Introduction: Atrial fibrillation represents the most common cardiac arrhythmia in clinical practice. By year 2030, 14–17 million AF patients are anticipated in the European Union. Atrial fibrillation remains one of the major causes of stroke, heart failure, sudden death all over the world. Research Objectives: The objective of our study is to determine the cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence during 11 years follow up period. Patients and methods: This study includes 2352 ambulant and hospitalized patients with atrial fibrillation (AF) who were enrolled during the follow up period. All patients underwent clinical evaluation in order to determine cardiac and cerebrovascular events (myocardial infarction, heart failure, stroke, sudden cardiac death) and their cumulative incidence. Results: The results of cumulative incidence for sudden cardiac death was 1.71%, for stroke 2.56%, for myocardial infarction 1.20% and for heart failure was 5.73%. In our study the age-adjusted incidence and prevalence of AF are slightly lower in women. The study shows that the risk of death is higher in females than in males with AF. Conclusion: Despite good progress in the management of patients with atrial fibrillation (AF), this arrhythmia remains one of the major causes of stroke, heart failure, sudden death. Effective treatment of patients with atrial fibrillation includes not only rate control, rhythm control, and prevention of stroke, but also management of cardiovascular risk factors and concomitant diseases.

Cardiologia CROATICA Background: Modern approach to evaluation of left ventricular diastolic function should be based on determining the value of left ventricular filling pressures, which are the actual parameters of the symptoms and/or signs and prognosis in acute myocardial infarction. Aim: Compare parameters of left ventricular filling pressure in patients with acute myocardial infarction (AMI) with anteroseptal and inferior localization. Methods: Prospective study of 60 patients (37 men, mean age 59 ±10 years) with acute myocardial infarction were divided into two groups. The first group consists of patients with myocardial infarction, anteroseptal localization (27 patients) and the second group consists of patients with myocardial infarction inferior localization (33 patients). Accompanied by the ratio of early diastolic filling velocity of mitral flow velocity and early mitral annular filling (E/E’), the difference between the duration of flow reversal in the pulmonary veins and duration of the mitral A wave flow (PVA-MVAdur), and the relative velocity of early diastolic filling mitral flow and color M mode display of early mitral flow (E/Vp) of the left ventricle as determined by continuous (mitral flow) and pulsed color Doppler echocardiographic technique (flow in the pulmonary veins and the mitral ring velocities). Results: The value of E/E’ ≥13 was found in 14 patients (8 patients in the first group, and 6 patients in the second group), while the value of 8 <E/E’ <13 in 25 patients. The value of E/E ‘<8 was found in 21 patients. The average value of Avg=E/E’ for the first group of patients was Avg=10.87 and the second group of subjects was Avg=9.39 was found to be a statistically significant difference (p <0.05) between the two groups, using the Student’s t-test. Using Pearson’s correlation coefficient we found that there was a significant correlation between E/E’ and E/Vp in all patients (P = 0.66), whereas there was no difference in the correlation of these two proposed relationships between groups (P = 0.70 and P = 0.67). When comparing the ratio E/E’ and PVA-MVAdur and E/Vp and PVA-MVAdur, Pearson correlation coefficient at a given group of 60 subjects showed no statistically significant correlation of this data. For PVA-MVAdur Pearson correlation coefficient has medium correlation compared to infarcted zone with inferior localization for the patients with E/E’ ≥13. Conclusions: Comparison of parameters of yhe left ventricular filling pressures, it is proved that the left ventricular filling pressures in acute myocardial infarction is increased. There is a high correlation between the filling pressures and infarcted zone in the AMI anteroseptal localization in relation to the inferior localization of E/E’ and E/Vp.

Background: Cardiovascular diseases are the greatest cause of morbidity and mortality in patients with chronic renal insufficiency. Prevalence rate of heart failure in patients with terminal renal insufficiency treated with dialysis ranges from 18% to 45%. Prevalence rate of symptomatic heart failure in the general population of European countries is estimated to be about 4%. Diastolic dysfunction is a cause of heart failure in 33-50% of cases. In the general population, it is considered that 30-40% of patients suffering from primary diastolic cardiac dysfunction due to disorders in relaxation or ventricular extensibility. Echocardiography is a sensitive non-invasive method for detecting disorders of systolic and diastolic function of the left ventricle. Aim: Evaluate the systolic and diastolic left ventricular function in patients in dialysis. Determine the incidence rate of systolic and diastolic left ventricular dysfunction in patients on dialysis. Patients and Methods: A prospective study was conducted that included 50 patients who were treated with chronic dialysis (hemodialysis and continuous ambulatory peritoneal hemodialysis). All the patients underwent ultrasound examination of the heart on the ultrasonic unit Vivid 3 Vingmed Tehnology. Left ventricular systolic function was evaluated on the basis of ejection fraction (EF), which we detected in M-mode according to Teichholz method. Evaluation of diastolic function the left heart chambers is done on the basis of Doppler echocardiographic transmitral flow. Results: The study included 50 patients: 22 males (44%) and 28 women (56%). 35 patients (70%) were treated with hemodialysis, and 15 patients (30%), continuous ambulatory peritoneal dialysis (CAPD). The average age of the patients was 47.33 ±12.74 years. The average duration of dialysis treatment was 42.6 ±17.2 months. Preserved systolic function of the left ventricle was recorded in 83% subjects. Weakened systolic function of the left ventricle was recorded in 17% subjects with average ejection fraction (EF 40%). Diastolic dysfunction of the heart’s left ventricle was verified in 20.4% of patients. All the patients with diastolic dysfunction of the left heart chambers had preserved systolic function of the heart’s left ventricle (regular ejection fraction). Conclusion: The incidence of systolic and diastolic dysfunction of the heart’s the left ventricle in patients on dialysis is high.

Background and aim: Hormonal and immunological aspects of acute myocardial infarction (AMI) are in the past decade in focus of interest of researchers. We investigated concentrations of insulin like growth factor 1 (IGF-1), growth hormone (GH), insulin and markers of insulin resistance as like as inflammatory markers in order to find out their role and relationship in AMI. Material and methods: A prospective study was performed at University Clinical Center Tuzla from January to October 2010. Study group was consisted of 75 patients with AMI. There were 30 healthy controls. Blood samples were taken within first 24 hours of admission and analyzed for GH, IGF-1 and insulin at the Department of Nuclear Medicine. Glucose, glycolised hemoglobin HbA1c, C-reactive protein (CRP), fibrinogen etc. were analyzed by standard methods at Biochemistry unit. Results: Median of GH in the study group (0,96) was higher than in controls (0,26); p <0.001. Difference in median’s concentrations of IGF-1 between AMI and controls was also significant (123 vs. 132 respectively; p< 0,05) as like as IGF-1/GH ratio (p <0.001). Concentration of insulin was higher in study (9,5) than in control group (7,1), but without statistical significance. Despite this, we found out significant difference between concentrations of glucose, HOMA-IR and HbA1C among groups. Levels of CRP and fibrinogen were significantly higher in AMI. Simple linear correlation analysis showed positive correlation between GH and CRP (R 0,350255, p< 0,005). Conclusions: GH resistance in AMI (Low IGF-1/GH) is probably result of inflammatory/immunological response and therefore could be prognostic marker.