Marko Buksa

Are We on the Path to Solve the Enigma of Resistant Hypertension: Renal Sympathetic Denervation

Renal sympathetic denervation (RSD) opens new perspectives and possibilities not only in the treatment of resistant hypertension but also of other cardiometabolic diseases. In patients with hypertension, it has been demonstrated that activity of the sympathetic nervous system correlates with grade of hypertension. Decreasing sympathetic activity using RSD significantly reduces blood pressure in resistant hypertension. It is too early to say a definite opinion about appropriateness of this method in the treatment of resistant hypertension, because there are not great studies with huge number of the patients. After we get and evaluate these results through a longer span of time, only than we shall know what is the role of RSD in the treatment of resistant hypertension and other cardiometabolic conditions related to increased function of the sympathetic nervous system, such as heart failure, diabetes mellitus, obstructive sleep apnea, renal disease with microalbuminuria and macroalbuminuria.

Impact of Gender and Other Risk Factors on Development of Coronary Artery Disease (Comparison of Dobutamine Stress Echocardiography and Coronary Angiography)

Objectives: The aim of this Study is to examine the development of ischaemic heart disease and occurrence of segmental wall motion abnormalities in men and women during Dobutamine stresss echocardiography in order to establish the impact of gender and other risk factors in development of coronary artery disease and the role of Dobutamine stress echocardiography in detecting and assessing the degree of myocardial ischemia and coronary stenosis in patients with suspected coronary artery disease in order to justify its wider application as a non-invasive diagnostic method. Research aim and purpose: Ischemic heart disease (IHD) causes more deaths, disability and economic loss in developed and developing countries than any other disease. Cardiovascular disease is the leading cause of ddath for women in western socitew. The epidemiology of the ischemic heart disease depends on fixed risk factors, such as sex, age and genetic predisposition, and on multiple risk factors that can be addressed, such as elevated lipid levels, arterial hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Cardiovascular diseases are the leading cause of morbidity and mortality in B&H and, considering the exposure profile of the B&H population to risk factors (unhealthy diet, ubiquitous smoking and alcohol drinking habits, inadequate physical activity, inadequate culture of health), further growing trend of cardiovascular diseases can be expected. Patients and methods: The research study covered 86 adult subjects of both sexes with cardiac risk factors, referred to dobutamine stress echocardiography test as part of their cardiological evaluation. The patients for whom invasive cardiac diagnostics was indicated following the dobutamine stress echocardiography were subjected to left heart catheterization: ventriculography and coronary angiography. The parameters obtained and results of each method applied were statistically processed. Results: The study results obtained indicate a high degree of sensitivity, specificity and accuracy of the dobutamine stress echocardiography as a non-invasive diagnostic method compared to invasive diagnostics i.e. coronary angiography, which is the gold standard for the detection and evaluation of coronary artery diseases. Dobutamine stress test, may play a key role in the optimal identification of high risk groups of patients with hypertension, diabetes mellitus, obesity, lifestyle (physical inactivity and stress), smoking, and alcohol consumption. Conslusion: Echocardiographic measures of inducible wall motion abnormalities and global and regional left ventricular function are highly accurate in detecting CAD in women and men alike. The safety and cost-effectiveness of the dobutamine stress echocardiography as a diagnostic procedure has been proved. In modern cardiology, the DSE occupies a significant place in the evaluation of patients with known or suspected coronary artery d