HDL particle concentrations remained significantly associated with 3-month mortality. Based on our results, we conclude that total and small HDL particle concentrations strongly and independently predict 3-month mortality in AHF patients