Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

INTRODUCTION: Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. OBJECTIVE: We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. METHODS: A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients'status was assessed by an office visit or telephone interview. RESULTS: Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n = 217). Groups had similar total ischemic time (319 ± 276 vs. 333 ± 372 min; p = 0.665), but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p < 0.001). The echocardiography revealed similar left ventricular volumes and systolic function, but TA+ group had significantly higher incidence of E/e' > 15, as a marker of severe diastolic dysfunction' (TA+ 23.1% vs. TA- 15.2%; p = 0.050). During average follow-up of 14 ± 5 months, major adverse cardiac/cerebral events occurred at the similar rate (log rank p = 0.867). CONCLUSION: Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn't influence the incidence of major adverse cardiovascular events.

Do components of metabolic syndrome contribute to cardiac autonomic neuropathy in non-diabetic patients?

OBJECTIVE: To evaluate whether autonomic dysfunction exist in patients with metabolic syndrome (MetS) to establish any association with components of MetS. METHODS: From July 2008 to January 2009, 32 outpatients attending the University Clinical Center, Zemun, Belgrade, Serbia, 15 with MetS, 17 with type 2 diabetes mellitus (T2DM), and 15 control subjects were recruited for cross-sectional study among adults. The study was completed at the University Clinical Center, Bezanijska Kosa, and University Clinical Center, Dragisa Misovic, Belgrade, Serbia. Inclusion criteria were the presence of MetS without T2DM, T2DM and healthy controls, matched for age and gender. Exclusion criteria were uncontrolled diabetes (glycosylated hemoglobin [HbA1c] higher than 9%), advanced complications of diabetes (retinopathy, nephropathy, coronary heart disease, or peripheral angiopathy). Besides anthropometric and metabolic parameters cardiovascular autonomic reflex tests, ambulatory ECG monitoring, and blood pressure monitoring for 24 hours was obtained. Power spectral analysis of heart rate variability (HRV) was carried out by Fourier transformation. RESULTS: Mean total power (TP) log-transformed (ln), very low frequency (VLF)ln power, and high frequency (HF)ln power were significantly lower in T2DM patients, when compared with controls, and only HFln power was significantly lower in the MetS group. The average value of low frequency (LF)/HFln ratio was significantly higher in T2DM and MetS, and significantly correlated with glucose level of the last one. CONCLUSION: Disturbed HRV indices were present in patients with MetS before the development of T2DM. With this in mind, improvement of glucose metabolism, as well as early detection of cardiac autonomic dysfunction should be important.

Is the routine abdominal ultrasound a sufficiently sensitive method for the detection of colonic malignancy?

OBJECTIVE: This study examined the sensitivity of routine abdominal ultrasound scanning in the detection of colonic malignancy. PATIENTS AND METHODS: A case control prospective study included 101 patients hospitalized at the Department of Gastroenterology and Liver Diseases of Zemun Clinical Hospital over a four-year period. Since the complaints pointed to colonic malignancy, the patients underwent routine golden standard diagnostic procedures. These patients were referred to an experienced abdominal ultrasound operator who searched for some characteristic signs of colonic malignancy. All of the participants were surgically treated after the completion of relevant procedures for diagnosing colonic malignancy. SPSS for Windows 10.0 was used for data analysis. RESULTS: The sensitivity of an abdominal ultrasound scan in the detection and location of pathological changes pointed to colonic malignancy was different- 76% and 84% respectively. This method was very reliable in detecting right-sided colonic carcinoma (100%). Some specific ultrasonographic signs of colonic carcinoma were observed at the advanced stages of disease. CONCLUSIONS: The routine abdominal ultrasonography can be used for the screening of colonic malignancy owing to its high sensitivity, particularly in advanced disease, but solely in conjunction with other methods. Finally, abdominal ultrasonography cannot be a definitive diagnostic tool for colonic carcinoma.