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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] [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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Comparison of angiographic estimation and invasive hemodynamic measurement of the significance of non-infarct-related residual stenoses in ST-elevation myocardial infarction patients. Arch Med Sci Atheroscler Dis 2023; 8:e169-e176. [PMID: 38283928 PMCID: PMC10811533 DOI: 10.5114/amsad/172971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction Up to 50% of patients with ST elevation myocardial infarction (STEMI) have ≥ 50% stenosis in a major non-infarct-related artery. Several studies have evaluated the prognostic value of the completion of revascularization with overall inconclusive results. Selection of the stenoses was based on the angiographic evaluation, invasive hemodynamic measurement or the combined approach. It is unknown whether such a selection provides correlation of comparable patient groups. Material and methods We enrolled 51 patients (62.7 ±10.2 years) with acute STEMI and at least one residual (50-90%) stenosis in a non-infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67.9 ±10.7%) were evaluated angiographically following primary percutaneous coronary intervention and the hemodynamic significance was estimated with respect to the stenosis severity, caliber of the arterial segment, localization of the stenosis (proximity) as well as the estimated size of the supplied vascular territory. During subsequent hospitalization, invasive measurement of the hemodynamic significance using fractional flow reserve (FFR) was performed to guide the final revascularization strategy (FFR value of ≤ 0.80 considered significant). Results Based on angiographic evaluation, a total of 44 stenoses would be recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, visual evaluation and hemodynamic measurement were discrepant in 27 of 65 (41.5%) stenoses. Conclusions We observed a weak correlation between visual angiographic evaluation and invasive hemodynamic measurement. More stents would be implanted based on angiographic evaluation compared to FFR measurement.
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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] [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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Catheter ablation of atrial fibrillation and atrial tachycardia in patients with pulmonary hypertension: a randomized study. Europace 2023:7161651. [PMID: 37178136 DOI: 10.1093/europace/euad131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
AIMS Atrial fibrillation (AF), typical atrial flutter (AFL), and other atrial tachycardias (ATs) are common in patients with pulmonary hypertension. Frequently, several supraventricular arrhythmias are successively observed in individual patients. We investigated the hypothesis of whether more extensive radiofrequency catheter ablation of the bi-atrial arrhythmogenic substrate instead of clinical arrhythmia ablation alone results in superior clinical outcomes in patients with pulmonary arterial hypertension (PH) and supraventricular arrhythmias. METHODS AND RESULTS Patients with combined post- and pre-capillary or isolated pre-capillary PH and supraventricular arrhythmia indicated to catheter ablation were enrolled in three centres and randomized 1:1 into two parallel treatment arms. Patients underwent either clinical arrhythmia ablation only (Limited ablation group) or clinical arrhythmia plus substrate-based ablation (Extended ablation group). The primary endpoint was arrhythmia recurrence >30 s without antiarrhythmic drugs after the 3-month blanking period. A total of 77 patients (mean age 67 ± 10 years; 41 males) were enrolled. The presumable clinical arrhythmia was AF in 38 and AT in 36 patients, including typical AFL in 23 patients. During the median follow-up period of 13 (interquartile range: 12; 19) months, the primary endpoint occurred in 15 patients (42%) vs. 17 patients (45%) in the Extended vs. Limited ablation group (hazard ratio: 0.97, 95% confidence interval: 0.49-2.0). There was no excess of procedural complications and clinical follow-up events including an all-cause death in the Extended ablation group. CONCLUSION Extensive ablation, compared with a limited approach, was not beneficial in terms of arrhythmia recurrence in patients with AF/AT and PH. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov; NCT04053361.
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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] [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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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] [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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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] [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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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] [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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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] [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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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] [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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Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci 2020; 416:116985. [PMID: 32563078 DOI: 10.1016/j.jns.2020.116985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Elderly cryptogenic ischemic stroke (IS) patients with embolic stroke of undetermined source (ESUS) have a high risk of recurrent IS (RIS) compared to other stroke subtypes. In young ESUS patients, different sources of embolism may be a cause and the risk of RIS remains not enough established. The aim was to assess and compare risk of RIS between ESUS and non ESUS patients <50 years. 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 analyzed patients, the brain ischemia was confirmed on CT or MRI. All patients underwent identical diagnostic protocol including TEE and long-term ECG-Holter. Cause of IS was assessed according to the ASCOD classification. RESULTS Of 320 enrolled patients <50 years, 219 (68.4%) were identified as cryptogenic (119 males, mean age 41.4 ± 7.2 years) and 122 (38.1%) patients fulfilled the ESUS criteria. During the follow-up with a median of 34 months, three (2.5%) ESUS and 5 (5.2%) non-ESUS patients suffered from RIS (p = .471). One-year risk of RIS was 0.008 (95% CI: 0-0.025) for ESUS and 0.036 (95% CI: 0-0.076) for non-ESUS patients (p = .262). CONCLUSION The risk of RIS was very low in ESUS patients and did not differ from those with non-ESUS. Our finding may indicate that antiplatelet therapy can be effective in the secondary prevention in young ESUS patients if high-risk sources of embolization are excluded extensively.
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Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence. J Stroke Cerebrovasc Dis 2020; 29:105046. [PMID: 32807456 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic strokes (IS) occur also in young adults and despite an extensive work-up the cause of IS remains very often cryptogenic. Thus, effectiveness of secondary prevention may be unclear. We aimed to analyze a relationship among vascular risk factors (VRF), clinical and laboratory parameters, outcomes and recurrent IS (RIS) in young cryptogenic IS (CIS) 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). All analyzed patients underwent transesophageal echocardiography, 24-h and 3-week ECG-Holter to assess cause of IS according to the ASCOD classification. Recurrent IS (RIS) was recorded during a follow-up (FUP). RESULTS Out of 294 young enrolled patients, 208 (70.7%, 113 males, mean age 41.6 ± 7.2 years) were identified as cryptogenic. Hyperlipidemia (43.3%), smoking (40.6%) and arterial hypertension (37.0%) were the most frequent VRF. RIS occurred in 7 (3.4%) patients during a mean time of FUP 19 ± 23 months. One-year risk of RIS was 3.4% (95%CI: 1.4-6.8%). Patients with RIS were older (47.4 vs. 41.1 years, p = 0.007) and more often obese (71.4 vs. 19.7%, p = 0.006), and did not differ in any of other analyzed parameters and VRF. Multivariate logistic regression analysis showed obesity (OR: 9.527; 95%CI: 1.777-51.1) and the previous use of antiplatelets (OR: 15.68; 95%CI: 2.430-101.2) as predictors of recurrent IS. CONCLUSION Despite a higher presence of VRF in young CIS patients, the risk of RIS was very low. Obesity and previous use of antiplatelet therapy were found the only predictors of RIS.
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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] [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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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] [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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Risk of recurrent ischemic stroke in young cryptogenic patients with embolic stroke of undetermined source. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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] [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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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] [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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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] [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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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] [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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Giant-cell myocarditis - A case report and a brief review. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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P1909The impact of ECG synchronization during acquisition of left atrium computed tomography model on radiation dose and arrhythmia recurrence rate after catheter ablation of atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prognostic value of cystatin C in relation to other markers of renal function in early prediction of hospital mortality and major cardiac adverse events in patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sexual activity and cardiovascular disease, erectile dysfunction as a predictor of ischemic heart disease. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cardiac magnetic resonance in cardiac angiosarcoma-Which contrast-enhancement pattern is typical? Echocardiography 2018; 35:287. [PMID: 29409131 DOI: 10.1111/echo.13802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Biomarkers of renal function in prognostic stratification of patients with acute coronary syndrome. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Vulnerable atherosclerotic plaque - a review of current concepts and advanced imaging. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:10-17. [DOI: 10.5507/bp.2018.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/06/2018] [Indexed: 01/31/2023] Open
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Macitentan in pulmonary hypertension due to left ventricular dysfunction. Eur Respir J 2018; 51:51/2/1701886. [PMID: 29437943 DOI: 10.1183/13993003.01886-2017] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/20/2017] [Indexed: 12/27/2022]
Abstract
The MELODY-1 study evaluated macitentan for pulmonary hypertension because of left heart disease (PH-LHD) in patients with combined post- and pre-capillary PH.63 patients with PH-LHD and diastolic pressure gradient ≥7 mmHg and pulmonary vascular resistance (PVR) >3WU were randomised to macitentan 10 mg (n=31) or placebo (n=32) for 12 weeks. The main end-point assessed a composite of significant fluid retention (weight gain ≥5% or ≥5 kg because of fluid overload or parenteral diuretic administration) or worsening in New York Heart Association functional class from baseline to end of treatment. Exploratory end-points included changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and haemodynamics at week 12.Seven macitentan-treated and four placebo-treated patients experienced significant fluid retention/worsening functional class; treatment difference, 10.08% (95% CI -15.07-33.26; p=0.34). The difference, driven by the fluid retention component, was apparent within the first month. At week 12, versus placebo, the macitentan group showed no change in PVR, mean right atrial pressure or pulmonary arterial wedge pressure; a non-significant increase in cardiac index (treatment effect 0.4 (95% CI 0.1-0.7) L·min-1·m-2) and decrease in NT-proBNP (0.77 (0.55-1.08)) was observed. Adverse events and serious adverse events were numerically more frequent with macitentan versus placebo.Macitentan-treated patients were quantitatively more likely to experience significant fluid retention versus placebo. Macitentan resulted in no significant changes in any exploratory end-points.
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Etiology of ischemic stroke and frequency of risk factors in young patients. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.3337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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P814Comparison of computed tomography of the left atrium with and without ECG gating before atrial fibrillation catheter ablation - a prospective, randomized, double-blind study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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P819Comparison of adenosine-mediated pulmonary vein dormant conduction absence and presence with its subsequent elimination in atrial fibrillation recurrence rate after catheter ablation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barriers in the implementation of guidelines for acute coronary syndromes. Focus on antiplatelet therapy. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Primary cardiac angiosarcoma in multimodality imaging - Case report and review of literature. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Changing Views: Safety and Efficacy of Implantable Cardioverter- Defibrillator Therapy in Athletes. Cent Eur J Public Health 2016; 23 Suppl:S74-7. [PMID: 26849548 DOI: 10.21101/cejph.a4228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 06/24/2015] [Indexed: 11/15/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) is highly effective in reducing sudden death from ventricular tachyarrhythmia among high-risk cardiac patients. Conventional advice given to patients with ICD is to avoid physical activity more strenuous than playing golf or bowling. This recommendation is given due to a theoretical risk of arrhythmia precipitation, and thus increased risk of death due to failure to defibrillate, injury resulting from loss of control caused by arrhythmia-related syncope or shock, and also due to sport related direct damage to the ICD system. Recent prospective data from an international registry involving 372 athletes with ICDs in situ and actively participating in sports has been published. This indicates that, although physical activity resulted in an increased number of shocks compared to rest, there was no significant difference between intensive physical activity and any other activity (10% vs. 8%, p=0.34) in frequency of shocks. Furthermore, over a median follow-up period of 31 months (21-46 months), in the period of sports activity and 2 hour rest directly after there were no occurrences of death, resuscitated arrest or arrhythmia, or shock-related injury. This data is likely to start a shift in every-day clinical decision-making leading to revision of the high level of precautions imposed on the rapidly enlarging ICD recipient population.
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2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Summary document prepared by the Czech Society of Cardiology. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2016.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Polymorphism of the Fcγ Receptor II as a Possible Predisposing Factor for Heparin-Induced Thrombocytopenia. Clin Lab 2015; 61:1027-32. [PMID: 26427148 DOI: 10.7754/clin.lab.2015.141207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Heparin-induced thrombocytopenia (HIT) represents a serious complication of heparin treatment. IgG antibodies binding platelet factor 4 (PF4) and heparin trigger the clinical manifestations of HIT. However, only a portion of the antibodies have the ability to activate platelets, and these can be identified by a platelet aggregation test (functional testing). However, this expression has been detected to have a molecular cause, which is a mutation of FcγRIIa. The FcγRIIa receptor is responsible for the activation of platelets by antibodies in HIT. METHODS To determine HIT, impedance aggregometry using the Multiplate analyzer (MEA) as heparin-induced aggregation technique and the Technozym HIT IgG ELISA test were used. The MEA method uses sensitization of donor platelets with patient plasma in the presence of heparin at a concentration of 0.5 IU/mL. The results were compared with the ELISA test. Mutation of FcγRHa was assessed using the asymmetric real-time PCR method that is based on the reaction with two hybridization probes and melting curve analysis. RESULTS Examined were 100 patients at a clinically intermediate and higher risk of HIT according to the 4T's score. All samples were examined by the ELISA test and MEA, with positive samples being further confirmed by high-concentration heparin. In the group of patients, 10.0% were positive by MEA as compared with 4% determined by ELISA. The results of genetic analysis of FcγRIIa did not provide statistically significant differences between positive patients found by the functional test as well as the ELISA test and seronegative patients. CONCLUSIONS The genetic mutation FcγRIIa is a predisposing factor for manifestation of HIT in the form of thrombocytopenia, but the process of seroconversion apparently needs another inducing factor. Therefore, the examination of mutations can be classified as predisposing factors rather than to confirm the diagnosis of HIT.
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Cardioembolic etiology of acute ischemic stroke in patients indicated to revascularization. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Summary document prepared by the Czech Society of Cardiology. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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AB1058 Echocardiographic and Humoral Parametres in Systemic Sclerosis and MCTD in Relation to Pulmonary Hypertension. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Paroxysmal atrial fibrillation in young cryptogenic ischemic stroke: A 3-week ECG Holter monitoring study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:283-7. [PMID: 25916280 DOI: 10.5507/bp.2015.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/14/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation is known very frequent cause of ischemic stroke. Undetected paroxysmal atrial fibrillation (PAF) is thus often considered a possible cause of cryptogenic ischemic stroke (CIS). The aim of this prospective study was to detect PAF using ECG Holter monitoring and determinate whether prolongation of the Holter monitoring to 3 weeks would increase the detection rates of PAF in young CIS patients ≤ 50 years. METHODS The study set consisted of IS patients ≤ 50 years enrolled in the HISTORY (Heart and Ischemic STrOke Relationship studY) study (NCT01541163). CIS was defined according to the TOAST criteria including the absence of ultrasonographic or angiographic signs of atherosclerosis, vasculitis or dissection. Admission ECG, serum levels of high sensitive Troponin T (hs TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP), markers of thrombophilia, transoesophageal echocardiography (TEE) and 24-hour ECG-Holter monitoring were performed in all patients. In case of negative 24-h ECG Holter, an additional 3-weeks monitoring was done. RESULTS Of the 105 enrolled patients ≤ 50 years, 95 (90%) were identified as cryptogenic (49 males, mean age 39.1 ± 8.2 years). All CIS patients had normal admission ECG. In total, PAF was detected in 9 (9.5%, 95% CI: 3.5% - 17.8%) patients; in two during 24-h ECG Holter and in seven during 3-weeks Holter monitoring. Patients with PAF had more frequently elevated admission hs TnT and NT-proBNP levels (P - 0.0001). CONCLUSIONS PAF was detected in 9.5% of young CIS patients and 3-weeks ECG Holter monitoring increased the detection rate.
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[The role of surgical embolectomy and extracorporeal membrane oxygen therapy in the treatment of massive pulmonary embolism - a review]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2015; 94:103-110. [PMID: 25754478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acute massive pulmonary embolism remains potentially lethal with mortality varying between 2553%. In the thrombolytic era, surgical pulmonary embolectomy is deemed as a rescue approach for patients with absolute contraindication of thrombolysis or its failure. However, close interdisciplinary cooperation, meticulous choice of optimal reperfusion strategy, standardization of surgical approach, and mainly the inclusion of mechanical circulatory support into the treatment algorithm have led to a drop in in-hospital mortality below 10% in the last 10 years. Nevertheless, cardiac arrest and refractory cardiogenic shock still remain independent risk factors of death with mortality exceeding 70%. Extracorporeal membrane oxygen therapy provides rapid circulatory support, end-organ perfusion and oxygenation which are essential for right-sided obstruction haemodynamic. Subsequently, optimal reperfusion strategy can be chosen or patients may be transported for it. The review highlights the contemporary role of surgical pulmonary embolectomy and extracorporeal membrane oxygen therapy in the treatment algorithm for acute massive pulmonary embolism, summarising current perspectives on the indications and contraindications for these treatment strategies and their results.Key words: massive pulmonary embolism - surgical pulmonary embolectomy - extracorporeal membrane oxygen therapy.
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Atrial Fibrillation in Young Ischemic Stroke Patients: An Underestimated Cause? Eur Neurol 2015; 73:158-63. [DOI: 10.1159/000369793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/09/2014] [Indexed: 11/19/2022]
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[Embolic ischemic strokes]. VNITRNI LEKARSTVI 2014; 60:1040-1049. [PMID: 25692830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Treatment of acute phase of ischemic stroke is aimed to limit the amount of damage using reperfusion strategy and subsequently administration of treatment providing pharmacological secondary prevention of recurrence. The early aetiology diagnosis of stroke is crucial for effective secondary prevention as the highest risk of recurrence is within few weeks after stroke. Exclusion of cardiac and vascular source of embolism by imaging methods is an important part in management of patients with ischemic stroke. These embolic sources are categorized as high risk and states are associated with moderate or unclear risk.
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Detection of clopidogrel resistance using ADP induced aggregometry with specific inhibitor PGE1. Clin Lab 2014; 60:1475-80. [PMID: 25291943 DOI: 10.7754/clin.lab.2013.131004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKROUND Antiaggregation therapy is still the most frequently used approach to prevent thrombotic events in cardiovascular diseases. It has a good clinical effect but increasing evidence shows high residual platelet aggregation activity in a number of patients. Laboratory methods only allow us to detect clopidogrel "non-responders" or "low responders". Recent methods are based on monitoring residual platelet aggregation activity (aggregation methods) or detecting the number of free epitopes for binding a specific monoclonal antibody such as vasodilator-stimulated phosphoprotein phosphorylation (VASP). METHODS The aims of our study were comparison light transmission aggregometry (LTA) and multiple electrode platelet aggregometry (MEA) with induction by ADP in concentrations of 20 micromol/L with or without prostaglandin E1 (PGE1) for monitoring clopidogrel resistance. RESULTS In the group of 84 patients with cardiovascular disease (CAD) studied, an impaired individual response to clopidogrel therapy was found 11.9% and 10.7% of the patients using MEA and LTA, respectively, induced by ADP with PGE1. The LTA and MEA methods with induction by ADP with PGE1 and without PGE1 were statistically compared using Spearman's nonparametric correlation analysis. Both methods with using PGE, showed a positive significant correlation (p = 0.003) in contrast with the results without PGE1 with a no significant correlation (p = 0.732). CONCLUSIONS The sensitivity for detecting clopidogrel resistance correlates well with other data in the literature suggesting that there are 5%-30% clopidogrel low-responders depending on the type of platelet function assay used and the criteria for defining a low-responder [16-18]. These results favor implementation of the ADP test with PGE1 by MEA specifically for identification of low-responders to clopidogrel.
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