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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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Role of echocardiography in the evaluation of functional and structural changes of the myocardium
Rob, Daniel ; Linhart, Aleš (advisor) ; Pudil, Radek (referee) ; Málek, Filip (referee)
Echocardiography plays a key role in the evaluation of functional and structural changes of the heart. Fabry disease (FD) is a genetic (X-linked) lysosomal storage disease caused by mutations in the gene for alpha-galactosidase A. Cardiovascular involvement is a major cause of morbidity and mortality in FD. The aim of our work was to refine the diagnosis and risk stratification of Fabry cardiac involvement using echocardiography. In the first part of our retrospective project, we analysed the relationship between the uric acid level, development, and progression of left ventricular (LV) hypertrophy and adverse events. Our results showed a strong relationship between uric acid level and progression of LV hypertrophy, mortality, and cardiovascular events. Uric acid can be used as a marker of cardiovascular risk in FD. In the second part of our retrospective project, we analysed the diagnostic value of tissue doppler imaging (TDI) of mitral annular velocities in Fabry cardiomyopathy. Despite the lower TDI mitral annular velocities in FD, the overlap with the general population is too large to allow reliable diagnosis of FD in routine clinical practice. In the prospective study, we analysed the prevalence, characteristics, prognosis and validity of the current echocardiographic criteria for heart...
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Function of systemic right ventricle after atrial correction of transposition of great arteries - longitudinal follow-up and impact on exercise capacity
Frank Antonová, Petra ; Rohn, Vilém (advisor) ; Linhartová, Kateřina (referee) ; Pudil, Radek (referee)
Function of systemic right ventricle after atrial correction of transposition of great arteries - longitudinal follow-up and impact on exercise capacity Abstract Maximal oxygen uptake during cardiopulmonary exercise test determines decision about pregnancy, therapeutic measures and timing of surgery and heart transplantation. Atrial correction of transposition of great arteries places right ventricle in the systemic positon. The aim of our work was to assess relation of parameters of function of systemic right ventricle to maximal oxygen uptake. 86 patients after Senning correction were subjected to testing of NYHA class, blood tests of NT-proBNP, Holter monitoring and cardiopulmonary exercise test. Systolic function of right ventricle was assessed semiquantitatively by echocardiography and precisely calculated by heart MRI. Maximal oxygen uptake was not associated with NYHA, NT-proBNP nor systolic function of systemic right and subpulmonary left ventricles. The only parameter associated with VO2max was heart rate reserve. Systolic function of the systemic right ventricle is likely only one integral part of a more complex haemodynamic mechanism of total heart output and its increase during exercise. In the second part of our study we aimed to ascertain long term mortality of all patients after atrial...
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Prognostic factors of surgical treatment of chronic thromboembolic pulmonary hypertension
Nižnanský, Matúš ; Lindner, Jaroslav (advisor) ; Rohn, Vilém (referee) ; Pudil, Radek (referee)
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by increased pulmonary artery pressure. It is caused by intraluminal thrombi organisation, stenoses and occlusions of pulmonary artery and its branches and peripheral vascular remodeling. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon pulmonary angioplasty or lung transplantation. Despite the high effectivity of PEA, there is a number of patients, whose pulmonary arterial pressure remains high and this plays a key role in postoperative mortality and morbidity. Incidence of residual pulmonary hypertension is according to literature between 16 and 51%. This leads to a pursuit of finding possible tools to predict residual pulmonary hypertension after PEA. The aim of...
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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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Ultrasonographic evaluation of cardiovascular abnormalities in patients with Fabry disease
Paleček, Tomáš ; Bultas, Jan (advisor) ; Pudil, Radek (referee) ; Kittnar, Otomar (referee)
Fabry disease is an X-linked glycosphingolipid storage disorder caused by deficient activity of the lysosomal enzyme α-galactosidase A. This leads to progressive intracellular accumulation of neutral glycosphingolipids, mainly globotriaosylceramide. Besides various extracardiac disease-related abnormalities, cardiovascular involvement represents a typical manifestation of Fabry disease. The primary underlying mechanism relies on pathological substrate accumulation in cardiomyocytes, conduction system cells, valvular fibroblasts, endothelial cells and vascular smooth muscle cells. The development of cardiac and vascular hypertrophy represents a characteristic cardiovascular feature of Fabry disease. The aim of our studies was to describe in detail cardiovascular abnormalities in patients with Fabry disease using ultrasonography, which currently represents basic noninvasive imaging modality in cardiology. We focused on structural and functional abnormalities of ventricles, valvular apparatus and their relationship to vascular involvement expressed on common carotid arteries. We also compared the diagnostic accuracy of the two novel echocardiographic methods used for the left ventricular diastolic function assessment. The possible existence of circulating proliferative factor, which might be associated with...
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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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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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