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Objective: To evaluate the need for ECG monitoring of unselected patients recovered from COVID-19 and to estimate the risk of development of arrhythmias and heart rate variability change after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: Between March 2020 and January 2021 patients who had recovered from PCR-proven SARS-CoV-2 symptomatic infection (alfa and beta variants) were enrolled in a prospective observational cohort study CoSuBr (COvid SUrvivals in BRno) and those with two 7-day ECG monitoring have been analysed. Demographic parameters, patient history, clinical evaluation, and 7-day ECG monitoring were recorded within two times intervals: the first at least six weeks after infection and a follow-up visit one year later to establish any changes in heart rate variability (HRV). Results: The study group consisted of 74 individuals, 42 of which were females (56.8%), with 7-day ECG monitoring performed in both time intervals. The mean age was 48 years (range 21-77 years). The mean time interval between the onset of the infection and the follow-up visit was 105 days. At the time of enrolment, 61% of the patients were experiencing ongoing symptoms, while more than half of the whole group (51.3%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue). There was no change in the average heart rate between visits (72.7 ± 8 vs. 72.5 ± 8/min; p = 0.756), and no difference in the incidence of supraventricular or ventricular ectopy. There was no difference in parameters between symptomatic/asymptomatic groups. At the one-year follow-up visit after COVID-19 infection, there was no change in heart rate variability evaluated by SDNN (V1 vs. V2 156.6 ± 40.6 vs. 156.0 ± 38.0; p = 0.855), rMSSD (V1: 33 ± 13.95 to 30.6 ± 12.89; p = 0.175) and triangle (V1: 28.5 ± 7.8 to 29.5 ± 8.8; p = 0.488). We evaluated the presence of supraventricular and ventricular arrhythmias, and the ECG monitoring showed no significant pathology. Conclusion: Despite a lot of information regarding cardiac impairment caused by SARS-CoV-2, our study does not suggest an increased risk in developing arrhythmias after COVID-19 in the one-year follow-up. Based on our results, routine ECG monitoring is currently not recommended after recovery from COVID-19.

Objective: This study evaluates the efficacy and safety of the 1940 nm diode laser for endovenous laser ablation (EVLA) compared to 1064 nm and 1470 nm wavelengths. The objective was to validate the theoretical benefits of high water absorption at 1940 nm, specifically the confinement of heat distribution within the vein wall, by correlating long-term clinical outcomes with quantitative data from 3D numerical thermal modeling. Methods: A prospective 15-year clinical registry (2010-2025) comprising 5,086 patients was analyzed, divided into sequential cohorts treated with 1064 nm (15 W), 1470 nm (10 W), and 1940 nm (8 W) lasers. Concurrently, a time-dependent 3D finite difference model based on the Pennes bioheat equation was developed to simulate heat distribution. The model quantified the cumulative thermal load on perivenous tissue and radial temperature profiles for each wavelength. Results: Numerical simulations demonstrated that the 1940 nm wavelength reduced the perivenous thermal load by over 30-fold compared to 1064 nm, strictly confining heat to the target vein. Clinically, the 1940 nm protocol (8 W) achieved a venous closure rate >98%; equivalent to higher-power wavelengths despite a 50% reduction in power settings. This resulted in minimal postoperative pain and a low complication rate, with secondary follow-up visits required in only 4.4% of cases. Conclusion: The 1940 nm wavelength optimizes selective photothermolysis by maximizing heat absorption within the vein wall. This allows for effective ablation at significantly lower power, ensuring procedural success while minimizing collateral thermal injury and improving patient comfort.

Coronary artery bypass grafting (CABG) remains the cornerstone surgical therapy for complex or advanced coronary artery disease. Yet, the long-term success of CABG depends heavily on systematic postoperative cardiac follow-up. Early evaluation focuses on arrhythmia prevention, hemodynamic stability, and detection of perioperative myocardial injury, whereas long-term care integrates graft surveillance, risk-factor modification, and rehabilitation. New data highlight biomarkers such as NT-proBNP, galectin-3, and adropin, together with imaging modalities like strain echocardiography and cardiac CT angiography. A multidisciplinary, patient-centered model ensures better outcomes and quality of life after CABG.

Prague, November 2–4, 2025

Aim: The CHA₂DS₂-VASc (heart failure, hypertension, age >75, diabetes mellitus, stroke history, vascular disease, 65-74 age range, gender) and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleed- ing history, labile INR, elderly, drugs/alcohol) are scoring system for using to estimate stroke and bleeding development in cases with atrial fibrillation. We aim to evaluate the relationship between the implantable cardioverter defibrillator (ICD) therapies and CHA₂DS₂-VASc and HAS-BLED scores. Methods: 398 patients were included in this retrospective study after reviewing the data of the patients above the age of 18 who had ICD implantation for any reason between 2014-2019 and who were found to have at least two pacemaker check-ups with 6-month intervals. CHA₂DS₂-VASc and HAS-BLED scores were calculated during the device implantation and last control visit date. Results: 148 of the patients received ICD therapy (appropriate shock [n = 118] and in appropriate therapy [n = 30]) and 250 of them did not receive any therapy. It was observed that the CHA₂DS₂-VASc and HAS-BLED scores were similar in the groups receiving and not receiving therapy (respectively, p = 0.64 and p = 0.60). CHA₂DS₂-VASc and HAS-BLED scores were similar in patients with appropriate shock or not (respectively, p = 0.89 and p = 0.85) with median follow-up period 5.5 years. Multivariate regression analysis showed that reduced ejection fraction, presence of single-chamber ICD, lapsing of a long time after the implantation were independent risk factors for ICD device therapies (p < 0.05). Conclusions: CHA₂DS₂-VASc and HAS-BLED scores are not associated with device-based ICD therapies.

Aim: Side branch (SB) ostial stenosis is a frequent bifurcation lesion and its optimal treatment strategy is still debated. Although the efficacy of the optimal medical therapy is well known, the comparison of the medical treatment and percutaneous coronary intervention (PCI) is controversial. Methods: A total of 357 consecutive patients with isolated SB ostial stenosis (Medina 0.0.1 classification) was evaluated retrospectively. Patients were divided into two groups; patients with only medical therapy (n = 305) and patients undergoing PCI (n = 52). Target vessel revascularization (TVR), myocardial infarction (MI), and mortality were evaluated as major adverse cardiovascular outcomes (MACE). Results: The mean age of the patients was 58.2±10.3 years. 102 patients (28.6%) were female. 279 patients (78.2%) had diagonal lesion while 78 (21.8%) had obtuse marginal lesion. The SB stenosis ratio (70±16; 88±13, p < 0.001) and SB lesion length (7.5±6.6; 14.7±6.0, p < 0.001) were higher in the PCI group. SB ostial stenting (38 patients [73.1%]) was the common PCI technique. There were no significant differences in terms of TVR (1.3%; 1.9%, p = 0.277, medical vs PCI groups, respectively), MI (8.2%; 7.7%, p = 0.302, medical vs PCI groups, respectively), mortality (10.2%; 9.6%, p = 0.095, medical vs PCI groups, respectively) and MACE (18.0%; 15.4%, p = 0.113, medical vs PCI groups, respectively) between groups. Additionally, in Kaplan-Meier long-term survival analysis, there were no differences in TVR (log-rank p = 0.247), MI (log-rank p = 0.295), mortality (log-rank p = 0.086), and MACE (log-rank p = 0.107) between groups. Conclusions: Medical therapy instead of PCI seems to be an appropriate and optimal treatment strategy in patients with non-left main SB ostial stenosis.

Introduction: Continuous medication use is essential for patients with atrial fibrillation using new oral anticoagulants. Older age and polymorbidity may affect compliance related to the anticoagulation therapy. Methods: An observational cohort study (STROBE) assessed patients' compliance with selected cardiovascular diagnoses and other comorbidities who received NOAC and outpatient care in specialized clinics in the Czech Republic in the questionnaire survey between April and May 2023. Results: Patients meeting the study criteria were approached by the treating physician for inclusion (4 cardiology and 1 neurology clinic). A total of 274 patients (146 women, 128 men) with a primary diagnosis of atrial fibrillation and at least one confirmed secondary diagnosis of heart attack, cerebral infarction, transient cerebral ischemic attack (TIA), obesity, arterial hypertension, or diabetes mellitus participated. Statistical analysis confirmed that patients with a history of stroke or TIA had a higher number of regular follow-up visits (once every three months) (p = 0.002492). Furthermore, data analysis demonstrated that patients who had been on treatment for a shorter time tended to have more frequent regular follow-up visits (treatment duration up to 3 months/average check-ups 1.7 times; 3-5 months/0.9 times; 6-12 months/0.7 times). In one patient (55 years) with paroxysmal atrial fibrillation and a diagnosis of TIA, who declared irregularity of NOAC use for 3-5 months of treatment, a relapse of TIA was identified. Conclusion: A high burden of additional comorbidities was identified in the observed sample, along with the inadequate declaration of the regularity of NOAC medication use and the resulting risks. Appropriate patient education is essential, especially among older patients at a high risk of stroke, considering the in- creasing prescription rates.

Hypertension as a global concern remains inadequately controlled, ultimately leading to cardiac structural and functional changes associated with hypertensive heart disease (HHD). Simultaneously, cancer, characterized with abnormal cell proliferation, exhibits diverse behaviours and responses to treatment strategies. Despite extensive efforts, certain type of cancers remains incurable, making both cardiovascular diseases and cancer the leading causes of non-communicable disease mortality in the world. To investigate this association, we conducted a cross-sectional study, reporting the incidence of cancer in the HHD population at Soetomo General Hospital. The population is characterized by a mean age of 58.1 years and a mean BMI of 25.9. We found a significant association between sex and the duration of hypertension and the presence of cancer in the HHD population. Specifically, the data indicate that females with HHD have a higher likeli- hood of having certain cancer types particularly breast and gynaecologic cancers. Additional types of cancer included prostate, blood & lymphatic system, head & neck, lung, thyroid, and renal cancers. Unfortunately, the analysis failed to demonstrate the association between duration of hypertension and the presence of cancer. Notably, previous studies revealed that the correlation between cancer and hypertension is not linked to the administration of antihypertensive medications, as the risk is also observed in untreated patients. Several shared risk factors between hypertension and cancer imply the existence of overlap in molecular pathophysiological mechanisms underlying both conditions. Future studies shall be conducted to explore further regarding the association of hypertension and cancer incidence with larger population and better-designed research.

Acute limb ischemia (ALI) poses a critical threat to limb viability, necessitating urgent revascularization interventions. This case report discusses a 47-year-old Asian woman with bilateral ALI due to severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), with neglected international normalized ratio (INR) control. The patient presented with sudden bilateral leg pain at rest, accompanied by bluish discoloration and sensory loss. Echocardiographic findings indicated severe rheumatic MS along with a thrombus in the left atrial appendage. The computed tomography angiogram revealed a near-total thrombus originating from the upper abdominal aorta. Immediate bilateral thromboembolectomy was performed. Subsequent improvements were observed, and the patient was eventually discharged in stable condition. Proper anticoagulant therapy, vigilant INR monitoring, and a strategic approach to valve replacement are crucial for optimizing outcomes in cases of ALI involving concurrent MS and AF.

The following clinical case presents the experience of using the MyVal (Meril Life Sciences) transcatheter biological aortic valve prosthesis to eliminate severe insufficiency of a degenerated mitral valve (MV) bioprosthesis, which occurred in the context of constant military operations, related air alerts, and power outages, which complicated the logistics of this procedure.

Vienna House Hotel, Prague, November 4–5, 2024

Aim: To analyze the frequency of early postoperative complications and predictors of long-stay patients in the intensive care unit (ICU) after the Bentall procedure. Materials and methods: This retrospective study is based on the obtained medical records of adult patients (aged 18-75), who underwent Bentall procedure for an ascending aortic aneurysm between 2012 and 2021. Depending on the length of ICU stay, all patients were divided into two groups: length of ICU stay up to 3 days (group 1) and length of ICU stay longer than 3 days (group 2). Univariate and multivariate analysis (logistic regression) was used to determine prognostic risk factors. Results: Patients of the second group were characterized by reliably older age (p = 0.005), more frequent presence of arterial hypertension (p = 0.044) among concomitant diseases (p = 0.044) and significantly lower baseline glomerular filtration rate (GFR) (p = 0.045). In case of the second group of patients in comparison with the first one, cell saver was used 3.6 times (p = 0.0005) more often and almost 6 times (p = 0.0037) more often, as well as the need for rethoracotomy due to bleeding, 4.3 times (p = 0.0002) more often acute renal failure and 3.3 times (p = 0.0004) more often acute respiratory failure. Multivariate logistic analysis revealed two independent predictors of long-stay ICU: duration of mechanical ventilation (OR 1.204 [CI 1.053-1.377], p = 0.007) and development of acute renal failure (OR 4,069 [CI 1,040-15,923], p = 0.044). Conclusions: All the patients must be treated in the same way to avoid per- and postoperative complications, but patients with risk factors for long-stay ICU should be under special attention.

Until the late 19th century, the heart was thought as an organ that shouldn't be touched. Famous surgeon Stephen Paget in 1895 wrote: "Surgery of the heart has probably reached the limit set by the nature, no new methods, and no new discovery can overcome the natural difficulties that attend a wound of the heart." But surgeons like Axel Cappelen in Norway in 1895, and Ludwig Rehn in Germany in 1896 dared to enter into this taboo territory and repaired stab injuries of the heart. With these, the era of cardiac surgery began. Later, the two world wars opened the opportunities of exploring heart wounds for the war veterans like George Gray Turner, Henry Souter, Dewitt E. Harken, Wilfred Gordon Bill Bigelow, Walton Lillehei, John Gib- bon, Vasilii Kolesov, Nikolai Amosov, Christian Cabrol and many others. At the turn of the century, rheumatic fever with endocarditis was almost an epidemic disease. Consequently, mitral valvular pathologies were common complications. The intense search for a surgical solution led to the valuable experimental works of Alexis Carrel and Tuffier in 1914, Elliot C. Cuttler in 1923, and Sir Henry Souttar in 1925. In 1944, Blalock-Taussig shunt designed for blue baby demonstrated that heart surgery could be possible. Finally in 1953 John Gibbon developed the cardiopulmonary bypass (CPB) technique with the heart lung machine com- mencing the modern era of cardiac surgery. The history of Pre-CPB innovations of cardiac surgery remains a fascinating part of the history of medicine.

Background: There are significant differences in electrocardiographic parameters between males and females. However, there is a lack of data regarding the gender-related differences in indications and findings of ambulatory electrocardiographic monitoring (AEM) especially in Middle Eastern population. Purpose: We sought to investigate the gender-related differences in the baseline ECG findings, indications, and findings of AEM in an Iraqi cohort of patients referred for AEM. Methods: Baseline ECG was analyzed for each patient, indications, and findings of AEM for each patient was documented. Results: n = 100 (53% were males and 47% were females). Patients were either referred for 24-hour or 48-hour AEM. Women were referred more for 48 hours AEM than male counterparts (19.1% vs 18.9%). Main indications for AEM referral in males were palpitation (26.41%), bradycardia (16.98%) and presyncope (13.2%) while main indications for AEM referral in females were palpitation (34.04%), presyncope (23.4%), and syncope (14.89%). Baseline ECG was normal in females more than in males (36.17% vs 20.75%). Premature atrial contractions (PAC), atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT) and significant pauses were detected more frequently in females while PVC and first degree heart block were detected more frequently in males. Conclusion: There are some gender-related differences in baseline ECG, indications, and findings of AEM. Further work is warranted to detect the impact of these changes on management and outcomes.

Received Date: 13 October 2021; Revision received Date: 15 November 2021; Accepted Date: 23 November 2021
Reproduced from: Vardas PE, Asselbergs FW, van Smeden M, Friedman P. The year in cardiovascular medicine 2021: digital health and innovation. Eur Heart J 2022;43:271–279. https://doi.org/10.1093/eurheartj/ehab874, by permission of Oxford University Press on behalf of the European Society of Cardiology

This article presents some of the most important developments in the fi eld of digital medicine that have appeared over the last 12 months and are related to cardiovascular medicine. The article consists of three main sections, as follows: (i) artifi cial intelligence-enabled cardiovascular diagnostic tools, techniques, and methodologies, (ii) big data and prognostic models for cardiovascular risk protection, and (iii) wearable devices in cardiovascular risk assessment, cardiovascular disease prevention, diagnosis, and management. To conclude the article, the authors present a brief further prospective on this new domain, highlighting existing gaps that are specifi cally related to artifi cial intelligence technologies, such as explainability, cost-effectiveness, and, of course, the importance of proper regulatory oversight for each clinical implementation.

Received Date: 16 December 2021; Revision received Date: 02 January 2022; Accepted Date: 01 March 2022
Reproduced from: Bucciarelli-Ducci C, Ajmone-Marsan N, Di Carli M, Nicol E. The year in cardiovascular medicine 2021: imaging. Eur Heart Journal (2022) 43, 1288–1295. https://doi.org/10.1093/eurheartj/ehac033, by permission of Oxford University Press on behalf of the European Society of Cardiology

This article reviews the most relevant literature published in 2021 on the role of cardiovascular imaging in cardiovascular medicine. Coronavirus disease 2019 (COVID-19) continued to impact the healthcare landscape, resulting in reduced access to hospital-based cardiovascular care including reduced routine diagnostic cardiovascular testing. However, imaging has also facilitated the understanding of the presence and extent of myocardial damage caused by the coronavirus infection. What has dominated the imaging literature beyond the pandemic are novel data on valvular heart disease, the increasing use of artifi cial intelligence (AI) applied to imaging, and the use of advanced imaging modalities in both ischaemic heart disease and cardiac amyloidosis.

Background: The chest-belt can be used to obtain a 1-lead ECG. Data from it have been validated for the determination of heart rate and for the possibility to detect atrial fibrillation (AF) compared to ECG-Holter on a short ECG recording in selected patients. However, validation of the possibility to evaluate long ECG recordings in patients with a wide range of heart diseases has not yet been performed. Methodology and results: 54 hospitalized patients, 53 outpatients and 54 healthy controls were enrolled in the study (n = 161 in total). Using a Polar H10 chest-belt, 1-2 hours of ECG were recorded in all patients (1 153 229 heartbeats, average heart rate 76.6/min, 86.3% in sinus rhythm, 13.7% with atrial fibrillation, 0.46% atrial premature beats, 0.49% ventricular premature beats). The presence of noise was 2.16% (A: 2.31%; B: 1.95%; C: 2.20%). 1 128 319 /1 153 229 were evaluated as easy to interpret. Using ECG from the belt, the basic rhythm was reliably determined by the physician in majority of patients (51/54, 94.4% in hospitalized patients; in 100% of outpatients and healthy controls) when compared to 12-lead ECG. 3 cases were evaluated as unclear; in all of these cases, all QRS complexes were stimulated by a pacemaker. In hospitalized patients, real-time ECG from the belt was comparable to telemetric ECG monitoring (match in 53/54, 98.1%). Conclusion: The ECG obtained from the chest-belt in hospitalized patients and outpatients with a wide range of cardiovascular diseases, as well as in healthy individuals, is usable in real practice for evaluation of baseline rhythm, atrial fibrillation and premature contractions with a minimal proportion of difficulties to interpret recordings due to artefacts. Caution should be exercised in interpretation of the ECG in patients with stimulated rhythm and in patients with atrial flutter. The chest belt can be used as a means for continuous monitoring of ECG, evaluation of rhythm and screening of atrial fibrillation.

Background: The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS). Materials and methods: The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998-2017. C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature ≥38 °C. Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature. Results: PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root. A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60±12 mm vs 48±5 mm; p = 0.003). All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5±84.4 mg/L vs 184.6±89.6 mg/L; p = 0.034 and 15.2±3.8 10⁹/L vs 11.9±3.3 10⁹/L; p = 0.029). Early and recurrent fever requiring hospital readmission was significantlymore frequent in the PEARS group (77% vs 36%; p = 0.032 and 46% vs 7%; p = 0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; p = 0.024 and 31% vs 0%; p = 0.024)., Conclusions: The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.

Background: Most patients with optimal PAH-targeted medical therapy suffer from clinical symptoms, reduced exercise tolerance and have a poor quality of life. The 2019 European Respiratory Society task force statement on physical exercise and rehabilitation in patients with severe, chronic PH suggests that individually adjusted and monitored exercise programs are likely to be safe for PH patients, who are clinically stable on medical therapy. Currently, the development of PAH-specific rehabilitation interventions is still in the research stage. We present the preliminary results of a more extensive study with the aim to show the effectiveness of a 12-week individualized, home-based exercise program in promoting physical capacity, quality of sleep and reducing signs of emotional distress in patients with PAH.

Introduction: Surgical treatment of atrial fibrillation (AF) is a common and time-proven treatment method for this type of arrhythmias both as a separate procedure and as a procedure related to cardiac surgery for another indication (concomitant procedure). Patients experience arrhythmia recurrence despite highly efficient surgical treatment. These arrhythmias are often resistant to pharmacological treatment (due to an extensive fibrous substrate); therefore, electroanatomical mapping accompanying catheter ablation is significantly more effective. The arrhythmogenic fibrous substrate is a result of both a primary cardiac disease (an underlying disease causing atrial dilation) and surgical intervention (incision, cannula insertion sites, MAZE lines with a renewed spread of electrical signal in these blocks).
Method and patients: Electroanatomical mapping and ablation were performed in 92 patients with arrhythmia recurrence following concomitant surgical treatment for AF between January 2010 and November 2015. The Cox-MAZE procedure was performed using a disposable cryoablation catheter. The heart rhythm in patients following radiofrequency ablation procedure was monitored in half-year intervals (24-hour Holter ECG, 7-day loop recorder, in some patients also by means of implanted pacemakers or implantable loop recorders). The average left atrial size (PLAX) was 50 mm, 59% of patients underwent mitral valve surgery, 54% of patients had tricuspid valve surgery, 16% were operated for congenital developmental disorders, in 17% of patients, repeated cardiac surgery was performed. The above-mentioned facts show that these are patients with an extensive arrhythmogenic substrate.
Results: The Cox-MAZE procedure resulted in an extensive fibrous arrhythmogenic substrate in the atrium (arrhythmia recurrence following the MAZE procedure is more often regular atrial tachycardias while AF is predominant among arrhythmias for which the MAZE procedure was indicated). All patients had a follow-up visit after 12 months, 80% of patients presented for a follow-up visit after 24 months. Early recurrence after ablation (within 3 months following the procedure) was found in 21% of patients. Early recurrence after ablation was statistically significantly related to arrhythmia recurrence within 12 months (p = 0.003) and arrhythmia recurrence within 24 months (p = 0.003). 73% of patients had no recurrent AF or atrial tachycardia (AT) after 12 months and 53% after 24 months. A total of 146 arrhythmias were ablated, i.e. one third of patients had more than one arrhythmia. These were persistent AF found in 24% of patients, paroxysmal AF seen in 13% of patients and regular AT detected in 53% of patients. More than one half of regular AT originated in LA (as perimitral atrial flutter in most cases). Remaining arrhythmias originated from the right atrium (as typical atrial flutter in half of the cases). 57% of patients had a renewed spread of signal in the mitral isthmus (ablation of the coronary sinus was necessary in one third of patients). No domination in the number of reconnections was found for any of the pulmonary veins. The finding of a significantly reduced signal amplitude in the entire LA was associated with a higher risk of acute ablation failure (p = 0.001). Acute ablation failure was as

Background: Sacubitril/valsartan (S/V) therapy has been demonstrated to improve prognosis of patients with systolic heart failure (HF) when compared to standard therapy with ACEi. The purpose of this investigation was to document the safety and consequences of transition from ACEi/angiotensin-II receptor blocker (ARB) to S/V in chronic stable HF patients.
Methods: A group of 12 stable HF outpatients (11 males, 1 female) was enrolled (NYHA 2.7 ± 0.7, 42% with coronary artery disease (CAD), average left-ventricle ejection fraction (LVEF) 26.5%. Patients were converted from ACEi/ARB to S/V. Laboratory evaluation, Minnesota Living with Heart Failure Questionnaire (MLHFQ), six-minute walk test (6MWT) were performed before the conversion and at 3-month follow-up visit.
Results: Conversion from ACEi/ARB to S/V was not associated with any adverse event. After 3 months, S/V therapy decreased blood pressure (-14.8 mmHg for systolic BP, -9.6 mmHg for diastolic BP) and serum potassium (-0.27 mmol/l, all p < 0.05). No worsening of renal function occurred (creatinine -7.8 µmol/l, p = 0.12, estimated glomerular filtration rate +0.08 ml/s/1.73 m2, p = 0.14). B-type natriuretic peptide (BNP) level remained unchanged (p = 0.18), but NT-proBNP level decreased significantly (median 1012 ng/l at baseline, 559.4 ng/l at follow-up, p = 0.005). A slight but significant decrease in high-sensitivity cardiac troponin T (hs-cTnT) was observed (median 14.76 ng/l at baseline, 12.63 ng/l at follow-up, p = 0.001). An improvement in MLHFQ total score (-8 points, p = 0.006) and in 6MWT by 55 m (p = 0.0007) was noted, which was not due to increased effort.
Conclusion: The transition from ACEi/ARB to S/V therapy in patients with chronic systolic heart failure appears to be safe and leads to an improvement in exercise tolerance and quality of life.

The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a public health emergency of international concern (PHEIC). Some studies reported SARS-CoV-2 may result in cardiovascular complications such as myocarditis, myocardial injury, acute myocardial infarction, arrhythmia, heart failure, and cardiomyopathy. It has been shown that COVID-19 patients with pre-existing medical conditions, such as heart disease, are at higher risk of increased mortality. Physicians should be well aware of cardiovascular complications when examining and treating patients with COVID-19 infection. Therefore, the current review assesses cardiovascular complications in COVID-19.

Heart failure is a major public health concern, being one of the most common reasons for hospitalization. Its prognosis is poor and the optimal management to date represents a continuous challenge. This case report describes a 67-year-old man with chronic heart failure with reduced ejection fraction (HFrEF), remaining symptomatic despite optimal medical therapy and refusing an implantable cardioverter-defibrillator (ICD) as a prevention for sudden cardiac death. We introduced Sacubitril/Valsartan and after 3 months of treatment we observed a significant improvement in symptoms with reduction of arrhythmic burden and, after six months even of echocardiographic parameters, leading to withdraw the indication to the ICD.

Background: Good quality of life is an important goal in treatment of complex cyanotic congenital heart disease (CHD); however, there is a lack of consensus concerning quality of life in complex CHD patients in the literature. The aim of this study was to assess quality of life and rate of depression in adults with complex cyanotic CHD late after repair. Method: The studied cohort consists of 212 adults with repaired complex cyanotic CHD and 86 healthy controls. Subjects filled in questionnaires evaluating quality of life (SF-36) and depression (Zung self-rating depression scale). Additional data on the influence of CHD on patient's life, physical activities, NYHA class, echocardiographic parameters, etc. were recorded. The results were compared with a previously published cohort of 32 cyanotic adults with unrepaired CHD. Results: The rate of depression did not differ significantly between repaired CHD patients and healthy controls. Severe depression was found in 8.5% of repaired complex CHD, in 7.0% of controls (p = 0.816), and in 28.1% of the unrepaired CHD with persistent cyanosis (p = 0.003). The quality of life measured by SF-36 was not significantly different between repaired CHD and controls, except for lower general health perception, physical functioning, and physical role limitation. Conclusion: The repaired complex cyanotic CHD patients have a good quality of life, similar to controls, while unrepaired patients have a significantly higher rate of depression.

Introduction: Secondary prevention after myocardial infarction is at least as important as treatment of the acute phase. Improved cardiovascular (CV) prevention can decisively contribute to the continuation of positive trends of CV morbidity and mortality seen in the Czech Republic in last three decades. Objectives: To determine, in patients with coronary heart disease (CHD), how the treatment goals as defined by the current European guidelines on CV secondary prevention (2012) are implemented in clinical practice. Methods: Patients ≤ 80 years when hospitalized for acute coronary syndrome, and/or CABG or PCI were identified from hospital records and invited to outpatient clinical investigation (interview) not less than 6 months and not more than 2 years after hospital discharge. Data collection was performed based on a review of medical records and the interview. Results: Of 624 invited patients, 406 responders were interviewed. Among these, 20% were smokers, 44.8% were obese (BMI ≥ 30), 85.5% were overweight or obese (BMI ≥ 25), 70.2% had central obesity (waist circumference ≥ 102 cm in men, ≥ 88 cm in women), the recommended level of physical activity (30 minutes 5 times a week) was not attained by 85%. Raised blood pressure (≥ 140/90 mmHg, in diabetics ≥ 140/80 mmHg) was measured in 55.1%, elevated LDL-cholesterol (≥ 1.8 mmol/L) in 63.5% of responders. Manifest diabetes mellitus (known plus newly discovered at interview) was present in 41.2%, and prediabetes in 23.4% of patients. The respective figures when using the oral glucose tolerance test (OGTT) were 44.7% and 32.3%. At interview, 88.4% of patients were being treated with aspirin or other antiplatelet drugs, 81.3% with beta-blockers, 78.8% with ACE inhibitors or angiotensin receptor blockers (ARBs), 92.1% with statins, and 92.9% had undergone revascularization., Conclusion: The majority of coronary patients have unhealthy lifestyles such as unhealthy diet and sedentary behavior. The prevalence of overweight, obesity, and diabetes is very high, and prevalence of obesity further increased. Although pharmacotherapy is used in the majority of patients, the recommended levels of blood pressure, lipid, and glucose metabolism are achieved in only a minority.

Background: Although depression is already elevated to the status of a risk factor for CVD in AHA and EACPR guidelines and recommendations, there is lack of gender specific information. Studies have proven that depression can be more prevalent in women at specific age and more significantly predisposes cardiovascular mortality compared to men. Purpose: The goal of our manuscript was to review current evidences suggesting prevalence of cardiovascular disease and depression in women, to find out the link between depression and cardiovascular disease in this particular population and determine plausible biological mechanism to account for this relationship. Methods: We reviewed original manuscripts and meta-analysis published before Apr 20, 2019. Results: Our review identified consistent association between depression and cardiovascular disease in women and predictive value of depression on cardiovascular mortality, also there are underlined some plausible pathophysiologic mechanisms responsible for this relation especially in women. Conclusions: Women are more frequently experiencing lack of social support and social integration, as well as presence of depression leading to adverse CVD outcome and enhanced risk of cardiac death, early assess- ment of psychosocial risk factors even in low CVD risk female patients will be paramount to avoid future complication and define effective timing for cognitive-based intervention.

Background: Exercise-based rehabilitation has been proved as a beneficial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term effect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training effects of 12-week individualized home-based exercise program in patients with idiopathic PAH.
Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confirmed by right-heart catheterization from the Latvian PAH registry were selected. A 12-week exercise program adapt- able for each patient's functional state and home environment was created. The program included muscle strength training, respiratory, aerobic exercise and neuro-muscular relaxation techniques, self-control monitoring, weekly phone control and on-site re-assessment by physiotherapist were parts of the program to ensure both individualized adjustments and proper execution, and to maximize clinical safety. The primary outcome measures for training effects were exercise capacity, breathing pattern and quality of life, for adherence days of performance, for safety any event of "alarm sign" indicators during exercising, incomplete recovery, worsening of PH symptoms., Results: The results showed a rather high degree of adherence to the prescribed exercise regimen (in average 92.5%). No adverse events were observed during the course of the program. The results proved the importance of ensuring optimal self-control skills both for objective measures and subjective symptoms. The 6-minute walking test (6MWT) results show that the developed program significantly improves exercise capacity (mean improvement 39 ± 17.5 m). In four participants (66.7%) the minimum clinically important difference (MCID) for 6MWT distance in PAH patients was observed (25-33 m). Significant improvement in chest excursions confirm changes in breathing pattern suggesting better engagement of diaphragm dur- ing breathing after the program. Results did not show significant improvements in either SF-36 survey domain. However, half of the participants reached MCID (11%) after the program at the physical health subscales., Conclusion: The results of this preliminary study prove that the created individualized home-based exercise program is safe, easily followed and allows progression in exercise intensity and improves physical functional state in clinically stable iPAH patients. This study hypothesis supports the need for RCT to continue research and approve the results.

A historical survey is presented of mortality clinical trials focussed on the inhibition of the renin-angiotensin-aldosterone system on different levels in patients with chronic heart failure. The first study, CONSENSUS, was published in 1987 and showed that the ACE-inhibitor enalapril clearly reduced mortality in severe heart failure compared with placebo. This was followed by studies with beta blockers, angiotensin II type 1 receptor blockers, blockers of mineralocorticoid receptors, and direct renin inhibitors.
A recent study, PARADIGM, comparing dual inhibitor of neprilysin and angiotensin II receptor (LCZ696) with enalapril, was terminated prematurely for a significant effect of inhibiting neprilysin and valsartan.