Aleksandra Vulin

Introduction/Objective. Hyperhidrosis is a condition of pathological excessive sweating that exceeds the body’s physiological requirements for thermoregulation. Endoscopic thoracic sympathicotomy (ETS) is a commonly used treatment for primary focal hyperhidrosis (PFH); however, it may result in compensatory sweating (CS), which represents its most frequent postoperative complication. This study aimed to investigate whether heart rate variability (HRV) parameters could predict CS. Methods. A prospective single-center study was conducted in 100 patients with primary focal hyperhidrosis (PFH) who underwent ETS. Preoperatively, all patients underwent 24-hour Holter ECG monitoring to assess standard HRV parameters. ETS was performed by transection of the sympathetic chain at the level of the third (R3) and fourth rib (R4), including the accessory Kuntz fibers. One month after surgery, the presence and severity of CS were assessed. Results. CS was absent in 61% of patients (p=0.028). Mild CS was the most common form (p < 0.01). No statistically significant differences were observed in the analyzed preoperative HRV parameters between patients with and without CS (p > 0.05), including the low-frequency (LF)/high-frequency (HF) ratios, which represent balanced autonomic activity (LF/HF < 2) and sympathetic predominance (LF/HF ≥ 2). ROC curve analysis showed that age had significant predictive accuracy for CS (AUC 0.7333; 95% CI 0.634-0.833; p < 0.01), with an optimal cutoff of 23.5 years (sensitivity 0.82, specificity 0.47). Conclusion. HRV parameters cannot reliably predict CS following bilateral ETC in patients with PFH. The study confirmed that the optimal age for surgery is below 23.5 years.

Introduction. Patients with diabetes mellitus and acute myocardial infarction often present with multiple comorbidities, among which chronic kidney disease significantly complicates management and worsens prognosis. This study aimed to assess the impact of chronic kidney disease on clinical, echocardiographic, and coronary findings, as well as on outcomes in diabetic patients with acute myocardial infarction. Material and Methods. A total of 1,353 patients with diabetes mellitus and acute myocardial infarction were analyzed and stratified according to the presence or absence of chronic kidney disease. Descriptive and analytical statistical methods, including the Mann-Whitney U and ?2 tests, were applied to evaluate demographic, clinical, echocardiographic, and angiographic parameters, treatment modalities, hospital stay, and in-hospital mortality. Results. Chronic kidney disease was present in 38.4% of patients, predominantly in advanced stages (III-V). Patients with chronic kidney disease were older, more often female, hypertensive, and non-smokers. Echocardiography showed lower left ventricular ejection fraction, larger left atrial volume, and impaired diastolic function. Patients with chronic kidney disease more frequently presented with non-ST elevation myocardial infarction, had multiple coronary stenoses, lower blood pressure, higher heart rates, and worse Killip class. They were less likely to undergo percutaneous coronary intervention and experienced longer hospitalization and higher in-hospital mortality. Conclusion. In diabetic patients with acute myocardial infarction, chronic kidney disease is associated with worse clinical, echocardiographic, and angiographic profiles, as well as poorer in-hospital outcomes. These findings underline the importance of individualized management strategies for this particularly high-risk population.

Gestational hypertension (GH) and preeclampsia (PE) are associated with the onset of hypertension. This study aimed to investigate whether the blood pressure (BP) pattern in GH is associated with the prevalence of hypertension later in life. In this prospective cohort study pregnant women screened for GH underwent medical history, laboratory analysis, ambulatory blood pressure monitoring (AMBP), and transthoracic echocardiography (with left ventricular global longitudinal strain (LVGLS)) assessment. Overall, 138 GH (67 non-dippers and 71 dippers), 55 preeclamptic, and 72 normotensive pregnant controls were included. Women were followed in the postpartum period, first after 6 weeks and later on, for the occurrence of hypertension. The median follow-up was 8.97 years (8.23; 9.03). Non-dippers and PE compared with normotensives and dippers had a higher prevalence of hypertension onset (p < 0.01), as well as significantly reduced absolute values of LVGLS during pregnancy, after delivery, and at the time of onset of hypertension during follow-up (p < 0.01). Night-time diastolic BP, LVGLS, age, and left ventricular ejection fraction were the strongest predictors of postpartum onset of hypertension. The non-dipping BP pattern in GH was significantly associated with the onset of hypertension later in life, as well as with decreased systolic function.

Background: There is evidence that right ventricular (RV) contractile function, especially its coupling with the pulmonary circulation, has an important prognostic value in patients with left ventricular dysfunction. Aims: This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery coupling (RV-PA coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF). Methods and results: The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS’). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS’/PASP ratios were taken as an index of RV-PA coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS’/PASP. TAS’/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531–0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723–0.859), p < 0.001, we obtained a threshold value of TAS’/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS’/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001). Conclusions: This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF—advanced age, atrial fibrillation, LAVI, and LVEF—but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS’/PASP improved risk stratification in patients with HFrEF. Variable TAS’/PASP has been shown to be the most powerful, independent predictor of one-year outcome.

Mining causes soil degradation, particle emission, and air and water quality deterioration. This study estimates some health risks in districts of Central Serbia affected by surface mining activities, and proposes measures for land restoration. The epidemiological risk assessment was based on data for seven cancers and three cardiovascular diseases during 2010 - 2020. Results showed a statistically significant increase in the incidence of lung and bronchial cancer in critical districts. Borski district stood out with the highest incidence rates for cardiovascular diseases. The suspected role of particulate air pollution from the mining industry in health deterioration calls for intensified air quality monitoring and development of mitigation technologies. A restoration strategy called the Pan-Life-Carpet technology is proposed for the restoration of mining areas and for air and water pollution control.

Introduction Pulmonary artery hypertension and right ventricular failure are potentially fatal complications that can develop in patients with portal hypertension. The objective of this case report was to report a patient with end-stage liver disease, and portal and pulmonary artery hypertension and right heart failure.Case outline A 57-year-old man was admitted to the Cardiology Department of a tertiary referral hospital due to signs of right-sided heart failure, ascites, pleural effusions, and pretibial edema. The patient had the history of alcohol abuse, arterial hypertension, and gout. Just prior to the admission, abdominal ultrasound revealed granular liver structure, as well as ascites. Laboratory tests showed microcytic anemia, values of transaminases below referent, hypoalbuminemia, low creatinine clearance. Echocardiography revealed pulmonary hypertension, and right ventricle failure. Right heart catheterization unraveled precapillary pulmonary hypertension, but thoracic CT scan and thoracocentesis excluded underlying pulmonary illness. Treatment continued at the Gastroenterology Department of the tertiary hospital. Abdominal CT scan diagnosed cirrhotic liver, and signs of portal hypertension. The patient was treated with symptomatic therapy, but developed acute-on-chronic renal failure and eventually died.Conclusion Multidisciplinary approach is very important to distinguish portopulmonary hypertension early in the course of liver disease, because evolution of right sided heart failure precludes these patients from adequate lifesaving therapy.

Introduction. Left ventricular hypertrophy is defined as an increase in the left ventricular mass. Electrocardiography is a widely used and cost-effective method for the initial screening of the condition, but it has limited sensitivity and specificity. The Sokolow-Lyon and Cornell criteria are still most commonly used in diagnosing the disease; their sensitivity, however, is low. On the contrary, the Romhilt-Estes scoring system incorporates atrial abnormalities and repolarization phases making this scoring system a better diagnostic tool. This study explores the correlation between electrocardiography and echocardiography in the diagnosis of left ventricular hypertrophy. Material and Methods. The study enrolled 30 patients with median age of 62, diagnosed with arterial hyperten­sion, who underwent a 12-lead electrocardiogram and transthoracic echocardiogram. The analysis included the assessment of correlation between the relevant electrocardiographic parameters and the left ventricular mass index, as well as calculation of their diagnostic capability including the area under the ROC curve. Re­sults. Positive correlation of moderate intensity has been observed between the left ventricular mass index and Sokolow-Lyon (ρ=0.479), Cornell index (ρ=0.366), and Cornell product (ρ=0.423). Cornell product had the highest sensitivity (0.82), while the Romhilt-Estes criteria exhibited the highest specificity (0.85). Sokolow-Lyon yielded the highest area under the curve (0.733), followed by Cornell product (0.640), Cornell voltage (0.622), and Romhilt-Estes criteria (0.570). Conclusion. The Sokolow-Lyon criterion exhibited the best balance between sensitivity and specificity, the highest and significant area under the ROC curve and the strongest correlation with the left ventricular mass index.

Introduction. The causes of dilated cardiomyopathy can be divided into ischemic and nonischemic. Although the importance of thyroid hormones for proper functioning of the cardiovascular system is well known, dilated cardiomyopathy is a rare presentation of hypothyroidism. Case Report. This is a case report of a 38-year-old man admitted to the Intensive Cardiac Care Unit with signs and symptoms of advanced heart failure. Dilated cardiomyopathy was established by echocardiography, while blood test showed highly elevated levels of thyroid stimulating hormone and decreased levels of free triiodothyronine and free thyroxine. The ejection fraction was significantly improved with levothyroxine replacement therapy. Conclusion. Hypothyroidism should always be considered as the cause of dilated cardiomyopathy. Thyroid hormone tests should be performed in all patients with dilated cardiomyopathy.

Infective endocarditis is an infection of the endocardial surface of the heart that usually involves the valves. Late diagnosis can lead to severe complications, such as heart failure, or even death. We have presented the case of a patient who was admitted with several months’ history of heart failure symptoms, intermittent fever, shiver and periodic neurological symptoms. MRI of endocranium depicted multiple ischemic lesions. Repeated transthoracic echocardiographies were done, thus setting the definitive diagnosis of the aortic valve endocarditis. Patient was treated with antibiotics according to guidelines and antibiogram. The surgical intervention in form of replacement of aortic valve was undergone; both early and later postoperative course was without complications. One should consider differential diagnosis of infective endocarditis in case of long term, unexplained fever, new onset of heart murmur and presence of risk factors.

Introduction/Objective. Patients with chronic renal failure (CRF) undergoing cardiac surgery are believed to have more postoperative complications and significantly higher mortality rate. The aim of the paper was to determine preoperative predictors of exacerbation of CRF and the outcome in patients with CRF submitted to cardiac surgery. Methods. A retrospective study included 169 patients hospitalized from 2012 to 2015 (age 67.71 ? 8.46 years, 72.3% male). The analysis included numerous perioperative characteristics. Results. Preoperative stage I CRF was present in 62 (37%), stage II in 77 (46%), and stage III?V in 30 (17%) patients. Exacerbation of CRF was registered in 37 (21.9%), and the lethal outcome in 16 (9.5%) patients. Stage II of CRF (odds ratio [OR] 4.76; 95% confidence interval [CI] 1.31?17.28; p = 0.018) and stage III?V of CRF (OR 11.39; 95% CI 2.87?45.14; p = 0.001) were designated as predictors for exacerbation of CRF following cardiac surgery. In patients with CRF stage I and II, multivariate analysis designated previous cerebrovascular insult (OR 3.36; 95% CI 1.04?10.93; p = 0.044) and ejection fraction ? 35% (OR 5.35; 95% CI 1.83?15.64; p = 0.02) as predictors for the exacerbation of CRF. The only predictor of postoperative dialysis requirement was higher stage of CRF (OR 5.81; 95% CI 1.22?27.81; p = 0.028). CRF stage III?V was a predictor of lethal outcome (OR 7.64; 95% CI 1.49?39.27; p = 0.015). Conclusion. Higher stage of CRF in patients submitted to cardiac surgery is a predictor of exacerbation of renal failure and the lethal outcome.