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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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.
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Left ventricular systolic function in patients with acute coronary syndrome-risk profile
(Oxford University Press (OUP), 2024-04)
Dobjani, A
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Bogevska Naumovska, I
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Shehu, E
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Taravari, H
Introductions and objectives Left ventricular (LV) systolic dysfunction is one of the most important determinants of long-term outcome in acute coronary syndrome (ACS). Aim To determine the impact of the patient’s risk profile on the LV systolic function. Methods A single-center cross-sectional cohort study that included 3093 patients with ACS without pre-existing LV dysfunction. The comparison was performed between patients who did or did not develop a reduction in LV systolic function during the index event (<50%/≥50%), analyzing patients’ demographic, clinical, biochemical data, LV functional data, and anatomical distribution of the coronary artery disease (CAD). Result 1369 patients out of 3093 developed LV systolic dysfunction (44.3%). They were predominantly males 75.1% (1028), p=0.002; older (63.39±11.04 vs 61.21±11.12, p<0.00000); had higher level of cardiac troponin (p=0.00002), higher stress glycemia (9.2±5.3; p=0.0000001), HbA1c (6.9±1.8, p=0.000003), WBC (11.7±4.1, p=0.00001), blood urea nitrogen (BUN) (6.8±3.7, p=0.000003), and creatinine (93.2±45.1 p=0.000167), and had anemia (OR 0.35 (CI 0.29–41, p=0.000012). They had more severe CAD (SINTAX score 16.8±8.4 p=0.000012). Patients with preserved LV systolic function were predominantly females (29.7%, OR 1.1 95% CI 1.0-1.2), p = 0.002), younger (p<0.00000), and severely metabolically burdened (hypothyreosis (2.7%, OR 1.28 95% CI 0.93-1.76, p=0.052), higher levels of triglycerides (2.2±1.7 vs 1.9±1.5, p = 0.001), cholesterol (5.3±1.4 vs 5.2±1.4, p = 0.002), non-HDL-C (4.1±1.5 vs 3.9±1.3, p=0.006), however less likely to have pre-existing DM (OR 0.8 (CI 0.78–0.92), p=0.000094). They were more often NSTEMI [851 (49.4%), p = 0.000012]. Independent variables associated with a reduction in LV function were: advanced age, male gender, previous DM and anemia, stress glycemia, WBC, creatinine, and BUN. Conclusion Patients who developed reduced LV function had a very specific risk profile with bigger neuro-hormonal activation and inflammation, higher degree of myocardial damage, and worse renal function, whereas those with preserved LV systolic function after ACS were younger, predominantly females, more severely metabolically burdened, more often with NSTEMI and without LAD involvement.
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CORONARY ARTERY BYPASS GRAFTING PORTENDS DECREASED RIGHT VENTRICULAR FUNCTION
(Macedonian Association od Anatomists, 2020-07-03)
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Sokarovski, M
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Lazovski, N
Decreased right ventricular (RV) function is a frequently observed phenomenon after coronary artery bypass grafting (CABG) that often implicated poor long term prognosis. The aim of this study was to assess the existence of RV dysfunction 4 to 6 months after CABG using echocardiographic Assessment of tricuspid annular plane systolic motion (TAPSE) and RV free wall longitudinal strain (RVFWS) using speckle tracking. During the period from October 2017 to October 2018, forty-seven consecutive patients undergoing CABG were enrolled in this prospective study. 2D transthoracic echocardiography was performed within one week before CABG as well as 4 to 6 months after surgery. All measurements were made by a single experienced investigator.4-6 months after CABG right atrial (RA)and RV dimensions were significantly increased although the mean value stayed in reference margins. TAPSE was significantly reduced (p=0.0001) as well as RVFWS (p=0.015) which showed fewer negative results implicating decrement in RV function after surgery. Patients with abnormal postoperative RVFWS had insignificantly larger preoperative end-diastolic and end-systolic volume index as well as worse left ventricular (LV)function manifested with lower LV ejection fraction (LVEF), lower systolic volume index (SVI) and more positive LV global longitudinal strain.We could not find any significant difference among preoperative values of RA and RV dimension as well as TAPSE and PAPs between patients with normal vs. abnormal postoperative RVFWS. Our study showed depressed RV function 4-6 months after CABG. We suggest that RV free wall strain could be obtained and should be applied along with other conventional markers in the assessment of RV function after CABG.

Andova, Valentina

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