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Non-invasive diagnosis of involvement of the right ventricle in hypertrophic cardiomyopathy
Zemánek, David ; Veselka, Josef (advisor) ; Málek, Ivan (referee) ; Pudil, Radek (referee)
Aim: The ~ulhor invesugatcd thc utility of !traio, ,trajo ratc, and tissue Doppler imagiDg (lDI) forthe evaluation oftbc right vcntticlc (RV) impainnenl io paritOU with a h)'P"nmphic c.rdiomyopathy (HCM) .flt;r ll. IUCOCSIIful alCQhoI ~ptal ablo.tÍOQ wilhout RV hypcrtrOphy in oompari$on wilh C<XI.trolgroup. Mcthodl &lid RCSllII",: A group ol 19 plllÍCOl! sufl"erin, fmm IleM with 22 controls was compaml. The parametcra of TOl M:re evaluated in mitral IIOd lricuspid annulUI. SlrIIm lnd Anno BIC derivW from ml wcre I5Sessed in lUl apH.:al fret:waU ofRV, u wcLl KS in ""!lilI SCgolCflts ofthc len vcntriclc. lktwcen bulh groupS, !bere wcrc statlstically 8ignificant difTerencc~ only III ;,ovolumic pre- ejoction ume (79.2±11.3 ml vs 58.5±8.1 ros, JK{l.OI), iSDVOlulOk ,-e!ll)tllio!1 time (HI4.7±26.2 ms vs n .ll24.5 ms, p<O.OI), m~lalperfOl"TT\3l)(;e(Tci)tndex mcasurcd fmm TOl (O.6I±O.14 Vll 0.49J.0.09, ~.Ol). and early peak diastoli<: veloc:ity of TOl ( 11 .2±1.8cm1I1'112.'»2.6cmll;~.05). CooclU$ion: Tbc: rcsul" IiUg&cJt the impainnent ofboth J)'$lOIi<: and diastolic RV f,metlon in palients rutfering frum HCM. TOI-relaled paramctcrs appcar more Be\lBilivc than ,rmin and I traln Rte for evalUlltion.
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Genetic and clinical correlates in hypertrophic cardiomyopathy
Čurila, Karol ; Gregor, Pavel (advisor) ; Málek, Ivan (referee) ; Krejčí, Jan (referee)
Hypertrophic cardiomyopathy (HCM) is a hereditary disease, which is caused by mutations in genech coding for proteins of carcomere of heart muscle. Disease is characterised by wide genotypic and fenotypic heterogeneity. Since the 90-th of 20-th century, when the first mutation responsible for HCM was identified, many research was done in detecting the correlation between mutant gene and clinical picture of the affected patient. As the first in Czech republic, we determined the frequencies of 4 most common genes in HCM in czech patients. We figured out, that spectrum of mutations is somehow different from another populations. We didn't find any correlation between specific gene mutation and morfologic and clinical characteristics of affected subjects. In our study with AT-1 receptor blocker - candesartan, we demostrated positive effect of candesartan on level of hypertrophy and function of the left heart ventricle and clinical symptoms of the patients with HCM.
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Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion
Skalická, Hana ; Horák, Jan (advisor) ; Vojáček, Jan (referee) ; Málek, Ivan (referee)
Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion Objective and background: Despite the use of reperfusion therapies, outcomes in patients with large ST elevation myocardial infarction (STEMI), late reperfusion and left ventricular (LV) dysfunction is poor. We investigated longterm safety and efficacy of intracoronary injections of autologous bone marrow-derived mononuclear cells (BMNCs). Methods: 27 patients with anterior STEMI (age 59 ± 12 yrs, mean baseline LV ejection fraction (LVEF) 39±5%), who underwent percutaneous coronary intervention 4-24 hours after the onset of symptoms, were randomly assigned either to intracoronary BMNCs injection (n = 17, BMNCs group, out of which 14 underwent longterm follow-up), or to standard therapy (n = 10, Control group). The LVEF, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and diastolic function (transmitral flow, pulmonary vein flow) were assessed by echocardiography at discharge, month 4 and 24. Myocardial perfusion was assessed using SPECT at baseline and month 4. Results: At 24-month, there was no difference in rates of serious clinical events (36% vs. 50%, p=0,54). At Month 4 LVEF improved to similar extent in...
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The value of neurohormonal activation assessment for treatment monitoring in congestive heart failure
Kubánek, Miloš ; Málek, Ivan (advisor) ; Špinarová, Lenka (referee) ; Pudil, Radek (referee)
Summary: Congestive heart failure (CHF) is associated with neurohormonal activation (NHA) which contributes to further progression of disease. Measurement of NHA has been used for diagnosis and prognostic stratification in CHF. Aims: The aim of this academic disertation was to analyze the value of NHA for treatment monitoring in CHF. We studied the relationship between NHA and pulmonary hypertension in compensated CHF using B-type natriuretic peptide (BNP) and big endothelin-1 (big ET-1). The rationale was to minimize repeated right heart catheterizations in candidates for orthotopic heart transplantation. A similar design had the second clinical study which used N-terminal pro-B- type natriuretic peptide (NT-proBNP) as a marker of NHA. In the third clinical study, we evaluated whether basal levels and/or change in NHA during treatment predict clinical efficacy of cardiac resynchronization therapy (CRT). We supposed that BNP and big ET-1 might be better predictors of outcome than standard methods of follow-up. Results: 1. Natriuretic peptides correlated with hemodynamic parameters better than big ET-1. An isolated measurement of BNP or NT-proBNP did not allow a reliable assessment of pulmonary hypertension or left ventricular filling pressure, respectively. On the other hand, serial evaluation of...
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Tissue factor in acute coronary syndromes
Malý, Martin ; Hampl, Václav (advisor) ; Wilhelm, Jiří (referee) ; Vízek, Martin (referee) ; Málek, Ivan (referee)
In this review are summarized essentials of the physiology and the pathophysiology of TF in terms of the literature sources. But still, until today, there are many questions to be answered: the source and the level of TF in healthy subjects, the method how to measure the "trombogenic" potential of TF because its role in many biological processes, the "normal" levels, the possible impact of risk factors and possibility of risk stratification of "healthy" subjects according to the levels of TF like marker of the blood with procoagulant potential. Answering these questions and impact of the blocking of TF as a therapeutical approach in acute coronary syndromes is a challenging field of investigation in blood coagulation. Powered by TCPDF (www.tcpdf.org)
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Allograft coronary artery disease
Kocík, Miroslav ; Málek, Ivan (advisor) ; Horký, Karel (referee) ; Hejnal, Jaroslav (referee)
We have proved high incidence of early detected TxCAD in OHTx recipients' population. Neither any of immunologic nor nonimmunologic factors tested in our study was found to represent a risk factor for early detected TxCAD development except of donor age and recipient's BMI. Despite proving survival to be worse in recipients suffering from early detected TxCAD in compare to the rest of OHTx recipients, we have failed to demonstrate, that early detected TxCAD is an independent risk factor for OHTx recipients negative clinical outcome. Similarly despite demonstration, that serious cardiac events are more frequent in subgroup of patients with early detected TxCAD, we have failed to prove early detected TxCAD to represent an independent risk factor for its occurrence.
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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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Contribution of New Immunosuppressants after Heart Transplantation
Skalická, Blanka ; Málek, Ivan (advisor) ; Horký, Karel (referee) ; Lischke, Robert (referee)
Background: Acute cellular rejection and graft vascular disease are major factors limiting the survival after orthotopic heart transplantation (OHTx). Tacrolimus could be more potent than cyclosporin A in therapy of recurrent acute rejection episodes in OHTx patients. Dyslipidemia is one of the risk factors involved in the development of graft vascular disease. Statins are common part of standard drug regimen after OHTx. On the other hand, they are potentially dangerous as they could interact with cyclosporin A. Study in healthy volunteers showed that tacrolimus should have no interactions with statins. Aim: In the first study we retrospectively assessed the effect of switching patients after OHTx with recurrent cellular rejection episodes from cyclosporin A to tacrolimus. In the second (prospective) study we evaluated the efficacy and safety of combined therapy with tacrolimus and atorvastatin in patients after OHTx with dyslipidemia. (...) Conclusions: Tacrolimus has a beneficial effect not only on recurrent acute rejection episodes in heart transplant recipients but it also decreases the incidence of future rejection episodes. In patients after OHTx with dyslipidemia switching to tacrolimus and atorvastatin could be a suitable therapeutic option, because this combination is safe and effective in...
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