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Introduction. Sustained monomorphic ventricular tachycardia (VT) – SMVT is a rare, underdiagnosed pathology with a very poor prognosis. Along with ventricular fibrillation, SMVT is responsible for nearly all of the arrhythmic sudden cardiac deaths (SCD). The most common cause of VT is ischemic heart disease, but there are many other reasons, among which are arrhythmogenic right ventricular cardiomyopathy (ARVD) and myocardial bridging phenomenon. Treatment options include a hybrid approach consisting of antiarrhythmic drugs, catheter ablation, and implantable cardioverter defibrillators (ICD). Case report. We present a case of a 46-year-old man, a military officer, who experienced chest pain, palpitations, and nausea during regular physical activity at home. Due to the symptoms described, he was examined immediately and diagnosed with SMVT. Shortly after the diagnosis, he lost consciousness and was successfully resuscitated. A complete non-invasive and invasive cardiology examination was performed. It revealed that the patient had stable coronary disease and a muscle bridge on the left anterior descending artery. An ARVD was suspected after transthoracic echocardiography and heart magnetic resonance imaging. Genetic testing for ARVD was negative, but according to the Heart Rhythm Society expert consensus criteria, we had enough for a definitive diagnosis. The patient was hospitalized for ten days and treated with drugs without recurring VT or other disorders. We implanted an implantable loop recorder before the discharge and monitored the heart rhythm for one year. During a three-year follow-up, all of his electrocardiographic findings presented sinus rhythm without heart rhythm disorders. Conclusion. Sudden SMVT is the most common cause of SCD. It is of inestimable importance to carry out a detailed examination and determine the immediate cause of the arrhythmia and the right therapy, which, for these patients, is a life-saving form of treatment. Therapy includes medications, electrophysiology or ICD, or a combination of these treatment approaches.

Using recently developed right-tailed sequential unit root tests at daily frequency in the extreme portion of the Serbian hyperinflation, we found that the money supply and the exchange rate exploded while the economy was approaching the maximum of the inflation tax Laffer curve, and remained explosive while on the wrong, decreasing side of that curve throughout the end of the hyperinflation. Money supply exploded as government tried first to raise seigniorage to a new higher plateau, and subsequently to prevent, albeit unsuccessfully, a decline in seigniorage while the economy was sliding down the decreasing side of the Laffer curve. The rational bubble was not found as the exchange rate explosiveness was driven by the explosiveness of its fundamental value: current and expected future money supply. Thus, even the extreme portion of the Serbian hyperinflation was driven by ever expanding money supply in the government quest for additional seigniorage and not by the rational bubbles.

Background/Aim. Previous studies have confirmed a positive correlation between homocysteine levels and a greater risk for acute coronary syndrome and stroke, but there are no available data to support an association between homo-cysteine and inflammatory markers and the severity of coronary artery disease according to the clinical SYNTAX score in patients with stable angina. The aim was to determine the association between homocysteine and inflammatory biomarker levels: interleukin (IL)-6, high sensitive C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR) and the severity of coronary artery disease according to clinical SYNTAX score. Methods. Eighty-two patients with stable angina pectoris (average age 65 ± 8 years, 28.9% females) underwent coronary angiography and were divided into three groups according to the clinical SYNTAX score: the group I < 22 (39 patients), the group II 23–32 (16 patients), the group III > 33 (27 patients). The severity and complexity of coronary artery disease were calculated by clinical SYNTAX score, multiplying the SYN-TAX score with the modified ACEF score, based on the patients’ left ventricular ejection fraction, age and creatinine clearance (derived with Cockcroft–Gault equation). Results. Homocysteine levels were significantly higher in patients with high clinical SYNTAX score [the group I: median (interquartile range – IQR): 10.20 (3.97), the group II: 10.45 (5.77), the group III: 14.70 (7.50), p = 0.005]. Patients in the group III had significantly higher homocysteine levels compared to the group I (p = 0.001). We also found a posi-tive association between inflammatory biomarkers (IL-6, hsCRP, fibrinogen, ESR) and the severity of coronary artery disease according to the clinical SYNTAX score (p = 0.017, 0.001, 0.032, 0.049 respectively). We detected significantly lower plasma levels of vitamin B12 in the group III and group II in comparison with the group I (the group I: median (IQR): 238 (160), the group II: 171 (160), the group III: 172 (102), p = 0.022), which indicates its important role in homocysteine metabolism. Conclusion. The elevated plasma levels of homocysteine, IL-6, hsCRP, fibrinogen, ESR were detected in patients with high clinical SYNTAX score (> 33). Our results showed that hyperhomocysteinemia and some inflammatory biomarkers can predict more severe and extensive coronary artery disease in stable angina patients.

Introduction. Cardiac resynchronization therapy (CRT) reduces mortality and hospitalization in patients with symptomatic heart failure and left bundle branch block (LBBB) on optimal drug therapy. Among all, the reasons for “non-response” to CRT pacemaker could be the failure to achieve optimal left ventricular (LV) lead position due to severe curve or stenosis/occlusion of the target vein. Case report. We presented a 79-old-male patient, New York Heart Association (NYHA) class III, with atrial fibrillation, chronic coronary syndrome (CCS), and prior myocardial infarction. The patient underwent coronary artery bypass surgery and mechanical prosthetic aortic valve implantation. He was indicated for CRT. The patient′s venogram revealed ostial/proximal severe curve and stenosis of the posterolateral vein, the only vein of coronary sinus that led to anatomically optimal LV segment for stimulation. After the balloon angioplasty of the curved and stenotic portion of the target vein with compliant balloon 4.0 × 30 mm, a satisfactory and stable position of quadripolar LV lead was achieved. Conclusion. Compliant balloon angioplasty could be a safe and efficient way to override severe coronary vein stenosis in some CRT cases.

Introduction/Objective. The purpose of the Echocardiographic Society of Serbia (ECHOS) national survey was to assess current echocardiography practice in Serbia, the availability of different echocardiographic techniques and self-perceived need for improvement at personal and institutional level. Methods. A survey comprising 20 questions about demographics, numbers and distribution of echocardiographic equipment and techniques, image acquisition and reporting standards as well as future educational preferences was sent to all ECHOS members via email. Results. A total of 106 members (42%) answered the survey. Echocardiographic examinations are most frequently performed by cardiologists and internal medicine specialists. Transesophageal echocardiography (TOE), stress echocardiography (SECHO) and speckle tracking echocardiography (SpTE) are available in approximately 20% of centers, three-dimensional echocardiography in 11%, while contrast echocardiography is practiced in only two centers. Less than a third of respondents always attach electrocardiographic electrodes and archive examinations. Almost all respondents (96%), always evaluate both systolic and diastolic function of the left ventricle (LV), although systolic LV function is frequently assessed (55%) using non-standard methods. The newer echocardiographic machines are more often available at university than non-university centers (87 versus 44%, p < 0.01). SECHO was perceived as the most needed technique at the institutional level, while SpTE and TOE were most often reported personal aspirations of the respondents. Conclusion. Advanced techniques, SECHO and TOE are needed but rarely performed outside the university hospitals in Serbia. In order to achieve a better adherence to standards of practice in echocardiography, the development of national guidelines and personal and laboratory accreditation seem warranted.

Dynamic relationship among unemployment rate and key macroeconomic variables is explored for the Serbian economy that has been characterized by high unemployment rates since the outcome of the Great Recession. This analysis reveals how effective policy measures can be in reducing unemployment rate. Cointegrated vector autoregressive model is employed for the period 2014-2019. Prior to multivariate dynamic modelling, the validity of hysteresis hypothesis for unemployment rate is assessed. Obtained results show significant negative long-run effect of real wages on unemployment rate, and positive long-run effect of real effective exchange rate appreciation on real wages. For further reduction of unemployment rate demand-side measures should be employed.

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.

The sustainability of purchasing power parity (PPP) theory is examined within the quantile autoregression model for the monthly data of the euro and the US dollar-based real exchange rate (RER) in selected European economies (the Czech Republic, Hungary, Poland, Romania, Serbia and Turkey). Period from January 2000 to December 2014 is covered. The application of quantile autoregression model is motivated by the necessity of identifying asymmetric behavior of the RER due to the shocks of different size and sign. The empirical results support to some extent the PPP theory for the euro- and US dollar-based RER in Romania, Serbia, and Turkey. The euro-based RER in Hungary and Poland is also identified to confirm the PPP theory. The dynamics of the RER in the Czech Republic cannot be associated with the PPP validity. The persistence of the euro-based RER is estimated to be more prominent after the depreciation shocks of smaller size.

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.

Background/Aim. Recently adopted technique, Transthoracic Doppler Echocardiography (TDE) enables the estimate of functional significance of coronary luminal narrowing. A multi-slice computed coronary angiography (MSCT), as one of the most important noninvasive methods, offers us a quite precise visualization of morphological characteristics of atherosclerotic changes in coronary arteries. We have tried to evaluate the most reliable noninvasive approach aimed at the detection of major stenosis on the left anterior descending artery (LAD) and the right coronary artery (RCA). Methods. This study involved 84 patients, with the previously detected atherosclerotic lesions on the LAD and/or RCA by MSCT. The coronary flow reserve (CFR) assessment by TDE with adenosine was obtained in LAD (n = 75); RCA (n = 61), resulting in 136 vessels subjected to the analysis. Invasive coronary angiography (ICA) was performed in all patients within 24 to 48 hours after the CFR as a reference technique. Results. The Cochrans Q test proved a significant statistical difference among these techniques in detection of a significant stenosis on the LAD and RCA (p < 0.01). Further analyses revealed a significant difference between the MSCT and CFR (p < 0.05), MSCT and ICA (p < 0.01), whereas we did not find a significant difference between the CFR and ICA (p > 0.05). The main discrepancies in results among the CFR, ICA and MSCT were noticed concerning intermediate and severe stenosis on the MSCT. The MSCT had a diagnostic accuracy for the LAD 66.67%, for the RCA 75.%, the CFR had for the LAD 90% and for the RCA 81.67%, in detection of significant stenosis. Where the consensus was reached between both techniques, diagnostic accuracy was improved for the LAD 97.33% and the RCA 90 %. Conclusion. Comprehensive noninvasive evaluation of both anatomical and functional imaging in coronary diseases makes the optimal approach for precise, noninvasive assessment of the coronary artery lesions in the coronary arteries.

Introduction: Platelets aggregability (PA) 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 (PCI). Objective: The aim of the study is to investigate the relationship between PA and activity of anticoagulant proteins with myocardial ischemia during dobutamine stress echocardiography (DSE) in asymptomatic patients four months after PCI. Methods: The study population included 74 asymptomatic patients who had successful PCI four months before high-dose dobutamine stress echocardiography (DSE).PA on epinephrine (EPI) and adenosine diphosphate (ADP) were determined by Light Transmission Aggregometry (LTA), together with plasma activity of protein C (PC) and antithrombin (AT) before DSE 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 DSE. Results: There were no statistically significant difference in PA 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 DSE. A statistically significant difference was found in the anticoagulant activity of the AT (84.85% vs. 74.75%, p=0.001) and PC (77.75% vs. 67.60%, p

This paper provides econometric evidence of the interest parity puzzle in Serbia over the period 2005-2016. Econometric findings are derived from the following techniques: long-run parameter estimation based on the autoregressive distributed lag model, impulse response function computed from the bivariate vector autoregressive model, and estimation of the two-regime Markov switching parameter model. Our results indicate that a positive interest differential corrected for country risk leads to significant dinar appreciation against the euro. The intensity of this impact is different across sub-periods of low exchange rate variability and high variability. Exchange rate movements are found to appreciate more strongly during lower variability episodes. Preliminary econometric investigation of four other European emerging economies documents similar findings only for Romania. Our results suggest that there is a huge incentive for shortterm carry trades in Serbia, regardless of substantial risks.

Introduction. Left ventricular noncompaction (LVNC) is a congenital disorder characterised by prominent trabeculations in the left ventricular myocardium. This heart condition very often goes completely undetected, or is mistaken for hypertrophic cardiomyopathy or coronary disease. Case report. A middle-aged female with a positive family history of coronary disease was admitted with chest pain, electrocardiography (ECG) changes in the area of the inferolateral wall and elevation in cardiac specific enzymes. Initially, she was suspected of having acute coronary syndrome. However, in the left ventricular apex, especially alongside the lateral and inferior walls, cardiac ultrasound visualised hypertrabeculation with multiple trabeculae projecting inside the left ventricular cavity. A short-axis view of the heart above the papillary muscles revealed the presence of two layers of the myocardium: a compacted homogeneous layer adjacent to the epicardium and a spongy layer with trabeculae and sinusoids under the endocardium. The thickness ratio between the two layers was 2.2:1. The same abnormalities were corroborated by multislice computed tomography (MSCT) of the heart. Conclusion. Left ventricular noncompaction is a rare, usually hereditary cardiomyopathy, which should be considered as a possibility in patients with myocardial hypertrophy. It is very often mistaken for coronary disease owing to ECG changes and elevated cardiac specific enzymes associated with myocardial hypertrophy and heart failure.

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The paper explores the link between the inflationary environment and the size of the exchange rate pass-through (ERPT) into domestic prices, as inflation descends from an extreme, second highest and second longest hyperinflation in the 20th century, to high and then moderate inflation in Serbia. We found that ERPT decreases with a decline in the inflation level, variability and persistence, thus supplementing findings previously acquired in panel studies across countries. Our findings can be explained by surging empirical evidence on state contingent behavior of pricing, which indicates a sharp increase in the frequency of price adjustment as one moves from moderate, via high to hyperinflation, suggesting that the degree of price rigidities is a key determinant of the size and speed of ERPT. ERPT estimates are embedded in careful analysis of inflation episodes in Serbia, showing that hyper and high inflation episodes subscribe to the same, fiscal explanation, as opposed to the moderate inflation ones, where supply and demand shocks have been the main inflation drivers.

Introduction. Spontaneous coronary artery dissection (SCAD) is a very rare disease with poor prognosis. It mainly affects young women free of risk factors for coronary artery disease (CAD) and women during the peripartum period. The prognosis for myocardial infarction caused by SCAD is poor, management is often difficult and guidelines still missing. Case report. We presented a woman with acute myocardial infarction of anterior wall of the left ventricle, caused by spontaneous dissection of medial segment of the left anterior descending coronary artery. We treated the patient with thrombolytic therapy and performed coronary angiography after that. Finally we decided to do nothing more. Two years later we performed coronary angiography again and founded the coronary artery normal. We also analyzed 19 cases publiched from 1996 to 2012 when coronary artery dissection had been treated with thrombolytic agent. Analysis revealed only one case of 19, with complication after treating SCAD with thrombolysis. Conclusion. Sometimes, regarding myocardial infarction in young women with no risk factors for CAD, especially in young women in peripartum, we should think about SCAD. The presented case, like eight others, demonstrates that good clinical outcomes can be achieved with thrombolysis. In spite of all this, we still need more data to verify that thrombolysis does not have to harm the therapy for SCAD. For the time being thrombolytic therapy could be an option.

The purpose of the paper is to econometrically exploit the characteristics of unemployment in Serbia upon the start of the 2008 economic crisis. The methodological framework is based on the cointegrated vector autoregressive model that consists of the following macroeconomic variables: unemployment rate, prices, nominal wages and nominal exchange rate. These variables are unit-root processes and their relationship is examined within the multivariate cointegrated time series set-up. Following the deductive modelling approach, we reached the specification that explains unemployment rate by real wages. The results show the negative consequences of the economic crisis to the labour market, with an extremely high increase in the unemployment rate. Strong negative impact of real wages on unemployment rate is additionally confirmed by its dynamic effects throughout the impulse response function.

Background/Aim. The FINish Diabetes RIsk SCore (FINDRISC) which includes age, body mass index (BMI), waist circumference, physical (in) activity, diet, arterial hypertension, history of high glucose levels, and family history of diabetes, is of a great significance in identifying patients with impaired glucose tolerance and a 10-year risk assessment of developing type 2 diabetes in adults. Due to the fact that the FINDRISC score includes parameters which are risk factors for coronary artery disease (CAD), our aim was to determine a correlation between this score, and some of its parameters respectively, with the severity of angiographically verified CAD in patients with stable angina in two ways: according to the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score and the number of diseased coronary arteries. Methods. The study included 70 patients with stable angina consecutively admitted to the Clinic of Cardiology, Military Medical Academy, Belgrade. The FINDRISC score was calculated in all the patients immediately prior to angiography. Venous blood samples were collected and inflammatory markers [erythrocyte sedimentation rate (ESR), leucocytes, C-reactive protein (CRP), total cholesterol, HDL cholesterol, triglycerides and fasting glucose] determined. Coronary angiography was performed in order to determine the severity of coronary artery disease according to the SYNTAX score and the number of affected coronary vessels: 1-vessel, 2-vessel or 3-vessel disease (hemodynamically significant stenoses: more than 70% of the blood vessel lumen). The patients were divided into three groups regarding the FINDRISC score: group I: 5-11 points; group II: 12-16 points; group III: 17-22 points. Results. Out of 70 patients (52 men and 18 women) enrolled in this study, 14 had normal coronary angiogram. There was a statistically significant positive correlation between the FINDRISC score and its parameters respectively (age, body mass index-BMI, waist circumference) and the severity of CAD according to the SYNTAX score (p < 0.001) and the number of diseased coronary arteries (p < 0.001). The patients with higher FINDRISC score (groups II and III) had more severe and extensive CAD according to the SYNTAX score than the group I. The odds ratio with 95% confidence intervals (CI) between the group III and the group I was 5.143 (95% CI 1.299-20.360, p = 0.002) and between the group II and the group I 5.867 (95% CI 1.590- 21.525, p = 0.007). There were no differences in odds ratio for multivessel disease according to FINDRISC score between the group II and the group III [1.141; (95% CI 0.348-3.734). In the group I mean SYNTAX score was 5.18, and more than 70% of patients had normal coronary angiogram. In the group II mean SYNTAX score was 17.06, and more than 70% of patients had 2-vessel disease and 3- vessel disease, and in the group III mean SYNTAX score was 18.89, and 2-vessel and 3-vessel disease had 36.36% and 31.82% patients, respectively. In multiple regression analysis, where SYNTAX score was dependent variable, and age, BMI, waist circumference, FINDRISC score were independent variables, we found that only FINDRISC score was independent predictor of SYNTAX score. Conclusion. The obtained results suggest a statistically significant correlation between the FINDRISC score and its parameters (age, BMI, waist circumference) and the severity of CAD according to the SYNTAX score and the number of diseased coronary arteries. The FINDRISC score may be useful in identifying patients at the high risk for coronary artery disease.

The purpose of the paper is to evaluate the validity of purchasing power parity (PPP) for eight countries from the Emerging Europe: Hungary, Czech Republic, Poland, Romania, Lithuania, Latvia, Serbia and Turkey. Monthly data for euro and U.S. dollar based real exchange rate time series are considered covering the period: January, 2000 - August, 2011. Given significant changes in these economies in this sample it seems plausible to assume that real exchange time series are characterized by more than one time structural break. In order to endogenously determine the number and type of breaks while testing for the presence of unit roots we applied the Lee-Strazicich approach. For two euro based real exchange rate time series (in Hungary and Turkey) the unit root hypothesis has been rejected. For the U.S. dollar based real exchange rate time series in Poland, Romania and Turkey the presence of unit root has been rejected. To assess the adjustment dynamics of those real exchange rates that were detected to be stationary with two breaks, the impulse response function is calculated and half-life is estimated. Our overall conclusion is that the persistence of real exchange rate in Emerging Europe is still substantially high. The lack of strong empirical support for PPP suggests that careful policy actions are needed in this region to prevent serious exchange rate misalignment.

The purpose of this paper is to measure inflation persistence in the following countries of Central and Southeastern Europe: Slovakia, the Czech Republic, Poland, Hungary, Romania and Serbia. The study sample covers monthly data from January, 1995 to May, 2010 for Poland, Hungary and Slovakia, from January 1994 to May, 2010 for the Czech Republic, and from January, 2002 to June 2010 for Romania. The shortest sample used, from January, 2003 to September, 2010, was for Serbia and is due to the late start in the transition process. The results of this study enriched the existing ones on this topic by extending the sample period to cover even the recent years of relatively higher inflation rates and by including Romania and Serbia, which were not previously considered. The study led to two main findings: first, inflation of moderate to high magnitude persistence in Hungary, Poland, Romania and Serbia, and inflation of smaller order persistence in Slovakia and the Czech Republic was detected within the Markov switching model approach. In addition, the changes in inflation persistence often correspond to changes in variability and mean of inflation. Second, New Keynesian Phillips Curve represents a valid structural approach to describe the inflation dynamics in this region. In all the six cases studied, weights on backward and forward looking behaviors were significant, while the impact of the driving variable was insignificant only once. It is found that significant influence of the economic driving variable can be captured by real gross wage inflation and real broad money growth. The estimates show that the backward-looking term plays an important role in determining the inflation dynamics. Similar conclusions are drawn by using quarterly data in econometric estimations for the selected countries.

Introduction. Coronary artery disease in people under 30 years is relatively uncommon, but once a disease occurs it brings a significant morbidity and psychological effects. Case report. We reported a 28-year-old patient presenting atypical symptoms after sincopa and non-specific changes on electrocardiogram at admission. After noninvasive and invasive cardiology diagnostic procedures were made, we concluded that he had a subtotal tubular stenosis in proximal segment of the left anterior descending coronary artery. Myocardial revascularization was successfully performed 24-hour after coronarography with the left internal mammary thoracic artery graft on the left anterior descending coronary artery and the patient had a prompt and satisfactory postoperative recovery. Conclusion. This case indicates the importance of a careful evaluation of young adults even if they do not experience typical anginal symptoms or do not have multiple risk factors for cardiovascular diseases.

The purpose of this paper is to examine the relationship between inflation and inflation uncertainty in the Serbian economy, being particularly vulnerable to shocks in inflation rate, during transition period 2001 - 2007. Based on monthly data several GARCH specifications are estimated to provide the measure for inflation uncertainty. Derived variables are then included into VAR model to test for Granger-causality between inflation and its uncertainty. Models that consider only permanent and transitory components of prices are also estimated to investigate the inflation-uncertainty relationship in the long and in the short run. The main conclusion of the paper is that high inflation invokes high uncertainty, while high uncertainty negatively affects the level of inflation at long horizon.

Background/Aim. Prognosis after acute myocardial infarction (AIM) depends on the extent of irreversibly damaged myocardium and viable tissue due to stunning or hibernation. The aim of the study was to assess the prognostic significance of early echocardiographic parameters of myocardial viability in prediction of late recovery of regional and global ventricular function. Methods. The study prospectively included 40 patients after the first, uncomplicated univessel AIM treated with percutaneous coronary intervention (PCI). Low-dose dobutamine echocardiography (LDDE) was preformed 7-10 days after AIM and follow-up resting echocardiography from 7 to 12 months later. Results. The sensitivity and specificity for the prediction of post revascularisation regional, dyssynergy improvement were 61.29% and 94.59% respectively. The positive and negative predicative values were 90.48% and 74.47% respectively. The number of viable segments (p = 0.01) and extent of contractile reserve (p = 0.01) were univariate, independent predictors of improvement in ejection fraction (EF). From the multivariate stepwise regression analysis contractile reserve was selected as most powerful predictor of late recovery of left ventricular contractile function (p = 0.007). Receiving-operator characteristic curve (ROC) analysis demonstrated that three or more recovered segments were necessary for an improvement of left ventricular ejection fraction (LVEF) ≥ 5% after the revascularisation, with the highest sensitivity, 100% and specificity 56% (p = 0.01). Conclusion. Low-dose dobutamine echocardiography is a powerful predictor of the regional dyssynergy recovery late after AIM treated with PTCA with implantation stent. Late full functional improvement of the left ventricle is related to the extent of contractile reserve and amount of viable tissue. At least three recovered segments are necessary for a significant recovery of the global left ventricular contractility.

In this paper different aspects of value-at-risk estimation are considered. Daily returns of CISCO, INTEL and NASDAQ stock indices are analyzed for period: September 1996 - September 2006. Methods that incorporate time varying variability and heavy tails of the empirical distributions of returns are implemented. The main finding of the paper is that standard econometric methods underestimate the value-at-risk parameter if heavy tails of the empirical distribution are not explicitly taken into account. .

Introduction. Cardiac resynchronization therapy (CRT) reduces mortality and hospitalization in patients with symptomatic heart failure and left bundle branch block (LBBB) on optimal drug therapy. Among all, the reasons for "non-response" to CRT pacemaker could be the failure to achieve optimal left ventricular (LV) lead position due to severe curve or stenosis/occlusion of the target vein. Case report. We presented a 79-old-male patient, New Y ork H eart A ssociation (NYHA) class III, with atrial fibrillation, chronic coronary syndrome (CCS), and prior myocardial infarction. The patient underwent coronary artery bypass surgery and mechanical prosthetic aortic valve implantation. He was indicated for CRT. The patient′s venogram revealed ostial/proximal severe curve and stenosis of the posterolateral vein, the only vein of coronary sinus that led to anatomically optimal LV segment for stimulation. After the balloon angioplasty of the curved and stenotic portion of the target vein with compliant balloon 4.0 × 30 mm, a satisfactory and stable position of quadripolar LV lead was achieved. Conclusion. Compliant balloon angioplasty could be a safe and efficient way to override severe coronary vein stenosis in some CRT cases. [ABSTRACT FROM AUTHOR]

This study investigates the effects of public debt uncertainty on economic growth in 10 emerging European economies over 2000–2015 period. Public debt uncertainty reflects fiscal policy volatility and macroeconomic instability. It also creates uncertainty about the characteristics of future fiscal policy, which further causes the rise of uncertainty in household and business incomes. Increasing the risk of future incomes leads to the reduction of household consumption and corporate investments, which negatively influences economic growth. An empirical analysis of public debt uncertainty impact on economic growth is performed by time series and panel data approaches based on quarterly data. Our key result indicates the significant detrimental effect public debt uncertainty has had on the GDP growth in emerging European economies, especially during the Great Recession episode that started in 2008. Robustness of our econometric findings is confirmed by different estimation methods and model specifications. [ABSTRACT FROM AUTHOR]

Background/Aim. Previous studies have confirmed a positive correlation between homocysteine levels and a greater risk for acute coronary syndrome and stroke, but there are no available data to support an association between homocysteine and inflammatory markers and the severity of coronary artery disease according to the clinical SYNTAX score in patients with stable angina. The aim was to determine the association between homocysteine and inflammatory biomarker levels: interleukin (IL)-6, high sensitive Creactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR) and the severity of coronary artery disease according to clinical SYNTAX score. Methods. Eighty-two patients with stable angina pectoris (average age 65 ± 8 years, 28.9% females) underwent coronary angiography and were divided into three groups according to the clinical SYNTAX score: the group I < 22 (39 patients), the group II 23-32 (16 patients), the group III > 33 (27 patients). The severity and complexity of coronary artery disease were calculated by clinical SYNTAX score, multiplying the SYNTAX score with the modified ACEF score, based on the patients' left ventricular ejection fraction, age and creatinine clearance (derived with Cockcroft-Gault equation). Results. Homocysteine levels were significantly higher in patients with high clinical SYNTAX score [the group I: median (interquartile range - IQR): 10.20 (3.97), the group II: 10.45 (5.77), the group III: 14.70 (7.50), p = 0.005]. Patients in the group III had significantly higher homocysteine levels compared to the group I (p = 0.001). We also found a positive association between inflammatory biomarkers (IL-6, hsCRP, fibrinogen, ESR) and the severity of coronary artery disease according to the clinical SYNTAX score (p = 0.017, 0.001, 0.032, 0.049 respectively). We detected significantly lower plasma levels of vitamin B12 in the group III and group II in comparison with the group I (the group I: median (IQR): 238 (160), the group II: 171 (160), the group III: 172 (102), p = 0.022), which indicates its important role in homocysteine metabolism. Conclusion. The elevated plasma levels of homocysteine, IL-6, hsCRP, fibrinogen, ESR were detected in patients with high clinical SYNTAX score (> 33). Our results showed that hyperhomocysteinemia and some inflammatory biomarkers can predict more severe and extensive coronary artery disease in stable angina patients. [ABSTRACT FROM AUTHOR]

Iako je engleski lekar Heberden opisao anginu pektoris (AP) još pre 2 i po veka, naše razumevanje ovog sindroma, kako uzroka, optimalnog dijagnostičkog pristupa tako i lečenja, nastavlja da se razvija. Novi vodič Evropskog udruženja kardiologa iz 2019 godine donosi pre svega promenu paradigme za stabilnu koronarnu bolest (SKB) u sveobuhvatni termin hronični koronarni sindromi (HKS), koja suštinski znači da hronična koronarna bolest (HKB) ili ishemična bolest srca (IBS) ima kompleksne kliničke scenarije i može imati periode nestabilnosti u bilo kojoj evolucionoj fazi. Rezultati esencijalne COURAGE studije te najnovijih studija: ISHEMIA, ORBITA i metanaliza o HKS kao i ključne poruke Evropskog Vodiča za dijagnostiku i lečenje hroničnih koronarnih sindroma (HKS) bacaju svetlo na problematiku koronarne bolesti, bolesti koja još uvek prednjači u svetskom mortalitetu. Koronarna bolest (KB) ima duge stabilne perode ali zbog akutnih aterotrombotskih događaja, erozije ili rupture aterosklerotskog plaka može preći u neki od akutnih koronarnih sindroma (AKS). Bolest je hronična, najčešće progresivna i zato ozbiljna čak i u asimptomatskim fazama. Dinamična priroda KB ispoljava se u različitim kliničkim prezentacijama, koje kategorizujemo u bilo akutne, bilo hronične koronarne sindrome. Promena paradigme naglašava činjenicu da dinamički procesi akumulacije u aterosklerotske plakove i funkcionalne alteracije koronarne cirkulacije, mogu biti modifikovani promenom životnih navika, farmakološkom terapijom i revaskularizacijom miokarda (RM), koje dovode do stabilizacije ili regresije bolesti ali nažalost ne i do potpunog izlečenja. Od kardinalnog značaja je pažljiva evaluacija anamneze, karakterizacija anginoznih i drugih simptoma i evaluacija rizik faktora i manifestacija predhodnih kardiovaskularnih bolesti (KVB), kao i procena adekvatnosti fizičke aktivnosti i tolerancije napora. U sadašnjem vodiču za HKS je prepoznato 6 vodećih i najčešćih kliničkih sindromascenarija : 1. Pacijenti sa suspektnom KB i stabilnom anginom pektoris i/ili dispnejom na napor; 2. Pacijenti sa novonastalom srčanom insuficijencijom (SI) ili disfunkcijom leve komore (DLK) i suspektnom KB; 3. Asimptomatski i simptomatski bolesnici sa stabilizovanim simptomima koji traju manje od jedne 1 godine posle AKS ili skorašnje revaskularizacije miokarda (KRM); 4. Asimptomatski i simptomatski pacijenti više od 1 godine protekle posle AKS ili RM; 5. Pacijenti sa anginom pektoris i suspektnom vazospastičnom ili mikrovaskularnom bolešću; 6. Asimptomatske osobe u kojih je KB otkrivena na skriningu. Svaki od ovih scenarija je klasifikovan kao HKS i posledice su različitih evolucionih faza hronične KB, te imaju različit rizik za buduće neželjene kardiovaskularne (KV) događaje. Pretest verovatnoća (PTP) koronarne bolesti, bazirana na starosti, polu i kvalitetima simptoma, podvrgnuta je reviziji i izmenjena u odnosu na predhodni vodič iz 2013. godine. Uveden je i novi termin: Klinička verovatnoća KB (KPKB) koji uključuje kako PTP tako i razne rizik faktore aterosklerotske KB i služi da isključi ili potvrdi sumnju na KB. Opšti metodološki pristup za inicijalnu dijagnozu za pacijente sa AP i suspektnom opstruktivnom KB uključuje 6 koraka. KORAK 1-Procena simptoma i znakova za identifikaciju pacijenata sa mogućom nestabilnom AP i drugim formama AKS; KORAK 2 je procena opšteg stanja i kvaliteta života koji odlučuju o planiranju lečenja; KORAK 3 uključuje osnovne dijagnostičke procedure i procenu funkcije leve komore (LK) srca; KORAK 4 čini odredivanje Pre-test i Kliničke verovatnoće opstruktivne KB; KORAK 5 je izbor dijagnostičkog testa fizičkim ili farmakološkim opterećenjem putem EKG i vizuelizacionih (slikovnih, imidžing) metoda uključujući MSCT (MDCT) koronarnu angiografiju (CTKA, CTA) za ustanovljavanje diagnoze KB. Na kraju, KORAK 6 je procena rizika od neželjenih KV događaja, posebno mortaliteta i na bazi toga donošenje definitivne terapijske odluka uz invazivnu koronarografiju (ICA) i eventualnu RM. Ako opstruktivna KB ne može biti isključena kliničkom evaluacijom, radi se bilo neinvazivni funkcionalni imidžing test bilo anatomski imidžing putem CTKA kao inicijalni test za isključenje ili potvrdu dijagnoze KB. Za odluku o RM treba razmotriti i anatomsku i funkcionalnu procenu, izuzev kod teških koronarnih stenoza >90%. čak i ako su asiptomatski. Uloga revaskularizacije miokarda (RM) je stavljena u kontekst novijih dokaza koji se odnose na prognostičku ulogu perkutanih koronarnih intervencija (PCI) ili koronarnog arterijskog premošćavanja graftom (CABG) u ovoj niskorizičnoj populaciji. RM je rezervisana za pacijente gde postoje jaki dokazi da bi se njom poboljšala prognoza na bazi dokaza regionalne ishemije perfuzionim imidžingom. Pacijenti sa visokim rizikom -mortalitetom od 3% godišnje i više podvrgavaju se frakcionoj rezervi koronarnog protoka (FFR) ili koronarnoj rezervi protoka (CFR) zbog RM čak i ako nemaju simptome. Primena zdravog načina života smanjuje rizik od naknadnih neželjenih KV događaja i spada u adekvatnu terapiju sekundarne prevencije. Neophodna je redovna vakcinacija protiv gripa kod svih sa HKS. Optimalnoj medikalnoj terapiji (OMT): nefarmakološkoj i farmakološkoj terapiji HKS poklanja se ogromna pažnja kao glavnoj vrsti lečenja HKS, a ne RM. Istaknuta je savremena uloga anti-ishemijskih (antianginalnih lekova): Prve linije- betablokatori (BB) i antagonisti kalcijuma (CCB) uz sublingvalni nitroglicerin, i Druge linije- dugodelujući nitrati (LAN), uz novije opcije: ivabradin, nikorandil, trimetazidine, ranolazine, alopuronol i drugo. Lekovi koji poboljšavaju prognozu HKS jesu statini i acetilsalicilna kiselina (ASA) i drugi antitrombocitni lekovi i od skora male doze rivaroksabana a dodatno inhibitori angiotensin konvertaze (ACEI) i ponovo BB u specifičnim indikacijama. Antiishemijski tretman mora se prilagoditi pojedinačnom pacijentu na osnovu komorbiditeta, druge konkomitantne terapije, očekivane tolerancije i pridržavanja i sklonosti pacijenta. Izbor anti-ishemijskih lekova za lečenje HKS-a treba da bude prilagođen srčanom ritmu, krvnom pritisku i funkciji srca. BB i ACEI se preporučuju pacijentima sa DLK ili SI sa smanjenom ejekcionom frakcijom leve komore (HFrEF). Antitrombotska terapija je ključni deo sekundarne prevencije kod pacijenata sa HKS-om. Pacijente sa prethodnim infarktom miokarda, koji su pod visokim rizikom od ishemijskih događaja i niskim rizikom od smrtnog krvarenja, trebalo bi razmotriti dugoročnu dvostruku antiagregacionu terapiju aspirinom i bilo inhibitorom P2Y12 receptora ili rivaroksabanom sa vrlo malim dozama, osim ako nemaju indikacija za oralnu antikoagulaciju kao što je atrijalna fibrilacija (AF). Inhibitori protonske pumpe preporučuju se kod pacijenata koji primaju i samo aspirin ili kombinaciju antitrombotske terapije koji su pod rizikom od gastrointestinalnog krvarenja. Statini se preporučuju svim pacijentima sa HKS-om bez obzira na nivo LDL. ACEI (ili blokatori receptora angiotenzina- ARB) preporučuju se u prisustvu SI, dijabetesa i hipertenzije i treba ih razmotriti kod pacijenata sa visokim rizikom za neželjene događaje. KLJUČNE REČI: Hronični koronarni sndromi, stabilna angina pektoris , koronarna arterijska bolest, ishemijska bolest srca, EKG test fizičkim opterećenjem, stres ehokardiografski farmakološki testovi, MSCT-skenerska koronarografija, invazivna koronarografija, farmakoterapija, antiishemijski lekovi, antitrombotski lekovi, statini, perkutana revaskularizacija miokarda, perkutane koronarne intervencije, hirurška revaskularizacija miokarda. [ABSTRACT FROM AUTHOR]