Trial marks a major step in the development of innovative treatments for high-risk cardiovascular disease

The research team at ‘Heart and Brain’ Pleven, led by Prof. Iana Simova, has achieved a major milestone in clinical trials with the successful randomisation of Europe’s first patient for the SHASTA-3 clinical trial. The trial, which targets patients with severe familial hypertriglyceridaemia, marks an important step forward in the development of innovative treatments for this high-risk cardiovascular disease.

Familial hypertriglyceridemia (FH) is a genetic disorder that results in dangerously high triglyceride levels and contributes to an increased risk of cardiovascular events. The SHASTA-3 study aims to evaluate the effectiveness of a novel therapeutic approach aimed at reducing triglyceride levels and minimizing associated risks.

In recognition of this achievement, John Montgomery, Chief Executive Officer of Arrowhead Pharmaceuticals, personally congratulated Professor Simova and her team, highlighting the importance of their work in advancing the understanding and treatment of cardiovascular disease.

This trial represents not only a key milestone for Prof. Simova’s team, but also a major milestone for Prof. Simova, but also an important collaboration between academic research and the pharmaceutical industry. It highlights the crucial role that clinical drug trials play in improving patient outcomes and advancing medical science.

He will present his innovative solution at the EIT Health I-Days finals in Budapest

Dr Silvia Ganeva, leading endocrinologist, and specialists from the IT department at ‘Heart and Brain’ advised eleventh-grader Mario Petkov from the Prof. Mario qualified for the finals of the technology competition thanks to his excellent performance at the Innovation Day in Sofia. He was the only student among the participants – 70 students from different majors who worked on real case studies.

Dr. Ganeva introduced Mario in detail to the specifics of the diagnosis and treatment of diabetes, as well as the characteristics of the pre-diabetic condition. The IT specialists gave him specific guidance on how he could technologically implement the medical parameters in his software application.

Betting on innovation in healthcare, ‘Heart and Brain’ traditionally supports young people with scientific interests in healthcare and the creation of advanced technological solutions for the benefit of Bulgarian patients.

November 13 has been declared International Day of Physical and Rehabilitation Medicine. On this day, 25 years ago, in 1999, the International Society of Physical and Rehabilitation Medicine (ISPRM) was born.

Physical and Rehabilitation Medicine (PRM) is a major clinical specialty providing theoretical and clinical education for medical professionals and patients, health promotion, prevention, medical diagnosis, functional assessment, therapy and rehabilitation for major and comorbid conditions for patients of all age groups. The clinic in the high-tech hospital complexes ‘Heart and Brain’ in Pleven and Burgas has a total of 36 beds and a team of 30 people. Under the leadership of Assoc. Prof. Dr. Ilia Todorov, M.D. the treatment of patients is organized according to state-of-the-art standards, based on constantly upgraded expertise of the staff and modern material and technical base of the hospital. The priority is the rehabilitation of patients with diseases of the central nervous system, as well as patients after surgical interventions in the fields of neurosurgery, orthopedics and traumatology, cardiac surgery, etc. The majority of patients are admitted for treatment immediately after their stay in the respective surgical clinic, thus the hospital ensures continuity, follow-up and coordination of the healing process. Patients with structural and functional disorders of the musculoskeletal system, diseases of the nervous system, sports injuries, etc. are consulted and treated on an outpatient basis. The equipment includes top models, allowing maximum acceleration of the therapeutic process at short exposure times. The clinic is a training base for medical students, physician assistant, nurse practitioner, rehabilitation therapist, etc.

The ESAIC examination provides the most prestigious diploma in anaesthesiology and intensive care in the world

In September 2025, ‘Heart and Brain’ Burgas will provide the opportunity for all anaesthesiologists in the country to sit the first part (of two) of the specialised examination for the first time within Bulgaria. The high-tech hospital complex has the necessary infrastructure and meets all the requirements of the European Society. The examination will be conducted in English. Its aim is to achieve a uniformly high standard of anaesthetists’ knowledge across Europe, assessed by an independent Board of Examiners. In 2022, more than 3300 anaesthetists and anaesthesiology trainees sat the first Part I of the exam and a further 1400 sat Part II in a hybrid online format.

The Anesthesiology and Intensive Care Unit (AICU) at , Heart and Brain, with Dr. Valentin Milev as Chief, is responsible for the treatment of patients in the largest intensive care unit in Eastern Bulgaria and provides anesthesia for over 12,000 surgeries per year. It is equipped with all modern anaesthesia tools, tailored to each age group, and has all the modern equipment needed to maintain organ function, including continuous renal replacement therapy, extracorporeal membrane oxygenation, and total plasma exchange.

The ICU employs specialists certified in the application of state-of-the-art techniques, bronchoscopy, transesophageal echocardiography and other highly specialized activities. The physicians in the department pay particular attention to continuing education and offer their patients only the most advanced methods of anesthesia and life support.

More information about the September 2025 exam: Dr. Kaloyan Junov – [email protected]

On 23 October, the Chairman of the Board of the Regional Council of the Bulgarian Medical Association in Veliko Tarnovo, Dr. Chavdar Vladimirov, awarded Dr. Valentin Krastev a badge of honour and a diploma for “Long-standing activity in the field of medicine and active contribution to the development of the specialty”.

Dr. Krastev has extensive experience in invasive cardiology and is an expert in echocardiography. He is an excellent diagnostician. He was the head of the sector of invasive cardiology at the hospital “Hr. Botev”, Vratsa, head of the cardiology clinic at “Sofamed” and invasive cardiologist at “St. Cherkezov in Veliko Tarnovo. He holds specialties in internal medicine and cardiology. He is a member of the Society of Cardiologists in Bulgaria and the Society of Interventional Cardiology, the European Society of Cardiology, a member of the Council of Cardio-oncology, the Council of Cerebrovascular Accidents and the European Association for Percutaneous Cardiovascular Interventions. He is also a member of the American Society of Cardiology and the American Heart Association, the European Society of Cardiovascular and Interventional Radiology and the Society of Cardiovascular Computed Tomography.

Dr. Krastev’s expertise in the field of cardiology is remarkable. He is one of the leading cardiologists of the Bulgarian Cardiology Institute and a preferred doctor by the residents of the Old Capital and the region.

15 doctors from the Cardiology Clinic, headed by Prof. Yana Simova, participated in the National Jubilee Congress of Cardiology in Plovdiv. The impressive delegation delivered two lectures presented by Prof. Simova, one clinical case presentation and 12 abstracts presented in the poster sessions. Interesting clinical cases as well as long-term projects of the Cardiology Clinic of great public and social importance were shared.

Presentations on identification of patients with familial hypercholesterolemia by cascade screening, screening for Fabry disease in a high-risk group of patients, systemic inflammation and atherosclerotic diseases, and difficulties in diagnosing patients with cardiac amyloidosis were of great interest. The cardiologists also paid special attention to the long-term follow-up of patients with unexplained syncope using an implantable loop recorder, and the multiple manifestations of cardiotoxicity in a patient with lung cancer.

All the developments that were presented at the congress are the result of the good collaboration of the multidisciplinary teams of ‘Heart and Brain’ Pleven – cardiologists, cardiac surgeons, neurosurgeons, imaging specialists, oncologists, neurologists, vascular surgeons, immunologists.

“The National Congress of Cardiology in Plovdiv was extremely well organized, for which the newly elected President of the Society of Cardiologists – Prof. Dr. Ivan Gruev has a great merit. The attendance exceeded our expectations, the halls were full, including standing room only. All delegates had the opportunity to enjoy an elite international presence on site in Plovdiv, with leading experts in various fields of cardiology presenting their expertise. We, the cardiologists from ‘Heart and Brain’, Pleven, are proud to have been part of this prestigious event and to have had the opportunity to share our experience and the results of our work in front of such an audience”, said Prof. Simova.

Nadezhda and Georgi were discharged in excellent health thanks to the dedicated work of the teams at the high-tech hospital  

Two high-risk newborns with extremely low birth weights have been discharged in excellent health from the country’s newest maternal and child health clinic – ‘Mama and I’ in Pleven. The children were born after high-risk pregnancies and were monitored and treated at the Obstetrics and Gynaecology clinic under the supervision of Assoc. Prof. Dr. Yordan Popov.

Nadezhda (“Hope” in Bulgarian) is a long awaited child, after a successful in-vitro procedure. The mother’s pregnancy had severe complications – pre-eclampsia and thyroid pathology. After a series of consultations, obstetricians, resuscitation specialists, cardiologists, endocrinologists and neonatologists decided on operative delivery at an early term, as the child suffered tremendously in the mother’s womb. Hope was born with an extremely low birth weight – only 960 grams. Immediately after birth, the neonatology team under the direction of Dr. Andrei Hristov began caring for her around the clock. The child is extremely risky. It is seriously delayed in its intrauterine development. The team conducts initial stabilization and intensive treatment. As a result of the incomplete rotation of the newborn’s intestinal system, he developed one of the rarest afflictions in the field of surgical pathology.

“Nadezhda turned out to be a very strong child, despite her weight and prematurity, the complications that occurred in the gastrointestinal system and liver,” says Dr. Hristov. “Our success with her is the result of the super modern and high-tech equipment, as well as the individual approach and dedicated work of the well-trained team of the department.” Nadezhda was discharged healthy, the parents are happy, and the follow-up of the child in the neonatology department continues.

George also became a favourite of the obstetricians and neonatologists. He is the third child in the family. The mother’s pregnancy proceeded normally until the amniotic fluid leaked prematurely. The parents are confused and seek help at another medical facility, but are left disappointed. On the recommendation of friends, they decide to visit ‘Mama and I’ and are quickly convinced that this is where their child will be born. The parents-to-be meet the obstetric team – Assoc. Prof. Dr. Yordan Popov and Dr. Mazhet Alkara, and Dr. Andrey Hristov introduces them to the capabilities of the neonatology department. Georgi was born weighing 1,000 grams, later reaching 800 grams. Intensive care was applied in full and with technology that is only available in the neonatology department of ‘Mama and I’. The child went through various trials, however the neonatology team successfully managed the complications that arose, the most severe of which was pulmonary haemorrhage. With each passing day the child’s condition improves, the parents are reassured and a smile appears on their faces. After several months of intensive care, George is now home and the family is happy.

“Such moments of happiness make us feel like winners,” says Dr. Hristov. Staying true to their motto, “We handle the difficult with ease, the impossible slows us down just a little,” the team took on the care of the next at-risk child.

Specialists from the “Pirogov” Emergency Care Institute visited “Heart and Brain” Pleven at the invitation of Prof. Dr. Plamen Bozhinov, Head of the Clinic of Nervous Diseases. They were presented by Assoc. Prof. Dr. Maria Dimitrova, Head of the Clinic of Nervous Diseases at Pirogov. The purpose of the visit was to exchange experience between the two leading hospitals in the country.

“Our long-term goal is to develop and deepen our cooperation in the field of neurology as well as in other specialties,” said prof. Bozhinov.

Representatives of both clinics made presentations, sharing their experience, various interesting clinical cases from practice, new methods of work and opportunities for joint work. Then the team of neurologists from “Pirogov” got acquainted with the work of their colleagues from “Heart and Brain” Pleven, the organization of medical activities in the clinic and high-tech equipment.

Every year on 29 September we celebrate World Heart Day. The motto in 2024 is “Act with Heart”, a call expressed in a petition that focuses political and public attention on improving access to prevention, diagnosis and treatment of cardiovascular disease. They claim over 20.5 million lives a year and are the undisputed number 1 killer, leading the black statistics ahead of all forms of cancer and chronic respiratory diseases combined. On this occasion, we talk to Assoc. Prof. Dobri Hazarbasanov – one of the leading cardiologists in the country, head of the cardiology department at the high-tech hospital complex ‘Heart and Brain’ in Burgas.

According to the World Heart Federation, 80% of premature deaths due to cardiovascular disease can be prevented. What are the steps?

Over the past 50 years, thanks to large randomized and epidemiological studies, it has been established which treatments improve the survival of patients with cardiovascular disease (CVD). Their effective implementation in North American and Western European countries has led to a significant reduction in CVD mortality. Lifestyle changes are key: increased physical activity, smoking cessation and limiting intake of carbohydrates and saturated animal fats. A huge role is also played by the effective organisation of emergency medical care, intensive cardiac care units, patients’ access to modern diagnostic and therapeutic methods: echocardiography, cardiac catheterisation, coronary angiography and percutaneous coronary intervention (PCI), coronary by-pass surgery, implantation of pacemakers and defibrillators. This is an established standard of medical management that, together with effective medical therapy, has led to a fourfold reduction in CVD mortality in the United States over 40 years. Of course, this is possible when therapy is truly administered according to medical standards and recommendations and all patients have access to it. This includes: beta-blockers, PCIs, thrombolytics, statins, ACE inhibitors, widespread use of aspirin for secondary prevention in acute myocardial infarctions, effective control of arterial hypertension, SGLT-2 blockers, MRA antagonists, mechanical thrombectomy in acute ischemic stroke.

The Bulgarian Heart Institute has been working for 15 years to improve access to specialised treatment for CVD.

Yes, this is our long-term goal – 15 years ago a structure of centres was established, available 7 days a week, 24 hours a day, for the treatment of Acute Myocardial Infarction/MI/, centres for endo-vascular therapy of peripheral arterial disease. Since 2 years, high-tech hospital complexes ‘Heart and Brain’ in Pleven and Burgas for treatment of acute stroke with thrombolysis and mechanical thrombectomy are functioning. Patients have permanent access to specialists: cardiologist, cardiac surgeon, vascular surgeon, neurologist and neurosurgeon and outreach examinations in small settlements.

As every year, the Bulgarian Cardiology Institute will celebrate September 29 with a number of activities in the cities of Burgas, Pleven, Yambol, Varna, Veliko Tarnovo, Shumen.

How do modern diagnostic methods change the approach to treatment?

The application of the latest as well as established modern methods in the diagnosis of CVD is a condition without which effective treatment cannot be carried out. This is based on the work of our multidisciplinary teams with the latest generation of imaging and diagnostic equipment for interventional cardiology, vascular surgery, and endovascular interventions, neurointerventions (mechanical thrombectomy), electrophysiology, performing coronary and valvular cardiac surgery with classical and endoscopic access and hybrid approach for revascularization, transcatheter valve interventions (TAVI) – all in one place.

The leading cardiac surgeon from ‘Heart and Brain’ Burgas, Assoc. Prof Kornovski, is an expert in valve and coronary surgery at the European Heart Association and STS and his team works in collaboration with Thierry Carrel from Switzerland. I myself have worked as a proctor for TAVI implantations in the UK, Morocco, RSM, Lebanon, Cyprus, Romania, Ukraine, Iran and Bulgaria, and over the years have gained experience in interventional correction of paraprosthetic regurgitation in collaboration with Eric Eeckhout from Switzerland.

What are the most common complaints of your patients, what do they seek you for most often?

The most frequent reason why patients seek us are the manifestations of heart failure: shortness of breath, fatigue, arrhythmias. All cardiovascular diseases eventually lead to heart failure, which is the most significant pandemic in the last 20 years.

Symptoms of acute myocardial infarction are prolonged chest pain – we work daily and long-term to better inform patients, including on the Bulgarian Cardiology Institute website, and make patients aware of the symptoms, approaches, diagnoses and treatments of certain cardiovascular diseases. Over the years we have organised and successfully implemented numerous campaigns to raise awareness, prevention and control of CVD.

Symptoms of acute stroke are sudden onset of paralysis of limbs or impairment in speech, vision and/or consciousness, and we also prepare information materials on these symptoms.

In recent years, cardiologists have been sounding the alarm that cardiovascular disease is getting younger. What has been your experience?

This trend is observed all over the world. Reduced physical activity and the consumption of large amounts of high-calorie food is leading to an epidemic of overweight and obesity, which in turn is leading to the premature development of type 2 diabetes, arterial hypertension, dyslipidaemias associated with obesity – this is also a pronounced trend in children, which is particularly worrying.

Gastroenterologists at ‘Heart and Brain’ Burgas performed for the first time laser destruction of a large-sized gallstone in a patient with a gallstone detected during a previous examination. This is the second attempt to remove the mass, after the doctors judged that the manipulation could not be performed in the traditional way by removal with a balloon or metal basket. With the help of a cholangioscope, a thin endoscope through which it is possible to view the bile ducts, the stone is visualized and subsequently fragmented using a laser fiber (Thulium laser) and equipment provided by the urology department. The patient recovered within only two days and was discharged without complications after the procedure. Thus, surgical intervention was avoided, which is usually severely tolerated and leads to prolonged hospital stay.

Non-operative removal of bile duct stones

Gallstone disease is common. When gallbladder concrements are found, patients undergo surgical treatment. However, when pathological formations get into the bile ducts, they cause yellowing of the skin and eyes and in these cases are the subject of gastroenterology. A highly specialized procedure called endoscopic retrograde cholangiopancreatography is performed to remove the stones from the bile ducts. In a not insignificant percentage of cases, specialists encounter large concrements (more than 15 mm) that cannot be removed by this method alone.The gastroenterology department in the high-tech hospital complex ‘Heart and Brain’ in Burgas has additional equipment, the so-called cholangioscopy, with which the bile ducts are examined.