Cardiologia Croatica. 2020;15(11-12)

Diana Delić-Brkljačić, Karlo Golubić

During the COVID-19 pandemic, there fewer examinations and diagnostic and therapeutic procedures were performed in patients with cardiovascular diseases. In several countries, an increase in mortality has been reported in this group of patients, both from COVID-19 and from cardiovascular diseases. It is important to continue to treat these patients and to prevent the unavailability of health care for subjective or objective reasons. Telemedicine can also help us in this, but much of the responsibility remains with the patients themselves to prevent the disease from getting worse through self-monitoring and regular therapy. We can help them by facilitating this task (telephone contacts, fixed drug combinations). It is also important to adapt healthcare to the pandemic in order to make it effective and safe for both patients and caregivers.

Iva Kurjaković, Juraj Jug, Martina Lovrić Benčić, Jurica Vuković, Ingrid Prkačin

Resistant hypertension is defined as failure to achieve target blood pressure (BP) in spite of using a minimum of 3 antihypertensive drugs of different classes, one of which must be a diuretic, at optimal tolerated doses. Device-based therapies like renal denervation are indicated in patients in whom pharmacological agents failed to control BP and patients with refractory resistant hypertension have no contraindications for the procedure. Pulse wave velocity is the measure of arterial stiffness which is directly connected to cardiovascular risk and hypertension-mediated organ damage. The aim of this study was to present measurement of arterial stiffness as a noninvasive method of assessing cardiovascular risk in patients with resistant hypertension after renal denervation. This study included 10 patients over the course of 1 to 4 years after renal denervation. Arterial stiffness was measured for patients with a noninvasive method using the Agedio B900 device operating on the principle of oscillometry. This study demonstrates that renal denervation as an additional method of controlling BP has long-term positive effects in addition to lowering BP and vascular stiffness over several years, thus lowering cardiovascular risk. Noninvasive measurement of arterial stiffness could be a novel prognostic marker of the impact of renal denervation on arterial stiffness.

Maja Strozzi, Margarita Brida, Denis Došen, Daniel Lovrić, Darko Anić, Irena Ivanac Vranešić, Kristina Marić Bešić, Mislav Planinc, Goran Međimurec, Maja Hrabak Paar

U svrhu obilježavanja pete godišnjice sustavne brige za odrasle bolesnike s prirođenom srčanom bolesti organizirali smo u Nacionalnom centru u Kliničkom bolničkom centru Zagreb sastanak uz prikaz kompleksnih kliničkih slučajeva iz tog područja. Zbog pandemije COVID-a 19 sastanak je otkazan, ali je umjesto toga održan multidisciplinarni konzilij uz sudjelovanje vrhunskoga međunarodnog stručnjaka. Prikazano je više bolesnika i doneseni zaključci o njihovu daljnjem liječenju. Ovdje iznosimo podatke o četirima bolesnicima: o dva bolesnika sa slučajno otkrivenom kasnom dijagnozom prirođene srčane bolesti (o jednom s atrijskim septalnim defektom i drugom s Fallotovom tetralogijom), o bolesnici sa slomom Fontanove cirkulacije, liječenom transplantacijom srca te o bolesnici s transpozicijom velikih krvnih žila i problemima nastalima nakon operacije. Uz prikaze bolesnika, u raspravama su iznesene dvojbe u vezi s liječenjem te najvažniji zaključci vezani uz svaki pojedini slučaj.

Hasan Ali Farhan, Zainab Atiyah Dakhil

Interventional cardiology specialty is progressing at a rapid pace, but the progress in cardiology fellowship programs does not parallel it fully. The educational and training environment provided by a healthcare facility to its trainees is a major determinant of the healthcare services it can provide to patients. Keeping that in mind, we tried to determine the fragile points in the traditional cardiology fellowship program by continuous precise feedback from fellows in training. We then tried to bridge the practice and teaching gaps by establishing a new training paradigm that implemented five courses in training of the final-year fellows, including training on device implantation, device programming and Holter basics, electrophysiology study basics, approaching and managing adult congenital heart disease, and cardio-maternal unit attendance. Once all fellows in training completed their new training program, they were surveyed for feedback regarding their satisfaction level with each course, privileges and educational pitfalls of each course, as well as their suggestions for future training programs for the next fellows to further improve competency. The survey found that the level of satisfaction was highest with electrophysiology and cardio-maternal unit training, while the lowest satisfaction level was reported for the device implantation course, mainly due to limited hands-on training. This program provides equal opportunities to all candidates in order to improve knowledge and upgrade skills to improve the competencies of this workforce nucleus which will subsequently impact cardiovascular care.