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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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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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The value of neurohormonal activation assessment for treatment monitoring in congestive heart failure
Kubánek, Miloš ; Málek, Ivan (advisor) ; Špinarová, Lenka (referee) ; Pudil, Radek (referee)
Summary: Congestive heart failure (CHF) is associated with neurohormonal activation (NHA) which contributes to further progression of disease. Measurement of NHA has been used for diagnosis and prognostic stratification in CHF. Aims: The aim of this academic disertation was to analyze the value of NHA for treatment monitoring in CHF. We studied the relationship between NHA and pulmonary hypertension in compensated CHF using B-type natriuretic peptide (BNP) and big endothelin-1 (big ET-1). The rationale was to minimize repeated right heart catheterizations in candidates for orthotopic heart transplantation. A similar design had the second clinical study which used N-terminal pro-B- type natriuretic peptide (NT-proBNP) as a marker of NHA. In the third clinical study, we evaluated whether basal levels and/or change in NHA during treatment predict clinical efficacy of cardiac resynchronization therapy (CRT). We supposed that BNP and big ET-1 might be better predictors of outcome than standard methods of follow-up. Results: 1. Natriuretic peptides correlated with hemodynamic parameters better than big ET-1. An isolated measurement of BNP or NT-proBNP did not allow a reliable assessment of pulmonary hypertension or left ventricular filling pressure, respectively. On the other hand, serial evaluation of...
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