DOI: 10.3897/bgcardio.31.e178367

Authors: D. Farandzha

Abstract: Acenocoumarol, a vitamin K antagonist (VKA), has played a pivotal role in anticoagulant therapy for over 60 years. Derived from the coumarin family, acenocoumarol inhibits vitamin K epoxide reductase, disrupting the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and effectively preventing thromboembolic events. Compared to warfarin, acenocoumarol offers a rapid onset and shorter half-life, providing clinicians greater therapeutic fl exibility. Despite advances and widespread adoption of direct oral anticoagulants (DOACs), acenocoumarol continues to hold clinical signifi cance, particularly in Europe, Latin America, and Asia, owing to extensive clinical experience, reversibility, and cost-effectiveness. However, its use necessitates regular monitoring of international normalized ratio (INR), with individualized dosage adjustments required due to genetic variability (CYP2C9, VKORC1 polymorphisms), drug-drug interactions, dietary infl uences, and special considerations in the elderly and patients with chronic kidney disease (CKD). Recent clinical trials have expanded our understanding of its effi cacy, safety, and optimal use. Precision dosing strategies, including genotype guidance and advanced INR monitoring based on body-surface area-adjusted estimated glomerular fi ltration rate (BSA-adjusted eGFR) dosing, promise enhanced safety and personalized treatment. Although DOACs are now widely adopted due to their predictable pharmacokinetics and lack of routine monitoring requirements, acenocoumarol remains indispensable in well-defi ned clinical scenarios such as in patients with mechanical heart valves, rheumatic mitral stenosis–associated atrial fi brillation, antiphospholipid syndrome, and other conditions in which individualized dose adjustment offers a therapeutic advantage.

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DOI: 10.3897/bgcardio.31.e169297

Authors: G. Chausheva, S. Shefket, K. Tsochev, T. Chalukova, Y. Bocheva, Y. Yotov, V. Iotova

Abstract: Background: Cardiovascular disease (CVD) is a major complication in patients with long-standing type 1 diabetes (T1D). Osteoprotegerin (OPG) has been proposed as a biomarker for cardiovascular risk (CVR), though its utility in this context requires further evaluation. This study aimed to assess the prognostic signifi cance of OPG in CVR estimation among T1D patients using specifi c CVR assessment tools. Patients and Methods: This prospective case–control study includes 183 participants: 124 with T1D (53.2% men, aged 42.7 ± 10.4 years, diabetes duration 25.3 ± 8.2 years) and 59 healthy controls (54.1% men, aged 45.1 ± 9.1 years). Serum OPG levels were determined via ELISA; CRP – immune-turbidimetric method (Advia chemistry 1800); HbA1C (%) – immuno-inhibition assay (ADVIA chemistry 1800); AlbU (mg/l) – immuno-turbidimetric analysis (Olympus AU600). CVR evaluation tools: STENO Type 1 Risk Engine (ST1RE) and ESC – 2019 guidelines. A RiskFactor3 model combined CRP ≥ 3 mg/l, HbA1C ≥ 7%, and AlbU ≥ 30 mg/l. Results: No signifi cant intergroup differences in OPG levels were observed. However, OPG was observably higher in women across both groups (T1D: 5.34 ± 1.2 pmol/l vs. 5.73 ± 1.83 pmol/l; controls: 5.06 ± 1.65 pmol/l vs. 6.16 ± 2.38 pmol/l, p < 0.05). In T1D patients, age (R² = 3%), disease duration (R² = 4.8%), and AlbU (R² = 3.9%) were signifi cant positive determinants of OPG (p < 0.05). According to ESC-2019, 30.6% of T1D patients had high CVR and 69.4% had very high CVR. ST1RE classifi ed 38.7% as low, 28.2% as moderate, and 33.1% as high CVR. ST1RE’s AUC-ROC for males was 0.716 (p = 0.005) with a cut-off of 5.075 pmol/l, and for females, 0.683 (p = 0.039) with a cut-off of 5.355 pmol/l. For ESC-2019, the AUC-ROC for females was 0.644 (p = 0.102) with a cut-off of 5.025 pmol/l. Conclusion: OPG is a promising biomarker for assessing CVR in patients with long-standing T1D. Higher OPG levels in women and its associations with age, disease duration, and AlbU emphasize its potential prognostic role. Using ST1RE and ESC-2019, OPG effectively stratifi ed patients by CVR. Incorporating OPG into clinical practice could improve early detection and personalized management of CVR in T1D patients.

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DOI: 10.3897/bgcardio.31.e167784

Authors: I. Kostovska, K. Tosheska Trajkovska

Abstract: Introduction: Low-density lipoprotein cholesterol (LDL-C) is a cornerstone biomarker for cardiovascular risk. The Friedewald formula has long been the standard for estimating LDL-C, however, it has limitations, particularly in patients with hypertriglyceridemia or low LDL-C levels. Several alternative equations, including the Martin–Hopkins (M/H) and Sampson formulas, have been developed to improve accuracy. Among them, M/H has gained recognition for its performance in specifi c populations, but it represents only one of several refi ned methods used across professional communities. This study aimed to perform a meta-analysis comparing the accuracy and precision of the Friedewald and M/H formulas in diverse populations, acknowledging that other approaches also exist. Methods: A systematic review of articles published between 2018 and 2024 was conducted using PubMed, Embase, Scopus (Elsevier), and Web of Science-eligible studies directly compared both formulas against direct LDL-C measurement in adult populations. A random-effects model was used to pool mean absolute errors (MAEs), root mean square errors (RMSEs), correlation coeffi cients, and p-values. Heterogeneity was assessed using the I² statistic. Results: Eight novel studies, involving a total of 192,094 participants, were included. The M/H formula showed signifi cantly lower MAE (3.6 mg/dL vs. 8.4 mg/dL, p < 0.001), lower RMSE (5.1 mg/dL vs. 9.8 mg/dL, p < 0.001), and a stronger correlation with direct LDL-C (r = 0.92 vs. r = 0.84) compared to the Friedewald formula. The superiority of the M/H formula was especially evident in patients with triglycerides >200 mg/dL or LDL-C <70 mg/dL. Conclusion: The M/H formula provides more accurate and precise LDL-C estimation than Friedewald, particularly in clinically vulnerable groups. However, it should be considered one of several improved approaches, alongside other equations such as Sampson, which may perform better in certain populations. M/H can be recommended as a strong option, but is not the sole alternative for routine lipid profi ling.

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DOI: 10.3897/bgcardio.31.e180003

Authors: Vesselina Koleva

Abstract:

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DOI: 10.3897/bgcardio.31.e152971

Authors: R. Talhi, S. Amrit, K. Chenni, D. Larbi, M. Raiah, A. Ghalmi, A. Abdelouahab, N. A. Khelifi Touhami, N. Ouchene, M. Bouziani, M. Farouk Mesli

Abstract: Acute coronary syndrome (ACS) is a heterogeneous and severe acute cardiovascular event, with an early mortality rate estimated at 10.5% in western Algeria. Existing ischemic risk stratifi cation scores for ACS vary in complexity and present certain limitations. The primary objective of this study is to develop and validate a prognostic score for ACS, based on a cohort of patients admitted to the three cardiology departments of Oran ; University Hospital Establishment (UHE), University Hospital Center (UHC) and Regional Military University Hospital (RMUH), with the aim of predicting 30-day mortality. This epidemiological, multicenter, observational study included all patients hospitalized for ACS between 2018 and 2020, with 30-day all-cause mortality as the primary endpoint. The fi nal predictive model was derived using binary logistic regression in a cohort representing 71% of the initial population, while the remaining 29% was used for validation. Model calibration was assessed using the Hosmer-Lemeshow test, and discrimination was evaluated based on the area under the Receiver Operating Characteristic (ROC) curve and C-statistic. A total of 1692 eligible patients were recruited, with a predominance of males (75%) and a mean age of 61 ± 12 years. The developed score consists of seven independent dichotomous variables, yielding a maximum total of ten points. It demonstrated good calibration (p = 0.906) and a discrimination of 0.76 [95% CI: 0.73-0.78] in the derivation cohort, compared to 0.71 [95% CI: 0.66-0.75] in the validation cohort. A new, simple, reproducible, and validated decision-support tool is proposed for practitioners. This prognostic score, designed to be quickly and easily calculated, provides an effective means of predicting 30-day mortality in ACS patients and is well-suited to emergency department practices.

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DOI: 10.3897/bgcardio.31.e165330

Authors: V. Gitsov, K. Gospodinov, S. Tisheva, K. Razlozhka

Abstract: Cardio-oncology is a new fi eld in medicine, uniting the two clinical disciplines of cardiology and oncology. With the improvement of anticancer therapies, patient survival has increased, creating conditions for the development of cardiovascular diseases, including rhythm and conduction disorders. Furthermore, the medications used for cancer treatment are themselves associated with cardiovascular system damage. The aim of this publication is to provide a brief overview of rhythm and conduction disorders resulting from treatment with anticancer drugs, to present the medications with the highest cardiotoxicity risk, and the mechanisms and factors that predispose to it.

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DOI: 10.3897/bgcardio.31.e146281

Authors: A. Borizanova, I. Gruev, V. Traykov

Abstract: Aim: “It’s Time for Lp(a)” is a survey of Bulgarian Society of Cardiology (BSC) assessing the awareness and use of lipoprotein(a) – Lp(a), and the challenges that limit this lipid assessment. Methods and results: In the period of July-August 2024, the BSC conducted an on-line national survey with questions in three areas: professional information; information on the clinical circumstances in which cardiologists are considering Lp(a) testing and questions about reasons for limited test recommendation. Of the 585 cardiologists who took part in the survey, 189 answered all of the questions, and 396 answered partially. Only 18% of clinicians declare that they routinely measure Lp(a) primarily for cardiovascular risk stratification and in cases of family history. Additionally, 50% of cardiologists never measure Lp(a) at all. The most common reasons for not referring patients for testing Lp(a), according to 55% of cardiologists, are its absence in standard lipid panel and the fact that the test is not reimbursed (54%). 94% of respondents say that they would use Lp(a) if the test was reimbursed. 48% of cardiologists need clear clinical guidance on the use of Lp(a). According to 64%, the availability of therapies targeting this lipoprotein would lead to a greater use of Lp(a) test. Conclusion: These results indicate the need for further efforts by scientific societies to introduce clear and detailed guidelines, inclusion in lipid panels and reimbursement of testing, as well as educational initiatives to address the limited use and recognition of Lp(a) as a risk factor.

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DOI: 10.3897/bgcardio.31.e150772

Authors: I. Paskaleva, E. Doncheva

Abstract: D-dimer is a terminal product of plasmin-mediated degradation of cross-linked fibrin and is a marker for the activation of both the coagulation and fibrinolytic systems. D-dimer is widely used in routine clinical practice to rule out venous thromboembolism (VTE), assess the risk of recurrent thrombosis, and determine the optimal duration of anticoagulant therapy, as well as for the diagnosis and monitoring of disseminated intravascular coagulation (DIC). The analytical methods for measuring D-dimer are high sensitive but relatively low specific, as D-dimer levels are elevated in several physiological and pathological conditions. The combination of D-dimer measurements with clinical probability scores allows for the safe exclusion of VTE. To improve diagnostic accuracy, several strategies have been proposed to increase the specificity of D-dimer testing. The application of age-adjusted and clinical probability adapted cutoff values for VTE allows VTE exclusion in a greater number of patients without the need for additional imaging studies.

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DOI: 10.3897/bgcardio.30.e145391

Authors: D.P. Amukti, L.M. Irham, S. Surono, W. Adikusuma, R. Chong, R. El Khair, B.D. Purwanto, R.D. Satria, I. Ates, S. Khairi, D. Rungprai

Abstract: Introduction: Atherosclerosis (AS) is a major risk factor for cardiovascular disease (CVD), which is the leading cause of death worldwide. Genetic factors are an integral factor in the cause of AS. This study aims to correlate epidemiological data, prevalence and mortality of AS worldwide with Single Nucleotide Polymorphisms (SNPs) associated with susceptibility and severity in different populations. Hence, utilized the gene variants to discover potential drug targets using bioinformatics. Material and methods: This study used a secondary data-driven bioinformatics approach to analyze the correlation between genetic variants associated with AS and epidemiological data from different regions of the world. Genetic data were obtained from the GWAS Catalog, while epidemiological data were collected from WHO and Our World in Data. The analysis was performed by filtering SNPs based on several criteria, namely the missense variant category, significant p-value < 10-5, and prediction of variant impact using PolyPhen (Possibly Damaging) and SIFT (Deleterious). The correlation between allele frequency and AS prevalence and mortality were analyzed using the Pearson test. The drug target identification process was carried out through the DrugBank database. Results: The results of the study obtained three missense variants – rs11466653 in TLR10, rs2296172 in MACF1 and rs6025 in F5. Variant rs11466653 has a role in the pathogenesis of AS with analysis using SNPnexus which shows the possibility of damaging (PolyPhen) and deleterious (SIFT) properties in addition to the results of the correlation test significant to the global prevalence and mortality of AS (p < 0.05). Due to the challenge of drugging all potential target genes, our study was only able to identify the F5 gene as a viable target. The TLR10 gene is a molecular target for immunomodulators such as hydroxychloroquine, chloroquine, eritoran, and resatorvid (TAK-242) to reduce inflammation and regulate immune responses. In addition, tacrolimus as an immunomodulator shows potential in overcoming chronic inflammation associated with AS through a mechanism involving the MACF1 gene. Conclusion: The findings in this study will encourage efforts to improve AS diagnosis and early treatment, as well as increase public awareness of the importance of genetic factors and lifestyle in preventing this disease. This study can also be a reference for further research focusing on genetic intervention and development of personalized therapy for AS. Therefore, it can provide broader benefits for global public health.

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DOI: 10.3897/bgcardio.30.e135426

Authors: V. Dimitrova, I. Gruev

Abstract: Hodgkin's lymphoma is a systemic disease of the lymphatic tissue that most commonly affects adolescents and young adults. Modern treatment of the disease aims at long-term remission in patients. During this process, some patients develop complications that require timely diagnosis and treatment. It is fundamental to ensure continuity between pediatric oncologists, pulmonologists, and cardiologists, pediatricians on the one hand, and specialists in the relevant field treating adult patients. Keeping and maintaining accurate patient medical data serves as a springboard for screening adolescents and young adults in remission after treatment for Hodgkin's lymphoma. The treatment methods (radiation, chemotherapy, etc.) have different mechanisms of action on the disease and, accordingly, different potential early and late complications. The role of functional breathing studies and cardiopulmonary stress tests with exercise in this group of patients can explain the etiology of clinical complaints, assess the functional status and effect of treatment, as well as timely diagnosis of complications during the treatment process with the aim of early cardio rehabilitation and achieving durable clinical remission.

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DOI: 10.3897/bgcardio.30.e129108

Authors: G. Voynova, P. Kalaydzhiev, R. Ilieva, G. Nikolova, D. Markov, S. Yakov, Ts. Kotsev, N. Georgieva, A. Hristova, L. Shopov, E. Kinova, A. Goudev

Abstract: The individual approach in the treatment of heart failure (HF) and personalized medicine have been the main topic in recent years in all scientific forums. The combination of chronic obstructive pulmonary disease (COPD) and sleep apnea (SA) further complicates the clinical presentation in patients with HF. The overlap of all three diseases requires a team of specialists and additional therapeutic approach for better control and to improve the prognosis. A large number of the pathophysiological mechanisms of the three diseases also overlap. The novel therapies for HF have shown good results, both in COPD and CA subgroups. Noninvasive ventilation during hospitalization and at home is an established method in the individual groups. In a combination of the three diseases, definitive data from randomized trials are still lacking.

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DOI: 10.3897/bgcardio.30.e127340

Authors: S. Stefanov, N. Stoyanov, N. Koleva, D. Mikova, A. Yordanov, Z. Pavlova, E. Kinova, I. Petrova, L. Demirevska, T. Todorov, T. Chamova, M. Garcheva, A. Kundurdjiev, A. Todorova, I. Tournev, Y. Palashev, I. Daskalov, M. Dimova, I. Gruev, Y. Yotov, A. Goudev, V. Velchev, Mariana Gospodinova

Abstract: Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a severe progressive disease, more common than previously expected. The main objectives were to evaluate hereditary and wild type ATTR-CM frequency and clinical manifestations. Material and methods: One hundred seventy-eight patients at mean age 68 ± 13 years (129 males), referred by cardiologists with suspected cardiac amyloidosis (left ventricular wall thickness ≥ 12 mm and red flags) were evaluated. Pyrophosphate scintigraphy (99mTc-PYP) grade 2-3 myocardial uptake in the absence of monoclonal protein confirmed the diagnosis. Genetic test differentiated variant from wild type ATTR-CM. Endomyocardial biopsy with amyloid typing was performed in two patients. Results: Cardiac amyloidosis was diagnosed in 69 patients: light chain in 24 (13%) and ATTR-CM in 45 patients (25%). Wild type (ATTRwt) was found in 21 (12%) male patients at mean age 81 ± 6 years and variant type (ATTRv) in 24 patients (13%) at mean age 58 ± 7 years (15 males). In all ATTRv-CM patients some degree of peripheral polyneuropathy was found. The most common clinical red flags at diagnosis in both ATTRv and ATTRwt were heart failure in all patients, atrial fibrillation (16; 36%), pacemaker (5; 11%), and carpal tunnel syndrome (8; 18%). Severe aortic stenosis (4; 19%), spinal stenosis (2;10%), biceps tendon rupture (1; 5%) were characteristic for the wild type. At follow up, four patients needed a pacemaker for high degree AV block, six patients developed new onset atrial fibrillation, seventeen patients needed either initiation or an increase of the dose of loop diuretic, another 7 patients were hospitalized for heart failure exacerbation. Eight patients (18%) died, 7 (33%) with ATTRwt-CM and 1 (4%) with ATTRv-CM, all with advanced heart failure, 4 with concomitant severe aortic stenosis. Conclusions: This study provides the first nationwide estimates of the frequency and the clinical manifestations of ATTR-CM. Confirming the severity of the disease and poor prognosis, a low threshold for screening is needed for early diagnosis and timely treatment.

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DOI: 10.3897/bgcardio.30.e120728

Authors: T. Shalganov, M. Stoyanov, K. Dzhinsov

Abstract: This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2023. Material and methods. This is a retrospective study of a full one-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, use of electroanatomic mapping (EAM), irrigated and cryoablations, distribution of different types of arrhythmias, acute procedural success, and complications are presented. Results. In 2023 nine EP centers performed 2021 ablations in 1309 men (61.8%) and 807 women, incl. 20 ablations in pediatric patients (1%). EAM was used in 941 procedures (46.6%), irrigated-tip catheter – in 1121 (55.5%), cryocatheter – in 420 (20.8%), and intracardiac echocardiography – in 43 (2.1%). The most frequently performed ablation was pulmonary vein isolation (46.4%), followed by ablation for AV nodal reentrant tachycardia (16.3%) and typical atrial flutter (15.2%). The acute success was over 98%, while intraprocedural complications were less than 2%. Conclusion. The national registry of electrophysiology collects systematically and continuously basic data on all ablations of cardiac arrhythmias performed in the country. In 2023, after the end of the COVID-19 pandemic, the number of ablations increased compared to 2022, but at a slightly slower rate. Distribution of EP procedure types was similar to previous years. Acute success was very high, while intraprocedural complications were rare.

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DOI: 10.3897/bgcardio.29.e107881

Authors: B. Grigorova, Al. Chobanov

Abstract: Mitral valve prolapse (MVP) and mild mitral regurgitation (MR) are ones of the most common structural changes of the heart and affect many young individuals, who aspire to partake in competitive sport or high intensity recreational exercise. These two conditions are associated with a different prognosis and possible omplications such as heart failure (HF), malignant arrhythmias and sudden cardiac death (SCD). Therefore it is essential to determine the risk factors predicting these complications and to define a follow-up algorithm. The objective is to present a literature review of consensus recommendations addressing criteria for eligibility and disqualification from organized competitive sports for the purpose of ensuring the health and safety of young athletes.

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DOI: 10.3897/bgcardio.28.e90366

Authors: B. Dobreva-Yatseva, F. Nikolov, R. Raycheva, M. Tokmakova

Abstract: Infective endocarditis (IE) is a disease of the endocardium of the heart and the endocardium of the great vessels, with infection affecting heart valves (native or prosthetic) and subvalvular structures and, in the last few decades, indwelling intracardiac devices or catheters. It is a life-threatening disease with a wide distribution worldwide. IE was first described 350 years ago, but it continues to be a huge challenge for doctors for several reasons. First – IE is a changing disease. Nowadays, the profile of patients with IE has significantly changed in terms of age, predisposing factors, microbiological causative agent, clinical picture, complications, therapeutic approach. Second, despite modern imaging and microbiological methods, diagnostics often encounter serious difficulties and delays. Third, the improvement in medical and surgical treatment in recent decades has not changed the rates of mortality and severe complications. Knowing the current profile of patients with IE helps in timely and accurate diagnosis, which is key to starting adequate treatment. Early identification of high-risk patients is important for the therapeutic approach, especially when deciding on operative treatment. This is associated with a reduction in in-hospital mortality and an improvement in the long-term prognosis of patients.

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DOI: 10.3897/bgcardio.28.e82407

Authors: T. Shalganov, M. Stoyanov, V. Traykov

Abstract: This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2021. Material and methods: This is a retrospective study of a full one-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, electroanatomic mapping (EAM), irrigated and cryoablations, distribution of different types of arrhythmias, acute procedural success and complications are presented. Results: In 2021 fi ve EP centers performed 872 ablations in 546 men (62.6%) and 326 women (4.4% increase compared to previous year), incl. 6 ablations in pediatric patients (0.7%). EAM was used in 60.9% of the procedures, irrigation catheter was used in 55.2%, cryoballoon catheter – in 6%, and intracardiac echocardiography – in 4.2%. The most common ablation was pulmonary vein isolation, followed by ablation for AV nodal reentrant tachycardia and typical atrial fl utter. The acute success was over 98%, while intraprocedural complications were less than 2%. Conclusion: The national registry of electrophysiology collects systematically and continuously basic data on all ablations of cardiac arrhythmias performed in the country. In 2021, during a continuing COVID-19 pandemic the number of ablations increased slightly compared to the previous year. Distribution of EP procedure types was similar to previous years. Acute success was very high, while intraprocedural complications were rare.

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DOI: 10.3897/bgcardio.27.e67571

Authors: Damyan Boychev, Naidenka Zlatareva, Ivo Petrov

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has affected health and economies around the globe at an unprecedented scale. Since the fi rst registered case of Covid-19 in December of 2019 until May 2021, more than 167 mil people have been infected and more than 3.5 mil have died. Patients with cardiovascular disease are one of the most affected groups. First, because cardiovascular disease, for example, stable angina or past myocardial infarction, weakens system’s abilities of dealing with stress due to infl ammation. Secondly, because COVID-19 is associated with multiple different mechanisms of cardiovascular injury. Developing COVID-19 related cardiovascular complications is associated with increased morbidity and mortality. The goal of this review is to present the known up to this moment mechanisms of cardiovascular injury and complications after COVID-19.

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DOI: 10.3897/bgcardio.27.e63645

Authors: Nikolay Runev, Emil Manov

Abstract: During the COVID-19 pandemic, studies of the early and late pulmonary and cardiovascular changes, coagulation disorders and risk of venous thromboembolism in thе course of the infection are ongoing. Of particular interest are the published data on these topics and the recommendations for anticoagulant prophylaxis and treatment in the clinical practice. This review summarizes answers to some of the most commonly asked questions about COVID-19: incidence of thromboembolic complications; should all patients with COVID-19 receive a prophylactic dose of anticoagulant; which anticoagulants are recommended for use in patients hospitalized in a general ward or intensive care unit; what potential drug interactions should be considered in patients on anticoagulant or antiplatelets who are also taking COVID-19 therapies; which patients with COVID-19 are recommended to continue antithrombotic prophylaxis after their hospital discharge. We hope this information will be useful for all medical specialists who are dealing with COVID-19 patients: internists, pulmonologists, cardiologists, general practitioners

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DOI: 10.3897/bgcardio.27.e64020

Authors: Radka Argirova, Vesselina Koleva

Abstract: Rapid and precise diagnosis of the causative virus SARS-CoV-2 under COVID-19 pandemic conditions is essential for the control of infection in both asymptomatic viral carriers and individuals with signs of the disease. Diagnostic tests allow identifi cation of contact persons, timely starting of treatment, possibilities for assessing progress of disease. They are the basis for important decisions aiming minimizing of the virus spread in the society, especially when effective therapy and appropriate vaccines are lacking. In this review, we summarize the two main groups of diagnostic tests – molecular and serologic ones – a subject of permanent evolving and improvement. Special attention is paid to different factors during performance of the tests as types of samples, intended use of every test and its correct interpretation.

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DOI: 10.3897/bgcardio.26.e58048

Authors: Galina Zlatancheva, Dobrin Vassilev, Raya Ivanova, Marusya Genadieva

Abstract: Cardiac injury is a common condition among patients hospitalized with COVID-19, and it is associated with a higher risk of in-hospital mortality. Since the first data analyses in China, elevated cardiac troponin has been noted in a substantial proportion of patients, implicating myocardial injury as a possible pathogenic mechanism contributing to severe illness and mortality. Physicians need to pay heed to the possibility of myocarditis in cases of COVID-19. We present a first possible SARS-CoV-2 associated myocarditis case, confirmed by autopsy examination. The overlap with acute coronary syndrome, acute decompensated heart failure should be taken into consideration in the current state to COVID-19 epidemics.

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DOI: 10.3897/bgcardio.26.e58060

Authors: Radostina Ilieva, Rumena Savova, Nataliya Spasova, Desislava Somleva, Bozhidar Krastev, Alexander Milanov, Stanimir Hasardzhiev, Assen Goudev

Abstract: Background: Telemedicine is an alternative to the standard consultation with a specialist during COVID-19 pandemic. Though their benefits are not well studied, the phone consultations are a potential effective resource for providing medical and psycho-social help to patients with chronic diseases during social isolation. Aim: To assess the demographic and clinical characteristics of patients, who looked for cardiology help on the phone, and the most common reasons for these consultations. Material and Methods: We analyzed the data of 196 consecutive patients with chronic cardiovascular diseases, who called for cardiology consultation at the National Patients’ Organization between 22.04.2020 and 31.07.2020. Results: The mean age of the included patients was 71,7 ± 11,3 years (17 ÷ 92), and 149 of them (76%) were above the age of 65 years (who we defi ned as elderly). 114 (58%) of the consulted on the phone were females. 96 patients (49%) called from Sofi a. The mean duration of the call was 8,5 minutes. The most common reasons for teleconsultation were unstable blood pressure – in 30% of the patients (n = 59) and anxiety – 17% (n = 33). Other reasons for seeking cardiology help were adjusting the therapy (different from the antihypertensive one) – 8%, chest pain – 7%, dyspnea – 7%, questions about follow-up of a chronic disease – 7%, palpitations – 6%, monitoring of INR – 4%, second opinion before an operation or a procedure – 2%, problems getting medications or protocols – 1,5%, administrative issues (TELK/LKK) – 1,5%. The most common chronic diseases of the consulted were: arterial hypertension (89%), heart failure (31%), ischemic heart disease (25%), diabetes mellitus (22%) and atrial fibrillation (15%). Conclusion: During COVID-19 pandemic the elderly and the women more often look for cardiology help on the phone. The suboptimal control of the blood pressure and the anxiety, caused by the pandemic, are the most common reasons for phone consultations of the patients with chronic cardiovascular diseases.

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DOI: 10.3897/bgcardio.26.e55099

Authors: Boris Yosifov, Plamen Gatzov

Abstract: The coronary heart disease is one of the leading causes for sudden cardiac death, cardiovascular morbidity and disability. The main risk factors, such as diabetes mellitus, arterial hypertension, dyslipidaemia, have been extensively studied and researched to this day. In the background, however, are some of the most common endocrinological diseases and abnormalities, mainly those related to thyroid hormones. The purpose of this review is to look at the role of thyroid pathology and hormones in the development of coronary heart disease, as well as their place as a prognostic marker in acute coronary syndrome.

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DOI: 10.3897/bgcardio.26.e54113

Authors: Zheina Cherneva, Radostina Cherneva

Abstract: The lack of prior immunity to SARS-CoV-2 coronavirus (COVID-19) infection has led to pandemic, where there is no certain management, regarding the complications of  this viral illness. The lungs are the target organ for COVID-19 and patients develop acute lung injury that may progress to respiratory and multiorgan failure. Recent data shows the presence of diffuse bilateral pulmonary inflammation in COVID-19 infection. It is associated with a specific pulmonary vasculopathy, defined as pulmonary intravascular coagulopathy (PIC) that is distinct from disseminated intravascular coagulopathy (DIC). The coagulopathy in the early stages of COVID-19 is characterized by initial elevation of D-dimer and fibrin/fibrinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time and platelet counts are uncommon. That is why screening of D-dimer and fibrinogen levels, are mandatory. COVID-19-associated coagulopathy should be treated, following the guidelines for thromboembolic prophylaxis. Although D-dimer is a marker of mortality, current data does not show routine application of anticoagulants, unless otherwise clinically indicated. Bleeding in COVID-19 is uncommon, even when a laboratory constellation for DIC is present. However, if it occurs, standard guidelines for DIC management should be followed. 

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