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.

In patients with heart failure, alterations in electrical fields generated within the myocardium have been associated with myocardial oedema which can act as a substrate for left ventricular dysfunction. Safety and efficacy of a direct microcurrent therapy using an implanted generator (C‐MIC) remain uncertain.

Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE).

BACKGROUND AND AIMS Adults with congenital heart disease (ACHD) knowledge regarding their heart condition is crucial for optimal long-term outcome. Previous studies from North-Western Europe showed that important gaps in ACHD knowledge still exist. This study evaluates ACHD patients' knowledge in Central and South-eastern Europe (CESEE) and aims to identify opportunities for improving life-long ACHD care and outcomes in this region. METHODS A structured survey regarding the baseline heart condition knowledge was prospectively distributed to stable ACHD patients over a one-year period (2021-2022). Patients' responses were verified by their ACHD physicians to ensure accurate background information. RESULTS Among 1650 patients (age 34.5 ±14) across 14 CESEE countries the majority 1023(62.0%) had simple congenital heart disease with at least one previous heart procedure performed 1201(72.8%); 1060(64.2%) were asymptomatic and 875(53.8%) had secondary school education. Overall, 576(34.9%) did not have basic knowledge regarding their congenital heart disease and 146(12.2%) did not have basic understanding regarding their previous heart procedure/s. Patients considered their life expectancy similar to the general population (p=0.039). Encouragingly, 962(59.5%) expressed a desire to learn more, and 929(58.1%) favoured technological integration in their care. CONCLUSIONS Significant knowledge gaps exist amongst CESEE ACHD patients regarding their heart condition. Better ACHD patient education on current health and prospects is urgently needed. The results of this study should serve for developing congenital heart disease structured transitional and educational programmes in CESEE incorporating technology for their ACHD care and education to enhance patients' health knowledge and healthy life-behaviours to positively influence their life-long prospects.

Background/Aim. Patients classified as belonging to simplified pulmonary embolism severity index (sPESI) class 0 are considered to have low-risk pulmonary embolism (PE). Yet, certain laboratory and echocardiographic parameters not accounted for in the sPESI score might suggest a likelihood of worse outcomes in PE cases. This study seeks to determine if the prognostic value of the sPESI score in acute PE can be improved, refined, and optimised by incorporating brain natriuretic peptide (BNP) and troponin I (TnI) levels, echocardiographic parameters, or glomerular filtration rate. Methods. The study encompassed 1,201 consecutive patients diagnosed with PE, confirmed by multidetector computed tomography (MDCT). Upon admission, each patient underwent an echocardiography exam, and blood samples were taken to measure B-type natriuretic peptide (BNP), troponin I (TnI), creatinine, and other routine laboratory markers. Results. The in-hospital mortality rate was 11.5%. The patients were categorized into three groups using the three-level sPESI model: sPESI 0, sPESI 1, and sPESI ≥ 2. Statistically significant differences were found among these groups regarding mortality rates, TnI values, BNP levels, estimated glomerular filtration rate (eGFR), and the presence of right ventricular dysfunction (RVD). Cox regression analysis identified eGFR as the most reliable predictor of 30-day all-cause mortality [HR 2.24 (CI 1.264-3.969); p = 0.006] across all sPESI categories. However, incorporating TnI, BNP, or RVD did not improve risk prediction beyond the three-level sPESI model. Conclusion. Renal dysfunction at the time of admission is closely related to an elevated risk of in-hospital mortality in patients with acute PE. The three-level sPESI score offers a more accurate method for prognostic stratification in these patients.

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.

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.

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.

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.

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.

Active malignant disease is associated with pulmonary embolism and the treatment of this condition is very challenging. The efficacy and safety of thrombolytic therapy for acute severe PE in patients with active malignant disease is unknown. This study aimed to investigate hospital mortality rate and the incidence of major bleeding at 7 days according to the International Society of Thrombosis and Hemostasis (ISTH) criteria in patients with active malignant disease who were treated with thrombolytic therapy due to severe acute PE. Patients with acute PE proven by computed tomography pulmonary angiography who were admitted to intensive care units have enrolled in the Regional PE Registry (REPER) since 2015, consisting of 10 hospitals from the 4 east Balkan countries. The decision to use thrombolytic therapy was at the discretion of the attending physicians, and it was used in high-risk, and intermediate-high-risk PE patients. Hospital mortality and the incidence of major bleeding at 7 days were compared between patients with active cancer and those without it who received thrombolytic therapy. Alteplase-based therapy was used. Among 2070 patients with acute PE enrolled in REPER, intermediate-high and high-risk PE had 795 patients without malignant disease and 135 had active malignant disease in the last 6 months. Patients with malignant disease had less chance to be treated with thrombolysis than patients without it (29.1% vs 44.7%, OR 0.508, 95%CI 0.341-0.756, p=0.001). For patients treated with thrombolysis, hospital mortality was non significantly higher in patients with the malignant disease compared to patients without it (25.6% vs 16,1%, OR 1.803, 95%CI 0.833-3.904, p=0.132), and the incidence of major bleeding at seven days was similar (15.4% vs 18.5%, OR 0.800, 95%CI 0.322-1.989, p=0.6131). There was no significant difference in age, sex, and PE risk distribution between patients with active malignant disease and those without it who were treated with thrombolysis. Thrombolytic therapy seems to be underutilized in patients with the active malignant disease compared to patients without it in severe acute PE. In the selected patients who were treated with thrombolysis for severe acute PE, the efficacy and safety are similar between patients with and without active malignant disease.

Acute pulmonary embolism (PE) management guidelines categorize normotensive patients with right ventricle dysfunction (RVD) and normal cardiac troponin (cTn) as intermediate low risk. This study explores the prevalence of cardiovascular comorbidities and their impact on risk stratification in this specific cohort. To investigate the characteristics of normotensive acute PE patients with RVD and normal cTn, emphasizing the role of pre-existing cardiovascular diseases in determining the intermediate-low risk status. A total of 1675 PE patients from a regional registry were screened, excluding high-risk and intermediate-high-risk cases. Among the remaining 400 normotensive patients with RVD, 353 with echocardiography and normal cTn were included. Patients were categorized into low or intermediate-low risk based on RVD presence. Cardiovascular comorbidities were assessed, and logistic regression analyzed their association with intermediate-low risk. Intermediate-low-risk patients (n=137) exhibited significantly higher rates of chronic heart failure, arterial hypertension, coronary artery disease, diabetes, and atrial fibrillation compared to low-risk patients (n=216). A substantial 77.4% of intermediate-low-risk patients had at least one cardiovascular comorbidity, significantly elevating the risk of RV dysfunction (adjusted OR 2.954, p<0.001). The all-cause hospital mortality was 5.1% in intermediate-low-risk and 1.4% in low-risk PE. Normotensive acute PE patients with RVD and normal cTn are predominantly burdened with chronic cardiovascular conditions. The majority of intermediate-low-risk patients have at least one cardiovascular comorbidity, indicating an increased risk of death during hospitalization compared to low-risk patients. This study underscores the necessity for nuanced risk stratification considering pre-existing cardiovascular diseases for tailored and effective management. These findings have important implications for optimizing treatment strategies and improving outcomes in this high-risk population.

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.