Sandra Makarović

Sex-dependent association between coronary vessel dominance and cardiac syndrome X: a case-control study

BackgroundPrevious studies have demonstrated the relevance of left coronary artery dominance in the outcome and prognosis of obstructive coronary artery disease (CAD). However, no studies have investigated the influence of coronary vessel dominance on non obstructive CAD. The aim of this study was to establish the association of left and mixed dominance of the major epicardial arteries with the development of non obstructive CAD and evaluate potential sex-dependent differences in the coronary artery supply.MethodsA total of 484 patients underwent the same diagnostic procedures. The patients were divided into two groups based on their coronary angiogram results: the control group (242 patients with obstructive CAD; coronary artery stenosis of ≥50%) and the experimental group (242 patients with non obstructive CAD; coronary artery stenosis of <50%).ResultsSignificantly more women than men were affected by non obstructive CAD (P = 0.005). Left dominance was more frequent in the non obstructive CAD group than in the control group (P = 0.018) and was more pronounced in women than in men (P = 0.013). Among men with non obstructive CAD, a left supply was more frequent than a mixed supply (P = 0.012). Women with non obstructive CAD had a higher frequency of a left supply, whereas a mixed supply was less frequent in men than in patients with obstructive CAD (P = 0.013 and 0.018, respectively).ConclusionThese results suggest that left dominance (particularly in women) and the absence of a mixed supply in men could cause regional ischemia, thus affecting the development of non obstructive CAD. Furthermore, sex may determine the incidence of specific coronary artery supply types, therefore influencing disease development and prognosis.

Bone mineral density in relation to metabolic syndrome components in postmenopausal women with diabetes mellitus type 2

Diabetes mellitus type 2 is associated with greater bone mineral density (BMD) due to obesity, although rapid bone loss observed over time could be explained by elevated chronic inflammation. The objective of this study was to investigate the relationship between central adiposity and hyperinsulinemia, as well as inflammation markers with vertebral and femoral BMD and bone turnover markers in postmenopausal women with type 2 diabetes. Femoral and vertebral BMD, osteocalcin, pyrilinks D, beta-CrossLaps (B-CTx), insulin, C-reactive protein (CRP), fibrinogen and plasminogen activator inhibitor-1 (PAI-1) were measured in 114 postmenopausal female patients with diabetes type 2. The patients of similar age, HbA1c levels and diabetes duration were divided into 2 groups based on their body mass index (BMI) values: lower or equal to 27 kg/m(2) (31 patients) and higher than 27 kg/m(2) (83 patients). Lower levels of osteocalcin (p=0.001), B-CTx (p=0.000007) and pyrilinks D (p=0.0365), and higher femoral BMD (p=0.00006), insulin level (p=0.0002), PAI-1 (p=0.00000) and CRP (p=0.002) were found in the overweight group. There were no signifi cant differences in vertebral BMD and fibrinogen. Osteocalcin and B-CTx showed inverse correlation, and femoral BMD positive correlation with waist circumference, insulin level and PAI-1. This suggests that abdominal obesity and hyperinsulinemia as components of the metabolic syndrome could increase femoral BMD by lowering bone rate. In addition, the only inflammation marker linked with femoral BMD was PAI-1, which is associated with increased mineralization of cortical bone in mouse.

Case Report: Surgical Treatment of Two Asymptomatic Myxomas at Two Atypical Locations

Atypical presentation of myxomas in the two cases described here arise from the fact that both patients were asymptomatic and both showed unexpected echocardiographic findings. Asymptomatic presentation is very rare, and occurs in only about 10% of individuals. Atrial myxomas discovered on incidental echocardiography is also a rare phenomenon, as seen in our cases. Early diagnosis and timely surgical treatment allow these patients to live a completely asymptomatic life.

Treatment of functional mitral regurgitation – cardiologists’ eternal enigma

ACCEpTED: May 10, 2018 Introduction: Prevalence of mitral regurgitation (MR) is still increasing in the western world despite the low incidence of rheumatic fever. Due to the complex structure of mitral apparatus pathology at any level can lead to valve dysfunction. Etiology of MR can be divided into primary, where the lesion is within the mitral apparatus, and secondary, which is caused by geometrical alteration of the left ventricle1. Secondary or functional MR is considered a disease of the left ventricle which is dilated with distorted papillary muscles preventing normal systolic coaptation of the mitral valve leaflets. Echocardiography is paramount for the diagnosis and evaluation of MR2,3. Qualitative, semi-quantitative and quantitative methods should be used for evaluating the severity of MR.

Mitral valve prolapse: a case report

ACCEpTED: May 10, 2018 Introduction: Mitral valve prolapse (MVP) is a condition in which one or both mitral flaps of the mitral valve (MV) do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium. It is relatively rare (frequency is 1-2%), and the highest percentage of patients is asymptomatic. Only a small number of patients reported palpitations, anxiety, tiredness, and atypical chest pain. An echocardiogram is a “gold standard” in diagnosing this disease. Complications are rare, and the most common and most important is mitral regurgitation. Asymptomatic patients should not be treated. Symptomatic patients need to be closely monitored clinically and ultrasonically, and surgical reconstruction of valves is considered in patients with severe mitral regurgitation1,2. Case report: 52-years-old female patient has heart murmur since childhood but so far has not been cardiologically treated. A few months ago, she felt chest pain spreading to her neck and intolerance of physical activity. The complete prolapse of the posterior MV has been diagnosed by echocardiography, with the suspected rupture of the chord, severe mitral insufficiency, consequently significant dilated left atrium, initially dilated left ventricle with still preserved left ventricular systolic function (LVEF 54%), and the signs of moderate pulmonary hypertension. Cardiac surgery was performed in our centre because of patient preference, and a mitral valve was replaced. Control echocardiography showed adequate position mechanical mitral valve with the non-parabolic flow and preserved systolic function of (LVEF 53%). On a follow-up visit the patient was subjectively well, without symptoms.

Serum Osteoprotegerin in Patients with Calcified Aortic Valve Stenosis in Relation to Heart Failure

The aim of the study was to assess the role of serum osteoprotegerin (OPG) as a biomarker in patients with aortic valve stenosis (AS) in relation to heart failure and symptomatic status. This was a case control study, which included 51 patients with AS and 39 control subjects. At the time of study enrolment, detailed medical history was obtained and all subjects underwent physical examination, chest x-ray and echocardiography. OPG levels were measured in all subjects, and serum N-terminal of the pro b-type natriuretic peptide (NT pro BNP) levels were determined in patients with AS. Serum OPG levels were elevated in patients with AS compared to control subjects (p=0.001). Patients with heart failure due to AS had elevated serum OPG levels in comparison to patients without heart failure (p=0.001). A significant correlation between OPG and symptomatic status was observed in all patients with AS (p<0.001), however, it was not the case in patients without heart failure (p=0.425). There was a positive correlation between OPG and NT pro BNP concentrations with objective signs of heart failure on chest x-ray (p<0.001). Negative correlation of OPG concentrations with aortic valve area was present (p<0.040), as well as with left ventricular ejection fraction (p<0.001). Serum OPG could be a valuable biomarker in the evaluation of severity of calcified AS and serve as an additional indicator besides clinical presentation and echocardiography in the assessment of surgical treatment or aortic valve replacement.