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Obradovic S, Dzudovic B, Simpson T, Matijasevic J, Salinger S, Neskovic A. S wave resolution in lead aVL at 48 hours after pulmonary embolism admission predicts lower mortality. Thromb Res 2024; 234:36-38. [PMID: 38154201 DOI: 10.1016/j.thromres.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia; School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- School of Medicine, University of Defense, Belgrade, Serbia; Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia.
| | - Tamara Simpson
- Jacobi North Central Bronx Hospital, New York City, NY, United States of America
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia; School of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Centre Nis, Nis, Serbia; School of Medicine, University of Nis, Nis, Serbia
| | - Aleksandar Neskovic
- Clical Centre Zemun, Belgrade, Serbia; School of Medicine University of Belgrade, Belgrade, Serbia
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Obradovic S, Dzudovic B, Pruszczyk P, Djuric I, Subotic B, Matijasevic J, Benic M, Salinger S, Kos L, Kovacevic-Preradovic T, Mitevska I, Kafedzic S, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V. The timing of death in acute pulmonary embolism patients regarding the mortality risk stratification at admission to the hospital. Heliyon 2024; 10:e23536. [PMID: 38187278 PMCID: PMC10767379 DOI: 10.1016/j.heliyon.2023.e23536] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background The management of patients with acute pulmonary embolism (aPE) depends on the severity of aPE. The timing of death in various aPE risk subgroups is only partially known. Methods 1618 patients with an objectively established aPE diagnosis with computed tomography pulmonary angiography enrolled in the regional PE registry were included in the study. According to ESC criteria, patients were stratified at admission to the hospital in four risk strata. The timing of PE-related and non-PE-related deaths was analyzed regarding mortality risk. Results PE-related, and non-PE-related hospital death rates were 1.1 % and 1.5 % in low, 1.1 % and 4.8 % in intermediate-low, 8.1 % and 5.9 % in intermediate-high, and 27.7 % and 6.9 % in high-risk groups, respectively. The median time of PE-related and non-PE-related death across the PE mortality risk were: 4 (1.7-7.5) and 7.0 (4-14.7) days in low, 1.5 (1.0-9.5) and 11.5 (2.0-21.0) days in intermediate-low, 4.0 (2.0-9.0) and 9.0 (5.7-18.2) days in intermediate-high, 2.0 (1.0-4.75) and 7.0 (3.0-21.2) days in high-risk subgroups. 48.2 % and 17.1 % of patients who died in the high and intermediate-high risks died during the first hospital day. After the 6th hospitalization day, PE-related deaths were recorded in 43.9 % of deaths from intermediate-high and 17.9 % from high-risk subgroups. Conclusion PE-related mortality is prominent on the first hospitalization day in high and intermediate-high-risk PE. A substantial proportion of intermediate-high and high-risk patient's PE deaths occurred after the first 6 days of hospitalization.
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Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Ivica Djuric
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia
- School of Medicine, University of Novi Sad, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, Serbia
- School of Medicine, University of Nis, Serbia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina
- School of Medicine, University of Banja Luka, Bosnia and Herzegovina
| | - Irena Mitevska
- University Cardiology Clinic, Intensive Care Unit, Skopje, Macedonia
| | - Srdjan Kafedzic
- Clinic of Cardiology, University Clinical Center Zemun, Serbia
| | - Aleksandar Neskovic
- Clinic of Cardiology, University Clinical Center Zemun, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, Montenegro
- School of Medicine, University of Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, Montenegro
- School of Medicine, University of Podgorica, Montenegro
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, Serbia
- School of Medicine, University of Kragujevac, Serbia
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Jermakow MT, Obradovic S, Salinas P, Roik M, Dzudovic B, Sekulic I, Macaya F, Paredes-Vazquez J, Velázquez Martín M, Maneiro Melón NM, Nedeljkov D, Matijasevic J, Łabyk A, Krakowian M, Stępniewski J, Araszkiewicz A, Pruszczyk P. Initial results of investigator initiated international database on catheter directed therapy of acute pulmonary embolism. Cardiol J 2023:VM/OJS/J/95949. [PMID: 37772352 DOI: 10.5603/cj.95949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Catheter directed therapies (CDT) are widely used in the treatment of acute pulmonary embolism (PE). A multicenter registry was organized to evaluate their application in real life and to determine efficacy and safety of these procedures. Local experience of participating centers in percutaneous techniques for PE treatment was assessed. METHODS An internet-based registry was designed to collect clinical, echocardiographic and laboratory data of consecutive PE patients treated with CDT in participating centers between 2017 and 2022. RESULTS Under analysis were 145 consecutive patients with acute PE, aged 61 ± 15 years, treated with CDT in 7 centers: 50 (34.5%) patients with high-risk PE (HRPE), and 95 (65.5%) patients with intermediate-high risk PE (IHRPE). 100 (69%) patients were treated with dedicated devices, in 45 (31%) subjects a pigtail catheter was used. Total PE or CDT related in-hospital mortality in HRPE reached 14% (7 patients), while in IHRPE 3.2% (3 patients) (p = 0.032). 50% of PE or CDT related deaths occurred in patients treated with a pigtail catheter. All-cause mortality in 145 patients was 9.7%, and it was higher in HRPE than in IHRPE (18% vs. 5.3%, p = 0.019). The use of pigtail catheters compared to dedicated systems was associated with higher mortality (20% vs. 5%, p = 0.01). CONCLUSIONS Catheter directed therapies is a real option of treating PE. It was used as primary therapy also in patients without contraindication for thrombolysis suggesting that clinical practice does not always follow current PE guidelines. Patients treated with dedicated CDT systems had a higher survival rate than subjects treated with pigtail catheters.
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Affiliation(s)
- Mateusz T Jermakow
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Pablo Salinas
- Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Marek Roik
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Boris Dzudovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Emergency Medicine, Military Medical Academy, Belgrade, Serbia
| | - Igor Sekulic
- School of Medicine, University of Defense, Belgrade, Serbia
- Institute of Radiology, Military Medical Academy, Belgrade, Serbia
| | - Fernando Macaya
- Interventional Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Maite Velázquez Martín
- Servicio de Cardiología, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
| | - Nicolás Manuel Maneiro Melón
- Servicio de Cardiología, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERCV, Madrid, Spain
| | - Djordje Nedeljkov
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- Faculty of Medicine, University of Novi Sad, Serbia
| | - Andrzej Łabyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Marcin Krakowian
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
| | - Jakub Stępniewski
- Pulmonary Circulation Center, Department of Cardiac and Vascular Disease, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
- Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland
| | | | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
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Obradovic S, Dzudovic B, Subotic B, Salinger S, Matijasevic J, Benic M, Kovacevic T, Kovacevic-Kuzmanovic A, Mitevska I, Miloradovic V, Jevtic E, Neskovic A. Association of Blood Leukocytes and Hemoglobin with Hospital Mortality in Acute Pulmonary Embolism. J Clin Med 2023; 12:6269. [PMID: 37834913 PMCID: PMC10573828 DOI: 10.3390/jcm12196269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to assess the prognostic significance of total leukocyte count (TLC) and hemoglobin (Hb) levels upon admission for patients with acute pulmonary embolism (PE), considering the European Society of Cardiology (ESC) model for mortality risk. 1622 patients from a regional PE registry were included. Decision tree statistics were employed to evaluate the prognostic value of TLC and Hb, both independently and in conjunction with the ESC model. The results indicated all-cause and PE-related in-hospital mortality rates of 10.7% and 6.5%, respectively. Subgrouping patients based on TLC cut-off values (≤11.2, 11.2-16.84, >16.84 × 109/L) revealed increasing all-cause mortality risks (7.0%, 11.8%, 30.2%). Incorporating Hb levels (≤126 g/L or above) further stratified the lowest risk group into two strata with all-cause mortality rates of 10.1% and 4.7%. Similar trends were observed for PE-related mortality. Notably, TLC improved risk assessment for intermediate-high-risk patients within the ESC model, while Hb levels enhanced mortality risk stratification for lower-risk PE patients in the ESC model for all-cause mortality. In conclusion, TLC and Hb levels upon admission can refine the ESC model's mortality risk classification for patients with acute PE, providing valuable insights for improved patient management.
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Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy of Belgrade, 11000 Belgrade, Serbia; (S.O.); (B.S.)
- School of Medicine, University of Defense, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- School of Medicine, University of Defense, 11000 Belgrade, Serbia
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy of Belgrade, 11000 Belgrade, Serbia; (S.O.); (B.S.)
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, 18000 Nis, Serbia;
- School of Medicine, University of Nis, 18000 Nis, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, 21204 Sremska Kamenica, Serbia; (J.M.); (M.B.)
- School of Medicine, University of Novi Sad, 24000 Subotica, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases Vojvodina, Novi Sad, 21204 Sremska Kamenica, Serbia; (J.M.); (M.B.)
| | - Tamara Kovacevic
- Clinic of Cardiology, Clinical Center Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
- School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | | | - Irena Mitevska
- Intensive Care Unit, University Cardiology Clinic, 1000 Skopje, North Macedonia;
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (V.M.); (E.J.)
- School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ema Jevtic
- Clinic of Cardiology, Clinical Center Kragujevac, 34000 Kragujevac, Serbia; (V.M.); (E.J.)
| | - Aleksandar Neskovic
- Clinic of Cardiology, University Clinical Center Zemun, 11080 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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5
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Djuric I, Dzudovic B, Subotic B, Dzudovic J, Matijasevic J, Benic M, Salinger S, Mitevska I, Kos L, Kovacevic-Preradovic T, Simovic S, Miloradovic V, Savicic T, Bozovic B, Bulatovic N, Kafedzic S, Neskovic AN, Kocev N, Marinković J, Obradovic S. New-Onset Paroxysmal Atrial Fibrillation in the Setting of Acute Pulmonary Embolism Is Associated with All-Cause Hospital Mortality in Women but Not in Men. Diagnostics (Basel) 2023; 13:diagnostics13111829. [PMID: 37296681 DOI: 10.3390/diagnostics13111829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Patients with acute pulmonary embolism (PE) may have various types of atrial fibrillation (AF). The role of AF in hemodynamic states and outcomes may differ between men and women. METHODS In total, 1600 patients (743 males and 857 females) with acute PE were enrolled in this study. The severity of PE was assessed using the European Society of Cardiology (ESC) mortality risk model. Patients were allocated into three groups according to their electrocardiography recordings taken during hospitalization: sinus rhythm, new-onset paroxysmal AF, and persistent/permanent AF. The association between the types of AF and all-cause hospital mortality was tested using regression models and net reclassification index (NRI) and integrated discrimination index (IDI) statistics with respect to sex. RESULTS There were no differences between the frequencies of the types of AF between men and women: 8.1% vs. 9.1% and 7.5% vs. 7.5% (p = 0.766) for paroxysmal and persistent/permanent AF, respectively. We found that the rates of paroxysmal AF significantly increased across the mortality risk strata in both sexes. Among the types of AF, the presence of paroxysmal AF had a predictive value for all-cause hospital mortality independent of mortality risk and age in women only (adjusted HR, 2.072; 95% CI, 1.274-3.371; p = 0.003). Adding paroxysmal AF to the ESC risk model did not improve the reclassification of patient risk for the prediction of all-cause mortality, but instead enhanced the discriminative power of the existing model in women only (NRI, not significant; IDI, 0.022 (95% CI, 0.004-0.063); p = 0.013). CONCLUSION The occurrence of paroxysmal AF in female patients with acute PE has predictive value for all-cause hospital mortality independent of age and mortality risk.
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Affiliation(s)
- Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Internal Medicine, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, 11000 Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, 18000 Nis, Serbia
| | - Irena Mitevska
- Clinic of Cardiology, School of Medicine, University of Skopje, 1000 Skopje, North Macedonia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Tanja Savicic
- Department for Internal Medicine, General Hospital Pancevo, 26000 Pancevo, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, 81000 Podgorica, Montenegro
- School of Medicine Podgorica, University of Podgorica, 81000 Podgorica, Montenegro
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
| | - Aleksandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, 11080 Zemun, Serbia
- School of Medicine Belgrade, University of Belgrade, 11000 Beograd, Serbia
| | - Nikola Kocev
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Jelena Marinković
- Institute for Medical Statistics School of Medicine, University of Belgrade, 11000 Beograd, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia
- School of Medicine Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Ružičić DP, Dzudovic B, Matijasevic J, Benic M, Salinger S, Kos L, Kovacevic-Preradovic T, Mitevska I, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V, Djuric I, Obradovic S. Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER). BMJ Open Respir Res 2023; 10:10/1/e001559. [PMID: 37076250 PMCID: PMC10124252 DOI: 10.1136/bmjresp-2022-001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. PATIENTS AND METHODS A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classified as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated. RESULTS The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not significantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate-risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001). CONCLUSION Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high-risk PE irrespective of sex and age.
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Affiliation(s)
- Dušan Predrag Ružičić
- Department of Internal Medicine and Invasive Cardiology, General Hospital Valjevo, Valjevo, Serbia
| | - Boris Dzudovic
- Clinic Of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
- School of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marija Benic
- Institute of Pulmonary Diseases of Vojvodina, Novi Sad, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, Nis, Serbia
- School of Medicine, University of Nis, Nis, Serbia
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic-Preradovic
- Clinic of Cardiology, Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
- School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Irena Mitevska
- Clinic of Cardiology, Intensive Care Unit, School of Medicine Skopje, University of Skopje, Skopje, North Republic of Macedonia
| | - Aleksandar Neskovic
- Clinic of Cardiology, Clinical Center Zemun, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, Podgorica, Montenegro
- School of Medicine, University of Podgorica, Podgorica, Montenegro
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Ivica Djuric
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- School of Medicine, University of Defense, Belgrade, Serbia
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia
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7
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Mladenovic Z, Obradovic S, Ristic S, Djenic L, Begic E. A Rare Case of Undifferentiated Pleomorphic Sarcoma with Central Necrosis in the Right Atrium. Turk Kardiyol Dern Ars 2023; 51:155-158. [PMID: 36916814 DOI: 10.5543/tkda.2022.97918] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Primary cardiac tumors, which are uncommon types of tumors, can be presented with a variety of clinical signs and symptoms, depending on their location. We present a case of a 57-year-old female patient with a severe right-sided heart failure. Examination using 2-dimensional transthoracic and 3-dimensional transoesophageal echocardiography detected a large, oval, tumor-like formation within the right atrium, which compromised the blood flow from the superior and inferior vena cava. It appeared to have an irregular echo-free space in its central part, probably due to necrosis. Thoracic multislice computed tomography revealed a heterogeneous, expansive, tumor-like mass in the right atrium, with signs of bleeding in its center. Although there were no signs of metastatic dissemination, it could not be excluded that the tumor-like mass originated outside of the heart. The patient underwent surgical resection of the tumor. The surgery was accompanied with bleeding complications that developed due to the central necrosis with local infiltration. During the postoperative period, severe systemic inflammatory response syndrome developed and the patient died. Pathologists diagnosed undifferentiated pleomorphic cardiac sarcoma for which the prognosis is usually poor. The median survival of patients with this type of diagnosis is less than 1 year, even with surgical resection and further adjuvant therapy.
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Affiliation(s)
- Zorica Mladenovic
- Clinic of Cardiology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | | | - Sasa Ristic
- Institute for Pathology, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Ljubinko Djenic
- Clinic for Cardiac and Thoracic Surgery, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
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Dzudovic B, Matijasevic J, Salinger S, Obradovic S. Increased B-type natriuretic peptide is a better predictor of hospital mortality then increased troponin in patients with acute pulmonary embolism. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1887] [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
Both elevated troponin (Tn) and B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-proBNP) are recognized as markers of increased right ventricular overload in acute PE. However, among these biomarkers, only elevated Tn is suggested in the current guideline for estimation of early mortality risk in acute PE.
Purpose
To compare the values of the increase above the upper limit of normal (ULN) for both Tn and BNP markers in terms of their predictive value for hospital mortality in acute PE patients.
Patients and methods
This is a multi-centric retrospective cross-sectional study of consecutive PE patients during the 6 years (2015–2021). BNP and Tn were measured on admission to the hospital. BNP or Tn values were then divided with ULN provided by the laboratory for each biomarker, and the results thus obtained were used in ROC curve comparison analysis to compare the prediction values for all-cause hospital mortality in PE patients.
Results
Overall 758 patients were included in the study, and among them, 72 (9.5%) died. The cut-off value for the increase of BNP was 2.3 times ULN and had 81.2% sensitivity and 55.5% specificity. Positive predictive value (PPV) and negative predictive value (NPV) were 15.3% and 96.8%, respectively. The cut-off value for the increase of Tn was 1.5 times ULN, with 77.3% and 45.6% of sensitivity and specificity, respectively (NPV 95.3% and PPV 12.3%). in the comparison of ROC curves, AUC for BNP increase was 0.716 and the AUC for Tn increase was 0.625, p=0.03 (Fig. 1).
Conclusion
The increase of BNP above the upper limit of normal is a better predictor of early mortality among acute PE patients than the increase of Tn in the same patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Dzudovic
- Military Medical Academy, Clinic of Emergency Internal Medicine , Belgrade , Serbia
| | - J Matijasevic
- Institute of Pulmonary Disease , Sremska Kamenica , Serbia
| | - S Salinger
- Clinical Center of Nis, Clinic of Cardiology , Nis , Serbia
| | - S Obradovic
- Military Medical Academy of Belgrade, Clinic of Cardiology , Belgrade , Serbia
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9
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Obradovic S, Dzudovic B, Matijasevic J, Salinger S, Kos LJ, Benic M, Mitevska I, Kafedzic S, Kovacevic-Preradovic T, Neskovic A, Bozovic B, Bulatovic N, Miloradovic V. The timing of death in acute pulmonary embolism patients regarding the mortality risk stratification at admission to hospital. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1866] [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 management of patients with acute pulmonary embolism (aPE) depend on the risk stratification at hospital admission. It is unknown when normotensive aPE patients with some other risk factors deteriorate.
Patients and methods
Patients with objectively established acute PE diagnosis enrolled in the regional PE registry from January 2015 to December 2021, were studied in this investigation. According to European Society od Cardiology criteria patients were stratified during admission to hospital in four risk stratums. The timing for death and the main reason for death were recorded. PE-related death was defined if patient has died because of cardiac arrest or obstructive shock if there is no another possible reason for that.
Results
In the REPER registry. Among 1541 patients (514 low risk, 366 intermediate-low risk, 472 intermediate-high risk and 189 high risk) with aPE, 101 (6.6%) have died primary from aPE and 64 (4.2%) have died from other reasons during the 30-day follow-up. PE-related death across the mortality risk groups were 0.8%, 1.1%, 8.5% and 28.5% in low-risk, intermediate-low, intermediate-high and high risk PE, respectively. Median time from hospital admission to PE related death was significantly longer in intermediate-high than in high risk patients 4.5 (2.0–9.0) vs 1.0 (1.0–4.5) days, p=0.001. In the high risk group 50.9% of patients died during the first 24 hours, 9.0% in the next 24 hours and 83.0% of patients died during the first 5 days from admission. In the intermediate-high risk group 17.5% died in the first 24 hours, 12.5% died in the next 24 hours and next 25% died till the fifth day. There was no difference in timing of non PE-related death between intermediate-high and high risk patients 9.5 (6.0–18.5) vs 7.0 (3.0–23.5) days, p=0.631.
Conclusion
There is significant delay in timing of death in intermediate-high compare to high risk PE patients, however, almost 50% of patients who died in the intermediate-high risk PE patients have died inside the first 5 days from hospital admission.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Obradovic
- Military Medical Academy of Belgrade, School of Medicine, University of Defense , Belgrade , Serbia
| | - B Dzudovic
- Military Medical Academy of Belgrade, School of Medicine, University of Defense , Belgrade , Serbia
| | - J Matijasevic
- Institute of Pulmonary Diseases Vojvodina , Novi Sad , Serbia
| | | | - L J Kos
- Clinical Center Banja Luka, Clinic of Cardiology , Banja Luka , Bosnia and Herzegovina
| | - M Benic
- Clinical Center Banja Luka, Clinic of Cardiology , Banja Luka , Bosnia and Herzegovina
| | - I Mitevska
- University Cardiology Clinic, Intensive Care Unit , Skopje , North Macedonia
| | - S Kafedzic
- Clinical Hospital Center Zemun, Clinic of Cardiology, Clinical Centre Zemun , Belgrade , Serbia
| | | | - A Neskovic
- Clinical Hospital Center Zemun, Clinic of Cardiology, Clinical Centre Zemun , Belgrade , Serbia
| | - B Bozovic
- Clinical Center of Montenegro, Clinic of Cardiology , Podgorica , Montenegro
| | - N Bulatovic
- Clinical Center of Montenegro, Clinic of Cardiology , Podgorica , Montenegro
| | - V Miloradovic
- University of Kragujevac Faculty of Medicine, Clinic of Cardiology , Kragujevac , Serbia
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10
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Jovanovic L, Rajkovic M, Subota V, Subotic B, Dzudovic B, Matijasevic J, Benic M, Salinger S, Simovic S, Miloradovic V, Kovacevic TP, Kos L, Neskovic A, Kafedzic S, Nikolic NM, Bozovic B, Bulatovic N, Obradovic S. Predictive value of admission glycemia in diabetics with pulmonary embolism compared to non-diabetic patients. Acta Diabetol 2022; 59:653-659. [PMID: 35094143 DOI: 10.1007/s00592-021-01843-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/19/2021] [Indexed: 11/01/2022]
Abstract
AIMS To examine the relationship between admission glucose (AG) level and short-term in-hospital mortality and to investigate the association between hyperglycemia and major bleeding in PE patients with and without DMT2. METHODS We evaluated 1165 patients with diagnosed acute PE with multi-detector computed tomography pulmonary angiography (MDCT-PA) enrolled in the Regional multicenter PE registry (REPER). The study population was classified to patients with diabetes mellitus type 2 (DMT2) and those without diabetes. According to quartiles of AG patients, both groups separately were categorized into four subgroups (DMT2 I: < 7.5 mmol/L; II: 7.5-10.0 mmol/L; III: 10.0-15.7 mmol/L; IV: > 15.7 mmol/L and (non-DMT2 I: < 5.5 mmol/L; II: 5.5-6.3 mmol/L; III: 6.3-7.9 mmol/L; IV: > 7.9 mmol/L). RESULTS All-cause mortality was higher in the DMT2 group (9.5% vs. 18.2%, p < 0.001), and PE-cause mortality was 6% for the patients without DMT2 and 12.4% for DMT2 patients (p = 0.02). The patients in the fourth AG quartiles in both groups, without DMT2 and with DMT2, had significantly higher all-cause and PE-cause in-hospital mortality compared with the first quartile. Rates of major bleeding were similar between the groups. On the multivariable analysis, after adjusting for age, gender and mortality risk, the adherence in the fourth AG quartile had an independent predictive value for all-cause death (HR 2.476, 95% CI 1.017-6.027) only in DM patients. CONCLUSION In our cohort of patients with acute PE, diabetes was associated with increased rates for all-cause and PE-cause mortality.
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Affiliation(s)
- Ljiljana Jovanovic
- Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia
| | - Milena Rajkovic
- Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia
| | - Vesna Subota
- Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- School of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marija Benic
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Sonja Salinger
- Clinic of Cardiology, Clinical Center Nis, University of Nis, Nis, Serbia
| | - Stefan Simovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Miloradovic
- Clinic of Cardiology, Clinical Center Kragujevac, School of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Tamara Preradovic Kovacevic
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Ljiljana Kos
- Clinic of Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina
| | - Aleksandar Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srdjan Kafedzic
- Department of Cardiology, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Natasa Markovic Nikolic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- University Clinical Center Zvezdara, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Bjanka Bozovic
- Clinic of Cardiology, Clinical Center Podgorica, School of Medicine, University of Podgorica, Podgorica, Montenegro
| | - Nebojsa Bulatovic
- Clinic of Cardiology, Clinical Center Podgorica, School of Medicine, University of Podgorica, Podgorica, Montenegro
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia.
- School of Medicine, University of Defense, Belgrade, Serbia.
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11
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Dzudovic J, Sakac MC, Antunovic M, Repic A, Obradovic S, Djordjevic S, Savic J, Dzudovic B. Development and validation of LC-MS/MS method for determination of plasma apixaban. ACTA CHROMATOGR 2021. [DOI: 10.1556/1326.2021.00948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
Oral anticoagulants are a group of drugs used for the prevention and treatment of venous thrombosis and venous thromboembolism. For the last ten years, direct oral anticoagulants (DOAC) have been available and are equally effective, but significantly safer than vitamin K antagonists. In the case of an overdose, their most important side effect is still bleeding. Due to their widespread use, as well as increased toxicological importance there is a need to develop an analytical method for the determination of DOAC in biological material.
The aim of this paper was to establish a method for the quantification of apixaban as one of the representatives of DOAC. The methodology of the study included the measurement of apixaban in the plasma of patients treated in the intensive care unit. Plasma apixaban concentrations were determined by LC-MS/MS technique using carbamazepine as an internal standard. Obtained validation parameters indicate that the introduced method is sensitive, reliable, precise and accurate. Using this method, apixaban can be quickly and easily detected and quantified in plasma in patients who are suspected of overdosing with this drug.
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Affiliation(s)
- Jelena Dzudovic
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Milkica Crevar Sakac
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Marko Antunovic
- National Poison Control Center, Military Medical Academy, Belgrade, Serbia
| | - Aleksandra Repic
- Serbian Institute for Occupational Health “Dr Dragomir Karajovic”, Belgrade, Serbia
| | | | - Snezana Djordjevic
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Jelena Savic
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
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12
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Begic E, Hadzidedic S, Obradovic S, Begic Z, Causevic M. Increased Levels of Coagulation Factor XI in Plasma Are Related to Alzheimer's Disease Diagnosis. J Alzheimers Dis 2020; 77:375-386. [PMID: 32804133 DOI: 10.3233/jad-200358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alzheimer's disease is a complex disorder of unclear etiology that develops in the elderly population. It is a debilitating, progressive neurodegeneration for which disease-modifying therapies do not exist. Previous studies have suggested that, for a subset of patients, dysregulation in hemostasis might be one of the molecular mechanisms that ultimately leads to the development of neurodegeneration resulting in cognitive decline that represents the most prominent symptomatic characteristic of Alzheimer's disease. OBJECTIVE To examine a relationship between factors that are part of coagulation and anticoagulation pathways with cognitive decline that develops during Alzheimer's disease. METHODS SOMAscan assay was used to measure levels of coagulation/anticoagulation factors V, VII, IX, X, Xa, XI, antithrombin III, protein S, protein C, and activated protein C in plasma samples obtained from three groups of subjects: 1) subjects with stable cognitively healthy function, 2) subjects with stable mild cognitive impairment, and 3) subjects diagnosed with probable Alzheimer's disease. RESULTS Our results show that protein levels of coagulation factor XI are significantly increased in patients who are diagnosed with probable Alzheimer's disease compared with cognitively healthy subjects or patients diagnosed with mild cognitive impairment. Furthermore, our results demonstrate that significant predictors of Alzheimer's-type diagnosis are factors IX and XI-an increase in both factors is associated with a reduction in cognitive function. CONCLUSION Our study justifies further investigations of biological pathways involving coagulation/anticoagulation factors in relation to dementia, including dementia resulting from Alzheimer's-type neurodegeneration.
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Affiliation(s)
- Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.,Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Suncica Hadzidedic
- Computer Science and Information Systems Department, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina.,Department of Computer Science, Durham University, Durham, UK
| | - Slobodan Obradovic
- Clinic for Emergency and Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Zijo Begic
- Department of Pediatric Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mirsada Causevic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
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13
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Dzudovic B, Subotic B, Novicic N, Matijasevic J, Trobok J, Miric M, Salinger-Martinovic S, Stanojevic D, Nikolic M, Miloradovic V, Markovic Nikolic N, Dekleva M, Lepojevic Stefanovic D, Kos L, Kovacevic Preradovic T, Obradovic S. Sex-related difference in the prognostic value of syncope for 30-day mortality among hospitalized pulmonary embolism patients. Clin Respir J 2020; 14:645-651. [PMID: 32129009 DOI: 10.1111/crj.13179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/19/2020] [Accepted: 02/23/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Recent studies report that syncope is not a significant predictor of 30-day mortality in pulmonary embolism (PE) patients, yet some data suggest sex-related differences may be relevant. OBJECTIVES To evaluate sex-specific prediction significance of syncope for 30-day mortality in PE patients. METHODS A multicentric, retrospective, observational, registry-based study on consecutive PE patients was undertaken. Patients were allocated into either a men or a women group before comparisons were made between patients with syncope and those without syncope. A sex-related prediction of the significance of syncope for 30-day mortality was evaluated. RESULTS Overall 588 patients [294 (50%) men and 294 (50%) women] were included within the study. Among men, patients with syncope were older and had significantly higher parameters of increased 30-day mortality then patients without syncope. Within the same group, however, difference in the 30-day mortality rate was not significant (log rank P = .942). In contrast to the men, fewer differences in admission characteristics were noticed among women, but those with syncope had significantly increased signs of the right ventricular dysfunction and increased 30-day mortality rate, as compared with those without syncope (log rank P = .025). After adjustment for age in a Cox regression analysis, syncope was a significant predictor of 30-day mortality in women (HR = 2.01, 95%CI 1.02-3.95). CONCLUSION Although syncope is associated with other predictors of higher early mortality in both male and female PE patients, only in women it is a significant predictor of 30-day mortality.
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Affiliation(s)
- Boris Dzudovic
- Clinic for Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Bojana Subotic
- Clinic for Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Natasa Novicic
- Clinic for Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Jadranka Trobok
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Milica Miric
- Institute for Pulmonary Diseases of Vojvodina, Clinic for Pulmonary Oncology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Dragana Stanojevic
- Clinic for Cardiology, Clinical Center Nis, School of Medicine, University of Nis, Serbia
| | - Maja Nikolic
- Clinic for Cardiology, School of Medicine, University of Kragujevac, Serbia
| | | | | | - Milica Dekleva
- Zvezdara University Medical Center, School of Medicine, University of Belgrade, Serbia
| | | | - Ljiljana Kos
- Clinic for Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Tamara Kovacevic Preradovic
- Clinic for Cardiology, Clinical Center Banja Luka, School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Slobodan Obradovic
- Clinic for Cardiology and Emergency Internal Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
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14
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Novicic N, Dzudovic B, Subotic B, Shalinger-Martinovic S, Obradovic S. Electrocardiography changes and their significance during treatment of patients with intermediate-high and high-risk pulmonary embolism. Eur Heart J Acute Cardiovasc Care 2020; 9:271-278. [PMID: 30632764 DOI: 10.1177/2048872618823441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electrocardiography (ECG) signs, typical or acute pulmonary embolism, and their changes can be used for the prediction of clinical and haemodynamic outcomes. PURPOSE To study the predictive value of the resolution of admission ECG signs in higher risk pulmonary embolism patients for 30-day survival and for the decrease in right ventricular systolic pressure. METHODS We analysed the 12-lead ECGs at admission and daily for the first 5 days after hospitalisation in 110 intermediate-high and high-risk pulmonary embolism patients admitted to the intensive care unit of a single tertiary centre. The predictive value of the resolution of four ECG signs were analysed for 30-day survival and for the changes in right ventricular systolic pressure during hospitalisation: S-wave in the first standard lead, right bundle branch block pattern, S-wave in the aVL lead and negative T-waves in precordial leads. RESULTS ECG recordings showed the existence of S-wave in the I lead in 71 (64.5%), S-wave in the aVL in 77 (70%), right bundle branch block pattern in 30 (27.3%) and negative T-waves in 66 (60%) patients. All-cause 30-day in-hospital mortality was 13.6%. Among the ECG signs, only the presence of right bundle branch block at admission was significantly associated with 30-day all-cause mortality (hazard ratio (HR) adjusted for age, gender and right ventricular systolic pressure at admission was 7.7, 95% confidence interval (CI) 2.1-27.9; P=0.002). The resolution of three ECG signs during the first 5 days of hospitalisation, S-wave in the I lead (HR 26.4, 95% CI 3.1-226.6; P=0.003), S-wave in the aVL (HR 21.5, 95% CI 2.6-175.3; P=0.004) and right bundle branch block configuration (HR 5.2, 95% CI 1.3-20.8; P=0.020) were associated with 30-day survival. The intermediate-high and high-risk pulmonary embolism patients with S-wave resolution in lead aVL had 0.0% and 7.1% 30-day all-cause mortality, respectively. The patients with resolution of the S-wave in the first lead and in aVL as well as right bundle branch block had more pronounced changes in right ventricular systolic pressure at discharge (27±13 vs. 13±15 mmHg; P=0.011 for S-wave in I lead resolution, 27±12 vs. 15±17 mmHg; P=0.004 for S-wave in aVL resolution and 23±14 vs. 9±14 mmHg; P=0.040 for right bundle branch block resolution) than patients without resolution. CONCLUSION Resolution of S-waves and right bundle branch block in ECG correlates with lower all-cause 30-day mortality in intermediate-high and high-risk pulmonary embolism patients. Resolution of S-waves in the first lead and in aVL and right bundle branch block correlates with a decrease of right ventricular systolic pressure.
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Affiliation(s)
- Natasha Novicic
- Clinic of Cardiology and Urgent Internal Medicine, Military Medical Academy, Serbia
| | - Boris Dzudovic
- Clinic of Cardiology and Urgent Internal Medicine, Military Medical Academy, Serbia
| | - Bojana Subotic
- Clinic of Cardiology and Urgent Internal Medicine, Military Medical Academy, Serbia
| | | | - Slobodan Obradovic
- Clinic of Cardiology and Urgent Internal Medicine, Military Medical Academy, Serbia.,School of Medicine, University of Defense, Serbia
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15
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Obradovic S, Begic E, Jankovic S, Romanovic R, Djenic N, Dzudovic B, Jovic Z, Malovic D, Subota V, Stavric M, Ljuca F, Kusljugic Z. Association of PC and AT levels in the early phase of STEMI treated with pPCI with LV systolic function and 6-month MACE. Acta Clin Belg 2020; 76:1-7. [PMID: 32436782 DOI: 10.1080/17843286.2020.1766850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine a relationship between protein C (PC) and antithrombin III (AT III) activities with ejection fraction of left ventricle (EFLV), in the early phase of acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), and to investigate whether PC and AT III are associated with major adverse cardiovascular events (MACE) within 6 months following from pPCI. PATIENTS AND METHODS The research had a prospective character and included 357 patients who had, following the diagnosis of the STEMI, undergone pPCI at the Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia, from January 2010 until April 2019. RESULTS The EFLV positively correlated with PC values (rho = 0.229). There was a statistically significant increase in the PC values between patients with MACE compared with those without MACE at 6 months' follow-up evaluation (p < 0.0001). Also, significant difference in PC values between patients who died in hospital and those who were alive at 6 months' follow-up (p < 0.01) was observed. PC values were different across different EFLV groups (p < 0.001), increasing from the 1st to the 4th EFLV quartiles: the median and the interquartile values for the 1st, 2nd, 3rd and 4th quartiles were 1.0400IU/l ± 0.15, 1.1400IU/l ± 0.15, 1.1350IU/l ± 0.16 and 1.2200IU/l ± 0.14, respectively. CONCLUSION Increased PC activity in the early phase of STEMI is associated with higher EFLV 5 days after the pPCI as well as with MACE at 6 months after the pPCI.
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Affiliation(s)
- Slobodan Obradovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Radoslav Romanovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Nemanja Djenic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Zoran Jovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
- School of Medicine, University of Defense, Belgrade, Serbia
| | - Dragana Malovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Vesna Subota
- School of Medicine, University of Defense, Belgrade, Serbia
- Institute of Biochemistry, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Milena Stavric
- Institute of Biochemistry, Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Farid Ljuca
- Department of Physiology, Faculty of Medicine Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zumreta Kusljugic
- Department for Science, Teaching and Clinical Trials, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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16
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Salinger-Martinovic S, Dimitrijevic Z, Stanojevic D, Momčilović S, Kostic T, Koracevic G, Subotic B, Dzudovic B, Stefanovic B, Matijasevic J, Miric M, Markovic-Nikolic N, Nikolic M, Miloradovic V, Kos L, Kovacevic-Preradovic T, Srdanovic I, Stanojevic J, Obradovic S. Renal dysfunction as intrahospital prognostic indicator in acute pulmonary embolism. Int J Cardiol 2020; 302:143-149. [DOI: 10.1016/j.ijcard.2019.12.025] [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] [Received: 10/14/2019] [Revised: 12/08/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
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17
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Subotic B, Dzudovic B, Novicic N, Matijasevic J, Salinger S, Obradovic S. P6459Comparison of the new BLLADS score with other scores for the prediction of major bleeding in patients with acute pulmonary embolism. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1051] [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
Hemorrhagic complications are a major obstacle for aggressive antithrombotic therapy in patients with acute pulmonary embolism (PE).
Objectives
We aimed to develop a simple risk score for predicting major bleeding (MB) in patients with acute PE using medical history and laboratory data at admission, including the potential influence of thrombolytic therapy, and to compare its predictive power to bleeding risk scores previously developed for patients with atrial fibrillation or venous thromboembolism.
Methods
A total of 630 consecutive patients treated for PE in six Serbian University hospitals were followed up for the occurrence of MB over a 90-day period after admission. A 6-component bleeding risk score was developed after Cox regression analysis of possible variables presented at admission. The use of thrombolytic therapy was also tested as a risk factor for bleeding and was integrated into the score. The ATRIA, HAS BLED, RIETE and VTE-BLEED scores were calculated for each patient at baseline and the predictive performances were compared with new score using c-statistics.
Results
MB occurred in 61 (9.7%) patients during the 90-day follow-up, with no increased risk of all-cause mortality (p=0.108). Six independent factors associated with MB were included in the final model (previous bleeding, leukocyte count ≥14x109/L, receipt of thrombolytic therapy, anemia, drugs associated with bleeding, and recent surgery; BLLADS). For the six- and five-variable models (without points for thrombolysis), C-indices were 0.774 (95% confidence interval [CI], 0.713–0.835, p<0.001) and 0.713 (95% CI, 0.639–0.788, p<0.001), respectively. The predictive power of the BLLADS score was found to be superior in comparison with other four scores: c-index 0.779 (95% CI 0.716–0.841, p<0.001), 0,614 (95% CI 0.535–0.692, p=0.005), 0.591 (95% CI 0.518–0.664, p=0.025), 0.589 (95% CI 0.518–0.659, p=0.029), 0.586 (95% CI 0.508–0.664, p=0.035), for continuous BLLADS, RIETE, VTE-BLEED, ATRIA and HAS BLED scores, respectively.
Conclusion
A simple six-variable score including the use of thrombolysis was developed with sufficient discriminative capacity comparing to current available scores for the prediction of 90-day MB for non-selected PE patients.
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Affiliation(s)
- B Subotic
- Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia
| | - B Dzudovic
- Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia
| | - N Novicic
- Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia
| | - J Matijasevic
- Institute of Pulmonary Diseases, Sremska Kamenica, Serbia
| | | | - S Obradovic
- Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia
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18
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Salinger-Martinovic S, Dimitrijevic Z, Stanojevic D, Subotic B, Dzudovic B, Stefanovic B, Matijasevic J, Miric M, Markovic-Nikolic N, Nikolic M, Miloradovic V, Kos LJ, Kovacevic-Preradovic T, Srdanovic I, Obradovic S. P6465Are we calculated enough? Glomerular filtration rate as a predictor of intra-hospital prognosis in patients with pulmonary embolism. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1057] [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
Pulmonary embolism (PE) can lead to multi-organ damage including an acute renal dysfunction which is associated with adverse events and high long-term mortality rate.
Purpose
The aim of our study was to investigate the predictive role of renal dysfunction on intrahospital mortality risk in patients hospitalized due to PE. The study was performed in intensive care units of six university hospitals.
Methods
The prospective cohort study comprised 665 consecutive patients with acute PE which was confirmed using MDCT. All patients underwent echocardiography examination on admission and blood samples were collected for troponin I (TnI), B-type natriuretic peptide (BNP) and routine laboratory analyses.
Results
Based on estimated glomerular filtration rate (GFR), patients were divided into three groups: first with the GFR <30ml/min, second with GFR 30–60 ml/min, and third with GFR >60 ml/min. During hospitalization in the first group the overall incidence of death was recorded in 28 (45.9%), in the second in 42 (18.9%), and in the third in 30 (7.9%) patients (p<0.0001). Pulmonary embolism as a cause of death was recorded in the first group in 18 (29.5%) patients, in the second in 25 (11.3%) and in the third in 17 (4.5%) patients (p<0.0001). Fatal bleeding was recorded in the first group in 1 (1.6%), in the second in 1 (0.5%) and in the third group in 3 (0.8%) patients (p<0.05). There were no significant differences regarding major bleeding frequency among the groups. Multivariate analysis showed that age, comorbidities, hemodynamic status, TnI, and GFR were strongly associated with an overall mortality rate and with death due to PE, while the use of anticoagulation therapy influenced the fatal bleeding rate. After controlling for age, we found that GFR on admission had a significant effect on in-hospital survival. Compared with patients in the third group, those from the second group had more than 2 fold increased mortality risk [OR 2.17 (CI 1.301–3.625), p=0.001], and patients in the first group had 6 fold higher risk of mortality [OR 6.006 (CI 3.487–6.006)]. In the ROC analysis GFR showed significant predictive value for intra-hospital mortality risk in PE patients [AUC= 0.725, 95% CI (0.68–0.78), p<0.001]. The highest sensitivity (64%) and specificity (70%) had GFR “cutoff” value of 59.12/min.
Conclusion
Renal dysfunction, on admission, in patients with acute PE is strongly associated with high intrahospital mortality risk and fatal bleeding. The estimation of GFR in these patients is important not only for prediction of the outcome but also for the prevention of bleeding complications, regarding the optimal dosage of anticoagulants. Even though it seems that GFR calculation is not still the clinical routine in PE.
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Affiliation(s)
| | - Z Dimitrijevic
- Clinical Center of Nis, Clinic for nephrology, Nis, Serbia
| | | | - B Subotic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
| | - B Dzudovic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
| | - B Stefanovic
- Clinical center of Serbia, Clinic of cardiology, Belgrade, Serbia
| | - J Matijasevic
- Institute of Pulmonary Diseases Sremska Kamenica, Sremska Kamenica, Serbia
| | - M Miric
- Institute of Pulmonary Diseases Sremska Kamenica, Sremska Kamenica, Serbia
| | | | - M Nikolic
- Clinical Center Kragujevac, Clinic of cardiology, Kragujevac, Serbia
| | - V Miloradovic
- Clinical Center Kragujevac, Clinic of cardiology, Kragujevac, Serbia
| | - L J Kos
- Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | | | - I Srdanovic
- Clinical Center of Vojvodina, Institute for Cardiovascular Diseases, Novi Sad, Serbia
| | - S Obradovic
- Military Medical Academy of Belgrade, Clinic of Cardiology and Emergency Internal Medicine, Belgrade, Serbia
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19
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Obradovic S, Dzudovic B, Sekulic I, Subotic B, Matijasevic J, Batranovic U, Salinger S, Nikolic M, Miloradovic V, Markovic-Nikolic N, Kos LJ, Preradovic-Kovacevic T. P5591Efficacy and safety of lower dose slow infusion of t-PA for intermediate-risk pulmonary embolism patients with risk for bleeding. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0535] [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
Current guidelines do not recommend thrombolytic therapy for the treatment of intermediate-risk pulmonary embolism (PE) because of the tight balance between the benefit and safety with classic protocols.
Aim
The aim of this study was to compare the new thrombolytic protocol with lower-dose slow-infusion (LDSI) of tissue plasminogen activator (tPA) to classic 2-hours tPA infusion protocol or no-reperfusion in patients with intermediate-high risk PE with higher bleeding risk regarding 30-day efficacy and safety.
Methods
Among 849 patients with PE from the Serbian multicenter registry, 469 patients who fulfilled criteria for intermediate-risk PE were involved in the study. After propensity score matching 425 patients [263 (61.9%), 99 (23.3%) and 63 (14.8%) were treated with no-reperfusion, classic tPA protocol (100 mg for 2 hours) and LDSI of tPA (2–5 mg/hour either vie local catheter or systemic venous infusion with dose range of 25–50 mg)]. The basic characteristics of patients were well balanced between groups except that patients treated with LDSI of tPA had significantly higher usage of drugs which can be associated to bleeding and more previous bleeding events. Thirty day all-cause and PE-caused mortality and 7-day major bleeding were the main efficacy and safety end-points, respectively.
Results
All-cause and PE-cause 30-day mortality were 8.7% vs 16.2% vs 1.6% (Log rank p=0.007) and 4.5% vs 11.0% vs 0.0% (Log rank p=0.008) in patients with no-reperfusion, classic tPA protocol and LDSI of tPA protocol, respectively. Major bleeding at 7 days were 2.7% vs 8.1% vs 14.3% (Log rank p=0.001) in patients with no-reperfusion, classic tPA protocol and LDSI of tPA protocol, respectively. There was one fatal intracranial bleeding during catheter infusion of tPA.
Conclusion
Lower-dose slow-infusion of tPA protocol decreased significantly all-cause and PE-cause mortality at 30-day at the cost of excess of non-fatal major bleeding at 7-day in patients with intermediate-risk PE and higher risk for bleeding.
Acknowledgement/Funding
None
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Affiliation(s)
- S Obradovic
- Military Medical Academy Belgrade, Belgrade, Serbia
| | - B Dzudovic
- Military Medical Academy Belgrade, Belgrade, Serbia
| | - I Sekulic
- Military Medical Academy Belgrade, Belgrade, Serbia
| | - B Subotic
- Military Medical Academy Belgrade, Belgrade, Serbia
| | - J Matijasevic
- Institute for Pulmonary Diseases Vojvodina, School of Medicine University of Novi Sad, Novi Sad, Serbia
| | - U Batranovic
- Institute for Pulmonary Diseases Vojvodina, School of Medicine University of Novi Sad, Novi Sad, Serbia
| | | | - M Nikolic
- University of Kragujevac Faculty of Medicine, Kragujevac, Serbia
| | - V Miloradovic
- University of Kragujevac Faculty of Medicine, Kragujevac, Serbia
| | - N Markovic-Nikolic
- Zvezdara University Medical Center, School of Medicine University of Belgrade, Belgrade, Serbia
| | - L J Kos
- Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
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20
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Stankovic S, Obradovic S, Dzudovic B, Djenic N, Romanovic R, Jovic Z, Spasic M, Djuric O, Malovic D, Stavric M, Subota V. Lower plasma protein C activity is associated with early myocardial necrosis and no-reflow phenomenon in patients with ST elevation myocardial infarction. Acta Cardiol 2019; 74:331-339. [PMID: 30204553 DOI: 10.1080/00015385.2018.1494116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Activity of protein C has important role in the development of early necrosis and no-reflow phenomenon in patients with ST-segment elevation myocardial infarction (STEMI) after successful primary percutaneous coronary intervention (pPCI). Methods: We examined association between plasma activity of protein C, antithrombin, coagulation factors II, VII, VIII and fibrinogen to early formation of new Q-waves (myocardial necrosis) before pPCI and early ST-segment resolution (microcirculatory reperfusion) after pPCI in patients with acute STEMI. According to ischaemic time, patients were considered as early or late presenters. 12-lead ECG was analysed for the presence of new Q-wave at admission and for significant ST-segment resolution 60 minutes after primary PCI. Results: In early presenters' group, protein C activity was significantly lower in patients who did not achieve significant ST-segment resolution after pPCI compared to patients who did (1.11 IU/L vs. 0.99 IU/L, p = .006) and in patients who had new Q-waves compared to group who had not (1.04 UI/l vs. 1.11 IU/L, p = .038). There was significant negative correlation between protein C activity and maximal CK-MB levels (R2 = 0.06, p = .009) and BNP levels (R2 = 0.109, p = .003) and significant positive correlation between protein C activity with LVEF (R2 = 0.065, constant = 33.940, b = 11.968, p = .007) in early STEMI presenters. There were no differences between the activity of other examined haemostasis factors. Conclusion: Therefore we concluded that STEMI patients with early myocardial necrosis and no-reflow phenomenon after pPCI have lower activity of plasma protein C levels.
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Affiliation(s)
- Suncica Stankovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Djenic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Radoslav Romanovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Zoran Jovic
- Clinic for cardiology, Military Medical Academy, Belgrade, Serbia
| | - Marijan Spasic
- Clinic for cardiology, Military Medical Academy, Belgrade, Serbia
| | - Obrad Djuric
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Dragana Malovic
- Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Milena Stavric
- Institute for Biochemistry, Military Medical Academy, Belgrade, Serbia
| | - Vesna Subota
- Institute for Biochemistry, Military Medical Academy, Belgrade, Serbia
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21
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Sekulic I, Dzudovic B, Matijasevic J, Batranovic U, Rusovic S, Mihajlovic M, Miladinovic U, Rancic N, Subotic B, Novicic N, Gavrilovic S, Boskovic-Sekulic J, Obradovic S. Ultrasound assisted thrombolysis in intermediate-risk patients with pulmonary thromboembolism. Acta Cardiol 2019; 75:623-630. [PMID: 31368848 DOI: 10.1080/00015385.2019.1646850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Systemic thrombolytic therapy is not recommended for patients with intermediate-risk pulmonary embolism (PE) because of major bleeding and intracranial bleeding overcomes the benefit of reperfusion. Patients and methods: A total of 342 PE patients with intermediate-risk PE from the multicenter Serbian PE registry were involved in the study. Of this group, 227 were not treated with reperfusion therapy (anticoagulation only), 91 were treated with conventional thrombolysis protocols at the discretion of their physicians and 24 patients were treated with ultrasound assisted catheter thrombolysis (USACT) with the EKOS® system. All patients treated with USACT had at least one factor which is associated with an increased risk of bleeding. Other patient characteristics were similar across the treatment groups. All-cause and PE-related mortality at 30 days and rate of major bleeding at 7 days were the main efficacy and safety outcomes of the study. Results: The 30-day all-cause mortality were 11.5% versus 17.6% versus 0.0% for no reperfusion, conventional thrombolysis protocols and USACT groups (p = 0.056), respectively. The difference between the rate of 30-day PE-related mortality was in a favour of EKOS and no reperfusion compare to conventional protocols (0.0% vs. 3.5% vs. 11.0%, p = 0.013, respectively). Major bleeding at 7 days, was presented in 1.8% versus 7.7% versus 8.0% (p = 0.021) in no reperfusion, conventional thrombolysis and USACT groups with no intracranial bleeding. Conclusion: In the patients with intermediate-risk PE and at least one bleeding factor, USACT could be an alternative treatment to anticoagulant therapy only and conventional thrombolytic protocols.
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Affiliation(s)
- Igor Sekulic
- Institute for Radiology, Military Medical Academy, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Jovan Matijasevic
- Institute of Pulmonary Diseases Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Uros Batranovic
- Clinic of Emergency Medicine, Clinical Centre Kragujevac, Kragujevac, Serbia
| | - Sinisa Rusovic
- Institute for Radiology, Military Medical Academy, Belgrade, Serbia
| | | | - Uros Miladinovic
- Institute for Radiology, Military Medical Academy, Belgrade, Serbia
| | - Nemanja Rancic
- Institute for Radiology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
| | - Bojana Subotic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Natasa Novicic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
| | - Srdjan Gavrilovic
- Institute of Pulmonary Diseases Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | | | - Slobodan Obradovic
- Clinic of Cardiology and Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia
- Medical Faculty Military Medical Academy, University of Defense, Belgrade, Serbia
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22
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Dzudovic J, Dzudovic B, Subota V, Antunovic M, Stavric M, Subotic B, Obradovic S. Differences between activities of coagulation factors after one month of therapy with different direct oral anticoagulant in pulmonary embolism patients. J Clin Pharm Ther 2018; 44:236-242. [DOI: 10.1111/jcpt.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/24/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jelena Dzudovic
- Clinic for Cardiology and Emergency Internal Medicine; Military Medical Academy; Belgrade Serbia
| | - Boris Dzudovic
- Clinic for Cardiology and Emergency Internal Medicine; Military Medical Academy; Belgrade Serbia
| | - Vesna Subota
- Institute for Medical Biochemistry; Military Medical Academy; Belgrade Serbia
| | - Marko Antunovic
- National Poison Control Center; Military Medical Academy; Belgrade Serbia
| | - Milena Stavric
- Institute for Medical Biochemistry; Military Medical Academy; Belgrade Serbia
| | - Bojana Subotic
- Clinic for Cardiology and Emergency Internal Medicine; Military Medical Academy; Belgrade Serbia
| | - Slobodan Obradovic
- Clinic for Cardiology and Emergency Internal Medicine; Military Medical Academy; Belgrade Serbia
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Mladenovic Z, Vranes D, Obradovic S, Dzudovic B, Angelkov Ristic A, Ratkovic N, Jovic Z, Spasic M, Maric Kocijancic J, Djruic P. Diagnostic significance of three-dimensional echocardiography in asymptomatic unicuspid aortic valve. Echocardiography 2018; 35:1247-1249. [DOI: 10.1111/echo.14039] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Danijela Vranes
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
| | | | - Boris Dzudovic
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
| | | | - Nenad Ratkovic
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
| | - Zoran Jovic
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
| | - Marijan Spasic
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
| | | | - Predrag Djruic
- Clinic for Cardiology; Military Medical Academy; Belgrade Serbia
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Obradovic S, Dzudovic B, Subotic B, Matijasevic J, Antonijevic N. P3505Heart rate is better than arterial systolic pressure at admission for the risk stratification in younger patients with pulmonary embolism. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3505] [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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Grdinic A, Vojvodic D, Djukanovic N, Colic M, Grdinic AG, Ignjatovic V, Majstorovic I, Ilic V, Magic Z, Obradovic S, Ostojic M, Pavlov Dolijanovic S. PCI and clopidogrel: antiplatelet responsiveness and patient characteristics. Acta Cardiol 2017. [DOI: 10.1080/ac.66.3.2114133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Danilo Vojvodic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
| | - Nina Djukanovic
- Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirko Colic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | | | | | - Ivana Majstorovic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
| | - Vesna Ilic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
| | - Zvonko Magic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
| | - Slobodan Obradovic
- Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia
| | - Miodrag Ostojic
- Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, Serbia
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Bartunek J, Terzic A, Davison BA, Filippatos GS, Radovanovic S, Beleslin B, Merkely B, Musialek P, Wojakowski W, Andreka P, Horvath IG, Katz A, Dolatabadi D, El Nakadi B, Arandjelovic A, Edes I, Seferovic PM, Obradovic S, Vanderheyden M, Jagic N, Petrov I, Atar S, Halabi M, Gelev VL, Shochat MK, Kasprzak JD, Sanz-Ruiz R, Heyndrickx GR, Nyolczas N, Legrand V, Guédès A, Heyse A, Moccetti T, Fernandez-Aviles F, Jimenez-Quevedo P, Bayes-Genis A, Hernandez-Garcia JM, Ribichini F, Gruchala M, Waldman SA, Teerlink JR, Gersh BJ, Povsic TJ, Henry TD, Metra M, Hajjar RJ, Tendera M, Behfar A, Alexandre B, Seron A, Stough WG, Sherman W, Cotter G, Wijns W. Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial. Eur Heart J 2017; 38:648-660. [PMID: 28025189 PMCID: PMC5381596 DOI: 10.1093/eurheartj/ehw543] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/22/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. METHODS AND RESULTS This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein-Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann-Whitney estimator 0.54, 95% confidence interval [CI] 0.47-0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200-370 mL (60% of patients) (Mann-Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. CONCLUSION The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted.
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Affiliation(s)
- Jozef Bartunek
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | - Andre Terzic
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | | | - Gerasimos S. Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | | | - Branko Beleslin
- Cardiology Clinic, Clinical Centre of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Bela Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Piotr Musialek
- Jagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Wojciech Wojakowski
- Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Peter Andreka
- Gottsegen Gyorgy Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Amos Katz
- Department of Cardiology, Barzilai Medical Center, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dariouch Dolatabadi
- Division of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Badih El Nakadi
- Division of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | | | - Istvan Edes
- Department of Cardiology, University of Debrecen, Debrecen, Hungary
| | - Petar M. Seferovic
- University of Belgrade School of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic of Emergency Medicine, Military Medical Academy, School of Medicine, University of Defense, Belgrade, Serbia
| | - Marc Vanderheyden
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | | | - Ivo Petrov
- Department of Cardiology, Angiology, and Electrophysiology, City Clinic Heart and Vascular Institute, Sofia University, Sofia, Bulgaria
| | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Majdi Halabi
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Valeri L. Gelev
- Department of Cardiology, Angiology, and Electrophysiology, City Clinic Heart and Vascular Institute, Sofia University, Sofia, Bulgaria
| | - Michael K. Shochat
- Heart Institute, Hillel Yaffe Medical Center, Hadera, Rappaport School of Medicine, Haifa, Israel, Technion
| | | | | | - Guy R. Heyndrickx
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
| | - Noémi Nyolczas
- Medical Centre, Hungarian Defense Forces, Budapest, Hungary
| | - Victor Legrand
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Antoine Guédès
- Department of Cardiology, Universite Catholique de Louvain, CHU UcL Namur, Yvoir, Belgium
| | - Alex Heyse
- Department of Cardiology, AZ Glorieux, Ronse, Belgium
| | | | | | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias I Pujol, Universitat Autònoma, Barcelona, Spain
| | | | | | - Marcin Gruchala
- Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Scott A. Waldman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R. Teerlink
- School of Medicine, University of California San Francisco and Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Bernard J. Gersh
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | - Thomas J. Povsic
- Duke Clinical Research Institute and Duke Medicine, Durham, NC, USA
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Spedali Civili, Brescia, Italy
| | | | - Michal Tendera
- Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Atta Behfar
- Mayo Clinic, Center for Regenerative Medicine, Department of Cardiovascular Diseases, 200 First Street SW, Rochester, Minnesota 550905, USA
| | | | | | - Wendy Gattis Stough
- Departments of Clinical Research and Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Cary, NC, USA
| | | | | | - William Wijns
- Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis OLV Hospital, Moorselbaan 164, Aalst, B-9300, Aalst, Belgium
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, Galway, Ireland
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Denic K, Tarabar D, Obradovic S, Stanic N, Spasic J, Ugresic N. Biochemical liver function tests parameters do not indicate any difference in the degree of hepatotoxicity in patients with metastatic colorectal carcinoma treated with conventional anticancer drugs regardless the use of bevacizumab. VOJNOSANIT PREGL 2017. [DOI: 10.2298/vsp150807221d] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Colorectal carcinoma (CRC) is one the most frequent malignant disease with early liver metastasis. It requires the timely use of anticancer drugs. Current treatment of metastatic CRC consists of conventional anticancer drugs use, but they cause liver damage which is manifested by disorder in biochemical liver function parameters. The addition of one of monoclonal antibodies, e.g. bevacizumab improves their therapeutic effect, but its influence on caused biochemical disturbances is not completely known. Therefore the aim of this study was to compare the level of liver function test parameters in patients treated with conventional anticancer drugs with parameters in patients additionally treated with bevacizumab. Methods. The study was performed on the two groups of adult patients with liver metastatic CRC assigned according to the treatment protocol. One group of the patients (n = 44) was treated with FOLFOX4 (the group 1), and the other one (n = 52) with bevacizumab added to FOLFOX4 treatment protocol (the group 2). Depending on the response of patients, the duration of treatment varied from 2 to 6 months. Standard liver function tests were performed before and after the completion of the treatment. Results. Initial values of some biochemical function test parameters [alkaline phosphatase (ALP) in the group 1 of patients, gamma-glutamyl transferase (GGT) and lactate dehydrogenase (LDH) in both groups] were increased in relation to the normal reference values, with some intergroup differences (p = 0.001). Biochemical disturbances of liver function tests in the group of patients treated with conventional anticancer drugs were due to not only their metastases but also due to the hepatotoxic effect of drugs used. After the treatment, significant differences in biochemical liver tests parameters were found in aspartate aminotransferase (AST), alanine aminotransferase (ALP), GGT and LDH, being lower in the group 2 (patients additionally treated by bevacizumab) (p values were: 0.002 for AST; 0.001 for ALP and GGT; 0.000 for LDH). The levels of the other studied parameters, alanine aminotransferase (ALT) bilirubin, and proteins did not differ significantly between groups both pre- or post-treatment. Conclusion. Both, metastatic CRC and treatment with the conventional anticancer drugs induce significant disturbances of several liver function parameters. The addition of bevacizumab to the conventional anticancer drugs did not affect these disturbances.
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Affiliation(s)
- Kristina Denic
- Military Medical Academy, National Poison Control Centre, Belgrade
| | - Dino Tarabar
- Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
| | - Slobodan Obradovic
- University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic for Emergency Medicine, Belgrade
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Roganovic B, Obradovic S, Micic A, Petrovic S. Hereditary hemorrhagic telangiectasia associated with inherited thrombophilia. VOJNOSANIT PREGL 2017. [DOI: 10.2298/vsp150601105r] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Hereditary hemorrhagic telangiectasia and inherited
thrombophilia are genetic disorders with quite opposite clinical
manifestation. The main characteristic for hereditary hemorrhagic
telangiectasia is recurrent bleeding, while the main characteristic for
hereditary thrombophilia is thrombosis. The association between hereditary
hemorrhagic telangiectasia and inherited thrombophilia in the same patient is
rare. Case report. We presented a 32-year-old female with recurrent
gastrointestinal hemorrhage and epistaxes, during a 9-year period. Hereditary
hemorrhagic telangiectasia was established according to ?Cura?ao? criteria.
Three of four criteria have been present: spontaneous recurrent epistaxis,
multiple telangiectasias (nose) and visceral lesions (gastric
angiodysplasias, jejunal telangiectasias, arterio- venous jejunal fistula).
Pulmonary thromboembolism was the first manifestation of thrombophilia; the
diagnosis was confirmed by genetic testing. Therapy of hemorrhage with
tranexamic acid (anti-fibrinolytic agent; its use increases risk of
thrombosis) was unsuccessful. Remission was achieved by thalidomide. The
initial therapy for pulmonary thromboembolism included aspirin (that have an
increased risk of bleeding), but aspirin had to be discontinued because of
massive hematemesis. Unfortunately, a year later, anticoagulant therapy
combined with the proton pump inhibitors, were introduced, because of a new
thrombosis. One month after, the patient was still on this therapy, without
new episodes of bleeding and thromboembolic events. Conclusion. Hereditary
hemorrhagic telangiectasia and inherited thrombophilia could be unrecognized
for years, partly due to the lower degree of clinical suspicion. Early
diagnosis and the appropriate choice of therapy are essential for reducing
serious consequences and to improve quality of life.
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Affiliation(s)
- Branka Roganovic
- Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade + University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade
| | - Slobodan Obradovic
- University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic for Urgent Internal Medicine, Belgrade
| | - Aleksandar Micic
- Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade
| | - Stanko Petrovic
- Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade
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Denić K, Tarabar D, Obradovic S, Ristić M, Spasić J, Radosavljević D, Ugrešić N. Biochemical liver function test parameter levels in relation to treatment response in liver metastatic colorectal patients treated with FOLFOX4 with or without bevacizumab. SRP ARK CELOK LEK 2016; 144:615-620. [PMID: 29659222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Combined use of bevacizumab and conventional anticancer drugs leads to a significant improvement of treatment response in patients with metastatic colorectal carcinoma (CRC). Conventional treatment protocols exert undesired effects on the liver tissue. Hepatotoxic effects are manifested as a disturbance of liver function test parameters. The relation between clinical outcome and disorder of biochemical parameters has not been completely evaluated. OBJECTIVE The objective of our study was to examine whether clinical outcome in patients with liver metastatic CRC correlates with the level of liver function test parameters. METHODS The study included 96 patients with untreated liver metastatic CRC who received FOLFOX4 protocol with or without bevacizumab. Biochemical liver parameters were performed before and after the treatment completion. Treatment response was evaluated as disease regression, stable disease, and disease progression. The patients were divided into three groups according to the accomplished treatment response. RESULTS In the group of patients with disease regression the post-treatment levels of aspartate aminotransferase, alanine aminotransferase, and bilirubin were statistically significantly increased. In contrast to this, gamma-glutamyltransferase and protein post-treatment values were significantly lower in relation to initial values. In patients with stable disease, difference was found only in the level of proteins being lower after the treatment. In patients with disease progression, values of aspartate aminotransferase and bilirubin were significantly increased after completed treatment. CONCLUSION Treatment responses are not completely associated with the level of liver function test parameters. The only parameter which correlated with treatment response is gamma-glutamyltransferase. Its decrease is accompanied with disease regression.
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Milovanovic DD, Milovanovic JR, Radovanovic M, Radosavljevic I, Obradovic S, Jankovic S, Milovanovic D, Djordjevic N. The influence of CYP2C8*3 on carbamazepine serum concentration in epileptic pediatric patients. Balkan J Med Genet 2016; 19:21-28. [PMID: 27785404 PMCID: PMC5026276 DOI: 10.1515/bjmg-2016-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to investigate the distribution of CYP2C8 variants *3 and *5, as well as their effect on carbamazepine pharmacokinetic properties, in 40 epileptic pediatric patients on carbamazepine treatment. Genotyping was conducted using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and allele-specific (AS)-PCR methods, and steady-state carbamazepine plasma concentrations were determined by high performance liquid chromatography (HPLC). The CYP2C8 *3 and *5 polymorphisms were found at frequencies of 17.5 and 0.0%, respectively. After dose adjustment, there was a difference in daily dose in CYP2C8*3 carriers compared to non carriers [mean ± standard deviation (SD): 14.19 ± 5.39 vs. 15.46 ± 4.35 mg/kg; p = 0.5]. Dose-normalized serum concentration of carbamazepine was higher in CYP2C8*3 (mean ± SD: 0.54 ± 0.18 vs. 0.43 ± 0.11 mg/mL, p = 0.04), and the observed correlation between weight-adjusted carbamazepine dose and carbamazepine concentration after dose adjustment was significant only in CYP2C8*3 non carriers (r = 0.52, p = 0.002). However, the population pharmacokinetic analysis failed to demonstrate any significant effect of CYP2C8 *3 polymorphism on carbamazepine clearance [CL L/h = 0.215 + 0.0696*SEX+ 0.000183*DD]. The results indicated that the CYP2C8*3 polymorphism might not be of clinical importance for epilepsy treatment in pediatric populations.
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Affiliation(s)
- D D Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - J R Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - M Radovanovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - I Radosavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - S Obradovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - S Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - D Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - N Djordjevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia
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Djordjevic N, Milovanovic DD, Radovanovic M, Radosavljevic I, Obradovic S, Jakovljevic M, Milovanovic D, Milovanovic JR, Jankovic S. CYP1A2 genotype affects carbamazepine pharmacokinetics in children with epilepsy. Eur J Clin Pharmacol 2016; 72:439-45. [PMID: 26762380 DOI: 10.1007/s00228-015-2006-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/29/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study is to investigate the effect of two of the most important functional CYP1A2 variations -3860G > A and -163C > A on carbamazepine pharmacokinetics in Serbian pediatric epileptic patients. METHODS The study involved 40 Serbian pediatric epileptic patients on steady-state carbamazepine treatment. Genotyping for -3860G > A and -163C > A was carried out using PCR-RFLP method, and carbamazepine plasma concentrations were determined by high pressure liquid chromatography (HPLC) method. For pharmacokinetic analysis, NONMEM software with implementation of ADVAN 1 subroutine was used. RESULTS CYP1A2 polymorphism -163C > A was found at the frequency of 65.0 %, while -3860G > A was not detected. The correlation between weight-adjusted carbamazepine dose and carbamazepine concentration after dose adjustment was significant only in carriers of -163C/C and C/A genotypes (r = 0.68, p = 0.0004). The equation that described population clearance (CL) was CL (l/h) = 0.176 + 0.0484 * SEX + 0.019 * CYP1A2 + 0.000156 * DD, where SEX has a value of 1 if male and 0 if female, CYP1A2 has a value of 1 if -163A/A and 0 if -163C/C or C/A, and DD is the total carbamazepine daily dose (mg/day). CONCLUSIONS CYP1A2 -163A/A genotype influence carbamazepine pharmacokinetics. In addition to sex and total carbamazepine daily dose, -163C > A CYP1A2 polymorphism should be considered as a predictor of carbamazepine clearance.
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Affiliation(s)
- Natasa Djordjevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia.
| | - Dragana Dragas Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Marija Radovanovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Ivan Radosavljevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Slobodan Obradovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Mihajlo Jakovljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Dragan Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Jasmina R Milovanovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
| | - Slobodan Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, 34 000, Kragujevac, Serbia
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Djukanovic N, Todorovic Z, Zamaklar-Trifunovic D, Protic D, Dzudovic B, Ostojic M, Obradovic S. Sustained increase in platelet aggregation after the cessation of clopidogrel. Clin Exp Pharmacol Physiol 2015; 43:161-5. [PMID: 26515635 DOI: 10.1111/1440-1681.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/18/2015] [Accepted: 10/25/2015] [Indexed: 11/29/2022]
Abstract
This study shows that the abrupt cessation of one-year clopidogrel treatment was not associated with thrombotic events in a prospective, multicentre study that enrolled 200 patients subjected to coronary stent implantation and treated with aspirin + clopidogrel 1 year after the stent placement. The aim of the study was to investigate the causes of a sustained increase of platelet aggregability, considering that the values of platelet aggregation stimulated with ADP + PGE1 (ADPHS values) significantly increased 10-90 days after the cessation of clopidogrel. Values of platelet aggregation induced by thrombin receptor activating peptide (TRAP values) and arachidonic acid (ASPI values) were divided into quartiles on the basis of ADPHS values 10 days after stopping clopidogrel (ADPHS10 ). There was a significant difference between TRAP values divided into quartiles according to ADPHS10 , 10, 45 and 90 days after stopping clopidogrel (P < 0.001, all), and ASPI values across the same quartiles 10 and 45 days after the cessation of clopidogrel (P = 0.028 and 0.003). The results of the study indicate that patients with early pronounced rebound phenomena to clopidogrel termination have a long-term (at least 90 days) increased platelet aggregation to other agonists such as thrombin-related activated protein and arachidonic acid, suggesting the complex mutual relationship of various factors/agonists influencing the function of platelets.
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Affiliation(s)
| | - Zoran Todorovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Zamaklar-Trifunovic
- Department of Cardiology, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dragana Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Boris Dzudovic
- Clinic of Emergency Medicine, Military Medical Academy, University of Belgrade, Belgrade, Serbia
| | - Miodrag Ostojic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Obradovic
- Clinic of Emergency Medicine, Military Medical Academy, University of Belgrade, Belgrade, Serbia
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Abstract
OBJECTIVE The objective of the study was to determine whether women significantly have more frequently right ventricular infarction than men. METHODS The study population consisted of consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous intervention. The following criteria were used for the diagnosis of right ventricular infarction: ST-segment elevation in one of the right precordial leads V4R-V6R for equal or more than 1 mm together with ST-segment elevation in at least two contiguous inferior leads. The odds ratio for the diagnosis was calculated according to gender. Searching PubMed, nine more relevant studies that used the same criteria for the diagnosis of right ventricular infarction were identified and a metanalysis was conducted. RESULTS In our group of 517 consecutive patients with STEMI, 32 (23.5%) of 136 women and 42 (11.0%) of 381 men had RVI (odds ratio (OR) = 2.48, 95% confidence interval (CI): 1.49-4.13; P = 0.001). Two hundred and seventy-five patients had inferior STEMI and among them 32 (42.7%) of 75 women and 42 (23.1%) of 182 men, had a right ventricular infarction (OR = 2.48, 95%CI: 1.40-4.40; P= 0.002). In a meta-analysis, a total number of 4,326 patients with inferior STEMI were included. Four hundred and thirty-seven (41.4%) out of 1,056 women and 1,221 (37.3%) out of 3,270 men, had been diagnosed with RVI (OR = 1.27, 95% CI: 1.09-1.48; P = 0.021). CONCLUSION Right ventricular infarctions occur more frequently in women than in men.
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Affiliation(s)
- Slobodan Obradovic
- Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Boris Dzudovic
- Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Ivica Djuric
- Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Republic of Serbia
| | - Zoran Jovic
- Clinic for Cardiology, Military Medical Academy, Belgrade, Republic of Serbia
| | - Nemanja Djenic
- Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Republic of Serbia
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Gyöngyösi M, Wojakowski W, Lemarchand P, Lunde K, Tendera M, Bartunek J, Marban E, Assmus B, Henry TD, Traverse JH, Moyé LA, Sürder D, Corti R, Huikuri H, Miettinen J, Wöhrle J, Obradovic S, Roncalli J, Malliaras K, Pokushalov E, Romanov A, Kastrup J, Bergmann MW, Atsma DE, Diederichsen A, Edes I, Benedek I, Benedek T, Pejkov H, Nyolczas N, Pavo N, Bergler-Klein J, Pavo IJ, Sylven C, Berti S, Navarese EP, Maurer G. Meta-Analysis of Cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data. Circ Res 2015; 116:1346-60. [PMID: 25700037 DOI: 10.1161/circresaha.116.304346] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022]
Abstract
RATIONALE The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. OBJECTIVE We analyzed the safety and efficacy of intracoronary cell therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). METHODS AND RESULTS The primary end point was freedom from combined major adverse cardiac and cerebrovascular events (including all-cause death, AMI recurrance, stroke, and target vessel revascularization). The secondary end point was freedom from hard clinical end points (death, AMI recurrence, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions. Secondary efficacy end points included changes in end-diastolic volume, end-systolic volume, and ejection fraction, analyzed with random-effects meta-analyses and ANCOVA. We reported weighted mean differences between cell therapy and control groups. No effect of cell therapy on major adverse cardiac and cerebrovascular events (14.0% versus 16.3%; hazard ratio, 0.86; 95% confidence interval, 0.63-1.18) or death (1.4% versus 2.1%) or death/AMI recurrence/stroke (2.9% versus 4.7%) was identified in comparison with controls. No changes in ejection fraction (mean difference: 0.96%; 95% confidence interval, -0.2 to 2.1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. CONCLUSIONS This meta-analysis of individual patient data from randomized trials in patients with recent AMI revealed that intracoronary cell therapy provided no benefit, in terms of clinical events or changes in left ventricular function. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01098591.
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Sarajlija A, Kisic-Tepavcevic D, Nikolic Z, Savic Pavicevic D, Obradovic S, Djuric M, Pekmezovic T. Epidemiology of Rett syndrome in Serbia: prevalence, incidence and survival. Neuroepidemiology 2015; 44:1-5. [PMID: 25571926 DOI: 10.1159/000369494] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rett syndrome (RTT) is a severe neurodevelopmental disorder that represents the second most common cause of mental retardation in females. However, incidence and prevalence of RTT are scarcely reported. METHODS A retrospective study included all patients with RTT diagnosed between 1981 and 2012 in Serbia. Estimation of incidence and prevalence was calculated on the basis of vital statistics reported by Statistical Office of Republic of Serbia. RESULTS From 1981 to 2012, RTT has been diagnosed in 102 girls in Serbia. Incidence of RTT in Serbia is estimated at 0.586:10,000 female live births. We estimated the prevalence of RTT in population of females younger than 19 years at 1:8,439. Death occurred in 19 patients (18.63%), with pneumonia as the most common cause. The lethal outcome by the age of 12 years could be expected for 11% of patients. The mean age at diagnosis was 3.5 years and we have confirmed a significant trend towards earlier dianosis during studied period. CONCLUSIONS Rett syndrome incidence in Serbia is in accordance with reports from other countries. Serbian RTT patients have increased risk for early death when compared to patients in more developed countries, most commonly due to pneumonia. There was significant trend towards early diagnosis of RTT in Serbia over recent decades.
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Affiliation(s)
- Adrijan Sarajlija
- Mother and Child Health Care Institute of Serbia 'Dr. Vukan Cupic',University of Belgrade, Belgrade, Serbia
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Obradovic S, Djukanovic N, Todorovic Z, Markovic I, Zamaklar-Trifunovic D, Protic D, Ostojic M. Men with lower HDL cholesterol levels have significant increment of soluble CD40 ligand and high-sensitivity CRP levels following the cessation of long-term clopidogrel therapy. J Atheroscler Thromb 2014; 22:284-92. [PMID: 25273829 DOI: 10.5551/jat.26765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to examine whether the termination of long-term clopidogrel therapy results in a proinflammatory state and whether lipid parameters influence the inflammatory response after stopping the drug. METHODS A prospective, multicenter study was conducted among 200 patients with implanted coronary stents who received dual antiplatelet therapy for one year, without ischemic or bleeding events. According to the guidelines, clopidogrel was discontinued after one year. In all patients, the high-sensitivity C-reactive protein (hsCRP), soluble CD40 ligand (sCD40L) and lipid [total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)] levels were measured twice: on the day of cessation of clopidogrel and 45 days after the termination of clopidogrel treatment. RESULTS In men (n=151), the sCD40L serum levels were significantly higher 45 days after the discontinuation of clopidogrel (p=0.007), while the hsCRP levels were not significantly different (p=0.407). Furthermore, when analyzed across the HDL-C quartiles, the hsCRP and sCD40L values were found to be associated with the levels of HDL-C after the discontinuation of clopidogrel in men. In addition, the men in the first HDL-C quartile exhibited the most pronounced increase in the sCD40L levels (p=0.001) and had significantly higher hsCRP levels (p=0.001) compared to the subjects in the other quartiles. Other lipid parameters did not show any associations with the sCD40L or hsCRP levels. CONCLUSIONS The discontinuation of clopidogrel is associated with higher increments in the sCD40L level, and a pronounced proinflammatory response is associated with a lower HDL-C concentration.
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Affiliation(s)
- Slobodan Obradovic
- Clinic of Emergency Medicine, Military Medical Academy, Medical Faculty, University of Defense
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Djukanovic N, Todorovic Z, Obradovic S, Njegomirovic S, Zamaklar-Trifunovic D, Protić D, Ostojic M. Clopidogrel cessation triggers aspirin rebound in patients with coronary stent. J Clin Pharm Ther 2013; 39:69-72. [PMID: 24286218 DOI: 10.1111/jcpt.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 10/17/2013] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Premature discontinuation of clopidogrel in patients undergoing percutaneous coronary intervention is a significant risk factor for thrombotic adverse outcomes. However, recent studies indicate that even discontinuation of long-term use of clopidogrel may be associated with multiple adverse outcomes, that is, rebound phenomenon whose mechanism is not definitely clear. The aim of the study was to examine the effect of clopidogrel withdrawal in those on combined aspirin and clopidogrel therapy. METHODS This prospective, multicenter study enrolled 200 patients who underwent coronary stent implantation and were on dual antiplatelet therapy (100 mg aspirin + 75 mg clopidogrel) 1 year after the stent placement. In all patients, we measured the platelet aggregation, by multiplate electrode aggregometry, using two agonists [adenosine diphosphate with PGE1 (ADPHS) and arachidonic acid (ASPI)] two times: on the day of cessation of clopidogrel and 90 days after clopidogrel was stopped. RESULTS AND DISCUSSION Following clopidogrel discontinuation, we registered an increase in ASPI values (P < 0·001), linear correlation between changes in ASPI and ADPHS values (P = 0·009) and significant difference in the values of ASPI first quartile of ADPHS compared with the other three (P < 0·001, P = 0·016, P < 0·001, I vs. II, I vs. III and I vs. IV quartile of ADPHS, respectively). WHAT IS NEW AND CONCLUSION Our findings show that cessation of clopidogrel causes loss of antiplatelet synergism with aspirin, leading to a weakening of the response to aspirin, which may be one explanation for the rebound after the clopidogrel cessation.
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Affiliation(s)
- N Djukanovic
- High Medical School Milutin Milankovic, Belgrade, Serbia
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Obradovic D, Obradovic S, Balint B, Rusovic S, Raicevic R, Tasic S, Ostojic J. Internal carotid transfer of autologous bone-marrow mononuclear cells for the treatment of severe stroke in patient with thrombotic thrombocytopenic purpura. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1031] [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: 11/16/2022]
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Obradovic D, Obradovic S, Culafic S, Radulac M, Subota V. Thrombolysis combined with antiplatelet and anticoagulant therapy in young patient with hypercoagulable state and acute severe ischemic stroke. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1027] [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: 11/30/2022]
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Obradovic S, Vukotic S, Banovic M, Vujanic S, Dzudovic B, Ostojic M. Serum level of parathyroid hormone in acute STEMI patients treated with primary PCI is an excellent predictor for six months death and acute heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1298] [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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Gyongyosi M, Lemarchand P, roncalli J, Lunde K, Tendera M, Wojakowski W, Bartunek J, Wollert K, Assmus B, Zeiher A, kastrup J, Bergmann M, Atsma D, Pokushalov E, Woehrle J, Obradovic S, Sylven JC, Malliaras K, Marban E, Maurer G. SAFETY AND EFFICACY OF CARDIAC CELL THERAPY: FIRST RESULTS OF THE MESS (META–ANALYSIS OF CARDIAC STEM CELL STUDIES) DATABASE INCLUDING INDIVIDUAL PATIENT DATA OF 13 RANDOMIZED AND 3 COHORT STUDIES. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61633-2] [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: 10/27/2022]
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Obradovic D, Petrovic M, Antanasijevic I, Marinkovic J, Stojanovic T, Obradovic S. The Brief Repeatable Battery: psychometrics and normative values with age, education and gender corrections in a Serbian population. Neurol Sci 2012; 33:1369-74. [PMID: 22552866 DOI: 10.1007/s10072-012-1099-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
Cognitive impairment is present in up to 65 % of multiple sclerosis (MS) patients. The Brief Repeatable Battery of neuropsychological tests (BRB) is one of the most used neuropsychological tools for cognitive assessment in MS. However, relative lack of normative data limits its application in research and clinical practice. In order to obtain normative data for a Serbian population, we administered the BRB version A to 140 healthy subjects and assessed the influence of demographic factors such as gender, age, and education on the tests' scores. We also calculated corrections for these factors. Higher education was associated with better performance on all the tests. Age influenced all the tests, except the word list generation, higher age being associated with worse performance on all other tests. Women performed worse on the paced auditory serial addition test 2, no other gender differences were observed. Our data obtained for the Serbian population could further improve use of the BRB in clinical practice and for the research purposes, establishing cognitive evaluation as a part of standard neurological examination of MS patients.
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Affiliation(s)
- D Obradovic
- Clinic of Neurology, University of Defence, Faculty of Medicine of the Military Medical Academy, Crnotravska 17, 11 000, Belgrade, Serbia,
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Nanka O, Krejci E, Pesevski Z, Sedmera D, Smart N, Rossdeutsch A, Dube KN, Riegler J, Price AN, Taylor A, Muthurangu V, Turner M, Lythgoe MF, Riley PR, Kryvorot S, Vladimirskaya T, Shved I, Schwarzl M, Seiler S, Huber S, Steendijk P, Maechler H, Truschnig-Wilders M, Pieske B, Post H, Caprio C, Baldini A, Chiavacci E, Dolfi L, Verduci L, Meghini F, Cremisi F, Pitto L, Kuan TC, Chen MC, Yang TH, Wu WT, Lin CS, Rai H, Kumar S, Sharma AK, Mastana S, Kapoor A, Pandey CM, Agrawal S, Sinha N, Orlowska-Baranowska EH, Placha G, Gora J, Baranowski R, Abramczuk E, Hryniewiecki T, Gaciong Z, Verschuren JJW, Wessels JAM, Trompet S, Stott DJ, Sattar N, Buckley B, Guchelaar HJ, Jukema JW, Gharanei M, Hussain A, Mee CJ, Maddock HL, Wijnen WJ, Van Den Oever S, Van Der Made I, Hiller M, Tijsen AJ, Pinto YM, Creemers EE, Nikulina SUY, Chernova A, Petry A, Rzymski T, Kracun D, Riess F, Pike L, Harris AL, Gorlach A, Katare R, Oikawa A, Riu F, Beltrami AP, Cesseli D, Emanueli C, Madeddu P, Zaglia T, Milan G, Franzoso M, Pesce P, Sarais C, Sandri M, Mongillo M, Butler TJ, Seymour AML, Ashford D, Jaffre F, Bussen M, Ferrara N, Koch WJ, Leosco D, Akhmedov A, Klingenberg R, Brokopp C, Hof D, Zoller S, Corti R, Gay S, Flohrschutz I, Von Eckardstein A, Hoerstrup SP, Luescher TF, Heijman J, Zaza A, Johnson DM, Rudy Y, Peeters RLM, Volders PGA, Westra RL, Martin GR, Morais CAS, Oliveira SHV, Brandao FC, Gomes IF, Lima LM, Fujita S, Okamoto R, Taniguchi M, Konishi K, Goto I, Engelhardt S, Sugimoto K, Nakamura M, Shiraki K, Buechler C, Ito M, Kararigas G, Nguyen BT, Jarry H, Regitz-Zagrosek V, Van Bilsen M, Daniels A, Munts C, Janssen BJA, Van Der Vusse GJ, Van Nieuwenhoven FA, Montalvo C, Villar AV, Merino D, Garcia R, Llano M, Ares M, Hurle MA, Nistal JF, Dembinska-Kiec A, Beata Kiec-Wilk BKW, Anna Polus AP, Urszula Czech UC, Tatiana Konovaleva TK, Gerd Schmitz GS, Bertrand L, Balteau M, Timmermans A, Viollet B, Sakamoto K, Feron O, Horman S, Vanoverschelde JL, Beauloye C, De Meester C, Martinez E, Martin R, Miana M, Jurado R, Gomez-Hurtado N, Bartolome MV, San Roman JA, Lahera V, Nieto ML, Cachofeiro V, Rochais F, Sturny R, Mesbah K, Miquerol L, Kelly RG, Messaoudi S, Gravez B, Tarjus A, Pelloux V, Samuel JL, Delcayre C, Launay JM, Clement K, Farman N, Jaisser F, Hadyanto L, Castellani C, Vescovo G, Ravara B, Tavano R, Pozzobon M, De Coppi P, Papini E, Vettor R, Thiene G, Angelini A, Meloni M, Caporali A, Cesselli D, Fortunato O, Avolio E, Madeddu P, Beltrami AP, Emanueli C, Schindler R, Simrick S, Brand T, Dube KN, Riley PR, Smart NS, Oikawa A, Katare R, Herman A, Emanueli C, Madeddu P, Roura Ferrer S, Rodriguez Bago J, Soler-Botija C, Pujal JM, Galvez-Monton C, Prat-Vidal C, Llucia-Valldeperas A, Blanco J, Bayes-Genis A, Foldes G, Maxime M, Ali NN, Schneider MD, Harding SE, Reni C, Mangialardi G, Caporali A, Meloni M, Emanueli C, Madeddu P, De Pauw A, Sekkali B, Friart A, Ding H, Graffeuil A, Catalucci D, Balligand JL, Azibani F, Tournoux F, Schlossarek S, Polidano E, Fazal L, Merval R, Carrier L, Chatziantoniou C, Samuel JL, Delcayre C, Buyandelger B, Linke W, Zou P, Kostin S, Ku C, Felkin L, Birks E, Barton P, Sattler M, Knoell R, Schroder K, Benkhoff S, Shimokawa H, Grisk O, Brandes RP, Parepa IR, Mazilu L, Suceveanu AI, Suceveanu A, Rusali L, Cojocaru L, Matei L, Toringhibel M, Craiu E, Pires AL, Pinho M, Pinho S, Sena C, Seica R, Leite-Moreira A, Zaglia T, Milan G, Franzoso M, Dabroi F, Pesce P, Schiaffino S, Sandri M, Mongillo M, Kiseleva E, Krukov N, Nikitin O, Ardatova L, Mourouzis I, Pantos C, Kokkinos AD, Cokkinos DV, Scoditti E, Massaro M, Carluccio MA, Pellegrino M, Calabriso N, Gastaldelli A, Storelli C, De Caterina R, Lindner D, Zietsch C, Schultheiss HP, Tschope C, Westermann D, Everaert BR, Nijenhuis VJ, Reith FCM, Hoymans VY, Timmermans JP, Vrints CJ, Simova I, Mateev H, Katova T, Haralanov L, Dimitrov N, Mironov N, Golitsyn SP, Sokolov SF, Yuricheva YUA, Maikov EB, Shlevkov NB, Rosenstraukh LV, Chazov EI, Radosinska J, Knezl V, Benova T, Slezak J, Urban L, Tribulova N, Virag L, Kristof A, Kohajda ZS, Szel T, Husti Z, Baczko I, Jost N, Varro A, Sarusi A, Farkas AS, Orosz SZ, Forster T, Varro A, Farkas A, Zakhrabova-Zwiauer OM, Hardziyenka M, Nieuwland R, Tan HL, Raaijmakers AJA, Bourgonje VJA, Kok GJM, Van Veen AAB, Anderson ME, Vos MA, Bierhuizen MFA, Benes J, Sebestova B, Sedmera D, Ghouri IA, Kemi OJ, Kelly A, Burton FL, Smith GL, Bourgonje VJA, Vos MA, Ozdemir S, Acsai K, Doisne N, Van Der Nagel R, Beekman HDM, Van Veen TAB, Sipido KR, Antoons G, Harmer SC, Mohal JS, Kemp D, Tinker A, Beech D, Burley DS, Cox CD, Wann KT, Baxter GF, Wilders R, Verkerk A, Fragkiadaki P, Germanakis G, Tsarouchas K, Tsitsimpikou C, Tsardi M, George D, Tsatsakis A, Rodrigues P, Barros C, Najmi AK, Khan V, Akhtar M, Pillai KK, Mujeeb M, Aqil M, Bayliss CR, Messer AE, Leung MC, Ward D, Van Der Velden J, Poggesi C, Redwood CS, Marston S, Vite A, Gandjbakhch E, Gary F, Fressart V, Leprince P, Fontaine G, Komajda M, Charron P, Villard E, Falcao-Pires I, Gavina C, Hamdani N, Van Der Velden J, Stienen GJM, Niessens HWM, Leite-Moreira AF, Paulus WJ, Messer AE, Marston S, Memo M, Leung MC, Bayliss CR, Memo M, Messer AE, Marston SB, Vafiadaki E, Qian J, Arvanitis DA, Sanoudou D, Kranias EG, Elmstedt N, Lind B, Ferm-Widlund K, Westgren M, Brodin LA, Mansfield C, West T, Ferenczi M, Wijnker PJM, Foster DB, Coulter A, Frazier A, Murphy AM, Stienen GJM, Van Der Velden J, Shah M, Sikkel MB, Desplantez T, Collins TP, O' Gara P, Harding SE, Lyon AR, Macleod KT, Ottesen AH, Louch WE, Carlson C, Landsverk OJB, Stridsberg M, Sjaastad I, Oie E, Omland T, Christensen G, Rosjo H, Cartledge J, Clark LA, Ibrahim M, Siedlecka U, Navaratnarajah M, Yacoub MH, Camelliti P, Terracciano CM, Chester A, Gonzalez-Tendero A, Torre I, Garcia-Garcia F, Dopazo J, Gratacos E, Taylor D, Bhandari S, Seymour AM, Fliegner D, Jost J, Bugger H, Ventura-Clapier R, Regitz-Zagrosek V, Carpi A, Campesan M, Canton M, Menabo R, Pelicci PG, Giorgio M, Di Lisa F, Hancock M, Venturini A, Al-Shanti N, Stewart C, Ascione R, Angelini G, Suleiman MS, Kravchuk E, Grineva E, Galagudza M, Kostareva A, Bairamov A, Krychtiuk KA, Watzke L, Kaun C, Demyanets S, Pisoni J, Kastl SP, Huber K, Maurer G, Wojta J, Speidl WS, Varga ZV, Farago N, Zvara A, Kocsis GF, Pipicz M, Csonka C, Csont T, Puskas GL, Ferdinandy P, Klevstigova M, Silhavy J, Manakov D, Papousek F, Novotny J, Pravenec M, Kolar F, Novakova O, Novak F, Neckar J, Barallobre-Barreiro J, Didangelos A, Yin X, Fernandez-Caggiano M, Drozdov I, Willeit P, Domenech N, Mayr M, Lemoine S, Allouche S, Coulbault L, Galera P, Gerard JL, Hanouz JL, Suveren E, Whiteman M, Baxter GF, Studneva IM, Pisarenko O, Shulzhenko V, Serebryakova L, Tskitishvili O, Timoshin A, Fauconnier J, Meli AC, Thireau J, Roberge S, Lompre AM, Jacotot E, Marks AM, Lacampagne A, Dietel B, Altendorf R, Daniel WG, Kollmar R, Garlichs CD, Verduci L, Parente V, Balasso S, Pompilio G, Colombo G, Milano G, Squadroni L, Cotelli F, Pozzoli O, Capogrossi MC, Ajiro Y, Saegusa N, Iwade K, Giles WR, Stafforini DM, Spitzer KW, Sirohi R, Candilio L, Babu G, Roberts N, Lawrence D, Sheikh A, Kolvekar S, Yap J, Hausenloy DJ, Yellon DM, Aslam M, Rohrbach S, Schlueter KD, Piper HM, Noll T, Guenduez D, Malinova L, Ryabukho VP, Lyakin DV, Denisova TP, Montoro-Garcia S, Shantsila E, Lip GYH, Kalaska B, Sokolowska E, Kaminski K, Szczubialka K, Kramkowski K, Mogielnicki A, Nowakowska M, Buczko W, Stancheva N, Mekenyan E, Gospodinov K, Tisheva S, Darago A, Rutkai I, Kalasz J, Czikora A, Orosz P, Bjornson HD, Edes I, Papp Z, Toth A, Riches K, Warburton P, O'regan DJ, Ball SG, Turner NA, Wood IC, Porter KE, Kogaki S, Ishida H, Nawa N, Takahashi K, Baden H, Ichimori H, Uchikawa T, Mihara S, Miura K, Ozono K, Lugano R, Padro T, Garcia-Arguinzonis M, Badimon L, Yin X, Ferraro F, Viner R, Ho J, Cutler D, Mayr M, Matchkov V, Aalkjaer C, Mangialardi G, Katare R, Oikawa A, Madeddu P, Krijnen PAJ, Hahn NE, Kholova I, Sipkens JA, Van Alphen FP, Simsek S, Schalkwijk CG, Van Buul JD, Van Hinsbergh VWM, Niessen HWM, Simova I, Katova T, Haralanov L, Caro CG, Seneviratne A, Monaco C, Hou D, Singh J, Gilson P, Burke MG, Heraty KB, Krams R, Coppola G, Albrecht K, Schgoer W, Wiedemann D, Bonaros N, Steger C, Theurl M, Stanzl U, Kirchmair R, Amadesi S, Fortunato O, Reni C, Katare R, Meloni M, Ascione R, Spinetti G, Cangiano E, Valgimigli M, Madeddu P, Caporali A, Meloni M, Miller AM, Cardinali A, Vierlinger K, Fortunato O, Spinetti G, Madeddu P, Emanueli C, Pagano G, Liccardo D, Zincarelli C, Femminella GD, Lymperopoulos A, De Lucia C, Koch WJ, Leosco D, Rengo G, Hinkel R, Husada W, Trenkwalder T, Di Q, Lee S, Petersen B, Bock-Marquette I, Niemann H, Di Maio M, Kupatt C, Nourian M, Yassin Z, Kelishadi R, Nourian M, Kelishadi R, Yassin Z, Memarian SH, Heidari A, Leuner A, Poitz DM, Brunssen C, Ravens U, Strasser RH, Morawietz H, Vogt F, Grahl A, Flege C, Marx N, Borinski M, De Geest B, Jacobs F, Muthuramu I, Gordts SC, Van Craeyveld E, Herijgers P, Weinert S, Poitz DM, Medunjanin S, Herold J, Schmeisser A, Strasser RH, Braun-Dullaeus RC, Wagner AH, Moeller K, Adolph O, Schwarz M, Schwale C, Bruehl C, Nobiling R, Wieland T, Schneider SW, Hecker M, Cross A, Strom A, Cole J, Goddard M, Hultgardh-Nilsson A, Nilsson J, Mauri C, Monaco C, Mitkovskaya NP, Kurak TA, Oganova EG, Shkrebneva EI, Kot ZHN, Statkevich TV, Molica F, Burger F, Matter CM, Thomas A, Staub C, Zimmer A, Cravatt B, Pacher P, Steffens S, Blanco R, Sarmiento R, Parisi C, Fandino S, Blanco F, Gigena G, Szarfer J, Rodriguez A, Garcia Escudero A, Riccitelli MA, Wantha S, Simsekyilmaz S, Megens RT, Van Zandvoort MA, Liehn E, Zernecke A, Klee D, Weber C, Soehnlein O, Lima LM, Carvalho MG, Gomes KB, Santos IR, Sousa MO, Morais CAS, Oliveira SHV, Gomes IF, Brandao FC, Lamego MRA, Lima LM, Fornai L, Angelini A, Kiss A, Giskes F, Eijkel G, Fedrigo M, Valente ML, Thiene G, Heeren RMA, Grdinic A, Vojvodic D, Djukanovic N, Grdinic AG, Obradovic S, Majstorovic I, Rusovic S, Vucinic Z, Tavciovski D, Ostojic M, Lin CS, Kuan TC, Lai SC, Chen MY, Wu HT, Gouweleeuw L, Oberdorf-Maass SU, De Boer RA, Van Gilst WH, Maass AH, Van Gelder IC, Azibani F, Benard L, Schlossarek S, Merval R, Tournoux F, Launay JM, Carrier L, Chatziantoniou C, Samuel JL, Delcayre C, Li C, Warren D, Shanahan CM, Zhang QP, Bye A, Vettukattil R, Aspenes ST, Giskeodegaard G, Gribbestad IS, Wisloff U, Bathen TF, Cubedo J, Padro T, Alonso R, Mata P, Badimon L, Ivic I, Vamos Z, Cseplo P, Kosa D, Torok O, Hamar J, Koller A, Norita K, De Noronha SV, Sheppard MN, Torre I, Amat-Roldan I, Iruretagoiena I, Psilodimitrakopoulos S, Gonzalez-Tendero A, Crispi F, Artigas D, Loza-Alvarez P, Gratacos E, Harrison JC, Smart SD, Besely EH, Kelly JR, Yao Y, Sammut IA, Hoepfner M, Kuzyniak W, Sekhosana E, Hoffmann B, Litwinski C, Pries A, Ermilov E, Fontoura D, Lourenco AP, Vasques-Novoa F, Pinto JP, Roncon-Albuquerque R, Leite-Moreira AF, Oyeyipo IP, Olatunji LA, Usman TO, Olatunji VA, Bacova B, Radosinska J, Viczenczova C, Knezl V, Dosenko V, Benova T, Goncalvesova E, Vanrooyen J, Tribulova N, Maulik SK, Seth S, Dinda AK, Jaiswal A, Mearini G, Khajetoorians D, Kraemer E, Gedicke-Hornung C, Precigout G, Eschenhagen T, Voit T, Garcia L, Lorain S, Carrier L, Mendes-Ferreira P, Maia-Rocha C, Adao R, Lourenco AP, Cerqueira RJ, Mendes MJ, Castro-Chaves P, De Keulenaer GW, Leite-Moreira AF, Bras-Silva C, Ruiter G, Wong YY, Lubberink M, Knaapen P, Raijmakers P, Lammertsma AA, Marcus JT, Westerhof N, Van Der Laarse WJ, Vonk-Noordegraaf A, Poitz DM, Steinbronn N, Koch E, Steiner G, Strasser RH, Berezin A, Lisovaya OA, Soldatova AM, Kuznetcov VA, Yenina TN, Rychkov AYU, Shebeko PV, Altara R, Hessel MHM, Hermans JJR, Janssen BJA, Blankesteijn WM, Soldatova AM, Kuznetcov VA, Yenina TN, Rychkov AYU, Shebeko PV, Berezin A, Berezina TA, Seden V, Bonanad C, Nunez J, Navarro D, Chilet MF, Sanchis F, Bodi V, Minana G, Chaustre F, Forteza MJ, Llacer A, Femminella GD, Rengo G, Galasso G, Zincarelli C, Liccardo D, Pagano G, De Lucia C. Poster session 3. Cardiovasc Res 2012. [DOI: 10.1093/cvr/cvr336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Vijayan S, Khanji M, Ionescu A, Vijayan S, Ionescu A, Podoleanu C, Frigy A, Ugri A, Varga A, Podoleanu D, Incze A, Carasca E, Dobreanu D, Mjolstad O, Dalen H, Graven T, Kleinau J, Hagen B, Fu H, Liu T, Li J, Liu C, Zhou C, Li G, Bordese R, Capriolo M, Brero D, Salvetti I, Cannillo M, Antolini M, Grosso Marra W, Frea S, Morello M, Gaita F, Maffessanti F, Caiani E, Muraru D, Tuveri F, Dal Bianco L, Badano L, Majid A, Soesanto A, Ario Suryo Kuncoro B, Sukmawan R, Ganesja MH, Benedek T, Chitu M, Beata J, Suciu Z, Kovacs I, Bucur O, Benedek I, Hrynkiewicz-Szymanska A, Szymanski F, Karpinski G, Filipiak K, Radunovic Z, Lande Wekre L, Steine K, Bech-Hanssen O, Rundqvist B, Lindgren F, Selimovic N, Jedrzychowska-Baraniak J, Jozwa R, Larysz B, Kasprzak J, Ripp T, Mordovin V, Ripp E, Ciobanu A, Dulgheru R, Dragoi R, Magda S, Florescu M, Mihaila S, Rimbas R, Cinteza M, Vinereanu D, Benavides-Vallve C, Pelacho B, Iglesias O, Castano S, Munoz-Barrutia A, Prosper F, Ortiz De Solorzano C, Manouras A, Sahlen A, Winter R, Vardas P, Brodin L, Sarvari SI, Haugaa KH, Zahid W, Bendz B, Aaberge L, Edvardsen T, Di Bella G, Pedri S, Donato R, Madaffari A, Zito C, Stapf D, Schreckenberg M, Carerj S, Yoshikawa H, Suzuki M, Kusunose Y, Hashimoto G, Otsuka T, Nakamura M, Sugi K, Grapsa J, Dawson D, Gin-Sing W, Howard L, Gibbs J, Nihoyannopoulos P, Smith B, Grapsa J, Dawson D, Coulter T, Rendon A, Gorissen W, Nihoyannopoulos P, Shiran A, Asmer I, Adawi S, Ganaeem M, Shehadeh J, Cameli M, Lisi M, Righini F, Maccherini M, Sani G, Galderisi M, Mondillo S, Kalimanovska-Ostric D, Nastasovic T, Jovanovic I, Milakovic B, Dostanic M, Stosic M, Sasic I, Sveen K, Nerdrum T, Hanssen K, Dahl-Jorgensen K, Steine K, Holte E, Vegsundvaag J, Hole T, Hegbom K, Wiseth R, Ikonomidis I, Lekakis J, Tritakis V, Papadakis I, Kadoglou N, Tzortzis S, Trivilou P, Koukoulis C, Paraskevaidis I, Anastasiou-Nana M, Smedsrud MK, Sarvari S, Haugaa KH, Gjesdal O, Aaberge L, Edvardsen T, Muraru D, Beraldo M, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Dores H, Abecasis J, Carvalho M, Santos M, Andrade M, Ribeiras R, Reis C, Horta E, Gouveia R, Mendes M, Zaliaduonyte-Peksiene D, Mizariene V, Cesnaite G, Tamuleviciute E, Jurkevicius R, Vaskelyte J, Zaliunas R, Smarz K, Zaborska B, Jaxa-Chamiec T, Maciejewski P, Budaj A, Trifunovic D, Sobic-Saranovic D, Stankovic S, Ostojic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Tesic M, Petrovic I, Peovska I, Srbinovska E, Maksimovic J, Andova V, Arnaudova F, Hristova E, Otljanska M, Vavlukis M, Jovanova S, Tamborini G, Fusini L, Gripari P, Muratori M, Pontone G, Andreini D, Bertella E, Ghulam Ali S, Bartorelli A, Pepi M, Zito C, Cusma-Piccione M, Salvia J, Antonini-Canterin F, Lentini S, Di Bella G, Donato D, Miceli M, Oreto G, Carerj S, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shnapp M, Gaspar T, Marchese A, Deste W, Sanfilippo A, Aruta P, Patane M, Millan G, Ussia G, Tamburino C, Banovic M, Vujisic-Tesic B, Kujacic V, Obradovic S, Nedeljkovic I, Trifunovic D, Petrovic M, Crkvenac Z, Ostojic M, Bernard A, Piquemal M, Muller G, Arbeille P, Charbonnier B, Broyd C, Davies J, Mikhail G, Mayet J, Francis D, Rosca M, Magne J, Szymanski C, Popescu B, Ginghina C, Pierard L, Lancellotti P, Gonzalez-Mansilla A, Solis J, Angulo R, Perez-David E, Madrid G, Garcia-Robles J, Yotti R, Prieto R, Bermejo J, Fernandez-Aviles F, Otsuka T, Suzuki M, Yoshikawa H, Ishikawa Y, Ishida T, Osaki T, Matsuyama M, Yamashita H, Ozaki S, Sugi K, Stevanella M, Votta E, Fusini L, Veronesi F, Tamborini G, Pepi M, Maffessanti F, Alamanni F, Redaelli A, Caiani E, Park SD, Lee J, Shin S, Woo S, Kim D, Park K, Kwan J, Tsang W, Chandra S, Weinert L, Gayat E, Djelassi M, Balbach T, Mor-Avi V, Lang R, De Meester P, Van De Bruaene A, Delcroix M, Budts W, Abid L, Frikha Z, Makni K, Rekik H, Znazen A, Mourad H, Kammoun S, Sargento L, Satendra M, Sousa C, Lopes S, Longo S, Lousada N, Palma Reis R, Fouad D, Shams Eldeen R, Rosca M, Popescu B, Beladan C, Calin A, Voinea F, Enache R, Jurcut R, Coman I, Ghionea M, Ginghina C, Tesic M, Djordjevic-Dikic A, Trifunovic D, Petrovic O, Nedeljkovic I, Petrovic M, Boricic M, Giga V, Ostojic M, Vujisic-Tesic B, Pisciella L, Lanzillo C, Minati M, Caselli S, Di Roma M, Fratini S, Romano S, Calo' L, Lioy E, Penco M, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Sinagra G, Finocchiaro G, Pinamonti B, Merlo M, Barbati G, Dilenarda A, Sinagra G, Comenale Pinto S, Ancona R, Caso P, Cavallaro C, Vecchione F, D'onofrio A, Fero' M, Calabro' R, Gustafsson S, Ihse E, Henein M, Westermark P, Suhr O, Lindqvist P, Oliva Sandoval M, Gonzalez Carrillo M, Garcia Navarro M, Garcia-Molina Saez E, Sabater Molina M, Saura Espin D, Lacunza Ruiz J, Gimeno Blanes J, De La Morena Valenzuela G, Valdes Chavarri M, Prinz C, Faber L, Horstkotte D, Hoetz H, Voigt J, Dores H, Gandara F, Correia M, Abecasis J, Rosario I, Fonseca C, Arroja I, Aleixo A, Martins A, Mendes M, Radulescu L, Dan Radulescu D, Parv Andreea P, Duncea Caius D, Ciuleanu T C, Mitrea Paulina M, Frea S, Capriolo M, Grosso Marra W, Cali Quaglia F, Bordese R, Ribezzo M, Boffini M, Rinaldi M, Gaita F, Morello M, Maceira Gonzalez AM, Cosin-Sales J, Dalli E, Diago J, Aguilar J, Ruvira J, Sousa C, Goncalves S, Gomes A, Pinto F, Tsai WC, Liu YW, Shih JY, Huang YY, Chen JY, Tsai LM, Chen JH, Sargento L, Satendra M, Longo S, Lousada N, Palma Reis R, Ribeiro S, Doroteia D, Goncalves S, Santos L, David C, Vinhas De Sousa G, Almeida A, Iwase M, Itou Y, Yasukochi S, Shiino K, Inuzuka H, Sugimoto K, Ozaki Y, Gieszczyk-Strozik K, Sikora-Puz A, Mizia M, Lasota B, Chmiel A, Lis-Swiety A, Michna J, Brzezinska-Wcislo L, Mizia-Stec K, Gasior Z, Luijendijk P, De Bruin-Bon H, Zwiers C, Vriend J, Van Den Brink R, Mulder B, Bouma B, Brigido S, Gianfagna P, Proclemer A, Plicht B, Kahlert P, Kaelsch H, Buck T, Erbel R, Konorza T, Yoon H, Kim K, Ahn Y, Jeong M, Cho J, Park J, Kang J, Rha W, Jansen Klomp WW, Brandon Bravo Bruinsma G, Van 'T Hof A, Spanjersberg S, Nierich A, Bombardini T, Gherardi S, Picano E, Ciarka A, Herbots L, Eroglu E, Van Cleemput J, Droogne W, Jasityte R, Meyns B, Voigt J, D'hooge J, Vanhaecke J, Al Barjas M, Iskreva R, Morris R, Davar J, Zhao Y, Lindqvist P, Holmgren A, Morner S, Henein M, Nedeljkovic I, Ostojic M, Giga V, Stepanovic J, Djordjevic-Dikic A, Beleslin B, Nedeljkovic M, Banovic M, Mazic S, Stojanov V, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Tomaszewski A, Kutarski A, Tomaszewski M, Eibel S, Hasheminejad E, Mukherjee C, Tschernich H, Ender J, Delithanasis I, Celutkiene J, Kenny C, Monaghan M, Van Den Oord S, Ten Kate G, Akkus Z, Renaud G, Sijbrands E, Ten Cate F, De Jong N, Bosch J, Van Der Steen A, Schinkel A, Lisowska A, Knapp M, Tycinska A, Sawicki R, Kralisz P, Sobkowicz B, Chang SA, Lee SC, Kim EY, Hahm SH, Ahn GT, Sohn MK, Park SJ, Choi JO, Park SW, Oh JK, Gursoy MO, Gokdeniz T, Astarcioglu M, Bayram Z, Cakal B, Karakoyun S, Kalcik M, Kahveci G, Yildiz M, Ozkan M, Muraru D, Dal Bianco L, Solda' E, Cucchini U, Peluso D, Tuveri M, Al Mamary A, Badano L, Iliceto S, Skidan V, Borowski A, Park M, Thomas J, Ranjbar S, Hassantash S, Karvandi M, Foroughi M, Davidsen ES, Cramariuc D, Bleie O, Gerdts E, Matre K, Cusma' Piccione M, Zito C, Bagnato G, Di Bella G, Mohammed M, Piluso S, Oreto L, Oreto G, Bagnato G, Carerj S, Prinz C, Bitter T, Faber L, Horstkotte D, Dores H, Abecasis J, Carvalho S, Santos M, Andrade M, Ribeiras R, Canada M, Reis C, Gouveia R, Mendes M, Santisteban Sanchez De Puerta M, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Pena Pena ML, Puentes Chiachio M, Suarez De Lezo Cruz-Conde J, Pan Alvarez-Ossorio M, Mazuelos Bellido F, Suarez De Lezo Herreros De Tejada J, Altekin E, Yanikoglu A, Karakas S, Oncel C, Akdemir B, Belgi Yildirim A, Cilli A, Yilmaz H, Lenartowska L, Furdal M, Knysz B, Konieczny A, Lewczuk J, Comenale Pinto S, Ancona R, Caso P, Severino S, Cavallaro M, Coppola M, Calabro' R, Motoki H, To A, Bhargava M, Wazni O, Marwick T, Klein A, Sinkovskaya E, Horton S, Abuhamad A, Mingo Santos S, Monivas Palomero V, Beltran Correas B, Mitroi C, Gutierrez Landaluce C, Garcia Lunar I, Gonzalez Mirelis J, Cavero M, Segovia Cubero J, Alonso Pulpon L, Gurel E, Karaahmet T, Tigen K, Kirma C, Dundar C, Pala S, Isiklar I, Cevik C, Kilicgedik A, Basaran Y, Brambatti M, Romandini A, Barbarossa A, Molini S, Urbinati A, Giovagnoli A, Cipolletta L, Capucci A, Park S, Choi E, Ahn C, Hong S, Kim M, Lim D, Shim W, Xie J, Fang F, Zhang Q, Chan J, Yip G, Sanderson J, Lam Y, Yan B, Yu C, Jorge Perez P, De La Rosa Hernandez A, Hernandez Garcia C, Duque Garcia A, Barragan Acea A, Arroyo Ucar E, Jimenez Rivera J, Lacalzada Almeida J, Laynez Cerdena I, Maffessanti F, Gripari P, Pontone G, Andreini D, Tamborini G, Carminati C, Pepi M, Caiani E, Capoulade R, Larose E, Clavel M, Dumesnil J, Arsenault M, Bedard E, Mathieu P, Pibarot P, Gargani L, Baldi G, Forfori F, Caramella D, D'errico L, Abramo A, Sicari R, Picano E, Giunta F, Lee WN, Larrat B, Messas E, Pernot M, Tanter M, Velagic V, Cikes M, Matasic R, Skorak I, Skorak I, Samardzic J, Puljevic D, Lovric Bencic M, Biocina B, Milicic D, Roosens B, Bala G, Droogmans S, Hostens J, Somja J, Delvenne E, Schiettecatte J, Lahoutte T, Van Camp G, Cosyns B, Ghosh A, Hardy R, Chaturvedi N, Francis D, Deanfield J, Pellerin D, Kuh D, Hughes A, Malmgren A, Dencker M, Stagmo M, Gudmundsson P, Seo Y, Ishizu T, Aonuma K, Schuuring MJ, Vis J, Bouma B, Van Dijk A, Van Melle J, Pieper P, Vliegen H, Sieswerda G, Mulder B, Foukarakis E, Pitarokilis A, Kafarakis P, Kiritsi A, Klironomos E, Manousakis A, Fragiadaki X, Papadakis E, Dermitzakis A. Poster Session 1: Thursday 8 December 2011, 08:30-12:30 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Djukanovic N, Todorovic Z, Obradovic S, Zamaklar-Trifunovic D, Njegomirovic S, Milic NM, Prostran M, Ostojic M. Abrupt cessation of one-year clopidogrel treatment is not associated with thrombotic events. J Pharmacol Sci 2011; 117:12-8. [PMID: 21821970 DOI: 10.1254/jphs.11076fp] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
We aimed to examine the rate of thrombotic events after discontinuation of one year clopidogrel therapy in patients with implanted coronary stent, and to determine platelet aggregability by multiple electrode analyzer after cessation of clopidogrel. This prospective, multicenter study enrolled 200 patients subjected to coronary stent implantation and treated with aspirin + clopidogrel one year after the stent placement. Platelet aggregation was measured using 3 agonists [adenosine diphosphate with PGE(1) (ADPHS), arachidonic-acid (ASPI), and thrombin receptor activating peptide (TRAP)] on the day of cessation of clopidogrel and at 10, 45, and 90 days after clopidogrel was stopped. Two thrombotic events were registered during the 6-months follow up (one ischemic stroke and one myocardial infarction; incidence of 1%). The mean values of ADP + PGE(1)- and ASPI-induced aggregation 10 - 90 days after the cessation of clopidogrel were significantly higher than values obtained before the termination of the drug (P < 0.001, all). Cessation of clopidogrel did not influence the TRAP-induced aggregation, which reached the plateau in all measurements. In conclusion, the incidence of thrombotic events after the cessation of one-year clopidogrel treatment might be lower than expected in patients with implanted coronary stent.
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Affiliation(s)
- Nina Djukanovic
- Department of Cardiology, Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Serbia
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Grdinic A, Vojvodic D, Djukanovic N, Colic M, Grdinic AG, Ignjatovic V, Majstorovic I, Ilic V, Magic Z, Obradovic S, Ostojic M, Dolijanovic SP. PCI and clopidogrel: antiplatelet responsiveness and patient characteristics. Acta Cardiol 2011; 66:333-40. [PMID: 21744703 DOI: 10.2143/ac.66.3.2114133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study on responsiveness to clopidogrel and aspirin evaluates its interaction with: (i) patient characteristics; (ii) procedure characteristics; (iii) antiplatelet dose. METHODS AND RESULTS After elective PCI, 60 patients receiving aspirin 100 mg daily, and clopidogrel 75 mg daily were monitored with the PFA 100 test and VASP assay. Non-responsiveness to aspirin and clopidogrel was found in 23 (38%) and 18 (30%) of 60 patients, respectively. Seven (12%) patients were dual nonresponders. Non-responders to both aspirin and clopidogrel were more often smokers. Non-responders to clopidogrel, in addition had elevated inflammatory markers (P < 0.05). Dual non-responders had (i) a higher platelet count, LDL, and CRP; (ii) a lower HDL (P < 0.05). Clopidogrel non-responders were receiving 150 mg clopidogrel, with a positive response in 72%. Eighty % of non-responders to 150 mg clopidogrel were also non-responders to aspirin. CONCLUSION Baseline patient characteristics and clopidogrel dose modify the antiplatelet response. Also, patients resistant to both aspirin and clopidogrel do no benefit from an increased clopidogrel dose.
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Bortel LM, Segers P, Egstrup K, Tho A, Moceri P, Bertora D, Gibelin P, Cho EJ, Choi KY, Kim BJ, Kim DB, Jang SW, Park CS, Jung HO, Jeon HK, Youn HJ, Kim JH, Donal E, Coquerel N, Bodi S, Thebault C, Kervio G, Carre F, Daly MJ, Fairley SL, Doherty R, Ashfield K, Kirkpatrick R, Smith B, Buchanan J, Hill L, Dixon LJ, Rosca M, O' Connor K, Magne J, Romano G, Calin A, Popescu BA, Beladan CC, Pierard L, Ginghina C, Lancellotti P, Bochenek T, Wita K, Tabor Z, Grabka M, Elzbieciak M, Trusz-Gluza M, Moreau O, Thebault C, Kervio G, Leclercq C, Donal E, Sahlen A, Shahgaldi K, Aminoff A, Aagaard P, Manouras A, Winter R, Ehrenborg E, Braunschweig F, Bedetti G, Gargani L, Pizzi C, Sicari R, Picano E, Ballo P, Nistri S, Innelli P, Galderisi M, Mondillo S, Zhang J, Zhang HB, Duan YY, Chen LL, Li J, Liu LW, Zhu T, Li HL, Su HL, Zhou XD, Ruiz Ortiz M, Mesa Rubio D, Delgado Ortega M, Romo Penas E, Toledano Degado F, Leon Del Pino C, Lopez Aguilera J, Villanueva Fernandez E, Cejudo Diaz Del Campo L, Suarez 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Delcroix M, Voigt JU, Ginghina C, Piatkowski R, Kochanowski J, Scislo P, Grabowski M, Marchel M, Roik M, Kosior D, Opolski G, Maceira Gonzalez AM, Cosin-Sales J, Dalli E, Igual B, Monmeneu JV, Lopez-Lereu P, Estornell J, Ruvira J, Sotillo J, Stevanovic A, Toncev A, Dimkovic S, Dekleva M, Paunovic N, Toncev D, Sekularac N, Yildirimturk O, Helvacioglu FF, Tayyareci Y, Yurdakul S, Demiroglu ICC, Aytekin S, Pinedo Gago M, Amat Santos I, Revilla Orodea A, Lopez Diaz J, Arnold R, De La Fuente Galan L, Recio Platero A, Gomez Salvador I, Puerto Sanz A, San Roman Calvar JA, Yotti R, Bermejo J, Mombiela T, Benito Y, Sanchez PL, Solis J, Prieto R, Fernandez-Aviles F, Zilberszac R, Gabriel H, Graf S, Mundigler G, Maurer G, Rosenhek R, Zito C, Salvia J, Longordo C, Donato D, Alati E, Miceli M, Pardeo A, Arcidiaco S, Oreto G, Carerj S, Kamperidis V, Hadjimiltiades S, Sianos G, Anastasiadis K, Grosomanidis V, Efthimiadis G, Karvounis H, Parcharidis G, Styliadis IH, Yousry M, Rickenlund A, Petrini J, 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Bobbo M, Merlo M, Massa L, Faganello G, Di Lenarda A, Sinagra G, Margato R, Ribeiro H, Ferreira C, Matias A, Fontes P, Moreira JI, Milan A, Puglisi E, Magnino C, Fabbri A, Leone D, Vairo A, Crudo V, Iannaccone A, Milazzo V, Veglio F, Maroz-Vadalazhskaya N, Ostrovskiy I, Zito C, Imbalzano E, Saitta A, Oreto G, Cusma-Piccione M, Di Bella G, Nava R, Ferro M, Falanga G, Carerj S, Frigy A, Buzogany J, Szabados CS, Dan L, Carasca E, Ikonomidis I, Lekakis J, Tzortzis S, Kremastinos DT, Papadopoulos C, Paraskevaidis I, Triantafyllidi H, Trivilou P, Venetsanou K, Anastasiou-Nana M, Wierzbowska-Drabik K, Kurpesa M, Trzos E, Rechcinski T, Mozdzan M, Kasprzak JD, Kosmala W, Kotwica T, Przewlocka-Kosmala M, Mysiak A, Skultetyova D, Filipova S, Chnupa P, Mantziari L, Pechlivanidis G, Giannakoulas G, Dimitroula H, Karvounis H, Styliadis IH, Milan A, Puglisi E, Magnino C, Fabbri A, Leone D, Vairo A, Iannaccone A, Crudo V, Milazzo V, Veglio F, Tsai WC, Liu YW, Lin CC, Huang YY, Tsai LM, Park SM, Kim 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Bramos D, Kalantaridou A, Takos D, Skaltsiotis E, Trika C, Tsirikos N, Pamboukas C, Kottis G, Toumanidis S, Aggeli C, Felekos I, Roussakis G, Kazazaki C, Lampropoulos K, Lagoudakou S, Stergiou C, Pitsavos C, Stefanadis C, Kihara C, Murata K, Wada Y, Tanaka T, Uchida K, Okuda S, Susa T, Matsuzaki M, Shahgaldi K, Manouras A, Abrahamsson A, Gudmundsson P, Brodin L, Winter R, Knebel F, Schattke S, Sanad W, Schimke I, Schroeckh S, Brechtel L, Lock J, Makauskiene R, Baumann G, Borges AC, Moelmen-Hansen HE, Wisloff U, Aamot IL, Stoylen A, Ingul CB, Estensen ME, Beitnes JO, Grindheim G, Henriksen T, Aaberge L, Smiseth OA, Gullestad L, Aakhus S, Gargani L, Agoston G, Moggi Pignone A, Capati E, Badano L, Moreo A, Bombardieri S, Varga A, Sicari R, Picano E, Carrideo M, Faricelli S, Corazzini A, Ippedico R, Ruggieri B, Di Blasio A, D'angelo E, Di Baldassarre A, Ripari P, Gallina S, Kentrschynskyj A, Rickenlund A, Caidahl K, Hylander B, Jacobson S, Pagels A, Eriksson MJ, Dumitrescu SI, Tintoiu I, Greere V, Cristian G, Chiriac L, Pinte F, Droc I, Neagoe G, Stanciu S, Voicu VA, Kuch-Wocial A, Pruszczyk P, Szmigielski CA, Szulc M, Styczynski G, Sinski M, Kaczynska A, Ryabikov A, Malyutina S, Halcox J, Bobak M, Nikitin YU, Marmot M, Barbosa D, Kiss G, Orderud F, Amundsen B, Jasaityte R, Loeckx D, Claus P, Torp H, D'hooge J, Kuhl JT, Lonborg J, Fuchs A, Andersen M, Vejlstrup N, Engstrom T, Moller JE, Kofoed KF, Smith LA, Bhan A, Paul M, Monaghan MJ, Zaborska B, Stec S, Sikora-Frac M, Krynski T, Kulakowski P, Pushparajah K, Dashwood D, Barlow A, Nugent K, Miller O, Simpson J, Valeur N, Ersboll MK, Kjaergaard J, Greibe R, Risum N, Hassager C, Sogaard P, Kober L, Sahlen A, Manouras A, Shahgaldi K, Winter R, Brodin L, Popovic D, Nedeljkovic I, Petrovic M, Vujisic-Tesic B, Arandjelovic A, Stojiljkovic S, Stojiljkovic S, Jakovljevic B, Damjanovic S, Ostojic M, Agrios IA, Bramos DB, Skaltsiotis HS, Takos DT, Kaladaridis A, Vasiladiotis NV, Kottis GK, Antoniou AA, Pamboucas CP, Toumanidis STT, Locorotondo G, Porto I, Paraggio L, Fedele E, Barchetta S, De Caterina AR, Rebuzzi AG, Crea F, Galiuto L, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Stefanczyk L, Rotkiewicz A, Shim A, Kasprzak JD, Vainer J, Habets J, Lousberg A, Pont De C, Waltenberger J, Farouk H, Heshmat H, Adel A, El Chilali K, Baghdady Y, Sorour K, Gustafsson U, Larsson M, Bjallmark A, Lindqvist P, A'roch R, Haney M, Waldenstrom A, Mladenovic Z, Tavciovski D, Mijailovic Z, Djordjevic - Dikic A, Obradovic S, Matunovic R, Jovic Z, Djuric P, Torp H, Aase S, Dalen H, Sarkola T, Redington AN, Keeley F, Bradley T, Jaeggi E, Sahlen H, Winter R, Brodin L, Sahlen A, Olsen NT, Risum N, Jons C, Mogelvang R, Valeur N, Fritz-Hansen T, Sogaard P. Poster session IV * Friday 10 December 2010, 14:00-18:00. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Barthelemy O, Silvain J, Brieger D, Bellemain-Appaix A, Cayla G, Beygui F, Lancar R, Collet JP, Mercadier A, Montalescot G, Cha KS, Nam YH, Kim JH, Park SY, Park TH, Kim MH, Kim YD, Lee HC, Ahn MS, Hong TJ, Blanco R, Blanco F, Szarfer J, Garcia Escudero A, Gigena G, Gagliardi J, Rodriguez A, Sarmiento R, Affatatto S, Riccitelli M, Petris A, Datcu MD, Pop C, Radoi M, Arsenescu-Georgescu C, Petrescu I, Petrescu L, Serban L, Nechita E, Tatu-Chitoiu G, Tatu-Chitoiu G, Dorobantu M, Benedek I, Craiu E, Sinescu C, Ionescu DD, Radoi M, Pop C, Ginghina C, Minescu B, Izzo A, Mantovani P, Tomasi L, Dall'oglio L, Bonatti S, Rosiello R, Romano M, Agostini F, Zanini R, Zhao ZY, Wu YJ, Li JJ, Yany YJ, Qian HY, Tang YD, Timoteo AT, Toste A, Lousinha A, Ramos R, Oliveira JA, Ferreira ML, Ferreira RC, Cabades C, Diez Gil JL, Aguar P, Sanmiguel D, Lopez-March A, Marmol R, Guerra L, Girbes V, Ferrando J, Rincon De Arellano A, Timoteo AT, Ramos R, Toste A, Oliveira JA, Patricio L, Ferreira ML, Ferreira RC, 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Faria P, Serrao M, Gomes S, Berdaoui B, Oliveira R, Caires G, Drumond A, Araujo J, Roussel JC, Senage T, Perigaud C, Habash O, Michel M, Treilhaud M, Labidi S, Despins P, Trochu JN, Baron O, Duveau D, Kitsiou AN, Giannakopoulos K, Papadimitriou G, Karas S, Babic Z, Nikolic Heitzler V, Tapia Ballesteros C, Milicic D, Bergovec M, Raguz M, Mirat J, Strozzi M, Plazonic Z, Giunio L, Steiner R, Freynhofer M, Brozovic I, Hernandez Luis C, Bruno V, Leherbauer L, Djurkovic M, Jarai R, Willheim M, Huebl W, Wojta J, Huber K, Vogel B, Hahne S, Sandin MG, Kozanli I, Kalla K, Jarai R, Freynhofer M, Smetana P, Geppert A, Unger G, Huber K, Simoes Marques Assuncao Caetano AF, Barra S, Vegas JM, Silva J, Providencia R, Faustino C, Botelho A, Mota P, Leitao Marques A, Ariza Sole A, Sanchez Salado JC, Lorente Tordera V, Martinez Garcia V, Andion R, Salazar Mendiguchia Y Garcia J, Gomez Hospital JA, Maristany Daunert J, Berdejo Gago FJ, Esplugas Oliveras E, Brzozowska-Czarnek A, Urbanik A, Kakouros N, Kakouros S, Lekakis J, Martinez N, Rizos J, Kokkinos D, Venevtseva J, Melnikov A, Valiahmetov M, Gomova T, Perelomova I, Ferrer Hita JJ, Bosa-Ojeda F, Sanchez-Grande-Flecha A, Gonzalez IA, Yanes-Bowden G, Vargas-Torres MJ, Rodriguez-Gonzalez A, Rubio-Iglesias-Garcia C, Dominguez-Rodriguez A, Enjuanes-Grau C, Marrero-Rodriguez F, Parepa I, Suceveanu AI, Suceveanu A, Alvarado M, Mazilu L, Alexandrescu L, Dumitru E, Miu V, Jitari V, Craiu E, Voinea FL, Balachandran KP, Schofield R, Sankaranarayanan R, Amat IJ, Helm K, Crowe C, Singh R, Mcdonald J, Chuen MJ, Kobusiak-Prokopowicz M, Preglowska M, Mysiak A, Doi T, Sakoda T, San Roman JA, Akagami T, Naka T, Tsujino T, Masuyama T, Ohyanagi M, Kume N, Mitsuoka H, Hayashida K, Tanaka M, Biasucci LM, Garcia Gonzalez MJ, Della Bona R, Biasillo G, Leo M, Zaninotto M, Plebani M, Crea F, Biasucci LM, Dellabona R, Leo M, Biasillo G, Arroyo Ucar E, Zaninotto M, Plebani M, Crea F, Cavusoglu Y, Gok B, Birdane A, Demirustu C, Gorenek B, Unalir A, Ata N, Hernandez Garcia C, Timuralp B, Nikulina N, Yakushin SS, Nikulina N, Yakushin SS, Furmenko GI, Akinina SA, Dores H, Ingrid R, Leal S, Dorta Martin M, Correia MJ, Bronze L, Monge J, Arroja I, Fonseca C, Aleixo A, Silva A, Djambazov S, Zhivkov A, Maznev I, Marrero Rodriguez F, Ingeliev M, Slavov R, Cvetkova N, Patarinski V, Groch L, Horak J, Dimitrov N, Hayrapetyan HG, Raposeiras Roubin S, Abu-Assi E, Dragu R, Cabanas-Grandio P, Agra-Bermejo R, Garcia-Acuna JM, Pena-Gil C, Gonzalez-Juanatey JR, Barra SNC, Silva J, Providencia R, Seca L, Gomes P, Kapeliovich M, Leitao Marques A, Daly MJ, Mc Keag NA, Mc Cann CJ, Cardwell C, Young IS, Adgey AAJ, Mikhalchikova N, Burova N, Zaccaria M, Hammerman H, Palmisano P, Palumbo V, Ciccone MM, Favale S, Chen KC, Yin WH, Liu JH, Goncalves S, Santos JF, Amador P, Silva D, Soares LN, Zahidova K, Guliyev F, Zahidov N, Carrilho-Ferreira P, Cortez-Dias N, Marques JS, Silva D, Jorge C, Robalo Martins S, Cortez-Dias N, Almeida Ribeiro M, Calisto C, Carvalho De Sousa J, Lopes MG, Cortez-Dias N, Calisto C, Silva D, Jorge C, Carrilho-Ferreira P, Silva Marques J, Jorge C, Robalo Martins S, Correia MJ, Carvalho De Sousa J, Lopes MG, Uthoff H, Thalhammer C, Potocki M, Reichlin T, Noveanu M, Aschwanden M, Silva Marques J, Staub D, Arenja N, Socrates T, Mueller C, Zhao Y, Wu X, Xue Q, Gao L, Lin H, Wang S, Carilho Ferreira P, Watanabe K, Kawamura A, Seko T, Omura A, Sakabe S, Kasai A, Starodubova AV, Storozhakov G, Kisliak O, Hautieva F, Robalo Martins S, Tursheva M, Fedotova N, Di Maio RC, Mclaughlin J, Allen JD, Anderson JMC, Adgey AAJ, Khaled Nagi H, Abed N, Tayeh O, Almeida Ribeiro M, Farok W, Mousa A, Neuzil P, Skoda J, Petru J, Sediva L, Kralovec S, Holy F, Holdova K, Jehlicka P, Calisto C, Plasil P, Reddy VY, Alabakovska S, Labudovic D, Jovanova S, Tosheska K, Alabakovski M, Jeevaratnam K, Tee SP, Zhang Y, Fiuza M, Guzadhur L, Gurung IS, Duehmke R, Grace AA, Lei M, Huang CL, Ishibashi Y, Yamauchi M, Akashi Y, Musha H, Lopes MG, Miyake F, Hnatek T, Kamenik L, Sedlon P, Luxova J, Steuerova B, Skvaril J, Cernohous M, Zavoral M, Ratkovic N, Milicevic P, Nemanja Djenic NR, Aleksandra Jovelic AJ, Slobodan Obradovic SO, Branko Gligic BG, Kletsiou E, Giannakopoulou M, Bozas E, Iliodromitis EK, Anastasiou-Nana M, Papathanassoglou EDE, Panic M, Anton M, Anton G, Muraru M, Stanojlovic T, Salinger Martinovic S, Radosavljevic M, Glasnovic J, Stanojevic D, Zivkovic M, Cortez-Dias N, Stankovic I, Jorge C, Calisto C, Silva D, Carrilho-Ferreira P, Silva Marques J, Robalo Martins S, Pessoa T, Fiuza M, Lopes MG, Aspromonte N, Milicevic D, Ronco C, Tubaro M, Santini M, Colivicchi F, Aiello A, Cruz D, Anzoletti Boscolo A, Vianello G, Valle R, Cavusoglu Y, Kalezic T, Parspour A, Birdane A, Tek M, Gorenek B, Unalir A, Ata N, Lee WP, Ong BB, Watkins S, Datta D, Kafedzic S, Halcox JPJ, Providencia RA, Barra S, Gomes PL, Seca L, Silva J, Botelho A, Quintal N, Pais JR, Mota P, Ilic I, Leitao-Marques AM, Nikishin AG, Pirnazarov MM, Nurbaev TA, 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S, Dores H, Pilar Cabanas Grandio PCG, Correia MJ, Monge JC, Abecasis J, Arroja I, Aleixo A, Silva A, Palmisano P, Zaccaria M, Zanna D, Marangelli V, Carlos Pena Gil CPG, Caiati C, Ciccone MM, Favale S, Picon Heras R, Loureiro MJ, Nunez-Gil I, Garcia Rubira JC, Acebal C, Ruiz-Mateos B, Ibanez B, Jose Maria Garcia Acuna JMGA, Fernandez-Ortiz A, Macaya C, Rosario I, Dores H, Leal S, Monge JC, Correia MJ, Bronze Carvalho L, Arroja I, Fonseca C, Jose Ramon Gonzalez Juanatey JRGJ, Aleixo A, Silva A, Urazovskaya I, Vinogradova D, Vasilieva E, Shpektor A, Faustino A, Seca L, Barra S, Providencia R, Daly MJ, Silva J, Gomes P, Costa G, Caetano F, Costa M, Leitao-Marques A, Conti E, Musumeci MB, Lauri FM, Dito E, Scott P, De Giusti M, Lallo A, Fusco D, Davoli M, Volpe M, Autore C, Gamra H, Dridi Z, Hassine M, Addad F, Owens CG, Gherissi I, Reda A, Mahjoub M, Bouraoui S, Abdennadher M, Betbout F, Mota PMFP, Silva JD, Providencia RA, Leitao-Marques A, Tomlin A, Nikolic Heitzler V, Babic Z, Milicic 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Abstracts. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq023] [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: 11/15/2022]
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Baskot B, Obradovic S, Rafajlovski S, Jankovic Z, Rusovic S, Orozovic V, Gligic B, Ratkovic N, Jung R, Ivanovic V, Bikicki M. Determination of culprit lesion in patients undergoing elective percutaneous coronary intervention by myocardial perfusion imaging. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2008; 29:243-256. [PMID: 19259050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. MATERIAL AND METHODS One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). RESULTS A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary intervention (ePCI). Overall sensitivity, specificity and accuracy using SRS were 90.2%, 87.5%, and 89.4%, with a positive predictive value of 94.1%. Overall sensitivity, specificity, and accuracy using ISRS were 94.4%, 90.6%, 93.2% and the positive predictive value was 95.7%. CONCLUSION DipyEX MPI with the two indices created, SRS and ISRS, significantly improves sensitivity, specificity and accuracy in the determination and localization of culprit lesions in patients undergoing elective PCI.
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Affiliation(s)
- Branislav Baskot
- Nuclear Medicine Institute, Military Medical Academy, Belgrade, Serbia.
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