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1.
Eur J Heart Fail ; 21(5): 553-576, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30989768

RESUMO

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.

2.
Front Physiol ; 9: 165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29559923

RESUMO

We investigated cardio-respiratory coupling in patients with heart failure by quantification of bidirectional interactions between cardiac (RR intervals) and respiratory signals with complementary measures of time series analysis. Heart failure patients were divided into three groups of twenty, age and gender matched, subjects: with sinus rhythm (HF-Sin), with sinus rhythm and ventricular extrasystoles (HF-VES), and with permanent atrial fibrillation (HF-AF). We included patients with indication for implantation of implantable cardioverter defibrillator or cardiac resynchronization therapy device. ECG and respiratory signals were simultaneously acquired during 20 min in supine position at spontaneous breathing frequency in 20 healthy control subjects and in patients before device implantation. We used coherence, Granger causality and cross-sample entropy analysis as complementary measures of bidirectional interactions between RR intervals and respiratory rhythm. In heart failure patients with arrhythmias (HF-VES and HF-AF) there is no coherence between signals (p < 0.01), while in HF-Sin it is reduced (p < 0.05), compared with control subjects. In all heart failure groups causality between signals is diminished, but with significantly stronger causality of RR signal in respiratory signal in HF-VES. Cross-sample entropy analysis revealed the strongest synchrony between respiratory and RR signal in HF-VES group. Beside respiratory sinus arrhythmia there is another type of cardio-respiratory interaction based on the synchrony between cardiac and respiratory rhythm. Both of them are altered in heart failure patients. Respiratory sinus arrhythmia is reduced in HF-Sin patients and vanished in heart failure patients with arrhythmias. Contrary, in HF-Sin and HF-VES groups, synchrony increased, probably as consequence of some dominant neural compensatory mechanisms. The coupling of cardiac and respiratory rhythm in heart failure patients varies depending on the presence of atrial/ventricular arrhythmias and it could be revealed by complementary methods of time series analysis.

3.
Echocardiography ; 34(10): 1447-1455, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28782130

RESUMO

OBJECTIVE: We aimed to research left atrial (LA) phasic function and heart rate variability (HRV), as well as their relationship, in subjects with uncomplicated systemic sclerosis (SSc). METHODS: The investigation involved 44 SSc patients and 33 age-matched healthy controls. All participants underwent clinical examination, serological tests, 24-hours Holter monitoring, and echocardiographic examination including strain analysis. RESULTS: Maximum, minimum, and pre-A LA volumes and volume indices were higher in the SSc patients than in the controls. The total emptying fraction, the parameter of the LA reservoir function, as well as passive LA emptying fraction, which represents the LA conduit function, were significantly lower in the SSc patients compared to the controls. Active LA emptying fraction, the parameter of the LA booster pump function, was significantly higher in the SSc participants. There was no difference in LA reservoir function between the diffuse and the limited SSc form. LA conduit function was significantly decreased, whereas LA booster pump function was compensatory increased in the diffuse SSc form compared to the limited SSc form. Similar results were obtained by LA strain analysis. HRV indices were significantly decreased in the SSc patients. Modified Rodnan skin score, the parameter of skin involvement in SSc, and HRV indices correlated well with LA phasic function in SSc. CONCLUSION: Left atrial (LA) phasic function, assessed by both volumetric and strain method, as well as cardiac autonomic nervous function is significantly deteriorated in SSc patients. Skin score and HRV indices correlate with LA phasic function parameters.


Assuntos
Frequência Cardíaca/fisiologia , Escleroderma Sistêmico/fisiopatologia , Estudos Transversais , Eletrocardiografia Ambulatorial/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/diagnóstico por imagem
4.
Biomed Tech (Berl) ; 61(6): 657-663, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27824611

RESUMO

Rearranged origin of heart rhythm in patients with atrial fibrillation (AF) influences the regulation of the heart and consequently the respiratory rhythm, and the bidirectional interaction of these rhythms not documented. Hence, we examined coupling of the RR interval and the respiration (Resp) signal by coherence, Granger causality and the cross-sample entropy method of time series analysis in patients with AF and a healthy control group. In healthy subjects, the influence of respiration on cardiac rhythm was found as increased coherence at the breathing frequency (BF) range, significantly stronger interaction and synchrony from Resp to RR than from RR to Resp. On the contrary, in patients with AF, coherence at BF diminished, there were no causal interactions between signals in both directions, which resulted in equally great asynchrony between them. In AF, the absence of full functionality of the sinoatrial node, as an integrator of neural cardiac control, resulted in diminished vagal modulation of heart periods and consequently impaired bidirectional cardio-respiratory interaction.


Assuntos
Fibrilação Atrial/fisiopatologia , Frequência Cardíaca/fisiologia , Eletrocardiografia/métodos , Entropia , Humanos , Respiração
5.
Front Neurosci ; 10: 38, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26909018

RESUMO

Classical Poincaré plot is a standard way to measure nonlinear regulation of cardiovascular control. In our work we propose a generalized form of Poincaré plot where we track correlation between the duration of j preceding and k next RR intervals. The investigation was done in healthy subjects and patients with atrial fibrillation, by varying j,k ≤ 100. In cases where j = k, in healthy subjects the typical pattern was observed by "paths" that were substituting scatterplots and that were initiated and ended by loops of Poincaré plot points. This was not the case for atrial fibrillation patients where Poincaré plot had a simple scattered form. More, a typical matrix of Pearson's correlation coefficients, r(j,k), showed different positions of local maxima, depending on the subject's health condition. In both groups, local maxima were grouped into four clusters which probably determined specific regulatory mechanisms according to correlations between the duration of symmetric and asymmetric observed RR intervals. We quantified matrices' degrees of asymmetry and found that they were significantly different: distributed around zero in healthy, while being negative in atrial fibrillation. Also, Pearson's coefficients were higher in healthy than in atrial fibrillation or in signals with reshuffled intervals. Our hypothesis is that by this novel method we can observe heart rate regimes typical for baseline conditions and "defense reaction" in healthy subjects. These data indicate that neural control mechanisms of heart rate are operating in healthy subjects in contrast with atrial fibrillation, identifying it as the state of risk for stress-dependent pathologies. Regulatory regimes of heart rate can be further quantified and explored by the proposed novel method.

6.
J Hypertens ; 34(4): 772-80, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26825168

RESUMO

OBJECTIVE: The aim of this study was to determine the relationship between blood pressure (BP) variability and left ventricular (LV) mechanical function in untreated normal-weight, overweight, and obese hypertensive patients. METHODS: This cross-sectional study included 144 untreated hypertensive study participants who underwent 24-h ambulatory BP monitoring and complete two (2DE) and three-dimensional echocardiography (3DE). All the patients were divided into three groups according to their BMI: normal-weight patients (BMI < 25 kg/m), overweight patients (25 ≤ BMI < 30 kg/m), and obese patients (BMI ≥ 30 kg/m). RESULTS: Daytime, night-time, and 24-h BP variability progressively increased from normal-weight, throughout overweight, to obese hypertensive study participants. 2DE and 3DE LV longitudinal, circumferential and radial strains, as well as 3DE area strain, were significantly lower in obese hypertensive patients than in normal-weight and overweight study participants. 3DE LV volumes indexed for BSA did not differ significantly among the three observed groups. Night-time and 24 h BP variability indices, more than daytime BP variability parameters, were associated with 2DE and 3DE longitudinal and circumferential strains independent of BMI, LV mass index, and average 24-h SBP and DBP values. CONCLUSION: BP variability and LV deformation are significantly affected by obesity in untreated hypertensive patients. BP variability is associated with 2DE and 3DE LV mechanics independently of main clinical and echocardiographic characteristics.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia
7.
J Med Biochem ; 35(2): 130-136, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28356872

RESUMO

BACKGROUND: In the majority of patients with a wide QRS complex and heart failure resistant to optimal medical therapy, cardiac resynchronization therapy (CRT) leads to reverse ventricular remodeling and possibly to changes in cardiac collagen synthesis and degradation. We investigated the relationship of biomarkers of myocardial collagen metabolism and volumetric response to CRT. METHODS: We prospectively studied 46 heart failure patients (mean age 61±9 years, 87% male) who underwent CRT implantation. Plasma concentrations of amino-terminal propeptide type I (PINP), a marker of collagen synthesis, and carboxy-terminal collagen telopeptide (CITP), a marker of collagen degradation, were measured before and 6 months after CRT. Response to CRT was defined as 15% or greater reduction in left ventricular end-systolic volume at 6-month follow-up. RESULTS: Baseline PINP levels showed a negative correlation with both left ventricular end-diastolic volume (r=-0.51; p=0.032), and end-systolic diameter (r=-0.47; p=0.049). After 6 months of device implantation, 28 patients (61%) responded to CRT. No significant differences in the baseline levels of PINP and CITP between responders and nonresponders were observed (p>0.05 for both). During follow-up, responders demonstrated a significant increase in serum PINP level from 31.37±18.40 to 39.2±19.19 µg/L (p=0.049), whereas in non-responders serum PINP levels did not significantly change (from 28.12±21.55 to 34.47± 18.64 µg/L; p=0.125). There were no significant changes in CITP levels in both responders and non-responders (p>0.05). CONCLUSIONS: Left ventricular reverse remodeling induced by CRT is associated with an increased collagen synthesis in the first 6 months of CRT implantation.

8.
J Cardiovasc Surg (Torino) ; 57(6): 872-880, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24866774

RESUMO

BACKGROUND: The aim of this paper was to present single centre experience in the treatment of extra cranial carotid artery aneurysms (ECCA) and to analyze results discussing different treatment modalities. METHODS: The study analyzed 60 patients with 62 ECCA treated surgically at the Clinic for vascular and endovascular surgery, Serbian Clinical Center (Belgrade) in the period between 1985 and 2013. Treatment strategy was individually selected and demographic, morphologic, intraoperative and postoperative data were collected. RESULTS: Thirty-day operative mortality was 3.3% and completely stroke related. Besides two fatal strokes one additional was registered making total number of 3 (4.8%) postoperative strokes. Only one (1.6%) early graft thrombosis has been found. The 30-day-patency rate was 98.4%. During the same period seven local complications were found: three (4.8%) hemorrhage and four (6.4%) cranial nerves injuries. In all cases of hemorrhage successful re-intervention was performed without any consequences. Cranial nerves injuries included transient contusions of hypoglossal (2) and superior laryngeal nerve (2). CONCLUSIONS: The etiology, location, and morphology of an ECCA are determining selection of appropriate therapy. Large or tortuous aneurysms, as well as aneurysms involving common carotid or proximal internal carotid artery, are also absolutely indicated to open surgical therapy. Aneurysms which involve the distal internal carotid artery and false anastomotic aneurysms are best managed with endovascular techniques. The ligature is indicated for the treatment of external carotid aneurysms, mycotic aneurysms with local infection and in ruptured ECCA with uncontrolled bleeding.


Assuntos
Aneurisma/terapia , Implante de Prótese Vascular , Doenças das Artérias Carótidas/terapia , Procedimentos Endovasculares , Veias/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/mortalidade , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/mortalidade , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Ligadura , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Seleção de Pacientes , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Sérvia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
9.
Srp Arh Celok Lek ; 144(11-12): 597-601, 2016 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29659218

RESUMO

Introduction: Vasovagal syncope is the most common type of reflex syncope. Efficacy of cardiac pacing in this indication has not been the subject of many studies and pacemaker therapy in patients with vasovagal syncope is still controversial. Objective: This study aimed to assess the efficacy and safety of pacing therapy in treatment of patients with vasovagal syncope, to determine contribution of new therapeutic models in increasing its success, and to identify risk factors associated with a higher rate of symptoms after pacemaker implantation. Methods: A retrospective study included 30 patients with pacemaker implanted due to vasovagal syncope in the Pacemaker Center, Clinical Center of Serbia, between November 2003 and June 2014. Head-up tilt test was performed to diagnose vasovagal syncope. Patients with cardioinhibitory and mixed type of disease were enrolled in the study. Results: Mean age was 48.1 ± 11.1 years and 18 (60%) patients were men. Mean follow-up period was 5.9 ± 3.0 years. Primarily, implantable loop recorder was implanted in 10 (33.3%) patients. Twenty (66.7%) patients presented cardioinhibitory and 10 (33.3%) mixed type of vasovagal syncope. After pacemaker implantation, 11 (36.7%) patients had syncope. In multiple logistic regression analysis we showed that syncope is statistically more likely to occur after pacemaker implantation in patients with mixed type of vasovagal syncope (p = 0.018). There were two (6.7%) perioperative surgical complications. Conclusion: Pacemaker therapy is a safe treatment for patients with vasovagal syncope, whose efficacy can be improved by strict selection of patients. We showed that symptoms occur statistically more often in patients with mixed type of disease after pacemaker implantation.


Assuntos
Estimulação Cardíaca Artificial , Marca-Passo Artificial , Síncope Vasovagal/terapia , Adulto , Estimulação Cardíaca Artificial/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Síncope Vasovagal/classificação , Síncope Vasovagal/etiologia
10.
J Clin Hypertens (Greenwich) ; 17(2): 118-25, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25496306

RESUMO

The authors sought to investigate left ventricular (LV) mechanics and heart rate variability (HRV), and their relationship, in untreated hypertensive patients. A total of 63 untreated hypertensive patients and 45 healthy patients were included. All patients underwent 24-hour Holter monitoring and echocardiographic examination (two- and three-dimensional). All parameters of time and frequency domain of HRV were decreased in the hypertensive patients. Two-dimensional LV longitudinal and circumferential deformation was significantly reduced in hypertensive patients. Three-dimensional LV strain in all three directions as well as area strain were reduced in the hypertensive group. In two different models of multivariate regression, two-dimensional LV longitudinal and circumferential strain, as well as three-dimensional LV area strain, remained associated with HRV parameters independently of LV structural and functional parameters. This study showed that LV mechanics and HRV were significantly impaired in untreated hypertensive patients. Two- and three-dimensional echocardiographic LV deformation were independently associated with HRV parameters in the whole study population.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia , Ecocardiografia Tridimensional , Eletrocardiografia Ambulatorial , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão
11.
Srp Arh Celok Lek ; 143(9-10): 551-8, 2015 Sep-Oct.
Artigo em Sérvio | MEDLINE | ID: mdl-26727862

RESUMO

INTRODUCTION: Atrial fibrillation (AF), the most common arrhythmia that requires treatment, does not come out of the focus of researchers. Monitoring its prevalence and effects of therapy is a good guideline approach to the growing population of patients in which this arrhythmia occurs. OBJECTIVE: The aim of the study was to evaluate the efficacy of treatment of AF and cardiovascular profiles in the observed population. METHODS: In this observational, cross-sectional, multicenter, international study, 584 patients in 30 centers in Serbia and Slovenia, older than 18 years and with AF or in sinus rhythm with a history of AF, were included. The assessment of the efficacy of treatment of AF was performed by analyzing the frequency of adequate therapeutic effect of medication in rhythm or frequency control in patients with AF. RESULTS: The results confirmed that the highest incidence of AF duration is more than seven days, and is accompanied by symptoms. Inadequate frequency regulation was registered at 8.9% of patients. Hypertension was registered in two-thirds of all patients, while other cardiovascular risk factors were registered in about one-third of patients. An echocardiographic finding in the group of patients with AF confirms generally adequate left ventricular function with a slightly enlarged left atrium (4.6±0.8 cm). Increasing age and time from the first episode of AF decreases the probability of maintaining sinus rhythm, while symptomatic AF had a positive impact on the presence of sinus rhythm. Propafenone, sotalol and amiodarone showed a statistically significant connection with a positive therapeutic response, while 3-blockers had a negative impact on the probability of establishing and maintaining sinus rhythm. CONCLUSION: Characteristics of therapeutic approaches, risks, comorbidity of patient populations in Slovenia and Serbia correspond to the fullest extent with the recommendations for good clinical practice, which further stresses the need for extensive measures in these regions.

12.
Srp Arh Celok Lek ; 135(1-2): 21-5, 2007 Jan-Feb.
Artigo em Sérvio | MEDLINE | ID: mdl-17503563

RESUMO

INTRODUCTION: Brain natriuretic peptide (BNP) has a role in control of cardiovascular and renal functions. OBJECTIVE: The objective was to assess the predictive value of BNP levels for development of heart failure in patients with permanent pacemakers. METHOD: In patients with implanted DDD pacemakers, BNP levels were measured at rest and after exercise testing, on DDD and VVI modes. There were 42 patients (25 males; 59.5%), without symptoms or signs of coronary disease or heart failure, and with normal echocardiograms. According to BNP levels, the patients were divided into three groups: with BNP levels lower than 80 pg/ml, BNP ranging from 81-150 pg/ml, and BNP levels over 151 pg/ml. RESULTS: In the first group (27 patients), BNP levels were significantly higher on VVI compared to DDD mode, both at rest and after exercise (p < 0.01), with all BNP levels within normal range. In the second group (5 pts), BNP levels at rest were also significantly higher on VVI than on DDD mode, p < 0.05. After exercise, these values were also higher on VVI compared to DDD mode, but without statistical significance. The third group (10 pts) as a whole had higher BNP values on VVI compared to DDD mode, with no statistical significance. In patients from this group who later developed heart failure, BNP levels were found to be significantly lower on DDD as opposed to VVI mode at rest, p < 0.05, and even higher significance was found after exercise, p < 0.01. After 6-year follow-up, 2 out of 5 patients from the second group developed dilated cardiomyopathy, and 8/10 patients in the third group experienced heart failure with LV EF 34.1 +/- 10%, LV EDD 6.1 +/- 0.42 cm, LV ESD 4.8 +/- 0.45 cm. Five of these patients died within the follow-up period. CONCLUSION: The increased BNP levels can be valuable for early screening of patients with higher risk of heart failure. In patients with increased BNP at the time of pacemaker implantation, DDD pacing is a modality of choice.


Assuntos
Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Marca-Passo Artificial , Idoso , Biomarcadores/sangue , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
13.
Circ J ; 69(1): 116-8, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15635215

RESUMO

There are more than 20 years of experience with implantation of defibrillator devices in humans and the procedure is an important therapeutic option for patients at high risk of life-threatening ventricular arrhythmias. The incidence of new defibrillator implantation has gradually increased, being used even in children, (1) although pediatric use is associated with several complications, especially with epicardial systems,(2) including fracture of the subcutaneous patch,(3-5) mainly because of growth.(3) We present a case of subcutaneous patch electrode fracture in the left axillary pectoral region of a patient who needed the patch for effective defibrillation, and we discuss the methods of treatment.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento , Adulto , Eletrodos , Feminino , Humanos
14.
Srp Arh Celok Lek ; 133(5-6): 237-41, 2005 May-Jun.
Artigo em Sérvio | MEDLINE | ID: mdl-16392279

RESUMO

INTRODUCTION: Resynchronisation therapy with biventricular permanent pacing stimulation is one method of treating patients with systolic heart failure, with echocardiograph signs of ventricular asynchrony and a prolonged QRS of longer than 120 milliseconds. This method has been accepted in most medical centres around the world and was instigated in our Pacemaker Centre in December 2001, 3 months after FDA approval for human use. OBJECTIVE: The aim of the study was to present this new procedure and the results obtained from our own group of patients. METHOD: A multi-site, biventricular pacemaker, with a special electrode for left-half heart stimulation was implanted in the coronary sinus of 17 patients who had suffered systolic heart failure (12 male and 5 female, average age 59.9 years). For all of them, the duration of the QRS interval was longer than 120 ms, with left bundle branch morphology, and an ejection fraction below 30%. All the patients were NYHA class II or III. Prior to and after the implantation, a 12-channel ECG and ECHO were carried out, a 6-minute hall walk test was performed, additionally, the total walked distance on a flat surface was measured, the general condition of the patient was evaluated, the number of medications being taken was noted, as was the number of days of hospitalisation. RESULTS: The average time from diagnosis to implantation was 22 months, and the average post-operative follow-up was 14 months. Two of the patients died 10 and 7 months after the implantation, due to a new myocardial infarction and refractory heart failure. In addition, one patient did not show any improvement after the implantation of the multi-site pacemaker (there were three "non-responder" patients). All the other patients felt much better: decreased NYHA class for I - II class, increased left ventricle ejection fraction, reduced use of diuretics, increased 6-minute hall walk distance and general walk distance on a flat surface, and decreased number of days of hospitalisation. CONCLUSION: Resynchronisation heart failure therapy in the majority of patients with systolic left ventricular dysfunction and a prolonged QRS interval considerably improves cardiac function, in addition to reducing symptoms and hospital stays.


Assuntos
Insuficiência Cardíaca/terapia , Marca-Passo Artificial , Eletrocardiografia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Disfunção Ventricular Esquerda/complicações
15.
Srp Arh Celok Lek ; 133(7-8): 338-42, 2005 Jul-Aug.
Artigo em Sérvio | MEDLINE | ID: mdl-16623256

RESUMO

INTRODUCTION: The implantable loop recorder (ILR) is a new diagnostic tool in cardiology for establishing the causes of unexplained syncope in patients where standard conventional tests, invasive tests included, have failed. The device is a diagnostic "pacemaker," surgically implanted underneath the skin of the chest, with leads attached to the case of the device, not requiring endovenous lead implantation. Heart rhythm is monitored continuously on the basis of an endless loop, up to a maximum period of 14 months. Recording is carried out either by applying an outside activator whenever symptoms occur, or automatically, according to a pre-set algorithm for bradycardia, tachycardia, and/or asystolic detection. OBJECTIVE: The aim of this study was to present this new diagnostic method as well as our first experiences with its implementation. METHOD: We followed 5 patients (3 male, 2 female, mean age: 46.4 +/- 19) who had ILRs ("Reveal Plus," Medtronic Inc., USA) implanted at our centre, over a period of 14 months (7.6 +/- 5.5), concentrating on their clinical course, symptom occurrence, and electronically monitored heart rhythm at the time of ILR auto activation and/or recordings triggered by outside activation whenever a patient's symptoms were discernible. RESULTS: In three patients, the ILR revealed syncope aetiology by documenting heart rhythm at the time of its occurrence. In one patient, involving a lethal outcome, the ILR was not explanted, so that the rhythm at the time of the fatal syncope, although assumed, remained undocumented. In one, most recently implanted patient, follow-up is still in progress. CONCLUSION: The implantable loop recorder represents an important innovation and a step forward in establishing the causes of recurrent syncope, which cannot be determined by standard invasive and non-invasive testing.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Síncope/diagnóstico , Adulto , Eletrodos Implantados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síncope/etiologia
16.
Srp Arh Celok Lek ; 131(3-4): 105-17, 2003 Mar-Apr.
Artigo em Sérvio | MEDLINE | ID: mdl-14608872

RESUMO

The authors present surgical techniques and distant results of the operative treatment in patients with occlusive lesions of the supraaortic branches. The study included 29 men (55.8%) and 23 women (44.2%), with the average age of 54 years. The majority of patients--44 (84.6%) had symptoms and signs of the upper extremities ischemia while 25 (48.1%) had symptoms and signs of cerebral ischemia (the posterior circulation mainly). Among seven patients with isolated cerebral ischemia of the anterior circulation, four of them developed transient ischemic attack (TIA) and three had cerebrovascular insult (CVI). All patients were examined ultrasonographically and angiographically. Operative treatment was performed under general anesthesia. In eight cases the anatomic, and in 44 extraanatomic procedure was applied. Following reconstructive procedures were used: endarterectomy and patch of the brachiocephalic trunk--2, bypass from ascending aorta--7, carotid to subclavian bypass--31, subclavian to carotid bypass--7, subclavian artery transposition--3, axillo-axillary bypass--2. During the follow-up period (10-228 months), eight out of 52 patients exhibited the occlusion of the graft. Six occlusions developed after carotid-subclavian bypass: in two patients reconstructions were performed using Dacron grafts, in three using PTFE grafts and in one patient using autologous vein graft. Two occlusions developed after subclavio-carotid bypass. In both cases the vein graft was used: one was coming from the ipsilateral and the other one from the contralateral subclavian artery. The mean period from the operation to the occlusion of the graft (the mean lasting of the primary flow) was 14.72 years (SE = 1.41; 95% CI = 11.96-17.48). There was no statistically significant difference in primary patency and survival without symptoms between patients treated with the anatomic and those treated with the extraanatomic approach. Practically, this means that both approaches were equally good, so that the decision about the approach should be made individually, according to the loading factors of each patient. In the case of the carotid-subclavian bypass, according to our results, we recomend the use of the PTFE graft.


Assuntos
Arteriopatias Oclusivas/cirurgia , Tronco Braquiocefálico/cirurgia , Artérias Carótidas/cirurgia , Artéria Subclávia/cirurgia , Procedimentos Cirúrgicos Vasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares/métodos
17.
Srp Arh Celok Lek ; 130 Suppl 4: 29-48, 2002 Sep.
Artigo em Sérvio | MEDLINE | ID: mdl-12577683

RESUMO

Professor Dr. Sci. Milan Djordjevitsh was an excellent cardiovascular surgeon and results of his professional and research work were well known to professional public in the country and over the world. He was born in Smederevska Palanka in 1933. He finished the University Schfool of Medicine in Belgrade in 1961 and specialized general surgery at the II Department of Surgery in Belgrade. His teacher, prof. dr. Vojislav Stojanovitsh, recognized his special interest for clinical and research work from the beginning. His doctor's thesis (1976) was "The Role of Veinous Valvula in Aortocoronographic Bypass During Increased Coronary Flow". In 1981 he formed a Bypass Centre of the Republic of Serbia which became later the Yugoslav European Reference Centre for pacemaker therapy. The same year (1981) he was rewarded "The October Award of the City of Belgrade" for science. He was the first to implant an implantable cardioverter defibrillator. This technique was carried out in Serbia only two months after the implantation of a similar system in Europe. Professor Djordjevitsh gave many lectures over the world: Detroit (1975), Huston (1975), Budapest (1978), Warsaw (1980), Stockholm (1982), Aman (1984), New-York (1988), Berlin (1987), Vienna (1998), Stockholm (1989), Moscow (1990). The professional and research work of professor Djordjevitsh in the field of electrostimulation of the heart was characterised by original ideas and permanent search for new possibilities, especially in the multidisciplinary field. Therefore, professor Djordjevitsh is considered to be the founder of modern clinical pacemaker therapy. He also practiced artistic and scientific photography. Since 1984 professor Djordjevitsh was member of the Nucleus of the European working group for heart electrostimulation and electrophysiology, and was elected in the presidency of the Nucleus; later he was its president. His interest was directed to the maturation of endocardial stimulation threshold; use of non-atrial sensors in the frequent adaptation of a permanent artificial conductor of cardiac rhythm-pacemaker to load; use of continuous electrostimulation of spinal cord in patients in terminal state of vasospastic and occlusive vascular diseases; study of the effort of electromagnetic fields on pacemaker inhibition and senzation; study of biologic-synthetic grafts. As a man of high standing, professor Djordjevitsh was expert for cardiovascular diseases and modern technology in the World Health Organization since 1988. On the basis of his great professional reputation in the country and abroad, professor Djordjevitsh was elected a corresponding member of the Serbian Academy of Science and Arts. After a few scientific meetings excellently organized by professor Djordjevitsh in the country (Dubrovnik, 1988 and in 1990 under the auspices of NASPE), professor Djordjevitsh had to organize a European congress on Pacemaker Therapy and Electrophysiology in Belgrade in 1993. Unfortunately, political events and early death of professor Djordjevitsh were the reasons why the congress was not held as planned. Professor Djordjevic died in Paris, but was buried in Belgrade in January 1993.


Assuntos
Cardiologia/história , Biobibliografia como Assunto , História do Século XX , Humanos , Iugoslávia
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