|
|
The metabolic response to acute coronary syndrome focusing on tissue factor, metalloproteinases and soluble CD40 ligand
Bis, Josef ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Vítovec, Jiří (referee)
The metabolic response to acute coronary syndrome focusing on tissue factor,, metalloproteinases and soluble CD40 ligand Introduction: The cause of acute coronary syndrome is unstable plaque and its rupture. Pathogenesis is complex and requires various mechanisms and depends both on the composition of plaque and thrombotic activity of blood. Objectives: The main goal of this work was to assess local levels of plasma tissue factor (TF), tissue factor inhibitor (TFPI), tissue metalloproteinases (MMP-2, 3 and 9) and inhibitor of metalloproteinases-2 (TIMP-2), a highly selective C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome and with stable angina pectoris in the systemic circulation, the coronary sinus and to determine the time course of blood levels in patients with acute coronary syndrome. Methods and results: Study population include patients with coronary artery disease (CAD). In 24 patients with stable CAD (SCAD) at time of diagnostic coronary angiography, we withdrew samples from the coronary sinus (CS), femoral vein (VF) and left coronary artery (LMCA). In 29 patients with acute coronary syndrome (ACS) we took samples of venous blood also 24 hours and 7 days from the start. The samples were fixed levels of TF, TFPI, MMP-2, 3 and 9, TIMP-2, CRP, and...
|
|
|
Pathophysiology and clinical implications of late coronary thrombosis after implantation of drug eluting stents in patients with manifest atherosclerosis
Jakabčin, Jozef ; Červinka, Pavel (advisor) ; Poledne, Rudolf (referee) ; Mates, Martin (referee)
Pathophysiology and clinical implications of late coronary thrombosis after implantation of drug eluting stents in patients with manifest atherosclerosis Abstract Drug-eluting stents (DES) have markedly reduced restenosis rates compared with bare metal stents (BMS) in controlled randomized trials. Concerns have been raised about a possibly increased incidence of stent thrombosis (ST) after discontinuation of dual antiplatelet treatment compared with BMS. While a restenosis is relatively benign process, this serious complication is an issue because mortality of such event is reaching almost 50%. Among well recognized predictors of late stent thrombosis (delayed endothelisation, renal failure, bifurcation lesions, diabetes, premature antiplatelet therapy discontinuation, slow thrombus disappearance), the stent under expansion and stent deployment technique are also considered to be a contributor for development of late stent thrombosis. There was a paucity of data regarding the IVUS guidance during DES implantation. The aim of this study was to assess the role of IVUS guidance during implantation of DES on longterm outcome in patients with high clinical and angiographic risk profile. Methods: Between January 2004 and December 2005, 2110 patients underwent percutaneous coronary intervention, including 276...
|
|
|
Ischemic heart disease-from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention
Kočka, Viktor ; Widimský, Petr (advisor) ; Mates, Martin (referee) ; Želízko, Michael (referee)
Ischemic heart disease - from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention As. MUDr. Viktor Kočka Summary Ischemic mitral regurgitation (IMR) and myocardial revascularization are from pathophysiological perspective closely linked. We first defined the incidence of IMR in current cardiology to be 129 patients per 1 million population annually. These patients have high mortality of 54% during 5 year follow-up. There is pathophysiological hypothesis of association between myocardial viability and IMR and we have proven this thesis to be correct. The presence of at least 5 viable segments of myocardium is a significant predictor of IMR improvement after revascularization. It is noteworthy that dimension of left ventricle indexed to body surface area is a better predictor of long term prognosis than the hemodynamic significance of IMR. We have also found surprisingly robust association between previous revascularization and better prognosis, even after in average 10 years. Further we have focused on the topic of percutaneous coronary intervention (PCI). Pathophysiology of neointimal hyperplasia (NIH) as a basis of clinical in-stent restenosis was examined on animal model. First, novel nanocrystalline diamond (NCD) coronary stent coating was developed with the help of...
|
|
|
Acute Myocardical Infarction with ST Elevation (STEMI), Direct PCI, Times and Lethality
Al Mawiri, Abdulwasya ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Fiala, Martin (referee)
In ST-segment elevation myocardial infarction (STEMI), rapid revascularization is of paramount importance, and direct transport to a percutaneous coronary intervention (PCI)-capable center is recommended. Long-term follow-up data comparing both approaches are scarce. The purpose of this study was to compare the long-term outcomes of direct primary transfer (PT) and indirect secondary transfer (ST) in patients with STEMI. Method and study group: We enrolled consecutive patients referred for STEMI within 12 h of symptom onset. The primary endpoint was to compare long-term lethality of direct PT and indirect ST in patients with STEMI. During a two-year period (2008-2009), we prospectively recorded lethality and the door-to-balloon time (DBT) of 869 patients with STEMI from arrival at the first hospital until reperfusion by PCI in the catheterization laboratory. A total of 677 patients (77.9%) were enrolled for the final evaluation, with 192 (22.1%) patients excluded. We divided the patients into two groups: the first group (PT) had been transferred directly from the field to a catheterization laboratory, while the second group (ST) had been transferred from regional hospitals to a catheterization laboratory. The final analysis included 677 patients aged 20 to 96 years; the mean age was 64,04 years,...
|
|
|
Ischemic heart disease-from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention
Kočka, Viktor ; Widimský, Petr (advisor) ; Mates, Martin (referee) ; Želízko, Michael (referee)
Ischemic heart disease - from pathophysiology of ischemic mitral regurgitation to percutaneous coronary intervention As. MUDr. Viktor Kočka Summary Ischemic mitral regurgitation (IMR) and myocardial revascularization are from pathophysiological perspective closely linked. We first defined the incidence of IMR in current cardiology to be 129 patients per 1 million population annually. These patients have high mortality of 54% during 5 year follow-up. There is pathophysiological hypothesis of association between myocardial viability and IMR and we have proven this thesis to be correct. The presence of at least 5 viable segments of myocardium is a significant predictor of IMR improvement after revascularization. It is noteworthy that dimension of left ventricle indexed to body surface area is a better predictor of long term prognosis than the hemodynamic significance of IMR. We have also found surprisingly robust association between previous revascularization and better prognosis, even after in average 10 years. Further we have focused on the topic of percutaneous coronary intervention (PCI). Pathophysiology of neointimal hyperplasia (NIH) as a basis of clinical in-stent restenosis was examined on animal model. First, novel nanocrystalline diamond (NCD) coronary stent coating was developed with the help of...
|
|
|
The metabolic response to acute coronary syndrome focusing on tissue factor, metalloproteinases and soluble CD40 ligand
Bis, Josef ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Vítovec, Jiří (referee)
The metabolic response to acute coronary syndrome focusing on tissue factor,, metalloproteinases and soluble CD40 ligand Introduction: The cause of acute coronary syndrome is unstable plaque and its rupture. Pathogenesis is complex and requires various mechanisms and depends both on the composition of plaque and thrombotic activity of blood. Objectives: The main goal of this work was to assess local levels of plasma tissue factor (TF), tissue factor inhibitor (TFPI), tissue metalloproteinases (MMP-2, 3 and 9) and inhibitor of metalloproteinases-2 (TIMP-2), a highly selective C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome and with stable angina pectoris in the systemic circulation, the coronary sinus and to determine the time course of blood levels in patients with acute coronary syndrome. Methods and results: Study population include patients with coronary artery disease (CAD). In 24 patients with stable CAD (SCAD) at time of diagnostic coronary angiography, we withdrew samples from the coronary sinus (CS), femoral vein (VF) and left coronary artery (LMCA). In 29 patients with acute coronary syndrome (ACS) we took samples of venous blood also 24 hours and 7 days from the start. The samples were fixed levels of TF, TFPI, MMP-2, 3 and 9, TIMP-2, CRP, and...
|
|
|
Pathophysiology and clinical implications of late coronary thrombosis after implantation of drug eluting stents in patients with manifest atherosclerosis
Jakabčin, Jozef ; Červinka, Pavel (advisor) ; Poledne, Rudolf (referee) ; Mates, Martin (referee)
Pathophysiology and clinical implications of late coronary thrombosis after implantation of drug eluting stents in patients with manifest atherosclerosis Abstract Drug-eluting stents (DES) have markedly reduced restenosis rates compared with bare metal stents (BMS) in controlled randomized trials. Concerns have been raised about a possibly increased incidence of stent thrombosis (ST) after discontinuation of dual antiplatelet treatment compared with BMS. While a restenosis is relatively benign process, this serious complication is an issue because mortality of such event is reaching almost 50%. Among well recognized predictors of late stent thrombosis (delayed endothelisation, renal failure, bifurcation lesions, diabetes, premature antiplatelet therapy discontinuation, slow thrombus disappearance), the stent under expansion and stent deployment technique are also considered to be a contributor for development of late stent thrombosis. There was a paucity of data regarding the IVUS guidance during DES implantation. The aim of this study was to assess the role of IVUS guidance during implantation of DES on longterm outcome in patients with high clinical and angiographic risk profile. Methods: Between January 2004 and December 2005, 2110 patients underwent percutaneous coronary intervention, including 276...
|
|
| |
|
| |
guest ::
