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Introduction/Objective The purpose of the current Echocardiographic Society of Serbia (ECHOS) survey was to assess echocardiography practice in Serbia during the Coronavirus disease 2019 (COVID-19) pandemic Methods An online survey consisting of 12 questions about the usa of echocardiography, the availability of portable ultrasound devices and personal protective equipment (PPE) was sent to all ECHOS members Results Overall, 126 ECHOS members (43%) answered the survey One-third of respondents (36%) were physicians from specialized COVID-19 centers During the pandemic, indications for echocardiographic examination were restricted in both COVID-19 and non-COVID-19 centers In COVID-19 centers, 41% of respondents performed lung ultrasound to each patient versus 26% in non-COVID-19 centers Transesophageal echocardiography was not performed in suspected or confirmed COVID-19 cases in any center Portable ultrasound devices were available to 66% of respondents from COVID-19 versus 44% of respondents from non-COVID-19 centers (p = 0 018) The respondents reported regular use of PPE, regardless of the patient’s COVID-19 status and found their personal knowledge about protective measures and use of PPE satisfactory Conclusion During the COVID-19 pandemic in Serbia, indications for echocardiography were restricted to clinical scenarios in which the results of examination were expected to alter patient management In both COVID-19 and non-COVID-19 centers, the use of PPE was in line with national and international recommendations A wider availability of portable ultrasound devices and application of lung ultrasound could improve patient management in similar situations in the future © 2020, Serbia Medical Society All rights reserved

Echocardiography is an indispensable diagnostic tool of cardiologists and other specialties involved in proving care to cardiovascular patients. In this paper, Echocardiographic Society of Serbia provides its viewpoint regarding the organization of basic education in transthoracic echocardiography, aiming at homogeneity of education and improving the quality of echocardiographic training in Serbia.

Introduction. Since clinical and electrocardiographic features of various cardiac disorders may overlap, the differential diagnosis of left ventricular (LV) dysfunction may be difficult even for the most experienced physicians. Recent advances in cardiac imaging may help clinicians to establish an accurate diagnosis and initiate adequate treatment. The aim of this case report is to raise awareness of a very short-lasting LV dysfunction during respiratory infections and to underline the importance of multimodality imaging in this clinical setting. Case outline. A previously healthy 37-year-old male presented with atypical chest pain and ST-segment elevation in the inferolateral leads during severe mental stress and acute respiratory infection. Acute myocardial infarction, myocarditis, coronary vasospasm and stress cardiomyopathy were all considered as a differential diagnosis. A rapid onset of severe LV dysfunction and a complete recovery within 4 days was detected by echocardiography and further evaluated by multimodality imaging, including multislice computed tomography and cardiac magnetic resonance imaging. Conclusion. Severe, but very short-lasting LV dysfunction may be triggered by various causes, including upper respiratory tract infections. Since the symptoms of respiratory infections may obscure those of LV dysfunction, myocardial dysfunction in these patients may go undetected with possible serious consequences.

Introduction/Objective. Chronic obstructive pulmonary disease (COPD) exacerbation is mostly triggered by infectious agents and seriously compromises the patient’s quality of life and predicts a poor outcome of the disease as well. If the signs of the probable bacterial cause of COPD exacerbation are presented in an intubated patient, initial antimicrobial management must be launched. Depending on the results of the respiratory system sample cultures, the initial antimicrobials can be changed or continued. The objective of this study is to present in-hospital suggestions regarding the use of the initial antimicrobial management of urgently intubated COPD adults with the probable bacterial cause of exacerbations, considering the source of bacterial acquisition (i.e. facility- or community-acquired bacteria). Methods. The cross-sectional study covered 51 patients urgently intubated on admission to the medical Intensive Care Unit of the Zemun Clinical Hospital Center during 2015/2016. The patients were divided into two groups: community-acquired (n = 26) and facility-acquired infection group (n = 25). The respiratory system samples were processed in the Microbiology Laboratory. Results. Acinetobacter and Pseudomonas spp. were the most frequently isolated bacteria in both groups, followed by Staphylococcus aureus and Klebsiella spp. as the third most frequent bacteria in the community- and facility-acquired group, respectively. The parallel use of tigecycline and aminoglycosides proved to cover a sensitive microbial spectrum in 52% of examinees of the community-acquired and 32% of examinees of the facility-acquired group. Conclusion. The present study suggests the initial management of intubated adults with probable bacterial infection-induced COPD exacerbation by the parallel use of tigecycline and aminoglycosides. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 173033]

INTRODUCTION It is not clear whether associated aortic regurgitation (AR) should be regarded as a risk factor in patients undergoing surgery for severe aortic stenosis (AS). Some authors have suggested that morbidity and mortality are increased in these patients as compared to patients operated for pure AS, whereas others have found no difference of the outcome and prognosis between these groups. OBJECTIVE This study made an attempt to compare the outcome and prognosis following the surgical intervention in patients with severe AS and associated AR and those operated for pure AS, as well as to determine predictive value of clinical, functional and echocardiographic data for the outcome of surgery. METHODS Study population consisted of 122 consecutive patients operated at Dedinje Cardiovascular Institute during 1999 due to severe AS, defined as mean gradient over aortic valve >30 mmHg. The patients were divided into AS group (63 patients with AS without AR or with mild AR) and AS+AR group (59 patients with AS and moderate, severe or very severe AR). The patients were subjected to control clinical, functional and echocardiographic examinations 12 and 18 months following the surgery. RESULTS AND DISCUSSION Preoperatively, the patients in AS group were older and had coronary artery disease more frequently, whereas patients in AS+AR group had higher left ventricular volumes and mass. Preoperative NYHA class, ejection fraction, mean gradient over aortic valve, type and size of the implanted mechanical prosthesis, and the incidence of associated coronary artery bypass surgery were similar between the groups. Similarly, the operative mortality was similar in AS and AS+AR groups (1.6% vs 8.5%, respectively, p=0.11). Twelve months postoperatively, there were no difference of average NYHA class and NYHA class III/ IV between the groups. The patients in AS+AR group were unable to walk >300 meters on 6 minute walk test more frequently than those in AS group (64% vs. 36%, respectively; p=0.043). Eighteen months postoperatively, NYHA class III/IV was found more frequently in AS+AR than in AS group (26% vs. 8%, respectively; p=0.0343). In patients with associated AR, there was no difference of NYHA class with respect to the severity of AR (p=0.815). Multivariate analysis found the association of more than mild AR as an independent predictor of poor functional capacity, irrespective of its severity. CONCLUSION Patients with severe AS and associated AR have poorer postoperative functional capacity as compared to patients operated for pure AS.

Background. The impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias is not yet clarified. The aim of this study was to investigate the impact of thrombolytic therapy on the incidence of complex ventricular arrhythmias, as well as long term association between complex ventricular arrhythmias and left ventricular remodelling, and their impact on five-year lethality. Methods. Ninety seven consecutive patients with first acute myocardial infarction (streptokinase was administered in 58 patients) underwent 24-hours Holter monitoring at discharge. Ventricular arrhythmias were classified according to Lown classification, and patients were grouped into the group with simple ventricular arrhythmias (Lown class 0 to 2), and the group with complex ventricular arrhythmias (Lown class 3 to 5). Echocardiography was performed at discharge, and six and twelve months after the infarction. Left ventricular volume indexes and ejection fraction was determined using Simpson's biplane formula. Results. In patients with complex ventricular arrhythmias left ventricular volume indexes were higher and ejection fraction was lower throughout the study, whereas wall motion score index was higher one year after the infarction. On the other hand, these variables were similar throughout the follow-up within the groups of patients with and without complex ventricular arrhythmias who received thrombolytic therapy. The incidence of complex ventricular arrhythmias was similar in thrombolysed and non-thrombolysed patients (11/58 vs. 5/39). There was no difference in five year lethality between patients with and without complex ventricular arrhythmias (4/16 vs. 13/81 patients). Conclusion. Our data indicated that left ventricular remodelling in patients with complex ventricular arrhythmias was not progressive after hospital discharge. The presence of complex ventricular arrhythmias was not associated with the increased five-year lethality, despite of more pronounced left ventricular remodelling. It occured that thrombolysis per se had no influence on the incidence of complex ventricular arrhythmias in the late hospital phase after the first acute myocardial infarction.

BACKGROUND: An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate-reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per minute or more.METHODS: We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12,049 patients with activity-limiting angina [class ≥II on the Canadian Cardiovascular Society scale, which ranges from I to IV, with higher classes indicating greater limitations on physical activity owing to angina]). We randomly assigned patients to placebo or ivabradine, at a dose of up to 10 mg twice daily, with the dose adjusted to achieve a target heart rate of 55 to 60 beats per minute. The primary end point was a composite of death from cardiovascular causes or nonfatal myocardial infarction.RESULTS: At 3 months, the mean (±SD) heart rate of the patients was 60.7±9.0 beats per minute in the ivabradine group versus 70.6±10.1 beats per minute in the placebo group. After a median follow-up of 27.8 months, there was no significant difference between the ivabradine group and the placebo group in the incidence of the primary end point (6.8% and 6.4%, respectively; hazard ratio, 1.08; 95% confidence interval, 0.96 to 1.20; P=0.20), nor were there significant differences in the incidences of death from cardiovascular causes and nonfatal myocardial infarction. Ivabradine was associated with an increase in the incidence of the primary end point among patients with activity-limiting angina but not among those without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, PCONCLUSIONS: Among patients who had stable coronary artery disease without clinical heart failure, the addition of ivabradine to standard background therapy to reduce the heart rate did not improve outcomes. (Funded by Servier; SIGNIFY Current Controlled Trials number, ISRCTN61576291.).