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Specofics of Acute Mocardial Infarction in Young Adults.
Dostálová, Gabriela ; Linhart, Aleš (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Univerzita Karlova 1. lékařská fakulta Studijní program: Doktorské studium biomedicíny 1. LF UK Studijní obor: Oborová rada Fyziologie a patofyziologie člověka MUDr. Gabriela Dostálová Disertační práce Vybrané aspekty akutního infarktu myokardu u mladých nemocných Specifics of Acute Myocardial Infarction in Young Adults Školitelé: prof. MUDr. A. Linhart, DrSc., doc. MUDr. D. Karetová, CSc. Praha 2017 Abstract Coronary heart disease is the leading cause of death in adults in the western world. Myocardial infarction can represent the lethal manifestation of coronary heart disease leading to sudden cardiac death. Although myocardial infarction mainly occurs in patients older than 45 years, the young population can be affected as well. Despite the relatively low incidence of myocardial infarction in the young population, the mortality rates and long-term disability make acute myocardial infarction in young patients an important clinical issue. Consequences of myocardial infraction usually have great impact on the young patient's psychology, ability to work and the overall quality of life. The management of young myocardial infarction patients should differ at least slightly from the older ones. Young patients usually have a different risk factor profile, clinical presentation, and prognosis in comparison with...
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Some aspects of pathogenesis and management of valvular heart diseases that are commonly treated with surgical interventions: aortic stenosis and mitral regurgitation
Fojt, Richard ; Moťovská, Zuzana (advisor) ; Špaček, Rudolf (referee) ; Kuchynka, Petr (referee)
Aortic stenosis (AS) and mitral regurgitation (MR) are the most common valvular heart diseases in the adult population. Additionally, they are the most likely to need surgical intervention. Treatment preceding surgical or percutaneous correction of a valvular defect is targeted primarily on symptoms, since causal pharmacological treatment is lacking. A detailed understanding of the mechanisms behind valvular heart disease is necessary to effectively intervene in the pathogenesis. Calcified aortic valve stenosis, currently considered an active process consisting of a wide range of cells, signaling molecules, and transcription factors, is largely consistent with the pathogenesis of atherosclerosis; however, about 50% of patients with calcified AS do not exhibit significant atherosclerosis. Our work was focused on measuring osteoprotegerin (OPG) levels in the tissue of calcified aortic valves. OPG acts as decoy receptor for RANKL and affects calcification and differentiation of various cells during progression of AS. We found significantly higher tissue levels of OPG in patients with isolated AS compared to patients with concurrent AS and coronary atherosclerosis. These findings support the hypothesis that there is a unique pathogenesis for each clinical manifestation of calcified aortic valve disease. MR is...
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Selected Immune Markers During Acute Myocardial Infarction
Horáková, Lucie ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute myocardial infarction belongs currently to the most important diseases in the cardiology and the pathogenesis of the ischemic-reperfusion injury still remains an open question. The process of ischemia and reperfusion is complex, it involves a number of pathogenetic processes and activates number of systems among which the activation of immune system has the important place. In this study we have chosen some of the markers and followed their dynamics during the ischemia and reperfusion. We compared them with the standard markers of necrosis and we analysed possible relationship between these markers and the systolic dysfunction of the left ventricle. The aim of this study is to contribute to understanding of ischemia and reperfusion during acute myocardial infarction with the ST segment elevation. Moreover, further benefit of this study is pointing out the possibilities of new technologies in the determination of cardiac markers.
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Prevention of ischemic and bleeding complications in patiens with known cardiovascular disease in relation to interruption and re-administration of antithrombotic therapy during non-cardiac surgery
Ondráková, Martina ; Moťovská, Zuzana (advisor) ; Vojáček, Jan (referee) ; Miklík, Roman (referee)
Background. The analysis of the current approaches to antithrombotic treatment of cardiac patients in the perioperative period of major non-cardiac surgery was performed. The incidence of ischemic and bleeding complications in relation to the interrupted antithrombotic was observed. The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes. Methods. The subanalysis of multicentre PRAGUE 14 study was performed. A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year. Results. Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p=0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p=0.021). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p=0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%). Non-reinstitution of aspirin until discharge was associated with higher...
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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 importance of genetic testing in prevention of bleeding complications of invasive procedures in cardiology
Sionová, Magdalena ; Moťovská, Zuzana (advisor) ; Ošťádal, Petr (referee) ; Pudil, Radek (referee)
Background: Periprocedural bleeding is the most common complication related to coronary angiography (CAG) and percutaneous coronary intervention (PCI) and it is associated with worse short-term and long-term prognosis. Determining risk factors and genetic variations associated with increased bleeding risk may improve use of avoidance bleeding strategies in prevention of bleeding. Aim: The aim of our study was to a) identify independent risk factors (of the baseline characteristics, clinical, laboratory a procedural data) associated with a higher risk of periprocedural bleeding b) to validate predictive value of CRUSADE and NCDR bleeding risk stratification algorithms c) to analyze the association between the presence of selected single nucleotide polymorphisms of key platelet proteins (GPIa, GPVI, P2Y12, COX-1) and the risk of periprocedural bleeding. Methods: The study included 73 patients with acute or chronic ischemic heart disease who developed bleeding complication within 30 days after invasive procedure (CAG/PCI). The control group consisted of 331 patients without bleeding. Baseline characteristics, clinical state at admission, laboratory data (creatinine, blood count, INR) and procedural data were evaluated. The CRUSADE and NCDR algorithms for bleeding risk were retrospectively applied on both...
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Quantification of liver function using breath test with 13C labeled methacetin
Hendrichová, Miluše ; Horák, Jiří (advisor) ; Ehrmann, Jiří (referee) ; Martásek, Pavel (referee) ; Moťovská, Zuzana (referee)
Kvantifikace jaterních funkcí pomocí dechového testu s 13 C-methacetinem MUDr. Miluše HENDRICHOVÁ SUMMARY Efforts to evaluace and quantify liver functions has accompanied hepatology over the last 50 years at least. Quantification of liver function was hindered by multiple blood samploing, the low specificity of monitored parameters and the risk of allergic reactions when using conventional chromoexcretory tests. The introduction of breath tests using the non-radioactive isotope 13C allows non-invasive and highly accurate measurement of liver function. Especially 13C.methacetin is a very suitable substrate for evaluation demethylační and oxidative capacity of hepatocytes. Using the breath test with 13 C-methacetin is noninvasive, easy for patients and the results are reproducible. The aim of this thesis is to introduce the use of breath test with 13 C-methacetin into clinical practice as one of standard items in the care of patients with chronic liver diseases. In the first study we are evaluating liver function using breath test with 13 C-methacetin in patients with liver cirrhosis. The results show that the breath test reliably distinguishes patients with liver cirrhosis from patients without liver damage. Using ROC curves we demonstrate that the most advantageous time of the breath test that best predicts...
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Prevention of postinfarction left ventricular remodeling with stem cells implantation
Pelnař, Jiří ; Moťovská, Zuzana (advisor)
Cell therapy is a tempting and possibly promising therapeutic approach, which could be used in the near future to prevent the serious health effects on the heart and thus on the whole human organism resulting from myocardial infarction. The portion of the heart afflicted by infarction disrupts the architecture of the heart chamber as a whole and causes it to undergo the process of remodeling in a less or more pronounced manner. This process leads to progressive deterioration of the heart function, which may eventually lead to heart failure. The potential regeneration of a viable heart tissue by stem cells implantation would have the means of ceasing or reverting this harmful process. The introduction of stem cells into the heart tissue following a myocardial infarction can be achieved by several different techniques, using various cell types and in various time intervals after the occurence of myocardial infarction. So far, a number of studies using animal models of myocardial infarction, have shown that the stem cells implantation has a favorable effect on the restoration of heart function, while not showing such occurence of adverse effects that would exclude further investigation in the form of clinical studies. The clinical studies described in this work do not allow to make a definite conclusion. Some...
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