Angina pectoris bez obstrukce koronárních tepen je častý nález u pacientů s bolestmi na hrudi, v jehož patofyziologii se uplatňují zejména dva mechanismy – strukturální nebo funkční poškození mikrocirkulace či funkční poškození epikardiálních tepen, případně jejich kombinace. Souhrnný článek se zabývá dia- gnostikou koronární mikrovaskulární dysfunkce se zaměřením na kontinuální termodiluci jako bezpečnou, jednoduchou, rychlou a na operatérovi nezávislou metodu. Popisuje teoretický základ i praktické aspekty s grafickými ukázkami měření.
Angina with non-obstructive coronary artery disease is a frequent finding in patients with chest pain. Its pathophysiology involves two main mechanisms: structural and functional dysfunction of microcircula- tion, functional dysfunction of epicardial arteries, and their combination. The review article focuses on the diagnostics of microvascular dysfunction, particularly continuous thermodilution, as a safe, easy, fast, and operator-independent method. It describes both theoretical background and practical aspects with graphical examples of measurements.
- Klíčová slova
- koronární průtok,
- MeSH
- angina pectoris * diagnóza klasifikace patofyziologie MeSH
- hemodynamické monitorování metody MeSH
- koronární cévy patologie MeSH
- lidé MeSH
- mikrocévy patologie MeSH
- mikrocirkulace MeSH
- perikard fyziologie MeSH
- termodiluce * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Excess fluid in the interstitium can adversely affect the microcirculation. We studied how gradual dilution of the blood plasma by crystalloid fluid influences microcirculatory variables and capillary filtration in 20 patients undergoing surgery. METHODS: Video recordings of the sublingual mucosal were made on four occasions during the surgery and compared with quasi-measurements of the capillary filtration rate using retrospective volume kinetic data collected over 5-10-minute periods during 262 infusion experiments with crystalloid fluid. RESULTS: The number of crossings (vessel density) increased up to plasma dilution of 15-20 % whereafter it decreased. The proportion of the vessels that were perfused (PPV) decreased and reached a nadir of -15 % at a dilution of 20-30 %. Changes in the number of crossings and the PPV correlated (r = 0.62, P < 0.001) but the curve was displaced so that crossings showed no change when PPV had decreased by approximately 10 %. However, the PPV of vessels with a thickness of ≤25 μm increased or remained constant in the dilution range of up to 20 %. The volume kinetic analysis showed that the capillary filtration was greater than expected from proportionality with the volume expansion up to a plasma dilution of 15 %, the greatest difference (+89 %) being for plasma dilution up to 5 %. CONCLUSION: Plasma dilution of up to 15 % increased the vessel density, and the capillary filtration increased by more than suggested by the volume expansion. Dilution >15 % had a negative influence on these variables.
- MeSH
- audiovizuální záznam MeSH
- časové faktory MeSH
- dospělí MeSH
- hemodiluce * MeSH
- isotonické roztoky aplikace a dávkování MeSH
- kapilární permeabilita MeSH
- kapiláry patofyziologie MeSH
- kinetika MeSH
- krystaloidní roztoky * aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrocirkulace * MeSH
- regionální krevní průtok MeSH
- retrospektivní studie MeSH
- rychlost toku krve MeSH
- senioři MeSH
- ústní sliznice krevní zásobení MeSH
- ústní spodina krevní zásobení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
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/HYPOTHESIS: The aim of this substudy (Eudra CT No:2019-001997-27)was to assess ATB availability in patients with infected diabetic foot ulcers(IDFUs)in the context of microcirculation and macrocirculation status. METHODS: For this substudy, we enrolled 23 patients with IDFU. Patients were treated with boluses of amoxicillin/clavulanic acid(AMC)(12patients) or ceftazidime(CTZ)(11patients). After induction of a steady ATB state, microdialysis was performed near the IDFU. Tissue fluid samples from the foot and blood samples from peripheral blood were taken within 6 hours. ATB potential efficacy was assessed by evaluating the maximum serum and tissue ATB concentrations(Cmax and Cmax-tissue)and the percentage of time the unbound drug tissue concentration exceeds the minimum inhibitory concentration (MIC)(≥100% tissue and ≥50%/60% tissue fT>MIC). Vascular status was assessed by triplex ultrasound, ankle-brachial and toe-brachial index tests, occlusive plethysmography comprising two arterial flow phases, and transcutaneous oxygen pressure(TcPO2). RESULTS: Following bolus administration, the Cmax of AMC was 91.8 ± 52.5 μgmL-1 and the Cmax-tissue of AMC was 7.25 ± 4.5 μgmL-1(P<0.001). The Cmax for CTZ was 186.8 ± 44.1 μgmL-1 and the Cmax-tissue of CTZ was 18.6 ± 7.4 μgmL-1(P<0.0001). Additionally, 67% of patients treated with AMC and 55% of those treated with CTZ achieved tissue fT>MIC levels exceeding 50% and 60%, respectively. We observed positive correlations between both Cmax-tissue and AUCtissue and arterial flow. Specifically, the correlation coefficient for the first phase was r=0.42; (P=0.045), and for the second phase, it was r=0.55(P=0.01)and r=0.5(P=0.021). CONCLUSIONS: Bactericidal activity proved satisfactory in only half to two-thirds of patients with IDFUs, an outcome that appears to correlate primarily with arterial flow.
- MeSH
- antibakteriální látky * farmakokinetika aplikace a dávkování terapeutické užití MeSH
- diabetická noha * farmakoterapie metabolismus MeSH
- intravenózní podání MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrocirkulace * účinky léků MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- glykokalyx fyziologie patologie MeSH
- kardiovaskulární fyziologické jevy * MeSH
- kardiovaskulární látky klasifikace terapeutické užití MeSH
- kardiovaskulární nemoci farmakoterapie patofyziologie MeSH
- kardiovaskulární systém patofyziologie účinky léků MeSH
- lidé MeSH
- mikrocirkulace * fyziologie účinky léků MeSH
- Check Tag
- lidé MeSH
BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the cardiovascular system. The current study investigated changes in heart rate (HR), blood pressure (BP), pulse wave velocity (PWV), and microcirculation in patients recovering from Coronavirus disease 2019 (COVID-19) infection. METHODOLOGY: Out of 43 initially contacted COVID-19 patients, 35 (30 males, 5 females; age: 60 ± 10 years; and body mass index (BMI): 31.8 ± 4.9) participated in this study. Participants were seen on two occasions after hospital discharge; the baseline measurements were collected, either on the day of hospital discharge if a negative PCR test was obtained, or on the 10th day after hospitalization if the PCR test was positive. The second measurements were done 60 days after hospitalization. The vascular measurements were performed using the VICORDER® device and a retinal blood vessel image analysis. RESULTS: A significant increase in systolic BP (SBP) (from 142 mmHg, SD: 15, to 150 mmHg, SD: 19, p = 0.041), reduction in HR (from 76 bpm, SD: 15, to 69 bpm, SD: 11, p = 0.001), and narrower central retinal vein equivalent (CRVE) (from 240.94 μm, SD: 16.05, to 198.05 μm, SD: 17.36, p = 0.013) were found. Furthermore, the trends of increasing PWV (from 11 m/s, SD: 3, to 12 m/s, SD: 3, p = 0.095) and decreasing CRAE (from 138.87 μm, SD: 12.19, to 136.77 μm, SD: 13.19, p = 0.068) were recorded. CONCLUSION: The present study investigated cardiovascular changes following COVID-19 infection at two-time points after hospital discharge (baseline measurements and 60 days post-hospitalization). Significant changes were found in systolic blood pressure, heart rate, and microvasculature indicating that vascular adaptations may be ongoing even weeks after hospitalization from COVID-19 infection. Future studies could involve conducting additional interim assessments during the active infection and post-infection periods.
- MeSH
- analýza pulzové vlny MeSH
- COVID-19 * MeSH
- hypertenze * MeSH
- krevní tlak fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrocirkulace MeSH
- pilotní projekty MeSH
- SARS-CoV-2 MeSH
- senioři MeSH
- tuhost cévní stěny * fyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Rheoferéza je jednou z aferetických metod. Jedná se o mimotělní selektivní dvojitě filtrační proceduru. Krev v mimotělním oběhu prochází prvním filtrem, kdy je oddělena plazma od krevních elementů, následně ve druhém filtru jsou zachyceny látky o vysoké molekulové hmotnosti. Takto očištěná krev je vracena zpět do oběhu pacienta. Procedurou jsou odstraňovány lipidy, fibrinogen, α2-makroglobulin, von Willebrandův faktor, imunoglobulin IgM. Cílem metody je zlepšení mikrocirkulace a rheologických vlastností krve. Patří mezi zavedené metody v rámci léčby makulární degenerace, náhlé senzorineurální ztráty sluchu, periferní cévní choroby, kalcifylaxe, systémové sklerozy a diabetické nohy.
Rheopheresis ranks among apheretic methods. It is a selective, extra-corporeal double cascade filtration treatment. First, the plasma is separated from blood elements in extra-corporeal circulation by passing through membrane filter. The plasma is then filtrated through the second filter in order to remove proteins with a high molecular mass, e.g. lipids, fibrinogen, α2-macroglobulin, von Willebrand factor, immunoglobulin IgM. The purified plasma is then returned together with the blood elements back to the patient. The aim of the procedure is to improve the microcirculation and rheological properties of the blood. Rheopheresis is well established method for the treatment of age-related macular degeneration, acute sensorineural hearing loss, calciphylaxis, systemic sclerosis or peripheral vascular disease.
- MeSH
- lidé MeSH
- makulární degenerace terapie MeSH
- mikrocirkulace MeSH
- plazmaferéza metody MeSH
- separace krevních složek * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: The sidestream dark-field imaging method is used to study microcirculation. Normal values of sublingual microcirculation parameters in healthy children of different age and gender categories are unknown. OBJECTIVE: The study's main goal was to determine normal values of selected parameters of sublingual microcirculation in healthy children of different age and gender categories. METHODS: 40 healthy children were measured, ten aged 3-5.9 years, ten aged 6-10.9 years, ten aged 11-14.9 years, and ten aged 15-18.9 years. After recording the basic anthropometric parameters and vital functions, each volunteer had their microcirculation measured using an SDF probe placed sublingually. Three video clips were recorded and processed offline, and the three best and most stable parts of each were analyzed. RESULTS: Total vascular density, small vessel density, proportion of perfused small vessels, perfused vessel density, perfused small vessel density, and DeBacker's score were significantly higher in females than in males. There were no differences between age groups in microcirculation parameters except MFI. CONCLUSIONS: Age does not influence normal values of microcirculatory parameters. Female gender was associated with higher vessel density, perfused vessel density, and DeBacker's score. A suggestion of the normal range of microcirculatory parameters in healthy children is provided.
- MeSH
- dítě MeSH
- dobrovolní pracovníci * MeSH
- lidé MeSH
- mikrocirkulace MeSH
- ústní spodina * krevní zásobení MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Endoteliální glykokalyx (EG) je tenká vrstva na povrchu endotelu s širokým významem pro mikrocirkulaci a metabolismus tkání. Role EG je různorodá – funguje jako ochrana endotelu proti smykovému tření, které mediuje na intracelulární struktury endoteliálních buněk, umožňuje interakci krevních elementů a endotelu, brání rozvoji nekontrolované nástěnné trombózy a nadměrnému oxidačnímu působení radikálů. K dysfunkci EG může dojít částečnou nebo úplnou ztrátou jeho složek, což má za následek zhoršení vaskulární regulace a zvýšení vaskulární permeability. Narušení nebo dysfunkce EG jsou spojeny s patologickými stavy, jako je diabetes, chronická renální insuficience, zánětlivé stavy, sepse, hypernatremie, hypervolemie a ischemicko-reperfuzní poškození. Enzymy jako hyaluronidáza a metaloproteinázy degradují komponenty EG. Poškození EG vede k uvolňování rozpadových produktů do krevního oběhu, které lze detekovat. Existují i přímé metody vizualizace EG. Díky pokrokům ve studiu EG při transplantaci ledviny lze hodnotit komplexní vztah k této oblasti a dané klinické aspekty. Do budoucna může mít zkoumání potenciálních terapeutických možností s cílem ochrany EG dopady na lepší funkci a přežívání ledvinných štěpů. Cílem práce je shrnutí současného stavu problematiky a poukázání na význam EG u transplantace ledvin.
The endothelial glycocalyx (EG) is a thin layer on the surface of the endothelium that plays an important role for microcirculation and tissue metabolism. The role of EG is diverse – it acts as a protection of the endothelium against shear stress which is mediated on the intracellular structures of endothelial cells, allows the interaction of blood elements and endothelium, prevents the formation of uncontrolled thrombosis and excessive oxidative stress by free radicals. EG dysfunction can occur with partial or complete loss of its components, resulting in impaired vascular regulation and increased vascular permeability. Disruption or dysfunction of EG has been associated with disease states such as diabetes, chronic kidney disease, inflammatory conditions, sepsis, hypernatraemia, hypervolaemia and ischaemia/reperfusion injury. Enzymes such as hyaluronidase and metalloproteinases can degrade the components of EG. Damage to EG leads to the release of breakdown products into the bloodstream which can be detected. There are also direct methods of visualization of EG. Thanks to advances in the study of EG in kidney transplantation a comprehensive relationship in this field and specific clinical aspects can be assessed. In the future exploring potential therapeutic options to protect EG may have implications for better graft function and survival. The aim of this paper is to summarize the current knowledge and to point out the importance of EG in kidney transplantation.
- MeSH
- flavonoidy terapeutické užití MeSH
- kvalita života MeSH
- lidé MeSH
- mikrocirkulace účinky léků MeSH
- průzkumy a dotazníky MeSH
- riziko MeSH
- statistika jako téma MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- žilní insuficience * farmakoterapie mortalita patofyziologie psychologie terapie MeSH
- Check Tag
- lidé MeSH
