Background The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). Methods Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). Results The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. Conclusions In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.

Introduction: Coronary Flow Reserve (CFR) is a clinically useful, non-invasive diagnostic method for assessing the functional ability of coronary arteries and it is important for their long-term follow-up in patients. However, CFR has not always been sufficiently investigated in previous studies. Objective: To examine the prognostic significance of CFR in the risk stratification of patients with chronic total occlusion of the right coronary artery (RCA) and the intermediary stenosis of the left coronary artery (LAD). Material and Methods: Number of 71 patients, mean age 64 ± 7 years, (84%) patients male, having LAD stenosis, diameter 50-70%, and CTO of RCA, were referred for noninvasive estimation of functional significance of LAD stenosis. Transthoracic Doppler echocardiography was used to obtain coronary flow velocities in the distal segment of LAD. Patients were followed for the mean period of 18.3 ± 7.1 months for the occurrence of composite end point including cardiovascular death, myocardial infarction, bypass surgery and PCI. Results: During the follow-up period, there were a total of 23 adverse events (4 deaths, 2 myocardial infarction, 7 bypass surgeries and 10 PCI). Patients with CFR < 2 had significantly more adverse events (n = 9; 56.3% vs. n = 14; 25.5%; p = 0.021), they were significantly older (68 ± 9 vs. 62 ± 6; p = 0.011), with a higher incidence of a positive family history (14; 87.5% vs. 26; 47.3%; p = 0.039), as well as a significantly higher frequency of three-dose coronary disease (14; 87.5% vs. 30; 54.5%; p = 0.017). Using Kaplan-Meier estimator, we obtained that patients with CFR < 2 have a significantly shorter average period without unwanted event (15.4 ± 2.8 months vs 23.5 ± 1.1 months, Log Rank 7.407; p = 0.008). Conclusion: CFR plays an important role in stratifying the risk of patients with CTO of RCA and the intermediary stenosis of LAD.

We present the case of a 68-year-old female patient with exertional dyspnea, mild pretibial oedema and echocardiographically verified enlarged left atrium, but with preserved left ventricular systolic function and normal left ventricular filling pressures at rest. NT-proBNP values were within reference values. The diastolic stress echocardiographic test confirms the presence of heart failure with preserved ejection fraction (HFpEF). This case report represents the complexity of diagnosing HFpEF in everyday clinical practice.

Uvod: Stresna ehokardiografija (SEHO) predstavlja pouzdanu tehniku ne samo za dijagnozu koronarne bolesti, već i za stratifikaciju rizika pacijenata sa suspektnom ili dokazanom koronarnom bolešću. Međutim, njena uloga u stratifikaciji rizika kod pacijenata sa inkompletnom revaskularizacijom nakon primarne perkutane koronarne intervencije (pPKI) još nije dovoljno proučena. Cilj rada je bio da se utvrdi i ispita pojava neželjenih događaja u odnosu na rezultat SEHO testa kod pacijenata koji su imali akutni infarkt miokarda i koji su lečeni primanom perkuatnom koronarnom intervencijom, ali su imali takođe i promene na drugim koronarnim arterijama koje u tom aktu nisu tretirane. Metode: Naša studija je obuhvatila 62 pacijenata (prosečne starosti 61 ± 8 godina, muski pol 42; 67,7%). Svi pacijenti su podvrgnuti stres ehokardiografskom testu po Bruce protokolu da bi se procenilo postojanje ishemije u neinfarktnoj arteriji. Stres ehokardiografski test je smatran pozitivnim za ishemiju ukoliko je nakon testa došlo do pojave nove ili pogoršanja postojeće abnormalnosti kinetike zida leve komore u regionu koji vaskularizuje sužena koronarna arterija. Duke skor, funkcionalni kapacitet (MET) i oporavak srčane frekevence su računati kod svakog pacijenta. Značajnost lezije na neinfarktnoj arteriji je procenjena na osnovu koronarne angiografije. Prosečno vreme praćenja ispitivane populacije bio je 35 ± 7 meseci za pojavu neželjenih događaja odnosno srčane smrti, infarkta miokarda i klinički indikovane revaskularizacije (bypass operacija ili perkutana koronarna intervencija). Rezultati: Tokom perioda praćenja bilo je ukupno 18 (29%) neželjenih događa (3 infarkta miokarda, 4 bypass operacije i 11 PKI). Pacijenti sa nežljenim događajima su imali statistički značajno veću učestalost pozitivnog SEHO testa (10; 55.6% vs 5; 11.4%, p<0,001), dijabetesa (9; 50% vs 10 22,7%, p=0,034) i značajno manji Duke skor (4,6 ± 3 vs 6,9 ± 2,7, p=0,007) u odnosu na pacijente bez neželjenih događaja. Koristeći Kaplan-Meier-ovu krivu preživljavanja pokazalo se da su rezultat SEHO testa (pozitivan SEHO prosečno vreme bez događaja 17,9 ± 5,2 meseca u odnosu na negativan SEHO test 41,6 ± 1,8, Log Rank 20,378, p<0,001) i dijabetes (prosečno vreme bez događaja 26,6 ± 4,8 meseca u odnosu na pacijente bez dijabetesa 40 ± 2,2, Log Rank 5,949, p=0,015) bili prediktori pojave neželjenih događaja. Međutim u Cox-ovoj regresionoj analizi kao nezavisni prediktor pojave neželjenih događaja bio je samo pozitivan SEHO test (HR 5,516 [95% CI 2,096-14,514], p=0.01) ali ne i dijabetes. Pozitivna prediktivna vrednost SEHO testa za predikciju neželjenih događaja bila je 66.7% a negativna prediktivna vrednost 82.9%. Zaključak: Naše ispitivanje je pokazalo da SEHO test ima visoku negativnu i zadovoljavajuću pozitivnu prediktivnu vrednost za pojavu neželjenih kardiovaskularnih događaja kod pacijenata sa inkompletnom revaskularizacijom nakon pPKI i da je veoma korisna metoda za stratifikaciju rizika kod ovih pacijenata. Stress ehokardiografoka, nekompletna revaskularizacija, prim...