Evropská kardiologická společnost vydala v roce 2023 aktualizovaný doporučený postup pro diagnostiku a léčbu infekční endokarditidy (1), který byl následně přejat i Českou kardiologickou společností (2). Doporučení v oblasti antibiotické profylaxe a léčby bohužel obsahují mnohé nedostatky a chyby (3), proto tři české odborné společnosti vytvořily vlastní doporučení (4). Následující text je tedy kompilací těchto textů určený zejména pro internisty.

The European Society of Cardiology published an updated guideline for the diagnosis and treatment of infective endocarditis in 2023 (1), which was subsequently adopted by the Czech Society of Cardiology (2). Unfortunately, the recommendations in the areas of antibiotic prophylaxis and treatment contain many shortcomings and errors (3), which is why three Czech professional societies have developed their own recommendations (4). The following text is a compilation of these documents, primarily intended for internists.

• MeSH
• antibakteriální látky aplikace a dávkování   terapeutické užití   MeSH
• antibiotická profylaxe MeSH
• echokardiografie MeSH
• embolie prevence a kontrola   MeSH
• endokarditida * diagnóza   etiologie   komplikace   terapie   MeSH
• kultivační vyšetření krve MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH

Sarkopenická obezita je charakterizovaná kombinací obezity a sarkopenie. Jedná se o jedinečný klinický stav, který se odlišuje od samotné obezity a sarkopenie. Tyto dva problémy se vzájemně výrazně potencují, a tím se maximalizuje jejich vliv na morbiditu a disabilitu. Sarkopenická obezita byla dosud identifikována pomocí různých definic a diagnostických kritérií, přičemž tato roztříštěnost měla negativní dopad na rozvoj strategií prevence a léčby sarkopenické obezity u seniorů. V roce 2022 Evropská společnost parenterální a enterální výživy (ESPEN) a Evropská společnost pro studium obezity (EASO) nově definovaly diagnostická kritéria sarkopenické obezity, která sjednocují doposud četné definice.

Sarcopenic obesity is characterized by the combination of obesity and sarcopenia, Sarcopenic obesity needs to be considered as a unique clinical condition, different from obesity or sarcopenia alone. These two problems significantly potentiate each other, thereby maximizing their impact on morbidity and disability. Until now, sarcopenic obesity has been identified using different definitions and diagnostic criteria, and this fragmentation has had a negative impact on the development of prevention and treatment strategies for sarcopenic obesity in the elderly. In 2022, the European Society for Parenteral and Enteral Nutrition (ESPEN) and the European Society for the Study of Obesity (EASO) redefined the diagnostic criteria for sarcopenic obesity, unifying the previously numerous definitions.

• MeSH
• lidé MeSH
• obezita * diagnóza   komplikace   patofyziologie   terapie   MeSH
• plošný screening metody   MeSH
• rizikové faktory MeSH
• sarkopenie * diagnóza   komplikace   patofyziologie   terapie   MeSH
• senioři MeSH
• složení těla fyziologie   MeSH
• stárnutí fyziologie   MeSH
• tuky škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND/AIM: The study aims to describe the role of diabetes in patients with heart failure. METHODS: In all, 1052 chronic heart failure patients were included in the FARmacology and NeuroHumoral Activation (FAR NHL) multicenter prospective registry. They had ejection fraction below 50% and were on stable medication for at least 1 month. RESULTS: More than one-third (38.9%) of the patients had diabetes mellitus (DM). Diabetic patients (N = 409) were older (median 67 vs. 64, p < 0.001), had higher body mass index (BMI) (30 vs. 28 kg/m2, p < 0.001), much more frequently had ischemic heart disease (71 vs. 47%, p < 0.001), hypertension (80 vs. 67%, p < 0.001), dyslipidemia (89 vs. 69%, p < 0.001), worse renal function (estimated glomerular filtration rate [eGFR] median 63 vs. 73 mL/min/1.73 m2, p < 0.001), and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) (median 681 vs. 463 pg/mL, p = 0.003). All-cause death, left ventricle assist device implantation, and orthotopic heart transplantation were set as the combined primary end point, which was present in 15.5% (163 patients) within the 2-year follow-up. In the 2-year follow-up, 81.0% of patients with diabetes survived without a primary end point, while 85.4% of the patients without diabetes survived, the difference being on the verge of statistical significance (p = 0.089). DM is a statistically significant predictor of NT-proBNP value in univariate analysis, but it is not an independent predictor in a multivariate analysis. When the NT-proBNP level was high, the presence of DM did not influence the prognosis. CONCLUSION: The combination of diabetes and NT-proBNP levels may better stratify the prognosis of patients with chronic heart failure.

• MeSH
• chronická nemoc MeSH
• diabetes mellitus * krev   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B * krev   MeSH
• peptidové fragmenty krev   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• registrace * MeSH
• senioři MeSH
• srdeční selhání * krev   patofyziologie   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

Epizody rychlé frekvence síní (atrial high‐rate episodes, AHRE) jsou síňové arytmie detekované implantovanými srdečními zařízeními. Dosud nebylo známo, zda nás výskyt AHRE u pacientů bez fibrilace síní opravňuje k zahájení an­ti­ko­agu­lač­ní léčby. Událostmi řízená dvojitě zaslepená, randomizovaná klinická studie NOAH‐AFNET 6 zahrnula pacienty ve věku 65 let nebo starší, kteří měli AHRE trvající alespoň šest minut a alespoň jeden další rizikový faktor pro vznik cévní mozkové příhody (CMP). Pacienti byli randomizováni v poměru 1 : 1 k podávání edoxabanu nebo placeba. Primární cílový ukazatel účinnosti byl složen z kardiovaskulárního úmrtí, CMP nebo systémové embolie a hodnocen v analýze doby do události. Bezpečnostní cílový ukazatel zahrnoval úmrtí z jakékoliv příčiny nebo velké krvácení. U pacientů s AHRE detekovanými implantabilními zařízeními antikoagulace edoxabanem ve srovnání s placebem významně nesnížila incidenci kardiovaskulárního úmrtí, CMP nebo systémové embolie, ale vedla k vyššímu výskytu úmrtí nebo velkého krvácení. Výskyt CMP byl v obou skupinách nízký.

AHRE (atrial high‐rate episodes) may be detected by implantable cardiac devices. So far, it is not clear whether AHRE unaccompanied by atrial fibrillation mandates the initiation of anticoagulation therapy. In the event‐driven, double blind, randomized clinical trial NOAH‐AFNET 6, patients aged 65 or older with a history of AHRE lasting at least 6 minutes and at least one more risk factor for stroke were investigated. They were randomized 1:1 to edoxaban or placebo. The composite primary endpoint consisted of cardiovascular death, stroke and systemic embolization – time to event was analyzed. All‐cause death and major bleeding represented the safety endpoint. In patients with AHRE detected by implantable cardiac devices, anticoagulation with edoxaban did not ensure significant decrease in the incidence of cardiovascular death, stroke and systemic embolization while it was associated with higher incidence of all‐cause death and major bleeding (compared to placebo). The stroke rate was low in both groups.

• Klíčová slova
• edoxaban, studie NOAH-AFNET 6,
• MeSH
• antikoagulancia * klasifikace   terapeutické užití   MeSH
• cévní mozková příhoda etiologie   mortalita   MeSH
• dvojitá slepá metoda MeSH
• embolie etiologie   mortalita   MeSH
• fibrilace síní * diagnóza   farmakoterapie   MeSH
• kardiovaskulární nemoci klasifikace   mortalita   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční arytmie diagnóza   farmakoterapie   klasifikace   MeSH
• srdeční frekvence účinky léků   MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• randomizované kontrolované studie MeSH

Stárnutí populace dramaticky a zásadním způsobem mění svět. Současná geriatrie má intervenčně preventivní charakter a snaží se o co nejdelší uchování fyzického a duševního zdraví, odvrácení ztráty soběstačnosti a zlepšení prognózy seniorů se zaměřením na kvalitu života. Mezi závažné problémy, kterým se věnuje geriatrie, patří problematika demencí. Diagnóza demence ovlivňuje nejen kvalitu života jednotlivců, ale také představuje obrovskou sociální a ekonomickou zátěž pro rodiny, zdravotní systémy a společnost. Se stárnutím populace se demence stala důležitým problémem našeho zdravotnictví a existuje naléhavá potřeba najít účinnou léčbu.

Population aging is changing the world dramatically and fundamentally. Contemporary geriatrics has an interventional and preventive nature and strives to preserve physical and mental health for as long as possible, prevent loss of self-sufficiency and improve the prognosis of seniors with a focus on quality of life. Dementia is a serious problem that geriatrics deals with. The diagnosis of dementia not only affects the quality of life of individuals, but also represents a huge social and economic burden for the family, health systems and society. With the aging of the population, dementia has become an important problem in our health care and there is an urgent need to find an effective treatment.

• Klíčová slova
• donanemab,
• MeSH
• biologická terapie MeSH
• biologické přípravky terapeutické užití   MeSH
• demence * terapie   MeSH
• fototerapie metody   MeSH
• humanizované monoklonální protilátky aplikace a dávkování   terapeutické užití   MeSH
• kyselina listová terapeutické užití   MeSH
• lidé MeSH
• probiotika terapeutické užití   MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH

We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.

• MeSH
• antihypertenziva terapeutické užití   farmakologie   MeSH
• diuretika farmakologie   terapeutické užití   MeSH
• hypertenze * komplikace   farmakoterapie   MeSH
• individualizovaná medicína MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe * komplikace   terapie   MeSH
• polysomnografie MeSH
• průřezové studie MeSH
• syndromy spánkové apnoe * komplikace   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). METHODS AND RESULTS: Hypertensive patients with AHT [monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 years, body mass index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, apnoea-hypopnoea index 46 ± 25/46 ± 24 n/h, proportion female 29/26%, respectively] started PAP treatment. Office BP at baseline and 2- to 36-month follow-up were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influences of age, gender, BMI, co-morbidities, BP at baseline, and study site were evaluated. Following PAP treatment (daily usage, 5.6 ± 1.6/5.7 ± 1.9 h/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all P < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT, respectively). PAP treatment duration predicted a larger BP improvement in the monotherapy group. Intake of renin-angiotensin blockers [angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)] alone or in any AHT combination was associated with better BP control. The AHT-dependent BP improvement was independent of confounders. CONCLUSION: In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Longer PAP treatment duration, was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.

• 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

Pulmonary embolism is one of the three most common emergent cardiovascular events. Concerning the related symptoms, it is always considered an urgent state of dyspnoea and chest pain. Its incidence is still increasing with the improving availability of laboratory and imaging methods. On the other hand, per case mortality is decreasing. With the introduction of direct oral anticoagulants into daily practice and the new extension of recommendations also among oncology patients, its treatment is significantly simplified. This can be useful not only in hospital treatment but especially in properly selected patients treated exclusively on an outpatient basis. In the following article, we focus on the current approach to diagnosis and treatment with an emphasis on recent guidelines.

Plicní embolie patří mezi tři nejčastější akutní kardiovaskulární příhody. S ohledem na doprovázející symptomy ji vždy zvažujeme v rámci akutních stavů dušnosti a bolestí na hrudi. Její incidence stále roste se zlepšující se dostupností laboratorních a zobrazovacích metod. Úmrtnost na počet případů naopak klesá. Se zavedením přímých perorálních antikoagulancií do běžné praxe a novým rozšířením jejich doporučení i mezi onkologicky nemocné se významně zjednodušuje její léčba. Toho lze s výhodou využít nejen při léčbě nemocniční, ale především u vhodně vybraných pacientů léčených výlučně ambulantně. V následujícím textu se věnujeme aktuálnímu přístupu v diagnostice a léčbě s důrazem na platné doporučené postupy.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• lidé MeSH
• plicní embolie * diagnóza   farmakoterapie   patofyziologie   MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Rehabilitation may be an effective additional treatment method in patients with obstructive sleep apnea (OSA). Physical exercise, weight reduction, pulmonary rehabilitation, and myofunctional therapy (MT) represent beneficial components of rehabilitation recommended as a possible adjunct to standard OSA treatment. METHODS AND RESULTS: A 54-year-old man with morbid obesity, long-lasting snoring, breathing pauses, frequent waking, as well as persistent drowsiness and fatigue during the day underwent polysomnography (PSG) to investigate suspected OSA. Severe OSA was confirmed by PSG and a 12-week comprehensive, home-based telerehabilitation program (tele-RHB program) along with continuous positive airway pressure (CPAP) therapy was implemented. The tele-RHB program included regular teleconsultations, aerobic-endurance training, MT, inspiratory and expiratory muscle training, as well as recommendations on proper nutrition, a healthy lifestyle, and behavioral changes. Following the treatment, the patient's quality of life (QoL), exercise capacity, lung function, and OSA severity significantly improved. The patient achieved an overall 19.9 kg reduction in weight, of which 16.2 kg was body fat, and his apnea-hypopnea index decreased by 42.6 episodes/hour. CONCLUSION: Our case report suggests that the comprehensive home-based tele-RHB program adjunct to CPAP therapy may be a novel approach for improving OSA severity, a patient's QoL, exercise capacity, lung function and body composition. It is important to note that such a program should be optional, however it may be needed to achieve the highest possible overall improvement in a patient's life. Further clinical investigations are needed to determine the therapeutic efficacy and clinical potential of this tele-RHB program.

• MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita * komplikace   MeSH
• obstrukční spánková apnoe * komplikace   terapie   MeSH
• telerehabilitace * MeSH
• trvalý přetlak v dýchacích cestách MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH