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Background: A body of data confirmed survival and hospitalization benefit regarding the use of SGLT2 inhibitors (SGLT2is) in patients with heart failure (HF) across the spectrum of ejection fractions. However, their potential effect on the prevention of sudden cardiac death (SCD) is not sufficiently explored. Purpose: This study was designed to determine crude rates and the relative risk of SCD in patients with HF with respect to treatment with SGLT2i (dapagliflozin or empagliflozin, each 10 mg once daily) or placebo. Methods: By thorough search of MEDLINE and EMBASE electronic databases and application of prespecified exclusion criteria, we identified 66 potential studies. A total of 5 randomized controlled trials (RCTs) examining the use of SGLT2is in HF, conducted in the period from 2019 to 2022, were included in the meta-analysis. This included pivotal trials such as DAPA-HF, DECLARE-TIMI 58, DEFINE- HF, EMPEROR-Preserved, and DELIVER. The main outcome measure was the risk of SCD events among HF patients, for which a risk ratio (RR) and respective 95% confidence intervals (95% CI) were reported. Meta-analysis was performed by utilizing the Mantel- Haenszel method with the fixed-effects model. The heterogeneity across included trials was assessed by using the I2 test. P-values

Vrtoglavica je subjektivni osjećaj stanja okretanja ili stanje gubitka ravnoteže u prostoru, često udruženo s mučninom, glavoboljom i povraćanjem, nesigurnošću i zanošenjem u hodu. Vrtoglavica ukazuje na oštećenje centralnoga ili perifernoga vestibularnog sustava. Gubitak sluha i tinitus uz vrtoglavicu najčešće ukazuju na periferno oštećenje koje zahvaća unutarnje uho (labirint). Vestibulospinalni sustav omogućuje orijentaciju u prostoru, kontrolu ravnoteže kretanja, stabilizaciju i fiksaciju slike predmeta u očima. Centralno (intrakranijalno) oštećenje vestibularnog sustava povezano je s disartrijom, disfagijom, diplopijama i hemiparezom. Najčešći uzroci centralnog oštećenja su neurovaskularni, demijelinizirajuće bolesti, ozljede glave te tumori mozga. Najčešći uzrok centralnog vertiga je vestibularna migrena. Vrtoglavica udružena s izraženim autonomnim simptomima poput povraćanja, znojenja, bljedila i mučnine upućuju ponajprije na oštećenje perifernoga vestibularnog sustava. Benigni paroksizmalni vertigo (BPV) i labirintitis najčešći su uzroci periferne vrtoglavice i povezani su s perifernim oštećenjem vestibularnog sustava. Akutna vrtoglavica povezana je s vestibularnim neuritisom, demijelinizirajućom bolesti, moždanim udarom, infekcijom središnjeg živčanog sustava (SŽS) i traumom glave. Subakutni i kronični vertigo pojavljuju se u ekspanzivnim intrakranijalnim procesima stražnje lubanjske jame te u okviru toksičnog oštećenja vestibularnog sustava. Racionalni dijagnostički pristup djetetu s vrtoglavicom periferne i centralne etiologije temelji se ponajprije na detaljnim anamnestičkim podatcima i detaljnom neurološkom statusu. Predloženi su dijagnostički algoritmi/postupnici (diferencijalno-dijagnostički pristup) koji omogućuju racionalizaciju pretraga u djece s perifernim i centralnim uzrocima vrtoglavice., Vertigo is a subjective feeling of spinning or a state of loss of balance in space, often associated with nausea, headache and vomiting, uncertainty and drifting while walking. Vertigo indicates damage to the central or peripheral vestibular system. Hearing loss and tinnitus with vertigo usually indicate peripheral damage affecting the inner ear (labyrinth). The vestibulospinal system enables orientation in space, control of movement balance, stabilization and fixation of the image of objects in the eyes. Central (intracranial) damage to the vestibular system is associated with dysarthria, dysphagia, diplopia and hemiparesis. The most common causes of central damage are neurovascular, demyelinating diseases, head injuries, and brain tumors. The most common cause of central vertigo is vestibular migraine. Dizziness associated with pronounced autonomic symptoms such as vomiting, sweating, pallor and nausea point primarily to damage to the peripheral vestibular system. Benign paroxysmal vertigo (BPV) and labyrinthitis are the most common causes of peripheral vertigo and are associated with peripheral damage to the vestibular system. Acute vertigo is associated with vestibular neuritis, demyelinating disease, stroke, CNS infection, and head trauma. Subacute and chronic vertigo appear in expansive intracranial processes of the posterior cranial fossa and in the context of toxic damage to the vestibular system. A rational diagnostic approach to a child with vertigo of peripheral and central etiology is primarily based on detailed anamnestic data and a detailed neurological status. Diagnostic algorithms/procedures and a differential diagnostic approach are proposed, which enable the rationalization of examinations in children with peripheral and central causes of vertigo.

Background: It was previously demonstrated that patients hospitalized for acute coronary syndrome (ACS) and presenting with symptoms of dyspnea without evident signs of heart failure may have worse short-term and long-term mortality, compared to patients without dyspnea. Purpose: We sought to determine whether the symptom of dyspnea among all-comers admitted for acute myocardial infarction (AMI) would be independently associated with worse in-hospital outcomes. Methods: A total of 202 consecutive patients admitted for AMI to the Emergency Department (ED) during 2019-2020 were analyzed. The primary endpoint of interest was a composite outcome consisting of in-hospital death and resuscitated cardiac arrest. Results: The mean age of enrolled patients was 65±12 years and 32.2% were women (N=65). More than half of patients presenting with ST-elevation myocardial infarction (STEMI, 58.9%) while 41.1% presented with non-ST-elevation myocardial infarction (NSTEMI). About a quarter of patients (25.7%, N=52) with AMI presented with the dominant symptom of dyspnea. The baseline characteristics of the analyzed cohort are shown in Figure 1. The rate of the primary outcome was 4.5% (N=9) in the total population. Patients presenting with dyspnea had a significantly higher rate of primary outcome compared to those without dyspnea (13.5% vs. 1.3%, p

Background: The presence of atrial fibrillation (AF) is known to be associated with reduced cardiac output due to ineffective atrial contraction during systole while recent research data shows that AF also contributes to adverse ventricular remodeling even if it is normofrequent. Likewise, AF and heart failure (HF) often co-exist while the presence of tachyarrhythmia may significantly contribute to myocardial dysfunction. Purpose: We hypothesized that the presence of AF in patients with non- ischemic dilated cardiomyopathy and left ventricular ejection fraction (LVEF)

BACKGROUND: To assess inpatient behaviors toward HF medications and self-care measures in the setting of acutely decompensated chronic heart failure (ADHF) prior to discharge from a tertiary clinical center. METHODS: Twenty patients with ADHF were provided an educational HF booklet and completed a 20-item questionnaire before discharge. FINDINGS: The mean age of patients was 70±11.8 years and 85% were male. Mean dyspnea per VAS scale prior to discharge was 2.9/10 points. Shortness of breath and leg edema were the most bothersome HF symptoms in 60% of patients. Forty percent of patients reported they feel they are taking too many medications for HF while 65% thought these medications cause them too many side effects. However, all patients reported that they would take as many HF medications as needed to treat their disease. Nearly half of patients (9/20) reported that financing and out-of-pocket costs for HF medications impose a significant financial burden on them. Up- titration of HF medications, as self-reported, did not occur in 70% of a patient during the period of last 12 months while 45% of patients were hospitalized due to HF at least once during the previous year. In terms of self-care, 40%, 75%, and 70% of patients reported they are regularly monitoring their weight, blood pressure, and salt or fluid intake at home, respectively. More than two- thirds of patients revealed they are not educated about the self-titration of diuretics at home. Patients identified antihypertensives and diuretics as the most important drugs for HF management while 50% of them would remove either diuretic or statin if they could omit one medication. DISCUSSION: Patient knowledge and self-care incentives regarding heart failure management were insufficient in several domains. Therefore, more educational interventions geared towards patients with ADHF are urgently needed to improve self-care behaviors thus potentially impacting relevant clinical outcomes.

Background: It is unknown if the mode of coronary revascularization among patients with heart failure with reduced ejection fraction (HFrEF) of ischemic etiology may differentially impact on advanced echocardiographic indices of myocardial function, independently of traditional parameters such as left ventricular ejection fraction (LVEF). Purpose: To determine whether the mode of coronary revascularization is associated with the difference in advanced echocardiographic parameters reflecting myocardial function among patients with HFrEF and ischemic cardiomyopathy. Methods: Forty consecutive HFrEF (LVEF

Background: The S2PLIT‐UG score has been recently published as a risk stratification tool for 1‐year all‐cause mortality among patients discharged after an acute decompensated heart failure (ADHF) event. This score stratifies ADHF patients into low, intermediate and high‐risk categories. It is calculated by combining 6 variables collected at admission including estimated glomerular filtration rate, uric acid, left ventricular ejection fraction, sodium, systolic blood pressure and the history of heart failure‐ related hospitalizations. The study aimed to determine if patients identified as high‐risk by the S2PLIT‐UG score have higher circulating levels of biomarkers associated with poor prognosis such as soluble suppressor of tumorigenicity 2 (ssT2), high‐ sensitivity cardiac troponin I (hs‐cTnI) and N‐ terminal pro b‐type natriuretic peptide (NT‐ proBNP). A secondary aim was to examine correlations of the S2PLIT‐UG score with the aforementioned biomarkers. Methods: A new validation cohort consisting of 96 patients hospitalized for ADHF and without acute coronary syndrome as an underlying culprit were consecutively included in the study during 2018‐ 2019. All patients underwent standard transthoracic echocardiography, laboratory analyses of peripheral blood, and had their S2PLIT‐UG score calculated with a high‐risk score being defined as having ≥4 points. Results: One‐ quarter of patients (25%, N=24) in analyzed cohort were identified as a high‐risk while 75% of patients (N=72) were non‐high risk according to the S2PLIT‐UG stratification system. Out of those designated as non‐high risk, vast majority were low risk (70.8%, N=51) and 29.2% (N=21) were intermediate risk. High risk group did not significantly differ from non‐high risk group of patients in terms of baseline characteristics including age (p=0.161), body mass index (p=0.437), sex distribution (p=0.637), smoking (p=0.626), dyslipidemia (p=0.898), diabetes mellitus (p=0.286) and presence of atrial fibrillation (p=0.288). Patients identified as high risk had significantly higher circulating levels of ssT2 (65.2±50.2 vs. 34.8±26.4 ng/mL, p

Background: Heart failure (HF) is currently classified according to left ventricular ejection fraction (LVEF) in three distinct phenotypes whereas novel indices of cardiac function such as global longitudinal strain of the left ventricle (LV GLS) and 2D free wall strain of the right ventricle (2D RV FWS) have shown to provide an additional prognostic value in this population. We aimed to determine the proportion of acutely decompensated heart failure (ADHF) patients that had abnormal LV GLS and 2D RV FWS at index admission and to examine if these indices differ significantly among three HF phenotypes and between men and women. Methods: A total of 42 consecutive patients with ADHF as adjudicated per ESC 2016 heart failure guidelines were enrolled at our university hospital. LVEF, LV GLS, and 2D RV FWS were measured by the same cardiologist with high expertise in echocardiography and an average of three consecutive measurements was chosen as the final value. Abnormal LV GLS was defined as a value 13% were considered asmildly reduced, >8 to 12.9% as moderately reduced and ≤8% as severely reduced LV GLS. Abnormal 2D RW FWS was defined as a value

Background: Myocardial injury (MI) defined as an elevation of cardiac troponins beyond a certain threshold is frequently encountered during the acute worsening of heart failure (AWHF) and is associated with an adverse prognosis. The MI has many potential causes other than myocardial ischemia and underlying etiology must be carefully investigated. In this study, we aimed to assess whether the symptomatic burden of the disease as assessed with the New York Heart Association (NYHA) classification will differ between AWHF patients with and without MI of nonischemic etiology. Furthermore, we sought to assess potential difference between those two groups in terms of circulating levels of soluble suppressor of tumorigenicity 2 (sST2) reflecting adverse myocardial remodeling under stressed conditions and biomarkers reflecting inflammatory response (C-reactive protein, CRP and neutrophiltolymphocyte ratio, NLR) and ventricular overload (N-terminal-proB-type natriuretic peptide, NTproBNP). Methods: A total of 85 consecutive patients with AWHF, NYHA class III-V, and without acute coronary syndrome (ACS) as an underlying cause of hospitalization were examined at our Cardiology Department. ACS was ruled out in all patients based on serial 12-lead electrocardiography tracings, clinical evaluation of symptoms/medical history and/or by diagnostic coronary angiography. All patients had their peripheral blood sampled within 24 hours of index hospitalization. The MI was defined as an elevation of high- sensitivity cardiac troponin I (hs-cTnI) beyond the upper limit of the 99th percentile, adjusted for sex, as following: >34.2 ng/L for men and >15.6 ng/L for women. All variables had normal distribution. Results: Patients were on average 71.7±9.1 years old, with predominance of women (51.8%) and with a mean left ventricular ejection fraction (LVEF) of 44.1±16.8 %. Most of the patients had reduced LVEF (43.5%), followed by preserved LVEF (38.8%) while 17.6% of patients had midrange LVEF. The mean hs-cTnI value was 68.9±101 ng/L. Slightly less than half of the patients (48.2%, N=41) had a myocardial injury with a mean hs-cTnI value of 132±108 ng/L, while 51.8% (N=44) of patients did not have a myocardial injury with mean hs-cTnI value of 14±8 ng/L. Both compared groups did not differ significantly in terms of age (p=0.952), body mass index (p=0.947) and estimated glomerular filtration rate (p=0.288). Patients with AWHF and with myocardial injury, compared to those without, had significantly higher NYHA class (3.2 vs. 2.8, p=0.017) and higher levels of circulating sST2 (62.1±45.2 vs. 40.2±32.5 ng/mL, p=0.018), CRP (26.9±29.6 vs. 11.4±14.0 mg/L, p=0.002), NLR (5.6±3.6 vs. 3.7±2.2, p=0.005) and NTproBNP (9763±10319 vs. 4825±7821 pg/mL, p=0.023) (Figure 1). Conclusion: A presence of nonischemic MI in AWHF is significantly associated with a higher symptomatic burden and an increase in adverse laboratory biomarkers that are historically associated with poor prognosis.

Background: Previous studies have shown that several pathophysiological mechanisms including myocardial injury and activation of thrombotic and inflammation pathways might impact on outcomes among patients with acute heart failure (AHF) syndromes. Purpose: Primary goal of the study was to determine the prevalence of laboratory marker abnormalities with respect to myocardial injury, systemic inflammation, and thrombosis. Secondly, we aimed to examine the association of these laboratory indices with N- terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) class, left- ventricular ejection fraction (LVEF), estimated glomerular filtration rate (eGFR) and glycated hemoglobin (HbA1c) values. Methods: A total of eighty patients with documented AHF according to ESC 2016 HF criteria were consecutively enrolled in the study during 2018. All patients underwent a physical examination, transthoracic echocardiography and blood withdrawal for laboratory analyses. Laboratory markers of principal interest were high-sensitivity cardiac troponin I (hs-cTnI), C-reactive protein (CRP) and D-dimers. Abnormal cut-offs were set according to assay specifications as follows: hs-cTnI ≥15.6 ng/L for women and ≥34.2 ng/L for men, CRP ≥5.0 mg/L, and D-dimers ≥0.5 mg/L. Finally, NT-proBNP, NYHA class, LVEF, eGFR, and HbA1c values were obtained in all patients. Results: Mean age of the cohort was 69.6±10 years, 47.5% were women and a vast majority (88.3%) were in NYHA III class or higher. Median NT-proBNP value was 3333 pg/mL (IQR 1219, 6990) with mean LVEF of 42%, mean eGFR of 57 mL/min/1.73 m2 , and mean HbA1c of 6.6%. Median values of examined laboratory markers were 20.3 ng/L (IQR 11.1, 36.5), 10.5 mg/L (IQR 5.9, 23.3) and 1.1 mg/L (IQR 0.7, 2.2) for hs- cTnI, CRP and D-dimer, respectively. Abnormalities of these markers were common in the observed cohort with 73.7%, 69.8%, and 47.9% of patients having abnormal CRP, D-dimer and hs-cTnI levels, respectively (Figure 1). One fifth (20.8%) of the cohort did not have an abnormality in any of the aforementioned markers. A total number of laboratory abnormalities positively correlated with NYHA class (r=0.448, p=0.002). hs-cTnI values correlated positively with NYHA class (r=0.374, p=0.021), HbA1c (r=0.312, p=0.014) and negatively with LVEF (r=-0.344, p=0.041). CRP correlated negatively with estimated glomerular filtration rate (r=-0.345, p=0.002) and positively with HbA1c (r=0.316, p=0.010). D-dimer values positively correlated to CRP (r=0.495, p=0.016) and NT-proBNP (r=0.330, p

Progresivni senzoneuralni gubitak sluha u 15-godišnje djevojčice s kongenitalnom CMV infekcijom

Background: Catestatin is a novel peptide with pleiotropic roles in the cardiovascular system that might have pathophysiological implications in terms of structure and function of the left ventricle (LV) among acutely decompensated heart failure (ADHF) patients. Purpose: This study tested associations of serum catestatin levels with structural and functional echocardiographic parameters of LV (Table 1). Methods: Thirty-five patients diagnosed with ADHF according to ESC 2016 HF criteria were consecutively enrolled during January-April of 2018. Each patient underwent physical and transthoracic echocardiography examination and antecubital venous blood sampling. Catestatin serum levels were determined by using an enzyme-linked immunosorbent assay (ELISA). Results: Mean age of the analyzed sample was 68 ± 10.2 years and 54.3% were men. Catestatin serum levels were in negative and significant correlation with LVEDd (r=-0.445, p=0.009), LVESd (r=-0.450, p=0.010), LVEDV (r=-0.407, p=0.021), LVESV (r=-0.407, p=0.009) and LV mass (r=-0.376, p=0.031) while they positively correlated with FS (r=0.422, p=0.016) and EF (r=0.311, p=0.039) (Figure 1). Remaining echocardiographic LV parameters did not significantly correlate with catestatin. Conclusions: Higher levels of circulating catestatinmeasured at admission of ADHF patients are significantly associated with more favorable structural remodeling and hemodynamic performance of the left ventricle.

Background: Dysfunction of the right ventricle (RV) can often be underestimated during the work-up of a congested patient with acutely decompensated heart failure (ADHF). Purpose: To determine the prevalence of RV dysfunction in ADHF patients and to characterize parameters of RV dysfunction when stratified by sex and the left ventricular ejection fraction (LVEF). Methods: Twenty-six patients with LVEF

Introduction: The Heart Failure (HF) surveys and registries have been developed with the intention to characterize this patient population and to improve diagnosis, treatment, and prognosis according to established guidelines of the European Society of Cardiology (ESC). We aimed to provide an overview of past, current, and future European HF registries and to integrate clinical information obtained from these registries. Patients and Methods: The data of EuroHeart Failure Survey (EHFS), ESC-HF Pilot Survey (ESC-HF Pilot), ESC HF Long-Term Registry (ESC- HF-LT-R) and Croatian Heart Failure Registry (CRO-HF-R) were analyzed. Results: The results from EHFS published more than a decade ago suggested that specific clinical investigations for patients with suspected HF such as echocardiography were not performed as frequently as recommended by the ESC. Several years later, the ESC-HF Pilot Survey that encompassed 136 cardiology centers from 12 European countries showed that ischemic etiology of HF was reported in about half of the patients while acute decompensation of HF was the most common clinical profile of acute HF. More recently, results from ESC-HF-LT-R showed that the presence of diabetes markedly increased the risk of 1-year adverse events in HF outpatients and that diabetes treatment was suboptimal. Likewise, the chronic obstructive pulmonary disease frequently coexists in HF and is associated with an increase in all-cause and HF-related hospitalizations during the 1-year follow-up. Data acquired from the CRO-HF-R revealed that disease presentation in HF might differ between women and men. For instance, women had a significantly higher proportion of HF with preserved left ventricular ejection fraction and had higher lipid and uric acid levels compared to men, while men had significantly lower hemoglobin levels and reduced left ventricular ejection fraction compared to women. Finally, latest established version of European HF registry, HF III Registry will continue to gather relevant information about this patient population in modern clinical practice. Conclusion: Registries are an important source of information about characteristics, diagnosis, treatment, and prognosis of HF patients and as such will continue to provide relevant clinical information in the future.

Introduction: Heart failure (HF) could be different in a specific population. The aim of the study was to analyze the clinical presentation of HF in female patients according to results from CRO-HF Registry. Methods and Results: We analysed 2203 hospital HF patients (data based on CRO-HF Registry): 1175 (53.3%) males (m) and 1028 (46.7%) females (f) ; median age 76 y. One third patients suffered of acute HF. Preserved left ventricular function (LVEF = 50%) was recorded in 37.8% patients. Females had frequently preserved LVEF ( = 50%) (f- 49.3%, m-29.3%, p < 0.001) and males reduced LVEF ( < 50%) (m- 70.7%, f-50.7%). History of hypertension (AH) had 67.5% patients, diabetes 34.4%, myocardial infarction 22.7%, renal failure 19.2%, COPD 17.3%, stroke 16.5% and atrial fibrillation 53.7% patients. In males, comparative to females, important disease was COPD (m-19.7%, f-14.7%, p = 0.009), renal failure (m-23%, f- 14.8%, p < 0.001), diabetes (m-36.1%, 32.6%, P = 0.08), stroke (m-17.1%, f- 15.9%, P = 0.547) and smoking habit (m-14.8%, f-6.4%, p= < 0.001). The frequently precipitating factors of HF were: arrhytmiae (m-56.1, f-58.3), valvular diseases (m- 67.3%, f-67%) and infections (m- 18.7, f-20.4%). Important "trigger" in females was hypertension (f-58.7%, m-52.7%, P = 0.009), arrhytmiae (f- 58.3%, m-56.1%), infections (f- 20.4%, m- 18.7%), and acute coronary syndrome (ACS) in males (m- 22.1%, f-17%, P = 0.010). Females had often atrial arrhytmiae (f-92.2%, m-87.6, P = 0.010). Lower values of haemoglobin were recorded in 51.9% patients, higher creatinine had 46.8%, ALT 29.8%, cholesterol 32.7%, triglycerides 31.9%, uric acid 79.3%, and hyperglycaemia 99.8% patients. In females, we recorded higher values of ALT (f-33%, m-27%, P = 0.012, C = 0.066), cholesterol (f- 36.8%, m- 29.1%, P = 0.009), triglycerides (f- 36.1%, m- 28.3%, P = 0.014), uric acid (f-82.9%, m-76.4%, P =0.007), and males lower haemoglobin levels (m-58%, f-44.8%, p = 0.001). Hospital mortality was lower in males than in females (m- 12.6%, f- 14.4%). There were no significant differences in HF treatment according to gender. Conclusions: Clinical presentation of HF could be different in female patients, according to CRO-HF Registry. Females have frequently preserved LVEF, higher values of ALT, cholesterol, triglycerides, and uric acid, and males have lower values of LVEF and hemoglobin. Hypertension is an important "trigger" of HF in females and ACS in males. HF treatment should be adapted to clinical presentations of HF according to gender.

We present a case of a 32-year old patient with acute recurrent perimyocarditis associated with thyrotoxicosis. To the best of our knowledge, this is the first reported case of acute recurrent pericarditis associated with increased thyroid hormones in the bloodstream and accompanied by a significant increase in cardioselective enzymes and reduced ejection fraction. Although some authors have described a single episode of myopericarditis mimicking acute coronary syndrome, it was not recurrent. Clinical improvement and normalization of laboratory results following the successful management of thyrotoxicosis, suggests a possible link between these two clinical entities-myopericarditis and thyrotoxicosis.

Introduction: Heart failure (HF) is a syndrome characterized by the activation of the complex cascade of neurohumoral mechanisms in order to maintain cardiac output. Previous studies have shown that activation of a sympathetic nervous system (SNS) is more pronounced in patients with ischemic cardiomyopathy (IC) compared to those with non-ischemic cardiomyopathy (NIC). On the other hand, catestatin is a pleiotropic endogenous peptide that inhibits nicotinic receptor-mediated catecholamine release into the circulation and, therefore, exhibits inhibitory action on SNS activity. The main goal of the study was to determine and compare circulating catestatin levels among HF patients with IC and NIC. Patients and Methods: This study included a total of 38 patients admitted to the University Hospital Centre Split during the March-June of 2018 with an acute decompensation of HF determined by the current diagnostic criteria for HF laid out in the European Society of Cardiology guidelines from 2016. Patients with acute coronary syndrome and/or infectious disease were excluded. Serum levels of catestatin were determined by the enzyme-linked immunosorbent assay (ELISA). Results: Twenty-one (55%) patient had IC while 17 (45%) had NIC. Both groups did not significantly differ in baseline anthropometric, clinical and echocardiographic parameters as well as medication intake (Table 1). Almost all patients were in NYHA III or IV class regarding the functional classification of HF (N=36, 95%). Patients with IC had significantly higher mean NYHA degree compared to NIC patients (3.4±0.6 vs. 3.1±0.4, p=0.039). Serum catestatin levels did not significantly differ between women and men (18.9 vs. 15.7 ng/mL, p=0.570). HF patients with IC had more than 2-fold higher catestatin serum levels compared to HF patients with NIC (22.8±20 vs. 10.6±8.5 ng/mL, p=0.025) (Figure 1). Catestatin showed positive significant correlation with NT-proBNP in a total sample of patients, independent of sex, age, body mass index and estimated glomerular filtration rate (r=0.516, p

Introduction: Atrial fibrillation (AF) is the most common arrhythmia associated with heart failure (HF). Previous studies have shown the correlation of cardiac markers such as NT- proBNP and high-sensitivity Troponin I (hsTnI) with increased risk for thromboembolic and adverse cardiovascular events in patients with AF. Goals of this study were to evaluate the risk for ischemic stroke (IS) and significant bleeding, to examine clinical and laboratory characteristics, and to determine potential associations of NT-proBNP and hsTnI with aforementioned risks in patients with acute decompensated HF (ADHF) and AF. Patients and Methods: This study included a total of 47 patients with ADHF and AF, diagnosed according to the current criteria of the European Society of Cardiology (ESC), which were hospitalized in University Hospital Centre Split during 2018 (Table 1). Patients with acute coronary syndrome and/or infectious disease were excluded. Results: Mean annual risk for IS without therapy was 8.74% while bleeding risk was 0.60% (p

OBJECTIVES: We determined whether stroke and/or TIA subjects have exercise-induced blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA ) and/or patent foramen ovale (QPFO ) and a genetic predisposition for ischemic stroke. METHODS: Twenty-eight stroke and/or TIA subjects (33-63 years old) underwent transthoracic saline contrast echocardiography concomitant with transcranial Doppler to detect QIPAVA and QPFO at rest and during supine exercise with and without breathing 100% O2 . We also examined genetic polymorphisms in FV Leiden (G1691A ; rs6025), factor II (FII) prothrombin (G20210A ; rs1799963), methylene tetrahydfropholate reductase (C677T, rs1801133), and plasminogen- activator inhibitor-1 (PAI-1) (4G/5G ; rs1799889) and angiotensin-converting enzyme (ACE ; I/D, rs4646994) in 24/28 subjects. RESULTS: No subject without PFO had QIPAVA at rest (n=17), but 12/17 did with exercise. All PFO subjects had QPFO at rest (n=11) and 7/11 had either QIPAVA or QPFO with exercise. Breathing 100% O2 during exercise reduced or eliminated left heart contrast in all subjects. Gene analyses revealed that 15/24 patients were either heterozygous or homozygous for methylenetetrahydrofolate reductase gene polymorphism ; 4G/4G and 4G/5G genotypes of plasminogen-activator inhibitor-1 were present in 7/24 and 13/24 patients, respectively ; polymorphisms of ACE D/D genotype were present in 6/24 and I/D in 14/24 patients. Having both I/D and 4G/4G genotypes was more prevalent in PFO+ subjects (P=.03), and there was a trend (P=.06) for PFO- subjects to have a greater D/D genotype prevalence. CONCLUSIONS: Novel genetic predispositions reported here in PFO subjects should be investigated further in larger stroke and/or TIA patient datasets.

Introduction: Congenital cytomegalovirus infection (CMV) affects 1% of the live-born infants. Around 10% of children with conatal infection at birth have severe disease that includes intrauterine growth restriction (IUGR), jaundice, purpura, hepatosplenomegaly, microcephaly, intracerebral calcifications, and retinitis. The most common permanent consequence of the CMV infection - sensorineural hearing loss, can possibly develop even several years after the infection. PURPOSE is to describe clinical course of the congenital CMV infection in a girl with a special overview on sensorineural hearing loss. Case Report: We represent a fifteen-year-old girl born from the first pregnancy in 38th week of gestation. In early newborn period, IUGR, jaundice, the signs of intrauterine and etiologically unproven infection were noticed. Brain US showed granulation of periventricular white matter. Hearing test of early hearing loss, at the time unavailable in Croatia, was not conducted. Due to delay in motor development at the age of 2, 5 years, she was clinically admitted. The girl was included in polyvalent habilitation. At the age of 5, 5 years a hearing impairment was noted. Diagnostics (audiometry, ABR) concluded the complete sensorineural hearing loss on the left side. CMV serology showed positive IgG and negative IgM antibodies result. Brain MRI showed hyperintense lesions in subcortical white matter, the biggest by trigonum of the left lateral ventricle. Metabolic analysis excluded leukodystrophy. At the age of 9 she underwent adenectomy due to recurrent otitis followed by hearing deterioration. Progressive sensorineural hearing loss extended on the right ear. MR brain imaging showed no progression change. The advancement in postnatal diagnostics PCR on CMV from a dried blood drop (Guthrie card) enabled etiological diagnostics. Hearing aid was provided for the right ear. She had adequately developed speech and average level of intellectual functioning. Conclusion: Congenital CMV infection in 15% of the diseased leaves permanent neurological damage, most commonly sensorineural hearing loss and learning difficulties. Gestational age during period of infection determines pathological changes in the brain. It is imperative to recognize the disease on time in order for patient to undergo of treatment. Based on clinical picture, MR brain imaging, serology and subsequent retrograde PCR diagnostics, it was concluded that we were dealing with congenital CMV infection. Reference: 1. Ross SA, Boppana SB. Congenital cytomegalovirus infection: outcome and diagnosis. 5emin Pediatr Infect Dis. 2005 Jan ; 16(1):44-9. 2. Grosse 5D, Ross D5, Dollard SC. Congenital cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing loss: a quantitative assessment. J Clin Virol. 2008 Feb ; 41(2):57-62. 3. Boppana 5B, Fowler KB, Pass RF i sur. Congenital cytomegalovirus infection: association between virus burden in infancy and hearing loss. J Pediatr. 2005 Jun ; 146(6):817-23. 4. Boudewyns A, Declau F, Smets K i sur. Cytomegalovirus DNA detection in Guthrie cards: role in the diagnostic work-up of childhood hearing loss. Otol Neurotol. 2009 Oct ; 30(7):943-9. 5. Christoni Z, Syggelou A, Soldatou A, Karakitsos P, Papaevangelou V. Evaluation of a modified extraction protocol increasing sensitivity in quantification of CMV viremia in Guthrie cards. J Clin Virol. 2012 Dec ; 55(4):360-2.

Retrospektivna analiza bolesnika s masivnom transfuzijom nakon kardiokirurškoga zahvata.

Background: Massive transfusion is usually defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h, or a corresponding blood loss of more than 1–1.5-fold of the body’s entire blood volume. Hemostatic control resuscitation for massively bleeding patients was introduced in collaboration between the blood bank and the clinicians. Aim: The trigger for red cell transfusion in cardiac surgical patients is hemoglobin (HGB) of 100 g/l or hematocrit (HCT) of 0.30 L/L. The goal of transfusion therapy is to raise the HGB values to the level that satisfies the need to maintain tissue perfusion and oxygenation with the aim to prevent dilution coagulopathy, acidosis, and multiorganic failure. We implemented control resuscitation with preemptive use of platelets and plasma in transfusion. Methods: A total of 406 patients were studied in the intensive care unit (ICU) in 2011 ; 21 (5.17%) male patients were observed (mean age 67.4 9.86 year). The reference group of patients was divided into two groups, according to the quantity of RBCs received. Group 1 (N = 15) received 5–9 units RBCs ; group 2 (N = 6) received 10 units RBCs. European system for cardiac operative risk evaluation (Euro- SCORE II) was used. Patients abided 6.9 days ( 7.97) in intensive care unit. Echocardiography was used for heart function evaluation. The left ventricular ejection fraction (LVEF) was 61.1 11.06%. During the 12-month study period, 21 patients were included in the analysis of the use of RBCs, platelet concentrates (PCs), and fresh frozen plasma (FFP) within 24 h. The patients received 176 (9.56%) of 1845 units RBC ; 140 (9.28%) of 1509 units FFP and 191 (7.54%) of 2534 platelet concentrates of a total blood products available for management of acute bleeding in ICU. In all these cases CBC (complete blood count) and conventional coagulation tests – prothrombin time (PT) ; activated partial thromboplastin time (aPTT) and international normalised ratio (INR) – were used to evaluate perioperative bleeding. Conventional laboratory measurements were performed prior to the start of the first transfusion and within 24 h after the first transfusion. Data are presented as mean and standard deviation ; P < 0.05 was considered statistically significant. Patients were monitored prior to surgery and for the first 24 h of transfusion of blood components for creatinine, pH, Ca++, troponin I. Duration of surgery/anesthesia (min) was registered too. Results: GROUP 1 (before/after) transfusion: HGB 92.93 g/l ( 11.84) / HGB 110.87 g/l ( 14.70) ; P = 0.001 ; HCT 0.27 L/L ( 0.03)/HCT 0.33 L/L ( 0.04) ; P = 0.007 ; PLT 171.47 9 109/l ( 56.69)/PLT 139.53 9 109/l ( 44.86) ; P = 0.02. GROUP 2: HGB 108.17 g/l ( 17.7) / HGB 103.33 g/l 14.1) ; P = 0.85 ; HCT 0.31 L/L ( 0.05) / HCT 0.31 L/L ( 0.04) ; P = 0.80 ; PLT 156.67 9 109 L ( 76.26) / PLT 119.67 9 109 ( 62.44) ; P = 0.04. The report based on retrospective observation indicates that plasma and platelets should be administered in a 1:1:1 ratio (i.e. equal parts of RBCs, FFP and platelets) to massively bleeding patients. Conclusion: Patients who received massive blood transfusion achieved satisfactory tissue perfusion and oxygenation. With this protocol we prevent dilution coagulopathy and acidosis. This approach is associated with improved survival.

The aim of this investigation was to analyze the total time from the onset of chest pain to the time of hospitalization in patients with acute myocardial infarction (AMI), and to estimate the parameters that could influence on late hospital admission. Results: A total of 1314 patients with diagnosis of AMI were adimitted to CCU of University Hospital Split during the 1999, 2003 and 2005. The measurement included the time from the onset of chest pain to admission to CCU. During three investigated years, median period from the onset of chest pain to hospitalization was significantly decreased (5.2 h : 6 h : 4.3 h ; p

The goal of this abstract was to investigate the parameters for assessment of outcome and survival rate of patients with chronic heart failure.

This work showed that the profile of patients with heart failure in Croatia may be different depending on gender.

This abstract describes the risk factors for the outcome and the survival rate of patients with chronic heart failure.