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Sex-related differences regarding cephalic vein lead access for CIEDs implantation
(Springer Science and Business Media LLC, 2021-11-17)
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Risteski, Dejan
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Janusevski, Filip
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Pocesta, Bekim
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Minimally invasive and safe central venous access is imperative for lead insertion of cardiac implantable electronic devices (CIEDs). The purpose of this trial was to explore and compare the usability of the cephalic vein (CV) between both sexes.</jats:p> </jats:sec><jats:sec> <jats:title>Methods and results</jats:title> <jats:p>This single-center prospective study included 102 consecutive patients in a period of six months. Pre-procedural contrast-enhanced venographic images of the upper arm were performed in all included patients. Our attention was focused on comparing several morpho-anatomical CV characteristics such as venous diameter, presence of valves and angle of entrance of the CV into the subclavian vein (SV). Study results concerning the CV morpho-anatomical differences were more favorable regarding the female patient group, with significant differences in CV diameter (<jats:italic>p</jats:italic>-0.030). There was also a difference in favor of the female group regarding the favorable CV angle of entrance into the SV, found in the 61.7% versus 54.4% in the male patient group. The comparison of usability of the CV and CVC technique was explored by comparing the number of leads inserted through the CV in both sexes. Two leads were implanted in 11.7% in the female group versus 5.8% in the male group, and 0 leads through the CV in 38.2% of the female patients versus 50% of male group.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Female patients have more favorable cephalic vein morpho-anatomical futures and better usability for lead placement than male patients.</jats:p> </jats:sec>
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SUBCLAVIAN CRUSH SYNDROME AND INAPPROPRIATE SHOCKS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILATOR
(Macedonian Association of Anatomists, 2022)
Misic, Irena
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Janusevski, Filip
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Risteski, Dejan
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The Impact of Glyco-Metabolic Status in Patients Treated for Acute Coronary Syndrome
(Macedonian Academy of Sciences and Arts/ Walter de Gruyter GmbH, 2018-07-01)
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Pocesta, Bekim
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Shehu, Enes
Objective: The aim of the study was to assess the prevalence of newly diagnosed diabetes in patients with acute coronary syndrome and estimate the relationship between stress hyperglycemia, glyco-regulation and newly diagnosed diabetes with hospital morbidity and mortality. Methods: This was an observational study which included all patients hospitalized due to acute coronary syndrome (January 2015 until April 2017) at the University Clinic of Cardiology in Skopje, Macedonia. We analyzed demographic, clinical, biochemical variables and hospital morbidity and mortality. Five investigated groups were compared using a single biochemical parameter glycated hemoglobin (HgbA1c) depending on the presence of known diabetes before the acute event: 0-without DM (HgbA1c <5.6%), 1-newly diagnosed pre-diabetes (HgbA1c 5.6-6.5%), 2-newly diagnosed diabetes (HgbA1c ≥ 6.5%), 3-known well controlled diabetes (HgbA1c <7%) and 4-known uncontrolled diabetes (HgbA1c ≥7%). Results: 860 patients were analyzed. Impaired glucose metabolism was confirmed in 35% of patients, 9% of which were with newly diagnosed diabetes. Stress hyperglycemia was reported in 27.3% (3.6% were without diabetes). The highest values of stress hyperglycemia were reported in newly diagnosed and known uncontrolled diabetes. In-hospital morbidity and mortality were 15% and 5% accordingly and the rate was highest in patients with newly diagnosed and known, but un-controlled diabetes. HgbA1c, stress hyperglycemia, and poor glycemic control have emerged as significant independent predictors of hospital morbidity and mortality in patients with acute coronary syndrome. Conclusion: High prevalence of newly diagnosed diabetes was observed in patients with acute coronary syndrome. Stress hyperglycemia and failure to achieve glycemic control are independent predictors of hospital morbidity and mortality.
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P1495ECG parameters as predictors of response to cardiac resynchronization therapy
(Oxford University Press (OUP), 2017-06)
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Taleski, Jane
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Boskov, Vladimir
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Risteski, D.
Aim: Cardiac resynchronization has proven benefit as treatment modality in patients with heart failure. Unfortunately, the use of current selection criteria is associated with a failure to respond of approximately 30% cases. The aim of our study is to define more ECG criteria which can predict response to cardiac resynchronization. Methods and results: A total of 82 patients were enrolled in our study, and were followed for a mean of 25.6 months. Mean QRS duration in our group was 174ms, and 75% were LBBB, no patients with RBBB, 25% with wide QRS but undetermined BB morphology. To define if the patient is responder we used scoring system defined as: increase in LVEF more than 10% (1 point), lowering of NYHA class (1 point), QRS narrowing (1 point), hospitalization for heart failure in the follow-up period (-1 point). As non –responders were defined all patient with a score 0 or -1 (8 patients), and responders were all patients with the score 1-3 (74 patients). In the responder group we found significantly wider QRS (p=0,04), higher R6/S6 ratio (p=0,02), higher (S1+R6)-(S6+R1) (p=0,02), and higher R amplitude in V6 (p<0,01). When we divided the group of patients according to BB morphology the significance in LBBB patients was kept in R6/S6 ratio (p=0,03), (S1+R6)-(S6+R1) (p=0,02) and R amplitude in V6 (p<0,01). In undetermined BB morphology – group of patients we found significantly higher R amplitude in V6 (p=0,01) and significantly higher S amplitude in V6 (p<0,01). Conclusion: We conclude that we could engage more ECG criteria to predict response to cardiac resynchronization therapy, even in the LBBB patients, but also in patients with wide QRS and undetermined BB morphology.
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Electrocardiographic Parameters as Predictors of Response to Cardiac Resynchronization Therapy
(ID Design 2012/DOOEL Skopje, 2018-02-15)
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Boskov, Vladimir
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Risteski, Dejan
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Janusevski, Filip
INTRODUCTION: Although strict selection criteria are used to select patients for cardiac resynchronisation therapy, up to 30% of patients do not have a positive clinical response. PATIENTS: A total of 102 consecutive patients who had biventricular pacemaker/defibrillator (CRT-P or CRT-D) implanted were enrolled in this prospective observational study. RESULTS: During the average follow-up period of 24.3 months 5 patients died and 17 (16.7%) patients were hospitalised with the symptoms of heart failure; 75 (73.5%) patients were responders based on the previously defined criteria. Responders in the group of LBBB patients kept the significant difference in a computed variable (S1 + R6) - (S6 + R1) and R6/S6 ratio. Responders in non-LBBB patients kept the significant difference only in the height of R waves in V6. The R6/S6 ratio tended to be higher, but it did not reach a statistical significance. CONCLUSION: None of the tested ECG parameters stands out as an independent predictor of response to cardiac resynchronisation therapy, but some of them were different in responder-compared to the non-responder group. The amplitude of R wave in V6, higher R/S ratio in V6 and higher computed variable (S1 + R6) - (S6 + R1) may predict the likelihood of response to CRT therapy in both LBBB-patients and non-LBBB patients.

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