Gestational hypertension (GH) and preeclampsia (PE) are associated with the onset of hypertension. This study aimed to investigate whether the blood pressure (BP) pattern in GH is associated with the prevalence of hypertension later in life. In this prospective cohort study pregnant women screened for GH underwent medical history, laboratory analysis, ambulatory blood pressure monitoring (AMBP), and transthoracic echocardiography (with left ventricular global longitudinal strain (LVGLS)) assessment. Overall, 138 GH (67 non-dippers and 71 dippers), 55 preeclamptic, and 72 normotensive pregnant controls were included. Women were followed in the postpartum period, first after 6 weeks and later on, for the occurrence of hypertension. The median follow-up was 8.97 years (8.23; 9.03). Non-dippers and PE compared with normotensives and dippers had a higher prevalence of hypertension onset (p < 0.01), as well as significantly reduced absolute values of LVGLS during pregnancy, after delivery, and at the time of onset of hypertension during follow-up (p < 0.01). Night-time diastolic BP, LVGLS, age, and left ventricular ejection fraction were the strongest predictors of postpartum onset of hypertension. The non-dipping BP pattern in GH was significantly associated with the onset of hypertension later in life, as well as with decreased systolic function.

Background and Objectives: Coronary artery bypass graft (CABG) surgery is the most common cardiac surgery. One of the main causes of postoperative complications and increased mortality after CABG is the inflammatory response. The aim of this study was to investigate whether continuous intraoperative dexmedetomidine can reduce the increase of IL-6 and other inflammatory markers after CABG surgery. Materials and Methods: The study is registered with ClinicalTrials.gov, NCT06378827, accessed on 23 April 2024. This prospective experimental study was conducted from April to December 2024 and included 100 patients undergoing CABG surgery. Patients in the experimental group (50 patients) received a continuous infusion of dexmedetomidine (0.5 μg/kg/h) from anesthesia induction until the end of surgery, while the patients in the control group (50 patients) received the same volume of saline. The primary outcomes were the changes in the values of interleukin-6 (IL-6), C-reactive protein (CRP), white blood cells (WBC), and fibrinogen on the first postoperative day (POD1) compared to the basal, preoperative values. Results: The patients in the control group were on average 65.26 years old, and the patients in the experimental group were 66.28 years old (p = 0.555). From the control group, 40 (80%) patients were male compared to 37 (74%) patients from the experimental group (p = 0.635). Median IL-6 before surgery was 2.0 pg/mL, while on POD 1 it was 76.2 pg/mL (p < 0.001). Median CRP before surgery was 2.5 mg/dL, while the POD1 value was 45.5 mg/dL (p < 0.001). Median WBC values were 6.7 × 10⁹/L before surgery and 13.6 × 10⁹/L on POD1 (p < 0.001). The average value of fibrinogen was 3.19 g/L before surgery, while on POD1 it was 3.37 g/L (p = 0.024). The increase in IL-6 on POD1 (ΔIL-6) was 72.4 pg/mL in the control group and 73.0 pg/mL in the experimental group (p = 0.427). ΔCRP was 41.2 mg/mL (control group) and 38.0 mg/mL (experimental group) (p = 0.725). ΔWBC was 7.45 × 10⁹/L (control group) and 6.81 × 10⁹/L (experimental group) (p = 0.407). Δfibrinogen was 0.16 g/L (control group) and 0.2 g/L (experimental group) (p = 0.771). Conclusions: Intraoperative administration of dexmedetodine during CABG surgery at a dose of 0.5 µg/kg/h without a loading dose does not lead to a decrease in the intensity of the inflammatory response after surgery.

Background/Objectives: Coronary microvascular dysfunction (CMD) is emerging as a critical factor in patients presenting with anginal symptoms without obstructive coronary artery disease (CAD). This study aims to investigate the relationship between invasive measurements of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) using thermodilution techniques, compared to non-invasive assessments of CFR with transthoracic Doppler echocardiography (TDE). Methods: In this observational prospective cross-sectional study, a total of 49 patients, clinically characterized as having angina with no obstructive CAD (ANOCA) or ischemia with no obstructive CAD (INOCA), underwent both TDE and invasive coronary angiography (ICA) followed by thermodilution assessment of CFR and IMR. Results: It was found that there is a statistically significant negative correlation between both non-invasive and invasive CFR measurements and IMR. Specifically, a negative moderate correlation was observed between non-invasive CFR and IMR (r_s = −0.477, p < 0.01), as well as a high negative correlation between invasive CFR and IMR (r = −0.541, p < 0.01). Receiver operating characteristic (ROC) analysis indicated that both non-invasive and invasive CFRs are effective predictors of CMD, defined as IMR > 25. Conclusions: Both noninvasive and invasive CFR measurements are significant independent predictors of CMD. Our results indicate that noninvasive TDE CFR can be a reliable tool for assessing CMD in patients with ANOCA, potentially facilitating earlier diagnosis and management strategies for this patient population.

Introduction. According to clinical studies, the prevalence of acute myocardial infraction with nonobstructive coronary arteries (MINOCA) is around 5%. MINOCA can be triggered by various atherosclerotic and nonatherosclerotic causes with heterogenous pathophysiological mechanisms. Plaque disruption is frequent at MINOCA patients and it implies plaque rupture, plaque erosion, and calcium node. We presented a case of a 32-year-old male patient with MINOCA caused by plaque erosion. Case report. A 32-year-old male patient was admitted due to chest pain, ECG abnormalities, and elevated cardio specific enzymes. Urgent coronary angiography was performed and non-significant 30% stenosis was found in proximal LAD. OCT was performed in LAD revealing plaque erosion with white thrombus masses, as well as a 57% stenosis, with minimal lumen area of 7.91mm2 . According to OCT findings, it was decided to proceed with medical treatment. During follow-up, the patient was without symptoms. Functional tests on ischemia were normal after one year of the incident. After two years of the incident, CT coronarography registered a mild 25% stenosis in the proximal LAD. Conclusion. In the diagnostics and treatment of the patients with MINOCA, it is vital to use a multimodal imaging. Plaque erosion is one of the possible causes of MINOCA, firstly because of the possibility to trigger vasospasm with consequential impaired flow. The usage of intracoronary imaging is paramount to adequately analyze the morphology in the culprit area.

Introduction. Congenital malformations of the mitral valve encompass a broad spectrum of lesions, with an incidence of approximately 0.4% among patients with congenital heart diseases. Case Report. A 45-year-old female was admitted to our institution due to a confirmed mitral valve defect identified via echocardiographic examination. She presented with leg swelling and rapid fatigue. Her medical history includes systemic lupus erythematosus. Upon admission, she was in cardiopulmonary decompensation, with a systolic murmur detected in the mitral valve area, radiating towards the axilla. Transesophageal echocardiographic revealed severe mitral stenosis with moderate regurgitation, without clear visualization of the two cusps. Cardiac computed tomography confirmed a voluminous anterior mitral cusp and a hypoplastic posterior cusp, observed in diastole as a crescent-shaped, characteristic of a unicuspid mitral valve. Follow-up echocardiographic showed progression of mitral regurgitation with circumferential pericardial effusion, necessitating pericardiocentesis. Due to further hemodynamic instability, urgent surgical mitral valve replacement was indicated. The surgery proceeded without complications, but the immediate period was marked by exacerbation of renal impairment, requiring hemodiafiltration on several occasions. Following cardiological stabilization, the patient was transferred to the Nephrology Clinic for further management of renal insufficiency and systemic lupus. Conclusion. It is crucial to emphasize the significance of a multidisciplinary approach for each patient, with particular emphasis on detailed imaging diagnostics to definitively establish a congenital heart disease diagnosis.