Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e110119
S. Tochev, N. Rifai, B. Finkov, А. Postadzhiyan
The aim of the study was to evaluate the long-term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension. The study included 32 patients with treatment-resistant hypertension and performed successful RSD. The effect of renal denervation was significant both in terms of daytime, nighttime and 24-hour arterial pressure, with the most pronounced effect on nocturnal blood pressure. In addition to mean BP reduction we found out a significant improvement of weighted 24 h SD and BP load during follow-up. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mm Hg at month 12, was found in 22 patients (68.8%). In multivariate regression analysis, two parameters remained predictive for successful renal denervation – higher nighttime systolic blood pressure (OR 0.9, 95% CI 0.8-1.005, p = 0.05) and lower pulse pressure (OR 1.13, 95% CI 1.01-1.26, p = 0.03).
本研究旨在评价肾交感神经去神经(RSD)对顽固性高血压患者24小时动态血压测量(ABPM)和血压负荷(BP负荷)的长期影响。该研究包括32例难治性高血压患者，并成功进行了RSD。肾去神经对日间、夜间和24小时动脉压的影响均显著，其中对夜间血压的影响最为显著。除了平均血压降低外，我们发现在随访期间加权24小时SD和血压负荷显著改善。在22例(68.8%)患者中发现了RSD的长期效应，即12个月时24小时收缩压降至10mmhg以上。在多变量回归分析中，两个参数仍然可以预测成功的肾去神经支配& &;夜间收缩压升高(OR 0.9, 95% CI 0.8 ~ 1.005, p = 0.05)，脉压降低(OR 1.13, 95% CI 1.01 ~ 1.26, p = 0.03)。
{"title":"Long term effect of renal denervation on 24 hour abpm blood pressure variability and blood pressure load parameters","authors":"S. Tochev, N. Rifai, B. Finkov, А. Postadzhiyan","doi":"10.3897/bgcardio.29.e110119","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e110119","url":null,"abstract":"The aim of the study was to evaluate the long-term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension. The study included 32 patients with treatment-resistant hypertension and performed successful RSD. The effect of renal denervation was significant both in terms of daytime, nighttime and 24-hour arterial pressure, with the most pronounced effect on nocturnal blood pressure. In addition to mean BP reduction we found out a significant improvement of weighted 24 h SD and BP load during follow-up. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mm Hg at month 12, was found in 22 patients (68.8%). In multivariate regression analysis, two parameters remained predictive for successful renal denervation – higher nighttime systolic blood pressure (OR 0.9, 95% CI 0.8-1.005, p = 0.05) and lower pulse pressure (OR 1.13, 95% CI 1.01-1.26, p = 0.03). ","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e105739
I. Yoncheva, D. Biserov, M. Negreva, S. Gogov, V. Vasilev
We present a clinical case of a 49-year-old man admitted in severe general condition and echocardiographic evidence of a thrombotic mass in the left ventricle. Due to a peripheral embolization clinic, catheter-directed thrombolysis (CDT) followed by anticoagulant therapy was performed. This resulted in lysis of the left ventricular thrombus and reperfusion of the emboli in the peripheral arteries. Due to residual occlusion of the left anterior tibial artery, amputation of the front part of the foot of the left lower limb was required. As a result of the treatment, stabilization of the patient’s condition and withdrawal of the amputation line as distal as possible was achieved. The patient had severe left ventricular systolic dysfunction and highgrade mitral regurgitation, necessitating discussion of further management.
{"title":"Left ventricular thrombosis with peripheral embolization in several vascular zones – clinical case","authors":"I. Yoncheva, D. Biserov, M. Negreva, S. Gogov, V. Vasilev","doi":"10.3897/bgcardio.29.e105739","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e105739","url":null,"abstract":"We present a clinical case of a 49-year-old man admitted in severe general condition and echocardiographic evidence of a thrombotic mass in the left ventricle. Due to a peripheral embolization clinic, catheter-directed thrombolysis (CDT) followed by anticoagulant therapy was performed. This resulted in lysis of the left ventricular thrombus and reperfusion of the emboli in the peripheral arteries. Due to residual occlusion of the left anterior tibial artery, amputation of the front part of the foot of the left lower limb was required. As a result of the treatment, stabilization of the patient’s condition and withdrawal of the amputation line as distal as possible was achieved. The patient had severe left ventricular systolic dysfunction and highgrade mitral regurgitation, necessitating discussion of further management.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e107056
R.P. Yalamanchi, R. Showkathali, A.М. Kumar, P. Kannan
Coronary artery disease (CAD) commonly occurs in individuals over the age of 45 years. Several studies categorize “young” individuals with CAD or acute myocardial infarction as those below the ages of 40 and 45. The protection provided by young age has slowly been eroded by risk factors like smoking, obesity, and sedentary lifestyle that are becoming more common among young individuals. We report a case of 21-year-old male with family history of premature coronary artery disease, who presented with acute anterior wall ST elevation myocardial infarction. Coronary angiogram revealed 100% thrombotic occlusion of proximal left anterior descending coronary artery. Further evaluation of the lesion morphology using optical coherence tomography revealed plaque erosion. Thrombolysis in Myocardial Infarction coronary grade III flow was achieved after thrombus aspiration. Stent deployment was deferred to avoid the need for lifelong medication and its associated side effects in a young patient. Due to their anti-thrombotic qualities, we also recommend using novel oral anticoagulants in this situation for short-term therapy.
{"title":"Contemporary approach to st elevation myocardial infarction in very young","authors":"R.P. Yalamanchi, R. Showkathali, A.М. Kumar, P. Kannan","doi":"10.3897/bgcardio.29.e107056","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e107056","url":null,"abstract":"Coronary artery disease (CAD) commonly occurs in individuals over the age of 45 years. Several studies categorize “young” individuals with CAD or acute myocardial infarction as those below the ages of 40 and 45. The protection provided by young age has slowly been eroded by risk factors like smoking, obesity, and sedentary lifestyle that are becoming more common among young individuals. We report a case of 21-year-old male with family history of premature coronary artery disease, who presented with acute anterior wall ST elevation myocardial infarction. Coronary angiogram revealed 100% thrombotic occlusion of proximal left anterior descending coronary artery. Further evaluation of the lesion morphology using optical coherence tomography revealed plaque erosion. Thrombolysis in Myocardial Infarction coronary grade III flow was achieved after thrombus aspiration. Stent deployment was deferred to avoid the need for lifelong medication and its associated side effects in a young patient. Due to their anti-thrombotic qualities, we also recommend using novel oral anticoagulants in this situation for short-term therapy.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e106722
D. Panayotova, R. Grigorov
Primary cardiac tumors are rare and most frequently benign. The most common primary cardiac tumors are myxomas. Early clinical symptoms can resemble different cardiovascular and systemic diseases. The heterogeneity in their presentation is due to the different localization of myxomas and different structural characteristics. In most cases an echocardiographic examination is sufficient to establish the diagnosis. Early diagnosis and referral for surgery can prevent debilitating complications. The definitive treatment is surgical extirpation of the tumor. We present two clinical cases of cardiac myxomas, the first of which was localized in the left atrium and had villous characteristics, presenting mainly with embolic events. In the second case, the tumor formation was in the right atrium, solid in nature, causing angina and dyspnea.
{"title":"Cardiac myxoma – two clinical cases with a different presentation","authors":"D. Panayotova, R. Grigorov","doi":"10.3897/bgcardio.29.e106722","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e106722","url":null,"abstract":"Primary cardiac tumors are rare and most frequently benign. The most common primary cardiac tumors are myxomas. Early clinical symptoms can resemble different cardiovascular and systemic diseases. The heterogeneity in their presentation is due to the different localization of myxomas and different structural characteristics. In most cases an echocardiographic examination is sufficient to establish the diagnosis. Early diagnosis and referral for surgery can prevent debilitating complications. The definitive treatment is surgical extirpation of the tumor. We present two clinical cases of cardiac myxomas, the first of which was localized in the left atrium and had villous characteristics, presenting mainly with embolic events. In the second case, the tumor formation was in the right atrium, solid in nature, causing angina and dyspnea.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e109746
A. Postadzhiyan, Y. Yotov, S. Tisheva-Gospodinova, F. Nikolov, K. Ramshev, I. Gruev, D. Raev
Cardiovascular diseases are not only the leading causes of mortality in Bulgaria but also the mortality rate is twice as high as the European Union average, so screening programmes identifying subjects with elevated blood pressure (BP) are of utmost importance. May Measurement Month (MMM) is an annual global initiative of the International Society of hypertension that began in 2017 aimed at raising awareness of high BP. Bulgaria joined the 3rd campaign of MMM in 2019 and an overview of the results of Bulgarian participation are presented in this paper. Hypertension was defined as systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg or treatment for hypertension, statistical analysis followed the standard MMM protocol. In Bulgaria, 150 screening points were set up in primary and secondary care facilities, in pharmacies, and outdoor spaces across 21 administrative districts. Out of 3678 individuals screened, 2587 participants (70.3%) had hypertension. Of 2896 participants with hypertension, 35.6% had controlled BP. Out of 1760 participants not on antihypertensive medication, 669 (38%) had elevated BP. In the case of treated individuals (n = 1918), 997 (52%) had uncontrolled hypertension. In the untreated cohort, every 4th subject had elevated BP, whilst among patients on antihypertensive medication, every second had uncontrolled BP, the worst results in terms of diagnosis and treatment are observed in men. By identifying almost two-third of the whole screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, our results confirm the importance of BP screening campaigns.
在保加利亚，心血管疾病不仅是导致死亡的主要原因，而且死亡率是欧盟平均水平的两倍，因此，确定血压升高受试者的筛查方案至关重要。五月测量月(MMM)是国际高血压学会于2017年发起的年度全球倡议，旨在提高人们对高血压的认识。保加利亚于2019年加入了MMM的第三次活动，本文概述了保加利亚参与的结果。高血压定义为收缩压;140mmhg和舒张压;90 mm Hg或治疗高血压，按照标准MMM方案进行统计分析。在保加利亚，在21个行政区的初级和二级保健设施、药房和户外场所设立了150个筛查点。在3678名被筛查的个体中，2587名参与者(70.3%)患有高血压。在2896名高血压患者中，35.6%的人血压得到控制。在1760名未服用抗高血压药物的参与者中，669名(38%)血压升高。在接受治疗的个体(n = 1918)中，997例(52%)高血压未得到控制。在未治疗的队列中，每4名受试者中就有1名血压升高，而在服用降压药的患者中，每1秒就有1名血压不受控制，诊断和治疗结果最差的是男性。通过确定几乎三分之二的筛查队列可能有新诊断或未控制的高血压，我们的结果证实了BP筛查活动的重要性。
{"title":"Opportunistic screening for hypertension in the general population in Bulgaria: international society of hypertension may measurement month campaign","authors":"A. Postadzhiyan, Y. Yotov, S. Tisheva-Gospodinova, F. Nikolov, K. Ramshev, I. Gruev, D. Raev","doi":"10.3897/bgcardio.29.e109746","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e109746","url":null,"abstract":"Cardiovascular diseases are not only the leading causes of mortality in Bulgaria but also the mortality rate is twice as high as the European Union average, so screening programmes identifying subjects with elevated blood pressure (BP) are of utmost importance. May Measurement Month (MMM) is an annual global initiative of the International Society of hypertension that began in 2017 aimed at raising awareness of high BP. Bulgaria joined the 3rd campaign of MMM in 2019 and an overview of the results of Bulgarian participation are presented in this paper. Hypertension was defined as systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg or treatment for hypertension, statistical analysis followed the standard MMM protocol. In Bulgaria, 150 screening points were set up in primary and secondary care facilities, in pharmacies, and outdoor spaces across 21 administrative districts. Out of 3678 individuals screened, 2587 participants (70.3%) had hypertension. Of 2896 participants with hypertension, 35.6% had controlled BP. Out of 1760 participants not on antihypertensive medication, 669 (38%) had elevated BP. In the case of treated individuals (n = 1918), 997 (52%) had uncontrolled hypertension. In the untreated cohort, every 4th subject had elevated BP, whilst among patients on antihypertensive medication, every second had uncontrolled BP, the worst results in terms of diagnosis and treatment are observed in men. By identifying almost two-third of the whole screened cohort with the possibility of newly diagnosed or uncontrolled hypertension, our results confirm the importance of BP screening campaigns.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e110316
T. Yaneva-Sirakova, Ivan Gruev, Arman Postadzhiyan
Individual blood pressure values tend to be close to a certain population pattern (because of environmental and socioeconomic factors), without fully following it (because of specifi c individual genetic predisposition). These population “patterns” or “trajectories’ can be followed back to prenatal period and across the whole lifespan. Some of them are correlated with higher risk for development of arterial hypertension. There are also several “cornerstones” in these patterns, where the individual may be at an increased risk for movement to a higher-risk group. They can explain why certain individuals are more prone to target organ damage than others and why we, as clinicians, should have an individualized approach when we translate population-based guidelines to the single patient. Proper defi nition and practical knowledge of the signifi cance of these blood pressure trajectories could be important for everyday prophylaxis and practice.
{"title":"Practical significance of individual blood pressure trajectories","authors":"T. Yaneva-Sirakova, Ivan Gruev, Arman Postadzhiyan","doi":"10.3897/bgcardio.29.e110316","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e110316","url":null,"abstract":"Individual blood pressure values tend to be close to a certain population pattern (because of environmental and socioeconomic factors), without fully following it (because of specifi c individual genetic predisposition). These population “patterns” or “trajectories’ can be followed back to prenatal period and across the whole lifespan. Some of them are correlated with higher risk for development of arterial hypertension. There are also several “cornerstones” in these patterns, where the individual may be at an increased risk for movement to a higher-risk group. They can explain why certain individuals are more prone to target organ damage than others and why we, as clinicians, should have an individualized approach when we translate population-based guidelines to the single patient. Proper defi nition and practical knowledge of the signifi cance of these blood pressure trajectories could be important for everyday prophylaxis and practice.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135769474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e109243
T. Chalakova, K. Tsochev, V. Iotova, N. Usheva, Y. Bocheva, G. Valchev, Y. Yotov
Type 1 diabetes mellitus (T1DM) has significantly better prognosis which has led to increased cardio-vascular diseases (CVD) prevalence. The detection of CVD risk factors and their treatment become tasks of paramount importance. Among them, high blood pressure (BP) is a target of primary purpose. Aim: to explore the blood pressure values, the prevalence of hypertension (HTN) and its management in patients with T1DM with long duration and without overt CVD, in comparison to matched controls. Participants and methods: totally, 124 patients with T1DM were matched to 59 controls by sex, age and approximate body mass index (BMI). All participants filled in questionnaires with information on demographics, physical activity, life style, concomitant diseases, treatments, presence of complications, etc. Blood samples were taken for laboratory and biomarkers investigation. Blood pressure was measured by investigators twice and the mean of the two measurements was used. HTN was accepted using standard definitions. BP values were compared using t-test. Multiple linear regression models with dependent variable BP measures and age, sex, BMI, presence of T1DM, glycated hemoglobin levels, creatinine levels as independent variables were created. ANOVA method was used to test the interaction of sex and presence of T1DM. Results: The mean age of the participants was 43.47 ± 10.1 years, 54% were males. The mean duration of T1DM was 25.31 ± 8.2 years and the mean HbA1c was 8.42 ± 1.8% for diabetic patients. The mean blood pressure measures in T1DM groups were higher than in controls, both in males and females. The difference reached significance for SBP and pulse pressure (PP). The presence of T1DM independently affected the BP values, after adjusting for major confounders. The mean adjusted differences between T1DM and controls were 8.37 mm Hg for SBP, 4.92 mm Hg for DBP, and 5.19 mm Hg for PP (p < 0.001). HTN was significantly more frequent in T1DM patients than in controls – 54% vs. 27%, p = 0.0001, mainly due to already known hypertension. BP control was insufficient – in only 36% and 13% of the treated hypertensive participants, respectively, for BP < 140/90 and < 130/80 mm Hg. The majority of the patients with HTN were treated with combination therapy, mostly single-pill fixed dosage but 30% of the hypertensive patients with diabetes did not take antihypertensive medications. Inhibitors of the renin-angiotensin system were the preferred class of medications. Conclusions: SBP and PP were significantly higher in middle-aged patients with T1DM with long duration than their control counterparts. The presence of HTN was significantly more common in T1DM. Although treated according to the current recommendations, the control of BP was far from effective. These results show the need for constant screening of patients with T1DM for HTN and other risk factors and for more aggressive antihypertensive treatment to preve
1型糖尿病(T1DM)预后明显较好，导致心血管疾病(CVD)患病率增加。心血管疾病危险因素的检测及其治疗成为重中之重。其中，高血压(BP)是主要目的靶标。目的:探讨持续时间长且无明显CVD的T1DM患者的血压值、高血压患病率(HTN)及其管理，并与对照组进行比较。参与者和方法:124名T1DM患者与59名对照者按性别、年龄和近似体重指数(BMI)进行匹配。所有参与者都填写了关于人口统计、体育活动、生活方式、伴随疾病、治疗、并发症存在等信息的调查问卷。采集血样进行实验室和生物标志物检测。研究人员测量了两次血压，并使用两次测量的平均值。使用标准定义接受HTN。BP值比较采用t检验。以因变量血压测量和年龄、性别、BMI、是否存在T1DM、糖化血红蛋白水平、肌酐水平为自变量建立多元线性回归模型。采用方差分析方法检验性别与T1DM存在的相互作用。结果:参与者平均年龄43.47岁;10.1岁，男性占54%。T1DM的平均持续时间为25.31±;8.2年，平均HbA1c为8.42 +;糖尿病患者1.8%。在男性和女性中，T1DM组的平均血压测量值都高于对照组。收缩压和脉压(PP)的差异具有显著性。在调整主要混杂因素后，T1DM的存在独立影响BP值。T1DM与对照组校正后的平均差异为收缩压8.37 mm Hg，舒张压4.92 mm Hg, PP 5.19 mm Hg (p <0.001)。HTN在T1DM患者中的发生率明显高于对照组&54%对27%，p = 0.0001，主要是由于已知的高血压。BP控制不足& nash;在接受治疗的高血压患者中，分别只有36%和13%140/90和<大多数HTN患者采用联合治疗，多为单片固定剂量，但30%的高血压合并糖尿病患者未服用降压药物。肾素-血管紧张素系统抑制剂是首选的一类药物。结论:长期T1DM中年患者的收缩压和PP明显高于对照组。HTN的存在在T1DM中更为常见。虽然按照目前的建议进行治疗，但对BP的控制还远远不够。这些结果表明，需要持续筛查T1DM患者的HTN和其他危险因素，并进行更积极的降压治疗，以预防未来的CVD事件。
{"title":"Blood pressure and hypertension in type 1 diabetes mellitus patients with long duration","authors":"T. Chalakova, K. Tsochev, V. Iotova, N. Usheva, Y. Bocheva, G. Valchev, Y. Yotov","doi":"10.3897/bgcardio.29.e109243","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e109243","url":null,"abstract":"Type 1 diabetes mellitus (T1DM) has significantly better prognosis which has led to increased cardio-vascular diseases (CVD) prevalence. The detection of CVD risk factors and their treatment become tasks of paramount importance. Among them, high blood pressure (BP) is a target of primary purpose. Aim: to explore the blood pressure values, the prevalence of hypertension (HTN) and its management in patients with T1DM with long duration and without overt CVD, in comparison to matched controls. Participants and methods: totally, 124 patients with T1DM were matched to 59 controls by sex, age and approximate body mass index (BMI). All participants filled in questionnaires with information on demographics, physical activity, life style, concomitant diseases, treatments, presence of complications, etc. Blood samples were taken for laboratory and biomarkers investigation. Blood pressure was measured by investigators twice and the mean of the two measurements was used. HTN was accepted using standard definitions. BP values were compared using t-test. Multiple linear regression models with dependent variable BP measures and age, sex, BMI, presence of T1DM, glycated hemoglobin levels, creatinine levels as independent variables were created. ANOVA method was used to test the interaction of sex and presence of T1DM. Results: The mean age of the participants was 43.47 &plusmn; 10.1 years, 54% were males. The mean duration of T1DM was 25.31 &plusmn; 8.2 years and the mean HbA1c was 8.42 &plusmn; 1.8% for diabetic patients. The mean blood pressure measures in T1DM groups were higher than in controls, both in males and females. The difference reached significance for SBP and pulse pressure (PP). The presence of T1DM independently affected the BP values, after adjusting for major confounders. The mean adjusted differences between T1DM and controls were 8.37 mm Hg for SBP, 4.92 mm Hg for DBP, and 5.19 mm Hg for PP (p < 0.001). HTN was significantly more frequent in T1DM patients than in controls &ndash; 54% vs. 27%, p = 0.0001, mainly due to already known hypertension. BP control was insufficient &ndash; in only 36% and 13% of the treated hypertensive participants, respectively, for BP < 140/90 and < 130/80 mm Hg. The majority of the patients with HTN were treated with combination therapy, mostly single-pill fixed dosage but 30% of the hypertensive patients with diabetes did not take antihypertensive medications. Inhibitors of the renin-angiotensin system were the preferred class of medications. Conclusions: SBP and PP were significantly higher in middle-aged patients with T1DM with long duration than their control counterparts. The presence of HTN was significantly more common in T1DM. Although treated according to the current recommendations, the control of BP was far from effective. These results show the need for constant screening of patients with T1DM for HTN and other risk factors and for more aggressive antihypertensive treatment to preve","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e109781
I. Gruev, V. Tsanova
COVID-19 pandemic affected directly and indirectly the healthcare system in Bulgaria in a very negative manner. The hospitals were flooded with COVID cases and patients were afraid to attend even the outpatient clinics. That resulted in increased mortality and poor control of cardiovascular diseases. We studied the results from the mandatory annual examinations of hypertensive patients in one cardiological outpatient practice in Sofia, Bulgaria in 2021 and 2022. The results showed low level of attendance by the patients in 2021 and poor control of hypertension and comorbidities, that continued even in the post-covid year – 2022.
{"title":"How COVID-19 affected the control of hypertension and comorbitities in one cardiological outpatient practice in Bulgaria?","authors":"I. Gruev, V. Tsanova","doi":"10.3897/bgcardio.29.e109781","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e109781","url":null,"abstract":"COVID-19 pandemic affected directly and indirectly the healthcare system in Bulgaria in a very negative manner. The hospitals were flooded with COVID cases and patients were afraid to attend even the outpatient clinics. That resulted in increased mortality and poor control of cardiovascular diseases. We studied the results from the mandatory annual examinations of hypertensive patients in one cardiological outpatient practice in Sofia, Bulgaria in 2021 and 2022. The results showed low level of attendance by the patients in 2021 and poor control of hypertension and comorbidities, that continued even in the post-covid year &ndash; 2022.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3897/bgcardio.29.e107881
B. Grigorova, Al. Chobanov
Mitral valve prolapse (MVP) and mild mitral regurgitation (MR) are ones of the most common structural changes of the heart and affect many young individuals, who aspire to partake in competitive sport or high intensity recreational exercise. These two conditions are associated with a different prognosis and possible omplications such as heart failure (HF), malignant arrhythmias and sudden cardiac death (SCD). Therefore it is essential to determine the risk factors predicting these complications and to define a follow-up algorithm. The objective is to present a literature review of consensus recommendations addressing criteria for eligibility and disqualification from organized competitive sports for the purpose of ensuring the health and safety of young athletes.
{"title":"Prognostic value of mitral valve prolapse and mild mitral regurgitation in competitive athletes","authors":"B. Grigorova, Al. Chobanov","doi":"10.3897/bgcardio.29.e107881","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e107881","url":null,"abstract":"Mitral valve prolapse (MVP) and mild mitral regurgitation (MR) are ones of the most common structural changes of the heart and affect many young individuals, who aspire to partake in competitive sport or high intensity recreational exercise. These two conditions are associated with a different prognosis and possible omplications such as heart failure (HF), malignant arrhythmias and sudden cardiac death (SCD). Therefore it is essential to determine the risk factors predicting these complications and to define a follow-up algorithm. The objective is to present a literature review of consensus recommendations addressing criteria for eligibility and disqualification from organized competitive sports for the purpose of ensuring the health and safety of young athletes.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135768969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-19DOI: 10.3897/bgcardio.29.e105075
S. Kanuri, P. J. Sirrkay
Takutsubo, or stress cardiomyopathy (TCM) is one of the important cardiovascular disorders encountered during the COVID-19 pandemic. We performed a PubMed search of relevant articles and presented this review which included epidemiology, etiopathogenesis, diagnosis and treatment of this clinical disorder. Takutsubo is usually more common in women than men. COVID-19 infection or vaccination can incite severe emotional disorders such as anxiety and depression, which flames up impaired neural networks in the limbic system. This stirs up disorganized regulation of autonomic nervous system with predominance and excessive firing of sympathetic nervous system to the ventricular myocardium. Moreover, direct invasion and systemic effects of COVID-19 infection including hormonal influences, autoimmunity, cytokine storm and neighboring infections might also play a significant role in the manifestation of this disorder. It commonly presents signs and symptoms of left ventricular dysfunction. Although most cases are undergoing remission within a few weeks, complications such as LV outflow tract obstruction, thromboembolism and arrhythmias were also reported. Since clinical symptoms are non-specific, a high degree of clinical suspicion is warranted particularly with the co-existing COVID-19 infections. Clinicians often leaned upon battery of tests including ECG, echocardiography and CMR to rule out myocarditis and coronary artery disease. Supportive management including treatment of heart failure and any associated arrhythmias and thromboembolism. Recurrences are common, but the treatment of underlying psychiatric disorders, including relaxation techniques, is the key strategy to avoid future occurrences.
{"title":"Unraveling the mystery of Takutsubo cardiomyopathy: a descendant of COVID-19 heart syndrome","authors":"S. Kanuri, P. J. Sirrkay","doi":"10.3897/bgcardio.29.e105075","DOIUrl":"https://doi.org/10.3897/bgcardio.29.e105075","url":null,"abstract":"Takutsubo, or stress cardiomyopathy (TCM) is one of the important cardiovascular disorders encountered during the COVID-19 pandemic. We performed a PubMed search of relevant articles and presented this review which included epidemiology, etiopathogenesis, diagnosis and treatment of this clinical disorder. Takutsubo is usually more common in women than men. COVID-19 infection or vaccination can incite severe emotional disorders such as anxiety and depression, which flames up impaired neural networks in the limbic system. This stirs up disorganized regulation of autonomic nervous system with predominance and excessive firing of sympathetic nervous system to the ventricular myocardium. Moreover, direct invasion and systemic effects of COVID-19 infection including hormonal influences, autoimmunity, cytokine storm and neighboring infections might also play a significant role in the manifestation of this disorder. It commonly presents signs and symptoms of left ventricular dysfunction. Although most cases are undergoing remission within a few weeks, complications such as LV outflow tract obstruction, thromboembolism and arrhythmias were also reported. Since clinical symptoms are non-specific, a high degree of clinical suspicion is warranted particularly with the co-existing COVID-19 infections. Clinicians often leaned upon battery of tests including ECG, echocardiography and CMR to rule out myocarditis and coronary artery disease. Supportive management including treatment of heart failure and any associated arrhythmias and thromboembolism. Recurrences are common, but the treatment of underlying psychiatric disorders, including relaxation techniques, is the key strategy to avoid future occurrences.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48767731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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