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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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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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Hlubocká Z, Kočková R, Línková H, Pravečková A, Hlubocký J, Dostálová G, Bláha M, Pěnička M, Linhart A. Assessment of Asymptomatic Severe Aortic Regurgitation by Doppler-Derived Echo Indices: Comparison with Magnetic Resonance Quantification. J Clin Med 2021; 11:jcm11010152. [PMID: 35011893 PMCID: PMC8745471 DOI: 10.3390/jcm11010152] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Reliable quantification of aortic regurgitation (AR) severity is essential for clinical management. We aimed to compare quantitative and indirect echo-Doppler indices to quantitative cardiac magnetic resonance (CMR) parameters in asymptomatic chronic severe AR. Methods and Results: We evaluated 104 consecutive patients using echocardiography and CMR. A comprehensive 2D, 3D, and Doppler echocardiography was performed. The CMR was used to quantify regurgitation fraction (RF) and volume (RV) using the phase-contrast velocity mapping technique. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. Correlation between RV and RF as assessed by echocardiography and CMR was relatively good (rs = 0.50 for RV, rs = 0.40 for RF, p < 0.0001). The best correlation between indirect echo-Doppler and CMR parameters was found for diastolic flow reversal (DFR) velocity in descending aorta (rs = 0.62 for RV, rs = 0.50 for RF, p < 0.0001) and 3D vena contracta area (VCA) (rs = 0.48 for RV, rs = 0.38 for RF, p < 0.0001). Using receiver operating characteristic analysis, the largest area under curve (AUC) to predict severe AR by CMR RV was observed for DFR velocity (AUC = 0.79). DFR velocity of 19.5 cm/s provided 78% sensitivity and 80% specificity. The AUC for 3D VCA to predict severe AR by CMR RV was 0.73, with optimal cut-off of 26 mm2 (sensitivity 80% and specificity 66%). Conclusions: Out of the indirect echo-Doppler indices of AR severity, DFR velocity in descending aorta and 3D vena contracta area showed the best correlation with CMR-derived RV and RF in patients with chronic severe AR.
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Affiliation(s)
- Zuzana Hlubocká
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
- Correspondence: ; Tel.: +420-224-962-635
| | - Radka Kočková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Hana Línková
- Department of Cardiology, Royal Vinohrady University Hospital, 10034 Prague, Czech Republic;
| | - Alena Pravečková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Jaroslav Hlubocký
- Department of Cardiovascular Surgery, General University Hospital, 12808 Prague, Czech Republic;
| | - Gabriela Dostálová
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
| | - Martin Bláha
- Department of Cardiology, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic; (R.K.); (A.P.); (M.B.)
| | - Martin Pěnička
- Onze-Lieve-Vrouwziekenhuis Aalst Clinic, Cardiovascular Centre Aalst, 9300 Aalst, Belgium;
| | - Aleš Linhart
- Department of Cardiovascular Medicine, General University Hospital, 12808 Prague, Czech Republic; (G.D.); (A.L.)
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Kočková R, Línková H, Hlubocká Z, Pravečková A, Polednová A, Súkupová L, Bláha M, Malý J, Honsová E, Sedmera D, Pěnička M. New Imaging Markers of Clinical Outcome in Asymptomatic Patients with Severe Aortic Regurgitation. J Clin Med 2019; 8:jcm8101654. [PMID: 31614523 PMCID: PMC6832544 DOI: 10.3390/jcm8101654] [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] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/03/2019] [Accepted: 10/06/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Determining the value of new imaging markers to predict aortic valve (AV) surgery in asymptomatic patients with severe aortic regurgitation (AR) in a prospective, observational, multicenter study. Methods: Consecutive patients with chronic severe AR were enrolled between 2015–2018. Baseline examination included echocardiography (ECHO) with 2- and 3-dimensional (2D and 3D) vena contracta area (VCA), and magnetic resonance imaging (MRI) with regurgitant volume (RV) and fraction (RF) analyzed in CoreLab. Results: The mean follow-up was 587 days (interquartile range (IQR) 296–901) in a total of 104 patients. Twenty patients underwent AV surgery. Baseline clinical and laboratory data did not differ between surgically and medically treated patients. Surgically treated patients had larger left ventricular (LV) dimension, end-diastolic volume (all p < 0.05), and the LV ejection fraction was similar. The surgical group showed higher prevalence of severe AR (70% vs. 40%, p = 0.02). Out of all imaging markers 3D VCA, MRI-derived RV and RF were identified as the strongest independent predictors of AV surgery (all p < 0.001). Conclusions: Parameters related to LV morphology and function showed moderate accuracy to identify patients in need of early AV surgery at the early stage of the disease. 3D ECHO-derived VCA and MRI-derived RV and RF showed high accuracy and excellent sensitivity to identify patients in need of early surgery.
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Affiliation(s)
- Radka Kočková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
- Faculty of Medicine in Hradec Králové, Charles University, Šimkova 870, Hradec Králové 500 03, Czech Republic.
| | - Hana Línková
- Department of Cardiology, Royal Vinohrady University Hospital, Prague 10034, Czech Republic.
| | - Zuzana Hlubocká
- Department of Cardiology, General University Hospital, Prague 12808, Czech Republic.
| | - Alena Pravečková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
| | - Andrea Polednová
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
| | - Lucie Súkupová
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
| | - Martin Bláha
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
| | - Jiří Malý
- Department of Cardiothoracic surgery, Institute for Clinical and Experimental Medicine, Prague 14021, Czech Republic.
| | - Eva Honsová
- Institute for Clinical and Experimental Medicine, Clinical and Transplant Pathology Centre, Prague 14021, Czech Republic.
| | - David Sedmera
- First Faculty of Medicine, Institute of Anatomy, Charles University in Prague, Prague 12800, Czech Republic.
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Hubacek JA, Staněk V, Gebauerová M, Poledne R, Aschermann M, Skalická H, Matoušková J, Kruger A, Pěnička M, Hrabáková H, Veselka J, Hájek P, Lánská V, Adámková V, Pitˇha J. Rs6922269 marker at the MTHFD1L gene predict cardiovascular mortality in males after acute coronary syndrome. Mol Biol Rep 2015; 42:1289-93. [PMID: 25809277 DOI: 10.1007/s11033-015-3870-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
Myocardial infarction (MI) is the leading cause of death in industrialized countries. All the traditional risk factors for MI are responsible for approximately 50% of cases of MI cases. Attention therefore has recently focused on genetic variants that are not associated with conventional risk factors. One of them is the marker rs6922269, which has been suggested as a risk factor for development of MI in Western populations. We analyzed the relationship between rs6922269 variant on MTHFD1L gene and (i) risk of the acute coronary syndrome (ACS) in the Czech population and (ii) mortality in 7 years follow up. Rs6922269 (G>A) variant was analyzed (CR 99.3% for patients and 98.0% for controls) by PCR-RFLP in consecutively examined 1614 men and 503 women with ACS (age below 65 years) and in population-based controls--1191 men and 1368 women (aged up to 65 years). ANOVA and Chi square were used for statistical analysis. The genotype frequencies were almost identical (P=0.87) in the ACS patients and in controls and no differences were observed, if males (P=0.73) and females (P=0.93) were analysed separately. In addition, rs6922269 polymorphism was not associated with the classical risk factors (dyslipidemia, hypertension, obesity, smoking, diabetes) in control population. Cardiovascular mortality was significantly higher in males, carriers of the AA genotype (P<0.001, OR 2.52, 95% CI 1.40-4.55, for AA vs. +G). We conclude, that rs6922269 variant at MTHFD1L gene could be an important prognostic factor for cardiovascular mortality in patients after ACS.
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Affiliation(s)
- J A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic,
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Tomašov P, Minárik M, Zemánek D, Čadová P, Homolová S, Čurilka K, Pěnička M, Benešová L, Belšánová B, Gregor P, Veselka J. Genetic testing in the management of relatives of patients with hypertrophic cardiomyopathy. Folia Biol (Praha) 2014; 60:28-34. [PMID: 24594054] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiac disease with vast genetic heterogeneity. First-degree relatives of patients with HCM are at 50% risk of inheriting the disease-causing mutation. Genetic testing is helpful in identifying the relatives harbouring the mutations. When genetic testing is not available, relatives need to be examined regularly. We tested a cohort of 99 unrelated patients with HCM for mutations in MYH7, MYBPC3, TNNI3 and TNNT2 genes. In families with identified pathogenic mutation, we performed genetic and clinical examination in relatives to study the influence of genetic testing on the management of the relatives and to study the usefulness of echocardiographic criteria for distinguishing relatives with positive and negative genotype. We identified 38 genetic variants in 47 patients (47 %). Fifteen of these variants in 21 patients (21 %) were pathogenic mutations. We performed genetic testing in 52 relatives (18 of them (35 %) yielding positive results). Genetic testing of one HCM patient allowed us to omit 2.45-5.15 future cardiologic examinations of the relatives. None of the studied echocardiographic criteria were significantly different between the relatives with positive and negative genotypes, with the exception of a combined echocardiographic score (genotype positive vs. genotype negative, 3.316 vs. -0.489, P = 0.01). As a conclusion, our study of HCM patients and their relatives confirmed the role of genetic testing in the management of the relatives and found only limited benefit of the proposed echocardiographic parameters in identifying disease-causing mutation carriers.
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Affiliation(s)
- P Tomašov
- Department of Cardiology, Second Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - M Minárik
- Laboratory for Molecular Genetics and Oncology, Genomac Research Institute, Prague, Czech Republic
| | - D Zemánek
- Department of Cardiology, Second Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - P Čadová
- Department of Cardiology, Second Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - S Homolová
- Department of Cardiology, Second Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - K Čurilka
- Third Department of Internal Medicine - Department of Cardiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - M Pěnička
- Third Department of Internal Medicine - Department of Cardiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - L Benešová
- Laboratory for Molecular Genetics and Oncology, Genomac Research Institute, Prague, Czech Republic
| | - B Belšánová
- Laboratory for Molecular Genetics and Oncology, Genomac Research Institute, Prague, Czech Republic
| | - P Gregor
- Third Department of Internal Medicine - Department of Cardiology, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - J Veselka
- Department of Cardiology, Second Faculty of Medicine, Charles University in Prague and University
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7
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Hubáček JA, Staněk V, Gebauerová M, Poledne R, Aschermann M, Skalická H, Matoušková J, Kruger A, Pěnička M, Hrabáková H, Veselka J, Hájek P, Lánská V, Adámková V, Pitha J. Association between a marker on chromosome 9 and acute coronary syndrome. confirmatory study on Czech population. Folia Biol (Praha) 2012; 58:203-208. [PMID: 23249639] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Myocardial infarction (MI) is the leading cause of death in industrialized countries. All the classical risk factors for MI are responsible for approximately 50 % of MI cases. Attention has therefore recently been attracted to those genetic variants that are not associated with conventional risk factors. One of them is the marker rs10757274 in the "genefree" zone on chromosome 9, which has been repeatedly recognized as a risk factor for development of MI in Western populations. We analysed the relationship between the rs10757274 variant on chromosome 9 and risk of the acute coronary syndrome (ACS) in Czech population. The rs10757274 (A > G) variant was successfully analysed (CR = 99.4 % for patients and 98.4 % for controls) by PCR-RFLP in consecutively examined 1,046 men and 281 women with ACS (age below 65 years) and in population-based controls - 1,162 men and 1,355 women (aged up to 65 years). ANOVA and χ2 were used for statistical analysis. We confirmed that GG homozygotes are more frequent (codominant model of analysis) among patients with myocardial infarction than in the control group both in men (28.5 % vs. 22.0 %, P = 0.0001, OR 1.73, 95 % CI 1.36-2.19) and women (32.0 % vs. 24.6 %, P = 0.02, OR 1.62, 95 % CI 1.13-2.34). However, rs10757274 polymorphism was not associated with the classical risk factors either in control population or in ACS patients. We conclude that the rs10757274 variant at 9p23.1 is an important genetic risk factor for ACS development in the Czech population.
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Affiliation(s)
- J A Hubáček
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Hubacek JA, Staněk V, Gebauerová M, Pilipčincová A, Poledne R, Aschermann M, Skalická H, Matoušková J, Kruger A, Pěnička M, Hrabáková H, Veselka J, Hájek P, Lánská V, Adámková V, Pit’ha J. Lack of an association between connexin-37, stromelysin-1, plasminogen activator-inhibitor type 1 and lymphotoxin-alpha genes and acute coronary syndrome in Czech Caucasians. Exp Clin Cardiol 2010; 15:e52-e56. [PMID: 20959880 PMCID: PMC2954029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 05/10/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND The majority of acute coronary syndrome (ACS) cases cannot be explained by the analysis of commonly recognized risk factors; thus, the analysis of possible genetic predispositions is of interest. The genes for connexin-37, stromelysin-1, plasminogen activator-inhibitor type 1 (PAI-1) and lymphotoxin-alpha are among many presently known candidate genes that are associated with risk factors for ACS. OBJECTIVE To identify the potential impact of the functional variants of connexin-37, stromelysin-1, PAI-1 and lymphotoxin-alpha on ACS in a Caucasian Czech population. METHODS A total of 1399 consecutive patients (1016 men and 383 women) with ACS from five coronary care units located in Prague (Czech Republic) were analyzed; a representative sample of 2559 healthy individuals (1191 men and 1368 women) were also genotyped and served as controls. RESULTS The gene variants analyzed were not significantly associated with the prevalence of ACS or the classical risk factors of ACS development such as high plasma lipid levels, hypertension, diabetes, high body mass index or smoking. CONCLUSION In a Caucasian Czech population sample, genetic variants of connexin-37, stromelysin-1, PAI-1 and lymphotoxin-alpha were not significantly associated with a predisposition toward ACS.
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Affiliation(s)
- Jaroslav Alois Hubacek
- Institute for Clinical and Experimental Medicine
- Centre for Cardiovascular Research, Prague
- Faculty for Public Health and Social Studies, South Bohemia University, Ceske Budejovice
- 2nd Department of Internal Medicine, General Teaching Hospital
| | | | | | | | - Rudolf Poledne
- Institute for Clinical and Experimental Medicine
- Cardiocenter, Department of Cardiology, University Hospital Královské Vinohrady
| | | | - Hana Skalická
- 2nd Department of Internal Medicine, General Teaching Hospital
| | - Jana Matoušková
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Andreas Kruger
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Martin Pěnička
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Hana Hrabáková
- 2nd Department of Internal Medicine, General Teaching Hospital
| | - Josef Veselka
- Cardiocenter, Department of Cardiology, University Hospital Královské Vinohrady
| | - Petr Hájek
- Cardiocenter, Department of Cardiology, University Hospital Královské Vinohrady
| | - Vera Lánská
- Institute for Clinical and Experimental Medicine
| | | | - Jan Pit’ha
- Institute for Clinical and Experimental Medicine
- Centre for Cardiovascular Research, Prague
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