Search

Učinak sakubitril/valsartana na funkciju lijeve klijetke nakon 3 mjeseca liječenja u pacijenata s akutnim dekompenziranim srčanim zatajivanjem Podaci o učinku sakubitril/valsartana na ehokardiografske parametre u pacijenata s akutnim dekompenziranim srčanim zatajivanjem (ADHF) su još uvijek manjkavi u dostupnoj literaturi. Prospektivno smo uključili 68 uzastopnih pacijenata hospitaliziranih zbog ADHF-a, koji su liječeni sakubitril/valsartanom (N=34, S/V grupa) ili terapijom baziranoj na inhibiciji angiotenzina (N=34, ACEi/ARB grupa). Dvodimenzionalna speckle- tracking ehokardiografska (2D-STE) analiza je urađena pri uključivanju u istraživanje i nakon 3 mjeseca liječenja. Promjene u parametrima 2D-STE, uključujući globalnu uzdužnu longitudinalnu deformaciju lijeve klijetke (LVGLS), su uspoređivane među grupama t-testom i ANCOVA-om. Nije bilo značajnih razlika u bazalnim demografskim, kliničkim i ehokardiografskim osobitostima među grupama. Nakon 3 mjeseca liječenja zabilježeno je značajno poboljšanje LVEF-a i LVGLS-a u S/V grupi (prosječni porast LVEF od 27 % na 34.5 % i LVGLS od -6.6 % na -9.4 %), ali ne i u ACEi/ARB grupi. Navedeno poboljšanje LVEF-a i LVGLS-a je bilo izraženije u onih s neishemijskom etiologijom srčanog zatajivanja.

Predavanje o Teslinom profesoru matematike na TU Graz.

Objectives This study aimed to directly measure pH in the lungs, determine lactate dehydrogenase (LDH), C-reactive protein (CRP), and glucose levels in serum and bronchoalveolar aspirate, and identify bacterial pathogens from bronchoalveolar fluid during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods We performed an observational, analytical case–control study from February 2015 to March 2017. We included 84 patients with AECOPD and 42 with stable chronic obstructive pulmonary disease (COPD). All participants underwent detailed medical anamnesis, a clinical examination, chest radiography, spirometry, an arterial blood gas test, bronchoscopy, bacterial culture, and serum/bronchiolar aspirate laboratory testing. Results The mean pH of bronchoalveolar fluid was significantly higher in patients with AECOPD than in patients with stable COPD. The mean lung pH value, bronchoalveolar and serum LDH levels, and serum CRP levels in patients with isolated bacteria were higher than those in patients without isolated bacteria in the AECOPD patient group. Lung pH values in patients with AECOPD were significantly correlated with bronchoalveolar LDH and glucose levels. Conclusions AECOPD is associated with local cell and tissue injury in the lungs, especially in the presence of bacterial pathogens, which is accompanied by a low systemic inflammatory response.

Uvod: Koronarna bolest srca praćena je negativnim psihološkim stanjima, osobito kod osoba podvrgnutih perkutanoj koronarnoj intervenciji (PCI), dok se kardiološka rehabilitacija pokazala učinkovitom u smanjenju simptoma i poboljšavanju kvalitete života. Cilj rada: Ispitati postojanje depresije, rizičnih faktora uz subjektivnu procjenu kvalitete zdravlja pacijenta podvrgnutih PCI-ju te utjecaj ambulantne kardiološke rehabilitacije na njihovo smanjenje 5 tjedana od operativnog zahvata. Metode: U prospektivnu kohortnu studiju uključeno je 50 muških ispitanika podvrgnutih PCI-ju podijeljenih u dvije jednake skupine. Pokusna skupina bili su ispitanici s provedenim PCI-jem koji nakon otpusta uzimaju medikamentoznu terapiju uz organiziranu ambulantnu rehabilitaciju. Kontrolna skupina su bili ispitanici s provedenim PCI-jem, po otpustu uzimaju medikamentoznu terapiju bez ambulantne kardiološke rehabilitacije. Anketiranje je provedeno neposredno nakon PCI-ja i nakon 5 tjedana od provedenog zahvata mjernim instrumentima: Beckov inventar depresije i SF-36 upitnik. Rezultati: Nakon 5 tjedana rehabilitacijski program dovodi do statističkih promjena u sniženju krvnog tlaka, hiperlipidemije i pušenja. U skupini koja je provodila rehabilitacijski program došlo je do statistički značajnih promjena u ukupnom rezultatu Beckovog inventara depresije i njegovim sastavnicama (bolje raspoloženje, osjećaj prihvaćenosti, manjak krivnje, mržnje prema sebi, neodlučnosti i negativne slike o sebi, bolji san, poboljšan apetit i smanjena izraženost hipohondrije) te u SF-36 upitniku (bolje fizičko funkcioniranje, percepcije općeg zdravlja, energije i vitalnosti). Statistički značajne promjene pojavljuju se kod skupine bez ambulantne kardiološke rehabilitacije u sastavnici Beckovog inventara: neodlučnosti, te sastavnici SF-36 upitnika:npercepciji općeg zdravlja. Zaključak: Ambulantna kardiološka rehabilitacija učinkovita je u smanjenju simptoma depresije, rizičnih faktora i poboljšanju kvalitete života kod pacijenata podvrgnutih PCI-ju., Introduction: Coronary heart disease is accompanied by negative psychological conditions occurring in patients after percutaneous coronary intervention (PCI), while cardiac rehabilitation happened to be effective in reducing symptoms and improving the quality of life. Objective: To examine the existence of the symptoms of depression, as well as to examine risk factors along with the subjective assessment of health quality in patients who underwent percutaneous coronary intervention and to examine the effects of ambulatory cardiac rehabilitation in reducing the depression and risk factors 5 weeks after the operation. Methods: A prospective cohort study included 50 male subjects who underwent PCI divided into two equal groups. The trial group consisted of patients who underwent the PCI and who, after hospital discharge, took medication therapy together with organized outpatient cardiac rehabilitation. The control group consisted of patients who underwent PCI and who, after hospital discharge, took medication therapy without outpatient cardiac rehabilitation. The survey was conducted immediately after PCI and 5 weeks after the intervention with the Beck Depression Inventory and SF-36 Questionnaire measurement instruments. Results: After 5 weeks, the rehabilitation program led to statistical changes in lowering blood pressure, hyperlipidemia and smoking. In the group that conducted the rehabilitation program there were statistically significant changes in the overall outcome of Beck’s inventory of depression and its components (better mood, the feeling of acceptance, as well as the lack of guilt, self-hate, indecision and negative self-image in general, sleep and appetite improved and the expression of hypochondria decreased) and in the SF-36 questionnaire (better physical state, perception of general health, energy and vitality appeared to be improved). Statistically significant changes occur in the group without outpatient cardiac rehabilitation: indecision was found in the Beck inventory component and the changes in general health perception occurred in the components of the SF-36 questionnaire. Conclusion: Outpatient cardiac rehabilitation is effective in reducing the symptoms of depression and risk factors as well as in improving of the quality of life in patients undergoing PCI.

Povodom 75. godišnjice smrti istaknutog hrvatskog matematičara i fizičara, akademika Vladimira Varićaka (1865.– 1942.), u organizaciji Razreda za matematičke, fizičke i kemijske znanosti Hrvatske akademije znanosti i umjetnosti, 26. svibnja 2017. u Zagrebu je održan znanstveni skup “Akademik Vladimir Varićak u hrvatskoj znanosti”. znanosti”. Oslanjajući se upravo na te radove, u ovom ćemo članku pokušati iznijeti podatke o životu Vladimira Varićaka i opisati različite aspekte rada ovoga iznimno cijenjenoga akademika, rektora Sveučilišta u Zagrebu, dekana Mudroslovnog fakulteta te dugogodišnjeg predstojnika Matematičkog zavoda čija je bogata znanstvena i nastavna karijera potrajala dulje od pola stoljeća.

The presence of circulating gas bubbles and their influence on pulmonary and right heart hemodynamics was reported after uncomplicated self-contained underwater breathing apparatus (SCUBA) dive(s). Improvements in cardiac imaging have recently focused great attention on the right ventricle (RV). The aim of our study was to evaluate possible effects of a single air SCUBA dive on RV function using 2D speckle tracking echocardiography in healthy divers after single open sea dive to 18 meters of seawater, followed by bottom stay of 47 minutes with a direct ascent to the surface. Twelve experienced male divers (age 39.5 ± 10.5 years) participated in the study. Echocardiographic assessment of the right ventricular function (free wall 2 D strain, tricuspid annular planes systolic excursion [TAPSE], lateral tricuspid annular peak systolic velocity [RV s`] and fractional area change [FAC]) was performed directly prior to and 30, 60, 90 and 120 minutes after surfacing. Two-dimensional strain of all three segments of free right ventricular wall showed a significant increase in longitudinal shortening in post-dive period for maximally 26% (basal), 15.4% (mid) and 16.3% (apical) as well as TAPSE (11.6%), RV FAC (19.2%), RV S` (12.7%) suggesting a rise in systolic function of right heart. Mean pulmonary arterial pressure (mean PAP) increased post-dive from 13.3 mmHg to maximally 23.5 mmHg (P = .002), indicating increased RV afterload. Our results demonstrated that single dive with significant bubble load lead to increase in systolic function and longitudinal strain of the right heart in parallel with increase in mean PAP.

Castleman’s disease (in the literature also known as angiofollicular hyperplasia) is a rare benign lymphoproliferative disease. Clinically, it can manifest as unicentric or multicentric disease. Unicentric disease is most often diagnosed by accident or by symptomatology resulting from compression upon the adjoining anatomical structures. Considering its lymphatic origin, tumor mass can theoretically occur in any body region. We present a case of paracardiac localization of unicentric Castleman’s disease in a previously healthy 24-year-old woman. In such clinical cases, the specific localization of the tumor and its radiological properties can pose a differential diagnostic dilemma. Correct diagnosis is only possible after complete surgical excision and histopathologic analysis, which is the optimal therapeutic approach in this disease.

Epikardna VT ablacija je vrlo invazivna procedura, no kada se radi u centrima s kardiokirurskom podrskom i velikim volumenom ablacijskih procedura, nudi mogucnost sigurnog izvođenja i daje sansu ostvariti kontrolu nad aritmijama koje ugrožavaju ne samo kvalitetu, vec i život ovih pacijenata.

The Republic of Croatia, with a gross domestic product per capita of US$11, 554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1, 190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in- hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to- balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries

U ovom članku predstavljamo stručne studije računarstva, informatike, elektrotehnike i graditeljstva, koji se izvode na Tehničkom veleučilištu u Zagrebu. Nastojali smo dati objašnjenja koja će, vjerujemo, čitateljima olakšati razumijevanje podataka o studijima dostupnih na internetu, koje pak u tekstu ne kopiramo, nego na njih upućujemo linkovima. S obzirom na profil MFL-a, a i činjenicu da su autori nastavnici matematičkih kolegija na tim studijima, članak obiluje primjerima zadataka iz tih kolegija. Njima želimo ilustrirati vezu između znanja stečenog u ranijem školovanju i novih spoznaja koje donosi studiranje.

Uvod: Lijekom obloženi baloni (DEB) predstavljaju novu tehnološku platformu u području perkutane koronarne intervencije. Jedina prihvaćena indikacija za njihovu uporabu je liječenje in-stent stenoze, a za sve ostale indikacije nema jasnog konsenzusa. Cilj: Evaluirati upotrebu DEB-a u rutinskoj kliničkoj praksi u Republici Hrvatskoj. Metode: Restrospektivni nerandomizirani multicentrični registar svih liječenih bolesnika u sedam hrvatskih centara između veljače 2011. i siječnja 2014. godine. Podatci su sakupljeni uvidom u dostupnu medicinsku dokumentaciju. Nije bilo kliničkih niti angiografskih isključnih kriterija, niti pisanog zajedničkog protokola za indikacije niti praćenje bolesnika. Praćena su velika nepovoljna događanja (MACE) definirana kao kombinacija srčane smrti, infarkta miokarda na tretiranoj krvnoj žili (MI) ili klinički indicirane reintervencije na tretiranoj krvnoj žili TLR za sve bolesnike tijekom iste hospitalizacije, nakon 6 mjeseci kliničkog praćenja te dostupni angiografski podatci. Rezultati: Kod 248 bolesnika tretirane su 284 lezije. Najčešća indikacija bila je in-stent restenoza u 31,4% bolesnika, u 21,4% bolesnika DEB je implantiran u žilama manjim od 2,75 mm, a ostale indikacije su bile: lezije veće od 2,8 mm, bifurkacije, ostijalne lezije, kronične totalne okluzije (redom: 11,3%; 11,3%; 7,3%; 1,6% ). U 39 bolesnika (15,6%) nakon prethodne implantacije običnih metalnih stentova (BMS) rađena je postdilatacija DEB-om. MACE su se tijekom hospitalizacije javili u 1,6% bolesnika: 1 smrt (0,4%), 3 akutne tromboze (1,2%), 1 MI (0,4%). Nakon 6 mjeseci praćenja dostupni su podatci za 83 bolesnika (33%). U 6% bolesnika je rađena TLR, a nije bilo registriranih smrti niti akutnih infarkta miokarda. Angiografska kontrola nakon 6 mjeseci učinjena je u 55 bolesnika (22%). U 69% bolesnika nalaz je opisivan kao potpuno uredan, nesignifikantna stenoza opisana je u 20% bolesnika, a u 11% bolesnika je opisana stenoza u rasponu od >50% do potpune okluzije. Zaključak: Naše kliničko iskustvo u svakodnevoj kliničkoj praksi pokazuje da se DEB u Hrvatskoj koristi u najvećem slučaju u prihvaćenim indikacijama in-stent restenoze, ali i u velikom postotku i za indikacije za koje ne postoji jasni konsenzus u literaturi. Akutni angiografski rezultati i rani klinički ishodi su odlični, a uporaba DEB-a je izrazito sigurna., Introduction: Drug-eluting balloons (DEB) represent a new technological platform in the area of percutaneous coronary interventions. The only accepted indication for their use is the treatment of in-stent stenosis, with no clear consensus for all other indications. Aim: To evaluate the use of DEB in routine clinical practice in Croatia. Methods: Retrospective nonrandomized multicentric register of all treated patients in seven Croatian centers in the time frame from February 2011 to January 2014. The data were collected from available medical documents. There were no clinical or angiographic exclusion criteria, nor was there any written common protocol for indications or for for the clinical follow up of patients. Major adverse cardiac events (MACE) were monitored. MACE were defined as the combination of cardiac death, development of myocardial infarction (MI) on treated vessel, and/or target lesion revascularization (TLR) for all patients during the same hospitalization, following a 6-month clinical observation and through available angiographic data. Results: 248 patients were treated for 284 lesions. The most common indication was the in-stent restenosis present in 31.4% of the patients, for 21.4% of the patients DEB was implanted in vessels smaller than 2.75 mm, and other indications were: lesions larger than 2.8 mm, bifurcations, ostial lesion, chronic total occlusions (11.3%; 11.3%; 7.3%; 1.6% respectively). On 39 patients (15.6%) following the previous implantation of bare metal stents (BMS), postdilatation with DEB was conducted. MACE during hospitalization appeared in 1.6% of the patients: 1 death (0.4%), 3 acute thromboses (1.3%), 1 MI (0.4%). Following the 6 month long observation, data is available for 83 patients (33%). TLR was performed on 6% of the patients, and there were no registered deaths or acute myocardial infarctions. Angiographic follow-up was performed on 55 patients (22%) after 6 months. In 69% of the patients the findings were described as completely clean, insignificant stenosis was described for 20% of the patients, and for 11% of the patients a stenosis to the amount of >50% of full occlusion was described. Conclusion: Our clinical experience in everyday clinical practice shows that in Croatia DEB is mostly used in cases of accepted indications of in-stent re-stenosis, but also to a great percentage for indications for which no clear consensus exists in literature. Acute angiographic results and early clinical results are excellent, and the use of DEB is highly safe.

Objective of this study was to assess platelet response to clopidogrel and its association with certain single nucleotide polymorphisms (SNPs) of the P2RY12 gene. Several studies have shown that patients with poor in vitro response to clopidogrel have worse outcomes after coronary interventions. Pharmacological response to clopidogrel is mediated by the P2Y12 platelet receptor, therefore, SNPs of the P2RY12 gene may account for some of the observed variability in the cardiovascular risk. Fifty patients with stable coronary heart disease, undergoing percutaneous coronary intervention were included in this study. Response to clopidogrel was analysed using light transmitted aggregometry before, and 5 days after the initation of therapy. SNPs analysed: c.-15+742C > T, c.-180+2739T > C and c.18C > T. A higher proportion of non-responders to clopidogrel were noted in carriers of 18C > T[T/T] (p = 0.05), and lower prevalence in carriers of 742C > T[T/T] (p = 0.05). Participants with 742C > T[T/T] had significantly higher change in aggregation compared to other 742C > T variants ([C/C] = 20.5 +/- 21.9% ; [C/T] = 20.0 +/- 31.2% ; [T/T] = 48.6 +/- 21.3% ; p = 0.03). Those carrying 18C > T[T/T] had smaller change in aggregation (7.6 +/- 15.0%) compared to other variants, but the difference was not statistically significant (p = 0.15). Analysis of variance showed 18C > T[T/T] was a statistically significant predictor of poor response to antiaggregation therapy, independent from other clinical and demographic variables. There was no relation between poor response to clopidogrel and any other genetic variant. Our results suggest that 18C > T SNP of the P2RY12 gene may be an independent predictor of pharmacological response to clopidogrel. Larger prospective studies are needed to confirm this link and assess its possible clinical consequences.

A 73-year-old woman, diabetic, presented with effort angina of Canadian Cardiological Society (CCS) scale III for the last two months. Coronary angiogram revealed multiple significant stenosis of the left anterior descending artery (LAD) and the right coronary artery (RCA). After she was presented to heart team and refused surgical revascularization we proceeded with PCI. LAD was successfully treated with one drug eluting stent. After that we proceeded with RCA intervention. After first balloon inflation huge contrast extravasation (4x4cm) was noticed in projection of aortic wall. Patient was stable, procedure was temporary interrupted and because of suspicion on aortic dissection urgent echocardiography and CT scan of aorta was performed. Echocardiography did not show fluid accumulation in pericardium while CT scan excluded aortic dissection and showed perforation of ostial RCA with cranial intrapericardial contrast extravasation. After that procedure was continued with implantation of three DE stents in RCA. Final angiogram showed successful sealing of ruptured ostial RCA without any contrast leak. During the following days there was no evidence of fluid in the pericardium, also MSCT coronarography confirmed normal flow in RCA and LAD. After five days patient was safely discharged from hospital.

Svrha rada: Cilj je istraživanja istražiti izvedivost programa PCI u bolnici bez kardiokirurške potpore, i usporediti naše rezultate sa smjernicama i skupinom konzervativno liječenih bolesnika u razdoblju prije uvođenja primarne perkutane koronarne intervencije (pPCI). Metode: Podatci o svim bolesnicima s akutnim infarktom miokarda sa ST elevacijom (STEMI) liječenim pPCI prospektivno su bilježeni. Rezultati: Od početka programa pPCI od siječnja 2005. do listopada 2007. godine kada je u našoj ustanovi započeo s radom Odjel kardiokirurgije liječeno je 366 bolesnika. Unutarbolnička smrtnost iznosila je 6,3%, u usporedbi s 15% (87/583) u skupini konzervativno liječenih bolesnika u trogodišnjem razdoblju prije uvođenja pPCI. Prosječno vrijeme od početka boli do postavljanja balona iznosilo je 315 minuta, vrijeme od boli do prvoga medicinskog kontakta 102 minute, vrijeme od prvoga medicinskog kontakta do vrata bolnice 94 minute, vrijeme od vrata bolnice do laboratorija 84 minute, vrijeme od laboratorija do otvaranja krvne žile 45 minuta, a vrijeme od vrata do postavljanja balona 129 minuta. Zaključak: Analiza rezultata pokazuje da je uvođenje programa primarne PCI u bolnici bez kardiokirurške potpore u regiji sigurno i da pruža značajnu redukciju mortaliteta u bolesnika sa STEMI. U organizaciji službe za zbrinjavanje akutnog infarkta miokarda treba naglasiti agresivno rješavanje vremenskog zastoja u primjeni pPCI unutar bolnice., Objectives: The aim of our study was to investigate the feasibility of pPCI in hospital without cardiac surgery, and to compare our »real-world« results to current guidelines and historical controls. Methods: Data of all STEMI patients treated by PCI were prospectively recorded. Results: From January 2005 through October 2007, 366 consecutive patients with STEMI were enrolled. In-hospital mortality was 6.3%, as compared to 15% (87/543) in historical records of a three year period before pPCI program was developed. Pain to balloon time was 315 minutes, pain to first medical contact was 102 minutes, first medical contact to door was 94 minutes, door to cathlab time was 84 minutes, cathlab to balloon time was 45 minutes, and door to balloon time was 129 minutes. Conclusions: Our preliminary experience indicates that implementation of pPCI in a hospital without regional cardiac surgical back-up is feasible and offers significant mortality reduction in STEMI patients. Intrahospital time delays should be managed aggressively.

Working hours and off-hours-are there differences? In Acute Cardiac Care

The purpose of this study was (i) to answer whether the reduction in the spleen size in breath-hold apnea is an active contraction or a passive collapse secondary to reduced splenic arterial blood flow and (ii) to monitor the spleen response to repeated breath-hold apneas. Ten trained apnea divers, 10 intact and 7 splenectomized untrained persons repeated five maximal apneas (A1-A5) with face immersion in cold water, with two minutes interposed between successive attempts. Ultrasonic monitoring of the spleen and noninvasive cardiopulmonary measurements were performed before, between apneas and at times 0, 10, 20, 40, and 60 minutes after the last apnea. Blood flows in splenic artery and splenic vein were not significantly affected by breath-hold apnea. The duration of apneas peaked after A3 (143, 127, and 74 seconds in apnea divers, intact and splenectomized persons, respectively). A rapid decrease in spleen volume (about 20% in both apnea divers and intact persons) was mainly completed throughout the first apnea. The spleen did not recover in size between apneas and only partly recovered 60 minutes after A5. The well-known physiological responses to apnea diving: bradycardia and increased blood pressure were observed in A1 and remained unchanged throughout the following apneas. These results show rapid, probably active contraction of the spleen in response to breath-hold apnea in humans. Rapid spleen contraction and its slow recovery may contribute to prolongation of successive, briefly repeated apnea attempts.

Ekstrakorporalna membranska oksigenacija u lijecenju akutnog zatajivanja lijeve klijetke- prikaz slucaja