Marija Petrović

Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function

BackgroundInsulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI).MethodsIn 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices.ResultsIR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (pu2009=u20090.001) and day 7 (pu2009<u20090.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (ru2009=u20090.331), whereas both HOMA indices correlated well with CFR (ru2009=u2009-0.331 to -0.386) (pu2009<u20090.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2xa0mm (OR 11.70, 95% CI 2.46-55.51, pu2009=u20090.002) and CFRu2009<u20092 (ORu2009=u20095.98, 95% CI 1.88-19.03, pu2009=u20090.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, pu2009=u20090.026).ConclusionIR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.

Coronary flow of the infarct artery assessed by transthoracic Doppler after primary percutaneous coronary intervention predicts final infarct size

Coronary microcirculatory function after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction is important determinant of infarct size (IS). Our aim was to investigate the utility of coronary flow reserve (CFR) and diastolic deceleration time (DDT) of the infarct artery (IRA) assessed by transthoracic Doppler echocardiography after pPCI for final IS prediction. In 59 patients, on the 2nd day after pPCI for acute anterior myocardial infarction, transthoracic Doppler analysis of IRA blood flow was done including measurements of CFR, baseline DDT and DDT during adenosine infusion (DDT adeno). Killip class, myocardial blush grade, resolution of ST segment elevation, peak creatine kinase-myocardial band and conventional echocardiographic parameters were determined. Single-photon emission computed tomography myocardial perfusion imaging was done 6xa0weeks later to define final IS (percentage of myocardium with fixed perfusion abnormality). IS significantly correlated with CFR (rxa0=xa0−0.686, pxa0<xa00.01), DDT (rxa0=xa0−0.727, pxa0<xa00.01), and DDT adeno (rxa0=xa0−0.780, pxa0<xa00.01). CFR and DDT adeno in multivariate analysis remained independent IS predictors after adjustment for other covariates and offered incremental prognostic value in models based on conventional clinical, angiographic, electrocardiographic and enzymatic variables. In predicting large infarction (ISxa0>xa020xa0%), the best cut-off for CFR was <1.73 (sensitivity 65xa0%, specificity 96xa0%) and for DDT adeno ≤720xa0ms (sensitivity 81xa0%, specificity 96xa0%). CFR and DDT during adenosine are independent and powerful early predictors of final IS offering incremental prognostic information over conventional parameters of myocardial and microvascular damage and tissue reperfusion.

Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients with Nonculprit Stenosis of Intermediate Severity Early after Primary Percutaneous Coronary Intervention

Background: Treatment of nonculprit coronary stenosis during primary percutaneous coronary intervention in patients with ST‐segment elevation myocardial infarction may be beneficial, but the mode and timing of the intervention are still controversial. The aim of this study was to examine the significance and prognostic value of preserved coronary flow velocity reserve (CFVR) in patients with nonculprit intermediate stenosis early after primary percutaneous coronary intervention. Methods: Two hundred thirty patients with remaining intermediate (50%–70%) stenosis of non‐infarct‐related arteries, in whom CFVR was performed within 7 days after primary percutaneous coronary intervention, were prospectively enrolled. Twenty patients with reduced CFVR and positive results on stress echocardiography or impaired fractional flow reserve underwent revascularization and were not included in further analysis. The final study population of 210 patients (mean age, 58 ± 10 years; 162 men) was divided into two groups on the basis of CFVR: group 1, CFVR > 2 (n = 174), and group 2, CFVR ≤ 2 (n = 36). Cardiac death, nonfatal myocardial infarction, and revascularization of the evaluated vessel were considered adverse events. Results: Mean follow‐up duration was 47 ± 16 months. Mean CFVR for the whole group was 2.36 ± 0.40. There were six adverse events (3.4%) related to the nonculprit coronary artery in group 1, including one cardiac death, one ST‐segment elevation myocardial infarction, and four revascularizations. In group 2, there were 30 adverse events (83.3%, P < .001 vs group 1), including two cardiac deaths, two ST‐segment elevation myocardial infarctions, and 26 revascularizations. Conclusions: In patients with CFVR > 2 of the intermediate nonculprit coronary lesion, deferral of revascularization is safe and associated with excellent long‐term clinical outcomes. HIGHLIGHTSTDE CFVR provides useful information on the functional status of coronary arteries.We performed TDE CFVR of the intermediate (50%‐70%) nonculprit coronary stenosis.TDE CFVR > 2 is associated with excellent long‐term clinical outcomes.Findings contribute to ongoing debate over the best management of nonculprit lesions.

Imobilisana ljuska kajsije kao bisorbent teških metala

U radu je ispitana mogucnosti finalne formulacije biosorbenata na bazi kostica kajsija (Prunus armeniaca L.) kombinovanjem sa Na-alginatom i bentonitom u obliku granula pogodnim za primenu u realnim efluentima. U eksperimentalnom radu ispitan je uticaj granulacije biomase na biosorpcioni kapacitet prema Cu(II), Zn(II) i Pb(II). Najsitnija granulacija, koja je pokazala najbolje biosorpcione osobine imobilisana je u Na-alginatu, dok je kao vezivno sredstvo dodat bentonit, sto je uticalo da se stepen uklanjanja Cu(II) i Zn(II) poveca za oko 35% i Pb(II) za oko 60%. Dobijene granule su ispitane u saržnom sistemu na realnom uzorku. Rezultati ukazuju da se kompozitni biosorbent može uspesno koristiti u tretmanu voda kontamiiranih teskim metalima.

Gauging the response to cardiac resynchronization therapy: The important interplay between predictor variables and definition of a favorable outcome

Selection of patients who are viable candidates for cardiac resynchronization therapy (CRT), prediction of the response to CRT as well as an optimal definition of a favorable response, all require further exploration. The purpose of this study was to evaluate the interplay between the prediction of the response to CRT and the definition of a favorable outcome.

Sustainable conversion of waste biomass using hydrothermal carbonization method

Hydrothermal carbonization represents a process for converting a wet organic material at elevated temperature and pressure in hydro char, coal-like product. The resulting hydro char, depending on the nature of biomass, can be used as a substitute for fossil coal, adsorbent of various pollutants, soil fertility supplement and others. This paper provides insight into the reaction mechanisms, as well as the influence of process parameters. It also highlighted the importance and advantage of the process of hydrothermal carbonization of biomass compared to traditional methods of conversion, as well as the actual implementation of the product.