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Skoda R, Bárczi G, Vágó H, Nemes A, Szabó L, Fülöp G, Hizoh I, Domokos D, Törő K, Dinya E, Merkely B, Becker D. Prognosis of the non-ST elevation myocardial infarction complicated with early ventricular fibrillation at higher age. GeroScience 2021; 43:2561-2571. [PMID: 33990895 PMCID: PMC8599743 DOI: 10.1007/s11357-021-00377-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
Early ventricular fibrillation (EVF) predicts mortality in ST-segment elevation myocardial infarction (STEMI) patients. Data are lacking about prognosis and management of non-ST-segment elevation myocardial infarction (NSTEMI) EMI with EVF, especially at higher age. In the daily clinical practice, there is no clear prognosis of patients surviving EVF. The present study aimed to investigate the risk factors and factors influencing the prognosis of NSTEMI patients surviving EVF, especially at higher age. Clinical data, including 30-day and 1-year mortality of 6179 NSTEMI patients, were examined; 2.44% (n=151) survived EVF and were further analyzed using chi-square test and uni- and multivariate analyses. Patients were divided into two age groups below and above the age of 70 years. Survival time was compared with Kaplan-Meier analysis. EVF was an independent risk factor for mortality in NSTEMI patients below (HR: 2.4) and above the age of 70 (HR: 2.1). Mortality rates between the two age groups of NSTEMI patients with EVF did not differ significantly: 30-day mortality was 24% vs 40% (p=0.2709) and 1-year mortality was 39% vs 55% (p=0.2085). Additional mortality after 30 days to 1 year was 15% vs 14.6% (p=0.9728). Clinical characteristics of patients with EVF differed significantly from those without in both age groups. EVF after revascularization—within 48 h—had 11.2 OR for 30-day mortality above the age of 70. EVF in NSTEMI was an independent risk factor for mortality in both age groups. Invasive management and revascularization of NSTEMI patients with EVF is highly recommended. Closer follow-up and selection of patients (independent of age) for ICD implantation in the critical first month is essential.
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Affiliation(s)
- Réka Skoda
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - György Bárczi
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Clinical Center, Medical Faculty, University of Szeged, Szeged, Hungary
| | - Liliána Szabó
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gábor Fülöp
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - István Hizoh
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Klára Törő
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Elek Dinya
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.
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Pólos M, Domokos D, Şulea CM, Benke K, Csikós G, Nagy A, Skoda R, Szabó A, Merkel E, Hartyánszky I, Szabolcs Z, Merkely B, Becker D. Needle in the heart: a rare case of cardiac tamponade caused by a migrated foreign body and mimicking ST segment elevation myocardial infarction. BMC Cardiovasc Disord 2021; 21:143. [PMID: 33730997 PMCID: PMC7972190 DOI: 10.1186/s12872-021-01950-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pericardial tamponade is a serious condition which may eventually lead to severe haemodynamic disturbances and cardiac arrest. It is most often caused by the accumulation of fluid inside the pericardium, as a result of different aetiological factors such as pericarditis, neoplastic diseases, lymphatic dysfunctions, or idiopathic pericardial disease. Pericardial tamponade can develop after cardiac surgical procedures or as a complication of myocardial infarction. Collection of blood inside the pericardial sack can be the result of pericardial or cardiac trauma. It is exceedingly rare for the injury to be caused by a migrating foreign body. Although a typical picture of pericardial tamponade has been previously described, the disorder may clinically resemble an acute myocardial infarction. CASE PRESENTATION We report the case of a 58-year-old female patient complaining of new onset thoracic pain and shortness of breath. Electrocardiographic examination results were suggestive of an acute inferior myocardial infarction. However, echocardiography revealed significant pericardial tamponade. The cause was found to be a needle which remained inside the pelvis following a previous cesarean delivery, which the patient had undergone 18 years prior. In emergency setting, the needle was removed and the pericardial tamponade was resolved. Due to the prompt and efficient management, the patient had an uneventful postoperative recovery and presented no recurrence at the follow-up examinations. CONCLUSIONS The migration of foreign bodies through tissues is exceedingly rare. If present, it may cause life-threatening complications. Since the aetiology of pericardial tamponade is vast, a thorough assessment is highly important. Therefore, echocardiography is the imaging modality of choice. We wish to highlight the possibility of migrating foreign bodies as probable cause for pericardial tamponade, as well as the importance of echocardiographic methods in the fast-track evaluation of such critical conditions.
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Affiliation(s)
- Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary.
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Cristina-Maria Şulea
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Gergely Csikós
- Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Andrea Nagy
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Réka Skoda
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - András Szabó
- Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | - Eperke Merkel
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - István Hartyánszky
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Varosmajor Str. 68, 1122, Budapest, Hungary
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Szabó A, Tóth K, Nagy Á, Domokos D, Czobor N, Eke C, Sándor Á, Merkely B, Susánszky É, Gál J, Székely A. The effect of cognitive dysfunction on mid- and long-term mortality after vascular surgery. BMC Geriatr 2021; 21:46. [PMID: 33441102 PMCID: PMC7805183 DOI: 10.1186/s12877-020-01994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background In recent decades, previous studies have noted the importance of frailty, which is a frequently used term in perioperative risk evaluations. Psychological and socioeconomical domains were investigated as part of frailty syndrome. The aim of this study was to assess the importance of these factors in mortality after vascular surgery. Methods In our prospective, observational study (ClinicalTrials.gov Identifier: NCT02224222), we examined 164 patients who underwent elective vascular surgery between 2014 and 2017. At the outpatient anaesthesiology clinic, patients completed a questionnaire about cognitive functions, depression and anxiety, social support and self-reported quality of life were assessed using a comprehensive frailty index, in addition to medical variables. Propensity score matching was performed to analyse the difference between patients and controls in a nationwide population cohort. The primary outcome was 4 year mortality. The Kaplan-Meier method and Cox regression analysis were used for statistical analyses. Results The patients’ mean age was 67.05 years (SD: 9.49 years). Mini-Mental State Examination scores of less than 27 points were recorded for 41 patients. Overall mortality rates were 22.4 and 47.6% in the control and cognitive impairment groups, respectively (p = 0.013). In the univariate Cox regression analysis, cognitive impairment measured using age- and education-adjusted MMSE scores increased the risk of mortality (AHR: 2.842, 95% CI: 1.389-5.815, p = 0.004). Conclusion Even mild cognitive dysfunction measured preoperatively using the MMSE represents a potentially important risk factor for mortality after vascular surgery.
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Affiliation(s)
- András Szabó
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary.
| | - Krisztina Tóth
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ádám Nagy
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Nikoletta Czobor
- Department of Anesthesiology and Intensive Care, Medical Centre of Hungarian Defense Forces, Budapest, Hungary
| | - Csaba Eke
- Károly Rácz School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Ágnes Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Éva Susánszky
- Institute of Behavioural Science, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 78 Üllői st., Budapest, H-1082, Hungary
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Szabo A, Domokos D, Nagy A, Sandor A, Eke C, Toth K, Szecsi B, Krupa Z, Merkely B, Gal J, Szekely A. Elevated preoperative C reactive protein level as an independent risk factor for mortality after coronary bypass graft surgery. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hizoh I, Domokos D, Banhegyi G, Becker D, Merkely B, Ruzsa Z. Erratum to mortality prediction algorithms for patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2020; 12:3913-3917. [PMID: 32802479 PMCID: PMC7399445 DOI: 10.21037/jtd-2020-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltan Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Invasive Cardiology, Bacs-Kiskun County University Teaching Hospital, Kecskemet, Hungary
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Hizoh I, Domokos D, Banhegyi G, Becker D, Merkely B, Ruzsa Z. Mortality prediction algorithms for patients undergoing primary percutaneous coronary intervention. J Thorac Dis 2020; 12:1706-1720. [PMID: 32395313 PMCID: PMC7212133 DOI: 10.21037/jtd.2019.12.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mortality risk of ST-segment elevation myocardial infarction (STEMI) patients shows high variability. In order to assess individual risk, a number of scoring systems have been developed and validated. Yet, as treatment approaches evolve over time with improving outcomes, there is a need to build new risk prediction algorithms to maintain/increase prognostic accuracy. One of the most relevant improvements of therapy is primary percutaneous coronary intervention (PCI). We overview the characteristics and discriminative performance of the most studied and some recently constructed mortality risk models that were validated in patients with STEMI who underwent primary PCI.
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Affiliation(s)
- Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltan Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Invasive Cardiology, Bacs-Kiskun County University Teaching Hospital, Kecskemet, Hungary
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Hizoh I, Domokos D, Banhegyi G, Major L, Edes IF, Becker D, Ruzsa Z, Merkely B. IMPACT OF MORPHINE USE ON MORTALITY IN STEMI PATIENTS TREATED WITH PRIMARY PCI. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30697-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Szabo A, Nagy A, Holndonner-Kirst E, Sandor A, Domokos D, Eke C, Lendvai M, Szecsi B, Czobor N, Merkely B, Gal J, Szekely A. The role of preoperative endocrine parameters in prediction of postoperative complication in adult patients undergoing elective heart surgery – Preliminary study. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Domokos D, Szabo A, Banhegyi G, Polgar B, Bari Z, Bogyi P, Marczell I, Papp L, Kiss RG, Duray GZ, Merkely B, Hizoh I. Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study. J Interv Card Electrophysiol 2019; 57:295-301. [PMID: 31342222 PMCID: PMC7093351 DOI: 10.1007/s10840-019-00596-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
Abstract
Purpose Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the “NA first” strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9–82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4–100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.
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Affiliation(s)
- Dominika Domokos
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary
| | - Andras Szabo
- Department of Anesthesiology and Intensive Care, Semmelweis University, Budapest, Hungary
| | | | - Balazs Polgar
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Zsolt Bari
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Peter Bogyi
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Istvan Marczell
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Leticia Papp
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Robert Gabor Kiss
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Gabor Zoltan Duray
- Department of Cardiology, Medical Center Hungarian Defense Forces, Budapest, Hungary
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary
| | - Istvan Hizoh
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary.
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Hizoh I, Banhegyi G, Domokos D, Major L, Andrassy P, Andreka P, Becker D, Buttl A, Cziraki A, Dezsi CA, Edes I, Forster T, Herczeg B, Janosi A, Katona A, Kiss R, Koszegi Z, Lupkovics G, Nagy G, Nagy L, Noori E, Tomcsanyi J, Veress G, Ruzsa Z, Merkely B. TCT-804 Comparative Validation of the ALPHA Score, a Novel Risk Model Including Vascular Access Site for Predicting 30-Day Mortality in Patients Treated With Primary PCI. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hizoh I, Banhegyi G, Domokos D, Gulyas Z, Major L, Kiss RG. Impact of Selective Aspiration Thrombectomy on Mortality in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 121:796-804. [PMID: 29397104 DOI: 10.1016/j.amjcard.2017.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 11/27/2022]
Abstract
Although routine aspiration thrombectomy (AT) is not recommended by the current American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guideline, for selected cases, a class IIb indication is given because of lack of data. We studied the impact of selective AT on mortality in patients with ST-segment elevation myocardial infarction using a prospective registry. We analyzed data of 1,255 patients, of whom 535 underwent AT based on operator's decision. Separate propensity score matching procedures were performed including all patients and only those with initial TIMI (Thrombolysis In Myocardial Infarction) 0 to 1 flow, indicating the highest thrombus burden. Primary outcome measure was time to all-cause death at 1 year. Both studies were sufficiently powered to detect the hazard ratio (HR) of 0.52 seen in the TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study) trial. In the study with open inclusion criteria, 1-year mortality rates were 15.5% and 14.5% in the AT and conventional percutaneous coronary intervention arm, respectively (p = 0.77). The unadjusted HR was 1.05 (95% CI 0.73 to 1.51), p = 0.80, whereas the adjusted HR was 0.97 (95% CI 0.66 to 1.41), p = 0.87. In patients with initial TIMI 0 to 1 flow, mortality rate at 1 year was 15.6% in the AT and 16.7% in the standard percutaneous coronary intervention group (p = 0.76). The unadjusted and adjusted HRs were similar: 0.91 (95% CI 0.62 to 1.34), p = 0.65 and 0.93 (95% CI 0.62 to 1.37), p = 0.70, respectively. In conclusion, selective AT based on operator's discretion offers no mortality benefit of the magnitude detected in the TAPAS trial, even for patients with initial TIMI 0 to 1 flow grade.
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Domokos D, Fülöp F, Falkay G, Gáspár R. Effects of newly synthetized isoquinoline derivatives on rat uterine contractility and ROCK II activity. Bioorg Med Chem Lett 2018; 28:466-469. [PMID: 29269216 DOI: 10.1016/j.bmcl.2017.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Protein kinases have an important role in signal transduction in the cellular system via protein phosphorylation. RhoA activated Rho-kinases have a pivotal role in the regulation of smooth muscle contraction. ROCK I and ROCK II phosphorylate myosin-phosphatase and myosin-kinase, which induces contraction in the myometrium. Several studies have investigated the affinity of isoquinoline alkaloids (HA-1077, H1152P) to Rho-kinases, and these compounds notably inhibited the Ca2+-independent process. We measured the efficiency of 25 original, newly synthesized isoquinoline derivatives for the Rho-kinase activity using Rho-associated kinase activity assay and determined their effects on the non-pregnant, 20-day pregnant and parturient rat myometrial contraction in vitro. The IC50 values of 11 from among the 25 derivatives were significantly lower on the oxytocin-induced non-pregnant rat uterine contraction compared with Y-27632 and fasudil, although their maximal inhibitory effects were weaker than those of Y-27632 and fasudil. We measured the effects of 11 isoquinoline molecules with significant IC50 values on ROCK II activity. We found two isoquinolines out of 11 compounds (218 and 852) which decreased the active ROCK II level similarly as Y-27632. Then we found that 218 and 852 relaxed the 20th-day pregnant and parturient rat uterus with greater potency as compared with fasudil. The majority of the synthesized isoquinoline derivatives have uterus relaxant effects and two of them significantly suppress the Rho-kinase mediated myosin light chain phosphorylation. Our results may suggest that the isoquinoline structure has a promising prospect for the development of new and effective inhibitors of uterine contractions in preterm birth.
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Affiliation(s)
- D Domokos
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, H-6701, P.O. Box 121, Hungary
| | - F Fülöp
- Institute of Pharmaceutical Chemistry, University of Szeged, H-6701, P.O. Box 121, Hungary
| | - G Falkay
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, H-6701, P.O. Box 121, Hungary
| | - R Gáspár
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, H-6701, P.O. Box 121, Hungary.
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Domokos D, Ducza E, Falkay G, Gaspar R. Alteration in expressions of RhoA and Rho-kinases during pregnancy in rats: their roles in uterine contractions and onset of labour. J Physiol Pharmacol 2017; 68:439-451. [PMID: 28820400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
Activation of RhoA and Rho-associated kinases (ROCKs) is known to play a pivotal role in the regulation of smooth muscle contraction via phosphorylation of myosin-light chain and myosin phosphatase. There are few data on the RhoA and ROCKs expression levels in rat uteri. Therefore, our aim was to investigate the mRNA and protein concentration of RhoA and ROCKs in rat uterus during pregnancy, during parturition and post-partum using real time PCR and Western blot analysis. The other purpose was to evaluate the effects of the ROCK (Y-27632, fasudil and RKI 1441) and RhoA inhibitors (simvastatin) on uterine contractility in isolated organ bath experiments. The mRNA and protein levels of RhoA decreased on the 5th day of pregnancy to day 22, then a sharp increase was detected at term. The mRNA and protein concentration of ROCKs was down-regulated in the early stage of pregnancy, while it sharply increased during parturition. The RhoA-inhibitor simvastatin relaxed the uterus contractions, although its inhibitory effects were not followed by the alteration of RhoA. The strongest inhibitory effect of non-selective ROCK inhibitor fasudil was found on non-pregnant uterus, while it elicited milder relaxation on day 22, during parturition and postpartum day 1. The maximum relaxing effects of Y-27632 and RKI 1441 were altered in a proportional way with the target protein expressions. The RhoA/ROCK signalling pathway might be a potential target for the development of new tocolytic agents; however, high specificity to RhoA, ROCK I or ROCK II seems to be fundamental to the high efficacy of uterine relaxation.
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Affiliation(s)
- D Domokos
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - E Ducza
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - G Falkay
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - R Gaspar
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.
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Hizoh I, Gulyas Z, Domokos D, Banhegyi G, Majoros Z, Major L, Ratkai T, Kiss RG. A novel risk model including vascular access site for predicting 30-day mortality after primary PCI: The ALPHA score. Cardiovasc Revasc Med 2016; 18:33-39. [PMID: 28029531 DOI: 10.1016/j.carrev.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/30/2016] [Accepted: 10/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mortality benefit of transradial primary PCI has been shown by several studies. Previous risk models have not considered access site as a candidate predictor and many of them were developed using low risk populations of randomized trials. We conducted a prospective cohort study to construct and validate an admission risk model including access site as candidate variable for predicting 30-day mortality after primary PCI. METHODS We analyzed data of 1255 patients using variables readily available at presentation. Predictor selection was based on backward logistic regression combined with bootstrap resampling. The model has been validated internally and temporally externally. RESULTS Thirty-day mortality was independently associated with older age, faster heart rate, need for life support on or prior to admission, and femoral access while it was inversely related to systolic blood pressure. ROC curve analysis revealed high discriminatory power, which was preserved in the validation set (c-statistic: 0.88 and 0.87, respectively). For the new score the acronym ALPHA (Age, Life support, Pressure, Heart rate, Access site) has been coined. Compared with previous models, our score achieved the highest c-statistic (0.87) followed by the GRACE 2.0 (0.86), APEX-AMI (0.86), and CADILLAC (0.85) models, the other scoring systems (TIMI, Zwolle, and PAMI) performed less well. The ALPHA, GRACE 2.0, APEX-AMI, and CADILLAC models predicted 30-day mortality better than the PAMI score (p=0.005, 0.004, 0.01, and 0.02, respectively). CONCLUSIONS Using this tool, mortality risk may be precisely assessed at admission and patients who may benefit most from transradial access may be identified.
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Affiliation(s)
- Istvan Hizoh
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary.
| | - Zalan Gulyas
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Dominika Domokos
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Gyongyver Banhegyi
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Zsuzsanna Majoros
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Laszlo Major
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Timea Ratkai
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
| | - Robert Gabor Kiss
- Department of Cardiology, Medical Center, Hungarian Defense Forces, Budapest, Hungary
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Hizoh I, Domokos D, Gulyas Z, Banhegyi G, Majoros Z, Major L, Ratkai T, Kiss RG. TCT-228 A Simple Admission Risk Model for STEMI Treated with Primary PCI: Development and Comparative Validation. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Varga T, Mogyoródi B, Bagó AG, Cservenák M, Domokos D, Renner É, Gallatz K, Usdin TB, Palkovits M, Dobolyi A. Paralemniscal TIP39 is induced in rat dams and may participate in maternal functions. Brain Struct Funct 2012; 217:323-35. [PMID: 22081168 PMCID: PMC3294170 DOI: 10.1007/s00429-011-0357-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 10/17/2011] [Indexed: 12/19/2022]
Abstract
The paralemniscal area, situated between the pontine reticular formation and the lateral lemniscus in the pontomesencephalic tegmentum contains some tuberoinfundibular peptide of 39 residues (TIP39)-expressing neurons. In the present study, we measured a 4 times increase in the level of TIP39 mRNA in the paralemniscal area of lactating mothers as opposed to nulliparous females and mothers deprived of pups using real-time RT-PCR. In situ hybridization histochemistry and immunolabeling demonstrated that the induction of TIP39 in mothers takes place within the medial paralemniscal nucleus, a cytoarchitectonically distinct part of the paralemniscal area, and that the increase in TIP39 mRNA levels translates into elevated peptide levels in dams. The paralemniscal area has been implicated in maternal control as well as in pain perception. To establish the function of induced TIP39, we investigated the activation of TIP39 neurons in response to pup exposure as maternal, and formalin injection as noxious stimulus. Both stimuli elicited c-fos expression in the paralemniscal area. Subsequent double labeling demonstrated that 95% of neurons expressing Fos in response to pup exposure also contained TIP39 immunoreactivity and 91% of TIP39 neurons showed c-fos activation by pup exposure. In contrast, formalin-induced Fos does not co-localize with TIP39. Instead, most formalin-activated neurons are situated medial to the TIP39 cell group. Our data indicate that paralemniscal neurons may be involved in the processing of maternal and nociceptive information. However, two different groups of paralemniscal neurons participate in the two functions. In particular, TIP39 neurons may participate in the control of maternal functions.
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Affiliation(s)
- Tamás Varga
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Bence Mogyoródi
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Attila G. Bagó
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary, National Institute of Neurosurgery, Budapest, Hungary
| | - Melinda Cservenák
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Dominika Domokos
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Éva Renner
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Katalin Gallatz
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Ted B. Usdin
- Section on Fundamental Neuroscience, National Institute of Mental Health, Bethesda, MD 20892, USA
| | - Miklós Palkovits
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
| | - Arpád Dobolyi
- Neuromorphological and Neuroendocrine Research Laboratory, Department of Anatomy, Histology and Embryology, Semmelweis University and the Hungarian Academy of Sciences, Tüzolto u. 58, Budapest 1094, Hungary
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