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Decision Aid Rules in Elderly Patients with Chest Pain
Hrečko, Juraj ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute chest pain is a common reason for examination at the emergency department. Elderly patients often have atypical symptoms, nonspecific changes on the electrocardiogram, and elevated levels of cardiac biomarkers from various causes. Differential diagnosis is quite broad and the aim of the examination at the emergency department should be to quickly rule out life-threatening conditions such as acute coronary syndrome, pulmonary embolism, or aortic dissection. Structured decision aid rules are accurate and can accelerate the diagnostic process, however we do not have sufficient data for the use of decision aids in the population of elderly. The aim of this work was: 1) to describe the clinical characteristics and occurrence of cardiac events in seniors examined at the emergency department for acute chest pain, 2) to identify risk factors for major cardiac events and 3) to compare the effectiveness and safety of selected decision aid rules for the rapid diagnosis of acute myocardial infarction in the population of elderly. We performed an analysis of patients older than 70 years who were examined within one year at the Department of Emergency Medicine of the University Hospital Hradec Králové for acute chest pain. Patients with ST segment elevations on the electrocardiogram were excluded from the...
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Heart Failure - Analysis of Risk Factors of Morbidity and Mortality
Dokoupil, Jiří ; Pudil, Radek (advisor) ; Moťovská, Zuzana (referee) ; Vítovec, Jiří (referee)
Acute heart failure represents a medical condition with very high mortality. Accurate risk stratification can help physicians to improve the health care about these patients. The aim of our study was to characterise patients admitted for acute heart failure, describe their demographic and clinical findings and to assess risk factors of short-term and long-term mortality. We further analysed risk factors of longer hospital stay among initial signs and precipitating factors of heart failure. We performed a retrospective analysis of patients admitted to the standard care and intensive care units from January to December 2017 to 1st Department of Internal Medicine - Cardioangiology of University Hospital Hradec Králové. We identified 385 patients admitted for acute heart failure. The all-cause in-hospital mortality was 12.7 %, 30-day mortality was 14.6 % and 1-year mortality was 34 %. Among risk factors of in-hospital mortality the most significant factors were the requirement of haemodialysis with ultrafiltration (OR 15.82, 95% CI 2.96-84.57, p = 0.0008), previously known chronic heart failure (OR 4.27, 95% CI 1.66- 11.03, p = 0.001) and STEMI as a precipitating factor of heart failure (OR 4.19, 95% CI 1.23- 14.25, p = 0.023). The requirement of haemodialysis with ultrafiltration (OR 4.28, 95% CI...
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The Role of MicroRNAs in the Progression of Cardiovascular Diseases
Černá, Václava ; Pešta, Martin (advisor) ; Vítovec, Jiří (referee) ; Chottová Dvořáková, Magdaléna (referee)
Current applied research of microRNA molecules is focused on the identification of their roles in the pathogenesis of various types of diseases, including cardiovascular (CV), with the assumption of their use as biomarkers or treatment targets. Cardiovascular diseases have a high incidence and prevalence in the population, are predominantly chronic, and are also a leading cause of hospitalization and death, and therefore represent a major burden on patients and the health system. Many metabolic parameters are currently used in the diagnosis of cardiovascular diseases and cardiovascular risk assessment, mostly proteins and lipids, while parameters from the group of nucleic acids, whether in the form of mutations in DNA molecules, or various RNA molecules, are very limited so far. Despite the undeniable importance and contribution of metabolic biomarkers in the diagnosis and prognosis of cardiovascular diseases, these markers still do not allow effective identification of all patients at high risk, and therefore additional molecules are being sought that could contribute to the accuracy of this identification. Finding other potential diagnostic and prognostic markers to contribute to the more precise CV risk assessment, and subsequently also to the more effective treatment of patients at high risk,...
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The metabolic response to acute coronary syndrome focusing on tissue factor, metalloproteinases and soluble CD40 ligand
Bis, Josef ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Vítovec, Jiří (referee)
The metabolic response to acute coronary syndrome focusing on tissue factor,, metalloproteinases and soluble CD40 ligand Introduction: The cause of acute coronary syndrome is unstable plaque and its rupture. Pathogenesis is complex and requires various mechanisms and depends both on the composition of plaque and thrombotic activity of blood. Objectives: The main goal of this work was to assess local levels of plasma tissue factor (TF), tissue factor inhibitor (TFPI), tissue metalloproteinases (MMP-2, 3 and 9) and inhibitor of metalloproteinases-2 (TIMP-2), a highly selective C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome and with stable angina pectoris in the systemic circulation, the coronary sinus and to determine the time course of blood levels in patients with acute coronary syndrome. Methods and results: Study population include patients with coronary artery disease (CAD). In 24 patients with stable CAD (SCAD) at time of diagnostic coronary angiography, we withdrew samples from the coronary sinus (CS), femoral vein (VF) and left coronary artery (LMCA). In 29 patients with acute coronary syndrome (ACS) we took samples of venous blood also 24 hours and 7 days from the start. The samples were fixed levels of TF, TFPI, MMP-2, 3 and 9, TIMP-2, CRP, and...
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Advanced heart failure in the 21st century: new physiological insights and new therapeutic avenues
Boilson, Barry Anthony ; Aschermann, Michael (advisor) ; Vítovec, Jiří (referee) ; Ošťádal, Petr (referee)
Countries with developed economies are currently facing an epidemic of heart failure (HF) and the prognosis of patients with advanced HF remains extremely poor. One of the therapeutic options for patients with advanced HF is heart transplant. The number of cardiac transplants performed in USA and other states each year has stagnated despite an increasing number of cases of end-stage heart failure each year, primarily due to limited donor supply. Therefore, novel therapies for cardiac replacement (such as left ventricular assist devices, LVADs), other cardiac assistance devices including arrhythmia treatment (cardiac resynchronization therapy, CRT or implantable cardiac defibrillators (ICDs) have been tested and are being used in clinical practice. Moreover, stem cell therapy has been tested as well as a role of endogenous progenitor cells has been explored. However, effects of the novel therapeutic approaches or their combination on pathophysiology of HF as well the involvement of endogenous progenitor cells are incompletely understood, which requires further research. The main aims of the thesis with corresponding main hypotheses were three as follows. First, to study the physiological effects of LVADs on pulmonary vascular resistance and the incidence and clinical tolerance of ventricular...
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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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Secondary prevention practice and prognosis of patients after ischemic stroke
Vaněk, Jiří ; Mayer, Otto (advisor) ; Rokyta, Richard (referee) ; Vítovec, Jiří (referee)
SECONDARY PREVENTION PRACTICE AND PROGNOSIS OF PATIENTS AFTER ISCHEMIC STROKE JIŘÍ VANĚK, M.D. 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic ABSTRACT It is evident that cerebrovascular disease including ischemic stroke belongs to the most common cause of disability or death in the world population. Secondary prevention in poststroke patiens can lead to reduce risk of recurrence or extend lifetime like in coronary heart disease (CHD). The principles of secondary prevention are well implemented in population with CHD, but the situation in poststroke patients is quite different. The assesment of secondary prevention in poststroke patiens and a comparison with patient with CHD was selected for a goal of this study. The study population consisted of Czech patients examined in the framework of well-defined surveys in patients after their first ischemic stroke. Patients represented pooled Czech samples of the project EUROASPIRE Stroke Modul or Stroke Survey in 2007 and in 2013. Better results in acute care were detected. Admissions in stroke unit in 2013 were realized more often than 2007 and fibrinolisis was aplicated more frequently too. On the contrary, arterial hypertension wasn't controlled better than the general population of...
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Transportation to primary percutaneous coronary intervention is a strong independent predictor of functional status after myocardial infarction with ST elevation. Five-year follow-up of the Prague-2 trial
Mocová, Danuše ; Widimský, Petr (advisor) ; Češka, Richard (referee) ; Vítovec, Jiří (referee)
Aim. Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (pPCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up. Methods. The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention center (pPCI) (n = 429) vs. thrombolysis in community hospitals (n = 421). The data was collected from primary hospitals and PCI centers or with questionnaires. Results. The mean follow-up was 58 months. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in pPCI patients (HR 1.8; 95% CI 1.38-2.33; p < 0.001). The respective cumulative incidence of recurrent infarction was 19 vs. 12 % (HR 1.72; 95% CI 1.15-2.58; p = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84- 2.23; p = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21-2.35; p < 0.001). At 5- years, 45.4 % of patients after primary percutaneous coronary intervention vs. 31.8 % of those treated with TL were in class I of the New York Heart Association (NYHA) (HR 2.02; 95%...
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Therapeutic drug monitoring in clinical practice and research
Ďuricová, Jana ; Grundmann, Milan (advisor) ; Mayer, Otto (referee) ; Vítovec, Jiří (referee)
Introduction: The human cytochrome P450 2D6 (CYP2D6) is involved in the oxidative metabolism of about 25 % of all commonly prescribed drugs. It is characterized by high range of interindividual variability due to both environmental and genetic factors. The ability to measure the activity of CYP2D6 enzyme is of high significance. Genotyping alone is not sufficient to accurately predict an individual's actual CYP2D6 activity, phenotyping on the other hand can determine the exact enzymatic activity as it also reflects non-genetic factors. Beta-blocker agent metoprolol undergoes extensive pre-systemic elimination, with enzyme CYP2D6 accounting for about 70 to 80 % of its metabolism. Metoprolol also serves as one of the probe drugs of CYP2D6. The metabolic ratio of metoprolol over its metabolite -hydroxymetoprolol in plasma 3 hours after metoprolol administration is used for the measurement of CYP2D6 enzyme activity. Aims: To compare CYP2D6 metabolic activity after first metoprolol dose and in steady state. Further to investigate the influence of CYP2D6 activity on metoprolol pharmacokinetics and pharmacodynamics in patients on metoprolol therapy. Methods: Thirteen adult hypertensive patients in whom an introduction of beta-blocker metoprolol was indicated were included for comparison of CYP2D6...
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Clinical Manifestations of Infective Endocarditis Depending on Infectious Agent
Pazderník, Michal ; Vojáček, Jan (advisor) ; Táborský, Miloš (referee) ; Vítovec, Jiří (referee)
Introduction: Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Aims and methods: A study of local IE cases was conducted in two leading Cardiac centres in the Czech Republic. The main objective was to analyse the features of this disease and, at the same time, to identify predictors that are associated with the development of acute complications and worse survival of patients with IE. Results: Infection of the aortic prosthesis was a significant predictor of paravalvular spread of infection (OR 6.706). Infection caused by Staphylococcus aureus (OR 8.459) and smoking (OR 8.403) were associated with a more frequent development of septic shock (OR 8.403). The most potent risk factors of possible embolization were mitral valve vegetation ≥ 13 mm (OR 3.59) and IE caused by Staphylococcus aureus (OR 3.24). The size of the vegetation was not only associated with the risk of embolization itself but also with a local destructive effect in the form of a new prolapse/perforation of the valve (OR 1.055). The importance...
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