Vavlukis, Marija
Preferred name
Vavlukis, Marija
Official Name
Vavlukis, Marija
Email
marija.vavlukis@medf.ukim.edu.mk
marija.vavlukis@gmail.com
Scopus Author ID
14038383200
Researcher ID
A-2688-2015
111 results
Now showing 1 - 10 of 111
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Item type:Publication, Sex-Specific Treatment Effects After Primary Percutaneous Intervention: A Study on Coronary Blood Flow and Delay to Hospital Presentation(2019); Background We hypothesized that female sex is a treatment effect modifier of blood flow and related 30-day mortality after primary percutaneous coronary intervention ( PCI ) for ST -segment-elevation myocardial infarction and that the magnitude of the effect on outcomes differs depending on delay to hospital presentation. Methods and Results We identified 2596 patients enrolled in the ISACS - TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30-day mortality. Key secondary outcome was the rate of suboptimal post- PCI Thrombolysis in Myocardial Infarction ( TIMI ; flow grade 0-2). Multivariate logistic regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [ OR ], 1.68; 95% CI , 1.15-2.44) and higher mortality ( OR, 1.72; 95% CI , 1.02-2.90). Using inverse probability of treatment weighting, 30-day mortality was higher in women compared with men (4.8% versus 2.5%; OR , 2.00; 95% CI , 1.27-3.15). Likewise, we found a significant sex difference in post- PCI TIMI flow grade 0 to 2 (8.8% versus 5.0%; OR , 1.83; 95% CI , 1.31-2.56). The sex gap in mortality was no longer significant for patients having hospital presentation of ≤120 minutes ( OR , 1.28; 95% CI , 0.35-4.69). Sex difference in post- PCI TIMI flow grade was consistent regardless of time to hospital presentation. Conclusions Delay to hospital presentation and suboptimal post- PCI TIMI flow grade are variables independently associated with excess mortality in women, suggesting complementary mechanisms of reduced survival. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01218776. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Sex Differences in Modifiable Risk Factors and Severity of Coronary Artery Disease(2020-10-20); Background It is still unknown whether traditional risk factors may have a sex-specific impact on coronary artery disease (CAD) burden. Methods and Results We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries; ClinicalTrials.gov, NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between traditional risk factors and severity of CAD and its relationship with 30-day mortality. Relative risk (RR) ratios and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Estimates were compared by test of interaction on the log scale. Severity of CAD was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD. The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49 (95% CI, 0.41-0.60) and among those with diabetes mellitus was 0.89 (95% CI, 0.62-1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41-0.61) in nonsmokers to 0.75 (95% CI, 0.54-1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex-related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30-day mortality rates than men (RR, 1.75; 95% CI, 1.48-2.07). No sex differences in mortality were observed in patients with nonobstructive CAD. Conclusions Obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01218776. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Gender differences in detecting coronary artery disease with dipyridamole stress myocardial perfusion imaging using 99m-Tc sestamibi gated SPECT(Macedonian Academy of Science and Art (MANU), 2005-08-26); ; ; ; Peovska, IrenaThere are some specifics in the presentation of coronary artery disease (CAD) in women compared with men that may cause diagnostic pitfalls. The accuracy of noninvasive diagnostic testing in women tends to be lower than that in men. Stress myocardial perfusion imaging with 99m-Tc sestamibi gated SPECT is an accurate technique for detecting CAD. Only a few studies have compared dipyridamole stress imaging according to gender. The aim of the study was to compare the diagnostic value of dipyridamole myocardial perfusion imaging with 99m-Tc sestamibi gated SPECT in detecting CAD among patients of both sexes. We studied 62 consecutive patients (38 men, 24 women) using 99m-Tc sestamibi gated SPECT and dipyridamole stress to detect CAD. All the patients also underwent coronary angiography. Overall regional sensitivity was significantly lower in women compared with men (71.4% vs. 92.7%, p=0.039). There were no significant differences for detecting CAD in individual coronary arteries, although regional sensitivity in all three vascular territories was higher in men compared to women. The lowest sensitivity in women was found in the LAD territory (66.6%). Overall regional specificity in men and women was similar and did not reach statistical significance (88.7% vs. 94.7%). Significantly lower specificity in men was found only in the RCA territory (79.1%), compared with that in women (100%). Our results confirmed that there are certain gender differences in the diagnostic performance of dipyridamole stress myocardial perfusion imaging with 99-Tc sestamibi gated SPECT which are assigned to the characteristics of the female population. However, the diagnostic accuracy is also quite high in women, which makes this technique efficient enough in detecting CAD among this population. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Secondary Thromboprophylaxis in Hereditary Thrombophilia(SCIENCEDOMAIN International, 2018-02); ; ; Aims: The aim of this study is to show how the coagulation laboratory and clinical findings worked together in the management of a patient with hereditary thrombophilia and pulmonary embolism (PE) in terms of diagnosis, the choice of anticoagulation treatment and the duration of secondary thromboprophylaxis. Study Design: A case report with the presentation of clinical and laboratory findings, treatment and long-term follow up of the patient. Place and Duration of Study: Institute of Transfusion Medicine and University Clinics of Cardiology, St Cyril and Methodius University, Skopje, Macedonia in the period from February 2015 and December 2017. Case Presentation: Computer tomography confirmed the diagnosis of PE in a 32-year-old man who was admitted to the cardiology emergency department with D-dimer level of 5980 ng/mL after an episode of syncope. After the initial anticoagulation with unfractionated heparin 30.000i.e./24 h,enoxaparin 80 mg/12 h and acenocoumarol were introduced. The therapeutic INR rang could not be achieved so the acenocoumarol was switched to rivaroxaban 2x15 mg/day. One year later the anticoagulation with rivaroxaban 20 mg/day was discontinued. Thrombophilia testing included: prothrombin (PTB), Factor V Leiden and methylene tetrahydrofolate reductase (MTHFR) C677T gene mutation, as well as antiphospholipid antibodies, antithrombin, protein C and S. Results: The patient was homozygous for the PTB. His parents were heterozygous for the same mutation; his mother also being heterozygous for MTHFR C677T. His brother was compound heterozygote for PTB and MTHFR C677T and his sister was heterozygous for the PTB. Coagulation status monitoring showed hypercoagulability (APTT was 24-26 seconds) and increment of D-dimer (2100-2400 ng/ml) when rivaroxaban was discontinued and normal APTT (28-38 seconds) and Ddimer (< 500 ng/mL) when it was reintroduced. Conclusion: According to the laboratory findings and also having in mind that this was a second episode of a thrombotic event, we decided for an extended secondary thromboprophylaxis. Although it sometimes implies that it will be continued life-long we consider worthwhile to apply the patientoriented approach to the decision when and whether to terminate anticoagulation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID-19 and Preexisting Cardiovascular Disease(American Heart Association, 2023-07) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Correlating the Cholesterol Levels to Glucose for Men and Women(Ss. Cyril and Methodius University in Skopje, Faculty of Computer Science and Engineering, Republic of North Macedonia, 2020-05-08); ; Objectives: This paper explores the correlation between multiple cholesterol levels of the lipid profiles of patients and their diabetes regulation abilities in men and women. Methodology: The methodology includes the following techniques: i) Pearson correlation ii) Spearman rank correlation and iii) setting thresholds for certainty of class assumption. Data: The methods were applied on data from 161 patients of which 110 male and 41 female, analyzing the variables about patients’ age, height, weight, BMI, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), glycated hemoglobin levels with respective glucose regulation and diabetes classes, history of heart, diabetes and other chronic illnesses, habitual behaviors (smoking, alcohol consumption, physical activity), and medications intake (calcium channel blockers, BETA blockers, anti-arrhythmics, AKE/ARB inhibitors, diuretics, statins anti-aggregation medication and anticoagulants). Conclusion: Analyzing the correlations between the lipid profile and glucose regulation in patients led to different results when the analysis was done separately on men and women. Thus, better predictions and insights can be made dependent on gender. The research found no strong stand-alone correlation when analyzing all data, but when the data was segmented in male and female records, a strong negative linear (r=-0.52, p=0.001) and non-linear (r=-0.55, p=0.001) correlation was found for the HDL-C and glucose levels in female patients. In men, statistically significant negative correlations with HbA1c were assessed for Chol (r=-0.27, p=0.009), LDL-C (r=-0.33, p=0.002) and HDL-C (r=-0.23, p=0.026). - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Effects of Rosuvastatin Versus Atorvastatin, Alone or in Combination, on Lipoprotein (a): A Single-Center Study(aop.sagepub.com, 2016); ; ; Domazetovska, SaskaBackground: There are little evidences about the therapeutic efficacy of different lipid-lowering agents in the reduction of elevated lipoprotein(a) [Lp(a)]. Objective: testing the effect of different lipid-lowering agents on elevated Lp(a). Methods: prospective interventional study performed in patients with CAD, or high CAD risk, with Lp(a), >50 mg/dL. Lp(a), total cholesterol (C), HDL-C, LDL-C, triglycerides (TGs), apolipoprotein (Apo) A1, Apo B, enzymes of myocyte and hepatic injury were comparatively analyzed between 4 lipid-lowering strategies: rosuvastatin (R group) 40 mg, atorvastatin (A group) 80 mg, atorvastatin 40 mg add-on micronized fenofibrate (A+F group), and atorvastatin 40 mg add-on 1 g extended-release niacin (A+ERN group). Comparison was made for their therapeutic efficacy on Lp(a), and safety. Results: 87 patients with mean Lp(a) 94.6 ± 39.6 mg/dL were analyzed. Groups: 25 patients in the R, 22 in the A, 20 in the A+F and 20 in A+ERN group. Significant reduction in all lipid fractions in all treatment groups was reported after 6 months. The average reduction of Lp(a) was 15.9 ± 21.0 mg/dL, with: 18.2 ± 24.8 (P = 0.001) in the R group, 17.3 ± 10.4 (P = 0.001) in A+F, 19.5 ± 10.9 (P = 0.001) in A+ERN and the lowest in the A group (11.24 ± 22.91, P = 0.032). No adverse effects were observed in any of the treatment groups. Conclusions: When compared with atorvastatin, it seems that rosuvastatin can achieve more significant decrease of Lp(a).The efficacy of the second one can be increased by adding fibrate or ERN. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Myocardial perfusion in patients with systemic lupus erythematosus and low to intermediate risk for coronary artery disease, assessed with 99mtc mibi myocardial perfusion scintigraphy –case reports(2017-06); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Correlating Glucose Regulation with Lipid Profile(Springer International Publishing, 2020); ; Objectives: The goal of this research was to detect the glucose regulation class by evaluating the correlation between the lipid profile of patients and their glucose regulation class. Methodology: The methods used in this research are: i) Point Biserial Correlation, ii) Univariate Logistic Regression iii) Multivariate Logistic Regression iv) Pearson Correlation and v) Spearman Rank correlation. Data: The dataset consists of the following features: age, BMI, gender, weight, height, total cholesterol (Chol), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglycerides (TG), glycated hemoglobin (HbA1C), glucose regulation and diabetes classes, history of diabetes, heart and other chronic illnesses, habitual behaviors (smoking, alcohol consumption, physical activity), and medications intake (calcium channel blockers, BETA blockers, anti-arrhythmic, AKE/ARB inhibitors, diuretics, statins anti-aggregation medication and anticoagulants). Conclusion: The methodologies that were worked through with our data in search for correlations of the lipid profile with HbA1c or the glucose regulation classes gave some significant correlations. Regarding the glucose regulation classes W and B the methods showed statistically significant negative correlations with Chol, HDL-C and LDL-C. When it comes to the correlations of the lipid profile with HbA1c, for all patients there were significant negative correlations with Chol (corr = −0.264, p = 0.002), LDL-C (corr = −0.297, p < 0.001) and HDL-C (corr = −0.28, p = 0.001) and a significant positive correlation with TG (corr = 0.178, p = 0.03). The correlations mentioned are the stronger ones that were found for linear relationships. For non-diabetic patients there was a stronger positive non-linear correlation for HbA1c and HDL-C (corr = 0.511, p = 0.006), and a slightly weaker linear correlation (corr = 0.393, p = 0.043). For prediabetic patients there were no significant correlations. For type 2 diabetes stronger significant negative non-linear correlations were found for HbA1c with LDL-C (corr = −0.299, p = 0.023) and HDL-C (corr = −0.438, p = 0.001). The linear relationships were again, slightly weaker with LDL-C (corr = −0.273, p = 0.038) and with HDL-C (corr = −0.391, p = 0.002).