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Identification of preventable factors of reperfusion injury in patients with acute myocardial infarction
Víchová, Teodora ; Moťovská, Zuzana (advisor) ; Malý, Martin (referee) ; Pařenica, Jiří (referee)
Background: The ischemic-reperfusion injury represents an important preventable factor, due to its essential impact on prognosis of patients with acute myocardial infarction (AMI). One of the most important modifiers of the extent of the injury is the time to reperfusion. Great efforts to reduce delays in reperfusion have been made during the previous two decades, however, in spite of significant improvement in organization and quality of AMI treatment, especially ST- segment elevations (STEMI), many patients are not being treated within recommended time frames. Aim: The aim of this work was to acknowledge the importance of time to reperfusion in preventable ischemic and reperfusion injury and patient prognosis at the current era of percutaneous coronary interventions (PCI). Furthermore, we intended to characterize the patient subpopulations in the highest risk of delayed reperfusion and the analysis of its backgrounds. Based on the acquired data, specific recommendations for preventive measures aimed at reducing the time delay to reperfusion would be formulated. Metodika: In the presented original works, study population consisted of 946 consecutive patients with AMI with STEMI or bundle- branch block AMI, who underwent PCI in Cardiocenter Královské Vinohrady. Patient baseline characteristics and their...
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The role of apoptosis in patients with coronary artery disease
Teringová, Elena ; Toušek, Petr (advisor) ; Málek, Filip (referee) ; Pařenica, Jiří (referee)
in English language Background: Apoptosis plays an important role in the myocardial injury after acute myocardial infarction and in the subsequent development of heart failure. Aim: To clarify serum kinetics of apoptotic markers TRAIL and sFas and their relation to left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods: In 101 patients with STEMI treated with pPCI, levels of TRAIL and sFas were measured in series of serum samples obtained during hospitalization and one month after STEMI. LVEF was assessed at admission and at one-month. Major adverse cardiovascular events (MACE - i.e. death, re-MI, hospitalisation for heart failure and stroke) were analysed during a two-year follow-up. Results: Serum level of TRAIL significantly decreased one day after pPCI (50.5pg/mL) compared to admission (56.7pg/mL), subsequently increased on day 2 after pPCI (58.8pg/mL) and reached its highest level at one month (70.3pg/mL). TRAIL levels on day 1 and 2 showed a significant inverse correlation with troponin and a significant positive correlation with LVEF at baseline. Moreover, TRAIL correlated significantly with LVEF one month after STEMI (day 1: r=0.402, p<0.001, day 2: r=0.542, p<0.001). On...
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Inflammatory and Fibrotic Myocardial Involvement
Šedivý, Jakub ; Hromádka, Milan (advisor) ; Mayer, Otto (referee) ; Pařenica, Jiří (referee)
1 Inflammatory and fibrotic myocardial involvement MUDr. Jakub Šedivý, Kardiologické oddělení FN Plzeň Introduction: The aim of my work was to evaluate the comprehensive approach to diagnosis and eventually monitoring the trend in two cardiac diseases of non-ischemic etiology. The first part is focused on evaluation of the inflammatory changes in patients with "infarct-like" myocarditis based on magnetic resonance (MRI) and laboratory tests. We also considered the possibility of restricting the length of physical activity restriction by bicycle ergometry. The second topic was the comprehensive assessment of cardiac risk in patients with systemic sclerosis, including the assessment of possible MR and new laboratory markers of myocardial fibrosis. Materials and methods: In the first part, we included prospectively 30 patients with "infarct- like" myocarditis and with a positive finding of late gadolinium enhancement (LGE) on MRI. Follow up MRI, echocardiography and stress ECG were performed at 1 and 6 month intervals. In the study focused on systemic sclerosis, a total of 33 long-term patients were prospectively enrolled. The study included a comparison of a group of 20 healthy volunteers. Results: In 47% of patients with infarct-like myocarditis, we found a left ventricular dyskinesia, but only 17% of...
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Association Between Echocardiogrtaphic Markers and Glomerular and Tubular Kidney Functions in Cardiologic Patients
Opatrný, Jan ; Matoušovic, Karel (advisor) ; Dusilová Sulková, Sylvie (referee) ; Pařenica, Jiří (referee)
A close relation between the kidneys and the heart functions is a long lasting clinical experience. In the second half of the XXth century, many studies documented a role of the kidneys in blood pressure regulation. Since the beginning of the XXI century, many findings have highlighted a role of a damaged kidney function as a risk factor for the heart injury. A close link between the heart and kidney functions is mediated by many common pathophysiologic mechanisms. It is surprising, that terms cardio-renal and renocardiac syndromes have got in a common awareness of clinicians only in the last 15 years. Some links between echocardiopgraphic signs of the systolic and diastolic heart dysfunction and the glomerular kidney function has already been described. Relations between the cardiorenal syndrome and echocardiographic findings versus the renal concentrating capacity are unknown. It is well established, that even mild renal insufficiency increases the mortality risk in ischemic heart disease patients. A question arises, if only a transient decrease of the renal function influences a mortality risk in ischemic heart disease patients. The aim of our study was to find out: A) The associations between the echocardiographic signs of systolic and diastolic heart dysfunction, the eGFR and the kidney...
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Structural and hemodynamic characteristics of atherosclerotic plaques in carotid arteries with relation to endovascular manipulation during carotid artery stenting.
Špaček, Miloslav ; Zemánek, David (advisor) ; Malík, Jan (referee) ; Pařenica, Jiří (referee)
Atherosclerotic diseases including stroke are the leading causes of morbidity, mortality as well as disability in industrialized countries. Carotid endarterectomy was long considered the stan- dard approach for the treatment of atherosclerotic carotid disease, one of major causes of stroke. Over time, carotid artery stenting (CAS) has evolved as an alternative approach and is considered equivalent to surgical treatment in selected patients. Particularly in the last years, CAS has gained attention with the increasing knowledge regarding atherosclerotic plaque and cerebrovascular flow. In our study, we focused on patients undergoing CAS and evaluated structural and hemodynamic characteristics of atherosclerotic plaques together with relation to endovascular manipulation. The major part of the study includes transcranial doppler ultrasound evaluation which is able to detect flow in major cerebral arteries as well as to detect microembolizations of atherosclerotic particles during CAS. In eligible patients, we investigated the usefulness of cerebrovascular reserve (CVR) testing to predict severe hemodynamic changes in ipsilateral middle cerebral artery induced by temporary carotid occlusion during proximally protected CAS. CVR was tested by means of a breath-holding test and ophthalmic artery flow...
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The role of apoptosis in patients with coronary artery disease
Teringová, Elena ; Toušek, Petr (advisor) ; Málek, Filip (referee) ; Pařenica, Jiří (referee)
in English language Background: Apoptosis plays an important role in the myocardial injury after acute myocardial infarction and in the subsequent development of heart failure. Aim: To clarify serum kinetics of apoptotic markers TRAIL and sFas and their relation to left ventricular ejection fraction (LVEF) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Methods: In 101 patients with STEMI treated with pPCI, levels of TRAIL and sFas were measured in series of serum samples obtained during hospitalization and one month after STEMI. LVEF was assessed at admission and at one-month. Major adverse cardiovascular events (MACE - i.e. death, re-MI, hospitalisation for heart failure and stroke) were analysed during a two-year follow-up. Results: Serum level of TRAIL significantly decreased one day after pPCI (50.5pg/mL) compared to admission (56.7pg/mL), subsequently increased on day 2 after pPCI (58.8pg/mL) and reached its highest level at one month (70.3pg/mL). TRAIL levels on day 1 and 2 showed a significant inverse correlation with troponin and a significant positive correlation with LVEF at baseline. Moreover, TRAIL correlated significantly with LVEF one month after STEMI (day 1: r=0.402, p<0.001, day 2: r=0.542, p<0.001). On...
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Inflammatory and Fibrotic Myocardial Involvement
Šedivý, Jakub ; Hromádka, Milan (advisor) ; Mayer, Otto (referee) ; Pařenica, Jiří (referee)
1 Inflammatory and fibrotic myocardial involvement MUDr. Jakub Šedivý, Kardiologické oddělení FN Plzeň Introduction: The aim of my work was to evaluate the comprehensive approach to diagnosis and eventually monitoring the trend in two cardiac diseases of non-ischemic etiology. The first part is focused on evaluation of the inflammatory changes in patients with "infarct-like" myocarditis based on magnetic resonance (MRI) and laboratory tests. We also considered the possibility of restricting the length of physical activity restriction by bicycle ergometry. The second topic was the comprehensive assessment of cardiac risk in patients with systemic sclerosis, including the assessment of possible MR and new laboratory markers of myocardial fibrosis. Materials and methods: In the first part, we included prospectively 30 patients with "infarct- like" myocarditis and with a positive finding of late gadolinium enhancement (LGE) on MRI. Follow up MRI, echocardiography and stress ECG were performed at 1 and 6 month intervals. In the study focused on systemic sclerosis, a total of 33 long-term patients were prospectively enrolled. The study included a comparison of a group of 20 healthy volunteers. Results: In 47% of patients with infarct-like myocarditis, we found a left ventricular dyskinesia, but only 17% of...
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Identification of preventable factors of reperfusion injury in patients with acute myocardial infarction
Víchová, Teodora ; Moťovská, Zuzana (advisor) ; Malý, Martin (referee) ; Pařenica, Jiří (referee)
Background: The ischemic-reperfusion injury represents an important preventable factor, due to its essential impact on prognosis of patients with acute myocardial infarction (AMI). One of the most important modifiers of the extent of the injury is the time to reperfusion. Great efforts to reduce delays in reperfusion have been made during the previous two decades, however, in spite of significant improvement in organization and quality of AMI treatment, especially ST- segment elevations (STEMI), many patients are not being treated within recommended time frames. Aim: The aim of this work was to acknowledge the importance of time to reperfusion in preventable ischemic and reperfusion injury and patient prognosis at the current era of percutaneous coronary interventions (PCI). Furthermore, we intended to characterize the patient subpopulations in the highest risk of delayed reperfusion and the analysis of its backgrounds. Based on the acquired data, specific recommendations for preventive measures aimed at reducing the time delay to reperfusion would be formulated. Metodika: In the presented original works, study population consisted of 946 consecutive patients with AMI with STEMI or bundle- branch block AMI, who underwent PCI in Cardiocenter Královské Vinohrady. Patient baseline characteristics and their...
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