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Pathophysiology of intraventricular electrical activation and its relation to cardiac resynchronization therapy
Sedláček, Kamil ; Wichterle, Dan (advisor) ; Linhart, Aleš (referee) ; Čurila, Karol (referee)
The QRS complex shortening by cardiac resynchronization therapy (CRT) has been associated with improved outcomes. We hypothesized that (1) the absence of QRS duration (QRSd) prolongation by right ventricular septal pacing may indicate a complete left bundle branch block (cLBBB), and (2) that the interval between the right-ventricular pacing stimulus and left-ventricular lead electrogram (RVP-LV) is a better predictor of the electrocardiographic effect of CRT than the interval Q-LV. We prospectively collected 12-lead surface ECG and intracardiac electrograms during CRT implant procedures. Digital ECG and intracardiac recordings were edited and manually measured. The outcome measure was the QRS duration change induced by CRT (deltaCRT). Several outcome predictors were investigated: native QRS duration (QRSd), cLBBB (as defined by Strauss), Q-LV and RVP-LV intervals, and a newly proposed index defined by the difference between the right-ventricle-paced QRSd and native QRSd (deltaRVP). We included 133 consecutive patients in the study and found that the baseline QRSd, deltaRVP, and Q-LV represent strong independent predictors of electrocardiographic response to CRT (deltaCRT). DeltaRVP correlates tightly with the CRT effect on QRSd and outperforms predictive value of the ECG-based cLBBB. Strong...
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Genetic and clinical correlates in hypertrophic cardiomyopathy
Čurila, Karol ; Gregor, Pavel (advisor) ; Málek, Ivan (referee) ; Krejčí, Jan (referee)
Hypertrophic cardiomyopathy (HCM) is a hereditary disease, which is caused by mutations in genech coding for proteins of carcomere of heart muscle. Disease is characterised by wide genotypic and fenotypic heterogeneity. Since the 90-th of 20-th century, when the first mutation responsible for HCM was identified, many research was done in detecting the correlation between mutant gene and clinical picture of the affected patient. As the first in Czech republic, we determined the frequencies of 4 most common genes in HCM in czech patients. We figured out, that spectrum of mutations is somehow different from another populations. We didn't find any correlation between specific gene mutation and morfologic and clinical characteristics of affected subjects. In our study with AT-1 receptor blocker - candesartan, we demostrated positive effect of candesartan on level of hypertrophy and function of the left heart ventricle and clinical symptoms of the patients with HCM.
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Genetic and Proteomic Screening in Patients with Cardiovascular Disease.
Šímová, Jana ; Škvor, Jiří (advisor) ; Gregor, Pavel (referee) ; Čurila, Karol (referee)
The aim of this study is to analyse a genetic and proteomic aspects that could play an important role in development of chosen cardiovascular disease. Matrix metalloproteinases are enzymes that contribute strongly to the degradation of extracellular matrix components. In this study the serological levels of MMP-2 and MMP-9 were investigated using immunological testing in patients with aortic valve disease and in patients with myocardial infarction. Significantly higher levels of MMP-2 and MMP-9 were determined in both above mentioned groups of patients. Association of serum levels of MMP-2 and MMP-9 and development of concomitant aortic dilatation was not confirmed in patients with aortic valve disease. Changes in serum levels within 24 hours and after 6 months post myocardial infarction were characterized. About 10 % of patients operated for aortic valve disease suffer simultaneously from ascending aortic dilatation. The current study did not reveal any significant genetic variation in TGFBR2 gene and in chosen exons of FBN1 gene in these patients. Further genetic research is needed to identify the cause of the pathology in aortic wall. Gene expression of selected genes was measured by microarray screening in patients with myocardial infarction. These genes were related to MMPs and did not show...
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Genetic and clinical correlates in hypertrophic cardiomyopathy
Čurila, Karol ; Gregor, Pavel (advisor) ; Málek, Ivan (referee) ; Krejčí, Jan (referee)
Hypertrophic cardiomyopathy (HCM) is a hereditary disease, which is caused by mutations in genech coding for proteins of carcomere of heart muscle. Disease is characterised by wide genotypic and fenotypic heterogeneity. Since the 90-th of 20-th century, when the first mutation responsible for HCM was identified, many research was done in detecting the correlation between mutant gene and clinical picture of the affected patient. As the first in Czech republic, we determined the frequencies of 4 most common genes in HCM in czech patients. We figured out, that spectrum of mutations is somehow different from another populations. We didn't find any correlation between specific gene mutation and morfologic and clinical characteristics of affected subjects. In our study with AT-1 receptor blocker - candesartan, we demostrated positive effect of candesartan on level of hypertrophy and function of the left heart ventricle and clinical symptoms of the patients with HCM.
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Cost analysis of remote and in office pacemaker check ups after device replacement from the perspective of health care payer
Čurila, Karol ; Lešetický, Ondřej (advisor) ; Pažitný, Peter (referee)
Current pacemakers allow check up of their function using telemonitoring. Even so, the majority of the checks are carried out on an outpatient basis. It is not known, whether remote follow ups of the patients after pacemaker replacement would be cost-effective compared to in-office controls. A retrospective analysis of patients files of patients after pacemaker replacement in 2002-2005 in Faculty hospital of Kralovske Vinohrady was done. A total of 1407 records from the years 2002-2015 was analyzed. It was demonstrated that the vast majority (96%) of planned controls of these patients was not associated with a change of program of the pacemaker, so it could be performed remotely. Based on the obtained data a model, which compared the cost-effectiveness of outpatient and theoretically made remote controls of pacemakers was created. Using an analysis of cost minimalization, it was found that the remote controls of pacemakers, was not associated with a significant reduction of the costs compared to the ambulatory controls.
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