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Impact of Admitting Department on the Management of Acute Coronary Syndrome after an Out of Hospital Cardiac Arrest
Jánský, Pavel ; Moťovská, Zuzana (advisor) ; Hutyra, Martin (referee) ; Ošťádal, Petr (referee)
Aim. This study aimed to analyze the influence of the hospital admitting department on adherence to the Guidelines of European Society of Cardiology for management of acute coronary syndromes in patients after out-of-hospital cardiac arrest (OHCA) of coronary etiology. Methods: We studied 102 consecutive patients with OHCA as a manifestation of acute coronary syndrome (ACS). Patients were admitted to the coronary care unit (CCU) 52, general intensive care unit (GICU) 21, or GICU after initial Cath lab treatment (CAG-GICU) 29. This study compared the differences in the management of ACS in patients with OHCA of coronary etiology based on the admitting department in a tertiary care institution. Results: Twelve of the 21 (57.1%) patients admitted to the GICU were evaluated as having ACS on- site where they experienced OHCA. In the CCU group, 50 out of 52 (96.2%) and 28 of 29 (100%) patients in the CAG-GICU group (p<0.001). Coronary angiography was performed in 10 of 21 patients (48%) admitted to the GICU. It was performed in 49 out of 52 (94%) CCU patients and, in the CAG-GICU group, 28 out of 29 patients. The mean time to CAG differed significantly across groups (that is, GICU 200.7 min., CCU 71.2 min., and CAG-GICU 7.5 min. (p<0.001)). Aspirin was used in 48% of GICU, 96% of CCU, and 79% of CAG-GICU...
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Novel echocardiographic and magnetic resonance methods in diagnostics of cardiac amyloidosis.
Fikrle, Michal ; Paleček, Tomáš (advisor) ; Hutyra, Martin (referee) ; Krejčí, Jan (referee)
Amyloidosis is a term used for a whole group of diseases caused by deposition of a substance called amyloid into different tissues. Amyloid may be produced by a range of pathologic processes. Heart affliction is typical for only several types of amyloidoses. Heart involvement is then the patient`s prognosis major limiting factor. Diagnosis of heart amyloidosis is difficult especially for nonspecific symptoms and nonspecific findings obtained during common diagnostic procedures. The aim of this thesis was to evaluate usefulness of novel diagnostic methods, namely cardiac magnetic resonance with gadolinium enhancement and a simplified echocardiographic evaluation of left ventricular longitudinal strain, in diagnosing amyloid cardiomyopathy. In our first study we examined 22 patients with light chain amyloidosis by echocardiography and also with cardiac magnetic resonance with late gadolinium enhancement. We compared morphologic and functional parameters acquired by magnetic resonance examination, which is considered a gold standard for morphologic and functional measurements, with values obtained by echocardiographic measurement. Afterwards we evaluated the presence and eventually pattern of late gadolinium enhancement during cardiac magnetic resonance exam. From acquired data we conclude that the...
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Use of cardiovascular magnetic resonance for evaluation of pathophysiollogy in dilated cardiomyopathy.
Šramko, Marek ; Kubánek, Miloš (advisor) ; Solař, Miroslav (referee) ; Hutyra, Martin (referee)
Dilated cardiomyopathy (DCM) is the second leading cause of heart failure. The pathophysiology in DCM is still poorly understood, partly because of currently limited research tools. We investigated whether cardiovascular magnetic resonance (CMR), using novel imaging techniques, could be used for in vivo assessment of some key pathophysiological mechanisms related to DCM. In addition, we evaluated whether the pathological findings on CMR would predict clinically relevant functional and morphological improvement of the left ventricular (LV) function - the LV reverse remodeling (LVRR). CMR together with endomyocardial biopsy, echocardiography, cardiopulmonary exercise testing and a thorough assessment of cardiac biomarkers was performed in 44 patients with new-onset DCM (<6 months of duration). The imaging was repeated after 12 months of clinical follow-up. Endomyocardial biopsy revealed myocardial inflammation in 34 % of the patients. LVRR at 12 months occurred in 45 % of the patients. Presence of late gadolinium enhancement (LGE) in the left ventricle was a sensitive but unspecific sign of myocardial inflammation because it was also a feature of hemodynamic stress related to the heart failure. The baseline extent of LGE was an independent predictor of future LVRR and also a predictor of adverse clinical...
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Feasibility and Clinical Value of Vena Contracta Area in the Quantification of Functional Mitral Regurgitation During Bicycle Exercise: A Color Doppler 3D Echocardiography Study
Večeřa, Jan ; Malý, Radovan (advisor) ; Hutyra, Martin (referee) ; Paleček, Tomáš (referee)
The utility of three-dimensional (3D) colour Doppler echocardiography for the evaluation of dynamic changes of secondary mitral regurgitation during dynamic stress echocardiography Previous studies proved, that severe functional mitral regurgitation (FMR) at rest and/or its significant increase during exercise have been shown to be associated with reduced functional capacity and impaired prognosis. In these studies, FMR has been assessed using 2- dimensional (D) quantitative techniques: proximal isovelocity surface (PISA) and pulsed Doppler volumetry. These methods, however, have several known limitations. Recently, color Doppler 3-D echocardiography-derived vena contracta cross-sectional area (VCA) has emerged as a new method to assess FMR severity at rest. VCA at rest has been shown to have higher correlation with the 2-D integrative method or magnetic resonance-derived regurgitant volume than any single 2-D method. The prognostic significance of VCA at rest and its increase during exercise, however, has not been investigated. Therefore, the goal of our study was 1) to find out if the the relationship between exercise-induced changes of FMR assessed by VCA, clinical and Doppler characteristics is different from previous PISA derived ERO based studies, 2) to find resting predictors of exercise-induced...
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Novel echocardiographic and magnetic resonance methods in diagnostics of cardiac amyloidosis.
Fikrle, Michal ; Paleček, Tomáš (advisor) ; Hutyra, Martin (referee) ; Krejčí, Jan (referee)
Amyloidosis is a term used for a whole group of diseases caused by deposition of a substance called amyloid into different tissues. Amyloid may be produced by a range of pathologic processes. Heart affliction is typical for only several types of amyloidoses. Heart involvement is then the patient`s prognosis major limiting factor. Diagnosis of heart amyloidosis is difficult especially for nonspecific symptoms and nonspecific findings obtained during common diagnostic procedures. The aim of this thesis was to evaluate usefulness of novel diagnostic methods, namely cardiac magnetic resonance with gadolinium enhancement and a simplified echocardiographic evaluation of left ventricular longitudinal strain, in diagnosing amyloid cardiomyopathy. In our first study we examined 22 patients with light chain amyloidosis by echocardiography and also with cardiac magnetic resonance with late gadolinium enhancement. We compared morphologic and functional parameters acquired by magnetic resonance examination, which is considered a gold standard for morphologic and functional measurements, with values obtained by echocardiographic measurement. Afterwards we evaluated the presence and eventually pattern of late gadolinium enhancement during cardiac magnetic resonance exam. From acquired data we conclude that the...
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Relation between the reperfusion of pulmonary arteries after an acute pulmonary embolism to the development of chronic thromboembolic pulmonary hypertension.
Mrózek, Jan ; Jansa, Pavel (advisor) ; Maxová, Hana (referee) ; Hutyra, Martin (referee)
Relation between the reperfusion of pulmonary arteries after acute pulmonary embolism to the development of chronic thromboembolic pulmonary hypertension Incomplete resolution of thromboemboli following acute pulmonary embolism (PE) is a key factor in development of chronic thromboembolic pulmonary hypertension (CTEPH). In our study, we evaluated the incidence, risk factors and clinical impact of incomplete reperfusion after acute PE. Study population and methods: 85 patients after the first acute PE were assessed clinically and by pulmonary scintigraphy and echocardiography at month 6, 12 and 24 after an acute PE. Results: Incomplete reperfusion was detected in 23.5 % of patients after 6 months, in 24.9 % of patients after 12 months and in 18.6 % of patients after 24 months. At month 6, patients with incomplete reperfusion were more obese when compared with patients with normal reperfusion BMI 30.8 vs 28.3 kg/m2 ; p=0.012) and their initial hemoglobin levels were higher (143.0 vs 136.0 g/l; p=0.012). Similar results were observed at month 12 - patients with residual perfusion defects were more obese (BMI 31.1 vs 28.5; p=0.016) with higher initial hemoglobin levels (144.0 vs 136.0; p=0.007). Patients with incomplete reperfusion at month 24 were significantly older (67.7 vs 55.0 years; p=0.02), their...
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Use of cardiovascular magnetic resonance for evaluation of pathophysiollogy in dilated cardiomyopathy.
Šramko, Marek ; Kubánek, Miloš (advisor) ; Solař, Miroslav (referee) ; Hutyra, Martin (referee)
Dilated cardiomyopathy (DCM) is the second leading cause of heart failure. The pathophysiology in DCM is still poorly understood, partly because of currently limited research tools. We investigated whether cardiovascular magnetic resonance (CMR), using novel imaging techniques, could be used for in vivo assessment of some key pathophysiological mechanisms related to DCM. In addition, we evaluated whether the pathological findings on CMR would predict clinically relevant functional and morphological improvement of the left ventricular (LV) function - the LV reverse remodeling (LVRR). CMR together with endomyocardial biopsy, echocardiography, cardiopulmonary exercise testing and a thorough assessment of cardiac biomarkers was performed in 44 patients with new-onset DCM (<6 months of duration). The imaging was repeated after 12 months of clinical follow-up. Endomyocardial biopsy revealed myocardial inflammation in 34 % of the patients. LVRR at 12 months occurred in 45 % of the patients. Presence of late gadolinium enhancement (LGE) in the left ventricle was a sensitive but unspecific sign of myocardial inflammation because it was also a feature of hemodynamic stress related to the heart failure. The baseline extent of LGE was an independent predictor of future LVRR and also a predictor of adverse clinical...
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