Fahir Baraković

Direct coronary stenting in reducing radiation and radiocontrast consumption

Direct coronary stenting in reducing radiation and radiocontrast consumption Introduction. Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. Patients and methods. In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Results. Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. Conslusions. If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation.

Determination of Probabilistic Neural Network’s Accuracy in Context of Cardiac Stress Test

In the last several decades the development of information-communication technology (ICT) and related fields has assisted medicine in many aspects. This paper tends to contribute to this ongoing trend by testing the accuracy of probabilistic neural network (PNN) trained to determine the results of cardiac stress test used for diagnosis of coronary/ischemic heart disease (CHD). The obtained results show that the network can determine the patients who really need immediate diagnosis treatments in the shortest time with the satisfactory accuracy. Therefore, the proposed simulations can be used for the physicians in the training process and additionally ease the work to cardiologists and improve the treatment of cardiac patients.

Utječu li hormon rasta i inzulinu sličan čimbenik rasta 1 na prognozu u bolesnika s akutnim infarktom miokarda klase killip I-II?

We investigated concentrations and roles of insulin-like growth factor 1 (IGF-1) and its binding protein (IGF1BP-3), growth hormone (GH), insulin, and markers of insulin resistance and inflammation in acute myocardial infarction (AMI). We aimed to assess any possible association between serum GH/IGF-1 axis following AMI and short-term survival rates. A follow up study was performed in 2010. Study group consisted of 75 patients with Killip I and II class AMI. There were 30 control subjects. Blood samples were obtained within 24 hours of admission and analyzed for the aforementioned hormones. Patients were followed-up during 6 months for new cardiac events. Median GH was higher in AMI (0.96; range 0.6-2.4) than in controls (0.26; p<0.001). IGF-1 was significantly lower in AMI (123 vs. 132; p<0.05), and so was the IGF-1/GH ratio (p<0.001) and IGF1BP-3. Insulin was higher in study group, but without statistical significance. However, we found significant between-group differences in other markers of insulin resistance (HbA1c, glycemia, HOMA-IR) and inflammation. Simple linear correlation showed positive correlation between GH and C-reactive protein. All patients with new cardiac events had IGF-1 below median and lower left ventricular ejection fraction. In conclusion, IGF-1 may affect outcome of AMI. GH resistance might be a result of inflammatory/immune response and therefore it could be a useful prognostic marker.

Effect of combination therapy on cardiovascular risk in the pit miners with hypertension, metabolic syndrome and depression.

Background: Higher cardiovascular (CV) morbidity and mortality in depressed patient has demonstrated repeatedly. Aim: Determine the degree of occurrence of hypertension, metabolic syndrome (MetS) and depression in the pit miners and the impact of the six-month holistic treatment of all CV risk factors and depression in the overall CV risk in miners with hypertension, MetS and depression. Methods: From 492 pit miners was taken smoking status, measured blood pressure, waist circumference and body mass index. Analysis was done using the concentration of sugar in blood, triglycerides, total cholesterol, HDL, LDL cholesterol and determined total CV risk. All respondents filled self-assessment Becks depression scale. Prevalence MetS hypertension and depression were determined. Group of 67 patients with joint hypertension, MetS and depression that is treated six months with psychotropic and somatotropin medication, was singled out. After six months, the effect of therapy on the risk factors and total CV was assessed. Results: Among 492 miners 67 (13,61%) of them had hypertension, MetS and depression. After six months treatment, it showed statistically significant reduction in blood pressure (p=0,0001), waist circumference (p=0,0001) ,total (p=0,002), HDL (p=0,007) and LDL cholesterol (p=0,003), smoking (p=0,002), Becks scale results (p=0,007) and reduction in total CV risk. Conclusion: After six month of combine therapy in respondents has led to reduced CV risk and level of all factors, except BMI and triglycerides.

Growth hormone axis in patients with ST elevation myocardial infarction and non-ST elevation myocardial infarction

We investigated the insulin-like growth factor 1 (IGF-1)/growth hormone (GH) axis in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). This was a prospective study that was carried out in 2010. The study included an analysis of levels of GH, insulin, IGF-1, and its binding protein (IGFBP-3) in 43 patients with STEMI, 30 patients with NSTEMI, and 30 healthy individuals (control group). Blood samples for all analyses were taken within 24 h of admission. We found lower IGF-1 and IGFBP-3 levels and higher GH, C-reactive protein, glucose, and glycol glycosylated hemoglobin (HbA1c) levels in both STEMI and NSTEMI patients compared with controls. Insulin levels and the insulin resistance index did not differ between NSTEMI patients and controls. A significant difference in GH values was observed between the STEMI and NSTEMI groups (P<0.05). The increased GH levels in the STEMI compared with the NSTEMI group are consistent with a stronger inflammatory response in patients with STEMI.

Elevated Antibodies to Oxidized Low Density Lipoprotein are Positively Related with a Severity of Coronary Artery Disease

Aim: The prognostic value of circulating antibodies to oxidized low-density lipoprotein (anti-oxLDL) in patients with coronary heart disease is not completely clear. We aimed to investigate the association between levels of anti-oxLDL in three groups of patients with different grades of severity of coronary heart disease. Patients and methods: The study included 101 patients classified into three groups: one (N=35) with acute myocardial infarction (AMI), a group (N=35) with angiographicallly proven coronary artery disease (APCAD), and a group without angiographicallly proven coronary artery disease (N=31) designated as a control group. Levels of IgG anti-oxLDL antibodies were meausured by enzyme-linked immunosorbent assay. Results: Mean anti-oxLDL value was significantly higher in patients with AMI than in patients with APCAS (1342.1±581.5 mIU/ml vs. 553.0±183.3 mIU/ml, p<0.001), as well as compared with control group (1342.1±581.5 mIU/ml vs. 246.5±114.3, p<0.001). Similarly, significant difference in anti-oxLDL levels was found between the patients with APCAS and control group (p<0.001). Conclusions: The present study showed that elevated levels of anti-oxLDL are positively related with a severity of coronary artery disease. Hence, elevated levels of anti-oxLDL may identify patients with unstable coronary heart disease. Oxidized LDL in circulating plasma could serve as a marker of cardiovascular events.

INFLUENCE OF PRIMARY STENTING IN ACUTE MYOCARDIAL INFARCTION ON LEFT VENTRICULAR FUNCTION

Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can be different forms and degrees of complications, e.g. left ventricular dysfunction. Fibrinolythic therapy is the only non-invasive treatment that directly influences the infarction outcome. The purpose of the study was to compare systolic function of the left ventricle measured by ejection fraction in circumstances in which an acute myocardial infarction was treated by primary stent implantation, by administration of fibrinolytic agent streptokinase, and medical treatment when none of the above mentioned methods has been used. Material and methods: A retrospective-prospective study was conducted with a sample of 90 patients, that were hospitalized in 2005 and 2006 for acute myocardial infarction, mean age being of 56±7. Patients were divided into three groups, with 30 patients in each: a group of patients refered to primary stenting, a group that received streptokinase, and a group of patients that were not treated with either of these methods. Elecrocardiogram and echocardiographic study were performed on all patients. Results: Ejection fraction was 58%±8 in stented group, 47%±7 in streptokinase group, and 33%±8 in group without either (p< .001). Discussion and Conclusion: Global systolic left ventricular function was significantly better in the group of stented patients compared to the one in patients treated with streptokinase. Streptokinase administered in the first 6 hours from myocardial infarction onset significantly improves preservation of left ventricular systolic function compared to conditions in which no fibrinolysis is used.