ObjectiveTo evaluate the predictive value of LA strain parameters and LASI for AF recurrence following electrical CV, and to compare them to conventional echocardiographic, biochemical, and clinical markers.MethodsIn this prospective, observational pilot study, 31 patients with persistent AF underwent electrical CV and were followed for six months. Echocardiographic evaluation included LA reservoir, conduit, and contractile strain, left atrial stiffness index, left atrial volume index (LAVI), left atrial appendage (LAA) morphology, left ventricular ejection fraction (LVEF), right atrial (RA) area, and right ventricular systolic pressure (RVSP). AF recurrence was assessed at three and six months.ResultsAt three months post-CV, LA reservoir, conduit, and contractile strain values were significantly negatively associated with AF recurrence (p < 0.001), while LASI and E/E' ratios were positively associated (p < 0.001). At six months, only contractile strain retained prognostic significance (p = 0.008). LVEF showed a positive correlation with recurrence at six months (p = 0.003), potentially reflecting the role of diastolic dysfunction.ConclusionLA strain parameters and LASI are valuable tools for predicting AF recurrence after CV, particularly in the early post-procedural period. Contractile strain may serve as a more reliable long-term predictor, emphasizing the importance of longitudinal atrial function assessment in rhythm outcome prediction. However, given the small sample size and single-center design, these results should be considered hypothesis-generating, requiring validation in larger studies.

Due to an epidemic of risk factors, such as hypertension, and an increase in life expectancy, cardiovascular disease (CVD) has an overwhelming morbidity and mortality burden worldwide. Various treatment options are available to disrupt pathophysiological processes along the cardiovascular continuum by focusing on distinct regions of the renin-angiotensin-aldosterone system (RAAS). As a RAAS inhibition, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are recommended first-line treatments for hypertension and CVD. Both ACE inhibitors and ARBs prevent CVD by lowering blood pressure (BP). Furthermore, a number of studies have shown that RAAS blockade can lower cardiovascular risk in ways that go beyond what could be predicted from lowering blood pressure alone. However, the ARBs are not all equally effective. Telmisartan is a long-lasting ARB that effectively controls BP over the full 24-hour period. In high cardiovascular risk patients, telmisartan reduces cardiovascular events in a manner comparable to that of the ACE inhibitor ramipril beyond lowering blood pressure alone, but with better tolerability. Research points to possible benefits for adipose tissue activity, neurovascular function, and enhancements in glucose and lipid metabolism. According to several studies, telmisartan has partial peroxisome proliferator-activated receptor gamma (PPARγ) agonist activity, which improves insulin resistance in diabetic patients by modifying adipokine levels. The combination of telmisartan and indapamide as metabolically neutral diuretic has an additional positive antihypertensive as well as cardioprotective effects. In addition to reviewing current CVD management guidelines, this article will examine important clinical trial and clinical practice data that assess the role of telmisartan/indapamide in CVD. Keywords: arterial hypertension, angiotensin II receptor blocker, telmisartan, cardiovascular risk.

Given the undeniable clinical and prognostic value, the function of the left atrium (LA) plays a leading role in the contemporary evaluation of cardiac diseases and is considered an essential morphological substrate for the development of cardiovascular diseases. It is sensitive to nervous, endocrine, and immunological stimuli. New evidence from the literature highlights the importance of fibrotic, electrical, and autonomic remodeling of the LA, introducing the concept of atrial cardiomyopathy, which is closely associated with atrial fibrillation and stroke. In the past, the diameter of the LA was the most important parameter for assessing its characteristics, but new information about the various roles of the LA has created the need for parameters that more precisely or thoroughly evaluate LA function. The function of the LA is complex, consisting of three phases: the reservoir phase (ventricular systole), the conduit phase (early diastole), and the pump phase (late diastole). The introduction of myocardial deformation analysis, or strain of the LA via speckle tracking, has achieved significant progress in detecting even subtle functional abnormalities before an increase in LA size. This method improves the diagnostic capabilities of standard echocardiographic examinations, and its diagnostic and prognostic value is sometimes comparable to more advanced and less accessible techniques such as cardiac magnetic resonance imaging and computed tomography.

BACKGROUND: Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE: This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS: A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS: LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION: LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The fibrosis of the LA, which is characteristic of AF, causes mechanical dysfunction of the LA and may also be present in patients without LA enlargement. LA strain represents a surrogate marker of this mechanical dysfunction. Early detection of LA dysfunction may be crucial in identifying patients who are more likely to experience AF recurrence following cardioversion and ablation. Before cardioversion and ablation, the probability of AF recurrence might be predicted, which could lead to better patient selection, an individualized therapeutic strategy with reduced risk and focused follow-up. Purpose The aim of this study was to evaluate the additional predictive value of LA function assessed by using strain echocardiography for early AF recurrence after cardioversion and ablation. Methods 94 patients diagnosed with symptomatic persistent atrial fibrillation (EHRA symptom score ≥3 (mean age 59.4 ± 12.2 years, 58% male, 42%female), preserved LV ejection fraction were prospectively analyzed. In 39 (41,5%) patients pharmacological cardioversion was done after saturation with antiarhythmic drugs,in 27 (28,7%) patients planed electrical cardioversion was done after medical saturation with antiarrhythmic drugs and failure of pharmacological cardioversion, and in 28 (29,8%) patients planed RF ablation was performed. Complete echocardiography evaluation including strain and volume index LA was performed before cardioversion and ablation. The rhythm evaluation was done in the first month after cardioversion and RF ablation (35±5 days). The primary endpoint was persistent AF recurrence. Results 29 (30,8%) patients had AF recurrence in the overall study population, independently of duration of AF or method of rhythm control. Peak atrial longitudinal strain (PALS) ≤15% had the highest incremental predictive value for AF recurrence (HR =8.42, 95% CI: 3.17–25.12, p < 0.001). In patients with non-dilated LA, PALS≤15% remained an independent predictor of AF recurrence (HR = 5.32, 95% CI: 1.77–17.42, p = 0.005). Conclusion This study shown that, in addition to LA dilatation, LA function as determined by PALS can provide a prognostic value for early AF recurrence after cardioversion or ablation. PALS also predicted AF recurrence in patients with nondilated LA. These findings highlight the additional prognostic usefulness of LA strain and recommend its implementation in the systematic assessment of AF patients prior to the choice of rhythm/rate control.

Background: Heart failure remains one of the most prevalent clinical syndromes associated with significant morbidity and mortality. According to current guidelines, the prescription of a MRA is recommended to reduce the risk of HF hospitalization and death in all patients with symptomatic heart failure and no contraindications for this therapy. Objective: The aim of our study was to determine the efficacy of eplerenone vs. spironolactone on left ventricular systolic function by measuring left ventricle ejection fraction (LVEF) in patients with chronic heart failure, especially their effect on preventing hospitalization, reducing mortality, and improving clinical status among patients with chronic HF. Methods: From June 2021 to June 2022, the study was a randomized, prospective clinical trial single blind study. A total of 142 patients of chronic heart failure with reduced ejection fraction were selected by random sampling. Each patient was randomly allocated into either of the two groups and was continued receiving treatment with either spironolactone (Spiron-HF group) or eplerenone (Epler-HF group). Patients in Epler-HF group were compared with an arm of the same size and matched by age and gender patients in Spiron-HF group for management of chronic HFrEF. Each patient was evaluated clinically, biochemically, and echocardiographically at the beginning of treatment (baseline) after 6 months and at the end of 12th month. Echocardiography was performed to find out change in left ventricular systolic function. Results: After 12 months of treatment, significant improvement of left ventricular ejection fraction was observed in eplerenone treated arm (37.9 ± 3.8 ± 4.6 in Spiron-HF group versus 40.1 ± 5.7 in Epler-HF group; P < 0.05). A significant reduction in left ventricular end-systolic volume (6.3 ± 2.5ml in Spiron-HF versus 17.8± 4.4ml in Epler-HF group; P < 0.05) and left ventricular systolic diameter volume (2.7 ± 0.5ml in Spiron-HF versus 6.7 ± 0.2ml in Epler-HF group; P < 0.05), occurred after 12 months of treatment. Left ventricular global longitudinal strain (LV GLS) was significantly improved in Epler-HF group compared with Spiron-HF group (0.6 ± 0.4 versus 3.4 ± 0.9; P < 0.05). There were no significant differences observed in reduction of left ventricular end-diastolic volume (2.2 ± 0.5 ml versus 4.7 ± 1.1ml; P =0.103) and left ventricular diastolic diameter (1.2 ± 0.6 versus 1.7 ± 0.3; P=0.082) in both arms. The effects of both MRA agents spironolactone and eplerenone on the primary composite outcome, each of the individual mortality and hospital admission outcomes are shown in Figure 1 and 2. Patients of the Epler-HF group showed statistically significant lower cardiovascular mortality (HR 0.53; 95% CI 0.34–0.82; p= 0.007) and all-cause mortality (HR 0.64; 95% CI 0.44–0.93; p= 0.022) than patients of the Spiron-HF group. The statistical analysis did not show a statistically significant difference between Epler -HF and Spiron-HF study groups regarding the risk of the primary composite outcome; cardiovascular death or hospitalization due to HF (Hazard Ratio (HR) eplerenone vs. spironolactone = 0.95; 95% Confidence Interval (CI) 0.73– 1.27; p= 0.675). Conclusion: Our study has demonstrated favorable effects of eplerenone on cardiac remodeling parameters and reduction of cardiovascular mortality and all-cause mortality compared with spironolactone in the treatment of HFrEF. The ability of eplerenone to effectively block the mineralocorticoid receptor while minimizing side effects and a significant reduction in the risk of hospitalization and cardiovascular death confirms its key role in the treatment of patients with chronic HFrEF.

Cardiotoxicity is one of the most important side effects of first-line chemotherapy medications. It is influenced by genetic variation, whereby the relationship between the chemotherapeutic dose and the risk of cardiotoxicity can be altered. The incidence of cardiotoxicity depends on the substance used in the therapeutic modality of cancer and can reach an incidence of 30% during a three-year follow-up. The main element of the clinical picture is systolic dysfunction of the left ventricle, with symptoms of heart failure, which can change or stop oncological therapy, along with pharmacological treatment of heart failure. These symptoms can occur during prolonged use of cancer therapies, monitoring the patient is advisable. Considering the increasing success of oncology therapy and the extension of life, as well as the improvement of the quality of life, a multidisciplinary approach, as well as the symbiosis of the work of cardiologists and oncologists, is imperative. Patient stratification concerning oncological treatment modality is imposed as part of a cardiologist's daily work from the beginning of cancer treatment.

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Aim To determine a status of systolic function in patients with diabetes mellitus (DM) type 2 with ST-segment elevation acute myocardial infarction (STEMI), to determine values of cardiac biomarkers in patients with DM type 2 with STEMI and correlate the parameters with ejection fraction of left ventricle (EFLV). Methods A total of 80 patients were divided into two groups, the study group (group I) consisting of 40 patients admitted with the diagnosis of DM type 2 and STEMI, and a control group (group II) with 40 patients with STEMI without diagnosed DM type 2. Cardiac biomarkers - creatine kinase MB fraction (CKMB), and troponin I were monitored. The EFLV was evaluated echocardiographically (using Simpson method) five days after primary percutaneous coronary intervention (pPCI). Results In the group I the EFLV five days after pPCI was significantly correlated with troponin values (with a minimum r = -0.47; p=0.002, a maximum r = -0.339; p = 0.032, as well as with an average value of r = -0.389; p=0.013), and with an average CK value (r = -0.319; p=0.045). In the group II there was a significant negative correlation of EFLV with the maximum value of troponin (r = -0.309; p=0.05). Conclusion Troponin values have an effect on the EFLV after STEMI, and thus on the left ventricular status, as well as on the pharmacological modality itself.

Aim To evaluate a correlation of serum level of neutrophil gelatinase-associated lipocalin (NGAL) to the risk of the occurrence of complications in patients with the early phase of ST-segment elevation myocardical infarction (STEMI) treated with fibrinolytic therapy prior to percutaneous coronary intervention (PCI). Methods A total of 54 patients with the diagnosis of STEMI treated with fibrinolytic therapy (alteplase) prior to PCI were included. Patients were admitted to the Intensive Care Unit (ICU) of Clinic for Heart, Blood Vessel and Rheumatic Diseases in the period January to March 2018. All patients underwent coronary angiography and PCI within the maximum of 48 hours delay after fibrinolysis, according to the hemodynamic and electrical stability and PCI availability. Blood samples were taken immediately after admission prior to fibrinolytic administration. Patients were divided into two groups according to NGAL values (less or more than 134.05 ng/mL). Results Higher values of NGAL have effect on a higher mean systolic and diastolic pressure (p=0.001 and p=0.003, respectively). Patients with higher NGAL values also have higher values of brain natriuretic peptide (p=0.0001) and highly sensitive troponin I (p=0.002). In that group relative risk (RR) for lethal outcome was 6.4 times significantly higher (p=0.002), for the development of heart failure 2.88 times (p=0.0002), for post-myocardial infarction angina pectoris 2.24 times (p=0.0158), and for ventricular rhythm disturbances (ventricular tachycardia, ventricular fibrillation) 1.96 times higher (p=0.0108). Conclusion Increased NGAL value is related to an unfavourable outcome of patients in the early phase of STEMI treated with fibrinolytic therapy prior to PCI.

Aim To examine the effects of therapeutic hypothermia on the outcome of patients with the diagnosis of out-of-hospital cardiac arrest (OHCA). Methods The study included 76 patients who were hospitalised at the Medical Intensive Care Unit (MICU) of the Clinical Centre University of Sarajevo, with the diagnosis of out-of-hospital cardiac arrest, following the return of spontaneous circulation. Therapeutic hypothermia was performed with an average temperature of 33oC (32.3 - 34.1o C) on the patients who had coma, according to the Glasgow Coma Scale (GCS). Results Multiple organ dysfunction syndrome (MODS) significantly affected survival (p=0.0001), as its presence reduced patients' survival by 96%. In addition, ventricular fibrillation (VF) as the presenting rhythm, also significantly affected survival (p=0.019). A degree of patient's coma, as measured by the GCS, significantly affected survival (p=0.011). For each increasing point on the GCS, the chance for survival increased twice. Moreover, other physiological factors such as the pH and the lactate serum levels significantly affected patients' survival (p=0.012 and p=0.01, respectively). Conclusion In patients with the diagnosis of OHCA who underwent to the treatment with therapeutic hypothermia, verified VF as a presenting rhythm was a positive predictive factor for their outcome. Therefore, therapeutic hypothermia represents an option of therapeutic modality for this type of patients.