A few randomized trials have compared impedance-compensated biphasic defibrillators in clinical use. We aim to compare pulsed biphasic (PB) and biphasic truncated exponential (BTE) waveforms in a non-inferiority cardioversion (CVS) study. This was a prospective monocentric randomized clinical trial. Eligible patients admitted for elective CVS of atrial fibrillation (AF) between February 2019 and March 2020 were alternately randomized to treatment with either a PB defibrillator (DEFIGARD TOUCH7, Schiller Médical, Wissembourg, France) or a BTE high-energy (BTE-HE) defibrillator (LIFEPAK15, Physio-Control Inc., Redmond, WA, USA). Fixed-energy protocol (200–200–200 J) was administered. CVS success was accepted if sinus rhythm was restored at 1 min post-shock. The study design considered non-inferiority testing of the primary outcome: cumulative delivered energy (CDE). Seventy-three out of 78 randomized patients received allocated intervention: 38 BTE-HE (52%), 35 PB (48%). Baseline characteristics were well-balanced between groups (p > 0.05). Both waveforms had similar CDE (mean ± standard deviation, 95% confidence interval): BTE-HE (253.9 ± 120.2 J, 214–293 J) vs. PB (226.0 ± 109.8 J, 188–264 J), p = 0.31. Indeed, effective PB shocks delivered significantly lower energies by mean of 25.6 J (95% CI 24–27.1 J, p < 0.001). Success rates were similar (BTE-HE vs. PB): 1 min first-shock (84.2% vs. 82.9%), 1 min CVS (97.4% vs. 94.3%), 2 h CVS (94.7% vs. 94.3%), 24 h CVS (92.1% vs. 94.3%), p > 0.05. Safety analysis did not find CVS hazards, reporting insignificant changes of myocardial-specific biomarkers, transient and rare ST-segment deviations, and no case of harmful tachyarrhythmias and apnea. Cardioversion of AF with fixed-energy protocol 200–200–200 J was highly efficient and safe for both PB and BTE-HE waveforms. These similar performances were achieved despite differences in the waveforms’ technical design, associated with significantly lower delivered energy for the effective PB shocks. Clinical Trial Registration: Registration number: NCT04032678, trial register: ClinicalTrials.gov.

Background and Objectives: Hypertension is found as the leading cardiovascular disease in Bulgaria and the most frequent lifelong condition with a high risk of non-adherence. The aim of this study is to assess the hypertension patients’ adherence to medication therapy in Bulgaria by using the self-efficacy for appropriate medication use scale (SEAMS). Materials and Methods: A cross-sectional study was conducted in the major cardiology settings in the capital Sofia and in Burgas, the fourth largest city in Bulgaria. Data were collected from January 2024 to July 2024. The SEAMS was validated in Bulgarian in a sample of patients with hypertension that made it extremely suitable for our study. We applied 19 questions. Additionally, we used Cronbach’s α, ANOVA analysis, Pearson correlation, and covariance tests for statistical significance. Results: A total of 232 patients completed the study. Both genders are almost equally distributed (49.6% male and 50.4% female). The results reveal that the increase in the number of diseases and prescribed medicinal products leads to a worsening adherence level. Advancing age negatively affects the adherence scores. The study showed that in half of the age groups studied (patients’ age: 40–49, 60–69, and 70–79), adherence in patients treated with FDCs was better or almost the same (patients’ age: 50–59) as those treated with several mono-products. Conclusions: Measuring adherence with SEAMS in the hypertensive Bulgarian population in two regions reveals a good level of adherence. Factors negatively affecting adherence were older age, polypharmacy, co-morbidity, and therapy with monoproducts.

Background and Aims: We investigated whether patients with coronary heart disease (CHD) in Europe are achieving the standards set by prevention and rehabilitation guidelines. Variability in achieved standards was also studied: (i) between countries, (ii) between geographical risk regions, and (iii) according to attendance at cardiac rehabilitation (CR). Methods: EUROASPIRE VI is an observational study conducted between September 2024 and February 2026 in 160 hospitals across 27 countries. Geographical risk regions were defined as high, moderate, or low based on World Health Organization cardiovascular mortality data. Results were standardized by age and sex. Results: Among 8590 patients with CHD (23.7% female), 17.1% were current smokers, 32.0% were obese, and 33.5% reported low physical activity. 59.8% were above blood pressure target (systolic ≥130 and/or diastolic ≥80 mmHg), 82.7% were above LDL-cholesterol target (≥1.4 mmol/L), 32.8% had known diabetes of whom 42.2% had HbA1c ≥7%, and 30.6% had chronic kidney disease. Prevalences of these risk factors were all highest in countries from high-risk regions. 29.1% of patients attended at least one CR session, with country variability ranging from 0% to 79% and differing by risk region (55.9% low risk, 29.7% moderate risk and 10.2% high risk; P < .001). Attendance at CR programmes was associated with significantly better lifestyles, risk factor control, and use of cardioprotective drugs. Conclusions: Most European patients are not achieving targets set by prevention guidelines. Despite better outcomes for those attending CR, there is marked variability in CR attendance and evidence of inverse care, with lowest attendance in highest risk regions. These results provide a baseline to inform the challenges for future implementation of the first European Society of Cardiology guideline on CR.

Chronic thromboembolic pulmonary hypertension is a rare condition that is usually a consequence of prior acute pulmonary embolism. It is caused by persistent obstruction of pulmonary arteries by organized thrombi resulting in redistribution of blood flow and secondary pulmonary microvascular remodelling. Thus, pulmonary vascular resistance and pulmonary artery pressure are increased leading to right ventricle pressure overload, development of right heart failure and death. In eligible patients pulmonary endarterectomy is the standard of care and it can result in complete normalization of haemodynamics and right ventricular morphology and function. We present the case of a patient with chronic thromboembolic pulmonary hypertension with severe right ventricular dilation and dysfunction and refractory heart failure. After successful pulmonary endarterectomy we observed almost complete normalization of hemodynamics and restoration of right ventricular dimensions and function, as well as significant clinical improvement.

Въведение: COVID-19 пандемията доведе до значима промяна в честотата и прогнозата на острия миокарден инфаркт (ОМИ) по индиректни и директни механизми. Цел: Да се оцени влиянието на COVID-19 пандемията върху честотата и прогнозата на ОМИ. Материал и методи: Направихме ретроспективен анализ на последователни пациенти с ОМИ (STEMI и NSTEMI) през два периода – извънредното положение и една от вълните на пандемията. Сравнихме рисковия им профил, протичането на индексното събитие, проведените изследвания и лечение с контролна група от периода преди пандемията. Резултати: През първия период включихме 52 пациенти с ОМИ без COVID-19 инфекция, които сравнихме с контролна група от 66 пациенти. Отчетохме намаляване на броя предимно на пациентите със STEMI. Скоровете за тежест на състоянието (GRACE, APACHE II, SOFA) са достоверно по-високи през 2020 спрямо преди пандемията. Повече пациенти постъпват с прояви на остра застойна сърдечна недостатъчност, няма разлика в смъртността. През втория период включихме 83 пациенти, 21 от които с COVID–19 инфекция. Отчетохме сигнификантно нарастване на забавянето от страна на системата при всички пациенти. Скоровете за тежест и изходният тропонин са достоверно по-високи през този период. Наблюдава се значимо увеличаване на вътреболничната смъртност в групата с COVID–19 спрямо контролната група (23,8% спрямо 9%, р = 0,0375), вероятно поради увеличената честота на кардиогенния шок и на необходимостта от апаратна вентилация. Заключение: По време на извънредното положение отчетохме намаляване на броя пациенти с ОМИ, както и повишена честота на остра застойна сърдечна недостатъчност без увеличаване на смъртността. По време на една от вълните на COVID-19 пандемията установихме достоверно увеличаване на забавянето от страна на системата, което не надвишава препоръчителния интервал от 120 минути, и на тежестта на състоянието на всички пациенти. Наличието на COVID-19 инфекция се свързва с увеличена вътреболничната смъртност за сметка на увеличена честота на кардиогенния шок и необходимостта от апаратна вентилация. 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.

Drug therapy is a mandatory component of the treatment of patients with acute and chronic aortic syndromes, regardless of the chosen therapeutic approach (surgical, endovascular, or conservative). In the acute phase, it aims to control pain, heart rate, and arterial blood pressure, while in the long-term it seeks to slow disease progression and potentially prevent aortic rupture. This review focuses on the therapeutic goals in aortic diseases, the medications used, and the evidence currently available. Attention is also given to the importance of lifestyle modifi cations, as well as recommendations for follow-up using various imaging modalities.