Edvard Galić

Natural History of Cardiovascular Disease in Patients With Diabetes: Role of hyperglycemia

Atherosclerotic vascular disease is more common in diabetic than in nondiabetic individuals. Diabetic macrovascular disease also has a more severe course with greater prevalence of multiple-vessel coronary artery disease and more diffuse elongated atheromas in affected blood vessels. In this review, we discuss possible reasons for increased incidence of cardiovascular (CV) events in individuals with diabetes. Although an increased prevalence of standard CV risk factors has been clearly documented in association with diabetes, diabetes-related abnormalities, particularly hyperglycemia, also play an important role. Epidemiological studies suggest that the effect of hyperglycemia on CV risk is independent of other known risk factors, but no data from primary interventional trials are available yet. Analysis of datasets from populations that included individuals with impaired glucose tolerance and impaired fasting glucose suggest that the pathogenic role of hyperglycemia on the blood vessel wall already exists in the early stages of glucose intolerance. The effect of postprandial or postchallenge hyperglycemia seems to be greater than the effect of fasting blood glucose abnormalities. The relationship of postprandial glycemia, fasting blood glucose, and CV risk in individuals with diagnosed (or overt) diabetes is less clear, although most reports indicate a greater pathogenic potential of postprandial hyperglycemia rather than fasting hyperglycemia. Based on the results of epidemiological reports, the most appropriate targets in interventional trials are postprandial hyperglycemia or A1C.

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.

Infective endocarditis after mitral valve repair wherefore mitral valve replacement was preformed

3. Thourani VH, Weintraub WS, Guyton RA, Jones EL, Williams WH, Elkabbani S, Craver JM. Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. Circulation. 2003 Jul 22;108(3):298304. https://doi.org/10.1161/01.CIR.0000079169.15862.13 Vera Slatinski1, Ante Pašalić1*, Marko Perčić1, Zrinka Planinić1, Edvard Galić1,2

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.

Left main occlusion in acute coronary syndrome: percutaneous coronary intervention or coronary artery bypass graft

Cardiologia CROATICA Coronary artery disease (CAD) is the narrowing or blockage of the coronary arteries, usually caused by atherosclerosis. It is a leading cause of death worldwide, causing approximately 7.2 million deaths worldwide each year. Complete occlusion of LCA is an unusual manifestation of CAD. The reported angiographic incidence is very low, it is found in 0.03% to 0.8% of patients in different studies. Occlusion of this vessel compromises flow to at least 75% of the left ventricle, unless it is protected by collateral flow or a patent bypass graft. Left main coronary artery disease rarely occurs as an isolated lesion; over 70% to 80% of patients also have multivessel coronary artery disease. Most patients with this condition complain of recurrent typical chest pain and have a history of myocardial infarction. They may also present with symptoms of heart failure. The diagnosis is usually made by angiography, which reveals a right dominant system. Right coronary artery provides collateral circulation to the left system, but up to two thirds of patients have a marked obstruction of the RCA. Our report describes two patients with ST-elevation myocardial infarction, who developed cardiogenic shock. In both cases, coronary angiography was performed immediately, and showed total occlusion of LCA and a right dominant system. The first patient was referred to primary PCI LMCA, and the second patient was referred to intraaortic balloon pump placement and multiple CABG. Six months later, both patients remain stable. Uncertainty surrounds the optimal revascularization strategy for patients with ST-elevation myocardial infarction LMCA occlusion and treatment guidelines in this setting are vague. PCI of the LMCA should be considered as a viable alternative to CABG for selected patients with myocardial infarction, including those with LCA occlusion and less than TIMI flow grade 3, cardiogenic shock, persistent ventricular arrhythmias, and significant comorbidities.

Drug eluting baloons — the new method of treating coronary artery disease

Cardiologia CROATICA Coronary artery disease (CAD) is one of the most common causes of death. Various technological advancements in interventional cardiology have significantly improved the treatment of CAD and significantly reduced the mortality of cardiovascular diseases. One recent development, the drug eluting balloon (DEB), decreases the incidence of restenosis and acute coronary events. DEB uses Paccocath technology in which the intima of the blood vessel is filled with carrier applied drug, paclitaxel, which penetrates into the lesion, preventing proliferation of vascular media and stabilizing atherosclerotic plaque. By applying that procedure the risk of restenosis is significantly reduced and most importantly the new acute coronary event. While the most common indication for DEB is stent restenosis, studies have also shown good results with bifurcation lesions, lesions in small vessels, certain lesions in native coronary arteries, and in patients who require a month of dual anti-aggregative therapy prior to noncardiac surgery. In our experience with twenty patients, the indication for DEB was restenosis in sixteen patients, lesion at a bifurcation in three patients, and a new lesion in one patient. Clinical observation was not an indication for recoronarography in any of our patients. Our early success with DEB reaffirms the method for treating CAD, with an emphasis on shortening the length of dual anti-aggregative therapy.