Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by pro... more Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG) changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae a...
Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences, 2008
The aim of this study was to determine and localize culprit lesion by myocardial perfusion imagin... more The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary inte...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in th... more Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in the detection of deep veins' thrombosis (DVT) in patients with confirmed thromboembolism of the lungs (TEL) was evaluated. RNP. These findings were compared to contrast phlebography (CP), performed in the group of 25 patients in whom TEL was confirmed clinically, radiologically, scintigraphically and biochemically, but without clinical signs and symptoms of DVT. In 15 patients where RNP revealed unilateral DVT, CP finding was confirmed in all: in 6 (40%) on the left, and in 9 (60%) on the right side. In 10 patients with bilateral signs of DVT observed by scintigraphy, DVT finding was confirmed in 7 (70%), while in 3 (30%) patients, scintigraphic signs of DVT were falsely positive. In the segments of deep venous system, specificity of RNP in the detection of DVT in the lower leg was 60%, sensitivity was 100%, accuracy was 64% with 62% falsely positive findings. In the upper legs specifi...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
The aim of this study was to evaluate the accuracy of 1-day stress-rest technetium-99m tetrofosmi... more The aim of this study was to evaluate the accuracy of 1-day stress-rest technetium-99m tetrofosmin myocardial tomography in the identification of patients with coronary artery disease (CAD), and in the detection of the individual occluded coronary vessels. A total of 42 patients with suspected CAD were studied. Significant coronary narrowing (> or = 50% luminal stenosis) was detected by angiography in 22 patients. All patients received two i.v. injections of 99mTc tetrofosmin, one at peak exercises (370 MBq) and the other (740 MBq) at rest 3 h after exercise (images 15-30 min after injections for both studies). At visual analysis, all patients with CAD (> or = 50% luminal stenosis) (n-22) had an abnormal 99mTc tetrofosmin tomogram. Nine out of 20 patients without significant coronary narrowing (but with tortuosis, atheromathosis, with microvascular diseases) showed abnormal findings. Overall sensitivity, specificity and diagnostic accuracy in the identification of CAD was 100%...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 g... more With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 groups comprising 22 patients were investigated in whom isolated thrombosis in one of the deep veins segments: lower leg, upper leg, and pelvis was determined by radionuclide phlebography (RNF) and contrast phlebography. Afterwards, all necessary investigations relevant for pulmonary thromboembolism (PTE), including perfusion scintigraphy of the lungs (PSL) were performed. Out of all patients with DTV, 17% were with pulmonary changes confirming PTE. Out of patients with DVT, 59% were with the changes in the upper leg segment, and 66% of patients were with changes in pelvic segment, respectively.
Background. Inspite the indisputable significance of coronarography, the implications of a reveal... more Background. Inspite the indisputable significance of coronarography, the implications of a revealed stenosis - and how close it is to occlusion could vary in regard to its physiological importance. Myocardial perfusion scintigraphy (MPS) possibility to prove and objectivise the presence of ischemia and myocardial viability within an occlusion found coronarographically is especially significant since it makes possible to the clinician to choose an adequate therapy. Case report. We reported a 43- year-old male patient who had been hospitalized to another institution due to acute myocardial infarction (AMI) of posterolateral localisation. Following the acute AMI stage the ergometric test per Bruce protocole was performed, negative to ischemic heart disease, while multislice computed tomography showed no significant changes on the coronary arteries. The performed one-day-protocole MPS showed a massive area of residual ischemia within myocardial infarction (MI) type culprit lesion of the...
Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitorni... more Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitornih celija mioblasta ili poreklom iz kostne srzi dolazi do poboljsanja srcane funkcije. Pomenute metode jos nose sa sobom veoma veliki broj pitanja. Da li je zaista moguce regenerisati miokard ?nekim? novim mioblastima, za koje se ocekuje da se diferenciraju u patoloskim uslovima u plemenito visoko diferentovano, funkcionalno tkivo miokarda? Kada je u pitanju ishemijska bolest srca ne treba zaboraviti osnovni problem - koronarnu insuficijenciju, koja se samom kardiomioplastikom ne resava. Kombinacija revaskularizacionih procedura sa celijskom kardiomioplastikom je sine qua non za prezivljavanje i transplantovanih celija. Da li je veca debljina oziljka na miokardu i njegova elasticnost dovoljna korist da bi se ove celije transplantovale kod bolesnika sa teskim oziljnim promenama na srcu? Koji su bolesnici pravi kandidati za ovaj vid terapije, koji je optimalan broj mioblasta koji treba tran...
Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonl... more Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise ...
Background/Aim. In our Intensive Coronary Care Unit (CCU) a specific scoring system named the AMI... more Background/Aim. In our Intensive Coronary Care Unit (CCU) a specific scoring system named the AMIS_NS was developed both for prediction of mortality in patients with acute myocardial infarction and for evaluation of the quality of work. One of the most important variables of the AMIS_NS system is the variable Jung which stands for the interrelationship unified mortality predictors. The variable includes all the values of systolic blood pressure, heart rate and age, without limiting values for any of these. The cutoff value is 2.08. The patients with the lower variable value account for a significantly higher mortality. Data on the actual infarction are not necessitated now for this variable. The aim of this study was to assess the significance of the variable Jung in non-infarction patients with acute pulmonary edema. Methods. In a 24-month period out of 2,223 patients there were 1,087 and 1,136 patients with and without acute myocardial infarction, respectively. There was the subgr...
Background/Aim. The coronary angiography provides information on the anatomical state of the coro... more Background/Aim. The coronary angiography provides information on the anatomical state of the coronary tree, while myocardial perfusion scintigraphy (MPI) facilitates the evaluation of the grade of ischaemia that a particular stenosis produces. The purpose of MPI is to detect the coronary stenosis that provokes the ischaemia and is termed the "culprit lesion". The aim of this study was to evaluate the accuracy of 1-day DypEX 99mTc-tetrofosmin tomography in the identification and localization of culprit lesion in the patients with known coronary artery disease (CAD). Methods. Ninety-one (91) patients with known CAD were studied. In all of them significant coronary narowing (? 75% luminal stenosis) was angiographically detected. All the patients were submitted to 2 iv. injections of 99mTc-tetrofosmin, one in a peak of pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DypEX) and the other 3 h after exercise. Quantification of regional ...
Background/Aim. Autologous bone-marrow-derived intracoronary injection of mononuclear cells (MNC)... more Background/Aim. Autologous bone-marrow-derived intracoronary injection of mononuclear cells (MNC) modestly improved left ventricular ejection fraction (LVEF) in the selected patients after acute ST elevation myocardial infarction (STEMI). Major determinants of stem cell therapy outcome in the subacute phase of STEMI still remain unknown. Therefore, the aim of this study was to determine modifying factors for the outcome of stem cell therapy after STEMI. Methods. Eighteen patients in the stem cell therapy group and 24 patients in the control group with the successfully reperfused first large STEMI (LVEF ? 40%) were enrolled in the study. The stem cell group was submitted to autologous bone-marrow-derived MNC injection between 7-12 days after MI. Left ventricular ejection fraction and infarction size at baseline and after 4 months were determined by echocardiography and scintigraphy examination. Age, pain onset to reperfusion time, admission glycemia, maximum lactate dehydrogenase (LD...
Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by pro... more Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG) changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae a...
Prilozi / Makedonska akademija na naukite i umetnostite, Oddelenie za biološki i medicinski nauki = Contributions / Macedonian Academy of Sciences and Arts, Section of Biological and Medical Sciences, 2008
The aim of this study was to determine and localize culprit lesion by myocardial perfusion imagin... more The aim of this study was to determine and localize culprit lesion by myocardial perfusion imaging (MPI) in cases of angiographically detected coronary narrowing >or= 75% of at least one coronary artery. One hundred and thirty-two (132) patients with angiographically detected significant coronary narrowing (>or= 75% luminal stenosis of at least one major coronary artery) were studied. All the patients submitted MPI (99m)Tc-MIBI, with pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DipyEX). We measured relative uptake (99m)Tc-MIBI for each myocardial segment using short-axis myocardial tomogram study. A 5-point scoring system was used to assess the difference between uptake degree in stress and rest studies for the same segments, and we created two indices: Sum reversibility score (SRS), Index of sum reversibility score (ISRS). A total of 396 vascular territories (2244 segments) were analyzed before elective percutaneous coronary inte...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in th... more Diagnostic reliability of radionuclide phlebography (RNP) compared to contrast phlebography in the detection of deep veins' thrombosis (DVT) in patients with confirmed thromboembolism of the lungs (TEL) was evaluated. RNP. These findings were compared to contrast phlebography (CP), performed in the group of 25 patients in whom TEL was confirmed clinically, radiologically, scintigraphically and biochemically, but without clinical signs and symptoms of DVT. In 15 patients where RNP revealed unilateral DVT, CP finding was confirmed in all: in 6 (40%) on the left, and in 9 (60%) on the right side. In 10 patients with bilateral signs of DVT observed by scintigraphy, DVT finding was confirmed in 7 (70%), while in 3 (30%) patients, scintigraphic signs of DVT were falsely positive. In the segments of deep venous system, specificity of RNP in the detection of DVT in the lower leg was 60%, sensitivity was 100%, accuracy was 64% with 62% falsely positive findings. In the upper legs specifi...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
The aim of this study was to evaluate the accuracy of 1-day stress-rest technetium-99m tetrofosmi... more The aim of this study was to evaluate the accuracy of 1-day stress-rest technetium-99m tetrofosmin myocardial tomography in the identification of patients with coronary artery disease (CAD), and in the detection of the individual occluded coronary vessels. A total of 42 patients with suspected CAD were studied. Significant coronary narrowing (> or = 50% luminal stenosis) was detected by angiography in 22 patients. All patients received two i.v. injections of 99mTc tetrofosmin, one at peak exercises (370 MBq) and the other (740 MBq) at rest 3 h after exercise (images 15-30 min after injections for both studies). At visual analysis, all patients with CAD (> or = 50% luminal stenosis) (n-22) had an abnormal 99mTc tetrofosmin tomogram. Nine out of 20 patients without significant coronary narrowing (but with tortuosis, atheromathosis, with microvascular diseases) showed abnormal findings. Overall sensitivity, specificity and diagnostic accuracy in the identification of CAD was 100%...
Vojnosanitetski pregled. Military-medical and pharmaceutical review
With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 g... more With the aim of the estimation of embolism at certain locations of deep vein thrombosis (DVT) 3 groups comprising 22 patients were investigated in whom isolated thrombosis in one of the deep veins segments: lower leg, upper leg, and pelvis was determined by radionuclide phlebography (RNF) and contrast phlebography. Afterwards, all necessary investigations relevant for pulmonary thromboembolism (PTE), including perfusion scintigraphy of the lungs (PSL) were performed. Out of all patients with DTV, 17% were with pulmonary changes confirming PTE. Out of patients with DVT, 59% were with the changes in the upper leg segment, and 66% of patients were with changes in pelvic segment, respectively.
Background. Inspite the indisputable significance of coronarography, the implications of a reveal... more Background. Inspite the indisputable significance of coronarography, the implications of a revealed stenosis - and how close it is to occlusion could vary in regard to its physiological importance. Myocardial perfusion scintigraphy (MPS) possibility to prove and objectivise the presence of ischemia and myocardial viability within an occlusion found coronarographically is especially significant since it makes possible to the clinician to choose an adequate therapy. Case report. We reported a 43- year-old male patient who had been hospitalized to another institution due to acute myocardial infarction (AMI) of posterolateral localisation. Following the acute AMI stage the ergometric test per Bruce protocole was performed, negative to ischemic heart disease, while multislice computed tomography showed no significant changes on the coronary arteries. The performed one-day-protocole MPS showed a massive area of residual ischemia within myocardial infarction (MI) type culprit lesion of the...
Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitorni... more Studije na zivotinjama i prva klinicka iskustva na ljudima pokazuju da nakon primene progenitornih celija mioblasta ili poreklom iz kostne srzi dolazi do poboljsanja srcane funkcije. Pomenute metode jos nose sa sobom veoma veliki broj pitanja. Da li je zaista moguce regenerisati miokard ?nekim? novim mioblastima, za koje se ocekuje da se diferenciraju u patoloskim uslovima u plemenito visoko diferentovano, funkcionalno tkivo miokarda? Kada je u pitanju ishemijska bolest srca ne treba zaboraviti osnovni problem - koronarnu insuficijenciju, koja se samom kardiomioplastikom ne resava. Kombinacija revaskularizacionih procedura sa celijskom kardiomioplastikom je sine qua non za prezivljavanje i transplantovanih celija. Da li je veca debljina oziljka na miokardu i njegova elasticnost dovoljna korist da bi se ove celije transplantovale kod bolesnika sa teskim oziljnim promenama na srcu? Koji su bolesnici pravi kandidati za ovaj vid terapije, koji je optimalan broj mioblasta koji treba tran...
Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonl... more Background/Aim. Treadmill test combined with myocardial perfusion scintigraphy (MPS) is a commonly used technique in the assessment of coronary artery disease. Many patients who cannot adequately perform exercise stress testing may nevertheless undergo pharmacological tests, most commonly with the vasodilator agents (adenosine and dipyridamole), as well as the positive inotropic agent dobutamine. Patients undergoing vasodilators stress testing with either dipyridamole or adenosine also perform simultaneous low-intensity exercise. The aim of this study was to compare various pharmacological stress tests alone or in combination with low intensity exercise as preparation for MPS in reagard to incidence of adverse effects, quality of diagnostic image and the acquisition initial time. Methods. A total of 2 205 patients underwent pharmacological stress tests. Pharmacological stress test with adenosine was applied in 493 patients. In 405 of them we performed concomitant low level exercise ...
Background/Aim. In our Intensive Coronary Care Unit (CCU) a specific scoring system named the AMI... more Background/Aim. In our Intensive Coronary Care Unit (CCU) a specific scoring system named the AMIS_NS was developed both for prediction of mortality in patients with acute myocardial infarction and for evaluation of the quality of work. One of the most important variables of the AMIS_NS system is the variable Jung which stands for the interrelationship unified mortality predictors. The variable includes all the values of systolic blood pressure, heart rate and age, without limiting values for any of these. The cutoff value is 2.08. The patients with the lower variable value account for a significantly higher mortality. Data on the actual infarction are not necessitated now for this variable. The aim of this study was to assess the significance of the variable Jung in non-infarction patients with acute pulmonary edema. Methods. In a 24-month period out of 2,223 patients there were 1,087 and 1,136 patients with and without acute myocardial infarction, respectively. There was the subgr...
Background/Aim. The coronary angiography provides information on the anatomical state of the coro... more Background/Aim. The coronary angiography provides information on the anatomical state of the coronary tree, while myocardial perfusion scintigraphy (MPI) facilitates the evaluation of the grade of ischaemia that a particular stenosis produces. The purpose of MPI is to detect the coronary stenosis that provokes the ischaemia and is termed the "culprit lesion". The aim of this study was to evaluate the accuracy of 1-day DypEX 99mTc-tetrofosmin tomography in the identification and localization of culprit lesion in the patients with known coronary artery disease (CAD). Methods. Ninety-one (91) patients with known CAD were studied. In all of them significant coronary narowing (? 75% luminal stenosis) was angiographically detected. All the patients were submitted to 2 iv. injections of 99mTc-tetrofosmin, one in a peak of pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DypEX) and the other 3 h after exercise. Quantification of regional ...
Background/Aim. Autologous bone-marrow-derived intracoronary injection of mononuclear cells (MNC)... more Background/Aim. Autologous bone-marrow-derived intracoronary injection of mononuclear cells (MNC) modestly improved left ventricular ejection fraction (LVEF) in the selected patients after acute ST elevation myocardial infarction (STEMI). Major determinants of stem cell therapy outcome in the subacute phase of STEMI still remain unknown. Therefore, the aim of this study was to determine modifying factors for the outcome of stem cell therapy after STEMI. Methods. Eighteen patients in the stem cell therapy group and 24 patients in the control group with the successfully reperfused first large STEMI (LVEF ? 40%) were enrolled in the study. The stem cell group was submitted to autologous bone-marrow-derived MNC injection between 7-12 days after MI. Left ventricular ejection fraction and infarction size at baseline and after 4 months were determined by echocardiography and scintigraphy examination. Age, pain onset to reperfusion time, admission glycemia, maximum lactate dehydrogenase (LD...
Uploads