MANAGEMENT OF PATIENTS WITH CARDIAC IMPLANTABLE ELECTRONIC DEVICES UNDERGOING MAGNETIC RESONANCE IMAGING - PROPOSAL FOR UNIFIED HOSPITAL PROTOCOL: CROATIAN WORKING GROUP ON ARRHYTHMIAS AND CARDIAC PACING.

For many years, magnetic resonance imaging (MRI) was contraindicated in patients with cardiac implantable electronic devices (CIED). Today, there is a growing amount of evidence that MRI can be performed safely in the majority of patients with CIEDs. Firstly, there are devices considered MRI conditional by manufacturers that are available on the market and secondly, there is clear evidence that even patients with MRI non-conditional devices can also undergo MRI safely. Protocols have been developed and recommendations from different cardiac and radiologic societies have been published in recent years. However, the majority of physicians are still reluctant to refer these patients to MRI. Therefore, this document is published as a joint statement of the Croatian Working Group on Arrhythmias and Cardiac Pacing and Department of Radiology, Sestre milosrdnice University Hospital Centre to guide and ease the management of patients with CIED undergoing MRI. Also, we propose a unified protocol and checklist that could be used in Croatian hospitals.

Croatian National Data and Comparison with European Practice: Data from the Cardiac Resynchronization Therapy Survey II Multicenter Registry.

AIMS: The Cardiac Resynchronization Therapy (CRT) Survey II was conducted between October 2015 and December 2016 and included data from 11088 CRT implantations from 42 countries. The survey's aim was to report on current European CRT practice. The aim of this study was to compare the Croatian national CRT practice with the European data. METHODS: Five centres from Croatia recruited consecutive patients, in a 15-month period, who underwent CRT implantation, primary or an upgrade. Data were collected prospectively by using online database. RESULTS: A total of 115 patients were included in Croatia, which is 33.2% of all CRT implants in Croatia during the study period (total n=346). Median age of the study population was 67 (61-73) years, and 21.2% were women. Primary heart failure (HF) aetiology was nonischemic in 61.1% of patients, and HF with wide QRS was the most common indication for the implantation (73.5%). 80% of patients had complete left bundle branch block, and over two-third had QRS ≥150 ms. Device-related adverse events were recorded in 4.3% of patients. When compared with European countries, Croatian patients were significantly younger (67 vs. 70 years, p=0.012), had similar rate of comorbidities with the exception of higher prevalence of hypertension. Croatian patients significantly more often received CRT-pacemaker when compared with European population (58.3 vs. 29.9%, OR 3.27, 95%CI 2.25-4.74, p < 0.001). CONCLUSION: Our data indicate strict selection of patients among HF population and adherence to guidelines with exception of higher proportion of CRT-pacemaker implantation. This is likely to be influenced by healthcare organization and reimbursement issues in Croatia.

Soluble intracellular adhesion molecule-1 and omentin-1 as potential biomarkers of subclinical atherosclerosis in hemodialysis patients.

PURPOSE: Atherosclerotic cardiovascular complications represent significant cause of mortality in hemodialysis (HD) patients. The aims of this study were to: (a) investigate association of sICAM-1, sVCAM-1, omentin-1 and other non-traditional risk factors with subclinical atherosclerosis; (b) examine the diagnostic value of these specific markers in the early detection of subclinical atherosclerosis; and (c) examine their role as predictors of mortality in group of patients with subclinical atherosclerosis on regular HD. MATERIALS AND METHODS: Starting from November 2011, a cohort of 210 HD patients participated in this 3-year follow-up study. The subjects were divided into three groups according to the presence of atherosclerosis. Atherosclerotic disease was assessed by measuring carotid intima-media thickness (IMT). Samplings were withdrawn at baseline and thereafter every 12 months until the end of follow-up. RESULTS: IMT showed weak correlation with sICAM-1 (r = 0.39, P = 0.001), sVCAM-1 (r = 0.27, P = 0.015) and omentin-1 (r = -0.25, P = 0.020), and also omentin-1 showed good correlation with parameters of systolic and diastolic function (r = 0.52, P = 0.001 and r = 0.51, P = 0.001). Multivariate analysis showed that sICAM-1 and sVCAM-1 concentrations were a strong independent correlate of IMT (P = 0.031 and P = 0.010, respectively). The Cox proportional analysis showed that sICAM-1 and omentin-1 concentrations were strong predictors of cardiovascular death (HR 1.85, CI 1.18-2.32, P = 0.021 and HR 4.14, CI 1.38-12.1, P = 0.004, respectively) and that serial measurements of these markers predict IMT progression (HR 1.98, 95 % CI 1.21-2.38, P < 0.002 and HR 2.91, 95 % CI 1.57-4.72, P < 0.001, respectively). CONCLUSIONS: Our study demonstrated that sICAM-1 and omentin-1 levels are strong predictors of cardiovascular death in HD patients with subclinical atherosclerosis.

Serum omentin-1 levels as a possible risk factor of mortality in patients with diabetes on haemodialysis.

AIM: The main cause of mortality in haemodialysis (HD) patients is cardiovascular disease. Serum omentin-1 level was found to be associated with cardio-metabolic disorders. The aim of this study was to examine the role of omentin-1 as a predictor of mortality in a group of diabetes positive HD patients. METHODS: A total of 120 prevalent HD patients were included in the study from December 2012 to May 2014. Patients were divided into two groups according to the presence or absence of diabetes. Venous blood samples were taken at months 0 and 18 following an overnight fast (prior to a midweek HD session). Serum omentin-1 level was assessed by enzyme-linked immunosorbent assay. RESULTS: A total of 84 HD patients were analysed at the end of an 18-month follow-up. Omentin-1 levels of HD patients with diabetes were found to be lower than of HD patients without diabetes (9.1±5.8 ng/mL vs. 11.4±4.1 ng/mL, respectively; P=0.015) at the end of follow-up. Omentin-1 levels of survived patients with diabetes were found to be higher than of nonsurvived patients with diabetes (16.5±10.1 ng/mL vs. 12.9±5.3 ng/mL, respectively; P=0.045). During follow-up, 36 patients (30%) died, of whom 25 had diabetes (34%). CONCLUSIONS: Serum omentin-1 levels were significantly lower in HD patients with diabetes. A decrease in omentin-1 levels could be an independent mortality risk factor in this patient group. Further investigation in a greater number of patients is needed.

Usefulness of liver test and controlled attenuation parameter in detection of nonalcoholic fatty liver disease in patients with chronic renal failure and coronary heart disease.

BACKGROUND: In recent years, nonalcoholic fatty liver disease (NAFLD) was recognized as an important factor in chronic kidney disease (CKD) pathogenesis. The concentrations of serum aminotransferases in both chronic dialysis and chronic renal failure (CRF) patients most commonly fall within the lower end of the range of normal values. The aim of the present study was to investigate the usefulness of four liver tests and four biological scores in detection of NAFLD in comparison with transient elastography (TE) findings in different groups of patients. METHODS: The study was cross-sectional analysis collected data from a single tertiary care center. Of 202 patents there were 52 patients with CKD, 50 patients with end-stage renal disease (ESRD) treated with haemodialysis (HD), 50 renal transplant recipients (RTRs) and 50 patients with proven coronary heart disease (CHD). Fifty sex- and age-matched individuals without NAFLD and with normal liver and kidney function tests served as controls. With the help of TE (FibroScan®, Echosense SA, Paris, France), liver stiffness was selected as the parameter to quantify liver fibrosis and Controlled Attenuation Parameter (CAP) was used to detect and quantify liver steatosis. RESULTS: According to the CAP findings 76.9 %CKD patients, 82 %HD patients, 74 %RTRs and 69.1 % CHD patients had CAP > 238 dB.m(-1) and thus by definition NAFLD. We have found that ALT, AST and GGT levels were positively correlated with CAP values while ALT and AST showed positive correlation with liver stiffness acquired with TE only in CHD patients. According to TE findings APRI (AUC 0.796) and FIB-4 (AUC 0.790) scores were correlated with the presence of fibrosis, while HIS score was correlated with the presence of steatosis (AUC 0.867) only in CHD patients. CONCLUSION: Liver tests and biological scores are not useful for NAFLD detection in CRF patients. TE with CAP provides the opportunity of noninvasive screening for NAFLD as well as liver fibrosis in patients with CRF.

Influence of the left ventricular types on QT intervals in hypertensive patients.

OBJECTIVE: To investigate the possible electrophysiological background of the greater excitability of concentric and eccentric left ventricular hypertrophy types in relation to the asymmetric type. METHODS: 187 patients with essential hypertension, without ishaemic heart disease were divided into three groups with regard to left ventricule type: concentric (relative wall thickness >0.42, interventricular septum/left ventricular posterior wall ≤1.3), eccentric (left ventricular diameter in systoles >32, relative wall thickness <0.42), asymmetric left ventricular hypertrophy (interventricular septum/left ventricular posterior wall >1.3), and three subgroups: mild (interventricular septum or left ventricular posterior wall 11-12 mm), moderate (interventricular septum or left ventricular posterior wall 13-14 mm) and severe left ventricular hypertrophy (interventricular septum or left ventricular posterior wall ≥15 mm). In all patients QT intervals, QT dispersion, left ventricular mass index and ventricular arrhythmias were measured. An upper normal limit for QT corrected interval: 450/460 ms for men/women; for QT dispersion: 70 ms. RESULTS: The QT corrected interval and QT dispersion were increased in severe concentric and eccentric left ventricular hypertrophy (443 and 480 ms for QT corrected; 53 and 45 ms for QT dispersion, respectively), not significantly. QT dispersion in men with severe left ventricular hypertrophy was significantly enlarged (67.5 vs. 30 ms, p=0.047). QT interval was significantly longer in patients with complex ventricular arrhythmias (p=0.037). CONCLUSION: No significant association of QT intervals or QT dispersion with the degree/type of left ventricular hypertrophy was found. QT corrected interval and QT dispersion tend to increase proportionally to the left ventricular mass only in the concentric and eccentric type.

Diagnostic accuracy of heart fatty acid binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) in diagnosis of acute myocardial infarction in patients with acute coronary syndrome.

INTRODUCTION: This study aimed to assess whether heart fatty acid-binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) could be used for the accurate diagnosis of acute myocardial infarction (AMI) in acute coronary syndrome (ACS) patients. MATERIALS AND METHODS: The study included 108 ACS patients admitted to a coronary unit within 3 h after chest pain onset. AMI was distinguished from unstable angina (UA) using a classical cardiac troponin I (cTnI) assay. H-FABP and GPBB were measured by ELISA on admission (0 h) and at 3, 6, 12, and 24 h after admission; their accuracy to diagnose AMI was assessed using statistical methods. RESULTS: From 92 patients with ACS; 71 had AMI. H-FABP and GPBB had higher peak value after 3 h from admission than cTnI (P = 0.001). Both markers normalized at 24 h. The area under the receiver operating characteristic curves was significantly greater for both markers in AMI patients than in UA patients at all time points tested, including admission (P < 0.001). At admission, the H-FABP (37%) and GPBB (40%) sensitivities were relatively low. They increased at 3 and 6 h after admission for both markers and decreased again after 24 h. It was 40% for H-FABP and approximately 2-times lower for GPBB (P < 0.01). In AMI patients, both biomarkers had similar specificities, positive- and negative-predictive values, positive and negative likelihood ratios, and risk ratios for AIM. CONCLUSION: H-FABP and GPBB can contribute to early AMI diagnosis and can distinguish AMI from UA.