Faculty of Medicine
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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); ; ;Risteski, Petar ;Popov, Aron FrederikShokarovski, MarjanBackground and Objectives: The role of coronary artery bypass grafting (CABG) on postoperative left ventricular (LV) function in patients with preoperatively preserved left ventricular ejection fraction (LVEF) is still being discussed and only a few studies address this question. This study aimed to assess LV function after CABG in patients with preoperatively preserved LVEF using left ventricular longitudinal strain assessed by 2D speckle tracking imaging (STI). Materials and Methods: Fifty-nine consecutive adult patients with coronary artery disease (CAD) referred for a first-time elective CABG surgery were enrolled in the final analysis of this prospective single-center clinical study. Transthoracic echocardiography (TTE), with conventional measures and STI measures, was performed within 1 week before CABG as well as 4 months after surgery. Patients were divided into groups based on their preoperative global longitudinal strain (GLS) value. Differences in systolic and diastolic parameters between groups were analyzed. Results: Preoperative GLS was reduced (GLS < -17%) in 39% of the patients. Parameters of systolic LV function were significantly reduced in this group of patients compared to the patient group with GLS% ≥ -17%. In both groups, 4 months after CABG there was a decline in LVEF but statistically significant only in the group with GLS% ≥ -17% (p = 0.035). In patients with reduced GLS, there was a statistically significant postoperative improvement (p = 0.004). In patients with preoperative normal GLS, there was not a significant change in any strain parameters after CABG. There was an improvement in diastolic function parameters measured by Tissue Doppler Imaging (TDI) in both groups. Conclusions: There is improvement in LV systolic and diastolic function after CABG in patients with preserved preoperative LVEF measured by STI and TDI. GLS might be more sensitive and effective than LVEF for monitoring improvements in myocardial function after CABG surgery in patients with preserved LVEF. - 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) ;Kostovska, Irena; ; ; 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) ;Reynolds, Harmony R ;Cyr, Derek D ;Merz, C Noel Bairey ;Shaw, Leslee JChaitman, Bernard RWomen with chronic coronary disease are generally older than men and have more comorbidities but less atherosclerosis. We explored sex differences in revascularization, guideline-directed medical therapy, and outcomes among patients with chronic coronary disease with ischemia on stress testing, with and without invasive management. - 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) ;Reynolds, Harmony R ;Page, Courtney B ;Shaw, Leslee J ;Berman, Daniel SChaitman, Bernard RThe relationship between the extent and severity of stress-induced ischemia and the extent and severity of anatomic coronary artery disease (CAD) in patients with obstructive CAD is multifactorial and includes the intensity of stress achieved, type of testing used, presence and extent of prior infarction, collateral blood flow, plaque characteristics, microvascular disease, coronary vasomotor tone, and genetic factors. Among chronic coronary disease participants with site-determined moderate or severe ischemia, we investigated associations between ischemia severity on stress testing and the extent of CAD on coronary computed tomography angiography. - 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); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SERUM ANTI-OXLDL ANTIBODIES IN PATIENTS WITH ANGRIOGRAPHICALLY CONFIRMED CORONARY ARTERY DISEASE(Macedonian Association of Anatomists and Morphologists, 2023-12); ;Kostovska, Irena; ; 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. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Role of Interleukin-1 and Interleukin-6 in the Development of Acute Myocardial Infarction(2023-08-26); ;Elizabeta Srbinovska-Kostovska; ;Slavica JosifovskaCertain cytokines as interleukin-1 (IL-1) and interleukin-6 (IL-6) are produced by the neutrophils and macrophages localized in the atheromatous plaques. The levels of circulating inflammatory cytokines IL-1 and IL-6 are found to be significantly increased in patients with ST-Segment Elevation Acute Myocardial Infarction (STEMI). In a group of 38 patients with STEMI, the levels of IL-1ß and IL-6 were determined in the coronary circulation (CC) by analysis of aspirates from the culprit lesions and the levels of these inflammatory markers in the systemic (peripheral) circulation (SC) during STEMI and six months after STEMI. Coronary angiography (CA) and percutaneous coronary intervention (PCI) were performed in all patients and the levels of cytokines were determined by the ELISA method. By examining the levels of IL-1ß and IL-6, the aim of this study was to determine their predictive value in short-term prognosis. In the acute phase (STEMI) there was a statistically significant difference between the mean values of IL-1ß (p=0, 000000) and IL-6 (p=0, 026204) in the samples of CC and SC, respectively. Results from the six months of follow-up showed that there were statistically no significant differences between the mean values of IL-1ß and IL-6 in the CC and SC. Moderate and low-positive correlation between the mean values of IL-1ß (r=0,6816; p=0,000) and IL-6 (r=0,4291; p=0,000) in CC and SC was observed at the sixth month of follow-up. In conclusion, our results confirm that IL-1ß and IL-6 are linked to the progression of Coronary Artery Disease (CAD) and should be considered as predictive markers.
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