B. Ilic

The Association Between Obesity and Visit-to-visit Variability in Systolic Blood Pressure: A Prospective Study

Abstract With the prevalence of obesity and all accompanying health risks, both prevention and health education, as well as identifying predictors for the development of obesity-related diseases are primary. Th e pathophysiological relationship between obesity and visit-to-visit variability in systolic blood pressure (SBPV) has not been completely resolved. To investigate the association between obesity and SBPV in hypertensive patients. Th e prospective study comprised three visits was performed at the hypertension outpatient clinic during the follow up period of 22-months between March 2014 and January 2016. Th is study included 300 randomly selected hypertensive patients (average 67.76±9.84 years), who were divided in groups of obese/non-obese examinees. SBPV was defined as the standard deviation (SD) from three values of SBP. Th e values of SBP and SBP-SD were significantly higher in the group of obese hypertensive patients than in the group of non-obese patients (126.67±8.22 vs 120.45±7.79 mmHg, 11.00±5.64 vs 7.34±3.96; p<0.01). Th e highest SBPV was recorded in the 4th quartile in obese patients (43.13±7.50 mmHg). Th ere was statistically stronger correlation between SBPV and BMI/Waist cirumferences (WC) (ρο=0.425/ ρο=0.356, p<0.01). During 22-months follow up there was a significant decrease of SBPV for 8.2 mmHg, BP for 31/8 mmHg, BMI for 3.8 kg/m2, WC for 10 cm and body weight for 8.24 kg. During 22-months follow-up, reduction of body weight was associated with reduction of blood pressure variability in hypertensive patients. Persistently decrease both body weight and long term visit-to-visit variability may explain lower cardiovascular risk in obese-related disease.

[PP.25.13] IMPACT OF EXERCISE TRAINING ON BIOMARKERS ON ENDOTHELIAL FUNCTION IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME

Objective: To evaluate the effects of exercise training on circulating blood markers of endothelial function: nitric oxide (NOx), Advanced Oxidation Protein Products (AOPP) and Xanthine Oxidase (XO) in hypertensive patients (pts) with metabolic syndrome. Design and method: 80 male hypertensive pts after myocardial infarction were studied. At baseline and after 3 weeks in all pts values of NOx, AOPP and XO were determined and exercise test was performed. After the initial study, pts were randomized to group with metabolic syndrome (MetS group, n = 40) and group without metabolic syndrome (no- MetS group, n = 40). All pts underwent a supervised 3 weeks aerobic exercise training at residential center. Results: Baseline value of NOx was lower (P = 0.018), and values of AOPP and XO were higher (ns for both) in MetS than in no- MetS group. After 3 weeks values of NOx increased in both groups: in MetS group from 39.09 ± 14.34 to 44.13 ± 13. 57 &mgr;mol/l (P = 0.025) and in no- MetS group from 47.11 ± 15.32 to 51.81 ± 16.48 &mgr;mol/l (P = 0.018), with mean difference higher in MetS than in no- MetS group 5.03 ± 13.71 vs 4.71 ± 12.01, ns. Compared to the baseline, value of XO at the end of the study was significantly lower in both groups (P < 0.0005, both) with mean difference higher in MetS than in no- MetS group (103.67 ± 27.57 vs 99.36 ± 28.11, ns) and with lower second value in MetS than in no- MetS group (P = 0.46).Value of AOPP significantly decreased in both groups (MetS group, P < 0.009; no- MetS group P = 0.002). After 3 weeks level (METs) and duration of exercise test significantly increased in both groups (P < 0.0005) with slightly higher mean increase of duration in MetS than in no- MetS group (ns). Conclusions: Regular residential exercise training induced improvement in endothelial function in hypertensive pts expressed through significant increase of NOx and decrease of XO and AOPP. Higher increase in NOx and reduction in XO in MetS than in no- MetS pts suggests that exercise training induces more pronounced benefit in pts with than in pts without metabolic syndrome.

Case Report of the Patient with Acute Myocardial Infarction: “From Flatline to Stent Implantation”

Summary Asystole is a rare primary manifestation in the development of sudden cardiac death (SCD), and survival during cardiac arrest as the consequence of asystole is extremely low. The aim of our paper is to illustrate successful cardiopulmonary resuscitation (CPR) in patients with acute myocardial infarction (AMI) and rare and severe form of cardiac arrest - asystole. A very short time between cardiac arrest in acute myocardial infarction, which was manifested by asystole, and the adequate CPR measures that have been taken are of great importance for the survival of our patient. After successful reanimation, the diagnosis of anterior wall AMI with ST segment elevation was established. The right therapeutic strategy is certainly the early primary percutaneous coronary intervention (PPCI). In less than two hours, after recording the “flatline” and successful reanimation, the patient was in the catheterization laboratory, where a successful PPCI of LAD was performed, after emergency coronary angiography. In the further treatment course of the patient, the majority of risk factors were corrected, except for smoking, which may be the reason for newly discovered lung tumor disease. Early recognition and properly applied treatment of CPR can produce higher rates of survival.

Perforation of the Right Ventricle as a Complication of Pericardiocentesis: A Case report

Summary Pericardial effusion represents the accumulation of larger amounts of fluid in the pericardial cavity. If not timely diagnosed and adequately treated, it can lead to cardiac tamponade. The treatment of pericardial effusion includes primarily the use of drugs like aspirin, NSAIDs, corticosteroids, and/or colchicine followed by invasive procedures such as pericardiocentesis or pericardiectomy. Pericardiocentesis complications are extremely rare but very serious especially in the case of the rupture of the right ventricle or the coronary arteries. Patient S.V, born in 1938, from Svrljig, was examined because of suffocating and swollen shin. The medical reports showed that the patient previously had had a permanent pacemaker implanted and that he had undergone a triple coronary artery bridging. Medical reports also showed that two months before the examination he was hospitalized due to pericardial effusion at the reference institution. The ultrasonographic examination registered large circular effusion with the motion of the right ventricle and the patient underwent urgent pericardiocentesis. During pericardiocentesis, the rupture of the right ventricle occurred and the patient was sent to the cardiac surgery clinic where he had catheter extraction performed. The control ultrasound examination of the heart showed no pericardial effusion, and no signs of damage to the right ventricle.

Aortic Dissection - The Role of Echocardiography in Emergency Unit: Case Report

Summary Aortic dissection is a quite rare but serious condition, often associated with a very high mortality rate; it is manifested by sudden chest pain and acute hemodynamic compromise. In the presented review, a case of an ascending aortic dissection with the lethal outcome is been shown. A healthy man with no past history of illness suddenly felt acute excruciating chest pain which was radiating to the back. A quick diagnosis, ideally within one hour of manifestation, heart auscultation and echocardiography are the key to aortic dissection recovery.

COMBINED ACE INHIBITOR AND STATIN THERAPY IN HYPERTENSIVE DIABETIC PATIENTS PRIOR TO ACUTE MYOCARDIAL INFARCTION HAVE PROTECTIVE EFFECTS ON HOSPITAL MORBIDITY AND MORTALITY: PP.5.200

Objective: To determine whether administration of combined ACE inhibitor and statin therapy prior to acute myocardial infarction (MI) is related to infarct size and hospital cardiovascular morbidity and mortality. Methods: Study population consisted of 232 consecutive hypertensive diabetic patients admitted with a diagnosis of acute MI. Outcome data were compared between groups of patients receiving ACE inhibitor prior to infarction (ACEI group, n=140) and those who received ACE inhibitor and statin therapy, at least 3 months prior to infarction (ACEIS group, n=92). Results: There were not significant differences in regard to age, sex, site of infarction, aspirin therapy, and value of blood pressure between ACEI and ACEIS group. Patients in ACEIS group experienced smaller MI size, determined by peak creatine kinase elevation (P < 0.05), and by wall motion score (13.7 ± 1.7 vs 14.2 ± 2.0; P < 0.05) than patients in ACEI group. Left ventricular ejection fraction was higher in ACEIS group than in ACEI group (47.7 ± 7.1 vs 45.9 ± 8.6%;NS). In patients in ACEIS group, intra-hospital cardiovascular events were less frequent than in ACEI group: heart failure (12% vs 18%), re-infarction (6% vs 9%), recurrent angina (9% vs 13%), vascular death (5% vs 8%). Conclusion: Our data showed that hypertensive diabetic patients who experience an acute MI, those receiving prior combined ACE inhibitor and statin therapy have smaller infarct size, better global systolic function, less hospital morbidity and mortality. Thus prior combined ACE inhibitor and statin therapy has cardioprotective effect in hypertensive diabetic patients with acute myocardial infarction.

93. The significance of neurophysiological examinations in preoperative evaluation of brachial plexus traction injuries

AED and remission of abnormal pattern was observed in an average time of 22.4 h (range: 6–48). Triphasic waves are often associated to metabolic encephalopathies. Our findings demonstrate that this series had a good electroclinical response to AED, even in the context of hepatic or renal failure. An epileptogenic process should be considered if this pattern is observed. Ideally, cEEG should be done because conventional EEG cannot always detect intermittent abnormalities. Cost/benefit of AED therapy should be further studied.