Showing papers by "Gani Bajraktari published in 2009"

Predictors of increased left ventricular filling pressure in dialysis patients with preserved left ventricular ejection fraction.

Abstract: Aim To study the left and right ventricular function and to assess the predictors of increased left ventricular (LV) fill ing pressure in dialysis patients with preserved LV ejection fraction. Methods This study included 63 consecutive patients (age 57 ± 14 years, 57% women) with end-stage renal failure. Echocardiography, including tissue Doppler measurements, was performed in all patients. Based on the median value of the ratio of transmitral early diastolic velocity to early myocardial velocity (E/E’ ratio), patients were divided into 2 groups: the group with high filling pressure (E/E’>10.16) and the group with low filling pressure (E/ E’≤10.16). Results Compared with patients with low filling pres sure, the group of patients with high filling pressure in cluded a higher proportion of diabetic patients (41% vs 13%, P = 0.022) and had greater LV mass index (211 ± 77 vs 172 ± 71 g/m 3 , P = 0.04), lower LV lateral long axis amplitude (1.4 ± 0.3 vs 1.6 ± 0.3 cm, P = 0.01), lower E wave (84 ± 19 vs 64 ± 18cm/s, P < 0.001), lower systolic myocardial velocity (S’: 8.6 ± 1. 5 vs 7.0 ± 1.3 cm/s, P < 0.001), and lower diastolic myocardial velocities (E’: 6.3 ± 1.9 vs 9.5 ± 2.9 cm/s, P < 0.001; A’: 8.4 ± 1.9 vs 9.7 ± 2.5 cm/s, P = 0.018). Multivariate analysis identified LV systolic myocardial velocity – S’ wave (adjusted odds ratio, 1.909; 95% confidence in terval, 1.060-3.439; P = 0.031) and age (1.053; 1.001-1.108; P = 0.048) as the only independent predictors of high LV filling pressure in dialysis patients. Conclusions In dialysis patients with preserved left ventricular ejection fraction, reduced systolic myocardial velocity and elderly age are independent predictors of increased left ventricular filling pressure.

chocardiography and 6-minute walk test in left ventricular systolic dysfunction

Abstract: BACKGROUND: Chronic heart failure is a major cardiovascular disorder. OBJECTIVE: The aim of this study was to prospectively examine whether a 6-min walk test (6-MWT) result correlates with echocardiographic variables in patients with left ventricular systolic dysfunction and stable chronic heart failure. METHODS: We prospectively studied 52 patients (65% male; mean age 60±11 years) who had chronic heart failure secondary to ischemic heart disease or idiopathic cardiomyopathy. All patients had left ventricular systolic dysfunction (ejection fraction <0.45), and were in stable NYHA class II or III heart failure. An echo-Doppler study and a 6-MWT were performed on the same day. RESULTS: 6-MWT had moderate, but statistically significant correlation with end-systolic diameter (ESD) (r=-0.46; p=0.0006), with shortening fraction-SF (r=0.52; p=0.0001), and with ejection fraction-EF (r=0.5; p=0.0001), whereas it had poor, but statistically significant correlation with myocardial performance index-MPI (r=-0.39; p=0.0046), E/A(tricuspid) ratio (r=-0.333; p=0.016), pulmonary acceleration time (r=0.328; p=0.018), and lateral long axis amplitude (r=0.283; p=0.04). Linear regression model demonstrated that age (χ2=-0.59, p=<0.001), restrictive transmitral filling pattern (χ2=-0.44, p=0.004) and left ventricular end-systolic dimension (χ2=-0.34, p=0.012) were independent factors that influenced the 6-MWT. CONCLUSION: In patients with heart failure due to left ventricular systolic dysfunction, the 6-MWT as a clinical assessment tool of the functional capacity has a significant correlation with the most important global LV systolic function parameters, as well as with LV MPI. In patients with LV systolic dysfunction, age, restrictive transmitral filling pattern, and left ventricular systolic dimension, were independently associated with the 6-MWT.

Cor triatriatum sinister--three case reports.

Abstract: UNLABELLED Cor triatriatum is a rare congenital heart disease (0.1% of all congenital cardiac defects), but a higher incidence, up to 0.4% has been reported in autopsies of pts with CHD (1, 2, 7). There are two types: left and right. Cor triatriatum sinister is more common that dexter. Cor triatriatum dextrum is extremely rare. Fewer than 300 cases of cor triatriatum have been reported. It can occur as an isolated defect (classic) or in association with other congenital cardiac anomalies (atypical). It's a surgically correctable CHD and can occur as an isolated defect (classic) or in association with other congenital cardiac anomalies (atypical). METHODS A retrospective review of three patients with Cor triatriatum, diagnosed at University Children's Hospital, during a eight year period (2000-2007). Among 1671 patients with CHD, the diagnosis of cor triatriatum has been established in three patients (0.18%). There were two boys and one girl, aged two years, 6 months and nine years, respectively. All of them had cor triatriatum sinister, with a communication between the right atrium and either the proximal or distal chamber. The first patient had a classic form of cor triatriatum, with a small hole in the diaphragm between atria, which imitated mitral stenosis, while the third patient had also mitral valve prolapse, but the hole between atria was unrestrictive. The second patient manifested atypical form, with many, additional defects: except large, unrestrictive ASD with a very small hole in the diaphragm between two atria, he had also total anomalous pulmonary venous return, draining in coronary sinus, large perimembranous VSD, hypoplastic aorta with coarctation, and high pulmonary vascular resistance. In the second patient, the diagnosis has been performed at 6 months of age, but due to lack of cardio-surgery and poor possibilities for going abroad for operation--finally he had been operated seven months later, but he died a week after surgery. The first patient has been successfully operated, immediately after the diagnosis was performed, while the last patient was diagnosed incidentally at the age of nine. She was symptoms free up to now, but recently she was developing symptoms and was successfully operated. CONCLUSION Cor triatriatum is more prevalent than is thought before echocardiography era. Echocardiography was method of choice in the diagnosis of typical forms, while in a atypical form cardiac catheterization was also performed. Two patients with classic form of CT were successfully operated, while the patient with atypical form and many additional cardiac anomalies died after cardio surgery. The main predictors for prognosis are: the size of the hole in the diaphragm between two chambers of atrium, additional cardiac malformations, and time of surgery.

MRSA endocarditis of bovine Contegra valved conduit: a case report

Abstract: Background Different techniques are used for the right ventricular outflow tract reconstruction, including homo- or porcine xenografts, which have several limitations. Contegra, a bovine jugular vein graft, is an interesting alternative to overcome these limitations. It consists of a bovine jugular vein with a naturally integrated valve in it. Isolated pulmonary valve endocarditis is extremely rare.

Late detection of noncompaction of the myocardium in an adult with complete interventricular septal defect.

Abstract: Noncompaction of the ventricular myocardium (NVM) is a morphogenetic anomaly that leads to the development of cardiomyopathy. It is often associated with other congenital cardiac malformations. Common clinical presentations of NVM involve heart failure symptoms, ventricular tachyarrhythmias, and thromboembolic events. Although the peculiar echocardiographic picture is characteristic for this entity, it may often be misdiagnosed. In this case report, we describe a 27-year-old man who had been followed-up since childhood, with the diagnosis of interventricular septal defect or enlarged "single ventricle" with a very small rudiment of the apical part of the interventricular septum. On his last echocardiographic examination, NVM was detected with heavy trabeculations and intertrabecular recesses. This case suggests that physicians should be more patient to detect other congenital abnormalities including NVM, which may influence the clinical and prognostic outcome of these patients.

The quality of arterial hypertension treatment in cardiology service in Kosovo--a single center study.

Abstract: OBJECTIVE: The epidemiological data have shown that the goal blood pressure (BP) control is achieved in only a small percentage of the hypertensive patients. The aim of this study was to assess the quality of the management of arterial hypertension (AH) in patients hospitalized in Service of Cardiology, University Clinical Centre of Kosovo, in Prishtina, and to determine the predictors of uncontrolled AH. METHODS: This retrospective study included 938 consecutive hypertensive patients (63.1+/- 11.3 years, 55.1% females), admitted to our institution between January 2003 and June 2006. Systolic and diastolic blood pressure, blood analyses, drug prescription and echocardiographic findings were analyzed in all study patients. Multiple regression analysis was used to identify the independent associates of poor BP control. RESULTS: Overall, 83%f of patients were discharged on angiotensin-converting enzyme inhibitors (A), 71% - on beta-blockers (B), 26% - on calcium channel blockers (C) and 60% - on diuretics (D). The most frequent drug combination used was ABD (30.5%), followed by AB (18%) and AD (8%). The goal systolic and diastolic BP was achieved in 50% of patients. Multivariate analysis identified diabetes, (OR=0.479, 95% confidence interval [CI] 0.339-0.677,<0.001), creatinine level (OR=0.997, 95% CI 0.996-0.999, p=0.001], and ABCD combination therapy (OR=0.445, 95% CI 0.253-0.774, p=0.046)], as independent correlates of in-hospital poor BP control. CONCLUSIONS: Half of hypertensive patients hospitalized in the Service of Cardiology had achieved the goal blood pressure. The diabetes, level of creatinine and a combination of 4 antihypertensive drugs were independent predictors of poor hypertension control.

Ecocardiografia e teste de caminhada de 6 minutos na disfunção sistólica do ventrículo esquerdo

Abstract: FUNDAMENTO: Insuficiencia cardiaca cronica e um grave disturbio cardiovascular. OBJETIVO: O objetivo deste estudo foi avaliar prospectivamente se o resultado do teste de caminhada de 6 minutos (TC-6M) se correlaciona com as variaveis ecocardiograficas em pacientes portadores de disfuncao sistolica do ventriculo esquerdo e insuficiencia cardiaca cronica estavel. METODOS: Foram estudados prospectivamente 52 pacientes (65% homens; media de idade de 60±11 anos) portadores de insuficiencia cardiaca cronica secundaria a cardiopatia isquemica ou miocardiopatia idiopatica. Todos os pacientes apresentavam disfuncao sistolica do ventriculo esquerdo (fracao de ejecao <0.45) e encontravam-se em insuficiencia cardiaca classe funcional II ou III da NYHA. Foram realizados um estudo de eco-Doppler e um TC-6M no mesmo dia. RESULTADOS: O TC-6M apresentou correlacao moderada, mas estatisticamente significante, com o diâmetro sistolico final - DSF (r=-0,46; p=0,0006), com a fracao de encurtamento - FEn (r=0,52; p=0,0001) e com a fracao de ejecao (FE) (r=0,5; p=0,0001), e apresentou correlacao fraca, mas estatisticamente significante, com o indice de desempenho miocardico - IDM (r=-0,39; p=0,0046), a relacao E/A (tricuspide) (r=-0,333; p=0,016), o tempo de aceleracao do fluxo pulmonar (r=0,328; p=0,018), e com a amplitude do eixo longo lateral (r=0,283; p=0,04). O modelo de regressao linear demonstrou que a idade (χ2=-0,59, p=<0,001), o padrao de enchimento restritivo transmitral (χ2=-0,44, p=0,004) e a dimensao sistolica final do ventriculo esquerdo (χ2=-0,34, p=0,012) foram fatores independentes que influenciam o TC-6M. CONCLUSAO: Em pacientes portadores de insuficiencia cardiaca decorrente de disfuncao sistolica do ventriculo esquerdo, o TC-6M como ferramenta de avaliacao clinica da capacidade funcional apresenta uma correlacao significante com os principais parâmetros da funcao sistolica global do VE e com o IDM do VE. Em pacientes com disfuncao sistolica do VE, a idade, o padrao de enchimento restritivo transmitral e a dimensao sistolica do ventriculo esquerdo mostraram-se independentemente associados ao TC-6M.