Kostovski, Lazar
Preferred name
Kostovski, Lazar
Official Name
Kostovski, Lazar
Main Affiliation
9 results
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Item type:Publication, Left ventricular function in patients with advanced stages of chronic obstructive pulmonary disease in correlation with GOLD classification system(2024); ; ; ; Background: Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease, with irreversible airflow obstruction, disease with high morbidity and early mortality rate. COPD is not just a disorder limited to the lungs. As the disease progresses, extra pulmonary co morbidities occur, where cardiovascular diseases are the most common. They mostly affect the right side of the heart, but sometimes changes also occur on the left side of the heart, as a result of long-term strain from the right ventricle (RV) and pulmonary hypertension which follows COPD. Material and methods: The design of our study was prospective-clinical cross-sectional study with 2 years follow up. In the study were included 94 patients with previously confirmed chronic obstructive pulmonary disease with spirometry and classified by Tiffeneau index in four gold classes. We have analyzed the values of some echocardiographic parameters that were selected as indicators of left heart function, and also we have analyzed them in relation to the progression of COPD from milder to more severe Golden classes, such as: left ventricular diastolic dimension (LvdD - mm), left ventricular ejection fraction (EF %), myocardial performance index (MPI) of the left ventricle, global longitudinal strain (Gl strain - %) of LV, diastolic function (E/e'). Echo analysis was done by Vivid 7 echo machine with a special feature to left heart chamber characteristics and function. Results: All echocardiographic parameters analyzed in our study, underline their significance in disease progression in patients with COPD and increasing Gold classes. A varies of statistical methods and parameters were used to evaluate: left ventricular diastolic dimension(mm), Ejection fraction of left ventricle (%), MPI of the left ventricle obtain by Tissue Doppler, GL strain of left ventricle (%) and E/e' in correlation of disease progression and GOLD class. Echo-parameters MPI of the left ventricle and Global longitudinal strain LV (%), progressively grow with the rise of the gold class (form I to IV). On the contrary the values of the parameters LvdD and EF% gradually decrease with the progression of the disease and gold class. Echocardiographic parameter GL strain LV % has the highest value and statistically by decreasing the values of this parameter the risk of disease progression from gold stage I/II to Gold stage III/IV is 1.570 times higher, with high statistical significance(p<0,01). The calculated value of the parameter EF% is lower than 0,75, which indicates that the model of prediction is not the best one but it's acceptable. Conclusion: COPD is a progressive disease that affects the dimensions of the right and left heart chambers, as well as the function of both chambers and the development of pulmonary hypertension. Monitoring echocardiographic parameters intended for assessment cardiac dimension and function can help tо predict disease progression for timely inclusion of specific therapeutic strategies. We suggest screening of all COPD patients for cardiac assessment using echocardiography as a non-invasive and repeatable method for their follow-up. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Prognostic Significance of Echocardiographic Parameters for Right Heart Assessment and Risk of Developing Advanced Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)(2023); ; ; Background: Chronic obstructive pulmonary disease (COPD) аaccording to World Health Organization is the third leading cause for early death and disability in 2022. COPD is characterized by persistent airflow limitation that is typically progressive and associated with an enhanced chronic inflammatory response in the airways and lung tissue. As the disease progresses more cardiovascular complication appear such as right ventricular hypertrophy with preserved systolic function, pulmonary artery pressure (which is slightly to moderately increased), and moderate tricuspid regurgitation. Material and methods: The design of our study was a prospective-clinical cross-sectional study. We analyzed 94 patients with COPD. All patients were divided in groups according to degree of obstruction and classified by GOLD classification system into four groups from GOLD 1-GOLD4. In our study all patients during admission and hospital stay were thoroughly examined with anamnesis, physical examination and electrocardiogram (ECG), as well as with basic and advanced echocardiographic assessment.13teen echo parameters were evaluated applying advanced echocardiographic analysis especially in terms of right heart features. Results: All echocardiographic parameters were analyzed to understand their significance in disease progression in patients with COPD and increasing Gold classes. Twelve of 13-teen echo-parameters evaluated in our study have quantitative values, while collapsibility of vena cava >50% is a qualitative parameter. Quantitative values of the same echo-parameters (DA, S TDV DV, TAPSE, FAC, AT a.pulmonalis, SPAP, v.max, MPI DV, Stain DV, DA area, PVR and collapsibility of vena cava > 50 %) were compared in terms of Gold classes by multivariate linear regression analysis. With multivariate linear regression analysis, there is a statistically significant correlation (with the following three echocardiographic parameters: S’ TDV DV, DV basal and Global strain DV according to GOLD classes. In further analyses, binary categorization of GOLD classes into two binary categories was additionally used: lower GOLD classes (1 and 2), and more advanced GOLD classes (3 and 4) by applying logistic regression model. The parameter basal dimension of the right ventricle (RV basal) has the highest values statistically, the parameters SPAP, AT a.pulm, Gl strain of DV and TAPSE have somewhat lower values. Conclusion: Prevalence of pulmonary hypertension has a linear relationship with severity of COPD and severe pulmonary hypertension is almost every time associated with development of right heart failure. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions. We suggest screening of all COPD patients for cardiac complications using echocardiography as a non-invasive and repeatable for their follow-up - Some of the metrics are blocked by yourconsent settings
Item type:Publication, LVAD for Improved Symptomatic Heart Failure- A Case Report(Macedonian Society of Cardiology, 2021-10); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dynamic LVOT Obstruction as a Reason of Syncope(Macedonian Society of Cardiology, 2021-10); ; Gerakarovska Radovic Marija - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Progressive dyspnea in patient with dilatation of main pulmonary artery and its branches(Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2020-12); ; Siljanovski, NikolaDilatation of the pulmonary artery (PA) can cause compression of the surrounding structures. We are presenting a rare case of dilatation of the main pulmonary artery and its branches with tracheobronchial compression and consecutive atelectasis of the right upper lobe segment. A 73-year-old woman was referred to cardiac examination because of the progressive dyspnea and detected dilated pulmonary artery on chest radiography. On echocardiography was revealed a dilatation of the main pulmonary artery and its branches, which was later confirmed with computerized tomography (CT) angiography. On CT angiography was also detected tracheobronchial tree compression with a consecutive atelectasis of the right upper lobe segment. Because of the progressive dyspnea and CT angiography findings, the patient was referred to a cardiac surgeon for further treatment, but she was rejected because of the high operative risk. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Nt-probnp as a Prognostic Marker in Different Gold Classes in Patients with Chronic Obstructive Pulmonary Disease (COPD)(2023-01-05); ; ; ; Background: Chronic obstructive pulmonary disease (COPD) was the fifth leading cause for early death and disability in 2020 with approximately 2.75 million deaths per year, which was 4.8%in total from the general mortality. Right ventricular hypertrophy with preserved systolic function is the most common finding in patients with COPD. The development of pulmonary hypertension leads to DV (right ventricle) dilatation and DV heart failure during the course of the disease. Material and methods: The design of the research was a prospective-clinical cross-sectional study as we analyzed 94 patients with COPD. All patients were divided in groups according to the degree of obstruction and classified by the GOLD classification system into four groups from GOLD 1 – GOLD4. All of our patients were analyzed thoroughly on admission and during hospital stay. ECG was made, Nt-proBNP analysis and basic and advanced echocardiography evaluation. Natriuretic peptides were measured and processed by commercially available assays with excellent precision where cut-off value was 125pg/ml. Echo analysis was done by Vivid 7 echo machine with a special feature to right heart chamber characteristics. Results: In terms of risk factors, hypertension, diabetes mellitus and hyperlipidemia were examined in all 94 patients in our study. Arterial hypertension was present in half of the patients, 51.06%. Diabetes mellitus was present in 19.15% of analyzed patients. The analysis of Nt-proBNP level in our study showed that the average value of this natriuretic peptide was above reference range and it was 236.27pg/ml. The highest average values of NT-proBNP were registered in GOLD class 3, while the lowest average and maximum value of NT-proBNP was found in GOLD class 2. According to the results of the Tukey post-hoc test, there was a statistically significant difference in Nt-proBNP levels between GOLD class 2 and GOLD class 3. The average values of Nt-proBNP in the group of patients with acute exacerbation was far higher than in the group of chronically stable patients. The difference between the two groups was 3.5 times in GOLD class 3 and approximately 2 times in GOLD class 4. Conclusion: BNP and NT-proBNP are natriuretic peptides that are secreted under conditions of cardiac stress and weakness. They are established biomarkers and are listed in the guidelines for chronic heart failure as they are quantitative markers used for diagnosis and risk stratification. Still, more studies with a larger number of patients are needed to confirm the role of Nt-proBNP in patients with COPD in different stages of GOLD and progression of the disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dynamic Left Ventricular Outflow Tract Obstruction - when to Intervene?(International Medical Journal Corp., 2021); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Chronic thromboembolic pulmonary hypertension presented as acute heart failure: a case report(Ecronicon, 2023); ; ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Dilatation of the pulmonary trunk and its branches - a case report(Macedonian Society of Cardiology, 2020-10); ; Siljanovski, Nikola