Daniel Lovrić

Initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction is related to platelet response to aspirin

INTRODUCTION A proportion of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary angiography (PCI) presents with patent infarct-related artery (IRA) on initial angiography. We tested the hypothesis that stronger platelet response to aspirin in these patients at admission might be associated with higher initial coronary flow in the IRA. METHODS Platelet response to aspirin was assessed with Multiplate ASPI-test before coronary angiography in 70 patients on previous aspirin treatment admitted for acute STEMI. Coronary flow on initial angiogram was evaluated quantitatively according to the Thrombolysis in Myocardial Infarction (TIMI) grading system. Depending on the degree of arachidonic acid (AA) induced platelet aggregation in ASPI-test, patients were stratified into four quartiles and compared according to initial TIMI flow. RESULTS When TIMI flow was compared according to quartiles of platelet aggregation in ASPI-test, we have found significantly higher frequency of TIMI-2 and TIMI-3 flow among patients with low values of ASPI-test, i.e. with stronger aspirin response (P=0.014). None of the patients in the highest quartile of ASPI-test had TIMI flow of 2 or 3. CONCLUSIONS Patients with stronger antiplatelet response to aspirin therapy in acute STEMI are more likely to present with spontaneous IRA recanalization.

Platelet response to standard aspirin and clopidogrel treatment correlates with long-term outcome in patients with acute ST-elevation myocardial infarction

In this article the authors analyze platelet response in patients with acute ST elevation myocardial infarction by measuring its residual activity with point of care method (Multiplate). After 12 months they analyze the connection between the paltelet response and clinical outcomes.

Venovenous extracorporeal membrane oxygenation in a patient with acute respiratory distress syndrome caused by drowning

Case report: 32-year-old male patient with no prior medical history presented to our Emergency Department following drowning and a successful resuscitation. He was found submerged in the pool just a couple of minutes after being seen conscious and swimming. Lifeguard on duty pulled him out of the pool and started cardiopulmonary resuscitation. Upon the arrival of Emergency Medical Service, patient had a pulse and was breathing spontaneously, but was exhibiting grand mal seizures and not recovering consciousness. In the emergency department he was put on mechanical ventilation (MV) due to global RF and in the Coronary Care Unit therapeutic hypothermia (TH) was started. Urgent diagnostics was performed and no signs of stroke, coronary artery disease, pulmonary embolism or significant electrolyte imbalance were detected. 12-lead ECG and echocardiography showed no abnormal findings despite severe respiratory acidosis. Due to signs of ARDS (Figure 1) and worsening RF in Marijan Pašalić*, Boško Skorić, Maja Čikeš, Daniel Lovrić, Jana Ljubas Maček, Hrvoje Jurin, Jure Samardžić, Joško Bulum, Davor Miličić

Global radial strain is reduced in healthy heart transplant patients

Cardiologia CROATICA Background: Allograft rejection and vasculopathy in heart transplant (HTx) patients require timely recognition, with coronary angiography and endomyocardial biopsy being the diagnostic gold standards. Finding a non-invasive alternative remains the major objective. Speckle tracking echocardiography (STE) permits early recognition of myocardial dysfunction. The reduction in strain has been shown to denote both rejection and vasculopathy. However, deformation indices are also reduced in “healthy” HTx recipients ≥1 year after transplantation when compared with control subjects. Whether the reduction in strain is a chronic progressive process or the immediate result of transplantation (due to allograft ischaemia, denervation, cardioplegia etc.) has not yet been established. Hence, the lack of STE reference values in HTx population, especially during early post-transplant period, is one of the reasons that strain has not been used to follow-up these patients. The aim of the study was to evaluate whether radial deformation parameters are reduced in “healthy” HTx recipients during the first post-transplant year. Methods: Two-dimensional STE was used to evaluate radial strain in 15 “healthy” patients up to 6 months following heart transplantation. Patients were excluded if they had histologic evidence of acute rejection (>1A ISHLT), reduced LVEF (<55%), significant coronary vasculopathy (epicardial coronary narrowing >50% assessed by coronary angiography), wide QRS-complex (>120 ms), significant valvular disease or major cardiac events. Frame rates of ≈50 to 70s to avoid speckle decorrelation and good image quality for accurate tracking were mandatory. Segmental radial strain analysis was performed at the LV basal, middle and apical levels, and values were averaged to determine global radial strain. The results were then compared with the healthy normal subjects’ values, using recent meta-analysis data. Results: Global radial strain was significantly lower in transplant patients when compared with control subjects — mean 39.2% (95% CI 33.5 to 44.9%) vs. 47.3% (95% CI 43.6 to 51.0%), p 0.008. Conclusions: The reduction of global radial strain in “healthy” HTx subjects during early post-transplant period may be an immediate consequence of the transplant procedure. The baseline strain values should be obtained in all transplant patients soon after the transplantation, so that these values can later be used as a reference for early detection of myocardial abnormalities.

Limitations of open chest management

We read with interest the article ‘Open chest management (OCM) after cardiac operations: outcome and timing of delayed sternal closure’ (DSC) by Boeken et al. [1]. We would like to congratulate the authors on the good outcome and presentation of their results—quick surgery, low bypass times and low crossclamp times for very delicate subset of patients. As cardiac surgery is facing more high-risk patients, it is important to develop and improve the management strategies to improve the outcomes of our treatment. Opening a chest is one that provides immediate improvement in cardiac output without escalating pharmacological support [2].