The discovery and development of new biomarkers continues to be a promising field. Since cardiovascular disease remains the principal cause of death in the developed countries, this is the area in ...which novel biomarkers have been most extensively evaluated. Arginine vasopressin (AVP or antidiuretic hormone) is one of the key hormones in the human body involved in cardiovascular homeostasis. It has so far escaped introduction into the routine clinical laboratory due to technical difficulties and pre-analytical errors. Copeptin, the C-terminal part of the AVP precursor peptide, was found to be a stable and sensitive surrogate marker for AVP release. During the past years, copeptin measurement has been shown to be of interest in a variety of clinical indications, including cardiovascular diseases such as heart failure, myocardial infarction, and stroke. This review summarizes the recent progress in the diagnostic use of plasma copeptin in cardiovascular diseases.
Otkriće i razvoj novih biomarkera je područje koje u poslednje dve decenije beleži značajan napredak i zauzima važno mesto na polju kliničke medicine. Kako kardiovaskularne bolesti i dalje predstavljaju glavni uzrok morbiditeta i mortaliteta u razvijenim zemljama, upravo je na tom polju evaluacija novih biomarkera najopsežnija. Arginin-vazopresin (AVP ili antidiuretski hormon) jedan je od ključnih hormona uključenih u održavanje homeostaze u kardiovaskularnom sistemu. Do danas je njegovo određivanje u rutinskoj laboratorijskoj dijagnostici ostalo problematično usled tehničkih poteškoća, ali i brojnih preanalitičkih grešaka. Kopeptin, C-terminalni deo prekursora AVP, stabilan je i osetljiv surogat marker otpuštanja AVP-a. Poslednjih godina, određivanje koncentracije kopeptina dalo je značajan doprinos u dijagnostici i prognozi različitih oboljenja, uključujući i kardiovaskularne bolesti, kao što su srčana slabost, infarkt miokarda i moždani udar. Ovaj pregledni članak prikazuje dosadašnji napredak u dijagnostici i prognozi kardiovaskularnih bolesti zahvaljujući određivanju koncentracije kopeptina kao novog biomarkera.
In patients undergoing coronary artery bypass grafting (CABG) surgery, post-operative atrial fibrillation (AF) occurs with a prevalence of up to 40%. The highest incidence is seen between the second ...and third day after the operation. Following cardiac surgery AF may cause various complications such as hemodynamic instability, heart attack and cerebral or other thromboembolisms. AF increases morbidity, duration and expense of medical treatments. This study aims at identifying patients at high risk of post-operative AF. Early prediction of AF would provide timely prophylactic treatment and would reduce the incidence of arrhythmia. Patients at low risk of post-operative AF could be excluded on the basis of the contraindications of anti-arrhythmic drugs. The study included 50 patients in whom lead II electrocardiograms were continuously recorded for 48 h following CABG. Univariate statistical analysis was used in the search for signal features that could predict AF. The most promising ones identified were P wave duration, RR interval duration and PQ segment level. On the basis of these, a nonlinear multivariate prediction model was made by deploying a classification tree. The prediction accuracy was found to increase over time. At 48 h following CABG, the measured best smoothed sensitivity was 84.8% and the specificity 85.4%. The positive and negative predictive values were 72.7% and 92.8%, respectively, and the overall accuracy was 85.3%. With regard to the prediction accuracy, the risk assessment and prediction of post-operative AF is optimal in the period between 24 and 48 h following CABG.
Cardiac fibromas are exceedingly rare neoplasms. We report the case of a 21-year-old woman who presented with symptoms that were initially misinterpreted as an acute coronary syndrome. Radical ...surgical resection was undertaken and was considered curative, as the mass histology was consistent with a benign fibroma.
In patients undergoing Coronary Artery Bypass Grafting (CABG) surgery postoperative atrial fibrillation (AF) occurs with prevalence of up to 40%. The highest incidence is between the second and third ...day after the operation. Following cardiac surgery AF causes various complications, hemodynamic instability, and can cause heart attack, cerebral and other thromboemolisms. AF increases morbidity, duration and expense of medical treatment. This study aims to identify patients at high risk of postoperative AF. An early prediction of AF would provide a timely prophylactic treatment and would reduce incidence of arrhythmia. Patients at low risk of postoperative AF could be excluded from the side effects of anti-arrhythmic drugs. The investigation included 50 patients in whom lead II electrocardiograms were continuously recorded for 48 hours following CABG. Univariate statistical analysis was used in the search of signal features that might predict AF. The most promising identified features were: P wave duration, RR interval duration and PQ segment level. On the basis of these a nonlinear multivariate prediction model was made deploying a Support Vector Machine (SVM) classifier. The prediction accuracy was found uprising over the time. At 48 hours following CABG; the measured best average sensitivity was 95.9% and specificity 93.4%. The positive and negative predictive accuracy were 88.9% and 98.8%, respectively and the overall accuracy was 94.6%. In regard to the prediction accuracy, the risk assessment and prediction of postoperative AF are optimal to be done in the period between 24 and 48 hours following CABG.
Interrupted aortic arch (IAA) is a congenital defect characterized by loss of luminal continuity between the ascending and descending aorta1. It is a rare malformation with an estimated incidence of ...perinatally diagnosed cases of 3 per million live births3. The condition is considered extremely rare in adults. However, its true prevalence in this population is unknown. We have found 30 case reports of IAA in adults in literature, 5 of whom were older than 50 years. Four of them had type A IAA. Arterial hypertension is a typical co-morbidity. In this report we describe a 60-year-old male patient who had a type A asymptomatic IAA. Although we initially suspected the aortic coarctation, further invasive procedures revealed complete interruption of the aortic arch just distal to the origin of the left subclavian artery. The patient underwent surgical repair, followed by full recovery and near-normalization of blood pressure.
The best option for the treatment of a failing heart is heart transplantation. The transplantation program at the University Hospital Center Rebro Zagreb started in 1988. To the best of our knowledge ...this is the first retrospective study on cardiac transplantation in Croatia looking into survival following heart transplantation. Between 1988 and 2006, we performed 81 heart transplantations at the University Hospital Center Rebro Zagreb. Our study focused on the last ten years after establishment of the Department of cardiac surgery as a separate institution. There were thirteen different hospitals throughout Croatia, which contributed to the donor network. Average age of the heart recipient was 48+/-11.8 years (range 14-72), and average age of the heart donor was 34+/-10.7 years (range 14-56). There were more women among the heart donors (34%) then among the heart recipients (18%). During the first ten years, from 1988-1998, the average number of cardiac transplantations was 3 per year In the period from 1998-2006, average number of cardiac transplantations increased to 6 per year. The average thirty-day mortality for the last nine years was 27%. It declined from 30% and 40% in 1998 and 1999, respectively down to 0% in the last two years. Average age of the patients who died was 50+/-6.5years (range 44-62) and did not significantly differ from those who survived. The donor network has grown up to fourteen different hospitals throughout Croatia. The limiting factor in cardiac transplant surgery is the number of available donors. Therefore in attempt to form a good transplant program it is crucial to form an efficient donor network. The number of performed cardiac transplantations is expected to rise until it reaches the number of available donors. With advances in operative technique and postoperative management--immunosuppressive therapy we have observed a remarkable drop in the early operative mortality in the studied period.
Postoperacijska fibrilacija atrija (AF) pojavljuje se u oko 40% pacijenata podvrgnutih operaciji aortokoronarnog premoštenja (CABG), s najvećom učestalosti pojavljivanja oko trećeg dana nakon ...operacije. Postoperacijska AF može stvoriti brojne komplikacije poput hemodinamske nestabilnosti, srčanog udara, cerebralnih i drugih tromboembolija; povećava morbiditet, trajanje i troškove liječenja. S tudija ima za cilj rano otkrivanje pacijenta sa visokim rizikom razvoja postoperacijske AF, što bi osiguralo pravovremenu profilaktičku terapiju i smanjilo učestalost aritmije, dok bi pacijenti sa niskim rizikom razvoja postoperacijske AF bili pošteđeni nuspojava antiaritmičkih lijekova. Podatkovni skup uključuje 50 pacijenata, snimanih II standardnim odvodom elektrokardiografa, kontinuirano u razdoblju od 48 sati nakon operacije. Univarijatna statistička analiza korištena je za određivanje parametara signala koji bi mogli predvidjeti AF, te su kao najznačajniji određeni: trajanje P vala, trajanje RR intervala i razina PQ spojnice; na temelju kojih je izveden nelinearni multivarijatni predikcijski model zasnovan na SVM klasifikatoru. Ukupna predikcijska točnost modela povećava se s vremenom. U 48 . satu nakon operacije najbolje prosječne značajke iznosile su: osjetljivost 95 , 9%, specifičnost 93, 4% , pozitivna prediktivnost 88, 9% , negativna prediktivnost 98 , 8% te ukupna
točnost 94, 6% . Prema rezultatima predikcijske točnosti, procjenu rizika i predikciju postoperacijske AF optimalno bilo bi načiniti u periodu između 24-tog i 48-og sata nakon operacije ugradnje aortokoronarnih premosnica.
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