Pulmonary hypertension (PH) is an established risk factor in patients with atrial septal defect (ASD), and its persistence after ASD closure is associated with increased mortality. Therefore, predictors for PH normalization after defect closure are needed. Multiple hemodynamic types of PH exist, but little is known about their prevalence and prognostic value for PH normalization after ASD closure. We carried out a retrospective study on 97 patients (76% female, median age at ASD closure 58 years) with four types of PH determined predominantly by right heart catheterization: hyperkinetic, pulmonary arterial hypertension, isolated post-capillary, and combined pre- and post-capillary. We investigated the frequency of the PH types and their prognostic significance for PH normalization after ASD closure. Frequency of PH types before ASD closure in our study was: hyperkinetic 55%, pulmonary arterial hypertension 10%, isolated post-capillary PH 24%, and combined PH 11%. Hyperkinetic PH type was positively associated with PH normalization after ASD closure (78% patients normalized), remaining a significant independent predictor when adjusted for age at closure, sex, heart failure, and NYHA. Hyperkinetic PH patients also had significantly better survival prognosis versus patients with other PH types (p = 0.04). Combined PH was negatively associated with PH normalization, with no patients normalizing. Pulmonary arterial hypertension and isolated post-capillary PH had intermediate rates of normalization (60 and 52%, respectively). In summary, all four hemodynamic types of PH are found in adult patients with ASD, and they can be used to stratify patients by their likelihood of PH normalization and survival after ASD closure.

• Publikační typ
• časopisecké články MeSH

Background: Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults and pulmonary hypertension (PH) is an established risk factor. A decision whether to perform ASD closure, especially in elderly patients with PH, is a complex dilemma. The aim of our study was to compare long-term survival in patients with closed and open ASD. Methods: A retrospective cohort study was performed on 427 patients with ASD (median age at diagnosis 38 years, IQR 18-56) out of which 186 patients (44%) manifested PH. ASD closure in patients with PH was only considered in patients without Eisenmenger syndrome with pulmonary vascular resistance < 5 WU. Median follow-up duration was 18 years (IQR 9-31 years). Kaplan-Meier and Cox proportional hazards survival analyses were performed to evaluate 12 potential predictors of survival. Results: Defect closure was associated with improved long-term survival in ASD patients both with (P < 0.001) and without PH (P = 0.01) and this association was present also in patients over 40 years. The 20-year survival since diagnosis was significantly higher in patients with PH and closed ASD compared to those with PH and open ASD (65% vs. 41%). ASD closure was a significant independent predictor of long-term survival (P = 0.003) after accounting for age at diagnosis, PH, NYHA class, Eisenmenger syndrome, and mitral regurgitation. Significant negative independent predictors of survival were older age at diagnosis (P < 0.001), Eisenmenger syndrome (P < 0.001), and PH (P = 0.03). Conclusion: ASD closure appears to be associated with improved long-term survival independently of age, PH, and other clinical variables.

• Publikační typ
• časopisecké články MeSH

Úvod: Zajištění dobré kvality života je důležitý cíl léčby pacientů s komplexní cyanotickou vrozenou srdeční vadou (VSV). V literatuře však neexistuje shoda o kvalitě života těchto pacientů. Cílem naší studie bylo zhodnocení kvality života a výskytu depresí u dospělých s původně komplexní cyanotickou VSV v dlouhodobém odstupu od operace. Metody: Vyšetřili jsme celkem 212 dospělých po operaci komplexní cyanotické VSV a 86 zdravých kontrol pomocí dotazníku hodnocení kvality života SF-36 a Zungova dotazníku hodnocení deprese. Všichni pacienti byli dále dotázáni na subjektivní hodnocení vlivu VSV na jejich život, na fyzické aktivity, funkční třídu NYHA, vzdělání, zaměstnání, počet dětí a všichni podstoupili echokardiografické vyšetření. Výsledky byly srovnány se skupinou 32 neoperovaných pacientů s komplexní cyanotickou VSV, jejichž výsledky jsme publikovali v minulosti. Výsledky: Výskyt deprese se významně nelišil mezi skupinou operovaných s VSV a zdravými kontrolami. Těžká deprese byla u 8,5 % pacientů s operovanou komplexní cyanotickou VSV a u 7 % zdravých kontrol (p = 0,816). Mezi neoperovanými pacienty s perzistující cyanózou byl výskyt těžké deprese významně vyšší (28,1 %) oproti operovaným (p = 0,003). Kvalita života hodnocená pomocí dotazníku SF-36 se významně nelišila mezi pacienty s operovanými komplexními VSV a kontrolami, kromě horšího vnímání obecného zdraví, hodnocení fyzických funkcí a fyzického omezení činností. Závěr: Pacienti s operovanou komplexní cyanotickou VSV mají v dospělosti dobrou kvalitu života, srovnatelnou s kontrolní skupinou zdravých jedinců, zatímco neoperovaní pacienti s perzistující cyanózou u komplexní VSV mají významně vyšší počet depresí.

Background: Good quality of life is an important goal in treatment of complex cyanotic congenital heart disease (CHD); however, there is a lack of consensus concerning quality of life in complex CHD patients in the literature. The aim of this study was to assess quality of life and rate of depression in adults with complex cyanotic CHD late after repair. Method: The studied cohort consists of 212 adults with repaired complex cyanotic CHD and 86 healthy controls. Subjects filled in questionnaires evaluating quality of life (SF-36) and depression (Zung self-rating depression scale). Additional data on the influence of CHD on patient's life, physical activities, NYHA class, echocardiographic parameters, etc. were recorded. The results were compared with a previously published cohort of 32 cyanotic adults with unrepaired CHD. Results: The rate of depression did not differ significantly between repaired CHD patients and healthy controls. Severe depression was found in 8.5% of repaired complex CHD, in 7.0% of controls (p = 0.816), and in 28.1% of the unrepaired CHD with persistent cyanosis (p = 0.003). The quality of life measured by SF-36 was not significantly different between repaired CHD and controls, except for lower general health perception, physical functioning, and physical role limitation. Conclusion: The repaired complex cyanotic CHD patients have a good quality of life, similar to controls, while unrepaired patients have a significantly higher rate of depression.

• MeSH
• deprese MeSH
• kvalita života * MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• vrozené srdeční vady * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

OBJECTIVE: The patients after Mustard and Senning corrections of transposition of the great arteries (TGA) are at an increased risk of unexpected death. The aim of this study was to identify markers allowing risk stratification of patients after atrial switch correction of TGA to provide them with optimum care. METHODS AND RESULTS: In this study, 87 patients were retrospectively evaluated after atrial switch correction of TGA followed-up between 2005 and 2015. The mortality during the follow-up was 9% (8 cardiac deaths). Markers significantly predictive of death using univariable Cox proportional hazard ratio survival analysis were: N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction and end-diastolic dimension of the systemic right ventricle, mitral E, e', and s'. Surprisingly, the Doppler parameters of mitral valve in subpulmonary ventricle were more important for prognosis than those of systemic tricuspid valve. In multivariable analysis, the only independent predictors of mortality were NT-proBNP (P = .00048; AUC 0.97) and the velocity of early diastolic filling (mitral E) in subpulmonary ventricle (P = .01815; AUC 0.81). According to Kaplan-Meier survival analysis, patients with NT-proBNP > 1000 pg/ml are at high risk of death. Patients with mitral E < 68 cm/s are also at an increased risk of death. CONCLUSIONS: NT-proBNP is the most reliable prognostic mortality factor and should be measured regularly in TGA patients after Mustard or Senning correction. Diastolic filling velocity of the subpulmonary left ventricle (mitral E) may be more important for prognosis than systolic function of the systemic right ventricle.

• MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• dopplerovská echokardiografie MeSH
• dospělí MeSH
• hodnocení rizik metody   MeSH
• kardiochirurgické výkony metody   MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• mladý dospělý MeSH
• následné studie MeSH
• natriuretický peptid typu B krev   MeSH
• peptidové fragmenty krev   MeSH
• pooperační období MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• transpozice velkých cév krev   mortalita   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

V posledních deseti letech bylo na Kardiochirurgickém oddělení v Nemocnici Na Homolce (NNH) provedeno celkem 844 operací u 805 dospělých s vrozenou srdeční vadou (VSV). Medián věku operovaných byl 37 let (mezikvartilové rozpětí 25–49, celkové rozpětí 16–81 let). Operace komplexních a vzácných VSV tvořily 47 %. Ve 44 % (u 354 pacientů) se jednalo o reoperaci po předchozí operaci v dětství či dospělosti, ve 14 % (113 pacientů) se jednalo o opakovanou reoperaci. Kombinované výkony byly provedeny v 70 % případů. Celková 30denní mortalita činila v celém souboru 1,36 %; hospitalizační mortalita 1,7 %. Průměrné pětileté přežívání po operaci VSV v NNH činilo 97 %. Mezi významné rizikové faktory časného i pozdního úmrtí po operaci VSV patřily symptomy ve třídě NYHA III–IV (p < 0,0001; OR 30,8), anamnéza městnavého srdeční selhání (p = 0,001; OR 6,7), cyanóza (p < 0,0001; OR 60,5), počet předchozích operací (p = 0,00033), přítomnost mechanické chlopenní protézy (p = 0,0032; OR 3,7) a univentrikulární cirkulace (p = 0,0276; OR 5,4). Statistické významnosti pro riziko úmrtí nedosáhly arytmie (p = 0,078), plicní hypertenze (p = 0,072), věk v době operace (p = 0,372) a pohlaví (p = 0,48). Centralizace péče o dospělé s VSV do center s vysokým počtem výkonů a zkušenostmi přináší velmi dobré chirurgické výsledky s nízkou časnou i pozdní mortalitou. Důležitá je včasná indikace operace a odstranění všech reziduálních nálezů kombinovaným výkonem. Přítomnost dětského kardiochirurga je nezbytná u operací komplexních VSV.

During the last 10 years, 844 operations of 805 adults with congenital heart disease (CHD) were performed in Hospital Na Homolce in Prague, Czech Republic. The median age was 37 (interquartile range 25–49, full range 16–81) years. Operations of complex and rare CHD represented 47%. Fourty-four percent of patients (354) underwent previous cardiac surgery in childhood or adulthood. Three and more operations were performed in 14% (113 patients). Combined surgical procedures were performed in 70% of operations. Thirty-day mortality was 1.36%, hospital mortality 1.7% and 5-year survival probability 97%. The risk factors for early and late mortality were NYHA class III and IV symptoms (p < 0.0001; OR 30.8), history of heart failure (p = 0.001; OR 6.7), cyanosis (p < 0.0001; OR 60.5), number of previous operations (p = 0.00033), presence of mechanical prosthetic valves (p = 0.0032; OR 3.7) and univentricular circulation (p = 0.0276; OR 5.4). The difference was not significant for arrhythmias (p = 0.078), pulmonary hypertension (p = 0.072), age at operation (p = 0.372) and gender (p = 0.48). Centralization of adult CHD care in a high volume center carries very good surgical results with low early and late mortality. It is important to perform the operations in time and to eliminate all residual lesions by combined surgical procedure. The presence of pediatric cardiac surgeon is necessary for the operations of complex CHD.

• MeSH
• dospělí MeSH
• hodnocení rizik statistika a číselné údaje   MeSH
• kardiochirurgické výkony * statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mortalita MeSH
• pooperační komplikace MeSH
• reoperace statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• senioři MeSH
• vrozené srdeční vady * epidemiologie   chirurgie   mortalita   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

There is ample experimental evidence describing changes of tonotopic organisation in the auditory cortex due to environmental factors. In order to uncover the underlying mechanisms, we designed a large-scale computational model of the auditory cortex. The model has up to 100 000 Izhikevich's spiking neurons of 17 different types, almost 21 million synapses, which are evolved according to Spike-Timing-Dependent Plasticity (STDP) and have an architecture akin to existing observations. Validation of the model revealed alternating synchronised/desynchronised states and different modes of oscillatory activity. We provide insight into these phenomena via analysing the activity of neuronal subtypes and testing different causal interventions into the simulation. Our model is able to produce experimental predictions on a cell type basis. To study the influence of environmental factors on the tonotopy, different types of auditory stimulations during the evolution of the network were modelled and compared. We found that strong white noise resulted in completely disrupted tonotopy, which is consistent with in vivo experimental observations. Stimulation with pure tones or spontaneous activity led to a similar degree of tonotopy as in the initial state of the network. Interestingly, weak white noise led to a substantial increase in tonotopy. As the STDP was the only mechanism of plasticity in our model, our results suggest that STDP is a sufficient condition for the emergence and disruption of tonotopy under various types of stimuli. The presented large-scale model of the auditory cortex and the core simulator, SUSNOIMAC, have been made publicly available.

• MeSH
• akční potenciály fyziologie   MeSH
• akustická stimulace MeSH
• lidé MeSH
• modely neurologické * MeSH
• nervová síť fyziologie   MeSH
• neurony fyziologie   MeSH
• počítačová simulace * MeSH
• sluchové korové centrum cytologie   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Natriuretic peptides are often elevated in congenital heart disease (CHD); however, the clinical impact on mortality is unclear. The aim of our study was to evaluate the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the prediction of all-cause mortality in adults with different CHD. In this prospective longitudinal mortality study, we evaluated NT-proBNP in 1,242 blood samples from 646 outpatient adults with stable CHD (mean age 35 ± 12 years; 345 women). Patients were followed up for 6 ± 3 (1 to 10) years. The mortality rate was 5% (35 patients, mean age 40 ± 14 years, 17 women). Median NT-proBNP (pg/ml) was 220 in the whole cohort, 203 in survivors, and 1,548 in deceased patients. The best discrimination value for mortality prediction was 630 pg/ml with 74% sensitivity and 84% specificity. During the follow-up, the survival rate was 65% for those with median NT-proBNP ≥630 pg/ml and 94% for NT-proBNP <630 pg/ml; p <0.0001. There was only 1% mortality among 388 patients with at least 1 NT-proBNP value ≤220 pg/ml compared with 41% mortality among 54 patients with at least 1 NT-proBNP value >1,548 pg/ml. Even the first (baseline) measurements of NT-proBNP were strongly associated with a high risk of death (log10 NT-proBNP had hazard ratio 7, p <0.0001). In conclusion, NT-proBNP assessment is a useful and simple tool for the prediction of mortality in long-term follow-up of adults with CHD.

• MeSH
• biologické markery krev   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• Kaplanův-Meierův odhad MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• následné studie MeSH
• natriuretický peptid typu B krev   MeSH
• peptidové fragmenty krev   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• vrozené srdeční vady krev   diagnóza   mortalita   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Two-Photon Processor (TPP) is a versatile, ready-to-use, and freely available software package in MATLAB to process data from in vivo two-photon calcium imaging. TPP includes routines to search for cell bodies in full-frame (Search for Neural Cells Accelerated; SeNeCA) and line-scan acquisition, routines for calcium signal calculations, filtering, spike-mining, and routines to construct parametric fields. Searching for somata in artificial in vivo data, our algorithm achieved better performance than human annotators. SeNeCA copes well with uneven background brightness and in-plane motion artifacts, the major problems in simple segmentation methods. In the fast mode, artificial in vivo images with a resolution of 256 × 256 pixels containing ≈ 100 neurons can be processed at a rate up to 175 frames per second (tested on Intel i7, 8 threads, magnetic hard disk drive). This speed of a segmentation algorithm could bring new possibilities into the field of in vivo optophysiology. With such a short latency (down to 5-6 ms on an ordinary personal computer) and using some contemporary optogenetic tools, it will allow experiments in which a control program can continuously evaluate the occurrence of a particular spatial pattern of activity (a possible correlate of memory or cognition) and subsequently inhibit/stimulate the entire area of the circuit or inhibit/stimulate a different part of the neuronal system. TPP will be freely available on our public web site. Similar all-in-one and freely available software has not yet been published.

• MeSH
• algoritmy * MeSH
• aniliny analýza   MeSH
• fluoresceiny analýza   MeSH
• fluorescenční barviva MeSH
• mikroskopie fluorescenční multifotonová metody   MeSH
• mozková kůra chemie   MeSH
• myši inbrední C57BL MeSH
• myši MeSH
• software * MeSH
• vápník analýza   MeSH
• zvířata MeSH
• Check Tag
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH