Cardiologia Croatica. 2019;14(7-8)

Rok Accetto

Average clinic blood pressure (BP) is the gold standard for the diagnosis and treatment of hypertension. However, BP fluctuates throughout the day and the measurement does not always reflect the actual BP. Therefore it is also important to measure BP variability, which has been associated with an increased frequency of cardiovascular events, death, and target organ damage. Treatment has to be directed not only towards reducing the 24-hour BP average but also towards normalizing the variability of BP during the day and at night. It has been found that reduction in average BP leads to a proportional reduction in its variability, which is why the use of long-acting medications may be beneficial in controlling hypertension. A 24-hour BP reading offers several advantages, such as providing information on the maximum effect and duration of effect of hypertension medication and enabling calculation of the smoothness index. A meta-analysis of studies demonstrated different effects and smoothness indices among hypertension medications. The smoothness index was higher for combined medications and medications at higher doses. Medications with a higher smoothness index have been shown to be superior in providing cardiovascular protection and preventing target organ damage.

Mario Ivanuša, Verica Kralj, Mario Olivari

The aim was to analyze ischemic heart disease (IHD) and acute myocardial infarction (AMI) mortality. Data on the respective mortality and in-hospital morbidity for the City of Zagreb and Republic of Croatia were retrospectively analyzed. The analysis included data on the number of deaths due to IHD (International Classification of Diseases-10th Revision (ICD-10) code I20-I25) and deaths due to AMI (ICD-10 code I21). Study results revealed the number of deaths from AMI to have continuously decreased from January 1, 2001 until December 31, 2016. During the study period, the age-standardized death rates from AMI decreased by 55.6% and 35.6% in Zagreb and Croatia, respectively. As the number of deaths due to the IHD group of syndromes did not show substantial decline, it was concluded that deaths due to IHD entities other than AMI were on an increase in both Zagreb and Croatia as a whole, calling for more attention to be paid to them.

Ljiljana Fodor

In April 2019, the symposium “Controversies in hypertension, cardiovascular protection and nephrology” was held in Zagreb. In dynamic and interesting ways, various subspecialists presented strategies of treating patients with numerous comorbidities, the complexity of the treatment strategy, and the risk of side effects. Guidelines were published, but despite them or even because of them, we have realized that an individual approach to the patient remains crucial to the decision on the treatment. The goal of this article is to describe the controversy over the application of sacubitril/valsartan in patients with chronic kidney disease.

Juraj Jug, Mirna Čilić, Martina Lovrić Benčić, Martina Matovinović, Ingrid Prkačin

As a health disorder, obesity is associated with many chronic diseases. Most study results indicate a positive association between pathophysiological processes in persons with excess body weight and the development of atrial fibrillation (AF), AF complications, and treatment success. Increased cardiac volume load in obesity and excess accumulation of epicardial adipose tissue are considered to be the main reasons for the development of AF. Additionally, some other conditions such as obstructive sleep apnea can influence treatment results and AF incidence. However, some studies have reported contradicting results. The results of this study performed at the Clinic for Cardiovascular Diseases at the Zagreb University Hospital Centre showed that a structured plan of body weight loss reduced cardiometabolic risk and thus also insulin resistance as well as inflammatory processes in the body that are considered to be an important factor for the development of AF. We believe that changing lifestyle habits, primarily through increased physical activity and reducing the sedentary lifestyle, could achieve a reduction of AF incidence in patients with increased body mass.

Afrasyab Altaf, Hammad Shah

Previous gender-related studies on ejection fraction (EF) were single vessel specific and considered only patients with ST-segment elevation myocardial infarction (STEMI). This study evaluated the effect of gender on EF in acute coronary syndrome, including STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) as well as all blood vessels, since they can affect left ventricular function. 480 patients with acute coronary syndrome (STEMI and NSTEMI) were enrolled. All baseline characteristics along with EF were noted. All patients received reperfusion therapy as per international guidelines. Patients were followed up for one year, after which EF was reassessed. Women were significantly older than men (P<0.05). There was significant difference between EF the between female and male groups (P<0.05). No significant change was seen in EF in the female group during follow-up (P>0.05). Age and female gender were found to be independent predictors of change in EF. Female gender is an independent predictor of recovery of EF in patients with acute coronary syndrome (STEMI and NSTEMI).

Ana Reschner Planinc, Maja Strozzi, Zoran Miovski, Kristina Marić Bešić, Joško Bulum

Troponin elevation usually indicates myocardial cell injury. However, elevated values of troponin are not always a consequence of infarction or ischemia. The aim of this study was to elucidate the diverse etiologies of elevated troponin in patients with normal coronary angiography. There were 947 patients at the Zagreb University Hospital Centre identified from the catheterization database who underwent coronary angiography in 2014 due to suspected acute coronary syndrome. We identified 32 (3.38%) patients who had an alternative cause for myocyte injury other than coronary artery disease, defined as coronary artery lumen stenosis above 30%. The elevation of cardiac troponin T (cTnT) in patients with normal coronary angiography was found to be the consequence of diverse etiologies, including hypertensive heart disease, Takotsubo syndrome, supraventricular tachycardia, myocarditis, and dilated cardiomyopathy, to name a few. Apart from acute coronary syndrome, cTnT can be elevated in a number of different conditions, which should be considered according to clinical presentation, and that could still reflect myocardial necrosis even in the absence of significant coronary artery disease.