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Kod značajnog broja bolesnika sa akutnim infarktom miokarda sa elevacijomST segmenta (STEMI) lečenih primarnom perkutanom koronarnom intervencijom(pPKI) dolazi do izostanka adekvatne miokardne perfuzije, pojave označene kaono-reflow fenomen (NRF), koji komplikuje dalji klinički tok i povezan je sa povišenimmorbiditetom i mortalitetom. Primarni cilj ove studije je bio da se razvijeklinički upotrebljiv, jednostavan i efikasan prediktivni model za stratifikacijurizika i predikciju pojave NRF kod bolesnika sa STEMI pre izvođenja pPKI. Studija je dizajnirana kao klinička, randomizovana, opservaciona, neinterventnairetrospektivna, u koju je uključeno 1254 bolesnika sa STEMI lečenih pPKItokomperioda od januara 2012. godine do decembra 2017. godine u Kliničko-bolničkomcentru Zemun u Beogradu. Rezultati ove studije su otkrili pet nezavisnih prediktoraNRF: starost ≥ 65 godina, srčana frekvencija ≥ 89 otkucaja u minuti, Killip klasa≥II, ukupno ishemijsko vreme ≥ 268 minuta i trombotsko opterećenje G ≥ 4. Skor rizikajekonstruisan kombinovanjem navedenih prediktora sa određenim brojem poena, takodasu ukupne vrednosti skora od 0 do 17 poena. Za optimalnu graničnu vrednost dobijenaje vrednost skora ≥ 11 poena koja označava povišen rizik od nastanka NRF. Internomvalidacojom modela pokazana je dobra diskriminaciona snaga. Skor rizika je nazvanHAKTT kao akronim početnih engleskih reči komponenata koje ga čine imožedasluži kao koristan i efikasan klinički alat za stratifikaciju rizika i predikcijupojave NRF kod bolesnika sa STEMI neposredno pre izvođenja pPKI., In a significant number of patients with acute myocardial infarction with STsegment elevation (STEMI) treated with primary percutaneous coronary intervention (pPCI), thereisalack of adequate myocardial perfusion, a phenomenon known as no-reflowphenomenon(NRF), which complicates the further clinical course and is related with increased morbidityand mortality. The primary aim of this study was to develop a clinically usable, simpleandeffective predictive model for risk stratification and prediction of NRF occurrence inpatientswith STEMI before performing pPCI. The study was designed as a clinical, randomized, observational, non-interventional, retrospective study that included 1254 patients withSTEMItreated with pPCI during the period from January 2012 to December 2017 at the ZemunClinical Hospital Center in Belgrade. The results of this study revealed five independent predictors of NRF: age ≥ 65 years, heart rate ≥ 89 beats per minute, Killip class ≥II, total ischemic time ≥ 268 minutes, and thrombotic burden G ≥ 4. A risk score was constructedbycombining these predictors with a fixed number of points, so the total score values are from0to 17 points. For the optimal threshold value, a score value of ≥ 11 points was obtained, whichindicates an increased risk of developing NRF. The internal validation of the model showedagood discrimination power. The risk score was named HAKTT as an acronymof the initial English words of the components that made it up and can serve as a useful and effectiveclinical tool for risk stratification and prediction of NRF occurrence in patients withSTEMIimmediately before performing pPCI.

Kardiovaskularne bolesti (KVB) predstavljaju vodeći uzrok mortaliteta u svetu i najčešći vid komorbiditeta kod bolesnika sa sistemskim eritemskim lupusom (SLE), primarnim Sjögrenovim sindromom (SjS), sistemskom sklerozom (SSc) i reumatoidnim artritisom (RA). Hronična inflamacija u reumatskim bolestima može uticati na ubrzani razvoj KVB. Iako su faktori rizika za razvoj KVB u opštoj populaciji detaljno ispitivani i danas dobro poznati, kod pacijenata sa hroničnim reumatskim bolestima do sada nisu precizirani specifični faktori rizika za razvoj KVB, kao i njihova veza sa tradicionalnim faktorima rizika, čime bi se objasnila povećana incidenca KVB kod ovih bolesnika..., Introduction: Cardiovascular diseases (CVD) are the leading cause of death in the world and the most common type of comorbidity in patients with systemic lupus erythematosus (SLE), primary Sjögren's syndrome (SjS), systemic sclerosis (SSc), and rheumatoid arthritis (RA). Chronic inflammation in systemic rheumatic diseases can contribute to the development of CVD. Although risk factors for the CVD in the general population are well known, in patients with chronic rheumatic diseases risk factors for the CVD have not been specified as well as their connection with traditional risk factors, which would explain the increased incidence of CVD in these patients...

Hipertrofična kardiomiopatija (HCM) je najčešće nasledno srčano oboljenje koje je povezano sa povišenim kardiovaskularnim morbiditetom i mortalitetom. Kao rezultat heterogenog kliničkog toka i fenotipa HCM, stratifikacija rizika ostaje izazov i uglavnom je usmeren na iznenadnu srčanu smrt (SCD). Međutim, određeni ehokardiografski i klinički parametri koji se koriste za predviđanje SCD imaju ograničenu prognostičku vrednost u predviđanju drugih kardiovaskularnih događaja povezanih sa HCM-om, poput progresivnog pogoršanja sistolne funkcije leve komore (LK) sa razvojem srčane insuficijencije ili ishemijskog moždanog udara. Mikrovaskularna disfunkcija može biti glavna odrednica kliničkog pogoršanja i ishoda kod pacijenata sa HCM. Međutim, dugoročna prognostička vrednost transtoraksne Doppler ehokardiografije (TDE) rezerve koronarnog protoka (CFVR) na klinički ishod kod pacijenata sa HCM je nepoznata. Cilj: Primarni cilj istraživanja je da se proceni prognostički značaj TDE CFVR-a na klinički ishod pacijenata sa HCM. Materijal i metode: Prospektivno smo uključili 150 HCM pacijenata, (82 ženskog pola); prosečne starosti 48±15 godina. Kod svih pacijenata su procenjivane kliničke i ehokardiografske karakteristike, kao i biohemijske i CFVR vrednosti za prednju descedentu koronarnu arteriju (LAD) i posterodescedentu koronarnu arteriju (PD). Primarni ishod je bio kombinacija: smrti povezane sa HCM-om, srčana insuficijencija koja zahteva hospitalizaciju, dugotrajna VT i ishemijski moždani udar. Rezultati: Vrednost CFVR LAD od 2.0 je uzeta kao granična na osnovu prethodno definisanih dijagnostičkih i prognostičkih graničnih vrednosti, pa su pacijenti podeljeni u 2 grupe: Grupa 1- sa očuvanim CFVR LAD > 2 (87 pacijenata) i Grupa 2 - sa sniženom vrednosti CFVR LAD ≤ 2 (63 pacijenta). Ženski pol (p=0.012) i NYHA funkcionalna klasa (p=0.003) su bile statistički zastupljenije u grupi sa smanjenim CFVR LAD. Nije bilo značajnih razlika u pogledu prisustva herediteta za HCM ili SCD, pri, Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease which is associated with increased cardiovascular morbidity and mortality. As a result of heterogeneous clinical course and phenotypes of HCM, risk stratification remains challenging, and is mainly focused on sudden cardiac death (SCD). However, certain echocardiographic and clinical parameters used for SCD prediction have limited prognostic value in predicting other HCM related cardiovascular events such as progressive deterioration of left ventricular (LV) systolic function with heart failure development or an ischemic stroke. Microvascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with HCM. However, long-term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on clinical outcome is uncertain in HCM patients. Objective: The primary aim of our study was to assess long-term prognostic value of CFVR on clinical outcome in HCM population. Methods: We prospectively included 150 HCM patients (82 female; mean age 48±15 years). Patients’ clinical characteristics, echocardiographic, biochemical, 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. Results: Patients were stratified into two subgroups depending on CFVR LAD value: Group 1 (CFVR LAD>2, (n=87)) and Group 2 (CFVR LAD≤2, (n=63)). Female sex (p=0.012) and NYHA functional class II (p=0.003) were more prevalent in patients with reduced CFVR LAD. Contrary, there were no differences in CFVR LAD or CFVR PD in patients with presence or absence of prior history for HCM or SCD, angina, syncope, hypertension or arrhythmia on 24 hour ECG. CFVR LAD significantly correlated with maximal wall thickness (r=-0.300, p<0.001)

Populacija osoba sa bolom u grudima i normalnim nalazom koronarografije je heterogena. Kardijalni sindrom X (eng. Cardiac Syndrome X - CSX) je najčešće zastupljen kod žena perimenopauzalne životne dobi, a definisan je pojavom bola u grudima, depresijom ST segmenta na testu opterećenja i angiografski isključenom epikardnom koronarnom bolesti. Mikrovaskularna disfunkcija (MVD) i posledična ishemija povezana je sa lošijom kliničkom prognozom i najverovatnije je objašnjenje elektrokardiografske pozitivnosti stres eho testova i simptoma bola u grudima kod žena sa CSX. Longitudinalna funkcija leve komore (LK) je posebno vulnerabilna na pojavu mikrovaskularne ishemije te se ona smatra ranim markerom subkliničke sistolne disfunkcije LK. Iako su u dosadašnjoj literaturi CSX i angiografski fenomen usporenog protoka kontrasta (eng. Slow Coronary Flow - SCF), koji se karakteriše usporenom opacifikacijom koronarnih arterija kontrastnim sredstvom u odsustvu epikardne bolesti, posmatrani kao zasebni klinički entiteti, bitno je napomenuti činjenicu da oni imaju zajednički patofiziološki supstrat – primarnu abnormalnost koronarne mikrocirkulacije - MVD. U tom smislu u aktuelnoj literaturi do sada nema podataka o proceni očuvanosti mikrovaskularne funkcije i sistolne longitudinalne funkcije LK u CSX populaciji stratifikovanoj prema prisustvu SCF. Cilj: Osnovni cilj naše studije je bio da se kod bolesnica sa CSX stratifikovanih po podgrupama u zavisnosti od prisustva SCF, analizira mikrovaskularna funkcija kvantifikacijom koronarne rezerve protoka (eng. Coronary Flow Velocity Reserve - CFVR) i kontraktilna funkcija LK metodom globalnog indeksa naprezanja (eng. Global Longitudinal Strain - GLS). Metode: Ispitivana populacija je uključivala 70 žena sa CSX (61±7 godina starosti) i 34 po godinama adaptiranih žena iz kontrolne grupe. Ovo istraživanje je sprovedeno u periodu od januara 2014. godine do juna 2019. godine na Klinici za kardiologiju Kliničkog centra Srbije. CSX grupa je stratif, Patients with chest pain and normal coronary arteries represent a rather nonhomogeneous population. Cardiac syndrome X (CSX) is defined by angina-like chest pain, ST segment depression during exercise and normal coronary arteries found mostly in post-menopausal women. Microvascular dysfunction (MVD) and consecutive ischemia carry an adverse prognosis, and most probably account for angina symptoms and electrocardiographically positive stress tests in women with CSX. Left ventricular (LV) longitudinal function is particularly susceptible to the effects of microvascular ischemia and as such is considered an early marker of subclinical systolic dysfunction. Although angiographic phenomenon of slow coronary flow (SCF) characterized by delayed opacification of coronary arteries in the absence of an obstructive coronary disease and CSX are still considered separate clinical entities in the contemporary literature, it is important to note that they share the same underlying mechanism of primary abnormality of microvascular function – MVD. In that sense, evaluation of microvascular and LV systolic longitudinal function in CSX patients with regard to the presence of SCF have not been investigated yet. Objective: The main objective of our study was to assess microvascular function by coronary flow velocity reserve (CFVR) and LV contractile function by global longitudinal strain (GLS) in CSX patients with respect to presence of SCF. Methods: Study population consisted of 70 women with CSX (mean age 61±7 years) and 34 age- and gander matched controls. All the women were recruited at the Cardiology Clinic, Clinical center of Serbia, Belgrade, during the period from January 2014 to June 2019. 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. Both women from the CSX and the control group had clinical and echocard

Do početka naše studije nije publikovana randomizovana prospektivna studija koja bi poredila elektivne bolesnike sa hroničnom totalnom okluzijom (CTO) lečene optimalnom medikamentnom terapijom (OMT) ili perkutanom koronarnom intervencijom (PCI). Ciljevi: Cilj ove prospektivne randomizovane studije bio je da proceni kvalitet života bolesnika sa CTO koristeći „Sijetl Angina Upitnik” (SAQ) lečenih OMT uz PCI ili samo OMT. Metode: U periodu od oktobra 2015. do maja 2017.god ukupno 100 bolesnika je prospektivno randomizovano prema kompijuterski generisanom kodu (1:1). Sve PCI su urađene u Sali za kateterizaciju Klinike za kardiologiju, Kliničkog centra Srbije. Rezultati: Nakon randomizacije nije bilo razlike u SAQ skorovima između grupa, sem za domen fizičkog ograničenja (p=0.03). Tokom prosečnog perioda praćenja od 275±88 dana, bolesnici u PCI grupi su imali statistički niže vrednosti u domenu fizičkog ograničenja tokom aktivnosti (72.7±21.3 vs 60.5±27, p=0.014), manju učestalost epizoda angine pektoris (89.8±17.6 vs 76.8±27.1, p=0.006), bolji ukupan kvalitet života (79.9±22.7 vs 62.5±25.5, p=0.001), veće vrednosti u domenu zadovoljstva primenjenom terapijom (91.2±13.6 vs 81.4±18.4, p=0.003) i graničnu značajnost u domenu stabilnosti angine (61.2±26.5 vs 51.0±23.7, p=0.046) u poređenju sa OMT grupom. Nije bilo statistički značajne razlike u SAQ skoru u OMT grupi nakon randomizacije i tokom perioda praćenja, dok je nađeno statistički značajno povećanje skora u svih 5 domena u PCI grupi. Zaključak: Simptomi i kvalitet života procenjeni preko SAQ su značajno poboljšani u grupi bolesnika PCI CTO u poređenju sa grupom bolesnika lečenih samo OMT., Until the start of this study no published data of the prospective randomized trial comparing percutaneous revascularization of chronic total occlusion (CTO) of the coronary artery with optimal medical therapy (OMT) in elective patients were available. Objectives: The aim of this randomized prospective study was to evaluate quality of life (QoL) using the „Seattle Angina Questionnaire” (SAQ) in patients with chronic total occlusion (CTO) on coronary arteries treated with either percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or only with OMT. Methods: Between October 2015 and May 2017, a total of 100 patients with CTO were randomized prospectively according to a computer-generated code (1:1 ratio). All PCIs were performed in the catheterization laboratory at the Cardiology Clinic in Belgrade, Clinical Centre of Serbia. Results: There were no baseline differences in the SAQ scores between the groups, except for physical limitation scores (p=0.03). During the mean follow-up (FUP) of 275±88 days, patients in the PCI group reported less physical activity limitations (72.7±21.3 vs 60.5±27, p=0.014), less frequent angina episodes (89.8±17.6 vs 76.8±27.1, p=0.006), better quality of life (79.9±22.7 vs 62.5±25.5, p=0.001), greater treatment satisfaction (91.2±13.6 vs 81.4±18.4, p=0.003) and borderline difference in angina stability (61.2±26.5 vs 51.0±23.7, p=0.046) compared to patients in the OMT group. There were no significant differences in SAQ scores in the OMT group at baseline and during FUP. There was statistically significant increase in all 5 domains in the PCI group. Conclusion: Symptoms and QoL measured by SAQ were significantly improved after CTO PCI compared to OMT alone.

Terapijska arteriogeneza predstavlja novu terapijsku opciju za ove bolesnike sa refraktornom ishemijkom koronarnom bolesti. Cilj terapijske arteriogeneze je da indukuje stvaranje novih krvnih sudova koji mogu da poboljšaju protok krvi u regionima koji nemaju adekvatno snabdevanje krvlju. Našim istraživenjem očekujemo da tokom perioda praćenja bolesnici koji budu dobijali heparin (H) zajedno sa fizičkim opterećenjem imaju više izraženu koronarnu arteriogenezu i kolateralnu cirkulaciju, manje tegoba po tipu stabilne srčane angine i manju ishemiju srčanog mišića na stresnoj ehokardiografiji. Ciljevi: ove studije, koja je uključivala bolesnike sa refraktornom srčanom anginom koji nisu kandidati za revaskularizaciju, su da se: 1. Proceni težina stabilne srčane angine pre i nakon fizičkog treninga. 2. Izračuna indeks pokretljivosti zidova leve komore pri maksimalnom opterećenju tokom stres egokardiografskog testa opterećenjem pre i nakon fizičkog treninga. 3. Proceni kolateralna cirkulacija na MSCT koronarnoj angiografiji pre i nakon fizičkog treninga. Materijal i metode: Naša studija je obuhvatila 32 bolesnika sa hroničnom stabilnom anginom pektoris refraktornom na optimalnu medikamentnu terapiju, koji nisu kandidati za perkutanu i/ili hiruršku revaskularizaciju (tzv. ''no-option” bolesnici). Kao drugi kriterijum za uključenje u studiju bolesnici su morali biti sposobni da vežbaju. Ovi pacijenti su se u periodu od 2013. do 2019. godine lečili na Klinici za kardiologiju Kliničkog Centra Srbije. Bolesnici su bili randomizovani u 2 grupe (po 16 bolesnika u svakoj grupi). Grupa 1 (placebo+vežbanje, P+E), bolesnici koji su podvrgnuti standardnoj fizikalnoj rehabilitaciji (iv. Placebo 10 minuta pre svake od 2 dnevne sesije fizičkog treninga koji se održava 5 dana nedeljno tokom 2 nedelje). Kao placebo injekciju koristili smo intravensku injekciju od 2 ml sa fiziološkim rastvorem (0,9% NaCl). Grupa 2 (heparin+vežbanje, H+E), bolesnici koji su bili podvrgnuti standardnoj fizikal, Therapeutic arteriogenesis represents a new therapeutic option for patients with refractory cardiac angina. The goal of therapeutic arteriogenesis is to induce the formation of new blood vessels that can improve blood flow in regions that do not have adequate blood supply. In our study, we expect that during the follow-up period, patients receiving heparin (H), together with physical activity (exercise, E), have a more pronounced coronary arteriogenesis and collateral circulation, less severe type of stable cardiac angina, and less cardiac muscle ischemia on stress echocardiography. The aims: of the present study, which included patients with refractory cardiac angina who were not candidates for revascularization, was to: 1. Assess the severity of stable cardiac angina before and after physical training. 2. Calculate the peak stress wall motion score index of the left ventricule during stress echocardiography testing before and after physical training. 3. Assess collateral circulation by MSCT coronary angiography before and after physical training. Matherial and methods: Our study included 32 patients with chronic stable angina pectoris refractory to optimal medicament therapy, who are not candidates for percutaneous and/ or surgical revascularization (so-called 'no option' patients). As a second criterion for inclusion in the study, patients had to be able to exercise. From 2013 to 2019, these patients were treated at the Cardiology Clinic of the Clinical Center of Serbia. Patients were randomized into 2 groups (16 patients in each group). Group 1 (placebo, P + exercise, E), patients undergoing standard physical rehabilitation (iv. placebo 10 minutes before each 2-day physical training session, held 5 days per week for 2 weeks). We used intravenous injection of 2 ml saline (0.9% NaCl) as a placebo injection. Group 2 (heparin, H + exercise, E), patients undergoing standard physical rehabilitation with heparin pretraetment (same exercise as the previous group but wit

Pacijenti sa akutnim koronarnim sindromom (AKS) i dijabetes melitusom (DM) imaju povećan rizik za pojavu velikih neželjenih kardiovaskularnih događaja (VNKD) nakon perkutane koronarne intervencije (PKI), a koji je nedovoljno višedimenzionalno procenjen u odnosu na vrstu i težinu AKS i/ili DM i angiografske nalaze. Cilj: Studija je imala za cilj da proceni i uporedi prediktivnu kliničku vrednost modifikovanog SYNTAX skora u odnosu na prediktivnu kliničku vrednost SYNTAX skora na jednogodišnju pojavu VNKD kod bolesnika sa DM (sa dijagnozom dužom od jedne godine i višesudovnom bolešću) i akutnim koronarnim sindromom (AKS), lečenih metodom PKI. Materijal i metode: Sprovedena je prospektivna studija preseka kod pacijenata sa DM i AKS, kojima su u periodu PKI evidentirani sledeći faktori rizika: 1) metaboličke varijable – glikozilirani hemoglobin (HbA1c), ukupni holesterol, trigliceridemija; 2) endokrinološke varijable – terapija DM, tip DM; 3) modaliteti AKS 4) radiološke / anatomske varijable – SYNTAX skor i 5) kliničke varijable u modifikovanom ACEF skoru i klinički SYNTAX skor. VNKD evidentirani su do godinu dana posle PKI. Rezultati: Nakon PKI, od konsekutivno uključenih 136 pacijenata, njih 55 razvilo je bar jedan VNKD u periodu praćenja od jedne godine. Konstruisana su dva visoko prediktivna indeksa rizika za VNKD (IRVNKD). Prvi indeks rizika – IRNVKD (c statistic = 0.879) definisan je SYNTAX skorom > 21, modifikovanim ACEF skom > 1.38, HbA1c ≥ 8 (%), trigliceridemijom ≥ 2.3 (mmol/L) kod pacijenata na insulinsulinskoj terapiji, kao i modalitetom ACS – nestabilna angina pektoris. IRVNKD ima bolje prediktivne karakteristike u odnosu na SYNTAX skor (c statistic = 0.798), kao i ACF skor, ali ne i u odnosu na klinički SYNTAX skor (c statistic = 0.820). Drugi indeks rizika – IRNVKD II (c statistic = 0.923) definisan je istim faktorima rizika kao i IRNVKD, izuzev HbA1c ≥ 8 (%), a koji dodatno kao faktor rizika sadrži i prisustvo trosudovne bolesti. IRNVKD II imao je znača, Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The Aim: The study was intended to estimate and compare the predictive clinical value of the modified SYNTAX score versus the predictive clinical value of the SYNTAX score to the one-year appearance of MACE after conducted PCI in patients with DM (with diagnosis longer than one year and multivessel disease) and acute coronary syndrome (ACS). Material and methods: A prospective cross-section study was performed in patients with DM and ACS. In the PCI period the following risk factors where were recorded: 1) age and metabolic variables – glycosylated hemoglobin (HbA1c), total cholesterol, triglyceridemia; 2) endocrinological variables – DM therapy, tip of DM; 3) ACS modality; 4) radiological / anatomical variable – SYNTAX score and 5) clinical variables in modified ACEF score and clinical SYNTAX score. One-year MACE were recorded. Results: From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. Two highly predictable MACE risk indexes (MACERI) were constructed. The first risk index – MACERI (c statistic = 0.879) was defined by: SYNTAX score > 21, modified ACEF > 1.38, HbA1c ≥ 8 (%), triglyceridemia ≥ 2.3 (mmol / L) in patients on insulin therapy and ACS modality – unstable angina pectoris. MACERI has better predictive characteristics than SYNTAX score (c statistic = 0.798) as well as ACF score, but not in relation to clinical SYNTAX score (c statistic = 0.820)...

Sleep apnea is described as a presence of at least five consecutive breathing interruptions longer than 10 seconds per hour of sleep with the presence of symptoms durig night and day. Hypopnea is defined as a reduction in airflow by more than 50% associated with a reduction of oxygen saturation by at least 4%. It has been shown that hypopnea has the same clinical consequences as sleep apnea. Depending on the respiratory failure mechanism, the sleep apnea was divided into obstructive, central and mixed. There are numerous mechanisms that explain the connection of sleep apnea and cardiovascular disorders, the most significant of which is the increased activity of the sympathetic nervous system. The aim of this study was to examine the role of the sympathetic nervous system using non-invasive methods in connection with sleep apnea and cardiovascular disorders, as well as their frequency. The activity of the sympathetic nervous system is tested by the indirect method of spectral analysis of heart rate variability. The frequency of the following cardiovascular disorders in patients with sleep apnea was investigated: the frequency and type of hypertension, the variability and absence of a nighttime fall in blood pressure; heart rhythm disorders, ischemic changes and metabolic disorders (diabetes mellitus, lipid disorders). Methodology: Study was designed as prospective, non-therapeutical, interventional clinical research, to examine the prevalence of cardiovascular disturbances/diseases in patients with sleep apnea. For the purpose of research we regruted patients of both genders, aged 18-80 years, hospitalized on Clinic for Pulmology, Clinical Center Kragujevac, from June to December 2014. for polygraphy due to a suspision on obstructive sleep apnea. Based on polygraphic results patients were classified into 3 equal groups of 25 patients, with diagnosed OSA. Control group were patients without diagnosed OSA. Data were collected prospectively and part of the data were col

Uvod: Agregabilnost trombocita i proces aktivacije hemostaze tokom ishemije miokarda u sklopu fizičkog ili mentalnog stresa, može biti jedan od brojnih faktora koji utiču na proces tromboze stenta nakon perkutane koronarne intervencije. Pacijenti i metode istraživanja: Studijsku populaciju čini 121 asimptomatskih pacijenata koji su imali uspešnu perkutanu koronarnu intervenciju četiri meseca pre visokodozne dobutamin stres ehokardiografije. Agregabilnost trombocita na epinefrin (EPI) i adenozin difosfat (ADP) je određena metodom light transmission aggregometry (LTA) zajedno sa aktivnošću proteina C i antitrombina u plazmi pre i u piku opterećenja tokom stres testa. Pacijenti su bili podeljeni u nekoliko grupa shodno tome da li su imali poremećaje kontraktilnosti određenih segmenata miokarda u miru ili u naporu. Svi pacijenti su u vreme dobutamin stres ehokardiografije bili na terapiji klopidogrelom i aspirinom. Rezultati: Nema statistički značajne razlike u agregabilnosti trombocita na ADP (47,50% prema 50,20%; p=0,970) kao ni na EPI (59,30% prema 60,30%; p=0,600) pre i u piku DSE. Statistički značajna razlika je utvrđena u aktivnosti antikoagulantnih proteina, antitrombina (84,85 IU/L prema 74,75 IU/L; p=0,001) i proteina C (77,75 IU/L prema 67,60 IU/L; p<0,001). Značajnost razlike u antitrombinu i proteinu C odnosi se na rezultat pre i u piku testa. Nije utvrđena značajna razlika u agregabilnosti trombocita i aktivnosti antikoagulantnih proteina u plazmi kod pacijenta sa ili bez indukovane ishemije u piku dobutamin stres ehokardiografije. Pacijenti koji su imali povišen wall motion score index (WMSI) u piku dobutamin stres ehokardiografije su imali veću agregabilnost trombocita na EPI (68,60% prema 54,70% p=0,017) nego pacijenti sa normalnom kontraktilnošću miokarda. Zaključak: Nema promena vrednosti u agregabilnosti trombocita pre i posle dobutamin stres ehokardiografije, međutim, dolazi do smanjenja aktivnosti antikoagulantnih proteina u plazmi u piku testa. Agr, Introduction: Platelets aggregability and the activation of hemostasis, during myocardial ischemia within physical or mental stress, can be one of many factors that influence the process of stent thrombosis after percutaneous coronary intervention. Patients and methods: The study population included 121 asymptomatic patients who had successful percutaneous coronary intervention four months before high-dose dobutamine stress echocardiography. Platelets aggregability on epinephrine (EPI) and adenosine diphosphate (ADP) were determined by Light Transmission Aggregometry (LTA), together with plasma activity of protein C and antithrombin before dobutamine stress echocardiography and at the peak stage of the stress test. Patients were divided into several groups whether they have baseline or induced disturbance of segmental myocardial kinetics or not. All patients were on clopidogrel and aspirin therapy at the time of dobutamine stress echocardiography. Results: There were no statistically significant difference in platelets aggregability on ADP (47.50% vs. 50.20%; p=0.970) as well as on EPI (59.30% vs. 60.30%, p=0.600) before and at the peak dobutamine stress echocardiography. A statistically significant difference was found in the anticoagulant activity of the antithrombin (84.85 IU/L vs. 74.75 IU/L, p=0.001) and protein C (77.75 IU/L vs. 67.60 IU/L, p<0.001). Significance of differences in antithrombin and the protein C, refers to the result before and at the peak levels of the test. There was no significant difference in Platelets aggregability and plasma activity of anticoagulant proteins in patients with or without induced myocardial ischemia at the peak of dobutamine stress echocardiography. Patients who had increased wall motion score index (WMSI) at the peak of dobutamine stress echocardiography had higher EPI induced platelets aggregability (68.60% vs. 54.70% p=0.017) than patients with normal myocardial contractility. Conclusion: There are no changes in the pla

Kako je koronarna bolest postala jedan od najznačajnijih problema kardiovaskularne patologije čovečanstva (u visoko i srednje razvijenim zemljama u poslednjih 30-40 godina), postoji interes za izučavanje njene etiologije, patogeneze, lečenja, a naročito prevencije i dijagnostike. Koronarna bolest, karcinom dojke, cerebrovaskularni insult su vodeći uzrok smrtnosti kod žena. Iako je napravaljen značajan progres na polju prevencije kardiovaskularnih oboljenja, prvi znak koronarne bolesti kod asimptomatskih žena može biti akutni infarkt miokarda ili naprasna srčana smrt. Neke studije ukazuju na lošiju prognozu za osobe ženskog pola kada je ishemijska bolest miokarda potvrđena. Postoji konsenzus da skrinig pacijenktinja na karcinom dojke mamografskim poregledima treba raditi na svake dve godine kod žena između 50-74 godine života, mada pojedini autori govore o potrebi skrining mamomgrafije svake godine, dok skrinig metod za kardiovaskularne bolesti još uvek nije definisan. Arterijske kalcifikacije dojke (BAC) koreliraju sa prisustvom fatalnih i nefatalnih neželjenih kardiovaskularnih događaja prema rezultatima mnogih studija. Pojedini autori pokazali su kvantitativnu korelaciju BAC i kalcifikacija na koronarnim krvnim sudovima. Još uvek nema podataka koji potvrđuju korelaciju između ozbiljnosti koronarne bolesti kvantifikovane SYNTAX skorom i BAC. Cilj: Cilj ove studije bio je pokazati korelaciju prisustva i ekstenzivnosti arterijskih kalcifikacija dojki i ozbiljnosti koronarne bolesti izražene SYNTAX skorom, kao i razvoj skora koji bi mogao prepoznati pacijentkinje sa BAC i povišenim rizikom za neželjene kardiovaskularne događaje. Materijal i metode: Studija predstavlja prospektivnu studiju preseka procene rizika pojave neželjenih kardiovaskularnih događaja na osnovu različitih nivoa SYNTAX skora (nizak, povišen ili visok nivo rizika) kod pacijentkinja kojima je urađena rutinska mamografija. Studija je obuhvatitila populaciju od 102 bolesinice starije od 45 godina kojim, Since coronary artery disease became one of the most important problem of cardiovascular pathology there is great interest for the study of its of its etiology, pathogenesis, treatment, and in particular the diagnosis and prevention. Coronary artery disease (CAD), breast cancer (BC) and stroke are the leading cause of mortality in women. Although there is significant progress in field of prevention CAD, first sign CAD in the asymptomatic women can be acute myocardial infarction and sudden cardiac death. Even more, some studies demonstrated that women had worse outcome compare to men when CAD had been confirmed. There is some consensus that women are screened for BC with mammography between 50 and 74 years old every second year, but many advocate yearly screening. Bearing in mind this we can say that the age range for screening mammography is the same age range as those who would benefit from preventive cardiology. Screening method for CAD has not be still defined. Breast arterial calcification (BAC) has been correlated with presence of fatal and non fatal cardiovascular adverse event, also some studies quantitatively shown that BAC are in correlation with coronary artery calcium (CAC). Severity of coronary artery disease was defined by SYNTAX score which has prognostic value for short and long-time MACCE (major adverse cardiovascular events) in this patients. There is no study which confirmed correlation between severity of coronary artery disease quantifying by SYNTAX score and BAC after coronary angiography. The Aim: The aim of this study was to demonstrate correlation between breast arterial calcification and severity of coronary artery disease, regarding to SYNTAX score. Material and methods: The study is prospective cross-sectional study of assessment of the risk of adverse cardiovascular events based on different levels SYNTAX score (level of low, medium and high risk) in patients who underwent screening mammography. The study was approved by the local Ethics

Učestalost subkliničke sistolne i dijastolne disfunkcije leve komore (LV) kod dijabetičara može biti velika i često neblagovremeno pepoznata. Kod normotenzivnih bolesnika sa Diabetes mellitus-om tip 2 noćni pad krvnog pritiska može biti manji od 10% (non-dipperi), što se može pokazati ambulatornim monitoringom krvnog pritiska (ABPM). Ovi bolesnici su u visokom riziku od neželjenih kardijalnih događaja. Cilj: Istražiti dijagnostičku i prognostičku ulogu tkivnog Doppler-a i parametara miokardne deformacije za rano otkrivanje disfunkcije leve komore. Odrediti značaj Doppler ehokardiografije i AMBP za prognozu i ishod tokom tri godine praćenja. Metode: U istraživanje je bio uključen 121 asimptomatski dijabetičar i grupa od 41 zdravih, po starosti i polu uporedivih ispitanika. Dimenzije, volumeni leve pretkomore i komore procenjeni su ehokardiografski, kao i svi konvencionalni Doppler parametri. Metodom tkivnog Doppler-a merene su brzine u nivou medijalnog anulusa (Em, Am, Sm), uključujući brzinu izovolumetrijske kontrakcije (IVCv), vreme akceleracije IVCv i akceleraciju tokom izovolumetrijske kontrakcije (IVA), odnos E/Em i tkivni indeks miokardne performanse (tMPI). Globalni longitudinalni strejn (GLS) određivan je dvodimenzionalnom speckle-tracking metodom. Svim ispitanicima je urađen ABPM. Tokom perioda od tri godine praćena je pojava nekog od neželjenih kardijalnih događaja. Rezultati: Značajne korelacije između mehanike i funkcije leve komore nađene su u odnosu na sledeće parametre: GLS sa E/Em (r=0.402; p=0.0001), IVCv (r= -0.358; p<0.001) i tMPI (r=0,289; p<0,001) sa signifikantno nižim vrednostima GLS (-17.5 ± 2.1 vs -24.4 ± 2.4; p<0.001), IVCv (0.07 ± 0.02m/s vs 0.09 ± 0.03m/s; p<0.001) i signifikantno višim E/Em (10.3 ± 2.24 vs 7.4 ± 1.8; p<0.001) kod dijabetičara. ABPM je pokazao da je procentualni pad sistolnog krvnog pritiska u toku noći bio očekivano signifikantno niži u grupi dijabetičara, gde je čak 38 bolesnika (31%) imalo noćni pad sistolnog krvnog pri, Subclinical left ventricular (LV) systolic and diastolic dysfunction is prevalent in diabetic subjects. In normotensive type 2 diabetic patients ambulatory blood pressure monitoring (ABPM) can show a non-dipping nocturnal pattern of blood pressure. This patients are at risk of cardiovascular morbidity and mortality. Aim: To explore the diagnostic and prognostic role of Tissue Doppler and myocardial deformation parameters for early detection of left ventricular dysfunction. To determine the significance of Doppler echocardiography and AMBP for prognosis and outcome during three years follow up. Methods: The study included 121 asymptomatic normotensive typ 2 diabetic patients and 41 age and sex matched healthy subject. Dimensions and left atrial and left ventricular volumes were assessed by echocardiography and all conventional Doppler parameters. Tissue Doppler velocities were measured from medial annulus (Em, Am, Sm), including isovolumic contraction velocity (IVCv), acceleration time of IVCv and acceleration during isovolumic contraction (IVA), E/Em and Doppler tissue myocardial performance index (tMPI) Global longitudinal strain (GLS) was derived from two-dimensional speckle-tracking. ABPM was performed in all patients. All patients were followed up for three years. The end point was some of the cardiac events. Results: There was close correlations between values of GLS and E/Em (r=0.402, p<0.001), IVCv (r= -0.358; p<0.001) and tMPI (r=0,289; p<0,001) with significantly lower values of GLS (-17.5 ± 2.1 vs -24.4 ± 2.4; p<0.001), IVCv (0.07 ± 0.02m/s vs 0.09 ± 0.03m/s; p<0.001), and significantly higher value of E/Em (10.3 ± 2.24 vs 7.4 ± 1.8; p<0.001) in group of diabetic patients. ABPM showed that 38 diabetic patients (31,4%) had a non-dipping pattern, despite the fact that they are considered normotensive and as many as 14 had an increase in blood pressure during the night (inverse-dipper). During of three years of follow up only 9 of 121 diabetic patients (7.4%)

Cilj ove doktorske disertacije je bio da se ispita povezanost psiholoških karakteristika pacijenata, simptoma depresije, anskioznosti i stresa, kao i tipa temperamenta pacijenta sa koronarnom ishemijom koja je procenjena FFR dijagnostikom. U periodu od decembra 2014. godine do januara 2016. godine u studiju je uključeno 147 pacijenata, kojima je nakon urađene koronarografije i uočenih intermedijarnih lezija na koronarnim arterijama, bila neophodna dodatna FFR dijagnostika. Procenat stenoze na koronarnim arterijama je procenjen uz pomoć dijagnostičkog softvera Quantitative Coronary Angiography (QCA). Intermedijarnim lezijama su smatrane lezije od 50-80% stenoze procenjene pomoću QCA. Pacijenti su po urađenoj koronarografiji potpisivali pristanak za učešće u istraživanju, nakon toga zamoljeni su da odgovore na upitnike samoprocene psiholoških karakteristika DASS 21 i TEMPS A. Pacijentima je urađena planirana FFR dijagnostika, a prema vrednosti FFR-a, svrstani su u u grupi pacijenata sa ishemijskim lezijama, definisanim kao FFR ≤ 0,80 u odnosu na grupu pacijenata bez ishemijskih lezija, FFR> 0,80. Rezultati istraživanja su prikazani kroz 56 tabela i 44 grafikona. 74,1% ispitanika je bilo muškog pola, 99.3% ispitanika boluje od hipertenzije. U braku je 81% ispitanika. Ispitanici koji nisu radno aktivni činili su 65,3% studijske populacije. Od ukupnog uzorka, 63 pacijenta (42,8%) je imalo FFR vrednost ≤ 0,80 i oni predstavljaju ishemijske grupu, 84 pacijenta (57.1%) imalo je FFR vrednost > 0,80 i oni predstavljaju neishemijsku grupu. Procentualno najviše ishemijskih lezija je lokalizovano na prednjoj descedentnoj arteriji (48.3%). Utvrđeno je da postoji statistički značajna razlika u stepenu depresivnosti i anksioznosti u grupi ispitanika sa koronarnom ishemijskom lezijom, procenjenom uz pomoć FFR-a (FFR ≤ 0,80) u odnosu na grupu ispitanika kod kojih koronarne lezije nemaju ishemijski potencijal (FFR> 0,80). Postoji statistički značajna razlika u stepenu stresa u grupi i, The aim of this study was to examine the correlation of psychological characteristics of patients, the symptoms of depression, anxiety and stress, and the type of temperament of a patients with coronary ischemia evaluated by FFR measurement. In the period from December 2014 to January 2016, the study involved 147 patients who needed additional FFR diagnostics after coronarography, when intermediate lesions were observed on coronary arteries. The percentage of coronary arteries stenosis was estimated using the Quantitative Coronary Angiography (QCA) diagnostic software. Intermediate lesions were considered as lesions of 50-80% of stenosis assessed by QCA. Patients signed a informed consent for participation in the research, after which they were asked to respond to self-assessment questionnaries of psychological characteristics, DASS 21 and TEMPS A. After FFR measurement was performed, according to FFR values patients were classified in a group with ischemic lesions, defined as FFR ≤ 0.80 or in a group of patients without ischemic lesions, in whom FFR > 0.80. The research results are presented in 56 tables and 44 graphs. Study sample consists of 147 patients. 74.1% were male, 99.3% suffer from hypertension, 81% are married, while 65.3% of the study population were retired. 63 patients (42.8%) had a FFR value of ≤ 0.80 and they represent an ischemic group, 84 patients (57.1%) had a FFR value of> 0.80 and they represent a non-ischemic group. Most of ischemic lesions were localized on left anterior descedent artery (LAD) (48.3%).

Kardiovaskularne bolesti (KVB) su vodeći uzrok smrti, kako u svetu tako i u našoj zemlji. Od svih KVB, najčešća je koronarna bolest srca koja je udružena sa najvećom stopom morbiditeta i mortaliteta do 25%. Kardiološka rehabilitacija (CR, od engl. Cardiac Rehabilitation) je skup aktivnosti i intervencija potrebnih za postizanje najboljeg mogućeg fizičkog, mentalnog i socijalnog stanja pacijenata sa KVB. Cilj: Ispitati uticaj i efekat tronedeljnog programa CR na poboljšanje funkcionalnog kapaciteta procenjenog CPET-om (od engl. Cardio Pulmonary Exercise Testing) i proceniti održivost efekata u periodu od šest meseci od okončanja programa CR kod pacijenata nakon perkutane i hirurške revaskularizacije miokarda. Metode: U ovoj studiji je uključeno 120 pacijenata (111 muškaraca, prosečne starosti 54,90 ± 8,80 i 9 žena, prosečne starosti 55,70 ± 5,20) podeljenih u III grupe. Grupa I koju je činilo 40 pacijenta (38 muškaraca i 2 žene) lečenih CABG (od engl. Coronary Artery Bypass Grafting). Grupa II koju je činilo 40 pacijenta (39 muškaraca i 1 žena) lečenih PCI (od engl. Percutaneous Coronary Intervention). Grupa III koju je činilo 40 pacijenta (34 muškaraca i 6 žena) lečenih Ele.PCI (od engl. Elective Percutaneous Coronary Intervention). Fizički trening se sastojao od dve trening sesije. Prve jutarnje sesije trajanja do 60 minuta sa aerobnim intervalnim treningom (3 minuta treninga i 3 minuta odmora) na biciklergometru. Kao i hoda preko Nyllinovog stepenika. Sesija je sadržala: vežbe zagrevanja 10 minuta, trening fazu trajanja do 45 minuta i potom fazu 5-to minutnog hlađenja. Druga, popodnevna sesija, koncipirana je od hoda po ravnom brzinom 3 do 5 km na čas (kontinuirani trening). Trajanje ove sesije je bilo individualno i svakodnevno je povećavano. Svim pacijentima I i II grupe posle tronedeljnog hospitalnog programa CR savetovan je program aerobnog fizičkog treninga koji se sastojao od šetnji brzinom 5 km/h, u trajanju od 60 min, 3-5 puta nedeljno, ciljanog intenzitet, Cardiovascular diseases (CVD) are the leading cause of death in the world and in our country. From all CVD, the most common is coronary heart disease which is associated with the highest morbidity and mortality by 25%. Cardiac rehabilitation (CR) is a set of activities and interventions needed to achieve the best possible physical, mental and social condition of patients with CVD. Aim: To examine the impact and effect of the three-week CR program to improve functional capacity estimated with CPET (Cardio Pulmonary Exercise Testing) and assess the sustainability of the effects of a period of six months from the end of the CR program in patients after percutaneous and surgical revascularization of myocardium. Methods: This study included 120 patients (111 males, mean age 54.90 ± 8.80 and 9 female, mean age 55.70 ± 5.20) who were divided into three groups. Group I consisted of 40 patients (38 men and 2 women) treated with CABG (Coronary Artery Bypass Grafting). Group II consisted of 40 patients (39 men and 1 women), treated with PCI (Percutaneous Coronary Intervention). Group III consisted of 40 patients (34 men and 6 women) treated with Ele.PCI (Elective Percutaneous Coronary Intervention). Physical training consisted of two training sessions. First morning sessions lasting up to 60 minutes with aerobic training interval (the training 3 minutes and 3 minutes of rest) on the ergo cycle. As an and walk through the Nyllin stairs. A session is contained of the: warm-up exercises for 10 min, a training phase of 45 minutes duration, and then 5 minute cooling phase. The second afternoon session, conceived by walking on a flat rate of 3 to 5 km per hour (continuous training). The duration of this session is an individual, and every day is increased. For all patients from first and the second group after a three-week hospital CR program, aerobic exercise training program is advised, consisting of a walking speed of 5 km/h, for 60 min, 3-5 times a week, a target intensity of 70

Hypertension is a leading risk factor for many complications and a major couse of death world wide. In a beging together with some traditional factors hypertension may develop some changes on some organs such us heart, kidney , brain , blood vessels ect. In some patients accept hypertension obesity and dyslipidemias play important role in a development of left ventricular hypertrophy. In this paper author discus and anlyse influence of hypertension as well as a obesity and following ehocardiocraphic changes in left ventriculy together with laboratory analyses compare which is dominant factor for development of left ventricular hypertrophy. Analysis of the patient comfirm that obese patients have increased intervent septum, posterior wall of left chamber but not reduce ejection fraction.Also is important to emphasise that there is no diference in a dimension of the left chamber which support idea that in a hypertensive patients is dominant concentric tipe of hypertrophy. In patients with hypertension is notice that if they have increased levels of triglicerides during 24 hours ambulatory blood pressure monitoring is find higher lavels of the blood pressure. In conclusion, this study support that in a development of left ventricular hypertrophy accepts hypertension important role play obesity as well as rised lvels of triglicerides.

Uvod: Analiza koronarnog protoka i parametara koji iz njega proističu u bazalnim i u uslovima maksimalne hiperemije pruža značajne podatke o stanju mikrocirkulacije u različitim patološkim stanjima. U našem radu je ispitivana povezanost između veličine infarkta miokarda u hroničnoj fazi nakon uspešne mehaničke reperfuzije i vrednosti koronarne rezerve protoka i dijastolnog deceleracionog vremena u bazalnim i u uslovima maksimalne hiperemije. Ciljevi: ove studije koja je uključila bolesnike sa prethodnim uspešno reperfundovanim prednjim infarktom miokarda u njegovoj hroničnoj fazi, su da se: 1. Utvrdi izvodljivost (feasibility) merenja koronarnog protoka, i koronarne rezerve protoka (CFR) neinvazivnom metodom transtoraksnom Doppler ehokardiografijom u infarktnoj i referentnoj koronarnoj arteriji 2. Utvrdi vrednost koronarne rezerve protoka u infarktnoj arteriji 3. Uporede vrednosti koronarne rezerve protoka u infarktnoj i referentnoj arteriji 4. Utvrdi veličina infarkta miokarda procenjena novom metodom na osnovu vrednosti koronarne rezerve protoka u infarktnoj i referentnoj arteriji i da se ovako izračunata veličina infarkta uporedi sa veličinom infarkta procenjenom na osnovu drugih metoda (enzimska, ehokardiografska, i scintigrafska) 5. Utvrdi dužina dijastolnog deceleracionog vremena (DDT) u infarktnoj i referentnoj arteriji kao i njihova povezanost sa veličinom infarkta miokarda 6. Utvrdi značaj procene dijastolnog deceleracionog vremena u infarktnoj i referentnj arteriji u hiperemiji Materijal i metode: Naša studija je obuhvatila 50 uzastopnih bolesnika sa prvim prednjim infarktom miokarda uspešno lečenih primarnom perkutanom koronarnom intervencijom..., Introduction: The analysis of coronary flow and its derived parameters provide useful information on state of microcirculation in different pathologocal settings. We assessed the relation between infarct size in chronic phase after successful mechanical reperfusion and coronary flow reserve and duration of diastolic deceleration time. The aims: of present study which included patients with previously successfully reperfused myocardial infarction in its chronic phase were: 1. To assess feasibility of coronary flow and coronary flow reserve (CFR) measurements in infarct related and reference artery using transthoracic Doppler echocardiography 2. To explore values of coronary flow reserve in infarct related coronary artery 3. To compare values of coronary flow reserve in infarct related and reference coronary artery 4. To estimate infarct size using novel pathophysiologically relevant model of infarct size estimation based on the measurement of coronary flow reserve in infarct related and reference coronary artery and assess its relation with other measurements of infarct size (enzymatic, echocardiographic and SPECT-MPI) . 5. To assess duration of diastolic deceleration time (DDT) of coronary flow in infarct related and in reference coronary artery in basal conditions and to assess their relation with infact size 6. To assess the value of DDT determination during hyperemia Methods: Our study included 50 consecutive patients with first anterior myocardial infarction successfully treated with primary percutaneous coronary intervention...