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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 Role of Patent Foramen Ovale in the Pathophysiology of Decompression Sickness.
Honěk, Jakub ; Šefc, Luděk (advisor) ; Linhartová, Kateřina (referee) ; Mandysová, Eva (referee)
Patent foramen ovale (PFO) has been associated with an increased risk of decompression sickness (DCS) in divers. Pathophysiologicaly this has been ascribed to paradoxical embolization of nitrogen bubbles from venous blood to systemic circulation, resulting in obstruction of peripheral capillaries and ischemic injury. However, the role of PFO has been largely debated and experimental and prospective clinical data has been missing. It is of note, that this hypothesis is not only of theoretical importance. The proof of PFO as a causative factor of DCS and, importantly, of unpredictable events (unprovoked DCS) could affect millions of divers worldwide through improved therapy and prevention. In our research we aimed to describe the pathophysiological role of PFO in decompression sickness and to determine whether the prevention of arterialization of post-dive venous gas emboli (VGE) would decrease the incidence of unprovoked DCS in divers. We have screened 489 scuba divers for the presence of PFO by means of transcranial color-coded Doppler ultrasonography. In a retrospective analysis we found that the incidence of unprovoked decompression sickness was 7% among these divers and that PFO was the only risk factor. Subsequently, we have studied the occurrence of VGE and arterial gas emboli (AGE) in divers with...
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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 role of adipose tissue in the pathophysiology of obesity and anorexia nervosa
Kratochvílová, Helena ; Haluzík, Martin (advisor) ; Pavlišová, Jana (referee)
The view of adipose tissue and its significance in human pathophysiology has changed substantially in the recent couple of years. It has been shown that adipose tissue is not only a passive storage site for excess energy, but that it actively participates in the maintenance of whole-body homeostasis as an endocrine organ producing various hormones and other biologically active molecules, which by acting in an endocrine, paracrine as well as autocrine fashion affect different organs and systems. An intact regulation of adipose tissue processes plays an important role in sustaining the integrity of the organism, whereas its defects lead to the development of a number of diseases. This thesis focuses primarily on the significance of adipose tissue in the pathogenesis of obesity and anorexia nervosa. In the last years, the incidence of obesity rapidly increases ranking, along with its complications, among the world's leading health problems. Obesity is associated with endocrine dysfunction of adipose tissue characterized by disrupted production of adipose tissue hormones and cytokines resulting in the development of numerous disorders including type 2 diabetes mellitus and cardiovascular diseases. A completely opposite disorder, where, however, adipose tissue, or more precisely the absence of it, plays...
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Life with pulmonary hypertension observed in the IKEM, Prague
KLOPOTOVÁ, Michaela
This undergraduate work deals with the issue of pulmonary hypertension monitored in clients at the Institute of Clinical and Experimental Medicine (IKEM) in Prague. The theoretical portion deals with the comprehensive issue of pulmonary hypertension {--} its aetiology, pathogenesis, pathophysiology, epidemiology, classification, clinical picture, examination methods, therapy and prognosis. It also covers its health and social aspect, which is further divided into its health and social impact. The health and social aspect is divided into health and illness, health support, prevention and quality of life. The health impact focuses on nutrition, physical activity, natural medications, colds and depression. The social aspect explores the social effects on health, illness and social benefits for clients with pulmonary hypertension. The practical portion of this work presents the results from a quantitative questionnaire carried out with clients monitored at IKEM Prague between 1 July 2008 and 28 February 2009. The purpose of the questionnaire was to establish whether patients with pulmonary hypertension often suffer from depression, whether the illness affects their health and social status and whether clients have sufficient information about pulmonary hypertension. The results show that the objectives were fulfilled. It has been proved that clients with pulmonary hypertension suffer from depression, their health and social status is also affected by the illness and most of them have sufficient information about pulmonary hypertension. This work can serve as a well-arranged source of information for different cardiology departments that deal with pulmonary hypertension. I am sure that the clients themselves would like to see the results of this work, let alone the Association of Pulmonary Hypertension Patients. This association follows not only specialized literature, but also the quality of life of and benefits for people with pulmonary hypertension.
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