Background: Microvascular dysfunction (MVD) is associated with adverse prognosis and may account for abnormal stress tests and angina symptoms in women with cardiac syndrome X (CSX). The aim of our study was to assess MVD by coronary flow velocity reserve (CFVR) and left ventricular (LV) contractile function by LV global longitudinal strain (LVGLS) in CSX patients with respect to presence of slow coronary flow (SCF). It was of additional importance to evaluate clinical status of CSX patients using Seattle Angina Questionnaire. Methods and results: Study population included 70 women with CSX (mean age 61 AE7 years) and 34 agematched controls. CSX group was stratified into two subgroups depending on SCF presence: CSX-Thrombolysis In Myocardial Infarction (TIMI) 3-normal flow subgroup (n = 38) and CSX-TIMI 2-SCF subgroup (n = 32) as defined by coronary angiography. LVGLS measurements and CFVR of left anterior descending (LAD) and posterior descending (PD) artery were performed. CFVR-LAD and PD were markedly impaired in CSX group compared to controls (2.34 AE 0.25 vs 3.05 AE 0.21, p < 0.001; 2.32 AE 0.24 vs 3.01 AE 0.13, p < 0.001), and furthermore decreased in CSX-TIMI 2 patients. Resting, peak, and DLVGLS were all significantly impaired in CSX group compared to controls (for all p < 0.001), and furthermore reduced in CSX-TIMI 2 subgroup. Strongest correlation was found between peak LVGLS and CFVR LAD (r = À0.784, p < 0.001) and PD (r = À0.772, p < 0.001). CSX-TIMI 2 subgroup had more frequent angina symptoms and more impaired quality of life. Conclusions: MVD in CSX patients is demonstrated by reduction in CFVR and LVGLS values. SCF implies more profound impairment of microvascular and LV systolic function along with worse clinical presentation.
Background/Aim. There is a burgeoning literature on the association between childhood victimization and the risk of suicidal behavior in early adolescence, while there is significantly less research showing this association in adults. The aim of our study was to examine whether victimization in childhood increased the likelihood of suicide attempt in adults. Methods. The sample consisted of 90 patients, 71 females and 19 males, aged 37.92 ± 11.04 years on average, hospitalized in the Day Hospital of the Clinic of Psychiatry Military Medical Academy, Belgrade, Serbia. The Juvenile Victimization Questionnaire (JVQ), Defense Style Questionnaire (DSQ-40) and Beck Depression Inventory were used for 50 patients following suicide attempt and in 40 patients who were on psychotherapeutic treatment due to various life crises not resulting in suicide attempt. According to the indications, we excluded the patients with psychosis (F20-F29, F30-31 and F 32.3), substances abuse (F10-F19) and dementia (F00-F09), satisfying International Classification of Diseases-10 version (ICD-10) (the World Health Organization criteria). The examinees of both groups were matched by age, education and marital status. Comparison of the patient groups was done by the Students' t-test for the parametric features and Mann-Whitney U test for nonparametric data. Results. The suicide attempters had moderate depression (19.76 ± 10.52) and used immature defense mechanisms (p < 0.001). The JVQ established statistical differences in the Total score (p < 0.005) and in two modules: Peer and Sibling Victimization (p < 0.005) and Sexual victimization (p < 0.005). Conclusion. The adults who were more likely to attempt suicide during their lifetime were more often victims of peer and sexual abuse in their childhood. Data on victimization in early childhood provide opportunities for early detection of persons with suicide risk that could help in the psychotherapeutic work with these patients, but also in the suicide prevention in a wider population. Apstrakt VOJNOSANITETSKI PREGLEDVol. 76, No 7Dedić G, et al. Vojnosanit Pregl 2019; 76 (7): 667-674.češće tokom života pokušale samoubistvo su bile žrtve vršnjačkog i seksualnog zlostavljanja u detinjstvu. Podaci o zlostavljanju u ranom detinjstvu pružaju mogućnosti rane detekcije osoba sa suicidnim rizikom što može pomoći u psihoterapijskom radu sa ovim osobama, kao i u prevenciji suicida u široj populaciji.
Background Patients with ischemia and no obstructive coronary artery disease (INOCA) are a heterogeneous group and an unmet diagnostic challenge. Noninvasive Doppler is a feasible tool to assess coronary flow velocity (CFV) in left anterior descending coronary artery (LAD) during stress echocardiography (SE). Aim To assess CFV response during coronary vasoconstrictor and vasodilator stimuli in INOCA patients. Methods In a prospective single center study, we enrolled 16 INOCA patients (age 60±12 years, 15 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO, 0.84 mg/kg in 1 min) on the other day. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio <1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve <2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation. Results The double product increased during HYP, in comparison to rest (13 337 vs 9858, p<0.001), and further increase with EXE (21 118 vs HYP, p<0.001). Chest pain or dyspnea were present in 2/16 pts during HYP, and in 5/16 patients during HYP+EXE (12.5% vs 31.25%, p=0.083). ST segment depression (≥1mm) was present in 1/16 patients during HYP, and 3/16 during HYP+EXE. Two patients showed regional wall motion abnormalities with HYP+EXE. CFVR response was blunted in 9/16 patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 6. Vasodilation during ADO was preserved in all patients. There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.5 vs 2.4±0.4 respectively, p=0.039), and between CFVR HYP and ADO (1.2±0.3 vs 2.4±0.4, p<0.001). Conclusion In INOCA patients, HYP+EXE is a more powerful ischemic stress than HYP alone and unmasks abnormalities in regional wall motion and/or CFV response in over one- half of patients, likely unmasking the underlying abnormal coronary vasomotor response of large epicardial and/ or small coronary vessels. INOCA patients show profound heterogeneity of coronary vasomotor responses which can be detected with a combined vasodilator - vasoconstrictor SE approach with CFV assessment. The clarification of underlying coronary microcirculatory heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from CFV-SE. Normal INOCA hearts are all alike, every abnormal heart is abnormal in its own way. Funding Acknowledgement Type of funding source: None
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