Post-infarct left ventricular remodeling (LVR) process increases the risk of heart failure (HF). Circulating galectin-3 has been associated with fibrosis, inflammation and cardiac dysfunction during ...the remodeling process after myocardial infarction (MI). The aims of this prospective case study were to investigate the association of potentially functional variants in the vicinity of
LGALS-3
locus, rs2274273 and rs17128183 with maladaptive LVR and whether these variants could affect
LGALS-3
mRNA expression in peripheral blood mononuclear cells of patients 6 months after the first MI. This study encompassed 167 patients with acute MI that were followed up for 6 months. Evidence of LVR was obtained by repeated 2D Doppler echocardiography. Rs2274273, rs17128183 and
LGALS-3
mRNA expression were detected by TaqMan
®
technology. Rs2274273 and rs17128183 rare allele bearing genotypes, according to the dominant model (CT+TT vs. CC and AG+GG vs. AA, respectively), were significantly and independently associated with maladaptive LVR (adjusted OR = 3.02,
P
= 0.016; adjusted OR = 3.14,
P
= 0.019, respectively) and higher
LGALS-3
mRNA expression (fold induction 1.203, P = 0.03 and 1.214, P = 0.03, respectively). Our exploratory results suggest that rs2274273 and rs17128183 variants affect
LGALS-3
mRNA and bear the risk for maladaptive LVR post-MI remodeling. Further replication and validation in a larger group of patients is inevitable.
This review emphasizes the importance of cardiopulmonary exercise testing (CPET) in patients diagnosed with hypertrophic cardiomyopathy (HCM). In contrast to standard exercise testing and stress ...echoes, which are limited due to the ECG changes and wall motion abnormalities that characterize this condition, CPET allows for the assessment of the complex pathophysiology and severity of the disease, its mechanisms of functional limitation, and its risk stratification. It is useful tool to evaluate the risk for sudden cardiac death and select patients for cardiac resynchronization therapy (CRT), cardiac transplantation, or mechanical circulatory support, especially when symptomatology and functional status are uncertain. It may help in differentiating HCM from other forms of cardiac hypertrophy, such as athletes' heart. Finally, it is used to guide and monitor therapy as well as for exercise prescription. It may be considered every 2 years in clinically stable patients or every year in patients with worsening symptoms. Although performed only in specialized centers, CPET combined with echocardiography (i.e., CPET imaging) and invasive CPET are more informative and provide a better assessment of cardiac functional status, left ventricular outflow tract obstruction, and diastolic dysfunction during exercise in patients with HCM.
The paper focuses on the question of how the application of a multilevel, integrated, and territorial approach can contribute to the protection of cultural heritage through planning instruments in ...Serbia. The principles of territorialization, integration and digitalization highlighted in the recent strategic documents of the Republic of Serbia are related to international recommendations and theoretical concepts and analyzed with regards to the possibilities of their implementation in planning methodology. The case study is the spatial plan for the Djerdap National Park, a special purpose area with already recognized international and national importance. The research suggests that the encompassed cultural heritage, except the Roman limes, is still recognized at the level of individual entities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The international and national significance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the integration of local values and local communities into development programs and projects.
Aims
This study aimed to investigate whether the risk of short‐term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as ...compared with those with heart failure with preserved ejection fraction (HFpEF).
Methods and results
Predictive value of HFrEF or HFpEF for 7‐day (intrahospital) and 30‐day all‐cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline‐proposed criteria. A 7‐day (intrahospital) and 30‐day all‐cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7‐day mortality (hazard ratio 2.22, 95% confidence interval 1.25‐4,38.41, P = 0.021) and neither HFrEF or HFpEF was an independent predictor for 30‐day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P = 0.01), and right ventricle systolic pressure (P = 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days.
Conclusions
Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.
Introduction
Recent studies report that syncope is not a significant predictor of 30‐day mortality in pulmonary embolism (PE) patients, yet some data suggest sex‐related differences may be relevant.
...Objectives
To evaluate sex‐specific prediction significance of syncope for 30‐day mortality in PE patients.
Methods
A multicentric, retrospective, observational, registry‐based study on consecutive PE patients was undertaken. Patients were allocated into either a men or a women group before comparisons were made between patients with syncope and those without syncope. A sex‐related prediction of the significance of syncope for 30‐day mortality was evaluated.
Results
Overall 588 patients 294 (50%) men and 294 (50%) women were included within the study. Among men, patients with syncope were older and had significantly higher parameters of increased 30‐day mortality then patients without syncope. Within the same group, however, difference in the 30‐day mortality rate was not significant (log rank P = .942). In contrast to the men, fewer differences in admission characteristics were noticed among women, but those with syncope had significantly increased signs of the right ventricular dysfunction and increased 30‐day mortality rate, as compared with those without syncope (log rank P = .025). After adjustment for age in a Cox regression analysis, syncope was a significant predictor of 30‐day mortality in women (HR = 2.01, 95%CI 1.02‐3.95).
Conclusion
Although syncope is associated with other predictors of higher early mortality in both male and female PE patients, only in women it is a significant predictor of 30‐day mortality.
Background/Aim. The evaluation of blood levels of cardiac troponin I (cTnI), D-dimer, B-type natriuretic peptide (BNP), and C-reactive protein (CRP) on admission and during the treatment of pulmonary ...embolism (PE) are the part of routine diagnostic process and estimation of mortality risk. The aim of this study was to evaluate the predictive value of these biomarkers on admission for all-cause 30-day mortality in consecutive PE patients regarding whether they classified as spontaneous, transiently provoked, or permanently provoked PE. Methods. This retrospective analysis was gained from the data of 590 PE patients from the Serbian University Multicenter Pulmonary Embolism Registry (SUPER). Patients had at least one of these biomarkers (BNP, CRP, cTnI, and D-dimer) measured during the first 24 hours upon admission. Results. Receiver operating characteristic (ROC) curve analyses demonstrated that BNP had the highest prognostic accuracy for 30-day mortality in patients (n = 219) who had data for all examined biomarkers. BNP provided an AUC of 0.785 (p < 0.001). Separately, BNP had the highest c-statistic for all three groups of patients. CRP had a modest predictive value for the 30-day all-cause mortality in the group with transient provoked PE. Troponin I had a very modest predictive value for the 30-day all-cause mortality only in patients with spontaneous PE, and D-dimer was a very weak predictor of this end-point only in patients with persistent provoked PE. Conclusion. Patients with spontaneous, transient provoked, and persistent provoked PE have a significantly different pro-file of blood biomarkers level with different prognostic significance for early all-cause mortality.
Although procalcitonin (PCT) was evaluated for the first time in the setting of heart failure (HF) in 1999, its utility in HF patients is still under examination. Patients with HF have significantly ...higher plasma PCT concentrations than healthy subjects and PCT levels are associated with severity of HF. It has been confirmed that higher levels of PCT are associated with worse outcomes, such as increased mortality and higher rate of rehospitalization, in HF patients with no evidence of infection. Furthermore, it has been approved that PCT-guided antibiotic treatment in HF patients reduces duration of antibiotic therapy and improves outcomes. This review summarizes current evidence from the published literature of the usefulness and limitations of PCT as a biomarker in HF.
Introduction. The COVID-19 pandemic caused by the SARS-CoV-2 virus has led to significant public health problems, severe complications, and functional impairment in persons who have recovered from ...this disease. Case report. A 60-years-old male deconditioned patient was transferred from Corona 4 Center to the Center for Physical Medicine and Rehabilitation of the University Clinical Center in Kragujevac for a post-COVID rehabilitation due to pronounced muscle weakness and inability to walk. After functional testing, an individual rehabilitation plan was created and a kinesitherapy program was adjusted daily based on the patient's respiratory status. After the kinesitherapy program, Respivol was used-a volumetric medical device for breathing exercises in patients with respiratory difficulties. At the time of admission, the patient could not move independently, could not move from the lying to the sitting position on his own, and could not maintain balance in the sitting position. Hypotrophy caused by prolonged inactivity of the muscles of the whole body dominated the clinical picture. A six-week rehabilitation treatment performed on the patient showed a significant improvement in functionality (FIM test), muscle strength (manual muscle test), daily life activity (Barthel index), as well as a reduction of anxiety (GAD-7 scale). Conclusion. The goal of the rehabilitation program is to restore the patient's state of functionality before the initiation of COVID-19 treatment, so that they can perform their regular professional activities and achieve complete independence in performing activities of daily living (ADL).
Introduction. Brain detrimental effects are under-recognised complication of chronic heart failure (CHF). One of the major causes may be cerebral hypoperfusion. This study was designed to investigate ...the relationship between cerebral blood flow (CBF) and severity of CHF as well as to evaluate its determinants among different parameters of cardiac dysfunction.
Methods. Seventy-one CHF males with NYHA class II and III and 20 control subjects age ≥ 55 years were recruited. CBF was evaluated by colour duplex sonography of extracranial arteries. Echocardiography, 6-min walk test, quality of life and endothelial function were also assessed. Serum NT-pro-BNP and adipokines levels (adiponectin and leptin) were measured.
Results. CBF was significantly reduced in elderly patients with CHF compared to healthy controls (677 ± 170 vs 783 ± 128 ml/min, p = 0.011). Reduced CBF was associated with reduced left ventricular ejection fraction (LVEF) (r = 0.271, p = 0.022), lower 6-min walk distance (r = 0.339, p = 0.004), deteriorated quality of life (r = −0.327, p = 0.005), increased serum adiponectin (r = −0.359, p = 0.002), and NT-pro-BNP levels (r = −0.375, p = 0.001). In multivariate regression analysis, LVEF and adiponectin were independently associated with reduced CBF in CHF patients (R2 = 0.289).
Conclusion. CBF was reduced in elderly males with mild-to-moderate CHF, and was associated with factors that represent the severity of CHF including high serum adiponectin and NT-pro-BNP levels, decreased LVEF, impaired physical performance, and deteriorated quality of life.
Abstract Introduction In patients with recent myocardial infarction (MI) limited exercise capacity during physical activity is an important symptom and the base for future treatment. The myocardial ...injury after MI leads to both systolic and diastolic left ventricular (LV) dysfunction. Objective The aim of this study was to assess the relevance of systolic and diastolic LV function for cardiopulmonary exercise capacity in patients with prior MI. Methods Sixty-five consecutive patients after first MI without signs and symptoms of heart failure, aged 52 ± 6 years, were included in the study. The following echo parameters were evaluated: LV ejection fraction (LVEF), peak early and late diastolic velocities (E, A), deceleration time of E wave (dec t E), ratio of early trans-mitral to early annular diastolic velocities (E/e′), velocity propagation of early filling (Vp), and diameters and volumes of LV and left atrium (LA). CPET variables included: oxygen uptake at peak exercise (peak VO2 ), oxygen pulse (VO2 HR), VE/VCO2 slope, circulatory power (CP) and recovery half time (T1/2). Results Significant correlations were demonstrated between peak VO2 and E/e’ ( p < 0.001), peak VO2 and dec t E ( p < 0.001), VO2 HR and E/e′ ( p = 0.002) and between VE/VCO2 and E/e′ ( p < 0.001). Twenty patients with elevated LV filling pressure achieved significantly lower peak VO2 (1624 vs. 1932 ml, p = 0.027) VO2 HR (11.70 vs. 14.05, p = 0.011) and CP (287,073 vs. 361,719, p = 0.014). By using multivariate regression model we found that only E/e′ ( p = 0.001) and dec t E ( p = 0.008) significantly contributed to peak VO2. Conclusions Diastolic dysfunction, particularly LV filling pressure, determine exercise capacity, despite differences in LV ejection fraction in patients with prior MI.