Branko Beleslin

Centar za Promociju Nauke

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Miodrag Ostojić

Institute for Cardiovascular Diseases of Vojvodina

112

Ana Djordjevic‐Dikic

University of Belgrade

Vojislav Giga

Centar za Promociju Nauke

Jelena Stepanović

Institute of Pesticides and Environmental Protection

Milan Nedeljković

Centar za Promociju Nauke

Milorad Tešić

University of Belgrade

Siniša Stojkovič

Centar za Promociju Nauke

Ivana Nedeljković

University of Belgrade

Goran Stanković

Centar za Promociju Nauke

Milan Dobrić

University of Belgrade

Cooperative Institutions

European Society of Cardiology

604

Sorbonne Université

595

Assistance Publique – Hôpitaux de Paris

536

University of Belgrade

477

Inserm

411

Pitié-Salpêtrière Hospital

396

Centro Cardiologico Monzino

391

Hacettepe University

367

Benha University

350

Assaf Harofeh Medical Center

343

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Papers

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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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Citations (7)

A Novel Penetration Device for Severe Stenosis or Chronic Total Occlusion in Coronary Artery Disease*

Herz (2008)

Siniša Stojković Miodrag Ostojić Shigeru Saito Milan Nedeljković Branko Beleslin

Interventional cardiology

Balloon dilatation

10.1007/s00059-008-3064-x

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Citations (3)

Long-Term Performance of the Magmaris Drug-Eluting Bioresorbable Metallic Scaffold in All-Comers Patients’ Population

Journal of Clinical Medicine (2022)

Arif Al Nooryani Wael Aboushokka Bassam AlBaba Jalal A. Kerfes Loai Abudaqa

Background: The long-term efficacy and safety of bioresorbable vascular scaffolds (BVS) in real world clinical practice including Magmaris need to be elucidated to better understand performance of this new and evolutive technology. The aim of this study was to evaluate long-term performance of Magmaris, drug-eluting bioresorbable metallic scaffold, in all-comers patients' population. Methods: We included in this prospective registry first 54 patients (54 ± 11 years; male 46) treated with Magmaris, with at least 30 months of follow-up. Diabetes mellitus and acute coronary syndrome were present in 33 (61%) and 30 (56%) of the patients, respectively. Patients were followed for device- and patient-oriented cardiac events during a median follow-up of 47 months (DOCE-cardiac death, target vessel myocardial infarction, and target lesion revascularization; POCE-all cause death, any myocardial infarction, any revascularization). Results: Event-free survivals for DOCE and POCE were 86.8% and 79.2%, respectively. The rate of DOCE was 7/54 (13%), including in total target vessel myocardial infarction in two patients (4%), target lesion revascularization in six patients (11%), and no cardiac deaths. The rate of POCE was 11/54 (21%), including in total any myocardial infarctions in 3 patients (6%), any revascularization in 11 patients (20%), and no deaths. Definite Magmaris thrombosis occurred in two patients (3.7%), and in-scaffold restenosis developed in five patients (9.3%). Variables associated with DOCE were implantation of ≥2 Magmaris BVS (HR: 5.4; 95%CI: 1.21-24.456; p = 0.027) and total length of Magmaris BVS ≥ 40 mm (HR: 6.4; 95%CI: 1.419-28.855; p = 0.016), whereas previous PCI was the only independent predictor of POCE (HR: 7.4; 95%CI: 2.216-24.613; p = 0.001). Conclusions: The results of the long-term clinical outcome following Magmaris implantation in patients with complex clinical and angiographic features were acceptable and promising. Patients with multi-BVS and longer multi-BVS in lesion implantation were associated with worse clinical outcome.

Bioresorbable scaffold

Bare metal

10.3390/jcm11133726

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Citations (5)

One-year follow-up of myocardial perfusion and function evaluated by gated SPECT MIBI in patients with earlier myocardial infarction and chronic total occlusion

Nuclear Medicine Communications (2009)

Smiljana Pavlović Dragana Šobić-Šaranović Branko Beleslin Miodrag Ostojić Milan Nedeljković

Objective Optimal treatment for chronic total occlusion (CTO) in the infarct-related coronary artery is not clear. Our aim was to assess myocardial perfusion, left ventricular ejection fraction (EF), and left ventricular size using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging with 99mTc-methoxy-isobutyl-isonitrile in patients with CTO before and 1 year after recanalization. Methods Thirty patients with earlier myocardial infarction and at least one CTO underwent percutaneous coronary intervention (PCI) as well as nitrate-enhanced gated SPECT myocardial perfusion and dobutamine stress echocardiography before and 11±1 months after recanalization. They were divided into three groups based on the outcome of the follow-up angiography: (i) successful recanalization with no evidence of in-stent restenosis (n=13); (ii) successful recanalization with in-stent restenosis (n=7) and (iii) unsuccessful recanalization (n=10). Results Overall success of recanalization for CTO was 74%. In group 1, myocardial viability was preserved in 11 of 13 (85%) patients at baseline. Gated SPECT at 1 year showed a significant decrease in perfusion abnormalities (29±12 to 23±14%, P<0.05) and left ventricular end-diastolic volume (EDV) (168±47 to 151±47 ml, P<0.05). Improvement in EF (51±11 to 54±13%, P>0.05) and reduction in left ventricular end-systolic volume (ESV) (84±37 to 77±40 ml, P>0.05) did not reach the level of significance. Myocardial viability was preserved in only two of seven patients (28%) in group 2. Neither mean perfusion abnormalities (37±24 to 35±22%, P>0.05) nor global left ventricular parameters (EF 41±15 vs. 42±19%, EDV 298±33 vs. 299±57 ml, ESV 197±12 vs. 195±32 ml; P>0.05) changed at the follow-up. In group 3, myocardial viability was preserved in seven of 10 patients (70%) at baseline, but no significant changes in perfusion (40±18 vs. 41±19%, P>0.05) and left ventricular function (EF 42±17 vs. 44±14%, EDV 228±101 vs. 227±81 ml, ESV 143±87 vs. 146±8ml; P>0.05) were seen at the follow-up. Conclusion Myocardial perfusion and EDV may significantly improve 1 year after PCI provided recanalization of CTO was successful. Our preliminary findings suggest that successful recanalization of CTO may have favorable outcome on left ventricular perfusion and function, particularly in patients with viable myocardium before PCI. The gated SPECT myocardial perfusion imaging with 99mTc-methoxy-isobutyl-isonitrile may be useful for monitoring long-term functional outcome of PCI in patients with CTO.

Gated SPECT

Dobutamine

10.1097/mnm.0b013e32831a40dd

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Citations (22)

Usefulness of NT-proBNP in the Follow-Up of Patients after Myocardial Infarction

Journal of Medical Biochemistry (2016)

Mina Radovanović Nebojša Radovanović Zorana Vasiljević Jelena Marinković Predrag Mitrović

Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up.Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events.Median (IQR) level of NT-proBNP was 521 (335-1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively.NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.Serijska merenja natriuretskih peptida kod pacijenata sa akutnim koronarnim sindromom su pokazala da su njihove vrednosti u kasnijoj, hroničnoj fazi bolji prediktor prognoze i pouzdaniji indikator funkcije leve komore nego one u akutnoj fazi. Stoga je cilj ovog rada da se ustanove vrednosti NT-proBNP-a 6 meseci nakon akutnog infarkta miokarda (AIM), njihova udruženost sa tradicionalnim faktorima rizika, karakteristikama intrahospitalnog i ranog postinfarktnog toka, kao i njegov prognostički značaj i optimalne prediktivne vrednosti, tokom narednog jednogodišnjeg praćenja.Uzorci krvi su uzeti našte kod 100 ambulantnih pacijenata. Koncentracije NT-proBNP-a u litijum-heparinskoj plazmi su određivane korišćenjem jedno-stepenog enzimskog imunoeseja, baziranog na »sendvič« principu, na uređaju »Dimension RxL clinical chemistry system« (DADE Behring-Siemens). Pacijenti su praćeni narednih godinu dana radi registrovanja novih srčanih događaja.Medijana (IQR) NT-proBNP-a u našoj populaciji bila je 521 (335–1095) pg/mL. Najviše vrednosti NT-proBNP-a bile su značajno pozitivno udružene sa srčanim događajima tokom prvih 6 meseci nakon AIM; nasuprot tome, negativna udruženost sa reperfuzionom terapijom u lečenju indeks infarkta potvrdila je njen dugotrajni povoljan efekat. Tokom jednogodišnjeg praćenja stabilnih pacijenata, multivarijantna regresiona Coxova analiza pokazala je nezavisan prognostički značaj NT-proBNP-a u predviđanju novonastale srčane insuficijencije (SI) (p=0,014), kao i novih koronarnih događaja (NKD) (p=0,035). Analizom ROC krive dobijene su optimalne prediktivne vrednosti NT-proBNP-a: 800 pg/mL za SI i 516 pg/mL za NKD.Vrednosti NT-proBNP-a 6 meseci nakon AIM su značajno udružene sa karakteristikama infarktnog i ranog postinfarktnog toka i nezavisno predviđaju najvažnije nove srčane događaje tokom narednih godinu dana.

10.1515/jomb-2016-0003

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Citations (13)

The ESC-EORP Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry

European Heart Journal - Quality of Care and Clinical Outcomes (2019)

Michel Komajda Francesco Cosentino Roberto Ferrari Cécile Laroche Aldo P. Maggioni

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischaemic Cardiovascular Disease Long Term (CICD LT) registry aims to study the clinical profile, treatment modalities, and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular (CV) risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid- and long-term outcomes and their determinants in this population.Nine thousand one hundred and seventy-four patients over 18 years with documented CICD defined by a history acute coronary syndrome with/without ST elevation, previous coronary revascularization, or stable coronary artery disease were enrolled between 1 May 2015 and 31 July 2018. Individual patient data on clinical profile, biology, and treatment modalities were collected across 154 centres from 20 ESC countries. Two years of follow-up is scheduled in order to determine the following clinical outcomes: all-cause and CV death, all-cause and CV hospitalizations, changes in medications, and quality of life using the EuroQol5D-5L score.The CICD LT is an international registry of care and outcomes of patients hospitalized with CICD which will provide insights into the contemporary profile and management of patients with this common disease.

Disease registry

Modalities

10.1093/ehjqcco/qcz057

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Citations (3)

Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy

The International Journal of Cardiovascular Imaging (2022)

Eszter Dalma Pálinkás Federica Re Jesús Peteiro Milorad Tešić Attila Pálinkás

B-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).To assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.We enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e'; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.LUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e' (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e' (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.Two-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.

Preload

Stress Echocardiography

Treadmill

10.1007/s10554-022-02620-0

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Citations (9)

Hemodynamic heterogeneity of inadequate cardiac output increase identified by 2-dimensional volumetric exercise echocardiography: slow, stiff or weak heart?

European Heart Journal (2020)

Tonino Bombardini A Zagatina Quirino Ciampi L Cortigiani Antonello D’Andrea

Abstract Background Two-dimensional (2-D) volumetric exercise stress echocardiography (ESE) provides an integrated view of preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose To assess the dependence of stroke volume (SV) and cardiac output (CO) upon LVCR EDV changes and heart rate (HR) during ESE. Methods We prospectively performed semi-supine bicycle or treadmill ESE in 1,344 patients (age 59.8±11.4 years; 550 female; ejection fraction = 62.5±8%) referred for known or suspected coronary artery disease in 20 quality controlled laboratories of 16 countries from 2016 to 2019. SV was calculated at rest and peak stress from raw measurement of LV EDV and ESV by biplane Simpson rule, 2-D echo. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values <2.0 identify a “weak” heart). Preload reserve was defined by an increase in LV EDV. Abnormal values (lack of EDV increase, peak EDV ≤ rest EDV) identify a “stiff” heart. Cardiac output was calculated as SV * HR (measured with standard EKG). HR reserve (stress/rest ratio) <1.85 identifies a “slow” heart with chronotropic incompetence. Results By selection, all patients had negative SE by wall motion criteria. Of the 1,344 patients included in the study, 448 belonged to the lowest tertile of CO increase. Of them 326 (73%) achieved HR reserve <1.85; 220 (49%) had a blunted LVCR and 374 (83%) a reduction of preload reserve, with 348 patients (78%) showing ≥2 abnormalities. The more the abnormal criteria, the worse the CO response, which was lowest in slow, stiff and weak hearts: see figure. Conclusion Patients with normal CO reserve during exercise usually have a fast, compliant and strong heart. Abnormal CO reserve is associated with heterogeneous hemodynamic responses, with slow, stiff and/or weak hearts. The clarification of underlying hemodynamic heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from a standard 2-D volumetric SE. Hearts with normal CO are all alike; every heart with abnormal CO is abnormal in its own way. CO % changes in subsets (*p<0.001) Funding Acknowledgement Type of funding source: None

Preload

Supine position

Stress Echocardiography

End-diastolic volume

10.1093/ehjci/ehaa946.0037

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Citations (0)

Clinical application of cardiopulmonary exercise testing in current cardiology practice and special patient subsets

Srce i krvni sudovi (2012)

Ivana Nedeljković Sanja Mazić Vladimir Žugić Vojislav Giga Milica Dekleva

Cardiopulmonary exercise test is reproducible, simple and accurate non-invasive method that provides additional useful information to standard exercise testing as an integral part of a growing number of recommendations and guidelines. Aerobic functional capacity can be estimated from expiratory gass analysis, in patients with unexplained exertional dyspnea, and in determination of diagnosis and prognosis for various groups of patients with heart, lung and muscle diseases. The choice of parameters depends on the type of disease we studied from stratification of heart failure to prescription of rehabilitation and participation in competitive sports.

Exercise prescription

Clinical Practice

10.5937/siks1203166n

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Citations (2)

Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients With Asymmetric Hypertrophic Cardiomyopathy

Journal of the American Heart Association (2021)

Milorad Tešić Branko Beleslin Vojislav Giga Ivana Jovanović Jelena Marinković

Background Microvascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with hypertrophic cardiomyopathy (HCM). However, long-term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on clinical outcome is uncertain in HCM patients. Therefore, the aim of our study was to assess long-term prognostic value of CFVR on clinical outcome in HCM population. Methods and Results We prospectively included 150 HCM patients (82 women; mean age 48±15 years). Patients' clinical characteristics, echocardiographic and CFVR findings (both for left anterior descending [LAD] and posterior descending artery [PD]), were assessed in all patients. The primary outcome was a composite of: HCM related death, heart failure requiring hospitalization, sustained ventricular tachycardia and ischemic stroke. Patients were stratified into 2 subgroups depending on CFVR LAD value: Group 1 (CFVR LAD>2, [n=87]) and Group 2 (CFVR LAD≤2, [n=63]). During a median follow-up of 88 months, 41/150 (27.3%) patients had adverse cardiac events. In Group 1, there were 8/87 (9.2%), whereas in Group 2 there were 33/63 (52.4%, P<0.001 vs. Group 1) adverse cardiac events. By Kaplan-Meier analysis, patients with preserved CFVR LAD had significantly higher cumulative event-free survival rate compared to patients with impaired CFVR LAD (96.4% and 90.9% versus 66.9% and 40.0%, at 5 and 8 years, respectively: log-rank 37.2, P<0.001). Multivariable analysis identified only CFVR LAD≤2 as an independent predictor for adverse cardiac outcome (HR 6.54; 95% CI 2.83-16.30, P<0.001), while CFVR PD was not significantly associated with outcome. Conclusions In patients with HCM, impaired CFVR LAD (≤2) is a strong, independent predictor of adverse cardiac outcome. When the aim of testing is HCM risk stratification and CFVR LAD data are available, the evaluation of CFVR PD is redundant.

10.1161/jaha.120.021936

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Citations (15)