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 kroničnom 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 1–3 (Crcl ≥ 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 učinkovitost i sigurnost svakog pojedinog antikoagulantnog lijeka i odrediti najbolju terapijsku opciju za bolesnike s fibrilacijom atrija (AF) i kroničnom bubrežnom bolešću (CKD -om). Metode i materijali: Napravljen je pregled literature dostupne na Pubmedu/MEDLINE u u potrazi za istraživanjima o učinkovitosti, 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 ≥ 30 mL/min) zahvaljujući visokoj učinkovitosti, 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 ograničen na varfarin i apiksaban. Međutim, čini se da postoji više negativnih aspekata varfarina nego DOAC-a, uključujući ubrzanu progresiju CKD -a i povišen rizik krvarenja. Zaključak: S obzirom na njihov dobar sigurnosni profil i mogućnost ostvarivanja zadovoljavajućeg antikoagulantnog učinka apiksabana, rivaroksabana te apiksabana i u teškom 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 značajkama i preživljenju bolesnika s akutnim zatajivanjem srca. Rastuća incidencija obvezuje na ispitivanje mogućnosti poboljšanog liječenja. Svrha ove studije je bila utvrditi spolno-zavisne razlike u bolesnika s akutnim zatajivanjem srca u hitnom prijmu radi poboljšanja kvalitete liječenja i preživljenja. Prospektivna opservacijska studija na 22.713 bolesnika je provedena u hitnom prijmu Sveučilišnog bolničkog centra tijekom 2010. godine i uključila je 726 uzastopnih bolesnika s akutnim zatajivanjem srca. Najučestaliji uzrok akutnog zatajivanja srca bilo je pogoršanje kroničnog zatajivanja srca. Žene su učestalije bolovale od hipertenzivnog akutnog zatajivanja srca, a muškarci od akutnog zatajivanja srca udruženog s akutnim koronarnim sindromom. Žene su bile starije, s višim indeksom tjelesne mase, atrijskom fibrilacijom, infekcijama mokraćnog sustava, anamnezom hipertenzije, hipertenzijom kod prijma i višim zbirom SAPS II. pri prijmu. Muškarci su imali višu učestalost srčanog infarkta s ST-elevacijom i dilatacijske kardiomiopatije, ultrazvučno potvrđenu sniženom izbačajnom frakcijom i dilatacijom lijeve klijetke sa smanjenom izbačajnom frakcijom. Muškarci su učestalije bili pušači s anamnezom kronične opstruktivne bolesti pluća. Treba naglasiti važnost liječenja hipertenzije i atrijske fibrilacije u žena te akutnog koronarnog sindroma i kronične opstruktivne bolesti pluća u muškaraca. Agresivnu identifikaciju i liječenje svih mogućih etiologija zatajivanja srca treba preporučiti u hitnom prijmu

Nomogram s jednostavnim i rutinskim kliničkim i biokemijskim parametrima može biti prediktor patološkog 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 vodeći uzrok pobola i smrtnosti u svijetu, a ishemijska bolest srca je njegov najvažniji etiološki čimbenik. Zatajivanje srca nastaje posljedično remodeliranju lijevog ventrikula, koje uzrokuje povećanje njegova volumena na kraju sistole i dijastole. U ovom prospektivnom opservacijskom istraživanju uključili smo 101 bolesnika koji su imali prvu epizodu STEMI i kojima je učinjena perkutana koronarna intervencija 12 sati od početka bolova uz postignuti protok TIMI III. Cilj istraživanja bio je utvrditi koji klinički i biokemijski parametri mogu pomoći u predviđanju nastupanja patološkog ventrikulskog remodeliranja godinu dana nakon preboljelog infarkta. Na temelju rezultata istraživanja stvoren je nomogram koji je uključivao vitalne parametre i rutinske biokemijske nalaze koji su pokazali najbolju korelaciju s pojavom patološkog ventrikulskog remodeliranja. Nomogram uključuje vrijednost NTproBNP-a 12 sati nakon postignute reperfuzije, vrijednost AST-a 12 sati nakon reperfuzije, vrijednost sistoličkog tlaka kod prijma te koronarnu arteriju okluzija koje je odgovorna za nastanak infarkta miokarda. Učinjena je ROC analiza koja je pokazala izvrsnu prediktivnu vrijednost nomograma. Površina 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 specifičnost od 74,0%. Mišljenja smo da bi ovaj nomogram, jednom validiran, mogao ponuditi jeftinu i široko primjenjivu metodu za rano prepoznavanje bolesnika koji će razviti patološko ventrikulsko remodeliranje nakon preboljelog infarkta miokarda i to omogućiti već 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 75.2 ± 10.3 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, p < 0.001) and small HDL particle concentrations (OR 0.35 per 1-SD increase, 95% CI 0.19-0.60, p < 0.001) with 3-month mortality, whereas concentrations of large HDL particles (p = 0.353) or HDL-cholesterol (p = 0.107) 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