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Kočková R, Vojáček J, Bedáňová H, Fila P, Skalský I, Žáková D, Klán M, Míková B, Mědílek K, Tuna M, Fialová M, Dvořáková R, Hlubocká Z, Panovský R, Slabý K, Kelen de Oliveira E, Casselman F, Pěnička M. Rationale and design of the ELEANOR trial early aortic valve surgery versus watchful waiting strategy in severe asymptomatic aortic regurgitation, ACRONYM: ELEANOR. Heliyon 2024; 10:e29470. [PMID: 38638969 PMCID: PMC11024602 DOI: 10.1016/j.heliyon.2024.e29470] [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: 02/08/2024] [Revised: 03/17/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Background The optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimodality imaging has brought new tools for the accurate selection of asymptomatic patients at risk of early clinical deterioration, however, prospective and randomized data are pending. Cardiac magnetic resonance (CMR)-derived AR quantification along with LV remodeling assessment appears to be the most accurate tool for a selection of such patients at risk. Trial design The objective of our prospective and multicenter study is to determine whether patients at risk of early clinical deterioration as per CMR assessment will benefit from early surgical treatment. The study is designed as a superiority trial to demonstrate that early surgical treatment is safe and more effective than the standard treatment. A total of 217 asymptomatic patients with severe AR, but without current guidelines-based surgical indication, will be enrolled across all centers. We expect 24 % of patients identified as high clinical risk and therefore eligible for 1:1 randomization to early surgical treatment within 3 months or a watchful waiting strategy. Follow-up will be annual. We expect a complete restoration of LV size and function along with improved quality of life and physical performance in a short-term follow-up of 12 months. The primary endpoint will be a composite safety and efficacy with all criteria mandatory: 15 % or larger reduction of baseline CMR-derived LV end-diastolic volume index, LV ejection fraction >50 %, and no major adverse cardiovascular events. The annual follow-up will continue for a minimum of 4 years until the required number of endpoints is achieved to show a statistically significant difference in cardiovascular morbidity and mortality in early surgically treated patients. Conclusion The ELEANOR trial is the first multicenter randomized controlled study to compare early surgical treatment with a watchful waiting strategy in asymptomatic patients with chronic severe AR at high risk of early clinical deterioration as per CMR assessment but without guidelines-based indications for surgical treatment.
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Affiliation(s)
- Radka Kočková
- Na Homolce Hospital, Prague, Czech Republic
- Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
| | - Jan Vojáček
- Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Helena Bedáňová
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | - Petr Fila
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Daniela Žáková
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
| | | | | | - Karel Mědílek
- Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Martin Tuna
- Charles University, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Monika Fialová
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Radka Dvořáková
- University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Zuzana Hlubocká
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital in Prague, First Faculty of Medicine, Charles University, Czech Republic
| | - Roman Panovský
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- 1st Department of Internal, Brno, Czech Republic Medicine/Cardioangiology at St. Anne's University Hospital, Brno, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Elayne Kelen de Oliveira
- CardioPaTh PhD Program, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Cardiovascular Center OLV Clinic Aalst, Belgium
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Badhwar V, Pereda D, Khaliel FH, Poffo R, Darehzereshki A, Mehaffey JH, Yan TD, Melnitchouk S, Geirsson A, Arghami A, Navia JL, Raikar GV, Weber AC, Ramzy D, Černý Š, Vojáček J, Smith RL, Bonatti J, Thourani VH, Wei LM. Outcomes following initial multicenter experience with robotic aortic valve replacement: Defining a path forward. J Thorac Cardiovasc Surg 2024; 167:1244-1250. [PMID: 38246340 DOI: 10.1016/j.jtcvs.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Feras H Khaliel
- Division of Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Robinson Poffo
- Department of Cardiovascular Surgery, Hospital Moriah, Sao Paulo, Brazil
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Arnar Geirsson
- Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jose L Navia
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, Fla
| | - Goya V Raikar
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Pleasant Prairie, Wis
| | - Alberto C Weber
- Department of Cardiovascular Surgery, Herzzentrum Hislanden, Zurich, Switzerland
| | - Danny Ramzy
- Division of Cardiac Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Štěpán Černý
- Department of Cardiac Surgery, University Hospital Motol, Prague, Czech Republic
| | - Jan Vojáček
- Department of Cardiac Surgery, University Hospital, Hradec Kralove, Czech Republic
| | - Robert L Smith
- Division of Cardiac Surgery, Baylor Scott & White Health, Plano, Tex
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Vinod H Thourani
- Department of Cardiothoracic Surgery, Piedmont Healthcare, Atlanta, Ga
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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Claus I, Veeragandham R, Žáček P, Vojáček J, Schäfers HJ. Tricuspid Aortic Valve Repair: How I Teach It. Ann Thorac Surg 2024; 117:54-58. [PMID: 37777149 DOI: 10.1016/j.athoracsur.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Isabelle Claus
- Department Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
| | | | - Pavel Žáček
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Vojáček
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Shahin Y, Gofus J, Harrer J, Šorm Z, Voborník M, Čermáková E, Smolák P, Vojáček J. Impact of smoking on the outcomes of minimally invasive direct coronary artery bypass. J Cardiothorac Surg 2023; 18:43. [PMID: 36670443 PMCID: PMC9862783 DOI: 10.1186/s13019-023-02104-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 01/02/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Tobacco smoking has been associated with an increased risk of complications after conventional coronary surgery. However, the impact of smoking on the risk of postoperative complications in minimally invasive coronary surgery is yet to be studied. We aimed to analyze the impact of the preoperative smoking status on the short- and long-term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in the context of isolated surgical revascularization or in association with percutaneous coronary intervention. METHODS This was a retrospective observational study of all patients undergoing MIDCAB at our institution between 2006 and 2020. Patients were divided into three groups: active smokers, ex-smokers who have quit smoking for at least 1 month before surgery, and non-smokers. The groups were compared using conventional statistical methods. Multivariate analysis was then performed where significant differences were found to eliminate bias. RESULTS Throughout the study period, 541 patients underwent MIDCAB, of which 135 (25%) were active smokers, 183 (34%) were ex-smokers, and 223 (41%) were non-smokers. Smokers presented for surgery at a younger age (p < 0.0001), more frequently with a history of myocardial infarction (p < 0.001), peripheral artery disease (p < 0.001) and chronic obstructive pulmonary disease (p < 0.0001). Using multivariate analysis, active smoking was determined to be a significant risk factor for the need of urgent revascularization (odds ratio 2.36 [1.00-5.56], p = 0.049) and the composite of pulmonary complications (including pneumothorax, respiratory infection, respiratory dysfunction, subcutaneous emphysema and exacerbation of chronic obstructive pulmonary disease; odds ratio 2.84 [1.64-4.94], p < 0.001). Preoperative smoking status did not influence the long-term survival (p = 0.83). CONCLUSIONS In our study, active smokers presented for MIDCAB at a younger age and more often with signs of atherosclerotic disease (history of myocardial infarction and peripheral artery disease). Active smoking was found to be the most significant risk factor for postoperative pulmonary complications, and is also associated with a more frequent need for urgent surgery at diagnosis. Long-term postoperative survival is not affected by the preoperative smoking status.
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Affiliation(s)
- Youssef Shahin
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ján Gofus
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Harrer
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Zdeněk Šorm
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Martin Voborník
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Eva Čermáková
- grid.4491.80000 0004 1937 116XDepartment of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Petr Smolák
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Vojáček
- grid.4491.80000 0004 1937 116XDepartment of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Kočková R, Línková H, Hlubocká Z, Mědílek K, Tuna M, Vojáček J, Skalský I, Černý Š, Malý J, Hlubocký J, Mizukami T, De Colle C, Pěnička M. Multiparametric Strategy to Predict Early Disease Decompensation in Asymptomatic Severe Aortic Regurgitation. Circ Cardiovasc Imaging 2022; 15:e014901. [PMID: 36538596 DOI: 10.1161/circimaging.122.014901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. METHODS This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. RESULTS The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points). CONCLUSIONS In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02910349.
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Affiliation(s)
- Radka Kočková
- Cardiothoracic Surgery Department, Na Homolce Hospital, Czech Republic (R.K., I.S., S.C.)
| | - Hana Línková
- Department of Cardiology, Royal Vinohrady University Hospital, Czech Republic (H.L.)
| | - Zuzana Hlubocká
- Department of Cardiology (Z.H.), General University Hospital, Prague, Czech Republic
| | - Karel Mědílek
- 1st Department Medicine - Cardioangiology, University Hospital Hradec Králové, Sokolská Czech Republic (K.M.)
| | - Martin Tuna
- Department of Cardiac Surgery, University Hospital Hradec Králové, Hradec Králové, Czech Republic (M.T., J.V.)
| | - Jan Vojáček
- Department of Cardiac Surgery, University Hospital Hradec Králové, Hradec Králové, Czech Republic (M.T., J.V.)
| | - Ivo Skalský
- Cardiothoracic Surgery Department, Na Homolce Hospital, Czech Republic (R.K., I.S., S.C.)
| | - Štěpán Černý
- Cardiothoracic Surgery Department, Na Homolce Hospital, Czech Republic (R.K., I.S., S.C.)
| | - Jiří Malý
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.M.)
| | - Jaroslav Hlubocký
- Department of Cardiovascular Surgery (J.H.), General University Hospital, Prague, Czech Republic
| | - Takuya Mizukami
- Cardiovascular Center Aalst, Belgium (T.M., C.D.C., M.P.).,Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan (T.M.)
| | - Cristina De Colle
- Cardiovascular Center Aalst, Belgium (T.M., C.D.C., M.P.).,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy (C.D.C.)
| | - Martin Pěnička
- Cardiovascular Center Aalst, Belgium (T.M., C.D.C., M.P.)
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Gofus J, Karalko M, Fila P, Ondrášek J, Schäfers HJ, Kolesár A, Lansac E, El-Hamamsy I, de Kerchove L, Dinges C, Hlubocký J, Němec P, Tuna M, Vojáček J. Comparison of bicuspidization and Ross procedure in the treatment of unicuspid aortic valve disease in adults – Insight from the AVIATOR registry. Front Cardiovasc Med 2022; 9:900426. [PMID: 36158795 PMCID: PMC9493194 DOI: 10.3389/fcvm.2022.900426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Unicuspid aortic valve (UAV) is the second most common underlying cause of aortic valve dysfunction in young adults after the bicuspid valve. The valve may be replaced (for example by pulmonary autograft) or repaired using the bicuspidization technique. The aim of our study was to compare short- and mid-term outcomes of Ross procedure with bicuspidization in patients with severe UAV dysfunction. Methods This was a multi-center retrospective observational cohort study comparing data from two dedicated Ross centers in the Czech Republic with bicuspidization outcomes provided by AVIATOR registry. As for the Ross group, only the patients with UAV were included. Primary endpoint was mid-term freedom from reintervention. Secondary endpoints were mid-term freedom from major adverse events, endocarditis and pacemaker implantation. Results Throughout the study period, 114 patients underwent the Ross procedure (years 2009-2020) and 126 patients underwent bicuspidization (years 2006-2019). The bicuspidization group was significantly younger and presented with a higher degree of dyspnea, a lower degree of aortic valve stenosis and more often with pure regurgitation. The primary endpoint occurred more frequently in the bicuspidization group than in the Ross group – 77.9 vs. 97.9 % at 5 years and 68.4 vs. 75.2 % at 10 years (p < 0.001). There was no difference in secondary endpoints. Conclusion Ross procedure might offer a significantly lower mid-term risk of reintervention than bicuspidization in patients with UAV. Both procedures have comparable survival and risk of other short- and mid-term complications postoperatively.
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Affiliation(s)
- Ján Gofus
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czechia
| | - Mikita Karalko
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czechia
| | - Petr Fila
- Department of Cardiac Surgery and Transplantation Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czechia
- *Correspondence: Petr Fila
| | - Jiří Ondrášek
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czechia
| | | | - Adrian Kolesár
- East Slovakian Institute for Cardiac and Vascular Diseases, Košice, Slovakia
| | | | - Ismail El-Hamamsy
- Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | | - Jaroslav Hlubocký
- Department of Cardiovascular Surgery, General University Hospital, Prague, Czechia
| | - Petr Němec
- Department of Cardiac Surgery and Transplantation Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czechia
| | - Martin Tuna
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czechia
| | - Jan Vojáček
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czechia
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Pudil R, Tichý M, Praus R, Bláha V, Vojáček J. NT-proBNP and Echocardiographic Parameters in Patients with Acute Heart Failure. Acta Med (Hradec Kralove, Czech Repub ) 2018. [DOI: 10.14712/18059694.2017.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim. The aim of this study was to analyse the relation between clinical, haemodynamic and X-ray parameters and plasma NT-proBNP level in pts with symptoms of left ventricular dysfunction. Methods. The plasma NT-proBNP levels, chest x-ray, transthoracic 2-d and Doppler echocardiography were performed at the time of admission in a group of 96 consecutive patients (mean age 68 ± 11 years) with symptoms of acute heart failure. NT-proBNP levels were assessed with the use of commercial tests (Roche Diagnostics). Results. All patients have significant increase in NT-proBNP (8 000 ± 9 000 pg/mL vs. controls 90 ± 80 pg/mL, p < 0.001). The group of all patients has shown a significant increase in cardiothoracic ratio (CTR, 0.6 ± 0.1, vs. 0.4 ± 0.1, p <0.001), left atrium diameter (LAD, 4.4 ± 0.8 cm, vs.3.5 ± 0.4 cm, p <0.01). Left ventricular ejection fraction (LVEF) was decreased (37 ± 15%, vs. 64 ± 5%, p <0.001). In patients with acute heart failure, NT-proBNP significantly correlated with end-systolic and end-diastolic left ventricle diameters, ejection fraction, vena cava inferior diameter and plasma creatinine levels. Conclusion. Increased plasma NT-proBNP level is influenced by the clinical severity of acute heart failure and correlates with LVEF and IVCD. NT-proBNP can serve as a marker for the clinical severity of the disease.
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Hanke I, Suchý T, Lopourová M, Vojáček J. [Chest drain injury of the heart]. Rozhl Chir 2017; 96:475-477. [PMID: 29318890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Injury to the heart during chest drainage is a very rare but potentially fatal complication of the procedure. CASE REPORT A 56-year-old, polymorbid, poorly co-operative and extremely obese patient with chronic cardiac subcompensation and pleural effusion was admitted to a district hospital. A drain was inserted into the left pleural cavity in order to evacuate the pleural effusion. Fresh oxygenated blood was flowing out from the drain. The drain was clamped immediately. Echocardiography showed drain insertion into the left ventricle. A cardiac surgeon was contacted and indicated patient transfer to a cardiac surgery department followed by an emergency surgery. During the surgery performed through a left thoracotomy, a defect in the left ventricular wall was sutured. The patient was then stabilized, transferred back to the district hospital and, after achieving cardiopulmonary compensation, discharged home. CONCLUSION Injury to the heart in chest drainage is a very serious iatrogenic complication. If it is to be managed successfully, the site of the insertion of the drain tip needs to be correctly identified and the drain must not be extracted. A surgical department capable of adequately addressing this complication needs to be contacted promptly, as emergency surgery may be the only lifesaving possibility.Key words: chest drainage - complication - heart injury.
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Pudil R, Tichý M, Andrýs C, Řeháček V, Bláha V, Vojáček J, Palička V. Plasma Interleukin-6 Level is Associated with NT-proBNP Level and Predicts Short- and Long Term Mortality in Patients with Acute Heart Failure. Acta Med (Hradec Kralove, Czech Repub ) 2016. [DOI: 10.14712/18059694.2016.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Interleukin 6 plays an important role in chronic heart failure (HF), but little is known about its involvement in acute decompensated heart failure (ADHF). The aim of our study is to evaluate the prognostic role of interleukin 6 (IL-6) in the patients with ADHF. Methods: Plasma levels of interleukin IL-6, N-terminal pro brain natriuretic peptide levels, and clinical covariates were measured in 92 patients with ADHF. Survival was followed up to 12 months, and prognostic factors were evaluated. Results: Elevated plasma IL-6 levels were increased in nonsurvivors and were associated with 1-year mortality (p<0.01). Plasma IL-6 levels were associated with plasma NT-proBNP levels. In multivariate analysis, increased plasma IL-6 and NT-proBNP levels remained strong independent predictors of 1-year mortality. Conclusions: Plasma IL-6 levels provide important prognostic information in the patients with ADHF. Measurement combining plasma IL-6 and NT-proBNP should serve as a powerful prognostic tool of multimarker strategy in patients with acute decompensated heart failure.
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Žáček P, Vojáček J, Dominik J, Harrer J. A history of the surgical treatment of aortic regurgitation. Cor Vasa 2015. [DOI: 10.1016/j.crvasa.2015.03.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Šteiner I, Špaček J, Matějková A, Vojáček J, Bis J, Dušek J. Histopathology of aspirated thrombi during primary percutaneous coronary intervention in patients with acute myocardial infarction. Cardiovasc Pathol 2014; 23:267-71. [DOI: 10.1016/j.carpath.2014.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022] Open
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Vojáček J. [Practical questions on therapy with new antithrombotic agents]. Vnitr Lek 2014; 60:389-395. [PMID: 24986003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recently, new peroral antithrombotic agents have proved better prevention of thrombotic complications in many clinical events such as acute coronary syndrome, tromboembolic disease or atrial fibrillation. New peroral anticoagulants (NPA) were introduced - dabigatran, rivaroxaban and apixaban and new antiplatelet agents - ticagrelol and prasugrel. Outcomes of pilot studies: RE-LY, ROCKET AF, ARISTOTLE, PLATO a TIMI 38 TRITON and subsequent clinical experiences supported their usage. NPA have proved non-inferiority in incidence of stroke or systemic embolism. Moreover, apixaban and dabigatran with administration of 150 mg twice a day have proved superiority. In addition, all 3 molecules have been non-inferior in incidence of severe bleeding. Apixaban and dabigatran - 110 mg twice a day have been proved as superior. Therefore, the guidelines favour NPA before warfarin in most patients. Previous antiplatelet agent - clopidogrel is ineffective due to genetic polymorphism in P450 (polymorphism of CYP2C19 and CYP3A4 allele - *1 isoforms in function, *2 and *3 non-functioning alleles) and due to failure of metabolic conversion to active molecule. This resistance depends on population and is present in 20-35% patients. New antiplatelet medications have faster and more homogenous onset in comparison with clopidogrel. Their metabolism is different and resistance is not so frequent. Prasugrel is contraindicated in patients after stroke or TIA, in elderly patients (more than 75 years) and in patients with weight less than 60 kg. Prasugrel has data of benefit especially in patients with STEMI or diabetes. Ticagrelor reduces mortality in patients with acute coronary syndrome concurrently without clinically significant bleeding comparing ticagrelor to clopidogrel administration. On the other hand, higher incidence of significant bleeding has been revealed unrelated to aortocoronary bypass with ticagrelor therapy, including higher incidence of fatal intracranial hemorrhage and reduced incidence of fatal hemorrhage of other types. Ticagrelor significantly reduced the primary end-point compared to clopidogrelu in patients with chronic kidney disease and creatinine clearance 30-60 ml/min. In addition, ticagrelor reduces all cause mortality in these patients. New antithrombotic agents have brought improvement not only in reducing the incidence of thrombotic and bleeding complications, but in decision-making algorithm as well. However, search for optimal therapy of thrombosis will clearly require more intensive clinical research.
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Fortunato J, Bláha V, Bis J, Št'ásek J, Andrýs C, Vojáček J, Jurašková B, Sobotka L, Polanský P, Brtko M. Lipoprotein-associated phospholipase A₂ mass level is increased in elderly subjects with type 2 diabetes mellitus. J Diabetes Res 2014; 2014:278063. [PMID: 24818163 PMCID: PMC4003792 DOI: 10.1155/2014/278063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/22/2014] [Accepted: 03/10/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE. Lipoprotein-associated phospholipase A₂ (Lp-PLA₂) is extensively expressed by advanced atherosclerotic lesions and may play a role in plaque instability. We selected a group of elderly subjects that underwent transcatheter aortic valve implantation (TAVI) or balloon angioplasty (BA) and separated them into two groups, diabetic and nondiabetic, to compare the level of Lp-PLA₂ mass between them. METHODS. 44 patients aged 79.6 ± 5.6 years with symptomatic severe aortic valve stenosis underwent TAVI (n = 35) or BA (n = 9). 21 subjects had confirmed type 2 diabetes mellitus. Lp-PLA₂ mass was measured using an enzyme-linked immunosorbent assay kit (USCN Life Science, China) before and 3 days after the procedure. RESULTS. Lp-PLA₂ mass was significantly elevated in this population (1296 ± 358 ng/mL before TAVI; 1413 ± 268 ng/mL before BA) and further increased after TAVI (1604 ± 437 ng/mL, P < 0.01) or BA (1808 ± 303 ng/mL, P < 0.01). Lp-PLA₂ mass was significantly increased on the diabetic group before these interventions. CONCLUSION. Lp-PLA₂ may be a novel biomarker for the presence of rupture-prone atherosclerotic lesions in elderly patients. Levels of Lp-PLA₂ in diabetic patients may accompany the higher amount of small dense LDL particles seen in these subjects.
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Affiliation(s)
- J. Fortunato
- 3rd Department of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
- *J. Fortunato:
| | - V. Bláha
- 3rd Department of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - J. Bis
- 1st Department of Internal Medicine, Cardioangiology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - J. Št'ásek
- 1st Department of Internal Medicine, Cardioangiology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - C. Andrýs
- Department of Immunology and Alergology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - J. Vojáček
- 1st Department of Internal Medicine, Cardioangiology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - B. Jurašková
- 3rd Department of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - L. Sobotka
- 3rd Department of Internal Medicine, Metabolism and Gerontology, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - P. Polanský
- Department of Cardiosurgery, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
| | - M. Brtko
- Department of Cardiosurgery, University Hospital Hradec Králové, Medical Faculty, Charles University, 50005 Hradec Králové, Czech Republic
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Pojar M, Vojáček J, Harrer J, Turek Z, Samek J, Omran N, Volt M. [Minimally invasive video-assisted operations for heart disease]. Rozhl Chir 2013; 92:644-649. [PMID: 24299287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Minimally invasive surgical access for the treatment of mitral and tricuspid valves has become an alternative method to the conventional approach via median sternotomy. The aim of this paper is to evaluate our experience and results with minimally invasive approach in cardiac surgery at our institution. MATERIAL AND METHODS A total of 52 patients underwent minimally invasive cardiac surgery between November 2011 and March 2013. Right lateral minithoracotomy and femoral vessels cannulation for cardiopulmonary bypass was used. Follow-up data was collected in a prospective database and analysed retrospectively. RESULTS The mean age of patients was 60.9 ± 11.6 years (female patients accounted for 63.5%). The procedures performed included mitral valve repair in 44 (85%) patients and tricuspid valve repair in 25 (48%). Atrial septal defect closure was performed in 8 (15%) patients and cryoablation of atrial fibrillation in 26 (50%) patients. There were 75% combined procedures. The median duration of the operation was 235 (155-315) minutes. The median length of cardiopulmonary bypass and crossclamp time was 139 (89-225) and 92 (51-168) minutes, respectively. The median duration of postoperative hospital stay was 12.5 (6-34) days. Hospital and 30-day mortality was 0%. At follow-up (121.3 ± 32.72 days), two patients (3.8%) required reoperation (1 for right haemothorax, 1 for aortic valve insufficiency). CONCLUSION Minimally invasive access has been adopted as a routine method for the therapy of valve disease. The minithoracotomy approach is a safe and feasible technique with comparable mortality and in-hospital morbidity.
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Hazuková R, Praus R, Čermáková E, Fűrmanová V, Vojáček J, Pleskot M. Pharmaco-refractory chronic heart failure – The need for drug level tailored management. Med Hypotheses 2012; 79:560-3. [DOI: 10.1016/j.mehy.2012.07.017] [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] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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Vojáček J, Kolář K. Comparison of the Effects of Nebivolol and Metoprolol on Left Ventricular Diastolic Function in Patients with Hypertension. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03258291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vavera Z, Vojáček J, Pudil R, Malý J, Eliáš P. NT-proBNP levels on admission predict pulmonary hypertension persistence in patients with acute pulmonary embolism. Cor Vasa 2012. [DOI: 10.1016/j.crvasa.2012.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hlubocký J, Mokráček A, Nováček V, Vojáček J, Burkert J, Kochová P, Klepáček J, Pepper J, Spatenka J. Mechanical properties of mitral allografts are not reasonably influenced by cryopreservation in sheep model. Physiol Res 2011; 60:475-82. [PMID: 21401294 DOI: 10.33549/physiolres.932074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A mitral allograft is used exceptionally in the mitral, as well as in the tricuspid position, mostly as an experimental surgical procedure. The authors decided to evaluate the possibility of inserting a cryopreserved mitral allograft into the tricuspid position in a sheep experimental model. Within the framework of this experimental project the mechanical properties of the cryopreserved mitral allograft were tested. A novel methodology studying the functional unit composed of mitral annulus, leaflet, chordae tendinaea, and papillary muscle is presented. A five-parameter Maxwell model was applied to characterize the viscoelastic behavior of sheep mitral valves. A control group of 39 fresh mitral specimens and a test group of 13 cryopreserved mitral allografts from tissue bank were tested. The testing protocol consisted of six loading cycles with 1 mm elongation every 5 min. There was no significant difference in the mean values of the determined parameters (p>0.05) which confirms the main hypothesis that cryopreservation does not influence significantly material parameters characterizing the tissue mechanics. Slight discrepancy is observed in variances of viscous parameters suggesting that the values of the test group may be spread over larger interval due to the treatment.
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Affiliation(s)
- J Hlubocký
- Department of Cardiovascular Surgery, General University Hospital, Prague, Czech Republic
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Bis J, Vojáček J, Dusek J, Pecka M, Palicka V, Stasek J, Malý J. Time-course of tissue factor plasma level in patients with acute coronary syndrome. Physiol Res 2008; 58:661-667. [PMID: 19093728 DOI: 10.33549/physiolres.931521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Enhanced expression of tissue factor (TF) may result in thrombosis contributing to acute clinical consequences of coronary artery disease. Several studies demonstrated elevated plasma levels of TF in patients with acute coronary syndrome (ACS). The aim of our study was to compare the concentrations of TF in coronary sinus (CS), proximal part of the left coronary artery (LCA) and peripheral vein (PV) of patients with ACS and stable coronary artery disease (SCAD). Time course of the TF plasma levels in PV was followed on day 1 and day 7 after index event of ACS presentation and was compared to day 0 values. No heparin was given prior to the blood sampling. Twenty-nine patients in the ACS group (age 63.6+/-10.8 years, 20 males, 9 females) and 24 patients with SCAD (age 62.3+/-8.1 years, 21 males, 3 females) were examined. TF plasma level was significantly higher in patients with ACS than in those with SCAD (239.0+/-99.3 ng/ml vs. 164.3+/-114.2 ng/ml; p=0.016). There was no difference in TF plasma levels in PV, CS and LCA (239.0+/-99.3 ng/ml vs. 253.7+/-131.5 ng/ml vs. 250.6+/-116.4 ng/ml, respectively). TF plasma levels tended to decrease only non-significantly on the day 7 (224.4+/-109.8 ng/ml). Significant linear correlation between TF and high sensitivity CRP (hs-CRP) levels on day 0 was found. In conclusion, TF plasma levels are elevated in patients with ACS not only locally in CS but also in systematic circulation. Our data support the relationship between TF production and proinflammatory mediators.
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Affiliation(s)
- J Bis
- First Department of Medicine, Charles University Prague, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.
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Pudil R, Pařízek P, Tichý M, Haman L, Horáková L, Ulrychová M, Vojáček J, Palička V. Use of the biochip microarray system in detection of myocardial injury caused by radiofrequency catheter ablation. Clin Chem Lab Med 2008; 46:1726-8. [DOI: 10.1515/cclm.2008.341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vojáček J, Dusek J, Bis J, Stasek J, Blazek M. Plasma tissue factor in coronary artery disease: further step to the understanding of the basic mechanisms of coronary artery thrombosis. Physiol Res 2007; 57:1-5. [PMID: 17223726 DOI: 10.33549/physiolres.931091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tissue factor is a cell surface protein that is expressed constitutively by monocytes, macrophages and fibroblasts, but also by some other cells in response to a variety of stimuli. The main function of the tissue factor is to form a complex with factor VII/VIIa that converts factors IX and X to their active forms. Tissue factor is also involved in the pathophysiology of systemic inflammatory disorders, coagulopathies, atherosclerotic disease, tumor angiogenesis and metastasis. Increased tissue factor expression either locally in the coronary plaques or systematically on circulating blood elements of patients with acute coronary syndromes may be responsible for increased thrombin generation, thus leading to platelet activation and fibrin formation. Tissue factor therefore plays a pivotal role in the initiation of thrombotic complications in patients with coronary artery disease.
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Affiliation(s)
- J Vojáček
- First Department Medicine, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Czech Republic.
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Boudik F, Tomečková M, Bultas J, Anger Z, Vojáček J, Aschermann M. Ischemic heart disease in men with coronary risk factors treated for 20 years and verified by means of body surface potential mapping (BSPM). Atherosclerosis 1999. [DOI: 10.1016/s0021-9150(99)80297-4] [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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Boudík F, Anger Z, Vojáček J, Aschermann M, Št'ovíček P. 3.P.337 Non-invasive detection of coronary artery narrowing by means of body surface potential mapping (BSPM). Atherosclerosis 1997. [DOI: 10.1016/s0021-9150(97)89416-6] [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: 10/16/2022]
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