INTRODUCTION: We aimed to evaluate the prognostic impact of renal insufficiency and fluctuation of glomerular filtration observed during hospitalization for heart failure (HF). METHODS: We followed 3,639 patients hospitalized for acute HF and assessed the mortality risk associated with moderate or severe renal insufficiency, either permanent or transient. RESULTS: After adjustment, severe renal failure defined as estimated glomerular filtration (eGFR) <30 mL/min indicates ≈60% increase in 5-year mortality risk. Similar risk also had patients with only transient decline of eGFR to this range. In contrast, we did not observe any apparent mortality risk attributable to mild/moderate renal insufficiency (eGFR 30-59.9 mL/min), regardless of whether it was transient or permanent. CONCLUSION: Even transient severe renal failure during hospitalization indicates poor long-term prognosis of patients with manifested HF. In contrast, only moderate renal insufficiency observed during hospitalization has no additive long-term mortality impact.

• MeSH
• hodnoty glomerulární filtrace MeSH
• hospitalizace MeSH
• ledviny MeSH
• lidé MeSH
• prognóza MeSH
• renální insuficience * komplikace   MeSH
• srdeční selhání * komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

UNLABELLED: Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD: A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS: There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION: Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.

• MeSH
• arterioly MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• mikrocirkulace MeSH
• retinální cévy diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

This editorial discusses the recent study conducted by Macias et al., revealing that anesthesiologists' case volume history has only a marginal impact on improving operating room efficiency, resulting in minimal clinical significance. The idea that a specific anesthesia team or type of anesthesia could enhance productivity has been previously investigated, yielding similar conclusions. Although the study primarily focuses on the time from patient arrival to the completion of anesthesia induction, excluding the latter part of anesthesia-controlled time, Macias et al. have made a valuable contribution by challenging the prevalent notion that less experienced anesthesiologists adversely affect operating room efficiency.

• MeSH
• anesteziologie * MeSH
• anesteziologové * MeSH
• celková anestezie MeSH
• lidé MeSH
• operační sály MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH

• MeSH
• beta blokátory * terapeutické užití   MeSH
• hypertenze * farmakoterapie   MeSH
• kombinovaná farmakoterapie MeSH
• komorbidita MeSH
• lidé MeSH
• Check Tag
• lidé MeSH

Impressively increasing availability of mechanical circulatory/cardiac support systems (MCSs) worldwide, together with the deepening of the knowledge of critical care medical practitioners, has inevitably led to the discussion about further improvements of intensive care associated to MCS. An appealing topic of the left ventricle (LV) overload related to VA ECMO support endangering myocardial recovery is being widely discussed within the scientific community. Unloading of LV leads to the reduction in LV end-diastolic pressure, reduction in pressure in the left atrium, and decrease in the LV thrombus formation risk. Consequently, better conditions for myocardial recovery, with comfortable filling pressures and a better oxygen delivery/demand ratio, are achieved. The combination of VA ECMO and Impella device, also called ECPELLA, seems to be a promising strategy that may bring the improvement of CS mortality rates. The series of presented trials and meta-analyses clearly showed the potential benefits of this strategy. However, the ongoing research has brought a series of new questions, such as whether Impella itself is the only appropriate unloading modality, or any other approach to unload LV would be beneficial in the same way. Benefits and potential risks of LV unloading and its timing are being discussed in this current review.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a representative population sample of the Czech Republic and to analyze the longitudinal trends in the basic characteristics of individuals with severe dyslipidemia. Methods: Seven independent cross-sectional surveys were organized in the Czech Republic to screen for major cardiovascular risk factors (from 1985 to 2015-2018). A total of 20,443 randomly selected individuals aged 25-64 years were examined. Results: The overall prevalence of severe dyslipidemia was 6.6%, with a significant downward trend from the fifth survey onwards (2000/2001). Over the study period of 30+ years, the individuals with severe dyslipidemia became older, increased in BMI, and did not change their smoking habits. Total cholesterol and non-HDL-cholesterol decreased significantly in both sexes throughout the duration of the study. Conclusions: Despite a significant improvement in lipids in the Czech Republic from 1985, substantially contributing to the decline in cardiovascular mortality, the number of individuals with severe dyslipidemia remained high, and in most cases, they were newly detected during our screening examinations and were thus untreated.

• Publikační typ
• časopisecké články MeSH

• MeSH
• anestetika aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• anestezie * metody   MeSH
• lidé MeSH
• perioperační období MeSH
• pooperační komplikace MeSH
• pooperační péče MeSH
• svodná anestezie metody   přístrojové vybavení   MeSH
• zajištění dýchacích cest metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• diagnostické techniky kardiovaskulární MeSH
• glifloziny farmakologie   terapeutické užití   MeSH
• komplikace diabetu * MeSH
• lidé MeSH
• srdeční selhání * diagnóza   etiologie   farmakoterapie   MeSH
• Check Tag
• lidé MeSH

Výkony v dutině břišní jsou spojeny obvykle s intenzivní pooperační bolestí. Kvalitní analgezie zkracuje hospitalizaci pacienta, snižuje náklady na léčbu i redukuje pooperační komplikace. V průběhu operačních výkonů je metodou volby kontinuální epidurální analgezie se směsí lokálního anestetika a opioidu. Pokud tato není možná, je indikována multimodální analgezie s kombinací silného opioidu, neopioidních analgetik a případně nitrožilní infuze lidokainu. V pooperačním období je opět vhodnou metodou kontinuální epidurální analgezie, i pacientem řízená. Ostatní možnosti zahrnují nitrožilní pacientem řízenou analgezii se silnými opioidy, kombinaci opioidů a neopioidních analgetik a multimodální neopioidní analgezii, kde se uplatňují paracetamol, metamizol, nesteroidní antiflogistika a selektivní inhibitory cyklooxygenázy 2. Systémová analgezie může být suplementována i technikami regionálních blokád břišní stěny, jako jsou rectus sheath blok, transversus abdominis plane blok, erector spinae blok nebo kontinuální infiltrace podkoží.

Surgical procedures inside the abdominal cavity are usually associated with intensive postoperative pain. Good-quality analgesia shortens the length of hospital stay, decreases the costs of treatment, and reduces postoperative complications. Continuous epidural analgesia with the mixture of local anesthetics and opioids remains the method of choice during surgical procedures. If this method is not feasible, multimodal analgesia with a combination of strong opioids, non-opioid analgesics, and eventually intravenous infusion of lidocaine is indicated. During the postoperative period, continuous epidural analgesia, even patient-controlled is a suitable method of pain relief. Other options include intravenous patient-controlled analgesia with strong opioids, a combination of opioids and non-opioid analgesics, or multimodal non-opioid analgesia, where paracetamol, metamizole, nonsteroidal anti-inflammatory drugs, and selective inhibitors of cyclooxygenase 2 may be employed. Systemic analgesia may be supplemented also with the techniques of abdominal wall regional blockades, such as rectus sheath block, transversus abdominis plane block, erector spinae block, or continuous wound infiltration.

• Klíčová slova
• protokol ERAS, protokol PROSPECT,
• MeSH
• analgetika aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• analgezie metody   MeSH
• anestetika lokální aplikace a dávkování   terapeutické užití   MeSH
• břišní stěna inervace   MeSH
• inhibitory cyklooxygenasy 2 terapeutické užití   MeSH
• kolorektální chirurgie rehabilitace   MeSH
• lidé MeSH
• pooperační bolest * farmakoterapie   MeSH
• protokoly protinádorové léčby MeSH
• synergismus léků MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Východisko: Analyzovali jsme preskripci a dávkování základní farmakoterapie u chronického srdečního selhání (CHSS) v době propuštění z hospitalizace pro kardiální dekompenzaci a nakolik mohly ovlivnit prognózu pacientů. Metodika: Celkem bylo sledováno 4097 pacientů (průměrný věk 70,7 let, 60,2 % mužů) hospitalizovaných v letech 2010-2020 pro kardiální dekompenzaci. Vitální stav byl zjištěn na základě registrů ÚZIS, ostatní okolnosti z nemocničního informačního systému. Výsledky: Preskripce betablokátorů (BB) činila 77,5 % (resp. jen 60,8 % pokud budeme počítat výhradně BB s důkazem u CHSS), blokátorů systému renin‐angiotenzin (RAS) 79 % a antagonistů mineralokortikoidního receptoru (MRA) 45,3 %. Takřka 87 % bylo v době propuštění léčeno furosemidem, ale jen asi 53 % pacientů s CHSS ischemické etiologie užívalo statin. Nejvyšší cílovou dávku BB mělo doporučenu ≈ 11 %, RAS blokátorů ≈ 24 %, zatímco MRA ≈ 12 % pacientů. U pacientů s konkomitantní renální insuficiencí byla preskripce BB a MRA obecně méně častá a se signifikantně nižším dávkováním, u RAS blokátoru tomu bylo naopak (jakkoliv statisticky nevýznamně). U pacientů s EF ≤ 40 % byla preskripce BB a RAS blokátorů častější, ale s významně nižším dávkováním. Naopak MRA byly doporučeny u těchto pacientů jak častěji, tak i ve vyšších dávkách. Z hlediska mortalitního rizika vykazovali pacienti léčení jen redukovanou dávkou RAS blokátorů asi o 77 % vyšší riziko úmrtí do 1 roku (resp. o 42 % v případě úmrtí do 5 let). Významný vztah byl nalezen rovněž mezi mortalitou a doporučenou dávkou furosemidu. Závěry: Preskripce i dávkování základní farmakoterapie zdaleka nedosahují svého optima a v případě RAS blokátorů toto má zřejmě vliv i na prognózu pacientů.

Background: We analyzed the prescription and dosage of essential pharmacotherapy in chronic heart failure (HF) at the time of discharge from the hospitalization for cardiac decompensation and how it may have influenced the prognosis of the patients. Methods: We followed 4097 patients [mean age 70.7, 60.2% males] hospitalized for HF between 2010 and 2020. The vital status we ascertained from the population registry, other circumstances from the hospital information system. Results: The prescription of beta-blockers (BB) was 77.5% (or only 60.8% of BB with evidence in HF), 79% of renin-angiotensin system (RAS) blockers, and 45.3% of mineralocorticoid receptor antagonists (MRA). Almost 87% of patients were treated with furosemide at the time of discharge, while only ≈53% of patients with ischemic etiology of HF took a statin. The highest target dose of BB was recommended in ≈11% of patients, RAS blockers in ≈ 24%, and MRA in ≈ 12% of patients. In patients with concomitant renal insufficiency, the prescription of BB and MRA was generally less frequent and on a significantly lower dosage. In contrast, the opposite was true for the RAS blocker (however statistically insignificant). In patients with EF ≤ 40%, the prescription of BB and RAS blockers were more frequent but in a significantly lower dosage. On the contrary, MRAs were recommended in these patients more often and in higher doses. In terms of mortality risk, patients treated only with a reduced dose of RAS blockers showed a 77% higher risk of death within one year (or 42% within five years). A significant relationship was also found between mortality and the recommended dose of furosemide. Conclusions: The prescription and dosage of essential pharmacotherapy are far from optimal, and in the case of RAS blockers, this affected the patient's prognosis as well.

• MeSH
• analýza dat MeSH
• chronická nemoc MeSH
• farmakoterapie metody   MeSH
• hospitalizace MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• srdeční selhání * farmakoterapie   mortalita   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH