Transcatheter Aortic Valve Implantation (TAVI) has revolutionized severe aortic stenosis treatment, but risk stratification remains challenging. This systematic review examined the association between computed tomography (CT)-derived adipose tissue parameters and TAVI outcomes. We searched major databases for studies on visceral (VAT), subcutaneous (SAT), and intramuscular (IMAT) adipose tissue parameters and post-TAVI outcomes. Fourteen studies (9692 patients) were included. Higher SAT area/volume was consistently associated with better survival (5 studies, HR range: 0.83-2.77, p < 0.05). Lower SAT and VAT density also correlated with better survival (5 and 4 studies, respectively, HR range: 1.31-1.46, p < 0.05). VAT area showed mixed results. A VAT:SAT ratio < 1 was associated with better cardiovascular outcomes in one study. Lower IMAT index correlated with shorter hospital stays in a single study. This review reveals complex relationships between adipose tissue parameters and TAVI outcomes. Lower adipose tissue density and higher subcutaneous adiposity were most consistently associated with better outcomes. These findings suggest that detailed analysis of adipose tissue characteristics may enhance risk stratification in TAVI candidates.
- MeSH
- aortální stenóza * chirurgie mortalita diagnostické zobrazování MeSH
- lidé MeSH
- počítačová rentgenová tomografie * metody MeSH
- pooperační komplikace * etiologie mortalita MeSH
- transkatetrální implantace aortální chlopně * škodlivé účinky mortalita MeSH
- tuková tkáň * diagnostické zobrazování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Background and Objectives: Aortic stenosis (AS) is a frequent valvular disease characterized by the obstruction of left ventricular outflow. The resulting hemodynamic and structural changes create an arrhythmogenic substrate, with sudden cardiac death (SCD) often caused by ventricular arrhythmias (VAs) being a feared complication. This review examines the relationship between severe AS and VA, detailing the epidemiology, pathophysiological mechanisms, risk factors, and management approaches prior to aortic valve replacement (AVR). Materials and Methods: We conducted a comprehensive narrative review of the historical and contemporary literature investigating ventricular arrhythmias in severe aortic stenosis. Literature searches were performed in PubMed, MEDLINE, and Scopus databases using keywords, including "aortic stenosis", "ventricular arrhythmia", "sudden cardiac death", and "aortic valve replacement". Both landmark historical studies and modern investigations utilizing advanced monitoring techniques were included to provide a complete evolution of the understanding. Results: The prevalence of ventricular ectopy and non-sustained ventricular tachycardia increases with AS severity and symptom onset. Left ventricular hypertrophy, myocardial fibrosis, altered electrophysiological properties, and ischemia create the arrhythmogenic substrate. Risk factors include the male sex, concomitant aortic regurgitation, elevated filling pressures, and syncope. Diagnostic approaches range from standard electrocardiography to continuous monitoring and advanced imaging. Management centers on timely valve intervention, with medical therapy serving primarily as a bridge to AVR. Conclusions: Ventricular arrhythmias represent a consequence of valvular pathology in severe AS rather than an independent entity. Their presence signals advanced disease and a heightened risk for adverse outcomes. Multidisciplinary management with vigilant monitoring and prompt surgical referral is essential. Understanding this relationship enables clinicians to better identify high-risk patients requiring urgent intervention before life-threatening arrhythmic events occur.
- MeSH
- aortální stenóza * komplikace chirurgie patofyziologie MeSH
- chirurgická náhrada chlopně * metody MeSH
- komorová tachykardie etiologie MeSH
- lidé MeSH
- náhlá srdeční smrt etiologie MeSH
- rizikové faktory MeSH
- srdeční arytmie * etiologie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
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
- chytré brýle MeSH
- koronární angiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- pochopení MeSH
- předoperační péče metody MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- statistika jako téma MeSH
- úzkost terapie MeSH
- virtuální realita * MeSH
- vzdělávání pacientů jako téma * metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- randomizované kontrolované studie MeSH
AIM: Assessment of blood pressure during exercise is routine in athletes, but normal values remain equivocal. This study examines the response of systolic blood pressure (SBP) to exercise in a large cohort of athletes and establishes normative values by sex and age. METHODS: Competitive athletes free of cardiovascular disease underwent pre-participation exercise testing on a bicycle ergometer. Resting (SBPrest) and peak blood pressure (SBPpeak), heart rate (HRrest and HRpeak), and power output (WR) were recorded. Workload indexed values were calculated. RESULTS: The cohort included 12,083 athletes (median age 15 years, 26.9% female). Median peak exercise SBP was similar between sexes, but WR-indexed measures including SBP/WR ratio and SBP/(WR/kg) slope were higher in females (0.9 vs. 0.7, p < 0.001; 10.94 vs. 9.52, p < 0.001). Univariate analyses revealed significant associations between SBPpeak and several predictors, including sex, age, weight, height, SBPrest, DBPrest, HRrest, HRpeak, and WR (all p < .001). Multivariate analysis showed that SBPrest (beta = 0.353, 95% CI [0.541, 0.609], p < 0.001), height (beta = 0.303, 95% CI [0.360, 0.447], p < 0.001), WR (beta = 0.171, 95% CI [0.029, 0.045], p < 0.001), and age (beta = 0.093, 95% CI [0.162, 0.241], p < 0.001) were the strongest predictors of SBPpeak. CONCLUSION: This study provides reference values for the interpretation of SBP responses to exercise in athletes. Multivariate analyses highlight the complex interplay of factors influencing peak SBP, including SBPrest, height, WR, age, DBPrest, sex, endurance sport category, and weight. In future studies, these findings may inform the development of personalised training strategies and risk stratification models in athletic populations.
- Publikační typ
- časopisecké články MeSH
This review examines the relationship between the physiological demands of diving and premature ventricular complexes (PVCs) in divers. In the general population, some individuals have a greater tendency to experience PVCs, often without awareness or a clear understanding of the triggering factors. With the increasing availability and popularity of both scuba and apnoea diving, more people, including those with a predisposition to PVCs, are engaging in these activities. The underwater environment, with its unique stressors, may increase the risk of arrhythmogenic events, particularly PVCs. Here, we review the prevalence, pathophysiology, and aggravating factors of PVCs in divers, emphasising the need for a comprehensive cardiovascular assessment. Evidence suggests a higher prevalence of PVCs in divers compared with the general population, influenced by factors such as age, dive depth, gas bubbles, cold water immersion, pre-existing cardiovascular diseases, and lifestyle factors. The change in environment during diving could potentially trigger an increased frequency of PVCs, especially in individuals with a pre-existing tendency. We discuss diagnostic strategies, management approaches, and preventive measures for divers with PVCs, noting that although guidelines for athletes can be adapted, individual assessment is crucial. Significant knowledge gaps are identified, highlighting the need for future research to develop evidence-based guidelines and understand the long-term significance of PVCs in divers. This work aims to evaluate potential contributing factors to PVCs in divers and identify individuals who may be at higher risk of experiencing major adverse cardiovascular events (MACEs). This work aims to improve diver safety by promoting collaboration between cardiologists and diving medicine specialists and by identifying key areas for future investigation in this field. This work aims to improve the safety and well-being of divers by understanding the cardiovascular challenges they face, including pressure changes, cold water immersion, and hypoxia. We seek to elucidate the relationship between these challenges and the occurrence of PVCs. By synthesising current evidence, identifying knowledge gaps, and proposing preliminary recommendations, we aim to encourage collaboration between cardiologists and diving medicine specialists to optimise the screening, management, and risk stratification of PVCs in the diving population.
- Publikační typ
- časopisecké články MeSH
- přehledy 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.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population. The purpose of study was to evaluate the prevalence of AFD in male patients with implanted permanent pacemaker (PM). METHODS: The prospective multicentric screening in consecutive male patients between 35 and 65 years with implanted PM for acquired third- or second- degree type 2 AV block or symptomatic second- degree type 1 AV block or sinus node dysfunction was performed. RESULTS: A total of 484 patients (mean age 54 ± 12 years at time of PM implantation) were enrolled to the screening in 12 local sites in Czech Republic. Out of all patients, negative result was found in 481 (99%) subjects. In 3 cases, a GLA variant was found, classified as benign: p.Asp313Tyr, p.D313Y). Pathogenic GLA variants (classical or non-classical form) or variants of unclear significance were not detected. CONCLUSION: The prevalence of pathogenic variants causing AFD in a general population sample with implanted permanent PM for AV conduction defects or sinus node dysfunction seems to be low. Our findings do not advocate a routine screening for AFD in all adult males with clinically significant bradycardia.
- MeSH
- atrioventrikulární blokáda * diagnóza epidemiologie terapie MeSH
- bradykardie komplikace terapie MeSH
- dospělí MeSH
- Fabryho nemoc * diagnóza epidemiologie genetika MeSH
- kardiostimulátor * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- syndrom chorého sinu diagnóza epidemiologie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Spontánní disekce koronární tepny je jednou z příčin akutního koronárního syndromu. Nejčastěji se vyskytuje u mladých žen a může vzniknout po fyzické nebo emoční zátěži. Vyskytuje se u pacientů s fibromuskulární dysplazií či zánětlivými onemocněními. Její léčba může být konzervativní a v případě pokračující ischemie myokardu je indikována revaskularizace, což je spojeno s rizikem vzniku iatrogenní disekce koronární tepny. V kazuistice popisujeme případ mladé ženy, u které vznikla disekce koronární tepny při vyhlídkovém letu. U pacientky byla pro pokračující bolesti na hrudi indikována perkutánní koronární intervence, která byla komplikována uzávěrem kmene levé koronární tepny. V diskusi je řešen možný vztah hypotyreózy a spontánní disekce koronární tepny.
Spontaneous coronary artery dissection is one of the causes of acute coronary syndrome. It is most common in young women and may occur after physical or emotional stress and may be associated with fibromuscular dysplasia or inflammatory diseases. Its treatment may be conservative and revascularization is indicated in case of ongoing myocardial ischemia, which is associated with the risk of iatrogenic coronary artery dis- section. In this case report, we present a young woman who developed coronary artery dissection during a sightseeing flight. Due to ongoing chest pain, the patient was indicated for PCI, which was complicated by left main coronary artery occlusion. The possible relationship between hypothyroidism and spontaneous coronary artery dissection is discussed.
- Klíčová slova
- Acute coronary syndrome, Hypothyroidism, Spontaneous coronary artery dissection, Akutní koronární syndrom, Hypotyreóza, Spontánní disekce koronární tepny,
- MeSH
- diagnostické techniky kardiovaskulární MeSH
- disekce cévy * klasifikace patologie terapie MeSH
- dospělí MeSH
- hypotyreóza komplikace MeSH
- inhibitory agregace trombocytů farmakologie terapeutické užití MeSH
- koronární angioplastika metody MeSH
- koronární cévy * patologie MeSH
- lidé MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
