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One of the primary causes of death worldwide is cardiovascular disease (CVD). Women typically have a lower incidence of CVD than men, however after acute cardiovascular events, women have a higher mortality and worse prognosis. Different CVDs, such as coronary heart disease, stroke, heart failure, and aortic diseases, exhibit these sex variances. These differences have raised serious concerns so sex consideration is significant for the prevention, diagnosis, treatment, and management of CVD. In order to highlight the need of taking sex differences into account when determining cardiovascular risk, this study seeks to offer an overview of sex-related differences in numerous common CVDs as well as an analysis of potential factors linked with the disparities. Future studies should focus on how to define and include sex-related indicators into the methods currently used for cardiovascular risk assessment and management.

In certain clinical situations, it is necessary to determine whether clinically relevant plasma levels of direct oral anticoagulants (DOACs) are present. We examined whether qualitative testing of DOACs in urine samples can exclude DOAC plasma concentrations of ≥30 ng/mL. This prospective single-center cohort study included consecutive patients treated with an oral direct factor Xa inhibitor (DXI) (apixaban, n = 31, rivaroxaban, n = 53) and direct thrombin inhibitor (DTI) (dabigatran, n = 44). We aimed to define the negative predictive value (NPV) and other statistical parameters of detecting DXIs and DTIs by DOAC Dipstick at plasma concentrations of ≥30 ng/mL. We also determined the best-fit threshold plasma levels using chromogenic substrate assays by logistic regression analysis. Between July 2020 and July 2021, 128 eligible patients (mean age 66 years, 55 females) were included into the study. The NPVs and sensitivities for DXI and DTI of DOAC Dipstick were 100% at ≥30 ng/mL plasma, for specificities 6 and 21% and for positive predictive values 62 and 72%, respectively. All diagnostic statistical tests improved to values between 86 and 100% at best-fitting plasma thresholds of ≥14 ng/mL for DXI and ≥19 ng/mL for DTI. Visual analysis using the DOAC Dipstick was 100% in agreement with that of the optoelectronic DOASENSE Reader for all the three DOACs.DOAC Dipstick testing can reliably exclude the presence of DOACs in urine samples at best-fitting thresholds of >14 and >19 ng/mL in plasma. The performance of the DOAC Dipstick at detecting lower DOAC concentrations in plasma requires confirmation.

Aim. The survey’s aim was to examine the significance of infarct-related artery (IRA) occlusion (verified angiographically) on very long-term outcomes of patients with acute myocardial infarction, within the STEMI and NSTEMI diagnosis. Methods. A single-center, nonrandomized, registry-based study on patients treated for acute coronary syndrome with percutaneous coronary intervention between June 2011 and December 2016 was conducted. Patients with angiographically proven IRA occlusion (100% stenosis with TIMI flow 0 distal to occlusion) were categorized as occlusive myocardial infarction (OMI) and patients with patent IRA (50–99% stenosis with TIMI 1–3 flow) were categorized as nonocclusive myocardial infarction (NOMI) and very long-term outcomes were analyzed. Data were collected prospectively from the hospital’s PCI registry and the database of the Croatian Institute of Public Health. Results. A total of 2450 patients were included in the study. 796 (32.5%) patients had NOMI and 1654 patients (67.5%) had OMI. According to ECG changes, 1534 patients presented with STEMI (62,6%) and 916 with NSTEMI (37,8%). 88% of STEMI patients presented with OMI and 12% with NOMI, while patients with NSTEMI in 33,8% presented with OMI and in 66,81% with NOMI. A median follow-up was 4.7 years. There was no significant difference in cardiovascular mortality between the groups (14.8% vs 13.1%; OMI vs NOMI, respectively; p = 0.374 ) neither in all-cause mortality (19% vs 21.5%; OMI vs NOMI, respectively; p = 0.374 ). Patients with NSTEMI had a significantly higher very long-term mortality (21.6% vs 18.1%; NSTEMI vs STEMI, respectively; p = 0.029 ). Conclusion. The main findings of the study are as follows: (1) total IRA occlusion was not associated with higher long-term mortality; (2) NSTEMI was associated with a higher mortality rate compared with STEMI, independent of angiographic presentation (OMI/NOMI); (3) IRA occlusion was not associated with significantly higher mortality rates in patients with STEMI and NSTEMI, respectively.

Aim: To determine whether therapeutic hypothermia (TH) improves survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. ----- Methods: This retrospective cohort study enrolled patients treated for OHCA with a return of spontaneous circulation admitted to the Cardiac Intensive Care Unit from October 2000 until March 2019. Data were collected from medical archives. Propensity score matching was used. The primary endpoint was death during hospital stay and secondary endpoint was cerebral performance category (CPC) score at discharge. ----- Results: Out of 152 patients included in the study, 58 (38.7%) underwent TH treatment. After matching (which left 70 patients in the analysis), death during hospital stay occurred less often in TH group (28.6% vs 57.1%, P=0.029), while the difference in CPC score was not significant. Cox proportional hazards model showed the predictors of death during hospital stay to be TH (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.13-0.68, P=0.004), initial Glasgow Coma Scale score of 3 (HR 7.55, 95% CI 1.44-39.63, P=0.017), and heart failure (HR 2.35, 95% CI 1.02-5.34, P=0.045). TH was not an independent predictor of CPC score. Mann-Whitney U test and linear regression model showed that TH was associated with higher gain in GCS. ----- Conclusion: TH was associated with better survival and certain variables suggesting improved neurological outcomes, suggesting that TH is a vital treatment option for comatose OHCA survivors.

Background: Although there are numerous studies reflecting predictors of atrial fibrillation (AF) recurrence (AFR) after pulmonary vein isolation (PVI), data on atrial appendages' mechanics is scarce. This study aimed to assess atrial appendages' mechanics by 2-dimensional (2D) and 3-dimenssional (3D) transoesphageal echocardiography (TEE) and to explore its value to predict AFR after PVI. Methods: Consecutive patients with paroxysmal AF undergoing first PVIwere analysed. 3D and 2D-TEE with tissue Doppler imaging (TDI) and strain analysis was obtained prior to the PVI, including: left atrial appendage (LAA) TDI and strain analysis, LAA ostium surface area, right atrial appendage’s TDI velocity and superior vena cava (SVC) ostium surface area. The primary end-point was freedom from any documented recurrence of atrial arrhythmia lasting > 30 s. Results: This single-centre, prospective study included 74 patients with paroxysmal AF (median age 59 years; 36% female; BMI 27.4 ± 4.1 kg/m2, LA volume index 32 ± 11 mL/m2). After a median follow-up of 14 (IQR 10–22) months, 21 (28%) patients had AFR. In a univariate and multivariate Cox-regression analysis LAA TDI velocity (HR 1.48, 95%CI 1.28–1.62, p

Kardiovaskularne bolesti (KVB), uključujući i koronarnu bolest srca (KBS), i dalje su vodeći uzrok smrti u Republici Hrvatskoj. Uz pravovremeno dijagnosticiranje bolesti, suvremene lijekove i organizirane sustave liječenja poput mreže primarne perkutane koronarne intervencije za bolesnike s akutnim infarktom miokarda (AIM), smrtnost od KVB-a je u padu. U ovom preglednom članku korištena je baza podataka PubMed i najnovija literatura o povezanosti novoga koronavirusa SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) i KVB-a. Navedeni virus, uzročnik koronavirusne bolesti 2019 (engl. coronavirus disease 2019 – COVID-19) postavio je nove izazove u liječenju KBS-a iz više razloga. COVID-19 je bolest koja najviše zahvaća starije ljude s komorbiditetima kao što su arterijska hipertenzija, dijabetes, debljina i KVB. Primarno zahvaća respiratorni sustav, ali može uzrokovati i kardiovaskularne komplikacije poput lezije/infarkta miokarda, miokarditisa, šoka, aritmija i smrti. Dijagnostika i liječenje bolesnika s AIM-om tijekom epidemije može biti otežana zbog protuepidemijskih mjera koje se provode s ciljem zaustavljanja transmisije na bolesnike i medicinsko osoblje. U preporukama Europskoga kardiološkog društva naglašava se pridržavanje dosadašnjih smjernica za liječenje AIM-a s ciljem što ranije i uspješne reperfuzije, ali uz obavezno korištenje osobne zaštite opreme i maske za bolesnika. Na morbiditet i mortalitet koronarnih bolesnika može utjecati strah od bolnica dovodeći do produženja vremena od početka simptoma do prvoga medicinskoga kontakta. Za vrijeme epidemije važno je educirati bolesnike i omogućiti im izravni kontakt i komunikaciju s liječnikom/kardiologom s ciljem korekcije terapije, poticanja na zdrav način života te prepoznavanja alarmirajućih simptoma., Cardiovascular diseases (CVDs), including coronary heart disease (CHD), are still the leading causes of death in the Republic of Croatia. With timely diagnosis, modern medication, and organized systems such as a network of primary percutaneous coronary intervention (PPCI) for patients with acute myocardial infarction (AMI), mortality from CVD is declining. The PubMed database and latest studies on the correlation of the new coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) and CVD were used in this review article. This virus, the cause of coronavirus disease 2019 (COVID-19), posed a new challenge in the treatment of CHD for several reasons. COVID-19 is a disease that mainly affects the elderly with comorbidities such as arterial hypertension, diabetes, obesity, and CVD. The respiratory system is primarily affected, but cardiovascular complications may develop, such as myocardial lesions/infarction, myocarditis, shock, arrhythmias and death. Diagnosis and treatment of patients with AIM during the epidemic may be delayed due to anti-epidemic measures to stop transmission to patients and medical staff. The recommendations of the European Society of Cardiology emphasize adherence to current guidelines for the treatment of AIM, including PPCI as an optimal reperfusion strategy as early as possible, but with obligatory use of personal protection equipment and masks for patients. The morbidity and mortality of coronary patients may be most affected by the patient’s fear of hospitals, leading to a prolongation of the time from the onset of symptoms to the first medical contact. During an epidemic, it is important to educate patients, enable them direct contact and communication with a primary physician/cardiologist to prescribe amendments to their therapy, encourage a healthy lifestyle, and identify alarming symptoms as early as possible.

Clinical application of rivaroxaban and apixaban does not require therapeutic monitoring. Commercial anti-activated factor X (anti-FXa) inhibition methods for all anti-FXa drugs are based on the same principle, so there are attempts to evaluate potential clinical application of heparin-calibrated anti-FXa assay as an alternative method for direct FXa inhibitors. We aimed to evaluate relationship between anti-FXa methods calibrated with low molecular weight heparin (LMWH) and with drug specific calibrators, and to determine whether commercial LMWH anti-FXa assay can be used to exclude the presence of clinically relevant concentrations of rivaroxaban and apixaban. Materials and methods: Low molecular weight heparin calibrated reagent (Siemens Healthineers, Marburg, Germany) was used for anti-FXa activity measurement. Innovance heparin (Siemens Healthineers, Marburg, Germany) calibrated with rivaroxaban and apixaban calibrators (Hyphen BioMed, Neuville-sur-Oise, France) was used for quantitative determination of FXa inhibitors. Results: Analysis showed good agreement between LMWH calibrated and rivaroxaban calibrated activity (κ = 0.76) and very good agreement with apixaban calibrated anti-Xa activity (κ = 0.82), respectively. Low molecular weight heparin anti-FXa activity cut-off values of 0.05 IU/mL and 0.1 IU/mL are suitable for excluding the presence of clinically relevant concentrations (< 30 ng/mL) of rivaroxaban and apixaban, respectively. Concentrations above 300 ng/mL exceeded upper measurement range for LMWH anti-FXa assay and cannot be determined by this method. Conclusion: Low molecular weight heparin anti-FXa assay can be used in emergency clinical conditions for ruling out the presence of clinically relevant concentrations of rivaroxaban and apixaban. However, use of LMWH anti-FXa assay is not appropriate for their quantitative determination as an interchangeable method.

Obesity is a risk factor for cardiometabolic and vascular diseases like arterial hypertension, diabetes mellitus type 2, dyslipidaemia, and atherosclerosis. A special role in obesity-related syndromes is played by cardiac visceral obesity, which includes epicardial adipose tissue and intramyocardial fat, leading to cardiac steatosis; hypertensive heart disease; atherosclerosis of epicardial coronary artery disease; and ischemic cardiomyopathy, cardiac microcirculatory dysfunction, diabetic cardiomyopathy, and atrial fibrillation. Cardiac expression of these changes in any given patient is unique and multimodal, varying in clinical settings and level of expressed changes, with heart failure development depending on pathophysiological mechanisms with preserved, midrange, or reduced ejection fraction. Progressive heart failure with misbalanced metabolic and catabolic processes will change muscle, bone, and fat mass and function, with possible changes in the cardiac fat state from excessive accumulation to reduction and cardiac cachexia with a worse prognosis. The question we address is whether cardiac obesity or cardiac cachexia is to be more feared.

SUMMARY The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

Iako intervencijska kardiologija u Hrvatskoj unatrag dvaju desetljeća bilježi napredak, ne nalazimo analizu broja intervencijskih kardioloških zahvata na nacionalnoj razini. Cilj je rada bila analiza broja koronarnih angiografija (CA) i perkutanih koronarnih intervencija (PCI) u razdoblju od 2010. do 2014. godine. Analizirani su dijagnostičko-terapijski postupci iz računa hospitaliziranih bolesnika u Hrvatskoj koji se odnose na CA i PCI u 13 hrvatskih centara. U promatranom je razdoblju prosječna stopa CA bila 4390 na milijun stanovnika godišnje uz porast od 8,5 % u promatranom razdoblju. Prosječna stopa PCI-ja bila je 2208 uz porast od 15 %. Omjer PCI/CA porastao je s 0,48 na 0,52. Od 47 470 PCI-ja učinjenih u Hrvatskoj od 2010. do 2014. godine 18,6 % učinjeno je u Klinici za kardiovaskularne bolesti Magdalena, 13,8 % u Kliničkom bolničkom centru (KBC) Zagreb, 11,9 % u KBC-u Rijeka i 11,3 % u Kliničkojbolnici Dubrava, dok su ostali centri imali udjele manje od 10 %. Prema broju PCI-ja, sedam hrvatskihcentara (54 %) ubrajamo u velike centre, a četiri (30,7 %) među srednje velike centre. Opća bolnica Dubrovnikod 2013. godine ima dovoljan godišnji broj PCI-ja (> 200), dok Opća bolnica Karlovac radi samo CA. Rezultati upućuju na izniman uspjeh hrvatske intervencijske kardiologije u zadnja dva desetljeća. Hrvatska je 2010. godine imala višu stopu PCI-ja od prosjeka članica Organizacije za ekonomsku suradnju i razvoj (OECD) i 21 zemlje članice Europske unije i veći prosječan godišnji rast (26,8 %) od svih analiziranih zemlja, osim Rumunjske. Stopa PCI-ja bila je viša od većine europskih zemalja, osim Njemačke, Belgije, Austrije i Norveške. Za daljnju analizu uspješnosti intervencijskih zahvata i planiranje daljnjeg razvoja nužno je formiranje unificiranoga Hrvatskog registra kardioloških procedura., Although there has been progress in interventional cardiology in Croatia over the last two decades, there has been no analysis of interventional cardiologic procedures at the national level. The aim of this article was to analyze of the number of coronary angiographies (CA) and percutaneous coronary interventions (PCI) in the period from 2010 to 2014. Diagnostic and treatment procedures were analyzed based on the CA and PCI hospital claims of Croatian patients in 13 Croatian centers. The average rate of CA in the observed period was 4 390 per million population annually, with a growth of 8.5% over the observed period. The average rate of PCI was 2 208 with an increase of 15%. The PCI/CA ratio grew from 0.48 to 0.52. Of the 47 470 PCI procedures performed in Croatia between 2010 and 2014, 18.6% were performed in the Magdalena Special Hospital for Cardiovascular Surgery and Cardiology, 13.8% in the University Hospital Centre Zagreb, 11.9% in the University Hospital Centre Rijeka, and 11.3% in the University Hospital Dubrava, while other centers had shares below 10%. Based on PCI numbers, 7 Croatian centers (54%) can be classified as high volume centers, and 4 (30.7%) as medium volume centers. The Dubrovnik General Hospital since 2013 had a sufficient annual number of PCIs (>200), while the Karlovac General Hospital only performed CA. Results indicate that Croatian interventional cardiology has achieved a great success over the last two decades: in 2010, Croatia already had an above average rate of PCIs compared with the Organization for Economic Co-operation and Development and 21 countries of the European Union, as well as a larger annual growth (26.8%) than all analyzed countries except Romania. PCI rates were higher than most European countries except Germany, Belgium, Austria, and Norway. Further analysis of the success of interventional procedures and further development plans require the formation of a unified Croatian Registry of Cardiologic Procedures.

Diet rich in lipids and hyperlipidaemia increases incidence of atrial premature beats and all supraventricular arrhythmias. The aim of the study was to investigate the prevalence of hyperlipidaemia in patients with AV re-entry tachycardia (AVRT) and AV nodal re-entry tachycardia (AVNRT). We conducted a retrospective, cross-sectional, case-control study that included all consecutive patients for whom AVRT or AVNRT was confirmed during electrophysiology study. Age and gender-matched patients admitted to hospital or outpatient clinic for various reasons were randomly included and served as a control group. Hyperlipidaemia was defined according to 2016 European Society of Cardiology guidelines. A total of 1448 subjects were included: 725 patients with AVRT/AVNRT and 723 controls. AVRT/AVNRT patients had high hyperlipidaemia prevalence, which was significantly higher when compared to the control group (50.1 vs. 35.8%, p

Background. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization.

We present a case of a 64-year-old female patient scheduled for implantable cardioverter defibrillator (ICD) implantation due to arrhythmogenic right ventricular cardiomyopathy (ARVC). Dual coil, active fixation ICD lead was introduced through the axillary vein. More than 20 positions were changed in the right ventricle (RV) (outflow tract, high, mid and apical septum, inferobasal, apical and lateral wall). Maximum R wave amplitude was 2 mV with pacing threshold of 0.5 V. Since the sensing was inappropriate, we decided to place the pace/sense lead of the ICD in the coronary sinus. The lead was placed in the basal part of the lateral vein. The pacing threshold was 1.0 V/0.40 ms and R wave was 9 mV. The lead was connected to the ICD sense-pace port and high voltage coils were connected in the usual way. The RV sense-pace lead was capped off. The device sensed an R wave of 7.0 mV 48 hours later. The purpose of this report is to show a possible solution of sensing problems during an ICD implantation in a patient with ARVC., Prikazujemo slučaj bolesnice s aritmogenom displazijom desne klijetke (ARVC) previđene za ugradnju kardioverter defibrilatora (ICD). Defibrilatorska elektroda s aktivnom fiksacijom postavljena je desnim aksilarnim pristupom. Adekvatni parametri stimulacije nisu se mogli postići na više od 20 pozicija u desnoj klijetki (izlazni trakt, bazalni, srednji i apikalni septum, inferobazalno, apikalno i na slobodnom zidu). Maksimalna amplitura R vala bila je 2 mV i prag stimulacije 0,5V. S obzirom na to da parametri nisu bili adekvatni odlučili smo se za postavljanje dodatne elektrode u bazalni segment lateralne grane koronarnog sinusa za sensing i stimulaciju. Amplituda R vala bila je 9 mV, a prag stimulacije 1 V. Cilj ovog prikaza slučaja je opisati potencijalna rješenja problema sa sensingom i stimulacijom tijekom ugradnje ICD-a kod bolesnika s aritmogenom displazijom desne klijetke.

The aim of this study was to assess the efficacy of high-sensitivity C-reactive protein (hsCRP), cardiac troponin T (cTnT) and creatine kinase (CK) as long-term predictors of reduced systolic function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) with complete revascularization. This prospective study evaluated consecutive patients with acute STEMI who had normal left ventricular ejection fraction (LVEF ≥50%) at admission with single-vessel disease and underwent complete revascularization. Blood samples were collected from admission to day 7. The primary endpoint was reduction of LVEF, Cilj istraživanja bio je utvrditi učinkovitost visokoosjetljivog C-reaktivnog proteina (hsCRP), kardijalnog troponina T (cTnT) i kreatin kinaze (CK) kao dugoročnih prediktora razvoja sistoličke disfunkcije u bolesnika sa STEMI-infarktom kojima je učinjena potpuna revaskularizacija tijekom primarne perkutane koronarne intervencije (PCI). Provedena je prospektivna studija kojom su evaluirani uzastopni bolesnici s akutnim STEMI-infarktom koji su imali urednu sistoličku funkciju kod prijma uz jednožilnu koronarnu bolest i koji su potpuno revaskularizirani tijekom primarne PCI. Uzorci krvi su prikupljani od prijma do 7. dana hospitalizacije. Primarni ishod bio je razvoj sistoličke disfunkcije lijevog ventrikla (LVEF

Aim: To evaluate clinical, interventional and outcome data of patients treated for left main (LM) stenosis. Patients and Methods: Study was conducted in University Hospital Centre „Sestre milosrdnice“, Zagreb. We retrospectively analyzed all coronary angiographies from June 20, 2017 until February 12, 2020. Cases were identified by a nation-wide database (Stenos). Patients with percutaneous coronary intervention (PCI) involving LM were analyzed, regardless of Medina stenosis class. Results: Out of 5537 procedures (3255 interventions, 1775 non elective), 400 procedures involved LM stenosis. PCI was performed in 235 patients. In 25 cases LM interventions were protected (excluded from further analysis). Centre yearly LM volume was 79.7, average operator LM volume was 9.9/year. Male sex was predominant (72.4%), average age was 68.6±10.3. Total of 63.8% patients presented with acute coronary syndrome (elevation 16.7%, non- elevation 33.3%, unstable angina 13.8%). Ad-hoc PCI was performed in 70.0% of cases. Stenoses involved LM in 92.4%, ostial left anterior descending artery in 59.5%, ostial circumflex artery in 44.3% patients. Bifurcation was stented in 80.5%, while 2 or more stents were used in 20.5% of all cases. Dominant bifurcation technique was provisional stenting (74.6%), followed by T and protrusion (15.4%). Proximal optimization (POT) was performed in 96.4%, which was followed by kissing in 34.7%, or strut dilatation in 10.3%, and re-POT in 57.8% of eligible patients. Intravascular ultrasound (IVUS) was used in 16.7%, coronary flow physiology in 1.4% patients. Radial access was most commonly used (83.1% ; 58.6% right-sided), followed by femoral (14.9%, rightsided in 84.6%). Shock was present in 7.3% on admission, while 9.6% of the patients were resuscitated. Mechanical circulatory support (MCS) was used in 1.4%. Two patients (0.9%) required emergent surgery. In-hospital mortality was 6.2%. Follow-up was available for 75.7% patients (294 [100-474] days). Major adverse cardiovascular event was observed in 7.0% patients. Conclusion: Patient preferences, operator and centre experience, and availability of cardiac surgery impacts the decision to interventional treat LM stenosis.1 Acute presentation, radial access, ad-hoc procedures, and simple stenting technics predominate. IVUS and MCS are still underutilized.

Objective: Obesity-related atherosclerosis is a systemic disease with a background connected to multiple metabolic-neurohumoral pathways. The leptin/adiponectin ratio has been suggested as an atherosclerotic marker in obese patients. The aim of this study was to assess (1) the significance of the L/A ratio in overweight subjects, (2) the relation with anthropometric/metabolic parameters and (3) gender difference. Method: The study included 80 adult males and females, overweight, non-diabetic patients. Biochemical blood analysis and anthropometric and cardiovascular measurements were performed. Serum leptin levels were measured with a radioimmunoassay test and total adiponectin levels with enzyme-linked immunosorbent assay. Leptin/adiponectin ratios were calculated as ratios between total serum concentrations of leptin and adiponectin. Results: Differences between leptin, adiponectin serum levels and leptin/adiponectin ratios are presented in overweight persons, where females have a significantly higher leptin/adiponectin ratio than men ( p Conclusion: The leptin/adiponectin ratio could represent an atherosclerotic risk marker of the early stage of obesity. Gender plays a significant role in pathophysiological changes, with different clinical manifestations, where sex hormones have a crucial effect on neurohumoral adipose tissue activity.

Polyarteritis nodosa (PAN) is a systemic vasculitis histologically characterized by necrotic lesions of small and medium- sized arteries occurring mostly in their bifurcations. PAN is a multi-organ disorder that affects numerous visceral arteries and leads to inflammation and necrosis, which may result in ischemia of vital organs. The etiology of the disease is unknown. It occurs in four forms - cutaneous (most common), classic, systemic, and microscopic. PAN preferably affects the renal and coronary arteries. The most common findings in the affected blood vessels are aneurysm, thrombosis, and stenosis. Cardiac complications are rare in children, but 35% of patients develop a complication in adulthood. The most common complication in adulthood is cardiac decompensation, which can be explained as a consequence of longstanding hypertension and changes in coronary blood vessels. The incidence of myocardial infarction is low, particularly in young patients. This paper describes a 25-year-old patient with acute myocardial infarction accompanied by changes in the coronary blood vessels and persistent arterial hypertension as a result of PAN diagnosed in childhood.

Propafenone is a sodium-channel blocker, class IC antiarrhythmic drug, frequently used to manage supraventricular dysrhythmias, especially atrial fibrillation. We report a self mono-intoxication with propafenone.A 68-year-old woman presented with a decreased level of consciousness, hypotension, and electrocardiogram showing QRS widening with atrial asystole and extreme bradycardia20 beats/min. After initial stabilization with transcutaneous pacing, laboratory findings detected normal electrolyte ranges and metabolic acidosis, and her medical history revealed availability of propafenone due to paroxysmal atrial fibrillation and depressive syndrome, which led to the suspicion of intoxication. Despite intravenous sodium bicarbonate, calcium, norepinephrine, and aggressive fluid replacement (10% glucose with insulin), hemodynamic stability was not achieved. Temporary intracardiac pacing was implanted. However, even with multiple electrode positions, effective capture could not be achieved. At that time, transcutaneous pacing was also ineffective. Consequently, the patient died in refractory asystole due to complete myocardial nonexcitability. The concentration of 5270 ng/mL of propafenone was found in the blood at autopsy, using gas spectrometry-mass chromatography. It is the third highest reported propafenone lethal concentration and the first case in which the myocardial nonexcitability refractory to intracardiac pacing was seen despite normal electrode position in the right ventricle, with failure to achieve the patient's hemodynamic stability. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware of possible propafenone ingestion causing toxicity, which is probably more frequent than previously described, especially because propafenone is widely available due to its use in managing atrial fibrillation, the most common arrhythmia nowadays.

Objective: Recent GWAS studies found uromodulin gene polymorphisms to be associated with increased risk for hypertension (HT) and chronic kidney disease. It was hypothesized that relation of uromodulin with HT might be through effects on sodium renal excretion. Our aim was to analyse association of urinary uromodulin concentrations (uUMc) with blood pressure (BP) and sodium excretion in a group of untreated middle-aged subjects. Design and method: In this cross-sectional study 175 apparently healthy untreated subjects without a history for CV and with eGFR> 60 ml/min/1.73 m2 were enrolled. Fasting blood and urine 24-hour urine sample were obtained and BP was measured following ESH/ESC guidelines in office (Omron M6) and during regular working (ABPM: Mobile-O-Graph). Based on office BP subjects were divided according to the JNC-7 classification. Uromodulin was determined by Enzyme

Introduction: Right ventricular (RV) function and cardiac involvement in systemic sclerosis (SSc) is important factor for the prognosis of SSc but often remains undetectable despite echocardiographic screening. 1,3 Speckle derived strain (2D-STE) of the right ventricle (RV GLS) was utilized to detect subclinical abnormalities in regional and global contractility in SSc patients with no echocardiographic signs of pulmonary arterial hypertension. Aim of pilot study was to study the advantages of 2D speckle-tracking echocardiographic derived parameters in identifying RV dysfunction in SSc patients for quantifying myocardial deformation and conventional RV indexes in patients with SSc and to investigate whether these could be indicative of right heart failure or can be used as non-invasive methods of screening in SSc. Methods and Results: 27 SSc patients (mean age, 54.3 years; 96% female) with technically adequate echocardiograms were studied. Standard morphological measurements of RV chamber function, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), tricuspid tissue Doppler annular velocities (TDIs,), right ventricular myocardial performance index (RIMP) and global longitudinal right ventricular free wall strain (RV FW GLS) were obtained. Twenty-two patients without pulmonary arterial hypertension (PAH) due to systemic sclerosis were studied. When we used the cutoff value recommended by the American Society of Echocardiography Guidelines to identify abnormal RV function4, patients were determined to have normal RV function, TAPSE 21.9 (±2.21), RV FAC 49.4 (±3.45), RIMP 0.44 (±0.08) respectively. Global longitudinal strain (LS) of the RV was calculated by averaging the LS value of 3 segments of the RV free wall in RV focused apical 4-chamber view (Figure 1). 40.9% of those patients had abnormal RV FW GLS (-14.8%) more pronounced in the basal regional longitudinal strain. Conclusion: Right ventricular strain reveals a diverse pattern of regional strain in SSc that is not detected by conventional measures of function, suggestive of subclinical RV myocardial disease and could be used as non-invasive method in screening for PAH in SSc to select patients eligible for right heart catheterization or to monitor the effects of PAH therapy.1-3

Background Ventricular tachycardia (VT) is frequently seen in ischemic settings like acute myocardial infarction with ST segment elevation (STEMI). Endothelial dysfunction (ED) represents inflammation and the loss of all protective features of the endothelium. We aimed to examine the association between VT and ED in patients with STEMI. Material/Methods The study included 90 subjects (30 with VT and acute STEMI, 30 with STEMI without VT, and 30 controls). Sera of all subjects were tested on ED markers by enzyme immunoassay: sICAM-1 (intracellular adhesive molecule-1), sVCAM-1 (vascular adhesive molecule-1), P- and E-selectins, and VEGF (vascular endothelial growth factor). In addition, CRP (C-reactive protein) was detected. Results Significantly increased values of low-density lipoprotein, triglycerides, leukocytes, creatinine, and the number of cigarettes smoked were observed among patients with VT+STEMI in comparison to controls. The levels of E-selectin were significantly lower in the VT+STEMI group than in the other groups, while the levels of VCAM-1 were significantly higher in the groups with STEMI and VT+STEMI compared to the controls. Lower levels of VEGF were recorded in STEMI and VT+STEMI groups compared to the control group. A significant correlation between CRP and VCAM-1 in patients with VT +STEMI was demonstrated. Conclusions We showed that ED may have a role in the immunopathogenesis of VT in patients with STEMI. The role of sE-selectin and correlation of sVCAM-1 with CRP as possible ED predictive markers in patients with VT+STEMI should be further investigated in a large cohort of patients.

Background: The prognostic significance of development of persistent atrial fibrillation (AF) in patients with atrioventricular (AV) block and dual chamber (DDD) pacemakers has not been separately investigated. We sought to determine whether persistent AF influences clinical outcome in these patients. Methods: Three hundred-eight consecutive patients with second- or third-degree AV block and implanted a DDD pacemaker were followed for 36 ± 20 months and retrospectively divided into two groups. Thirty-four patients who developed persistent AF formed persistent AF group, and 278 patients who remained free of this arrhythmia control group. Clinical and outcome data of the two groups were compared. The primary outcome was cardiovascular death. Results: The primary outcome occurred more often among the patients in the persistent AF group (6.8% per year) than among those in the control group (2.9% per year; P = 0.028). This difference was primarily because of higher rate of heart failure-related deaths in the persistent AF group (P = 0.009). Secondary outcomes, hospitalization for heart failure and paroxysmal AF episode ≥5 minutes, occurred also more often among the patients in the persistent AF group (P = 0.008 and P < 0.001, respectively), although the risk of nonfatal stroke was similar in both groups (P = 0.628). Conclusion: In patients with second- or third-degree AV block and DDD pacemaker, the development of persistent AF is associated with an increased risk of cardiovascular death and heart failure. (PACE 2012; 35:695–702)

AIM: To evaluate how coronary computed tomography-angiography (CCTA) altered the management and treatment of patients with suspected coronary artery disease (CAD). ----- METHODS: During 2009, we studied 792 consecutive patients with suspected CAD. CCTA was performed in all patients using a 64-slice dual-source CT scanner and standard scanning protocols. ----- RESULTS: After CCTA, obstructive CAD was excluded in 666 patients. During the 12-month clinical follow-up, 98.6% of these patients were free of major adverse cardiac events. Also, the indication for cardiac catheterization (CC) was revoked in 77.2% of patients. It was also revoked in all patients with low Morise pre-test risk, 80.7% with intermediate risk, and 72.6% with high risk. Medical therapy was changed in 54.7% of patients with confirmed CAD. ----- CONCLUSION: CCTA can reliably exclude significant CAD not only in patients with low and moderate risk, but also in those with high risk. It can also reliably replace CC in the majority of elective patients regardless of risk stratification. It can also be useful in risk reclassification and optimization of medical therapy in patients with CAD.

Aim was to evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average ± standard deviation 23 ± 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63 ; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0 ; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5 ; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27 ; P = 0.045) were identified as predictors of atrial fibrillation. In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.ular block and dual chamber pacemaker implantation.

Poliarteritis nodoza (PAN) sistemski je vaskulitis histološki karakteriziran nekrotizirajućim lezijama srednje velikih i malih arterija, ponajviše na njihovim bifurkacijama. PAN je multiorganski poremećaj koji zahvaća sve visceralne arterije te zbog posljedica upale i nekroze može dovesti do ishemije vitalnih organa. Etiologija bolesti je nepoznata. Postoje četiri oblika – kutani (koji je najčešći), klasični, sistemski i mikroskopski. PAN ponajprije zahvaća renalne i koronarne arterije. Najčešći nalaz zahvaćenih krvnih žila jesu aneurizme, tromboze i stenoze. Kardijalne su komplikacije rijetke u djece, no u 35% bolesnika u odrasloj dobi razvije se neka komplikacija. Od tih je najčešća kardijalna dekompenzacija koja se objašnjava kao posljedica dugogodišnje hipertenzije te promjena na koronarnim krvnim žilama. Incidencija akutnog infarkta miokarda niska je, posebno u mladih bolesnika. U ovom radu opisan je 25-godišnji bolesnik s akutnim infarktom miokarda i promjenama na koronarnim krvnim žilama te perzistirajućom arterijskom hipertenzijom kao posljedicom dijagnosticiranog PAN-a u djetinjstvu., Polyarteritis nodosa (PAN) is a systemic vasculitis histologically characterized by necrotic lesions of small and medium- sized arteries occurring mostly in their bifurcations. PAN is a multi-organ disorder that aff ects numerous visceral arteries and leads to infl ammation and necrosis, which may result in ischemia of vital organs. Th e etiology of the disease is unknown. It occurs in four forms - cutaneous (most common), classic, systemic, and microscopic. PAN preferably aff ects the renal and coronary arteries. Th e most common fi ndings in the aff ected blood vessels are aneurysm, thrombosis, and stenosis. Cardiac complications are rare in children, but 35% of patients develop a complication in adulthood. Th e most common complication in adulthood is cardiac decompensation, which can be explained as a consequence of longstanding hypertension and changes in coronary blood vessels. Th e incidence of myocardial infarction is low, particularly in young patients. Th is paper describes a 25-year-old patient with acute myocardial infarction accompanied by changes in the coronary blood vessels and persistent arterial hypertension as a result of PAN diagnosed in childhood.

Primary light-chain (AL) amyloidosis is a plasma cell dyscrasia associated with the deposition of immunoglobulin-derived amyloid in multiple organs. In the heart, this results in an infiltrative cardiomyopathy, with increased left ventricular wall thickness, normal or decreased left ventricular (LV) cavity size and congestive heart failure. Cardiac involvement is a major determinant of prognosis of AL amyloidosis. We report a patient with cardiac amyloidosis proven by cardiac biopsy, and aim to point out at transthoracic echocardiography as the hallmark of diagnostics. Echocardiography revealed increased LV thickness at 20mm, impaired LV ejection fraction (EF) at 35%, enlarged atria, transmitral deceleration time at 156 ms and increased E/A ratio at 4.25. Early diagnosis and intervention can have a significant impact on the patient's response to treatment, especially when the underlying condition involves a malignancy or infiltrative disorder. Standard transthoracic echocardiography as a noninvasive diagnostic tool is valuable and has a significant role in diagnosis and prognosis.