UNLABELLED: Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD: A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS: There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION: Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.

• MeSH
• arterioly MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• mikrocirkulace MeSH
• retinální cévy diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

AIMS: While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients' stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended Global Registry of Acute Coronary Events (GRACE) score. METHODS AND RESULTS: A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. Data from 1135 patients (aged 64 ± 12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire and clinical variables were used as possible predictors. The best model included the following variables: age, HF history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months [the area under the receiver operating curve (AUC) 90.1, 95% confidence interval (CI) 81.8-98.4 vs. 77.4, 95% CI 62.2-92.5, P = 0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5-96.0 vs. 76.2, 95% CI 64.7-87.7, P = 0.004). CONCLUSION: The PragueMi score combining HF symptoms and clinical variables performs better than the currently recommended GRACE score.

• MeSH
• časové faktory MeSH
• hodnocení rizik MeSH
• infarkt myokardu * mortalita   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metody pro podporu rozhodování MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• reprodukovatelnost výsledků MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční selhání * mortalita   diagnóza   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• validační studie MeSH

Cílem předkládaného přehledového článku je poukázat na zásadní vliv zánětu při vzniku a komplikacích arteriální hypertenze i kardiovaskulárních onemocnění. Použití specifické protizánětlivé terapie, jako je kanakinumab nebo kolchicin, sice snižuje kardiovaskulární riziko, ale zvyšuje riziko infekčních komplikací. Ovlivnění tradičních rizikových faktorů, jako je arteriální hypertenze, dyslipidemie, obezita a kouření, nabízí bezpečnou cestu snížení kardiovaskulárního rizika a systémo - vého zánětu. V oblasti antihypertenzní terapie ACEi vynikají ve schopnosti redukovat systémový zánět. Protože arteriální hypertenze i systémový zánět vedou k cévnímu a orgánovému poškození, je důležité neodkládat nasazení antihypertenzní terapie a včas dosáhnout kontroly krevního tlaku.

The aim of this review article is to highlight the crucial impact of inflammation on the development and complications of arterial hypertension and cardiovascular diseases. The use of specific anti-inflammatory therapies, such as canakinumab or colchicine, indeed reduces cardiovascular risk but also increases the risk of infectious complications. Addressing traditional risk factors, such as arterial hypertension, dyslipidemia, obesity, and smoking, offers a safe pathway to reduce cardiovascular risk and systemic inflammation. In the realm of antihypertensive therapy, ACE inhibitors excel in their ability to reduce systemic inflammation. Since both arterial hypertension and systemic inflammation lead to vascular and organ damage, it is important to initiate antihypertensive therapy without delay and achieve early blood pressure control.

• MeSH
• antiflogistika terapeutické užití   MeSH
• ateroskleróza komplikace   patofyziologie   MeSH
• hypertenze farmakoterapie   imunologie   komplikace   patofyziologie   MeSH
• inhibitory ACE terapeutické užití   MeSH
• kardiovaskulární nemoci * etiologie   farmakoterapie   komplikace   prevence a kontrola   MeSH
• lidé MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• zánět * komplikace   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Despite significant advances in treatment and secondary prevention of myocardial infarction (MI), the cardiovascular risk of post-MI patients remains high. Increased risk is largely due to insufficient control of risk factors and lack of lifestyle change. The aim of cardiorehabilitation is to influence these risk factors. However, there are currently no cost-effective and widely available tools of cardiorehabilitation. Using wearable electronics can increase long-term effectiveness and availability of the intervention. But, these methods are currently not recommended due to paucity of clinical data. Therefore, the first goal of the project will be to verify how the use of smart watches can improve functional capacity and control of risk factors. Another issue in patients after IM is heart failure, which is often diagnosed at advanced stage. This aggravates patient prognosis and increases financial costs. Therefore, another goal of the project will be to verify the ability of a new ambulatory questionnaire (Prague Heart Failure Probability Questionnaire), that was developed by our group, to predict the risk of heart failure.

I přes významné pokroky v léčbě a sekundární prevenci infarktu myokardu (IM) zůstává kardiovaskulární riziko pacientů po IM vysoké. Za zvýšené riziko je z velké části odpovědná nedostatečná kontrola rizikových faktorů a absence změny životního stylu. Cílem kardiorehabilitace po IM je ovlivnit uvedené rizikové faktory. V současné době chybí nákladově-efektivní a dostupné nástroje kardiorehabilitace. Použití nositelné elektroniky může zvýšit dlouhodobou efektivitu a dostupnost intervence. Pro nedostatek dat o účinnosti ale nejsou telemedicínské programy běžně používány. Prvním cílem projektu proto bude ověřit, jak může použití chytrých hodinek zlepšit funkční kapacitu a kontrolu rizikových faktorů. Dalším problémem pacientů po IM je srdeční selhání, které je často diagnostikováno pozdě. To zhoršuje prognózu pacientů a zvyšuje finanční nároky na léčbu. Proto dalším cílem projektu bude ověřit schopnost námi vytvořeného ambulantního dotazníku (Prague Heart Failure Probability Questionnaire) predikovat riziko vzniku srdečního selhání po IM.

• Klíčová slova
• infarkt myokardu, myocardial infarction, Heart failure, srdeční selhání, telemedicína, Telemedicine, fyzická aktivita, physical activity, patient reported outcomes, kardiorehabilitace, chytré hodinky, pacientem sdělované výsledky, cardiorehabilitation, smart watch,

• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR

BACKGROUND: Data on the clinical significance of iron deficiency (ID) in patients with myocardial infarction (MI) are conflicting. This may be related to the use of various ID criteria. We aimed to compare the association of different ID criteria with all-cause mortality after MI. METHODS: Consecutive patients hospitalized for their first MI at a large tertiary heart center were included. We evaluated the association of different iron metabolism parameters measured on the first day after hospital admission with all-cause mortality. RESULTS: From the 1,156 patients included (aged 64±12 years, 25 % women), 194 (16.8 %) patients died during the median follow-up of 3.4 years. After multivariate adjustment, iron level ≤13 μmol/L (HR 1.67, 95 % CI 1.19-2.34) and the combination of iron level ≤12.8 μmol/L and soluble transferrin receptor (sTfR) ≥3 mg/L (HR 2.56, 95 % CI 1.64-3.99) termed as PragueID criteria were associated with increased mortality risk and had additional predictive value to the GRACE score. Compared to the model including iron level, the addition of sTfR improved risk stratification (net reclassification improvement 0.61, 95 % CI 0.52-0.69) by reclassifying patients into a higher-risk group. No association between ferritin level and mortality was found. 51 % of patients had low iron levels, and 58 % fulfilled the PragueID criteria. CONCLUSION: Iron deficiency is common among patients with the first MI. The PragueID criteria based on iron and soluble transferrin receptor levels provide the best prediction of mortality and should be evaluated in future interventional studies for the identification of patients potentially benefiting from intravenous iron therapy.

• MeSH
• anemie z nedostatku železa * mortalita   MeSH
• deficit železa MeSH
• ferritin krev   MeSH
• hospitalizace MeSH
• infarkt myokardu * mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multivariační analýza MeSH
• příčina smrti MeSH
• proporcionální rizikové modely MeSH
• receptory transferinu krev   MeSH
• rizikové faktory MeSH
• senioři MeSH
• železo * krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The cardio-ankle vascular index (CAVI) measure of arterial stiffness is associated with prevalent cardiovascular risk factors, while its predictive value for cardiovascular events remains to be established. The aim was to determine associations of CAVI with cardiovascular morbimortality (primary outcome) and all-cause mortality (secondary outcome), and to establish the determinants of CAVI progression. METHODS: TRIPLE-A-Stiffness, an international multicentre prospective longitudinal study, enrolled >2000 subjects ≥40 years old at 32 centres from 18 European countries. Of these, 1250 subjects (55% women) were followed for a median of 3.82 (2.81-4.69) years. FINDINGS: Unadjusted cumulative incidence rates of outcomes according to CAVI stratification were higher in highest stratum (CAVI > 9). Cox regression with adjustment for age, sex, and cardiovascular risk factors revealed that CAVI was associated with increased cardiovascular morbimortality (HR 1.25 per 1 increase; 95% confidence interval, CI: 1.03-1.51) and all-cause mortality (HR 1.37 per 1 increase; 95% CI: 1.10-1.70) risk in subjects ≥60 years. In ROC analyses, CAVI optimal threshold was 9.25 (c-index 0.598; 0.542-0.654) and 8.30 (c-index 0.565; 0.512-0.618) in subjects ≥ or <60 years, respectively, to predict increased CV morbimortality. Finally, age, mean arterial blood pressure, anti-diabetic and lipid-lowering treatment were independent predictors of yearly CAVI progression adjusted for baseline CAVI. INTERPRETATION: The present study identified additional value for CAVI to predict outcomes after adjustment for CV risk factors, in particular for subjects ≥60 years. CAVI progression may represent a modifiable risk factor by treatments. FUNDING: International Society of Vascular Health (ISVH) and Fukuda Denshi, Japan.

• MeSH
• cévní index srdce-kotník * MeSH
• dospělí MeSH
• kardiovaskulární nemoci * mortalita   diagnóza   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• longitudinální studie MeSH
• prognóza MeSH
• progrese nemoci MeSH
• prospektivní studie MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• rizikové faktory MeSH
• ROC křivka MeSH
• senioři MeSH
• tuhost cévní stěny * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

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

BACKGROUND: Heart failure is a common complication after myocardial infarction (MI) and is associated with increased mortality. Whether remote heart failure symptoms assessment after MI can improve risk stratification is unknown. The authors evaluated the association of the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ) with all-cause mortality after MI. METHODS AND RESULTS: Prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart center between June 2017 and September 2022 were used. Patients remotely completed the KCCQ 1 month after discharge. A total of 1135 (aged 64±12 years, 26.7% women) of 1721 eligible patients completed the KCCQ. Ranges of KCCQ scores revealed that 30 (2.6%), 114 (10.0%), 274 (24.1%), and 717 (63.2%) had scores <25, 25 to 49, 50 to 74, and ≥75, respectively. During a mean follow-up of 46 months (interquartile range, 29-61), 146 (12.9%) died. In a fully adjusted analysis, KCCQ scores <50 were independently associated with mortality (hazard ratio [HR], 6.05 for KCCQ <25, HR, 2.66 for KCCQ 25-49 versus KCCQ ≥50; both P<0.001). Adding the 30-day KCCQ to clinical risk factors improved risk stratification: change in area under the curve of 2.6 (95% CI, 0.3-5.0), Brier score of -0.6 (95% CI, -1.0 to -0.2), and net reclassification improvement of 0.71 (95% CI, 0.45-1.04). KCCQ items most strongly associated with mortality were walking impairment, leg swelling, and change in symptoms. CONCLUSIONS: Remote evaluation of heart failure symptoms using the KCCQ among patients recently discharged for MI identifies patients at risk for mortality. Whether closer follow-up and targeted therapy can reduce mortality in high-risk patients warrants further study.

• MeSH
• hospitalizace MeSH
• infarkt myokardu * komplikace   diagnóza   MeSH
• kvalita života MeSH
• lidé MeSH
• proporcionální rizikové modely MeSH
• propuštění pacienta MeSH
• srdeční selhání * terapie   MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakt z konference MeSH

BACKGROUND: Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. METHODS: A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. RESULTS: RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. CONCLUSION: RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.

• Publikační typ
• časopisecké články MeSH