Faculty of Medicine
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Item type:Publication, Epidemiology and impact of frailty in patients with atrial fibrillation in Europe(Oxford University Press (OUP), 2022-08) ;Proietti, Marco ;Romiti, Giulio Francesco ;Vitolo, Marco ;Harrison, Stephanie LLane, Deirdre ABackground: Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. Methods A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. Results Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55–0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. Conclusions In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Ново дијагостицирана атријална фибрилација кај пациентка со активен карцином на дојка: тераписки предизвик - приказ на случај(2023-10)Breast cancer is the most common malignant disease in females. The specific cancer treatment protocol involves drugs with known cardiovascular toxicity. Patients with significant risk of cancer therapy-related cardiovascular toxicity (CRT-CVT) should be reported for cardiology referral. CASE REPORT: Seventy-year-old, obese patient with a previous history of hypertension and low normal left ventricular ejection fraction (LVEF) was diagnosed with breast cancer and scheduled for baseline assessment before initiating cardiotoxic cancer treatment protocol. Regular monitoring for an already high-risk patient for CRT-CVT was not enough for developing of first diagnosed, paroxysmal, asymptomatic atrial fibrilation after completing the 4 th cycle of anthracyclines and total cumulative dose of 208.3mg/m2. Transthoracic echocardiography did not reveal significant changes in LVEF and global longitudinal strain, so cancer therapy-related cardiac dysfunction was not the related diagnosis. Laboratory measurements of cardiac biomarkers did not confirm subclinical cardiac injury. Besides ACEinhibitors already prescribed for hypertension, drugs for rate control and anticoagulation therapy with both low-molecular-weight heparin and NOAC was the preferred therapeutic decision for successful completion of the oncological treatment. After a week, the electrocardiogram showed sinus rhythm. The patient also completed left-sided radiotherapy with total tumor dose of 41,25Gy, and six months after has stabile cardiac performances and normal sinus rhythm. CONCLUSION: CRT-CVT is the second leading cause of death in breast cancer patients. Management of the adverse effects is challenging and complex due to the imperative of completing the cancer therapy and frequent drug-drug interactions. Early detection, multidisciplinary approach and close monitoring are the cornerstone for overall good outcome in these patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SARS-COV-2 INFECTION: CARDIAL AND MULTI-ORGAN INVOLVEMENT(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R.N. Macedonia, 2022-12) ;Furnadziski, Aleksandar ;Mitevski, Goran ;Nikolovski, Robert; SARS-COV-2 is a single-strain RNA virus that attacks primarily the respiratory system. The second most commonly affected system is the cardiovascular. Often it attacks multiple organ systems causing multi-organ failure. Atrial fibrillation (AF) is the most common sustained supraventricular arrhythmia in acute settings of COVID-19 infection and is associated to more complications and mortality rates. The presence of AF in patients with COVID-19 pneumonia should be managed with increased attention to prevent adverse outcomes. COVID-19 may be a cause of multiple organ damage in some infected patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Atrial fibrillation and risk for ischemic stroke(League against epilepsy of Macedonia, 2017) ;Mitrevska Velkov, Jasmina; ;Babunovska, Marija; Cheperganova Changovska, TatjanaAbstract Objective: To investigate the frequency of atrial fibrillation in patients who develope acute ischemic stroke, associated risk factors and their outcome. Material and methods: A retrospective study was conducted at the University Clinic of Neurology Clinic, Department for Urgent Neurology.We analyzed medical records of acute ischemic stroke patients hospitalized between April 2014 and April 2016. Statistical analysis was performed with the programme Statistica for Windows 12. Results: Of the 1102 patients in the study,219 (19.8%) had atrial fibrillation. Of them, 109 (49,8%) were males and 110 (50,2%) were females. The mean age of those patients was 65±14 years compared to 60±16 years for the rest. Patients with AF had higher modified Rankin Scale(mRS) score on admission and at discharge from the hospital and had lethal outcome in higher percentage, compared to the rest (p<0.05). Conclusion: AF significantly increases the risk of stroke and affects its prognosis and outcome. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Generation X- Challenges in anticoagulation(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2022-12); ; ; ;Doneva, AnaAngelova, AleksandraAtrial fibrillation (AF) increases an individual’s risk of stroke by 4 to 6 times on average. The risk increases with age. In people over 80 years old, AF is the direct cause of 1 in 4 strokes. In these cases, anticoagulation therapy is recommended for primary prevention and secondary stroke prevention. Direct oral anticoagulants(DOACs) such asRivaroxaban are preferred over Vitamin K antagonists(VKA), according to the latest guidelines.To presentinteresting and challenging cases from the clinical practice and discuss use of Rivaroxaban in primary and secondary prevention in patients with AFand stroke.In November 2022 we organized a two-day workshop, under the auspices of the pharma company Bayer d.o.o. Ljubljana-Representative Office Skopje, Macedonia. Neurology and Cardiologyresidents presented 10 clinical cases, under the mentorship of respective specialists, experts in theirfields. Clinical features, laboratoryanalysis,neuroimaging findings and contemporary management of each case were discussed in detail. Designated mentors presented the latest guidelines and recommendations regarding use of Rivaroxaban in primary and secondary prevention in patients with AFand stroke.Belowwe present 10 clinical cases and describe in detail their physical and neurological condition, laboratory and imaging findings and therapeutic approach - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF Long-Term General Registry(Oxford University Press (OUP), 2022) ;Ding, Wern Yew ;Proietti, Marco ;Boriani, Giuseppe ;Fauchier, LaurentBlomström-Lundqvist, CarinaThe 4S-AF classification scheme comprises of four domains: stroke risk (St), symptoms (Sy), severity of atrial fibrillation (AF) burden (Sb), and substrate (Su). We sought to examine the implementation of the 4S-AF scheme in the EORP-AF General Long-Term Registry and compare outcomes in AF patients according to the 4S-AF-led decision-making process. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association between antithrombotic treatment and outcomes at 1-year follow-up in patients with atrial fibrillation: the EORP-AF General Long-Term Registry(Oxford University Press (OUP), 2019) ;Boriani, Giuseppe ;Proietti, Marco ;Laroche, Cécile ;Fauchier, LaurentMarin, FranciscoIn recent years, stroke prevention in patients with atrial fibrillation (AF) has radically changed, with increasing use of non-vitamin K antagonist oral anticoagulants (NOACs). Contemporary European data on AF thromboprophylaxis are needed. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of malignancy on outcomes in European patients with atrial fibrillation: A report from the ESC-EHRA EURObservational research programme in atrial fibrillation general long-term registry(Wiley, 2022-07) ;Malavasi, Vincenzo L ;Vitolo, Marco ;Proietti, Marco ;Diemberger, IgorFauchier, LaurentThe management of patients with atrial fibrillation (AF) and malignancy is challenging given the paucity of evidence supporting their appropriate clinical management. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry(Wiley, 2022-06) ;Ding, Wern Yew ;Potpara, Tatjana S ;Blomström-Lundqvist, Carina ;Boriani, GiuseppeMarin, FranciscoAtrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Arrhythmias induced cardiomyopathy - reversible dilated cardiomyopathy in patients with atrial fibrillation/flutter with fast ventricular rate(Macedonian Society of Cardiology, 2014); ;Arnaudova-Dezhulovikj F.; ;Kamcevska-Dobrkovic L.Otljanska M
