Violeta Iric-Cupic

Influence of Different β-Blockers on Platelet Aggregation in Patients With Coronary Artery Disease on Dual Antiplatelet Therapy

Introduction: The use of β-blockers in the treatment of patients with coronary heart disease is associated with a decrease in the frequency of angina pectoris and mortality of patients. Due to the severity of the disease and previous cardiovascular interventions, many patients with coronary artery disease (CAD) use dual antiplatelet therapy to achieve greater inhibition of platelet aggregation. The influence of β-blockers on platelet aggregation in patients using antiplatelet therapy is not well understood. Objective: To examine the effect of different β-blockers on platelet aggregation in patients on dual antiplatelet therapy. Methodology: The study included 331 patients who were treated at the Department of Cardiology, Clinical Center Kragujevac during 2011. Patients were divided into 4 groups depending on the type of β-blockers that were used (bisoprolol, nebivolol, metoprolol, and carvedilol). Platelet aggregation was measured using the multiplate analyzer and expressed through the value of adenosine diphosphate (ADP) test (to assess the effect of clopidogrel), ASPI test (to assess the effect of acetyl salicylic acid), TRAP test (to assess baseline platelet aggregation), and the ratio of ADP/TRAP and ASPI/TRAP ASPI/TRAP (ASPI - aranchidonic acid induced aggregation, TRAP - thrombin receptor activating peptide) representing the degree of inhibition of platelet aggregation compared to the basal value. In consideration were taken the representation of demographic, clinical characteristics, laboratory parameters, and cardiovascular medications between the groups. Results: Patients who used nebivolol had a significantly lower value of the ratio of ADP/TRAP (0.39 ± 0.30) compared to patients who used bisoprolol (0.48 ± 0.26; P = .038), and trend toward the lower values of ADP test (328.0 ± 197.3 vs 403.7 ± 213.2; P = .059), while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups. Conclusion: Patients with CAD on dual antiplatelet therapy who used nebivolol had significantly lower levels of residual ADP-induced platelet aggregation compared to baseline than patients who used bisoprolol.

Fulminant myocarditis as a primary manifestation of H1N1 infection: A first reported case from Serbia

A 19-year-old male was admitted to our clinic with a diagnosis of suspected acute pericarditis and acute coronary syndrome. The initial diagnostics at our clinic revealed fulminant myocarditis. Twenty-four hours after admission, the patients condition deteriorated, and he required mechanical ventilation and cardiopulmonary resuscitation. Unfortunately, the patient died. Clinical course, postmortem pathohistological findings and virus serology indicated that an H1N1 viral caused fulminant myocarditis and was the primary manifestation.

Correlation between Timi Risk Score and Clinical Outcome in Patients with Unstable Angina Pectoris

Abstract Given Taking that the TIMI score is a major predictor of MACE, this study aimed to determine the value of the TIMI risk score in predicting poor outcomes (death, myocardial infarction, recurrent pain) in patients presenting with unstable angina pectoris in short-term observation. A total of 107 patients with APns were examined at the Clinical Centre Kragujevac and were included in the investigation. The TIMI score was determined on the first day of hospitalization. During hospitalization, the following factors were also observed: troponin, ECG evolution, further therapy (pharmacologic therapy and/or emergency PCI or CABG), age, hypertension and hyperlipidaemia. The low-risk group (TIMI 0 - 2) included 30.8% of patients, whereas 47.6% of patients were in the intermediate-risk group (TIMI 3 - 4), and 21.5% of patients were in the high-risk group (TIMI 5 - 7). Good outcomes (without adverse event) and poor outcomes (death, myocardial infarction, and recurring chest pain) were dependent on the TIMI risk score. The increase in TIMI risk score per one unit increased the risk of a poor outcome by 54%. Troponin and TIMI risk score were positively correlated. Our results suggest that the TIMI risk score may be a reliable predictor of a poor outcome (MACE) during the short-term observation of patients with APns. Moreover, patients identified as high-risk benefit from early invasive PCI, enoxaparin and Gp IIb/IIIa inhibitors. Th us, routine use of the TIMI risk score at admission may reduce the number of patients not recognized as high-risk.

„Obesity Paradox“ – Fiction or a Fact?

Abstract Background: Many cardiovascular diseases are associated with obesity, but, despite this fact, obese people live longer than their normal-weight counterparts do. This phenomenon is called the „obesity paradox“. Aim: Purpose was to investigate the impact of obesity on the final outcome; determine the connection between obesity and heart rate > 80 beats per minute and other risk factors, and presence of „obesity paradox“. Material and Methods: Research included 140 patients with anterior wall acute STEMI treated in Coronary Unit, Clinical Center Kragujevac form January 2001-June 2006. Heart rate was calculated as the mean value of baseline and heart rate in the first 30 minutes after admission. Body mass index was calculated as the ratio of body weight in kilograms and body height in squared meters, and classified according to the WHO recomendations. Results: More than 75% obese patients were in both groups, survivors and those who died. In the subgroup with heart rate > 80 results were similar. Obesity had no significant effect on mortality despite the fact that the large number of patients with fatal outcome was obese. Conclusion: Correlation with acute myocardial infarction and elevated heart rate is evident, but obesity was not independent predictor for mortality which can only partly confirm presence of „obesity paradox“.

Can Statins Help „Good Cholesterol“ to Become Even Better

Abstract Background: Ischemic heart disease (IHD) is a most common manifestation of generalised atherosclerosis. Hyperlipidemia is one of the most significant risk factors causing atherosclerosis. Becouse of this, statin therapy is the (guideline) in therapy of hyperlipoproteinemia. Aim: The aim of this study was to show the hypolipemic effect of statins. Material and Methods: The research included 74 patients with hyperlipoproteinemia type II and III, with (59 patients) or without (15) coronary disease diagnosis. All patients have been treated with statins. In all patients, we analizing statins hypolipemic effects, and the research was carried out: before therapy, after 2 and 6 weeks, 3 months, and than every 3 months during 2 years of treatment. Results: Target value of lipoprotein profile parameter is achieved after 3-6 months of statin treatment. According to the results HDL-cholesterol was changed with the statins for 12.5% average; the highest average value change of 27.5% was recorded at the end of follow-up, and the minimal mean change, observed 2 weeks after therapy initiation was 4.59%. Conclusion: The statin therapy has significant effect on lipoprotein profile and atherogenic index. That effect is the most intensive after 3 month therapy, and target level of lipoprotein parameter are achieved after 3-6 months of statin treatment.

Fractional Flow Reserve Method in Cardiac Catheterization Laboratory without Cardiosurgical Backup: Initial Experiences

Abstract Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities. Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions. Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization. Results: Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005). Conclusion: Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI.

Dobutamine stress echocardiographyin distinguishing ischemic from nonischemic dilated cardiomyopathy

Introduction The aim of this study was to evaluate the diagnostic accuracy of dobutamine stress echocardiography for detection of coronary artery disease in patients with dilated cardiomyopathy. Detection of regional wall motion abnormalities at rest does not reliably distinguish ischemic from nonischemic cardiomyopathy. Material and methods To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 50 patients with left ventricular dysfunction (20 ischemic and 30 nonischemic, detected by coronary angiography) using dobutamine stress echocardiography. Echocardiographic images were obtained at baseline, low and paek dose of dobutamine. Rest and stress left ventricular wall motion scores were derived from analysis of regional wall motion. Results Dobutamine infusion was terminated after achievement of the target heart rate or maximal protocol dose in 16 (80%) patients with ischemic heart disease and in 23 (73.3%) patients with nonischemic heart disease. At rest, there were more normal segments (p<0.001) and a trend toward more akinetic segments (p, not significant) per ischemic than per nonischemic DCM patients. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many normal or dyssinergic regions at rest (in some cases after inprovement with low-dose dobutamine); in contrast, in nonischemic DCM, further mild impovement was observed in a variable number of left ventricular areas. Thus, with peak-dose dobutamine, more akinetic and less normal segments were present per ishemic than per nonischemic DCM patient (both, p<0.001). A value of six or more akinetic segments was 90% sensitive and 98% specific for ischemic DCM. Conclusions Our data show that analysis of regional contraction by dobutamine stress echocardiography can distinguish between.