Imbalance of activation and inhibition of matrix metalloproteinases (MMPs) lead to an increase in their activity and the occurrence of pathological changes in the vascular wall. The purpose of this paper is to determine the role of MMP-2 and MMP-9 in vascular and ventricular remodelling in patients with heart failure with preserved ejection fraction. The patients were divided into three groups: 15 patients with heart failure with preserved ejection fraction (HFpEF), 72.73 ± 10.44 years old; 15 patients with arterial hypertension (AH), 63.73 ± 7.06 years old; 10 healthy controls, 58.7 ± 5.87 years old. Arterial stiffness was assessed by pulse wave velocity (PWV). Diastolic dysfunction was assessed by the ratio of early diastolic mitral flow velocity and early diastolic myocardial velocity (E/Em ratio). Left ventricular mass was calculated by area-length method and indexed to body surface area (LVMI). MMP-2, MMP-9 and Brain Natriuretic Peptide (BNP) were measured by ELISA technique.MMP-2 was higher in patients with HFpEF and AH versus controls (13987 ± 4464 ng/ml and 13040 ± 5060 ng/ml vs 9260 ± 4135 ng/ml, p = 0.047). MMP-9 was similar across the groups. BNP was higher in HFpEF versus AH and controls (775.33±443.59 pg/ml vs 370.00±158.29 pg/ml and 345.00±94.39 pg/ml, p = 0.002). In HFpEF patients, PWV (12.04 ± 2.46 m/s vs 10.06 ± 1.94 m/s vs 7.22±1.19 m/s, p < 0.0001), LVMI (134.11±29.40 g/m 2 vs 122.45±23.73Elisa kits for MMP-2, MMP-9 and BNP were purchased with funds from project "Young researcher" No 4D/2011 of the Medical University of Sofia. 289 g/m 2 vs 101.66 ± 11.92 g/m 2 , p < 0.0001), E/Em (16.30 ± 6.80 vs 9.57 ± 2.70 and 8.15 ± 1.63, p < 0.0001) were significantly higher, compared to hypertensive patients and controls. Higher MMP-2 was associated with higher PWV (r = 0.43, p = 0.007), E/Em (r = 0.40, p = 0.011) and LVMI (r = 0.46, p = 0.003). The measuring of MMP-2 could be useful for early detection of high risk patients and initiation of therapy before the development of organ damage.

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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Heart failure is often accompanied by sleep disorders. CPAP therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders - frequency, severity, and types to treat.

A 23-year-old man was admitted to a cardiology department with a several-month history of increasing shortness of breath, ascites, and leg oedema. The patient had a history of a hepatic hydatid cyst and had undergone a surgical intervention four years earlier. He had poor compliance and eventually stopped the prescribed therapy with albendazole. Admission electrocardiogram demonstrated a sinus rhythm with a right bundle branch block ( Fig. 1A). There were no clinically significant laboratory findings except an elevated level of D-dimer (2050 ng/mL; reference range, < 500 ng/mL) and low albumin levels (27 g/L; reference range, 30-50 g/L). The high-sensitivity cardiac troponin I was normal (13.9 pg/mL; reference range, 29-39 pg/mL). Transthoracic echocardiography showed an extremely dilated right ventricle without any detectable cystic formations in the cardiac chambers. Severe pulmonary hypertension and plethora of the inferior vena cava were observed. Global systolic function of the left ventricle was preserved. Notably, a major pericardial effusion without a collapse of the high-pressure right chambers, although with a mild collapse of the left atrium, was detected ( Fig. 1B, C). There were no significant changes in the mitral and tricuspid inflow patterns. A full-body computed tomography (CT) scan demonstrated multiple disseminated cystic formations in the lungs, liver and peritoneal cavity (Fig. 1D, E). We performed a CT pulmonary angiography which revealed bilateral embolisation of the main branches of the pulmonary arteries (PAs). The capsulated hypodense formations in the PA had the same density as the liver and pulmonary cysts, which strongly suggested echinococcosis as the reason for PA occlusion (Fig. 1F). Because of the dissemination process, conservative treatment with albendazole was restarted. The standard therapy for right-sided heart failure was applied. The patient refused any invasive procedure and was discharged with clinical improvement. Four months after discharge the patient died at home. Autopsy was not performed. Cardiac involvement of echinococcosis includes approximately 2% of cases and most commonly involves the left-sided chambers. Engagement of the PA is extremely rare. The pathogenesis could be related to an intraoperative or spontaneous rupture of the cyst near the hepatic vein and the distribution of its contents into the inferior vena cava and subsequently to the PA [1]. The growth of the cysts gradually leads to progressive pulmonary hypertension. In some cases, endarterectomy can be performed with satisfactory outcomes [2]. Our case demonstrates severe disseminated echinococcosis with multiorgan involvement and complications, which has poor prognosis and limited therapeutic options. Adequate and timely treatment of echinococcosis is needed to prevent irreversible lesions. References