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The objective of this study is to analyse the spatial-temporal patterns of traffic accidents using data from 2011 to 2020 for the AP Vojvodina. The spatial-temporal patterns of traffic accident hotspots were identified at the municipality level using the Getis–Ord Gi⁎ statistic in ArcGISPro software. Trends in traffic accidents were analysed using the Mann-Kendall (MK) statistic. A certain trend in the number of traffic accidents, fatalities, and injuries was detected in 15 out of 45 municipalities. In two municipalities, the trend in the number of traffic accidents is decreasing, while in seven, it is increasing. In three municipalities, a decreasing trend in the number of traffic fatalities was observed. A decreasing trend in traffic injuries was identi fied in five municipalities. Hotspot analysis on the number of traffic accidents and traffic injuries revealed hotspots in seven municipalities, while no hotspots were detected in the number of traffic fatalities. In the traffic casualties weighted number, persons in tractors, hotspots were identified in two municipalities. This research has the potential to enhance traffic safety by directing targeted safety measures towards identified hotspots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatalities and injuries.

The objective of this paper is to analyse the spatial-temporal pattern of traffic accidents using ten years of data from 2011 to 2020 for the Autonomous Province of Vojvodina, northern part of Serbia. The spatial pattern of traffic accident hot spots and their temporal evolution were identified on the municipality level of the study area using hot spot analysis (Getis–Ord Gi*) techniques within the GIS environment. Trends in the traffic accidents on the municipality level were analysed using Mann-Kendall statistic. In majority of municipalities there were no trend detected. In 15 out of 45 local administrative units some kind of trend in the number of traffic accidents, fatalities and injuries was detected. In only two municipalities, Bački Petrovac and Žabalj, trend in the number of traffic accidents is decreasing, while in seven is increasing, Bačka Palanka, Bačka Topola, Kanjiža, Kikinda, Mali Iđoš, Novi Kneževac and Vrbas. In only three municipalities decreasing trend in the number of traffic fatalities was detected, Bačka Topola, Novi Bečej and Titel. Also, five municipalities have decreasing trend in traffic injuries, Opovo, Sečanj, Vršac, Zrenjanin and Žabalj. Hot spot analysis on the number of traffic accidents and traffic injuries detected hot spots in seven municipalities – Bački Petrovac, Beočin, Irig, Novi Sad, Sremski Karlovci, Temerin and Žabalj. In the hot spot analysis on the number of traffic fatalities, there were no hot spots detected. The hot spot analysis on the traffic casualties weighted number showed similar results to the hot spot analysis on the traffic accidents, with only difference regarding persons in tractors. In this category, hot spots were detected in two municipalities – Nova Crnja and Žabalj. This research holds potential to enhance traffic safety by directing targeted safety measures toward identified hot spots. Such measures could ultimately lead to a reduction in traffic accidents, consequently curbing the number of both fatali

Gojaznost je jedno od najznačajnjih oboljenja savremene medicine u grupi hroničnih nezaraznih bolesti. Posebno je važan uticaj uvećane masne mase tela u patogenezi kardiovaskularnih bolesti, sa mogućim posledicama za nastanak insuficijencije srca, koronarne insuficijencije, poremećaja ritma. Disproporcija u efektima agresivnih faktora, mehaničkih faktora zbog uvećanja telesne mase, i funkcionalnih zbog poremećaja adipokinske sekrecije i prisutnih faktora rizika, otežavaju prevenciju poremećaja na ciljnim organima. Sama činjenica da gojaznost kao hronična bolest dovodi do nastanka komorbiditeta na srcu, uz prisutne tradicionalne faktore rizika, stavlja u fokus interakciju proinflamatornih adipokina disfunkcionalnog masnog tkiva i poremećaj geometrije miokarada leve komore na prvo mesto. CILJ: Ispitati povezanost veličine subkutanih i visceralnih abdominalnih masnih depoa, cirkulišućih koncentracija hemerina i SFRP-5 i geometrije miokarda leve komore kod gojaznih bolesnika sa kardiometaboličkim sindromom, kao i utvrditi da li porast stepena kardiometaboličkog sindroma doprinosi većoj učestalosti poremećaja geometrije miokarda leve komore kod gojaznih ispitanika. MATERIJAL I METODE: Istraživanje je uključivalo gojazne ispitanike, bez pridruženih komorbiditeta, kao i zdrave normalno uhranjene ispitanike usklađene po godinama života i polu koji su činili kontrolnu grupu. Dodatno, ispitivana grupa je podeljena na tri podgrupe u odnosu na kriterijume za postojanje kardiometaboličkog sindroma. Svim ispitanicima su urađena antropometrijska merenja, analiza komponenata telesne kompozicije, laboratorijska analiza uzoraka krvi na automatizovanim analizatorskim sistemima, sa određivanjem parametara metabolizma glikoze (bazalno i 2 h u toku oralnog glukoza tolerans testa), lipida i lipoproteina i parametara inflamacije. Serumske koncentracije proinflamatornih adipokina, hemerina i rezistina, odnosno antiinflamatornog adipokina SFRP-5, su određivane ELISA tehnikom, Enzyme-linked i, Obesity is one of the most important diseases of modern medicine in the group of chronic non-communicable diseases. The influence of increased body fat mass is especially important in the pathogenesis of cardiovascular diseases, with possible consequences for the occurrence of heart failure, coronary insufficiency and rhythm disorders. Disproportion in the effects of aggressive factors, mechanical factors due to weight gain, and functional factors due to disorders of adipokine secretion and present risk factors, make it difficult to prevent disorders on target organs. The very fact that obesity as a chronic disease leads to comorbidities in the heart, with the presence of traditional risk factors, focuses on the interaction of proinflammatory adipokines of dysfunctional adipose tissue and left ventricular myocardial geometry disorder in the first place. OBJECTIVE: To examine the relationship between the size of subcutaneous and visceral abdominal fat depots, circulating concentrations of chemerin and SFRP-5 and left ventricular myocardial geometry in obese patients with cardiometabolic syndrome, as well as to determine whether the increase in cardiometabolic syndrome contributes to higher frequency of geometric disorders in obese subjects. MATERIAL AND METHODS: The study included obese subjects, without any associated comorbidities, as well as healthy normally fed subjects matched by age and gender who made up the control group. Additionally, the examined group was divided into three subgroups according to the criteria for the existence of cardiometabolic syndrome. All subjects underwent anthropometric measurements, analysis of body composition components, laboratory analysis of blood samples on automated analytical systems, with determination of glucose metabolism parameters (basal and 2 hours during oral glucose tolerance test), lipids and lipoproteins and inflammation parameters. Serum concentrations of proinflammatory adipokine, chemerin, and resistin, and the a

The study aimed to determine if the non-dipping pattern of blood pressure (BP) influences preterm delivery in gestational hypertension (GH), but also maternal clinical findings and birth weight. Sixty women with GH, i.e. 30 women with a dipping BP profile (control group) and 30 non-dippers (study group), were included in the study. Echocardiography was performed in all subjects, as well as ambulatory blood pressure monitoring (ABPM) during third trimester. ABPM was repeated 6-8 weeks after delivery. Thirteen women with preterm delivery were classified as non-dippers and only four as dippers (p=0.01). The average and peak systolic and diastolic night-time BP had negative linear correlation with birth weight (p<0.0005). Total vascular resistance (p<0.0005) and mass index (p=0.014) were significantly higher as compared with women with term delivery, while ejection fraction (EF) (p=0.007) and circumferential systolic velocity (p=0.042) were significantly reduced in the preterm delivery group. Multivariate binary logistic regression identified the average night-time systolic BP, left ventricular mass index and EF as independent predictors of preterm delivery. Study results suggested a relationship of the non-dipping BP pattern in GH with preterm delivery, birth weight, and maternal clinical findings., Cilj ovoga istraživanja bio je utvrditi povezanost non-dipping profila krvnog tlaka (KT) s prijevremenim porođajem, porođajnom težinom novorođenčeta te kliničkim i ehokardiografskim parametrima kod žena s gestacijskom hipertenzijom (GH). Istraživanje je obuhvatilo 60 žena s GH, 30 s dipping profilom KT (kontrolna skupina) i 30 non-dippera (ispitna skupina). Sve žene podvrgnute su kompletnoj ehokardiografiji i 24-satnom ambulantnom praćenju krvnog tlaka (ambulatory blood pressure monitoring, ABPM) tijekom trećeg trimestra, a ABPM je ponovljen 6-8 tjedana nakon porođaja. Ukupno 17 žena imalo je prijevremeni porođaj. Trinaest žena s prijevremenim porođajem imalo je non-dipping profil KT, dok su samo četiri žene imale dipping profil KT (0,01). Prosječni i maksimalni sistolički i dijastolički noćni KT imali su negativnu linearnu korelaciju s porođajnom težinom (p<0,0005). Ukupna vaskularna rezistencija (p<0,0005) i indeks mase miokarda lijeve klijetke (p=0,014) bili su znatno viši u skupini žena s prijevremenim porođajem, dok su parametri sistoličke funkcije, tj. ejekcijska frakcija (EF) (p=0,007) i brzina cirkumferentnog skraćenja miokarda lijevog ventrikla (p=0,042) bili statistički značajno sniženi u skupini žena s prijevremenim porođajem. Multivarijatna regresijska analiza pokazala je da su prosječni noćni sistolički KT, indeks mase lijevog ventrikla i EF identificirani kao nezavisni prediktori prijevremenog porođaja. Rezultati istraživanja pokazali su da postoji povezanost između non-dipping profila KT s prijevremenim porođajem, porođajnom težinom novorođenčeta i poremećajem hemodinamskog statusa majke u GH.

Uvod: Pacijenti na hemodijalizi (HD) imaju visoku stopu ukupnog i kardiovaskularnog morbiditeta i mortaliteta. Preko 80% bolesnika na HD ima neki tip kardiovaskularne bolesti. Hipervolemija značajno doprinosi njihovom nastanku, dovodeći do hipertenzije, hipertrofije miokarda leve komore, srčane insuficijencije i nastanka plućnog edema. Procena stanja volemije kod pacijenata na HD najčešće se vrši kliničkim pregledom, uprkos nezadovoljavajućoj specifičnosti i senzitivnosti. Hipervolemija je prisutna kod određenog broja pacijenata, uprkos normotenziji, odsustvu edema i urednom auskultatornom nalazu na plućima. Različite metode se koriste za procenu stanja volemije, svaka sa određenim manama. Upotreba analize bioelektrične impedanse zahteva skupu opremu i potrošni materijal, vrednosti B-tipa natriuretskog peptida (BNP) i njegovog N terminalnog propeptida (NT-proBNP) zavise i od stanja volemije i od srčane funkcije, kao i od tipa dijalizne membrane. Ehokardiografija (EHO) i ultrazvuk donje šuplje vene (UZ ICV) sa određivanjem dijametara u inspirijumu i ekspirijumu (IVCDi i IVCDe) zahteva posebno obučen kadar. Ultrazvuk pluća (UZ pluća) je jednostavna, brza i jeftina metoda za detekciju ekstravaskularne plućne tečnosti (EVLW). EVLW predstavlja onu količinu tečnosti koja se nalazi u plućnom intersticijumu. UZ pluća detektuje EVLW kao UZ artefakte zvane „B linije“. Količina EVLW zavisna je od pritiska punjenja leve komore i povećava se u stanjima hipervolemije, što se na UZ pluća manifestuje kao veći broj detektovanih „B linija“. Zbir svih „B linija“ detektovanih na definisanim mestima na grudnom košu naziva se „skor B linija“ (BLS) i koristi se za kvantifikaciju EVLW pomoću UZ pluća. Cilj: Uporediti adekvatnost i efikasnost UZ pluća u proceni stanja volemije kod pacijenata na HD u odnosu na standardne tehnike UZ donje šuplje vene, EHO i BNP-a. Proceniti mogućnost pojednostavljenja protokola UZ pregleda pluća redukcijom broja analiziranih plućnih polja. Materijal i metode, Introduction: Patients on hemodialysis (HD) have a high general morbidity and all-cause mortality, as well as high cardiovascular morbidity and mortality. More than 80% of patients on HD have some cardiovascular disease. Hypervolemia plays a significant role here, contributing to hypertension, left ventricular hypertrophy, heart failure and pulmonary edema. Fluid status assessment in HD is still mostly clinical, despite having low specificity and sensitivity. A number of patients remain hypervolume, despite being normotensive, without edema or bibasilar crackles on lung auscultation. Different methods are used for volume status assessment in HD setting, no method without its flaws. Bioelectric impedance analysis requires expensive equipment and supplies. B type natriuretic peptide (BNP) values, and those of its terminal propeptide (NT-proBNP) depend on volume status, cardiac function as well as type of dialysis membrane used. Echocardiography (ECHO) and ultrasonography of inferior vena cava (IVC US) with measurements of its diameters in inspirum and expirium (IVCDi and IVCDe) require trained medical personnel. Lung ultrasound (LUS) is a simple, fast and inexpensive method for detection of extravascular lung water (EVLW), which is the water contained in the lung interstitium. LUS detects EVLW as ultrasonographic artefacts called „B lines“. EVLW is dependent on left ventricular filling pressures and is increased in volume overload, manifesting as more „B lines“ on LUS. The sum of all „B lines“ detected on predetermined places on the chest is called „B line score“ (BLS) and is used to quantify EVLW using LUS. Goal: Compare the adequacy and efficacy of LUS in assessment of volume status in patients on HD to other methods (IVC US, ECHO, BNP). Assess the possibility of simplifying LUS by reducing the number of examined lung fields. Materials and methods: A cross-section study was performed from April 2016 to June 2017. on 83 dialysis patients in Dialysis unit of Internal

Uvod: U savremenom svetu koronarna arterijska bolest srca (KABS) je vodeći uzrok obolevanja i umiranja, a akutni koronarni sindrom (AKS) je jedna od njenih najčešćih i najopasnijih kliničkih manifestacija. Dijastolna disfunckija leve komore često prati KABS i mogući je doprinosni faktor za loš klinički tok i ishod. Postavlja se pitanje u kom obimu je dijastolna disfunkcija leve komore udružena sa koronarnom arterijskom bolešću i da li savremeni programi ambulantne sveobuhvatne kardijalne rehabilitacije (ASKR) imaju uticaja na bolju prognozu ove grupe kardioloških bolesnika. Uprkos širokoj primeni revaskularizacionih procedura u svakodnevnoj kardiološkoj praksi i brojnih studija koje su ukazale na pozitivne efekte programa SKR na funkcionalni status pacijenata nakon AKS, još uvek postoji mnogo kontroverzi o efektima fizičkog treninga, na srčanu funkciju i poboljšanje funkcionalnog kapaciteta kod pacijenata sa KABS i pridruženom dijastolnom disfunkcijom. Cilj istraživanja: bio je da ispita uticaj superviziranih vežbi fizičkim opterećenjem (VFO) u okviru programa ambulantne sveobuhvatne kardijalne rehabilitacije (ASKR), na dijastolnu disfunkciju leve komore (DDLK) i funkcionalni status pacijenata (FS), nakon AKS, rešenog perkutanom koronarnom intervencijom (PCI), kao i da li, s druge strane, prisustvo i stepen dijastolne disfunkcije na početku istraživanja, utiče na funkcionalni status i pojavu neželjenih kardijalnih događaja, kod ove grupe pacijenata u okviru programa ASKR i van njega Materijal i metode: Istraživanjem je bilo obuhvaćeno ukupno 85 ispitanika, oba pola, starosti od 18-65 godina, koji su tokom indeksne hospitalizacije lečeni kao klinički dokazani AKS (APNS; NSTEMI; STEMI) i kod kojih je urađena neka od interventnih koronarnih procedura (pPCI; PCI; PTCA). Nakon 4 nedelje od otpusta sa hospitalizacije, zbog NSTEMI ili APNS, odnosno nakon 6 nedelja od otpusta sa hospitalizacije zbog STEMI, pacijenti sa EFLK ≥ 45%, bez značajnih valvularnih i drugih mana i, Background: In modern world, coronary artery disease (CAD) is one of the leading cause of morbidity and mortality, and acute coronary syndrome (ACS) is one of its most common and most dangerous clinical manifestations. Left ventricle diastolic dysfunction (LVDD) is often associated with CAD and is possibly a contributing factor for poor clinical course and outcome. The question arises as to the extent to which the left ventricle diastolic dysfunction is associated with CAD and whether modern ambulatory comprehensive cardiac rehabilitation programs (ACCR) have an impact on a better prognosis of this group of cardiac patients. Despite the wide use of revascularization procedures in everyday clinical practice and numerous trials that have indicated the positive effects of the ACCR on the functional status of patients after ACS, there is still much controversy about the effects of physical training, and its impact on cardiac function and the improvement of functional capacity in patients with CAD and associated diastolic dysfunction. Objective: to examine the influence of supervised physical training programe as a part of ambulatory comprehensive cardiac rehabilitation (ACCR), on diastolic dysfunction and the functional capacity of patients after ACS resolved by percutaneous coronary intervention (PCI), and whether, on the other hand, the presence and the degree of diastolic dysfunction at the beginning of the study, affects the functional capacity and occurrence of unwanted cardiac events (MACE), in this group of patients within the ACCR program and without it. Methods: The study include a total of 85 subjects, both sexes, ages 18-65, who were treated as clinically proven ACS during the index hospitalization and in which some of the interventional coronary procedures were performed (pPCI; PCI; PTCA). After 4 weeks of hospitalization due to NSTEMI or APNS, or after 6 weeks of hospitalization due to STEMI, patients with LVEF ≥ 45%, without significant valvular and other

Cilj: Cilj ovog istraživanja bio je da se utvrde promene koje arterijska hipertenzija dvojakim mehanizmima (dnevno-noćnim ritmom i svojim trajanjem) ostavlja na funkciju i geometriju leve pretkomore i komore srca. Ispitanici i metode: u ovo istraživanje bilo je uključeno 180 ispitanika koji su bili podeljeni u ispitivane grupe u odnosu na dnevno-noćni ritam arterijskog krvnog pritiska tokom 24-časovnog monitoringa arterijskog krvnog pritiska i to na sledeći način: grupa ispitanika sa očuvanim dnevno-noćnim ritmom arterijskog krvnog pritiska sastojala se od ukupno 90 ispitanika, a grupu onih sa narušenim dnevno-noćnim ritmom arterijskog krvnog pritiska takođe je činilo 90 ispitanika. U svakoj od ovih grupa izvršena je dodatna podela ispitanika prema dužini trajanja arterijske hipertenzije na one kod kojih je arterijska hipertenzija trajala do 5 godina, one kod kojih je trajala od 5 do 10 godina i na one sa trajanjem arterijske hipertenzije više od 10 godina. Svim ispitanicima rađen je incijalno 24-časovni ambulantni monitoring arterijskog krvnog pritiska, a nakon toga i ehokardiografski pregled radi određivanja parametara morfologije leve pretkomore i komore, kao i dijastolne funkcije leve komore. Rezultati i diskusija: nakon statističke obrade podataka dobijeni su rezultati koji ukazuju da se dijastolna disfunkcija stepena većeg od I statistički značajno češće (p=0,011) uočava kod onih ispitanika koji nemaju očuvan dnevno-noćni ritam arterijskog krvnog pritiska. Narušen dnevno-noćni ritam arterijskog krvnog pritiska takođe dovodi do povećanja indeksirane mase miokarda leve komore prema površini tela ispitanika (LVM/BSA) – p=0,001; do zadebljanja zidova leve komore (IVS/PLW) – p=0,025, kao i do smanjenja sistolne brzine miokarda na nivou septalnog dela mitralnog anulusa (s’) - p<0,0005. Pored ovoga, u grupi onih sa narušenim dnevno-noćnim ritmom arterijskog krvnog pritiska primećeno je češće prisustvo ekscentrične hipertrofije miokarda leve komore (p=0,027). U odnosu, Objective: The aim of this study was to determine the changes that arterial hypertension by its dual mechanisms (circadian rhythm and its duration) leaves on the function and geometry of left atrium and left ventricle of the heart. Respondents and Methods: This study involved 180 subjects who were divided into examined groups in relation to the circadian arterial blood pressure rhythm during 24-hour monitoring of arterial blood pressure, as follows: group of subjects with preserved circadian rhythm of arterial blood pressure consisted of a total of 90 subjects, and a group of those with impaired circadian rhythm of arterial blood pressure also comprised 90 subjects. In each of these groups an additional division of subjects was performed according to the duration of arterial hypertension to those whose arterial hypertension lasted up to 5 years, those in whom it lasted 5-10 years and those with duration of arterial hypertension for more than 10 years. All participants received an incisional 24-hour ambulatory monitoring of arterial blood pressure, followed by an echocardiographic examination to determine the morphology parameters of the left atrium and ventricle, as well as the diastolic functions of the left ventricle. Results and discussion: after statistical data processing, results have been obtained indicating that diastolic dysfunction of a level greater than I statistically significantly more frequently (p = 0.011) was observed in those subjects who didn’t have preserved circardian rhythm of arterial blood pressure. A non-dipper circadian arterial blood pressure rhythm also led to an increase in the indexed left ventricular myocardial mass according to the body surface of the respondent (LVM / BSA) - p = 0.001; to the increase in the wall thickness of the left ventricle (IVS / PLW) - p = 0.025, as well as to the decrease in systolic myocardial velocity at the level of the septal portion of the mitral anulus (s') - p <0.0005. In addition, in the group of those

Cilj: Svrha ovog istraživanja je da se odredi prediktivna vrednost pojedinačnih i kombinovanih ehokardiografskih parametara desne komore za pojavu jednogodišnjeg neželjenog ishoda kod bolesnika sa hroničnom srčanom slabošću i sniženom istisnom frakcijom leve komore. Metodologija: U studiju je uključeno 191 bolesnik koji su od juna 2016. do marta 2017. godine hospitalizovani na Klinici za kardiologiju Instituta za kardiovaskuarne bolesti Vojvodine sa simptomima i znacima srčane slabosti sa sniženom istisnom frakcijom leve komore. Svim bolesnicima je uzeta anamneza, urađen klinički pregled, laboratorijske analize i trans-torakalni ehokardiografski pregled. Pacijenti su nakon toga praćeni godinu dana u cilju registrovanja značajnih neželjenih kardijalnih događaja (kardijalne smrti, smrti zbog drugih - nekardijalnih uzroka, rehospitalizacije zbog akutizacije hronične srčane slabosti, infarkta srca, malignih ventrikularnih poremećaja ritma i šloga). Kod 111 pacijenata je registrovan neželjeni ishod tokom jednogodišnjeg praćenja. Rezultati i diskusija: Kod pacijenata u istraživanju, kao značajni prediktori neželjenog ishoda unutar godinu dana, izdvojili su se sledeći eho-parametri desne komore: morfološki parametar - RV1 (granična vrednost 42 mm); parametar sistolne funkcije - TAs´(granična vrednost 10 cm/s) ; parametar opterećenja desne komore – RVSP (granična vrednost 40 mmHg) i kombinovani parametri - TAs´/RVSP granična vrednost 1,92 cm/s/mmHg) i TAPSE/RVSP (granična vrednost 0,28 mm/mmHg). Kombinovani ehokardiografski parametri, koji predstavljaju kombinaciju različitih osobine desne komore, imaju veći prediktivni značaj od pojedinačnih parametara. Među njima se izdvojio TAPSE/RVSP (parametri sistolne funkcije i opterećenja desne komore). Među svim posmatranim demografskim, kliničkim, laboratorijskim i ehokardiografskim parametrima obe komore parametar TAPSE/RVSP <0,28 mm/mmHg se opet izdvojio se kao statistički značajan i nezavisni prediktor neželjenog ishoda. Do sad, Objective: The aim of this study is to determine the predictive value of individual and combined echocardiographic parameters of the right ventricle for the occurrence of major adverse cardiac events in patients with chronic heart failure with reduced ejection fraction, during one-year follow-up. Methodology: The study included 191 patients, hospitalized with symptoms and signs of heart failure with reduced ejection fraction, from June 2016 to March 2017. All patients were subjected to clinical examination, laboratory analysis and transthoracic echocardiography. Patients were then followed up for one year in order to detect major adverse cardiac events (cardiac deaths, deaths due to other non-cardiac causes, rehospitalisation due to acute chronic heart failure, cardiac infarction, malignant ventricular disorders of rhythm and stroke). During a mean follow-up of 340±84 days, 111 patients reached the primary endpoint. Results and discussion: The following echo parameters of the right ventricle were selected as the important predictors of adverse cardiac events. Morphological parameter - RV1 (cut off threshold was 42 mm ); systolic function parameter - TAs (cut off value was 10 cm / s); right ventricular load parameter - RVSP (cut off value 40 mmHg) and combined parameters - TAs / RVSP (cut off value was 1.92 cm / s / mmHg) and TAPSE / RVSP (cut off value was 0.28 mm / mmHg). Combined echocardiographic parameters, which represent a combination of different properties of the right chamber, have a greater predictive significance than individual parameters. TAPSE / RVSP stands out among them (parameters of systolic function and right chamber load). Among all the observed demographic, clinical, laboratory and echocardiographic parameters of both chambers, the parameter TAPSE / RVSP <0.28 mm / mmHg is again stands out to a statistically significant and independent predictor of an adverse outcome. The combined parameters: TAs'/RVSP and TAs'x PVAcT (parameters of systolic fun

Resinhronizaciona terapija (RT) postala je deo standardnog lečenja bolesnika sa srčanom insufucijеncijom i proširenim QRS intervalom, ali oko 30-50% bolesnika ne odgovori adekvatno na ovaj vid lečenja. Postojanje mehaničke asinhronije (MA) čini se logičnim preduslovom uspeha RT, ali su dosadašnji rezultati bazirani na ovom principu bili razočaravajući. Novi princip definisanja MA zasnovan na vizuelnim fenomenima asinhrone kontrakcije leve komore mogao bi da poboljšlja selekciju kandidata za RT. Cilj Istražiti povezanost vizuelno procenjene MA, volumetrijskog odgovora i dugoročnog preživljavanja bolesnika sa srčanom insuficijencijom lečenih RT i uporediti odgovor bolesnika sa intrinzičkim i jatrogenim blokom leve grane (BLG). Metode Istraživanjem je obuhvaćeno 1060 bolesnika lečenih RT prema važećim preporukama i 155 bolesnika koji nisu lečeni RT. MA je definisana kao prerana kontrakcija septuma i klaćenje vrha leve komore i vizuelno je procenjena pre i 12±6 meseci nakon implantacije RT pejsmejkera. Volumetrijski odgovor je definisan kao smanjenje end-sistolnog volumena leve komore (ESV) za ≥15%. Smrt bilo kog porekla tokom prosečnog perioda praćenja od 46 meseci nakon implantacije bila je primarni ishod istraživanja. Rezultati Oba parametra MA, ukoliko su korigovana RT, udruženi su sa volumetrijskim odgovorom sa tačnošću od 82% (klaćenje vrha) i 77% (septalni trzaj). Takođe, oba parametra su nezavisno udružena sa boljim preživljavanjem nakon RT i imaju dodatnu vrednost u odnosu na kliničke parametre i širinu QRS intervala u identifikaciji odgovora na RT (klaćenje vrha: koeficijent rizika 0.40, 95% interval poverenja (IP) 0.30–0.53, p<0.001; septalni trzaj: koeficijent rizika 0.45, 95% IP 0.34–0.61, p<0.001). Smanjenje ESV nezavisno je udruženo sa preživljavanjem, tako da je svakih 10% smanjenja ESV udruženo sa 8% smanjenja mortalieta (p = 0.0039). Nije bilo značajnih razlika u volumetrijskom odgovoru (unakrsni odnos 0.71; 95% IP 0.33 – 1.53; p=0.385) i dugoročnom pr, Cardiac resynchronization therapy (CRT) has become an established treatment option for patients with heart failure (HF) and wide QRS width, but 30-50% of patients do not respond to this treatment. The presence of mechanical dyssynchrony (MD) seems like a logical prerequisite for CRT success but previous results have been disappointing. New principles of defining MD based on visual phenomena of left ventricular dyssynchronous contraction might improve patient selection for CRT. Aims To investigate the relationship of visually assessed MD, volumetric response, and longterm survival of HF patients undergoing CRT and to compare CRT response of patients with intrinsic and iatrogenic left bundle branch block (LBBB). Methods A total of 1060 patients treated with CRT under current guidelines and 155 patients eligible for but not treated with CRT were included. MD was defined as a premature septal contraction (septal flash, SF) or apical rocking (ApRock) and was visually assesed before and 12±6 months post-implantation. Volumetric response was defined as a left ventricular endsystolic volume (ESV) decrease of ≥15%. The occurrence of death of any cause during a median period of 46 months was the primary endpoint of the study. Results Both parameters of MD, if corrected by CRT, were associated with reverse remodelling with an accuracy of 82 and 77%. In addition, both parameters were independently associated with lower all-cause mortality after CRT and had an incremental value over clinical variables and QRS width for identifying CRT responders (ApRock: hazard ratio 0.40, 95% confidence interval (CI) 0.30–0.53, p< 0.001); SF: hazard ratio 0.45 95% CI 0.34–0.61, p< 0.001). ESV change is independently associated with survival, with an 8% reduction in mortality for every 10% decrease in LVESV (p=0.0039). There was no significant difference in volumetric response (odds ratio 0.71; 95% CI 0.33 – 1.53; p=0.385) and long-term survival between patients with RVP and intrinsic LBBB (haza

Uvod. Kardiovaskularne bolesti kao deo grupe hroničnih nezaraznih bolesti predstavljale su i predstavljaju vodeći uzrok obolevanja i umiranja u svetu. Brojni naučni dokazi potvrđuju da je arterijska hipertenzija glavni kardiovaskularni faktor rizika, a da postignute vrednosti krvnog pritiska niže od 140/90mmHg značajno smanjuju kardiovaskularni rizik, odnosno pojavu kardiovaskularnih događaja, prvenstveno infarkta miokarda i moždanog udara. Arterijska hipertenzija je najzastupljenije stanje koje se viđa u ustanovama primarne zdravstvene zaštite, a mere prevencije, rano dijagnostikovanje, lečenje i kontrola arterijske hipertenzije predstavljaju javno-zdravstveni izazov u svim zemljama sveta. Ciljevi. Ciljevi istraživanja su utvrđivanje prevalencije arterijske hipertenzije koja je pod kontrolom; utvrđivanje prevalencije i povezanosti metaboličkih faktora sa ishodom u kontroli krvnog pritiska; utvrđivanje prevalencije i povezanosti nezdravih stilova života sa ishodom u kontroli krvnog pritiska; utvrđivanje prediktora loše kontrole krvnog pritiska i izračunavanje 10-godišenjeg kardivaskularnog rizika. Metode. U studiju preseka (prevalencije) uključeno je 373 ispitanika oba pola starosti od 45 do 75 godina sa dijagnozom arterijske hipertenzije u kartonu koji su u periodu od oktobra 2015. godine do februara 2016. godine dolazili kod svog izabranog lekara. Prikupljanje podataka obavljeno je merenjem krvnog pritiska, antropometrijskim merenjima, biohemijskim analizama i anketiranjem popunjavanjem upitnika. Rezultati. Uzorak ispitanika je činilo 55% žena i 45% muškaraca prosečne starosti 59±6,3 godine. Utvrđena je niska učestalost arterijske hipertenzije pod kontrolom od 39,1%, a visoka učestalost metaboličkih faktora (44,5% predgojaznosti, 34% gojaznosti, 29% šećerne bolesti, 88,2% povišenih masnoća i 41,8% metaboličkog sindroma) kao i njihova povezanost sa ishodom u kontroli krvnog pritiska jer su ispitanici sa nekontrolisanim krvnim pritiskom najčešće imali dva faktora ri, Introduction. Cardiovascular diseases, as part of a group of chronic noncommunicable diseases, have been and still are the leading cause of morbidity and mortality in the world. Numerous scientific proofs confirm that arterial hypertension is a major cardiovascular risk factor and that the achieved blood pressure values lower than 140/90mmHg significantly reduce cardio-vascular risk, or the appearance of cardio-vascular events, mainly myocardial infarction and stroke. Arterial hypertension is the most common condition that is seen in primary health care institutions and preventive measures, early diagnosis, treatment and control of arterial hypertension are a public health challenge in all countries of the world. Objectives. The objectives of the research were to determine the prevalence of arterial hypertension which is controlled; to determine the prevalence and correlation of the metabolic factors with the outcome in blood pressure control; to determine the prevalence and correlation of unhealthy lifestyles with the outcome in blood pressure control; to determine the predictors of poor blood pressure control and calculate a 10-year cardiovascular risk. Methods. The cross-sectional study (of prevalence) included 373 respondents of both sexes aged 45 to 75 years diagnosed with arterial hypertension who in the period from October 2015 to February 2016 visited their chosen doctor. Data collection was performed by measuring blood pressure, anthropometric measurements, biochemical analyses and surveying by filling out a questionnaire. Results. The sample consisted of 55% women and 45% men, of mean age of 59±6.3 years. The results showed low incidence of arterial hypertension under control of 39.1%, and high incidence of metabolic factors (44.5% of overweight, 34% of obesity, 29% of diabetes mellitus, 88.2% of elevated fat and 41.8% of the metabolic syndrome) as well as their association with the outcome in blood pressure control as the respondents with uncontrolled blo

Cilj: Kod trećine bolesnika sa akutnim ST-eleviranim infarktom (STEMI) nakon primarne angioplastike (pPCI) razvije se postinfarktno remodelovanje leve komore (LK). Cilj istraživanja je nalaženje ranih prediktora post-infarktnog remodelovanja leve komore nakon akutnog STEMI i pPCI. Metodologija: Uključeno je 210 ispitanika sa prvim akutnim STEMI prednjeg zida, lečenih pPCI. Urađena je ehokardiografija u prva 24h, a zatim nakon 6 meseci, kada su ispitanici podeljeni u 2 grupe: ispitivanu sa remodelovanjem (n=55; 26%) i kontrolnu bez remodelovanja (n=155; 74%). Ispitanici su klinički praćeni godinu dana. Rezultati i dikusija: Multivarijantnom regresionom analizom, kao najsnažniji rani prediktori post-infarktnog remodelovanja izdvojili su se: postojanje "no reflow" fenomena nakon pPCI (OR=30.0 95% CI, p<0.0001), pojava dijastolne disfunkcije u prva 24h (OR=27.7 95% CI, p<0.0001), povećan dijametar leve pretkomore - LA (OR=5.0 95% CI, p=0,044) i srčana slabost na prijemu - Killip klasa 2-4 (OR=3.4 95% CI, p=0.003.). Univarijantnom regresionom analizom, snažni prediktori su neadekvatna rezolucija ST segmenta - STR (OR 2.0 95% CI, p=0.024) i zbirni indeks zidne pokretljivosti – WMSI >2 (OR 21.6 95% CI, p<0.0001). Totalno ishemijsko vreme nije imalo uticaja na post-infarktno remodelovanje (p=0.546). Tokom jednogodišnjeg praćenja ispitanici sa post-infarktnim remodelovanjem su imali značajno veću incidencu glavnih neželjenih kardioloških događaja: rehospitalizacija (61.8% vs 22.6%; p<0.0001) / najviše rehospitalizacija zbog srčane slabosti (40% vs 2.6%; p<0.0001), sa mortalitetom 5.5%/; reinfarkta (20% vs 7.1%; p=0.007); rekoronarografija (45.5% vs 18.1%; p<0.0001); revaskularizacija (30.9% vs 11%; p=0.001). Zaključak: Kod pacijenata sa akutnim STEMI prednjeg zida lečenih pPCI, pojava "no reflow" fenomena, dijastolne disfunkcije, povećana LA i srčana slabosti na prijemu su najjači rani nezavisni prediktivni faktori za nastanak post-infarktnog remodelovanja. Značajni predikto, Objective: Patients with ST-elevated myocardial infarction (STEMI) treated by primary angioplasty (pPCI) will develop left ventricular (LV) remodeling in one third of the cases. The purpose of this study is to determine early predictors of LV remodeling after acute STEMI and pPCI. Methods: 210 patients with a first acute anterior STEMI treated by pPCI were included. All participants underwent echocardiography in the first 24hrs and again after 6 months, after which they were divided into two groups: remodeling (n=55; 26%) and nonremodeling (n=155; 74%). Results and discussion: The most powerful independent early predictors were: "no reflow" after pPCI (OR=30.0 95% CI, p<0.0001), diastolic dysfunction in the first 24hrs (OR=27.7 95% CI, p<0.0001), increased diameter of the left atrium - LA (OR=5.0 95% CI, p=0.044) and at admission Killip class 2-4 (OR=3.4 95% CI, p=0.003), by multivariant regression analysis. Also, strong predictors were incomplete ST-resolution - STR (OR 2.0 95% CI, p=0.024) and Wall motion score index - WMSI >2 (OR 21.6 95% CI, p<0.0001), by univariant regression analysis. Total ischaemic time had no influence on LV remodeling. The group with remodeling had more frequent major adverse cardiac events (MACE) during one year follow-up: re-hospitalisation (61.8% vs 22.6%; p<0.0001) / mostly re-hospitalisation due to heart failure (40% vs 2.6%; p<0.0001) and mortality 5.5%; reinfarction (20% vs 7.1%; p=0.007); recoronagraphy (45.5% vs 18.1%; p<0.0001); revascularisation (30.9% vs 11%; p=0.001). Conclusion: For the patients with a first acute anterior STEMI, treated by pPCI, development of "no reflow" after pPCI, diastolic dysfunction, increased LA and heart failure on admission are the most powerful early independent predictors for LV remodeling. Incomplete STR and WMSI>2 are strong predictors too. Remodeling patients will have a more frequent incidence of MACE and mortality.