Violeta Irić-Ćupić

University of Kragujevac

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Co-Authors

Goran Davidović

University of Kragujevac

Stefan Simović

University of Kragujevac

Ivan Simić

Clinical Centre of Kragujevac

S Milanov

Medical University of Silesia

Jelena Vučković-Filipović

University of Kragujevac

Vladimir Miloradović

Clinical Centre of Kragujevac

M. Vuleta

University Hospital Center Dr Dragiša Mišović

Mehmet Birhan Yılmaz

Dokuz Eylül University

Vladimir Ignjatović

Clinical Centre of Kragujevac

Dragoș Vinereanu

Amita Health St. Mary's Hospital

Cooperative Institutions

University of Liverpool

752

Aalborg University

677

Liverpool Heart and Chest Hospital

671

Laboratoire Informatique d'Avignon

642

Uppsala University

517

Associazione Nazionale Medici Cardiologi Ospedalieri

407

University of Modena and Reggio Emilia

388

University of Belgrade

379

Policlinico di Modena

360

Ludwig-Maximilians-Universität München

295

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The “widow maker” warning sign or Wellens’ syndrome: A case report

Archives of Biological Sciences (2012)

M. Karadzic Jelena Vučković-Filipović Goran Davidović Violeta Irić-Ćupić Mladen Tasić

Wellens? syndrome, also known as LAD (left anterior descending) coronary T-wave syndrome, ?widow maker? or warning sign, is a potentially unrecognized critical proximal LAD stenosis with possible fatal consequences. It can be associated with extensive acute anterior wall myocardial infarction, with left ventricular dysfunction and a lethal outcome within a few days after the onset of symptoms. It usually consists of a typical ECG finding in the precordial leads that represents a significant proximal LAD stenosis in patients with unstable angina pectoris. Although this syndrome is not indicated for PCI (the patient is usually pain-free at the time of electrocardiography registration), it is necessary to recognize the characteristic pattern and perform an emergency coronary angiography and percutaneous or surgical revascularisation of the affected blood vessel. Here we present the case report of a 47 year-old woman without previous anamnesis of coronary disease. On admission to the Coronary Care Unit she was chest pain-free and had all the indicators of Wellens? syndrome.

T wave

Culprit

Anamnesis

Unstable angina

10.2298/abs1202733k

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Citations (2)

Dobutamine stress echocardiographyin distinguishing ischemic from nonischemic dilated cardiomyopathy

Medicinski pregled (2005)

Vladimir Miloradović Violeta Irić-Ćupić Aleksandar Popović

Introduction The aim of this study was to evaluate the diagnostic accuracy of dobutamine stress echocardiography for detection of coronary artery disease in patients with dilated cardiomyopathy. Detection of regional wall motion abnormalities at rest does not reliably distinguish ischemic from nonischemic cardiomyopathy. Material and methods To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM), we studied 50 patients with left ventricular dysfunction (20 ischemic and 30 nonischemic, detected by coronary angiography) using dobutamine stress echocardiography. Echocardiographic images were obtained at baseline, low and paek dose of dobutamine. Rest and stress left ventricular wall motion scores were derived from analysis of regional wall motion. Results Dobutamine infusion was terminated after achievement of the target heart rate or maximal protocol dose in 16 (80%) patients with ischemic heart disease and in 23 (73.3%) patients with nonischemic heart disease. At rest, there were more normal segments (p<0.001) and a trend toward more akinetic segments (p, not significant) per ischemic than per nonischemic DCM patients. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many normal or dyssinergic regions at rest (in some cases after inprovement with low-dose dobutamine); in contrast, in nonischemic DCM, further mild impovement was observed in a variable number of left ventricular areas. Thus, with peak-dose dobutamine, more akinetic and less normal segments were present per ishemic than per nonischemic DCM patient (both, p<0.001). A value of six or more akinetic segments was 90% sensitive and 98% specific for ischemic DCM. Conclusions Our data show that analysis of regional contraction by dobutamine stress echocardiography can distinguish between.

Dobutamine

Dilated Cardiomyopathy

10.2298/mpns0512541m

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PP.37.19

Journal of Hypertension (2015)

S Milanov Jelena Vučković-Filipović Goran Davidović Ivan Čekerevac Violeta Irić-Ćupić

Objective: Patients with sleep apnoea-hypopnea syndrome show very high levels of sympathetic activity, which may affect both short-term and long-term blood pressure regulation. Spectral analysis of heart rate variability allows simple, non-invasive testing of the autonomic function. Aim was to determine the level of sympathetic activity using spectral analysis of HRV in hypertensive patients with/without SA. Design and method: Research included 100 patients who underwent polysomnograpic examination in UCC Kragujevac. According to apnoea-hypopnea index (AHI) all patients were divided into 3 equal groups, 25 patients in each group (AHI 5–15; 15–30 and > 30). Fourth group was a control group with 25 patients without SA. All patients were evaluated for prior hypertension and antihypertensive therapy. Diagnosis was confirmed using ABPM and HTN was classified according to the latest guidelines. Spectral analysis of HRV was used for non-invasive testing of autonomic function. The analysis was performed using a fast Fourier transform of the autoregression method integrated into 24 h ECG Holter monitoring. All data were statistically analyzed in the SPSS for Windows. Results: Study population consisted of 69% of male and 31% of female patients with mean age of 55.05 ± 11.16 years. Prior hypertension was present in 76% of patients (x2 = 27.04; p = 0.000), with 68% on antihypertensive therapy (x2 = 12.96; p = 0.000). Among patients with diagnosed SA 62% had hypertension (x2 = 7.31; p = 0.007). More than 50% of patients had beta blockers in their therapy in total popultion and 46% in group with SA. Spectral analysis of HRV showed higher sympathetic activity: LF component – 984.29 ± 3893.04 vs HF component – 464.04 ± 1938.75. LF/HF ratio was >2.0 in 70% of patients confirming that autonomic balance is shifted towards sympathetic activity (x2 = 12.96; p = 0.000). Among patients using beta blockers 66.1% had higher sympathetic activity. Conclusions: As previously described, males have sleep apnoea-hypopnea syndrome more often than females. More than a half of patients with sleep apnoea had prior hypertension. Autonomic balance was shifted towards sympathetic activity. Although majority of patients in both groups, total and patients with sleep apnea, had beta blockers in therapy, sympathetic activity remained higher.

Spectral Analysis

10.1097/01.hjh.0000468879.68412.27

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Kounis syndrome

PONS - medicinski casopis (2015)

Jelena Vučković-Filipović Srdjan Milanov Violeta Irić-Ćupić Vladimir Miloradović Ivan Simić

Kounis syndrome is a group of symptoms manifested as unstable vasospastic or non- vasospastic angina, or even as acute myocardial infarction. Inflammatory mediators released into a bloodstream during some allergic reaction are most frequently mentioned to be a trigger for Kounis syndrome. We present a case of acute myocardial infarction associated with an allergic reaction after a honeybee sting, in an 79-year-old Serbian male.

Kounis syndrome

Vasospastic angina

Sting

Unstable angina

Allergic reaction

10.5937/pomc12-8665

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Wells’ Score in Diagnosis of Pulmonary Embolism in Patient with Thrombocytopenia: A Case Report

Serbian Journal of Experimental and Clinical Research (2018)

D. Panic Andreja Todorović Milica Stanojević Violeta Irić-Ćupić

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.

D-dimer

Clinical Diagnosis

Clinical Practice

10.1515/sjecr-2017-0061

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Effect and significance of hyperlipoproteinemia on stent thrombosis in patients with implanted drug-eluting stents: The 5-year follow up study

The American Journal of the Medical Sciences (2021)

Maja Stojanović Violeta Irić-Ćupić

10.1016/j.amjms.2021.05.012

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Citations (1)

Influence of admission plasma glucose level on short- and long-term prognosis in patients with ST-segment elevation myocardial infarction

Vojnosanitetski pregled (2010)

Violeta Mladenović Vladimir Zdravković Marina Jovic Rada Vučić Violeta Irić-Ćupić

Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and long-term prognostic significance of APG levels in patients with STEMI with and without diabetes.This study included 115 patients with STEMI, 86 (74.8%) nondiabetic and 29 (25.2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and short- and long-term mortality.Comparison of APG levels between nondiabetic (8.32 +/- 2.4 mmol/L) and diabetic (10.09 +/- 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 +/- 2.68 vs 10.0 +/- 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 +/- 1.92 vs 10.09 +/- 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 +/- 2.97 vs 7.91 +/- 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 +/- 2.49 vs 7.84 +/- 2.24 mmol/L, respectively; p = 0.013).Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.

Elevation (ballistics)

Plasma levels

10.2298/vsp1004291m

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Citations (9)

[Near miss sudden infant death syndrome ].

PubMed (1982)

Violeta Irić-Ćupić V Dürrigl

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Citations (4)

Fulminant myocarditis as a primary manifestation of H1N1 infection: A first reported case from Serbia

Hellenic Journal of Cardiology (2016)

Goran Davidović Stefan Simović Slobodanka Mitrović Violeta Irić-Ćupić Vladimir Miloradović

A 19-year-old male was admitted to our clinic with a diagnosis of suspected acute pericarditis and acute coronary syndrome. The initial diagnostics at our clinic revealed fulminant myocarditis. Twenty-four hours after admission, the patient's condition deteriorated, and he required mechanical ventilation and cardiopulmonary resuscitation. Unfortunately, the patient died. Clinical course, postmortem pathohistological findings and virus serology indicated that an H1N1 viral caused fulminant myocarditis and was the primary manifestation.

Fulminant

10.1016/j.hjc.2015.06.001

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Citations (8)

THE EFFECT OF STRESS INDUCED-HYPERGLYCEMIA ON HOSPITAL TREATMENT OUTCOME IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION

Acta Medica Medianae (2012)

Aleksandar Stojković Miloje Tomašević Nebojša Krstić Zoran Perišić Milan Pavlović

Elevated glucose level on admission in the number of emergency conditions, including acute myocardial infarction (AMI), is linked to worse outcomes, regardless of the current treatment. The introduction of primary percutaneous coronary intervention (PPCI) in therapy of AMI patients with ST segment elevation (STEMI) has improved the treatment of these patients. However, there are contradictory evidences regarding the impact of stressinduced hyperglycemia on the treatment outcome. The present study is aimed to indentify the effect of stress-induced hyperglycemia on in-hospital prognosis of patients with STEMI treated with AIM-PPCI. Prospective study included 116 patients with a diagnosis of first AMI-STEMI treated with PPCI at the Department of Cardiovascular Diseases, Clinical Center Nis in the period 2010-2011. Immediately after establishing the diagnosis, the patients with adequate medicament preparation were transferred into the angiography room for the coronary stent implantation. Laboratory analysis of the whole blood samples were done immediately after admission and in the next 24 hours. Receiver operator characteristic (ROC) analysis revealed that stress-induced hyperglycemia (glucose 11.2 mmol / L, an area under the curve of 0.812) is a delimiting factor for distinguishing the outcome and survival of patients on admission. The group of patients without stress-induced hyperglycemia had mortality rate about five times less (1/79 -1.2%) than the group of patients with stress-induced hyperglycemia (5/37 13.5%), p=0.041. Comparing these groups with the incidence of DM, stress-induced hyperglycemia had no significant effect on mortality in the group without DM (1/54 vs. 3/26, ns) and in the group with DM (1/25 vs. 1/11, ns). The cut-off value of glucose, obtained by ROC curve, is 11.2 mmol/L for stressinduced hyperglycemia in patients with STEMI treated with PPCI. This value could determine a significant gradient of risk: patients with glycemia <11.2 mmol/L on admission had almost five times lower risk of mortality in hospital than those with the level of glucose ≥ 1.2mmol/L. Stress-induced hyperglycemia has an equally bad effect on hospital survival in the groups with and without DM. Acta Medica Medianae 2012;51(3):18-23.

Stress hyperglycemia

10.5633/amm.2012.0303

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Citations (3)