The objective of this study was to evaluate whether global longitudinal strain (GLS), early systolic lengthening (ESL), and postsystolic shortening (PSS), individually and combined, predict anatomical disease severity and significant coronary artery stenosis in non–ST-elevation acute coronary syndrome (NSTE-ACS) with preserved left ventricular ejection fraction (LVEF). We prospectively enrolled 112 NSTE-ACS patients with preserved LVEF and no regional wall motion abnormalities. GLS, ESL, and PSS were measured using two-dimensional speckle-tracking echocardiography. Significant coronary artery disease (CAD) was defined as ≥90% stenosis in at least one major epicardial artery, and anatomical burden was quantified using the SYNTAX score. Linear and logistic regression, receiver-operating characteristic (ROC) analysis, DeLong comparison, and internal validation were performed. GLS and PSS were significant predictors of SYNTAX score in univariate linear regression. In the multivariable model, only GLS remained independently associated with SYNTAX ( P < 0.001), explaining 26.2% of variance (adjusted R ² =0.24; variance inflation factor <5). Significant stenosis was present in 70 patients (62%). ESL ( P = 0.028) and PSS ( P = 0.001) predicted ≥ 90% stenosis in univariate analysis, whereas GLS reached significance only in multivariable analysis (odds ratio 1.28, 95% confidence interval 1.09–1.51, P = 0.003). The multimarker model (GLS + ESL + PSS) had the highest ROC area under the curve (AUC) (0.726) but did not significantly outperform GLS alone (AUC 0.707; P = 0.390). Model-predicted probabilities correlated with SYNTAX (ρ =0.480, P < 0.001). GLS is the strongest strain-derived predictor of both significant stenosis and anatomical CAD burden in NSTE-ACS with preserved LVEF. Strain-based analysis may aid early, noninvasive risk stratification in this population.

Background/Objectives: Elevated lipoprotein(a) [Lp(a)] is an independent causal risk factor for atherosclerotic cardiovascular disease and may contribute to increased coronary complexity and adverse outcomes after acute myocardial infarction (AMI). Data regarding its prognostic significance in Southeastern Europe remains limited. This study aimed to evaluate the association between elevated Lp(a) levels, coronary artery disease severity, and major adverse cardiovascular events (MACE) at 1 and 6 months after AMI. Methods: This prospective study included 150 consecutive patients with STEMI and NSTEMI enrolled between December 2024 and August 2025. MACE was defined as a composite of overall cardiac death, recurrent myocardial infarction, cerebrovascular insult, heart failure with reduced ejection fraction occurrence, and new revascularization, either PCI or CABG. Results: Patients with elevated Lp(a) had significantly greater coronary disease burden, reflected by higher mean SYNTAX scores (17.3 ± 7.0 vs. 13.8 ± 7.0; p = 0.011) and a greater proportion of intermediate- and high-risk SYNTAX classifications (p = 0.016). Although the number of diseased vessels did not differ significantly, three-vessel disease was more frequent in the elevated Lp(a) group. At 1-month follow-up, overall MACE incidence was numerically higher but not statistically significant between groups. At 6 months, heart failure with reduced ejection fraction was significantly increased in patients with elevated Lp(a) (27.7% vs. 12.2%; p = 0.027). Binary logistic regression demonstrated that elevated Lp(a) independently predicted 6-month MACE (OR 2.768, p = 0.011, 95% CI 1.262–6.072), but not 1-month outcomes. Conclusions: Elevated Lp(a) is associated with increased coronary artery disease severity and higher mid-term MACE risk after AMI.

For patients presenting with non-ST-elevation acute coronary syndrome (NSTE-ACS) who are not considered to be at very high mortality risk at the time of admission, current clinical guidelines advocate for coronary angiography (CAG) to be performed during hospitalization. Therefore, in these patients, introduction of novel non-invasive methods for prediction of severity of coronary artery disease is needed in order to identify patients who could benefit from CAG earlier during their hospital stay. The aim of this study was to evaluate the association between severity of CAD and echocardiographically assessed global longitudinal strain (GLS) and post-systolic shortening (PSS) of left ventricular myocardium in patients with NSTE-ACS. This prospective cross-sectional study included patients admitted to the cardiology clinic with the diagnosis of NSTE-ACS. Inclusion criteria were: preserved left ventricular ejection fraction (>50%), absence of regional wall motion abnormalities and indication for CAG set by interventional cardiologist and performed during the hospital stay. Patients who were estimated to be at very high mortality risk were excluded from the study. In addition to conventional echocardiography parameters, post-systolic shortening index (PSI), LAD specific PSI (PSI-LAD) and GLS were measured. PSI was calculated as the average PSS across all 17 myocardial segments, generated from strain curves, while PSI-LAD was calculated as the average PSS across 10 myocardial segments vascularized by LAD. The severity of CAD was assessed using the SYNTAX score. Significant coronary artery stenosis was defined as ≥90% narrowing in one of the three main epicardial arteries. Among the 70 enrolled patients, 45.7% (n=32) were diagnosed with unstable angina, while 54.3% (n=38) were diagnosed with NSTEMI. There was a significant positive correlation between SYNTAX score and both GLS (rho=0.504; p<0.001) and PSI (rho=0.249; p=0.035). Patients with significant LAD stenosis had higher GLS values (-14.88±2.53% vs. -17.02±3.23%, p=0.001) and higher PSI-LAD values (10.65 [3.13–18.53] vs. 4.2 [2.53–8.3], p=0.015) compared to those without significant LAD stenosis. GLS emerged as an independent predictor of significant stenosis on one of three main epicardial arteries (p=0.001; OR 1.43; 95% CI: 1.16–1.76). Both PSI-LAD and GLS demonstrated significant predictive value for LAD stenosis, with AUCs of 0.672 (p=0.020) and 0.675 (p=0.019), respectively. In addition to other known clinical factors, GLS and PSI may serve as feasible non-invasive echocardiographic parameters for additional risk stratification in NSTE-ACS patients who are not at very high risk. These measures could help identify individuals who might benefit from earlier CAG during hospitalization. Further research is warranted to develop precise risk assessment models incorporating these parameters.

Aim To investigate the relationship between postoperative serum thyroglobulin level ​​and outcome of therapy with I-131 of follicular thyroid cancer. Methods A total of 106 patients with follicular thyroid cancer who were being treated and monitored at the Clinic for Nuclear Medicine at Clinical Center of the University of Sarajevo were included. The inclusion criteria were: surgery of total thyroidectomy, histopathological diagnosis of follicular thyroid cancer, and applied therapy with radioactive iodine. Exclusion criteria were patients with incomplete data, who were not treated with radioidine treatment, or had a different histopathological diagnosis. Postoperative serum thyroglobulin levels were correlated with results of whole body scintigraphies after 12 months (first diagnostic scintigraphy) and whole body scintigraphies after 24 months (second diagnostic scintigraphy). Results The higher frequency of recurrent disease in patients with elevated level of thyroglobulin was found compared to patients with lower postoperative thyroglobulin level. Elevated level ​​of postoperative thyroglobulin correlated with positive scintigraphy findings, i.e., with the occurrence of recurrence and/or metastases in patients with follicular cancer. The cut-off level of postoperative thyroglobulin for recurrence and/or metastasis, i.e. for failure of ablative therapy with I-131, was >12.6 ng/mL. Conclusion  Our study showed that level of postoperative thyroglobulin is an important prognostic factor for the outcome of radiodine therapy of follicular thyroid cancer and should be taken into account in deciding on therapy in this type of cancer in everyday practice Keywords: prognosis, radioiodine, thyroid neoplasm, recurrence.

Introduction. Over the past decades, there has been a significant improvement in the quality of percutaneous coronary interventions (PCI). The goal of this study is to assess patient related risk factors for the development of ST in patients treated with PCI. Results. According to the study, the percentage of patients with ST who had bare metal stents (BMS) was significantly higher (72.41%) than that of patients without ST (27.59%). Conclusion. Lower ejection fraction, presence of dyslipidemia and usage of BMS were identified as independent predictors of ST. Keywords: Stent Thrombosis, Risk Factors, Prognosis.

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease’s burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), “lower is better for longer”, and recent data have strongly emphasised the need for also “the earlier the better”. In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of “extremely high-risk” individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy’s effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

Background: Lactate dehydrogenase (LDH) isoenzyme assay was used widely in the past to diagnose myocardial infarction (MI). Recent studies show that lactate dehydrogenase seems to be a promising biomarker of adverse left ventricular remodeling. Objectives: Higher levels of these biomarkers were associated with lower odds for favorable reverse remodeling in patients with MI. Methods: The study was performed on patients with the first occurrence of acute myocardial infarction (ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)), aged 34 to 80 years who underwent catheterization at the admission or during their hospital stay depending on indications. In this study, we compared peak levels of lactate dehydrogenase (LDH) and left ventricular ejection fraction (LVEF). Peak values of LDH were used from the second to the fourth day of hospitalization. Echocardiography has been done in the first 72 hours, which represents an early phase of cardiac remodeling. The ejection fraction was evaluated using the Simpson method. Results: Spearman's rank test showed a negative, statistically significant correlation between LDH and ejection fraction ρ(80)=−0.543, p<0.001. Weighted least squares regression model included LDH concentration, age, and type of myocardial infarction (STEMI/NSTEMI), and the slope coefficient for the LDH level was −0.010 (95% confidence interval (CI): −0.013 to −0.006). With each unit of LDH increase, there was a decrease of 0.01% in left ventricular ejection fraction when age and type of myocardial infarction were held constant. Conclusion: The increased LDH level could be a new predictor for early myocardial remodeling after the first occurrence of myocardial infarction independent of age and type of myocardial infarction.