DOI: 10.3897/bgcardio.32.e126222

Authors: D. Smilkova, A. Krushka

Abstract: Oxidative stress plays a critical role in the development and progression of cardiovascular diseases. This review presents the essence of oxidative stress and its association with cardiovascular issues. It discusses the mechanisms underlying stress formation, its impacts on cellular structures, and potential therapeutic strategies to mitigate its harmful effects. Current research and future perspectives in the fi eld of oxidative stress and cardiovascular diseases are also explored.

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DOI: 10.3897/bgcardio.32.e178064

Authors: L. F. J. Jusni, F. A. Theja, L. Alexander, D. A. Theja

Abstract: Objectives: Myocardial infarction (MI) remains a major cause of morbidity and mortality worldwide, primarily due to irreversible cardiomyocyte injury and minimal regenerative potential. While mesenchymal and bone-marrow-derived stem cells have been widely studied, evidence for cardiac stem cells (CSCs) remains limited. This systematic review and meta-analysis evaluate the effi cacy of cardiac stem cell therapy after MI. Methods: We conducted this meta-analysis in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Eligible studies were identifi ed from electronic searches of PubMed, EBSCO, and ProQuest for randomized controlled trials (RCTs) evaluating the effi cacy of cardiac stem cell therapy after MI. The random effect analysis was performed using R v4.4.1. Results: Four randomized controlled trials comprising 329 participants were included. At six months, cardiac stem cell therapy was associated with a signifi cant reduction in scar mass (MD: -4.25 g, 95% CI: -7.16 to -1.34, p = 0.004) and infarct size (MD: -2.32%, 95% CI: -3.91 to -0.73, p = 0.004) compared with placebo. No signifi cant differences were observed in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVi), left ventricular end-diastolic volume index (LVEDVi) at either six or twelve months, or in the 6-minute walk test at 12 months. Conclusion: Cardiac stem cell therapy after MI is associated with modest reductions in scar mass and infarct size at six months, without signifi cant improvement in global ventricular function or functional capacity up to twelve months. These fi ndings suggest that while CSCs may confer early structural benefi ts, their clinical impact remains uncertain and requires confi rmation in larger trials with longer follow-up.

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DOI: 10.3897/bgcardio.31.e164364

Authors: H. Nough, F. Moradi, H. Varasteravan, M. Motamedzade, N. Sartipzade, S. Vaziribozorg, A. Nouah

Abstract: Introduction: Coronary artery ectasia (CAE) is an uncommon angiographic fi nding often associated with atherosclerosis. However, the risk profi le of patients with pure CAE (defi ned as ectasia in the absence of signifi cant obstructive coronary artery disease) remains incompletely understood. This study aimed to evaluate the association between traditional atherosclerotic risk factors and pure CAE in an Iranian population. Material and methods: In this retrospective cross-sectional study, 354 patients with pure CAE were identifi ed among 23,000 consecutive coronary angiography reports from two tertiary hospitals (2015–2022). Pure CAE was defi ned as segmental or diffuse coronary artery dilatation ≥1.5-fold the adjacent normal segment in the absence of ≥50% stenosis in any epicardial vessel. Patients with diffuse but non-obstructive atherosclerosis, history of vasculitis, autoimmune disease, congenital syndromes, or incomplete records were excluded. Demographic data and cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking, family history) were collected. Statistical analysis included both univariate comparisons and multivariable logistic regression to identify independent predictors of CAE. Results: The mean age was 57.5 ± 12.6 years; 64.1% were male. Hypertension (64.7%) and hyperlipidemia (57.9%) were the most prevalent risk factors. Multivariable regression identifi ed male sex (OR 1.8, 95% CI 1.1–2.9, p = 0.01), hypertension (OR 2.1, 95% CI 1.3–3.2, p = 0.002), and hyperlipidemia (OR 1.7, 95% CI 1.1–2.5, p = 0.01) as independent predictors of CAE. Diabetes mellitus and smoking were not signifi cantly associated. Family history showed borderline signifi cance (OR 1.4, p = 0.06). The most common angiographic pattern was three-vessel ectasia (37.9%). Conclusion: Pure CAE is more frequent in men and strongly associated with hypertension and hyperlipidemia, supporting a shared risk profi le with atherosclerosis. The absence of association with diabetes and smoking suggests a distinct underlying pathophysiology.

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DOI: 10.3897/bgcardio.31.e168585

Authors: M. C. R. Bernardo, I. M. Moreira, C. Carvalho, A. Baptista, P. Mateus, S. S. Carvalho, J. I. Moreira, on Behalf of the ProACS Investigators

Abstract: Introduction and objectives: Multivessel disease (MVD) occurs in approximately half of non–ST elevation myocardial infarction (NSTEMI) patients and is associated with an increased risk of cardiovascular events. However, current recommendation for complete revascularization in NSTEMI is based in observational and non-randomized studies suggesting a possible benefi t regarding mortality and major cardiovascular events. This study aimed to retrospectively evaluate the prognostic impact of complete percutaneous revascularization in a population of patients with NSTEMI and MVD. Material and methods: This was a national multicentre retrospective study of patients hospitalized for NSTEMI with MVD, included on the Portuguese Registry for Acute Coronary Syndromes (ProACS). The impact of complete percutaneous revascularization on in-hospital and one-year mortality rates, as well as on the probability of cardiovascular re-hospitalization was evaluated. Results: A total of 3084 patients were included in this analysis. We found no signifi cant differences between groups regarding in-hospital complications and mortality, as well as median hospitalization length. Nevertheless, complete revascularization showed a signifi cant impact on the primary endpoint of all-cause mortality or cardiovascular re-hospitalization (11.9% vs. 20.4%, p < 0.001), mainly driven by a major reduction in unplanned cardiovascular re-hospitalizations at one year of follow-up (9.3 vs. 16.8%, p < 0.001). Conversely, one-year mortality rate was once again similar between groups (4.2 vs. 5.0%, p = 0.536). Conclusions: In our population, complete revascularization during hospitalization was associated with lower risk of the primary endpoint of all-cause mortality or cardiovascular re-hospitalization, mainly driven by a major reduction in cardiovascular re-hospitalizations, with similar rate of intra-hospital complications.

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DOI: 10.3897/bgcardio.31.e163761

Authors: H. Nough, A. Amani, A. Andishmand, M. Emami, S. Vaziribozorg, A. Nough

Abstract: Introduction: Pure coronary artery ectasia (CAE) was defi ned as segmental or diffuse coronary artery dilatation ≥ 1.5-fold the adjacent normal segment in the absence of ≥ 50% stenosis in any epicardial vessel. Previous studies on the relationship between ABO blood groups and ischemic heart disease have reported inconsistent fi ndings. This study aimed to investigate the distribution of blood groups in patients with pure CAE. Methods: This descriptive cross-sectional study included 250 patients diagnosed with pure CAE based on angiography fi ndings between 2015 and 2022 at two teaching hospitals. Data on age, gender, ABO blood group, Rh factor, white blood cell (WBC) count, lymphocyte and neutrophil percentages, and number of involved coronary vessels were collected. A control group was selected from patients undergoing coronary angiography in 2019-2020 without CAE and matched with the CAE group. Statistical analyses included Chi-square, Fisher’s Exact test, T-test, ANOVA, and logistic regression. Results: The mean age of patients was 56.2 ± 12.5 years; 160 (64%) were male and 90 (36%) were female. Rh positivity was observed in 222 (88.8%) patients, while 28 (11.2%) were Rh-negative. Blood group distribution among CAE patients was: O, 41.6%; B, 30.4%; A, 21.6%; and AB, 6.4%. Compared with the control group, a signifi cantly higher frequency of blood group O was observed among CAE patients (P < 0.001). In multivariable logistic regression adjusted for age, gender, and number of involved vessels, blood group O remained independently associated with CAE (OR = 1.78, 95% CI: 1.12–2.82, P = 0.015). Conclusion: Blood group O was signifi cantly more frequent among CAE patients compared with controls, even after adjusting for confounders.

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DOI: 10.3897/bgcardio.31.e165714

Authors: G. Goranov, V. Goranova-Marinova

Abstract: Somatic mutations in hematopoietic stem cells (HSCs) are an inevitable part of human aging. When these mutations reach a certain variant allele frequency (VAF), they may confer a proliferative advantage to mutated clones, leading to clonal hematopoiesis. Once the HSCs generate over 10¹⁰-10¹² mutated cells, they can initiate various myeloid or lymphoid malignancies. In cases where the VAF exceeds 2% (roughly 10⁴ mutated blood cells) but without clinical evidence of hematologic cancer, the condition is termed clonal hematopoiesis of indeterminate potential (CHIP). Numerous studies have identifi ed that CHIP is frequently driven by mutations in genes implicated in hematologic malignancies, most notably TET2, DNMT3A, and JAK2. CHIP has also been strongly linked to cardiovascular diseases, particularly atherosclerosis. This dual role highlights a shared pathogenesis between cardiovascular and hematologic disorders through mutations in HSCs. CHIP-associated monocytes exhibit a pro-infl ammatory phenotype, activating infl ammasomes and overexpressing cytokines such as interleukin (IL)-1β and IL-6, as well as chemokines like Cxcl1-3 and Pf4. This leads to a chronic infl ammatory loop that contributes to endothelial dysfunction and atherosclerosis. Current data suggest that CHIP poses a cardiovascular risk comparable to traditional risk factors. Ongoing research continues to uncover the complex mechanisms underlying this association.

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DOI: 10.3897/bgcardio.31.e142199

Authors: F. Farabi, M. N. Afifa, P. Puspawikan, B. B. Tiksnadi

Abstract: Background: Coronary collateral plays a role in maintaining myocardial function, limiting infarct size, and reduced morbidity and mortality. Uric acid to albumin ratio (UAR) has recently been discovered as a novel biomarker associated with cardiovascular disease. However, studies investigating the relationship between UAR and coronary collateral circulation (CCC) formation are limited and have low magnitude. Therefore, this study aims to determine the relationship between UAR and CCC formation in coronary artery disease patients. Methods: The literature was searched in PubMed, Medline, SpringerLink, ScienceDirect, and Scopus for articles published before August 2024. Studies that did not report UAR results as one of the parameters but included uric acid and albumin in their laboratory parameters, had UAR values calculated using the error propagation for ratio formula. Statistical analysis for meta-analysis using Review Manager 5.4 software to evaluate the relationship between UAR and CCC. Results: A systematic search retrieved nine studies that met the eligibility criteria. The total population in these studies was 5290 subjects, including 3744 subjects with good coronary collateral circulation and 1546 subjects with poor coronary circulation. Four of the nine studies assessed albumin parameters using glycated albumin and one study assessed albumin parameters using ischemic modifi ed albumin. The uric acid/albumin ratio is correlated with CCC formation, with the lower the UAR, the more likely CCC formation will occur (SMD -0.31, 95% CI -0.56 to -0.05, p-value 0.02, I2 93%). In the subanalysis of the different parameters, uric acid is also correlated with CCC formation (SMD -0.41, 95% CI -0.74 to -0.08, p-value 0.01, I2 96%), while albumin has no strong correlation. Conclusion: Uric acid to albumin ratio could be a new parameter in predicting the formation of coronary collateral circulation in patients with stable coronary artery disease.

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DOI: 10.3897/bgcardio.31.e146656

Authors: R. Grigorov, S. Yambolov

Abstract: A large proportion of patients with angina and evidence of myocardial ischemia do not have obstructive coronary disease. One of the main mechanisms of ischemia/angina with non-obstructive coronary arteries is coronary microvascular dysfunction, which is rarely diagnosed in clinical practice and patients continue to experience symptoms and have a reduced quality of life. The current review discusses the advantages, limitations, and clinical application of the fluoroscopic methods for assessment of microvascular dysfunction.

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DOI: 10.3897/bgcardio.30.e141217

Authors: J.Ch. Kurniawan

Abstract: Background: Patients presenting with acute myocardial infarction with ST-segment elevation (STEMI) are recommended to undergo primary percutaneous coronary intervention (PPCI) as a reperfusion therapy to maximize myocardial salvage and maintain myocardial viability. The extent of the myocardial salvage index (MSI) is greatly infl uenced by the onset and severity of myocardial ischemia, which can be assessed using the Anderson-Wilkins score and the Sclarovsky Birnbaum score. Objective: This study aims to determine the effect of the Anderson-Wilkins score and the Sclarovsky Birnbaum score on the electrocardiogram-based myocardial salvage index in patients with STEMI undergoing PPCI. Material and methods: We conducted a hospital-based cross-sectional analytical study from March 1st, 2024, to May 31st, 2024. All STEMI patients who underwent PPCI and met the inclusion criteria had their initial ECG analyzed using the Anderson-Wilkins and Sclarovsky-Birnbaum scores, with an ECG-based myocardial salvage index (MSI) assessment conducted on the last day of hospitalization. Results: Out of a total of 60 study subjects, 70% of the sample patients were men, with an average age of 57.4 years. The median Anderson-Wilkins score was 2.25 (interquartile range (IQR) 1.52 - 3.0), with an AW score ≥ 3 observed in 17 patients (28.3%). Meanwhile, grade III ischemia severity (SB score = 3) was found in 52 patients (86.7%). The median total ischemic time was 850 min (IQR 570-1290), with a total ischemic time of < 720 min found in 23 patients (38.3%). The AW score showed a strong correlation with MSI (p < 0.001, r = 0.588), whereas the SB score did not (p = 0.107, r = 0.163). Conclusion. The Anderson-Wilkins score shows a strong correlation with the myocardial salvage index in patients with acute myocardial infarction with ST-segment elevation (STEMI) undergoing primary percutaneous coronary intervention.

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DOI: 10.3897/bgcardio.30.e139418

Authors: J.W. Martha, A.H.S. Katamihardja, A. Nazir, N. Sylviana, D.K. Turbawaty, B.B. Tiksnadi

Abstract: Introduction: Cardiac rehabilitation may improve health outcomes in coronary artery disease (CAD) patients, but the mechanism is still unknown. Collateralization and improvement of microvascular fl ow is one of the hypotheses underlying this mechanism, however research on this is scant and inconclusive. Collateralization is affected by VEGF expression and has the effect of improving myocardial perfusion. Therefore, this study aimed to assess VEGF levels and myocardial perfusion before and after cardiac rehabilitation. Methods and Results: This study is a comparative study of patients who received cardiovascular rehabilitation treatment at Dr. Hasan Sadikin Hospital. The subjects of this study were consecutively selected from patients who received cardiovascular rehabilitation treatment at Dr. Hasan Sadikin Hospital. The primary outcome of this study is to assess the expression of VEGF A and myocardial perfusion in coronary artery disease patients who have undergone complete revascularization before and after phase II cardiac rehabilitation. Conclusion: This study will assess the benefi cial effects of phase II rehabilitation in more detail as it uses proteomics parameters to determine the underlying mechanism and assesses myocardial perfusion as an outcome.

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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.e138638

Authors: D. Junior, I G.N.A.S. Diksha, I G.A.M.H. Prawista, R.C. Suteja, I K.H. Adiputra, G.V. Purnama, C.A.W. Purnamasidhi, C.W.D. Sinardja, I G.B.G.P. Putra, S. Harkitasari

Abstract: Myocardial infarction is one of the leading causes of global mortality and is strongly associated with permanent damage and sudden cardiac death. The human heart loses its proliferative ability after birth as cardiomyocytes are compelled to differentiate into mature cells focusing on hypertrophy. Based on the review of existing studies, we hypothesised that the combination of hypoxia and 3, 3', 5-triiodo-L-thyronine (T3) inhibitors could potentially be a more sustainable treatment method. We searched trusted scientific databases, such as PubMed, Directory of Open Access Journals (DOAJ), and Scopus, for relevant studies. T3 is a physiological hormone that was found to promote cardiomyocyte differentiation and inhibit its proliferation. Studies implied that inhibiting T3 during perinatal development could preserve the heart’s proliferative and regenerative capacities for a more extended period. Several animal experiments and human studies have found that inducing a hypoxic environment could revert cardiomyocytes to their endogenous proliferative state. However, long periods of hypoxia were not sustainable due to its deleterious effects on the human body. We suggested that administering T3 inhibitors after the cardiomyocytes have been reverted under hypoxic conditions could enable patients to leave the hypoxic environment while preventing physiological maturation by T3, thus preserving the heart’s regenerative capacity.

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DOI: 10.3897/bgcardio.30.e129676

Authors: S. Barakova, B. Grigorova, E. Pashkuleva-Dermenjieva, N. Ivanov, P. Moraliyska, P. Lazarov, A. Gamisheva

Abstract: We present a clinical case of a 19-year-old young woman who was admitted to the Emergency Department of the Medical Military Academy in September 2023 with complaints of palpitations, nausea, vomiting, a shortness of breath and a previous syncope. After the conducted clinical, laboratory and instrumental tests, an acute myocardial infarction (AMI) with ST-elevation (STEMI) was established in the presence of increased levels of total (TC) and low-density cholesterol (LDL) and triglycerides (TG). There was no indication of hypercholesterolemia up to this point from the anamnesis. The case is interesting because of the young age of the patient, which suggests familial hypercholesterolemia (FH) as a risk factor (RF) for atherogenesis in the absence of other RF, such as diabetes mellitus (DM) and arterial hypertension (AH).

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DOI: 10.3897/bgcardio.30.e134809

Authors: D. Hristov

Abstract: Atherosclerosis is a generalised process with a long latent period. Its manifestations in the context of ischemic heart disease are acute coronary syndrome and chronic coronary syndrome. Vascular inflammation is an integral part of the development and complications of atherosclerosis. Although primary and secondary prevention of ischemic heart disease has received much attention in clinical practice, the role of vascular inflammation remains incompletely understood and studied. Pentraxin 3 is an inflammatory biomarker that has the potential to be used for diagnostic and prognostic purposes in cardiology due to its local secretion from the vascular endothelium with peak values in the setting of acute coronary syndrome within 6-8 hours from symptom onset. The aim of this review is to examine the available evidence in the literature for its use in patients with ischemic heart disease.

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DOI: 10.3897/bgcardio.30.e125503

Authors: P. Moraliyska, P. P. Lazarov, E. Pashkuleva-Dermendzieva, S. Barakova, E. Georgieva

Abstract: We present a clinical case of a 20-year-old woman with acute myocardial infarction with persistent ST-segment elevation (STEMI). The coronary angiography performed on the patient showed coronary vasospasm with no evidence of atherosclerotic plaque. The aim of this case report is to draw attention to the different types of myocardial infarction, other possible differential diagnoses (DD), and to the investigations necessary for determining a definitive diagnosis.

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DOI: 10.3897/bgcardio.30.e125882

Authors: S. Yambolov, R. Grigorov

Abstract: Colchicine, one of the oldest medications still in use, is a relatively inexpensive and well-tolerated agent with a documented role in a range of inflammatory diseases, such as gout, Behchet’s disease and pericarditis. In recent years, different clinical trials also tested colchicine in the management of cardiovascular conditions and demonstrated favorable results. The aim of this literature review is to evaluate the prospective use of colchicine instead of aspirin as double-antiplatelet therapy (DAPT) after percutaneous coronary interventions in patients with acute coronary syndrome.

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DOI: 10.3897/bgcardio.30.e117188

Authors: N. Dragnev, V. Valkov, N. Kalvachev

Abstract: We are presenting a clinical case of a 53-year-old woman with a sudden decline of the general condition during a stressful moment, respiratory arrest requiring intubation and intensive care unit transfer. Due to the clinical evidence of acute left-sided heart failure, ECG and echocardiographic evidence of acute coronary syndrome, invasive coronary angiography with left ventriculography was performed, demonstrating a non-occlusive coronary artery disease with signifi cant LAD stenosis and left ventricular kinetics indicative of a stress-induced cardiomyopathy. In the course of the treatment, the patient regained consciousness with favourable dynamics in the ECG, echocardiographic and laboratory fi ndings. A follow-up coronary angiography and intervention of the signifi cant LAD stenosis at a later stage were discussed with the patient.

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DOI: 10.3897/bgcardio.29.e116198

Authors: M Szotek, W. Kula, A. Malik, A. Czunko, J. Lelakowski, V. Traykov, P. Matusik

Abstract: We present a case of a 78-year-old patient with persistent atrial fl utter, history of atrial fi brillation and atrioventricular conduction disturbances, including fi rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial fl utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and effi cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach.

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DOI: 10.3897/bgcardio.29.e107056

Authors: R.P. Yalamanchi, R. Showkathali, A.М. Kumar, P. Kannan

Abstract: Coronary artery disease (CAD) commonly occurs in individuals over the age of 45 years. Several studies categorize “young” individuals with CAD or acute myocardial infarction as those below the ages of 40 and 45. The protection provided by young age has slowly been eroded by risk factors like smoking, obesity, and sedentary lifestyle that are becoming more common among young individuals. We report a case of 21-year-old male with family history of premature coronary artery disease, who presented with acute anterior wall ST elevation myocardial infarction. Coronary angiogram revealed 100% thrombotic occlusion of proximal left anterior descending coronary artery. Further evaluation of the lesion morphology using optical coherence tomography revealed plaque erosion. Thrombolysis in Myocardial Infarction coronary grade III flow was achieved after thrombus aspiration. Stent deployment was deferred to avoid the need for lifelong medication and its associated side effects in a young patient. Due to their anti-thrombotic qualities, we also recommend using novel oral anticoagulants in this situation for short-term therapy.

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DOI: 10.3897/bgcardio.29.e106477

Authors: S. Nikolaeva, A. Angelov

Abstract: Chronic obstructive pulmonary disease is a cause of morbidity and mortality worldwide. The presence of infl ammatory markers in circulation, sputum, and broncho-alveolar fl uid suggest systemic infl ammation is one of the potential mechanisms responsible for both chronic obstructive pulmonary disease and metabolic syndrome. Circulating markers of infl ammation, on the other hand, are those that have been found to predict future cardiovascular events as well. One of the main causes of increased cardiovascular risk in patients with chronic obstructive pulmonary disease and metabolic syndrome is hyperglycemia. It induces oxidative stress and subsequently micro- and macrovascular complications. This review describes in details the various components of metabolic syndrome and its impact on long outcomes in chronic obstructive pulmonary disease and cardiovascular pathology.

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DOI: 10.3897/bgcardio.29.e102027

Authors: A. Alexandrov, H. Mateev, G. Vladimirov, I. Bayraktarova, I. Petrova, E. Kostova-Dimitrova

Abstract: Age is an important non-modifi able risk factor for cardiovascular disease. Both European and American guidelines recommend offering an invasive reperfusion strategy in elderly patients with ACS, taking into account the patients‘ comorbidities and baseline level of functioning. Materials and methods: All patients over 80 years of age with acute coronary syndrome, treated in the Department of Invasive Cardiology of the National Heart Hospital for the period between January 1, 2016. and December 31, 2018, are retrospectively analyzed. The primary endpoint was defi ned as all-cause mortality during the hospital stay and at follow-up. Predictors of mortality were assessed and independent predictors were identifi ed. Results: During the study period, 179 patients aged 80 years or older were identifi ed as being treated for ACS with PCI. In the study population, in hospital mortality for the index event was 11.8%. At a mean follow-up time of 20.19 ± 11.9 months, mortality rose signifi cantly to 64.6%. When evaluating in-hospital mortality on multivariate analysis, the two independent predictors were Cardiogenic shock (HR 0.005, 95% CI 0.01–0.44; p < 0.001) and acute/exacerbated renal failure (0.986 95% CI 0.984-0.997; p = 0.015). Conclusion: The present study provides important information regarding characteristics and outcomes in very elderly patients undergoing PCI for ACS. In the future, this subset of patients is predicted to grow, meaning that their approach must be evidence-based to ensure safe and effective treatment options.

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DOI: 10.3897/bgcardio.29.e100441

Authors: I. Bayraktarova, G. Vladimirov, H. Mateev, A. Alexandrov, E. Trendafilova

Abstract: Anaemia at admission is a known predictor of death in patients with myocardial infarction with ST-elevation (STEMI). Data on the effect of anaemia on the prognosis in patients with non-ST-elevation myocardial infarction (NSTEMI) is less readily available. Purpose: We aimed to evaluate the frequency of anaemia in a Bulgarian tertiary centre NSTEMI patient population, and its effect on the immediate and extended prognosis of the patients. Methods: We performed ambispective analysis of 138 consecutive patients with NSTEMI, and anaemia was defi ned as haemoglobin at admission below 120 g/L for females and below 130 g/L for males. Results: There was no signifi cant difference in the frequencies of standard risk factors between patients with and without anaemia. Anaemic patients tended to be older, with lower body mass index and worse kidney function. Patients with baseline anaemia tended to have higher GRACE risk scores and a larger size of the realised myocardial infarction as judged by maximal reached troponin I. There was no signifi cant difference in interventional treatment in both groups. Median hospital stay was signifi cantly longer in anaemic patients and was marked by more complications. Despite a lack of increase in inhospital bleeding and no difference in treatment with oral antiaggregants, patients with anaemia received haemotransfusion treatment more often. Mortality rate was higher in anaemic patients both during the index hospitalization and during the follow up. Conclusion: Anaemia at admission is associated with an increased risk of both in hospital cardiovascular complications and after dehospitalisation all-cause mortality in patients with NSTEMI and should be considered as an additional risk factor in the global risk assessment of patients.

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DOI: 10.3897/bgcardio.29.e98397

Authors: E. Dimitrova, E. Trendafilova, S. Nateva, S. Georgieva, E. Kostova, G. Hristova, A. Alexandrov, H. Mateev, G. Vladimirov

Abstract: Introduction: COVID-19 pandemic has led to a signifi cant change in the incidence and prognosis of acute myocardial infarction (AMI) by indirect and direct mechanisms. Aim: To assess the impact of the COVID-19 pandemic on the incidence and prognosis of AMI. Material and methods: We performed a retrospective analysis of consecutive patients with AMI (STEMI and NSTEMI) during two time periods – the complete lockdown in Bulgaria and one of the waves of the pandemic. We compared patients’ risk profi le, index event, investigations and treatment to a control group from the pre-pandemic period. Results: During the fi rst period we included 52 patients with AMI without COVID-19 and compared them to a control group of 66 patients. We found a decrease primarily in the number of patients with STEMI. The scores for assessing diseaseseverity (GRACE, APACHE II, SOFA) were higher in 2020 compared to the pre-pandemic period. More patients presented with acute congestive heart failure, mortality was similar. During the second period we included 83 patients, 21 of them with COVID-19 infection. System delay was increased in all patients. Disease severity scores and baseline troponin were higher especially in the COVID-19 group. In-hospital mortality was substantially higher in patients with COVID-19 compared to controls (23,8% versus 9%, р = 0,0375), probably due to increased incidence of cardiogenic shock and need for mechanical ventilation. Conclusion: During the complete lockdown there was a reduction in the number of patients admitted with AMI, higher incidence of acute congestive heart failure and similar mortality. During one of the waves of the pandemic we found a signifi cant increase in system delay, not exceeding the recommended time frame of 120 minutes, and in disease severity in all patients. Concomitant COVID-19 infection was associated with higher in-hospital mortality due to increased incidence of cardiogenic shock and need for mechanical ventilation.

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DOI: 10.3897/bgcardio.29.e101578

Authors: M. Stoyanov, T. Shalganov

Abstract: Ventricular arrhythmias are among the most serious complications of myocardial infarction that defi ne not only increased morbidity and mortality, but also signifi cantly impaired quality of life. The pathogenesis of ventricular arrhythmias that arise during and after myocardial infarction is a combination of various triggering and modulating factors. We present a summary of the main structural and functional changes that occur with myocardial ischemia and create substrate for ventricular arrhythmias. The electrophysiological mechanisms underlying infarction-related ventricular arrhythmias are reviewed, as well as the most common pharmacological and non-pharmacological treatment’s strategies.

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DOI: 10.3897/bgcardio.29.e100372

Authors: D. Kyuchukov

Abstract: Percutaneous coronary revascularization of the „culprit“ lesion is the most contemporary method of treating patients with acute coronary syndrome (ACS) of all forms. In the management of acute ST-elevation myocardial infarction (STEMI), cardiac surgery remains, in most cases, a third option following PCI and thrombolysis, nevertheless serves an important role in a select subgroups of patients. This review will discuss current indications and potentiality of cardiac surgery in the treatment of patients with STEMI.

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DOI: 10.3897/bgcardio.29.e101955

Authors: N. Gotcheva

Abstract: The last 120 years have witnessed famous physicians and pathologists connected their medical investigation to study pathophysiology, diagnostics and treatment of acute myocardial infarction (AMI). Modern treatment algorithms based on precise and refi ned new technologies have as a main target to achieve rapid reperfusion and salvage threatened myocardium in order to enhance patients’ recovery and also to decrease mortality rate. Although long-lasting and multiple studies appeared to have impressive results, there still exist unknown or disputable viewpoints/concepts concerning for example the appearance of the reperfusion injuries, left ventricular remodeling, AMI in patients with normal coronary arteries, identifi cation of vulnerable lesions or plaques which are threatened by rupture or fi ssuring. This short historical review is aimed to remind us the evolution of the AMI knowledge and also to pull out some of the forgotten but relevant milestone hypothesis, as well as to help shaping the modern management of AMI.

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DOI: 10.3897/bgcardio.28.e97466

Authors: M. Nedevska, V. Grudeva, A. Partenova

Abstract: Ischemic heart disease, its sequelae and complications contribute substantially to morbidity and mortality worldwide. Significant technological progress in recent years has significantly expanded the application of non-invasive imaging modalities in the systematic and complex evaluation of patients with ischemic heart disease in the preclinical and clinically developed stages of the disease. Cardiac magnetic resonance imaging includes a complex morphological and functional assessment. Regional and global myocardial kinetics and function, morphological changes in myocardial tissue in the form of edema, hemorrhage, and scarring determine various manifestations of myocardial ischemia in its acute and chronic form. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Under the influence of unceasing clinical interest, cardiac magnetic resonance imaging is constantly developing and improving with emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents.

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DOI: 10.3897/bgcardio.28.e87553

Authors: I. Petrov, Z. Stankov, S. Vasilev

Abstract: The cardiogenic shock is a state of low cardiac output, primarily due to cardiac dysfunction, which leads to severe organ hypoperfusion with tissue hypoxia and increased lactate levels. It presents a severe complication with a prevalence of around 15% of all forms of shock and 2-5% of the cardiogenic shock is a complications of acute heart failure. Despite the diverse etiology of the cardiogenic shock, up to 80% of the cases are due to acute myocardial infarction. The ischemia, leads to dysfunction of the myocardium cells, which causes a decline in the blood pressure and subsequent tissue hypoperfusion. The most important part is to start the treatment regime as soon as possible in the pre-shock stage. The treatment of refractory cardiogenic shock is complex, as it contains an intravenous therapy with inotropes/vasopressors and mechanical circulatory support (MCS). The MCS devices are supposed to reduce the workload of the heart and the oxygen need of the myocardial cells and in the same time to maintain an adequate coronary and systemic perfusion. There are different MCS devices like IABP, Impella, Tandem Heart, V-A ECMO. The aim of this review article is to present the new trends in the treatment approach to cardiogenic shock and to bring clarity in the treatment regimes, based on the latest studies and guidelines.

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DOI: 10.3897/bgcardio.28.e79582

Authors: H. Baychev, E. Kostadinova, A. Partenova, K. Genova, T. Shalganov

Abstract: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome of diverse etiology and unclear pathogenesis, with an incidence of 5-15% and varying prognosis. Cardiac magnetic resonance imaging (MRI) is playing an increasing role in the diagnosis of MINOCA and in distinguishing the causes that led to it, while being at the same time an important predictor of prognosis in these patients. We present a 40-year-old man with clinical, laboratory and instrumental data for acute coronary syndrome complicated by acute heart failure. The invasive assessment ruled out obstructive coronary heart disease as well as Takotsubo cardiomyopathy. MINOCA and myocarditis were discussed in the differential diagnostic plan. To differentiate them, cardiac MRI was performed, which confi rmed the diagnosis of „myocardial infarction with non-obstructive coronary arteries“.

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DOI: 10.3897/bgcardio.28.e82140

Authors: P. Polomski, Z. Stankov, I. Petrov, Zh. Stoykova

Abstract: The frequency of TAVI procedures worldwide is progressively increasing. The age of patients applying for TAVI is also declining, as a result of which life expectancy is increasing. Atherosclerotic disease (including ischemic heart disease) and aortic stenosis share some common risk factors and pathogenesis, which explains the frequent combination of diseases in the same patient. We present a clinical case of successful percutaneous coronary intervention in a patient presenting with acute coronary syndrome with a previously implanted TAVI prosthesis.

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DOI: 10.3897/bgcardio.28.e82423

Authors: R. Pencheva, J. Shabani, D. Trendafilova, J. Jorgova, H. Angelov, P. Simeonov, I. Dimitrova

Abstract: In the modern days and the era of the rapid development of medical technology, the introduction of innovative invasive methods of treatment is gradually displacing traditional conventional surgery. In 2002 was performed the fi rst transcatheter implantation of an aortic valve. Over the next twenty years, with the advancement of technology and the accumulation of experience in clinical centers, transcatheter aortic valve implantation has become the standard in adult and high-risk patients with high-grade Ao stenosis. In a large percentage of cases enrolled under the transcatheter aortic valve protocol a concomitant ischemic heart disease is detected or known. Globally, there is no signifi cant difference in overall mortality on the thirtieth day after TAVI in patients with ischemic heart disease. However, the overall mortality was signifi cantly higher in one – year follow - up of patients after transcatheter aortic valve implantation with underlying coronary pathology. We conducted a study comparing the number of late and early adverse events in patients with concomitant fully revascularized ischemic heart disease and those with insignifi cant coronary atherosclerosis. Based on the data collected, analyzed and summarized in our clinical center, fully revascularized ischemic heart disease does not increase the percentage of major adverse events after transcatheter aortic valve implantation. It can be considered when assessing the risk of transcatheter aortic implantation, as part of the individual approach for each case.

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DOI: 10.3897/bgcardio.27.e60233

Authors: Denislav Biserov, Ivaneta Yoncheva, Mariana Konteva, Svetoslav Gogov

Abstract: Radiation therapy is the main treatment for a large number of neoplastic diseases. Improved survival in this group of patients led to the emergence of a new nosological unit – radiation-induced damage to neighbouring organs and systems. Data accumulated in recent decades has proven conclusively that chest radiotherapy could result in heart damage. Cardiovascular diseases are the leading cause of death in oncological patients in remission. The onset of radiation-induced heart disease (RIHD) can be early with clinical picture of acute myocarditis and late with manifestations of constrictive pericarditis, restrictive cardiomyopathy, coronary artery disease, valvular involvement, heart failure and conduction pathology. Clinical symptoms may manifest years after exposure to radiation. Our team performed a mini-review on the topic, after which we shared our own experience in 10 patients who underwent radiation therapy in the past and were admitted to the Clinic of Cardiology of University Multyprofile Hospital for Active Treatment „Deva Mariya“ with a clinical picture of ACS.

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DOI: 10.3897/bgcardio.27.e67905

Authors: Zhenya Marinova, Svetoslava Slavcheva, Atanas Angelov, Veselin Valkov

Abstract: We present a case of a 75-year-old male who underwent percutaneous coronary intervention in the setting of acute myocardial infarction with ST-segment elevation and who was hospitalized 12 days afterwards with COVID-19 pneumonia. Later the patient presented himself again with acute coronary syndrome with ST-segment elevation in the same region due to in-stent thrombosis. Transient atrioventricular conduction disorders were registered before and after the percutaneous coronary intervention. Possible pathophysiological mechanisms of the in-stent thrombosis following COVID-19 infection are discussed.

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DOI: 10.3897/bgcardio.27.e53896

Authors: Zoran Stankov, Iveta Tasheva, Petar Polomski, Aleksandra Cherneva, Mariya Dotseva, Inna Tsareva, Georgi Dobrev, Ivo Petrov

Abstract: Transcatheter implantation of the aortic valve is an increasingly used method for the treatment of aortic stenosis, with a steady trend worldwide to increase the number of TAVI procedures and reduce the age of patients. In Europe, over 180,000 TAVI procedures are currently implemented annually. This review aims to evaluate the patient’s prognosis for the different approaches, the technical diffi culties during the procedure, and to offer useful tips for overcoming them. We publish our experience in transcatheter treatment of ischemic heart disease after TAVI implantation.

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DOI: 10.3897/bgcardio.26.e60521

Authors: Svetlin Tsonev

Abstract: Etiology, diagnostics and treatment of patients with angina like symptoms and angiographically coronary arteries with no changes remain uncertain. Microvascular dysfunction is main cause for the symptoms in these patients. Chest pain is usually severe and longer than in patients with obstructive coronary artery disease and this results in reduced functional capacity and often hospitalizations. Classic scheme of antiischemic treatment is insufficient in patients with microvascular dysfunctions, but metabolic class medicines reduce anginal episodes and their duration. We represent original data from our study and clinical case of a woman with long history of severe stenocardia and verified microvascular angina.

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DOI: 10.3897/bgcardio.26.e58770

Authors: Ivo Petrov, Naydenka Zlatareva-Gronkova, Todor Kundurdjiev, Viktoria Dimitrova

Abstract: Acute coronary syndrome (ACS) represent emergency state in an intensive cardiovascular care unit, which implies immediate and specific treatment. Of peculiar interest for cardiologists are young patients with acute myocardial infarction (AMI). The family history taking for premature coronary artery disease (CAD) and establishment of genetic factors, responsible for coagulation, both are on target for this group of patients. Gold standard for AMI diagnosis is coronary angiography (CA), which usually implies endovascular treatment (EVT). When coronary thrombus formation is found in young patients, different diagnostic opportunities are possible. Thrombophilia (TF) represents blood coagulation abnormality resulting in an increased risk of thrombosis. It could affect different sections of the cardiovascular system, most commonly venous, but also arterial. This clinical condition could be confirmed by performing laboratory genetic tests. We studied a group of forty-one young patients with first appearance of ACS ≤ 55 years old included for a five-year period. All of them were evaluated with CA and received EVT. According to the thrombotic risk, we defined a high-risk group, treated with anticoagulant (AC) on top of dual antiplatelet therapy (DAPT). The patients were followed-up for recurrent ischemic and bleeding events. We performed laboratory tests for the most frequent TF gene mutations in Bulgarian population. There is a conflicting data about this issue in different ethnic origins. The aim of our study is to estimate the possible relationship between the TF and the arterial thrombosis in young ACS patients, to defi ne specific treatment strategies, improving the prognosis of the patients.

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DOI: 10.3897/bgcardio.26.e57740

Authors: Velina Stoyanova

Abstract: Coronary artery disease (CAD) is a chronic progressive disease with social signifi cance, result ofobstructive or non- obstructive atherosclerotic plaque accumulation in the epicardial arteries. CAD is one of the leading causes for deterioration in quality of life and cardiovascular mortality. CAD has dynamic character and its major clinical presentations are: acute coronary syndromes (STEMI, NSTEMI, UA) and chronic coronary syndromes. In this case report we present the treatment algorithm in patient with chronic coronary syndrome: from optimal medical therapy, through objective methods of examination leading to the decision for interventional treatment and the importance of regular follow-up.

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DOI: 10.3897/bgcardio.26.e54126

Authors: Ivayla Zheleva-Kyuchukova, Valeri Gelev

Abstract: Revascularization in patients with severe stenosis of left coronary artery (LCAS) trunk signifi cantly improves their prognosis. Modern clinical studies, registries and meta-analyses have identifi ed percutaneous coronary intervention (PCI) of LCAS as a safe alternative to aorto-coronary bypass (ACB) in patients with low and intermediate lesion complexity. Aims: To confi rm the safety and effectiveness of PCI and implantation of second generation drug eluting stent (DES) in patients with unprotected LCAS and concomitant complex coronary pathology. Material and Methods: For the period March 2013–October 2018 we performed 225 PCIs of patients with LCAS. 170 of patients who received PCI were divided into 2 groups, according to their SS-1 (ST elevation excluded). We analyzed the major adverse cardio-vascular events (MACE – all-cause mortality, cardiac mortality, stroke and ischemia driven TLR) rate and time-to-fi rst MACE during follow up. Results: 103 patients had SS-I < 32 and 67 patients had SS-I ≥ 32 and their mean age was 67,25 ± 11,03. The median follow-up was 26,6 ± 19,1 months. MACE rate was 12,4% and there was no signifi cance between groups (p = 0,118). Conclusions: PCI of unprotected LCAS has high procedural success rate and good mid-term results, even in pts with complex anatomy. High anatomical complexity of coronary lesions defi ned by SS-I ≥ 32 is not predictive for poor clinical outcome after PCI.

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DOI: 10.3897/bgcardio.26.e51199

Authors: Iskra Bayraktarova, Elina Trendafilova

Abstract: Multivessel coronary artery disease is a frequent fi nding during primary PCI procedures in patients with ST-elevation myocardial infarction (STEMI). Optimal therapy of the infarct-related lesion has been largely elucidated and is stipulated in current guideline documents. Therapeutic options for the additional lesions are a subject of active debate and clinical trial worldwide – both the target degree of revascularization and its timing in relation to the index procedure remain unclear.

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DOI: 10.3897/bgcardio.26.e54743

Authors: Liliya Demirevska, Ivaylo Daskalov

Abstract: Cardiovascular complications are a major cause of morbidity and mortality in patients with end-stage liver disease undergoing liver transplantation (LT). Coronary artery disease (CAD) contributes to major portion of cardiovascular complications and therefore warrants evaluation in the preoperative period. Patients awaiting LT are a special subgroup that carries heterogeneous risk factors and has unique pathogenic and clinical characteristics. These patients usually demonstrate increased cardiac output and a compromised response to stress. Low systemic vascular resistance and bradycardia are also commonly seen in cirrhosis and can be aggravated by beta-blocker use. Current non-invasive tests that assess for subclinical CAD have low sensitivity, and altered hemodynamics during the LT surgery can unmask latent cardiovascular disease either intraoperatively or in the immediate postoperative period. This review focuses on the expanding body of evidence for diagnosis and risk stratifi cation of CAD in LT candidates. The systematic approach to evaluate preoperative CAD risk in LT candidates may be helpful to optimize post-LT outcome.

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DOI: 10.3897/bgcardio.26.e51992

Authors: Stefan Denchev, Niya Emilova, Mariana Gospodinova, Simeon Dimitrov

Abstract:  Purpose: We aimed at assessing the impairment in coronary flow and left ventricular function in patients without obstructive coronary disease on anti-ischemic treatment admitted with diagnosis unstable angina. Material and methods: The epicardial coronary flow was evaluated in 71 patients with unstable angina in absence of coronary stenosis >50% applying the methods the corrected TIMI frame count and systolic arrest of coronary flow at coronary angiography. The abnormalities in the diastolic function were assessed by echocardiography using PW-Doppler of the diastolic mitral flow and tissue Doppler imaging. Results:  The early diastolic velocity of interventricular septum (E’sept) and left ventricular free wall (E’ lat) were reduced in the SFLVH group compared to SCFP and the patients with normal coronary flow. Significant difference was found in between the patients with SFLVH and SCFP regarding DT and A-wave velocity in sub-analysis. The epicardial coronary flow of the patients with SFLVH was as tendency impaired compared to SCFP. The therapy with β- blocker alone or combined with calcium channel blocker or nitrate did not influence either cardiac function or coronary flow in this analysis. Conclusion:  Slower left ventricular relaxation is typical for the patients with microvascular angina and left ventricular hypertrophy associated with hypertension on treatment compared to SCFP and patients with normal coronary flow.

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DOI: 10.3897/bgcardio.26.e52847

Authors: Yoana Mladenova, Konstantin Gospodinov, Nadya Stancheva, Snezhanka Tisheva-Gospodinova

Abstract: COVID-19 is caused by SARS-CoV-2. In March 2020, the WHO declared a pandemic of COVID-19. The virus attacks human angiotensin-converting enzyme 2 receptors (ACE2), which are found in the lungs, vessels, heart, kidneys. This is the cause of the formation of multiple organ dysfunction in severe cases. These ones  are observed in patients with accompanying CVD, hypertension, DM, cancer, immune deficiencies. It can lead to hundreds of damage to the cardiovascular system such as myocarditis and CH. Treatment with antiviral medications may cause additional myocardial devices, including rhythm-conduction disorders. The use of ACE inhibitors and ARBs continues according to current guidelines, based on a number of evidence from clinical trials for their use, in the absence of such harm to date in the course of the COVID-19 pandemic.

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DOI: 10.3897/bgcardio.26.e53735

Authors: Andrey Ivanov, Nikolay Runev, Emil Manov, Elisaveta Levunlieva

Abstract: The myocardial performance index (MPI) is used for global systolic-diastolic left ventricular function and prognosis assessment in patients with heart disease, allowing assessment of the patient‘s current condition and disease development follow-up. The classic method of calculation is pulsed Doppler echocardiography. The aim of the study was to evaluate the correlation of myocardial performance index with established left ventricular systolic and diastolic function indices and to determine cut-off values of the myocardial performance index in M-mode color tissue Doppler echocardiography through the aortic and mitral valves predicting abnormal myocardial performance index by pulsed Doppler echocardiography. One hundred and fi ve subjects were studied, including 30 healthy controls, 45 hypertensive patients, and 30 patients with CHD. MPI was calculated using pulsed Doppler (MPIPW) and M-mode color tissue Doppler echocardiography through the aortic (MPIAO1 and MPIAO2) and mitral (MPIMV) valves. In all patients, the myocardial performance index showed a low to moderatenegative correlation with the left ventricular ejection fraction, and the correlation with the diastolic function indices was moderate to high. In healthy persons, the correlations were not signifi cant in almost all comparisons. The MPIAO1, MPIAO2,and MPIMV values predicting abnormal MPI by pulsed Doppler (MPIPW ≥ 0.50) are MPIAO1 ≥ 0.578, MPIAO2 ≥ 0.446, and MPIMV ≥ 0.552. The cut-off values of MPI by M-mode color tissue Doppler echocardiography through the aortic and mitral valve obtained can be used for global left ventricular function assessment in patients with heart disease. Further studies, on a larger number of patients, are necessary to estimate the predictive value of the parameters established.

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