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Non-invasive diagnosis of involvement of the right ventricle in hypertrophic cardiomyopathy
Zemánek, David ; Veselka, Josef (advisor) ; Málek, Ivan (referee) ; Pudil, Radek (referee)
Aim: The ~ulhor invesugatcd thc utility of !traio, ,trajo ratc, and tissue Doppler imagiDg (lDI) forthe evaluation oftbc right vcntticlc (RV) impainnenl io paritOU with a h)'P"nmphic c.rdiomyopathy (HCM) .flt;r ll. IUCOCSIIful alCQhoI ~ptal ablo.tÍOQ wilhout RV hypcrtrOphy in oompari$on wilh C<XI.trolgroup. Mcthodl &lid RCSllII",: A group ol 19 plllÍCOl! sufl"erin, fmm IleM with 22 controls was compaml. The parametcra of TOl M:re evaluated in mitral IIOd lricuspid annulUI. SlrIIm lnd Anno BIC derivW from ml wcre I5Sessed in lUl apH.:al fret:waU ofRV, u wcLl KS in ""!lilI SCgolCflts ofthc len vcntriclc. lktwcen bulh groupS, !bere wcrc statlstically 8ignificant difTerencc~ only III ;,ovolumic pre- ejoction ume (79.2±11.3 ml vs 58.5±8.1 ros, JK{l.OI), iSDVOlulOk ,-e!ll)tllio!1 time (HI4.7±26.2 ms vs n .ll24.5 ms, p<O.OI), m~lalperfOl"TT\3l)(;e(Tci)tndex mcasurcd fmm TOl (O.6I±O.14 Vll 0.49J.0.09, ~.Ol). and early peak diastoli<: veloc:ity of TOl ( 11 .2±1.8cm1I1'112.'»2.6cmll;~.05). CooclU$ion: Tbc: rcsul" IiUg&cJt the impainnent ofboth J)'$lOIi<: and diastolic RV f,metlon in palients rutfering frum HCM. TOI-relaled paramctcrs appcar more Be\lBilivc than ,rmin and I traln Rte for evalUlltion.
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Tissue factor in acute coronary syndromes
Malý, Martin ; Hampl, Václav (advisor) ; Wilhelm, Jiří (referee) ; Vízek, Martin (referee) ; Málek, Ivan (referee)
In this review are summarized essentials of the physiology and the pathophysiology of TF in terms of the literature sources. But still, until today, there are many questions to be answered: the source and the level of TF in healthy subjects, the method how to measure the "trombogenic" potential of TF because its role in many biological processes, the "normal" levels, the possible impact of risk factors and possibility of risk stratification of "healthy" subjects according to the levels of TF like marker of the blood with procoagulant potential. Answering these questions and impact of the blocking of TF as a therapeutical approach in acute coronary syndromes is a challenging field of investigation in blood coagulation. Powered by TCPDF (www.tcpdf.org)
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Contribution of New Immunosuppressants after Heart Transplantation
Skalická, Blanka ; Málek, Ivan (advisor) ; Horký, Karel (referee) ; Lischke, Robert (referee)
Background: Acute cellular rejection and graft vascular disease are major factors limiting the survival after orthotopic heart transplantation (OHTx). Tacrolimus could be more potent than cyclosporin A in therapy of recurrent acute rejection episodes in OHTx patients. Dyslipidemia is one of the risk factors involved in the development of graft vascular disease. Statins are common part of standard drug regimen after OHTx. On the other hand, they are potentially dangerous as they could interact with cyclosporin A. Study in healthy volunteers showed that tacrolimus should have no interactions with statins. Aim: In the first study we retrospectively assessed the effect of switching patients after OHTx with recurrent cellular rejection episodes from cyclosporin A to tacrolimus. In the second (prospective) study we evaluated the efficacy and safety of combined therapy with tacrolimus and atorvastatin in patients after OHTx with dyslipidemia. (...) Conclusions: Tacrolimus has a beneficial effect not only on recurrent acute rejection episodes in heart transplant recipients but it also decreases the incidence of future rejection episodes. In patients after OHTx with dyslipidemia switching to tacrolimus and atorvastatin could be a suitable therapeutic option, because this combination is safe and effective in...
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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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Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion
Skalická, Hana ; Horák, Jan (advisor) ; Vojáček, Jan (referee) ; Málek, Ivan (referee)
Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion Objective and background: Despite the use of reperfusion therapies, outcomes in patients with large ST elevation myocardial infarction (STEMI), late reperfusion and left ventricular (LV) dysfunction is poor. We investigated longterm safety and efficacy of intracoronary injections of autologous bone marrow-derived mononuclear cells (BMNCs). Methods: 27 patients with anterior STEMI (age 59 ± 12 yrs, mean baseline LV ejection fraction (LVEF) 39±5%), who underwent percutaneous coronary intervention 4-24 hours after the onset of symptoms, were randomly assigned either to intracoronary BMNCs injection (n = 17, BMNCs group, out of which 14 underwent longterm follow-up), or to standard therapy (n = 10, Control group). The LVEF, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and diastolic function (transmitral flow, pulmonary vein flow) were assessed by echocardiography at discharge, month 4 and 24. Myocardial perfusion was assessed using SPECT at baseline and month 4. Results: At 24-month, there was no difference in rates of serious clinical events (36% vs. 50%, p=0,54). At Month 4 LVEF improved to similar extent in...
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Experimental and clinical aspect of calcineurin inhibitors-induced nephrotoxicity.
Hošková, Lenka ; Málek, Ivan (advisor) ; Tesař, Vladimír (referee) ; Špinarová, Lenka (referee)
The introduction of calcineurin inhibitors (CNI) into immunosuppressive regimens significantly improved patients prognosis after heart transplantation. Some of the most significant complications have been recognized, such as the development of arterial hypertension and renal impairment due to calcineurin inhibitor toxicity. The aim of the study was to compare the effect of the dual blockade of the renin-angiotensin system (dual RAS combination) with standard antihypertensive medication on blood pressure control. The second aim was to evaluate whether effective antihypertensive combination therapy (dual RAS or a standard antihypertensive drugs combination) would reduce the progression of chronic kidney disease in patients with chronic immunosuppressive prophylaxis. Treatment of arterial hypertension involving the combination of angiotensin-converting enzyme inhibitor (ACEi) and angiotensin II receptor blocker (ARB) was similarly effective compared to the standard combination of antihypertensives. Blood pressure treatment targets were achieved in both studies. Administration of antihypertensive combination therapy including dual blockade of RAS alleviated the progression of chronic renal disease in the experimental and clinical part, where the nephroprotective effect of dual RAS blockade...
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Contribution of BNP to prognostic stratification of patients with advanced heart failure.
Hegarová, Markéta ; Málek, Ivan (advisor) ; Bedáňová, Helena (referee) ; Pudil, Radek (referee)
Plasma levels of B-type natriuretic peptide (BNP) are a strong and independent predictor of prognosis in patients with advanced heart failure (CHF). However, the importance of this biomarker has been documented only in CHF of common causes such as dilated or ischemic cardiomyopathy. We hypothesized that BNP can serve as a strong predictor of end-stage CHF in group of patients with advanced CHF due to congenital heart disease (CHD) with the right ventricle in systemic position (SRV). The second hypothesis was that BNP monitoring in patients with implanted left ventricular assist device (LVAD) Heart Mate II could detect serious complications which negatively affect prognosis. We performed a retrospective analysis in 28 consecutive patients with severe systolic dysfunction of the SRV (ejection fraction 23 ± 6%) evaluated as heart transplant (HTx) candidates between May 2007 and October 2014. During a median follow-up of 29 months (interquartile range, 9-50), 14 pts reached primary endpoints of the study (death, urgent HTx, and LVAD implantation). We have considered these events equivalent to end-stage CHF. Using ROC analysis, we identified the first measured value of BNP as the strongest predictor of prognosis with the area under the curve (AUC) of 1.00, followed by the New York Heart Association...
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