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

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Funding Acknowledgements Type of funding sources: None. BACKGROUND   Arterial hypertension (HTN) is the most prevalent risk factor for Atrial fibrillation (AF) through structural and functional changes of the left atrium. Paroxysmal AF is mainly asymptomatic and silent forms in patients with HTN are associated with thromboembolic complications. However, prompt identification of HTN patients at risk for AF may be strategic for preventing purposes.  PURPOSE To assess sensitive and  predictive parameters for AF onset in HTN patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA) and left ventricle (LV).  METHODS A total of 165 consecutive patients were screened for participation in the study.  Only 80 patients met the inclusion criteria ( age below 60 years; with well controlled HTN or HTN with AF; without concomitant disease or other risk factors for AF).They were separated in two groups: 43 with HTN and 37 patients with AF and HTN. All patients underwent standard 2D echocardiography with volumetric and Speckle tracking analysis for assessment of: LV global longitudinal strain; LA total ( LATEF), passive ( LAPEF), active (LAAEF) emptying fractions; LA stiffness and expansion index; LA - reservoir (LASr), conduit (LAScd) and contractile (LASct) strain.  RESULTS There were statistically significant differences between patents with HTN and  HTN with AF group in: LASr (30.88 ± 3.99% vs. 27.89 ± 8.21 %, p= 0.049), LASct (-17.64 ± 2.04% vs. -14.4 ± 6.74 %, p= 0.007) and LA expansion index (122 ± 42% vs. 174 ± 115%; p = 0.014). There were no significant differences in other LV and LA structural and functional indices. Multiple regression analysis demonstrated that  LASct ( B= - 0.043’ p= 0.001; 95%CI -0.063- -0.023) and expansion index (B= 0.023; p= 0.001, 95%CI 0.117- 0.349)  are independent predictors of AF in hypertensive patients.  Conclusion Preserved LA compliance and contractile function are essential for maintenance of sinus rhythm in younger HTN patients. These findings could be used for  prediction of cardiovascular events and preventing AF onset in younger hypertensive population with a huge social impact.

Objective: Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between left atrial remodeling and arterial stiffness in middle – aged hypertensive patients. AIM: To investigate the early changes in left atrial (LA) mechanical function and parameters of arterial stiffness in a population of asymptomatic hypertensive individuals. Design and method: A total 95 patients (57 ± 14 years) with hypertension, were separated in two groups: 22 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees))and 73 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling (VAC). All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) strain. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24 h) and central pulse pressure (cPP24 h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA. Results: RESULTS: Statistically significant differences in parameters of vascular stiffness were found in patients with normal VAC in comparison with disturbed EA/Ees: cSys24 h (107.64 ± 9.19 vs. 116.64 ± 16.7 mm Hg, p = 0.02), cPP24 h (40.23 ± 11.84 vs. 48.08 ± 10.51 mm Hg, p = 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.86 ± 1.94 vs. 19.49 ± 1.35 %, p < 0.001), LASr (30.22 ± 3.26 vs. 31.81 ± 5.32 %, p = 0.007) and LAVI (30.95 ± 9.22 vs. 36.65 ± 8.83 ml/m2, p = 0.007). There was positive correlation between LAScd with EA/Ees (r = 0.272, p < 0.008) and negative E/Em (r = -0.264, p < 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.407, p < 0.0001) and negatively with LAScd (r = - 0.410, p < 0.0001). Conclusions: LA mechanical deformation is dependent to arterial stiffness. Reduced LAScd could play a key role in early stages of atrial remodeling. These findings could be used for the prediction of cardiovascular events in this population.

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