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.

Introduction. When considering revascularization modalities, for patients with stable presentation, with appropriate coronary anatomy suitable for both PCI and CABG and low predicted surgical mortality, the recommendations are specifically focused on patients with main stem stenosis. In these cases, patients should be individually assessed according to the complexity of the anatomical disease, as determined by the anatomical SYNTAX score. In the last few years, the results of four randomized studies have been published comparing PCI with newer-generation DES and CABG in patients with left-main stenosis. The latest 2024 ESC guidelines for the management of chronic coronary syndromes recommend CABG over PCI when the anatomical SYNTAX score exceeds 22, as indicated by recent trials. The aim of this study was to examine whether the indications for CABG or PCI, as determined by the well-informed intuitive judgment of PCI operators in everyday clinical practice, align with the treatment recommendations outlined in the recently published ESC guidelines. Methods. Between January 1, 2023, and December 31, 2023, patients were recruited from the University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, utilizing the hospital information system. The study included consecutive patients diagnosed with significant unprotected left main coronary artery disease (≥50% diameter stenosis) confirmed through angiography, who did not exhibit major hemodynamic instability and received PCI at our facility. Patients were divided into two groups, based on the anatomical SYNTAX score i.e. those with SYNTAX ≤ 22 and those with SYNTAX > 22. Results. Following inclusion criteria, a total number of 38 patients were included in the analysis. The included patients had either previously diagnosed coronary artery disease or a high suspicion of coronary artery disease. The majority of the participants were male, with an average age of 65.6 years, with the youngest participant being 31 years old and the oldest 83 years old. A large majority of both sexes suffered from arterial hypertension, dyslipidemia, and type 2 diabetes. Participants in whom SYNTAX score was ≤ 22 were younger (p=0.049) and had less complex coronary artery disease i.e. fewer MEDINA 1,1,1 (p< 0.001) with less stents implanted (p=0.040). Over the course of one year of follow-up, three patients passed away, two of whom had a SYNTAX score exceeding 22. Additionally, two patients were lost to follow-up. Conclusion. The present study demonstrates that an intuitive decision-making process by experienced interventional cardiologists for choosing the optimal myocardial revascularization method for the individual patient with left main stenosis led to a discordance of the definitely chosen methods vs. the recommended method based on the SYNTAX score and ESC guidelines. This discordance between the recommended and the finally performed revascularization strategy led to a higher shortterm mortality.

Acute myocardial infarction with ST elevation (STEMI) is a disease of the elderly, rarely of people younger than 40 years, predominantly men with comorbidities. The incidence of STEMI infarction in the general population in women younger than 40 years is very low. This paper presents the case of a young woman who was admitted with a diagnosis of STEMI infarction, which was understood as SCAD after coronary angiography. Repeated invasive diagnostics with intracoronary imaging determined that it was a classic infarction with plaque rupture/erosion and a large intraluminal thrombotic mass that partially embolized with occlusion of the apical part of the anterior descending artery (LAD). She was treated during hospitalization with dual antiplatelet therapy (DAPT) using a potent P2Y12 inhibitor and low molecular weight heparin, high dose of statins. Control coronary angiography revealed insignificant narrowing of the distal part of the main trunk of the left coronary artery (LM) and the proximal segment of the LAD with almost complete resolution of the thrombus. DAPT treatment was continued without stent implantation.

Background. Patent foramen ovales are very common in the population. Thrombus entrapped in a patent foramen ovale is very rare and can cause paradoxical embolism with a high mortality rate. We present the case of a patient diagnosed with a massive pulmonary embolism and a huge thrombus stuck over the interatrial septum. Case presentation. An 83-year-old female patient was admitted to our Coronary care unit with the diagnosis of massive pulmonary embolism confirmed by contrast-enhanced chest CT scan. At admission, the patient complained of chest pain and shortness of breath for the last 24 hours. Transthoracic echocardiography (TTE) showed the presence of a thrombus entrapped in a patent foramen ovale and floating in both atria. Transesophageal echocardiography was done as well to confirm the diagnosis. Deep vein thrombosis was diagnosed by duplex ultrasonography. After discussing the risks and benefits of surgical versus medical treatment, the patient was treated with unfractionated heparin during hospitalization and rivaroxaban on discharge. Seven days later, follow-up TTE showed no clot in the heart. Conclusion. Although rare, the thrombus stuck in patent foramen ovale presents a clinical emergency so early diagnosis and treatment is mandatory.

Cryptogenic stroke is an ischemic stroke of unknown cause after a comprehensive diagnostic workup and accounts for a significant percentage of all strokes. This paper presents the case of a 37-year-old female patient with recurrent ischemic strokes, in whom a patent foramen ovale (PFO) was diagnosed and subsequently closed via catheter-based intervention. Despite this therapeutic procedure, further recurrences occurred. During electrophysiological evaluation and ablation of paroxysmal supraventricular tachycardia, paroxysms of atrial fibrillation were detected, leading to the initiation of anticoagulant therapy. During follow-up, the patient remained free of symptomatic recurrences. This case highlights the importance of prolonged monitoring for the detection of atrial fibrillation in patients with cryptogenic strokes, which can significantly influence therapeutic strategies and recurrence prevention.

Medical professionals have a responsibility to inform the public about contemporary research on alcohol consumption. Earlier health recommendations focused primarily on the link between alcohol and cardiovascular diseases. Over time, these guidelines have expanded to consider the broader impact of alcohol on all-cause morbidity and mortality. Unlike the tobacco industry, which remains profitable but faces strict regulations on marketing and lobbying, the alcohol industry benefits from fewer regulations. This allows alcohol manufacturers to freely promote their products and influence both federal and state policies. Clear emphasis on the importance of ceasing alcohol consumption is crucial, particularly in primary and secondary prevention efforts. Keywords: cardiovascular diseases, alcoholics, prevention.

Atrial cardiomyopathy is closely associated with atrial fibrillation (AF), and some patients exhibit no dysfunction at rest but demonstrate evident changes in left atrial (LA) function and LA volume during exercise. This study aimed to identify distinguishing signs during exercise stress echocardiography (ESE) among patients in sinus rhythm (SR), with and without history of paroxysmal/persistent AF (PAF). A prospective cohort of 1055 patients in SR was enrolled across 12 centers. The main study cohort was divided into two groups: the modeling group (n = 513) and the verification group (n = 542). All patients underwent ESE, which included B-lines, LA volume index (LAVi), and LA strain of the reservoir phase (LASr). Age, resting and stress LAVi and LASr, and B-lines were identified as a combination of detectors for PAF in both groups. In the entire cohort, aside from resting and stress LAVi and LASr, additional parameters differentiating PAF and non-PAF patients were the presence of systemic hypertension, exercise E/e’ > 7, worse right ventricle (RV) contraction during exercise (∆ tricuspid annular plane systolic excursion < 5 mm), a lower left ventricular contractile reserve (< 1.6), and a reduced chronotropic reserve (heart rate reserve < 1.64). The composite score, summing all 9 items, yielded a score of > 4 as the best sensitivity (79%) and specificity (65%). ESE can complement rest echocardiography in the identification of previous PAF in patients with SR through the evaluation of LA functional reservoir and volume reserve, LV chronotropic, diastolic, and systolic reserve, and RV contractile reserve. A scoring system predicting the probability of PAF. The score was computed using the cutoff values as in the illustration. The score >4 demonstrated a sensitivity of 79% and a specificity of 65% of PAF.

Introduction: Treatment-resistant hypertension (TRH) is a frequent phenomenon, for which no complete solution has yet been found. More than 5% of patients treated for hypertension do not achieve blood pressure control with three first-generation antihypertensive drugs. Objective: The aim of this new cohort investigation, which is an extension of the TRYCORT study, is to re-examine the efficacy and safety of additional antihypertensive therapy in a group of adult patients with TRH. Methods: The study was designed as multi-national, multi-centre, prospective cohort study, which compared effectiveness and safety of add-on treatmentsof resistant hypertension. The patients were followed-up for 6 months, and primary outcome was treatment response. Results: In total139 patients completed the study(66women and 73 men), with average age of 63.6 years. Initial add-on therapy was changed at study visits if response to treatment was inadequate. The blood pressure below 140/90 mmHg was achieved in 75% of patients with add-on spironolactone, while effectively all patients achieved drop in systolic blood pressure ≥ 10 mmHg, and drop in diastolic blood pressure ≥ 5 mmHg. Only one treatment-related adverse effect was observed (pretibial oedema in patient taking amlodipine), while serum levels of potassium remaind within the reference limits. Quality of life increased and paralleled the treatment response. Conclusion: In conclusion, spironolactone proved to be the most effective and safe add-on therapy of resistant hypertension, but it needs several months of regular intake to achieve full effect and improve quality of life. Conclusion Spironolactone proved to be the most effective and safe add-on therapy of resistant hypertension, but it needs several months of regular intake to achieve the full effect and improve quality of life.

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.

Background: Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. Aim: This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. Methods: In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. Results: LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). Conclusions: In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.

INTRODUCTION Sodium-glucose cotransporter-2 (SGLT2) inhibitors are integral in treating patients with heart failure, regardless of the existence of diabetes mellitus. In light of their benefits on the heart muscle, the question of their effect on acute coronary syndrome is raised, and a hypothesis as to whether they can be implemented in its treatment is proposed. The aim of the article was to indicate the potential of using SGLT2 inhibitors in the treatment of myocardial infarction (MI). EVIDENCE ACQUISITION A PubMed search for articles published between October 2017 and May 2022 was conducted using the following keywords: "SGLT2 inhibitors," "Acute Coronary Syndrome," "Treatment," "Prognosis." Reference lists of identified articles were searched for further articles. EVIDENCE SYNTHESIS Reports from clinical trials and animal studies thus far investigating mechanistic pathways of SGLT2 inhibitors' effect in relation to acute myocardial infarction were interplayed to extract relevant findings and analyze the safety of this therapy in acute coronary syndrome (ACS) patients. CONCLUSIONS SGLT2 inhibitors indicate beneficial effects in acute cardiovascular incident by various mechanisms, and early initiation of therapy may improve outcomes for AMI survivors.

In modern cardiology, sodium‐glucose cotransporter 2 (SGLT2) inhibitors are critical components of heart failure (HF) treatment algorithms and exert their effects primarily by preventing glucose reabsorption and facilitating its urinary excretion. The objective was to systematically review randomized controlled trials (RCTs) assessing the effects of SGLT2 inhibitors, particularly canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, sotagliflozin (dual SGLT inhibitor), and their use in HF. Systematic searches of PubMed/Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were performed. There were no restrictions imposed on the date and status of publication; however, there were restrictions on language for the searched studies. A total of 1139 records were identified in the bibliographic searches from both databases and the register of choice for this systematic review. Following duplicate removal, screening for titles and abstracts, and thorough assessment of full‐text articles, 12 RCTs met the inclusion criteria. Altogether, 83 878 patients were included in this review. Among the included studies, two RCTs, with six respective reports, investigated canagliflozin, four RCTs with 13 derived reports investigated dapagliflozin, three RCTs with 12 separate reports studied the effects of empagliflozin, one RCT and its three respective reports assessed ertugliflozin's effects, and two RCTs with one added report investigated the dual inhibitor sotagliflozin. Pooled meta‐analytic effects of SGLT2 inhibitors were as follows: on atrial fibrillation odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.68–1.01, prediction interval (PI): 0.57–1.19; on HF hospitalization OR = 0.69, 95% CI: 0.60–0.78, PI: 0.60–0.78; on cardiovascular death OR = 0.82, 95% CI: 0.58–1.15, PI: 0.42–1.60; and on major adverse cardiovascular events OR = 0.90, 95% CI: 0.77–1.06, PI: 0.71–1.15. SGLT2 inhibitors significantly improve the quality of life in HF patients. Their beneficial effects on HF, especially in left ventricular dysfunction, have made their use possible irrespective of diabetes mellitus or atrial fibrillation status.