Davor Milicic

Introduction: Arterial hypertension (AH) is one of the leading public health issues worldwide, and patients’ adherence to recommended treatment is essential for successful regulation of blood pressure (BP), disease control, and prevention of complications. Aim: The aim of this study was to evaluate the adherence of patients with hypertension to medication and lifestyle changes in Croatia, based on the primary care arm of the EUROASPIRE V survey. Methods: A cross-sectional study was conducted in nine family medicine practices in the city of Zagreb, following the protocol of the EUROASPIRE V primary care study. Out of the total Croatian cohort of 203 participants, data on 156 participants with AH were included in this study. The study used components of the EUROASPIRE V questionnaire on self-assessment of adherence to medications, existing lifestyle characteristics and self-reported lifestyle changes (smoking, salt intake, and physical activity, respectively). Results: A total of 156 participants were included, with almost even distribution of men (n = 77, 49.4%) and women (n = 79, 50.6%); median age was 65 (57, 72). A self-reported medication adherence to antihypertensive medication of 100% (all of the time) was reported by 56.9% patients. According to the lifestyle change questionnaire, the highest adherence was concerning reduction in salt intake (74.4%), while smoking was reduced in 24.1% of advised participants with AH, 13.8% had quit smoking, and increased physical activity was reported by 24.4% patients. Conclusions: The results of the primary care arm of EUROASPIRE V study in Croatia on treated patients with AH indicate suboptimal BP control in a significant proportion of patients (55.1%) and suboptimal lifestyle change adherence. Achieving target BP and optimal disease control requires additional efforts to foster patients’ adherence to prescribed medications and lifestyle recommendations.

Background: Catheter ablation is an established first-line treatment for supraventricular tachycardia (SVT). Traditionally, these procedures have been performed under fluoroscopic guidance. The objective of this study was to demonstrate the feasibility and safety of a completely fluoroless approach, as well as to evaluate clinical outcomes. Methods: This retrospective, single-center analysis included two patient cohorts, comprising a total of 400 patients: 200 in the main (fluoroless) group and 200 in the control (fluoroscopy) group. In the main group, ablation was performed using a 3D mapping system and intracardiac echocardiography (ICE) without the use of fluoroscopy and lead aprons. In the control group, procedures were conducted under fluoroscopic guidance. The primary outcomes were feasibility and safety. Secondary outcomes included acute procedural success, defined as non-inducibility of tachycardia, and chronic success, measured as arrhythmia recurrence-free survival during a 6-month follow-up period. Results: Completely fluoroless ablation was successfully performed in all patients in the main group (100%). Procedures were shorter in the fluoroless group (59.0 ± 25.8 min vs. 72.7 ± 34.0 min, p < 0.001), with no difference in acute success rates (100% vs. 100%). No serious complications occurred in the main group, compared to one event in the control group (0 vs. 1.0, p = 0.313). Arrhythmia recurrence rates during follow-up were similar between groups (HR: 0.877, 95% CI: 0.367–2.097, p = 0.769). Conclusions: A completely fluoroless, “apron-less” approach to SVT ablation is feasible, with complication and success rates comparable to the traditional fluoroscopy-guided approach.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today, we are talking about a new paradigm—cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, an unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today we are talking about a new paradigm - cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Dietary inorganic nitrate lowers blood pressure (BP) in healthy individuals through improved nitric oxide (NO) bioavailability. However, there is limited evidence examining the long-term effects of dietary nitrate for managing hypertension. We aimed to determine whether the sustained intake of dietary nitrate improved BP and cardiovascular disease (CVD) risk factors in individuals with early-stage hypertension. The Dietary Nitrate (NO₃) on BP and CVD Risk Factors (DINO₃) Trial was a multi-center, double-blinded, parallel, randomized, controlled trial in participants with elevated BP. Participants were supplemented with high-nitrate (HN) (~400 mg nitrate) or low-nitrate (LN) vegetable powder (~50 mg nitrate) on top of their usual diets for 16 weeks. The primary outcome was office systolic BP at 16 weeks. The secondary outcomes were 24 h ambulatory BP, central BP, heart-rate-corrected augmentation index (AIx75), carotid–femoral pulse wave velocity (cf-PWV), lipids, and high-sensitivity C-reactive protein (hs-CRP). Sixty-six participants were randomized at baseline (39M:27F, age: 51.5 ± 10.8 years, BMI:27.9 ± 3.2 kg/m²). In an intention-to-treat analysis, no differences were observed between HN and LN groups in terms of office systolic BP at 16 weeks (3.91 ± 3.52 mmHg, p = 0.27) or secondary outcomes. In this exploratory study, sustained HN vegetable supplementation did not exhibit more favorable vascular effects than LN vegetable supplementation in individuals with elevated BP.

This study was designed to examine the association between myocardial concentrations of the trace elements Cu, Fe, Mn, Mo, and Zn and the expression of mitochondrial unfolded protein response (UPRmt) elements and the age of patients who received heart transplantation or a left-ventricular assist device (ageHTx/LVAD). Inductively coupled plasma mass spectrometry was used to determine the concentration of Cu, Fe, Mn, Mo, and Zn in the myocardium of control subjects and patients undergoing heart transplantation or left-ventricular assist device (LVAD) implantation. We used ELISA to quantify the expression of UPRmt proteins and 4-Hydroxynonenal (4-HNE), which served as a marker of oxidative-stress-induced lipid peroxidation. Concentrations of Cu, Mn, Mo, and Zn were similar in the control and heart failure (HF) myocardium, while Fe showed a significant decrease in the HF group compared to the control. A higher cumulative concentration of Fe and Zn in the myocardium was associated with reduced age_HTx/LVAD, which was not observed for other combinations of trace elements or their individual effects. The trace elements Cu, Mn, and Zn showed positive correlations with several UPRmt proteins, while Fe had a negative correlation with UPRmt effector protease YME1L. None of the trace elements correlated with 4-HNE in the myocardium. The concentrations of the trace elements Mn and Zn were significantly higher in the myocardium of patients with dilated cardiomyopathy than in patients with ischemic cardiomyopathy. A higher cumulative concentration of Fe and Zn in the myocardium was associated with a younger age at which patients received heart transplantation or LVAD, potentially suggesting an acceleration of HF. A positive correlation between myocardial Cu, Mn, and Zn and the expression of UPRmt proteins and a negative correlation between myocardial Fe and YME1L expression suggest that these trace elements exerted their actions on the human heart by interacting with the UPRmt. An altered generation of oxidative stress was not an underlying mechanism of the observed changes.

A 44-year-old female patient with chemotherapy-induced cardiomyopathy presented with acute cardiogenic shock requiring ECMO support. Multiple failed weaning trials from temporary mechanical circulatory assistance prompted a transition to staged durable biventricular support. Her course was complicated with recurrent RVAD stoppages. The initial event was treated with pump exchange, while for the subsequent RVAD standstill, we employed a device wash-out and reimplantation strategy. A brief period of circulatory arrest was employed to explore the right-sided cardiac chambers using a single-use bronchoscope.

Heart failure (HF) is a common cause of morbimortality with different etiopathogenesis and prognosis between men and women. This review provides a brief overview of gender-based differences in response to pharmacological therapies of heart failure with or without reduced ejection fraction (EF). It focuses on the differences in therapy outcomes with angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), angiotensin neprilysin inhibitors (ARNI), beta-adrenergic blockers, mineralocorticoid/aldosterone receptor antagonists, diuretics, ivabradine and digoxin. The baseline data originates from randomised controlled trials (RCTs) and large registries. We conclude that current guidelines recommending similar therapeutic approaches for both men and women are appropriate, while additional consideration should be given for different approaches regarding the use of ARBs, ACEi, and digoxin. Based on the available data, the ARBs might be considered a first-line therapy of HR for women instead of ACEi. Moreover, female patients should have stricter digoxin monitoring due to higher sensitivity and increased risk of complications. Finally, women are underrepresented in current clinical trials, and therefore future trials should aim to balance the gender recruitment disparity allowing sub-group analysis and comparisons between genders to guide individualised therapeutic strategies and appropriately targeted preventative steps.