Management of all patients with heart failure and reduced left ventricular ejection fraction is based on optimal drug treatment - „the great four” that reduce mortality (1-angiotensin converting enzyme inhibitors or angiotensin receptor neprilyzine inhibitor; 2-beta-adrenoblockers; 3-mineralocorticoid receptor antagonists; 4-sodium-glucose cotransporter inhibitors-2). For certain categories of patients, treatments with implantable cardiac devices (CRT-P/D or ICD) and cardiac surgery (coronary artery bypass grafting, aortic or mitral valve repair operations) that improve the life prognosis are required, and for advanced heart failure may be considered methods of mechanical circulatory support and heart transplantation.

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Objective: In HT, both arterial elasticity of the central arteries (C1) and of the distal circulation (C2) has been reported to be reduced and this condition favours the development of other cardiovascular diseases. Diastolic dysfunction (DD) identifies hypertensives with high cardiovascular risk independent of LV mass and BP level. Several studies have shown that the extent of diastolic function's impairment could be interdependent on the level of arterial elasticities’ alteration. PURPOSE: To evaluate the correlation between the elasticity of large and small arteries and DD Design and method: Arterial elasticity indices (C1, C2) were derived from pulse wave analysis based on a modified Windkessel model in 101 hypertensive subjects, (mean age 51.08 ± 0.79 yrs; 48.51% of men, SBP/DBP: 202.49 ± 7.41/106.7 ± 5.54 mmHg, BMI- 29.38 ± 0.22 kg/m2), without other co-morbidities. Ambulatory blood pressure monitoring (ABPM), transthoracic echocardiography (TE)were performed at baseline and after 6, 12- months period of treatment. DD patterns were appreciated according to ASE/EACVI 2016 guidelines. Altered arterial elasticity was considered for C1 < 10 ml/mm Hg × 10, C2 < 6 ml/mm Hg × 1. Correlation analysis was performed using Pearson's test. The correlation coefficient was considered weak at < 0.3, medium-0.3–0.7 and strong > 0.7–1.0. Statistical significance was appreciated at a P-value < 0.05 and highly significant at a P-value < 0.001 Results: Diastolic dysfunction and C1 and C2 indices demonstrated a statistically significant correlation (p < 0.001). More advanced patterns of diastolic dysfunction were associated with higher C1 and C2 abnormalities (Tab. 1,). Conclusions: Diastolic dysfunction is associated with arterial elasticity's alteration, and this association appears to have a particularly strong relationship with the extent of diastolic function's impairment. The more advanced patterns of diastolic dysfunction occurred, the stronger is the interdependence with arterial elasticity abnormalities.

Objective: Comparative evaluation of the impact of renal denervation versus pharmacological treatment with sympathetic nervous system (SNS) blockers on blood pressure variability in patients with resistant hypertension. Design and method: 75 patients with resistant hypertension without comorbidities after a 3-week standardized treatment with Losartan, Amlodipine and Indapamide and confirmation of their resistance were randomized into three groups, depending on medication supplimented to the previously administred: group I M - selective I1-imidazoline agonist Moxonidine, group II B – cardioselective beta-blocker Bisoprolol, group III D – renal artery denervation (RDN). Blood pressure variability assessed by ambulatory blood pressure monitoring (ABPM) were determined at baseline, 3 and 6 months follow-up. Results: The media/day and media/night systolic blood pressure (SBP) variability increased at the baseline in all three groups was reduced statistically significant from 3 months of monitoring, reaching the maximum effect towards the end of the study, when its normal values were recorded in all observational groups. Although treatment group supplimented with Moxonidine demonstrated an effect superior to that with Bisoprolol, and RDN - superiority to both, all three schemes had an authentic dynamics in improving SBP at 6 months of evaluation (p < 0,001) (Fig.1). The evolution of diastolic blood pressure (DBP) media/day and media/night variability noted a beneficial effect, starting with 3 months, the improvement of this parameter being maintained until the end of the study. Although the reduction of DBP variability was statistically authentic in all three groups at all stages of evaluation, the Bisoprolol treatment group noted a smaller effect in improving this parameter, the higher net effect being manifested by the RDN patients group (p < 0,001) (Fig.2). Conclusions: RDN in patients with resistant hypertension reduced statistically significant SBP and DBP variability starting with 3 months of follow-up and reaching maximum effect at the end of the study, simultaneously demonstrating superiority over treatment with SNS blockers.

Prosthetic obstructive thrombosis, being a major emergency, requires the identification of symptoms of heart failure, which are crucial elements in the early diagnosis and initiation of prompt therapeutic management. Adequate clinical, preclinical and instrumental assessment is the key tactic, used both to confirm the diagnosis and to assess the severity of the general condition and the prognosis of survival of the patient with obstructive thrombosis of the valve prosthesis. Prosthetic heart valve thrombosis is a rare but serious complication. Surgery is the first-line therapy in symptomatic obstructive mechanical valve thrombosis, thrombolytic therapy has been used as an alternative to surgical treatment. In this case report we described a 63-year-old woman who had undergone mitral valve replacement operation 11 months ago, presenting to the guard room in an extremely serious general condition, in polyvisceral and polysystemic dysfunction syndrome (MODS). A thrombus was detected on the prosthetic mitral valve with high transmitral gradient by transthoracic echocardiography. Tissue plasminogen activator treatment was administered successfully. The gradient was improved on prosthetic mitral valve and embolic complications or bleeding were not occurred.