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Boskovic N, Giga V, Dedic S, Ostojic M, Karadzic T, Rakocevic I, Aleksandric S, Petrovic O, Tesic M, Jovanovic I, Nedeljkovic I, Banovic M, Beleslin B, Djordjevic-Dikic A. Additive negative prognostic value of coronary flow reserve in patients with left bundle branch block without inducible ischemia and without known coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left bundle branch block (LBBB) can be isolated thing, but it is also often associated with underlying coronary artery disease (CAD). Stress echocardiography (SECHO) is widely used as an imaging method for the diagnosis of CAD. However, the diagnostic value of stress echocardiography in patients (pts) with LBBB is limited.
Purpose
To evaluate negative prognostic value of coronary flow reserve (CFR) in pts with LBBB without inducible ischemia and without known CAD.
Methods
This retrospective study included 224 pts (98, 43.8% male gender, average age 66±11 years) with LBBB and without known CAD. All the pts had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), Duke treadmill score, functional capacity (Metabolic Equivalents - METs) were recorded in all pts. Out of 224 pts, in 64 (29.5%) coronary flow reserve on the left anterior descending artery was assessed using pulsed Doppler echocardiography with adenosine in a dose of 140μcg/kg/body weight during 3 minutes. As the normal value we took value of CFR ≥2. Median follow up of the pts was 72 months (IQR 56.25–132 months) for the occurrence of MACE (cardiovascular death (CVD), non-fatal myocardial infarction (nfMI), coronary artery bypass graft (CABG) and percutaneous coronary revascularization (PCI).
Results
Out of 224 pts, 6 (2.7%) had positive SECHO test, 2 pts (0.9%) had died due to non-cardiac causes and 11 pts (4.9%) were lost to follow up so they were excluded from further analysis. The remaining 204 pts were divided in 2 groups: 1. pts with only negative SECHO (n=144, 68.8%); 2. pts with negative SECHO and normal CFR (n=64, 31.2%). During the follow-up period 22 out of 205 pts (10.7%) had an adverse event (6 CVD, 6 nfMI, 5 CABG, 8 PCI). Between the two groups there was no significant difference in risk factors and parameters of the SECHO test. Pts with CFR had significantly lower rate of MACE compared to the pts with only SECHO test (2, 3.1% vs 20, 14.2%, p=0.018, respectively). Using the Cox regression analysis, univariate predictors of MACE were insulin dependent diabetes (HR 10.851 [95% CI 2.095–56.220], p=0.004), Duke score (HR 0.603 [95% CI 0.414–0.878], p=0.008), and MET (HR 0.393 [95% CI 0.209–0.737], p=0.004). In the multivariate analysis only the insulin dependent diabetes remained an independent predictor of MACE (HR 6.906 [95% CI 1.100–43.363], p=0.039). Using the Kaplan-Meier survival curve we see that the pts with SECHO test and CFR had shorter event-free time compared to the pts with SECHO test (136.3±3.6 months vs 149.8±2.9 months, Log Rank 4.022, p=0.045) (Figure 1).
Conclusion
Normal value of CFR has good negative prognostic value in pts with LBBB without inducible ischemia and without known CAD, while pts with insulin dependent diabetes have more pronounced risk for the occurrence of adverse events.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Boskovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - V Giga
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - S Dedic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - M Ostojic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - T Karadzic
- Medical Faculty, University of Belgrade , Belgrade , Serbia
| | - I Rakocevic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - S Aleksandric
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - O Petrovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Tesic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - I Jovanovic
- Clinical center of Serbia, Cardiology Clinic , Belgrade , Serbia
| | - I Nedeljkovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - M Banovic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - B Beleslin
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
| | - A Djordjevic-Dikic
- Clinical center of Serbia, Faculty of Medicine, University of Belgrade, Cardiology department, Clinical Center of Serbia , Belgrade , Serbia
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Ciampi Q, Picano E, Djordjevic Dikic A. Haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise test in patients with ANOCA (SESPASM). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with angina and non-obstructed coronary arteries (ANOCA), functional dysregulation such as epicardial coronary spasm and microvascular dysfunction (microvascular spasm and /or impaired microvascular dilatation) frequently coexist.
The aim was to analyse haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise stress echo test in patients with ANOCA.
Methods
In a prospective study we enrolled 38 patients (56±13 years, 31 females) with ANOCA, proven by normal coronary angiogram. Stress echocardiography protocol with Doppler measurements of coronary flow consisted of hyperventilation test for spasm provocation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise test (HYP+EXE) for assessment of endothelium dependent function. Adenosine test was done (ADO 140 mcg/kg in 1 min) for estimation of endothelium independent vasodilatation. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography at the end of the each stage of the test. Abnormal response to HYP was a CFV ratio (stress/rest) <1.0 (vasoconstrictor response). CFV ratio at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation (<2 blunted response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response).
Results
The double product increased during HYP in comparison to rest (13263 vs 10321, p<0.001), and further increased with EXE (23817 vs HYP, p<0.001). Chest pain was present in 6 pts during HYP, and in additional three pts during HYP+EXE (15.8% vs 23.7%, p=0.25). ST segment depression was present in 6 pts during HYP and 23 during HYP+EXE (15.79% vs 60.52%, p<0.001). Wall motion abnormality was provoked with HYP in three pts (7.89%) and in ten (26.3%) with HYP+EXE (p=0.016). CFV ratio was abnormal for vasoconstriction during HYP in 16 (42.1%) and blunted in 23 (60.52%) pts during HYP+EXE (Fig 1). Vasodilation during ADO was preserved in all patients, but one. There was significant difference between CFV reserve during HYP+EXE vs ADO (1.98±0.49 vs 2.53±0.43 respectively, p<0.001) (Fig. 2).
Conclusion
Our results indicate that HYP induce microvascular dysfunction with vasospastic component which is reflected in reduced CFV ratio. This prevents the normal hyperemic response during EXE in more than a half of patients. Endothelial independent vasodilatation during ADO hyperemia was perserved in all patients, excluding structural microvasculature remodeling. HYP+EXE provocation with noninvasive measurement of coronary flow is a promising test for assessing mechanism of arteriolar dysregulation in ANOCA patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Dedic
- School of Medicine, Belgrade University , Belgrade , Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology , Belgrade , Serbia
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento , Benevento , Italy
| | - E Picano
- Institute of Clinical Physiology (IFC) , Pisa , Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology , Belgrade , Serbia
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3
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Aleksandric S, Al-Lamee R, Djordjevic-Dikic A, Giga V, Tesic M, Banovic M, Zobenica V, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Davies J, Beleslin B. Diagnostic accuracy of instantaneous wave-free ratio at rest and during dobutamine provocation to assess myocardial bridging relevance. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diastolic fractional flow reserve (d-FFR) during dobutamine provocation (DOB) was found to be a more reliable physiological index for the functional assessment of myocardial bridging (MB). However, d-FFR calculation is complicated and time-consuming, and therefore several authors have suggested the use of instantaneous wave-free ratio (iFR) to overcome these issues.
Purpose
The aim of our study was to assess diagnostic performance of d-FFR and iFR at rest and during DOB with exercise-induced myocardial ischemia as reference.
Methods
Twenty-four symptomatic patients (17 males, mean age 58±8 years) with MB and systolic compression ≥50% diameter stenosis on the left anterior descending (LAD) artery were included. Exercise stress-echocardiography test (SE), and both d-FFR and iFR in the distal segment of LAD at rest and peak DOB (30–50μg/kg/min), were performed in all patients. Optimal cut-off values and diagnostic performance of resting and hyperemic d-FFR and iFR were assessed using SE.
Results
Exercise-SE was positive for myocardial ischemia in 7/24 patients (29%). The area-under-the-receiver-operating-characteristic curve (ROC-AUC) for exercise-induced myocardial ischemia was 0.64 (95% CI: 0.400–0.885) for resting d-FFR, 0.62 (95% CI: 0.378–0.866) for resting iFR, 1.000 (95% CI: 0.999–1.000) for d-FFR at peak DOB, and 0.96 (95% CI: 0.895–1.000) for iFR at peak DOB. No significant difference in ROC-AUC was observed between d-FFR and iFR at peak DOB (p=0.243). The best cut-off value for both d-FFR and iFR at peak DOB was <0.76 with similar sensitivity and negative predictive values (100 vs. 100% for both), but lower specificity and positive predictive value for iFR in identifying MB associated with exercise-induced ischemia (94% vs. 82%; 88% vs. 70%, respectively). Compared with exercise-induced myocardial ischemia, the diagnostic accuracy of d-FFR and iFR at peak DOB was 96% (kappa=0.903, p<0.001) and 88% (kappa=0.731, p<0.001), respectively.
Conclusions
iFR during DOB provocation showed similar diagnostic accuracy as d-FFR to identify the functionally significant MB when compared with exercise-induced myocardial ischemia.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - R Al-Lamee
- Imperial College London , London , United Kingdom
| | | | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Tomasevic
- Clinical Center Kragujevac, Clinic for Cardiology , Kragujevac , Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
| | - J Davies
- Imperial College London , London , United Kingdom
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology , Belgrade , Serbia
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Boskovic N, Giga V, Djordjevic-Dikic A, Beleslin B, Stojkovic S, Nedeljkovic I, Aleksandric S, Tesic M, Dedic S, Burazor I, Karadzic T, Paunovic I, Jovanovic I. Comparison of SCORE and SCORE 2 risk prediction tools in contemporary very high risk european population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
New SCORE 2 algorithm overperformed SCORE algorithm in population with decreasing prevalence of cardiovascular (CV) morbidity and mortality. However, there is limited data in risk stratification with SCORE 2 model in contemporary populations from very high risk countries.
Aim
The aim of this study was to compare risk prediction using SCORE 2 and SCORE model and to compare the proportions of patients requiring statin treatment in primary prevention.
Methods
Our study included 1317 patients (511, 38.8% male gender, average age 54±8) without known CV disease aged 40 to 70 years. Data on CV risk factors were prospectively collected in 20 primary care centers throughout the Serbia from January 2020. to December 2020. Based on the CV risk profile, patients were stratified into 4 categories: low, moderate, high and very high risk according to SCORE model and into 3 categories: low to moderate, high and very high risk according to SCORE 2 model. The number of patients requiring statin treatment was assessed according to the risk category and value of LDL cholesterol in SCORE model and the value of non-HDL cholesterol in SCORE 2 model.
Results
Overall, 589 patients (44.7%) were smokers, mean value of total cholesterol was 6.2±1.1 mmol/L, LDL 3.9±1.1, HDL 1.4±0.5, non HDL 4.8±1.2 mmol/L. Systolic blood pressure was 138.6±19.6, diastolic blood pressure was 85.3±10.4 mmHg and was BMI 26.9±5.2. Based on the SCORE model 166 patients (12.6%) were classified into low risk category, 658 (49.9%) into moderate, 276 (20.9%) into high risk and 217 (16.6%) into very high risk category. Based on the SCORE 2 model 30 (2.8%) patients were classified into low to moderate, 273 (18%) and 1014 (79.2%) into very high risk category. There was significantly less patients in low to moderate group in SCORE 2 model compared to SCORE model (30, 2.8% vs 824, 62.6%, p<0.001 respectively) and significantly more patients with very high risk (1014, 79.2% vs 217, 16.6%, p<0.001), but without significance difference in the high risk group (Figure 1). The use of SCORE 2 model resulted in significantly higher proportion of patients requiring statin treatment 93% vs. 43% using SCORE model (p<0.001).
Conclusion
The use SCORE 2 risk prediction tool, in comparison to SCORE model, results in significant higher proportion of patients being classified as very high risk category with the increase number of patients requiring statin treatment in primary prevention.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Krka Farma
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School , Belgrade , Serbia
| | - V Giga
- University Belgrade Medical School , Belgrade , Serbia
| | | | - B Beleslin
- University Belgrade Medical School , Belgrade , Serbia
| | - S Stojkovic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Nedeljkovic
- University Belgrade Medical School , Belgrade , Serbia
| | - S Aleksandric
- University Belgrade Medical School , Belgrade , Serbia
| | - M Tesic
- University Belgrade Medical School , Belgrade , Serbia
| | - S Dedic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Burazor
- University Belgrade Medical School , Belgrade , Serbia
| | - T Karadzic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Paunovic
- University Belgrade Medical School , Belgrade , Serbia
| | - I Jovanovic
- University Belgrade Medical School , Belgrade , Serbia
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5
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Ciampi Q, Picano E, Djordjevic Dikic A. Assessment of left ventricular contractile reserve during hyperventilation and exercise in patients with ANOCA. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction. Mechanism of ischemia in patients with angina and no obstructive coronary artery disease (ANOCA), is often unrecognized since invasive tests are seldom done and proper noninvasive test is not established yet.
The aim of our study was to assess changes in ventricular function during hyperventilation test (HYP) designed to provoke vasoconstriction, immediately followed by supine bicycle exercise to increase ischemic stimuli in patients with ANOCA (HYP + EXE).
Methods. : In a prospective study, we enrolled 29 ANOCA patients (age 59.6 ±11 years, 27 females) with previously normal angiograms. All patients underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5"), immediately followed by supine bicycle exercise (HYP + EXE). Ventricular function was assessed based on left ventricular contractile reserve (LVCR), calculated by ratio of the ventricular force at the peak of the each stress level and rest. Force was assessed as the quotient between systolic arterial pressure and end-systolic volume determined by two-dimensional echocardiography. Values range from normal (> 2.0) to mild (1.5–2.0), moderate (1.01–1.49), and severe (≤1.0) dysfunction. For LVCR HYP values are shifted towards lower values (abnormal < 1.1).
Results. Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP + EXE (13.8% vs 24.1 %, p = 0.001). Three patients showed wall motion abnormalities with hyperventilation and additional two patients with HYP + EXE. LVCR HYP response was normal in 19/29 (65.5%) pts and abnormal in 10/29 (34.5%) pts. LVCR HYP + EXE response was normal in 9/29 (31%) pts, 4/29 (13.8%) pts had mild, 11/29 (37.9%) pts had moderate and 5/29 (17.3%) pts had severe dysfunction.
Conclusion. In patients with ANOCA subtle changes in LV function occurred with HYP and EXE stress more often than wall motion abnormality. Measurement of contractile reserve might be a useful tool in assessment of ischemia and ventricular dysfunction in patients with ANOCA. Abstract Figure 1. Abstract Figure 2.
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - Q Ciampi
- Fatebenefratelli Hospital of Benevento, Division of cardiology, Benevento, Italy
| | - E Picano
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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6
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Aleksandric S, Djordjevic-Dikic A, Tesic M, Giga V, Dobric M, Banovic M, Boskovic N, Juricic S, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Nedeljkovic M, Stankovic G, Beleslin B. Cut-off value of coronary flow velocity reserve obtained by transthoracic Doppler echocardiography during intravenous infusion of dobutamine for diagnosis of functional significant myocardial bridging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Recent studies showed that coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) during inotropic stimulation with dobutamine (DOB), in comparison to vasodilation with adenosine, provides more reliable functional evaluation of myocardial bridging (MB). However, the adequate cut-off value of CFVR during DOB for diagnosing functional significant MB has not been fully established.
Purpose
The purpose of the study was to evaluate the adequate cut-off value of TTDE- CFVR during DOB for diagnosis of functional significant MB.
Methods
This prospective study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery (LAD) and systolic compression ≥50% diameter stenosis. Exercise stress-echocardiography test (ExSE) and TTDE-CFVR in the distal segment of LAD during DOB infusion (DOB: 10–40μg/kg/min) were performed in all patients. Percent diameter stenosis (DS) of MB at end-systole and end-diastole were analyzed using quantitative coronary angiography.
Results
Exercise-SE was positive for myocardial ischemia in 22/79 (28%). CFVR during peak DOB was significantly lower in SE-positive group in comparison to SE-negative group (1.94±0.16 vs. 2.78±0.53, p<0.001). ROC analysis identifies the optimal CFVR during peak DOB cut-off value <2.1 (AUC 0.985, 95% CI: 0.965–1.000, p<0.001), with a sensitivity of 96% and specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%, for identifying functionally significant MB associated with stress-induced myocardial ischemia. The categorical agreement between TTDE-CFVR at peak DOB and ExSE was high (kappa value = 0.877, p<0.001). Multivariate logistic regression analysis showed that percent DS at end-diastole was the only independent predictor of ischemic CFVR value <2.1 (OR: 1.136, 95% CI: 1.045–1.235, p=0.003).
Conclusion
A cut-off value <2.1 of CFVR during DOB infusion obtained by TTDE may adequate discriminate functional significant MB that induce myocardial ischemia which is caused by an incomplete diastolic MB-decompression.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Banovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Nedeljkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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7
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Dedic S, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Picano E, Djordjevic Dikic A. Noninvasive functional testing in ANOCA: hyperventilation-exercise study for spasm (SESPASM). Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In patients with angina and no obstructive coronary artery disease (ANOCA), different mechanisms of ischaemia, epicardial spasm, microvascular spasm, and impaired microvascular dilatation frequently coexist.
The aim was to assess CFVR changes during coronary vasoconstrictor and vasodilator stimuli in patients with ANOCA.
Methods
In a prospective single center study, we enrolled 29 ANOCA patients (age 59.6±11 years, 27 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO 140 mcg/kg in 1 min) on the other day. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio <1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.
Results
The double product increased during HYP, in comparison to rest (13213 vs 10517, p<0.01), and further increased with EXE (23387 vs HYP, p<0.001). Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP+EXE (13.8% vs 24.1%, p=0.001). ST segment depression (≥1mm) was present in 7/29 patients during HYP, and 14/29 during HYP+EXE (24.13% vs 48.3%, p<0.01). Five patients (17%) showed regional wall motion abnormalities with HYP+EXE. CFVR response was abnormal in 19/29 (65%) patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 13 (44%). Vasodilation during ADO was preserved in all patients.There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.35 vs 2.47±0.42 respectively, p<0.01), and between CFVR HYP and ADO (1.28±0.29 vs 2.47±0.42, p<0.001).
Conclusion
In patients with ANOCA, HYP+EXE is a more powerful ischemic stress than HYP alone. In over one-half of patients HYP+EXE unmasks abnormalities in CFVR response and/or regional wall motion, likely unmasking the underlying endothelium dependent microcirculatory dysfunction with enhanced vasoconstriction in 44% of the patients and mixed vasoconstriction and reduced relaxation in 65%.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): University Clinical Centre of Serbia, Faculty of Medicine
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - I Nedeljkovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - E Picano
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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8
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Trifunovic Zamaklar D, Krljanac G, Asanin M, Savic-Spasic L, Vratonjic J, Arnautovic N, Aleksandric S, Cucic L, Sulovic V, Mrdovic I. Myocardial deformation imaging in early prediction of heart failure development after STEMI is better than conventional echocardiography: true or false? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
onbehalf
PREDICT-VT
Heart failure (HF) still develops in 4% up to 28% of STEMI pts treated by pPCI, with the highest incidence in the first year. Accurate and early identification of high-risk patients would allow targeted and personalized intensive treatment .
Aim
the current study is a sub-study of PREDICT-VT study (NCT03263949). Its aim is to define multi-parametric model for early HF prediction in STEMI patients treated by pPCI, based on clinical data, conventional echocardiographic data and data from myocardial deformation analysis obtained by early speckle tracking echocardiography.
Methods
in 307 consecutive pts enrolled in PREDICT-VT, early echocardiography (5 ± 2 days after pPCI) was done and included LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV indices of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains were also calculated .
Results
From 242 patients who completed 1-year follow-up, 9 % develop HF NYHA class 3 or 4, 27 % NYHA class 2 and remaining 64% were in NYHA class I. Significant univariate NYHA predictors were: from clinical parameters - female gender (ß =0.156, p = 0.015; 95% CI -0.431 to – 0.047), older age (ß =0.130, p = 0.044; 95% CI 0.000 to 0.017), Killip class on admission (ß=0.131, p = 0.043; 95% CI 0.007 to 0.435) and previous atrial fibrillation (ß=0.181, p = 0.005; 95% CI 0.175 to 0.960); from conventional echo parameters- LVEF (ß=-0.302, p < 0.001; 95% CI -0.029 to -0.012), LAVI (ß=0.134, p = 0.046; 95%CI 0.000 to 0.030), degree of diastolic dysfunction (ß=0.297, p < 0.001; 95% CI 0.192 to 0.465) and TAPSE (ß=-4.255, p < 0.001); from parameters of longitudinal LV deformation – peak systolic epicardial LS (ß=0.293, p < 0.001; 95% CI 0.030 to 0.074), SRs (ß=0.274, p < 0.001; 95% CI 0.398 to 1.069) and epicardial PSS (ß=0.336, p < 0.001; 95%CI 0.925 to 2.019); from parameters of LV circumferential deformation – peak systolic endocardial CS (ß=0.254, p < 0.001; 95% CI 0.013 to 0.041), SR E (ß= -0.247, p < 0.001; 95%CI -0.556 to -0.173) and epicardial PSS CS (ß=0.206, p = 0.003; 95% CI 0.302 to 1.473); from left atrial mechanics - LA strain (ß=-0.231, p = 0.001; 95% CI -0.025 to -0.007).
Predictive power of model based on clinical variables (Killip class on admission, female gender, and history of atrial fib) for HF development was significantly improved when conventional ehocardiographic variables were added (LVEF, TAPSE, degree of diastolic function) (R2 from 0.076 to 0.197, p < 0.001). However, addition of MDI parameters (longitudinal and cirumferential PSS on epicardial levels) increased it further (R2 from 0.200 to 0.229, p < 0.001).
Conclusion
above from clinical and conventional echocardiographic parameters, amount of left ventricular post-systolic deformation in longitudinal and circumferential directions, expressed as LV indexes of post-systolic shortening, significantly improved early prediction of HF after pPCI.
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Affiliation(s)
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - J Vratonjic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - N Arnautovic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Cucic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - V Sulovic
- Clinical center of Serbia, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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9
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Trifunovic Zamaklar D, Krljanac G, Asanin M, Savic-Spasic L, Vratonjic J, Arnautovic N, Aleksandric S, Sulovic V, Cucic L, Mrdovic I. Left ventricular and left atrial deformation imaging early after pPCI: does diabetes mellitus make any difference? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
onbehalf
PREDICT-VT
More extensive coronary atherosclerosis in diabetes mellitu (DM) induces poorer clinical outcomes after STEMI, but there are data suggesting that impaired myocardial function in DM, even independently from epicardial coronary lesions severity, might have detrimental effect, predominately on heart failure development in DM.
Aim
the current study is a sub-study of PREDICT-VT study (NCT03263949), aimed to analyse LV and LA function using myocardial deformation imaging based on speckle tracking echocardiography after pPCI in STEMI patients with and without DM.
Methods
in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and analysis of LV rotation mechanic.
Results
from 242 patients who completed 1 year follow up, 48 (20%) had DM. Pts with DM were older (60 ± 1,01 vs 57 ± 10; p = 0.067) and had insignificantly higher SYNTAX score (18.5 ± 9.2 vs 15.8 ± 9.8, p = 0.118) . However, diabetics had more severely impaired EF (44.2 ± 8.6 vs 49.2 ± 9.8, p = 0.001), E/A ratio (0.78 ± 0.33 vs 0.90 ± 0.34; p = 0.036) and MAPSE (1.18 ± 0.32 vs 1.32 ± 0.33; p = 0.001). Global LV LS on all layers (endo: -13.6 ± 4.0 vs-16.2 ± 4.7; mid: -11.9 ± 3.5 vs -14.1 ± 4.1; epi: -10.4 ± 3.1 vs -12.3 ± 3.6; p < 0.005 for all) was impaired in DM patients, as well as longitudinal systolic SR (-0.71 ± 0.23 vs -0.84 ± 0.24; p = 0.001) and SR during early diastole (0.65 ± 0.26 vs 0.83 ± 0.33, p < 0.001). Patients with DM had more pronounced longitudinal posts-systolic shortening throughout LV wall (endo: 21.4 ± 16.1 vs 13.7 ± 13.3, p = 0.005; mid: 21.9 ± 16.1 vs 14.3 ± 13.1, p = 0.006; epi: 22.4 ± 16.5 vs 15.3 ± 13.7, p = 0.010) and higher LV mechanical dispersion (MDI: 71.3 ± 38.3 vs 59.0 ± 18.9, p = 0.037). LA strain was significantly impaired in DM patients (18.9 ± 7.7 vs 22.6 ± 10.0, p = 0.011) and even more profoundly LA strain rate during early diastole (-0.73 ± 0.48 vs -1.00 ±0.58, p = 0.002). Patients with DM also had more impaired LV global (15.7 ± 9.1 vs 19.8 ± 10.4, p = 0.013) radial strain, global LV circumferencial strain, especially at the mid-wall level (-13.9 ± 4.2 vs -16.0 ± 4.3, p = 0.005) and impaired circumferential SR E (1.25± 0.44 vs 1.49 ± 0.46, p = 0.003). End-systolic rotation of the LV apex was more impaired in DM (4.7 ± 5.1 vs 6.8 ± 5.5, p= 0.022). During 1 year follow-up heart failure and all-cause mortality tend to be higher among DM pts (46.7% vs 35.2%, p = 0.153).
Conclusion
STEMI patients with DM have more severely impaired LV systolic and diastolic function estimated both by traditional parameter and advanced echo techniques. These results might, at least partially, explain why outcomes after STEMI in DM might be poorer, even in the absence of more complex angiographic findings, pointing to the significance of impaired myocardial function DM itself.
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Affiliation(s)
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - J Vratonjic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - N Arnautovic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - V Sulovic
- University Belgrade Medical School, Belgrade, Serbia
| | - L Cucic
- University Belgrade Medical School, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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10
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Trifunovic Zamaklar D, Krljanac G, Asanin M, Savic-Spasic L, Vratonjic J, Arnautovic N, Aleksandric S, Vorkapic M, Cucic L, Mrdovic I. Can analysis of myocardial mechanic help me to predict heart failure development in my STEMI patient whose EF is equal or above 50% after pPCI? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
onbehalf
PREDICT-VT
In spite of contemporary STEMI management, heart failure (HF) develops in 4% up to 28% of pPCI-treated patients, with the highest incidence in the first year. Left ventricular ejection fraction (EF) is strong predictor predominately for HFrEF development, but risk stratification in case of preserved post pPCI EF (i.e. EF ≥ 50%) is still challenging.
Aim
the current study is a sub-study of PREDICT-VT study (NCT03263949). Its aim is to define clinical and "echocardiographic" profile of STEMI patient at risk to develop HF despite preserved post pPCI EF, including not only conventional echocardiographic data, but data from myocardial mechanic analysis obtained by early speckle tracking echocardiography.
Methods
in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done and included LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), calculation of LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and thorough analysis of LV rotation mechanic.
Results
From 242 patients who completed 1-year follow-up, 109 pts (45 %) had post pPCI EF ≥50%. Of those patients 34 (31%) became NYHA ≥ 2 or died during 1-year follow-up (MACE+ group). Patients with MACE were older (63 ± 8 vs 55 ± 10, p < 0.001), more frequently were female (47% vs 27%; p = 0.036) and more frequently had hypertension (40% vs 20%; p = 0.025). There were no significant differences in LV EF ( 56.5 ± 4.8% vs 56.3 ± 4.8 %; p = 0.849) and from conventional echo parameters only differences in E/A ratio (0.75 ± 0.24 vs 0.92 ± 0.32; p = 0.015) and MAPSE (1.54 ± 0.40 vs 1.36 ±0.27; p = 0.015) reached statistical significance. Surprisingly, there were no significant differences neither in LV longitudinal, nor circumferential deformations. However, LV radial deformation was significantly impaired in MACE+ pts both during systole (global radial strain: 16.4 ± 7.1 vs 21.1 ± 10.3; p = 0.008; end-systolic radial strain 13.1 ± 7.3 vs 18.1 ± 9.9; p = 0.005), early (radial SR E: -1.27 ± 0.66 vs 1.59 ± 0.79; p = 0.044) and late (radial SR A: -0.94 ± 0.41 vs -1.20 ± 0.59, p = 0.011) diastole. LV rotation was not significantly impaired, but slowed and delayed both during systole (time to peak systolic apical rotation (ms) 168 ± 86 vs 128 ± 70; p = 0.022) and diastole (rotation rate of LV base during early diastole (°/sec): 38.3 ± 27.4 vs 55.0 ± 31.5, p = 0.008; time to maximal LV untwisting rate (ms) 580 ± 210 vs 484 ± 154; p = 0.044), despite no differences in HR.
Conclusion
STEMI patients who will develop heart failure despite preserved post pPCI EF might have different clinical profile and different pattern of deviation in LV mechanic (predominately involving radial and rotational mechanic) and can be detected by contemporary echocardiographic techniques.
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Affiliation(s)
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - J Vratonjic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - N Arnautovic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Vorkapic
- Clinical center of Serbia, Belgrade, Serbia
| | - L Cucic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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11
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Tesic M, Travica L, Giga V, Trifunovic D, Jovanovic I, Boskovic N, Dobric M, Aleksandric S, Juricic S, Radomirovic M, Petrovic O, Vratonjic J, Stankovic G, Beleslin B, Djordjevic-Dikic A. Prognostic value of mitral regurgitation in patients with asymmetric hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Since mitral regurgitation (MR) is a very common finding in patients with hypertrophic cardiomyopathy (HCM), the evaluation of the mitral valve anatomy and the degree of MR is of utmost importance in this population. However, data regarding the prognostic value of different degrees of MR in HCM remains scarce.
Purpose
The aim of this study was to determine whether the presence of a higher degree of MR affects: 1) long term prognosis; 2) clinical and echocardiographic presentation of HCM patients.
Material and Methods
We included prospectively 102 patients, diagnosed with primary asymmetric HCM. The degree of MR was determined echocardiographicaly according to current recommendations of the American Association of Echocardiography. According to the MR severity, patients were divided into 2 groups: Group 1 (n = 52) with no/trace or mild MR and Group 2 with moderate or moderate to severe MR. All patients had clinical and echocardiographic examination, 24-hour Holter ECG and NT pro BNP analysis performed. The primary outcome was a composite of: 1) HCM related death or sudden death; 2) hospitalization due to acute heart failure; 3) sustained ventricular tachycardia; 4) ischemic stroke.
Results
Patients with higher MR degree had more frequent chest pain (p = 0.039), syncope (p = 0.041) and NYHA II functional class (p < 0.001). Group 2 patients had mostly obstructive form of HCM (p < 0.001) with more frequent presence of previous atrial fibrillation (AF) (p = 0.032), as well as the new onset of AF (p = 0.014) compared to patients in Group 1. Patients with higher MR degree had significantly more SAM (p < 0.001) resulting in a more frequent eccentric MR jet (p < 0.001), along with calcified mitral annulus (p = 0.007), enlarged left atrial volume index (p < 0.001), and elevated right ventricular pressure (p = 0.001). As a result of higher MR grade, Group 2 had higher E/e" values (p < 0.001), elevated LV filling pressure (lateral E/e’ >10), as well as higher levels of NT pro BNP (p = 0.001). By Kaplan-Meier analysis we demonstrated that the event free survival rate during follow up of median 75 (IQR 48-103) months was significantly higher in Group 1 compared to the Group 2 (79% vs. 46%, p < 0.001), Figure 1. After adjustment for relevant confounders, moderate/moderate to severe MR remained as an independent predictor of adverse outcome (hazard ratio 2.58, 95% CI: 1.08-6.13, p < 0.001).
Conclusion
Presence of moderate, or moderate to severe MR was associated with poor long-term outcome of HCM patients. These results indicate the importance of an adequate MR assessment and detailed evaluation of the mitral valve anatomy in the prediction of complications and adequate treatment of patients with HCM.
Abstract Figure.
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Affiliation(s)
- M Tesic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - L Travica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Trifunovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Jovanovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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12
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Dedic S, Boskovic N, Giga V, Tesic M, Aleksandric S, Jovanovic I, Hadzi Tanovic L, Mihajlovic Varbusova I, Stojicic M, Beleslin B, Djordjevic Dikic A. Long term perspective with LBBB: role of stress echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies have shown that left bundle branch block (LBBB), as a relatively common electrocardiographic (ECG) abnormality, represents the condition with often non benign and sometimes adverse outcome.
Purpose
The Aim of our study was to determine the predictive value of a stress echocardiography test in patients with LBBB.
Methods
Our study population included 189 patients (88 male, 46.6%, mean age 63.08±9.65) with diagnosed left bundle branch block who performed stress echocardiography (SECHO) according to Bruce protocol. Median follow-up of the patients was 56 months (IQR 48–71 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction, repeat revascularization (coronary artery bypass grafting-CABG or percutaneous coronary intervention-PCI).
Results
Out of 189 patients, 32 (16.9%) patients had positive, while 157 (83.1%) patients had negative SECHO test. During the follow up period 28 patients had major adverse cardiac event: 1 nonfatal myocardial infarction, 6 heart failure hospitalizations, 5 CABGs, 8 PCIs, while 8 patients had cardiac death. Using the Cox regression analysis, univariate predictors of adverse cardiac events were diabetes mellitus (HR 4.530 [95% CI 1.355–15.141], p=0.014), PCI (HR 4.288 [95% [95% CI 2.010–9.144], p<0.001) and positive SECHO test (HR 2.289 [95% CI 1.006–5207], p=0.048). In the multivariate analysis only previous PCI remained independent predictor of adverse events (HR 3.650 [95% CI 1.665–8.003], p=0.001). p=0.048). Using the Kaplan-Meier survival curve the patients with negative SECHO had better outcome compared to patients with positive SECHO (140/160; 87,5% vs 21/29; 72.4%, p=0.035) and much longer event-free time (77.4±1.6 months vs 67.1±5.4 months, Log Rank 4.136, p=0.042)
Conclusion
Patients with LBBB and negative SEHO test have good prognosis. Patients with history of CAD and diabetes mellitus and LBBB are at increased risk for future events and need periodical reassessment.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - N Boskovic
- University Belgrade Medical School, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | | | | | - M Stojicic
- General Hospital “Dr Djordje Joanovic”, Zrenjanin, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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13
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Juricic S, Petrovic O, Tesic M, Dobric M, Dikic M, Mehmedbegovic Z, Zivkovic M, Vukcevic V, Aleksandric S, Milasinovic D, Tomasevic M, Orlic D, Stankovic G, Beleslin B, Stojkovic S. A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility.
Purpose
Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function.
Methods
We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity
Results
Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1).
Conclusion
Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dikic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Zivkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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14
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Boskovic N, Djordjevic-Dikic A, Dedic S, Giga V, Nedeljkovic I, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Picano E. Hyperventilation echocardiography in INOCA: the HEROIC study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with ischemia and no obstructive coronary artery disease (INOCA) are a heterogeneous group and an unmet diagnostic challenge. Noninvasive Doppler is a feasible tool to assess coronary flow velocity (CFV) in left anterior descending coronary artery (LAD) during stress echocardiography (SE).
Aim
To assess CFV response during coronary vasoconstrictor and vasodilator stimuli in INOCA patients.
Methods
In a prospective single center study, we enrolled 16 INOCA patients (age 60±12 years, 15 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO, 0.84 mg/kg in 1 min) on the other day. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio <1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.
Results
The double product increased during HYP, in comparison to rest (13 337 vs 9858, p<0.001), and further increase with EXE (21 118 vs HYP, p<0.001). Chest pain or dyspnea were present in 2/16 pts during HYP, and in 5/16 patients during HYP+EXE (12.5% vs 31.25%, p=0.083). ST segment depression (≥1mm) was present in 1/16 patients during HYP, and 3/16 during HYP+EXE. Two patients showed regional wall motion abnormalities with HYP+EXE. CFVR response was blunted in 9/16 patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 6. Vasodilation during ADO was preserved in all patients. There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.5 vs 2.4±0.4 respectively, p=0.039), and between CFVR HYP and ADO (1.2±0.3 vs 2.4±0.4, p<0.001).
Conclusion
In INOCA patients, HYP+EXE is a more powerful ischemic stress than HYP alone and unmasks abnormalities in regional wall motion and/or CFV response in over one- half of patients, likely unmasking the underlying abnormal coronary vasomotor response of large epicardial and/ or small coronary vessels. INOCA patients show profound heterogeneity of coronary vasomotor responses which can be detected with a combined vasodilator - vasoconstrictor SE approach with CFV assessment. The clarification of underlying coronary microcirculatory heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from CFV-SE. Normal INOCA hearts are all alike, every abnormal heart is abnormal in its own way.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Jovanovic
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - E Picano
- University of Pisa, CNR Institute of Clinical Physiology, Pisa, Italy
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15
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Banovic M, Iung B, Brkovic V, Aleksandric S, Mitrovic P, Nedeljkovic I, Popovic D, Jaukovic M, Asanin M, Penicka M, Bartunek J. Gender specific differences in functional capacity in asymptomatic patients with isolated severe aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS.
Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo)
There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max
Conclusion
Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Banovic
- Clinical center of Serbia, Belgrade, Serbia
| | - B Iung
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
| | - V Brkovic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - P Mitrovic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - D Popovic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Jaukovic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
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16
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Krljanac G, Trifunovic D, Asanin M, Savic L, Vratonjic J, Zlatic N, Viduljevic M, Arnautovic N, Sulovic V, Aleksandric S, Mrdovic I. The importance of early and late ventricular arrhythmias detection and prediction in acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Malignant arrhythmias, ventricular tachycardia or ventricular fibrillation (VT/VF) in acute myocardial infarction (AIM) carry ominous prognosis including sudden cardiac death (SCD). It is not clear whether the timing of VT/VF occurrence always affects the poor prognosis of patients with AMI.
Aim
To investigate the prognosis of patients who undergoing primary percutaneous coronary intervention (PCI) in accordance with timing of VT/VF and to find the power predictors of their occurrence.
Methods
307 consecutive patients in PREDICT-VT study (NCT03263949), 57.9±10.6 year old, 72.3% males were analysed. Of these patients, 27.7% had VT/VF from the symptoms onset, within 48 hours of AIM (early VT/VF group). 8.1% of patients had VT/VF after 48h, during one year follow up (late VT/VF group).
Results
The frequency of VT/VF occurrence was high between symptoms onset and the end of 2nd month and during 5th and 6th month of AIM. The parameters of conventional echocardiography were significantly impaired in late VT/VF group, as well as parameters of longitudinal strain (LS) (table). Moreover, the MACE (cardiovascular mortality, SCD, new infarction, emergency revascularisation, and hospitalized heart failure) was the highest in late VT/VF group (p=0.000). The most significant predictor of late VT/VF was systolic LS (cut off −12.72%, ROC 0.680, Sen 71%, Sp 64%, p=0.006).
Conclusions
Although late VT/VF occurrence after primary PCI were less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis. The most power predictor of late VT/VF were systolic longitudinal strain.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Clinical Center of Serbia
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Affiliation(s)
- G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - D Trifunovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | | | - N Zlatic
- Clinical center of Serbia, Belgrade, Serbia
| | | | | | - V Sulovic
- Clinical center of Serbia, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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17
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Petrovic O, Juricic S, Arnautovic N, Paunovic I, Trifunovic-Zamaklar D, Rakocevic I, Boricic-Kostic M, Aleksandric S, Milasinovic D, Dobric M, Tesic M, Ivanovic B, Stankovic G, Stojkovic S. Echocardiographic assessment of the impact of percutaneous revascularisation of chronic total occlusion on myocardial function and electrical stability, two-year follow up period. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chronic total coronary occlusion (CTO) is frequent finding in patients with ischaemic heart disease, but it is not clear yet how it affects myocardial function, especially electrical stability. Myocardial strain by echocardiography can objectively quantify extent and timing of myocardial deformation. Echocardiographically derived dyssynchrony, mechanical dispersion, is good predictive tool for patients at risk of ventricular arrhythmias.
Purpose
The purpose of this study was to evaluate the influence of chronic total occlusion percutaneous coronary intervention (CTO PCI) on myocardial contractility and arrhythmogenicity.
Methods
We analysed total of 35 CTO patients (age 56±9, 86% male). Convectional echocardiographic exam with two dimensional speckle tracking echocardiography (2D STE) was performed before CTO PCI and after 24 months of follow-up. Peak longitudinal strain was assessed in 17 left ventricular segments. 2D STE computed global longitudinal strain (GLS). Time intervals from start of Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity.
Results
24 months after CTO PCI patients showed no change in ejection fraction (EF) (55.75±7.56% vs. 56.03±6.29%, p=0.622). There was slight improvement in GLS (−14.89±2.81% vs. −15.93±2.64%, p<0.05), Mechanical dispersion was significantly reduced (62.78±23.44ms vs 47.96±12.10ms, p<0.001)
Conclusion
CTO recanalization improved GLS without changes in left ventricular EF after 24 months. Mechanical dispersion as a surrogate for arrhythmogenic substrate was reduced by CTO PCI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Arnautovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Paunovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - I Rakocevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Boricic-Kostic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Ivanovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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18
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Kotevska Angjushev M, Dedic S, Boskovic N, Giga V, Tesic M, Jovanovic I, Aleksandric S, Beleslin B, Djordjevic Dikic A. The prognostic value of coronary flow reserve of left anterior descending artery in non-diagnostic or inconclusive stress echocardiography tests. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Relevant number of all stress echocardiography results are non-diagnostic or inconclusive. Such importance cannot be ignored as previous studies have shown that these patients have higher risk for adverse events. Non-invasive transthoracic Doppler derived coronary flow reserve (CFR) of left anterior descending (LAD) artery, as additional test, is an effective tool to predict adverse cardiac events in various clinical settings.
Purpose
The aim of this study was to investigate the value of CFR of LAD in predicting outcome.
Methods
122 patients, (35,8% with previous MI) with nondiagnostic stress echocardiography results (target heart rate not reached, chest pain without ECG and echo changes) and with inconclusive stress echocardiography results (target heart rate reached, chest pain with ECG changes and without echo changes) were referred for transthoracic
Doppler echocardiographic CFR assessment of LAD. CFR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. CFR ≤2 was considered abnormal. All patients were followed for major adverse cardiac events (MACE): nonfatal myocardial infarction, hospitalization, revascularization (CABG or PCI) and death.
Results
Measured values of CFR LAD were in the range 1,52- 4,00 (mean: 2,4±0.44). CFR LAD was abnormal in 22 (18%), and preserved in 100 patients (82%). During median follow-up of 23 months (interquartile range 9–35), 14 patients underwent revascularization (2 had CABG, 12 had PCI). There were no myocardial infarctions, hospitalizations or cardiovascular deaths in the follow-up period. Patients with lower CFR values (CFR≤2) had a higher event rate and shorter event free survival time compared to those with CFR>2, event rate (9/22, 40,9% vs 5/98 5,1%; p<0.0001) and event free time (22±3 vs 33±1 months; p<0.0001) by Kaplan Maier analyses, (Log Rank 24.42; p<0.001).
Conclusions
Preserved CFR of LAD (>2.0) predicts excellent survival in patients with non-diagnostic and inconclusive stress echocardiography.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Kotevska Angjushev
- City General Hospital 8 September, Department of Cardiology, Skopje, North Macedonia
| | - S Dedic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - N Boskovic
- University Clinical Center of Serbia, Belgrade, Serbia
| | - V Giga
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - M Tesic
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - I Jovanovic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
| | - S Aleksandric
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - B Beleslin
- University Clinical Center of Serbia, Department of interventional cardiology, Belgrade, Serbia
| | - A Djordjevic Dikic
- University Clinical Center of Serbia, Department of functional cardiology, Belgrade, Serbia
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19
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Trifunovic D, Krljanac G, Asanin M, Savic-Spasic L, Aleksandric S, Dudic J, Cucic L, Sulovic V, Mrdovic I. P963 Heart failure development in patients with preserved ejection fraction after STEMI: how frequent is It and can we predict it? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Data regarding heart failure (HF) development among patients with preserved EF (≥50%) after STEMI are spare. Accurate and early identification of patients at risk might allow timely application of modern therapy targeted for HFpEF.
Aim
the current study is a sub-study of PREDICT-VT (NCT03263949). Its aim was to determine the incidence and predictors of HFpEF development in STEMI patients treated by pPCI.
Methods
in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done and included multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec) and rotational LV mechanics. LV index of post systolic shortening for longitudinal strain (PSS LS) and for circumferential strain (PSS CS) were calculated as average of PSS over 18 LV segments. LV diastolic function was assessed according to the current ESC guidelines.
Results
From 264 patients enrolled in PREDICT-VT study, until now 195 patients completed one-year follow and among them 87 pts (46 %) had EF≥50%. From those patients during one-year follow-up 30 pts (30.3 %) develop HF: 3 pts NYHA class 3/ 4 and 27 pts NYHA class 2. Patients who developed HF (Group HF, n = 30) were older (62 ± 7 vs55 ± 11, p = 0.002), had lower E/A ratio (0.77 ± 0.25 vs 0.94 ± 0.32, p = 0.014), more commonly altered LV diastolic function (83 vs 60%, p = 0.028) compared with pts who remained in NYHA class I (Group none-HF, n = 57). There were no significant differences in LVEF, MI localisation, nor in WMSI between groups. Longitudinal and circumferential myocardial deformations did not differ significantly, except for more pronounced PSS LS on epicardial level in Group –HF (11.5 ±7.5 vs 8.3 ± 7.7%, p = 0.073). Rotation mechanic analysis revealed that Group –HF had increased (14.08 ± 5.5 vs 12.5 ± 5.4°, p = 0.202), but delayed twist (350 ± 69 vs 327 ± 68 ms, p = 0.139) with reduced magnitude of peak untwisting velocities (-88.58 ±34.16 vs -95.20 ± 39.75°/sec, p = 0.488). However, only statistically significant difference was increased magnitude of untwisting velocity during late diastole (-57.53 ± 30.61 vs -42.88 ± 27.78, p = 0.029). Significant univariate predictors of HF development were: older age (Exp (B)=1.08, CI 1.027-1.139, p = 0.03), E/A ratio (Exp (B) =0.130, p = 0.018, 95%CI 0.024-0.700), female gender (Exp (B)=2.933, 95% CI 1.163 -7.397, p = 0.023) and late-diastolic untwisting velocity (Exp (B)=0.983, 95%CI 0.967-0.999, p = 0.033). However, in multivariable analysis only older age (Exp B= 1.09, 95% CI 1.028-1.155, p = 0.004) and female gender (Exp B= 2.80, 95% CI 1.01-7.708, p = 0.046) remained significant predictors.
Conclusion
HF after STEMI in patients with preserved EF is not rare and probably substantially contributes to the total incidence HF after STEMI. However, its prediction remained challenging, with female gender and older age confirmed as its significant determinants.
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Affiliation(s)
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | | | - J Dudic
- University Belgrade Medical School, Belgrade, Serbia
| | - L Cucic
- University Belgrade Medical School, Belgrade, Serbia
| | - V Sulovic
- Clinical center of Serbia, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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20
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Petrovic O, Juricic S, Trifunovic-Zamaklar D, Paunovic I, Rakocevic I, Gavrilovic N, Jovanovic I, Boskovic N, Aleksandric S, Ivanovic B, Djordjevic-Dikic A, Beleslin B, Vukcevic V, Stankovic G, Stojkovic S. P278 Does recanalization of chronic total occlusion reflect on myocardial function? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention for chronic total occlusion (PCI CTO) is still high risk procedure and it is doubtful will it become standard of care. There is evidence that it can reduce angina but even silent ischemia represent ischemic burden that ultimately lead to left ventricle remodeling and electrical instability.
Purpose
Our aim was to access effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) on myocardial function.
Methods
We compared two groups of pts. First patients with percutaneous coronary intervention of chronic total occlusion with optimal medical therapy and second group - patients with only optimal medical therapy (control group). Echocardiographic exam was performed before randomization and after 6 months of follow-up. Doppler intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured. MPI (Myocardial performance index) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral wave (E) was divided by average peak early diastolic annular velocity (e"). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time intervals from 17 segments, reflecting myocardial contraction heterogeneity.
Results
A total of 94 age matched CTO patients (48 in PCI + OMT group and 46 in OMT) were analyzed. Changes in ejection fraction (EF), diastolic function represented by E/e", global cardiac function represented by MPI, global longitudinal strain (GLS) and myocardial dispersion changes were compared between groups. At follow up between groups in there was no significant change in ejection fraction (EF), diastolic function, GLS and mechanical dispersion, but there was improvement in MPI.
Conclusion
Myocardial performance index is sensitive marker which can detect subtle improvement in global myocardial function after recanalization of chronic total occlusion..
Variable PCI + OMT (n = 46) OMT (n = 48) ΔOMT vs. ΔPCI + OMT p value baseline At 6month follow up P value baseline At 6month follow up P value EF (%) 55.69 ± 8.56 54.83 ± 8.44 0.10 50.22 ± 11.71 51.42 ± 10.45 0.06 0.71 MPI 0.676 ± 0.99 0.632 ± 0.96 <0.01* 0.593 ± 0.14 0.604 ± 0.12 0.22 <0.01* E/e" 13.10 ± 6.90 12.05 ± 5,08 <0.05* 14,12 ± 5.70 13.02 ± 5.62 <0.05* 0.23 GLS (%) -14,38 ± 3,38 -15,22 ± 3,68 <0.05* -13.33 ± 3.43 -13.29 ± 3.42 0.87 0.07 Mechanical dispersion (ms) 63.89 ± 26.22 57.35 ± 27.33 <0.01* 53.30 ± 21.68 50.00 ± 22.40 0.05 0.06 Δ- percentage changes between baseline and at 6 month follow up
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Affiliation(s)
- O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - I Paunovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Rakocevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Gavrilovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Jovanovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Boskovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Ivanovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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21
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Boskovic N, Popovic A, Petrovic MT, Dedic S, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Giga V. P328 Relation between CHA2DS2-VASc and impaired heart rate recovery in patients without inducible myocardial ischemia. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart rate recovery (HRR) has been shown to predict cardiovascular and all-cause morbidity and mortality in different populations. Recent studies have indicated the CHA2DS2-VASc score can be used as predictor of mortality in patients with coronary artery disease, without atrial fibrillation. However, the relation between these two parameters has not yet been documented.
The Aim: The aim of this study was to determine the relation between CHA2DS2-VASc score and impaired heart rate recovery in patients without inducible myocardial ischemia.
Methods
Our study comprised of 2699 consecutive patients (1319 male, 42.8%, average age 60 ± 11 years) who underwent treadmill exercise testing (stress echocardiography or stress echocardiography) according to Bruce protocol for the assessment of myocardial ischemia. We excluded patients with the systolic heart failure (left ventricle ejection fraction <45%) and those with inducible ischemia. CHA2DS2-VASc score was calculated according to the guidelines. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), chronotropic competence (CC), body mass index (BMI) were calculated in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min.
Results
Out of 2699 patients, 378 (12.3%) had a positive test and they were excluded from further analysis. Of the remaining 2321 patients, 251 (10.8%) had an impaired HRR, whereas 2070 (89.2%) had normal HRR. Previously known coronary artery disease (previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery) had 78 (3.4%) patients. Patients with impaired HRR had significantly higher CHA2DS2-VASc score (3.1 ± 1.3 vs 2.3 ± 1.2, p < 0.001), higher resting heart rate (76.9 ± 16.1 vs 73.3 ± 12.3bpm, p < 0.001), higher systolic blood pressure at rest (122.1 ± 13.9 vs 117.2 ± 13.4mmHg, p < 0.001), higher diastolic blood pressure at rest (73.7 ± 7.5 vs 72.3 ± 7.2mmHg, p < 0.001), higher rate of hyperlipproteinemia (176/251, 70.1% vs 1294/2070, 62.5%, p < 0.001), higher BMI (27.3 ± 3.6 vs 26.4± 3.6kg/m2, p < 0.001), shorter duration of the test (5.2 ± 1.8 vs 6.4 ± 1.9 minutes, p < 0.001). lower Duke score (4.6 ± 2.4 vs 6.1 ± 2.4 minutes, p < 0.001). lower MET (6.3 ± 1.8 vs 7.5 ± 1.9, p < 0.001) and higher rate of chronotropic incompetence (173/251, 68.9% vs 1036/2070, 50%, p < 0.001) compares to the patients with normal HRR. Multivariate predictors of impaired HRR were higher CHA2DS2-VASc score (p < 0.001), not achieved THR (p < 0.001), higher heart rate at rest (p = 0.001), higher systolic blood pressure at rest (p = 0.001) and shorter duration of test (p = 0.046).
Conclusion
CHA2DS2-VASc score is an independent predictor of impaired HRR in patients without inducible ischemia.
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Popovic
- University Belgrade Medical School, Belgrade, Serbia
| | - M T Petrovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Dobric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
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22
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Juricic S, Petrovic O, Tesic M, Dobric M, Orlic D, Aleksandric S, Trifunovic-Zamaklar D, Vukcevic V, Djordjevic-Dikic A, Mehmedbegovic Z, Milasinovic D, Zivkovic M, Stankovic G, Beleslin B, Stojkovic S. P284 Patients with reduced systolic function benefit most from recanalisation of chronic total occlusion. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention of chronic total coronary occlusion (PCI of CTO) is proved to reduce symptoms of angina and long term survival.
Purpose
This study aimed to assess systolic and diastolic left ventricular function with standard echocardiographic indices.
Methods
We analyzed total of 46 CTO patients (age 58 ± 9, 73% male). Measures were obtained with the transducer in the apical four-chamber view. Doppler time intervals were measured from mitral inflow and left ventricular outflow Doppler tracings by pulsed wave Doppler. The isovolumetric relaxation time (IVRT) was measured from closure of the aortic valve to opening of the mitral valve. The isovolumetric contraction time (IVCT) was measured from closure of the mitral valve to opening of the aortic valve. Ejection time (ET) was measured from the opening to the closure of the aortic valve on the LV outflow velocity profile. Myocardial performance index (MPI) is simple method for evaluation of overall cardiac function and is independent of heart rate and blood pressure. MPI was equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e") which was measured as average value between septal and lateral side of the mitral annulus using Doppler tissue imaging. The E/e’ ratio was calculated to estimate the LV filling pressures
Results
Six months after PCI of CTO patients showed no change in ejection fraction (EF) (55.69 ± 8.56% vs. 54.83 ± 8.44%, p = 0.10). MPI was significantly decreased (0.676 ± 0.99 vs. 0.632 ± 0.96 p < 0.01), E/e" was significantly reduced, (13,10 ± 6.90 vs. 12.05 ± 5.1 p < 0.05), and when we analyzed only patients with baseline EF < 50% (n = 9) improvement of diastolic function (reduction of E/e") was even greater (22.53 ± 5.52 vs. 15.65 ± 4.8 p < 0.01).
Conclusion
PCI of CTO improves overall cardiac function, particularly diastolic function in patients with reduced ejection fraction.
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Affiliation(s)
- S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - Z Mehmedbegovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Zivkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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23
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Trifunovic D, Krljanac G, Asanin M, Savic-Spasic L, Aleksandric S, Dudic J, Cucic L, Sulovic V, Mrdovic I. 570 Myocardial deformation imaging after STEMI: can we better predict one-year mortality and heart failure development? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Prognosis after STEMI is still challenging. One-year mortality ranges between 10-12% and the incidence of heart failure (HF) is between 4% and 28%. Early and accurate identification of high-risk patients necessitates therapy intensification.
Aim
this study is a part of PREDICT-VT study (NCT03263949). The aim was to test whether deformation imaging based on spackle tracking echocardiography predict MACE (total mortality, HF hospitalization and NYHA class ≥3 development) better than conventional echocardiography and clinical parameters.
Methods
in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strain were calculated as average of PSS over 18 LV segments.
Results
198 patients completed 1-year follow-up and 22 patients (11.1%) experienced MACE. Significant echo, clinical and laboratory predictors with the ROC analysis are listed in the table according to AUC .
Conclusion
peak systolic longitudinal and to a lesser degree peak systolic circumferential deformation predict mortality and HF development after pPCI better than conventional echo and even clinical parameters. From diastolic parameters only radial SR during atrial contraction was better MACE predictor compared to conventional echocardiography.
AUC p Cut-off Senz Spec Peak systolic LS epicardial layer 0.757 <0.001 -11 75 63 Radial SR during atrial contraction 0.754 <0.001 -0.63 65 80 Peak systolic LS mid-wall layer 0.750 <0.001 -12.58 80 60 PSS LS endocardial layer 0.744 <0.001 0.1409 70 61 Peak systolic CS endocardial layer 0.744 <0.001 -18.08 70 67 Wall Motion Score Index 0.740 0.001 1.53 70 70 Peak systolic CS mid-wall layer 0.730 0.001 -13.66 80 60 Peak radial LV strain 0.722 0.001 14.08 80 60 Creatine kinase peak level 0.698 0.003 2155 64 73 LV EF 0.692 0.004 47.5 67 60 TAPSE 0.685 0.015 1.95 75 60 LA strain 0.676 0.012 18.33 63 64 Killip class 0.644 0.028
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Affiliation(s)
- D Trifunovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - J Dudic
- University Belgrade Medical School, Belgrade, Serbia
| | - L Cucic
- Clinical center of Serbia, Belgrade, Serbia
| | - V Sulovic
- Clinical center of Serbia, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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24
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Krljanac G, Trifunovic D, Asanin M, Savic Spasic L, Aleksandric S, Dudic J, Cucic L, Sulovic V, Mrdovic I. P1472Predicting significant ventricular arrhythmias in STEMI patients in middle-range and preserved EF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Predicting malignant ventricular and sudden cardiac death (SCD) in STEMI patients with middle-range and preserved EF is challenge.
Aim
To identify the best parameters to predict composite end-point defined as secondary VF, sustained/non-sustained VT and sudden death, 48h after and during the first year of follow up after STEMI in patients with middle-range and preserved EF.
Methods
In the 192 consecutive STEMI patients (pts) 57.8±10.4yr, 69.9% males, in PREDICT-VT study (NCT03263949) treated with pPCI, with EF ≥40%, early echo (5±2 days) was done including conventional parameters and comprehensive speckle tracking left ventricle (LV) deformation analysis with longitudinal (L), circumferential (C) strain (S; %) strain rate (SR, 1/sec), index mechanical dispersion (IMD) and rotational LV mechanics.
Results
Thirteen patients (8.3%) reached the end-point. Classical parameters of LV systolic function, including LVEF, wall motion score index and parameters of diastolic dysfunction were not significant predictors of the malignant arrhythmias. IMD of late rotation rate (63.7 vs. 40.7ms, p=0.055) and late diastolic untwisting rate (−48.85 vs. −63.18°/s, p=0.059) had trend to become the significant predictors. CS in papillary muscle level in endo and mid layers predicted the primary end-point (endo: −20.5±11.8 vs. −24.9±4.6, mid: −14.6±3.9 vs. −17.0±2.1, epi: −10.1±3.3 vs. −11.8±1.8) (table).
Parameter of circumferencial mechanics ROC area 95% CI p Cutt-off Sens Spec PM endo (%) 0.302 0.146–0.458 0.038 −22.75 70 67 PM mid (%) 0268 0.153–0.383 0.015 −15.65 80 62
Conclusion
Myocardial deformation imaging offers deeper insight into complex mechanical abnormalities during LV contraction and relaxation in STEMI patients with middle-range and preserved EF that predicts serious arrhythmic events.
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Affiliation(s)
- G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - D Trifunovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - J Dudic
- Medical Faculty, Belgrade, Serbia
| | - L Cucic
- Medical Faculty, Belgrade, Serbia
| | | | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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25
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Krljanac G, Trifunovic D, Asanin M, Savic Spasic L, Aleksandric S, Dudic J, Cucic L, Sulovic V, Mrdovic I. P5977Predicting significant ventricular arrhythmias in STEMI patients: never-ending challenge, still more place for myocardial deformation imaging? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Malignant ventricular arrhythmias in STEMI patients carry ominous prognosis including sudden cardiac death (SCD). According to the current guidelines only EF<35%, 40 days after STEMI, is indication for ICD implantation. Recently, index of myocardial dispersion (IMD) estimated by myocardial deformation imaging (speckle tracking echocardiography) was documented to provide better risk stratification.
Aim
To define whether quantification of myocardial mechanics early after pPCI using modern echocardiography offers information more to predict malignant arrhythmias during the first year after STEMI.
Methods
In the 226 consecutive STEMI patients (pts) 57.8±10.4yr, 71.7% males, in PREDICT-VT study (NCT03263949) treated with pPCI early echo (5±2 days) was done including conventional parameters and comprehensive speckle tracking LV deformation analysis with longitudinal (L), circumferential (C) strain (S;%) and strain rate (SR, 1/sec) and rotational LV mechanics. ROC analysis was performed to identify the best parameters to predict composite end-point defined as secondary VF, sustained/non-sustained VT and SCD, 48h after pPCI and during the first year of follow up.
Results
Twenty two patients (9.7%) reached the end-point. Classical parameters of LV systolic function, including LVEF, wall motion score index; global, systolic LS, CS and parameters of diastolic dysfunction were not significant predictors of the malignant arrhythmias. Early L SR, systolic C SR, IMD of global rotation and late rotation rate predicted the primary end-point (table).
Parameter ROC area 95% CI p Cutt-off Sens Spec Longirudinal mechanics SR E (1/sec) 0.687 0.577–0.796 0.019 0.69 64 65 IMD S (ms) 0.752 0.666–0.838 0.002 66.1 71 72 Circumferencial mechanics SR S (1/sec) 0.732 0.613–0.852 0.002 −1.22 71 67 Rotational mechanics Global IMD (ms) 0.329 0.177–0.481 0.036 82.9 63 62 Late rotation rate IMD (ms) 0.318 0.196–0.442 0.026 41.1 65 64
Conclusion
Myocardial deformation imaging offers deeper insight into complex mechanical abnormalities during LV contraction and relaxation in longitudinal, circumferential and rotational directions (impaired and asynchronous deformations) in STEMI patients and predicts serious arrhythmic events.
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Affiliation(s)
- G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - D Trifunovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - J Dudic
- Clinical center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - L Cucic
- Medical Faculty, Belgrade, Serbia
| | | | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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26
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Trifunovic D, Krljanac G, Asanin M, Savic-Spasic L, Aleksandric S, Dudic J, Cucic L, Sulovic V, Mrdovic I. P1950How to improve early prediction of heart failure development after STEMI in clinical arena-is there a place for myocardial deformation imaging? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Heart failure (HF) development after myocardial infarction with ST segment elevation (STEMI) in the modern era varies greatly (between 4% and 28%), with the highest incidence in the first year. Since, HF still carries substantial morbidity and mortality, accurate and early identification of high-risk patients for HF development after pPCI allows for targeted use of intensive therapy.
Aim
The current study is a sub-study of PREDICT-VT study (NCT03263949). Its aim is to define multi-parametric model for early HF prediction in STEMI patients treated by pPCI, based on three data sets: clinical data, conventional echocardiographic data and data from myocardial deformation analysis obtained by early speckle tracking echocardiography.
Methods
In 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5±2 days after pPCI) was done and included LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal strain (PSS LS) and for circumferential strain (PSS CS) were calculated for the purpose of this study as average of PSS over 18 LV segments.
Results
From 195 patients who completed 1-year follow-up, 17 (8.7%) develop HF NYHA class 3 or 4, 60 (30.8%) NYHA class 2 and remaining 118 patients (60.5%) were in NYHA class I. Significant univariate predictors of NYHA were: from clinical parameters – female gender (β=0.169, p=0018), Killip class on admission (β=0.253, p<0.001) and previous atrial fibrillation (β=0.205, p=0.004); from conventional echocardiographic parameters – LV WMSI (β=0.223, p=0.0072), LVEF (β=−0.256, p<0.001), LAVI (β=0.174, p=0.020) and TAPSE (β=−0.263, p=0.001); from parameters of longitudinal LV deformation – LS at the epicardial level (β=0.242, p=0.001) and PSS LS (β=0.360, p<0.001); from parameters of LV circumferential deformation – CS at epicardial level (β=0.225, p=0.001) and PSS CS at epicardial level (β=0.124, p=0.004); from left atrial mechanics – LA strain (β=−0.199, p=0.007). In multivariable stepwise regression model 5 variables were further identified as independent predictors that significantly increased model power to predict HF development (R square from 0.134 to 0.270, p<0.001). They are: PSS LS (β=0.255, p=0.002), previous atrial fibrilation (β=0.205, p=0.008), TAPSE (β=−0.176, p=0.031), female gender (β=0.165, p=0.032) and PSS CS (β=0.155, p=0.047).
Conclusion
Independently from and above classical clinical and echocardiographic parameters, amount of left ventricular post-systolic deformation in longitudinal and circumferential direction, expressed as LV indexes of post-systolic shortening, significantly improved early prediction of HF development after pPCI.
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Affiliation(s)
- D Trifunovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - G Krljanac
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Asanin
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Savic-Spasic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - J Dudic
- Clinical center of Serbia, Belgrade, Serbia
| | - L Cucic
- Clinical center of Serbia, Belgrade, Serbia
| | - V Sulovic
- Clinical center of Serbia, Belgrade, Serbia
| | - I Mrdovic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
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27
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Boskovic N, Markovic F, Petrovic MT, Giga V, Jovanovic I, Dedic S, Banovic M, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A. P1511Promising prognostic value of negative stress echocardiography in patients with incomplete revascularization after successful primary PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The specific role of non-invasive functional testing in a risk stratification of patients with incomplete revascularization after primary percutaneous coronary intervention (pPCI) still needs to be evaluated. The aim of our study was to assess negative prognostic value of stress echocardiography (SECHO) after successful pPCI and incomplete revascularization of non-culprit lesions.
Methods
Our study consisted of 202 patients (mean age 59±10 years, male 142) successfully treated with pPCI, who performed SECHO according to Bruce protocol in order to assess residual ischemia in coronary artery with non-culprit lesion. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), achieved target heart rate (THR), heart rate recovery (HRR), wall motion score index (WMSI) and ejection fraction were interrogated in all patients. Slow HRR was defined as ≤18 beats/min. Median follow-up of the patients was 70 months (IQR 55–83 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction. We also assessed the independent predictors for the occurrence of the adverse events.
Results
Out of 202 patients, 42 (20.8%) had positive SECHO test, 4 patients (1.98%) had died due to non-cardiac causes and 7 patients (3.5%) were lost to follow-up. From the remaining 149 patients with negative SECHO, 13 (8.7%) had an adverse event (7 cardiovascular deaths and 6 non-fatal MI). Negative predictive value of SECHO test was 91.3%. Univariate predictors of adverse events were slow HRR (HR 4.343 [95% CI 1.473–14.011], p=0.008), and not achieved THR (HR 0.322 [95% CI 0.105–0.985], p=0.047). By multivariate analysis, only slow HRR remained independent predictor of adverse events (HR 3.324 [95% CI 1.013–10.906], p=0.048).
Conclusion
SECHO test has excellent negative prognostic value in patients with incomplete revascularization of non-culprit lesions after successful pPCI. Still, particular care should be taken to the patients with slow HRR and negative SECHO due to increased risk for the occurrence of adverse events.
Acknowledgement/Funding
Ministry of Education and Science of the Republic of Serbia (Grant No III41022)
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Affiliation(s)
- N Boskovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - F Markovic
- University Belgrade Medical School, Belgrade, Serbia
| | - M T Petrovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - V Giga
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Jovanovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Dedic
- University Belgrade Medical School, Belgrade, Serbia
| | - M Banovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - S Aleksandric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - M Dobric
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - I Nedeljkovic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - B Beleslin
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
| | - A Djordjevic-Dikic
- University Belgrade Medical School, Cardiology clinic, Clinical center of Serbia, Belgrade, Serbia
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28
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Aleksandric S, Djordjevic-Dikic A, Stepanovic J, Dobric M, Giga V, Stankovic G, Vukcevic V, Tomasevic M, Stojkovic S, Orlic D, Saponjski M, Nedeljovic M, Juricic S, Petrovic MT, Beleslin B. P5510Stress-induced myocardial ischemia in patients with myocardial bridging: correlations with fractional flow reserve and quantitative coronary angiography measurements during dobutamine infusion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Aleksandric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | | | - J Stepanovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Giga
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Saponjski
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Nedeljovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Juricic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M T Petrovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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29
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Trifunovic D, Krljanac G, Savic L, Asanin M, Aleksandric S, Dudic J, Cucic L, Vorkapic M, Mrdovic I. P2268Left ventricular function in STEMI patients assessed by myocardial deformation imaging early after pPCI: does the presence of diabetes mellitus make any difference? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Trifunovic
- Institute for cardiovascular disease, Clinical centre of Serbia, Belgrade, Serbia
| | - G Krljanac
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - L Savic
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - M Asanin
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - J Dudic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - L Cucic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - M Vorkapic
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - I Mrdovic
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
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30
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Trifunovic D, Krljanac G, Savic L, Asanin M, Aleksandric S, Dudic J, Cucic L, Vorkapic M, Mrdovic I. P2700Utility of myocardial deformation imaging early after pPCI in STEMI patients to predict major adverse cardiac events during the first 12 months of follow up. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Trifunovic
- Institute for cardiovascular disease, Clinical centre of Serbia, Belgrade, Serbia
| | - G Krljanac
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - L Savic
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - M Asanin
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
| | - S Aleksandric
- Clinical Centre of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - J Dudic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - L Cucic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - M Vorkapic
- Clinical Centre of Serbia, Cardiology Clinic, Medical Faculty, Belgrade, Serbia
| | - I Mrdovic
- Cardiology department, Clinical center of Serbia, Faculty of medicine, University of Belgrade, Belgrade, Serbia
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Juricic S, Petrovic O, Tesic M, Dobric M, Aleksandric S, Mehmedbegovic Z, Zivkovic M, Milasinovic D, Dedovic V, Tomasevic M, Orlic D, Vukcevic V, Beleslin B, Stankovic G, Stojkovic S. P3579Prospective randomised comparison of percutaneous coronary intervention and optimal medical therapy in patients with chronic total occlusion. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Juricic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - O Petrovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Dobric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Aleksandric
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Zivkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Tomasevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Orlic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - B Beleslin
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Stojkovic
- Clinical center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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Petrovic M, Giga V, Boskovic N, Djordjevic-Dikic A, Beleslin B, Trifunovic D, Rakocevic I, Aleksandric S, Dobric M, Tesic M, Nedeljkovic I, Stepanovic J. P559The aVR lead ST-segment elevation during the exercise stress test as a predictor of a left main stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Banovic M, Nedeljkovic I, Brkovic V, Aleksandric S, Stepanovic J, Jaukovic M, Giga V, Beleslin B, Petrovic M. P6199Predictive value of ve/vco2 slope in discovering hfpef during combined cardiopulmonary/stress-echocardiography testing in patients with hypertension and normal systolic and diastolic function at rest. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Petrovic M, Boskovic N, Giga V, Rakocevic I, Trifunovic D, Dobric M, Tesic M, Aleksandric S, Orlic D, Nedeljkovic I, Saponjski J, Djordjevic-Dikic A, Beleslin B, Ostojic M, Stepanovic J. P564Significance of heart rate recovery after exercise testing in patients with type 2 diabetes and silent myocardial ischemia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brown LAE, Thomas K, Reskovic Luksic V, Bernard AB, Montilla Padilla I, Savelev A, Tufaro V, Nossikoff A, Ingimarsdottir IJ, Almeida Morais L, Meel R, Surkova E, Moharem-Elgamal S, Macabeo RAM, Cueva Recalde JF, Teixeira R, Petrovic M, Mahmoud HM, Lavanco V, De Kleijn MC, Vertes V, Kozan H, Padron-Encalada R, Zheng AW, Main SE, Jancis RSC, Steadman CD, Carpenter JP, Senaratne DNS, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ljubas Macek J, Pasalic M, Ostojic Z, Matasic R, Veceric S, Separovic Hanzevacki J, Martinez C, Dulgheru RE, Reskovic V, Lancellotti P, Jimenez Lopez-Guarch C, Velazquez Martin M, Nuche Berenguer J, Jimenez J, Solis J, Alonso S, Lopez Gude MJ, Perez Vela JL, Escribano Subias P, Tregubov AV, Shubik YV, Bandera F, Generati G, Alfonzetti E, Guazzi M, Evrev D, Razboynikov R, Atanasova A, Angelov K, Lazarova G, Radkova M, Stamboliyski G, Simova I, Kalionsky R, Hadjidekov G, Plachkov I, Petkov R, Gatzov P, Donova T, Hellgren Johansson L, Flachskampf FA, Galrinho A, Moura Branco L, Abreu J, Timoteo AT, Pinto-Teixeira P, Aguiar-Rosa S, Rio P, Portugal G, Cruz-Ferreira R, Nethononda R, Peters F, Libhaber E, Essop MR, Bidviene J, Brunello G, Veronesi F, Cavalli G, Cherata D, Romeo G, Badano LP, Muraru D, Tawfik M, Samir R, Amin M, Abol Maaty M, Pestano NSP, Estanislao IHE, Gayan Ordas J, Lacambra I, Pelegrin Diaz J, Dinis P, Monteiro R, Santos M, Botelho A, Quintal N, Goncalves L, Giga V, Boskovic N, Rakocevic I, Trifunovic D, Aleksandric S, Tesic M, Dobric M, Nedeljkovic I, Beleslin B, Djordjevic-Dikic A, Stepanovic J, Hassan M, Nagy M, Samaan A, Kharabish A, Philip P, Wagdy K, Elmaghawry M, Elguindy A, Yacoub M, Leo AL, Pasotti E, Faletra FF, Moccetti T, Houthuizen P, Bracke FALE, Lopata RGP, Nogradi A, Porpaczy A, Minier T, Czirjak L, Komocsi A, Faludi R, Sade LE, Turgay O, Pirat B, Muderrisoglu H, Barreiro-Perez M, Diaz-Pelaez E, Martin-Garcia A, Cruz-Gonzalez I, Jimenez-Candil J, Sanchez PL. HIT Poster session 3P915Direct access to transthoracic echocardiography in a district general hospital: are referrals appropriate?P916Surveillance echocardiography for valve disease; have the AHA valve guidelines translated in clinical practice? A retrospective study from a large general hospital in the United KingdomP917Effects of immediate echo guided AV and VV CRT optimization on left ventricular function and hemodynamicsP9183D echocardiography estimation of ventricular performance : correlation between 3D strain and elastancesP919 Right ventricular reverse remodeling after balloon pulmonary angioplasty in patients with non operable chronic thromboembolic pulmonary hypertensionP920Pseudonormal and restrictive left ventricular filling patterns are associated with lower effectiveness of pulmonary vein isolation in patients with paroxysmal atrial fibrillationP921Impact of new guidelines on diastolic dysfunction classification of HFrEF patients and correlation with cardiopulmonary exercise test functional parametersP922Prevalence of proximal DVT on compression ultrasound in patients with acute pulmonary embolism and it's diagnostic utility as a rule-in point-of-care testP923Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prosthesesP924New insights into the mechanics of left ventricular systolic and diastolic function in severe aortic stenosisP925Comparison of cardiac magnetic resonance and echocardiography for evaluation of mitral regurgitation severity in patients with rheumatic heart diseaseP926Tricuspid annulus remodeling in patients with permanent atrial fibrillation and functional tricuspid regurgitationP927Assessment of ventricular electromechanical dyssynchrony in CRT candidatesP928Native aortic valve infective endocarditis due to streptococcus sanguinis in a patient with possible behcets disease, patent foramen ovale and thymomaP929GLS is associated with conduction abnormalities in patients with type 1-myotonic dystrophyP930Descending aortic mechanics and stroke: a two-dimensional echocardiographic speckle tracking studyP931Correlation between prognostic markers of stress echocardiography and angiographic severity of coronary artery disease in patients after primary PCIP932A novel method for calculating the mitral valve area in patients with rheumatic mitral stenosisP933Three dimensional printing of cardiac anatomical structures from three dimensional echocardiograpfic images: preliminary experienceP934Reliability of fully automated calculation of global longitudinal strain by commercially available software: implications for daily practiceP935Global longitudinal strain is a suitable tool to unmask the subclinical left ventricular dysfunction in patients with systemic sclerosisP936Concomitant use of echocardiographic strain analysis and treadmill stress testing to predict coronary artery diseaseP937Cardiac-CT and transoesophageal echocardiography comparison for left atrial appendage clots detection in patients referred for left atrial interventional procedures. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ota T, Senaratne DNS, Preston NK, Ferrara F, Djikic D, Villemain O, Takahashi L, Niki K, Patrascu N, Benyounes N, Popa E, Diego Bellavia DB, Sundqvist M, Wei-Ting C, Papachristidis A, Djordjevic-Dikic A, Volpi C, Reis L, Nieto Tolosa J, Nishikawa H, D'angelo M, Testuz A, Mo YJ, Hashemi N, Toyota K, Nagamine K, Koide Y, Nomura T, Kurata J, Murakami Y, Kozuka Y, Ohshiro C, Thomas K, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ring L, Gargani L, Carannante L, Russo V, D'alto M, Marra AM, Cittadini A, D'andrea A, Vriz O, Bossone E, Mujovic N, Dejanovic B, Peric V, Marinkovic M, Jankovic N, Orbovic B, Simic D, Sitefane F, Pernot M, Malekzadeh-Milani G, Baranger J, Bonnet D, Boudjemline Y, Uejima T, Nishikawa H, Semba H, Sawada H, Yamashita T, Sugawara M, Kayanuma H, Inoue K, Yagawa M, Takamisawa I, Umemura J, Yoshikawa T, Tomoike H, Mihalcea DJ, Mihaila S, Lungeanu L, Trasca LF, Bruja R, Neagu MS, Albu S, Cirstoiu M, Vinereanu D, Van Der Vynckt C, Gout O, Cohen A, Enache R, Jurcut R, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Sonia Dell'oglio SD, Attilio Iacovoni AI, Calogero Falletta CF, Giuseppe Romano GR, Sergio Sciacca SS, Lissa Sugeng LS, Joseph Maalouf JM, Michele Pilato MP, Michele Senni MS, Cesare Scardulla CS, Francesco Clemenza FC, Salman K, Tornvall P, Ugander M, Chen ZC, Wang JJ, Fisch S, Liao RL, Roper D, Casar Demarco D, Papitsas M, Tsironis I, Byrne J, Alfakih K, Monaghan MJ, Boskovic N, Rakocevic I, Giga V, Tesic M, Stepanovic J, Nedeljkovic I, Aleksandric S, Kostic J, Beleslin B, Altman M, Annabi MS, Abouchakra L, Cucchini U, Muraru D, Badano LP, Ernande L, Derumeaux G, Teixeira R, Fernandes A, Almeida I, Dinis P, Madeira M, Ribeiro J, Puga L, Nascimento J, Goncalves L, Cambronero Sanchez FJ, Pinar Bermudez E, Gimeno Blanes JR, De La Morena Valenzuela G, Uejima T, Takahashi L, Semba H, Sawada H, Yamashita T, Lopez Fernandez T, Irazusta Cordoba FJ, Rosillo Rodriguez SO, Dominguez Melcon FJ, Meras Colunga P, Gemma D, Moreno Gomez R, Moreno Yanguela M, Lopez Sendon JL, Nguyen V, Mathieu T, Kerneis C, Cimadevilla C, Kubota N, Codogno I, Tubiana S, Estrellat C, Vahanian A, Messika-Zeitoun D, Ondrus T, Van Camp G, Di Gioia G, Barbato E, Bartunek J, Penicka M, Johnsson J, Gomez A, Alam M, Winter R. Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view for assessing for prolapseP629Right atrial volume by two-dimensional echocardiography in healthy subjectsP630Disturbance of inter and intra atrial conduction assessed by tissue doppler imaging in patients with medicaly controlled hypertension and prehypertension.P631Liver stiffness by shear wave elastography, new noninvasive and quantitative tool for acute variation estimation of central venous pressure in real-time?P632Weak atrial kick contribution is associated with a risk for heart failure decompensationP633Usefulness of wave intensity analysis in predicting the response to cardiac resynchronization therapyP634Early subclinical left ventricular systolic and diastolic dysfunction in gestational hypertension and preeclampsiaP635Clinical comparison of three different echocardiographic methods for left ventricular ejection fraction and LV end diastolic volume measurementP636Assessment of right ventricular-arterial coupling parameters by 3D echocardiography in patients with pulmonary hypertension receiving specific vasodilator therapyP637Prediction of right ventricular failure after left ventricular assist device implant: assessing usefulness of standard and strain echocardiographyP638Kinematic analysis of diastolic function using the novel freely available software Echo E-waves - feasibility and reproducibilityP639Evaluation of coronary flow velocity by Doppler echocardiography in the treatment of hypertension with the ARB: correlation to the histological cardiac fibrosisP640The clinical significance of limited apical ischaemia and the prognostic value of stress echocardiography - A contemporary study from a high volume centerP641Effects of intermediate stenosis of left anterior descending coronary artery on survival in patients with chronic total occlusion of right coronary arteryP642Left ventricular remodeling after a first myocardial infarction in patients with preserved ejection fraction at dischargeP643Left atrial size and acute coronary syndromes. Let is make simple.P644Influence of STEMI reperfusion strategy on systolic and diastolic functionP645Aortic valve resistance risk-stratifies low-gradient severe aortic stenosisP646Does permanent pacemaker implantation complicate the prognosis of patients after transcatheter aortic valve implantation?P647Influence of metabolic syndrome and diabetes on progression of calcific aortic valve stenosis - The COFRASA - GENERAC StudyP648Low referral for aortic valve replacement accounts for worse long-term outcome in low versus high gradient severe aortic stenosis with preserved ejection fractionP649The impact of right ventricular function from aortic valve replacement: A randomised study comparing minimally invasive aortic valve surgery and conventional open heart surgery. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, De La Rosa Riestra A, Alonso Bello J, Perez Gonzalez F, Wan S, Sun JP, Lee AP, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Cimino S, Salatino T, Silvetti E, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Yesin M, Gunduz S, Gursoy MO, Astarcioglu MA, Karakoyun S, Bayam E, Cersit S, Ozkan M, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Quintana Razcka O, Romero Pereiro A, Zugazabeitia Irazabal G, Braga M, Flores L, Ribeiro V, Melao F, Dias P, Maciel MJ, Bettencourt P, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Vaturi M, Weisenberg D, Monakier D, Valdman A, Vaknin- Assa H, Assali A, Kornowski R, Sagie A, Shapira Y, Ribeiras R, Abecasis J, Teles R, Castro M, Tralhao A, Horta E, Brito J, Andrade M, Mendes M, Avegliano G, Ronderos R, Matta MG, Camporrotondo M, Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aleksandric S, Djordjevic-Dikic A, Teofilovski-Parapid G, Stepanovic J, Tomasevic M, Vukcevic V, Petrovic M, Dobric M, Parapid B, Beleslin B. Comparison of coronary flow reserve by transthoracic Doppler echocardiography after adenosine and dobutamine infusions for hemodynamic assessment of myocardial bridging. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Banovic M, Vujisic-Tesic B, Bojic S, Petrovic M, Popovic D, Nedeljkovic I, Trifunovic D, Aleksandric S, Petrovic O, Seferovic P. Prognostic value of low-dose dobutamine testing in asymptomatic patients with moderate or severe aortic stenosis and preserved ejection fraction. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Antic V, Ciraj-Bjelac O, Rehani M, Aleksandric S, Arandjic D, Ostojic M. Eye lens dosimetry in interventional cardiology: results of staff dose measurements and link to patient dose levels. Radiat Prot Dosimetry 2012; 154:276-284. [PMID: 23152146 DOI: 10.1093/rpd/ncs236] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Workers involved in interventional cardiology procedures receive high eye lens dose if protection is not used. Currently, there is no suitable method for routine use for the measurement of eye dose. Since most angiography machines are equipped with suitable patient dosemeters, deriving factors linking staff eye doses to the patient doses can be helpful. In this study the patient kerma-area product, cumulative dose at an interventional reference point and eye dose in terms of Hp(3) of the cardiologists, nurses and radiographers for interventional cardiology procedures have been measured. Correlations between the patient dose and the staff eye dose were obtained. The mean eye dose was 121 µSv for the first operator, 33 µSv for the second operator/nurse and 12 µSv for radiographer. Normalised eye lens doses per unit kerma-area product were 0.94 µSv Gy⁻¹ cm⁻² for the first operator, 0.33 µSv Gy⁻¹ cm⁻² for the second operator/nurse and 0.16 µSv Gy⁻¹ cm⁻² for radiographers. Statistical analysis indicated that there is a weak but significant (p < 0.01) correlation between the eye dose and the kerma-area product for all three staff categories. These values are based on a local practice and may provide useful reference for other studies for validation and for wider utilisation in assessing the eye dose using patient dose values.
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Affiliation(s)
- V Antic
- Center for Nuclear Medicine, University Clinical Centre of Serbia, Belgrade, Serbia
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Golubicic I, Nikitovic M, Barjaktarevic Z, Rasovic N, Aleksandric S, Sobic V. 527 MOPP/ABVD and radiotherapy in the treatment of pediatric hodgkin's disease (HD). Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)95781-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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