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Motovska Z, Hlinomaz O, Hromadka M, Mrozek J, Precek J, Kala P, Muzafarova T, Kettner J, Matejka J, Bis J, Cervinka P, Tomasov P, Klechova A, Sanca O, Jarkovsky J. Utilization of healthcare services in acute myocardial infarction and the risk of out-of-hospital cardiac death. Panminerva Med 2024; 66:79-81. [PMID: 37535044 DOI: 10.23736/s0031-0808.23.04910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Affiliation(s)
- Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic -
| | - Ota Hlinomaz
- First Department of Internal Medicine and Cardioangiology, International Clinical Research Center, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Milan Hromadka
- Department of Cardiology, Faculty of Medicine in Pilsen, University Hospital of Pilsen, Charles University, Pilsen, Czech Republic
| | - Jan Mrozek
- Department Cardiovascular Surgery, University Hospital of Ostrava, Ostrava, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I and Cardiology, Faculty of Medicine and Dentistry, University Hospital of Olomouc, Palacky University, Olomouc, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital of Brno, Masaryk University, Brno, Czech Republic
| | - Tamilla Muzafarova
- Cardiocenter, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Cardiology, Prague, Czech Republic
| | - Jan Matejka
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czech Republic
| | - Josef Bis
- Department of Cardiovascular Medicine I, University Hospital of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajska Zdravotni A.S., Masaryk Hospital, Jan Evangelista Purkyne University, Usti nad Labem, Czech Republic
| | - Pavol Tomasov
- Cardiocenter, Liberec Regional Hospital, Liberec, Czech Republic
| | - Anna Klechova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Ondrej Sanca
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Hlinomaz O, Motovska Z, Kala P, Hromadka M, Precek J, Mrozek J, Červinka P, Kettner J, Matejka J, Zohoor A, Bis J, Jarkovsky J. Outcomes of patients with myocardial infarction and cardiogenic shock treated with culprit vessel-only versus multivessel primary PCI. Hellenic J Cardiol 2024; 76:1-10. [PMID: 37633488 DOI: 10.1016/j.hjc.2023.08.009] [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] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Multivessel primary percutaneous coronary intervention (pPCI) is still often used in patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and multivessel coronary disease (MVD) treated with culprit vessel-only pPCI or multivessel-pPCI during the initial procedure. MATERIAL AND METHODS From 2016 to 2020, 23,703 primary PCI patients with STEMI were included in a national all-comers registry of cardiovascular interventions. Of them, 1,213 (5.1%) patients had CS and MVD at admission to the hospital. Initially, 921 (75.9%) patients were treated with culprit vessel (CV)-pPCI and 292 (24.1%) with multivessel (MV)-pPCI. RESULTS Patients with 3-vessel disease and left main disease had a higher probability of being treated with MV-pPCI than patients with 2-vessel disease and patients without left main disease (28.5% vs. 18.6%; p < 0.001 and 37.7% vs. 20.6%; p < 0.001). Intra-aortic balloon pump, extracorporeal membrane oxygenation (ECMO), and other mechanical circulatory support systems were more often used in patients with MV-pPCI. Thirty (30)-day and 1-year all-cause mortality rates were similar in the CV-pPCI and MV-pPCI groups (odds ratio, 1.01; 95% confidence interval [CI] 0.77 to 1.32; p = 0.937 and 1.1; 95% CI 0.84 to 1.44; p = 0.477). The presence of 3-vessel disease and the use of ECMO were the strongest adjusted predictors of 30-day and 1-year mortality. CONCLUSIONS Our data from an extensive all-comers registry suggests that selective use of MV-pPCI does not increase the all-cause mortality rate in patients with CS-STEMI and MVD compared to CV-pPCI.
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Affiliation(s)
- Ota Hlinomaz
- International Clinical Research Center and Department of Cardioangiology, St. Anne University Hospital and Masaryk University, Brno, Czech Republic
| | - Zuzana Motovska
- Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Petr Kala
- University Hospital Brno and Faculty of Medicine of Masaryk University, Department of Internal Medicine and Cardiology, Brno, Czech Republic
| | - Milan Hromadka
- University Hospital and Faculty of Medicine, Pilsen, Czech Republic
| | - Jan Precek
- University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Mrozek
- University Hospital and Faculty of Medicine, Ostrava, Czech Republic
| | | | - Jiri Kettner
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Matejka
- Regional Hospital, Pardubice, Czech Republic
| | | | - Josef Bis
- University Hospital and Faculty of Medicine, Hradec Kralové, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses of Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Czech Republic
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Vetrovsky T, Siranec M, Frybova T, Gant I, Svobodova I, Linhart A, Parenica J, Miklikova M, Sujakova L, Pospisil D, Pelouch R, Odrazkova D, Parizek P, Precek J, Hutyra M, Taborsky M, Vesely J, Griva M, Semerad M, Bunc V, Hrabcova K, Vojkuvkova A, Svoboda M, Belohlavek J. Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial. Circulation 2024; 149:177-188. [PMID: 37955615 PMCID: PMC10782943 DOI: 10.1161/circulationaha.123.067395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Physical activity is pivotal in managing heart failure with reduced ejection fraction, and walking integrated into daily life is an especially suitable form of physical activity. This study aimed to determine whether a 6-month lifestyle walking intervention combining self-monitoring and regular telephone counseling improves functional capacity assessed by the 6-minute walk test (6MWT) in patients with stable heart failure with reduced ejection fraction compared with usual care. METHODS The WATCHFUL trial (Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction) was a 6-month multicenter, parallel-group randomized controlled trial recruiting patients with heart failure with reduced ejection fraction from 6 cardiovascular centers in the Czech Republic. Eligible participants were ≥18 years of age, had left ventricular ejection fraction <40%, and had New York Heart Association class II or III symptoms on guidelines-recommended medication. Individuals exceeding 450 meters on the baseline 6MWT were excluded. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly telephone counseling from research nurses who encouraged them to use behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The patients in the control group continued usual care. The primary outcome was the between-group difference in the distance walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate to vigorous physical activity as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention to treat. RESULTS Of 218 screened patients, 202 were randomized (mean age, 65 years; 22.8% female; 90.6% New York Heart Association class II; median left ventricular ejection fraction, 32.5%; median 6MWT, 385 meters; average 5071 steps/day; average 10.9 minutes of moderate to vigorous physical activity per day). At 6 months, no between-group differences were detected in the 6MWT (mean 7.4 meters [95% CI, -8.0 to 22.7]; P=0.345, n=186). The intervention group increased their average daily step count by 1420 (95% CI, 749 to 2091) and daily minutes of moderate to vigorous physical activity by 8.2 (95% CI, 3.0 to 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. CONCLUSIONS Whereas the lifestyle intervention in patients with heart failure with reduced ejection fraction improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the lack of association between increased physical activity and functional outcomes. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03041610.
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic (T.V., M. Semerad, V.B.)
| | - Michal Siranec
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
| | - Tereza Frybova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
| | - Iulian Gant
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
| | - Iveta Svobodova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic (J.P., M.M., L.S., D.P.)
| | - Marie Miklikova
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic (J.P., M.M., L.S., D.P.)
| | - Lenka Sujakova
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic (J.P., M.M., L.S., D.P.)
| | - David Pospisil
- Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic (J.P., M.M., L.S., D.P.)
| | - Radek Pelouch
- 1st Department of Internal Medicine, Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic (R.P., D.O., P.P.)
| | - Daniela Odrazkova
- 1st Department of Internal Medicine, Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic (R.P., D.O., P.P.)
| | - Petr Parizek
- 1st Department of Internal Medicine, Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Czech Republic (R.P., D.O., P.P.)
| | - Jan Precek
- Department of Internal Medicine 1, Cardiology, University Hospital Olomouc, Czech Republic (J.P., M.H., M.T.)
| | - Martin Hutyra
- Department of Internal Medicine 1, Cardiology, University Hospital Olomouc, Czech Republic (J.P., M.H., M.T.)
| | - Milos Taborsky
- Department of Internal Medicine 1, Cardiology, University Hospital Olomouc, Czech Republic (J.P., M.H., M.T.)
| | - Jiri Vesely
- Edumed sro, Broumov, and Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic (J.V.)
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic (M.G.)
| | - Miroslav Semerad
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic (T.V., M. Semerad, V.B.)
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic (T.V., M. Semerad, V.B.)
| | - Karolina Hrabcova
- Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic (K.H., A.V., M. Svoboda)
| | - Adela Vojkuvkova
- Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic (K.H., A.V., M. Svoboda)
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic (K.H., A.V., M. Svoboda)
| | - Jan Belohlavek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic (M. Siranec, T.F., I.G., I.S., A.L., J.B.)
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Sluka M, Hutyra M, Nykl R, Ostransky J, Furst T, Petrova P, Precek J, Hudec S, Taborsky M. Risk stratification using growth differentiation factor 15 in patients undergoing transcatheter aortic valve implantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:263-271. [PMID: 35416185 DOI: 10.5507/bp.2022.017] [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] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Growth differentiation factor 15 (GDF15) shows potential predictive value in various cardiac conditions. We investigated relationships between GDF15 and clinical or procedural outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) in order to propose clinically useful predictive risk stratification model. METHODS This prospective single-center registry enrolled 88 consecutive patients with severe symptomatic aortic stenosis treated with TAVI. Clinical parameters were collected and biomarkers including GDF-15 were measured within 24 h before TAVI. All relevant clinical outcomes according to the Valve Academic Research Consortium-2 were collected over the follow-up period. RESULTS The cohort included 52.3% of females. The mean age of study participants was 81 years; the mean Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 3.6% and 15.4%, respectively. The mortality over the entire follow-up period was 10.2%; no death was observed within the first 30 days following TAVI. Univariate analysis showed significant associations between GDF15 and mortality (P=0.0006), bleeding (P=0.0416) and acute kidney injury (P=0.0399). A standard multivariate logistic regression model showed GDF-15 as the only significant predictor of mortality (P=0.003); the odds ratio corresponding to an increase in GDF15 of 1000 pg/mL was 1.22. However, incremental predictive value was not observed when the STS score was combined with GDF15 in this predictive model. CONCLUSIONS Based on our observations, preprocedural elevated GDF15 levels are associated with increased mortality and demonstrate their additional value in predicting adverse clinical outcomes in a TAVI population.
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Affiliation(s)
- Martin Sluka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Jiri Ostransky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Tomas Furst
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University Olomouc, Czech Republic
| | - Pavla Petrova
- Department of Clinical Biochemistry, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Stepan Hudec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
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Vetrovsky T, Siranec M, Frybova T, Gant I, Semerad M, Miklikova M, Bunc V, Vesely J, Stastny J, Griva M, Precek J, Pelouch R, Parenica J, Jarkovsky J, Belohlavek J. Statistical analysis plan for a randomized controlled trial examining pedometer-based walking intervention in patients with heart failure with reduced ejection fraction: the WATCHFUL trial. Trials 2023; 24:539. [PMID: 37587489 PMCID: PMC10433657 DOI: 10.1186/s13063-023-07516-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Physical activity is an effective management strategy for heart failure with reduced ejection fraction, but patients' compliance is challenging. Walking is a suitable form of physical activity due to its convenience and sustainability, and it can potentially improve functional capacity in heart failure patients. OBJECTIVES The WATCHFUL trial aims to determine whether a pedometer-based walking intervention combined with face-to-face sessions and regular telephone contact improves functional capacity in heart failure patients. METHODS The WATCHFUL trial is a 6-month multicenter, parallel-group, randomized, controlled, superiority trial with a 6-month follow-up. A total of 202 patients were recruited for the trial. The primary analysis will evaluate the change in distance walked during the 6-min walk test from baseline to 6 months based on the intention-to-treat population; the analysis will be performed using a linear mixed-effect model adjusted for baseline values. Missing data will be imputed using multiple imputations, and the impact of missing data will be assessed using a sensitivity analysis. Adverse events are monitored and recorded throughout the trial period. DISCUSSION The trial has been designed as a pragmatic trial with a scalable intervention that could be easily translated into routine clinical care. The trial has been affected by the COVID-19 pandemic, which slowed patients' recruitment and impacted their physical activity patterns. CONCLUSIONS The present publication provides details of the planned statistical analyses for the WATCHFUL trial to reduce the risks of reporting bias and erroneous data-driven results. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT03041610, registered: 3/2/2017).
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.
| | - Michal Siranec
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tereza Frybova
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iulian Gant
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miroslav Semerad
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Marie Miklikova
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Jiri Vesely
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- Edumed S.R.O, Broumov, Czech Republic
| | - Jiri Stastny
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
- Innere Medizin I - Abteilung Für Kardiologie Und Internistische Intensivmedizin, Landesklinikum Mistelbach, Mistelbach, Austria
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
- University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Jiri Parenica
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Belohlavek
- 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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Muzafarova T, Motovska Z, Hlinomaz O, Kala P, Hromadka M, Precek J, Mrozek J, Matejka J, Kettner J, Bis J, Jarkovsky J. The Prognosis of Cardiogenic Shock Following Acute Myocardial Infarction-an Analysis of 2693 Cases From a Prospective Multicenter Registry. Dtsch Arztebl Int 2023; 120:538-539. [PMID: 37721142 PMCID: PMC10534133 DOI: 10.3238/arztebl.m2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Tamilla Muzafarova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Czech Republic,
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Czech Republic,
| | - Ota Hlinomaz
- First Department of Internal Medicine-Cardioangiology, ICRC, Faculty of Medicine of Masaryk University and St. Anne’s University Hospital Brno, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital Brno, Czech Republic
| | - Milan Hromadka
- Department of Cardiology, University Hospital and Faculty of Medicine in Pilsen, Charles University, Czech Republic
| | - Jan Precek
- First Internal Cardiology Clinic, University Hospital Olomouc, Czech Republic
| | - Jan Mrozek
- Cardiovascular Department, University Hospital Ostrava, Czech Republic
| | - Jan Matejka
- Department of Cardiology, Regional Hospital Pardubice, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Bis
- First Department of Internal Medicine – Cardioangiology, University Hospital, Faculty of Medicine, Charles University, Hradec Králové, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- The Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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Spacek M, Vacha J, Precek J, Hutyra M, Nykl R, Sluka M, Taborsky M. Complete revascularization of multivessel coronary artery disease in patients with ST elevation acute coronary syndrome - for whom and when? A comprehensive review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:16-23. [PMID: 35703363 DOI: 10.5507/bp.2022.024] [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] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Atherosclerosis is the most common cause of coronary steno-occlusive disease and acute myocardial infarction is the leading cause of death in industrialized countries. In patients with acute ST elevation myocardial infarction (STEMI), there is unquestionable evidence that primary percutaneous coronary intervention providing recanalization of the infarct related artery (IRA) is the preferred reperfusion strategy. Nevertheless, up to 50% of patients with STEMI have multivessel coronary artery disease defined as at least 50% stenosis exclusive of IRA. There is conflicting data regarding the optimal treatment strategy and timing in such patients. Currently, it is assumed that stable patients might benefit from complete revascularization particularly in reducing the need for future unplanned procedures but only culprit lesion should be treated during index procedure in unstable patients. In this article, we provide a comprehensive overview of this important and currently highly debated topic.
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Affiliation(s)
- Miloslav Spacek
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Vacha
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Radomir Nykl
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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Nykl R, Hutyra M, Cechakova E, Precek J, Vindis D, Richter D, Taborsky M. High incidence of acute and subacute ischaemic foci on brain MRI in patients with a diagnosis of acute pulmonary embolism and confirmed patent foramen ovale. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 36691764 DOI: 10.5507/bp.2023.005] [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: 01/25/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is a common and potentially life-threatening diagnosis when a certain amount of thrombotic mass obstructs blood flow through the pulmonary circulation. The finding of acute and subacute ischaemic foci on magnetic resonance imaging (MRI) of the brain in a group of patients with this diagnosis in whom we demonstrate the presence of patent foramen ovale (PFO) by transoesophageal echocardiography (TEE) is surprisingly high. METHODS A total of 129 patients with a diagnosis of pulmonary embolism (confirmed by computed tomography with contrast agent, CTA) who consented to further examination were examined by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) with contrast agent, underwent magnetic resonance imaging of the brain according to a specific protocol, and underwent a comprehensive baseline laboratory examination. RESULTS In our group of 129 patients, we found the presence of PFO in 36.4% (n=47) of them. A total of 5.4% (n=7) patients had asymptomatic acute and subacute ischaemic changes on brain MRI; 6 of them had concomitant PFO. The statistically significant correlation between troponin levels and the presence of pathological findings on MRI and the trend of a similar correlation for NT-proBNP values is also very interesting finding. CONCLUSIONS The association between the presence of PFO and the occurrence of symptomatic or asymptomatic findings on brain MRI is a well-known fact (the issue of paradoxical embolism) but the high frequency of acute and subacute lesions on brain MRI in the group of patients with a diagnosis of acute PE is surprising.
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Affiliation(s)
- Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Eva Cechakova
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Vindis
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Richter
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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9
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Hudec S, Hutyra M, Precek J, Latal J, Nykl R, Spacek M, Sluka M, Sanak D, Tudos Z, Pastucha D, Taborsky M. Determination of the prevalence and predictors of ventricular thrombus with assessment of the risk of systemic embolization to the CNS in patients after acute myocardial infarction using magnetic resonance imaging, echocardiography and cardiac markers - a prospective, unicentric, observational study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023. [PMID: 38214057 DOI: 10.5507/bp.2023.050] [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: 01/13/2024] Open
Abstract
BACKGROUND Left ventricular thrombus (LVT) formation is one of the well-known and serious complications of acute myocardial infarction (AMI) due to the risk of systemic arterial embolization (SE). To diagnose LVT, echocardiography (TTE) is used. Late gadolinium-enhanced cardiovascular magnetic resonance (DE-CMR) is the gold standard for diagnosing LVT. OBJECTIVES The aim of this observational study was to determine the role of transthoracic echocardiography and cardiac markers in predicting the occurrence of LVT compared with a reference cardiac imaging (DE-CMR) and to determine the risk of systemic embolization to the CNS using brain MRA. METHODS Seventy patients after MI managed by percutaneous coronary intervention (localization: 92.9% anterior wall, 7% other; median age 58.7 years) were initially examined by transthoracic echocardiography (TTE, n=69) with a focus on LVT detection. Patients were then referred for DE-CMR (n=55). Laboratory determination of cardiac markers (Troponin T and NTproBNP) was carried out in all. Brain MRA was performed 1 year apart (n=51). RESULTS The prevalence of LVT detected by echocardiography: (n=11/69, i.e. 15.9%); by DE-CMR: (n=9/55, i.e. 16.7%). Statistically significant parameters to predict the occurrence of LVT after AMI (cut off value): (a) detected by echocardiography: anamnestic data - delay (≥ 5 hours), echocardiographic parameters - left atrial volume index (LAVI≥ 32 mL/m2), LV EF Simpson biplane and estimated (≤ 42%), tissue Doppler determination of septal A wave velocity (≤ 7.5cm/s); (b) detected by DE-CMR: anamnestic data - delay (≥ 13 hours), DE-CMR parameters - left ventricular end-diastolic diameter (≥ 54mm). The value of cardiac markers (Troponin T and NTproBNP in ng/L) in LVT detected by echocardiography did not reach statistical significance. In LVT detected by DE-CMR, NTproBNP was statistically significantly increased at 1 month after AMI onset (no optimal cut-off value could be determined). There was no statistically significant association between the LVT detection (both modalities) and the occurrence of clinically manifest and silent cardioembolic events. CONCLUSION Our study confirmed a relatively high prevalence of LVT in the high-risk group of patients with anterior wall STEMI. Due to the low prevalence of thromboembolic complications, no significant association between the LVT detection and the occurrence of a cardioembolic event was demonstrated.
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Affiliation(s)
- Stepan Hudec
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Latal
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Radomir Nykl
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Miloslav Spacek
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Sanak
- Complex Cerebrovascular Centre, Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Dalibor Pastucha
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava and University Hospital Ostrava, Ostrava, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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10
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Motovska Z, Hlinomaz O, Hromadka M, Kala P, Klechova A, Precek J, Kettner J, Mrozek J, Cervinka J, Matejka J, Zohor A, Bis J, Jarkosvky J. Impact of COVID-19 pandemic on the occurrence and outcome of cardiogenic shock complicating acute myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1510] [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: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic had influenced the patient's behavior and impacted the homeostasis to a pro-thrombotic niveau.
Aim
The study aimed to follow the impact of COVID-19 on the incidence and prognosis of cardiogenic shock complicated initially acute myocardial infarction (CS-AMI).
Methods
We used data entered into a large national all-comers registry of coronary intervention over five years. From 1/2016 to 12/2020, 50,745 AMI patients were included, and 2,822 (5.6%) initially had CS.
Results
The incidence of CS-AMI was significantly higher in the COVID period (2020) than the mean incidence in 2016–2019 (5.5% vs 6%, p=0.032). The difference was caused by significant increase of CS in acute STEMI (7.6% vs. 8.7%, p=0.011); it was 7.1% in 2016, 7.8% (2017), 7.6% (2018), 7.8% (2019), and 8.7% (2020). The CS complicated 2.3% (2016), 2.7% (2017), 2.7% (2018), 2.8% (2019), and 2.8% (2020) of NSTEMI.
The observed rise in CS-STEMI incidence each month during the pandemic compared to the average incidence in non-pandemic years correlated with the substantial increase in the number of COVID infected/hospitalized (Table 1). In these months, no changes in time delay to reperfusion layout were observed in CS-STEMI patients (Table 2).
Except of less frequent history of previous PCI (13.9% and 8.2%, p<0.001), we found no significant differences in the followed CS-STEMI patient characteristics in 2016–2019 and 2020; men 72.7% and 75.4% (p=0.1), mean age (SD) 66.3 (12.3)yrs and 66.3 (12.2) yrs, Diabetes 20.9% and 19.1% (p=0.2), CKD 5.4% and 5.7% (p=0.4), previous CABG 4.5 and 4.2% (p=0.5), left main disease (14.3% and 16%, p=0.5), one vessel disease 24.9% and 32.1% (p=0.9), pre-PCI TIMI flow 0 64.4% and 66.2% (p=0.6), post-PCI TIMI flow 3 76.7% and 76.9%.
The COVID pandemic didn't influence the proportions of pre-hospital resuscitated CS-AMI patients (57.5% and 58.7%, p=0.6) and those on mechanical ventilation (67.8% and 68.3%, p=0.8).
The 30-day mortality trend of CS-AMI was 53.7% in 2016, 51.6% (2017), 49.7% (2018), 49.3% (2019), and 47.9% (2020). And in CS-STEMI it was 50.8%, 47.1%, 46.4%, 44.1%, and 45.3% (P2019 vs. 2020 =0.8), respectively.
Conclusion
Data from a large national all-comer registry showed an increase in the proportion of patients admitted to hospitals with STEMI complicated by CS in the year of the COVID pandemic. The CS rise correlated with the increase in the COVID infected population. Factors other than the patient's cardiovascular risk profile or prolongation of a time delay to reperfusion influenced this trend. We suggest that the availability of health care and patient adherence may have affected the risks control. We did not observe any effect of the pandemic on CS-AMI mortality.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic
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Affiliation(s)
- Z Motovska
- Charles University Prague, 3rd Faculty of Medicine, Faculty Hospital Kralovske Vinohrady , Prague , Czechia
| | - O Hlinomaz
- St. Anne University Hospital Brno (FNUSA) , Brno , Czechia
| | - M Hromadka
- Charles University and Univ. Hospital, Department of Cardiology , Plzen , Czechia
| | - P Kala
- University hospital-Bohunice and Masaryk University , Brno , Czechia
| | - A Klechova
- Institute for Health Information and Statistics , Prague , Czechia
| | - J Precek
- University Hospital Olomouc , Olomouc , Czechia
| | - J Kettner
- Institute of Clinical and experimental cardiology , Prague , Czechia
| | - J Mrozek
- University Hospital Ostrava , Ostrava , Czechia
| | - J Cervinka
- Masaryk Hospital , Usti Nad Labem , Czechia
| | - J Matejka
- Regional Hospital Pardubice , Pardubice , Czechia
| | - A Zohor
- Hospital Karlovy Vary , Karlovy Vary , Czechia
| | - J Bis
- University Hospital Hradec Kralove , Hradec Kralove , Czechia
| | - J Jarkosvky
- Institute of Biostatistics and Analyses of Masaryk University , Brno , Czechia
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11
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Hlinomaz O, Motovska Z, Kala P, Hromadka M, Precek J, Mrozek J, Cervinka P, Kettner J, Matejka J, Zohor A, Bis J, Jarkovsky J. All-cause mortality of patients with STEMI, cardiogenic shock and multivessel coronary disease treated with culprit vessel only versus multivessel primary PCI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2069] [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: 11/12/2022] Open
Abstract
Abstract
Background
Patients with ST elevation myocardial infarction (STEMI) and cardiogenic shock (CS) treated with primary percutaneous coronary intervention (pPCI) have high mortality. A recent trial demonstrated that a culprit vessel-only strategy (CV-pPCI) was superior to immediate multivessel PCI (MV-pPCI) for patients with CS and multivessel coronary artery disease (MVD). Irrespective of it and current guidelines, multivessel PCI is still often used in these patients.
Purpose/Methods
The study aimed to compare the characteristics and prognosis of patients with CS-STEMI and MVD treated with culprit vessel only pPCI or multivessel PCI during initial procedure. From 2016 to 2020, 23703 primary PCI patients with STEMI were included in the national all-comers registry of cardiovascular interventions. From them, a total of 1213 (5.1%) patients had cardiogenic shock and MVD at admission to the hospital. Initially 921 (75.9%) patients were treated with CV-pPCI and 292 (24.1%) with MV-pPCI.
Results
CV-pPCI was a preferred strategy to MV-pPCI in men (74.6% vs 25.4%; p<0,001) and women (79.8% vs 20.2%; p<0,001) with CS-STEMI and MVD. Patients with 3-vessel disease and left main disease had higher probability to be treated with MV-pPCI than patients with 2-vessel disease and without left main disease (28.5% vs 18.6%; p<0,001 and 37.7% vs 20.6%; p<0,001).The CV-pPCI and MV-pPCI group patients did not differ in age (68.1±11.2 vs 66.2±11.4 years; p=0.780), previous PCI (16.1% vs 12.0%; p=0.890) and CABG (6.2% vs 4.8%; p=0.376), chronic kidney disease (6.8% vs 8.2%; p=0.426), cardiopulmonary resuscitation (60.4% vs 58.9%; p=0.657) and pulmonary ventilation (66.8% vs 70.5%; p=0.227) at admission, localization of myocardial infarction (anterior 50.8.% vs 58.9%; p=0.671), time to reperfusion (<2 hours 5.2% vs 4.8%; p=0.722) and TIMI flow 0 before PCI (63.1% vs 64.0%; p=0.675). Based on the results of logistic regression analysis, 30-days (odds ratio, 0.99; 95% CI 0.76 to 1.29; p=0.937) and 1-year (odds ratio, 0.91; 95% CI 0.69 to 1.19; p=0.477) all-cause mortality rates were similar in CV-pPCI and MV-pPCI groups. The presence of 3-vessel disease was the strongest adjusted predictor of 30-days (odds ratio, 1.61; 95% CI 1.27 to 2.04; p<0.001) and 1-year (odds ratio, 1.64; 95% CI 1.30 to 2.08; p<0.001) all-cause mortality in patients with STEMI and CS treated with pPCI.
Conclusion
Immediate multivessel primary PCI is still used in patients with CS-STEMI and MVD in routine clinical practice. We did not find difference in 30-days and 1-year mortality among patients with CS-STEMI and MVD treated either with culprit vessel-only or multivessel primary PCI.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NV19-02-00086 supported by Ministry of Health of the Czech Republic
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Affiliation(s)
- O Hlinomaz
- St. Anne University Hospital and Masaryk University , Brno , Czechia
| | - Z Motovska
- Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady , Prague , Czechia
| | - P Kala
- Faculty of Medicine of Masaryk University and University Hospital, Department of Internal Medicine and Cardiology , Brno , Czechia
| | - M Hromadka
- University Hospital and Faculty of Medicine , Pilsen , Czechia
| | - J Precek
- University Hospital and Faculty of Medicine , Olomouc , Czechia
| | - J Mrozek
- University Hospital and Faculty of Medicine , Ostrava , Czechia
| | - P Cervinka
- Masaryk Hospital , Usti Nad Labem , Czechia
| | - J Kettner
- Institute of Clinical and Experimental Medicine , Prague , Czechia
| | - J Matejka
- Regional Hospital , Pardubice , Czechia
| | - A Zohor
- Regional Hospital , Karlovy Vary , Czechia
| | - J Bis
- University Hospital and Faculty of Medicine , Hradec Kralové , Czechia
| | - J Jarkovsky
- Institute of Biostatistics and Analyses of Masaryk University , Brno , Czechia
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12
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Hutyra M, Sanak D, Kral M, Dornak T, Precek J, Hudec S, Navratil K, Kocianova E, Koubek F, Kanovsky P, Taborsky M. Transoesophageal echocardiography findings in young patients with cryptogenic ischemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2627] [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 and purpose
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. The use of transoesophageal echocardiography (TEE) allows reliable detection of most relevant structural pathologies. The aim was to assess frequency and spectrum of relevant cardiac abnormities in young IS patients.
Subjects and methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, registered on ClinicalTrials.gov NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, TEE, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 1284 patients enrolled in the HISTORY study, 135 (73 males, mean age 40.2±8.1 years) were <40 years. In total, the relevant TEE abnormities were present in 47 (35%) of these patients. Patent foramen ovale (PFO) with evident left to right shunt was detected in 38 (28%) patients, with significant right to left shunt in 25 (19%) patients, and other atrial septal defect with clinically significant bidirectional flow in 4 (3%) patients. Significant valvular heart disease was present in 2 (1%) patients (1 bicuspid aortic valve with moderate aortic regurgitation, 1 chronic severe mitral regurgitation), and 4 (3%) patients severe left ventricular systolic dysfunction (left ventricular ejection fraction ≤35%) due to idiopathic dilated cardiomyopathy. Left atrial myxoma was detected in one patient.
Conclusion
The relevant structural abnormities with embolic potential were detected using TEE in 35% of young IS patients. Routine use of TEE to elucidate the causes of stroke, has a role especially in young patients who present with cryptogenic stroke and no cardiovascular risk factors, as well as in the setting of a PFO associated with a deep venous thrombosis.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA LF UP, MH CZ - DRO
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Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - S Hudec
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - K Navratil
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - E Kocianova
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - F Koubek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology , Olomouc , Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology , Olomouc , Czechia
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13
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Siranec M, Vetrovsky T, Parenica J, Miklikova M, Pelouch R, Precek J, Vesely J, Griva M, Linhart A, Belohlavek J. Moderate-to-vigorous physical activity of HFrEF patients is strongly associated with age, but not with functional capacity (6MWT), ejection fraction, NYHA, NT-proBNP, sex or BMI. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.019] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council of the Ministry of Health of the Czech Republic
Introduction
Patients with heart failure with reduced ejection fraction (HFrEF) commonly have impaired functional capacity and exercise intolerance which negatively affect their daily living activities and quality of life. Patients’ level of moderate-to-vigorous physical activity (MVPA) remains low. A popular, easily incorporated into everyday life activity is walking, which at a pace of 5 km/h can be considered moderate intensity physical activity. We explored whether the level of MVPA in HFrEF patients is associated with certain demographic and clinical parameters.
Methods
We analysed baseline values of HFrEF patients recruited in a multicentre randomised controlled trial of a six-month walking intervention (WATCHFUL trial, ClinicalTrials.gov identifier: NCT03041610). Their physical activity was objectively measured over seven days using accelerometer ActiGraph wGT3X-BT worn on the waist. Weekly minutes of MVPA were calculated using Freedson (1998) algorithm. The association between minutes of MVPA and sex, age, body mass index (BMI), HF symptoms (NYHA class), left ventricular ejection fraction (LVEF), serum levels of NT-proBNP, and distance walked in a six-minute walk test (6MWT) was explored in a series of univariate and multivariate linear regression models.
Results
One hundred twenty-two patients were included in the analysis (31 females and 81 males, age 63.2±11.7 years, BMI 30.1±5.4, NYHA class II/III: 99/13, LVEF 30.5±7.0%, NT-proBNP 1169±1888 ng/L, 6MWT 365±61 m). They accumulated 33.8±40.3 min/week of MVPA. The weekly minutes of MVPA were negatively associated with patients' age: being one year older was associated with 1.8 min (SE 0.3) less MVPA (p < 0.001). Neither sex, BMI, NYHA Class, distance walked in 6MWT, nor serum levels of NT-proBNP were associated with weekly minutes of MVPA.
Conclusion
Our results show that moderate-to-vigorous physical activity of HFrEF patients was strongly associated only with age. Surprisingly, commonly used prognostic markers of heart failure such as ejection fraction, NYHA, NT-proBNP, and functional capacity (6MWT) did not show significant. Neither did sex nor BMI. Exercise rehabilitation and increased physical activity improve functional capacity and should be regularly recommended, and even emphasised with age.
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Affiliation(s)
- M Siranec
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Second Department of Medicine - Department of Cardiovascular Medicine, Prague, Czechia
| | - T Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - J Parenica
- University Hospital Brno and Medical Faculty of the Masaryk University, Cardiology Department, Brno, Czechia
| | - M Miklikova
- University Hospital Brno and Medical Faculty of the Masaryk University, Cardiology Department, Brno, Czechia
| | - R Pelouch
- University Hospital Hradec Kralove, 1 st Department of Internal Medicine — Cardioangiology, Hradec Kralove, Czechia
| | - J Precek
- University Hospital Olomouc, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - J Vesely
- Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czechia
| | - M Griva
- Tomas Bata Regional Hospital in Zlin, Department of Cardiology, Zlin, Czechia
| | - A Linhart
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Second Department of Medicine - Department of Cardiovascular Medicine, Prague, Czechia
| | - J Belohlavek
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Second Department of Medicine - Department of Cardiovascular Medicine, Prague, Czechia
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Nykl R, Precek J, Sluka M, Hudec S, Richter D, Heinc P, Taborsky M. Interventional prevention of paradoxical embolism as the gold standard: End of discussion? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:241-248. [PMID: 34158673 DOI: 10.5507/bp.2021.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Paradoxical embolism is one of the predominant causes of cryptogenic stroke and interventional secondary prevention, i.e., closure of the patent foramen ovale (PFO), is a much discussed issue. This review aims to provide a complex perspective on this topic, aggregates and comments on the available data and current guidelines. Several large trials were performed, some of which proved the superiority of PFO closure over pharmacotherapy while others have not. Studies detecting significant superiority of intervention worked with disproportionately high representation of large shunts compared to the general population. Other controversies also remain, such as the lack of comparison of the effect of modern anticoagulant/antiplatelet treatment to PFO closure or the risk of developing unwanted side effects after intervention, and these are discussed in detail. PFO closure is a suitable method for secondary prevention of paradoxical embolism and, therefore, cryptogenic stroke. However, this is only true for carefully selected patient populations and such selection is of the utmost importance in deciding on interventional or conservative treatment.
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Affiliation(s)
- Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Stepan Hudec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - David Richter
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Petr Heinc
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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Aiglova R, Taborsky M, Lazarova M, Pavlu L, Danek J, Precek J, Schee A, Gloger V, Cernicek V, Vicha M, Skala T. Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor antagonists and angiotensin-receptor blocker/neprilysin inhibitor utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:322-327. [PMID: 34092792 DOI: 10.5507/bp.2021.035] [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] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II-receptor antagonists (ARB) and angiotensin receptor blocker/neprilysin inhibitor (ARNI) use. METHODS AND RESULTS ACEi and ARBs were generally used in 87.6% of all HF patients in 2012 (n=154 627); 84.5% in 2013 (n=170 861); 83.5% in 2014 (n=186 963); 81.6% in 2015 (n=198 844); 80.1% in 2016 (n=205 793); 78.0% in 2017 (n=212 152) and in 76.7% in 2018 (n=219 235). In a sub-analysis of patients with a medical procedure and/or examination using an I50.x ICD code accounted for in the given year, ACEi and ARBs were generally used in 99.3% in 2012 (n=63 250); 96% in 2013 (n=62 241); 95.2% in 2014 (n=64 414); 93.3% in 2015 (n=65 217); 91.8% in 2016 (n=65 236); 90.1% in 2017 (n=65 761) and in 88.6% in 2018 (n=66 332). In 2018, the majority of patients with HF were prescribed ramipril (n=49 909; 17.5%) and perindopril (n=44 332; 15.5%). The mostly prescribed ARBs in 2018 were telmisartan (n=18 669; 6.5%); losartan (n=13 935; 4.9%) and valsartan (n=4 849; 1.7%). In 24.5% of cases, ACEIs and ARBs were prescribed in a fixed combination with another drug. ARNI became gradually more prescribed from 2018 (n=9 659 in November 2020). CONCLUSION In an analysis of ACEIs, ARBs and ARNIs utilization in all patients treated for heart failure in the given year in the whole country, we found a comparable rate of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Ramipril and perindopril remained the mostly prescribed ACEIs and telmisartan became the mostly prescribed ARB. Since 2018, ARNIs began to be widely prescribed.
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Affiliation(s)
- Renata Aiglova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Marie Lazarova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ludek Pavlu
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Josef Danek
- Department of Internal Medicine, Military University Hospital Prague, Prague, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Alexander Schee
- Cardio center, Regional Hospital Karlovy Vary, Karlovy Vary, Czech Republic
| | - Vit Gloger
- Bata's Regional Hospital, Zlin, Czech Republic
| | | | - Marek Vicha
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
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Latal J, Pazdernik M, Holicka M, Pelouch R, Widimsky J, Pudich J, Vancata R, Siranec M, Blechova K, Butta T, Mikulcova M, Mikulica M, Wohlfahrt P, Hutyra M, Precek J. Cardiac device-related infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:168-172. [PMID: 33724263 DOI: 10.5507/bp.2021.013] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. PATIENTS AND METHODS National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. RESULTS Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. CONCLUSIONS The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.
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Affiliation(s)
- Jan Latal
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Michal Pazdernik
- Department of Cardiology, IKEM, Prague, Czech Republic.,Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Maria Holicka
- Department of Internal Medicine and Cardiology, University Hospital Brno, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
| | - Jiri Widimsky
- Department of Cardiology, Regional Hospital Liberec, Czech Republic
| | - Jiri Pudich
- Department of Cardiovascular Diseases, University Hospital in Ostrava, Czech Republic
| | - Radek Vancata
- Department of Cardiology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Michal Siranec
- 2nd Department of Internal Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kamila Blechova
- Cardiocenter, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Tadeas Butta
- Department of Cardiology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marketa Mikulcova
- Cardiovascular Center for Adults, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Michal Mikulica
- Cardiovascular Center for Adults, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, 1st Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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17
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Pazdernik M, Holicka M, Pelouch R, Precek J, Widimsky J, Pudich J, Vancata R, Siranec M, Bohm A, Blechova K, Butta T, Mikulcova M, Mikulica M, Wohlfahrt P. Characteristics, management, and outcome of infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry. ACTA ACUST UNITED AC 2021; 122:95-100. [PMID: 33502876 DOI: 10.4149/bll_2021_014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. METHODS Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. RESULTS Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). CONCLUSION High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).
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Taborsky M, Aiglova R, Lazarova M, Pavlu L, Danek J, Precek J, Schee A, Gloger V, Vicha M, Skala T. Beta-blockers utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:402-407. [PMID: 33325457 DOI: 10.5507/bp.2020.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/20/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at beta-blockers (BBs) utilization. METHODS AND RESULTS The beta-blockers were generally used in 81.8% of all patients treated for HF in 2012 (n=52 140); 81.8% in 2013 (n=53 058); 83.1% in 2014 (n=56 221); 82.1% in 2015 (n=57 421); 83.3% in 2016 (n=59 187); 82.2% in 2017 (60 058) and in 81.4% in 2018 (n=60 966). In 2018, the majority of patients treated for HF were prescribed metoprolol (22 974; 30.7%) and bisoprolol (21 001; 28%). Carvedilol was prescribed in 7 331 patients treated for HF (9.8%), nebivolol in 5 392 HF patients. Despite its primary indication, betaxolol was used in 2 341 patients treated for HF (3.1%). All other beta-blockers were used in less than 1% of HF patients. In some of the mostly used BBs, their prescription in patients treated for HF changed in the last years (metoprolol 32.4% in 2012, 30.7% in 2018; bisoprolol 20.3% in 2012, 28% in 2018; carvedilol 18.3% in 2012, 9.8% in 2018; nebivolol 2.5% in 2012, 7.2% in 2018; betaxolol 4.2% in 2012, 3.1% in 2018). CONCLUSION In an analysis of beta-blockers utilization in all patients treated for heart failure in the given year in the whole country, we have found only slightly lower amount of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Metoprolol remained the mostly prescribed drug. The prescription of bisoprolol and nebivolol has increased at the expense of carvedilol.
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Affiliation(s)
- Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Renata Aiglova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Marie Lazarova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Ludek Pavlu
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Josef Danek
- Department of Internal Medicine, Military University Hospital, Prague, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Alexander Schee
- Cardio center, Regional Hospital Karlovy Vary, Karlovy Vary, Czech Republic
| | - Vit Gloger
- Bata's Regional Hospital, Zlin, Czech Republic
| | - Marek Vicha
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
| | - Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, 775 20 Olomouc, Czech Republic
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Precek J, Vykoupil K, Kovacik F, Hutyra M. Prognostic relevance of sleep apnea syndrome in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2243] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep disordered breathing (SDB) is a group of ventilatory disorders during sleep which includes obstructive sleep apnea (OSA), central sleep apnea (CSA), and sleep related hypoventilation. In patients with SDB, the prevalence of pulmonary hypertension (PH) ranges from 17% to 52%. While SDB is prevalent in the general population with recent estimates of 20% to 30%, in those with cardiovascular disease, particularly left ventricular failure, there is a higher reported prevalence of 47%.
Aims
The aims of this study were to determine the prevalence and prognostic relevance of sleep apnea in a cohort of patients with newly diagnosed pulmonary arterial hypertension (ESC/WHO Group 1 pulmonary hypertension).
Methods
We evaluated prospectively 76 patients with the pulmonary arterial hypertension (mean age 54±16 years; 45% male). All patients underwent right heart catheterisation, clinical assessments, sleep study, standard laboratory testing and evaluation of subjective sleepiness by the Epworth Sleepiness Scale. Sleep test was provided with an ApneaLink Plus, consisting of nasal pressure sensor, respiratory effort band, and pulse oximeter worn on the finger. Subjects previously treated for or diagnosed with SDB were excluded from the study.
Results
Sleep apnea (SA) – defined as apnea-hypopnea index (AHI) ≥5/h – was found in 59 (77.6%) of the pulmonary arterial hypertension (PAH) patients. Mean AHI in the cohort of PAH patients with SA was 26.1±16.6/h. Mean follow-up was 24 months, during which 15 (19.7%) patients died. Characteristics of parameters related to SA in groups of survivors and deceased are in table 1. From the sleep apnea-related parameters, only time with O2Sat <90% – T90 was significantly associated with mortality (AUC 0.856; 95% CI 0.693 – 1.019; p<0.001).
Conclusions
The presence of sleep apnea in pulmonary arterial hypertension patients is high. The prevalence of sleep apnea is higher in PAH patients than in the general population. The presence of sleep apnea in patients with PAH was not associated with worse prognosis, but noctural hypoxemia (time with O2Sat <90%) was related to poor prognosis. Sleep apnea in patients with PAH should be screened for systematically.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Precek
- University Hospital Olomouc, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - K Vykoupil
- University Hospital Olomouc, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - F Kovacik
- University Hospital Olomouc, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - M Hutyra
- University Hospital Olomouc, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
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Vetrovsky T, Frybova T, Gant I, Semerad M, Cimler R, Bunc V, Siranec M, Miklikova M, Vesely J, Griva M, Precek J, Pelouch R, Parenica J, Belohlavek J. The detrimental effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. ESC Heart Fail 2020; 7:2093-2097. [PMID: 32696600 PMCID: PMC7405478 DOI: 10.1002/ehf2.12916] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 06/05/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023] Open
Abstract
AIMS A reduction of habitual physical activity due to prolonged COVID-19 quarantine can have serious consequences for patients with cardiovascular diseases, such as heart failure. This study aimed to explore the effect of COVID-19 nationwide quarantine on accelerometer-assessed physical activity of heart failure patients. METHODS AND RESULTS We analysed the daily number of steps in 26 heart failure patients during a 6-week period that included 3 weeks immediately preceding the onset of the quarantine and the first 3 weeks of the quarantine. The daily number of steps was assessed using a wrist-worn accelerometer worn by the patients as part of an ongoing randomized controlled trial. Multilevel modelling was used to explore the effect of the quarantine on the daily step count adjusted for weather conditions. As compared with the 3 weeks before the onset of the quarantine, the step count was significantly lower during each of the first 3 weeks of the quarantine (P < 0.05). When the daily step count was averaged across the 3 weeks before and during the quarantine, the decrease amounted to 1134 (SE 189) steps per day (P < 0.001), which translated to a 16.2% decrease. CONCLUSIONS The introduction of the nationwide quarantine due to COVID-19 had a detrimental effect on the level of habitual physical activity in heart failure patients, leading to an abrupt decrease of daily step count that lasted for at least the 3-week study period. Staying active and maintaining sufficient levels of physical activity during the COVID-19 pandemic are essential despite the unfavourable circumstances of quarantine.
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, José Martího 269/31, Prague, 162 52, Czech Republic
| | - Tereza Frybova
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iulian Gant
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miroslav Semerad
- Faculty of Physical Education and Sport, Charles University, José Martího 269/31, Prague, 162 52, Czech Republic
| | - Richard Cimler
- Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, José Martího 269/31, Prague, 162 52, Czech Republic
| | - Michal Siranec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marie Miklikova
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Jiri Vesely
- Faculty of Medicine in Hradec Králové, Charles University, Prague, Czech Republic.,Edumed s.r.o., Broumov, Czech Republic
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital in Zlin, Zlin, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine-Cardioangiology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jiri Parenica
- Cardiology Department, University Hospital Brno and Medical Faculty of the Masaryk University, Brno, Czech Republic
| | - Jan Belohlavek
- 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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Nykl R, Precek J, Spacek M, Sluka M, Hudec S, Heinc P, Taborsky M. Radial artery pseudoaneurysm as a rare very late complication of transradial cardiac catheterization. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:452-453. [PMID: 32597422 DOI: 10.5507/bp.2020.027] [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] [Received: 04/23/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS Here, we report a case of very late (70+ days) development of pseudoaneurysm on the site of sheath insertion in a 60- year old woman. METHODS The patient underwent cardiac catheterization using transradial approach. RESULTS Despite the transradial approach, which is generally considered as a suitable prevention of this problem, and despite absence of any periprocedural complications, the patient developed a pseudoaneurysm after more than 70 days from the procedure. CONCLUSIONS In some cases, a pseudoaneurysm may develop extremely late after cardiac catheterization. Such an extremely late development of pseudoaneurysm has not been described in literature so far.
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Affiliation(s)
- Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Milos Spacek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Sluka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Stepan Hudec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Petr Heinc
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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22
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Moravec O, Skala T, Klementova O, Skalova J, Hutyra M, Precek J, Fedorco M, Cernicek V, Tudos Z, Zapletalova J, Taborsky M. General anesthesia or conscious sedation in paroxysmal atrial fibrillation catheter ablation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:162-168. [PMID: 32285847 DOI: 10.5507/bp.2020.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/16/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Catheter ablation of paroxysmal atrial fibrillation (AF) can be performed under general anesthesia or conscious sedation. The influence of type of anesthesiology care on procedural characteristics and ablation outcome in patients in whom intracardiac echocardiography (ICE) and elimination of adenosine-mediated dormant conduction (DC) is used is not entirely known. METHODS 150 patients with paroxysmal AF were randomized to point-by-point radiofrequency catheter isolation of pulmonary veins (PVI) under general anesthesia (n=77) or conscious sedation (n=73). Adenosine-mediated dormant conduction was eliminated in all patients. Antiarrhythmic medication was discontinued after PVI. During twelve months of follow-up, all patients underwent four times 7-day ECG monitorings. RESULTS There was no difference between groups in AF recurrence (28.6% vs. 31.5%, P=0.695). Patients in conscious sedation had longer procedure times (160 ± 32.1 vs. 132 ± 31.5 min, P<0.001), longer RF energy application times (40 ± 15 vs. 29 ± 11 min, P<0.001) and longer fluoroscopy times (6.2 min ± 5.3 vs. 4.3 min ± 2.2, P<0.001) with similar complication rates. CONCLUSION Conscious sedation is not inferior to general anesthesia in regard to arrhythmia recurrence or complication rates of catheter ablation of paroxysmal atrial fibrillation. However, it is associated with longer procedure times, longer time of radiofrequency energy application and longer fluoroscopy times.
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Affiliation(s)
- Ondrej Moravec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Jitka Skalova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Marian Fedorco
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Vlastimil Cernicek
- Cardiovascular Centre, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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23
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Hudec S, Hutyra M, Precek J, Latal J, Nykl R, Spacek M, Sluka M, Sanak D, Tudos Z, Navratil K, Pavlu L, Taborsky M. Acute myocardial infarction, intraventricular thrombus and risk of systemic embolism. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:34-42. [DOI: 10.5507/bp.2020.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/03/2020] [Indexed: 01/02/2023] Open
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Hutyra M, Sanak D, Kral M, Veverka T, Dornak T, Divisova P, Precek J, Spacek M, Latal J, Kanovsky P, Taborsky M. P3709Risk of recurrent cerebral ischemia in young patients with cryptogenic ischemic stroke and patent foramen ovale. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0563] [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: 11/12/2022] Open
Abstract
Abstract
Background
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. A persistent foramen ovale (PFO) is a known risk factor for paradoxical embolism, including ischemic stroke (IS).
Aims
The aims of our prospective study were to assess the rates of recurrent ischemic stroke events in young IS patients with PFO during a 35-month follow-up period (FUP) on effective antiplatelet therapy (OAT) and to evaluate a potential relationship with the presence of PFO on transesophageal echocardiography (TEE).
Methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, transesophageal echocardiography, 24-hour and 3-week ECG-Holter were performed in all patients.
Results
Out of 980 patients enrolled in the HISTORY study, 260 patients were younger than 50 years and 185 (56% males, mean age 41±8 years) patients were classified as cryptogenic IS in ASCOD classification. PFO was diagnosed in 60 patients (32%). Six new clinically apparent recurrent ischemic brain events were recorded during a 35-month FUP. No significant difference was found in the presence of IS recurrence between patient group with PFO and without PFO (2 [3.2% patients with PFO] versus 4 [3.2% without PFO] of young IS patients, P=0.99).
Conclusion
The presence of PFO was not associated with a higher risk of new brain ischemic lesions in young patients with with cryptogenic ischemic stroke during a 35-month follow-up period. Number of recurrent clinical IS is relatively small, thus achieved results may be not so robust.
Acknowledgement/Funding
Grant support IGA MZ CR NT/14288-3, AZV MZ CR 17-30101A, IGA LF UP Olomouc (2016-2018), FNOL SUG No. 87-85
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Affiliation(s)
- M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Veverka
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - T Dornak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - P Divisova
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - M Spacek
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - J Latal
- Palacky University, Faculty of Medicine and Dentistry, 1st Dept of Internal Medicine-Cardiology, Olomouc, Czechia
| | - P Kanovsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czechia
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Hetclova D, Hutyra M, Precek J, Moravec O, Skala T, Sanak D, Adam T, Taborsky T. 4034Distance from hospital as an early marker of outcomes in out of hospital cardiac arrest acute myocardial infarction survivors treated with endovascular mild therapeutic hypothermia. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/13/2022] Open
Abstract
Abstract
Background
The prediction of outcome in comatose patients after out of hospital cardiac arrest (OHCA) has major ethical and socioeconomic implications. At present, there is a lack of data comparing the predictive value from cardiac arrest localization to hospital distance in OHCA survivors treated with endovascular therapeutic hypothermia.
Methods
86 patients (64±14 years, 69 men) were evaluated after OHCA due to ventricular fibrillation (VF) during an acute myocardial infarction (MI). All patients (NSTEMI 28%, STEMI 72%) were indicated for urgent coronary angiography, echocardiography for left ventricular ejection fraction (LVEF) estimation using Simpson biplane formula and treated with mild therapeutic hypothermia (MTH) using intravascular temperature management to maintain target temperature (33 °C) for 24 hours. The Cerebral Performance Categories scale (CPC) was used as the outcome measure and was assessed 3 months post admission; a CPC of 3–5 was regarded as a poor outcome (n=45), and a CPC of 1–2 (n=41) as a good outcome.
Results
Distance to hospital was significantly higher (p=0.0473) in patients with poor outcomes (CPC 3–5) after OHCA (37.5±4.5 km) compared with CPC 1–2 patients (27.1±4.4 km). No significant differences in return of spontaneous circulation time (21; 10.5–47.5 95th percentile vs. 23; 10.0–50.0, p=0.738), lactate (7.8; 4.5–12.4 vs. 8.4; 5.4–13.5, p=0.54), LVEF (40; 22–50 vs. 40; 21–62%, p=0.208), peak cardiac troponin T (1.5; 0.08–10.00 vs. 0.64; 0.04–5.28 μg/L, p=0.078), NSE (29.2; 15.7–54.9 vs. 25.8; 13.6–52.3 μg/L, p=0.26) and S100-B (0.17; 0.09–1.69 vs. 0.19; 0.04–1.14 μg/L, p=0.734) were found in CPC 3–5 and CPC 1–2 groups comparison. Using an optimal cut-off value ≥33 km calculated from the receiver operating characteristic curve (area under curve = 0.62; p=0.004), the sensitivity of predicting survival with poor neurological outcome was 61% and the specificity was 62%.
Conclusions
In patients after OHCA for VF during MI, distance from cardiac arrest localization to hospital gives reliable and on return of spontaneous circulation time independent prognostic information concerning outcome after cardiopulmonary resuscitation.
Acknowledgement/Funding
Grant support FNOL RIV 87-85
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Affiliation(s)
- D Hetclova
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - O Moravec
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - T Skala
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Dept. of Neurology, Olomouc, Czechia
| | - T Adam
- Palacky University, Faculty of Medicine and Dentistry, Department of Clinical Biochemistry, Olomouc, Czechia
| | - T Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I - Cardiology, Olomouc, Czechia
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Skala T, Tudos Z, Moravec O, Hutyra M, Precek J, Skalova J, Klementova O, Zapletalova J, Taborsky M. Atrial fibrillation inducibility after pulmonary vein isolation under general anaesthesia. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:261-266. [PMID: 30829344 DOI: 10.5507/bp.2019.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/25/2019] [Indexed: 01/08/2023] Open
Abstract
AIMS Atrial fibrillation (AF) inducibility with rapid atrial pacing following AF ablation is associated with higher risk of AF recurrence. The predictive value of AF inducibility in paroxysmal AF patients after pulmonary vein isolation (PVI), done under general anaesthesia (GA), remains questionable since GA might alter AF inducibility and/or sustainability. METHODS Consecutive patients (n = 120) with paroxysmal AF without prior catheter ablation (CA) were enlisted in the study. All patients were ablated under GA. We have used a point-by-point CA and elimination of dormant conduction after adenosine in all patients. A predefined stimulation protocol was used to induce arrhythmias after PVI. Regular supraventricular tachycardias were mapped and ablated. Patients were divided into 3 subgroups - noninducible, inducible AF with spontaneous termination in five minutes, inducible AF without spontaneous termination. During 12 months of follow-up, all patients were examined four-times with 7-day ECG recordings. RESULTS There was no statistical difference between the three subgroups in a rate of arrhythmia recurrence (11.1 vs. 27.5 vs. 27.3%, P=0.387), despite a clear trend to a better success rate in the non-inducible group. The subgroups did not differ in left atrial (LA) diameter (41.0±6, 43.0±7, 42.0±5 mm, P=0.962) or in any other baseline parameter. CONCLUSION AF inducibility as well as presence or absence of its early spontaneous termination after PVI done under general anaesthesia in paroxysmal AF patients were not useful as predictors of procedural failure.
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Affiliation(s)
- Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Ondrej Moravec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jitka Skalova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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Skala T, Precek J, Hutyra M, Moravec O, Tudos Z, Skalova J, Klementova O, Antonicka A, Zapletalova J, Taborsky M. Long-term outcome of paroxysmal atrial fibrillation catheter ablation with and without pulmonary vein dormant conduction after adenosine challenge. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:147-153. [PMID: 30829343 DOI: 10.5507/bp.2019.005] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/26/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The prognostic significance of adenosine-mediated pulmonary vein (PV) dormant conduction is unclear. We prospectively followed patients with adenosine-mediated PV reconduction with a subsequent repeated ablation until there was no reconduction inducible with patients without reconduction after PV isolation. METHOD AND RESULTS Consecutive patients (n=179) with paroxysmal atrial fibrillation (AF) without prior catheter ablation (CA) were enlisted in the study. We used a point-by-point CA and general anesthesia in all patients. Twenty minutes after PV isolation we administered adenosine in a dose sufficient to produce an atrioventricular block. If a dormant conduction was present (n=54) we performed additional ablation until there was no adenosine mediated reconduction inducible. During 36 months of follow-up, all patients were examined for eight 7-day ECG recordings. There was no difference in arrhythmia recurrence rate between patients with and without dormant conduction (29.6 vs. 24.8% at 12 months, P=0.500; 31.5 vs. 30.4% at 36 months, P=1.000), for any echocardiographic parameter or any parameter of the ablation procedure. CONCLUSION The patients with dormant conduction after adenosine during catheter ablation of paroxysmal atrial fibrillation with complete elimination of the dormant conduction by additional extensive ablation have the same outcome in the long term as patients without a dormant conduction.
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Affiliation(s)
- Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Ondrej Moravec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
| | - Zbynek Tudos
- Department of Radiology, University Hospital Olomouc, Czech Republic
| | - Jitka Skalova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Olga Klementova
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Czech Republic
| | - Andrea Antonicka
- Cardiovascular Center, Tomas Bata County Hospital, Zlin, Czech Republic
| | - Jana Zapletalova
- Department of Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
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Precek J, Hutyra M, Jarkovsky J, Snehota M, Kovacik F, Taborsky M. P5568Prognostic value of markers of renal function ani inflammation in early prediction of hospital mortality and major cardiac adverse events in patients with ST elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5568] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I-Cardiology, Olomouc, Czech Republic
| | - M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I-Cardiology, Olomouc, Czech Republic
| | - J Jarkovsky
- Institute of Biostatistics and Analyses of Masaryk University, Brno, Czech Republic
| | - M Snehota
- Palacky University, Faculty of Medicine and Dentistry, Department of Medical Biophysics, Olomouc, Czech Republic
| | - F Kovacik
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I-Cardiology, Olomouc, Czech Republic
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine I-Cardiology, Olomouc, Czech Republic
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Spacek M, Hutyra M, Vindis D, Precek J, Sanak D, Kral M, Cechakova E, Littnerova S, Adam T, Hudec S, Taborsky M. P4561Relevance of N-terminal fragment of brain natriuretic peptide in prediction of new cerebral infarcts in acute pulmonary embolism. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4561] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Spacek
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine 1 - Cardiology, University Hospital, Olomouc, Czech Republic
| | - M Hutyra
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine 1 - Cardiology, University Hospital, Olomouc, Czech Republic
| | - D Vindis
- Palacky University, Faculty of Medicine and Dentistry, Department of Cardiac Surgery, Olomouc, Czech Republic
| | - J Precek
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine 1 - Cardiology, University Hospital, Olomouc, Czech Republic
| | - D Sanak
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czech Republic
| | - M Kral
- Palacky University, Faculty of Medicine and Dentistry, Department of Neurology, Olomouc, Czech Republic
| | - E Cechakova
- Palacky University, Faculty of Medicine and Dentistry, Department of Radiology, Olomouc, Czech Republic
| | - S Littnerova
- Institute of Biostatistics and Analyses of Masaryk University, Brno, Czech Republic
| | - T Adam
- Palacky University, Faculty of Medicine and Dentistry, Department of Clinical Biochemistry, Olomouc, Czech Republic
| | - S Hudec
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine 1 - Cardiology, University Hospital, Olomouc, Czech Republic
| | - M Taborsky
- Palacky University, Faculty of Medicine and Dentistry, Department of Internal Medicine 1 - Cardiology, University Hospital, Olomouc, Czech Republic
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Sanak D, Hutyra M, Kral M, Precek J, Divisova P, Veverka T, Dornak T, Latal J, Franc D, Bartkova A, Taborsky M, Kanovsky P. Relevant structural and functional heart abnormities in young ischemic stroke patients: Tee findings from the history study. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Latal J, Hutyra M, Vymetal J, Horak P, Precek J, Adam T, Hudec S, Taborsky M. P2585Contribution of right ventricular deformation analysis to screening of pulmonary hypertension in patients with systemic sclerosis and mixed connective tissue disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2585] [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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Vetrovsky T, Siranec M, Parenica J, Griva M, Stastny J, Precek J, Pelouch R, Bunc V, Linhart A, Belohlavek J. Effect of a 6-month pedometer-based walking intervention on functional capacity in patients with chronic heart failure with reduced (HFrEF) and with preserved (HFpEF) ejection fraction: study protocol for two multicenter randomized controlled trials. J Transl Med 2017; 15:153. [PMID: 28673328 PMCID: PMC5496141 DOI: 10.1186/s12967-017-1257-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/24/2017] [Indexed: 12/28/2022] Open
Abstract
Background Regular physical activity is recommended for patients with chronic heart failure to improve their functional capacity, and walking is a popular, effective, and safe form of physical activity. Pedometers have shown potential to increase the amount of walking across a range of chronic diseases, but it is unknown whether a pedometer-based intervention improves functional capacity and neurohumoral modulation in heart failure patients. Methods Two multicenter randomized controlled trials will be conducted in parallel: one in patients with chronic heart failure with reduced ejection fraction (HFrEF), the other in patients with chronic heart failure with preserved ejection fraction (HFpEF). Each trial will consist of a 6-month intervention with an assessment at baseline, at 3 months, at the end of the intervention, and 6 months after completing the intervention. Each trial will aim to include a total of 200 physically inactive participants with chronic heart failure who will be randomly assigned to intervention or control arms. The 6-month intervention will consist of an individualized pedometer-based walking program with weekly step goals, behavioral face-to-face sessions with a physician, and regular telephone calls with a research nurse. The intervention will be based on effective behavioral principles (goal setting, self-monitoring, personalized feedback). The primary outcome is the change in 6-min walk distance at the end of the 6-month intervention. Secondary outcomes include changes in serum biomarkers levels, pulmonary congestion assessed by ultrasound, average daily step count measured by accelerometry, anthropometric measures, symptoms of depression, health-related quality of life, self-efficacy, and MAGGIC risk score. Discussion To our knowledge, these are the first studies to evaluate a pedometer-based walking intervention in patients with chronic heart failure with either reduced or preserved ejection fraction. The studies will contribute to a better understanding of physical activity promotion in heart failure patients to inform future physical activity recommendations and heart failure guidelines. Trial registration The trials are registered in ClinicalTrials.gov, identifiers: NCT03041610, registered 29 January 2017 (HFrEF), NCT03041376, registered 1 February 2017 (HFpEF)
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Affiliation(s)
- Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic
| | - Michal Siranec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic
| | - Jiri Parenica
- Cardiology Department of University Hospital Brno, Jihlavska 340/20, 625 00, Brno, Czech Republic
| | - Martin Griva
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Havlickovo nabrezi 600, 762 75, Zlin, Czech Republic
| | - Jiri Stastny
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Havlickovo nabrezi 600, 762 75, Zlin, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, I. P. Pavlova 185/6, 779 00, Olomouc, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Charles University in Prague - Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Vaclav Bunc
- Faculty of Physical Education and Sport, Charles University, Jose Martiho 31, 162 52, Prague 6, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 00, Prague 2, Czech Republic.
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Kovacik F, Taborsky M, Hutyra M, Moravec O, Precek J. Cardiac amyloidosis: case report. Interv Cardiol 2017. [DOI: 10.4172/interventional-cardiology.1000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Hutyra M, Skala T, Kaminek M, Horak D, Kocher M, Tudos Z, Jarkovsky J, Precek J, Taborsky M. Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2013; 157:12-21. [DOI: 10.5507/bp.2012.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 07/09/2012] [Indexed: 11/23/2022] Open
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Simícek J, Precek J. [Malignant arrhythmia in patients treated with permanent pacemakers]. Vnitr Lek 1982; 28:136-41. [PMID: 7064366] [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: 01/23/2023]
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Kána A, Klabusay L, Mícková V, Precek J, Simícek J, Tomecková A. [Care of patients with acute myocardial infarct in clinical practice]. Vnitr Lek 1978; 24:545-55. [PMID: 676110] [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: 12/23/2022]
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