E. Trendafilova - Academia.edu (original) (raw)
Papers by E. Trendafilova
Zenodo (CERN European Organization for Nuclear Research), Apr 7, 2023
We report оur ехреrieпсе in radiofrequency (RF) catheter ablation оf 42 patients less than 18 yea... more We report оur ехреrieпсе in radiofrequency (RF) catheter ablation оf 42 patients less than 18 years оf age. The follow-uр period is from 3 tо 120 months. We were аblе successfully tо eliminate the accessory pathway in 22 оf 23 patients (96%). Аblаtiоn proved successful in аll cases оf А-V node re-entry tachycardia. The ablation was successful in 1 patient with left VT and respectively аtrial flutter, and unsuccessful in 1 VT from the right ventricular outflow tract. The success rate was 83% for аtrial есtopic tachycardias. Overall, therefore, ablation was immediately successful in 37 patients (88%), with а recurrence оf the arrhythmia in 6 cases (16%). We performed а second ablation in these children, 5 оf them then proving successful. Serious соmрliсаtions occurred in 4% (2/49) procedures. There was 1 pericardial effusion and 1 pneumothorax. The long-term success rate proved tо bе 93% (39/42 patients). We conclude that radiofrequency catheter ablation сап bе considered safe and eff...
Българска кардиология, Apr 7, 2023
European Journal of Preventive Cardiology, 2018
Funding Acknowledgements: Topic: Chronic Heart Failure-Other Background: The single balloon (SB) ... more Funding Acknowledgements: Topic: Chronic Heart Failure-Other Background: The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). Objective: This study aimed to demonstrate that mitral balloon valvuloplasty (MBV) with the Balt single balloon (BSB) has similar outcome and long-term follow-up (FU) than MBV performed with the Inoue worldwire accepted technique. Methods: From 1987 to 2013 a total of 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU in IB group was 33AE27 (2 to 118) and 55AE33 (1 to 198) months, p<0.0001. Univariate analysis (UA) and multivariate Cox analysis (MVA) were utilized to determine independent predict variables of survival and event free survival (EFS) in both techniques groups. The major events (ME) were death, cardiac surgery and new MBV. Results: In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3AE10.0 (19 to 63) and 38.0AE12.6 (13 to 83) years, p=0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p=0.1754; echo score (ES) 7.6AE1.3 (5 to 10) and 7.2AE1.5 (4 to 14) points, p=0.0528; echo mitral valve area (MVA) pre-MBV 0.96AE0.18 and 0.93AE0.21 cm 2 , p=0.2265; post-MBV mean MVA (Gorlin) were 2.00AE0.52 and 2.02AE0.37 cm 2 , p=0.9554; MBV dilatation a´rea 6,09 AE 0,27 and 7,02 AE 0,30, p<0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71AE0.41 and 1.54AE0.51 cm 2 , p=0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p=0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p=0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p=0.3456; deaths 2 (3.6%) and 11 (4.3%), p=1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p=1.000; ME 5 (8.9%) and 46 (18.0%), p=0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival (MCA with 2 models with 5 and 6 variables) were: age <50 years (p=0.016, HR=0.233, 95% IC 0.071-0.764), ES 8 (p<0.001, HR=0.105, 95% IC 0.34-0.327), MBV dilatation area (p<0.001, HR 16.838, 95% IC 3.353-84.580) and no mitral valve surgery in the FU (p=0.001, HR0.152, 95% IC 0.050-0.459). Independent risk factors to EFS: no prior commissurotomy (p=0.012, HR=0.390, 95% IC 0.187-0.813) and post-MBV MVA!1.50 cm 2 (p=0.001, HR=7.969, 95% IC 3.413-18.608). Conclusion: MBV with BSB and IB were equally efficient, there were similar survival and EFS in the FU. Independent predictors of survival were: age <50 years, ES 8 points, MBV dilatation area > 7 mm2 and no mitral valve surgery in the FU. Independent risk factors of EFS were no prior commissurotomy and post-MBV MVA!1.50 cm 2 P592 Echocardiographic score influence, survival and event free survival in long-term follow-up of percutaneous mitral balloon valvuloplasty
Hellenic Journal of Cardiology, 2020
SAMe-TT 2 R 2 atrial fibrillation non-vitamin-K antagonist oral anticoagulants vitamin-K-antagoni... more SAMe-TT 2 R 2 atrial fibrillation non-vitamin-K antagonist oral anticoagulants vitamin-K-antagonist oral anticoagulants a b s t r a c t Aim: The SAMe-TT 2 R 2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT 2 R 2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and !1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT 2 R 2 score >2 and 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT 2 R 2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT 2 R 2 scores >2 and 27.5% in those with scores 2. Conclusions: The lack of a clear association between the SAMe-TT 2 R 2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT 2 R 2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.
Journal of Medical Engineering & Technology, 2001
Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid wavef... more Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid waveform, initiated in 60 s, was adopted in virtually all defibrillators. Biphasic pulses were introduced recently, achieving success with less energy. A biphasic exponential waveform was modelled with 4 ms duration per phase with a balanced 3:1 ratio of the first to second phase peak voltages and implemented in a defibrillator. A version obtained by chopping the pulses with a 5 kHz frequency was also used. It was hypothesized that the modelled transmembrane voltage decay time is a parameter that could be associated with successful defibrillation. The results of cardioversion for two groups of patients with the 'classic' monophasic waveform and with the biphasic pulses were compared. The mean efficient energy with the damped sinusoid was 205 +/- 85 J, versus 88 +/- 43 J with the biphasic pulses, yielding a ratio of 2.32 (1.92 to 3.2 for fibrillation and flutter, respectively). An acceptable agreement between model data and clinical results was found. The transmembrane voltage decay time ratios for monophasic versus biphasic pulses was in the approximate range of 2.5 to 3.5.
Journal of Hypertension
Objective: The aim of this study is to analyse the prevalence of diagnosed or undiagnosed diabete... more Objective: The aim of this study is to analyse the prevalence of diagnosed or undiagnosed diabetes in Bulgarian high risk patients during the period 2007-2014. Design and method: We analyse the data from Bulgarian cohorts of high risk patients included in both surveys EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) III and IV, held in 2007 and 2014. The protocols of EUROASPIRE III and IV trials comprise standard questionnaires used by all countries to determine the patient health status. Results: The prevalence of diagnosed or undiagnosed diabetes (self-reported diabetes or fasting glucose >7 mmol/L) among high risk patients in EUROASPIRE III is 48.9% in men and 44.7% in women (on average 45.7%). The prevalence of undiagnosed diabetes among non-diabetic patients (fasting glucose >7 mmol/L) is 20.0% in men and 17.6% in women (on average 18.1%). 60.7% of the patients with self-reported diabetes have HbA1c<7.0% and 42.9% of them have HbA1c<6.5%. The prevalence of diagnosed or undiagnosed diabetes among high risk patients in EUROASPIRE IV is 60%. The prevalence of undiagnosed diabetes (fasting glucose >7 mmol/L and/or HbA1c >6.5%) among non-diabetic patients is 40%. 65% of the patients with self-reported diabetes have HbA1c<7.0% and 45% of them have HbA1c<6.5%. Conclusions: About 1/3 of the high risk patients have diabetes. We found an increase of the undiagnosed diabetes among them. Most of the patients with self-reported diabetes do not reach blood glucose under target levels.
Journal of Hypertension
Objective: aim of this study is to analyse the changes in the risk profile (blood pressure and li... more Objective: aim of this study is to analyse the changes in the risk profile (blood pressure and lipid levels) in high risk patients without atherosclerotic diseases during the last 8 years. Design and method: We analyse the data from Bulgarian cohorts of high risk patients included in both surveys EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) III and IV, held in 2007 and 2015. The protocols of EUROASPIRE III and IV trials comprise standard questionnaires used by all participating into the trial countries to determine the patient health status. Results: Bulgarian high risk patients in EUROASPIRE III have a mean blood pressure (BP) 160.8/96.0 mmHg, 85.3% have BP levels >140/90 mmHg, 86.7% are taking antihypertensive medication. Only 12% have BP under target levels (<140/90 mmHg in patients using BP lowering drugs and <140/80 mmHg in diabetes). 36% of high risk patients in EUROASPIRE IV have BP under targets. Among the high risk patients in EUROASPIRE III the mean total cholesterol level is 5.69 mmol/L, the mean LDL-cholesterol level is 3.54 mmol/L, the mean HDL-cholesterol level is 1.26 mmol/L, and the mean triglycerides level is 1.70 mmol/L. Raised total cholesterol >4.5 mmol/L is recorded in 85.5% of all patients. Raised fasting triglycerides >1.7 mmol/L is measured in 50.0%. Raised LDL-cholesterol >2.5 mmol/L is recorded in 88.1% of all patients. Lipid-lowering drugs are use in 4.3% of the patients. Therapeutic control of LDL-cholesterol is achieved in 16.7% of the patients on lipid-lowering therapy. Among the high risk patients in EUROASPIRE IV raised total cholesterol >4.5 mmol/L is recorded in 70% of all patients. Raised LDL cholesterol >2.5 mmol/L is recorded in 83% of all patients. Therapeutic control of LDL-cholesterol is achieved in 27% of the patients on lipid-lowering therapy. Conclusions: We find better control of the blood pressure and LDL-cholesterol during the last 8 years in high risk patients in Bulgaria. Despite the increased number of patients with achieved target levels, a great number of them still need better preventive strategies and drugs for achievement of the needed target levels.
Journal of Hypertension, 2016
Objective: Blood pressure variability (BPV) is considered an independent poor prognostic factor i... more Objective: Blood pressure variability (BPV) is considered an independent poor prognostic factor in acute stroke. The aim of the study was to analyze the blood pressure (BP) dynamics and variability in patients with hypertensive crisis and acute ischemic (IS) or hemorrhagic stroke (HS). Design and method: The study included 108 randomly selected in-hospital patients (equal men and women) with acute stroke /70 patients with IS and 38 with HS/, accompanied by hypertensive crisis at admission (systolic blood pressure /SBP/>180 mmHg and/or diastolic blood pressure /DBP/>120 mmHg). Dynamics of BP, some indices of BPV and their potential association with the outcome of stroke were analyzed. Results: Some differences in BP dynamics and BPV between the two types of stroke were found. Patients with HS demonstrated significantly higher initial levels of SBP, pulse pressure and mean BP. The BP drop was steeper in the first 24 hours and then smoother. We observed more gradual fall in SBP and DBP in persons with clinical improvement. Those who did not improve or deteriorated showed steep reduction of SBP in the first 24 hours, then more fluctuations and a trend for slight increase >160 mmHg after the 24th hour. Significantly greater BPV was established in patients with HS. Indices of BPV significantly associated with the outcome at hospital dissmission in patients with IS were the maximal variations of SBP and in patients with HS - mean standard deviation of SBP, and maximal variations of SBP >50 mmHg. Conclusions: BP dynamics and BPV might be of definite importance for the outcome of acute stroke. In our study we observed significantly higher initial BP values and more variations in the group with HS, which correlated with worse prognosis. High BP in the acute phase of stroke should be reduced carefully using therapeutic strategies associated with stable BP and low BPV.
Central European Journal of Medicine, 2013
This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lower... more This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lowering drugs (LLDs) for at least 3 months with no dose change for a minimum of 6 weeks. The primary objective was to establish the proportion of patients who are on LDL-C target, according to the Fourth Joint European Task Force (FJETF) guidelines. The secondary objectives were to define the proportion of patients at target: according to the 2001 National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the 2004 NCEP ATP III guidelines. The patients’ demographics, current LLD treatment, cardiovascular medical history were recorded. Next the lipid profile, glucose level and HbA1c were obtained from these patients. The investigators and patients completed questionnaires related to the LLD therapy. Gender, BMI, history of CHD, therapy compliance, risk category, lack of patient’s awareness of LDL-C targets were all studied as determinants of the undertreatment. Despite the...
Journal of Hypertension, 2012
ABSTRACT Hypertension is the most common disease in the practice of the general practitioners (GP... more ABSTRACT Hypertension is the most common disease in the practice of the general practitioners (GPs). The good knowledge of the guidelines will ensure good control of this risk factor for coronary heart disease (CHD).
Journal of Hypertension, 2012
ABSTRACT To achieve the target blood pressure levels in real life we need more than one antihyper... more ABSTRACT To achieve the target blood pressure levels in real life we need more than one antihypertensive drug. Combined therapy is the foundation of modern antihypertensive treatment. The purpose of this study was to analyse the physicians' preference of combined antihypertensive therapy and whether it applies in practice.
European Heart Journal
Background Current European Society of Cardiology guidelines on atrial fibrillation (AF) propose ... more Background Current European Society of Cardiology guidelines on atrial fibrillation (AF) propose a structured characterization of AF in order to facilitate the evaluation of patients by physicians at all healthcare levels. The 4S-AF structured scheme includes four domains: stroke risk, symptoms, severity of AF burden and substrate severity. Purpose To evaluate the adherence to the 4S-AF scheme in patients with high risk of stroke (CHA2DS2-VASc score ≥3 in females or ≥2 in males) in the post-hoc analysis of the BALKAN-AF dataset. Methods Prospective enrolment of consecutive patients with electrocardiographically documented AF was conducted in seven Balkan countries. Results Of the 2,712 enrolled patients, 2,712 (100.0%) had data on CHA2DS2-VASc score. 162 (6.0%) had truly low risk of stroke (CHA2DS2-VASc score of 0 in males and 1 in females). 2099 (77.4%) of patients had high risk of stroke and 613 (22.6%) individuals had low or intermediate risk of stroke (CHA2DS2-VASc score <3 i...
European Heart Journal: Acute Cardiovascular Care
Background: The present survey aims to describe the intensive cardiac care unit organization and ... more Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries ( n=13) from middle-income countries ( n=14). Results: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit...
Zenodo (CERN European Organization for Nuclear Research), Apr 7, 2023
We report оur ехреrieпсе in radiofrequency (RF) catheter ablation оf 42 patients less than 18 yea... more We report оur ехреrieпсе in radiofrequency (RF) catheter ablation оf 42 patients less than 18 years оf age. The follow-uр period is from 3 tо 120 months. We were аblе successfully tо eliminate the accessory pathway in 22 оf 23 patients (96%). Аblаtiоn proved successful in аll cases оf А-V node re-entry tachycardia. The ablation was successful in 1 patient with left VT and respectively аtrial flutter, and unsuccessful in 1 VT from the right ventricular outflow tract. The success rate was 83% for аtrial есtopic tachycardias. Overall, therefore, ablation was immediately successful in 37 patients (88%), with а recurrence оf the arrhythmia in 6 cases (16%). We performed а second ablation in these children, 5 оf them then proving successful. Serious соmрliсаtions occurred in 4% (2/49) procedures. There was 1 pericardial effusion and 1 pneumothorax. The long-term success rate proved tо bе 93% (39/42 patients). We conclude that radiofrequency catheter ablation сап bе considered safe and eff...
Българска кардиология, Apr 7, 2023
European Journal of Preventive Cardiology, 2018
Funding Acknowledgements: Topic: Chronic Heart Failure-Other Background: The single balloon (SB) ... more Funding Acknowledgements: Topic: Chronic Heart Failure-Other Background: The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV). Objective: This study aimed to demonstrate that mitral balloon valvuloplasty (MBV) with the Balt single balloon (BSB) has similar outcome and long-term follow-up (FU) than MBV performed with the Inoue worldwire accepted technique. Methods: From 1987 to 2013 a total of 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU in IB group was 33AE27 (2 to 118) and 55AE33 (1 to 198) months, p<0.0001. Univariate analysis (UA) and multivariate Cox analysis (MVA) were utilized to determine independent predict variables of survival and event free survival (EFS) in both techniques groups. The major events (ME) were death, cardiac surgery and new MBV. Results: In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3AE10.0 (19 to 63) and 38.0AE12.6 (13 to 83) years, p=0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p=0.1754; echo score (ES) 7.6AE1.3 (5 to 10) and 7.2AE1.5 (4 to 14) points, p=0.0528; echo mitral valve area (MVA) pre-MBV 0.96AE0.18 and 0.93AE0.21 cm 2 , p=0.2265; post-MBV mean MVA (Gorlin) were 2.00AE0.52 and 2.02AE0.37 cm 2 , p=0.9554; MBV dilatation a´rea 6,09 AE 0,27 and 7,02 AE 0,30, p<0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71AE0.41 and 1.54AE0.51 cm 2 , p=0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p=0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p=0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p=0.3456; deaths 2 (3.6%) and 11 (4.3%), p=1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p=1.000; ME 5 (8.9%) and 46 (18.0%), p=0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival (MCA with 2 models with 5 and 6 variables) were: age <50 years (p=0.016, HR=0.233, 95% IC 0.071-0.764), ES 8 (p<0.001, HR=0.105, 95% IC 0.34-0.327), MBV dilatation area (p<0.001, HR 16.838, 95% IC 3.353-84.580) and no mitral valve surgery in the FU (p=0.001, HR0.152, 95% IC 0.050-0.459). Independent risk factors to EFS: no prior commissurotomy (p=0.012, HR=0.390, 95% IC 0.187-0.813) and post-MBV MVA!1.50 cm 2 (p=0.001, HR=7.969, 95% IC 3.413-18.608). Conclusion: MBV with BSB and IB were equally efficient, there were similar survival and EFS in the FU. Independent predictors of survival were: age <50 years, ES 8 points, MBV dilatation area > 7 mm2 and no mitral valve surgery in the FU. Independent risk factors of EFS were no prior commissurotomy and post-MBV MVA!1.50 cm 2 P592 Echocardiographic score influence, survival and event free survival in long-term follow-up of percutaneous mitral balloon valvuloplasty
Hellenic Journal of Cardiology, 2020
SAMe-TT 2 R 2 atrial fibrillation non-vitamin-K antagonist oral anticoagulants vitamin-K-antagoni... more SAMe-TT 2 R 2 atrial fibrillation non-vitamin-K antagonist oral anticoagulants vitamin-K-antagonist oral anticoagulants a b s t r a c t Aim: The SAMe-TT 2 R 2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA) and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less frequently to patients with AF and SAMe-TT 2 R 2 scores >2 than to patients with lower scores. Methods and results: We analyzed the Phase III dataset of the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation (GLORIA-AF), a large, global, prospective global registry of patients with newly diagnosed AF and !1 stroke risk factor. We compared baseline clinical characteristics and antithrombotic prescriptions to determine the probability of the VKA prescription among anticoagulated patients with the baseline SAMe-TT 2 R 2 score >2 and 2. Among 17,465 anticoagulated patients with AF, 4,828 (27.6%) patients were prescribed VKA and 12,637 (72.4%) patients an NOAC: 11,884 (68.0%) patients had SAMe-TT 2 R 2 scores 0-2 and 5,581 (32.0%) patients had scores >2. The proportion of patients prescribed VKA was 28.0% among patients with SAMe-TT 2 R 2 scores >2 and 27.5% in those with scores 2. Conclusions: The lack of a clear association between the SAMe-TT 2 R 2 score and anticoagulant selection may be attributed to the relative efficacy and safety profiles between NOACs and VKAs as well as to the absence of trial evidence that an SAMe-TT 2 R 2-guided strategy for the selection of the type of anticoagulation in NVAF patients has an impact on clinical outcomes of efficacy and safety. The latter hypothesis is currently being tested in a randomized controlled trial.
Journal of Medical Engineering & Technology, 2001
Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid wavef... more Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid waveform, initiated in 60 s, was adopted in virtually all defibrillators. Biphasic pulses were introduced recently, achieving success with less energy. A biphasic exponential waveform was modelled with 4 ms duration per phase with a balanced 3:1 ratio of the first to second phase peak voltages and implemented in a defibrillator. A version obtained by chopping the pulses with a 5 kHz frequency was also used. It was hypothesized that the modelled transmembrane voltage decay time is a parameter that could be associated with successful defibrillation. The results of cardioversion for two groups of patients with the 'classic' monophasic waveform and with the biphasic pulses were compared. The mean efficient energy with the damped sinusoid was 205 +/- 85 J, versus 88 +/- 43 J with the biphasic pulses, yielding a ratio of 2.32 (1.92 to 3.2 for fibrillation and flutter, respectively). An acceptable agreement between model data and clinical results was found. The transmembrane voltage decay time ratios for monophasic versus biphasic pulses was in the approximate range of 2.5 to 3.5.
Journal of Hypertension
Objective: The aim of this study is to analyse the prevalence of diagnosed or undiagnosed diabete... more Objective: The aim of this study is to analyse the prevalence of diagnosed or undiagnosed diabetes in Bulgarian high risk patients during the period 2007-2014. Design and method: We analyse the data from Bulgarian cohorts of high risk patients included in both surveys EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) III and IV, held in 2007 and 2014. The protocols of EUROASPIRE III and IV trials comprise standard questionnaires used by all countries to determine the patient health status. Results: The prevalence of diagnosed or undiagnosed diabetes (self-reported diabetes or fasting glucose >7 mmol/L) among high risk patients in EUROASPIRE III is 48.9% in men and 44.7% in women (on average 45.7%). The prevalence of undiagnosed diabetes among non-diabetic patients (fasting glucose >7 mmol/L) is 20.0% in men and 17.6% in women (on average 18.1%). 60.7% of the patients with self-reported diabetes have HbA1c<7.0% and 42.9% of them have HbA1c<6.5%. The prevalence of diagnosed or undiagnosed diabetes among high risk patients in EUROASPIRE IV is 60%. The prevalence of undiagnosed diabetes (fasting glucose >7 mmol/L and/or HbA1c >6.5%) among non-diabetic patients is 40%. 65% of the patients with self-reported diabetes have HbA1c<7.0% and 45% of them have HbA1c<6.5%. Conclusions: About 1/3 of the high risk patients have diabetes. We found an increase of the undiagnosed diabetes among them. Most of the patients with self-reported diabetes do not reach blood glucose under target levels.
Journal of Hypertension
Objective: aim of this study is to analyse the changes in the risk profile (blood pressure and li... more Objective: aim of this study is to analyse the changes in the risk profile (blood pressure and lipid levels) in high risk patients without atherosclerotic diseases during the last 8 years. Design and method: We analyse the data from Bulgarian cohorts of high risk patients included in both surveys EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) III and IV, held in 2007 and 2015. The protocols of EUROASPIRE III and IV trials comprise standard questionnaires used by all participating into the trial countries to determine the patient health status. Results: Bulgarian high risk patients in EUROASPIRE III have a mean blood pressure (BP) 160.8/96.0 mmHg, 85.3% have BP levels >140/90 mmHg, 86.7% are taking antihypertensive medication. Only 12% have BP under target levels (<140/90 mmHg in patients using BP lowering drugs and <140/80 mmHg in diabetes). 36% of high risk patients in EUROASPIRE IV have BP under targets. Among the high risk patients in EUROASPIRE III the mean total cholesterol level is 5.69 mmol/L, the mean LDL-cholesterol level is 3.54 mmol/L, the mean HDL-cholesterol level is 1.26 mmol/L, and the mean triglycerides level is 1.70 mmol/L. Raised total cholesterol >4.5 mmol/L is recorded in 85.5% of all patients. Raised fasting triglycerides >1.7 mmol/L is measured in 50.0%. Raised LDL-cholesterol >2.5 mmol/L is recorded in 88.1% of all patients. Lipid-lowering drugs are use in 4.3% of the patients. Therapeutic control of LDL-cholesterol is achieved in 16.7% of the patients on lipid-lowering therapy. Among the high risk patients in EUROASPIRE IV raised total cholesterol >4.5 mmol/L is recorded in 70% of all patients. Raised LDL cholesterol >2.5 mmol/L is recorded in 83% of all patients. Therapeutic control of LDL-cholesterol is achieved in 27% of the patients on lipid-lowering therapy. Conclusions: We find better control of the blood pressure and LDL-cholesterol during the last 8 years in high risk patients in Bulgaria. Despite the increased number of patients with achieved target levels, a great number of them still need better preventive strategies and drugs for achievement of the needed target levels.
Journal of Hypertension, 2016
Objective: Blood pressure variability (BPV) is considered an independent poor prognostic factor i... more Objective: Blood pressure variability (BPV) is considered an independent poor prognostic factor in acute stroke. The aim of the study was to analyze the blood pressure (BP) dynamics and variability in patients with hypertensive crisis and acute ischemic (IS) or hemorrhagic stroke (HS). Design and method: The study included 108 randomly selected in-hospital patients (equal men and women) with acute stroke /70 patients with IS and 38 with HS/, accompanied by hypertensive crisis at admission (systolic blood pressure /SBP/>180 mmHg and/or diastolic blood pressure /DBP/>120 mmHg). Dynamics of BP, some indices of BPV and their potential association with the outcome of stroke were analyzed. Results: Some differences in BP dynamics and BPV between the two types of stroke were found. Patients with HS demonstrated significantly higher initial levels of SBP, pulse pressure and mean BP. The BP drop was steeper in the first 24 hours and then smoother. We observed more gradual fall in SBP and DBP in persons with clinical improvement. Those who did not improve or deteriorated showed steep reduction of SBP in the first 24 hours, then more fluctuations and a trend for slight increase >160 mmHg after the 24th hour. Significantly greater BPV was established in patients with HS. Indices of BPV significantly associated with the outcome at hospital dissmission in patients with IS were the maximal variations of SBP and in patients with HS - mean standard deviation of SBP, and maximal variations of SBP >50 mmHg. Conclusions: BP dynamics and BPV might be of definite importance for the outcome of acute stroke. In our study we observed significantly higher initial BP values and more variations in the group with HS, which correlated with worse prognosis. High BP in the acute phase of stroke should be reduced carefully using therapeutic strategies associated with stable BP and low BPV.
Central European Journal of Medicine, 2013
This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lower... more This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lowering drugs (LLDs) for at least 3 months with no dose change for a minimum of 6 weeks. The primary objective was to establish the proportion of patients who are on LDL-C target, according to the Fourth Joint European Task Force (FJETF) guidelines. The secondary objectives were to define the proportion of patients at target: according to the 2001 National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the 2004 NCEP ATP III guidelines. The patients’ demographics, current LLD treatment, cardiovascular medical history were recorded. Next the lipid profile, glucose level and HbA1c were obtained from these patients. The investigators and patients completed questionnaires related to the LLD therapy. Gender, BMI, history of CHD, therapy compliance, risk category, lack of patient’s awareness of LDL-C targets were all studied as determinants of the undertreatment. Despite the...
Journal of Hypertension, 2012
ABSTRACT Hypertension is the most common disease in the practice of the general practitioners (GP... more ABSTRACT Hypertension is the most common disease in the practice of the general practitioners (GPs). The good knowledge of the guidelines will ensure good control of this risk factor for coronary heart disease (CHD).
Journal of Hypertension, 2012
ABSTRACT To achieve the target blood pressure levels in real life we need more than one antihyper... more ABSTRACT To achieve the target blood pressure levels in real life we need more than one antihypertensive drug. Combined therapy is the foundation of modern antihypertensive treatment. The purpose of this study was to analyse the physicians' preference of combined antihypertensive therapy and whether it applies in practice.
European Heart Journal
Background Current European Society of Cardiology guidelines on atrial fibrillation (AF) propose ... more Background Current European Society of Cardiology guidelines on atrial fibrillation (AF) propose a structured characterization of AF in order to facilitate the evaluation of patients by physicians at all healthcare levels. The 4S-AF structured scheme includes four domains: stroke risk, symptoms, severity of AF burden and substrate severity. Purpose To evaluate the adherence to the 4S-AF scheme in patients with high risk of stroke (CHA2DS2-VASc score ≥3 in females or ≥2 in males) in the post-hoc analysis of the BALKAN-AF dataset. Methods Prospective enrolment of consecutive patients with electrocardiographically documented AF was conducted in seven Balkan countries. Results Of the 2,712 enrolled patients, 2,712 (100.0%) had data on CHA2DS2-VASc score. 162 (6.0%) had truly low risk of stroke (CHA2DS2-VASc score of 0 in males and 1 in females). 2099 (77.4%) of patients had high risk of stroke and 613 (22.6%) individuals had low or intermediate risk of stroke (CHA2DS2-VASc score <3 i...
European Heart Journal: Acute Cardiovascular Care
Background: The present survey aims to describe the intensive cardiac care unit organization and ... more Background: The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe. Methods: A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries ( n=13) from middle-income countries ( n=14). Results: A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit...