Anastazija Stojšić-Milosavljević

Investigating the relationship between education level and disease incidence are critical indicators of population health. This study examines the relationship between educational attainment and cardiovascular diseases (CVDs) among patients treated at the Institute for Cardiovascular Diseases of Vojvodina (ICDV) in Sremska Kamenica, northern Serbia. The study period spans from 2003 to 2023. To perform statistical analysis, data processing, and visualisation, several Python modules were utilised. A chi-squared test was first conducted, yielding values indicating a statistically significant relationship between education level and the number of admitted CVDs patients. Subsequently, a Poisson regression model was applied to aggregated patient admission data to assess the association between educational attainment and CVDs incidence over time. The results confirmed strong statistical significance for both the main effects and their interactions, with all interaction terms showing p-values smaller than 10⁻¹⁸. Additionally, this study conducted an Emerging Hot Spot (EHS) analysis by the education level of patients. Spatial patterns were identified in 152 settlements. All of these settlements exhibited hot spots only, specifically “Consecutive Hot Spot” and “Sporadic Hot Spot” patterns. These findings indicate that temporal trends in hospitalisation rates vary significantly by education level, emphasising the need for targeted preventive measures among the lower-educated populations. Studies of this kind can serve as a model for similar research in other regions, helping to inform evidence-based public health strategies and contribute to a better understanding of the social determinants of health on a broader scale.

The professional structure of the population plays a significant role in the development of cardiovascular diseases. The aim of this study was to analyse the occupational structure of patients treated at the Institute of Cardiovascular Diseases of Vojvodina (ICDV) in Sremska Kamenica in order to determine which occupational groups are more frequently represented among cardiovascular patients. Emerging Hot Spot Analysis was used to identify spatial and temporal patterns. The analysis was applied to the five most represented occupations. In the occupation category “housewives”, 17 municipalities were classified as consecutive hotspots. In the category “workers without a specified occupation”, a total of 35 municipalities were classified as emerging hotspots, of which 31 were consecutive and 4 spo-radic. In the group “metal, machinery, and related workers”, 23 municipalities were classified as emerging hotspots, including 16 consecutive and 7 sporadic hotspots. For the occupation category “other craftsmen and related workers”, 29 municipalities were identified as emerging hotspots, of which 20 were consecutive and 9 sporadic. In the category “clerical workers”, 24 municipalities were classified as emerging hotspots, including 18 consecutive and 6 sporadic hotspots. The obtained results may serve as a basis for identifying occupations associated with increased risk. This could enable timely planning and implementation of preventive measures, improvement of working conditions, and strengthening of healthcare protection for employees in particularly vulnerable occupational groups.

Cardiovascular diseases represent one of the most dominant categories of non-communicable diseases, with a high prevalence both in Serbia and globally. Understanding their spatial distribution provides valuable insights for public health planning and disease prevention. This study applies geospatial analysis to examine the patterns of CVD among patients treated at the Institute for Cardiovascular Diseases of Vojvodina in Serbia, over the period 1995–2023. Beyond identifying spatial clusters, the analysis reveals long-term intensification of CVD burden in the South Bačka urban-suburban zone, indicating a sustained spatial polarization of cardiovascular morbidity over nearly three decades. Mann-Kendall trends per settlement were calculated. The spatial dimension of the research was addressed using the Emerging Hot Spot Analysis to detect statistically significant clusters of high and low values. To further refine the spatial representation of CVD clusters, the Kriging interpolation method was applied. The findings underscore the significance of geospatial methods in pinpointing high-risk areas in cardiovascular diseases, providing an evidence-based foundation for targeted healthcare interventions and resource allocation. Moreover, this study demonstrates the potential of integrating spatial geostatistics with health data to support the development of preventive strategies and to guide future epidemiological research on non-communicable diseases in Serbia and beyond.

Background: Hypertensive disorders in pregnancy (HDP) are associated with adverse pregnancy outcomes. Three-dimensional (3D) echocardiography provides greater accuracy for assessing cardiac geometry and function during pregnancy. The aim was to assess the impact of the 3D left ventricle (LV) systolic function in HDP on pregnancy outcomes. Methods: The prospective cohort study included primiparous with singleton pregnancies, without previous comorbidities who underwent medical history assessment, laboratory tests, ambulatory blood pressure monitoring (ABPM), and transthoracic echocardiography at baseline and six weeks after delivery. Participants were divided into a HDP group and a control group. Pregnancy outcomes (intrauterine growth restriction (IUGR), preterm delivery, and birth weight) were recorded and analyzed. Results: The study involved 174 HDPs and 64 controls, with a median gestational age of 34 weeks (31; 36). Compared to controls HDP exhibited significantly impaired values in both two-dimensional (2D) and 3D parameters for the systolic and diastolic function of the LV. They had higher LV mass index values and lower absolute values for 2D global longitudinal strain and 3D LV strain in all directions (p < 0.001). Multivariable regression analysis revealed that body mass index (BMI) with odds ratio (OR) of 0.751 (95% confidence interval (CI): 0.666–0.847, p < 0.001) and 3D LV global area strain (GAS) with OR of 0.234 (95% CI: 0.155–0.352, p < 0.001) were the strongest predictors of IUGR, while BMI with OR of 0.832 (95% CI: 0.758–0.914), nighttime systolic blood pressure (SBP) with OR of 1.055 (95% CI: 1.032–1.079, p < 0.01) and 3D LV ejection fraction (EF) with OR of 0.780 (95% CI: 0.687–0.885) were the strongest predictors of preterm delivery. The receiver operating characteristic (ROC) curve showed that the model with BMI and 3D LV GAS can be a good predictor for IUGR with an area under the curve (AUC) 0.951 (0.925–0.976) with 89.5% sensitivity and 86.4% specificity, p < 0.001, while the model with BMI, nighttime SBP and 3D LV EF is a predictor for preterm delivery with AUC of 0.835 (0.776–0.893) with 79.1% sensitivity and 73.7% specificity, p < 0.001. Person correlation showed a significant positive correlation between birth weight and 3D GAS, r = 0.485; p < 0.001. Conclusions: LV GAS is significantly associated with IUGR and birth weight, while 3D LV EF strongly predicts preterm delivery.

Introduction. Paradoxical sinus deceleration is an uncommon hemodynamic response observed during dobutamine stress echocardiography, characterized by a decrease in heart rate despite escalating doses of dobutamine, with or without a concomitant reduction in arterial blood pressure. Earlier studies associated this phenomenon with inferior myocardial ischemia, whereas more recent evidence suggests a potential autonomic mechanism mediated by activation of the Bezold-Jarisch reflex, particularly in the absence of left ventricular segmental wall motion abnormalities. The reported incidence of paradoxical sinus deceleration ranges from 5% to 10%, and its clinical significance appears to depend primarily on the presence of inducible ischemia. Case Report. A 53-year-old woman with arterial hypertension, dyslipidemia, and a positive family history of cardiovascular disease was evaluated for atypical anginal symptoms. At the maximal dose of dobutamine, asymptomatic paradoxical sinus deceleration accompanied by transient hypotension was observed. Electrocardiography revealed no ischemic changes or rhythm disturbances, and echocardiography demonstrated no left ventricular segmental wall motion abnormalities. The examination was therefore interpreted as negative for inducible myocardial ischemia. Conclusion. In the absence of echocardiographic evidence of ischemia, paradoxical sinus deceleration during dobutamine stress echocardiography does not represent an independent indication for invasive diagnostic procedures. The absence of left ventricular segmental wall motion abnormalities is pivotal in therapeutic decisionmaking, and conservative medical management with structured clinical follow-up constitutes a rational and safe approach.

The concept of diversity, equity, inclusion and belonging is essential for research and academic programs and institutions worldwide, but although women do not lag behind men at entry and graduation from Serbian universities, equitable leadership does and it further hinders outcomes in every way: from translational science via healthcare up to legislative efforts to protect children, women and elderly. Although all these may seem as l?art-pour-l?art issues when compared to mere survival in war zones on two continents and all issues women face under circumstances of displacement and bans on rights to education, healthcare and sounds of their own voices in public, still it is the ongoing fight for rights lost in silence and where one least expects it that has to push every human being to fight for the oppressed and underprivileged.

Introduction Pulmonary artery hypertension and right ventricular failure are potentially fatal complications that can develop in patients with portal hypertension. The objective of this case report was to report a patient with end-stage liver disease, and portal and pulmonary artery hypertension and right heart failure.Case outline A 57-year-old man was admitted to the Cardiology Department of a tertiary referral hospital due to signs of right-sided heart failure, ascites, pleural effusions, and pretibial edema. The patient had the history of alcohol abuse, arterial hypertension, and gout. Just prior to the admission, abdominal ultrasound revealed granular liver structure, as well as ascites. Laboratory tests showed microcytic anemia, values of transaminases below referent, hypoalbuminemia, low creatinine clearance. Echocardiography revealed pulmonary hypertension, and right ventricle failure. Right heart catheterization unraveled precapillary pulmonary hypertension, but thoracic CT scan and thoracocentesis excluded underlying pulmonary illness. Treatment continued at the Gastroenterology Department of the tertiary hospital. Abdominal CT scan diagnosed cirrhotic liver, and signs of portal hypertension. The patient was treated with symptomatic therapy, but developed acute-on-chronic renal failure and eventually died.Conclusion Multidisciplinary approach is very important to distinguish portopulmonary hypertension early in the course of liver disease, because evolution of right sided heart failure precludes these patients from adequate lifesaving therapy.

Introduction. The number of adult patients with a congenital heart defect (adult congenital heart disease - ACHD) is higher than children born with the defect. The study aimed to examine the characteristics of patients with ACHD treated over a 10-year period at the Institute for Cardiovascular Diseases of Vojvodina (ICVDV). Methods. A retrospective cohort study included patients examined and treated under the diagnosis of congenital heart defect at IKVBV from 2011 to 2021. Patients with ACHD were identified by searching the electronic database based on the ICD classification. In the examined group, we evaluated demographic characteristics, the presence of comorbidities, and complications that developed during follow-up in a predefined time period. Results. Out of 106123 patients treated during the 10-year period, 0.8% were diagnosed with ACHD. The most frequently registered ACHD were atrial septal defect (ASD) with 49.1%, ventricular septal defect with 13.1%, congenital anomalies of the aortic valve 10%, and coarctation with aorta narrowing 6.2%. In comparison, complex defects like tetralogy of Fallot with 2.7% and transpositions of great arteries (1.2%) had lower prevalence. The most prevalent complications were heart rhythm disturbances in 44% and pulmonary hypertension in 15.2% of ACHD patients. The most common comorbidities were arterial hypertension (46.7%) and ischemic heart disease (20.5%). Conclusion. The prevalence of ACHD was 0.8%. The most prevalent defects were from the group of septal defects. The most prevalent complications were heart rhythm disorders and pulmonary hypertension.

Introduction: Left ventricular dysfunction (LVD) in chronic obstructive pulmonary disease (COPD) increases the risk of mortality. The coexistence of LVD and COPD has substantial number of diagnostic difficulties. It is still not clear how prevalent is it and what causes LVD in COPD patients without cardiovascular diseases. The aim of our study was to assess the prevalence of LVD and its association with the severity of the COPD. Methods: The prospective cohort study included 120 patients with previously diagnosed stable COPD. In all patients spirometry and transthoracic echocardiography were performed. Patients were divided into four stages of COPD, according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Results: The prevalence of LVDD across the cohort was 65.8%. The first degree of DD was found in 42.5% of COPD patients, second degree in 20.8% and third degree DD in 2.5% of patinets. LVDD was present in all COPD stages, but was not associated with the severity of the COPD disease (p = 0.8). The parameters of systolic function are decreasing with COPD stage, with significant differences between groups (SVI (p=0.01), EF p<0.001). Decreased EF≤49% was found in the 16.6% of cochort, in the first COPD stage 13.3% vs. 10% in GOLD II vs. 20% in GOLD III and 23.3% of patients in GOLD IV. Conclusion: Undiagnosed LVD in COPD patients without previously diagnosed CVD was highly prevalent. These results highlight the need for regular echocardiography screening to reduce morbidity and mortality in these patients.

Background. Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease that affects approximately one in 500 people. HCM is a recognized genetic disorder most often caused by mutations involving myosin-binding protein C (MYBPC3) and β-myosin heavy chain (MYH7) which are responsible for approximately three-quarters of the identified mutations. Aim. So far, no medical treatment has reliably shown to halt or reverse progression of HCM or to alleviate its symptoms. While the angiotensin receptor neprilysin inhibitor sacubitril/valsartan has shown to reduce mortality and hospitalization in heart failure with reduced ejection fraction, data on its effect on HCM are sparse. We sought to explore the effect of sacubitril/valsartan on exercise tolerance (ie, peak oxygen consumption) in patients with nonobstructive HCM compared to the optimal standard therapy (control group). Methods. The study presented is a part of SILICOFCM - a prospective, multicenter, open-label, randomized, controlled, three-arm clinical trial (NCT03832660) that will recruit 240 adult patients with a confirmed diagnosis of nonobstructive HCM. However, this study included only 41 patients from a single center. Eligible patients are randomized to sacubitril/valsartan, or optimal standard therapy alone (control group). The primary endpoint is the change in functional capacity (ie, peak oxygen consumption). Results. The study included 41 patients assigned to intervention group (29 patients) and control (12 patients). Mean age was 60.0±10.4 years, and majority of patients were male (73.2%). Left ventricular wall thickness measured at interventricular septum and posterolateral wall was 17.3±4.3 mm and 15.6±3.5 mm, respectively. Baseline peak VO2 was 14.0±4.4 ml/kg/min and VE/VCO2 28.1±6.4. After 4 months follow-up, the intervention group expressed an increase in VO2 from 14.4 ml/kg/min to 16.4 ml/kg/min (p=0.016). The value of VE/VCO2 decreased from 26.6 to 25.8 in the intervention group, while in the control group it changed from 26.0 to 30.9. The value of VE/VCO2 after 4 months follow-up was significantly lower in the intervention group (25.8±5.3 vs 30.9±4.9; p=0.050). Conclusion. The results of the present study suggest that, despite the relatively short treatment period of 4 months, sacubitril/valsartan treatment can have positive effects functional capacity in patients with HCM. These results, together with the rest of the SILICOFCM study outcomes, will hopefully contribute to the optimization of the HCM management.