Biomarkers and their combination in a prediction of decompensation after an index hospitalization for acute heart failure.

Introduction: Heart failure (HF) still remains as one of the most common causes of hospital admission with a high mortality rate. Aim: To investigate the possible prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation after an index hospitalization and to investigate their possible additive prognostic value. Patients and Methods: Two hundred twenty-two patients hospitalized with acute HF were monitored and followed for 18 months. Results: BNP at discharge has the highest sensitivity and specificity in the prediction of decompensation. For a cutoff value of 423.3 pg/ml, sensitivity was 64.3% and specificity was 64.5%, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P < 0.001). The hazard risk (HR) for decompensation when the discharge BNP was above the cutoff value was 2.18. Cystatin C, at a cutoff value of 1.46 mg/L, had a sensitivity of 57% and specificity of 57.8%, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125, in the prediction of decompensation in patients with acute heart failure (AHF) and at a cutoff value of 80.5 IU/L, had a sensitivity of 60.5% and specificity of 53.3%, with a positive predictive value of 64.5% and an AUC of 0.59 (P = 0.022). The time till onset of decompensation was significantly shorter in patients with four versus three elevated biomarkers (P = 0.047), with five versus three elevated biomarkers (P = 0.026), and in patients with four versus two elevated biomarkers (P = 0.026). The HR for decompensation in patients with five positive biomarkers was 3.7 (P = 0.001) and in patients with four positive biomarkers was 2.5 (P = 0.014), compared to patients who had fewer positive biomarkers. Conclusion: BNP, cystatin C, and CA125 are predictors of decompensation, and their combined usage leads to better prediction of new decompensation.

Triglyceride level as a potential marker of residual cardiovascular risk and its relation to HeartScore.

BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) are still the leading cause of morbidity and mortality in Bosnia and Herzegovina. Elevated LDL-cholesterol is established as a strong marker of cardiovascular risk. Some researchers believe that measuring triglyceride levels gives a good assessment of the residual risk for ASCVD besides the measurement of LDL-cholesterol. OBJECTIVE: The aim of this study was to evaluate the overall prevalence of major risk factors for ASCVD, lipid profile and 10-year fatal cardiovascular risk using the HeartSCORE scoring system. Further, we want to evaluate the prevalence and relationship between elevated triglyceride levels and high 10-year fatal cardiovascular risk calculated as a HeartSCORE. METHODS: This is a cross-sectional study conducted on 832 volunteers aged between 40 and 65 years without a diagnosis of diabetes and without known preexisting cardiovascular disease, as a part of the preventive program conducted at the Family Medicine office. Data were collected for ASCVD risk factors and lipid panel (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides). 10-year fatal cardiovascular risk was calculated using the HeartSCORE scoring system for countries with high CV risk. RESULTS: Among 832 participants included, 565 (67.9%) were female, and 267 (32.1%) were male. We found high prevalence of hypertension (27.7%), obesity (32.2%), and smoking (36.2%). All lipid parameters, except HDL-C, were not optimal. Only 17.4% of participants had normal estimated HeartSCORE risk, while more than one-third (33.9%) had high or very high estimated HeartSCORE risk. Although we found a higher percentage of participants with elevated triglycerides in groups with higher HeartSCORE, there was a very weak positive correlation between values of triglycerides and the 10-year risk of a fatal cardiovascular event (r= 0.249, p= 0.000). CONCLUSION: The high prevalence of major known risk factors and high estimated HeartSCORE risk indicate a high overall risk for ASCVD in the sample. The proportion of participants with elevated triglycerides was increased in patients with high HeartSCORE risk what implicates importance of triglyceride measurement.

Relation between thyroid hormonal status, neutrophillymphocyte ratio and left ventricular systolic function in patients with acute coronary syndrome.

Aim To examine a relation of thyroid function, neutrophil-lymphocyte ratio (NLR) with left ventricular function measured through the left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction treated with percutaneous coronary intervention (PCI). Methods This prospective research involved 160 consecutive patients with acute myocardial infarction. Patients were divided into those with normal thyroid hormone status (n=80) and those with hypothyroidism (newly diagnosed) (n=80). Inflammatory parameters and parameters of hormonal status were taken for analysis: thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3). All patients underwent transthoracic echocardiographic examination (TTE) five days upon admission, and left ventricular ejection fraction (LVEF) was analysed. Results Significant difference between the two groups was verified in values of T3, T4, erythrocytes, haemoglobin, haematocrit, neutrophil, lymphocytes, NLR, C-reactive protein (CRP) and sedimentation rate. Patients with euthyroidism had a higher frequency of coronary single-vessel disease (p=0.035) and a significantly lower frequency of triple vessel disease (p=0.046), as well as a higher median value of LVEF (p=0.003). There was a significant correlation between LVEF with haemoglobin values (p=0.002), NLR (p=0.001), and CRP (p=001). Conclusion The altered status of the thyroid gland in acute myocardial infarction is associated with the severity of the coronary blood vessel lesion, LVEF and correlates with inflammatory response.

Pericardial Effusion in Postcoronavirus Disease Patients with Preserved Ejection Fraction of the Left Ventricle and Normal Values of N-Terminal-Pro B-Type Natriuretic Peptide-Link with C-Reactive Protein and D-Dimer.

Aim: The aim of this study was to link the values of D-dimer and C-reactive protein (CRP), with the occurrence of pericardial effusion in patients who had coronavirus disease 2019 (COVID-19) and have preserved systolic function of the left ventricle (LV). Methods: This was a prospective study and included 146 patients who underwent echocardiographic examination 30 days after the acute phase of COVID-19. Patients who were placed on mechanical ventilation, patients who had pulmonary thromboembolism or acute coronary syndrome during the acute period of the disease, patients who had an ejection fraction of the LV <50%, patients who were diagnosed with pericarditis during acute illness or clinical signs of heart failure (or had elevated N-terminal-pro hormone B-type natriuretic peptide value), with verified renal or hepatic dysfunction were excluded from the study, including patients with diabetes mellitus Type 1, patients with cancer, connective tissue disease, or pregnant women. The existence of cardiovascular risk factors (hypertension, diabetes mellitus Type 2, and hyperlipidemia), the presence of previous ischemic heart disease, maximum values of D-dimer, and CRP (during the first 15 days of the disease) was taken into the analysis. Results: Effusion was verified around the right atrium (RA) in 104 patients (3.85 ± 1.75 mm), in 135 patients next to the free wall of the right ventricle (RV) (5.24 ± 2.29 mm), in front of the apex of the LV in 27 patients (2.44 ± 0.97 mm), next to the lateral wall of LV in 35 patients (4.43 ± 3.21 mm), and behind the posterior wall of LV in 30 patients (2.83 ± 1.62 mm). Mean CRP values during the acute phase of the disease were 43.0 mg/L (8.6-76.2 mg/L), whereas D-dimer mean value was 880.00 µg/L (467.00 -2000.00 µg/L). CRP values correlated with effusion next to the free wall of RV (rho = 0.202; P = 0.018). The D dimer correlated with effusion around RA (rho = 0.308; P = 0.0001). Conclusion: The clinical picture of the post-COVID patients could be explained by the appearance of pericardial effusion. D-dimer value correlates with the occurrence of effusion around RA, whereas CRP value correlates with effusion next to the free wall of RV.

Recanalization rate of proximal deep venous thrombosis related to therapeutic modality during six months follow-up.

Aim To evaluate the efficacy (rate of recanalization) of therapy with novel oral anticoagulants (NOAC; rivaroxaban, apixaban) compared to conventional treatment (low molecular weight heparin - LMWH and vitamin K antagonist) in the treatment of deep vein thrombosis (DVT) of the proximal segments of lower extremities. Methods The first group consisted of patients diagnosed with DVT and treated with NOAC (n = 100), while the second group consisted of patients diagnosed with DVT, who were treated by conventional treatment (low molecular weight heparin and vitamin K antagonists) (n = 100). In the first group, NOAC was included in the initial treatment. Patients in the second group were treated with LMWH for four days, and on the fifth day vitamin K antagonist was included in therapy, international ratio (INR) was titrated to therapeutic values (2.0-3.0), and then low molecular weight heparin was excluded from the therapy. Results There was a statistically significant difference in the estimated values of free lumen of the blood vessel between the examined groups after 30 days (p=0.0001), after 90 days (p=0.0001) and after 180 days (p=0.0001). After 180 days, the average free lumen values in the NOAC group were 85% (81-89%), which was significantly higher than the free lumen values in the second group, 73% (69-79%). Conclusion The use of NOAC represents more efficient treatment of DVT comparing to vitamin K antagonists.

Impact of load on the knee in relation to a treadmill angle.

Aim To determine the effect of the load on the meniscus in relation to a different angle, and to present the impact of force on eventual injury of menisci. Methods Research included 200 males with average height of 178.5 cm, mass 83.5 kg, and average age of 22 years. The simulation of treadmill that was used in the evaluation of ischemic heart disease was made. Effects on the knee were evaluated by measuring at different inclinations (5°70', 6°80', 7°90', 9°10', 10°20', 11°30' and 12°40'). Results With increasing ascent of treadmill the load on the meniscus also increased. Each increase in ascent after 22% (which corresponded to the angle of 12°40' and seventh degree of load according to the Bruce protocol) at given anthropological values was an etiological factor for meniscus injury. Conclusion The seventh degree of load according to the Bruce protocol can lead to the meniscus injury.

Influence of thyroid hormones on bone density.

Aim To investigate the relations between hormonal status of the thyroid gland and mineral bone density in women in menopause with or without osteoporosis. Methods The study included 120 postmenopausal women, who were divided into two groups. Group I included postmenopausal patients with osteoporosis, of whom 30 were in the early stages of postmenopause, and 30 of them where in the late postmenopausal phase. The second group included patients with preserved bone mass, of which 30 were in the early stage of postmenopause, and 30 were in the late postmenopausal phase. Bone densitometry (DEXA) was performed for all patients, along with analysis of the level of follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Results A statistically significant correlation between TSH level and mineral bone density in the lumbar spine level (r=0.27) was found in early postmenopausal women (r<0.05), TSH and T-score at the level of the lumbar spine (r=0.31) (p<0.05), as well as between TSH and mineral content of the femur bone (r=0.29; <0.05). There was statistically significant independent association between thyroxine and mineral bone density at the lumbar spine level in the late postmenopausal women (ß=0.29; p=0.025). Conclusion In the early postmenopausal phase, TSH was associated with mineral bone density in the lumbar spine and in the area of the femur.

Evaluation of the Occlusive Arterial Disease and Diabetic Angiopathy Treatment Effects by Hyperbaric Oxygenation.

INTRODUCTION: One of the most severe complications of atherosclerosis is arterial occlusive disease (AOD) and with diabetic angiopathy (DA), is a common chronic problem in clinical practice worldwide. Hyperbaric oxygen (HBO) therapy is a therapeutic modality for solving all forms of hypoxia. AIM: To compare the treatment with HBO therapy in patients with AOD and DA ischemic symptomatology with standard treatment i.e. vasodilators, antibiotics, antiplatelets and statins, and to demonstrate the benefit of the therapeutic modality itself. METHODS: We conducted a clinical prospective study and included a total of 80 patients, divided into two groups: 40 patients with the arterial occlusive disease and lower-extremity wounds, with sub-group (n=20) treated with HBO therapy on the top of the standard therapy and 40 patients with diabetic angiopathy and diabetic lower-extremity wounds, with sub-group (n=20) treated with HBO therapy on top of the standard therapy. RESULTS: The efficacy of therapy in patients treated with HBO therapy on the top of standard therapy was significantly higher than in the group of HBO non-treated patients. There was a significant improvement in 9 patients treated with HBO therapy, while in HBO non-treated patients the significant improvement effect was observed only in one patient. CONCLUSION: HBO therapy is an effective therapeutic component in the healing of diabetic lower-extremity wounds in the patients with AOD and DA. In our patients HBO therapy on the top of standard therapeutic protocol has an effect of reducing the number of lower-limb amputations in patients with AOD and DA. These results support clinical use of HBO therapy for diabetic lower-extremity wound healing.

Serum Aldosterone as Predictor of Progression of Coronary Heart Disease in Patients Without Signs of Heart Failure After Acute Myocardial Infarction.

INTRODUCTION: In patients with acute myocardial infarction (AMI) early risk assessment of development of complications is of great importance. It is proven that aldosterone level has a major role in progression of cardiovascular pathology. AIM: Determination of influence of aldosterone plasma level in the progression of heart disease in patients without signs of heart failure after AMI. MATERIAL AND METHODS: Research included 207 patients, hospitalized in the acute phase of myocardial infarction, and who were divided into two groups: 127 patients with no clinical signs of heart failure and 60 patients with heart failure. RESULTS: The serum aldosterone concentration was 73.4% higher in the group of decompensated patients, 128 pg/mL (75.4-236 pg/mL) in decompensated and 73.7 pg/mL (42.7 -115.25 pg/mL) in compensated. In the group of compensated patients, changes in aldosterone levels showed a statistically significant effect on the incidence of post-infarction angina (p=0.0001) as well as reinfarction (p=0.009). There is a connection between changes in aldosterone plasma level and positive stress test (p=0.012). CONCLUSION: In patients with AMI, elevated serum aldosterone level can be prognostic factor of the progression of coronary heart disease, development of heart failure, as well of development of post-infarction angina, myocardial reinfarction and pathological finding on the stress test.

Screening of pulmonary embolism by ventilation / perfusion tomography-SPECT and comparation with planar scintigraphy--our experiences.

UNLABELLED: Pulmonary embolism (PE) affects up to 1 per 1000 people every year and is one of the commonest preventable causes of death among hospital inpatients. Laboratory chemical test alone cannot confirm or exclude PE but are used together with the clinical test probability for risk stratification. Ventilation/ perfusion tomographic imaging may be the best practical way to accomplish on this larger scale. The aim of this study was to screen the pulmonary embolism by ventilation/perfusion tomography V/P SPECT. We also compared V/P SPECT with planar scintigraphy. RESULTS: A total of 40 patients with clinically suspected pulmonary embolism were examined. Fifteen patients (37.5%) considered to have perfusion defect with preserved ventilation using ventilation/ perfusion tomography-SPECT. In this group five patients (33%) had multiple perfusion defects (RoPer = 16 poens, RoVent = o poens). Correlation coefficient has been sign among visual analysis and quantitative analysis (C = 0.510). In 25 patients (62.5%) we have found normal ventilation/ perfusion scintigraphy. On the planar scintigraphy PE with high probability was considered in five (26.6%) patients. Intermediate and low probability was considered in seven patients with planar ventilation/ perfusion scintigraphy. Sub-segmental perfusion defect with preserved ventilation we have found in two patients (13%). On the planar scintigraphy the same defect was unclear. CONCLUSIONS: Ventilation/ Perfusion tomography-SPECT is clinically relevant in the diagnosis of pulmonary embolism, and may help reduce the number of non-diagnostic scintigraphy results. On the planar perfusion scintigraphy patients tended to have fewer perfusion defects corresponding pulmonary embolism.

[Perfusion myocardial scintigraphy - SPECT with TC-99m MIBI in detection coronary artery desease in diabetic patients]. / Perfuziona scintigrafija miokarda-SPECT sa TC-99m MIBI u detekciji koronarne bolesti kod pacijenata sa diabetes mellitus-om.

UNLABELLED: Diabetes mellitus is very frequent disease. The prevalence of coronary artery disease is higher in diabetic than in non-diabetic patients. Coronary artery disease (CAD) is the main cause of morbidity and mortalitiy in patients with Diabetes mellitus. The aim of this study was to evaluate usfulnes of myocardial perfusion scintigraphy in diabetic patients for detection of coronary artery disease. PATIENTS AND METHODS: this study included 15 patients with verified diabetes mellitus. All patients were treated with oral hypoglicemic or insulin. Parameters observed for every patients were level of lipemia (cholesterol, triglycerides), family hystory of CAD, hystory of chest pain. All patients underwent sress/rest Tc-99m MIBI study. We have performed one day protocol. Exercise tolerance test were performing in all patients according to the Bruce protocol. 260MBq was injected intravenously at peak exercise. 740MBg was injected for the rest. Myocardial perfusion scintigraphy was clasified as: 1. normal, 2. reversible defect or 3. irreversible defect. RESULTS: reversible perfusion defect we have found in 8 patients. The same patients had elevated glicemia, high level of lipemia; 1 patient had fixed defect, without any previous known history for myocardial infarction. In 6 patients we could not see any significant defect during stress/rest scintigraphy. CONCLUSION: The frequency of abnormal myocardial perfusion scintigraphy suggest that this procedure can be very useful in the detection of high-risk diabetic patients.

[Effect of anti-thyroid agents in the treatment of hyperthyroidism]. / Efekat tireostatika na lijecenje hipertireoze.

The treatment for hyperthyreoidism is usually conservative and consists of medications that limit the production of thyroid hormones. The diagnose of hyperthyreoidism was set up according to clinical finding, to determine the level of FT3, FT4, TSH with thyroid scintigraphy, and ultrasonography. In this study we showed the result in the therapy of the hyperthyreoidism with Favistan-Tiamazol tbl. during the period 2000-2001.