Mitevska, Irena

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Mitevska, Irena

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Mitevska, Irena

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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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Special Conditions in Venous Thrombembolism - Case Series
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2019-10-01)
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Klincheva, Milka
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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable cause of in-hospital death, and one of the most prevalent vascular diseases. There is a lack of knowledge with regards to contemporary presentation, management, and outcomes of patients with VTE. Many clinically important subgroups (including the elderly, those with recent bleeding, renal insufficiency, disseminated malignancy or pregnant patients) have been under-represented in randomized clinical trials. We still need information from real life data (as example RIETE). The paper presents case series with VTE in special conditions, including cancer associated thrombosis, malignant homeopathies, as well in high risk population.
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Single-Photon Emission Computed Tomography Myocardial Ischemia Detection in High-Risk Asymptomatic Patients: Correlation with Coronary Calcium Score and High-Sensitivity C-Reactive Protein
(2019)
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Stojanovska, Lily
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Apostolopoulos, Vasso
The association between myocardial ischemia in high-risk patients with coronary calcium score (CCS) and high-sensitivity C-reactive protein (hs-CRP) is not well established.
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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
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Page, Courtney B
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Shaw, Leslee J
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Berman, Daniel S
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Chaitman, Bernard R
The 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.
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Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)
(Macedonian Academy of Sciences and Arts / Walter de Gruyter GmbH, 2018-12-01)
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Krstevski, Gorjan
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Bosevska, Golubinka
These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.
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Chloroquine and Hydroxychloroquine in Treatment of Coronavirus Disease-19
(Scientific foundation Spiroski, 2020-08-20)
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<jats:p>At present, we are facing coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 with several treatment choices and reports of different treatment outcomes. Chloroquine and hydroxychloroquine use for the management of severely ill patients started as a quite enthusiastic treatment option, following several small clinical trials, case series reports, public authorities, and media affirmation. However, the evidence we have so far is conflicting and some national societies and professional institutions implicate that we should wait for definite treatment recommendations until there are solid data for or against the use of these drugs. Until we have more powerful evidence in our hands, we should be aware of safety issues of the old drugs for the new application in the emergency state we are facing today with the COVID-19 pandemic. We performed a concise review of strengths, limitations, and awareness for chloroquine and hydroxychloroquine use for COVID-19 infection treatment based on the evidence the science has today.</jats:p>
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Diabetic Cardiomyopathy: Intersection of Macrovascular and Microvascular Disease, or Much More?
(Македонско лекарско друштво = Macedonian Medical Association, 2016-12-01)
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Cardiovascular disease is responsible for over 75% of deaths in diabetic patients, the majority caused by coronary artery disease (CAD) and heart failure. Cardiovascular morbidity and mortality in diabetic patients might be independently associated with other pathophysiologic mechanisms than coronary artery disease, epicardial and microvascular disease. There is an increasing notion that diabetic patients suffer from an additional cardiac condition named “diabetic cardiomyopathy”. There are several clinical, experimental, pathological and epidemiological researches that support the existence of a specific “diabetic cardiomyopathy”. This is assumed to be influenced by complex interaction of several metabolic changes that leads to both functional and structural alterations of the diabetic myocardium. In this review epidemiological aspects and clinical implications of this condition are presented.
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Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial
(Ovid Technologies (Wolters Kluwer Health), 2024-06)
Pracoń, Radosław
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Spertus, John A.
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Broderick, Samuel
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Bangalore, Sripal
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Rockhold, Frank W.
ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) did not find an overall reduction in cardiovascular events with an initial invasive versus conservative management strategy in chronic coronary disease; however, there were conservative strategy participants who underwent invasive coronary angiography early postrandomization (within 6 months). Identifying factors associated with angiography in conservative strategy participants will inform clinical decision-making in patients with chronic coronary disease. METHODS: Factors independently associated with angiography performed within 6 months of randomization were identified using Fine and Gray proportional subdistribution hazard models, including demographics, region of randomization, medical history, risk factor control, symptoms, ischemia severity, coronary anatomy based on protocol-mandated coronary computed tomography angiography, and medication use. RESULTS: Among 2591 conservative strategy participants, angiography within 6 months of randomization occurred in 8.7% (4.7% for a suspected primary end point event, 1.6% for persistent symptoms, and 2.6% due to protocol nonadherence) and was associated with the following baseline characteristics: enrollment in Europe versus Asia (hazard ratio [HR], 1.81 [95% CI, 1.14–2.86]), daily and weekly versus no angina (HR, 5.97 [95% CI, 2.78–12.86] and 2.63 [95% CI, 1.51–4.58], respectively), poor to fair versus good to excellent health status (HR, 2.02 [95% CI, 1.23–3.32]) assessed with Seattle Angina Questionnaire, and new/more frequent angina prerandomization (HR, 1.80 [95% CI, 1.34–2.40]). Baseline low-density lipoprotein cholesterol <70 mg/dL was associated with a lower risk of angiography (HR, 0.65 [95% CI, 0.46–0.91) but not baseline ischemia severity nor the presence of multivessel or proximal left anterior descending artery stenosis >70% on coronary computed tomography angiography. CONCLUSIONS:Among ISCHEMIA participants randomized to the conservative strategy, angiography within 6 months of randomization was performed in <10% of patients. It was associated with frequent or increasing baseline angina and poor quality of life but not with objective markers of disease severity. Well-controlled baseline low-density lipoprotein cholesterol was associated with a reduced likelihood of angiography. These findings point to the importance of a comprehensive assessment of symptoms and a review of guideline-directed medical therapy goals when deciding the initial treatment strategy for chronic coronary disease.
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GENDER DIFFERENCES AND PREDICTORS OF INCRASED CORONARY CALCIUM SCORE AND MYOCARDIAL ISCHEMIA IN DIABETES TYPE 2 PATIENTS
(Macedonian Association of Anatomists, 2021)
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Predictors for Prognosis in Patients With Nonfatal Pulmonary Embolism: A Registry-Based Cohort Study
(SAGE Publications, 2018-07-26)
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Krstevski, Gorjan
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Gjorgievski, Atanas
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The article's aim was to determine predictors for short- and long-term prognosis of patients with pulmonary embolism (PE). Cohort prospective study based on the National registry on venous thromboembolism. Eighty-four patients with PE, on age 60.3 + 12.5 years, were selected and followed up in a prospective study. Pulmonary embolism was confirmed by computed tomography angiography in all the patients, while deep venous thrombosis was confirmed by ultrasound in 21 patients. Study population was followed up for 6.7 months. Multivariate regression analysis was done where right ventricular (RV) diameter (mean 37.5 mm), systolic pulmonary artery pressure (68 ± 23 mm Hg) measured by echocardiography, d-dimer level at baseline 2654.5 ± 420.3 ng/mL, number of comorbidities (2.4 ± 0.7), and present symptoms (3.1 ± 0.9) entered the model. The model was age-adjusted. d-dimer level was revealed as a predictor for the length of hospitalization (β = .25, P = .05) and RV diameter as a factor for duration of anticoagulation (β = .29, P = .05). Our results imply that the baseline measurement of these parameters independently influence both the short-term and long-term prognosis of patients with nonfatal PE.

Mitevska, Irena

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