Olga Nedeljkovic‐Arsenovic

University of Belgrade

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Ivana Nedeljković

University of Belgrade

Biljana Parapid

Univerzitetski Klinički Centar Srbije

Ružica Maksimović

University of Belgrade

Gordana Krljanać

University of Belgrade

Miodrag Ostojić

Institute for Cardiovascular Diseases of Vojvodina

Vladimir Kanjuh

Serbian Academy of Sciences and Arts

David R. Jacobs

Minnesota Department of Health

Milika Ašanin

University of Belgrade

Branko Beleslin

Centar za Promociju Nauke

Hisashi Adachi

Kurume University

Cooperative Institutions

University of Belgrade

Centar za Promociju Nauke

Univerzitetski Klinički Centar Srbije

Institute for Cardiovascular Diseases of Vojvodina

University of Kragujevac

University of Belgrade – Faculty of Medicine

Institut za Reumatologiju

Center for Health, Exercise and Sport Sciences

University of Nis

University of Minnesota

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Focal Myocarditis after Mild COVID-19 Infection in Athletes

Diagnostics (2021)

Ivana Nedeljković Vojislav Giga M. Ostojic Ana Djordjevic‐Dikic Tamara Stojmenović

COVID-19 infection in athletes usually has a milder course, but in the case of complications, myocarditis and even sudden cardiac death may occur. We examined an athlete who felt symptoms upon returning to training after asymptomatic COVID-19 infection. Physical, laboratory, and echocardiography findings were normal. The cardiopulmonary exercise test was interrupted at submaximal effort due to severe dyspnea in the presence of reduced functional capacity in comparison to previous tests. Cardiac magnetic resonance (CMR) detected the focal myocarditis. After three months of recovery, CMR still revealed the presence of focal myocarditis and the persistence of decreased functional capacity. This case raises the question of screening athletes even after asymptomatic forms of COVID-19 infection.

2019-20 coronavirus outbreak

10.3390/diagnostics11081519

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Unexpected echocardiographic findings in one vessel coronary artery disease

Cor et Vasa (2017)

Olga Nedeljkovic‐Arsenovic Bosiljka Vujisić-Tešić Olivera Ninković-Mrđenovački M Boricic-Kostic Ivana Nedeljković

Úvod: Aneurysma levé komory je jednou z nejvýznamnějších komplikací infarktu myokardu; předpokládá se, že k jeho tvorbě dochází u 5-10 % všech osob s akutním infarktem myokardu.Kasuistika: Padesátiletý muž s anamnézou chronické nadměrné konzumace alkoholu a rizikovými faktory ischemické choroby srdeční byl dvakrát vyšetřen v krajské nemocnici pro srdeční selhání. V prvním případě nebylo echokardiografické vyšetření provedeno. O tři roky později byl dopraven na oddělení urgentního příjmu s bolestí na hrudi jako hlavní zdravotní obtíží. Echokardiografické vyšetření prokázalo jizvu zadní stěny levé komory s aneurysmatem na jeho bazální části, kde byl rovněž přítomen trombus. Následné vyšetření transezofageální echokardiografií potvrdilo rupturu komisurálních šlašinek posteriorního cípu mitrální chlopně spolu s těžkou regurgitací. Vzhledem k těmto nálezům byl pacient odeslán na koronarografické vyšetření, které prokázalo ischemické postižení jedné koronární tepny. U pacienta byla následně provedena náhrada nativní mitrální chlopně mechanickou spolu s odstraněním aneurysmatu v levé komoře.Závěr: Vzhledem k anamnéze nadměrné konzumace alkoholu je pravděpodobné, že u nemocného proběhl němý infarkt myokardu zadní stěny (bazální) komplikovaný vznikem aneurysmatu na stěně levé komory.

10.1016/j.crvasa.2017.01.002

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Endurance Sports and Atrial Fibrillation: A Puzzling Conundrum

Journal of Clinical Medicine (2024)

M. Ostojic Mladen Ostojić Olga Petrović Olga Nedeljkovic‐Arsenovic Francesco Perone

The confirmed benefits of regular moderate exercise on cardiovascular health have positioned athletes as an illustration of well-being. However, concerns have arisen regarding the potential predisposition to arrhythmias in individuals engaged in prolonged strenuous exercise. Atrial fibrillation (AF), the most common heart arrhythmia, is typically associated with age-related risks but has been documented in otherwise healthy young and middle-aged endurance athletes. The mechanism responsible for AF involves atrial remodeling, fibrosis, inflammation, and alterations in autonomic tone, all of which intersect with the demands of endurance sports, cumulative training hours, and competitive participation. This unique lifestyle requires a tailored therapeutic approach, often favoring radiofrequency ablation as the preferred treatment. As the number of professional and non-professional athletes engaging in high-level daily sports activities rises, awareness of AF within this demographic becomes imperative. This review delivers the etiology, pathophysiology, and therapeutic considerations surrounding AF in endurance sports.

Endurance Training

Etiology

Overtraining

10.3390/jcm13247691

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Cardiac MRI as a Risk Stratification Tool in COVID -19 Myocarditis

Olga Nedeljkovic‐Arsenovic Arsen Ristić Nemanja Đorđević Milenko Tomić Gordana Krljanać

The aim of this retrospective study was to identify myocardial injury after COVID-19 inflamation and to explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. The study included 139 patients who were enrolled between January-June 2021, mean age 46.7±15.2 years, 68 were men, 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work up, lab. analyses, cardiac ultrasound, and CMR on 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE, (4.3±0.23 vs 3.2±0.14g/L, p<0.05; respectively), as well as D-dimer (1.8±0.3 vs 0.8±0.1 mg/L FEU). Also troponin was statistically significantly higher in patients with myocardial LGE (13.1±0.4ng/L) compared to those with normal myocardium (4.9±0.3ng/L, p<0.001). We demonstrated chest pain, fatigue and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.

Risk Stratification

Viral Myocarditis

2019-20 coronavirus outbreak

10.20944/preprints202401.2154.v1

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Chronic or Changeable Infarct Size after Spontaneous Coronary Artery Dissection

Diagnostics (2023)

Gordana Krljanać Svetlana Apostolović Z Mehmedbegovic Olga Nedeljkovic‐Arsenovic Ružica Maksimović

Spontaneous coronary artery dissection (SCAD) could be the cause of acute myocardial infarction (AMI) and sudden cardiac death. Clinical presentations can vary considerably, but the most common is the elevation of cardiac biomarkers associated with chest discomfort. Different pathological etiology in comparison with Type 1 AMI is the underlying infarct size in this population. A 42-year-old previously healthy woman presented with SCAD. Detailed diagnostical processing and treatment which were performed could not prevent myocardial injury. The catheterization laboratory was the initial place for the establishment of a diagnosis and proper management. The management process can be very fast and sometimes additional imaging methods are necessary. Finding predictors of SCAD recurrence is challenging, as well as predictors of the resulting infarct scar size. Patients with recurrent clinical symptoms of chest pain, ST elevation, and complication represent a special group of interest. Therapeutic approaches for SCAD range from the ”watch and wait” method to complete revascularization with the implantation of one or more stents or aortocoronary bypass grafting. The infarct size could be balanced through the correct therapeutical approach, and, proper multimodality imaging would be helpful in the assessment of infarct size.

Scad

Etiology

10.3390/diagnostics13091518

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The importance of the imaging methods in patients with COVID-19 infection

European Heart Journal - Cardiovascular Imaging (2023)

Gordana Krljanać Milika Ašanin Ružica Maksimović Olga Nedeljkovic‐Arsenovic N. Djordjević

Abstract Funding Acknowledgements Type of funding sources: None. Background Echocardiography, pulmonary CT and cardiac magnetic resonance (CMR) were have been used in detecting organ damage in COVID-19 patients. The aim of this study is to compare imaging findings and clinical symptoms patients with COVID-19. Methods The study was conducted in our university clinical center. All pts underwent clinical examination, laboratory analysis, echocardiography, pulmonary CT and CMR. Results 126 pts with COVID-19 infection, 61 (48%) male, mean age 45±15years with symptoms of palpitation, fatigue, dyspnea and chest pain. Meantime from the onset of infection to observation was 107 days. In pts with palpitation, brain natriuretic peptide (NTproBNP) was not higher (39.4±9.1 vs. 19.2±9.4 pg/ml, p = 0.075). In case of pts with dyspnea ejection fraction of the left ventricle (LVEF) as founded by echocardiography, was significantly lower (62±6 vs. 67±6%, p = 0.025). The CT severity score index was not significantly higher in patients with fatigue after acute infection (21.0±8.1 vs. 10.1±5.1, p = 0.060). Late gadolinium enhancement (LGE) was seen in 61/126 (48%) pts, distribution was predominantly in mid and epicardial layers 41/61 pts (67%), >3 segments were identified in 37/61 pts (61%), myocardial edema was seen in 50/126 pts (40%). The extracellular volume (ECV) quantification by CMR were significantly higher in patients with fatigue (22.6±3.8 vs. 19.7±5.2%, p = 0.010). There is no significant correlation between clinical symptoms and myocardial oedema by using T2FS. Conclusions Echocardiography and CMR are the most important imaging methods in risk stratification and optimal therapeutic strategies in pts with myocardial injury caused by COVID-19 infection.

10.1093/ehjci/jead119.385

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Efekat barijatrijske hirurgije na kardiopulmonalni funkcionalni kapacitet kod bolesno gojaznih osoba

Универзитет у Београду (2019)

Olga Nedeljkovic‐Arsenovic

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[OP.8B.02] HYPERTENSION WITHIN THE METABOLIC SYNDROME

Journal of Hypertension (2017)

Biljana Parapid Nicolas Danchin Vladimir Kanjuh Miloš Stojanović Olga Nedeljkovic‐Arsenovic

Objective: The metabolic syndrome (Met Sy) is in the focus of as a cluster of risk factors that are known to promote atherosclerosis, diabetes and obesity, primarily, while the Seven Countries Study remains one of the core epidemiological trials that taught us the basis of modifiable risk factors for coronary heart disease, mainly. Inhereted risk factors and parental morbidity and mortality was equally studied in all the participants, and we are presenting the results of the 40 years follow-up. Design and method: The Seven Countries Study encompassed 12,763 participants who were healthy at baseline and who underwent regular check ups every 5 years throughout over 4 decades. Results: Using the IDF definition of the Metabolic Syndrome, 9.09% of participants were identified and the combination of risk factors (RF) is presented in Picture 1.Conclusions: Hypertension was the leading risk factor in all the cohorts, irrelevant of presence or absence of MetSy and influenced 40y mortality independently, while also being the most frequent risk factor in the MetSy population.

10.1097/01.hjh.0000523199.12200.79

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Abstract P123: Metabolic Syndrome Risk Factors' Aggregation Within the Seven Countries' Study: 45 Years Follow Up Results

Circulation (2020)

Biljana Parapid Nicolas Danchin Olga Nedeljkovic‐Arsenovic Bratislav Kirćanski Dragana Bubanja

Introduction: Components of the metabolic syndrome (MetSy) have gone through myriad of changes ever since the initial cluster was defined. The Seven Countries Study taught us the basics of classical risk factors for atherosclerotic artery disease and their influence on both cardiovascular and cerebrovascular morbidity and mortality. Material and Methods: In a 3-continent, 7-country (USA, Japan, Greece, the Netherlands, Finland, Italy, and former Yugoslavia then, now Croatia and Serbia) sample of 12,763 participants -- all healthy men over 40 at entry -- systematic, quinquennial checkups were conducted over 4 decades and MetSy was defined using the IDF definition. ResultS: A total of 9,09% of participants were identified to have MetSy, while the detailed description of risk factors' combination is shown in Table 1 and Figure 1, below. Conclusion: The leading combination was hypertension (HTA), diabetes (DM) and dyslipidemia (HLP), while hypertension was the hallmark risk factor irrelevant of presence or absence of MetSy. The results of this study call for a contemporary comprehensive research involving both sexes that could elucidate better real life risk factors' relationships in aforementioned countries.

Dyslipidemia

Atherosclerotic cardiovascular disease

10.1161/circ.141.suppl_1.p123

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Cardiac Magnetic Resonance Imaging as a Risk Stratification Tool in COVID-19 Myocarditis

Diagnostics (2024)

Olga Nedeljkovic‐Arsenovic Arsen Ristić Nemanja Đorđević Milenko Tomić Gordana Krljanać

The aim of this retrospective study was to identify myocardial injury after COVID-19 inflammation and explore whether myocardial damage could be a possible cause of the persistent symptoms following COVID-19 infection in previously healthy individuals. This study included 139 patients who were enrolled between January and June 2021, with a mean age of 46.7 ± 15.2 years, of whom 68 were men and 71 were women without known cardiac or pulmonary diseases. All patients underwent clinical work-up, laboratory analysis, cardiac ultrasound, and CMR on a 1.5 T scanner using a recommended protocol for morphological and functional assessment before and after contrast media application with multi-parametric sequences. In 39% of patients, late gadolinium enhancement (LGE) was found as a sign of myocarditis. Fibrinogen was statistically significantly higher in patients with LGE than in those without LGE (4.3 ± 0.23 vs. 3.2 ± 0.14 g/L, p < 0.05, respectively), as well as D-dimer (1.8 ± 0.3 vs. 0.8 ± 0.1 mg/L FEU). Also, troponin was statistically significantly higher in patients with myocardial LGE (13.1 ± 0.4 ng/L) compared to those with normal myocardium (4.9 ± 0.3 ng/L, p < 0.001). We demonstrated chest pain, fatigue, and elevated troponin to be independent predictors for LGE. Septal LGE was shown to be a predictor for arrhythmias. The use of CMR is a potential risk stratification tool in evaluating outcomes following COVID-19 myocarditis.

Cardiac magnetic resonance

Subclinical infection

Risk Stratification

10.3390/diagnostics14080790

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