Homocysteine in angiographically proven coronary disease.

The research included 200 subjects, of which 150 had angiographically proven coronary disease with the coronary artery stenosis of 50% or more, and 50 subjects who did not have angiographically proven coronary disease. Patients were chosen randomly out of approximately 1000 patients who underwent angiography. All the subjects were treated at the Clinical Center of University of Tuzla--at the Clinic for Cardiovascular Diseases. The average value of homocysteine concentration in plasma of patients with angiographically proven coronary disease was 13.86 micromol/L, and 10.65 micromol/L in the controls, which is statistically significant difference (P < 0.0001). Lowered values of ejective fraction of the left ventricle of 50% and over was found in 25 patients (or 16.66%) with angiographically proven coronary disease, while the control group had only 4 subjects (or 8%). Student's t-test have proven that the average values of ejective fraction of the left ventricle of subject with angiographically proven coronary disease were statistically significantly different in comparison with the values of ejective fraction of the subjects in the control group (t = 5.87, df = 197, P < 0.0001). In all the groups the negative values of coefficients of correlation (R) shows that with the increase of plasma homocysteine concentrations the ejective fractions of the left ventricle dropped. Using logistical regressive analysis it was established that the following factors contribute the most to the development of coronary disease: increased concentration of plasma LDL-cholesterol, increased concentration of plasma homocysteine, diabetes mellitus and hereditary factors. In all the different forms of angiographically proven coronary disease (coronary disease in a one-vessel or in multiple-vessels), the increased concentration of plasma homocysteine was the significant risk factor for the development of coronary disease.

[Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol in coronary artery disease]. / LDL i HDL holesterol u angiografski dokazanoj koronarnoj bolesti.

The retrospective study included 250 patients, treated at Clinic for cardiovascular diseases of Tuzla Clinical center, between 30.08.2003. and 15.11.2004. In the coronary disease group there were 145 men, 55 women, with diagnosed coronary artery stenosis of 50% or more. The control group had 150 patients, 35 men and 15 women, medium age of 58.2. The control group had coronary artery stenosis of 50% or less. Coronarography was done using AXIOM ARTIS DFC (SIEMENS). Lipoproteins were determined on the Clinic for biochemistry of Tuzla Clinical Center using automatic analyser DIMENSION LxR (DADE BOEHRING). In the coronary artery disease (CAD) group elevated triglycerides were found in 38.5%, total cholesterol in 88% and LDL 55.5% of patients. The concentration of HDL cholesterol was elevated in 52.5% of patients. In the control group elevated values of triglycerides were found in 28%, total cholesterol 46%, LDL cholesterol 16%, and lower values of HDL in 10% of patients. Statistically significant differences of lipide profile of CAD patients in relation to the control group was defined. Using regresional analysis it was established that decide elevated values of total and LDL cholesterol, low values of HDL were also significant.

[Clinical aspects and haemodynamic parameters for monitoring patients with acute myocardial infarct (AIM)]. / Uporedni znacaj klinickih i hemodinamskih parametara za pracenje oboljelih od akutnog infarkta miokarda (AIM-a).

In acute myocardial infarct (AIM) incomes to a local disturbances in contractility: hypokinesia, akinesia, diskinesia, asynchronia. With repeated AIM esspecially in high oclussive coronary disease incomes to diffuse disturbance in contractility of myocard, with disorder in systolic and diasystolic function of heart. The aim is to point on significance of clinical and haemodynamic parameters in revealing heart weakness in AIM. By retrograded analysis in our study was embraced 86 patients deseased from AIM, average age of 58.42 years. Front wall infarct had 60,46%, backwall infarct had 39.54% of deseased patients. Patients were monitored clinically, electrocardiographically and haemodynamically with microcatetherisation of the right heart by Schwan-Ganz threeluminal thermodilutional catether with regulation of heart minute volumen. By haemodynamic values they were splitted in four groups. In clinical study, silent heart tones had 33%, systolic murmurs on ictus 19%, gallop rhythm 26% and lung failure 22% of patients. The most reliable clinical sign for heart weakness were low heart tones and gallop rhythm as well as lung failure. By haemodynamic values aquired by microcatetherisation of right heart with regulation of minute heart volumen, deseased with AIM were 15% in first group, 28% in second group, 3% in third group and 54% in fourth group of patients.

[Coronary disease and left branch block]. / Koronarna bolest i blok lijeve grane.

In the LBBB (the block of the left branch) control group there were 2 examinees Hi (6.45%). LAH and LHP were not found. The block of the left branch often creates problems in electrocardiographic diagnosis of coronary disease. It can be registered as complete LBBB, anterior-left hemiblock (LAH) and posterior-left hemiblock (LPH). The combinations are possible with the block of the right branch (RBBB) and A-V blocks. The most frequent cause is coronary disease, and next is sclerodegenerative changes in heart intrinsic-conduction system. Our study involves 98 of examinees with coronary disease, and 78 of that number are males and 24 are females, all average-aged 60.83+/-12.6. Control group (examinees who do not suffer from coronary disease) is made of 31 subjects, and 24 of that number are males, and 7 are females, all average-aged 57.16+/-10.4. Those diagnosed with coronary disease, as the examinees from control group, had the indications for the coronagraphy. The coronagraphy was performed and electrocardiographic findings were analyzed. The average degree of coronary arteries stenosis of the ill examinees was 77.5+/-14.9%, and in the examined group 23.5+/-12.5%. Of the examinees with the block of the left branch, 4 Hi examinees had one-artery illness (4.08%), 3 Hi had two-artery illness (3.06%) and 1 Hi had three-artery illness (1.02%). In one-artery coronary disease LAD stenosis was most frequent. Disruptions in conduction LBBB+LAH was found in 17.34% ill examinees, and 8.16% of those from LBBB and 9.8% from LHH. Of examinees with LAH, one-vessel coronary disease was found in 5.1% and two-vessel coronary disease in 4.08%. The most frequent was LAD stenosis, rarely combined with CX stenosis, and in one case LAD combined with RCA stenosis. In group with coronary disease LPH was not found.

[Intracoronary radiotherapy]. / Intrakoronarna radioterapija.

Intervenient cardiology is significantly more represented in attempts to solve problems of heart coronary artery disease in comparison to aortocoronary bypass procedures. Resthenoses of coronary artery blood vessel after PTCA, or PTCA and stent placement are frequent. The main causes are: neointimal hyperplasia, late contraction, and remodelling. The application of brachitherapy offers the possibility to prevent resthenosis especially stent resthenosis. Our report encompasses eight patients diseased from coronary artery occlusionn. Half of there patients had a stent resthenosis. The average degree of blood vessel occlusionn before the intervenient manipulation was 78%, and after treatment 25%-30%. Early results after recanalisation of coronary blood vessel are thus fat satisfactory, but results are to be followed carefully.