Ilija Srdanovic - Academia.edu (original) (raw)

Papers by Ilija Srdanovic

Research paper thumbnail of Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Research paper thumbnail of Intravascular imaging and drug-coated balloons for unprotected left main percutaneous coronary interventions: Questions with a predictable or unpredictable answer? Author’s reply

Research paper thumbnail of Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry

European Heart Journal

Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challe... more Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). Methods and results This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04–1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41–0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly d...

Research paper thumbnail of Percutaneous coronary intervention to treat unprotected left main: Common (un-answered) challenges

Kardiologia Polska

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely a... more Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely adopted strategy to obtain myocardial revascularization in patients with unprotected left main (LM) disease. Although thoroughly investigated across scientific literature, LM PCI offers patient-specific technical options and poses many operative challenges that cannot be fully addressed by the published studies. Therefore, we have summarized and discussed in this review possible options related to PCI in LM patients. First, functional and imaging assessment for LM is still evolving and requires increased dedication to identify patients requiring revascularization and to enhance the results in the case of PCI performance. Second, specific coronary atherosclerosis patterns of LM involvement (like an isolated ostial disease of one of its bifurcation branches, extensive disease jeopardizing both branches, etc.) pose specific challenges for DES implantation so that careful selection of technical options (stepwise provisional single stent, upfront 2-stent strategy, when and how apply "kissing ballooning") is required. Third, despite improvement of techniques, PCI-related ischemia might not be tolerated by some patients with LM disease so mechanical circulatory support devices may come into play.

Research paper thumbnail of P4653Complete myocardial revascularization in patients with STEMI complicated by cardiogenic shock

European Heart Journal, 2017

Methods: WHO recommends that least 5% of gross domestic product (GDP) should be spent on health (... more Methods: WHO recommends that least 5% of gross domestic product (GDP) should be spent on health (public health care expenditures; PHE). Bosnia and Herzegovina, Croatia, and Serbia have higher values. Macedonia, Romania Lithuania, Russian Federation, Kosovo and Montenegro, have lower values. The primary outcome was CMS concordant care, defined as 100% compliance with 6 measures: 1) aspirin administration within 24 hours of hospital arrival; discharge prescriptions for 2) aspirin, 3) β-blockers, or 4) statins; 5) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker among those patients with an ejection fraction <40%; and 6) time from hospital arrival to primary PCI ≤90 minutes. In addition we analyzed the achievement of a shorter (≤2 hours) time from symptom onset to hospital admission Results: 30-day mortality was 7.6% in both low and high PHE patients. The ageadjusted all-cause mortality was similar for low versus high PHE patients (OR: 1.10; 95% CI: 0.94-1.30). Rates of reperfusion therapy by PCI were greater in high PHE patients (OR: 1.54; 95% CI: 1.41-1.69). Adherence to individual process measures was relatively low, with composite measure adherences exceeding 60% in high and 45% in low PHE patients. Composite adherence for CMS performance measures was inversely associated with age-adjusted 30 day mortality both in low PHE patients (OR: 0.32; 95% CI 0.21-0.49) and in high PHE patients (OR: 0.23; 95% CI 0.14-0.42). The odds of mortality became consistently lower in high versus low PHE patients when analysis was restricted to patients having time from symptom onset to admission ≤2 hrs (OR: 0.59, 95% CI: 0.40-0.86). Conclusions: CMS process performance is associated with mortality. Time to admission is a potentially important proxy measure for the overall STEMI quality of care, which may be used as complementary metrics in addition to CMS performance measures of care

Research paper thumbnail of Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

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.

Research paper thumbnail of “TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

Srpski arhiv za celokupno lekarstvo, 2021

Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who d... more Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who developed non-ST segment elevation myocardial infarction complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for left anterior descending artery (LAD) and ramus circumflex artery (RCX). Case outline. A 72-year-old woman was admitted to the coronary care unit as an emergency in September 2017 due to acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with thrombolysis in myocardial infarction (TIMI) grade 2 flow. According to the general condition of patient, a life-saving ad hoc percutaneous coronary intervention (PCI) was performed. Two stents were implanted in the Y graft with T and protrusion (TAP) technique achieving optimal result followed with p...

Research paper thumbnail of Myocardial injury triggered by combination of emotional stress and carbon monoxide poisoning

Srce i krvni sudovi, 2018

Case presentation UDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGY SOCIETY OF SERBIA Introduction: Carbon m... more Case presentation UDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGY SOCIETY OF SERBIA Introduction: Carbon monoxide (CO) is a leading cause of poisoning worldwide.Central nervous systems and the heart have the highest demand for oxygen and may be severely injured in CO poisoning. Case report: A patient was referred to the emergency department after exposure to CO and strong emotional stress. On admission she was comatose with elevated lactate 14,62, metHgb 0,3% and carboxyhemoglobin 12,9%. Electrocardiogram showed sinus rhythm, 100 beats/min, poor R wave progression with inverted T waves in V1-V3 leads, biphasic T waves in V5 and V6. Transthoracic echocardioography showed left ventricle with akinetic apex and all apical segments of the left ventricle with reduced systolic function. Cardiac troponin was significantly elevated; coronary angiography showed normal coronary arteries without culprit lesion. Takotsubo syndrome was diagnosed. She was treated with high flow oxygen on mechanical ventilation, antiplatelet, angiotenzinconvertase inhibitors, beta blockers and statin therapy with complete recovery. After one month ehocardiography showed left ventricle normal in size and function. Conclusion: CO poisoning hasn't yet been described as a trigger for Takotsubo syndrome. We propose that two risk factors CO poisoning and stress by may have initiated a catecholamine surge and caused the development of this specific condition. carbon monoxide poisoning, cardiotoxicity, takotsubo syndrome

Research paper thumbnail of Serum Bilirubin Level at Admission Predicts In-Hospital Outcome in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Journal of Hypertension, 2018

Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial inf... more Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial infarction. Serum cortisol is one such laboratory marker. There are only few studies done in the recent past which prove that cortisol is a prognostic marker in STEMI. Methods: We studied a total of 168 patients who presented with STEMI and underwent primary percutaneous intervention (PPCI) within 12 hours of symptom onset between April 2016 and November 2016. Results: The average age of study population was 61 ± 0.12 years. Males were predominant (n = 132, 78.57%). 155 patients survived, whereas 13 patients died in the hospital. Mean syntax score was 16.65 ±5. 33 among patients who died, whereas it was 13.11 ± 5.62 among survivors (P = 0.03). Mean cortisol was significantly higher among the patients who died (46.13 ± 14.61 mcg/dl) than the survivors (31.16 ± 13.16 mcg/dl) (P = 0.003). The ROC AUC for in-hospital mortality was 0.77 (95% confidence interval [CI], 0.645-0.897). An optimal cut-point identified from the ROC curve was a random serum cortisol concentration of 33.66 mcg/dl, with corresponding sensitivity and specificity of 69.2 % and 64 %, respectively. At a cut-point of 29.55 mcg/dl, sensitivity and specificity were 84.6 and 50 %, respectively. Conclusion: This study showed that serum cortisol level is a strong predictor of mortality in patients undergoing PPCI for STEMI. Levels more than 33.66 mcg/dl can predict mortality with a sensitivity of almost 70 percent and specificity of 64 percent.

Research paper thumbnail of Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

ESC Heart Failure, 2020

Aims This study aimed to investigate whether the risk of short-term mortality is different in pul... more Aims This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P ¼ 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P ¼ 0.01), and right ventricle systolic pressure (P ¼ 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. Conclusions Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.

Research paper thumbnail of Infective endocarditis of partial atrioventricular septal defect: A case report

Vojnosanitetski pregled, 2018

Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease... more Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease (CHD) rarely detected in adults. Infective endocarditis represents a severe complication that carries a substantial risk. Case report. We here reported a case of a 43-year-old female with previously diagnosed adult CHD (partial AVSD and bicuspid aortic valve) presented to the hospital with fever and malaise 14 days prior to admission. On the lung computed tomography scan inflammatory consolidations were found and dual antibiotic therapy (ceftazidime and clarithromycin) was administered without significant regression of pulmonary inflammatory consolidations. The antibiotic treatment was continued with amoxicillin/clavulanic acid combined with levofloxacin and metronidazole. Transthoracic and transesophageal echocardiography revealed a large vegetation (dimension, 3.6 x 1.8 cm) attached to the septal leaflet of the tricuspid valve floating between right atrium and right ventricle through ...

Research paper thumbnail of Primary mitral regurgitation: Echo evaluation

Srce i krvni sudovi, 2018

Research paper thumbnail of Renal dysfunction as intrahospital prognostic indicator in acute pulmonary embolism

International Journal of Cardiology, 2019

Background: Acute pulmonary embolism (PE), due to hemodynamic disturbances, may lead to multi-org... more Background: Acute pulmonary embolism (PE), due to hemodynamic disturbances, may lead to multi-organ damage, including acute renal dysfunction. The aim of our study was to investigate the predictive role of renal dysfunction at admission regarding the short-term mortality and bleeding risk in hospitalized PE patients. Methods: The retrospective cohort study included 1330 consecutive patients with PE. The glomerular filtration rate (GFR) was calculated using the serum creatinine value and Cocroft-Gault formula, at hospital admission. Primary outcomes were all-cause mortality and PE-related mortality in the 30 days following admission, as well as major bleeding events. Results: Based on the estimated GFR, patients were divided into three groups: the first with GFR b 30 mL/min, the second with GFR 30-60 mL/min, and the third group with GFR N 60 mL/min. A multivariable analysis showed that GFR at admission was strongly associated with all-cause death, as well as with death due to PE. Patients in the first and second group had a significantly higher risk of 30-day all-cause mortality (HR 7.109, 95% CI 4.243-11.911, p b 0.001; HR 2.554, 95% CI 1.598-4.081, p b 0.001). Fatal bleeding was recorded in 1.6%, 0.5% and 0.8% of patients in the first, second and in the third group (p b 0.05). There were no significant differences regarding major bleeding rates among the groups. Conclusion: Renal dysfunction at admission in patients with acute pulmonary embolism is strongly associated with overall PE mortality.

Research paper thumbnail of Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor

International Journal of Cardiology, 2019

Background. The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicia... more Background. The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicians at individualizing the optimal dual antiplatelet therapy duration (DAPT) after percutaneous coronary intervention (PCI). Nevertheless, external validation of these RSs it has not yet been performed in ACS (acute coronary syndrome) patients treated with prasugrel or ticagrelor in a real-world scenario. Methods: 4,424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to December 2016 at 12 European centers, were included. PRECISE-DAPT and PARIS bleeding RS, as well as PARIS ischemic RS, were computed, and their performance at predicting major bleeding (MB; BARC type 3 or 5) and ischemic events (MI and stent thrombosis) during follow up was compared. Results: After a median follow-up of 14 (interquartile range 12-20.9) months, 83 (1.88%) patients developed MB and 133 (3.0%) suffered an ischemic episode. PRECISE-DAPT performed better than PARIS bleeding RS (c-statistic= 0.653 vs. 0.593; p= 0.01 for comparison) in predicting MB. The RSs performance for MB prediction remained consistent in STEMI patients (c-statistic= 0.632 vs 0.575) or in those treated with prasugrel (c-statistic = 0.623 vs 0.586). PARIS ischemic RS exhibited modest but superior discrimination in predicting ischemic complications as compared to PRECISE-DAPT (c-statistic= 0.604 vs 0.568 p= 0.05 for comparison). Conclusion: Our data provide support to the use of PRECISE-DAPT in MB risk stratification for patients receiving DAPT in form of aspirin and prasugrel or ticagrelor whereas the PARIS ischemic RS has potential to complement the risk prediction with respect to ischemic events.

Research paper thumbnail of Extracorporeal life support for severe cardiogenic shock induced by diltiazem intoxication

Vojnosanitetski pregled, 2019

Introduction. Management of cardiogenic shock caused by severe drug intoxication is always challe... more Introduction. Management of cardiogenic shock caused by severe drug intoxication is always challenging. In case of multidrug intoxication, a result, despite aggressive medical therapy, is often unpredictable. Utilization of extracorporeal life support devices in these cases has been suggested and reported results are promising. Case report. We presented a case of profound cardiogenic and distributive shock caused by suicidal intoxication with diltiazem and anionic surfactant ingestion in a 36-year-old woman. The patient ingested more than 90 tablets of diltiazem of 90 mg (ingested dose of 8.1 g), and 4 pieces of household toilet refresh agent containing anionic surfactant. During the admission, systemic blood pressure was 65/40 mmHg, heart rate 45 beats per minute, with signs of metabolic acidosis. The patient underwent several repeated gastric lavages. Emergent fluid resuscitation, calcium gluconate, insulin and vasopressive agents (dopamine and noradrenaline) infusions were admini...

Research paper thumbnail of Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

Vojnosanitetski pregled, 2018

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and ... more Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The ...

Research paper thumbnail of Ventriculoatrial synchrony induced heart failure

Acta Clinica Belgica, 2018

Objective and importance: Endless loop tachycardia or pacemaker-mediated tachycardia, and atriove... more Objective and importance: Endless loop tachycardia or pacemaker-mediated tachycardia, and atrioventricular desynchronization arrhythmia or repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are two forms of reverse impulse conduction-ventriculoatrial (VA) synchrony. Although VA synchrony can theoretically cause aggravation of heart failure, clinical cases describing severe consequential heart failure are lacking. Clinical presentation and intervention: We describe a case of a 60-year-old patient who underwent primary percutaneous coronary intervention and mitral valve surgery. Implantation of a two-chamber pacemaker was also performed during the same hospitalization due to development of third-degree atrioventricular block. Ten months later, he presented with a severe form of heart failure with a significant reduction of left ventricular ejection fraction (LVEF). The atrial lead was displaced and VA synchrony was registered (RNRVAS-like condition). The pacemaker was reprogrammed and VA synchrony induced heart failure was successfully resolved. Echocardiographic follow-up showed improvement in LVEF. Conclusion: Ventriculoatrial conduction can be present even when the patient has a complete atrioventricular block. Atrial lead displacement and consequently loss of atrial capture with preserved sensing can be a predisposing factor for initiation of ventriculoatrial synchrony. Permanent ventriculoatrial synchrony may provoke aggravation of heart failure.

Research paper thumbnail of Late complications of transcatheter atrial septal defect closure requiring urgent surgery

Postepy w kardiologii interwencyjnej = Advances in interventional cardiology, 2017

Research paper thumbnail of Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients

Advances in Interventional Cardiology, 2017

Introduction: Psychological characteristics of patients, depression, stress and anxiety are recog... more Introduction: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). Material and methods: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. Results: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

Research paper thumbnail of Effects of tirofiban and percutaneous coronary intervention in an old patient with acute myocardial infarction and cardiogenic shock

Medical review, 2010

A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ... more A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ST-segment elevation myocardial infarction and cardiogenic shock, 40 minutes after the pain onset. He was pretreated with 300 mg of aspirin, 600 mg of clopidogrel, and was taken to the catheterization laboratory. Door to needle time was 35 minutes. Primary percutaneous coronary intervention with bare-metal stent implantation first in infarct related right coronary artery, with subsequent high-bolus dose (25 fig/kg) tirofiban, and then in suboccluded RCx were done. The procedures were done during the cardio-pulmo-cerebral reanimation because of relapsing ventricular fibrillation, with final TIMI 3 coronary flow established. Subsequently, intraaortic balloon pump was inserted. Echocardiography taken on the second day showed globaly hypokinetic left ventricle, with 10% ejection fraction and competent valves. During the next three weeks of hospital follow-up, there were no major adverse card...

Research paper thumbnail of Correction to: Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

Research paper thumbnail of Intravascular imaging and drug-coated balloons for unprotected left main percutaneous coronary interventions: Questions with a predictable or unpredictable answer? Author’s reply

Research paper thumbnail of Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry

European Heart Journal

Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challe... more Aim Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). Methods and results This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04–1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41–0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly d...

Research paper thumbnail of Percutaneous coronary intervention to treat unprotected left main: Common (un-answered) challenges

Kardiologia Polska

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely a... more Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely adopted strategy to obtain myocardial revascularization in patients with unprotected left main (LM) disease. Although thoroughly investigated across scientific literature, LM PCI offers patient-specific technical options and poses many operative challenges that cannot be fully addressed by the published studies. Therefore, we have summarized and discussed in this review possible options related to PCI in LM patients. First, functional and imaging assessment for LM is still evolving and requires increased dedication to identify patients requiring revascularization and to enhance the results in the case of PCI performance. Second, specific coronary atherosclerosis patterns of LM involvement (like an isolated ostial disease of one of its bifurcation branches, extensive disease jeopardizing both branches, etc.) pose specific challenges for DES implantation so that careful selection of technical options (stepwise provisional single stent, upfront 2-stent strategy, when and how apply "kissing ballooning") is required. Third, despite improvement of techniques, PCI-related ischemia might not be tolerated by some patients with LM disease so mechanical circulatory support devices may come into play.

Research paper thumbnail of P4653Complete myocardial revascularization in patients with STEMI complicated by cardiogenic shock

European Heart Journal, 2017

Methods: WHO recommends that least 5% of gross domestic product (GDP) should be spent on health (... more Methods: WHO recommends that least 5% of gross domestic product (GDP) should be spent on health (public health care expenditures; PHE). Bosnia and Herzegovina, Croatia, and Serbia have higher values. Macedonia, Romania Lithuania, Russian Federation, Kosovo and Montenegro, have lower values. The primary outcome was CMS concordant care, defined as 100% compliance with 6 measures: 1) aspirin administration within 24 hours of hospital arrival; discharge prescriptions for 2) aspirin, 3) β-blockers, or 4) statins; 5) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker among those patients with an ejection fraction <40%; and 6) time from hospital arrival to primary PCI ≤90 minutes. In addition we analyzed the achievement of a shorter (≤2 hours) time from symptom onset to hospital admission Results: 30-day mortality was 7.6% in both low and high PHE patients. The ageadjusted all-cause mortality was similar for low versus high PHE patients (OR: 1.10; 95% CI: 0.94-1.30). Rates of reperfusion therapy by PCI were greater in high PHE patients (OR: 1.54; 95% CI: 1.41-1.69). Adherence to individual process measures was relatively low, with composite measure adherences exceeding 60% in high and 45% in low PHE patients. Composite adherence for CMS performance measures was inversely associated with age-adjusted 30 day mortality both in low PHE patients (OR: 0.32; 95% CI 0.21-0.49) and in high PHE patients (OR: 0.23; 95% CI 0.14-0.42). The odds of mortality became consistently lower in high versus low PHE patients when analysis was restricted to patients having time from symptom onset to admission ≤2 hrs (OR: 0.59, 95% CI: 0.40-0.86). Conclusions: CMS process performance is associated with mortality. Time to admission is a potentially important proxy measure for the overall STEMI quality of care, which may be used as complementary metrics in addition to CMS performance measures of care

Research paper thumbnail of Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry

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.

Research paper thumbnail of “TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

Srpski arhiv za celokupno lekarstvo, 2021

Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who d... more Introduction. Bifurcation lesions on venous Y grafts are rare. We present a case of a woman who developed non-ST segment elevation myocardial infarction complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for left anterior descending artery (LAD) and ramus circumflex artery (RCX). Case outline. A 72-year-old woman was admitted to the coronary care unit as an emergency in September 2017 due to acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with thrombolysis in myocardial infarction (TIMI) grade 2 flow. According to the general condition of patient, a life-saving ad hoc percutaneous coronary intervention (PCI) was performed. Two stents were implanted in the Y graft with T and protrusion (TAP) technique achieving optimal result followed with p...

Research paper thumbnail of Myocardial injury triggered by combination of emotional stress and carbon monoxide poisoning

Srce i krvni sudovi, 2018

Case presentation UDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGY SOCIETY OF SERBIA Introduction: Carbon m... more Case presentation UDRUŽENJE KARDIOLOGA SRBIJE CARDIOLOGY SOCIETY OF SERBIA Introduction: Carbon monoxide (CO) is a leading cause of poisoning worldwide.Central nervous systems and the heart have the highest demand for oxygen and may be severely injured in CO poisoning. Case report: A patient was referred to the emergency department after exposure to CO and strong emotional stress. On admission she was comatose with elevated lactate 14,62, metHgb 0,3% and carboxyhemoglobin 12,9%. Electrocardiogram showed sinus rhythm, 100 beats/min, poor R wave progression with inverted T waves in V1-V3 leads, biphasic T waves in V5 and V6. Transthoracic echocardioography showed left ventricle with akinetic apex and all apical segments of the left ventricle with reduced systolic function. Cardiac troponin was significantly elevated; coronary angiography showed normal coronary arteries without culprit lesion. Takotsubo syndrome was diagnosed. She was treated with high flow oxygen on mechanical ventilation, antiplatelet, angiotenzinconvertase inhibitors, beta blockers and statin therapy with complete recovery. After one month ehocardiography showed left ventricle normal in size and function. Conclusion: CO poisoning hasn't yet been described as a trigger for Takotsubo syndrome. We propose that two risk factors CO poisoning and stress by may have initiated a catecholamine surge and caused the development of this specific condition. carbon monoxide poisoning, cardiotoxicity, takotsubo syndrome

Research paper thumbnail of Serum Bilirubin Level at Admission Predicts In-Hospital Outcome in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Journal of Hypertension, 2018

Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial inf... more Introduction: Various laboratory markers have been proposed to assess prognosis in myocardial infarction. Serum cortisol is one such laboratory marker. There are only few studies done in the recent past which prove that cortisol is a prognostic marker in STEMI. Methods: We studied a total of 168 patients who presented with STEMI and underwent primary percutaneous intervention (PPCI) within 12 hours of symptom onset between April 2016 and November 2016. Results: The average age of study population was 61 ± 0.12 years. Males were predominant (n = 132, 78.57%). 155 patients survived, whereas 13 patients died in the hospital. Mean syntax score was 16.65 ±5. 33 among patients who died, whereas it was 13.11 ± 5.62 among survivors (P = 0.03). Mean cortisol was significantly higher among the patients who died (46.13 ± 14.61 mcg/dl) than the survivors (31.16 ± 13.16 mcg/dl) (P = 0.003). The ROC AUC for in-hospital mortality was 0.77 (95% confidence interval [CI], 0.645-0.897). An optimal cut-point identified from the ROC curve was a random serum cortisol concentration of 33.66 mcg/dl, with corresponding sensitivity and specificity of 69.2 % and 64 %, respectively. At a cut-point of 29.55 mcg/dl, sensitivity and specificity were 84.6 and 50 %, respectively. Conclusion: This study showed that serum cortisol level is a strong predictor of mortality in patients undergoing PPCI for STEMI. Levels more than 33.66 mcg/dl can predict mortality with a sensitivity of almost 70 percent and specificity of 64 percent.

Research paper thumbnail of Predictive value of heart failure with reduced versus preserved ejection fraction for outcome in pulmonary embolism

ESC Heart Failure, 2020

Aims This study aimed to investigate whether the risk of short-term mortality is different in pul... more Aims This study aimed to investigate whether the risk of short-term mortality is different in pulmonary embolism (PE) patients who have heart failure with reduced ejection fraction (HFrEF) as compared with those with heart failure with preserved ejection fraction (HFpEF). Methods and results Predictive value of HFrEF or HFpEF for 7-day (intrahospital) and 30-day all-cause mortality was determined in the cohort of 1055 out of 1201 consecutive acute PE patients from the Serbian multicentre PE registry. Patients were classified into either HFrEF or HFpEF group, according to guideline-proposed criteria. A 7-day (intrahospital) and 30-day all-cause mortality was 18.5% vs. 7.3% vs. 4.5% (P < 0.001) and 22.2% vs. 16.3% vs. 7.9% (P < 0.001) for patients with the history of HFrEF, HFpEF, and without HF, respectively. Multivariable analysis adjusted to age, gender, history of chronic obstructive pulmonary disease, diabetes mellitus, arterial hypertension, presence of atrial fibrillation, and mortality risk assessment at admission has shown that only HFrEF, but not HFpEF, was an independent predictor for 7-day mortality (hazard ratio 2.22, 95% confidence interval 1.25-4,38.41, P ¼ 0.021) and neither HFrEF or HFpEF was an independent predictor for 30-day mortality. Among various admission parameters associated to PE outcome, only systolic pressure in HFrEF patients (P < 0.001), heart rate (P ¼ 0.01), and right ventricle systolic pressure (P ¼ 0.039) in HFpEF patients were significantly different in patients who died compared with those who survived at 7 days. Conclusions Our study has shown that the presence of previous history of HFrEF, but not HFpEF, in acute PE is an independent risk factor for mortality at 7 days.

Research paper thumbnail of Infective endocarditis of partial atrioventricular septal defect: A case report

Vojnosanitetski pregled, 2018

Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease... more Introduction. Partial atrioventricular septal defect (AVSD) is a form of congenital heart disease (CHD) rarely detected in adults. Infective endocarditis represents a severe complication that carries a substantial risk. Case report. We here reported a case of a 43-year-old female with previously diagnosed adult CHD (partial AVSD and bicuspid aortic valve) presented to the hospital with fever and malaise 14 days prior to admission. On the lung computed tomography scan inflammatory consolidations were found and dual antibiotic therapy (ceftazidime and clarithromycin) was administered without significant regression of pulmonary inflammatory consolidations. The antibiotic treatment was continued with amoxicillin/clavulanic acid combined with levofloxacin and metronidazole. Transthoracic and transesophageal echocardiography revealed a large vegetation (dimension, 3.6 x 1.8 cm) attached to the septal leaflet of the tricuspid valve floating between right atrium and right ventricle through ...

Research paper thumbnail of Primary mitral regurgitation: Echo evaluation

Srce i krvni sudovi, 2018

Research paper thumbnail of Renal dysfunction as intrahospital prognostic indicator in acute pulmonary embolism

International Journal of Cardiology, 2019

Background: Acute pulmonary embolism (PE), due to hemodynamic disturbances, may lead to multi-org... more Background: Acute pulmonary embolism (PE), due to hemodynamic disturbances, may lead to multi-organ damage, including acute renal dysfunction. The aim of our study was to investigate the predictive role of renal dysfunction at admission regarding the short-term mortality and bleeding risk in hospitalized PE patients. Methods: The retrospective cohort study included 1330 consecutive patients with PE. The glomerular filtration rate (GFR) was calculated using the serum creatinine value and Cocroft-Gault formula, at hospital admission. Primary outcomes were all-cause mortality and PE-related mortality in the 30 days following admission, as well as major bleeding events. Results: Based on the estimated GFR, patients were divided into three groups: the first with GFR b 30 mL/min, the second with GFR 30-60 mL/min, and the third group with GFR N 60 mL/min. A multivariable analysis showed that GFR at admission was strongly associated with all-cause death, as well as with death due to PE. Patients in the first and second group had a significantly higher risk of 30-day all-cause mortality (HR 7.109, 95% CI 4.243-11.911, p b 0.001; HR 2.554, 95% CI 1.598-4.081, p b 0.001). Fatal bleeding was recorded in 1.6%, 0.5% and 0.8% of patients in the first, second and in the third group (p b 0.05). There were no significant differences regarding major bleeding rates among the groups. Conclusion: Renal dysfunction at admission in patients with acute pulmonary embolism is strongly associated with overall PE mortality.

Research paper thumbnail of Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor

International Journal of Cardiology, 2019

Background. The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicia... more Background. The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicians at individualizing the optimal dual antiplatelet therapy duration (DAPT) after percutaneous coronary intervention (PCI). Nevertheless, external validation of these RSs it has not yet been performed in ACS (acute coronary syndrome) patients treated with prasugrel or ticagrelor in a real-world scenario. Methods: 4,424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to December 2016 at 12 European centers, were included. PRECISE-DAPT and PARIS bleeding RS, as well as PARIS ischemic RS, were computed, and their performance at predicting major bleeding (MB; BARC type 3 or 5) and ischemic events (MI and stent thrombosis) during follow up was compared. Results: After a median follow-up of 14 (interquartile range 12-20.9) months, 83 (1.88%) patients developed MB and 133 (3.0%) suffered an ischemic episode. PRECISE-DAPT performed better than PARIS bleeding RS (c-statistic= 0.653 vs. 0.593; p= 0.01 for comparison) in predicting MB. The RSs performance for MB prediction remained consistent in STEMI patients (c-statistic= 0.632 vs 0.575) or in those treated with prasugrel (c-statistic = 0.623 vs 0.586). PARIS ischemic RS exhibited modest but superior discrimination in predicting ischemic complications as compared to PRECISE-DAPT (c-statistic= 0.604 vs 0.568 p= 0.05 for comparison). Conclusion: Our data provide support to the use of PRECISE-DAPT in MB risk stratification for patients receiving DAPT in form of aspirin and prasugrel or ticagrelor whereas the PARIS ischemic RS has potential to complement the risk prediction with respect to ischemic events.

Research paper thumbnail of Extracorporeal life support for severe cardiogenic shock induced by diltiazem intoxication

Vojnosanitetski pregled, 2019

Introduction. Management of cardiogenic shock caused by severe drug intoxication is always challe... more Introduction. Management of cardiogenic shock caused by severe drug intoxication is always challenging. In case of multidrug intoxication, a result, despite aggressive medical therapy, is often unpredictable. Utilization of extracorporeal life support devices in these cases has been suggested and reported results are promising. Case report. We presented a case of profound cardiogenic and distributive shock caused by suicidal intoxication with diltiazem and anionic surfactant ingestion in a 36-year-old woman. The patient ingested more than 90 tablets of diltiazem of 90 mg (ingested dose of 8.1 g), and 4 pieces of household toilet refresh agent containing anionic surfactant. During the admission, systemic blood pressure was 65/40 mmHg, heart rate 45 beats per minute, with signs of metabolic acidosis. The patient underwent several repeated gastric lavages. Emergent fluid resuscitation, calcium gluconate, insulin and vasopressive agents (dopamine and noradrenaline) infusions were admini...

Research paper thumbnail of Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

Vojnosanitetski pregled, 2018

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and ... more Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The ...

Research paper thumbnail of Ventriculoatrial synchrony induced heart failure

Acta Clinica Belgica, 2018

Objective and importance: Endless loop tachycardia or pacemaker-mediated tachycardia, and atriove... more Objective and importance: Endless loop tachycardia or pacemaker-mediated tachycardia, and atrioventricular desynchronization arrhythmia or repetitive non-reentrant ventriculoatrial synchrony (RNRVAS) are two forms of reverse impulse conduction-ventriculoatrial (VA) synchrony. Although VA synchrony can theoretically cause aggravation of heart failure, clinical cases describing severe consequential heart failure are lacking. Clinical presentation and intervention: We describe a case of a 60-year-old patient who underwent primary percutaneous coronary intervention and mitral valve surgery. Implantation of a two-chamber pacemaker was also performed during the same hospitalization due to development of third-degree atrioventricular block. Ten months later, he presented with a severe form of heart failure with a significant reduction of left ventricular ejection fraction (LVEF). The atrial lead was displaced and VA synchrony was registered (RNRVAS-like condition). The pacemaker was reprogrammed and VA synchrony induced heart failure was successfully resolved. Echocardiographic follow-up showed improvement in LVEF. Conclusion: Ventriculoatrial conduction can be present even when the patient has a complete atrioventricular block. Atrial lead displacement and consequently loss of atrial capture with preserved sensing can be a predisposing factor for initiation of ventriculoatrial synchrony. Permanent ventriculoatrial synchrony may provoke aggravation of heart failure.

Research paper thumbnail of Late complications of transcatheter atrial septal defect closure requiring urgent surgery

Postepy w kardiologii interwencyjnej = Advances in interventional cardiology, 2017

Research paper thumbnail of Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients

Advances in Interventional Cardiology, 2017

Introduction: Psychological characteristics of patients, depression, stress and anxiety are recog... more Introduction: Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR). Material and methods: From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21) self-report questionnaire. Results: Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS) class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions: Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

Research paper thumbnail of Effects of tirofiban and percutaneous coronary intervention in an old patient with acute myocardial infarction and cardiogenic shock

Medical review, 2010

A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ... more A 75 year old man presented in our institutiton with acute inferoposterior and right ventricular ST-segment elevation myocardial infarction and cardiogenic shock, 40 minutes after the pain onset. He was pretreated with 300 mg of aspirin, 600 mg of clopidogrel, and was taken to the catheterization laboratory. Door to needle time was 35 minutes. Primary percutaneous coronary intervention with bare-metal stent implantation first in infarct related right coronary artery, with subsequent high-bolus dose (25 fig/kg) tirofiban, and then in suboccluded RCx were done. The procedures were done during the cardio-pulmo-cerebral reanimation because of relapsing ventricular fibrillation, with final TIMI 3 coronary flow established. Subsequently, intraaortic balloon pump was inserted. Echocardiography taken on the second day showed globaly hypokinetic left ventricle, with 10% ejection fraction and competent valves. During the next three weeks of hospital follow-up, there were no major adverse card...