Cardiologia Croatica. 2017;12(1-2)

Josip Lukenda, Boris Starčević, Edvard Galić, Tomislav Krčmar, Zrinka Biloglav

With the advancements in interventional cardiology in the Republic of Croatia over the last two and a half decades, the goal of this study was to analyze the number and complexity of percutaneous coronary intervention (PCI) procedures in individual centers. Between 2010 and 2014, an average of 9,494 PCI procedures was performed annually in a total of 13 centers. Seven centers are classified as high-volume centers: the Magdalena Clinic with the highest number of PCI procedures performed annually, with an average annual increase of 6.2% (1545 to 1941 PCI over analyzed period), the University Hospital Centre (UHC) Zagreb with an average annual decrease of 1.8% in procedure numbers (1474 to 1308), UHC Rijeka with an average annual increase of 15.8% (1013 to 1632), University Hospital (UH) Dubrava with an average annual decrease of 5.7% (1153 to 905), and the UHC "Sestre milosrdnice” with an average annual increase of 2.3%; however this hospital experienced a decrease of procedures in the last year of period (1082 to 815). These are followed by the UHC Split with an average annual increase of 6.7% (662 to 821) and the UHC Osijek with an increase of 12.4% (677 to 905). Five centers are classified as medium-volume centers: the UH Merkur with an average annual decrease in PCI procedures of 3.7% (670 to 506), whereas the number of procedures increased in the rest of the medium-sized centers: in General Hospital (GH) Slavonski Brod by 29.1% annually (264 to 660), UH "Sveti Duh” by 7.5% annually (306 to 382), in the GH Zadar by as much as 70.5% annually (105 to 430), and in the GH Dubrovnik by 32.4% annually (84 to 232). In Croatia overall, the percentage of complex procedures on two or more vessels was 9.7%. It was highest in the UHC Rijeka (18.2%) and UH Dubrava (17.1%), followed by the GH Zadar (15.3%), UHC Split (11.0%), and the Magdalena Clinic (10.4%). The UHC Zagreb had a value similar to the national average (10.1%), as did the GH Dubrovnik (8.6%). Lower percentages of complex procedures were present in the UH "Sveti Duh” (7.9%), UHC "Sestre milosrdnice” (6.9%), and the GH Slavonski Brod (6.3%), whereas the lowest rate of complex procedures was found in the UHC Osijek (3.5%) and the UH Merkur (1.7%). With such advancements in coronary interventions and once the introduction of a registry of coronary interventions and certificates for centers and staff is completed, the next step in Croatia should be the introduction of a plethora of new procedures in patients with acquired or congenital structural heart diseases that are currently underdeveloped.

Karlo Golubić

Many physicians today rely uncritically on the results of diagnostic tests, resulting in further needless examination and interventions. This article shows why this is incorrect and what the consequences of such practices are.

Jure Berkopec, Anja Zaletel, Polona Knavs Vrhunec, Breda Barbič-Žagar

Raised blood pressure (BP) is the leading global risk factor for cardiovascular disease and chronic kidney disease. Thus, in addition to lifestyle changes effective antihypertensive medication is clearly needed to provide not only symptomatic relief but also cardiovascular protection. The VICTORY trial was performed to assess the efficacy and safety of valsartan monotherapy (Valsacor®) and therapy with the fixed-dose combination (FDC) of valsartan and hydrochlorothiazide (Valsacombi®) in a broad population of patients with mild to moderate arterial hypertension. A total of 365 patients were enrolled in this 16-week, international, multicentre, open-label, prospective trial. The patients started the treatment with 80 mg valsartan daily, which could be up-titrated to 320 mg daily or combined with hydrochlorothiazide (HCTZ) in a fixed-dose combination to achieve target BP. The results of the VICTORY trial showed that valsartan and the FDC of valsartan and hydrochlorothiazide effectively reduce BP in patients with mild to moderate arterial hypertension, and have a very good tolerability profile.

Mario Ivanuša

What makes the book Clinical Cardiology: Current Practice Guidelines stand out and why is it necessary and important to cardiologists? In addition to employing modern concepts and designs as well as providing an extensive list of current literature, what makes this edition special is that the authors/editors Katritsis, Gersh and Camm offer an instructive and practical integration of European and American knowledge. Thus, the reader gets an excellent synopsis of modern evidence-based cardiology in a single book. Due to its large scope (more than 20 topics over 970 pages) and presentation of current guidelines in an accessible way, the book can, for instance, be used to prepare for residency examination, but also to find new information necessary to the practicing cardiologist.

Ivo Darko Gabrić

Cardiotoxicity has been increasingly reported as a side effect of oncologic treatment, including novel targeted biological therapy. Specific monoclonal antibodies or tyrosine kinase inhibitors have been developed for blockade of HER2 receptors, VEGF receptors, or Abl kinase activity. However, these actions also interfere with molecular mechanisms that are crucial for cardiovascular health. Anti HER2 therapy generally induces reversible systolic left ventricular dysfunction, whereas VEGF receptor blockade leads to development of arterial hypertension and increased susceptibility to thromboembolic events. In patients developing cardiotoxicity, better clinical outcome and quality of life can be achieved by early recognition and treatment, thus also enabling continuation of anti-cancer therapy in many cases. A multidisciplinary approach including cardiologists and oncologists, along with regular cardiologic follow up, is crucial for successful patient management.