BACKGROUND: There is conflicting evidence on the role of acetylsalicylic acid (ASA) use in the development of cardiac allograft vasculopathy (CAV). METHODS: A nationwide prospective two-center study investigated changes in the coronary artery vasculature by highly automated 3-D optical coherence tomography (OCT) analysis at 1 month and 12 months after heart transplant (HTx). The influence of ASA use on coronary artery microvascular changes was analyzed in the overall study cohort and after propensity score matching for selected clinical CAV risk factors. RESULTS: In total, 175 patients (mean age 52 ± 12 years, 79% male) were recruited. During the 1-year follow-up, both intimal and media thickness progressed, with ASA having no effect on its progression. However, detailed OCT analysis revealed that ASA use was associated with a lower increase in lipid plaque (LP) burden (p = .013), while it did not affect the other observed pathologies. Propensity score matching of 120 patients (60 patient pairs) showed similar results, with ASA use associated with lower progression of LPs (p = .002), while having no impact on layered fibrotic plaque (p = .224), calcification (p = .231), macrophage infiltration (p = .197), or the absolute coronary artery risk score (p = .277). According to Kaplan-Meier analysis, ASA use was not associated with a significant difference in survival (p = .699) CONCLUSION: This study showed a benefit of early ASA use after HTx on LP progression. However, ASA use did not have any impact on the progression of other OCT-observed pathologies or long-term survival.
- MeSH
- alografty patologie MeSH
- aterosklerotický plát * komplikace MeSH
- dospělí MeSH
- koronární angiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci koronárních tepen * etiologie MeSH
- optická koherentní tomografie škodlivé účinky metody MeSH
- prospektivní studie MeSH
- transplantace srdce * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Poruchy autonomní funkce srdce asociované s komorovými extrasystolami (KES) jsou často spojeny se snížením ejekční frakce a se zvýšenou kardiovaskulární morbiditou a mortalitou. Standardní zobrazovací techniky jako magnetická rezonance srdce (CMR) a koronární angiografie zajišťují vyloučení jiných příčin komorových extrasystol jako ischemie a neischemické fibrózy myokardu, ale nejsou schopny zobrazit narušení autonomního nervového systému srdce. Toto lze studovat pomocí scintigrafie myokardu (SPECT) s použitím 123 I-metajodbenzylguanidinu (MIBG). Vyšetřili jsme pilotní soubor šesti pacientů, z nichž u tří pacientů byla zjištěna porucha v adrenergní inervaci myokardu levé komory, a ty prezentujeme jako kazuistiky.
Disturbances of autonomic function in the heart associated with premature ventricular complexes (PVC) are associated with a decrease in ejection fraction as well as increased cardiac morbidity and mortality. Standard imaging techniques such as cMRI and coronary angiography secure the exclusion of other causes of PVC as ischemia and progressive fibrosis. These methods are not suitable for cardiac autonomic nervous system imaging and can't describe the cause of related PVCs. This may be described by 123I-metaiodobenzylguanidine (MIBG) scintigraphy. We examined a pilot group of 6 patients, in which 3 individuals presented a disorder in the adrenergic innervation of the left ventricular myocardium and we present these as case reports.
- MeSH
- 3-jodobenzylguanidin farmakologie terapeutické užití MeSH
- autonomní nervový systém diagnostické zobrazování MeSH
- diagnostické zobrazování metody MeSH
- kazuistiky jako téma MeSH
- komorové extrasystoly * diagnostické zobrazování diagnóza etiologie MeSH
- lidé MeSH
- multimodální zobrazování * klasifikace metody MeSH
- myokard patologie MeSH
- pilotní projekty MeSH
- senioři MeSH
- zobrazování myokardiální perfuze metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
V populaci diabetiků 2. typu je častěji než v běžné populaci diagnostikováno jak srdeční selhání, tak i chronické onemocnění ledvin (CKD). Screening CKD musí směřovat k časnému záchytu onemocnění s cílem zvrátit, nebo alespoň významně zpomalit jeho průběh a oddálit přechod do selhání ledvin s nutností chronické dialyzační anebo transplantační léčby. Finerenon je nesteroidní, selektivní antagonista mineralokortikoidního receptoru. Efekty finerenonu u nemocných s diabetem 2. typu byly zkoumány ve velkých registračních klinických studiích fáze III FIDELIO-DKD, FIGARO-DKD a následně v jejich sdružené analýze FIDELITY. Na základě výsledků publikovaných prospektivních randomizovaných kontrolovaných studií s finerenonem je jeho použití u pacientů s CKD a diabetem 2. typu zmíněno v několika recentních doporučeních. Zástupci expertního panelu zahrnujícího Českou nefrologickou společnost, Českou diabetologickou společnost ČLS JEP, Českou internistickou společnost ČLS JEP a Českou kardiologickou společnost v souladu s recentními mezinárodními doporučeními považují finerenon za jeden z pilířů léčby pacientů s chronickým onemocněním ledvin a diabetem 2. typu pro jeho nefroprotektivní a kardioprotektivní účinky.
Both heart failure and chronic kidney disease (CKD) are detected more often in the type 2 diabetic population than in the general population. CKD screening should focus on its early detection to reverse, or at least significantly slow down its course and delay stage 5 CKD with the need for chronic dialysis or transplant treatment. Finerenone is a nonsteroidal, selective mineralocorticoid receptor antagonist. The effects of finerenone in patients with type 2 diabetes were investigated in the large registration phase III clinical trials FIDELIO-DKD, FIGARO-DKD and subsequently in their pooled analysis FIDELITY. Based on the results of published prospective randomized controlled trials with finerenone, its use in patients with CKD and type 2 diabetes is mentioned in several recent recommendations. Representatives of an expert panel including the Czech Nephrological Society, the Czech Diabetological Society, the Czech Internal Medicine Society and the Czech Cardiology Society, in accordance with recent international recommendations, consider finerenone to be one of the pillars of the treatment of patients with chronic kidney disease and type 2 diabetes for its nephroprotective and cardioprotective effects.
- Klíčová slova
- finerenon,
- MeSH
- chronická renální insuficience * farmakoterapie prevence a kontrola MeSH
- diabetes mellitus 2. typu * farmakoterapie komplikace MeSH
- dialýza ledvin MeSH
- komplikace diabetu farmakoterapie MeSH
- lidé MeSH
- naftyridiny farmakologie terapeutické užití MeSH
- randomizované kontrolované studie jako téma MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
PURPOSE OF REVIEW: An evidence for lipid lowering therapy in heart failure is briefly summarized in this review. RECENT FINDINGS: Heart failure therapy is based on recent guidelines for diagnosis and treatment of acute and chronic heart failure. The question of the importance of hypolipidemic treatment in heart failure remains insufficiently answered. We still rely only on results of two randomized controlled trials that did not show significant benefit of statins on mortality in these patients. In contrast, some meta-analysis, prospective or retrospective cohorts, found some positive effects of this therapy. Recently, the role of inflammation and the possibility of its influence by hypolipidemics have been discussed. PCSK9 inhibitors, new lipid lowering drugs, are very effective in LDL-cholesterol lowering and atherosclerotic cardiovascular diseases prevention. The role of PCSK9 inhibitors in heart failure treatment is investigated. Based on current knowledge, hypolipidemics are not generally recommended in heart failure therapy, unless there is another indication for their use.
BACKGROUND: Dilated cardiomyopathy (DCM) is a major cause of heart failure and carries a high mortality rate. Myocardial recovery in DCM-related heart failure patients is highly variable, with some patients having little or no response to standard drug therapy. A genome-wide association study may agnostically identify biomarkers and provide novel insight into the biology of myocardial recovery in DCM. METHODS: A genome-wide association study for change in left ventricular ejection fraction was performed in 686 White subjects with recent-onset DCM who received standard pharmacotherapy. Genome-wide association study signals were subsequently functionally validated and studied in relevant cellular models to understand molecular mechanisms that may have contributed to the change in left ventricular ejection fraction. RESULTS: The genome-wide association study identified a highly suggestive locus that mapped to the 5'-flanking region of the CDCP1 (CUB [complement C1r/C1s, Uegf, and Bmp1] domain containing protein 1) gene (rs6773435; P=7.12×10-7). The variant allele was associated with improved cardiac function and decreased CDCP1 transcription. CDCP1 expression was significantly upregulated in human cardiac fibroblasts (HCFs) in response to the PDGF (platelet-derived growth factor) signaling, and knockdown of CDCP1 significantly repressed HCF proliferation and decreased AKT (protein kinase B) phosphorylation. Transcriptomic profiling after CDCP1 knockdown in HCFs supported the conclusion that CDCP1 regulates HCF proliferation and mitosis. In addition, CDCP1 knockdown in HCFs resulted in significantly decreased expression of soluble ST2 (suppression of tumorigenicity-2), a prognostic biomarker for heart failure and inductor of cardiac fibrosis. CONCLUSIONS: CDCP1 may play an important role in myocardial recovery in recent-onset DCM and mediates its effect primarily by attenuating cardiac fibrosis.
- MeSH
- antigeny nádorové terapeutické užití MeSH
- celogenomová asociační studie MeSH
- dilatační kardiomyopatie * metabolismus MeSH
- fibróza MeSH
- funkce levé komory srdeční MeSH
- lidé MeSH
- molekuly buněčné adheze metabolismus MeSH
- srdeční selhání * MeSH
- tepový objem MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent, intermittent partial or complete obstruction of the upper respiratory tract during sleep, which negatively affects the patient's daily quality of life (QoL). Middle-aged and older men who smoke and have obesity are most at risk. Even though the use of continuous positive airway pressure (CPAP) during sleep remains the gold standard treatment, various rehabilitation methods, such as exercise, respiratory therapy, myofunctional therapy, and nutritional lifestyle interventions, also appear to be effective. Moreover, it is increasingly recommended to use alternative or additional therapy options in combination with CPAP therapy. OBJECTIVE: This study aims to evaluate if a comprehensive home-based, remotely supervised rehabilitation program (tele-RHB), in combination with standard therapy, can improve OSA severity by decreasing the apnea-hypopnea index (AHI); improve objective parameters of polysomnographic, spirometric, anthropometric, and body composition examinations; improve lipid profile, maximal mouth pressure, and functional capacity tests; and enhance the subjective perception of QoL, as well as daytime sleepiness in male participants with moderate to severe OSA. Our hypothesis is that a combination of the tele-RHB program and CPAP therapy will be more effective by improving OSA severity and the abovementioned parameters. METHODS: This randomized controlled trial aims to recruit 50 male participants between the ages of 30 and 60 years with newly diagnosed moderate to severe OSA. Participants will be randomized 1:1, either to a 12-week tele-RHB program along with CPAP therapy or to CPAP therapy alone. After the completion of the intervention, the participants will be invited to complete a 1-year follow-up. The primary outcomes will be the polysomnographic value of AHI, Epworth Sleepiness Scale score, 36-Item Short Form Health Survey (SF-36) score, percentage of body fat, 6-minute walk test distance covered, as well as maximal inspiratory and expiratory mouth pressure values. Secondary outcomes will include polysomnographic values of oxygen desaturation index, supine AHI, total sleep time, average heart rate, mean oxygen saturation, and the percentage of time with oxygen saturation below 90%; anthropometric measurements of neck, waist, and hip circumference; BMI values; forced vital capacity; forced expiratory volume in 1 second; World Health Organization's tool to measure QoL (WHOQOL-BREF) score; and lipid profile values. RESULTS: Study recruitment began on October 25, 2021, and the estimated study completion date is December 2024. Analyses will be performed to examine whether the combination of the tele-RHB program and CPAP therapy will be more effective in the reduction of OSA severity and improvement of QoL, body composition and circumferences, exercise tolerance, lipid profile, as well as respiratory muscle and lung function, compared to CPAP therapy alone. CONCLUSIONS: The study will evaluate the effect of a comprehensive tele-RHB program on selected parameters mentioned above in male participants. The results of this intervention could help the further development of novel additional therapeutic home-based options for OSA. TRIAL REGISTRATION: ClinicalTrials.gov NCT04759456; https://clinicaltrials.gov/ct2/show/NCT04759456. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47460.
- Publikační typ
- časopisecké články MeSH
V této práci popisujeme případ pacienta se syndromem spánkové apnoe při srdečním selhání a následně po ortotopické transplantaci srdce (OTS) a její ovlivnění přetlakovou ventilací. Spánková apnoe (SA) je ovlivnitelným nezávislým rizikovým faktorem kardiovaskulárních onemocnění. Jejími klinickými příznaky mohou být dlouhotrvající únava a nadměrná denní spavost, poruchy kognitivních funkcí zahrnující zhoršenou krátkodobou paměť a poruchy soustředění, behaviorální poruchy, jako je náladovost, agresivita, ztráta motivace a tzv. noční symptomy: ronchopatie (chrápání), častá probuzení lapavými dechy - pavor nocturnus, nykturie, fragmentace spánku a po probuzení typické sucho v ústech nebo ranní cefalea. Diagnostika SA je založena na výsledcích polysomnografického či polygrafického vyšetření, její léčba pak spočívá v tzv. neinvazivní přetlakové ventilaci. SA může vést k rozvoji nových či zhoršení stávajících kardiovaskulárních onemocnění, a tedy v konečném důsledku k rozvoji srdečního selhání (HF), klinickému syndromu zapříčiněnému funkčními či strukturálními abnormalitami vedoucími k poruše srdeční funkce. Výskyt srdečního selhání se u nás i celosvětově neustále zvyšuje, a to i přes rozvoj nových účinných léků a nefarmakologických postupů, k nimž patří i ortotopická transplantace srdce.
This article shows different types of sleep apnea syndrome (SA) in a patient with severe heart failure before and after orthotopic heart transplant and the treatment of SA. Sleep apnea is an influenceable independent risk factor of cardiovascular diseases. Its main symptoms may be long-term fatigue and excessive daytime sleepiness, cognitive deficit including impaired short-term memory and concentration disorder, behavioral disorders such as moodiness, aggressivity, the lack of motivation and so-called nocturnal symptoms: ronchopathy (snoring), frequent sleep arousals accompanied by gasping, nycturia, fragmentation of sleep, mouth dryness after awakening or morning headache. The diagnosis of SA is based on respiratory polygraphy or videopolysomnography. The treatment of SA consists in positive airway pressure ventilation therapy. SA may lead to the new development or progression of current cardiovascular diseases, and eventually, to the development of heart failure (HF) - clinical syndrome caused by functional or structural abnormalities leading to the failure of heart function. The prevalence of HF is on the rise in the Czech Republic and worldwide as well, despite the new development of efficient pharmacological therapies and non-pharmacological methods including the orthotopic heart transplant.
- MeSH
- bakteriální endokarditida etiologie farmakoterapie MeSH
- defibrilátory implantabilní MeSH
- diagnostické techniky kardiovaskulární MeSH
- lidé středního věku MeSH
- lidé MeSH
- polysomnografie metody MeSH
- srdeční selhání * diagnóza farmakoterapie terapie MeSH
- stafylokokové infekce etiologie farmakoterapie MeSH
- syndromy spánkové apnoe * diagnóza terapie MeSH
- transplantace srdce MeSH
- ventilace umělá s výdechovým přetlakem metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
