OBJECTIVES: This cross-sectional analysis from the CZecking Heart Failure in patients with advanced Chronic Kidney Disease trial (ISRCTN18275480) examined pulmonary hypertension and right ventricular-pulmonary arterial coupling in patients on chronic hemodialysis. The aims of this analysis were: 1. To analyze relations between pulmonary hypertension and right ventricular-pulmonary arterial coupling with dialysis access flow and current hydration; 2. To analyze structural heart changes associated with right ventricular-pulmonary arterial uncoupling; 3. To reveal the prevalence, etiology and severity of pulmonary hypertension in the Czech hemodialysis population. METHODS: We performed expert echocardiography, vascular access flow measurements, bioimpedance analysis, and laboratory testing in 336 hemodialysis patients. RESULTS: Pulmonary hypertension was present in 34% (114/336) patients and right ventricular-pulmonary arterial uncoupling was present in 25% of patients with pulmonary hypertension. Only weak associations between the flow of the dialysis arteriovenous access and estimated pulmonary arterial systolic pressure and right ventricular-pulmonary arterial coupling was proved. There was a strong association between hydration status assessed by estimated central venous pressure with pulmonary arterial systolic pressure (Rho 0.6, p < 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.52, p < 0.0001) and association between overhydration to extracellular water ratio with pulmonary arterial systolic pressure (Rho 0.31, p = 0.0001) and right ventricular-pulmonary arterial coupling (Rho -0.29, p = 0.002). The prevalence of heart failure was significantly higher in patients with right ventricular-pulmonary arterial uncoupling (88% vs. 52%, p = 0.0003). CONCLUSION: These findings suggest that optimizing volume status and treating heart failure should be prioritized in hemodialysis patients to prevent pulmonary hypertension progression and right ventricular-pulmonary arterial uncoupling.

• Klíčová slova
• Right ventricular-pulmonary arterial coupling, arteriovenous access flow, chronic hemodialysis, fluid overload, heart failure, pulmonary hypertension,
• MeSH
• arteria pulmonalis * patofyziologie   diagnostické zobrazování   MeSH
• chronické selhání ledvin * terapie   komplikace   MeSH
• dialýza ledvin * škodlivé účinky   MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní hypertenze * patofyziologie   epidemiologie   etiologie   MeSH
• prevalence MeSH
• průřezové studie MeSH
• senioři MeSH
• srdeční komory * patofyziologie   diagnostické zobrazování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Many patients with atrial fibrillation (AF) who are in need of stroke prevention are not treated with oral anticoagulation or discontinue treatment shortly after its initiation. Despite the availability of direct oral anticoagulants (DOACs), such undertreatment has improved somewhat but is still evident. This is due to continued risks of bleeding events or ischemic strokes while on DOAC, poor treatment compliance, or aversion to anticoagulant therapy. Because of significant improvements in procedural safety over the years left atrial appendage closure (LAAC), using a catheter-based, device implantation approach, is increasingly favored for the prevention of thromboembolic events in AF patients who cannot have long-term oral anticoagulation. This article is an executive summary of a practical guide recently published by an international expert consensus group, which introduces the LAAC devices and briefly explains the implantation technique. The indications and device follow-up are more comprehensively described. This practical guide, aligned with published guideline/guidance, is aimed at those non-implanting physicians who may need to refer patients for consideration of LAAC.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• cévní mozková příhoda * prevence a kontrola   etiologie   MeSH
• fibrilace síní * komplikace   terapie   diagnóza   MeSH
• konsensus MeSH
• lidé MeSH
• síňové ouško * chirurgie   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• srdeční katetrizace * škodlivé účinky   přístrojové vybavení   MeSH
• tromboembolie * prevence a kontrola   etiologie   MeSH
• uzávěr ouška levé síně MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• směrnice pro lékařskou praxi MeSH
• Názvy látek
• antikoagulancia MeSH

Mechanical restitution (MR) represents the time recovery of the heart muscle's ability to contract. Despite intensive research, some aspects of MR remain unclear. To describe MR in guinea pig cardiac muscle, we modified our published mathematical model of guinea pig ventricular cardiomyocyte and supplemented it with a description of cellular contraction. To achieve the best agreement between the model simulations and available experimental data, some model parameters were optimised. The model enables the simulation of the experimentally observed fast onset of recovery of action potential duration, L-type Ca2+ current amplitude, and isometric force. The performed simulations and analyses of model data showed that the high time constant of voltage-dependent inactivation of L-type Ca2+ channels used in previously published models (~ 600 ms at resting voltage) is not consistent with the initial steep rise of the MR curve in guinea pig cardiomyocytes. It also suggests that the adaptation rate of ryanodine receptors, which was set differently in the previous models, is fast (~ 100 s- 1). Finally, analysis of the effect of a 50% reduction in membrane currents on MR revealed a marked dependence on stimulation frequency. At 1 Hz, only the reduction of INaCa and INaK significantly affected the MR course.

• Klíčová slova
• Calcium current, Guinea pig cardiomyocyte, Mathematical model, Mechanical restitution, Ryanodine receptor,
• MeSH
• akční potenciály fyziologie   MeSH
• kardiomyocyty * fyziologie   metabolismus   MeSH
• kontrakce myokardu * fyziologie   MeSH
• modely kardiovaskulární * MeSH
• morčata MeSH
• počítačová simulace MeSH
• ryanodinový receptor vápníkového kanálu metabolismus   MeSH
• vápníkové kanály - typ L metabolismus   MeSH
• zvířata MeSH
• Check Tag
• morčata MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• ryanodinový receptor vápníkového kanálu MeSH
• vápníkové kanály - typ L MeSH

BACKGROUND: Leadless pacemakers (LPs) are limited by the current inability to perform left bundle branch area pacing (LBBAP). OBJECTIVE: The purpose of this first-in-human acute feasibility study was to evaluate the safety and performance of a novel helix-based LP with an extended electrode for LBBAP (LPCSP). METHODS: After obtaining informed consent, the LPCSP (Aveir CSP LP) was temporarily deployed in patients with indications for LP implantation. The LPCSP was introduced from the right internal jugular (IJ) vein and temporarily implanted deep into the interventricular septum (IVS) under fluoroscopic and intracardiac echocardiographic guidance. The primary safety endpoint was freedom from serious device adverse events (SADEs) within 1 month of the implant procedure. The primary performance endpoints were intraprocedural electrical parameters, including pacing threshold, impedance, and sensed R-wave amplitude. The LPCSP then was removed, and a conventional LP was implanted in the right ventricle using the same IJ access. RESULTS: Among 14 enrolled patients (age 69.4 ± 9.9 years, 71% male), the LPCSP was successfully implanted into the IVS in 10 patients. Pacing threshold (1.2 ± 0.6 V at 0.4 ms), R-wave amplitude (10.2 ± 4.1 mV), and impedance (373 ± 56 Ω) were acceptable. LBBAP capture was observed in 5 patients, segmented into direct capture of the left bundle branch (n = 1) and left ventricular septal pacing (n = 4). Deep septal pacing was observed in 3 additional patients. Freedom from SADEs within 1 month of the implant procedure was 85.7%. CONCLUSION: This first-in-human study demonstrated acute successful implantation of the LPCSP with clinically acceptable intraprocedural electrical performance and safety.

• Klíčová slova
• Conduction system pacing, First-in-human study, Helix fixation, Internal jugular vein, Leadless pacemaker, Left bundle branch area pacing,
• MeSH
• blokáda Tawarova raménka * terapie   patofyziologie   MeSH
• design vybavení MeSH
• echokardiografie MeSH
• elektrokardiografie MeSH
• Hisův svazek * patofyziologie   MeSH
• kardiostimulace umělá * metody   MeSH
• kardiostimulátor * MeSH
• lidé MeSH
• následné studie MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is an established treatment of heart failure with reduced ejection fraction and wide QRS. Left bundle branch area pacing (LBBAP) has emerged as a physiologic alternative by directly engaging the His-Purkinje system, potentially improving electrical resynchronization and clinical outcomes. OBJECTIVE: The aim of the study was to compare the clinical outcomes between BVP and LBBAP in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing CRT. METHODS: This multicenter observational study included patients with LVEF ≤50% receiving CRT with either LBBAP or BVP at 18 centers from January 2018 to June 2023. The primary outcome was a composite of all-cause mortality or first heart failure hospitalization (HFH). Secondary outcomes included separate analyses of HFH and all-cause mortality. Propensity score matching was used to balance baseline characteristics. Kaplan-Meier curves, Cox proportional hazards models, and competing risk analyses were performed. RESULTS: A total of 2579 patients were included (BVP, 1118; LBBAP, 1461). In the propensity score-matched cohort (BVP, 780; LBBAP, 780), LBBAP demonstrated shorter paced QRS duration (129 ± 19 ms vs 143 ± 22 ms; P < .001). LBBAP was associated with a significantly lower risk of the composite primary outcome (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.66-0.98; P = .048) and reduced HFH (HR, 0.63; 95% CI, 0.49-0.82; P < .001). No significant difference in all-cause mortality was observed (HR, 0.82; 95% CI, 0.63-1.07; P = .156). Procedural complications were lower with LBBAP (3.5% vs 6.5%, P = .004). CONCLUSION: LBBAP was associated with superior electrical resynchronization, fewer HFHs, and lower procedural complications compared with BVP in patients with LVEF <50% requiring CRT. Randomized trials are needed to confirm long-term benefits.

• Klíčová slova
• Biventricular pacing, Cardiac resynchronization therapy, Heart failure hospitalization, Left bundle branch area pacing, Mortality,
• MeSH
• funkce levé komory srdeční * fyziologie   MeSH
• Hisův svazek * patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční resynchronizační terapie * metody   MeSH
• srdeční selhání * terapie   patofyziologie   mortalita   MeSH
• tepový objem * fyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH

BACKGROUND: The treatment of aortic valve disease in small annuli remains a debated topic in terms of prosthetic choice - biological or mechanical - and risk of patient prosthesis mismatch. METHODS: The clinical data of the 241 patients who received a small size sutureless prosthesis from the Sorin Universal REgistry on Aortic Valve Replacement (SURE-AVR) (NCT02679404) were analysed at 30 days and at follow-up. The mean age was 75.5 ± 7.8 years (89.2% female); the mean Society of Thoracic Surgeons (STS) score was 4.2 ± 3.2%, and the preoperative NYHA class II or III score was 83.8%. A minimally invasive approach was performed in 52.7% of patients; concomitant procedures were performed in 27.8% of patients. Similar aortic clamping and cardiopulmonary bypass times were observed in the overall isolated cohort and the isolated minimally invasive cohort. The mean intensive care unit (ICU) stay was 2.4 ± 2.0 days and the total length of stay was 10.3 ± 6.1 days. RESULTS: Three deaths were recorded at 30 days (1.2%), 2 for noncardiac causes. One patient experienced a myocardial infarction (0.4%) and 2 a nondisabling stroke (0.8%). 2 patients showed intraprosthetic leakage ≥ 2 and one patient para-prosthetic leakage ≥ 2; of these, one patient required reoperation with prosthesis removal. 4.1% of patients required a pacemaker implant. At a maximum follow-up of 8.1 years, 10 cardiovascular deaths, 4 valve related reinterventions (3 structural valve deterioration (SVD) requiring TAVI Valve-in-Valve, 1 endocarditis) occurred. CONCLUSIONS: With their good clinical outcomes, sutureless prostheses represent a good alternative for patients with small annuli, who are at high risk for annular enlargement and anticoagulant therapy. TRIAL REGISTRATION: Study number 587/2015.

• Klíčová slova
• Biological heart prosthesis, Follow-up outcome, Patient‒prosthesis mismatch, Sutureless aortic valve,
• MeSH
• aortální chlopeň * chirurgie   MeSH
• aortální stenóza * chirurgie   MeSH
• bezstehová chirurgie * metody   MeSH
• chirurgická náhrada chlopně * metody   MeSH
• lidé MeSH
• následné studie MeSH
• prognóza MeSH
• protézy - design MeSH
• registrace * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční chlopně umělé * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Cardiac atrophy is the most common complication of prolonged application of the left ventricle (LV) assist device (LVAD) in patients with advanced heart failure (HF), obviously, it is a consequence of LVAD-induced mechanical unloading. Previous studies employing heterotopic heart transplantation (HTx) as a model of heart unloading after LVAD implantation discovered sex-linked differences in the course of unloading-induced in the healthy hearts. It remains to be clarified if sex-related differences are present in the failing hearts after heterotopic HTx. Therefore, we first compared the course of unloading-induced cardiac atrophy in the failing hearts in intact (without gonadectomy) male and female rats, and in animals after gonadectomy, to explore the influence of sex hormones on this process. Second, we examined if the animal's sex modifies the effects of increased isovolumic loading of the LV on the course of unloading-induced cardiac atrophy. Heterotopic abdominal heart transplantation (HTx) was used as a rat model of heart unloading. HF was induced by volume overload achieved by creation of aorto-caval fistula. Increased isovolumic loading was obtained by implantation of specially designed three-branch spring expander into the LV. The degree of cardiac atrophy was assessed as the whole heart weight (HW) ratio of the heterotopically transplanted to the native control heart. We found that decreases in HW after HTx were similar in intact male and female rats, similarly in intact and gonadectomized animals. Implantation of the expander significantly and comparably reduced decreases in HW in male and in female rats. We conclude that there are no sex-linked differences in the development of unloading-induced cardiac atrophy in the failing hearts. Our results also show that enhanced isovolumic heart loading obtained using the spring expander attenuates the development of unloading-induced cardiac atrophy in the failing hearts; the degree of attenuation is similar in both sexes. Key words Heart failure " Cardiac atrophy " Sex differences " Heterotopic heart transplantation " Mechanical heart unloading.

• MeSH
• atrofie MeSH
• heterotopická transplantace * škodlivé účinky   MeSH
• krysa rodu Rattus MeSH
• myokard * patologie   MeSH
• podpůrné srdeční systémy * škodlivé účinky   MeSH
• pohlavní dimorfismus * MeSH
• potkani Wistar MeSH
• sexuální faktory MeSH
• srdeční selhání * patologie   patofyziologie   chirurgie   MeSH
• transplantace srdce * škodlivé účinky   metody   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease associated with increased cardiovascular morbidity and mortality. Myocardial fibrosis, a key pathological consequence of prolonged inflammation, contributes to diastolic dysfunction and the development of heart failure with preserved ejection fraction (HFpEF) in RA patients. Understanding its pathophysiology, early detection, and potential therapeutic strategies is crucial for improving patient outcomes. In this study we explore the underlying mechanisms of myocardial fibrosis in RA, focusing on immune-mediated pathways, oxidative stress, and extracellular matrix dysregulation, with concise look at the impact of immunosuppressive therapy on cardiac remodeling and role of speckle-tracking echocardiography (STE) in detecting subclinical myocardial fibrosis, emphasizing global longitudinal strain (GLS) as a promising surrogate marker. Key words Rheumatoid arthritis " Myocardial fibrosis " Diastolic dysfunction " Cardiovascular disease surveillance " Strain echocardiography.

• MeSH
• diastola fyziologie   MeSH
• fibróza MeSH
• kardiomyopatie * etiologie   patofyziologie   diagnostické zobrazování   MeSH
• lidé MeSH
• myokard * patologie   metabolismus   MeSH
• revmatoidní artritida * komplikace   patofyziologie   metabolismus   farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVES: The CEASE-AF trial demonstrated that epicardial-endocardial hybrid ablation (HA) had superior effectiveness compared to endocardial catheter ablation (CA) for non-paroxysmal atrial fibrillation (AF), without significantly increasing major complications during a 12-month period. Most contemporary AF ablation trials have not evaluated durability beyond 12 months. Therefore, 24-month effectiveness and safety of HA and CA are compared. METHODS: CEASE-AF is a prospective, multicentre, randomized trial. Patients 18-75 years of age with symptomatic, drug refractory persistent AF and left atrial diameter >4.0 cm or long-standing persistent AF were randomized 2:1 to HA (posterior wall and pulmonary vein isolation with left atrial appendage exclusion) or CA (pulmonary vein isolation). Secondary effectiveness was freedom from AF/atrial flutter/atrial tachycardia off class I/III anti-arrhythmic drugs except for those who previously failed at doses not exceeding those previously failed through a 24-month follow-up period. Major complications and reinterventions were evaluated. RESULTS: The intention-to-treat population was 102 patients with HA and 52 patients with CA. Seventy-five percent were male, 80.5% had persistent AF and 19.5% had long-standing persistent AF, with a mean age of 60.7 ± 7.9 years. Effectiveness for 24 months was 66.3% (63/95) with HA and 33.3% (17/51) with CA [absolute difference 33.0% (95% confidence interval 14.3%, 48.3%; P < 0.001)]. Major complication rates were 10.8% (11/102) with HA and 9.6% (5/52) with CA (P = 1.0), and fewer patients had reinterventions after HA than CA [18.9% (18/95) vs 52.9% (27/51), P < 0.001]. CONCLUSIONS: CEASE-AF demonstrated that the 32.4% absolute benefit of HA over CA for 12 months was durable for 24 months at 33% with continued similar safety rates and fewer reinterventions after HA (funded by AtriCure, Inc.; NCT02695277). CLINICALTRIALS.GOV REGISTRATION: NCT02695277.

• Klíčová slova
• Atrial fibrillation, Catheter ablation, Hybrid ablation, Left atrial appendage, Surgical ablation,
• MeSH
• dospělí MeSH
• endokard chirurgie   MeSH
• fibrilace síní * chirurgie   MeSH
• katetrizační ablace * metody   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prospektivní studie MeSH
• senioři MeSH
• venae pulmonales chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

Myocardial infarction is a leading cause of death and morbidity in individuals with cardiovascular diseases. Natural antioxidants, such as those found in green tea leaves, are beneficial in preventing these diseases. This study evaluated the protective effects of green tea leaves powder against isoprenaline (ISO)-induced myocardial infarction in rats. Four groups of male Long Evans rats were used: Control, Control + green tea leaves powder, ISO, and ISO + green tea leaves powder. Organ and blood plasma samples were collected to measure oxidative stress biomarkers, biochemical parameters, and gene expressions. Furthermore, tissue sections were prepared and stained histologically. ISO-induced rats showed decreased cellular antioxidants (catalase activity and glutathione concentration) and elevated oxidative stress markers. Notable inflammatory cell infiltration and fibrosis were observed in the heart and kidneys of ISO-induced rats. Supplementation with green tea leaves powder significantly restored catalase activity and glutathione concentration (p < 0.05) in plasma and tissues. It also considerably reduced lipid peroxidation, nitric oxide, and advanced oxidation protein products (p < 0.05) in ISO-administered rats. Furthermore, green tea leaves powder supplementation halted inflammatory gene expression (p < 0.05), restored antioxidant genes (p < 0.05) such as Nrf-2-HO-1, and prevented cardiac fibrosis in ISO-administered rats. Green tea leaves powder supplementation may reduce oxidative stress, inflammation, and fibrosis in ISO-administered rats, potentially through the Nrf-2-HO-1-mediated restoration of antioxidant enzymes and prevention of heart inflammation.

• Klíčová slova
• Camellia sinensis, Fibrosis, Inflammation, Isoprenaline, Myocardial infarction,
• MeSH
• antioxidancia * metabolismus   farmakologie   MeSH
• čajovník čínský * chemie   MeSH
• faktor 2 související s NF-E2 * metabolismus   MeSH
• infarkt myokardu * chemicky indukované   farmakoterapie   metabolismus   patologie   MeSH
• isoprenalin škodlivé účinky   MeSH
• katechin * farmakologie   MeSH
• krysa rodu Rattus MeSH
• myokard patologie   metabolismus   MeSH
• oxidační stres účinky léků   MeSH
• polyfenoly * farmakologie   chemie   MeSH
• poranění srdce * chemicky indukované   farmakoterapie   metabolismus   MeSH
• potkani Long-Evans MeSH
• prášky, zásypy, pudry MeSH
• rostlinné extrakty farmakologie   MeSH
• signální transdukce účinky léků   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antioxidancia * MeSH
• faktor 2 související s NF-E2 * MeSH
• hemová oxygenasa (decyklizující) MeSH
• Hmox1 protein, rat MeSH Prohlížeč
• isoprenalin MeSH
• katechin * MeSH
• Nfe2l2 protein, rat MeSH Prohlížeč
• polyfenoly * MeSH
• prášky, zásypy, pudry MeSH
• rostlinné extrakty MeSH