Dario Gulin

Nutrition in primary and secondary prevention of cardiovascular risk in the continental and Mediterranean regions of Croatia

BackgroundThe aim of this observational study was to evaluate the effect of Mediterranean and continental nutrition on cardiovascular risk in patients with acute and chronic coronary heart disease in Croatia.MethodsThe study included 1284 patients who were hospitalized in a 28-month period due to acute or chronic ischaemic heart disease in hospitals across Croatia. An individual questionnaire was prepared which enabled recording of various cardiovascular risk factors.ResultsPatients with chronic coronary artery disease have a better index of healthy diet than patients with acute coronary disease. Women have a better index of diet than men in both Croatian regions. When the prevalence of risk factors (impaired glucose tolerance, diabetes mellitus types I and II, hypercholesterolaemia, hypertriglyceridaemia and hypertension) in patients with Mediterranean and continental nutrition is compared, a trend is seen for patients who have risk factors to consume healthier food.ConclusionThe Mediterranean diet is associated with reduced risk of developing cardiovascular disease. This effect is more evident in patients with known cardiovascular disease.

Spontaneous pregnancy during ulipristal acetate treatment of giant uterine leiomyoma

Ulipristal acetate, a progesterone receptor modulator, pharmacologically inhibits endometrial proliferation and thereby prevents pregnancy. It is primarily used as emergency contraception, but also for the treatment of fibroids in women of reproductive age. There have been no published cases of pregnancy, while on therapy with ulipristal acetate.

Distribution of coronary artery disease in acute coronary syndrome patients with diabetes mellitus

Results Leading diagnosis at admission in ACS patients with DM and without DM was STEMI (53%, 55% respectfully). According to the ACC/AHA classification of coronary lesions patients with DM had 56% of type B lesion, 41% of type C lesion and 3% of type A lesion. In our study, the largest number of significant stenosis was observed in the proximal and middle segment of LAD: 74% of patients with DM and 60% in patients without DM. In patients with DM single-vessel CAD was observed in 26%, twovessel in 41% and three-vessel in 32%, whereas in patients without DM, 52% single-vessel CAD, 30% two-vessel and 18 % three-vessel CAD. Conclusion Most of the studies showed that patients with DM are more likely to have diffuse distribution of CAD. Results of studies about the association of DM with the location of the lesion in CAD is also contradictory, in some studies was observed a higher incidence of proximal, and in other distal lesions. In our study, mostly affected was LAD, usually its proximal and middle segment. Also, RCA and ACx were more affected in the proximal and middle segment. The study found a higher prevalence of type C lesions and a higher prevalence of three-vessel CAD in patients with DM which confirms previous findings that patients with DM usually have diffuse CAD.

A Case Report of Drug-Eluting Balloon as a New Treatment Option for Cardiac Allograft Vasculopathy

Cardiac allograft vasculopathy (CAV) is the principal longterm cause of graft failure responsible for more than 30% of all deaths in heart transplanted patients. Driven mainly by immune factors, CAV is characterized by concentric thickening of the blood vessel wall. Previous studies about drugand bare-metal stents in the treatment of CAV showed no significant differences in treatment outcomes. Until now, heart retransplantation remains the only treatment option for severe CAV. To our knowledge, there are no reported studies about the use of drug-eluting balloons in CAV. There are several expected benefits from this kind of intervention: an optimized homogeneous drug dispersion stopping the immunological process, the lack of residual metal reducing local tissue reactions, and the need for short-term antiplatelet treatment providing fewer interactions with immunosuppressive therapy.

Differences in risk factors, presentation and angiographic findings in elderly patients with coronary artery disease

3. Vasiljevic-Pokrajcic Z, Mickovski N, Davidovic G, Asanin M, Stefanovic B, Krljanac G, et al. Sex and age differences and outcomes in acute coronary syndromes. Int J Cardiol. 2016 Aug;217 Suppl:S27-31. https://doi.org/10.1016/j.ijcard.2016.06.217 Introduction: Coronary artery disease (CAD) is common among elderly patients and may have certain characteristics that are different from those in younger age.1-3 The aim of this study is to determine the presented risk factors, clinical presentation and angiographic findings in elderly patients.

Mitral regurgitation and other valvular heart diseases

2. Zamorano JL, Manuel Monteagudo J, Mesa D, Gonzalez-Alujas T, Sitges M, Carrasco-Chinchilla F, et al. Frequency, Mechanism and Severity of Mitral Regurgitation: Are There any Differences Between Primary and Secondary Mitral Regurgitation? J Heart Valve Dis. 2016 Nov;25(6):724729. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28290172 Ante Pašalić1*, Leon Adrović1, Tea Friščić1, Zrinka Planinić1, Marko Perčić1, Dario Gulin1, Dijana Bešić1, Jozica Šikić1,2

Additional file 1 of Nutrition in primary and secondary prevention of cardiovascular risk in the continental and Mediterranean regions of Croatia

*Questionnaire English version, *Study questionnaire containing main personal information, laboratory and physical findings and diet habits. (PDF 316 kb)

Percutaneous coronary interventions in cardiac allograft vasculopathy - a case report and review of the literature.

2016;11(3-4):108. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloških medicinskih sestara i tehničara Introduction: Cardiac allograft vasculopathy (CAV) is a challenging long-term complication of cardiac transplantation and remains a leading long-term cause of graft failure, re-transplantation, and death.1-3 Not only pathological characteristics, but also asymptomatic presentation of CAV is significantly different from typical atherosclerotic coronary artery disease (CAD). Large multicenter studies of heart transplant recipients undergoing percutaneous coronary interventions are lacking.

Reversible peripartum cardiomyopathy in a triplet pregnancy

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that occurs in previously healthy women in the last month of pregnancy and up to several months after delivery. The incidence of PPCM is low, but its morbidity and mortality rate are high, with a substantial risk of poor outcome of the pregnancy. Patients who have recovered from PPCM run a high risk of reoccurrence in subsequent pregnancies. In this case report we present a 32-year old female patient who developed acute heart failure (HF) associated with significantly reduced systolic function due to PPCM soon after a delivery of triplets. Treatment was immediately initiated in the intensive coronary unit with oxygen-therapy, loop diuretics, aldosterone blockers, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and bromocriptine. During the follow up period, a year and a half after delivery, a complete recovery of systolic function was observed with no residual symptoms.

The effect of statin therapy on the characteristics of coronary artery disease in patients with acute coronary syndrome

Results 31 patients (24.8%) were treated with StTh prior to admission. Leading diagnoses for patients previously on StTh were STEMI (39%) and unstable angina (39%), while in the group of patients without StTh the leading diagnosis was STEMI (60%). In patients who were treated with StTh the proximal and middle segment of LAD were the most common locations of stenosis. The frequency of single-vessel, two-vessel and three-vessel CAD was equal amongst both groups, while single-vessel CAD was more frequent in patients without prior StTh. According to ACC/AHA classification, type C lesion was discovered in 41% of patients without StTh and in 26% of patients with StTh. Conclusion According to the results of studies, 10-20% of patients experiencing an ACS were being treated with statins prior to the event. In our study, 24.8% of patients had been on StTh. The number of vessels with lesions was seen with equal frequency amongst patients with and without StTh. This apparent lack of benefit can most likely be explained by the increased number of risk factors amongst patients on StTh. Another advantageous finding seen in patients previously treated with statins was a significantly lower proportion of total occlusions, especially STEMI.