Úvod: Efektivní preprocedurální edukace je klíčová pro spolupráci a následnou compliance pacientů. V současnosti se v medicíně stále více používá virtuální realita (VR). Cílem naší studie bylo prokázat non-inferioritu VR v edukaci pacientů před elektivní koronarografií ve srovnání s klasickou edukací zdravotnickým personálem. Metodika: V této prospektivní studii bylo zařazeno 386 pacientů před elektivní koronarografií, kteří byli randomizováni do dvou skupin. Pacienti ve skupině VR (n = 193) sledovali 360° video o plánovaném výkonu s použitím VR brýlí Oculus Meta Quest 2 a pacienti v konvenční skupině (n = 193) byli před výkonem edukováni lékařem. Pacienti následně vyplnili dotazník, který hodnotil kvalitu edukace, porozumění plánovanému výkonu a spokojenost pacientů. Výsledky: Edukace ve VR byla ve srovnání s klasickou edukací non-inferiorní, se statisticky podobným výsledkem při hodnocení porozumění plánovanému výkonu po edukaci v nemocnici (93,8 % vs. 90,2 %, p = 0,19) a subjektivní evaluací kvality edukace s použitím Likertovy stupnice (77,2 % vs. 68,4 % pacientů hodnotilo edukaci známkou 1, p = 0,261). Edukace VR prokázala lepší zapamatování poskytunutých informací, kdy 34,7 % pacientů dosáhlo nejlepšího možného skóre (4 ze 4 možných bodů) v dotazníku ve srovnání s 18,8 % pacientů v konvenční skupině (p < 0,001). V následné subanalýze se ukázalo, že horší výsledky měli starší pacienti (p = 0,028). Závěr: Edukace s použitím virtuální reality se ukázala být stejně efektivní jako klasická edukace lékařem a prokázala lepší následné zapamatování poskytnutých informací, zejména u mladších pacientů. Potvrdil se tak potenciál virtuální reality jako užitečného edukačního nástroje.

Background: Effective pre-procedural education is crucial for patients' cooperation and adherence to treat- ment plans. Virtual reality (VR) has recently been expanding in clinical medicine. This study aimed to prove the non-inferiority of VR education compared to conventional education in patients prior to invasive coronary angiography. Methods: In this prospective study, 386 participants undergoing elective coronary angiography were randomized into a VR group (n = 193) that watched a 360° video about the procedure using VR headset Oculus Meta Quest 2 and a conventional group (n = 193) educated by a physician. Patients completed question- naires assessing educational quality, knowledge of the procedure, and satisfaction.

• MeSH
• Smart Glasses MeSH
• Coronary Angiography MeSH
• Middle Aged MeSH
• Humans MeSH
• Comprehension MeSH
• Preoperative Care methods   MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Statistics as Topic MeSH
• Anxiety therapy   MeSH
• Virtual Reality * MeSH
• Patient Education as Topic * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Randomized Controlled Trial MeSH

INTRODUCTION: Education of patients prior to an invasive procedure is pivotal for good cooperation and knowledge retention. Virtual reality (VR) is a fast-developing technology that helps educate both medical professionals and patients. OBJECTIVE: To prove non-inferiority of VR education compared to conventional education in patients prior to the implantation of a permanent pacemaker (PPM). METHODS: 150 participants scheduled for an elective implantation of a PPM were enrolled in this prospective study and randomized into two groups: the VR group (n = 75) watched a 360° video about the procedure using the VR headset Oculus Meta Quest 2, while the conventional group (n = 75) was educated by a physician. Both groups filled out a questionnaire to assess the quality of education pre- and in-hospital, their knowledge of the procedure, and their subjective satisfaction. RESULTS: There was no significant difference in the quality of education. There was a non-significant trend towards higher educational scores in the VR group. The subgroup with worse scores was older than the groups with higher scores (82 vs. 76 years, p = 0.025). Anxiety was reduced in 92% of participants. CONCLUSION: VR proved to be non-inferior to conventional education. It helped to reduce anxiety and showed no adverse effects.

• Publication type
• Journal Article MeSH

Úvod: Náhrada aortální chlopně chirurgickou metodou (transcatheter aortic valve replacement, TAVR) je stále prevalentnější metodou náhrady aortální chlopně, zejména u pacientů s vyšším operačním rizikem. I přes velké pokroky ve vývoji chlopní se však incidence poruch rytmu vyžadujících trvalou kardiostimulaci po TAVR výrazně nesnižuje. Existuje množství rizikových faktorů, pomocí nichž lze predikovat riziko nutnosti kardiostimulace po náhradě chlopně. Cíl: Přinést data o prevalenci komplikace v podobě nutnosti kardiostimulace u pacientů po TAVR z jednoho českého centra, kde probíhají implantace TAVR již déle než dekádu. Metodika: Byla analyzována skupina pacientů, kteří podstoupili TAVR v našem centru v období mezi srpnem 2009 a únorem 2021. Ze vzorku byli vyjmuti pacienti, kteří již mají naimplantovaný kardiostimulátor či defibrilátor. V souboru 717 pacientů průměrný věk dosahoval 78,8 roku, 52 % tvořily ženy, průměrný index tělesné hmotnosti (BMI) je 29,6. V tomto období byly implantovány chlopně od různých výrobců od chlopní první generace až po protézy novějších generací. Výsledky: Trvalá kardiostimulace byla nutná u 162 pacientů (22,6 %), kterým bylo implantováno srdeční implantabilní elektronické zařízení (cardiac implantable electronic device, CIED) v průměru 3,9 dnu od TAVR. Z naimplantovaných pacientů bylo signifikantně více mužů (56,2 %) v porovnání s pacienty bez CIED (45,4 %); p = 0,016. Rovněž byl zaznamenán významný rozdíl mezi výškou, hmotností a BSA mezi těmito skupinami. Pacienti s preexistující blokádou pravého Tawarova raménka (right bundle branch block, RBBB) byli četnější mezi pacienty vyžadujícími kardiostimulaci v porovnání s nestimulovaným souborem (p < 0,0001), tento parametr rovněž vyšel jako jediný nezávislý prediktor implantace CIED po TAVR (poměr šancí [OR] 3,8, 95% interval spolehlivosti [CI] 2,0-7,0; p < 0,0001). Jednotlivé typy protéz se výrazně lišily v procentuálním zastoupení pacientů s nutností kardiostimulace. Nebyl nalezen signifikantní rozdíl mezi jednotlivými velikostmi protéz, stejně jako u pacientů s predilatací či postdilatací, v zastoupení pacientů s CIED a bez nich. Závěr: Naše data jsou ve shodě s jinými studiemi zabývajícími se tímto tématem a podporují přítomnost RBBB jako jeden z rizikových faktorů pro nutnost kardiostimulace po TAVR. Mezi stimulovanými pacienty bylo rovněž četnější mužské pohlaví a pacienti s větším tělesným povrchem (BSA). Náš vzorek je však nehomogenní a další subanalýzy v rámci jednotlivých designů chlopní ve větším zastoupení by byly potřebné k vyhodnocení dalších rizikových faktorů.

Introduction: Transcatheter aortic valve replacement (TAVR) is becoming more prevalent option of aortic valve replacement, predominantly amongst patients with a higher surgical risk. Despite a rapid development of TAVR prostheses, incidence of conduction abnormalities requiring cardiac pacing as a result of TAVR is not significantly decreasing. There are numerous risk factors which can help to predict the risk for cardiac pacing after TAVR. Aim: To present our data of a prevalence of this complication from one Czech center where TAVR prostheses have been implanted for over a decade. Methods: A group of patients who underwent TAVR between August 2009 and February 2021 in our center were analyzed. Patients with already implanted pacemaker or defi brillator were excluded from this group, leaving 717 patients for further analysis. The mean age was 78.8 years, 52% were females, the mean BMI was 29.6. Various different prostheses of different manufacturers and generations were implanted. Results: Permanent pacing was required in 162 patients (22.6%), in whom CIED (cardiac implantable electronic device) was implanted in average 3.9 days from TAVR. There was a signifi cantly higher amount of men in the paced group (56.2%) compared to the group without CIED (45.4%); p = 0.016. Moreover, there was a signifi cant difference between height, weight, and BSA among these groups. Patients with preexisting right bundle branch block (RBBB) were more prevalent in the paced group compared to non-paced group (p <0.0001); this parameter was the only independent predictor of the implantation of CIED after TAVR (odds ratio 3.8, 95% CI 2.0–7.0; p <0.0001). There were marked differences between the amounts of implanted prostheses of various designs. No signifi cant difference was found in the size of prostheses, predilatation or postdilatation between the two groups of patients. Conclusion: Our data are in concordance with other published studies, supporting the RBBB being one of the risk factors for pacing after TAVR. Males and patients with higher BSA were more prevalent in the paced group. Our sample is, however, rather inhomogeneous and further analysis of different designs in higher numbers would be necessary to identify other risk factors of this prevalent complication

• MeSH
• Aortic Valve Stenosis surgery   MeSH
• Bundle-Branch Block therapy   MeSH
• Cardiac Pacing, Artificial methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications epidemiology   therapy   MeSH
• Heart Disease Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Transcatheter Aortic Valve Replacement * methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH

Nukleární kardiologie je jednou z nejdůležitějších neinvazivních metod zobrazení srdce. Umožňuje primárně funkční hodnocení srdce s kvantifikací perfuze a systolické funkce. Vývoj nových typů přístrojů pro nukleární kardiologii přináší nové možnosti ve výzkumu a klinické praxi. Tento článek popisuje stručný přehled některých aplikací kadmium-zinek-telluridových (CZT) kamer ve srovnání s konvenčními přístroji.

Nuclear cardiology is one of the most important non-invasive imaging methods in cardiac imaging. It makes possible primarily functional assessment of the heart with quantification of perfusion and systolic function. Development of new types of scanners for nuclear cardiology brings more possibilities in research and clinical practice. This paper describes a brief review of some applications of cadmium–zinc–telluride (CZT) scanners in comparison with conventional cameras.

• MeSH
• Radiation Dosage MeSH
• Tomography, Emission-Computed, Single-Photon * methods   instrumentation   MeSH
• Cadmium MeSH
• Coronary Angiography * methods   instrumentation   MeSH
• Humans MeSH
• Tellurium MeSH
• Myocardial Perfusion Imaging methods   instrumentation   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

AIM: The purpose of this study is to determine the association between eotaxin 426 C/T, -384 A/G, 67 G/A, eNOS -786 T/C, 4 a/b, and MMP-13 rs640198 G/T and prognosis of patients with known CAD. METHODS: From total of 1161 patients referred to coronary angiography, 532 patients with angiographically confirmed CAD were selected. Their long-term outcome was followed up using hospital database. Subsequent events were assessed in this study: death or combined endpoint-myocardial infarction, unstable angina pectoris, revascularization, heart failure hospitalization, and cardioverter-defibrillator implantation. RESULTS: The multivariate Cox regression model identified age, smoking, and 3-vessel disease as significant predictors of all-cause death. Further analysis showed that eotaxin 67 G/A (GA + AA versus GG) and eotaxin -384 A/G (GG versus GA + AA) were significant independent prognostic factors when added into the model: HR (95% CI) 2.81 (1.35-5.85), p = 0.006; HR (95% CI) 2.63 (1.19-5.83), p = 0.017; eotaxin -384 A/G was significantly associated with the event-free survival, but it did not provide the prognostic information above the effect of two- or three-vessel disease. CONCLUSION: The A allele in eotaxin 67 G/A polymorphism is associated with worse survival in CAD patients.

• MeSH
• Chemokine CCL11 genetics   MeSH
• Polymorphism, Single Nucleotide * MeSH
• Middle Aged MeSH
• Humans MeSH
• Matrix Metalloproteinase 13 genetics   MeSH
• Coronary Artery Disease diagnosis   genetics   MeSH
• Aged MeSH
• Case-Control Studies MeSH
• Nitric Oxide Synthase Type III genetics   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

BACKGROUND: The European procedural guidelines for cardiac gated SPECT imaging demonstrate considerable variability in recommended administered radiopharmaceutical activity and imaging protocols. This study compared stress-only and stress-rest protocols to evaluate the safety of stress-only imaging, and to identify characteristics of patients who need full stress-rest imaging. METHODS: Patients referred for a chest pain were scheduled for stress-rest gated SPECT imaging. If the stress images were interpreted as normal according to the perfusion and left ventricular function, the examination of patients was finished and patients did not undergo the rest imaging. A total number of 1063 patients was included (mean age 61 ± 11 years). These patients have been followed for hard cardiac events, i.e. cardiac deaths or nonfatal myocardial infarction. RESULTS: During a follow-up of 3.2 ± 2.5 years, hard events occurred in 12 patients with normal SPECT and 59 with abnormal SPECT had hard events (0.7 vs. 3.6% /year, P < 0.001). Among the 536 patients with normal study, there was no significantly lower incidence of hard events in the subgroup of patients with stress-only imaging (0.6 vs. 0.8% /year, P = 0.641). Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT (1.3 vs. 0.5%/year, P < 0.001). We found a higher incidence of hard events in diabetic patients with normal study with the necessity of full stress-rest imaging in comparison with those with stress-only imaging (1.7 vs. 0.7% /year, P < 0.001). CONCLUSIONS: Our results support the good prognosis of normal stress-only study. Diabetes mellitus was an independent predictor of hard events in patients with normal SPECT. Diabetic patients with normal results who required additional rest imaging had significant adverse outcome.

• MeSH
• Time Factors MeSH
• Diabetes Mellitus physiopathology   MeSH
• Incidence MeSH
• Myocardial Ischemia diagnostic imaging   epidemiology   etiology   MeSH
• Tomography, Emission-Computed, Single-Photon * MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Prognosis MeSH
• Risk Factors MeSH
• Exercise Test methods   MeSH
• Myocardial Perfusion Imaging methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Treadmill exercise nitrogen-13 ((13)N)-ammonia positron emission tomography (PET) has logistical challenges and limited literature. We aimed to assess its feasibility, image quality, and diagnostic accuracy in obese and nonobese patients. METHODS AND RESULTS: Between 2009 and 2012, 10,804 patients were referred for myocardial perfusion imaging, including 300 for treadmill PET, of whom 265 were included in this study. Treadmill testing and PET were performed using standard procedures. Image quality, perfusion, and summed stress score (SSS) were assessed. Invasive coronary angiography was performed within 90 days of PET in 43 patients. Mean ± SD body mass index (BMI) was 35.7 ± 7.7 kg/m(2) (range 19.5-63.5 kg/m(2)). Feasibility of treadmill (13)N-ammonia PET was 100%. Exercise duration was less for obese patients than nonobese patients (P < .001). Image quality was rated good for 96.9% of obese and 100% of nonobese patients. For all patients, sensitivity was 86.4% and specificity was 74.4%. Diagnostic accuracy did not change significantly with increasing BMI. SSS remained significant in predicting angiographic coronary artery disease after adjustment for age, sex, and Duke treadmill score. CONCLUSIONS: Treadmill (13)N-ammonia PET is highly feasible, yields good image quality, and has moderately high diagnostic accuracy in a small subset of obese and nonobese patients who are deemed able to perform treadmill exercise.

• MeSH
• Ammonia MeSH
• Middle Aged MeSH
• Humans MeSH
• Coronary Artery Disease complications   MeSH
• Obesity complications   MeSH
• Positron-Emission Tomography methods   MeSH
• Radiopharmaceuticals MeSH
• Nitrogen Radioisotopes * MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Feasibility Studies MeSH
• Exercise Test MeSH
• Myocardial Perfusion Imaging methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

BACKGROUND: While sleep apnea (SA) might be a modifiable cardiovascular risk factor, recent data suggest that SA is severely underdiagnosed in patients after acute myocardial infarction (MI). There is limited evidence about day-night variation of onset of MI on dependence of having SA. We therefore investigated the prevalence of SA and examined the day-night variation of onset of MI in acute MI patients. METHODS: We prospectively studied 782 consecutive patients admitted to the hospital with the diagnosis of acute MI. All subjects underwent sleep evaluations using a portable device after at least 48 h post-admission. Using the apnea-hypopnea index (AHI), groups were defined as patients without SA (<5 events/h), mild SA (5-15 events/h), moderate SA (15-30 events/h), and severe SA (≥ 30 events/h). RESULTS: Almost all patients (98%) underwent urgent coronary angiography and 91% of patients underwent primary PCI. Using a threshold of AHI ≥ 5 events/h, SA was present in 65.7% of patients after acute MI. Mild SA was present in 32.6%, moderate in 20.4% and severe in 12.7%. The day-night variation in the onset of MI in all groups of SA patients was similar to that observed in non-SA patients. From 6 AM to 12 PM, the frequency of MI was higher in both SA and non-SA patients, as compared to the interval from 12 AM to 6 AM (all p<0.05). CONCLUSION: There is a high prevalence of SA in patients presenting with acute MI. Peak time of MI onset in SA patients was between 6 AM and noon, similar to that in the general population. Whether diagnosis and treatment of SA after MI will significantly improve outcomes in these patients remains to be determined.

• MeSH
• Time Factors MeSH
• Myocardial Infarction diagnosis   epidemiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prevalence MeSH
• Prospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Sleep Apnea Syndromes diagnosis   epidemiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

Akutní plicní embolie patří mezi časté život ohrožující onemocnění kardiovaskulárního systému. Její závažnost kolísá od nízkého rizika s dobrou prognózou až po vysoce závažné šokové stavy s vysokou mortalitou. Co nejpřesnější diagnostika a stratifikace rizika u pacientů s plicní embolií je tedy základním předpokladem úspěšné terapie. Článek přináší přehled zobrazovacích metod, které tvoří nedílnou součást diagnostického algoritmu u akutní plicní embolie.

Acute pulmonary embolism is one of frequent life-threatening cardiovascular diseases. Its severity varies from low risk cases with good prognosis to severe shock states with high mortality. The most exact diagnostics and risk stratification is basic requirement for successful therapy. This paper provides review of imaging methods which are fundamental part of diagnostic process in acute pulmonary embolism.

• MeSH
• Angiography MeSH
• Diagnostic Imaging * methods   MeSH
• Ultrasonography, Doppler, Duplex MeSH
• Echocardiography MeSH
• Risk Assessment * MeSH
• Clinical Trials as Topic statistics & numerical data   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Perfusion Imaging MeSH
• Pulmonary Embolism * diagnosis   MeSH
• Tomography, X-Ray Computed MeSH
• Radiography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Mezi nejčastější poruchy dýchání ve spánku patří spánková apnoe, kterou můžeme dále dělit na obstrukční a centrální. Zatímco centrální spánková apnoe se vyskytuje nejčastěji u pacientů se srdečním selháním, obstrukční je častější u pacientů s hypertenzí, arytmiemi, cévní mozkovou příhodou či s onemocněním koronárních tepen. Epidemiologické, klinické a terapeutické studie přinesly přesvědčivé důkazy o souvislostech mezi obstrukční spánkovou apnoí a vzrůstajícím rizikem kardiovaskulární morbidity a mortality. Obstrukční spánková apnoe je ale zároveň modifikovatelným rizikovým faktorem, kdy může léčba pomocí neinvazivní kontinuální pozitivní přetlakové ventilace vést např. k redukci časných známek endoteliální dysfunkce a aterosklerózy, ke snížení krevního tlaku, nefatálních kardiovaskulárních příhod a mortality související s kardiovaskulárními onemocněními. Přitom až 85 % pacientů s klinicky signifikantní a léčitelnou obstrukční spánkovou apnoí nikdy nebylo diagnostikováno, a tudíž ani léčeno. Je tedy důležité vytvořit diagnostickou strategii orientovanou na zjišťování přítomnosti obstrukční spánkové apnoe u pacientů s kardiovaskulárními onemocněními.

The most common breathing disorders during sleep include sleep apnea, which can be divided into obstructive and central. While central sleep apnea occurs most frequently in patients with heart failure, obstructive is more common in patients with hypertension, arrhythmias, stroke or coronary artery disease. Epidemiological, clinical and therapeutic studies provided convincing evidence of an association between obstructive sleep apnea and increased risk of cardiovascular morbidity and mortality. Obstructive sleep apnea is also a modifiable risk factor when treatment with continuous non‐invasive positive pressure ventilation might lead to reduction of early signs of endothelial dysfunction and atherosclerosis, lowering of blood pres­sure and nonfatal cardiovascular events and mortality associated with cardiovascular disease. However, up to 85% of patients with clinically significant and treatable obstructive sleep apnea were never diagnosed and therefore not treated. It is therefore important to develop a diagnostic strategy oriented towards the detection of obstructive sleep apnea in patients with cardiovascular disease.

• MeSH
• Apnea * classification   physiopathology   MeSH
• Hypertension MeSH
• Myocardial Infarction MeSH
• Myocardial Ischemia MeSH
• Cardiovascular Diseases * physiopathology   MeSH
• Clinical Trials as Topic MeSH
• Humans MeSH
• Oxidative Stress MeSH
• Prevalence MeSH
• Prognosis MeSH
• Arrhythmias, Cardiac MeSH
• Heart Failure MeSH
• Sleep Apnea Syndromes MeSH
• Respiration, Artificial MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH