Faculty of Medicine
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Item type:Publication, THE ROLE OF SHOCKWAVE INTRAVASCULAR LITHOTRIPSY IN THE TREATMENT OF HEAVILY CALCIFIED CORONARY ARTERY LESIONS: OUR FIRST EXPERIENCE(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2025-12-17); ; Introduction: Coronary artery disease (CAD) is typically a chronic, progressive, inflammatory disease of the coronary arteries caused by coronary atherosclerosis. Moderate-to-severe calcification is present in up to 30% of patients undergoing coronary angiography (CA). Calcified coronary artery lesions are one of the most complex and challenging lesion subsets in interventional cardiology. Shockwave intravascular lithotripsy (IVL) is a recently introduced calcium-modifying technique for the treatment of concentric, eccentric and nodular calcifications. Case presentation: We present a clinical case of a 73-year-old male complaining of intermittent chest pain. He was a non-smoker with a positive familiar history for CVD. He had previous myocardial infarction and stenting of the right coronary artery (RCA), previous CVI, paroxysmal atrial fibrillation, insulin-dependent type 2 diabetes, heart failure with mildly reduced ejection fraction (HFmrEF) and chronic kidney disease (CKD) stage II/IIIa. CA revealed heavily calcified CAD. A calcified lesion of the left anterior descending artery (LAD) was treated using a 3.0/12 mm Shockwave IVL balloon; and calcium cracks and fractures were confirmed by optical coherence tomography (OCT). We proceeded with an NC balloon and finally treated the lesion with a 3.5/15 mm drug-coated balloon (DCB). The calcified lesion of the RCA was treated with conventional techniques using guiding catheter extension, NC balloons and drug-eluting stent (DES). Conclusion: Heavily calcified coronary artery lesions remain one of the biggest challenges for interventional cardiologists. Shockwave IVL is designed for treatment of all types of heavily calcified lesions using acoustic waves (shock waves). IVL is safe and effective technique that will definitely strengthen the armamentarium for modern treatment of heavily calcified lesions. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, PON1 (Paraoxonase 1) Q192R Gene Polymorphism in North Macedonian Population with Confirmed Coronary Artery Disease(Walter de Gruyter GmbH, 2025-12-01); ; Aim This study aims to examine the association between the prevalence of Q192R polymorphism of PON1 gene and the occurrence of atherosclerosis and coronary artery disease in patients in Republic of North Macedonia. Method This cross-sectional study includes subjects undergoing percutaneous coronary angiography with or without stenting due to monitoring of stable angina or induced ischemia, divided into two groups. Q192R polymorphism and its genotypic variants were analysed. The Polymerase Chain Reaction technique was used as a method for determining the single nucleotide polymorphism. Results A total of 165 subjects (106 belonging to the coronary artery disease (CAD) group and 59 to non-CAD group were evaluated in terms of their biochemical parameters and genetic variants. Results of the PON1 SNP Q192R groups (QQ, QR and RR) association related to CAD and non-CAD groups, resulted in a non-significant association (p=0.0632, OR=0.511, CI: 0.25–0.595, χ 2=3.4508, df=1). In further analyses, to obtain a more precise association, we analysed the association between SNP Q192R groups and stenting patients (control vs. stenting group). Further analysis confirmed the association of QQ vs. QR and control vs. stenting (p=0.0418, OR=0.461, CI: 0.216–0.589, χ2=4.1432, df=1). Conclusion Results support the concept that genetic variants may contribute to an increased risk of CAD, emphasizing the importance of combined biochemical and genetic testing for better stratification of cardiovascular risk and early confirmation of the predisposition to develop serious cardiovascular disease. Further studies with a larger sample size are needed before Q192R gene polymorphism can be considered as a genetic risk factor for CAD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Myocardial Function after Coronary Artery Bypass Grafting in Patients with Preoperative Preserved Left Ventricular Ejection Fraction-The Role of the Left Ventricular Longitudinal Strain(MDPI AG, 2023-05-12); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ROLE OF LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2) IN THE PREDICTION AND ASSESSMENT OF THE SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS(Society of Medical Biochemists of Serbia, Belgrade, 2025-05); ; ; Background: Lipoprotein-associated phospholipase A2 (LpPLA2) is a specific biomarker associated with an increased risk of coronary artery disease (CAD) development. This study aims to determine the relationship between Lp-PLA2 activity and the risk of development and severity of CAD in patients with type 2 Diabetes mellitus (T2DM). Methods: The cross-sectional study included 148 patients with T2DM, divided into two groups: patients with T2DM without confirmed CAD (n=56) and patients with T2DM and confirmed CAD (n=92), further divided into three subgroups based on the stage of CAD, and a control group of healthy individuals (n=44). Venous blood samples were collected from all participants to measure glucose, cholesterol, triglycerides, HDL, LDL, C-reactive protein, urea, and creatinine levels using standard photometric methods. LpPLA2 activity was measured using a chemiluminescent immunoassay method.Results: Patients with T2DM and confirmed CAD had significantly higher Lp-PLA2 levels than those without confirmed CAD and healthy individuals. A significant difference in LpPLA2 levels was found between the group without CAD, the patients with CAD divided into subgroups according to disease stage, and the healthy control group. A positive correlation was observed between Lp-PLA2 and BMI, glycated haemoglobin, total cholesterol, and HDL cholesterol. The optimal cutoff value for Lp-PLA2<250 ng/mL yielded a diagnostic sensitivity of 95.65% and specificity of 88.64% for patients with T2DM and diagnosed CAD. Conclusions: Lp-PLA2 can be used as a predictor for developing and assessing the severity of CAD in patients with T2DM. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial(Wiley, 2024-03-05) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Relationship Between Severity of Ischemia and Coronary Artery Disease for Different Stress Test Modalities in the ISCHEMIA Trial(Lippincott Williams & Wilkins for the American Heart Association, 2024-12) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Carotid intima media thickness is in a relation to risk factors for coronary artery disease(Geotar-Media Publishing Group, 2020-01); ; Introduction: Carotid intima-media thickness (CIMT) is a double line pattern measured from the lumen-intima to media-adventitia interface. Measuring CIMT with B-mode ultrasound can detect early arterial wall changes. We aimed to measure CIMT in manifested atherosclerotic disease and find a relation to present risk factors. Material and methods: This cross sectional study included a population of 657 patients, with documented coronary artery disease (CAD), 66,1% were men (469 pts), 33,9% were women (241 pts). The mean age of patients was 64,72 years (55,6-73,8). The measurement of CIMT (maximal and mean) was performed with B-mode ultrasound, on longitudinal view, on multiple plaque-free segments at the level of common carotid artery, on the far wall, on both sides. Multivariate regression analysis was done to estimate independent factors for CIMT, when risk factors, age, and sex included in analysis. Results: The mean value of maximal CIMT was 0,96 mm (0,52-1,4), mean value of mean CIMT was 0,88 mm (range 0,61-1,15) and mean systolic blood pressure of 133,21 mm Hg (108,03-158,39) was found. Increased CIMT was found in 75,7% of patients (502 pts). Smoking was found as an independent risk factor for increased CIMT with odds ratio (OR) 4,7 (95% CI; 0,67-5,32) and diabetes mellitus with OR 1,6 (95% CI; 0,47-2,16). Conclusion: Diabetes and smoking are independently related to increased CIMT. These are preliminary results of National survey on 657 pts with coronary artery disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association of PvuII polymorphism in the lipoprotein lipase gene with the coronary artery disease in Macedonian population(Macedonian Academy of Sciences and Arts, 2008); ; Sadikario, SamuelIn the etiology of coronary artery disease there are many factors involved as a result of the complex interaction between genetic predisposition and environmental influences. The lipoprotein lipase (LPL) plays a very important role in lipid metabolism. It hydrolyzes the triglycerides in hylomicrones and very low density lipoproteins - VLDL. PvuII polymorphism in the LPL gene is a frequent variant and it increases triglyceride levels and the risk of the appearance of coronary arterial disease. Aim: The aim of this work is to show LPL-PvuII polymorphism as an independent risk factor and also as a predictor of coronary arterial disease in the Macedonian population. Material and methods: The study included 109 randomized patients with coronary artery disease (CAD) (83 males, 26 females), treated at the Cardiology Clinic. The stenosis of coronary arteries greater than 70% of the artery lumen was angiographically documented in the CAD group. The control group consisted of 32 patients (25 males, 7 females) with documented normal coronarographic findings. The patients' age ranged from 50 to 59; the mean age in the CAD group was 59.4 and the mean age in the control group was 57.9. LPL-PvuII polymorphism in the intron 6 in the CAD and control group was detected by PCR amplification and restriction enzyme digestion. Results: A statistically significant association between CAD and the control group was found regarding the presence of hyperlipidaemia (p < 0.001), diabetes (p < 0.05) and the use of antilipidaemic drugs (p < 0.049). The presence of LPL-PvuII polymorphism in both investigated groups does not represent a statistically significant risk factor for the appearance of coronary artery disease (p = 0.816). The PvuII + allele frequency of 0.495 and 0,469 was obtained in both the angiographically confirmed CAD and the control groups, respectively. This finding indicates no significant differences between the prevalence of the LPL-PvuII genotypes in both study groups, suggesting a lack of association of LPL-PvuII polymorphism with CAD. However, the homozygous genotype (PvuII +/+) was more prevalent in the CAD group (22.9%) in comparison with the control group (15.6%). Conclusion: In our study LPL-PvuII polymorphism was not identified as an independent risk factor for the appearance of CAD. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, ASSOCIATION OF LPL-HINDIII POLYMORPHISM WITH CORONARY ARTERY DISEASE IN MACEDONIAN POPULATION(Association of medical doctors „Sanamed” Novi Pazar, 2013)Objective: Coronary artery disease (CAD) is a leading cause of high mortality and morbidity in worldwide. The HindIII polymorphism of the LPL gene (LPL-HindIII) is a common variant and has been associated with plasma lipid and lipoprotein variability in population studies. Aim: Evaluation of the LPL-HindIII polymorphism as an independent risk factor for coronary artery disease in Macedonian population. Material and Methods: Apolymerasechainreaction amplification and consecutive restriction enzyme digestion was used to reveal lipoprotein lipase, the intron 8 LPL-HindIII polymorphism. Study group included 114 randomized subjects with angiographically documented coronary artery stenosis (CAD group: 87 males, 27 females). Control group consisted of 35 patients (21 males and 14 females) without significant stenosis in coronary arteries. Results: Independent multiple regression analysis of LDLplasma level and their correlation with LPL-HindIII polymorphism and analyzed risk factors: hypertension, diabetes, family history of CAD, physical activity, antilipidemic drugs and alcohol consumption, LDL, show statistically significant correlation with BMI, and also between LPL-HindIII and LDLplasma level. In the examined group, only triglycerides reached a statistically significant association with the LPL-HindIII polymorphism. Conclusion: In our study, the LPL-HindIII polymorphismwasnotidentified as independent risk factor for CAD, but showed association with high triglycerides and LDLlevels. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, FREQUENCY OF GENETIC VARIANTS ASSOCIATED WITH CORONARY ARTERY DISEASE AND VENOUS THROMBOEMBOLISM IN YOUNG PATIENTS IN REPUBLIC OF N. MACEDONIA(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022); ; ; ;
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