Faculty of Medicine

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Capecitabine-induced Cardiotoxicity Complicated with Acute Coronary Syndrome and Acute Heart Failure: A Case Report and Review of Scientific Data
(Medicinska Naklada d.o.o., 2025-04)
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Grueva Nastevska, Elena
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Shehu, Enes
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Petkovski, Dushan
Capecitabine cardiotoxicity is relatively common and may lead to serios cardiovascular complications. The aim of this case report is to emphasize the importance of considering potential toxic effects, rapid therapy discontinuation, and prompt treatment of all complications. We present a case of a 46-yearold male patient who was admitted to our clinic with chest pain and ST segment elevation in the anterior and lateral leads as a sign of acute ST-segment elevation myocardial infarction. Urgent coronary angiography was performed with the finding of a thrombus in the left anterior descendent coronary artery, and percutaneous coronary intervention was subsequently performed. Two months before admission, the patient had undergone surgery for rectal cancer. The above symptoms started three days after the introduction of treatment with capecitabine, which was discontinued on admission. The patient clinically deteriorated during the procedure, with development of cardiogenic shock. An echocardiography exam performed after the procedure showed severe reduction of left ventricular (LV) function (ejection fraction (EF) 21%). Due to further deterioration and cardiogenic shock refractory to optimal inotropic and vasopressor support, veno-arterial extracorporeal membrane oxygenation support was applied and the patient was placed on mechanical ventilation. After all these treatment measures, the patient clinically stabilized. He was extubated after 2 days and hemodynamically stabilized with gradually improvement of LV function. Control echocardiography after 9 days from admission showed an EF of 58%. Our case is an example of successful treatment of the potential serious cardiotoxic complications of capecitabine therapy in a young patient. The case also emphasizes the necessity of multidisciplinary collaboration in similar clinical scenarios.
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SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS IN HEART FAILURE
(MIT University Skopje, 2023)
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Tonev, Jelena
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Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are antidiabetic drugs whose therapeutic action has gone beyond diabetes and extended to the cardiovascular and renal systems. They are class I evidence, guideline-directed medical therapy in heart failure irrespective of ejection fraction or diabetes mellitus. There are several assumptions about the mechanism of their action, but the exact mechanism has not yet been determined. Every doctor should be familiar with these new drugs for the implementation of their uses and better recognize and limit side effects.
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Dilated cardiomyopathy in acromegaly - Case report
(2014-10)
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Todorova, Biljana
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Introduction: Patients diagnosed with acromegaly develop many cardiovascular complications such as hypertension, arrhythmia, systolic and diastolic dysfunction, valvular dysfunction and heart failure. Dilated cardiomyopathy (DCM) with systolic and diastolic dysfunction is relatively rare but is associated with high mortality to 60%. In MCC the heart muscle gradually dilate and the dysfunction that develops is irreversible. It is therefore necessary early diagnosis and treatment of acromegaly by removal of the tumor and drug treatment with drugs that prevent the heart failure. Material and methods: We present a case of acromegaly diagnosed at the patient at the age of 27 with pituitary macroadenom, hipopituitarizam, diabetes,insipiden diabetes and atrophy of the optic nerve. The patient was subjected to endoscopic surgery but the disease remained active and she was treated with radiotherapy. Our patient has ignored the underlying disease and didn’t call in to the review and controls. The patient was hospitalized with difficult situation of heart failure with anasarca, hypertension, fatigue and severe left ventricular dysfunction with global hypocinesia in the Clinic for Cardiology. She was treated with diuretics, cardiotonics, vasodilators and hormone replacement therapy. Conclusion: Early diagnosis and prompt treatment of acromegaly can prevent irreversible cardiomyopathy. The problem is greater, if it is associated with other morbidities such as hypertension and diabetes.
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Prognosticators of heart failure in patients after treatment because of acute coronary syndrome
(2016-05)
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Bekim Pocesta
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Gorjan Krstevski
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Hajber Taravari
Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.
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Functional outcome and quality of life after coronary artery bypass surgery in patients with severe heart failure and hibernated myocardium
(Wolters Kluwer, 2008-03-29)
Peovska, Irena
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Maksimovic, Jelena
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Background: Myocardial viability is an important parameter, predictive of improvement in left ventricular function after coronary artery bypass surgery (CABG). We wanted to define the relationship between the extent of hibernated myocardium and improvement in ejection fraction function and quality of life after CABG. Methods: Sixty-five consecutive patients with ischaemic cardiomyopathy (mean LVEF <40%) undergoing surgical revascularization were studied with (99m)Tc-sestamibi myocardial perfusion Gated SPECT imaging (MPI) to assess preoperative myocardial viability. Patients were divided into two groups, based on the extent of viable myocardium before CABG: group 1, 39 patients with more than four viable segments; and group 2, 26 patients with fewer than four viable segments. Regional and global ejection fraction function, heart failure symptoms and quality of life were measured before and 14+/-4 months after revascularization. We used bull's eye quantitative analysis of MPI scans and a 17-segment model of ejection fraction function and perfusion evaluation. Results: The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r=0.79, P<0.01). Patients with more than four viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79%, respectively, for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms and quality of life after revascularization. Conclusion: The presence of more than four viable segments (24% of the left ventricle) on MPI in patients with ischaemic heart failure before CABG surgery is significantly correlated with the improvement in LVEF, heart failure symptoms and quality of life post-operatively.
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Relationship between myocardial viability and improvement in left ventricular function and heart failure symptoms after coronary artery bypass surgery
(Macedonian Academy of Science and Art (MANU), 2007-07-28)
Peovska, I
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Maksimovic, J
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Davceva, J
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Background: The evaluation of myocardial viability is an important preoperative parameter, predictive of improvement in regional and global left ventricular (LV) function after coronary artery bypass surgery (CABG). However, whether the presence of viability is also associated with relief of heart failure symptoms after revascularization is not always certain. The aims of the study were to define the relationship between extent of viable myocardium and improvement in LV function after CABG and to determine whether preoperative viability testing can predict improvement in heart failure symptoms. Methods: Eighty-five consecutive patients with ischemic cardiomyopathy (mean LVEF 35%) undergoing surgical revascularization were studied with a Tc-99m sestamibi one-day rest/nitrate enhanced myocardial perfusion SPECT imaging (MPI) to assess viability. Regional and global function were measured before and 16 -/+ 6 months after revascularization. We have used the Bull's eye quantitative analysis of MPI scans and 17 segment model of LV function and perfusion evaluation. Heart failure symptoms were graded according to the New York Heart Association (NYHA) criteria, before and 16 -/+ 6 months after revascularization. Results: The number of viable segments per patient was directly related to the improvement in LVEF after revascularization (r 0.79, P < 0.01). Patients with > 4 viable segments representing 24% of the left ventricle yielded the sensitivity of 83% and specificity of 79% respectively for predicting improvement in LVEF. Furthermore, the presence of four or more viable segments predicted improvement in heart failure symptoms after revascularization, with positive and negative predictive values of 79% and 74%, respectively. Conclusion: The presence of substantial viability (four or more viable segments, 24% of the left ventricle) on myocardial perfusion gated SPECT imaging in patients with ischemic heart failure before CABG surgery has significant correlation with the improvement in LVEF and heart failure symptoms postoperatively.
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In-hospital outcome of patients with peripartum cardiomyopathy – a single center study
(Medical Publishing, d.o.o., 2014-10-29)
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Arnaudova-Dezulovic, Frosina
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Palasheva, Lidija
Peripartum cardiomyopathy (PPCMP) is a disorder of unknown cause in which initial left ventricular systolic dysfunction and symptoms of heart failure (HF) occur between the last month of pregnancy and the first 5 months postpartum. The causes and pathogenesis are poorly understood and PPCMP remains a diagnosis of exclusion. Clinical presentation includes usual signs and symptoms of heart failure, and unusual presentations relating to thromboembolism. Effective HF treatment reduces mortality rates and increases the number of women who fully recover left ventricular (LV) systolic function. PPCMP is common in some countries and rare in others. During 6 years period (2008-2014) 22 patents (pts) were admitted to our hospital with diagnosis of PPCMP. 16(73%) pts were admitted to our hospital immediately post-partum, because of acute HF which needed immediate and aggressive HF treatment. Six (27%) pts presented congestive HF symptoms during the first three months after delivery. At the admission all the pts had documented LV systolic dysfunction with echocardiography (EF <45%). Five of them (23%) had severely impaired LV systolic function (EF=25-30%), seven (32%) pts had EF of 30-40%, and 10 (45%) pts had mild LV systolic dysfunction. During the hospitalization, clinical and functional improvement and stabilization was achieved in all patients. Complete recovery of LV systolic function was observed in 12 (55%) pts with PPCMP. In 10 pts (45%) there was persistence of LV systolic dysfunction determined with echocardiography. Peripartum cardiomyopathy is rare, but a serious disease associated with significant cardiac functional deterioration. Early diagnosis and appropriate medical treatment allows good functional recovery in majority of these patients and favorable prognosis. Reliable population-based information about incidence and prevalence of PPCMP is essential to the development of health policies for prevention and control of this condition.

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