The most important adipocytokines affecting the formation and the regression of atheromas plaque in the coronary blood vessels are adiponectin and resistin. The essence of this test is to determine the correlation of the leading biochemical parameters of atherosclerosis, adiponectin and resistin and determine their interdependence with other biochemical parameters in patients with diabetes mellitus and coronary heart disease. Our study group consisted of 140 patients and 40 control group (healthy), 50 with diabetes mellitus and 50 with coronary heart disease (myocardial infarction and angina pectoris). We find that the average value of adiponectin in the group with type 2 diabetes mellitus were significantly lower than in the control group (4.38 to 6.74, p = 0.001, p <0.05). In the same study group average value of resistin was significantly higher than in the control group (15.8 to 7.88, p <0.001). The average value of adiponectin and resistin in patients with myocardial infarction and angina pectoris are no different from the value obtained in diabetes mellitus (4.94 to 4.38 and p = 0.397, p> 0.05). In the same study group average value of resistin was significantly higher than in the control group (15.73 to 7.88, p = 0.001, p <0.01) and not different than in the group with diabetes mellitus. Values Pearsonovg correlation coefficient shows that the biggest falls inversely proportional dependence of adiponectin with a simultaneous increase in resistin is expressed in patients with myocardial infarction, which is expressed very good correlation coefficient (-0.36). In all the groups, shows that there is a negative correlation between resistin and adiponectin, with increasing values of resistin values of adiponectin are reduced.

Tests have shown that adipose tissue is very important in the production of chemical substances that have a major impact on atherosclerosis. The basic fat cells adiposity is very active in bio secretion hormones and other substances. Adiposities secrete chemical substances such as leptin, resistin, adiponectin, and others who participate in metabolic processes. One of the most important adipocytokine affecting the formation and the regression of atheromas plaque in the coronary blood vessels are adiponectin and resistin. So our aim was to determine the value of the concentration of adiponectin and resistin on patient with myocardial heart attack and determine their correlation with the control group of healthy subjects. In this study were included 68 subjects, 40 with myocardial heart attacks and 28 control groups of normal healthy. In the group with myocardial 78.6% of respondents were male and 21.4% female. Tests have shown that the concentration of adiponectin in the group with myocardial heart attack was significantly lower than the control group (4.94 to 6.74, p=0.043, p<0.05. In the same study group average value of resistin was significantly higher than in the control group (15.73 to 7.88, p=0.001, p<0.01) (Student's t-test, p = 0.581, p> 0.05). All this indicates that in patients with myocardial heart attack there is a decline in the concentration of adiponectin, which has cardio protective effect. The increase in resistin in myocardial heart attack in directly related to the appearance of athermanous plaques in the coronary blood vessels and has a bad prognostic significance.

Introduction: The study of importance of left ventricular contractile reserve presence and changes plasma brain natriuretic peptide levels (BNP) during exercise in patinets with idiopathic dilated cardiomyopathy is very popular today, but these two parametres have rarely been interconnected. The study of response BNP during echocardiography stress tests in patients with idiopathic dilated cardiomyopathy with or without preserved left ventricular contractile reserve. We studied 55 consecutive patients with idiopathic dilated cardiomyopathy (mean age 54.98 ± 9.84, 49 (89.1%) male) treated in the outpatient clinic for heart failure at the Institute of Cardiovascular Diseases "Dedinje". All the patients underwent the echocardiography stress test. Contractile reserve was assessed by measuring of the changes of the left ventricle ejection fraction basally and in the first minute after the strongest stress. Level of BPN was measured at rest, in the first minute and after 20 minutes of maximal exercise stress. Following the kinetics of BNP level during stress testing, we find that in patients with preserved left ventricular contractile reserve BNP level is rising at maximum load achieved (Mediana (IQR) - 59 (22-113) vs. 91 (37-135) vs. 78 (30-159) ng/L, p<0.001), whereas in patients without preserved left ventricular contractile reserve BNP level does not change significantly (Mediana (IQR) – 89 (50-322) vs. 119.5 (61.3-321.8) vs. 136 (72- 281), p=0.102). The increase in BNP in the peak load compared to its value at rest was positively correlated with preserved contractile reserve (r=0.38, p=0.009), better WMSI at rest (r=-0.28, p=0.04), greater difference in the double product (r=0.40, p=0.002), as well as the work accomplished on the test (r = 0.47, p <0.001), and longer duration of the test (r = 0.43, p = 0.001). The increase in BNP during physical exercise in patients with idiopathic dilated cardiomyopathy suggests a preserved contractile reserve of the left ventricle.

 Atrial arrhythmias are an often and common problem in patients with arterial hypertension. Some recent studies have shown that the electrical pulse delay estimated by echocardiography is prolonged in patients with paroxysmal atrial fibrillation compared to healthy persons. To assess the electromechanical function of the left atrium in patients with various degrees of hypertension compared to healthy persons. The study has included 103 patients with artery hypertension, who were divided into four groups according to the degree of arterial hypertension and 46 healthy persons as a control. The volumes of the left atrium were measured by echocardiography using the disk, active and passive emptying volumes of left atrium and the fractions were calculated. Electrical delay within the left atrium and between the two atria were measured using the tissue Doppler. The values of passive left atrial emptying fraction were highest in patients in the control group and in patients with prehypertension they have significantly declined with the increased degree of hypertension (12.8 vs 12.6 vs 11.2 vs .10.2 vs 9.9%, p˂0.001). The values of the active emptying fractions left atrium were higher in patients in the control group and with prehypertension threy have significantly declined as increased degree of arterial hypertension (28 vs 23 vs 40 vs 40 vs 39%). Electrical delay within the left atrium was significantly lower in patients in the control group and it has been significantly increased as a growing belonging to a group with higher levels of arterial hypertension (6 ... 9 ... 15 ... 23 ... 31 ms, p˂0.001). Patients with prehypertension had significantly higher values of electrical delays within the left atrium compared to the patients in the control group. Electrical delay between the two atria grew significantly as a growing belonging to the group with a higher degree of hypertension (15.6 ... 25.3 ... 35.2 ... 50.2 ... 67.4ms, p˂0.001). The study showed that even patients with regulated arterial hypertension have disturbed electromechanical function of the left atrium. Electrical delay in the atrium between the two atria is extended to the increasing degree of arterial hypertension, which can be explained by the higher risk for atrial arrhythmias in these patients.

One of possibilities to estimate size of myocardial injury during the acute myocardial infarction are electrocardiographic changes,
forming of QS formation (ECG signs of scares changes). This investigation which included three groups of patients receiving thrombolytic, nitrates or beta blockers in acute phase of myocardial infarction has aim to analyze 12-chanels electrocardiogram and to establish difference between this therapeutics groups in sum of QRS score, but also to indicateon frequency of periinfarction heart insufficiency in this therapeutics groups, comparing with observed ECG changes. Analysis shows significant differences between groups
in value of QRS score, and also significant lower value of QRS score in patients with acute myocardial infarction treated with thrombolytic therapy. This difference relative to other two groups shows lower level of myocardial injury during acute myocardial infarction in patients treating with thrombolytic therapy. 

U radu je prikazana žena stara 73 godine koja je hospitalizovana u jedinicu Intenzivne nege zbog osećaja nedostatka vazduha i atpičnog diskomfora u grudima unazad dva sata. Krvni pritisak na prijemu je bio veoma povišen (240/130 mmHg), kardijalni troponin i iznad referentnih vrednosti (2,1 ng/ml) a inicijalni EKG zapis bio je sugestibilan za infarkt miokarda bez ST elevacije. Ehokardiografska evaluacija i koronarna arteriografija koje su usledile isključile su akutni koronarni sindrom kao uzrok povećanog kardijalnog troponina.

Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Utvrditi razlike u kliničkim karakteristikama kod pacijenata sa dilatacionom kardiomiopatijom u zavisnosti od očuvane kontraktilne rezerve leve komore. U studiju je uključeno uzastopnih 55 bolesnika sa idiopatskom dilatativnom kardiomiopatijom. Svim bolesnicima uključenim u studiju urađen je stres ehokardiografski test fizičkim opterećenjem po standardnom protokolu. Postojanje očuvane kontraktilne rezerve je određivano uz pomoć promene ejekcione frakcije leve komore. Prosečna starost ispitivanih bolesnika je bila 54,98 ± 9,84 godina, 49 (89,1%) je bilo muškog pola. Na osnovu promene ejekcione frakcije leve komore kao kriterijuma kontraktilne rezerve leve komore, očuvanu kontraktilnu rezervu je imalo 25 bolesnika (45,5%). Bolesnici bez očuvane kontraktilne rezerve leve komore znatno češće u anamnezi imaju zastupljenu arterijsku hipertenziju (46,7 vs. 20,0%, p=0,038). Nema značajne razlike u zastupljenosti ostalih faktora rizika. Pacijenti sa očuvanom kontraktilnom rezervom leve komore imaju manju dimenziju leve komore na kraju sistole (49,64 ± 7,26 vs. 55,27 ± 8,36 mm, p=0.011), manji indeks volumena leve komore na kraju dijastole (77,35 ± 26,41 vs. 94,59 ± 34,97 ml/m2, p=0,005) i na kraju sistole (59,31 ± 26,05 vs. 78,62 ± 34,42 ml/m2, p=0,002), veću ejekcionu frakciju leve komore (25,48 ± 8,32 vs. 18,33 ± 6,49%, p=0,002) i niži indeks pokreta zidova leve komore (2,23 ± 0,27 vs. 2,48 ± 0,27, p=0,002). Kod bolesnika sa očuvanom kontraktilnom rezervom leve komore nalazimo manju zastupljenost arterijske hipertenzije i morfološki i funkcionalno manje oštećenu levu komoru.

Acute instable atherosclerotic plate in the basis of the pathophysiology of the acute coronary syndrome and it is divided on two big groups: a) acute coronary syndrome without ST elevation (NONSTEMI) and b) myocardial infarction with ST elevation (STEMI). Clopidogrel belongs to the group of antiaggregation drugs which inhibit ADP receptors and on that way prevent platelets aggregation. The clinical confirmation of the clopidogrel efficiency is confirmed trough 4 big clinical studies: CAPRIE, CURE, COMMIT/CCS 2 and CLARITY-TIMI 28 studies. In CAPRIE study, clopidogrel showed moderate but significant advantage comparing to aspirin in prevention of the secondary ischemic cerebrovascular stroke and myocardial infarction. The results of CURE study showed that doubled combined therapy with clopidogrel and aspirin brought the reduction of the relative risk of cardiovacular events with patients with acute coronary syndrome without ST elevation. The results of this study showed that the group of patients which received clopidogrel beside aspirin and thrombolytic therapy it came to the reduction of the occluded arteries. In COMMIT were also involved the patients with the acute myocardial infarction with ST elevation. Total number of lethal cases of the repeated myocardial infarctions or acute brain stroke was smaller in a group which was receiving clopidogrel beside thrombolytic therapy and aspirine in comparison with the placebo group. The results of CLARITY and COMMIT studies gave us recommendation that patients with acute myocardial infarction with ST elevation which have thrombolytic therapy or percutaneous coronary intervention should receive clopidogrel as well.

In clinical hyperkalemia, correlation between plasma K and the ECG is less reliable. A tall, peaked, symmetrical T wave with a narrow base, the so-called "tented" T wave is the earlinest ECG abnormality, usually best seen in leads II, III, V2, V3, and V4. The tented appearance and the narrow base are probably more characteristic of hyperkalemia than is the amplitude of the T wave. A decrease in amplitude of the R wave, appearance of a prominent S wave, widening of the QRS complex, depression of the ST segment evolve as plasma K approaches 8-9m Eq/liter. With hyperkaliemia, depression of intraventricular conduction is characteristically diffuse and results in prolongation of both the initial and terminal parts of the QRS complex. The resulting pattern may resemble RBBB, LBBB, left anterior or posterior divisional block, or a combination of the four.

Doppler ultrasound check-up significantly increases a possibility of initial functioning of arteriovenous fistula. The aim of the study was the preoperative evaluation of vascular system of the extremity for creation of arteriovenous fistula for haemodialysis. The examination was organized at Urology and Nephrology Clinic, Clinical Centre "Kragujevac". The examined subjects were 87 patients, 52 (59,8%) male and 35 (40,2%) female, mean age of 61±11,1 years. There were performed the routine biochemical analyses, demographical structure and clinical characteristics (type of anastomosis, fistula placement, arterial blood pressure, lumen size of the artery and vein, measured intraoperatively by Doppler technique). In 72,1% of patients with functioning fistula there was made a terminal-lateral anastomosis, compared to 57,7% of patients with initial non-functioning fistula, there was found a statistically significant difference between the groups p=0,008. Radiocephalic fistula was created in 62,3% of the examined patients with initial functioning , in patients with non-functioning, the distal fistula was created in 38,5% of the examined patients. Regarding the type of the fistula location there was obtained statistically significant difference; p=0,04. There was found a statistically significant difference between the group of patients with initial functioning of arteriovenous and the group without, concerning the intraoperatively measured lumen of the cephalic vein (2±0,29 vs. 2±0,38 mm); p=0,03 (2,1±0,5 vs. 1,8±0,4); p=0,0009. Statistical significance between the groups was also found in the lumen of the cephalic vein verified by the ultrasound (2,1±0,53 vs. 1,8±0,25 mm); p=0,038. Peak of the systolic speed of the radial, corelated to the group of patients with and the group without initial functioning fistula (50 ± 12,42 vs. 40 ± 6,9 cm/sec); (p=0,0026), has statistically significant value. By the correlation of the group of patients with initial functioning and the group of patients without initial functioning, regarding hemoglobin (97 ± 16,1 vs. 88 ± 18,3 g/l); p=0,006 and the level of urea (22,6 ± 12,7 vs. 23,9 ± 9,8); p=0,02, there was found a statistically significant difference. Color Doppler ultrasound has an important role in preoperative evaluation of blood vessels and it represents a meaningful predictive parameter of functioning of arteriovenous fistula.