Aim. In our study, we researched whether on-pump and off-pump coronary artery bypass grafting (CABG) differ as regards their effect on postoperative red cell distribution width (RDW). Moreover, we also investigated whether there was a link between the preoperative and postoperative RDW levels and the early adverse events after CABG.

Material and methods. In this study there were 127 consecutive patients who had previously undergone CABG. The patients were divided as group 1 (off-pump, n: 49) and group 2 (on-pump, n: 78). The hemogram and biochemistry panel values were measured a day before the operation, on the first, third and seventh days after it, and in the postoperative first and sixth months.

Results. The statistically significant values detected in the hemogram were as follows: postoperative first day hemoglobin, postoperative first day leukocyte, postoperative first day thrombocyte, postoperative first day C-reactive protein, postoperative third day RDW, postoperative third day leukocyte, postoperative seventh day RDW, postoperative seventh day leukocyte, postoperative first month RDW, and postoperative first month thrombocyte (p<0,05). It was found in multivariate analysis that preoperative RDW is an independent risk factor for plasma used in the postoperative period (odds ratio: 0.552; 95% CI: 0.346–0.879; P=0.012). There was no link between preoperative RDW and other early adverse events in the postoperative period (p>0,05).

Conclusion. We found that on-pump CABG increases the RDW levels more in the acute period, when compared with off-pump surgery, but that this effect disappears by the sixth month after the operation. For this reason, RDW can be used as a new inflammatory marker in patients undergoing CABG. Moreover, we observed that there was no clinical link between early adverse events after CABG and the pre- and postoperative RDW levels.

Cardiopulmonary bypass (CPB) is often associated with renal dysfunction, as measured by plasma creatinine levels and hemodialysis rates.

Aim. To compare creatinine clearance (CrCl), estimated with the Cockroft and Gault formula, between patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump CABG (on-CAB).

Material and methods. Between April 2008 and April 2009, 119 patients underwent coronary bypass graft surgery. Fifty-eight (58) of these patients underwent OPCAB while 61 had on-CAB. Creatinine clearance, plasma creatinine levels, and clinical outcome were compared between the groups. A creatinine clearance value of 50 mL/minute was accepted as the lowest limit of normal renal function.

Results. There were two hospital deaths caused by sepses after pulmonary infection. Creatinine clearance (Preoperative OPCAB 73,64±33,72 x on-CAB 75,70±34,30mL/min; discharge OPCAB 75,73±35,07 x on-CAB 79,07±34,71 mL/ min; p=0,609), and creatinine levels (Preoperative OPCAB 1,04±0,38 x on-CAB 1,13±0,53 mg/dL; discharge OPCAB 1,12±0,79 x on-CAB 1,04±0,29mg/dL; p=0,407) did not show statistically inter-group differences.

Conclusion. Deterioration in renal function is associated with higher rates of postoperative complications. No significant difference in CrCl could be demonstrated between the groups.

Some studies have disclosed atrial fibrillation (AF) is associated with inflammation. Cystatin C is not only inflammatory markers but also an independent predictor of cardiovascular events.

Aim. We sought to investigate the relationship between serum levels of cystatin C and the occurrence and development of AF.

Material and methods. 235 paroxysmal and persistent AF (AF1 group) and 254 permanent AF (AF2 group) patients in AF group and 221 healthy people in control group were prospectively measured for cystatin C, other inflammatory markers, biochemical indicators, left atrial diameter (LAD), left ventricular diameter (LVD) and left ventricular ejection fraction (LVEF).

Results. (1) Compared with control and AF1 groups, AF2 group had higher values of cystatin C, high sensitivity C reactive protein (hsCRP), LAD and LVD whereas lower values of LVEF (P<0.05). (2) After adjust for age, gender and body mass index (BMI), correlation analysis showed that serum level of cystatin C was closely related to hsCRP, LAD, systolic blood pressure (SBP) and creatinine, the correlation coefficient were respectively 0,614, 0,520, 0,463 and 0,538 (all P<0,01), but negatively associated with LVEF (r= –0,356, P=0,012) in AF group. (3) Multivariate regression analysis showed the hsCRP, cystatin C, LAD and LVEF entered finally into the regression equation (cystatin C, OR: 3.25, 95%CI: 1.05–10.17, P=0,008).

Conclusion. The serum levels of cystatin C has significant correlation with AF, which indicates cystatin C may play an important role in the process of AF development.

Aim. To assess the correlation between left ventricle remodeling induced by physical training with QTc duration in preadolescent professional football players.

Material and methods. Ninety-four highly trained male footballers (mean aged 12,85±0,84) competing in the Serbian Football League (at least 7 training hours/ week) and 47 age-matched healthy male controls were enrolled in the study. Main outcome measures: They were screened by ECG and echocardiography at a tertiary referral cardio center. The control group had sedentary life style (less than 2 training hours/week). QTc values and left ventricle dimensions were compared in these two groups.

Results. In all participants, normal values of QTc interval were registered. Mean QTc in athletes was significantly higher compared to non-athletes (419,89±13,07 msec vs 399,78±13,27 msec) (p<0,001). QTc interval had strong positive correlation to left atrium dilatation, LV dilatation, LV mass and LV mass index. There was no correlation between QTc interval and LV wall thickness, but there were correlations between QTc interval duration and specific LV mass indexes (LVM/BSA 1,5 and LVM/h 2.7).

Conclusion. QTc interval prolongation is present in early stage of athlete’s heart remodeling, hence QTc prolongation could be the early ECG marker of physiological LV remodeling in young preadolescent footballers, without any other standard ECG and echocardiographic signs of early LV hypertrophy. This could be explained by a different pattern of left ventricle remodeling in preadolescent period, where LV wall thickness increase cannot usually be seen and the predominant characteristic is left ventricle dilatation.

Cardiac resynchronization therapy (CRT) improves ventricular dyssynchrony and is associated with an improvement in life quality and prognosis.

Aim. The aim of study was to examine acute hemodynamic changes with different of CRT device modalities throughout optimization procedure and its impact on one year prognosis.

Material and methods. The study comprised 62 patients with severe left ventricular systolic dysfunction (LVEF 24,6±4,4%, QRS duration 154,71±14,92 ms, NYHA class III/IV 47/15) with implanted CRT device. After implantation and before discharge all the patients underwent optimization procedure guided by Doppler echocardiography. Left (LVPEI) and right (RVPEI) ventricular pre-ejection intervals, interventricular mechanical delay (IVD) and the maximal rate of ventricular pressure rise during early systole (max dP/dt) were measured during left and biventricular pacing with three different atrioventricular (AV) delays. Stroke volume derived from the left ventricular outflow tract velocity–time integral (VTI) of left ventricular outflow tract (LVOT VTI) was measured as well. After one year patients underwent clinical, echocardiographical examination and 6 minute walking test.

Results. After CRT device optimization, optimal AV delay and CRT mode were defined. Left ventricular pre-ejection intervals changed from 175,4±21,5 to 142,6±16,7 (p < 0,01), RVPEI from 108,6±18,9 to 127,3±18,3 (p < 0,001), IVD from 71,3±14,8 to 24,7±7,6 (p < 0,001) and dP/dt from 532,2±74 to 675,2±111 (p < 0,001). Left ventricular outflow tract VTI increased after optimization procedure from 18±3,4 to 21±1,5 cm (p<0,05).

Conclusions. Echocardiographic optimization procedure emphasizes the individualized approach in CRT optimization procedure in order to derive the best short and long term results.

Aim. Echocardiography has become the main mean in detection of noncompaction cardiomyopathy (NCC). However, misdiagnosis and missed diagnosis were common. The aim of this paper was to analyze the misdiagnosis and missed diagnosis of NCC, improve the diagnostic accuracy of this disease.

Material and methods. We retrospectively analyzed the data of 56 subjects who had been clinically diagnosed with NCC in our institution, which included patients’ total echocardiographic data since the disease onset. Echocardiographic data and cardiac magnetic resonance (CMR) data were compared with each other.

Results. 17 of the total subjects had been diagnosed with NCC after the first echocardiography at our institution. 39 subjects had not been diagnosed correctly until several times checking of echocardiography. 28 of them had been misdiagnosed as dilated cardiomyopathy (DCM) in local hospitals. All but 2 subjects were inconsistent between echocardiography measurement and CMR. The ratio of N/C was 2,63±0,49 by CMR, and 2,55±0,43 by echocardiography.

Conclusion. Echocardiography can be the first choice of NCC assessment for its advantages of being non-radiative, real-time, economic and characteristic. When the echocardiographic image is not typical in the early stage of NCC, a combination with CMR is necessary.

Aim. Acute rheumatic fever is an inflammatory disease developing after upper respiratory tract infection with group A streptoccoci and its most important complication is rheumatic heart disease (RHD). Tumor necrosis factor (TNF)-α and interleukin (IL) –1–1082 gene polymorphisms were associated with susceptibility to develop rheumatic heart disease. The aim of our study is to determine the frequency of IL-10–1082 A/G and TNF-α-308 G/A gene polymorphism in Turkish population and to investigate the relationship between these polymorphisms and rheumatic heart disease.

Material and Methods. Genotypes of 57 unrelated children with rheumatic heart disease and 99 controls were determined by use of PCR-RFLP.

Results. No significant differences were found in genotypes or allele frequencies of TNF-α-308 and IL-10–1082 genes between RHD and control group. There was no relation between TNF-α-308 genotype and allel distribution with valvular involvement (p>0.05). IL-10–1082 GG and AG genotypes were seen more frequent in patients with multiple valvular disease but there was no statistical significance (p>0.05).

Conclusion. As a result, there was no relationship between TNF-α-308, IL-10– 1082 gene polymorphisms and rheumatic heart disease or valvular involvement in the study population (p>0,05). Our results are thought that TNF-α-308 polymorphisms are silent and may become important only with some certain HLA allels. Further studies checking both cytokine polymorphism and HLA allels are needed.

Aim. Congenital heart defects (CHD) are the leading cause of infant mortality becoming an important public health problem. Time trends in CHD by specific phenotype and with long follow-up time are rarely available for a large pediatric population.

Material and methods. We present the prevalence of CHD over the past 5 years among Romanian children. Individuals with CHDs were classified by several criteria including type of pathology, association of the pathology with various syndromes and abnormalities, postnatal complications or treatment.

Results. The overall CHD birth prevalence increased. Generally, prevalence increased for defects diagnosed in infancy and preschoolers patients. Isolated septal defects such as atrial septal defect (ASD) was present in 29,69% of patients while transposition of the great vessels was present in 1,87% of children, respectively. Among the severe defects, tetralogy of Fallot — atresia/hypoplasia of the pulmonary artery association showed the largest prevalence. Considering the syndromatic CHD, the highest incidence (78,78%) was recorded for Down syndrome, followed by Turner syndrome. The most frequent postnatal complication in CHD patients was cardiomegaly, followed by pulmonary hypertension. Only 29,94% of the patients underwent corrective surgery, the rest remained on medication. The highest incidence rate was recorded for tetralogy of Fallot (42,85%), followed by isolated septal defects. On average, tetralogy of Fallot cases were operated on 16,6 months after diagnosis while transposition of the great vessels after 2,5 months.

Conclusion. The increasing prevalence of CHDs reported was confirmed in the present study. This is mostly due to an increasing number of isolated septal defects diagnosed in infancy. In the future, the etiology of CHD needs to be further clarified and prospective birth defect registries covering the a large population are needed to determine the exact birth prevalence of CHD.

An analog device which can simulate myocardium bridge oppresses mural coronary artery is designed. The device can be used to research the dynamic changes of the proximal and distal hoop stresses. Meanwhile, the independent regulation of the hoop stresses is realized. The “myocardial bridge — coronary artery” analog device is built to adjust the external pressure of the simulated coronary artery and the oppression level of the myocardial bridge and to record the changes of the hoop stresses. The In vitro simulation experiment indicate that the anomaly of hoop stress mainly occurs in the proximal end. As the oppression level increases, the mean proximal hoop stress and the oscillatory value (maximum-minimum) increase obviously. The “myocardial bridge — coronary artery” analog device can provide a method to study the influence of the hoop stress on the mural coronary artery in vitro.