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Hozman M, Herman D, Zemanek D, Fiser O, Vrba D, Poloczek M, Varvarovsky I, Obona P, Pokorny T, Osmancik P. Transseptal puncture in left atrial appendage closure guided by 3D printing and multiplanar CT reconstruction. Catheter Cardiovasc Interv 2023; 102:1331-1340. [PMID: 37855202 DOI: 10.1002/ccd.30867] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC). AIMS The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. METHODS Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. RESULTS Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane. CONCLUSIONS In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.
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Affiliation(s)
- Marek Hozman
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - David Zemanek
- Second Department of Internal Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Fiser
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - David Vrba
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic
| | | | - Peter Obona
- Cardiocenter, University Hospital Nitra, Nitra, Slovakia
| | - Tomas Pokorny
- Department of Biomedical Technology, Faculty of Biomedical Engineering, CTU in Prague, Prague, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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Branny M, Osmancik P, Kala P, Poloczek M, Herman D, Neuzil P, Hala P, Taborsky M, Stasek J, Haman L, Chovancik J, Cervinka P, Holy J, Kovarnik T, Zemanek D, Havranek S, Vancura V, Peichl P, Tousek P, Hozman M, Lekesova V, Jarkovsky J, Novackova M, Benesova K, Widimsky P, Reddy VY. Nonprocedural bleeding after left atrial appendage closure versus direct oral anticoagulants: A subanalysis of the randomized PRAGUE-17 trial. J Cardiovasc Electrophysiol 2023; 34:1885-1895. [PMID: 37529864 DOI: 10.1111/jce.16029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/07/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Observational studies have shown low bleeding rates in patients with atrial fibrillation (AF) treated by left atrial appendage closure (LAAC); however, data from randomized studies are lacking. This study compared bleeding events among patients with AF treated by LAAC and nonvitamin K anticoagulants (NOAC). METHODS The Prague-17 trial was a prospective, multicenter, randomized trial that compared LAAC to NOAC in high-risk AF patients. The primary endpoint was a composite of a cardioembolic event, cardiovascular death, and major and clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Hemostasis (ISTH). RESULTS The trial enrolled 402 patients (201 per arm), and the median follow-up was 3.5 (IQR 2.6-4.2) years. Bleeding occurred in 24 patients (29 events) and 32 patients (40 events) in the LAAC and NOAC groups, respectively. Six of the LAAC bleeding events were procedure/device-related. In the primary intention-to-treat analysis, LAAC was associated with similar rates of ISTH major or CRNMB (sHR 0.75, 95% CI 0.44-1.27, p = 0.28), but with a reduction in nonprocedural major or CRNMB (sHR 0.55, 95% CI 0.31-0.97, p = 0.039). This reduction for nonprocedural bleeding with LAAC was mainly driven by a reduced rate of CRNMB (sHR for major bleeding 0.69, 95% CI 0.34-1.39, p = .30; sHR for CRNMB 0.43, 95% CI 0.18-1.03, p = 0.059). History of bleeding was a predictor of bleeding during follow-up. Gastrointestinal bleeding was the most common bleeding site in both groups. CONCLUSION During the 4-year follow-up, LAAC was associated with less nonprocedural bleeding. The reduction is mainly driven by a decrease in CRNMB.
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Affiliation(s)
- Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
- Department of Internal Medicine and Cardiology, Faculty of Medicin, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Osmancik
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Dalibor Herman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Neuzil
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Milos Taborsky
- Department of Cardiology, Cardiocenter, University Hospital Olomouc, Olomouc, Czech Republic
| | - Josef Stasek
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Prague, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Prague, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Stepan Havranek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Tousek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Hozman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Veronika Lekesova
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Martina Novackova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Vivek Y Reddy
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
- Icahn School of Medicine at Mount Sinai, Helmsley Electrophysiology Center, New York, New York, USA
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Rob D, Smalcova J, Smid O, Kral A, Kovarnik T, Zemanek D, Kavalkova P, Huptych M, Komarek A, Franek O, Havranek S, Linhart A, Belohlavek J. Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial. Crit Care 2022; 26:330. [PMID: 36303227 PMCID: PMC9608889 DOI: 10.1186/s13054-022-04199-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. METHODS Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. RESULTS Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). CONCLUSIONS In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
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Affiliation(s)
- Daniel Rob
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jana Smalcova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ondrej Smid
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Kral
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Tomas Kovarnik
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - David Zemanek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Petra Kavalkova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Michal Huptych
- grid.6652.70000000121738213Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, Prague, Czech Republic
| | - Arnost Komarek
- grid.4491.80000 0004 1937 116XDepartment of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Ondrej Franek
- Emergency Medical Service Prague, Prague, Czech Republic
| | - Stepan Havranek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Linhart
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jan Belohlavek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
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Matera L, Sajgalik P, Fabian V, Mikhailov Y, Zemanek D, Johnson BD. Feasibility of Brachial Occlusion Technique for Beat-to-Beat Pulse Wave Analysis. Sensors (Basel) 2022; 22:7285. [PMID: 36236381 PMCID: PMC9572570 DOI: 10.3390/s22197285] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Czech physiologist Penaz tried to overcome limitations of invasive pulse-contour methods (PCM) in clinical applications by a non-invasive method (finger mounted BP cuff) for continuous arterial waveform detection and beat-to-beat analysis. This discovery resulted in significant interest in human physiology and non-invasive examination of hemodynamic parameters, however has limitations because of the distal BP recording using a volume-clamp method. Thus, we propose a validation of beat-to-beat signal analysis acquired by novel a brachial occlusion-cuff (suprasystolic) principle and signal obtained from Finapres during a forced expiratory effort against an obstructed airway (Valsalva maneuver). Twelve healthy adult subjects [2 females, age = (27.2 ± 5.1) years] were in the upright siting position, breathe through the mouthpiece (simultaneously acquisition by brachial blood pressure monitor and Finapres) and at a defined time were asked to generate positive mouth pressure for 20 s (Valsalva). For the purpose of signal analysis, we proposed parameter a “Occlusion Cuff Index” (OCCI). The assumption about similarities between measured signals (suprasystolic brachial pulse waves amplitudes and Finapres’s MAP) were proved by averaged Pearson’s correlation coefficient (r- = 0.60, p < 0.001). The averaged Pearson’s correlation coefficient for the comparative analysis of OCCI between methods was r- = 0.88, p < 0.001. The average percent change of OCCI during maneuver: 8% increase, 19% decrease and percent change of max/min ratio is 35%. The investigation of brachial pulse waves measured by novel brachial blood pressure monitor shows positive correlation with Finapres and the parameter OCCI shows promise as an index, which could describe changes during beat-to-beat cardiac cycles.
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Affiliation(s)
- Lukas Matera
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 16627 Prague, Czech Republic
| | - Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
| | - Vratislav Fabian
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 16627 Prague, Czech Republic
| | - Yegor Mikhailov
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 16627 Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Internal Medicine—Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 12808 Prague, Czech Republic
| | - Bruce D. Johnson
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Kovarnik T, Hitoshi M, Kral A, Jerabek S, Zemanek D, Kawase Y, Omori H, Tanigaki T, Pudil J, Vodzinska A, Branny M, Stipal R, Kala P, Mrozek J, Porzer M, Grezl T, Novobilsky K, Mendiz O, Kopriva K, Mates M, Chval M, Chen Z, Martasek P, Linhart A. Fractional Flow Reserve Versus Instantaneous Wave-Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study. J Am Heart Assoc 2022; 11:e021490. [PMID: 35502771 PMCID: PMC9238629 DOI: 10.1161/jaha.121.021490] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave‐free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips‐Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase‐1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56, P<0.0001) than FFR (R=0.36, P<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64, P<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthaser+heme oxygenase‐1r): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%), P=0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase‐1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT03033810.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Ales Kral
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Stepan Jerabek
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - David Zemanek
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | | | | | - Jan Pudil
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Marian Branny
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Roman Stipal
- Department of Internal Medicine and Cardiology University HospitalFaculty of MedicineMasaryk University Brno Brno Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology University HospitalFaculty of MedicineMasaryk University Brno Brno Czech Republic
| | - Jan Mrozek
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Martin Porzer
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Tomas Grezl
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Kamil Novobilsky
- Cardiology Department Municipal Hospital Ostrava Ostrava Czech Republic
| | | | - Karel Kopriva
- Cardiology Department Homolka Hospital Prague Czech Republic
| | - Martin Mates
- Cardiology Department Homolka Hospital Prague Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education Faculty of Education Charles University Prague Czech Republic
| | - Zhi Chen
- Department of Electrical & Computer Engineering Iowa Institute for Biomedical ImagingThe University of Iowa IA
| | - Pavel Martasek
- Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles UniversityGeneral University Hospital Prague Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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Rob D, Kavalkova P, Smalcova J, Kral A, Kovarnik T, Zemanek D, Franěk O, Smid O, Havranek S, Linhart A, Belohlavek J. Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation. Resuscitation 2022; 175:133-141. [PMID: 35367316 DOI: 10.1016/j.resuscitation.2022.03.027] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to examine coronary angiography (CAG) findings, percutaneous coronary intervention (PCI) results and outcomes in out-of-hospital cardiac arrest patients (OHCA) without return of spontaneous circulation (ROSC) on admission to hospital. METHODS We analyzed the OHCA register and compared CAG, PCI, and outcome data in patients with and without ROSC on admission to hospital. RESULTS Between January 2012 and December 2020, 697 OHCA patients were analyzed. Of these, 163 (23%) did not have ROSC at admission. Patients without ROSC were younger (59 vs. 61 years, p=0.001) and had a longer resuscitation time (62 vs. 18 minutes, p<0.001) than patients with ROSC. Significant coronary artery disease was highly prevalent in both groups (65% vs. 68%, p=0.48). Patients without ROSC had higher rates of acute coronary occlusions (42% vs. 33%, p=0.046), specifically affecting the left main stem (16% vs. 1%, p<0.001). PCI was performed in 81 patients (50%) without ROSC and in 295 (55%) with ROSC (p=0.21). The success rate was 86% in patients without ROSC and 90% in patients with ROSC (p=0.33). Thirty-day survival was 24% in patients without ROSC and 70% in patients with ROSC. CONCLUSIONS OHCA patients without ROSC on admission to hospital had higher acute coronary occlusion rates than patients with prehospital ROSC. PCI is feasible with a high success rate in patients without ROSC. Despite prolonged resuscitation times, meaningful survival in patients admitted without ROSC is achievable.
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Affiliation(s)
- Daniel Rob
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - Petra Kavalkova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jana Smalcova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ales Kral
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Tomas Kovarnik
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - David Zemanek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ondrej Franěk
- Prague Emergency Medical Service, Prague, Czech Republic
| | - Ondrej Smid
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ales Linhart
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jan Belohlavek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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Belohlavek J, Smalcova J, Rob D, Franek O, Smid O, Pokorna M, Horák J, Mrazek V, Kovarnik T, Zemanek D, Kral A, Havranek S, Kavalkova P, Kompelentova L, Tomková H, Mejstrik A, Valasek J, Peran D, Pekara J, Rulisek J, Balik M, Huptych M, Jarkovsky J, Malik J, Valerianova A, Mlejnsky F, Kolouch P, Havrankova P, Romportl D, Komarek A, Linhart A. Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2022; 327:737-747. [PMID: 35191923 PMCID: PMC8864504 DOI: 10.1001/jama.2022.1025] [Citation(s) in RCA: 234] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. OBJECTIVE To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. DESIGN, SETTING, AND PARTICIPANTS Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). INTERVENTIONS In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). MAIN OUTCOMES AND MEASURES The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). RESULTS The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. In the main analysis, 39 patients (31.5%) in the invasive strategy group and 29 (22.0%) in the standard strategy group survived to 180 days with good neurologic outcome (odds ratio [OR], 1.63 [95% CI, 0.93 to 2.85]; difference, 9.5% [95% CI, -1.3% to 20.1%]; P = .09). At 30 days, neurologic recovery had occurred in 38 patients (30.6%) in the invasive strategy group and in 24 (18.2%) in the standard strategy group (OR, 1.99 [95% CI, 1.11 to 3.57]; difference, 12.4% [95% CI, 1.9% to 22.7%]; P = .02), and cardiac recovery had occurred in 54 (43.5%) and 45 (34.1%) patients, respectively (OR, 1.49 [95% CI, 0.91 to 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). CONCLUSIONS AND RELEVANCE Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01511666.
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Affiliation(s)
- Jan Belohlavek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jana Smalcova
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
- Emergency Medical Service, Prague, Czech Republic
| | - Daniel Rob
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Ondrej Smid
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Jan Horák
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Vratislav Mrazek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Stepan Havranek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Petra Kavalkova
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | | | | | | | - David Peran
- Emergency Medical Service, Prague, Czech Republic
| | | | - Jan Rulisek
- Department of Anesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Martin Balik
- Department of Anesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Malik
- 3rd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Anna Valerianova
- 3rd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Frantisek Mlejnsky
- 2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Petr Kolouch
- Emergency Medical Service, Prague, Czech Republic
| | - Petra Havrankova
- Department of Neurology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Dan Romportl
- Long-term Intensive Care Unit, Etoile, Prague, Czech Republic
| | - Arnost Komarek
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
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Hegde SM, Lester SJ, Solomon SD, Michels M, Elliott PM, Nagueh SF, Choudhury L, Zemanek D, Zwas DR, Jacoby D, Wang A, Ho CY, Li W, Sehnert AJ, Olivotto I, Abraham TP. Effect of Mavacamten on Echocardiographic Features in Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2021; 78:2518-2532. [PMID: 34915982 DOI: 10.1016/j.jacc.2021.09.1381] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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] [Received: 07/09/2021] [Revised: 08/27/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND EXPLORER-HCM (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy) demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM). OBJECTIVES The purpose of this study was to evaluate mavacamten's effect on measures of cardiac structure and function and its association with changes in other clinical measures. METHODS Key echocardiographic parameters from serial echocardiograms over 30 weeks from 251 symptomatic oHCM patients (mavacamten [n = 123], placebo [n = 128]) were assessed in a core laboratory. RESULTS More patients on mavacamten (80.9%; n = 76 of 94) vs placebo (34.0%; n = 33 of 97) showed complete resolution of mitral valve systolic anterior motion after 30 weeks (difference, 46.8%; P < 0.0001). Mavacamten also improved measures of diastolic function vs placebo, including left atrial volume index (LAVI) (mean ± SD baseline: 40 ± 12 mL/m2 vs 41 ± 14 mL/m2; mean change from baseline of -7.5 mL/m2 [95% CI: -9.0 to -6.1 mL/m2] vs -0.09 mL/m2 [95% CI: -1.6 to 1.5 mL/m2]; P < 0.0001) and lateral E/e' (baseline, 15 ± 6 vs 15 ± 8; change of -3.8 [95% CI: -4.7 to -2.8] vs 0.04 [95% CI: -0.9 to 1.0]; P < 0.0001). Among mavacamten-treated patients, improvement in resting, Valsalva, and post-exercise LVOT gradients, LAVI, and lateral E/e' was associated with reduction in N-terminal pro-B-type natriuretic peptide (P ≤ 0.03 for all). Reduction in LAVI was associated with improved peak exercise oxygen consumption (P = 0.04). CONCLUSIONS Mavacamten significantly improved measures of left ventricular diastolic function and systolic anterior motion. Improvement in LVOT obstruction, LAVI, and E/e' was associated with reduction in a biomarker of myocardial wall stress (N-terminal pro-B-type natriuretic peptide). These findings demonstrate improvement in important markers of the pathophysiology of oHCM with mavacamten. (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy; NCT03470545).
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Affiliation(s)
- Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Steven J Lester
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - David Zemanek
- 2nd Department of Internal Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Donna R Zwas
- Heart Institute, Hadassah University Medical Center, Jerusalem, Israel
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut, USA
| | - Andrew Wang
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wanying Li
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Amy J Sehnert
- MyoKardia, Inc, a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, California, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi and the University of Florence, Florence, Italy
| | - Theodore P Abraham
- UCSF HCM Center of Excellence, University of California San Francisco, San Francisco, California, USA
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9
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Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, Poloczek M, Stasek J, Haman L, Branny M, Chovancik J, Cervinka P, Holy J, Kovarnik T, Zemanek D, Havranek S, Vancura V, Peichl P, Tousek P, Lekesova V, Jarkovsky J, Novackova M, Benesova K, Widimsky P, Reddy VY. Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17. J Am Coll Cardiol 2021; 79:1-14. [PMID: 34748929 DOI: 10.1016/j.jacc.2021.10.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [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] [Received: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PRAGUE-17 trial demonstrated that left atrial appendage closure (LAAC) was non-inferior to non-warfarin oral anticoagulants (NOAC) for preventing major neurological, cardiovascular or bleeding events in high-risk patients with atrial fibrillation (AF). OBJECTIVE To assess the pre-specified long-term (4-year) outcomes in PRAGUE-17. METHODS PRAGUE-17 was a randomized non-inferiority trial comparing percutaneous LAAC (Watchman or Amulet) with NOACs (95% apixaban) in non-valvular AF patients with a history of cardioembolism, clinically-relevant bleeding, or both CHA2DS2-VASc > 3 and HASBLED > 2. The primary endpoint was a composite of cardioembolic events (stroke, transient ischemic attack, or systemic embolism), cardiovascular death, clinically-relevant bleeding, or procedure/device-related complications (LAAC group only). The primary analysis was modified intention-to-treat (mITT). RESULTS We randomized 402 AF patients (201 per group, age 73.3±7.0 years, 65.7% male, CHA2DS2-VASc 4.7+1.5, HASBLED 3.1+0.9). After 3.5 years median follow-up (1,354 patients-years), LAAC was non-inferior to NOAC for the primary endpoint by mITT (subdistribution hazard ratio[sHR] 0.81, 95% CI 0.56-1.18; p=0.27; p for non-inferiority=0.006). For the components of the composite endpoint, the corresponding sHRs (and 95% CIs) were 0.68 (0.39-1.20; p=0.19) for cardiovascular death, 1.14 (0.56-2.30; p=0.72) for all-stroke/TIA, 0.75 (0.44-1.27; p=0.28) for clinically-relevant bleeding, and 0.55 (0.31-0.97; p=0.039) for non-procedural clinically-relevant bleeding. The primary endpoint outcomes were similar in the per-protocol [sHR 0.80 (95% CI 0.54-1.18), p=0.25] and on-treatment [sHR 0.82 (95% CI 0.56-1.20), p=0.30] analyses. CONCLUSION In long-term follow-up of PRAGUE-17, LAAC remains non-inferior to NOACs for preventing major cardiovascular, neurological or bleeding events. Furthermore, non-procedural bleeding was significantly reduced with LAAC.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Neuzil
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Milos Taborsky
- Cardiocenter, Dept. of Cardiology, University Hospital Olomouc, Czech Republic
| | - Petr Kala
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Martin Poloczek
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Josef Stasek
- 1(st) Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Czech Republic
| | - Ludek Haman
- 1(st) Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Czech Republic
| | - Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk hospital and UJEP, Usti nad Labem, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - Stepan Havranek
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Veronika Lekesova
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Novackova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Vivek Y Reddy
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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10
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Kovarnik T, Matsuo H, Jerabek S, Kawase Y, Omori H, Tanigaki T, Zemanek D, Kral A, Pudil J, Vodzinska A, Branny M, Kala P, Mendiz O, Mates M, Mrozek J. Coronary flow reserve can explain some of FFR and iFR discrepancies. Results from international, multicenter and prospective trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The trial collected prospective data from physiology measurements of borderline lesions in five Czech, one Japan and one Argentinian cathlabs. The main purposes were to analyze diagnostic agreement between FFR (fractional flow reserve) and iFR (instantaneous wave free ratio) examinations and to find possible explanations for discrepant results.
Methods
FFR and iFR examinations were analyzed using Philips-Volcano console and coronary flow reserve (CFR) was analyzed by using Combomap machine Philips-Volcano. Hyperemia for FFR and CFR measurements was induced by intracoronary administration of adenosine. We used CFR as a truth for comparison between FFR and iFR, because CFR has higher impact on patients prognosis than pressures indices.
Results
Data were collected from February 2016 to June 2019 and the database includes 1.789 examinations from 1.492 patients (282 of them, 15.8%, with ACS). CFR were measured in 343 lesions in 293 patients. (ACS 31.2%). Overall correlation between FFR and iFR is high (R=0.86 p<0.0001). The FFR/iFR discrepancy occurred in 84 measurements (24.5%), more frequently it was FFRp (positive) / iFRn (negative) type of discrepancy (65, 18.9%) compare to FFRn/iFRp (19, 5.5%) one. There was no difference in occurrence of FFR/iFR discrepancy in stable patients and ACS ones (25.1%vs. 22.4%, p=0.59). The CFR correlated better with iFR than with FFR (R=0.56, p<0.0001 vs. R= 0.36, p<0.0001) (see table). In lesions with FFRp/iFRn type of discrepancy we found substantially higher CFR value compared to FFR/iFR agreement group (2.4±0.7 vs. 1.5±0.5, p<0.0001). Unlike to FFRn/iFRp discrepancy, where CFR value was similar with agreement group (1.4±0.1 vs. 1.5±0.1, p=0.25)
Conclusion
The FFR/iFR discrepancy occurred in almost one quarter of examinations. Correlation between CFR and iFR is better than between CFR and FFR. High flow is probably one of the main reason for FFRp/iFRn type of discrepancy.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council
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Affiliation(s)
- T Kovarnik
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - S Jerabek
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - H Omori
- Gifu Heart Center, Gifu, Japan
| | | | - D Zemanek
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | - A Kral
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | - J Pudil
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - M Branny
- University Hospital Ostrava, Ostrava, Czechia
| | - P Kala
- Masaryk University, Brno, Czechia
| | - O Mendiz
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - M Mates
- Na Homolce Hospital, Prague, Czechia
| | - J Mrozek
- University Hospital Ostrava, Ostrava, Czechia
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11
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Simek S, Kral A, Kovarnik T, Zemanek D, Anger Z, Lubanda JC, Linhart A. Do the ESC guidelines improve the treatment of acute myocardial infarction due to acute circumflex artery occlusion? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The left circumflex artery (LCX) and its branches are less often recognized as infarct related artery (IRA) in STEMI compared to NSTEMI patients because of lower ability to detect posterior AMI on 12leads ECG. Significant proportion of patients with acute LCX occlusion therefore did not receive immediate reperfusion therapy. The recent ESC guidelines recommendation of immediate coronary angiography for NSTEMI with ongoing ischemia should change the situation.
Objectives
To estimate the change in proportion of patients receiving immediate reperfusion therapy for acute LCX occlusion within last 20 years.
Methods
Prospective registry of patients with acute coronary syndromes treated in the cardiac centre. The group of patients treated with direct PCI as STEMI and the group of patients treated as NSTE ACS were compared.
Results
Of 369 STEMI patients treated with primary PCI in 1995–2000, the LCX was recognized as IRA in only 29 (8%) patients. In the group of 809 STEMI patients treated in period 2008–2011, the LCX was detected as IRA in 133 (16%). In he recent group of 1006 patients treated as STEMI in period 2016–2019 the LCX was IRA in 166 (16.5%) patients. LAD, LM and RCA were detected as IRA in 407 (40.5%), 17 (1.7%) and 415 (41%) patients respectively. In the parallel group of 1087 NSTE-ACS patients the proportion of LCX, LAD, LM and RCA as culprit artery was 271 (25%), 438 (40%), 52 (5%) and 326 (30%) respectively. The difference of LCX involvement in STEMI (16%) compared to NSTE-ACS patients (25%) was highly significant (p<0,001).
Conclusion
The disproportion of LCX involvement among the patients with STEMI and NSTE-ACS is not decreasing in the course of last 10 years. Our data show that still significant part of patients with acute LCX occlusion are diagnosed as having NSTE-ACS and are not treated with adequate immediate reperfusion. So even in recent era of modern reperfusion therapy these patients which mostly suffer posterior AMIs have a lower chance to receive the proper treatment in our region. The new ESC guidelines did not change this fading yet. Better diagnostics of AMI due to the acute LCX occlusion (including 15 leads ECG) is routinely needed or every suspected NSTEMI patient should undergo the acute coronary angiogram as he would be a STEMI patient.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Simek
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - A Kral
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - T Kovarnik
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - D Zemanek
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - Z Anger
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - J.-C Lubanda
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - A Linhart
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
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Marek J, Kuchynka P, Mikulenka V, Palecek T, Sikora J, Hulkova H, Lambert L, Linkova H, Zemanek D, Tesarova M, Linhart A, Zeman J, Magner M. Combined valve replacement and aortocoronary bypass in an adult mucopolysaccharidosis type VII patient. Cardiovasc Pathol 2020; 50:107297. [PMID: 33045360 DOI: 10.1016/j.carpath.2020.107297] [Citation(s) in RCA: 2] [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] [Received: 08/18/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022] Open
Abstract
Mucopolysaccharidosis type VII (MPS VII) is a rare autosomal recessive lysosomal storage disorder. MPS VII is caused by mutations in the GUSB gene that encodes β-glucuronidase. Adult MPS VII patients present with musculoskeletal abnormalities, coarse features, and corneal clouding. Cardiac and valvular impairment are common; however, severe valvular disease necessitating surgery has not yet been reported. We present a 32-year-old male MPS VII patient admitted to our hospital with decompensated heart failure. We identified aortic valve disease with severe stenosis (valve area 0.69 cm2) and moderate regurgitation. Severe mitral valve stenosis (valve area 1 cm2) with moderate to severe regurgitation was also found in the patient. In addition, an occlusion of the right coronary artery (RCA) was documented. The patient underwent surgical replacement of the mitral and aortic valves with mechanical prostheses and implantation of a venous bypass graft to his RCA. The surgery led to a significant improvement of his clinical symptoms. Six months after the procedure, both mechanical valves function normally. Histopathological assessment identified chronic inflammatory infiltrates, fibrosis and calcifications in both resected valves. Foamy cytoplasmic transformation was most evident in the valvular interstitial cells. The ultrastructural vacuolar abnormality seen in these cells corresponded to storage changes observed in other MPSs. In conclusion, we describe clinical findings and valvular pathology in an MPS VII patient with the first-reported successful combined surgical valve replacement and myocardial revascularization. The histological and ultrastructural analyses revealed that the lysosomal storage predominantly affected the valvular interstitial cells.
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Affiliation(s)
- Josef Marek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Kuchynka
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vladimir Mikulenka
- 2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jakub Sikora
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Helena Hulkova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady in Prague, Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marketa Tesarova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jiri Zeman
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic; Department of Pediatrics, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
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Jerabek S, Zemanek D, Pudil J, Bayerova K, Kral A, Kopriva K, Kawase Y, Omori H, Tanigaki T, Chen Z, Vodzinska A, Branny M, Matsuo H, Mates M, Sonka M, Kovarnik T. Endothelial dysfunction assessed by digital tonometry and discrepancy between fraction flow reserve and instantaneous wave free ratio. Acta Cardiol 2020; 75:323-328. [PMID: 30945607 DOI: 10.1080/00015385.2019.1586089] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: We tested whether the level of endothelial dysfunction assessed by digital tonometry, and expressed as reactive hyperemia index (RHI), is related to occurrences of a discrepancy between fractional flow reserve (FFR) and the instantaneous wave free ratio (iFR) (ClinicalTrials.gov identifier: NCT03033810).Methods: We examined patients with coronary stenosis in the range of 40-70%, assessed by both FFR and iFR (system Philips-Volcano) for stable angina. We included consecutive patients with FFR and iFR in one native coronary artery, and who had had no previous intervention.Results: We included 138 patients. Out of those, 24 patients (17.4%) had a negative FFR (with an FFR value >0.8) and positive iFR (with a iFR value ≤0.89) - designated the FFRn/iFRp discrepancy group, and 22 patients (15.9%) had a positive FFR (≤0.8) and negative iFR (>0.89) - designated the FFRp/iFRn discrepancy. RHI was higher in the discrepancy groups compared the group without discrepancy (1.73 ± 0.79 vs. 1.48 ± 0.50, p = 0.025). However, this finding was not confirmed in multivariant logistic regression analyses. Patients with any type of discrepancy differed from the agreement group by having a higher occurrence of diabetes mellitus [9 patients (21.4%) vs. 36 patients (39.6%), p = 0.029], active smoking (23 patients or 54.8% vs. 26 patients or 28.6%, p = 0.003) and lower use of calcium channel blockers (9 patients, 21.4%, vs. 43 patients, 46.7%, p = 0.004).Conclusion: The presence of endothelial dysfunction can be associated with a discrepancy in FFR/iFR. However, RHI correlated with risk factors of atherosclerosis, not with FFR or iFR.
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Affiliation(s)
- Stepan Jerabek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Kristyna Bayerova
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Karel Kopriva
- Cardiology Department, Homolka Hospital, Prague, Czech Republic
| | | | | | | | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | | | - Marian Branny
- Cardiology Department, Trinec Podlesi Hospital, Trinec, Czech Republic
| | | | - Martin Mates
- Cardiology Department, Homolka Hospital, Prague, Czech Republic
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Zemanek D, Palecek T, Marek J, Magage S, Dostálová G, Linhart A. ALCOHOL SEPTAL ABLATION FOR SUCCESSFUL TREATMENT OF THE LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION IN FABRY DISEASE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31937-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Fabian V, Matera L, Bayerova K, Havlik J, Kremen V, Pudil J, Sajgalik P, Zemanek D. Noninvasive Assessment of Aortic Pulse Wave Velocity by the Brachial Occlusion-Cuff Technique: Comparative Study. Sensors (Basel) 2019; 19:s19163467. [PMID: 31398931 PMCID: PMC6719951 DOI: 10.3390/s19163467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases are one of most frequent cause of morbidity and mortality in the world. There is an emerging need for integrated, non-invasive, and easy-to-use clinical tools to assess accurately cardiovascular system primarily in the preventative medicine. We present a novel design for a non-invasive pulse wave velocity (PWV) assessment method integrated in a single brachial blood pressure monitor allowing for up to 100 times more sensitive recording of the pressure pulsations based on a brachial occlusion-cuff (suprasystolic) principle. The monitor prototype with built-in proprietary method was validated with a gold standard reference technique SphygmoCor VX device. The blood pressure and PWV were assessed on twenty-five healthy individuals (9 women, age (37 ± 13) years) in a supine position at rest by a brachial cuff blood pressure monitor prototype, and immediately re-tested using a gold standard method. PWV using our BP monitor was (6.67 ± 0.96) m/s compared to PWV determined by SphygmoCor VX (6.15 ± 1.01) m/s. The correlation between methods using a Pearson’s correlation coefficient was r = 0.88 (p < 0.001). The study demonstrates the feasibility of using a single brachial cuff build-in technique for the assessment of the arterial stiffness from a single ambulatory blood pressure assessment.
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Affiliation(s)
- Vratislav Fabian
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic.
| | - Lukas Matera
- Department of Physics, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic
| | - Kristyna Bayerova
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
| | - Jan Havlik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, 166 27 Prague, Czech Republic
| | - Vaclav Kremen
- Czech Institute of Informatics, Robotics, and Cybernetics, Czech Technical University in Prague, 160 00 Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
| | - Pavol Sajgalik
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 559 05, USA
| | - David Zemanek
- 2nd Department of Internal Medicine-Cardiology and Angiology of General University Hospital and 1st Medical Faculty of Charles University, 128 08 Prague, Czech Republic
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Zemanek D, Januska J, Honek T, Kubanek M, Taborsky M, Linhart A. PREVALENCE OF FABRY DISEASE IN A NATION-WIDE SCREENING PROGRAM OF MALES WITH HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31467-6] [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: 11/29/2022]
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Spacek M, Zemanek D, Hutyra M, Sluka M, Taborsky M. Vulnerable atherosclerotic plaque - a review of current concepts and advanced imaging. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:10-17. [DOI: 10.5507/bp.2018.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/06/2018] [Indexed: 01/31/2023] Open
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Kara T, Zemanek D, Veselka J, Krejci J, Belehrad M, Konecny T, Hude P, Ludka O, Somers V. P4495Sleep apnea diagnosis by using polysomnography may improve individual risk stratification in patients with hypertrophic cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4495] [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: 11/13/2022] Open
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Palecek T, Kucchynka P, Kovarnik T, Zemanek D, Linhart A. P714Large inter-laboratory variability in the assessment of the presence of viral genomes in endomyocardial biopsies in patients with recently diagnosed dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p714] [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: 11/13/2022] Open
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Osmancik P, Tousek P, Herman D, Neuzil P, Hala P, Stasek J, Haman L, Kala P, Poloczek M, Branny M, Chovancik J, Cervinka P, Holy J, Vancura V, Rokyta R, Taborsky M, Kovarnik T, Zemanek D, Peichl P, Haskova S, Jarkovsky J, Widimsky P. Interventional left atrial appendage closure vs novel anticoagulation agents in patients with atrial fibrillation indicated for long-term anticoagulation (PRAGUE-17 study). Am Heart J 2017; 183:108-114. [PMID: 27979034 DOI: 10.1016/j.ahj.2016.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/05/2016] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA. OBJECTIVE To determine whether percutaneous LAA occlusion is noninferior to treatment with NOAC in AF patients indicated for long-term systemic anticoagulation. STUDY DESIGN The trial will be a prospective, multicenter, randomized noninferiority trial comparing 2 treatment strategies in moderate to high-risk AF patients (ie, patients with history of significant bleeding, or history of cardiovascular event(s), or a with CHA2DS2VASc ≥3 and HAS-BLED score ≥2). Patients will be randomized into a percutaneous LAA occlusion (group A) or a NOAC treatment (group B) in a 1:1 ratio; the randomization was done using Web-based randomization software. A total of 396 study participants (198 patients in each group) will be enrolled in the study. The primary end point will be the occurrence of any of the following events within 24months after randomization: stroke or transient ischemic attack (any type), systemic cardioembolic event, clinically significant bleeding, cardiovascular death, or a significant periprocedural or device-related complications. CONCLUSION The PRAGUE-17 trial will determine if LAA occlusion is noninferior to treatment with NOAC in moderate- to high-risk AF patients.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Neuzil
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Stasek
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Prague, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Prague, Czech Republic
| | - Petr Kala
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Martin Poloczek
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Richard Rokyta
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Milos Taborsky
- Cardiocenter, Department of Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Sarka Haskova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Zemanek D, Veselka J, Belehrad M, Somers V, Kara T. Prevalence of sleep disordered breathing in patients with hypertrophic cardiomyopathy. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.1479] [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: 11/15/2022]
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Zemanek D, Tomasov P, Bělehrad M, Hladká K, Košťálová J, Kára T, Veselka J. Comparison of sublingual isosorbide dinitrate and Valsalva maneuver for detection of obstruction in hypertrophic cardiomyopathy. Arch Med Sci 2015; 11:751-5. [PMID: 26322086 PMCID: PMC4548019 DOI: 10.5114/aoms.2015.47096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/12/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION A left ventricular outflow tract (LVOT) obstruction assessment with a provoking test should be a routine part of the evaluation of patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to compare the utility of the Valsalva maneuver (VM) and sublingual spray application of isosorbide dinitrate (ISDN) for detection of an obstruction. MATERIAL AND METHODS We prospectively evaluated 81 consecutive HCM patients without severe rest LVOT obstruction (defined as peak rest pressure gradient (PG) ≥ 50 mm Hg). We measured PG at rest, during the VM, after sublingual ISDN spray, and during the VM after ISDN. An obstruction was defined as a PG ≥ 30 mm Hg. RESULTS An obstruction was present in 15 patients (19%) at rest (median and interquartile range of PG 16 (7-26) mm Hg), in 38 patients (47%) during the VM (PG 28 (12-49) mm Hg), in 50 (62%) patients after ISDN (PG 50 (12-79) mm Hg), and in 55 patients (68%) during the VM after ISDN (PG 59 (20-87) mm Hg). The difference in occurrence of obstruction among different provoking tests was statistically significant for all comparisons (p < 0.001, except for the comparison of the ISDN test with the VM during ISDN, p = 0.025). CONCLUSIONS The ISDN test and the VM are useful screening methods for the detection of an HCM obstruction. Although ISDN appears to be more precise than the VM, the best option is a combination of both methods, which maximizes inducement of LVOT obstruction in patients with HCM.
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Affiliation(s)
- David Zemanek
- Department of Cardiology, 2 Medical School of Charles University and University Hospital Motol, Prague, Czech Republic
- International Clinical Research Center Brno, Brno, Czech Republic
| | - Pavol Tomasov
- Department of Cardiology, 2 Medical School of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Miloš Bělehrad
- International Clinical Research Center Brno, Brno, Czech Republic
| | - Katarína Hladká
- Department of Cardiology, 2 Medical School of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jana Košťálová
- International Clinical Research Center Brno, Brno, Czech Republic
| | - Tomáš Kára
- International Clinical Research Center Brno, Brno, Czech Republic
| | - Josef Veselka
- Department of Cardiology, 2 Medical School of Charles University and University Hospital Motol, Prague, Czech Republic
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Zemanek D, Veselka J, Spacek M. Arteria Lusoria and Superdominant Right Coronary Artery: Two Rare Arterial Anomalies Diagnosed during Transradial Coronary Catheterization. Int J Angiol 2015; 25:e106-e107. [DOI: 10.1055/s-0034-1395988] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- David Zemanek
- Department of Cardiology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic
| | - Miloslav Spacek
- Department of Cardiology, University Hospital Motol, 2nd Medical School, Charles University, Prague, Czech Republic
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Curila K, Benesova L, Tomasov P, Belsanova B, Widimsky P, Minarik M, Zemanek D, Veselka J, Gregor P. Variants in miRNA regulating cardiac growth are not a common cause of hypertrophic cardiomyopathy. Cardiology 2015; 130:137-42. [PMID: 25633875 DOI: 10.1159/000369247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/15/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES A substantial proportion of patients with hypertrophic cardiomyopathy (HCM) do not have causative mutations in the genes for heart sarcomere. The purpose of this study was to evaluate the association between microRNA (miRNA) sequence variants and HCM. METHODS We performed genetic testing on 56 HCM patients who had previously been found to be negative for mutations in the 4 major genes for sarcomeric proteins. The coding and adjacent regions (120-220 nt) of selected miRNAs were analyzed for the presence of sequence variants. The testing was based on PCR amplification of DNA-encoding miRNAs and subsequent denaturing capillary electrophoresis. RESULTS A total of 3 different variants were detected in the 11 selected miRNAs. These included polymorphisms rs45489294 in miRNA 208b, rs13136737 in miRNA 367 and rs9989532 in miRNA 1-2. In the patient group, the most frequent polymorphism was in miRNA 208b (10 times) followed by miRNA 367 (7 times). Both polymorphisms were found to occur with similar frequencies in the group of healthy controls. The remaining detected variant was not present in the control group, but was not connected with the HCM phenotype in the children of the probands. CONCLUSION Sequence variants in miRNAs of patients with HCM are not frequent and the contribution of these variants to the development of this disease was not demonstrated.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Shahgaldi K, Hegner T, Da Silva C, Fukuyama A, Takeuchi M, Uema A, Kado Y, Nagata Y, Hayashi A, Otani K, Fukuda S, Yoshitani H, Otsuji Y, Morhy S, Lianza A, Afonso T, Oliveira W, Tavares G, Rodrigues A, Vieira M, Warth A, Deutsch A, Fischer C, Tezynska-Oniszk I, Turska-Kmiec A, Kawalec W, Dangel J, Maruszewski B, Bokiniec R, Burczynski P, Borszewska-Kornacka K, Ziolkowska L, Zuk M, Troshina A, Dzhalilova D, Poteshkina N, Hamitov F, Warita S, Kawasaki M, Tanaka R, Yagasaki H, Minatoguchi S, Wanatabe T, Ono K, Noda T, Wanatabe S, Minatoguchi S, Angelis A, Ageli K, Vlachopoulos C, Felekos I, Ioakimidis N, Aznaouridis K, Vaina S, Abdelrasoul M, Tsiamis E, Stefanadis C, Cameli M, Sparla S, D'ascenzi F, Fineschi M, Favilli R, Pierli C, Henein M, Mondillo S, Lindqvist P, Tossavainen E, Gonzalez M, Soderberg S, Henein M, Holmgren A, Strachinaru M, Catez E, Jousten I, Pavel O, Janssen C, Morissens M, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Tsai WC, Sun YT, Lee WH, Yang LT, Liu YW, Lee CH, Li WT, Mizariene V, Bieseviciene M, Karaliute R, Verseckaite R, Vaskelyte J, Lesauskaite V, Chatzistamatiou E, Mpampatseva Vagena I, Manakos K, Moustakas G, Konstantinidis D, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Hristova K, Cornelissen G, Singh R, Shiue I, Coisne D, Madjalian AM, Tchepkou C, Raud Raynier P, Degand B, Christiaens L, Baldenhofer G, Spethmann S, Dreger H, Sanad W, Baumann G, Stangl K, Stangl V, Knebel F, Azzaz S, Kacem S, Ouali S, Risos L, Dedobbeleer C, Unger P, Sinem Cakal S, Elif Eroglu E, Baydar O, Beytullah Cakal B, Mehmet Vefik Yazicioglu M, Mustafa Bulut M, Cihan Dundar C, Kursat Tigen K, Birol Ozkan B, Ali Metin Esen A, Tournoux F, Chequer R, Sroussi M, Hyafil F, Rouzet F, Leguludec D, Baum P, Stoebe S, Pfeiffer D, Hagendorff A, Fang F, Lau M, Zhang Q, Luo X, Wang X, Chen L, Yu C, Zaborska B, Smarz K, Makowska E, Kulakowski P, Budaj A, Bengrid TM, Zhao Y, Henein MY, Caminiti G, D'antoni V, Cardaci V, Conti V, Volterrani M, Warita S, Kawasaki M, Yagasaki H, Minatoguchi S, Nagaya M, Ono K, Noda T, Watanabe S, Houle H, Minatoguchi S, Gillebert TC, Chirinos JA, Claessens TC, Raja MW, De Buyzere ML, Segers P, Rietzschel ER, Kim K, Cha J, Chung H, Kim J, Yoon Y, Lee B, Hong B, Rim S, Kwon H, Choi E, Pyankov V, Aljaroudi W, Matta S, Al-Shaar L, Habib R, Gharzuddin W, Arnaout S, Skouri H, Jaber W, Abchee A, Bouzas Mosquera A, Peteiro J, Broullon F, Constanso Conde I, Bescos Galego H, Martinez Ruiz D, Yanez Wonenburger J, Vazquez Rodriguez J, Alvarez Garcia N, Castro Beiras A, Gunyeli E, Oliveira Da Silva C, Shahgaldi K, Manouras A, Winter R, Meimoun P, Abouth S, Martis S, Boulanger J, Elmkies F, Zemir H, Detienne J, Luycx-Bore A, Clerc J, Rodriguez Palomares JF, Gutierrez L, Maldonado G, Garcia G, Galuppo V, Gruosso D, Teixido G, Gonzalez Alujas M, Evangelista A, Garcia Dorado D, Rechcinski T, Wierzbowska-Drabik K, Wejner-Mik P, Szymanska B, Jerczynska H, Lipiec P, Kasprzak J, El-Touny K, El-Fawal S, Loutfi M, El-Sharkawy E, Ashour S, Boniotti C, Carminati M, Fusini L, Andreini D, Pontone G, Pepi M, Caiani E, Oryshchyn N, Kramer B, Hermann S, Liu D, Hu K, Ertl G, Weidemann F, Ancona F, Miyazaki S, Slavich M, Figini F, Latib A, Chieffo A, Montorfano M, Alfieri O, Colombo A, Agricola E, Nogueira M, Branco L, Rosa S, Portugal G, Galrinho A, Abreu J, Cacela D, Patricio L, Fragata J, Cruz Ferreira R, Igual Munoz B, Erdociain Perales M, Maceira Gonzalez A, Estornell Erill Jordi J, Donate Bertolin L, Vazquez Sanchez Alejandro A, Miro Palau Vicente V, Cervera Zamora A, Piquer Gil M, Montero Argudo A, Girgis HYA, Illatopa V, Cordova F, Espinoza D, Ortega J, Khan U, Islam A, Majumder A, Girgis HYA, Bayat F, Naghshbandi E, Naghshbandi E, Samiei N, Samiei N, Malev E, Omelchenko M, Vasina L, Zemtsovsky E, Piatkowski R, Kochanowski J, Budnik M, Scislo P, Opolski G, Kochanowski J, Piatkowski R, Scislo P, Budnik M, Marchel M, Opolski G, Abid L, Ben Kahla S, Abid D, Charfeddine S, Maaloul I, Ben Jmaa M, Kammoun S, Hashimoto G, Suzuki M, Yoshikawa H, Otsuka T, Isekame Y, Yamashita H, Kawase I, Ozaki S, Nakamura M, Sugi K, Benvenuto E, Leggio S, Buccheri S, Bonura S, Deste W, Tamburino C, Monte IP, Gripari P, Fusini L, Muratori M, Tamborini G, Ghulam Ali S, Bottari V, Cefalu' C, Bartorelli A, Agrifoglio M, Pepi M, Zambon E, Iorio A, Di Nora C, Abate E, Lo Giudice F, Di Lenarda A, Agostoni P, Sinagra G, Timoteo AT, Galrinho A, Moura Branco L, Rio P, Aguiar Rosa S, Oliveira M, Silva Cunha P, Leal A, Cruz Ferreira R, Zemanek D, Tomasov P, Belehrad M, Kostalova J, Kara T, Veselka J, Hassanein M, El Tahan S, El Sharkawy E, Shehata H, Yoon Y, Choi H, Seo H, Lee S, Kim H, Youn T, Kim Y, Sohn D, Choi G, Mielczarek M, Huttin O, Voilliot D, Sellal J, Manenti V, Carillo S, Olivier A, Venner C, Juilliere Y, Selton-Suty C, Butz T, Faber L, Brand M, Piper C, Wiemer M, Noelke J, Sasko B, Langer C, Horstkotte D, Trappe H, Maysou L, Tessonnier L, Jacquier A, Serratrice J, Copel C, Stoppa A, Seguier J, Saby L, Verschueren A, Habib G, Petroni R, Bencivenga S, Di Mauro M, Acitelli A, Cicconetti M, Romano S, Petroni A, Penco M, Maceira Gonzalez AM, Cosin-Sales J, Igual B, Sancho-Tello R, Ruvira J, Mayans J, Choi J, Kim S, Almeida A, Azevedo O, Amado J, Picarra B, Lima R, Cruz I, Pereira V, Marques N, Chatzistamatiou E, Konstantinidis D, Manakos K, Mpampatseva Vagena I, Moustakas G, Memo G, Mitsakis O, Kasakogias A, Syros P, Kallikazaros I, Cho E, Kim J, Hwang B, Kim D, Jang S, Jeon H, Cho J, Chatzistamatiou E, Konstantinidis D, Memo G, Mpapatzeva Vagena I, Moustakas G, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Jedrzejewska I, Konopka M, Krol W, Swiatowiec A, Dluzniewski M, Braksator W, Sefri Noventi S, Sugiri S, Uddin I, Herminingsih S, Arif Nugroho M, Boedijitno S, Caro Codon J, Blazquez Bermejo Z, Valbuena Lopez SC, Lopez Fernandez T, Rodriguez Fraga O, Torrente Regidor M, Pena Conde L, Moreno Yanguela M, Buno Soto A, Lopez-Sendon JL, Stevanovic A, Dekleva M, Kim M, Kim S, Kim Y, Shim J, Park S, Park S, Kim Y, Shim W, Kozakova M, Muscelli E, Morizzo C, Casolaro A, Paterni M, Palombo C, Bayat F, Nazmdeh M, Naghshbandi E, Nateghi S, Tomaszewski A, Kutarski A, Brzozowski W, Tomaszewski M, Nakano E, Harada T, Takagi Y, Yamada M, Takano M, Furukawa T, Akashi Y, Lindqvist G, Henein M, Backman C, Gustafsson S, Morner S, Marinov R, Hristova K, Geirgiev S, Pechilkov D, Kaneva A, Katova T, Pilosoff V, Pena Pena M, Mesa Rubio D, Ruiz Ortin M, Delgado Ortega M, Romo Penas E, Pardo Gonzalez L, Rodriguez Diego S, Hidalgo Lesmes F, Pan Alvarez-Ossorio M, Suarez De Lezo Cruz-Conde J, Gospodinova M, Sarafov S, Guergelcheva V, Vladimirova L, Tournev I, Denchev S, Mozenska O, Segiet A, Rabczenko D, Kosior D, Gao S, Eliasson M, Polte C, Lagerstrand K, Bech-Hanssen O, Morosin M, Piazza R, Leonelli V, Leiballi E, Pecoraro R, Cinello M, Dell' Angela L, Cassin M, Sinagra G, Nicolosi G, Savu O, Carstea N, Stoica E, Macarie C, Moldovan H, Iliescu V, Chioncel O, Moral S, Gruosso D, Galuppo V, Teixido G, Rodriguez-Palomares J, Gutierrez L, Evangelista A, Jansen Klomp WW, Peelen L, Spanjersberg A, Brandon Bravo Bruinsma G, Van 'T Hof A, Laveau F, Hammoudi N, Helft G, Barthelemy O, Michel P, Petroni T, Djebbar M, Boubrit L, Le Feuvre C, Isnard R, Bandera F, Generati G, Pellegrino M, Alfonzetti E, Labate V, Villani S, Gaeta M, Guazzi M, Gabriels C, Lancellotti P, Van De Bruaene A, Voilliot D, De Meester P, Buys R, Delcroix M, Budts W, Cruz I, Stuart B, Caldeira D, Morgado G, Almeida A, Lopes L, Fazendas P, Joao I, Cotrim C, Pereira H, Weissler Snir A, Greenberg G, Shapira Y, Weisenberg D, Monakier D, Nevzorov R, Sagie A, Vaturi M, Bando M, Yamada H, Saijo Y, Takagawa Y, Sawada N, Hotchi J, Hayashi S, Hirata Y, Nishio S, Sata M, Jackson T, Sammut E, Siarkos M, Lee L, Carr-White G, Rajani R, Kapetanakis S, Ciobotaru V, Yagasaki H, Kawasaki M, Tanaka R, Minatoguchi S, Sato N, Amano K, Warita S, Ono K, Noda T, Minatoguchi S, Breithardt OA, Razavi H, Nabutovsky Y, Ryu K, Gaspar T, Kosiuk J, John S, Prinzen F, Hindricks G, Piorkowski C, Nemchyna O, Tovstukha V, Chikovani A, Golikova I, Lutai M, Nemes A, Kalapos A, Domsik P, Lengyel C, Orosz A, Forster T, Nordenfur T, Babic A, Giesecke A, Bulatovic I, Ripsweden J, Samset E, Winter R, Larsson M, Blazquez Bermejo Z, Lopez Fernandez T, Caro Codon J, Valbuena S, Caro Codon J, Mori Junco R, Moreno Yanguela M, Lopez-Sendon J, Pinto-Teixeira P, Branco L, Galrinho A, Oliveira M, Cunha P, Silva T, Rio P, Feliciano J, Nogueira-Silva M, Ferreira R, Shkolnik E, Vasyuk Y, Nesvetov V, Shkolnik L, Varlan G, Bajraktari G, Ronn F, Ibrahimi P, Jashari F, Jensen S, Henein M, Kang MK, Mun HS, Choi S, Cho JR, Han S, Lee N, Cho IJ, Heo R, Chang H, Shin S, Shim C, Hong G, Chung N. Poster session 3: Thursday 4 December 2014, 14:00-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Veselka J, Krej i J, Toma ov P, Zemanek D. Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population. Eur Heart J 2014; 35:2040-5. [DOI: 10.1093/eurheartj/eht495] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Veselka J, Lawrenz T, Stellbrink C, Zemanek D, Branny M, Januska J, Sitar J, Dimitrow P, Krejci J, Dabrowski M, Mizera S, Bartel T, Kuhn H. Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv 2013; 84:101-7. [DOI: 10.1002/ccd.25236] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Josef Veselka
- Department of Cardiology2nd Medical School, Charles University and University Hospital MotolPrague Czech Republic
| | - Thorsten Lawrenz
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
| | - Christoph Stellbrink
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
| | - David Zemanek
- Department of Cardiology2nd Medical School, Charles University and University Hospital MotolPrague Czech Republic
- 1st Department of Internal Medicine/CardioangiologyInternational Clinical Research Centre–St. Anne's University HospitalBrno Czech Republic
| | - Marian Branny
- Department of CardiologyPodlesi HospitalTrinec Czech Republic
| | | | - Jan Sitar
- Department of CardiologyVarna Bulgaria
| | - Pawel Dimitrow
- 2nd Department of Cardiology, Collegium MedicumJagiellonian UniversityCracow Poland
| | - Jan Krejci
- 1st Department of Internal Medicine/CardioangiologyInternational Clinical Research Centre–St. Anne's University HospitalBrno Czech Republic
| | - Maciej Dabrowski
- Department of Interventional Cardiology and AngiologyInstitute of CardiologyWarsaw Poland
| | - Stanislav Mizera
- Department of CardiologyNational Institute of Cardiovascular DiseasesBratislava Slovakia
| | - Thomas Bartel
- Department of Internal Medicine IIIMedical University Innsbruck Austria
| | - Horst Kuhn
- Klinikum Bielefeld‐Mitte, Department of Cardiology and Internal Intensive Care, BielefeldUniversity of Witten/Herdecke Germany
- Department of CardiologyUniversity of Witten/Herdecke Germany
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Veselka J, Lawrenz T, Stellbrink C, Zemanek D, Branny M, Januska J, Groch L, Dimitrow P, Krejci J, Dabrowski M, Mizera S, Kuhn H. Low Incidence of Procedure-Related Major Adverse Cardiac Events After Alcohol Septal Ablation for Symptomatic Hypertrophic Obstructive Cardiomyopathy. Can J Cardiol 2013; 29:1415-21. [DOI: 10.1016/j.cjca.2013.04.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022] Open
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Honek J, Zemanek D, Veselka J. Alcohol septal ablation as a treatment of left ventricular outflow tract obstruction after mitral valve repair. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht312.3498] [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: 11/14/2022] Open
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Krejci J, Gregor P, Zemanek D, Zidova K, Curila K, Stepanova R, Novak M, Groch L, Veselka J. Dual-chamber pacing and alcohol septal ablation in hypertrophic obstructive cardiomyopathy - results of long-term follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2992] [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: 11/14/2022] Open
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Veselka J, Lawrenz T, Stellbrink C, Zemanek D, Branny M, Januska J, Groch L, Dimitrow P, Krejci J, Dabrowski M, Mizera S, Kuhn H. TCT-761 Complications of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy with Focus on Complete Heart Block: A European Multicenter Study. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.804] [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: 11/26/2022]
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Curila K, Benesova L, Penicka M, Minarik M, Zemanek D, Veselka J, Widimsky P, Gregor P. Spectrum and clinical manifestations of mutations in genes responsible for hypertrophic cardiomyopathy. Acta Cardiol 2012; 67:23-9. [PMID: 22455086 DOI: 10.1080/ac.67.1.2146562] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hypertrophic cardiomyopathy (HCM) is a cardiovascular disease with autosomal dominant inheritance. It is caused by mutations in the genes coding for structural and/or regulatory proteins found in the sarcomere of cardiomyocytes. A group of genes, including the heavy chain of beta-myosin (MYH7), myosin binding protein C (MYBPC3), cardiac troponin I (TNNI3) and cardiac troponin T (TNNT2) are frequently affected by causal mutations. While exact mutation frequency data has been obtained for various populations, no screening has been reported for Central European populations. PATIENTS AND METHODS We performed a complete sequencing of MYH7, MYBPC3, TNNI3 and TNNT2 genes in 100 HCM patients. RESULTS We discovered mutations in a total of 40 patients (40%), including 4 patients with double mutations. A total of 35 different mutation types were detected, of which 17 were novel. The contributions from individual genes were: 24 mutations in MYBPC3 (54.5%), 14 in MYH7 (31.8%), 4 in TNNI3 (9%) and 2 mutations in TNNT2 (4.5%). We have observed a wide variability in disease manifestation across the different genes/mutation types. In addition, we have discovered differences in both frequency and distribution of mutations of the two most common genes (MYBPC3 and MYH7) compared to other populations. CONCLUSION The most common gene responsible for HCM in our study population was MYBPC3, followed by MYH7, TNNI3 and TNNT2. Phenotypic heterogeneity, as well as the dissimilarity to other populations, prevents effective use of a pre-screening test, which would be directed at the most common mutation hotspots, in our population.
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Affiliation(s)
- Karol Curila
- Cardiocentre, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lucie Benesova
- Laboratory for Molecular Genetics and Oncology, Genomac International, Prague, Czech Republic
| | - Martin Penicka
- Cardiocentre, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Minarik
- Laboratory for Molecular Genetics and Oncology, Genomac International, Prague, Czech Republic
| | - David Zemanek
- Cardiovascular Centre of Faculty Hospital in Motol, Prague, Czech Republic
| | - Josef Veselka
- Cardiovascular Centre of Faculty Hospital in Motol, Prague, Czech Republic
| | - Petr Widimsky
- Cardiocentre, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Gregor
- Cardiocentre, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Veselka J, Cadova P, Tomasov P, Theodor A, Zemanek D. Dual-source CT angiography for detection and quantification of in-stent restenosis in the left main coronary artery: comparison with intracoronary ultrasound and coronary angiography. J Invasive Cardiol 2011; 23:460-464. [PMID: 22045078] [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] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic accuracy of dual-source computed tomography coronary angiography (CTCA) compared to coronary angiography (CAG) and intravascular ultrasound (IVUS) for detection and quantification of in-stent restenosis after left main (LM) coronary artery stenting. MATERIALS AND METHODS Fifty-one patients with percutaneous coronary intervention of the LM were prospectively evaluated. Thirty-four of them underwent 56 complete follow-up examinations (CTCA, CAG, and IVUS as gold standard examination) that focused on detection and quantification of restenosis. RESULTS Sensitivity, specificity, and positive and negative predictive values were 100%, 94%, 50%, and 100% for CAG, respectively, and 100%, 74%, 18%, and 100% for CTCA, respectively. There was a correlation between the minimal luminal areas (MLA) measured by CTCA and IVUS (r = 0.63; P<.01). A Bland-Altman analysis showed that the MLA measured by CTCA was underestimated (mean difference, 2.14 ± 2.24 mm²). CONCLUSION Dual-source CTCA has a high negative predictive value and might be considered a less invasive alternative to CAG for exclusion of LM in-stent restenosis. However, there was only a moderate correlation between the MLA measurements by IVUS and CTCA in the stented LMs. Moreover, the present results suggest a systematic underestimation of MLAs measured by CTCA. Therefore, finding of any restenosis according to CTCA should be re-evaluated by CAG or, better, by subsequent IVUS.
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Affiliation(s)
- Josef Veselka
- Department of Cardiology, CardioVascular Center, University Hospital Motol, Vúvalu 84, Prague 5, 15000, Czech Republic.
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Zemanek D, Tomasov P, Homolova S, Linhartova K, Veselka J. Sublingual isosorbide dinitrate for the detection of obstruction in hypertrophic cardiomyopathy. European Journal of Echocardiography 2011; 12:684-7. [DOI: 10.1093/ejechocard/jer115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Veselka J, Zimolova P, Martinkovicova L, Spacek M, Debreova J, Hajek P, Maly M, Zemanek D, Tesar D, Tomasov P. COMPARISON OF MID-TERM OUTCOMES OF CAROTID ARTERY STENTING FOR MODERATE VERSUS CRITICAL STENOSIS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61956-6] [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: 10/18/2022]
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Veselka J, Zimolova P, Martinkovicova L, Spacek M, Fiedler J, Zemanek D, Hajek P, Maly M, Tomasov P, Tesar D. COMPARISON OF CAROTID ARTERY STENTING IN PATIENTS WITH SINGLE VERSUS BILATERAL CAROTID ARTERY DISEASE AND FACTORS AFFECTING OUTCOME. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61957-8] [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: 11/30/2022]
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Zemanek D, Veselka J, Adla T, Setina M, Ferda J. Uncommon cause of obstruction in the left ventricular outflow tract by a metastasis of adenocarcinoma. Arch Med Sci 2010; 6:981-3. [PMID: 22427777 PMCID: PMC3302715 DOI: 10.5114/aoms.2010.19313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 08/23/2009] [Revised: 11/24/2009] [Accepted: 10/16/2010] [Indexed: 11/17/2022] Open
Abstract
Cardiac metastases are rare diagnoses among cardiac disorders. This case demonstrates a unique presence of an obstruction in the left ventricular outflow tract caused by the metastasis of a renal carcinoma. Adequate diagnostic and therapeutic procedures were lifesaving in this potentially fatal diagnosis.
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Affiliation(s)
- David Zemanek
- Department of Cardiology, University Hospital Motol, 1st Medical School of Charles University, Prague, Czech Republic
| | - Josef Veselka
- Department of Cardiology, University Hospital Motol, 1st Medical School of Charles University, Prague, Czech Republic
| | - Teodor Adla
- Department of Imaging Methods, University Hospital Motol, 2nd Medical School of Charles University, Prague, Czech Republic
| | - Marek Setina
- Department of Cardiac Surgery, University Hospital Motol, 2nd Medical School of Charles University, Prague, Czech Republic
| | - Jiri Ferda
- Radiodiagnostic Clinic, Charles University Teaching Hospital, Prague, Czech Republic
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Zemanek D, Svab P, Veselka J. Power Doppler myocardial contrast echocardiography in alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Clin Cardiol 2010; 33:E82. [PMID: 20860005 DOI: 10.1002/clc.20656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Revised: 06/22/2009] [Indexed: 11/06/2022] Open
Affiliation(s)
- David Zemanek
- Department of Cardiology, University Hospital Motol, Prague, Czech Republic.
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Ostadal P, Alan D, Vejvoda J, Kukacka J, Macek M, Hajek P, Mates M, Kvapil M, Kettner J, Wiendl M, Aschermann O, Slaby J, Holm F, Telekes P, Horak D, Blasko P, Zemanek D, Veselka J, Cepova J. Fluvastatin in the first-line therapy of acute coronary syndrome: results of the multicenter, randomized, double-blind, placebo-controlled trial (the FACS-trial). Trials 2010; 11:61. [PMID: 20500832 PMCID: PMC2886041 DOI: 10.1186/1745-6215-11-61] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [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: 03/11/2010] [Accepted: 05/25/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Statins have been proved to be effective in reduction of mortality and morbidity when started in the early secondary prevention in stabilized patients after acute coronary syndrome (ACS). The safety and efficacy of statin administration directly in the first-line therapy in unstable ACS patients is not clear. The aim of our study was, therefore, to assess the effect of statin treatment initiated immediately at hospital admission of patients with ACS. METHODS The trial was stopped prematurely after enrollment of one hundred and fifty-six patients with ACS that were randomized at admission to fluvastatin 80 mg (N = 78) or placebo (N = 78). Study medication was administered immediately after randomization and then once daily for 30 days; all patients were then encouraged to continue in open-label statin therapy and at the end of one-year follow-up 75% in the fluvastatin group and 78% in the placebo group were on statin therapy. RESULTS We did not demonstrate any difference between groups in the level of C-reactive protein, interleukin 6, and pregnancy-associated plasma protein A on Day 2 and Day 30 (primary endpoint). Fluvastatin-therapy, however, significantly reduced one-year occurrence of major adverse cardiovascular events (11.5% vs. 24.4%, odds ratio (OR) 0.40, 95% CI 0.17-0.95, P = 0.038). This difference was caused mainly by reduction of recurrent symptomatic ischemia (7.7% vs. 20.5%, OR 0.32, 95% CI 0.12-0.88, P = 0.037). CONCLUSIONS This study failed to prove the effect of fluvastatin given as first-line therapy of ACS on serum markers of inflammation and plaque instability. Fluvastatin therapy was, however, safe and it may reduce cardiovascular event rate that supports immediate use of a statin in patients admitted for ACS. TRIAL REGISTRATION NCT00171275.
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Affiliation(s)
- Petr Ostadal
- Heart Center, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic.
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Veselka J, Zemanek D, Hajek P, Maly M, Tesar D, Tomasov P, Martinkovicova L. AS-115: C-Reactive Protein and Balloon Ischemic Time Are Predictors of Periprocedural Myocardial Infarction in Stable Angina Patients Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2010. [DOI: 10.1016/j.amjcard.2010.01.156] [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: 10/19/2022]
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Bradacova P, Zemanek D, Adla T, Veselka J. AS-17: Dual-Source Computed Tomography Has a High Negative Predictive Value in the Evaluation of Restenosis after the Left Main Coronary Artery Stenting. Am J Cardiol 2010. [DOI: 10.1016/j.amjcard.2010.01.048] [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: 11/29/2022]
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Zemanek D, Celeryn S, Hajek P, Maly M, Veselka J. AS-37: Sodium Bicarbonate in Saline Infusion Is Worse for the Prevention of Contrast-Induced Nephropathy than Saline Infusion Alone: A Randomized Single-Center Study. Am J Cardiol 2010. [DOI: 10.1016/j.amjcard.2010.01.070] [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: 10/19/2022]
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Curila K, Benesova L, Penicka M, Minarik M, Zemanek D, Veselka J, Widimsky P, Gregor P. Low prevalence and variable clinical presentation of troponin I and troponin T gene mutations in hypertrophic cardiomyopathy. Genet Test Mol Biomarkers 2010; 13:647-50. [PMID: 19645627 DOI: 10.1089/gtmb.2009.0041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder caused by mutations in cardiac sarcomeric proteins. Troponin I (TNNI3) and troponin T (TNNT2) are important parts of the sarcomere in heart muscle, and mutations in their genes are responsible for development of HCM. The prevalence of mutations in these two genes is low; hence, the data on clinical outcome are scarce. Yet, some of these mutations were shown to be malignant with a high incidence of sudden death. Here, we describe the disease course in three families affected with TNNI3 and one family with TNNT2 gene mutations. In TNNI3-HCM, the phenotypic manifestation ranged from clinically silent to sudden cardiac death with the worst prognosis observed in carriers of Ala157Val mutation in exon 7. In contrast, TNNT2-HCM was associated with favorable prognosis. Thus, the findings of the present study add evidence on the phenotypic presentation of this genetic disease.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
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Affiliation(s)
- David Zemanek
- Department of Cardiology, Cardiovascular Center, University Hospital Motol and 1st Medical School
| | - Josef Veselka
- Department of Cardiology, Cardiovascular Center, University Hospital Motol and 1st Medical School
| | - Renata Chmelova
- Department of Pathology and Molecular Medicine, University Hospital Motol and 2nd Medical School
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Zemanek D, Veselka J, Kautznerova D, Tesar D. The anomalous origin of the left coronary artery from the right aortic sinus: is the coronary angiography still a 'gold standard'? Int J Cardiovasc Imaging 2005; 22:127-33. [PMID: 16078000 DOI: 10.1007/s10554-005-9005-3] [Citation(s) in RCA: 13] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 06/11/2005] [Indexed: 11/28/2022]
Abstract
Coronary artery anomalies remain a poorly understood topic in modern cardiology. The most important issue is the origin of the left coronary artery or the left anterior descending artery from the opposite aortic sinus, frequently associated with sudden cardiac death. We report our experience concerning the evaluation of these anomalies. From 15 April 1997 to 1 December 2004, we performed 13.407 coronary angiographies and found eight patients with these anomalies. In seven patients the coronary angiography was sufficient for the ultimate decision. However, in one case was the angiographic signs contradictory and the optimal imaging of the coronary tree was received by the multi-slice spiral computer tomography. We consider the coronary angiography a sufficient method of evaluation in most of the patients with the coronary artery anomalies, but the 'gold standard' is 3-dimensional examination by the multi-slice computer tomography or the magnetic resonance. The computer tomography is the method of the choice to distinguish interarterial, intraseptal and prepulmonary course of the left coronary artery originating from the right aortic sinus.
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Affiliation(s)
- David Zemanek
- Department of Cardiology, University Hospital Motol, Prague, Czech Republic.
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Bender M, Gardner TP, Urbano RC, Forness SR, Lynch EW, Rothberg JM, Zemanek D. Identifying inservice training programs in university affiliated facilities. Ment Retard 1981; 19:173-5. [PMID: 7278644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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