Andova, Valentina

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Andova, Valentina

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Andova, Valentina

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Role of Echocardiography in Diagnosis and Treatment of Patients with Infective Endocarditis
(Македонско лекарско друштво = Macedonian Medical Association, 2014-08-01)
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Tosev, Slavco
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<jats:title>Abstract</jats:title> <jats:p>Infective endocarditis is an endovascular microbial infection of cardiovascular structures, localized on valves, large intrathoracic vessels, ventricular and atrial endocardium and prosthetic materials. IE may present as an acute, subacute and chronic disease. The incidence of IE ranges from one country to another within 3-10 episodes/100.000 persons per years. The classification of IE according to the localization of the infection is: left-sided native valve IE, left-sided prosthetic valve IE (PVE), right-sided IE and device-related IE.</jats:p> <jats:p>Echocardiography plays a key role in each of the steps of assessment of IE: the diagnosis, risk stratification and follow-up of patients with infective endocarditis. The major echocardiographic criteria for IE are discovering vegetations, abscess, new valvular regurgitation and prosthesis dehiscence. According to the recent ESC recommendation for diagnosis and assessment of patients with IE, in all patients with clinical suspicion of IE, transthoracic echocardiography (TTE) is the first step of assessment. If we speak about patients with prosthetic endocarditis, then transoesophageal echocardiography (TEE) is recommended in case of poor quality of TTE and in majority of patients with positive TTE. If TTE examination is negative with low suspicion of IE, further follow-up has to be stopped. If TTE is negative but there is a high suspicion of IE, TEE has to be repeated in 7-10 days. Anatomical features on IE echocardiography have specific characteristics: vegetation, destructive valve lesion (perforation, prolapse of the valve) and abscess formation (more frequent in <jats:italic>Ao valve and in prosthetic valve</jats:italic>), which can be complicated with pseudoaneurysm and fistulization). Other cardiac imaging modalities (multislice computed tomogramphy (CT), magnetic resonance, 18F-fluorodesoxyglucose PET-CT, and single photon emission computed tomography (SPECT) /CT sometimes can be used in discovering complications in IE.</jats:p> <jats:p><jats:bold>Conclusion:</jats:bold> Echocardiography is useful in diagnosis of endocarditis, assessment of the severity of the disease, prediction of short-term and long-term prognosis, prediction of embolic risk, management of its complications, as well as deciding whether to operate or not and in choosing optimal time for surgery and follow-up.</jats:p>
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Effect of nephrology referral on the initiation of haemodyalisis and mortality in ESRD patients
(Macedonian Academy of Sciences and Arts, 2007-12)
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Polenakovic, M
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Gelev, S
Late nephrology referral of patients with chronic kidney disease (CKD) has been suggested as increasing mortality after the initiation of dialysis. The aim of this study was to assess the impact of nephrology referral on the initiation of haemodyalisis (HD) and mortality during HD treatment in end-stage renal disease (ESRD) patients who have died in our institution over a five-year period. We studied data from all 117 patients on HD treatment in our institution who died (after 90 days of HD treatment) in the period between 01.01. 2002 and 31.12. 2006. Early (ER) and late referral (LR) were defined by the time of follow-up by a nephrologist greater than or less than 6 months, respectively, before the initiation of haemodialysis. Out of a total of 117 patients, 37.6% (44 patients) started HD in the ER group and 62.4% (73 patients) in the LR group. At the start of HD, LR patients were older, had a higher proportion of temporary catheters and had a significantly lower levels of haemoglobin and diuresis. Creatinine clearance was less in the LR (7.67 +/- 3.86 ml/min/1.73 m2) vs. the ER group (8.70 +/- 3.62 ml/min/1.73 m2), but not significantly different. Cardiovascular disease (CVD), defined by a history of myocardial infarction, cerebral vascular disease, peripheral arteriopathy, and/or heart failure, was also significantly more common among LR patients compared to ER (56%; 27%, p = 0.002). During the haemodyalisis treatment, the LR group had significantly lower levels of haemoglobin and haematocrit. CVD accounted for about 64% of deaths observed in the LR group. According to echocardiography data, there were no significant differences in the left ventricular mass index (LVMI) between the LR and ER groups at the time of dialysis initiation, but during haemodialysis treatment the LR group had significantly greater LVMI than the ER group (232,96 +/- 92,48 g/m2 vs.184,09 +/- 51,74 g/m2; p = 0,031). The time until death in months during dialysis treatment was significantly different between the LR and ER group, (69.51 +/- 64.03 vs.113.27 +/- 89.03, p = 0.0025). LR patients experienced a greater degree of anaemia and a high prevalence of CVD at the time of dialysis initiation. Our data suggest that the anaemia, CV damage and progression of left ventricular hypertrophy (LVH) in the LR patients during haemodialysis treatment are associated with poor survival on haemodialysis.
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A Case of Tacotsubo Cardiomyopathy - How We Uncovered the Diagnosis
(Sciencedomain International, 2020-08)
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Otljanska, M
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Taravari, H
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Jovkovski, A
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Introduction: Tacotsubo cardiomyopathu (TTC) is a stress-induced condition characterized by transient appical hypokinesia and is usually caused by stress-induced catecholamine release with toxic action that leads to stunning myocardium. Methods and Results: The patient was a 62 year old woman without any history of heart disease and she admitted with chest pain and electrocardiography (ECG) with ST segment elevation in the precordial leads and troponins suggesting acute anterior myocardial infarction (MI). Emergency coronary angiography which is performed showed no significant coronary artery disease. Echocardiography showed reduced LV ejection fraction with left ventricular apical ballooning and (LV) thrombus. Cardiac magnetic resonance imaging showed localized hypokinesia of the mid septal segments and akinesis of all segments of the apex of the left ventricle and T2 hyperintesity consistent with myocardial transmural oedema in the same area with diffuse involvement. During the hospitalizasion patient was treated with single antiplatelet, anticoagulation therapy, diuretics, angiotensin-converting-enzyme inhibitors (ACE inhibitors) and beta blockers for treatment of heart failure reduced Ejection fraction (HFrEF). At 3 months follow up ECG was normal with reversal of symptoms and regression of wall motion abnormalities at echocardiography. According to investigation results, a diagnosis of takotsubo syndrome (TTS) was established. Conclusion: Tako-tsubo cardiomyopathy often presents as an acute coronary syndrome with ST segment changes, as ST-segment elevation and/or T-wave inversion. Clinical presentation is characterized by acute coronary artery disease, in the absence of obstruction, verified by coronarography.Diagnostic methods are very important to make true decision of Tacotsubo cardiomyopathy.
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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)
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Risteski, Petar
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Popov, Aron Frederik
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Shokarovski, Marjan
Background 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.
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Finding of a mass on the mitral valve in a patient on chronic dialysis
(Elsevier BV, 2025-04)
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Shokarovski, Marjan
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Lazovski, Nikola
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Mehmedovic, Nadica
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Myxomas are cardiac neoplasms that are most commonly located in the left atrium, usually arising from the vicinity of the fossa ovalis. However, there have been cases, although very rarely, of valvular myxoma. A cardiac mass found incidentally on echocardiography can present a challenge in particular if asymptomatic or found in an unusual location. We present the case of a 58-year-old male with kidney disease treated with chronic dialysis, referred to the cardiology clinic because of an incidental finding of a mitral valvular mass on routine transthoracic echocardiography. Although this lesion was initially misdiagnosed as native valvular endocarditis with vegetation, a series of clinical and radiological investigations led to the preoperative diagnosis of possible papillary fibroelastoma or calcified thrombotic mass. Given the increased risk of embolization due to the mass being mobile and greater than 1 cm in size, the patient was referred to cardiac surgery. Excision of the mass without mitral valve replacement was performed. Histopathological findings of the mass revealed the existence of a cardiac myxoma. In such cases of a mitral valve mass, multimodality imaging should have of high priority to achieve an accurate diagnosis. Although a definitive diagnosis can only be established after surgical excision of the mass and histopathological confirmation, it is very important to consider a differential diagnosis of mitral valve myxoma in any patient with an unexplained mitral valve mass.
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Changes in left ventricular function after coronary artery bypass grafting in patient with left ventricular dysfunction
(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2020)
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Sokarovski, Marjan
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PERIOPERATIVE CHARACTERISTICS IN DIABETIC VS. NON DIABETIC PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY
(SHMSHM / AAMD, 2020)
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Marija Gjerakaroska-Radovikj
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Objectives: This study aims to compare the perioperative clinical, angiographic and operative characteristics and early complications of diabetic patients with non-diabetic patients, undergoing isolated CABG at the University Hospital for Cardiac Surgery in Skopje. Methods: During the period from October 2017 to October 2018, ninety one consecutive patients undergoing CABG were enrolled in this prospective observational study. This population was then divided into those with DM and those without DM. For these groups, preoperative clinical, angiographic, intraoperative characteristics and postoperative complications were evaluated. Results: In our cohort, 48, 4% of the patients were diabetic. Except for smoking, all other risk factor were evenly distributed between the two groups. Patients with DM had similar SYNTAX score like non-diabetic patients (31, 7±5, 5 vs. 30, 3±7, 2, p=0,312). Patients with DM had higher No of diseased vessels (2, 9±0, 7 vs. 2, 5±0, 6, p=0,020), less LM disease (22, 7% vs. 42, 6% p=0,036). There was no statistical difference between the two groups in terms of intubation time (p=0,137), inotropic support (p=0,774) and vasopressor support (p=0,076). Diabetic patients had less re-sternotomies (p=0,066) than non-diabetic patients. Postoperative AF, perioperative MI, stroke, sternal wound infection and leg wound infection were similar in both groups. Length of hospital stay was 9 days in both groups. Conclusion: Our data do not support the conclusions by other authors who found diabetes to be a risk factor for significantly adverse early morbidity following CABG. In our study DM was not risk factor for perioperative complications and preoperative characteristic of diabetic patients were not different than in no diabetic
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Frequency of Left Atrial Enlargement According to Different Modes of Indexing in Overweight and Obese Individuals
(Macedonian Academy of Sciences and Arts, 2023-03)
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Background: Current guidelines recommend indexing left atrial volume (LAV) by body surface area (BSA). However, in overweight and obese individuals this may result in the underestimation of left atrial enlargement (LAE). The aim of our study was to assess whether alternative LAV indexing to height and/or height-squared better identifies individuals with LAE among those who are overweight and/or obese. Methods: LAV was indexed to BSA (LAVI), height (LAVh), and height-squared (LAVh2) in 127 individuals with a mean age of 45.7 years and a mean body mass index (BMI) of 34.9 kg/m2 who underwent outpatient echocardiography at the University clinic of cardiology in Skopje. Results: LAVI, LAVh, and LAVh2 showed a progressive increase of respective values with the extent of BMI showing the most enlarged LA size in individuals with Class III obesity. There was a progressive significant increase in the prevalence of LAEh and LAEh2 in obese groups with the highest prevalence among those with class III obesity (p=0.002, p=0.002, respectively), on the contrary of LAEBSA where we could not find any significance in its distribution among obese classes. The greatest degree of reclassification occurred when indexing for height-squared, having relatively less reclassification when indexing for height (p=0.0001). The degree of reclassification varied depending on BMI with the greatest impact among the Class III obese patients, where as many as 76.5% and 88.2% of individuals were reclassified according to height or height-squared, respectively. Conclusions: The use of height, and especially height-squared, in comparison to BSA-based indexing methods are more successful in identifying the LAE prevalence in each class of obesity. Using allometric indexation leads to the significant reclassification of LA size from normal to dilated, especially in women and those with severe obesity, thereby providing an opportunity to identify more individuals at increased risk of adverse events.
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Mycotic aortic aneurysm and endocarditis
(National Society of Cardiology of N. Macedonia, 2022-11)
Bede I
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Chaparoska E
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Otljanska M
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Taravari H
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MORPHOLOGICAL AND FUNCTIONAL CHANGES OF THE LEFT ATRIUM IN OBESITY
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2023-03)
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Obesity-related atrial cardiomyopathy is a clinical entity characterized by a variety of functional and structural abnormalities in the atria's myocardium. This study aimed to investigate the morphological and functional alterations of the left atrium (LA) in overweight and obese subjects. The study included 56 subjects aged 47+9.6 years, categorized into 4 groups according to their body mass index (BMI): group 1 - overweight (BMI 25-29.9 kg/m2); group 2 - class I obesity (BMI 30-34.9 kg/m2); group 3 - class II obesity (BMI 35-39.9 kg/m2) and group 4 - class III obesity (BMI >40 kg/m2). All subjects underwent two-dimensional (2D) conventional echocardiography and speckle tracking myocardial deformation assessment. Left atrial enlargement (LAE) was registered in all four groups, with an average value of LA diameter 40.0±4.9 mm and LA volume (LAV) indexed to height (LAVh) 35.0 +7.8 ml. Global longitudinal strain (GLS%) and circumferential strain (GCS%) of LA were lower than reference normal values in all groups. LAV indexed to body surface area (LAVI) correlated with hip circumference (r=0.264; p=0.049), whereas LAVh correlated with waist and hip circumference (r=0.378; p=0.004). Linear regression analysis showed that hip circumference was a predictive factor for increasing LAVI (B=0.114; p=0.049; 95%CI 0.000-0.227) and LAVh (B=0.266; p =0.0001; 95%CI 0.129–0.403). LAVh is a clinically useful echocardiographic parameter to assess LA size in obese population. A sensitive method for detecting subclinical functional alterations of LA is assessment of its speckle tracking longitudinal strain.

Andova, Valentina

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