Dragana Kosevic - Academia.edu (original) (raw)
Papers by Dragana Kosevic
BMC Cardiovascular Disorders
Background Chronic heart failure (CHF) is a severe condition, often co-occurring with depression ... more Background Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2–3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. Methods 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. Results It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001),...
European Journal of Cardio-Thoracic Surgery, 2021
OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculat... more OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculator to predict 30-day mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD) was recently launched. Using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), it is also possible to predict operative mortality for the same type of surgery. The goal of our study was to validate the prediction accuracy of these 2 on-line risk prediction models. METHODS Prospectively collected data for EuroSCORE II risk factors as well as all data for GERAADA scoring were extracted from an institutional database for 147 patients who underwent surgery for ATAAD between April 2018 and April 2021. The discriminative power was assessed using area under the receiver operating characteristic curve. The calibration of the models was tested by the Hosmer–Lemeshow statistics and by using the observed-to-expected (O/E) mortality ratio with the 95% confidence interva...
European Journal of Neurology, 2001
ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of up... more ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).
Interactive Cardiovascular and Thoracic Surgery, May 6, 2022
The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterize... more The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterized by premature physical ageing. Severe aortic stenosis has been described in progeria patients, but no previous surgical aortic valve replacement was reported. We describe a successful surgical aortic valve replacement combined with coronary artery bypass grafting in a progeria patient with severe aortic stenosis and a small aortic annulus.
Vojnosanitetski Pregled, 2019
Background/Aim. The EuroSCORE II has recently been developed with an idea to provide better accur... more Background/Aim. The EuroSCORE II has recently been developed with an idea to provide better accuracy in prediction of perioperative mortality in the patients who underwent open heart surgery. The aim of this study was to validate clinical performances of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk stratification model in the Serbian adult cardiac surgical population undergoing open heart surgery. Methods. The Euro-SCORE II values on 10,048 consecutive patients undergoing major adult cardiac surgery from 1st January 2012 to 31st March 2017, were prospectively calculated and entered the institutional database. The discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by the Hosmer-Lemeshow (H-L) statistics and the observed to expected (O/E) mortality ratio. The patients with the EuroSCORE II values of 0.5-2.50%, > 2.50-6.50%), and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Results. The observed in-hospital mortality was 3.86% (388 of 10,048) and the mean predicted mortality by the Euro-SCORE II was 3.61%. The discriminatory power was very Key words: mortality; predictive value of tests; risk assessment; thoracic surgical procedures. Apstrakt Uvod/Cilj. EuroSCORE II je razvijen nedavno sa idejom da se obezbedi bolja tačnost u predviđanju perioperativnog mortaliteta bolesnika podvrgnutih operacijama na otvorenom srcu. Cilj rada je bio da se provere kliničke performanse modela za stratifikaciju operativnog rizika u kardiohirur-giji-EuroSCORE II (Evropski sistem za procenu kadiohirurškog operativnog rizika) kod odraslih bolesnika u Srbiji kod kojih se izvode kardiohirurške procedure. Metode. Vrednosti EuroSCORE II za 10 048 uzastopno operisanih (od 1. januara 2012. do 31. marta 2017. godine) odraslih kardiohirurških bolesnika prospektivno su izračunate i unete u bazu podataka Instituta za kardiovaskularne bolesti Ključne reči: mortalitet; testovi, prognostička vrednost; rizik, procena; hirurgija, torakalna, procedure.
European Heart Journal, 2013
Background: Hypertension is a potent risk factor for congestive heart failure (CHF). Development ... more Background: Hypertension is a potent risk factor for congestive heart failure (CHF). Development of overt CHF may be preceded by a phase of asymptomatic left venrticular systolic dysfunction. The aim of this study was early detection of alteration in left ventricular systolic function. Methods: 120 hypertensive patients, with preserved ejection fraction (EF), were divided in three groups according LVDD: normal (n=40), abnormal relaxation (Grade I, n=37) and pseudonormal (Grade II, n=43). Left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular dimensions and volume inexes (LVEDV/BSA and LVESV/BSA) and EF were estimated by echocardiography. We measured coresponding velocities from tissue Doppler at the level of the septal mitral annulus (Em, Am, Sm), including E/Em and tissue Doppler myocardial performance index (tMPI). The same measurements were repeated after three years. Results: Close correlations were found between Sm and EF (r=0.349; p=0.0009), LVMI (r=-0.222; p=0.015), LVEDV/BSA (r =-0.317; p=0.0004) and LVESV/BSA (r =-0.472; p=0.0005). Levels of LVEDV/BSA (89.3 vs 103.8 vs 101.7; p=0.009), LVESV/BSA (34.0 vs 42.9 vs 44.0; p=0.0004), LVMI (104.3 vs 112.5 vs 123.0; p=0.0004), LAVI (32.0 vs 35.5 vs 44.5; p=0.0001) and MPI (61.7 vs 72.1 vs 76.3; p=0.036) progressively increased from the normal group through LVDD Grade I and II groups. Significantly different values of EF (63 vs 61 vs 59; p=0.003) and Sm (0.074 vs 0.067 vs 0.059; p=0.003) were obtained between groups too, but with progressively decrease from the normal group through LVDD Grade I and II groups. General linear model for repeated measures showed increase of LVEDV/BSA (F=50.009; p<0.001), LVESV/BSA (F=34.258; p<0.001), LVMI (F=27.648; p<0.001), LAVI (F=17.083; p<0.001) and tMPI (F=35.842; p<0.001) during three years, with significant time difference, but withot significant difference between groups, these parameters enarged in all groups almost at the same manner. Sm also significantly changed during three years with significant time difference (F=128.24; p<0.001) and with significant difference between groups (F=4.597; p< 0,012), Sm decrease in all groups, but most expressed in LVDD Grade II group. Conclusion: Left ventriculae EF was not sensitive indicator for the detection of subclinical systolic dysfunction, but decrease of Sm appeared as the first sign of systolic abnormalities following established diastolic dysfunction and was the clear reflection of LV remodeling process. This suggests that Sm may aid in the identification of patients at high risk for development of CHF who need preventive treatment.
Infection, 2022
Purpose High mortality and a limited performance of valvular surgery are typical features of infe... more Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
Vojnosanitetski pregled
Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgi... more Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patien...
BMC Proceedings
Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a ... more Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspect...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2014
Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right a... more Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right atrium into 2 chambers. We report the case of a 43-year-old woman who had cor triatriatum dexter and a large atrial septal defect. During attempted percutaneous closure, the balloon disrupted the membrane and revealed that the defect had no inferior rim, precluding secure placement of an Amplatzer Septal Occluder. Surgical treatment subsequently proved to be successful. In patients with an incomplete membrane and a septal defect with well-defined rims, percutaneous treatment can be the first choice. In patients who have cor triatriatum dexter and unfavorable anatomic features or concomitant complex heart anomalies, open-heart surgery remains the gold standard for treatment.
The Journal of Thoracic and Cardiovascular Surgery, 2020
Objective: Chronic kidney disease is a known risk factor in cardiovascular disease, but its influ... more Objective: Chronic kidney disease is a known risk factor in cardiovascular disease, but its influence on treatment effect of bypass surgery remains unclear. We assessed the influence of chronic kidney disease on 10-year mortality and cardiovascular outcomes in patients with ischemic heart failure treated with medical therapy (medical treatment) with or without coronary artery bypass grafting. Methods: We calculated the baseline estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula, chronic kidney disease stages 1-5) from 1209 patients randomized to medical treatment or coronary artery bypass grafting in the Surgical Treatment for IsChemic Heart failure trial and assessed its effect on outcome.
Journal of Cardiology Cases, 2015
Recently in Japan, transcatheter aortic valve implantation (TAVI) has become available for patien... more Recently in Japan, transcatheter aortic valve implantation (TAVI) has become available for patients with severe aortic stenosis who are deemed inoperable or who have too high risk for conventional surgical aortic valve replacement (AVR). TAVI is a minimally invasive procedure in which surgical incisions are limited and cardiopulmonary bypass is usually unnecessary. Furthermore, because it can be performed quickly, the patients have less chance of surgically-related bacteremia causing prosthetic valve endocarditis (PVE) soon after the operation. In fact, it is known that PVE after TAVI is rare. We experienced a case of TAVI complicated with early postprocedural PVE, which subsequently required surgical AVR. Case report An 80-year-old male presented for elective TAVI for symptomatic severe aortic stenosis. Preoperative transthoracic echocardiography (TTE) demonstrated severe, tricuspid, and calcified aortic stenosis with a peak transvalvular pressure gradient of 108 mmHg (mean 64 mmHg) and a calculated aortic valve area of 0.86 cm 2. In addition, he had multiple co-morbidities including chronic kidney disease (estimated glomerular filtration ratio: 33.9 mL/min/1.73 m 2), and a remote history of cerebral infarction, bronchial asthma, hypertension, and prostatic cancer. Since preoperative coronary angiography showed severe stenosis of
Thank you for your thoughtful analysis of our paper. We tried to answer to all of your comments, ... more Thank you for your thoughtful analysis of our paper. We tried to answer to all of your comments, as it is described below. General comments Comment 1. Where were the radial artery grafts deployed to? Were they deployed to the next most significant artery with a tight stenoses (> 80%) or were they deployed to whatever artery the surgeon chose at that time? Answer: To clarify this important issue we added the following in the Methods: "... All RA grafts were deployed to the artery with at least 80% stenosis, providing that it is considered an important coronary artery (smaller, same territory arteries or arteries supplying heavily infarcted areas were not grafted with radial artery). ..." Comment 2. The authors should include a table of the distribution of radial artery grafts to make it easy for the reader to follow.. Answer: We have included the Table 2 and renumbered the other tables consecutively.
Circulation, 2014
Background: Among patients with ischemic heart failure with reduced ejection fraction (EF), the i... more Background: Among patients with ischemic heart failure with reduced ejection fraction (EF), the impact of medical therapy (MED) versus coronary artery bypass grafting (CABG) on left ventricular (LV) structure and function has not been well established. Method: The STICH trial randomized 1212 ischemic heart failure patients (EF ≤ 35%) to CABG or MED from 2002 through 2007. Echocardiogram, cardiac MRI, or radionuclide scan at baseline and 4 months were interpreted by blinded core labs. Among patients with paired imaging at baseline and 4 months, the change in EF, LV end systolic volume index (ESVI), and end diastolic volume index (EDVI) were evaluated by treatment as randomized. The association between changes at 4 months in EF, LVESVI and/or LVEDVI with subsequent all-cause mortality (50 months median follow-up) was tested in landmark analyses with the Cox model. Results: Paired images were available on 523 patients (266 MED and 257 CABG) surviving to 4 months. EF improved slightly a...
Circulation, 2016
Introduction: Studies have shown sex-specific differences regarding CAD and heart failure with le... more Introduction: Studies have shown sex-specific differences regarding CAD and heart failure with left ventricular (LV) dysfunction. Whether these differences impact the benefit of CABG in patients with ischemic LV dysfunction has not been studied prospectively. Female sex is conventionally considered a risk factor for open-heart surgery, and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We investigated the impact of sex on the long-term benefit of CABG in patients enrolled in the prospective Surgical Treatment for Ischemic Heart Failure Study (STICH) trial. Method: The STICH trial randomized 1212 patients [148 (12%) women and 1064 (88%) men] with CAD and EF≤ 35% to medical therapy alone (MED) versus MED plus CABG. Long-term (10-year) outcomes with each treatment were compared according to sex. Results: At baseline, women were older with higher BMI and more CAD risk factors (e.g. diabetes) except for smoking, and had lower rates of ...
Background The role of coronary-artery bypass grafting (CABG) in the treatment of patients with c... more Background The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. Methods Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. Results The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P = 0.12). A total of 201 patients (33%) in the medicaltherapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the followup period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. Conclusions In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
Journal of the American College of Cardiology
Vojnosanitetski pregled
Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly ... more Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly determined for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) by literature at present. The aim of this study was to suggest risk groups categorization within EuroSCORE II risk statification model. Methods. A 7,641 consecutive patients were scored preoperatively using EuroSCORE II. The end point for the study was in-hospital mortality accross the risk group categories. Patients with EuroSCORE II values of ? 2.50, > 2.50?6.50%, and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by Hosmer-Lemeshow statistics, and with observed/expected (O/E) mortality ratio. Results. Inhospital mortality observed in our sample was 3.85% (295 out of 7,641 patients). The ...
BMC Cardiovascular Disorders
Background Chronic heart failure (CHF) is a severe condition, often co-occurring with depression ... more Background Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2–3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. Methods 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. Results It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001),...
European Journal of Cardio-Thoracic Surgery, 2021
OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculat... more OBJECTIVES The German Registry of Acute Aortic Dissection Type A (GERAADA) on-line score calculator to predict 30-day mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD) was recently launched. Using the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), it is also possible to predict operative mortality for the same type of surgery. The goal of our study was to validate the prediction accuracy of these 2 on-line risk prediction models. METHODS Prospectively collected data for EuroSCORE II risk factors as well as all data for GERAADA scoring were extracted from an institutional database for 147 patients who underwent surgery for ATAAD between April 2018 and April 2021. The discriminative power was assessed using area under the receiver operating characteristic curve. The calibration of the models was tested by the Hosmer–Lemeshow statistics and by using the observed-to-expected (O/E) mortality ratio with the 95% confidence interva...
European Journal of Neurology, 2001
ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of up... more ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).
Interactive Cardiovascular and Thoracic Surgery, May 6, 2022
The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterize... more The progeroid syndrome includes a group of rare, severe genetic disorders clinically characterized by premature physical ageing. Severe aortic stenosis has been described in progeria patients, but no previous surgical aortic valve replacement was reported. We describe a successful surgical aortic valve replacement combined with coronary artery bypass grafting in a progeria patient with severe aortic stenosis and a small aortic annulus.
Vojnosanitetski Pregled, 2019
Background/Aim. The EuroSCORE II has recently been developed with an idea to provide better accur... more Background/Aim. The EuroSCORE II has recently been developed with an idea to provide better accuracy in prediction of perioperative mortality in the patients who underwent open heart surgery. The aim of this study was to validate clinical performances of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk stratification model in the Serbian adult cardiac surgical population undergoing open heart surgery. Methods. The Euro-SCORE II values on 10,048 consecutive patients undergoing major adult cardiac surgery from 1st January 2012 to 31st March 2017, were prospectively calculated and entered the institutional database. The discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by the Hosmer-Lemeshow (H-L) statistics and the observed to expected (O/E) mortality ratio. The patients with the EuroSCORE II values of 0.5-2.50%, > 2.50-6.50%), and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Results. The observed in-hospital mortality was 3.86% (388 of 10,048) and the mean predicted mortality by the Euro-SCORE II was 3.61%. The discriminatory power was very Key words: mortality; predictive value of tests; risk assessment; thoracic surgical procedures. Apstrakt Uvod/Cilj. EuroSCORE II je razvijen nedavno sa idejom da se obezbedi bolja tačnost u predviđanju perioperativnog mortaliteta bolesnika podvrgnutih operacijama na otvorenom srcu. Cilj rada je bio da se provere kliničke performanse modela za stratifikaciju operativnog rizika u kardiohirur-giji-EuroSCORE II (Evropski sistem za procenu kadiohirurškog operativnog rizika) kod odraslih bolesnika u Srbiji kod kojih se izvode kardiohirurške procedure. Metode. Vrednosti EuroSCORE II za 10 048 uzastopno operisanih (od 1. januara 2012. do 31. marta 2017. godine) odraslih kardiohirurških bolesnika prospektivno su izračunate i unete u bazu podataka Instituta za kardiovaskularne bolesti Ključne reči: mortalitet; testovi, prognostička vrednost; rizik, procena; hirurgija, torakalna, procedure.
European Heart Journal, 2013
Background: Hypertension is a potent risk factor for congestive heart failure (CHF). Development ... more Background: Hypertension is a potent risk factor for congestive heart failure (CHF). Development of overt CHF may be preceded by a phase of asymptomatic left venrticular systolic dysfunction. The aim of this study was early detection of alteration in left ventricular systolic function. Methods: 120 hypertensive patients, with preserved ejection fraction (EF), were divided in three groups according LVDD: normal (n=40), abnormal relaxation (Grade I, n=37) and pseudonormal (Grade II, n=43). Left atrial volume index (LAVI), left ventricular mass index (LVMI), left ventricular dimensions and volume inexes (LVEDV/BSA and LVESV/BSA) and EF were estimated by echocardiography. We measured coresponding velocities from tissue Doppler at the level of the septal mitral annulus (Em, Am, Sm), including E/Em and tissue Doppler myocardial performance index (tMPI). The same measurements were repeated after three years. Results: Close correlations were found between Sm and EF (r=0.349; p=0.0009), LVMI (r=-0.222; p=0.015), LVEDV/BSA (r =-0.317; p=0.0004) and LVESV/BSA (r =-0.472; p=0.0005). Levels of LVEDV/BSA (89.3 vs 103.8 vs 101.7; p=0.009), LVESV/BSA (34.0 vs 42.9 vs 44.0; p=0.0004), LVMI (104.3 vs 112.5 vs 123.0; p=0.0004), LAVI (32.0 vs 35.5 vs 44.5; p=0.0001) and MPI (61.7 vs 72.1 vs 76.3; p=0.036) progressively increased from the normal group through LVDD Grade I and II groups. Significantly different values of EF (63 vs 61 vs 59; p=0.003) and Sm (0.074 vs 0.067 vs 0.059; p=0.003) were obtained between groups too, but with progressively decrease from the normal group through LVDD Grade I and II groups. General linear model for repeated measures showed increase of LVEDV/BSA (F=50.009; p<0.001), LVESV/BSA (F=34.258; p<0.001), LVMI (F=27.648; p<0.001), LAVI (F=17.083; p<0.001) and tMPI (F=35.842; p<0.001) during three years, with significant time difference, but withot significant difference between groups, these parameters enarged in all groups almost at the same manner. Sm also significantly changed during three years with significant time difference (F=128.24; p<0.001) and with significant difference between groups (F=4.597; p< 0,012), Sm decrease in all groups, but most expressed in LVDD Grade II group. Conclusion: Left ventriculae EF was not sensitive indicator for the detection of subclinical systolic dysfunction, but decrease of Sm appeared as the first sign of systolic abnormalities following established diastolic dysfunction and was the clear reflection of LV remodeling process. This suggests that Sm may aid in the identification of patients at high risk for development of CHF who need preventive treatment.
Infection, 2022
Purpose High mortality and a limited performance of valvular surgery are typical features of infe... more Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
Vojnosanitetski pregled
Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgi... more Background/Aim. The transobturator tape (TOT) procedure is considered as a gold standard of surgical treatment option for stress urinary incontinence (SUI). The aim of this study was to determine the efficacy of this procedure in the surgical management of SUI by analyzing a single centre short-term results. Methods. From April 2011 until January 2018, 40 patients with predominantly SUI were operated by the standard TOT procedure. A polypropylene tape was placed in the mid-urethra by a percutaneous transobturator approach. The postoperative assessment considered cough tests and post-void residual urine volume at a week following the operation with additional clinical examination and urine culture at one, three and six months. Results. The mean age of the patients was 58 (42?78) years. Predominantly SUI was present in 32 patients (80%) and mixed urine incontinence in 8 patients (20%). At the initial (one week) assessment, the cough test was positive in 3 patients (7.5%), and 4 patien...
BMC Proceedings
Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a ... more Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspect...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2014
Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right a... more Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right atrium into 2 chambers. We report the case of a 43-year-old woman who had cor triatriatum dexter and a large atrial septal defect. During attempted percutaneous closure, the balloon disrupted the membrane and revealed that the defect had no inferior rim, precluding secure placement of an Amplatzer Septal Occluder. Surgical treatment subsequently proved to be successful. In patients with an incomplete membrane and a septal defect with well-defined rims, percutaneous treatment can be the first choice. In patients who have cor triatriatum dexter and unfavorable anatomic features or concomitant complex heart anomalies, open-heart surgery remains the gold standard for treatment.
The Journal of Thoracic and Cardiovascular Surgery, 2020
Objective: Chronic kidney disease is a known risk factor in cardiovascular disease, but its influ... more Objective: Chronic kidney disease is a known risk factor in cardiovascular disease, but its influence on treatment effect of bypass surgery remains unclear. We assessed the influence of chronic kidney disease on 10-year mortality and cardiovascular outcomes in patients with ischemic heart failure treated with medical therapy (medical treatment) with or without coronary artery bypass grafting. Methods: We calculated the baseline estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration formula, chronic kidney disease stages 1-5) from 1209 patients randomized to medical treatment or coronary artery bypass grafting in the Surgical Treatment for IsChemic Heart failure trial and assessed its effect on outcome.
Journal of Cardiology Cases, 2015
Recently in Japan, transcatheter aortic valve implantation (TAVI) has become available for patien... more Recently in Japan, transcatheter aortic valve implantation (TAVI) has become available for patients with severe aortic stenosis who are deemed inoperable or who have too high risk for conventional surgical aortic valve replacement (AVR). TAVI is a minimally invasive procedure in which surgical incisions are limited and cardiopulmonary bypass is usually unnecessary. Furthermore, because it can be performed quickly, the patients have less chance of surgically-related bacteremia causing prosthetic valve endocarditis (PVE) soon after the operation. In fact, it is known that PVE after TAVI is rare. We experienced a case of TAVI complicated with early postprocedural PVE, which subsequently required surgical AVR. Case report An 80-year-old male presented for elective TAVI for symptomatic severe aortic stenosis. Preoperative transthoracic echocardiography (TTE) demonstrated severe, tricuspid, and calcified aortic stenosis with a peak transvalvular pressure gradient of 108 mmHg (mean 64 mmHg) and a calculated aortic valve area of 0.86 cm 2. In addition, he had multiple co-morbidities including chronic kidney disease (estimated glomerular filtration ratio: 33.9 mL/min/1.73 m 2), and a remote history of cerebral infarction, bronchial asthma, hypertension, and prostatic cancer. Since preoperative coronary angiography showed severe stenosis of
Thank you for your thoughtful analysis of our paper. We tried to answer to all of your comments, ... more Thank you for your thoughtful analysis of our paper. We tried to answer to all of your comments, as it is described below. General comments Comment 1. Where were the radial artery grafts deployed to? Were they deployed to the next most significant artery with a tight stenoses (> 80%) or were they deployed to whatever artery the surgeon chose at that time? Answer: To clarify this important issue we added the following in the Methods: "... All RA grafts were deployed to the artery with at least 80% stenosis, providing that it is considered an important coronary artery (smaller, same territory arteries or arteries supplying heavily infarcted areas were not grafted with radial artery). ..." Comment 2. The authors should include a table of the distribution of radial artery grafts to make it easy for the reader to follow.. Answer: We have included the Table 2 and renumbered the other tables consecutively.
Circulation, 2014
Background: Among patients with ischemic heart failure with reduced ejection fraction (EF), the i... more Background: Among patients with ischemic heart failure with reduced ejection fraction (EF), the impact of medical therapy (MED) versus coronary artery bypass grafting (CABG) on left ventricular (LV) structure and function has not been well established. Method: The STICH trial randomized 1212 ischemic heart failure patients (EF ≤ 35%) to CABG or MED from 2002 through 2007. Echocardiogram, cardiac MRI, or radionuclide scan at baseline and 4 months were interpreted by blinded core labs. Among patients with paired imaging at baseline and 4 months, the change in EF, LV end systolic volume index (ESVI), and end diastolic volume index (EDVI) were evaluated by treatment as randomized. The association between changes at 4 months in EF, LVESVI and/or LVEDVI with subsequent all-cause mortality (50 months median follow-up) was tested in landmark analyses with the Cox model. Results: Paired images were available on 523 patients (266 MED and 257 CABG) surviving to 4 months. EF improved slightly a...
Circulation, 2016
Introduction: Studies have shown sex-specific differences regarding CAD and heart failure with le... more Introduction: Studies have shown sex-specific differences regarding CAD and heart failure with left ventricular (LV) dysfunction. Whether these differences impact the benefit of CABG in patients with ischemic LV dysfunction has not been studied prospectively. Female sex is conventionally considered a risk factor for open-heart surgery, and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We investigated the impact of sex on the long-term benefit of CABG in patients enrolled in the prospective Surgical Treatment for Ischemic Heart Failure Study (STICH) trial. Method: The STICH trial randomized 1212 patients [148 (12%) women and 1064 (88%) men] with CAD and EF≤ 35% to medical therapy alone (MED) versus MED plus CABG. Long-term (10-year) outcomes with each treatment were compared according to sex. Results: At baseline, women were older with higher BMI and more CAD risk factors (e.g. diabetes) except for smoking, and had lower rates of ...
Background The role of coronary-artery bypass grafting (CABG) in the treatment of patients with c... more Background The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. Methods Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. Results The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P = 0.12). A total of 201 patients (33%) in the medicaltherapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the followup period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. Conclusions In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes.
Journal of the American College of Cardiology
Vojnosanitetski pregled
Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly ... more Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly determined for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) by literature at present. The aim of this study was to suggest risk groups categorization within EuroSCORE II risk statification model. Methods. A 7,641 consecutive patients were scored preoperatively using EuroSCORE II. The end point for the study was in-hospital mortality accross the risk group categories. Patients with EuroSCORE II values of ? 2.50, > 2.50?6.50%, and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by Hosmer-Lemeshow statistics, and with observed/expected (O/E) mortality ratio. Results. Inhospital mortality observed in our sample was 3.85% (295 out of 7,641 patients). The ...