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Current interventional approach to coronary artery disease
Klinčeva, Milka ; Widimský, Petr (advisor) ; Čelko, Alexander (referee) ; Hradec, Jaromír (referee)
Coronary artery disease is the main cause of death in both genders worldwide. Many preclinical and clinical studies present the concept of modifiable and non modifiable cardiovascular risk factors. The basic management of the coronary artery disease is medical, but the prognosis in many patients can be improved by potentially invasive procedures, such as the percutaneous coronary intervention (PCI) and the coronary artery bypass grafting (CABG). The cardiovascular risk scores may help cardiologists and cardiac surgeons alike to individualize the risk profile of patients in order to better define the revascularization strategy and to appropriately counsel the patient, in same time reducing the morbidity and mortality. The first part of the thesis evaluates the validity of both forms of the most used cardiovascular tool in the present day, the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The second part of the thesis concentrates on the prevalence of stress-induced myocardial stunning (Tako-Tsubo syndrome) among patients undergoing urgent coronary angiography for suspected acute myocardial infarction. The third part of the thesis obtains a realistic contemporary picture of how patients with STelevation myocardial infarction (STEMI) are treated in different European countries.
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The contribution of myocardial contrast echocardiography in patients with coronary heart disease
Toušek, Petr ; Gregor, Pavel (advisor) ; Chaloupka, Václav (referee) ; Hradec, Jaromír (referee) ; Kittnar, Otomar (referee)
Contrast echocardiography is a new myocardial echocardiographic method that extends the capabilities of conventional echocardiography. In our first two works, we focused on determining the size of infarction in patients after AMI and compared this method with today's most commonly used diagnostic methods. We found good agreement between KEM and SPECT in the evaluation of infarction size and correlation between the extent of oscillations Q on ECG and impaired microvascular perfusion of the myocardium - or the size of infarction. In patients with chronic forms of CHD, we found that the KEM can fairly well predict the kinetics porevaskularizační improvement segments with severely impaired kinetics and in this clinical situation is comparable with Contrast-magnetic resonance imaging. In addition, low variability and low number of investigative areas nehodnotitelných infarction KEM show that it is a simple, easily reproducible and teachable method. Finally, the relatively low cost and wide availability KEM indicate great potential usefulness of this method in clinical practice.
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Current interventional approach to coronary artery disease
Klinčeva, Milka ; Widimský, Petr (advisor) ; Čelko, Alexander (referee) ; Hradec, Jaromír (referee)
Coronary artery disease is the main cause of death in both genders worldwide. Many preclinical and clinical studies present the concept of modifiable and non modifiable cardiovascular risk factors. The basic management of the coronary artery disease is medical, but the prognosis in many patients can be improved by potentially invasive procedures, such as the percutaneous coronary intervention (PCI) and the coronary artery bypass grafting (CABG). The cardiovascular risk scores may help cardiologists and cardiac surgeons alike to individualize the risk profile of patients in order to better define the revascularization strategy and to appropriately counsel the patient, in same time reducing the morbidity and mortality. The first part of the thesis evaluates the validity of both forms of the most used cardiovascular tool in the present day, the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The second part of the thesis concentrates on the prevalence of stress-induced myocardial stunning (Tako-Tsubo syndrome) among patients undergoing urgent coronary angiography for suspected acute myocardial infarction. The third part of the thesis obtains a realistic contemporary picture of how patients with STelevation myocardial infarction (STEMI) are treated in different European countries.
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Treatment of heart failure guided by B-type natriuretic peptide plasma levels
Krupička, Jan ; Hradec, Jaromír (advisor) ; Málek, Ivan (referee) ; Ošťádal, Bohuslav (referee)
Incidence of heart failure is steadily increasing over the past several decades, partly due to the population aging and improved methods in the treatment of patients with acute coronary syndromes. With regard to the evidence that natriuretic peptides are independent prognostic markers of cardiovascular diseases and reflect actual hemodynamic and clinícal status of the patients with heart failure, an idea has emerged to use natriuretic peptide monitoring in guidance of heart failure therapy. This means to treat heart failure with the goal of decreasing BNP and NT-proBNP plasma levels as low as possible. (...) ln conclusion, in our first study we found out that the treatment strategy of heart failure guided by plasma SNP did not lead to significant reduction of cardiovascular events in comparison with the standard treatment strategy. Nevertheless, we observed trend in favor of the strategy based on SNP. In our second study we described fast and transient rise of plasma SNP concentrations immediately after short-term maximal physical exercise in healthy individuals. However, this rise did not reach pathological values typical for heart failure. We assume that it was probably caused by SNP release from cardiomyocytes storage granules rather than synthesis de novo.
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The contribution of myocardial contrast echocardiography in patients with coronary heart disease
Toušek, Petr ; Gregor, Pavel (advisor) ; Chaloupka, Václav (referee) ; Hradec, Jaromír (referee) ; Kittnar, Otomar (referee)
Contrast echocardiography is a new myocardial echocardiographic method that extends the capabilities of conventional echocardiography. In our first two works, we focused on determining the size of infarction in patients after AMI and compared this method with today's most commonly used diagnostic methods. We found good agreement between KEM and SPECT in the evaluation of infarction size and correlation between the extent of oscillations Q on ECG and impaired microvascular perfusion of the myocardium - or the size of infarction. In patients with chronic forms of CHD, we found that the KEM can fairly well predict the kinetics porevaskularizační improvement segments with severely impaired kinetics and in this clinical situation is comparable with Contrast-magnetic resonance imaging. In addition, low variability and low number of investigative areas nehodnotitelných infarction KEM show that it is a simple, easily reproducible and teachable method. Finally, the relatively low cost and wide availability KEM indicate great potential usefulness of this method in clinical practice.
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