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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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