Dragana Dabović

Elevated coronary artery calcium (CAC) is associated with increased cardiovascular and all-cause mortality. Coronary artery calcium score (CACS) may aid cardiovascular risk assessment beyond traditional models, particularly in primary prevention populations. This study aimed to evaluate the association between CACS and major adverse cardiovascular events (MACE) and its relationship with conventional cardiovascular risk models in patients without established coronary artery disease. We conducted a retrospective analysis of patients aged >40 years with at least one cardiovascular risk factor who underwent computed tomography coronary angiography. Data on cardiovascular risk factors, medication use, atherosclerotic cardiovascular disease (ASCVD) score, MESA score, and CACS were collected. Among 100 patients (61% male; mean age 57.1 ± 10.7 years), 47% were at intermediate ASCVD risk. Median CACS was 65.0 (IQR 0.0–383.3). CACS was significantly associated with ASCVD and MESA scores. In multivariable analysis, glucose level, ASCVD score, and MESA score were significantly associated with MACE, while CACS showed a borderline association. These findings should be interpreted as exploratory and suggest that CACS reflects overall cardiovascular risk burden and may contribute to risk assessment when integrated with conventional approaches. Further prospective studies are needed to validate these findings.

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a tertiary care center due to CHF. Patients were divided into two groups based on the presence of CKD, defined as eGFR < 60 mL/min/1.73 m². Demographic, clinical, laboratory, and echocardiographic data were collected for all patients. Comparative analyses were performed to assess differences in cardiovascular risk factors, comorbidities, laboratory parameters, and echocardiographic findings between the two groups. Results: The proportion of men was significantly higher in the non-CKD group, whereas women predominated in the CKD group (p < 0.001). Dyspnea, orthopnea, leg swelling, claudication, and expectoration were significantly more frequent in patients with CKD, while chest pain and palpitations were more common in the non-CKD group (all p < 0.05). A significant difference in the distribution of NYHA functional classes was observed between the groups (p < 0.001), with NYHA class IV being more prevalent in the CKD group and classes II and III more frequent in the non-CKD group. Levels of CRP and NT-proBNP were significantly higher in the CKD group (p < 0.001). In-hospital mortality was 2.5-fold higher in patients with CKD (28.6% vs. 11.1%; p < 0.001). Conclusions: Coexistence of CKD was associated with a more severe clinical presentation, advanced functional limitation, and a distinct laboratory and echocardiographic profile in CHF patients.

Background: The lockdown and other measures for coronavirus disease 2019 (COVID-19) prevention have presented an enormous burden on healthcare systems, causing reorganization in work and lowering the number of elective hospitalizations, along with a consequent reduction in hospital-acquired infections and bacteremia. The aim of this study was to examine the influence of the COVID-19 pandemic on the diagnosis and management of infective endocarditis (IE). Methods: The study included 111 patients admitted for IE from 1 January 2017 to 31 December 2021. They were divided in two groups chronologically according to the COVID-19 pandemic: the first group consisted of patients before the pandemic (n = 85), while the second group consisted of patients during the pandemic (n = 26). Results: Before the pandemic there were 2.26 ± 1.41 cases/month with diagnosis of IE, while during the pandemic there were only 1.14 ± 1.15 cases/month (p = 0.004). IE patients during the pandemic were younger (53 [41–65] vs. 68 [52–74] years; p < 0.05). A similar number of patients underwent surgical treatment before and during COVID-19 (53% vs. 67%; p = 0.210) and 30-day mortality was comparable (28% vs. 22%; p = 0.539). Conclusion: The COVID-19 pandemic and lockdown measures have led to a reduction in the number of patients with IE, although this change did not influence management strategies and mortality.

Background: Hypertensive disorders in pregnancy (HDP) are associated with adverse pregnancy outcomes. Three-dimensional (3D) echocardiography provides greater accuracy for assessing cardiac geometry and function during pregnancy. The aim was to assess the impact of the 3D left ventricle (LV) systolic function in HDP on pregnancy outcomes. Methods: The prospective cohort study included primiparous with singleton pregnancies, without previous comorbidities who underwent medical history assessment, laboratory tests, ambulatory blood pressure monitoring (ABPM), and transthoracic echocardiography at baseline and six weeks after delivery. Participants were divided into a HDP group and a control group. Pregnancy outcomes (intrauterine growth restriction (IUGR), preterm delivery, and birth weight) were recorded and analyzed. Results: The study involved 174 HDPs and 64 controls, with a median gestational age of 34 weeks (31; 36). Compared to controls HDP exhibited significantly impaired values in both two-dimensional (2D) and 3D parameters for the systolic and diastolic function of the LV. They had higher LV mass index values and lower absolute values for 2D global longitudinal strain and 3D LV strain in all directions (p < 0.001). Multivariable regression analysis revealed that body mass index (BMI) with odds ratio (OR) of 0.751 (95% confidence interval (CI): 0.666–0.847, p < 0.001) and 3D LV global area strain (GAS) with OR of 0.234 (95% CI: 0.155–0.352, p < 0.001) were the strongest predictors of IUGR, while BMI with OR of 0.832 (95% CI: 0.758–0.914), nighttime systolic blood pressure (SBP) with OR of 1.055 (95% CI: 1.032–1.079, p < 0.01) and 3D LV ejection fraction (EF) with OR of 0.780 (95% CI: 0.687–0.885) were the strongest predictors of preterm delivery. The receiver operating characteristic (ROC) curve showed that the model with BMI and 3D LV GAS can be a good predictor for IUGR with an area under the curve (AUC) 0.951 (0.925–0.976) with 89.5% sensitivity and 86.4% specificity, p < 0.001, while the model with BMI, nighttime SBP and 3D LV EF is a predictor for preterm delivery with AUC of 0.835 (0.776–0.893) with 79.1% sensitivity and 73.7% specificity, p < 0.001. Person correlation showed a significant positive correlation between birth weight and 3D GAS, r = 0.485; p < 0.001. Conclusions: LV GAS is significantly associated with IUGR and birth weight, while 3D LV EF strongly predicts preterm delivery.

Background/Objectives: Coronary microvascular dysfunction (CMD) is emerging as a critical factor in patients presenting with anginal symptoms without obstructive coronary artery disease (CAD). This study aims to investigate the relationship between invasive measurements of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) using thermodilution techniques, compared to non-invasive assessments of CFR with transthoracic Doppler echocardiography (TDE). Methods: In this observational prospective cross-sectional study, a total of 49 patients, clinically characterized as having angina with no obstructive CAD (ANOCA) or ischemia with no obstructive CAD (INOCA), underwent both TDE and invasive coronary angiography (ICA) followed by thermodilution assessment of CFR and IMR. Results: It was found that there is a statistically significant negative correlation between both non-invasive and invasive CFR measurements and IMR. Specifically, a negative moderate correlation was observed between non-invasive CFR and IMR (r_s = −0.477, p < 0.01), as well as a high negative correlation between invasive CFR and IMR (r = −0.541, p < 0.01). Receiver operating characteristic (ROC) analysis indicated that both non-invasive and invasive CFRs are effective predictors of CMD, defined as IMR > 25. Conclusions: Both noninvasive and invasive CFR measurements are significant independent predictors of CMD. Our results indicate that noninvasive TDE CFR can be a reliable tool for assessing CMD in patients with ANOCA, potentially facilitating earlier diagnosis and management strategies for this patient population.

Introduction: Emergency conditions in cardiology refer to situations that indicate an immediate, life-threatening risk to the patient. Suspected urgent cardiovascular conditions are the most common reason for exams in emergency departments, with patients often presenting unnecessarily or being inadequately referred and triaged. Objective: To identify the most common emergency conditions that lead to patient referrals to the cardiology outpatient clinic, the mode of arrival, and the proportion of hospitalized patients in relation to the referring diagnosis. Material and Methods: A retrospective study was conducted by analyzing the medical records of 418 patients (157 female and 261 male) referred to the emergency cardiology outpatient clinic of the Institute for Cardiovascular Diseases of Vojvodina. Data on patient demographics, referral diagnoses, pre-hospital care, management in the outpatient clinic, vital parameters, and hospitalization rates were analyzed. Results: The most common diagnosis in the emergency cardiology clinic was arterial hypertension, with 1.01% of hospitalized patients being referred for it. The most common diagnosis for hospitalization was myocardial infarction. Congestive heart failure occurs more frequently in individuals aged ≥65 years. Patients with diagnoses of myocardial infarction, unstable angina, pulmonary edema, and respiratory insufficiency usually arrive via emergency medical services, while patients with chest pain of uncertain origin and arterial hypertension mostly come by their own transportation. Conclusion: A higher number of men visited the emergency cardiology outpatient clinic compared to women. The most common diagnosis in the emergency cardiology outpatient clinic was arterial hypertension. Most patients presenting to the outpatient clinic were aged 65 or older.

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.

Introduction: Takotsubo cardiomyopathy (TCM) is a reversible form of cardiomyopathy characterized by transient regional systolic dysfunction of the left ventricle. Case outline: A 78-year-old woman was admitted to the general hospital due to acute inferior STEMI late presentation. Two days after admission, the patient reported intense chest pain and an ECG registered diffuse ST-segment elevation in all leads with ST-segment denivelation in aVR. The patient also showed clinical signs of cardiogenic shock and was referred to a reference institution for further evaluation. Echocardiography revealed akinesia of all medioapical segments, dynamic obstruction of the left ventricular outflow tract (LVOT), moderate mitral regurgitation, and pericardial effusion. Coronary angiography showed the suboccluded right coronary artery, and a primary percutaneous coronary intervention was performed, which involved implanting a drug-eluting stent. The patient’s condition worsened as pericardial effusion increased and led to tamponade. Pericardiocentesis was performed, resulting in the patient’s stabilization. At this point, significant gradients at the LVOT and pericardial effusion were not registered. After eight days without symptoms and stable status, the patient was discharged. Conclusions: The simultaneous presence of AMI and TCM increases the risk of developing cardiogenic shock. The cardio-circulatory profile of these patients is different from those with AMI.

Introduction. There is limited information available regarding the quality of life (QoL) in patients with Peripartum Cardiomyopathy (PPCM). We assessed how the disease impacted the day-to-day functioning of respondents, who were concerned about their QoL in the two weeks preceding the survey. Methods. The study involved 24 subjects treated at the Institute for Cardiovascular Diseases of Vojvodina from January 2006 to December 2019. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess their quality of life. The collected data were statistically processed. Results. The mean age of the subjects was 37 ± 6.4 years, with an average time since initial diagnosis of 5.9 ± 3.4 years. Out of 24, thirteen participants completed the questionnaire, and a majority of respondents (53.8%) reported feeling sad or discouraged due to the effects of heart failure on their lives. Only 30.8% of respondents expressed complete satisfaction with the idea of living at their current level due to heart failure. Fatigue and weakness were reported by 76.9% of female participants. The initial left ventricle ejection fraction (EFLV) was predominantly severely impaired, while the currently measured EFLV averaged 55±10%. At follow-up, 38.4% showed no symptoms of heart failure. A majority (76.9%) were unable to engage in high-intensity physical activities. Conclusion. Although most patients experience cardiac muscle recovery after the acute phase of PPCM, the disease continues to have long-term effects on their quality of life and mental well-being.

Introduction. Pericardial effusion represents a significant medical issue with diverse origins, often associated with malignant conditions. This study aims to comprehensively analyze the demographic, clinical, and cytological aspects of pericardial effusion in patients treated at a tertiary center. Methods. This retrospective study included a four-year period and obtained fine needle aspiration cytology (FNAC) analysis results of pericardial effusion in 80 patients. Data covering demographics, reasons for hospitalization, and cytological analyses were collected and statistically evaluated. Results. The average age of participants was 67±12 years, with a slight male predominance. The primary reasons for hospitalization were impending cardiac tamponade (41%), massive effusions (27%), and cardiac decompensation (9%). Hemorrhagic and malignant effusions were prevalent cytologically. Malignant effusions were noted in 20% of cases, primarily originating from lung adenocarcinoma, and in approximately 15% of cases, served as an initial indicator of hidden malignancy. Conclusion. Understanding the demographic patterns, clinical presentations, and cytological types of pericardial effusion is crucial for timely diagnosis and treatment. This research highlights the significance of pericardial effusion as a potential indicator of an underlying malignancy and underscores the importance of early detection and intervention.