Faculty of Medicine

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CIRCULATING OXIDIZED LOW-DENSITY LIPOPROTEIN LEVELS IN AN EARLY STAGE OF ACUTE ISCHEMIC STROKE
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2024)
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Kerala, Coskun
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Kostovska, Irena
Introduction: Atherosclerosis remains the most common cause of coronary artery disease (CAD) and cerebral or peripheral artery disease. At present, lipid peroxidation is considered one of the basic mechanisms involved in the initiation and progression of many diseases. An oxidative stress resulting in lipid peroxidation and protein modification is involved in the pathogenesis of atherosclerosis and cardiovascular diseases. Aim: The primary aim of this study was to determine the circulating levels of oxidized low-density lipoprotein (ox-LDL) in patients with acute stages of ischemic stroke. The secondary aim was to evaluate if there was an association between ox-LDL concentration and conventional lipid risk factors for cardiovascular diseases (CVD). Material and methods: Seventy-five patients with acute ischemic stroke (AIS) and ninety control subjects without cardiovascular risk factors were included in the study. Total cholesterol, triglycerides, HDL-cholesterol, and LDL-cholesterol were measured in patients as well as in control subjects by enzymatic methods on Roche C311 Cobas Analyzer. Ox-LDL was measured by the sandwich ELISA technique. Results: There was no significant difference in BMI, total cholesterol, triglycerides, HDLc, and LDL-c between the two groups. There was a significant difference between patients with AIS and the control group regarding ox-LDL concentrations (p=0.03). We did not find any significant correlation between plasma ox-LDL concentration and lipid parameters. Conclusions: Levels of circulating ox-LDL were elevated in patients with acute ischemic stroke. Ox-LDL levels were not statistically correlated with major lipid risk factors for CVD. Therefore, ox-LDL levels may represent a novel risk marker of CVD.
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EVALUATING A TRANSITORY RIGHT BUNDLE BRANCH BLOCK IN FOOTBALL PLAYER
(Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2022)
Janushevski, Filip
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Background: Athletic heart is a non-pathological condition. The occurrence of arrhythmias or branch block in athletes should be taken seriously. Cardiac examinations performed by an experienced cardiologist are crucial for defining the true condition of the athlete's heart and the eventual prevention of sudden cardiac death. Case report A professional football player at the age of 22 years with no personal or familial history of cardiovascular disease is referred to a cardiologist for abnormal treadmill test results. The treadmill test was impressive for the RBBB pattern on the electrocardiogram (ECG) that was not revealed on his basic and native ECG. As mentioned before he had no history of cardiovascular disease and he had been playing football skillfully for 10 years. This case report represents the importance of the electrocardiogram as a diagnostic tool in the evaluation of the athlete’s heart. Conclusion Despite consensus documents, recommendations and guidelines for electrocardiogram interpretation in athletes this method lacks specificity and sensitivity and sometimes further evaluation is needed for proper diagnosis and treatment.
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SERUM ANTI-OXLDL ANTIBODIES IN PATIENTS WITH ANGRIOGRAPHICALLY CONFIRMED CORONARY ARTERY DISEASE
(Macedonian Association of Anatomists and Morphologists, 2023-12)
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Kostovska, Irena
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Cardiovascular disease (CVD) remains the leading cause of death worldwide. Oxidized low density lipoprotein (oxLDL) is believed to be central to the atherosclerotic cascade. Oxidative modification of LDL induces immunogenic epitopes in the LDL molecule, and the presence of antibodies against oxidized LDL (anti-oxLDL) has been demonstrated in human sera. Anti-oxLDL titer not only can predict a presence of atherosclerotic CAD but may also be a marker of plaque instability. The primary aim of this study was measurement of serum anti ox-LDL concentrations in CAD patients confirmed with coronary angiography. The secondary aim of the study was to evaluate if there is an association between anti-ox-LDL concentration and conventional risk factors for CAD. Ninety patients with coronary artery disease and 90 controls were included in the study. Patients were selected according to the positive result of coronary angiography. Total cholesterol, triglycerides, HDL-c and LDL-c were determined on Roche C311 Cobas Analyzer and OxLDLD and anti-oxLDL were determined with sandwich ELISA technique. We find significant difference between CAD patients and controls regarding OxLDL (p< 0.001). Serum anti OxLDL antibodies were correlated with LDL-c and we found significant correlation (p<0.05) in the CAD group. The regression model showed that the variables Age, BMI, DBP, SBP, Total cholesterol, HDL-c LDL-c and TG explained 30.39% of the variance from the variable anti-ox-LDL. Our results show that serum levels of ox LDL are associated with presence of CAD and with the lipid parameters.
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Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study
(Elsevier BV, 2021-09)
Kudo, Takashi
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Lahey, Ryan
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Hirschfeld, Cole B
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Williams, Michelle C
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Lu, Bin
Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected the management of cardiovascular disease around the world. The effect of the pandemic on the volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers canceled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased by 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on the effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
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Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19
(ELSEVIER, 2022-05-24)
Einstein, Andrew J
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Hirschfeld, Cole
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Williams, Michelle C
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Vitola, Joao V
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Better, Nathan
Background: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown. Objectives: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery. Results: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing. Conclusions: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.
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THE IMPACT OF PHYSICAL ACTIVITY ON CARDIOVASCULAR DISEASE
(MIT Univerzitet Skopje, 2022)
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Grueva E
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Petkovski Z
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Bojovski I
Background: Cardiovascular diseases are the leading cause of death in the adult population worldwide. Factors that affect heart health can be split into two groups: factors that can be controlled, influenced i.e. modified (obesity, diabetes, hyperlipemia, hypertension, physical activity, etc.), and factors that cannot be controlled, influenced i.e. non - modifying factors (genetics, aging, congenital valvular diseases, etc.). The advantage of physical activity is that it belongs to the modifying factors for preserving heart health, which means that it is never too late to start exercising. The aim of this paper is to introduce international experiences and recommendations for physical activity and its contribution to preserving heart health. The impact and connection of physical activity on the health of the human body have been observed and studied by many scientists from various medical fields over the years. Regular physical activity also helps in reducing the levels of glycemia in the blood, improving the mental state, as well as reducing body weight factors that directly affect the health of the heart. It has been proven on several occasions that physical activity or lack of it has an impact on almost all organs in the human body. The physical activity of the heart, as one of the most active organs in the human body, has both direct and indirect effects. In the continuation of this paper,we will refer to some of the global experiences and recommendations for physical activity that will lead to benefits not only for the heart but also for the entire organism. Conclusion: Physical activity is crucial for a healthy heart and a long life. More involvement from the scientific communityis needed for the promotion of the physical activity.
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Cardiovascular disease and COVID-19: a consensus paper from the ESC Working Group on Coronary Pathophysiology & Microcirculation, ESC Working Group on Thrombosis and the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Heart Rhythm Association (EHRA)
(Oxford University Press (OUP), 2021-09-16)
Cenko, Edina
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Badimon, Lina
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Bugiardini, Raffaele
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Claeys, Marc J
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De Luca, Giuseppe
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular response to cytokine production and the interaction between SARS-CoV-2 and ACE2 receptor may lead to a significant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. This conditions often referred to as "post-acute COVID-19" may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic inflammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic continues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by integrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.
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International Impact of COVID-19 on the Diagnosis of Heart Disease
(ELSEVER, 2021-01-19)
Einstein, Andrew J
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Shaw, Leslee J
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Hirschfeld, Cole
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Williams, Michelle C
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Villines, Todd C
The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.
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Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia
(Elsevier BV, 2021-09)
Kudo, Takashi
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Lahey, Ryan
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Hirschfeld, Cole B.
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Williams, Michelle C.
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Lu, Bin
Abstract: Background The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.
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Impact of COVID-19 on Cardiovascular Testing in the United States Versus the Rest of the World: The INCAPS-COVID Study
(Elsevier BV, 2021-06-10)
Hirschfeld, Cole B
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Shaw, Leslee J
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Williams, Michelle C
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Lahey, Ryan
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Villines, Todd C
This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic.

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