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Radomir Matunović

Publications and source records attributed to Radomir Matunović.

9 recordsLinked to original sources
PubMed2005

[Stunned myocardium].

BACKGROUND: Stunned myocardium is a state of delayed recovery of regional contractility after a transient period of ischemia followed by reperfusion. CASE REPORT: A 67-year-old patient was admitted to our hospital with acute anterior myocardial infarction, and treated using percutaneous transluminal coronary angioplasty (PTCA) within acute disease stage. Reversible myocardial dysfunction persisted after ischemia following the return of normal perfusion. Abnormal resting wall motion with augmentation of contractility at low and high doses of dobutamine characterizes the stunned myocardium and reflects the normal blood flow reserve, characteristic for these postischemic, reperfused segments. SPECT (Single Photon Emission Computerized Tomography) with Tc 99 and dipyradamole showed normalization of perfusion defects in the apical region. There months after the infarction and PTCA, contractility was almost completely recovered. CONCLUSION: Stunned myocardium recovery lasted from few weeks to few months. Control ultrasonography as well as SPECT showed normalization of systolic function of the left ventricle in the viable segments registered at previous examinations.

Aged↗
PubMedDate not supplied

[Assessment of tissue viability for improvement of the left ventricular function after revascularization].

INTRODUCTION: Treatment of patients with heart failure following myocardial infarction is still a clinical challenge. Drug therapy in these patients is limited, and invasive revascularization is not always successful and does not guarantee desired results. The aim of this study was to compare the effectiveness of invasive revascularization procedures (coronary artery bypass grafting - CABG or percutaneous transluminal coronary angioplasty - PTCA) with conventional drug therapy in patients with heart failure after acute myocardial infarction in whom significant portion of viable myocardial tissue was detected during low dose dobutamine stress echocardiography. MATERIAL AND METHODS: Using a prospective analysis, we investigated 66 patients with heart failure following myocardial infarction and reduced left ventricular ejection fraction (LVEF <35%). 34 patients underwent revascularization procedures including CABG or PTCA. The other 32 patients received only conventional drug therapy. The patients were followed during 12 months examing LVEF, left ventricular wall motion score index (WMSI), NYHA functional class, and cardiac death. RESULTS: After 12 months, patients undergoing revascularization procedures presented with significantly better functional improvement of LVEF (37.84% vs. 33.14%, p<0.05), better clinical status and significantly less cardiac deaths (8.82% vs. 21.87%, p<0.01) in comparison to patients who stayed on drug therapy. After 12 months WMSI was significantly better in patients who underwent interventional therapy (1.69 +/- 07 vs. 1.82 +/- 04, p<0.01). CONCLUSION: After a 12-month follow up period, patients with presence of viable myocardial tissue after myocardial infarction and undergoing revasculkatization procedures presented with better functional recovery and less cardiac events, including cardiac death, in comparison with patients who received only drug therapy.

Female↗
PubMedDate not supplied

[Natriuretic peptides and multimarker approach to risk stratification of patients with acute coronary syndromes].

NATRIURETIC PEPTIDES IN ACUTE CORONARY SYNDROMES: Brain natriuretic peptides (BNP) and N-terminal prohormone brain natriuretic peptides (N-proBNP) have been shown to provide important prognostic information in patients with acute coronary syndrome (ACS). Ischemia may be an important stimulus for BNP release. This does not imply, however, that BNP is useful for diagnosing ischemia, and BNP is unlikely to prove sensitive or specific enough for this purpose. SIGNIFICANCE OF NATRIURETIC PEPTIDES IN ASSESSING PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROMES: In patients with ST-elevation and non-ST-elevation myocardial infarction, higher BNP and N-proBNP levels have been shown to predict a greater likelihood of death or heart failure, independent of other prognostic factors. THERAPEUTIC IMPLICATIONS OF BNP ELEVATION IN ACUTE CORONARY SYNDROMES: Patients with BNP or NT-proBNP elevation following ACS are clearly at high risk for death and for developement of heart failure, but specific therapeutic implications of BNP elevation have not been defined. In particular, it is not known how patients with BNP elevation should be treated considering the fact that they have normal troponin levels and no clinical evidence of heart failure. MULTIMARKER STRATEGIES FOR RISK STRATIFICATION IN ACUTE CORONARY SYNDROMES: It has been shown recently that in patients with acute coronary syndromes the risk increased sequentially among those with one, two or three elevated biomarkers. THERAPEUTIC APPLICATIONS OF CARDIAC BIOMARKERS IN ACUTE CORONARY SYNDROMES: Multimarker strategies, that incorporate panels of cardiac biomarkers, are likely to be used in the future for risk stratification and for pathophysiologically-guided treatment of patients with ACS.

Angina, Unstable↗
PubMedDate not supplied

[Effects of reperfusion on late potentials of the QRS complex in acute myocardial infarction].

INTRODUCTION: Cardiac rhythm disorders are common in patients after myocardial infarction. They play an important role in the course and in prognosis of this illness. Signal-averaged electrocardiogram (SAECG) is a non-invasive diagnostic method for the induction of sustained monomorphic ventricular tachycardia. Early opening of the infarct-related artery decreases occurrence of ventricular disorders in these patients. The aim of this study was to establish the connection between the late potentials of the QRS complex (SAECG) and unsuccessful reperfusion in patients with acute myocardial infarction (AMI). MATERIAL AND METHODS: After myocardial infarction, presence of SAECG was examined in patients receiving reperfusion therapy in order to establish the treatment outcome. Late potentials in SAECG were determined by computer measurements in regard to criteria for its positivity. RESULTS: The study group consisted of 33 patients. Out of 23 patients with successful reperfusion, only 6 (26.1%) had late potentials, in contrast to the group without reperfusion, 8 (80%) out of 10 patients had late potentials. CONCLUSION: Based on our results, we can conclude that there is a significant association between the presence of late ORS-complex potentials (SAECG) and unsuccessful reperfusion. Also, we can conclude that presence of late potentials is an independent predictor of infarct-related artery patency in patients with AMI treated with thrombolytic therapy.

Electrocardiography↗
PubMedDate not supplied

[Aortic valve stenosis].

There is a long latent period in the clinical course of aortic valve stenosis in adults. Symptoms usually occur in the case of critical stenosis, when aortic orifice area is under 0.7 cm2 (0.4 cm2/m2). In this study 78 patients with critical aortic valve stenosis were investigated. The first manifestation of the disease was dyspnea (78.2%), angina (52.5%), less often a syncope (34.6%), while 17.9% of patients were asymptomatic. Left ventricular systolic function was preserved in 77% of patients, while left ventricular dyastolic dysfunction occurred in almost all the patients. In 42 patients (53.4%) aortic valve replacement was performed. Left ventricular systolic function improved in 88.1% of patients postoperativelly, as well as in patients with preoperatively preserved or poor systolic function. Recovery was fast particularly during the first 6 postoperative months. After the surgery the improvement of the left ventricular dyastolic function was slower then systolic, particularly in patients with extreme hypertrophy of myocardium in whom the process of recovery might last several years.

Adolescent↗
PubMedDate not supplied

[Therapeutic and prognostic significance of cardiac biomarkers in patients with the acute coronary syndrome].

Diagnostics in patients with the acute coronary syndromes (ACS) is becoming even more complex with the increase of number of available options. In addition, the number of treatment options accessible to patients with ACS keeps on growing rapidly. Physicians must now choose from a wide variety of antiplatelet and antithrombotic therapies and also determine what patients would benefit from an invasive management approach. These decisions have become more difficult with the introduction of recent drugs such as low molecular weight heparins, direct-acting antithrombins, thienopyridines, and glycoprotein IIb/IIIa inhibitors. Simple tools, which can often be applied at the patient's bedside, can help physicians to choose the intensity of antiplatelet and antithrombotic therapy, and decide whether to use invasive coronary procedures. Cardiac biomarkers have proven to be particularly effective for these purposes. Moreover, cardiac biomarkers play an important role in risk stratification in ACS, and the results of cardiac biomarker tests can be used to help us choose between alternative therapies. In addition to biomarkers of myocyte necrosis, markers of neurohormonal activation, such as B-type natriuretic peptide (BNP), provide important prognostic information in ACS. However, the increase of number of elevated biomarkers, although simple to implement in practice, does not allow for full employment of value of information provided by these biomarkers. In the future, multimarker strategies that incorporate panels of cardiac biomarkers are likely to be used for risk stratification and for pathophysiology guided treatment in patients with ACS.

Angina, Unstable↗