Early left ventricular systolic and diastolic dysfunction in patients with newly diagnosed obstructive sleep apnoea and normal left ventricular ejection fraction.

UNLABELLED: The aim of the study was to evaluate whether obstructive sleep apnea (OSA) contributes directly to left ventricular (LV) diastolic and regional systolic dysfunction in newly diagnosed OSA with normal left ventricle ejection fraction. METHODS: 125 consecutive patients were prospectively enrolled in the study. Control group consisted of 78 asymptomatic age-matched healthy subjects who did not have any cardiovascular and respiratory diseases. All patients had undergone overnight polysomnography and standard transthoracic and tissue Doppler imaging echocardiogram. RESULTS: The E/A ratio and the peak E wave at mitral flow were significantly lower and the peak A wave at mitral flow was significantly higher in OSA patients compared with control subjects. Left ventricle isovolumetric relaxation time (IVRT) and mitral valve flow propagation (MVFP) were significantly longer in OSA patients than in controls. Tissue Doppler derived S' amplitude of lateral part at mitral valve (S'Lm) and E' wave amplitudes both at the lateral (E'Lm) and septal parts of the mitral valve (E'Sm) were significantly lower in OSA patients compared to controls. CONCLUSION: Newly diagnosed OSA patients with normal global LV function have significantly impaired diastolic function and regional longitudinal systolic function. OSA is independently associated with these changes in LV function.

Markers of oxidative damage and antioxidant enzyme activities as predictors of morbidity and mortality in patients with chronic heart failure.

BACKGROUND: Although the majority of previous findings unequivocally confirmed the existence of systemic oxidative stress in chronic heart failure (CHF) patients, data on prognostic potential of biomarkers of oxidative lipid and protein damage are limited. We aimed to address the relation of oxidative stress markers to severity and prognosis in CHF secondary to ischemic cardiomyopathy. METHODS AND RESULTS: Plasma malondialdehyde (MDA), protein thiol groups (P-SH), reactive carbonyl derivatives (RCD), together with glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined in 120 CHF patients and 69 healthy controls. Increased lipid peroxidation (MDA) and oxidation of plasma proteins (RCD; P-SH) s well as downregulated GSH-Px activity were found in CHF patients compared with controls. Significant correlation was obtained only for RCD content and remodeling indices (LVEDV: r = 0.469, P = .008; LVESV: r = 0.452; P = .011). Cox regression analysis demonstrated only MDA (HR = 3.33; CI: 1.55-7.12; P = .002) as independent predictor of death, whereas SOD was associated with unstable angina pectoris (HR = 2.09; CI: 1.16-3.78; P = .011). CONCLUSIONS: In the course of CHF progression, carbonyl stress is implicated in the LV remodeling. Malondialdehyde level might be a useful parameter for monitoring and planning management of CHF patients.

Autonomic dysfunction in alcoholic cirrhosis and its relation to sudden cardiac death risk predictors.

Patients with liver cirrhosis have autonomic dysfunction and complex cardiovascular changes. Increases risk for sudden cardiac death (SCD) was recently recognized in liver cirrhosis. This study analyzed risk predictors for SCD related to autonomic dysfunction in patients with alcoholic liver cirrhosis (ALC). Twenty five patients with ALC were examined and compared with healthy control group. Cardiovascular autonomic reflex tests, comprehensive ECG with QTc interval, late potentials, short-term heart rate variability (HRV) analysis (time domain, spectral and nonlinear-Poincare plot analysis) and 24-h Holter ECG with long-term HRV analysis were done. According to autonomic reflex tests patients with ALC had high incidence (56%) of severe autonomic dysfunction, manifested as pronounced damage of vagal function. Patients had significantly depressed HRV (SDNN, SDANN, triangular index, LF and HF) and more frequently had serious arrhythmias, prolonged QTc and Poincare plot in a shape of dot (p < 0.001). In patient group QTc significantly inversely correlated with spectral components from short-term HRV analysis (ln(LF): r = -0.53, ln(HF): r = -0.47; p < 0.05), and Lown class significantly correlated with total autonomic function score (r = 0.64, p = 0.04). This study indicates that in ALC autonomic neuropathy with vagal impairment and sympathetic predominance is related to SCD risk predictors and onset of serious ventricular arrhythmias.

Anxiety level and responses to stress caused by air raids among patients with ischemic heart disease.

BACKGROUND: This study was undertaken to examine the short-term responses of patients with ischemic heart disease to life-threatening events such as war. METHODS: This retrospective study included 75 persons with ischemic heart disease who were admitted to the Cardiac policlinic for a control check-up immediately after the suspension of air raids. Two-thirds of them were male (average age 62 +/- 10). Data were obtained using a specially conceived questionnaire based on recall. RESULTS: Almost 40% of patients estimated that they were very anxious the week before the attacks began, but the anxiety decreased after the beginning of the air raids. Frequency of anginal pains increased after the start of the air raids, but the difference was not statisticaly significant. The intensity of pains drastically increased in the first week of war. Consequently, the average number of pain killers consumed increased from the week before the attacks to the first week of the attacks, and it reached the highest value the week after the suspension of the attacks (1.39, 1.87, and 3.02 pain pills per week, respectively). The average weekly number of medications was 3.50 in the week prior to the air raids, increased to 5.05 during the first week of air raids, and rose to 6.06 in the week after the suspension. CONCLUSION: The adjustment on the psychological level was rapid but physical symptoms increased. This implies that physical adaptation to stress could be slower, or that the stress of the war provoked permanent changes in physical status.

Prevalence of arterial hypertension in Serbia: PAHIS study.

BACKGROUND: Arterial hypertension (AH) is the most common cardiovascular disease risk factor, affecting between 30 and 50% of the adult population in developed countries. A steady increase of the prevalence of AH by about 60% is expected by year 2025. METHODS: Serbian Society of Hypertension conducted a prevalence study from February to May 2012 on a sample of 3878 adult respondents. The study included 2066 women (53.3%) and 1812 men (46.7%). Average age was 48.89 ±â€Š17.48 years. Most participants resided in urban areas (2956 people, 76.2%), whereas 922 resided in rural areas (23.8%). RESULTS: The prevalence of AH in Serbia is 42.7%. Hypertension is more frequently diagnosed among women (53.3%), than among men (46.7%). One thousand, four hundred and twelve respondents were previously diagnosed and treated for hypertension. The estimated awareness of the presence of AH was 42.99% (i.e. 40.00% among male and 45.41% among female participants). Out of all diagnosed cases of hypertension, 390 persons (27.7%) have well regulated blood pressure values, whereas 1022 persons (72.3%) do not have their blood pressure under control. CONCLUSION: Serbia belongs to countries with a high prevalence of AH. A poor control of AH may be explained in view of socioeconomic problems. High prevalence of AH may indicate a remarkably high cardiovascular disease mortality in Serbia.

[Brugada syndrome: case report].

INTRODUCTION: Brugada syndrome is an arrhythmogenic disease characterized by coved ST segment elevation and J point elevation of at least 2 mm in at least two of the right precordial ECG leads (V1-3) and ventricular arrhythmias, syncope, and sudden death. Risk stratifications of patients with Brugada electrocardiogram are being strongly debated. CASE OUTLINE: A 23-year-old man was admitted to the Coronary Care Unit of the Clinical Centre "Bezanijska kosa" due to weakness, fatigue and chest discomfort. The patient suffered from fainting and palpitations. There was a family history of paternal sudden death at 36 years. Electrocardiogram showed a coved ST segment elevation of 4 mm in leads V1 and V2, recognised as spontaneous type 1 Brugada pattern. Laboratory investigations revealed normal serum cardiac troponin T and serum potassium, and absence of inflammation signs. Echocardiographic finding was normal, except for a mild enlargement of the right atrium and ventricle. The diagnosis of Brugada syndrome was made by Brugada-type 1 electrocardiogram and the family history of sudden death <45 years. The patient was considered as a high risk, because of pre-syncope and palpitations. He underwent ICD implantation (Medtronic MaximoVR7232Cx) using the standard procedure. After implantation, noninvasive electrophysiology study was done and demonstrated inducible VF that was interrupted with the second 35 JDC shock. The patient was discharged in stable condition with beta-blocker therapy. After a year of pacemaker check-ups, there were no either VT/ VF events or ICD therapy. CONCLUSION: Clinical presentation is the most important parameter in risk stratification of patients with Brugada electrocardiogram and Brugada syndrome.

Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: the CIBIS-ELD trial.

AIMS: Various beta-blockers with distinct pharmacological profiles are approved in heart failure, yet they remain underused and underdosed. Although potentially of major public health importance, whether one agent is superior in terms of tolerability and optimal dosing has not been investigated. The aim of this study was therefore to compare the tolerability and clinical effects of two proven beta-blockers in elderly patients with heart failure. METHODS AND RESULTS: We performed a double-blind superiority trial of bisoprolol vs. carvedilol in 883 elderly heart failure patients with reduced or preserved left ventricular ejection fraction in 41 European centres. The primary endpoint was tolerability, defined as reaching and maintaining guideline-recommended target doses after 12 weeks treatment. Adverse events and clinical parameters of patient status were secondary endpoints. None of the beta-blockers was superior with regards to tolerability: 24% [95% confidence interval (CI) 20-28] of patients in the bisoprolol arm and 25% (95% CI 21-29) of patients in the carvedilol arm achieved the primary endpoint (P= 0.64). The use of bisoprolol resulted in greater reduction of heart rate (adjusted mean difference 2.1 b.p.m., 95% CI 0.5-3.6, P= 0.008) and more, dose-limiting, bradycardic adverse events (16 vs. 11%; P= 0.02). The use of carvedilol led to a reduction of forced expiratory volume (adjusted mean difference 50 mL, 95% CI 4-95, P= 0.03) and more, non-dose-limiting, pulmonary adverse events (10 vs. 4%; P < 0.001). CONCLUSION: Overall tolerability to target doses was comparable. The pattern of intolerance, however, was different: bradycardia occurred more often in the bisoprolol group, whereas pulmonary adverse events occurred more often in the carvedilol group. This study is registered with controlled-trials.com, number ISRCTN34827306.

[Quality of life evaluation in cardiovascular diseases].

DEFINITION OF QUALITY OF LIFE: In recent years, quality of life has become a very important measure of treatment of disease and successful therapy, regarding not only general health of an individual patient but also of the whole population. In 1993 the WHO proclaimed "Vision of health for all", as "Add years to life" but also "Add life to years", emphasizing quality of life to be as important as life duration. Although the remaining life expectancy in patients with cardiovascular disease is prolonged, there is still medical challenge: "How to improve quality of life in these patients?". MEASUREMENT OF QUALITY OF LIFE: Quality of life can be defined as the patient's perception of impact of disease and concomitant therapy and procedures on his physical and working capacity, emotional role, social communication and general health. DIFFERENT TYPES OF STANDARDIZED QUESTIONNAIRES FOR QUALITY OF LIFE EVALUATION: It can be measured by general health questionnaires and specified questionnaires for disease. Questionnaire SF-36 is regarded as one of the most reliable, considering the great number of publications. CONCLUSION: The most important step in complicated evaluation of quality of life is the adequate selection of questionnaire with a high confidence.

Triple Björk-Shiley valve--more than 30 years of asymptomatic functioning: to the memory of late academic prof. Isidor Papo and the 45th anniversary of the first valve implantation in Yugoslavia.

INTRODUCTION: The Björk-Shiley Delrin (BSD) tilting disc heart valve was first clinically used in 1969. A triple BSD valve replacement has not been quite common, because of high postoperative risk and complications, but there have been several cases with different postoperative course. The first implantation of artificial valve in Yugoslavia was done by Prof. Isidor Papo, in 1965. CASE REPORT: We presented patient with more than 30 years of successful triple (aortic, mitral and tricuspid) BSD valve functioning. This is a rare case of a triple BSD valve long-term functioning and, as far as we know, the case of the longest period of successful functioning of the triple BSD valves. In March 1977, a 34-year-old female with severe congestive heart failure of the New York Heart Association (NYHA) functional class IV was admitted to the Military Medical Academy, Belgrade, for triple valve (aortic, mitral and tricuspid) surgery with BSD mechanical valves. Complicated surgery was done well. Sixteen months later the patient was diagnosed with infective endocarditis caused by Enterobacter spp. that was isolated from blood cultures. The patient was successfully cured. After that the patient had no cardiovascular symptoms and regular physical and echocardiographic examinations used to reveal satisfactory cardiovascular function. The patient died more than 30 years after the surgery due to a terminal phase of uterine carcinoma. CONCLUSION: Although BSD valves were withdrawn from clinical use long time ago, there are still some rare cases of their successful functioning, mostly due to the precise surgical technique and regular follow-up by the cardiologists.

Gender differences in acute coronary syndrome in Serbia before organized primary PCI network service.

INTRODUCTION: Numerous studies were focused on coronary artery disease, most of them in the male population and it seems that data on gender differences in CAD were extrapolated from these studies. GOAL: The multi-center prospective study was designed to analyze gender differences in features, clinical presentation, and early in-hospital mortality in patients with acute coronary syndrome (ACS) admitted to coronary units in 50 hospitals in Serbia, during a 12 month-period. METHODS: The data were collected from the central register of ACS, analyzed with respect to gender differences. The study protocol included all consecutive patients with diagnosis of ACS. In the study 12,094 patients were analyzed, 7639 men and 4455 women. Women were significantly older than men in all ACS manifestations (p < 0.001). RESULTS: Incidence of myocardial infarction (MI) in women was the highest between the 7th and 8th life decade, while in men the highest incidence is observed between their sixties and seventies. Equalization in the incidences of MI in men and women is observed between the sixth and seventh life decades. There were significant differences in the incidence of fibrinolytic therapy and heart failure (p < 0.001) in favor of women. Women with unstable angina and NSTEMI had higher in-hospital mortality (2.4% vs. 1.7% and 9.0% vs. 7.1%, respectively), without statistical significance, while in STEMI the difference was highly statistically significant (16.1% compared to men 10.1), p < 0.001. DISCUSSION: The mean age of the greatest frequency of occurrence of MI has been shifted five years earlier in the population of women, different from other studies related to the analysis of MI by gender differences. CONCLUSION: Female mortalitywas significantly higher compared to the male population, thus more aggressive therapy should be administrated.

Cardiac autonomic dysfunction in patients with systemic lupus, rheumatoid arthritis and sudden death risk.

INTRODUCTION: The manifestations of autonomic nervous system (ANS) dysfunction in autoimmune diseases have been the subject of many studies. However, the published results pertaining to such research are controversial. Sudden cardiac death due to fatal arrhythmias is frequent in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). OBJECTIVE: To analyse risk predictors of sudden cardiac death related to the degree of autonomic dysfunction. METHODS: We performed cardiovascular ANS assessment in 90 patients in this case-controlled study, including 52 (6 male, 46 female) patients with SLE, 38 (6 male, 32 female) with RA and 41 (23 male, 17 female) healthy subjects. The methodology included a comprehensive ECG analysis (with Schiller software AT-10) of QTc interval, late potentials, short-term heart rate variability (HRV) and nonlinear HRV (Poincare plot) analysis; 24-hour Holter ECG monitoring with ECG QTc interval analysis, HRV analysis; 24-hour blood pressure monitoring with systolic and diastolic blood pressure variability; cardiovascular autonomic reflex tests (according to Ewing). Vagal dysfunction was established by performing 3 tests: Valsalva maneuver, deep breathing test and heart rate response to standing test. Dysfunction of the sympathetic nervous system was examined by applying 2 tests: blood pressure response to standing and handgrip test. RESULTS: In all cardiovascular reflex tests, the frequencies of abnormal results were significantly higher among the patients than among the healthy subjects. Severe autonomic dysfunction was more common in RA. QTc interval was more prolonged in patients with SLE. Both diseases were associated with depressed heart rate variability compared to controls, the reduction being greater in RA patients. In the patients with SLE, autonomic dysfunction is predominantly with higher sympathetic activity while in RA vagal predominance is evident. CONCLUSION: SLE and RA are associated with severe autonomic dysfunction and the presence of significant risk predictors related to the onset of sudden cardiac death.

Echocardiographic study of early left ventricular remodeling in highly trained preadolescent footballers.

Almost all the studies of athlete's heart have been carried out on adult and older adolescent players; hence the limited data on the cardiac response to exercise in the beginning of the active sports career in the youngest athletes. The study was designed to examine the physiological limits of left ventricle (LV) cavity size and wall thickness in elite footballers at the preadolescent age, it the beginning of the active sports career. Ninety-four highly trained male footballers (mean aged 12.85±0.84) competing in the Serbian Football League and 47 age-matched healthy male controls, aged 12-14, were enrolled in the study. All the echocardiographic findings were adjusted to BSA(-0.5), while left ventricle mass (LVM) was additionally adjusted to BSA(-1.5). Reference ranges were defined as values of 5-95th centile according to the mean values in both groups. The proportions of the footballers with LV dimensions outside expected ranges were additionally noted. The data indicate significant increases in absolute values of LV dimensions, aortic root size and left atrium (p<0.001) in preadolescent professional footballers compared with the values expected for age-matched controls, whereas there are no differences in absolute values of ventricular septal and posterior wall thickness, LV wall thickness and LVM (p>0.05). Upon body-size adjustments, significant increases were observed in all echocardiographic parameters (p<0.001). Our data indicate an early cardiac remodeling, already apparent in pre-adolescence, even after a short period of training.

The significance of amlodipine on autonomic nervous system adjustment (ANSA method): a new approach in the treatment of hypertension.

INTRODUCTION: Cardiovascular autonomic modulation is altered in patients with essential hypertension. OBJECTIVE: To evaluate acute and long-term effects of amlodipine on cardiovascular autonomic function and haemodynamic status in patients with mild essential hypertension. METHODS: Ninety patients (43 male, mean age 52.12 +/- 10.7) years with mild hypertension were tested before, 30 minutes after the first 5 mg oral dose of amlodipine and three weeks after monotherapy with amlodipine. A comprehensive study protocol was done including finger blood pressure variability (BPV) and heart rate variability (HRV) beat-to-beat analysis with impedance cardiography, ECG with software short-term HRV and nonlinear analysis, 24-hour Holter ECG monitoring with QT and HRV analysis, 24-hour blood pressure (BP) monitoring with systolic and diastolic BPV analysis, cardiovascular autonomic reflex tests, cold pressure test, mental stress test. The patients were also divided into sympathetic and parasympathetic groups, depending on predominance in short time spectral analysis of sympathovagal balance according to low frequency and high frequency values. RESULTS: We confirmed a significant systolic and diastolic BP reduction, and a reduction of pulse pressure during day, night and early morning hours. The reduction of supraventricular and ventricular ectopic beats during the night was also achieved with therapy, but without statistical significance. The increment of sympathetic activity in early phase of amlodipine therapy was without statistical significance and persistence of sympathetic predominance after a few weeks of therapy detected based on the results of short-term spectral HRV analysis. All time domain parameters of long-term HRV analysis were decreased and low frequency amongst spectral parameters. Amlodipne reduced baroreflex sensitivity after three weeks of therapy, but increased it immediately after the administration of the first dose. CONCLUSION: The results of the study showed that amlodipine affected autonomic modulation as a shift to sympathetic hyperactivity, but without statistical significance. In the selected group of patients with vagal predominance in sympathovagal balance, amlodipine increased sympathetic and decreases vagal activity. Therefore we conclude that amlodipine mostly exerts impact on autonomic function modulation in patients with vagal predominance in resting state.

Preoperative echocardiographic parameters influencing quality of life five years after coronary artery bypass graft surgery.

BACKGROUND/AIM: Factors associated with mortality and morbidity following coronary artery bypass graft surgery have been well defined and the Parsonnet score is widely used in mortality prediction. The evaluation of quality of life has not been still implemented in everyday work and preoperative echocardiographic factors affecting the quality of life in patients undergoing coronary artery bypass graft surgery have been poorly documented. The aim of this study was to evaluate echocardiographic parameters influencing quality of life following coronary artery bypass graft surgery and its correlation with widely used Parsonnet score. METHODS: A total of 449 consecutive patients with myocardial revascularization, operated during 1999 and 2000 were enrolled in this retrospective-prospective study. The patients with comorbidities were excluded as well as those with in complete myocardial revascularization. A group of 180 patients who accepted to participate in quality of life evaluation was followed for 60 months. The quality of life was evaluated using a questionnaire SF-36. RESULTS: The mean patients' age was 57.8 +/- 7.8 years, 79.4% were males. A 5-year survival was 84.2%. The mean number of risk factors was 3.4 +/- 1.0. Most of the patients were in New York Heart Association (NYHA) II class (104 of them or 59.4%), 61 of them (34.9%) in NYHA III class and only 10 patients or 5.7% of them were in NYHA IV class. The mean End-Diastolic Diameter (EDD) was 55.3 +/- 5.6 mm, mean End-Systolic Diameter (ESD) 38.7 +/- 5.6 mm and mean ejection fraction (EF) 51.7 +/- 9.6%. Left atrium dilatation (p < 0.001), as well as left ventricle dilatation (p < 0.001), low left ventricle ejection fraction (p < 0.001), multisegmental disorders of contractility (p < 0.001), and severe mitral regurgitation (p < 0.001) were in negative correlation with almost all dimensions of quality of life. ROC analysis showed that left ventricle EDD of 54.5 mm can be used as good cut-off value for prediction of optimal quality of life, with sensitivity of 57% and specificity of 70% (RR = 1.386), left ventricle ESD of 37.5 mm with sensitivity of 65% and specificity of 57% (RR = 0.855) and left ventricle EF of 50% with sensitivity of 61% and specificity of 70% (RR = 0.916). CONCLUSION: Echocardiographic parameters, that can easily be obtained preoperatively, have strong predictive value not only in postoperative survival, but also in determination of the quality of life of the patients five years after coronary artery bypass graft surgery.

Large saphenous venous graft aneurysm mimicking atypical mediastinal mass.

BACKGROUND: Saphenous venous graft (SVG) aneurysm is a very rare but potentially fatal complication of the coronary artery bypass surgery. CASE REPORT: We reported a case of 72-year-old man admitted to hospital because of atypical chest pain related to body motions in horizontal position, especially to the left side. Pain was followed by dispnea, palpitations, fatigue, cough, yellow sputum expectorations, as well as elevated temperature. He had had coronary artery bypass grafting (CABG) surgery with saphenous vein grafts (SVGs) to the left anterior descending artery (LAD) and right coronary artery (RCA) 27 years earlier. Chest X-ray revealed a poor-defined shadow in the region of the right atrium. A transthoracic echocardiogram revealed an atypical tumorous mediastinal mass near the right atrium and right ventricle that seemed partially calcified on transesophaeal echocardiography (TEE). CT scan confirmed an atypical mediastinal mass in contact with the right ventricle that might be a right ventricle aneurysm, pericardial cyst or SVG aneurysm. Coronary angiography was performed subsequently and it revealed a big saphenous venous graft aneurysm originating from the previous venous graft to the RCA. The aneurysm was resected and a new bypass graft was placed. Histopathology confirmed a true aneurysm of the venous graft. CONCLUSION: Although SVG aneurysm is a very rare complication of CABG surgery, patients presenting with atypical hilar or mediastinal mass following CABG should always be evaluated firstly for existence of this cardiosurgical complication.

Cardio-renal effects of the A1 adenosine receptor antagonist SLV320 in patients with heart failure.

BACKGROUND: Blocking the tubuloglomerular feedback mechanism with adenosine A1 receptor antagonists seems to improve diuresis and sodium excretion without compromising the glomerular filtration rate in patients with heart failure. However, the direct cardiac effects of this compound class have not been investigated to date. METHODS AND RESULTS: In total, 111 patients (109 men and 2 women) received a 1-hour infusion of 5, 10, and 15 mg SLV320, an adenosine A1 receptor antagonist, placebo, or 40 mg furosemide. Mean age was 57.9 years, mean ejection fraction was 28.1%, 82 patients were of New York Heart Association class II, and 29 patients were of New York Heart Association class III. Hemodynamic parameters (heart rate, blood pressure, pulmonary capillary wedge pressure, mean pulmonary arterial pressure, systemic vascular resistance, right atrial pressure, and cardiac output) were determined. Kidney function was assessed by cystatin C measurements and by analysis of urine output and urine electrolytes. In addition, pharmacokinetics of SLV320 and ex vivo inhibition of adenosine A1 receptor activity were performed. SLV320 was well tolerated, and no serious adverse events were observed. Heart rate, blood pressure, pulmonary capillary wedge pressure, mean pulmonary arterial pressure, right atrial pressure, and cardiac output were not altered by any dose of SLV320. Pulmonary capillary wedge pressure was significantly (P=0.04) decreased by furosemide (-6.2+/-5.9 mm Hg). Systemic vascular resistance was significantly (P=0.04) increased in the furosemide group (+166.70+/-261.87 dynes . s(-1) . cm(-5)), whereas all SLV320 groups showed no significant alterations of systemic vascular resistance. Changes from baseline cystatin C plasma concentrations decreased after 10 mg SLV320 (-0.093+/-0.137 mg/L, P=0.046), whereas furosemide resulted in a significant (P=0.03) increase of cystatin C (+0.052+/-0.065 mg/L) versus baseline. All values represent mean changes+/-SD from baseline at 3 hours postdosing: SLV320 (10 and 15 mg) increased significantly sodium excretion and diuresis compared with placebo during the 0- to 6-hour collection period postdosing. CONCLUSIONS: SLV320 infusion shows no immediate effects on cardiac hemodynamics. SLV320 might improve glomerular filtration rate while simultaneously promoting natriuresis and diuresis. Clinical Trial Registration- clinicaltrials.gov Indentifier: NCT00160134.

[Hospital mortality trend analysis of patients with ST elevation myocardial infarction in the Belgrade area coronary care units].

INTRODUCTION: Mortality in ST elevation myocardial infarction (STEMI) ranges from 4-24% and is dependent on the variety of patients' clinical characteristics (CC) that are present prior to and within the first hours of the onset of MI, affecting reliability of the diagnosis. The higher mortality rate of patients with STEMI should be associated with a higher rate of applied reperfusion therapy according to guidelines and randomized study results, which is in opposition to everyday hospital practice. OBJECTIVE: The aim of this study was to analyze the mortality of STEMI patients in relationship to their clinical characteristics at presentation, their age, sex, risk factors, prior coronary disease, and time interval from symptom onset to hospital presentation, complications and administered therapy. METHOD: The analysis involved patients treated in five coronary care units, four Belgrade Hospital Centres and the Belgrade Emergency Centre of the Clinical Centre of Serbia. Evaluated data was obtained from the Serbian National Registry for Acute Coronary Syndrome (REAKSS) and databases of local coronary care units (CCU). RESULTS: During 2005 and 2006, a total of 2739 patients with STEMI, of average age 63.3 +/- 11.7, with 64.9% males aged 61.3 +/- 11.7 and 35.1% females aged 67.0 +/- 10.7 (p < 0.01) who underwent treatment. Most of the patients (80.5%) were distributed within the elderly groups of 60, 70 and 80 years of age, with the highest percent of mortality rate (45.9%) noted at age 80 years. Anterior localization of myocardial infarction was observed in 40.2% of patients, with lethal outcome in 21.4% patients, while 59.8% of patients suffered inferiorly localized MI with much lower mortality rate (12.2%, p < 0.01). In 2005, STEMI was registered in 48.7%, while in 2006 in 44.7% of patients. Prior angina pectoris was present in 19.9% of patients, more frequently among women (p < 0.05), prior MI in 14.5% of patients, more often among males (p < 0.05), while aortocoronary revascularization was found in 3.9% of patients. Hospital mortality rate due to STEMI was higher in the group of patients with a history of prior MI (19.1% vs. 15.7%; p > 0.05). Regarding risk factors, hypertension was present in 61.8% of patients, more often among women (69.1% vs.57.9%) (p < 0.01), carrying a higher mortality rate of 18.9% vs. 9.9% among males (p < 0.01). Hyperlipidemia was found in 31.9% of patients; more frequently among women 34.8% vs. 30.4% males (p < 0.05), as well as diabetes mellitus observed in 25.1% of patients; 22.4% males and 30.1% females (p < 0.01). 39.6% of patients were smokers; 46.9% males and 28.0% females (p < 0.01). Heart failure had 33.4% of patients; mortality rate was registered in 28.2% of patients, and was significantly higher than in the non heart failure group (7.9%, p < 0.01). Heart rhythm disorders were registered in 21.3% of patients, more frequently involving posterior MI 55.3% vs 44.7% of anterior MI (p > 0.05), and was significantly higher among females 23.5% vs. 20.1% in males (p < 0.05). In 2005 in Belgrade hospitals, reperfusion therapy (RT) was performed in 34.6% of patients, mostly as thrombolytic therapy (TT) (in 99.0% of patients), and as percutaneous coronary intervention (PCI) in 1.0% of patients. STEMI mortality rate was 12.8%. In 2006, in the CCU of the In the Emergency Center RT was applied in 48.0% of patients, TT in 13.8% and PCI in 34.2%, while classical therapy without RT was applied in 52.0% of patients. CONCLUSION: Clinical characteristics significantly influence mortality in STEMI; a significantly higher mortality is among women, patients in their 80's and 90's, anterior MI localization and prior coronary disease. RT significantly lowers mortality in STEMI compared to the use of classical therapeutic approach and therefore STEMI patients with a higher mortality determined by their prehospital charactheristics, i.e. higher risk, are those who have higher benefit of RT, which should be taken into consideration when making decision about the therapy of choice.

Markers of oxidative damage in chronic heart failure: role in disease progression.

BACKGROUND: We aimed to study the relationship between markers of oxidative lipid or protein damage and ventricular remodeling and the validity of 8-epi-prostaglandin F(2alpha) (8-epi-PGF(2alpha)) as an indicator of disease severity in patients with ischemic chronic heart failure (CHF). PATIENTS AND METHODS: We enrolled four groups of 12 patients with varying CHF according to the New York Heart Association (NYHA) classification and 25 controls. Urinary 8-epi-PGF(2alpha) and plasma malondialdehyde and protein thiol (P-SH) groups were correlated with echocardiographic indices of remodeling. The reliability of isoprostanes was analyzed by a receiver operating characteristics (ROC) curve. RESULTS: NYHA class III and IV patients exhibited elevated 8-epi-PGF(2alpha) levels, increased malondialdehyde concentrations and decreased P-SH groups when compared to controls and NYHA I and II patients. 8-Epi-PGF(2alpha) and P-SH groups correlated significantly with indices of remodeling. The ROC curve drawn for 8-epi-PGF(2alpha) allowed us to differentiate NYHA class III and IV patients from NYHA class I and II patients with a sensitivity of 95.8% and specificity of 95.8% (cut off 0.84 ng/mg creatinine; area under curve 0.99; P < 0.001). CONCLUSIONS: Markers of oxidative damage are unlikely to play a significant role in early stages of CHF. However, they might become important in the course of CHF when their concentrations reach critical levels. Urinary 8-epi-PGF(2alpha) is a reliable indicator of symptomatic CHF.

[Prognostic value of Poincare plot as nonlinear parameter of chaos theory in patients with myocardial infarction].

INTRODUCTION: There are different proofs about association of autonomic nervous system dysfunction, especially nonlinear parameters, with higher mortality after myocardial infarction. OBJECTIVE: The objective of the study was to determine predictive value of Poincaré plot as nonlinear parameter and other significant standard risk predictors: ejection fraction of the left ventricle, late potentials, ventricular arrhythmias, and QT interval. METHOD: The study included 1081 patients with mean follow-up of 28 months (ranging from 0-80 months). End-point of the study was cardiovascular mortality. The following diagnostic methods were used during the second week: ECG with commercial software Schiller AT-10: short time spectral analysis of RR variability with analysis of Poincaré plot as nonlinear parameter and late potentials; 24-hour ambulatory ECG monitoring: QT interval, RR interval, QT/RR slope, ventricular arrhythmias (Lown > II); echocardiography examinations: systolic disorder (defined as EF < 40%). RESULTS: There were 103 (9.52%) cardiovascular deaths during the follow-up. In univariate analysis, the following parameters were significantly correlated with mortality: mean RR interval < 800 ms, QT and RR interval space relationship as mean RR interval < 800 ms and QT interval > 350 ms, positive late potentials, systolic dysfunction, Poincaré plot as a point, ventricular arrhythmias (Lown > II). In multivariate analysis, the significant risk predictors were: Poincaré plot as a point and mean RR interval lower than 800 ms. CONCLUSION: Mean RR interval lower than 800 ms and nonlinear and space presentation of RR interval as a point Poincaré plot were multivariate risk predictors.