Arterial stiffness represents an independent predictor of the risk of subsequent cardiovascular events. Early identification of high-risk individuals is necessary for effective prevention and targeted interventions. Carotid wall echo-tracking is a modern method for an accurate evaluation of the structural and functional properties of carotid arteries. This study aimed to assess age and sex-specific reference values of the echo-tracking parameters of carotid stiffness in 400 healthy children and adolescents and to evaluate the potential early effect of elevated blood pressure and overweight in 69 overweight normotensives, 45 white coat hypertensives, and 44 essential hypertensives. Stiffness index β, pressure-strain elastic modulus (Ep), arterial compliance (AC), and pulse wave velocity β (PWV β) were evaluated using Aloka ProSound F75. Both white coat and essential hypertension were associated with impaired carotid wall properties with the greatest effect on Ep, followed by PWV β, index β, and AC. The excess weight showed a weaker effect on Ep and PWV β. This is the first study to compare the effects of white coat and essential hypertension on carotid arterial stiffness assessed using the echo-tracking technique in childhood and adolescence with direct application of pediatric reference values specific to age and sex.

• Publikační typ
• časopisecké články MeSH

Stilbenes in food and medicinal plants have been described as potent antiphlogistic and antioxidant compounds, and therefore, they present an interesting potential for the development of dietary supplements. Among them, macasiamenene F (MF) has recently been shown to be an effective anti-inflammatory and cytoprotective agent that dampens peripheral and CNS inflammation in vitro. Nevertheless, this promising molecule, like other stilbenes and a large percentage of drugs under development, faces poor water solubility, which results in trickier in vivo administration and low bioavailability. With the aim of improving MF solubility and developing a form optimized for in vivo administration, eight types of conventional liposomal nanocarriers and one type of PEGylated liposomes were formulated and characterized. In order to select the appropriate form of MF encapsulation, the safety of MF liposomal formulations was evaluated on THP-1 and THP-1-XBlue-MD2-CD14 monocytes, BV-2 microglia, and primary cortical neurons in culture. Furthermore, the cellular uptake of liposomes and the effect of encapsulation on MF anti-inflammatory effectiveness were evaluated on THP-1-XBlue-MD2-CD14 monocytes and BV-2 microglia. MF (5 mol %) encapsulated in PEGylated liposomes with an average size of 160 nm and polydispersity index of 0.122 was stable, safe, and the most promising form of MF encapsulation keeping its cytoprotective and anti-inflammatory properties.

• Publikační typ
• časopisecké články MeSH

• MeSH
• dítě MeSH
• kardiovaskulární nemoci * prevence a kontrola   MeSH
• lidé MeSH
• screeningové diagnostické programy MeSH
• služby preventivní péče MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Geografické názvy
• Česká republika MeSH

Prevence infekční endokarditidy je v podmínkách České republiky nedílnou součástí péče o dětského pacienta se srdečním onemocněním. Zkušenosti vyplývající z omezení profylaktického podávání antibiotik před rizikovými výkony nasvědčují tomu, že tato populace dětí může ze správné aplikace antibiotické profylaxe profitovat. Kromě podávání antibiotik v indikovaných případech je nezbytné důsledně dodržovat režimová opatření zejména k prevenci zubního kazu a edukovat o nich pacienta i rodiče.

Prevention of infective endocarditis is an integral part of the management of paediatric patients with cardiovascular disease in the Czech Republic. The experience resulting from the restrictions on prophylactic antibiotic administration prior to high-risk procedures, which have been introduced worldwide, suggests that pediatric population may benefit from the antibiotic prophylaxis. In addition, it is essential to follow general preventive measures, especially the prevention of dental caries, and to educate the patient and parents about them.

• MeSH
• dítě MeSH
• endokarditida * diagnóza   etiologie   prevence a kontrola   MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

Srdeční šelest je v dětském věku velmi častý nález. Nutné je odlišení nevýznamného šelestu od šelestu, kterým se projevuje kardiální patologie. Součástí posouzení je pečlivá anamnéza, celkové fyzikální vyšetření a zhodnocení charakteru šelestu. Nevýznamný šelest je vždy systolický, nízké intenzity u asymptomatického pacienta. O významnosti šelestu rozhoduje dětský kardiolog, šelest na srdci je nejčastějším důvodem odeslání dítěte do kardiologické ambulance. Nepřítomnost šelestu nevylučuje přítomnost významné nebo kritické srdeční vady.

A heart murmur is a very common finding in childhood. It is necessary to differentiate between an insignificant murmur and murmur that indicates any cardiac pathology. The assessment involves an in-depth patient history, thorough physical examination and evaluation of the murmur itself. In an asymptomatic patient, the insignificant murmur is exclusively systolic and of low intensity. A heart murmur is the most common reason for child´s referral to a cardiology clinic and its significance is assessed by a pediatric cardiologist. The absence of a murmur does not exclude the presence of a significant or critical heart defect.

• MeSH
• anamnéza MeSH
• dítě MeSH
• fyzikální vyšetření MeSH
• kardiovaskulární nemoci diagnóza   MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• poslech srdce MeSH
• předškolní dítě MeSH
• šelest na srdci * diagnóza   etiologie   patologie   MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH

IMPORTANCE: Prenatal cardiac screening of the first and second trimesters has had a major impact on postnatal prevalence of congenital heart defects (CHDs), rates of termination of pregnancy (TOP), and outcomes among children born alive with CHDs. OBJECTIVE: To examine the prenatal and postnatal incidence of major CHDs (ie, necessitating intervention within the first year of life), detection rate trends, rates of TOP, and the association of cardiac screening with postnatal outcomes. DESIGN, SETTINGS, AND PARTICIPANTS: In this cross-sectional study, 3827 fetuses with antenatally diagnosed major CHDs in the Czech Republic (population 10.7 million) between 1991 and 2021 were prospectively evaluated with known outcomes and associated comorbidities. Prenatal and postnatal prevalence of CHD in an unselected population was assessed by comparison with a retrospective analysis of all children born alive with major CHDs in the same period (5454 children), using national data registry. Data analysis was conducted from January 1991 to December 2021. MAIN OUTCOMES AND MEASURES: Prenatal detection and postnatal prevalence of major CHDs and rate of TOPs in a setting with a centralized health care system over 31 years. RESULTS: A total of 3 300 068 children were born alive during the study period. Major CHD was diagnosed in 3827 fetuses, of whom 1646 (43.0%) were born, 2069 (54.1%) resulted in TOP, and 112 (2.9%) died prenatally. The prenatal detection rate increased from 6.2% in 1991 to 82.8% in 2021 (P < .001). Termination of pregnancy decreased from 70% in 1991 to 43% (P < .001) in 2021. Of 627 fetuses diagnosed in the first trimester (introduced in 2007), 460 were terminated (73.3%). Since 2007, of 2066 fetuses diagnosed in the second trimester, 880 (42.6%) were terminated, resulting in an odds ratio of 3.6 (95% CI, 2.8-4.6; P < .001) for TOP in the first trimester compared with the second trimester. Postnatal prevalence of major CHDs declined from 0.21% to 0.14% (P < .001). The total incidence (combining prenatal detection of terminated fetuses with postnatal prevalence) of major CHD remained at 0.23% during the study period. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, the total incidence of major CHD did not change significantly during the 31-year study period. The prenatal detection of major CHD approached 83% in the current era. Postnatal prevalence of major CHD decreased significantly due to early TOPs and intrauterine deaths. The introduction of first trimester screening resulted in a higher termination rate in the first trimester but did not revert the overall decreasing trend of termination for CHDs in general.

• MeSH
• dítě MeSH
• indukovaný potrat * MeSH
• lidé MeSH
• prevalence MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• těhotenství MeSH
• vrozené srdeční vady * diagnóza   epidemiologie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Úvod: Turnerův syndrom (TS) je spojen s řadou jasně definovaných kardiovaskulárních rizik v podobě vrozených srdečních vad a získaných kardiovaskulárních onemocnění. Nejednotné jsou údaje o arytmogenním potenciálu u nositelek TS, především ve výskytu maligních komorových arytmií na podkladě dlouhého intervalu QT. Cílem této práce bylo zhodnocení výskytu abnormalit EKG u pacientek s tímto syndromem. Metodika: Do studie bylo zařazeno 61 dívek a žen s TS, u kterých bylo provedeno kompletní kardiologické vyšetření včetně EKG a holterovské monitorace EKG. Na 12svodovém EKG byla hodnocena délka intervalu PR a QT, při holterovské monitoraci EKG průměrná tepová frekvence (TF) včetně z-score, přítomnost síňové/komorové extrasystolie a jiných arytmií. Interval QT byl korigován dle Bazetta a Hodgese a tyto hodnoty byly porovnány. Analyzována byla závislost parametrů na jednotlivých karyotypech. Výsledky: Medián intervalu PR byl 120 ms (průměr 118,4 ms), krátký interval PR byl identifikován u 13 % (8/61), žádná z pacientek neměla delta vlnu jako obraz preexcitace komor. Absolutní hodnota QT byla v mediánu 340 ms (průměr 336 ms). Interval QTc prodloužený nad 440 ms mělo 5 % (3/61) pacientek při užití korekce dle Bazetta a 3 % (2/61) při korekci dle Hodgese. Hodnota QTc dle Bazetta se významně lišila od QTc dle Hodgese (medián 410 ms, průměr 405 ms vs. medián 390 ms, průměr 390 ms; p < 0,001). Z holterovské monitorace byla TF za 24 hodin v mediánu 92/min (průměr 93,3/min). TF nad +2 z-score se potvrdila u 6,5 % (4/61) případů. U 48 % (29/61) pacientek byla zachycena síňová a u 25 % (15/61) komorová extrasystolie, četnější výskyt byl u monosomie 45,X na rozdíl od ostatních skupin karyotypů. Závažné arytmie nebyly identifikovány. Závěr: EKG změny jsou u nositelek TS srovnatelně četné jako v obecné populaci a jsou klinicky nevýznamné. Riziko maligních arytmií nebylo v této studii prokázáno. Pro hodnocení intervalu QTc u pacientek s TS je pravděpodobně vhodnější metoda dle Hodgese než běžně používaná Bazettova formule.

Introduction: Turner syndrome (TS) is associated with a range of distinct cardiovascular risks such as congenital heart disease and acquired cardiovascular disease. Data on arrhythmogenic potential in TS carriers are inconsistent, especially regarding the occurrence of malignant ventricular arrhythmias due to long QT interval. The aim of this study was to evaluate the prevalence of ECG abnormalities in patients with TS. Methods: 61 girls and women with TS syndrome were included in the study and underwent a cardiac examination including ECG and 24-hour ECG Holter monitoring. The 12-lead ECG was used to assess the length of PR and QT interval, the mean heart rate (HR) including z-score, presence of atrial/ventricular premature beats and other arrhythmias. QT interval was corrected according to Bazett and Hodges formulas, and both values were statistically compared. The relationship of parameters to individual karyotypes was analyzed. Results: Median PR interval was 120 ms (mean 118.4 ms), short PR interval was identified in 13% (8/61), none of the patients had delta wave as a manifestation of ventricular pre-excitation. Median of absolute QT values was 340 ms (mean 336 ms). QTc interval prolonged above 440 ms was observed in 5% (3/61) of patients using Bazett, and 3% (2/61) using Hodges formula. The QTc value according to Bazett significantly differed from the QTc according to Hodges (median 410 ms, mean 405 ms vs. median 390 ms, mean 390 ms; p <0.001). Regarding Holter monitoring, the median 24-hour HR was 92/min (mean 93.3/min). HR above +2 z-score was confirmed in 6.5% (4/61) of cases. Atrial and ventricular premature beats were detected in 48% (29/61) and 25% (15/61) of patients, respectively, with the highest frequency in monosomy 45.X. No clinically relevant arrhythmias were identified. Conclusions: ECG changes in TS individuals are as frequent as in the general population and are clinically insignificant. The increased risk of malignant arrhythmias was not demonstrated in this study. The Hodges formula seems to be more appropriate than the widely used Bazett formula for the evaluation of the QTc interval in TS patients.

• MeSH
• diagnostické techniky kardiovaskulární MeSH
• elektrokardiografie ambulantní metody   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• srdeční arytmie * etiologie   MeSH
• syndrom dlouhého QT etiologie   etiologie   MeSH
• Turnerův syndrom * genetika   komplikace   patologie   MeSH
• vrozené srdeční vady etiologie   genetika   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.

• Publikační typ
• časopisecké články MeSH

Myokarditida u dětí je poměrně vzácné a zároveň potenciálně závažné onemocnění. Často představuje diagnostické a terapeutické dilema, stejně tak volba diagnostických metod a jejich interpretace nemusí být vždy jednoznačná. V posledních letech stoupá význam magnetické rezonance, u které může být limitací její dostupnost. Variabilní přístup k dětem s myokarditidou je často patrný i v oblasti terapeutické. Významným příspěvkem je odborné stanovisko American Heart Association z roku 2021. Níže předkládaný přehledový článek představuje souhrn současných dostupných literárních dat.

Myocarditis in children is a relatively rare disease which often presents a dilemma that has to be faced not only by paediatric cardiologists but also paediatricians. The diagnosis often remains clinically suspected or probable. Only recent advancements in cardiac magnetic resonance have enabled us to confirm the diagno- sis. However, it may not be readily available. Scientific statement of the American Heart Association on paediatric myocarditis was published in 2021 and provides useful support for treatment. Hence, this article is a result of published guidelines.

• MeSH
• diagnostické techniky kardiovaskulární klasifikace   MeSH
• dítě MeSH
• lidé MeSH
• myokarditida * diagnóza   etiologie   patofyziologie   terapie   MeSH
• vzácné nemoci diagnóza   etiologie   patofyziologie   terapie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• přehledy MeSH

INTRODUCTION: Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity that has emerged in the context of the COVID-19 pandemic. Despite the less severe course of the disease, varying degrees of cardiovascular events may occur in MIS-C; however, data on vascular changes occurring in MIS-C are still lacking. Endothelial dysfunction (ED) is thought to be one of the key risk factors contributing to MIS-C. BACKGROUND: We conducted a prospective observational study. We investigated possible manifestations of cardiac and endothelial involvement in MIS-C after the treatment of the acute stage and potential predictive biomarkers in patients with MIS-C. METHODS: Twenty-seven consecutive pediatric subjects (≥9 years), at least three months post-treated MIS-C of varying severity, in a stable condition, and twenty-three age- and sex-matched healthy individuals (HI), were enrolled. A combined non-invasive diagnostic approach was used to assess endothelial function as well as markers of organ damage using cardiac examination and measurement of the reactive hyperemia index (RHI), by recording the post- to pre-occlusion pulsatile volume changes and biomarkers related to ED and cardiac disease. RESULTS: MIS-C patients exhibited a significantly lower RHI (indicative of more severe ED) than those in HI (1.32 vs. 1.80; p = 0.001). The cutoff of RHI ≤ 1.4 was independently associated with a higher cardiovascular risk. Age and biomarkers significantly correlated with RHI, while serum cystatin C (Cys C) levels were independently associated with a diminished RHI, suggesting Cys C as a surrogate marker of ED in MIS-C. CONCLUSIONS: Patients after MIS-C display evidence of ED, as shown by a diminished RHI and altered endothelial biomarkers. Cys C was identified as an independent indicator for the development of cardiovascular disease. The combination of these factors has the potential to better predict the cardiovascular consequences of MIS-C. Our study suggests that ED may be implicated in the pathophysiology of this disease.

• Publikační typ
• časopisecké články MeSH