Three-Year Impact of Immediate Invasive Strategy in Patients With Non-ST-Segment Elevation Myocardial Infarction (from the RIDDLE-NSTEMI Study).

Previous studies compared clinical outcomes of early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome up to 1-year follow-up, but long-term data remain scarce. Our aim was to evaluate the long-term effects of immediate invasive intervention in patients with Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non-ST-Segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) was a randomized, investigator-initiated, parallel-group trial that assigned 323 patients with NSTEMI (1:1) to either immediate (median time to intervention 1.4 hours) or delayed invasive strategy (61.0 hours). The primary end point was the composite of death or new myocardial infarction (MI). At 3 years, immediate invasive intervention was associated with a lower rate of death or new MI, compared with a delayed invasive strategy (12.3% vs 22.5%, hazard ratio 0.50, 95% confidence interval 0.29 to 0.87, p = 0.014). The observed benefit of immediate intervention was mainly driven by an increased early reinfarction risk in delayed strategy, with similar new MI rates beyond 30 days (4.4% in the immediate and 5.6% in the delayed group, p = 0.61). Three-year mortality was 9.3% in the immediate invasive strategy, and 10.0% in the delayed strategy (p = 0.83). High baseline Global Registry of Acute Coronary Events score (>140) was associated with a significant increase in long-term mortality, regardless of the timing of invasive intervention. In conclusion, whereas immediate invasive intervention significantly reduced the early risk of new MI, the timing of invasive intervention appears to have no significant impact on clinical outcomes beyond 30 days, which seem to mostly be related to the baseline clinical risk profile.

Risk factors for intraoperative bradycardia during ear, nose, throat and maxillofacial surgery.

Intraoperative bradycardia (IOB) is one of the most common cardiac arrhythmias observed in clinical anaesthetic practice. Controlled hypotension, as a strategy of lowering patient's blood pressure during anesthesia has been practiced for decades in head and neck surgery. The aim of our study was to determine the incidence and the risk factors for intraoperative bradycardia in maxillofacial, ear, nose and throat surgery, as well as to determine whether controlled hypotension affects the occurrence of IOB. The retrospective study included 2304 patients who underwent maxillofacial, ear, nose or throat surgery. We studied the influence of: sex, age, comorbidity, type of surgery, duration of anesthesia and controlled hypotension on the occurrence of IOB. IOB was registered in 473 patients (20.5%). Patients with controlled hypotension had IOB significantly more often than patients without controlled hypotension (33.9 vs 15.1%) (p = 0.000). The significant predictors of IOB were: age (OR = 1.158; 95% CI = 1.068-1.256; p = 0.000), sex (OR = 0.786; 95% CI = 0.623-0.993; p = 0.043), ischemic heart disease (OR = 2.016; 95% CI = 1.182-3.441; p = 0.010); ear surgery (OR = 1.593; 95% CI = 1.232-2.060; p = 0.000), anesthesia duration, (OR = 1.006; 95% CI = 1.004-1.007; p = 0.000) and controlled hypotension (OR = 2.204; 95% CI = 1.761-2.758; p = 0.000). IOB is common in maxillofacial, ear, nose and throat surgery, particularly in male, older age and patients with ishemic heart disease. The ear surgery, longer anesthesia duration and controlled hypotension raise the risk for occurrence of IOB.

The relationship between causative microorganisms and cardiac lesions caused by infective endocarditis: New perspectives from the contemporary cohort of patients.

BACKGROUND: The etiology of infective endocarditis (IE) is changing. More aggressive forms with multiple IE cardiac lesions have become more frequent. This study sought to explore the relationship between contemporary causative microorganisms and IE cardiac lesions and to analyze the impact of multiple lesions on treatment choice. METHODS: In 246 patients hospitalized for IE between 2008 and 2015, cardiac lesions caused by IE were analyzed by echocardiography, classified according to the 2015 European Society of Cardiology guidelines and correlated with microbiological data. We defined a new parameter, the Echo IE Sum, to summarize all IE cardiac lesions in a single patient, enabling comprehensive comparisons between different etiologies and treatment strategies. RESULTS: Staphylococcus aureus was associated with the development of large vegetation (OR 2.442; 95% CI 1.220-4.889; p=0.012), non-HACEK bacteria with large vegetation (OR 13.662; 95% CI 2.801-66.639; p=0.001), perivalvular abscess or perivalvular pseudoaneurysm (OR 5.283; 95% CI 1.069-26.096; p=0.041), and coagulase-negative staphylococci (CoNS) with leaflet abscess or aneurysm (OR 3.451; 95% CI 1.285-9.266, p=0.014), and perivalvular abscess or perivalvular pseudoaneurysm (OR 4.290; 95% CI 1.583-11.627; p=0.004). The Echo IE Sum significantly differed between different etiologies (p<0.001), with the highest value in non-HACEK and the lowest in streptococcal endocarditis. Patients operated for IE had a significantly higher Echo IE Sum vs those who were medically treated (p<0.001). CONCLUSION: None of the IE cardiac lesions is microorganism-specific. However, more severe lesions were caused by S. aureus, CoNS, and non-HACEK bacteria. The highest propensity to develop multiple lesions was shown by the non-HACEK group. Higher Echo IE Sum in patients sent to surgery emphasized the importance of multiple IE cardiac lesions on treatment choice and potential usage of Echo IE Sum in patient management.

Right heart mechanics in untreated normotensive patients with prediabetes and type 2 diabetes mellitus: a two- and three-dimensional echocardiographic study.

BACKGROUND: The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. METHODS: This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. RESULTS: Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8 mL/m(2), P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4 vs 22 ± 4 mL/m(2), P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. CONCLUSIONS: RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.

Left Ventricular Mechanics in Untreated Normotensive Patients with Type 2 Diabetes Mellitus: A Two- and Three-dimensional Speckle Tracking Study.

BACKGROUND: Our aim was to investigate left ventricular (LV) mechanics estimated by two- (2DE) and three-dimensional echocardiography (3DE) strains in subjects with type 2 diabetes mellitus (DM). METHODS: This cross-sectional study included 50 untreated normotensive DM subjects and 50 healthy controls similar by sex and age. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS: Left ventricular mechanics, assessed by 2DE, was impaired in all three directions. Global longitudinal 3DE strain was significantly decreased in the DM group in comparison with the controls (-17.8 ± 2.5 vs. -19.1 ± 2.7%, P = 0.014). Similar results were found for 3DE global circumferential strain (-18.9 ± 2.9 vs. -20.4 ± 3.2%, P = 0.01), 3DE global radial strain (40.3 ± 6.9 vs. 43.1 ± 7.3%, P = 0.035), and 3DE global area strain (-29.2 ± 3.7 vs. -31 ± 4%, P = 0.024). LV torsion was similar between the DM patients and the controls (2.1 ± 0.6 vs. 1.9 ± 0.5 °/cm, P = 0.073); whereas LV untwisting rate was significantly increased in the DM subjects (-114 ± 26 vs. -96 ±23 °/s, P < 0.001). A multivariate analysis showed that 3DE global longitudinal and area myocardial functions were associated with HbA1c independently of 3DE LV mass index. CONCLUSION: Left ventricular deformation obtained by 3DE is significantly impaired in the type 2 DM patients. HbA1c is independently associated with LV mechanics that implies that early anti-diabetic therapy and normalization of the fasting glucose level and HbA1c could impede further cardiac damage.

The impact of the metabolic syndrome on the outcome after aortic valve replacement.

OBJECTIVES: The aim of this study was to examine the influence of the metabolic syndrome on the left ventricular geometry as well as on the early and mid-time outcome in patients with aortic stenosis who underwent aortic valve replacement. METHODOLOGY: The study included 182 patients who underwent aortic valve replacement due to aortic stenosis. The metabolic syndrome was defined by the presence of at least three AHA-NHLB (American Heart Association/National Heart, Lung and Blood Institute) criteria. All the patients were followed for at least 2 years after the surgery. RESULTS: The metabolic syndrome did not influence the severity of aortic stenosis (mean gradient and aortic valve area). However, the metabolic syndrome was associated with the reduced prevalence of the normal left ventricular geometry and the increased risk of concentric left ventricular hypertrophy in patients with aortic stenosis. Among the metabolic syndrome criteria, only increased blood pressure was simultaneously associated with the short-term and mid-term outcome, independently of other risk factors. Increased fasting glucose level was an independent predictor of the only 30-day outcome after the valve replacement. The metabolic syndrome and left ventricular hypertrophy were, independently of hypertension and diabetes, associated with the 30-day outcome, as well as incidence of major cerebrovascular and cardiovascular events in the 2-year postoperative period. CONCLUSION: The metabolic syndrome does not change severity of the aortic stenosis, but significantly impacts the left ventricular remodeling in these patients. The metabolic syndrome and left ventricular hypertrophy, irrespective of hypertension and diabetes, are predictors of the short-term and mid-term outcome of patients with aortic stenosis who underwent aortic valve replacement.

The influence of the metabolic syndrome on atrial fibrillation occurrence and outcome after coronary bypass surgery: a 3-year follow-up study.

BACKGROUND: We sought to investigate the influence of the metabolic syndrome (MS) on new-onset postoperative atrial fibrillation (POAF), and occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in a period of 3 years after isolated coronary artery bypass grafting (CABG) surgery. METHODOLOGY: The study included 460 patients who underwent the first CABG operation without baseline atrial fibrillation. The MS was defined by the presence of three or more Adult Treatment Panel (ATP)-American Heart Association (AHA)- National Heart, Lung, and Blood (NHLB) Institute criteria. POAF was diagnosed by continuous electrocardiographic monitoring during the first 48 to 72 hours after CABG. All the patients were followed up for at least 3 years after surgery. RESULTS: The MS and its criteria were significantly associated with POAF and MACCE occurrence in the 3-year period after isolated CABG surgery. Among the MS risk factors, hypertension, abdominal obesity, and the increased fasting glucose level were independently associated with both POAF and MACCE onset in the observed patients. Individuals with four or five MS criteria have similar risk of POAF or MACCE as individuals with three MS criteria. In the 3-year period of follow-up, the MS was proven to be associated with MACCE occurrence, independently of hypertension, diabetes, and obesity defined by body mass index. CONCLUSIONS: The MS and its criteria significantly increased risk of POAF and MACCE in a 3-year period. The MS, irrespective of hypertension, diabetes, and obesity, was associated with POAF and MACCE in the patients who underwent CABG.

Risk factors for intraoperative hypotension during thyroid surgery.

BACKGROUND: Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. MATERIAL AND METHODS: The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. RESULTS: IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). CONCLUSIONS: IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

[Aspirin withdrawal in high risk cardiac patients before the operation of total colectomy with resection of ileum--case report].

Coronary artery disease is one of the risk factors for myocardial infarction and it is present in 40% of patients who are undergoing noncardiac surgery. Despite evidence of the benefit of the antiplatelet therapy in patients at risk of cardiac complications, aspirin treatment is often discontinued before surgery due to the risk of perioperative bleeding. In many studies and meta-analysis it is shown that aspirin withdrawal in perioperative period was associated with three-fold higher risk of major adverse cardiac events. Perioperative continuation of aspirin increase the rate of bleeding by 1.5, but it doesn't increase the level of the severity of bleeding complications. In perioperative periode aspirin is discontinued only if it is estimated that the bleeding risk is higher than the risk of thrombosis. In the paper authors present a case report of patient who developed a perioperative myocardial in-farction as a consequence of aspirin withdrawal before total colectomy.

Correlation of different imaging modalities in pre-surgical evaluation of pericardial metastasis of liposarcoma.

A patient presented with a large pericardial tumor of uncertain etiology. Five years earlier, she had been treated for myxoid liposarcoma of the thigh. For pre-surgical evaluation, conventional radiography, positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), CT of the heart, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed. The final histopathologic diagnosis was metastatic liposarcoma. Each of the imaging modalities used had advantages and disadvantages, and their coordination was necessary for optimal evaluation.

Preoperative preparation of patients with arterial or pulmonary hypertension in noncardiac surgery.

Arterial hypertension is not an independent risk factor in cardiovascular complications in noncardiac surgery. Nevertheless, preoperative evaluation is necessary and includes estimation of arterial hypertension grade and possible damage of target organs. In patients with first and second grade of arterial hypertension postponement of elective intervention is not necessary, only optimization of therapy. On the other hand, patients with third level arterial hypertension have benefit if intervention is postponed till the reduction of arterial pressure. There is no indication that any of the antihypertensive drug groups has advantage in the preoperative treatment of hypertension. Unlike arterial hypertension pulmonary hypertension increases the risk of cardiac morbidity and mortality in the perioperative period. In patients with pulmonary hypertension, anesthesia and surgery may be complicated with heart failure, hypoxia and arrhythmias. Preoperative and postoperative treatments include calcium channel blockers, prostanoids, endothelin receptor antagonists and inhibitors of phosphodiesterase type 5.

The preoperative assessment of patients with valvular heart disease as a comorbidity.

In patients with valvular heart disease planned for any type of surgery preoperative evaluation and preparation are especially important for a successfull outcome of the surgery. Preoperative preparation and intraoperative treatment of patients with valvular heart disease are different de-Spending on the type of valvular disease: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation or mitral valve prolapse. In this paper we have outlined the criteria for evaluating the severity of valvular disease, given that the risk in surgery is proportional to the degree of valvular disease. Also, given that the risk in surgery is also directly proportional to the type and extent of non cardiac surgery, it will be presented recommendations for intraoperative monitoring, with the purpose of evaluating patient's hemodynamic state, as well as recommendations for perioperative treatment of hypotension, tachycardia, and other hemodynamic disturbances. In the paper we will separately discuss bacterial endocarditis profilaxys which can occur after the surgery of patients with valvular disease. Since the patients with valvular disease, and especially the ones with implanted prosthetic valve or heart arrhythmia, are usually on oral anticoagulation therapy, it will be given recommendations for treatment of patients on oral anticoagulation therapy as part of preoperative preparations.

Preoperative preparation of patients with cardiomyopathies in non-cardiac surgery.

Cardiomyopathies are myocardial diseases in which there is structural and functional disorder of the heart muscle, in the absence of coronary artery disease, hypertension, valvular disease and congenital heart disease. Cardiomyopathies are grouped into specific morphological and functional phenotypes: dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and unclassified cardiomyopathies. Patients with dilated and hypertrophic cardiomypathy are prone to the development of congestive heart failure in the perioperative period. Also, patients with hypertrophic and arrhythmogenic right ventricular cardiomyopathy are prone to arrhythmias in the perioperative period. Preoperative evaluation includes history, physical examination, ECG, chest radiography, complete blood count, electrolytes, creatinine, glomerular filtration rate, glucose, liver enzymes, urin analysis, BNP and echocardiographic evaluation of left ventricular function. Drug therapy should be optimized and continued preoperatively. Surgery should be delayed (unless urgent) in patients with decompensated or untreated cardiomyopathy. Preoperative evaluation requires integrated multidisciplinary approach of anesthesiologists, cardiologist and surgeons.

Modern concepts of preoperative preparation of patients with thyroid gland disease.

Preoperative evaluation of patients with thyroid land disease, in any kind of surgery, should include the possibility of difficult intubation caused by thyromegaly, the hormonal status (its disbalance), as well as the screening, and therapy of consequences of thyroid imbalance on specific organ systems, especially cardiovascular. It is necessary to select the adequate anesthetics and other pharmacological agents, according to current hormonal status. It is also necessary to select the adequate medications and other therapeutic measures for prevention and treatment of possible complications in perioperative period, some of which are life-threatening (thyroid storm and mixedema coma).

Preditores de função ventricular esquerda global na síndrome metabólica / Predictors of global left ventricular function in metabolic syndrome / Predictores de función ventricular izquierda global en el síndrome metabólico

FUNDAMENTO: A síndrome metabólica (SM) representa um conjunto de fatores de risco cardiovascular que agem de forma sinérgica. OBJETIVO: O objetivo desse estudo foi determinar quais parâmetros estavam associados de forma independente à função global do ventrículo esquerdo (VE) em indivíduos com SM, estimada através do índice Tei. MÉTODOS: O estudo incluiu 234 indivíduos com SM e 96 controles ajustados por idade. A SM foi definida pela presença de três ou mais critérios da ATP-NCEP III. Todos os indivíduos foram submetidos a testes laboratoriais e ecocardiograma bidimensional e com Doppler pulsátil e tecidual. Intervalos de tempo apropriados no Doppler tecidual para a estimativa do índice Tei também foram avaliados. RESULTADOS: O índice Tei estava aumentado em todos os indivíduos com SM (0,35 ± 0,05 vs 0,49 ± 0,10, p < 0,001). Análise de regressão múltipla dos parâmetros clínicos mostrou que a pressão arterial sistólica (β= 0,289, p < 0,001), glicemia de jejum (β= 0,205, p = 0,009), índice de massa do VE (β= 0,301, p < 0,001), E/e'septal (β= 0,267, p < 0,001) e e'septal (β= -0,176, p = 0,011) estavam independentemente associados com a função ventricular esquerda global estimada pelo índice Tei. CONCLUSÃO: A SM teve um impacto significante na função global do VE. A pressão arterial sistólica, glicemia de jejum, índice de massa do VE E/e'septal, e e'septal estavam independentemente associados com a função global do VE.

BACKGROUND: The metabolic syndrome (MS) represents a cluster of cardiovascular risk factors that act synergistically. OBJECTIVE: The aim of this study was to determine which parameters were independently associated with the global left ventricular (LV) function in subjects with MS estimated with the Tei index. METHODS: The study included 234 subjects with MS and 96 controls adjusted by age. MS was defined by the presence of three or more of ATP- NCEP III criteria. All subjects underwent laboratory blood tests and two-dimensional, pulsed and tissue Doppler echocardiography. Appropriate tissue Doppler time intervals for the estimation of the Tei index were also assessed. RESULTS: The Tei index was increased in subjects with MS (0.35 ± 0.05 vs 0.49 ± 0.10, p < 0.001). Multiple regression analysis of the clinical parameters showed that systolic blood pressure (β= 0.289, p < 0.001), fasting glucose (β= 0.205, p = 0.009), LV mass index (β= 0.301, p < 0.001), E/e'septal (β= 0.267, p < 0.001), and e'septal (β= -0.176, p = 0.011) were independently associated with the global left ventricular function estimated by Tei index. CONCLUSION: MS has a significant impact on LV global function. Systolic blood pressure, fasting glucose, LV mass index, E/e'septal, and e'septal were independently associated with the LV global function.

FUNDAMENTO: El síndrome metabólico (SM) representa un conjunto de factores de riesgo cardiovascular que actúan de forma sinérgica. OBJETIVO: El objetivo de este estudio fue determinar cuales parámetros estaban asociados de forma independiente a la función global del ventrículo izquierdo (VI) en individuos con SM, estimada a través del índice Tei. MÉTODOS: El estudio incluyó 234 individuos con SM y 96 controles ajustados por edad. El SM fue definido por la presencia de tres o más criterios ATP-NCEP III. Todos los individuos fueron sometidos a tests de laboratorio y ecocardiograma bidimensional y con Doppler pulsado y tisular. Intervalos de tiempo apropiados en el Doppler tisular para la estimativa del índice Tei también fueron evaluados. RESULTADOS: El índice Tei estaba aumentado en todos los individuos con SM (0,35 ± 0,05 vs 0,49 ± 0,10, p < 0,001). Análisis de regresión múltiple de los parámetros clínicos mostró que la presión arterial sistólica (β = 0,289, p < 0,001), glucemia de ayuno (β = 0,205, p = 0,009), índice de masa del VI (β = 0,301, p < 0,001), E/e'septal (β = 0,267, p < 0,001) y e'septal (β = -0,176, p = 0,011) estaban independientemente asociados con la función ventricular izquierda global estimada por el índice Tei. CONCLUSIÓN: El SM tuvo un impacto significativo en la función global del VI. La presión arterial sistólica, glucemia de ayuno, índice de masa del VI E/e'septal, y e'septal estaban independientemente asociados con la función global del VI. (Arq Bras Cardiol 2011;96(5):377-385).

Cerebral aneurysm associated with cardiac myxoma: Case report.

Left atrial myxomas are a rare but well known cause of cerebrovascular accidents in young people. Cerebral embolism is the most common cause of cerebral ischemic stroke. The intracranial aneurysm is rarely associated with myxoma. We report the case of a patient who had an operation of PICA aneurysm due to subarachnoid hemorrhage ten months before the discovery of the large left atrial myxoma. Fortunately, the untimely diagnosis of the myxoma did not have other consequences. In order to prevent possible complications of we should keep in mind that these two apparently different entities could be associated.

Predictors of atrial fibrillation following coronary artery bypass surgery.

BACKGROUND: New-onset atrial fibrillation is the most common form of rhythm disturbance following coronary artery bypass grafting surgery (CABG). It is still unclear which factors have a significant impact on its occurrence after this procedure. The aim of this study was to evaluate clinical predictors of postoperative atrial fibrillation (POAF) after myocardial revascularization. MATERIAL/METHODS: We performed a retrospective analysis of 322 patients who underwent the first CABG operation without baseline atrial fibrillation. All subjects underwent laboratory blood tests, echocardiography and selective coronarography with ventriculography. Patients were continuously electrocardiographically monitored during the first 48-72 h after the operation for the occurrence of POAF. RESULTS: POAF was diagnosed in 72 (22.4%) of the patients. Multivariate logistic regression analysis was used to identify the following independent clinical predictors of POAF: age≥65 years (OR 1.78; 95%CI: 1.06-2.76; p=0.043), hypertension (OR 1.97; 95%CI: 1.15-3.21; p=0.018), diabetes mellitus (OR 2.09; 95% CI: 1.31-5.33; p=0.010), obesity (OR 1.51; 95%CI: 1.03-3.87; p=0.031), hypercholesterolemia (OR 2.17, 95%CI: 1.05-4.25; p=0.027), leukocytosis (OR 2.32, 95%CI: 1.45-5.24; p=0.037), and left ventricular segmental kinetic disturbances (OR 3.01; 95%CI: 1.65-4.61, p<0.001). CONCLUSIONS: This study demonstrates that advanced age, hypertension, diabetes, obesity, hypercholesterolemia, leukocytosis, and segmental kinetic disturbances of the left ventricle are powerful risk factors for the occurrence of POAF.

[Are new recommendations on the prevention of infective endocarditis applicable in our environment?].

INTRODUCTION: Over half a century ago the process of prevention of infective endocarditis in patients with predisposed cardiac diseases was started. The application of prevention has been based on the fact that infective endocarditis is preceded by bacteraemia, which can be caused by some invasive diagnostic and therapeutic procedures, and whose development can be prevented by applying antibiotics before an intervention. According to the latest guidelines of the European Society of Cardiology published this year, prevention is recommended only in high risk patients with previous infective endocarditis, prosthetic valves, cyanotic congenital heart diseases without surgical repair or with residual defects, palliative shunts or conduits, congenital heart diseases with complete repair with prosthetic material up to six months after the procedure (surgery or percutaneous intervention), and when the residual defect persists at the site of implantation of a prosthetic material. In addition, antibiotic prophylaxis is limited to dental procedures with the manipulation of gingival or periapical region of the teeth or perforation of the oral mucosa. OBJECTIVE: The aim of this testing was to confirm whether these novelties in recommendations were applicable in our environment. METHODS: Fifty-seven patients (44 men and 13 women) with infective endocarditis were included in the testing. Infective endocarditis was diagnosed in 68% of patients based on two major criteria and in 32% based on one major and three minor criteria. RESULTS: In 54.4% of patients the entry site of infection could be determined. Twenty-one percent of patients developed infection after a dental intervention, 17.5% of patients the infection occurred after a skin/soft tissue lesion, whereas urinary infection preceded infective endocarditis in 14% of patients and bowel diverticulosis was a possible cause in of 1.75% of patients. In all cases with infective endocarditis preceded by the dental intervention, antibiotic prophylaxis was not applied due to absent data of heart disease or negligence. CONCLUSION: In our country a high incidence of infective endocarditis following dental procedures has been observed. One of possible reasons is poor oral hygiene. Its improvement and a regular dental control, as well as the individual risk assessment of intervention and conditions under which the intervention is performed could determine risk reduction for the development of infective endocarditis.

Right ventricular myxoma obstructing the outflow tract.

Cardiac myxomas are benign tumors of endocardial origin. Symptoms might mimic heart disease as well as infectious disease, immunodeficiency, and malignant processes. We present the case of a 59-year-old female patient with a large right ventricular myxoma that was connected to the basal interventricular septum. Movement in systole provoked the obstruction of the right ventricular outflow tract. She presented clinically with syncope, systolic murmur, and signs of right heart failure. The diagnosis of the right ventricular tumor was based on 2D echocardiography, magnetic resonance, and multislice computed tomography findings.Emergency surgical excision of the myxoma was necessary to prevent embolism and sudden death.