Biljana Obrenovic-Kircanski

The Gender Impact on Morphogenetic Variability in Coronary Artery Disease: A Preliminary Study

We analyzed morphogenetic variability and degree of genetic homozygosity in male and female individuals with coronary artery disease (CAD) versus unaffected controls. We have tested 235 CAD patients; 109 were diagnosed also with diabetes mellitus (DM) and 126 with hypertension (HTN). We additionally evaluated 152 healthy individuals without manifested CAD. For the evaluation of the degree of recessive homozygosity, we have performed the homozygously recessive characteristics (HRC) test and tested 19 HRCs. In controls, the frequency of HRC for males was 2.88 ± 1.89, while for females, it was 3.65 ± 1.60. In the CAD group, the frequency of HRC for males was 4.21 ± 1.47, while for females, it was 4.73 ± 1.60. There is significant difference in HRC frequencies between controls and CAD separately for males (p < 0.001) and females (p < 0.001). The same applies between controls and CAD with DM (males: p < 0.001 and females: p = 0.004), and controls and CAD with HTN (males: p < 0.001 and females: p < 0.001). There is no significant difference in HRC frequencies between the group of CAD with DM and the group of CAD with HTN (males: p = 0.952 and females: p = 0.529). Our findings point to the increased degree of recessive homozygosity and decreased variability in both genders of CAD patients versus controls, indicating the potential genetic predisposition for CAD.

Genetic and Environmental Dispositions for Cardiovascular Variability: A Pilot Study

Background: The aim of our study was to evaluate the degree of genetic homozygosity in the group of patients with coronary artery disease (CAD), as well as to evaluate morphogenetic variability in CAD patients regarding the presence of investigated risk factors (RF) compared to a control sample of individuals. Additionally, we aimed to evaluate the distribution of ABO blood type frequencies between tested samples of individuals. Methods: This study analyzed individual phenotype and morphogenetic variability of 17 homozygously-recessive characteristics (HRC), by using HRC test in a sample of 148 individuals in CAD patients group and 156 individuals in the control group. The following RF were analyzed: hypertension, diabetes mellitus, hyperlipidemia, and smoking. Results: The mean value of HRC in CAD patients is significantly higher, while variability decreases compared to the control sample (CAD patients: 4.24 ± 1.59, control sample: 3.75 ± 1.69; VCAD-patients = 37.50%, VC = 45.07%). There is a significant difference in individual variations of 17 HRC between control sample and CAD patients (χ2 = 169.144; p < 0.01), which points out to different variability for tested genes. Mean values of HRC significantly differed in CAD patients in regard to the number of RF present. A blood type (OR = 1.75) is significant predictor for CAD, while O blood type (OR = 0.43) was significantly associated with controls. Conclusion: There is a higher degree of recessive homozygosity in CAD patients versus individuals in the control sample, and the presence of significant variations in the degree of recessive homozygosity as the number of tested RF increases.

The relationship between causative microorganisms and cardiac lesions caused by infective endocarditis: New perspectives from the contemporary cohort of patients

BACKGROUND The etiology of infective endocarditis (IE) is changing. More aggressive forms with multiple IE cardiac lesions have become more frequent. This study sought to explore the relationship between contemporary causative microorganisms and IE cardiac lesions and to analyze the impact of multiple lesions on treatment choice. METHODS In 246 patients hospitalized for IE between 2008 and 2015, cardiac lesions caused by IE were analyzed by echocardiography, classified according to the 2015 European Society of Cardiology guidelines and correlated with microbiological data. We defined a new parameter, the Echo IE Sum, to summarize all IE cardiac lesions in a single patient, enabling comprehensive comparisons between different etiologies and treatment strategies. RESULTS Staphylococcus aureus was associated with the development of large vegetation (OR 2.442; 95% CI 1.220-4.889; p=0.012), non-HACEK bacteria with large vegetation (OR 13.662; 95% CI 2.801-66.639; p=0.001), perivalvular abscess or perivalvular pseudoaneurysm (OR 5.283; 95% CI 1.069-26.096; p=0.041), and coagulase-negative staphylococci (CoNS) with leaflet abscess or aneurysm (OR 3.451; 95% CI 1.285-9.266, p=0.014), and perivalvular abscess or perivalvular pseudoaneurysm (OR 4.290; 95% CI 1.583-11.627; p=0.004). The Echo IE Sum significantly differed between different etiologies (p<0.001), with the highest value in non-HACEK and the lowest in streptococcal endocarditis. Patients operated for IE had a significantly higher Echo IE Sum vs those who were medically treated (p<0.001). CONCLUSION None of the IE cardiac lesions is microorganism-specific. However, more severe lesions were caused by S. aureus, CoNS, and non-HACEK bacteria. The highest propensity to develop multiple lesions was shown by the non-HACEK group. Higher Echo IE Sum in patients sent to surgery emphasized the importance of multiple IE cardiac lesions on treatment choice and potential usage of Echo IE Sum in patient management.

309: Successful treatment of mitral valve endocarditis during the human brucellosis relapse

Background Brucellosis is the most frequent zoonotic infectious disease in the world. The most common affected systems are the locomotor, gastrointestinal, genitourinary and hematologic. Endocarditis is the most common cardiovascular manifestation of brucellosis with high mortality rate. Despite treatment by means of several antibiotic regimens, the relapse is estimated to occur in 5-40%. Brucella is an intracellular pathogen which makes it inaccessible to antibiotics and relapse can occur after a variable period of clinical latency. Case report This is a case report of Brucella mitral valve endocarditis as a complication of severe relapse of Brucella infection, which was successfully treated by medical and surgical therapy. Conclusion Cardiac involvement in human brucellosis is rare, especially in relapse, but should not be overlooked, since it is a major mortality cause in brucellosis infection. The success of Brucella endocarditis treatment depends on timely and complete medical and epidemiological evaluation, which leads to adequate medicamentous and surgical treatment of the patient. This approach would reduce complications and mortality associated with Brucella endocarditis and would improve patients quality of life.

308: Asymptomatic carotid artery stenosis in patients with coronary artery disease: could it be predicted?

Background Asymptomatic carotid artery stenosis (CAS) combined with coronary artery disease (CAD) remains of special interest to cardiologists and cardiac surgeons given the fact that coronary artery bypass grafting (CABG) is one of the most frequent procedures and that CAS cause 30% of all post-CABG strokes. Aim Determining the frequency of asymptomatic CAS in CAD patients and to what degree the extent of CAD and presence of certain risk factors can be indicators of CAS in asymptomatic patients. Methods Retrospective evaluation of consecutive patients that underwent CABG during one year in our center whithout present symptoms or signs of CAS. The pre-operative Doppler ultrasonography was used to determine the presence and the degree of CAS. Patients were divided according to the presence of significant CAS. Impact of age, gender, body mass index, presence of hypertension, diabetes, smoking, cholesterol, triglycerides and three echo-cardiographic variables obtained from transthoracic echocardiography (the presence of aortic wall sclerosis, aortic valve sclerosis and mitral valve calcification) were assessed. Results Hemodinamically significant asymptomatic CAS was present in 18 patients (7.1%). The risk of presence of CAS was more significant in those older than 60 years (OR 2.58; 95% CI 0.98–6.77) and in patients with left main stenosis (OR 8.92; 95% CI 3.2–24.83). Conclusion The presence of asymptomatic CAS is strongly associated with the presence of left main stenosis and an age older than 60. Noninvasive screening for carotid disease should be done in these subgroups of patients reffered to CABG.