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Impact of atherosclerotic plaque composition on the development of acute coronary syndrome
Kopřiva, Karel ; Kovárník, Tomáš (advisor) ; Kaňovský, Jan (referee) ; Toušek, Petr (referee)
Thin fibrous cap atheroma with a high lipid content is the most common morphological substrate for acute coronary syndrome. Lipid content can be reliably determined by near infrared spectroscopy (NIRS) imaging. Optical coherence tomography (OCT) is a commonly available morphological imaging method in the guidance of coronary interventions. In our study, we examined a single coronary lesion in patients with acute coronary syndrome using both OCT and NIRS. Based on OCT, we performed a detailed morphological analysis using semi-automated software. Using NIRS, we determined the lipid content of each lesion. In the first part of the study, we used noninvasive CT coronary angiography to detect the progression of atherosclerotic plaques between the first and second year after the initial examination and attempted to demonstrate that morphological characteristics and lipid content of plaques were risk factors for plaque progression. In the second part of the study, we assessed the ability of detailed morphological analysis based on OCT examination to identify the lipid content of plaques using NIRS as a reference method. We observed no significant linear correlation when assessing the relationship between morphological parameters and plaque volume progression. In the analysis of plaque lipid content,...
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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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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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Long term outcome of patients after myocardial infarction with bioresorbable vascular scaffold implantation
Kozel, Martin ; Toušek, Petr (advisor) ; Zemánek, David (referee) ; Branny, Marian (referee)
Background: A higher rate of bioresorbable vascular scaffold (BVS) thrombosis has been observed after device implantation compared to implantation of permanent metallic stents in recently published studies. The mechanism of BVS thrombosis is currently under debate. Aim: To assess whether the immune-inflammatory response after BVS implantation is a potential trigger of BVS thrombosis. Methods and results: The PRAGUE-19 study was an academic study that enrolled consecutive patients with ST-segment elevation myocardial infarction (STEMI) with the intention to implant a BVS. A laboratory sub-study included 49 patients with an implanted BVS (of which 38 underwent the complete 2-year follow-up and 44 5-year telephone follow-up) and 52 patients as the control group having an implanted permanent metallic stent (of which 30 underwent the complete 2-year follow-up and 44 5-year telephone follow-up). Samples for inflammatory markers (high sensitivity C-reactive protein [hs-CRP], interleukin-6 [IL-6] and tumor necrosis factor-alpha [TNF-α]) were taken before BVS or stent implantation, on days 1 and 2 after device implantation and at 1 month and 2 years of a clinical control. The primary combined clinical endpoint of the sub-study (death, reinfarction or target vessel revascularization) occurred in 14.29 % of...
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Radial Approach in Therapy of Ischemic Heart Disease
Jirouš, Štěpán ; Bernat, Ivo (advisor) ; Toušek, Petr (referee) ; Hlinomaz, Oto (referee)
Presently, coronary catheterizations and interventions are more often performed by a radial artery approach than by a previously dominant femoral artery approach due to the lower incidence of both local and systemic complications. In addition, based on evidence of lower mortality associated with this approach, the radial approach has received class IA recommendation in the 2015 European Society of Cardiology (ESC) guidelines for interventional treatment of NSTEMI, in the 2017 ESC guidelines for STEMI and lately in the 2018 ESC guidelines for other forms of ischemic heart disease. Although a large number of studies concerning the radial approach have been published, many questions remain unanswered; for example, the evaluation of the radial approach in patients with myocardial infarction complicated with cardiogenic shock. The assessment of radial artery occlusion as the most frequent local complication of this approach has been very heterogeneous so far both in terms of different methods of detection that were used and timing of their application. Thus, there are still possibilities to further reduce the incidence of local complications and to optimize methodology of radial artery occlusion detection. In this dissertation thesis we address the issue of interventional treatment via radial artery access site...
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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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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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