Cardiologia Croatica. 2020;15(9-10)

Aleša Primožič, Alenka Glavač Povhe, Mateja Grošelj, Breda Barbič-Žagar

Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality worldwide. In spite of many different recommendations and actions related to screening and management of hypertension, reaching target levels of blood pressure (BP) is still a challenge in clinical practice. The main goal of treating patients with hypertension remains the maximum reduction in the risk of fatal and non-fatal CV complications, cerebrovascular complications, and chronic kidney disease. To achieve this goal, it is necessary to lower BP to target levels. In addition to lifestyle changes, effective antihypertensive medication is needed. The VICTORY II study was performed to assess the efficacy and safety of the use of single-pill combinations (SPCs) of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide in achieving the target level of BP in newly diagnosed or uncontrolled patients with grade 2 or 3 arterial hypertension. A total of 100 patients were enrolled in this multicenter, open, prospective clinical study. All patients with grade 2 hypertension started the treatment with SPC of amlodipine/valsartan, 5 mg/80 mg, which if necessary could be up-titrated step-by-step to the final option, i.e. SPC of amlodipine/valsartan/ hydrochlorothiazide 10/160/12.5 mg, to achieve target levels of BP. Patients with grade 3 hypertension started the treatment with SPC of amlodipine/valsartan 5 mg/160 mg, which could be up-titrated step-by-step to SPC of amlodipine/valsartan/hydrochlorothiazide 10/160/25 mg if necessary to achieve target levels of BP. The results of the VICTORY II study showed that SPCs of amlodipine/valsartan and amlodipine/valsartan/hydrochlorothiazide effectively reduce BP in patients with grade 2 or 3 hypertension and have a good tolerability profile.

Daren Lučinger, Nenad Lakušić, Duško Cerovec, Krunoslav Fučkar, Ljubica Vincelj Šalković

The classic triad of aortic stenosis symptoms – angina pectoris, heart failure, and syncope - is well-known among clinicians, but manifestations of aortic stenosis on other systems often remain unrecognized. Gastrointestinal (GI) angiodysplasia, like aortic stenosis, is degenerative disease and both entities are more common in older patients. Heyde syndrome refers to a triad of aortic stenosis, acquired coagulopathy (von Willebrand syndrome type 2A), and sideropenic anemia due to bleeding from gastrointestinal angiodysplasia or from an idiopathic site. Acquired coagulopathy arises from degradation of vWF multimers by the shear stress across the stenotic aortic valve. Aortic valve replacement leads to rise in vW factor multimers and ultimate resolution of gastrointestinal bleeding and sideropenic anemia. In patients with established aortic stenosis, development of iron deficiency anemia should raise the possibility of Heyde syndrome, but patients with GI bleeding with presence of angiodysplasia or failure of endoscopy to find the site of GI bleeding should also be evaluated for aortic stenosis.

Hasan Haghaninejad, Farkhondeh Khaleghi, Aryan Naghedi

Valvular heart diseases are common worldwide and are associated with a high rate of mortality and morbidity. Surgical valve replacement is the most important treatment for valvular diseases. One of the most important complications of this treatment is prosthetic valve malfunction which requires rapid diagnosis and treatment. In this study, we examined the etiologies, treatment strategies, and treatment outcomes in a series of patients with prosthetic valve malfunction. In this cross-sectional, analytic-descriptive study, 63 cases in 52 patients with prosthetic valve malfunction were included. Their coagulation status, demographic, and clinical information was collected in a questionnaire. Patients treatment and their outcomes or rehospitalization rate was recorded as well. Data were analyzed using SPSS 20 software. In our study population, average age was 49.98±14.31, and 53.9% of patients were women. Among 63 cases, 57 of them had mechanical valve malfunction and 6 of them had biological valve malfunction. All cases of mechanical valve malfunction were caused by thrombosis. Surgery was the most common treatment strategy and was associated with excellent outcomes compared with other strategies (p=0.002). In this study, we observed acceptable outcomes for thrombolytic therapy. Thrombosis was the most frequent cause of prosthetic valve malfunction in this study, which seems to be due to inadequate anticoagulant therapy. It can be concluded that educating and following patients for their accurate coagulation status is necessary for decreasing prosthetic valve malfunction. We also found surgical treatment to be significantly better than other treatments.

Dora Jelinek, Ljiljana Banfić, Majda Vrkić Kirhmajer, Stipe Pelajić, Savko Dobrota, Dražen Perkov

The rate of percutaneous endovascular treatment is increasing because of the high incidence of peripheral artery disease and improved endovascular techniques. Therapeutic decisions in patients with intermittent claudication are based on the patient’s functional impairment, specifically in the Fontaine II class. Endovascular or surgical revascularization versus optimal medical therapy with supervised exercise training is a very frequent dilemma in clinical practice. Patient surveillance and follow up after angiointerventions requires a rational approach in the era of new technical advancements in the 21st century. The aim of this retrospective study was to analyze changes in ankle brachial index (ABI) values and walking distance changes as functional status parameters after successful angiointerventions in the observational period: before intervention, after the procedure, and in follow-up. Increased ABI values and walking distance were associated with successful revascularization in the group of patients who did not respond to the initial standard medical treatment in the 6-month period. Comorbidities had no influences on data evaluated in the study. ABI values on the contralateral leg revealed a positive correlation with the incremental ABI values in the leg where revascularization was successfully performed. Significant increase in walking distance after percutaneous revascularization and significantly greater ABI values in follow-up confirmed the importance of both parameters that reflect successful angiographic findings after percutaneous transluminal angioplasty (PTA). Both parameters were consistent with successful revascularization and improved functional status in the follow-up period. Walking distance deserves to be reevaluated in the assessment of functional status in patients after successful percutaneous angiointerventional revascularization. It should not be neglected as a valuable parameter in estimating functional status after PTA.