Introduction: The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH). Research Objectives: Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice. This is important because masked hypertension is associated with a high risk of cardiovascular events. This study was conducted to obtain more information about the association between hypertension and other CV risk factors, about office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients, also to define the prevalence and characteristics of masked uncontrolled hypertension (MUCH) among treated hypertensive patients in routine clinical practice. Patients and methods: In this study 2514 male and female patients were included during a period of 5 years follow up. All patients have ambulatory blood pressure monitoring (ABPM) for at least 24h. We identified patients with treated and controlled BP according to current international guidelines (clinic BP, 140/90mmHg). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Masked uncontrolled hypertension (MUCH) was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130mmHg and/or 24-h diastolic BP ≥80mmHg). Results: Patients had a mean age of 60.2+10 years, and the majority of them (94.6%) were followed by specialist physicians. Average clinic BP was 150.4+16/89.9+12 mmHg. About 70% of patients displayed a very high-risk profile. Ambulatory blood pressure monitoring (ABPM) was performed in all recruited patients for at least 24h. Despite the combined medical treatment (78% of the patients), clinic control (<140/90 mmHg) was achieved in only 26.2% of patients, the corresponding control rate for ambulatory BP (<130/80 mmHg) being 32.7%. From 2514 patients with treated BP, we identified 803 with treated and controlled office BP control (<140/90 mmHg), of whom 258 patients (32.1%) had MUCH according to 24-h ABPM criteria (mean age 57.2 years, 54.7% men). The prevalence of MUCH was slightly higher in males, patients with borderline clinic and office BP (130–139/80–89 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension (MUCH) was most often due to poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (22.3 vs. 10.1%, P 0.001). Conclusion: The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. The characteristics of patients with MUCH (male, longer duration of hypertension, obesity, smoking history, and diabetes) indicate that this is a higher-risk group with most to gain from improved BP.

Introduction: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Research Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE echocardiography for detection and assessment of ischaemic mitral regurgitation (IMR) with baseline age (62 ± 9), ejection fraction (EF 41±12%), the regurgitant volume (RV) were 42±21 mL/beat, and effective regurgitant orifice area (EROA) 20±16 mm2, the regurgitant fraction (RF) were 48±10%, Jet/LA area 47±12%. Also we measured the of vena contracta width (VC width cm) 0,4±0,6 for assessment of IMR severity. During 5 years follow up, total mortality for patients with moderate/severe IMR–grade II-IV (54.2±1.8%) were higher than for those with mild IMR–grade I (30.4±2.9%) (P<0.05), the total mortality for patients with EROA ≥20 mm2(54±1.9%) were higher than for those with EROA <20 mm2(27.2±2.7%) (P<0.05), and the total mortality for patients with RVol ≥30 mL (56.8±1.7%) were higher than for those with RVol<30ml (29.4±2.9%) (P<0.05). After assessment of IMR and during follow up period 64 patients (46%) underwent CABG alone or combined CABG with mitral valve repair or replacement. In this study, the procedure of concomitant down-sized ring annuloplasty at the time if CABG surgery has a failure rate around 24% in terms of high late recurrence rate of IMR during the follow period especially after 18–42 months. Conclusion: The presence of ischaemic MR is associated with increased morbidity and mortality. Chronic IMR, an independent predictor of mortality with a reported survival of 40–60% at 5 years. Ischaemic mitral regurgitation has important prognosis implications in patients with coronary heart disease. Recognizing the mechanism of valve incompetence is an essential point for the surgical planning and for a good result of the mitral repair. It is important that echocardiographers understand the complex nature of the condition. Despite remarkable progress in reparative surgery, further investigation is still necessary to find the best approach to treat ischaemic mitral regurgitation.

Introduction: Obesity is defined as an excess of body fat, and the fundamental causes are sedentary lifestyles, high-fat and energy-dense diets and the behavioural patterns of communities as a consequence of increased urbanization. Research on obese individuals has shown that they have impaired immune function, which increases their susceptibility to infection. Recently, research has found that various microbes, including gut microbiota, influenza H1N1 virus, adenovirus 36 and Toxoplasma gondii, increase adiposity in humans and that proliferating pre-adipocytes and immune cells share an embryonic origin, which explains the link between obesity and infections. Aim and objectives: The aim of this literature review was to search the scientific literature to ascertain the association between obesity and infectious diseases and to analyse which is a more serious issue – obesity predisposing people to infections or infections leading to obesity. Material and methods: Google, Google Scholar, PubMed and the Journal of Obesity were the research repositories searched for relevant studies using the keywords infectious diseases, microbes and obesity. The research studies were reviewed and the results presented. Results: Through our review we found that the agents that most strongly predisposed people to obesity were adenovirus 36 and 37, T. gondii and Enterobacter, which led to obesity in 30% of adults. A vast majority of micro-organisms, such as influenza H1N1 virus, Candida albicans, Mycobacterium tuberculosis, coxsackievirus and Helicobacter pylori, were found to cause diseases in obese individuals. Conclusion: A review of the current studies does not conclusively prove that infections lead to obesity, with the exception of adenovirus 36; however, it does prove that obese people are prone to infections through an interplay of different mechanisms. Further research is required to establish the eminence of one over the other.

Objectives: The aim of this Study is to examine the development of ischaemic heart disease and occurrence of segmental wall motion abnormalities in men and women during Dobutamine stresss echocardiography in order to establish the impact of gender and other risk factors in development of coronary artery disease and the role of Dobutamine stress echocardiography in detecting and assessing the degree of myocardial ischemia and coronary stenosis in patients with suspected coronary artery disease in order to justify its wider application as a non-invasive diagnostic method. Research aim and purpose: Ischemic heart disease (IHD) causes more deaths, disability and economic loss in developed and developing countries than any other disease. Cardiovascular disease is the leading cause of ddath for women in western socitew. The epidemiology of the ischemic heart disease depends on fixed risk factors, such as sex, age and genetic predisposition, and on multiple risk factors that can be addressed, such as elevated lipid levels, arterial hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Cardiovascular diseases are the leading cause of morbidity and mortality in B&H and, considering the exposure profile of the B&H population to risk factors (unhealthy diet, ubiquitous smoking and alcohol drinking habits, inadequate physical activity, inadequate culture of health), further growing trend of cardiovascular diseases can be expected. Patients and methods: The research study covered 86 adult subjects of both sexes with cardiac risk factors, referred to dobutamine stress echocardiography test as part of their cardiological evaluation. The patients for whom invasive cardiac diagnostics was indicated following the dobutamine stress echocardiography were subjected to left heart catheterization: ventriculography and coronary angiography. The parameters obtained and results of each method applied were statistically processed. Results: The study results obtained indicate a high degree of sensitivity, specificity and accuracy of the dobutamine stress echocardiography as a non-invasive diagnostic method compared to invasive diagnostics i.e. coronary angiography, which is the gold standard for the detection and evaluation of coronary artery diseases. Dobutamine stress test, may play a key role in the optimal identification of high risk groups of patients with hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Conslusion: Echocardiographic measures of inducible wall motion abnormalities and global and regional left ventricular function are highly accurate in detecting CAD in women and men alike. The safety and cost-effectiveness of the dobutamine stress echocardiography as a diagnostic procedure has been proved. In modern cardiology, the DSE occupies a significant place in the evaluation of patients with known or suspected coronary artery d

Background: Pulmonary hypertension (PH) is a haemodinamic and pathophysiological condition defined as increase in mean Pulmonary Artery Pressure (PAP) ≥ 25mmHg at rest as sessed by right heart catheterization (RHC). Objective and purpose: The objective of this study is to determine, by investigating haemodynamic parameters of the pulmonary hypertension in congenital and left heart diseases, the linkage and diagnostic value of echocardiography in detecting the pulmonary hypertension in heart diseases and assessing its degree, as well as to warrant a wider application of this non-invasive diagnostic method. Patients and methods: The research covered 56 adult subjects of both genders, who were subjected to echocardiography as part of the clinical cardiological examination. The patients were examined on an ultrasound machine ATL HDI-3000 and 5000, equipped with a cardiologic probe for adults 2.25 MHz and a multi-plan transoesophageal probe ATL MPT7-4 TEE. The patients, for whom invasive cardiologic diagnostic methods were indicated following evaluation by echocardiography, were subjected to cardiac catheterization. RHC was performed in all patients and diagnosis of pulmonary hypertension was established by measuring mean PAP ≥ 25mmHg at rest, also left heart catheterization was performed in order to define the underlying heart disease. The haemodynamic parameters, obtained for each method applied, have been statistically processed. Results: By the statistical processing of the echocardiographic parameters a correlation ratio has been found, which shows significant correlation between the non-invasive variables (AcT, Act/RVET, PEP/AcT, PEP/RVET and RVSP according to modified Bernoulli equation. MPAP according to Mahan’s equation, SPAP according to Berger’s equation) and the variables obtained by right heart catheterization (RHC): (RVSP, MPAP, SPAP): a) In AcT and AcT/RVET variables, a negative correlation was found AcT r = -0.936, Standard Estimation Error (SEE) = 5.53, p

BACKGROUND Ischemic heart disease (IHD) causes more deaths, disability and economic loss in developed and developing countries than any other disease. Our country belongs to the group of countries in transition, and it has seen a continuous growth in mortality and morbidity rates caused by cardiovascular diseases. An early, accurate and fast diagnosis of the myocardial ischemia is the main step toward reducing patient morbidity and mortality, and hospital costs. It also reduces prolonged diagnostic observation, defines the strategy of approach and etiological treatment in order to prevent serious complications. OBJECTIVES The aim of this study is to examine the occurrence of segmental wall motion abnormalities during pharmacological stress and measurement of coronary flow reserve in order to establish the diagnostic value of Dobutamine stress echocardiography in detecting and assessing the degree of myocardial ischemia and coronary stenosis in patients with suspected coronary artery disease, and to justify its wider application as a non-invasive diagnostic method. METHODS The research study covered 86 adult subjects of both genders, referred to dobutamine stress echocardiography test and assessment of coronary flow reserve as part of their cardiological evaluation. RESULTS The study results obtained indicate a high degree of sensitivity (97%), specificity (83%) and accuracy (95%) of the dobutamine stress echocardiography as a non-invasive diagnostic method compared to invasive diagnostics i.e. coronary angiography. Measurement of coronary flow reserve represents a strong diagnostic and prognostic tool in evaluation patients with suspected CAD. CONCLUSIONS The Dobutamine stress echocardiography (DES) has come a long way as a diagnostic tool, from detecting myocardial ischemia, viability, and prognostics to problems underlying the coronary artery diseases. The safety and cost-effectiveness of the Dobutamine stress echocardiography as a diagnostic procedure has been proved. In modern cardiology, the DSE occupies a significant place in the evaluation of patients with known or suspected coronary artery disease, which has contributed to its accessibility and availability in a great number of centers.

BACKGROUND The transient left ventricular apical ballooning syndrome, also known as takotsubo cardiomyopathy was first described in Japan approximately 20 years ago (Satoh and coworkers, 1991). It was later described elsewhere as well and is being increasingly recognized. Takotsubo Cardiomyopathy characterized by transient apical and midventricular LV dysfunction in the absence of significant coronary artery disease that is triggered by emotional or physical stress. Its name refers to a contraption used for catching octopuses and suggests the aspect assumed by the ventricle during the systole due to the typical regional wall motion abnormalities that occur after onset. Takotsubo cardiomiopathy occurring mainly in post-menopausal women, echocardiography in the Takotsubo cardiomyopathy reveals during its acute phase a ballooning resembling the octopus trap configuration--the apex and lateral ventricular segments are hypokinetic while the base is hyperkinetic--along with reduced ejection fraction. Ventricular function will usually recover within a few days/weeks. OBJECTIVE AND PURPOSE The objective of this study is to determine the role of echocardiography in detecting and establishing the diagnosis of Takotsubo cardiomiopathy in patients with suspect acute coronary syndrome and during the follow up period. PATIENTS AND METHODS The study covered 12 adult patients the majority are women (92%) who were subjected to echocardiography evaluation as part of the clinical cardiological examination due to suspect acute coronary syndrome or Takotsubo Stress Cardiomyopathy. The patients were examined on an ultrasound machine Philips iE 33 x Matrix, ATL HDI and GE Vived 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated clinical characteristics, LV systolic function, biomarkers, and prognosis in all patients. RESULTS Among all the patients referred for Echocardiographic evaluation for left ventricle motion abnormalities with suspect acute coronary syndrome, the echo exam revealed 12 patients with acute apical ballooning which involving the left ventricular apex and med-ventricle. The triggering factors were physical stress in 4 patients (33%) and emotional stress in 8 patients (67%). The initial symptom was chest pain (n = 8, 67%) rather than dyspnea (n = 4, 33%). An initial electrocardiogram (EKG) presented ST-elevation (n = 10, 83%) and T-wave inversion (n = 2, 17%), other data are shown on Table 2. Among the all patients 8 of them (66%) had normal EF by the 1st follow up (47 +/- 51 days), and the rest 4 patients (34%) had normal EF by 68 +/- 96 days. CONCLUSION Widespread uses of echocardiography has contributed to more frequent recognition of Takotsubo stress cardiomyopathy and highlight the central role of this noninvasive method from an echocardiographers' perspective.

INTRODUCTION Atrial myxomas are the most frequent benign tumors of the heart. Left atrial myxomas are about 3-4 times more frequent then right. Clinical findings reveal atrioventricular obstruction symptoms and signs, symptoms and signs of peripheral arteries or pulmonary artery embolisation and/or nonspecific symptoms. AIM Review of atrial myxomas diagnosed at the Clinic of Cardiology in 20 years period and analysis of clinical characteristics, transthoracic echocardiographic (TTE), transesophageal echocardiographic (TEE), and M-mod echophonographic findings. METHODS TTE is performed in all, but TEE in 16 patients. Simultaneous M-mod echophonocardiographic examination were performed in 11 patients, when optional equipment was applicable. RESULTS We found 24 atrial myxomas: 19 (79.2%) in left and 5 (20.810%) in right atrium. 21(87.5%) patients had some of the symptoms, but 3 (12.5%) were asymptomatic. TTE was performed in all patients, but we found 1 (2.4%) false negative result. TEE was performed in 14 (58.3%) patients. Echophonocardiographic recordings showed early diastolic tumor "plop" in 10 patients and unusual late diastolic tumor "plop" in one right atrial myxoma, which has not yet been described. CONCLUSIONS TTE is a reliable method in diagnosis of atrial myxomas, but not in all cases, while TEE has been found as always reliable. Echophonocardiographic recording is useful for confirmation and understanding of auscultatory finding when applicable.