Mitochondrial disorders comprise a heterogeneous group of diseases with multisystem involvement including myocardium. Most cases of mitochondrial cardiomyopathy are associated with myopathy and encephalopathy and are generally present in infancy or childhood. The disease often exhibits a rapid downward course with death frequently occuring within the first year of life. We describe a unique case of hypertrophic cardiomyopathy due to mitochondrial DNA mutation m.3303C >T in the MT-TL1 gene, diagnosed accidentally in a 35-year-old male. The patient initially presented with stroke of assumed cardioembolic origin due to the presence of two interatrial communications associated with mobile aneurysm of the interatrial septum. No other extracardiac manifestations of mitochondrial disorder were observed.

• MeSH
• biopsie MeSH
• bodová mutace * MeSH
• dospělí MeSH
• echokardiografie MeSH
• elektrokardiografie MeSH
• elektronová mikroskopie MeSH
• hypertrofická kardiomyopatie diagnóza   etiologie   genetika   MeSH
• lidé MeSH
• magnetická rezonance kinematografická MeSH
• mitochondriální DNA genetika   MeSH
• mitochondriální nemoci komplikace   diagnóza   genetika   MeSH
• myokard patologie   MeSH
• srdeční mitochondrie genetika   ultrastruktura   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

This study was designed to determine whether the treatment of patients with unstable angina pectoris or non-Q-wave myocardial infarction with a stent containing a protection net to prevent coronary microembolization affects the severity of biomarker release.The MGuard stent (InspireMD, Tel Aviv, Israel) was designed as a plaque/thrombus-trapping device, using a conventional bare metal stent covered with an ultrathin, flexible mesh net. We hypothesized that this stent would partly eliminate distal embolization and decrease subsequent troponin I (TnI) release.Forty-six acute coronary syndrome patients referred for percutaneous coronary intervention (PCI) were included and randomized in this study. Serum concentrations of TnI were measured prior to, as well as 24 and 48 hours after, the PCI procedure.Technical success was 95% and 100% in the MGuard group and non-MGuard group, respectively. A transient no-reflow phenomenon was observed in one interventional procedure in each group of patients (5% versus 4%; NS). Two patients (one in each group) died during the hospital stay. There was no statistically significant difference in median postprocedural TnI levels in either group.The results suggest that coronary stenting with a stent system containing a protection net to prevent coronary microembolization (eg the MGuard stent) in patients with acute coronary syndromes does not decrease procedural myocardial injury, as measured by TnI release. It seems likely that stenting with the MGuard stent is feasible, however, its safety should be verified in larger studies.

• MeSH
• akutní koronární syndrom krev   patofyziologie   terapie   MeSH
• balónková koronární angioplastika přístrojové vybavení   MeSH
• biokompatibilní potahované materiály MeSH
• biologické markery krev   MeSH
• elektrokardiografie MeSH
• koronární angiografie MeSH
• koronární cirkulace MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrocirkulace MeSH
• následné studie MeSH
• no-reflow fenomén krev   patofyziologie   prevence a kontrola   MeSH
• pilotní projekty MeSH
• protézy - design MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stenty MeSH
• troponin I krev   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

Sternal dehiscence following cardiac surgery has a multifactorial etiology. Significant risk factors contributing to sternal dehiscence include chronic obstructive pulmonary disease (COPD), obesity, or re-exploration due to bleeding or pericardial tamponade. We have focused on the role of allogeneic blood transfusion as a factor leading to the poor healing of surgical wounds. A prospective observational study of 1553 elective and emergency cardiac surgery patients was performed between January 2003 and June 2007. All of the patients enrolled in this study underwent median sternotomy. We studied the relationship between sternal dehiscence following cardiac surgery and the total number of packed red blood cells transfused. The incidence of sternal dehiscence in the study group was 3.4%. Diabetic patients did not have a higher incidence of wound dehiscence. Although COPD, obesity, and re-exploration contributed to sternal dehiscence, the number of allogeneic blood transfusions during the perioperative period was an important independent risk factor for sternal dehiscence. Patients with sternal dehiscence received an average of 7.6 transfusion units (TU) of allogeneic blood versus 1.6 TU of allogeneic blood in the group without sternal dehiscence (P < 0.00005). The dehiscence affected patients without any other significant risk factor who received 6 or more TU, or patients with at least one significant risk factor who received 4 or more TU of allogeneic blood. According to our results, the total amount of allogeneic blood transfused is an important risk factor contributing to sternal dehiscence. Regardless of other risk preconditions, the transfusion of 6 or more TU could result in sternal dehiscence following cardiac surgery.

• MeSH
• chronická obstrukční plicní nemoc epidemiologie   MeSH
• dehiscence operační rány epidemiologie   MeSH
• kardiochirurgické výkony MeSH
• krevní transfuze MeSH
• lidé středního věku MeSH
• lidé MeSH
• obezita epidemiologie   MeSH
• potransfuzní reakce MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sternum chirurgie   patologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

This study tested the feasibility and safety of next day hospital discharge after successful primary PCI for uncomplicated STEMI. Twenty-three p-PCI patients (out of 271 consecutive patients) who fulfilled the study inclusion criteria were enrolled in the pilot nonrandomized phase (transfer of patients from the coronary unit to a standard ward within 24 hours after their admission) of the study. The randomized phase of the study screened a total of 1946 consecutive STEMI patients undergoing p-PCI in the two participating centers. Only 56 (ie, 2.9% from all p-PCI) very low risk patients residing less than 20 km from the PCI center were selected. They were randomized 1:2 to either a standard hospital stay (group A, n = 19, age, 58 +/- 8) or first day discharge (group B, n = 37, age, 56 +/- 10; NS). There were no serious complications among 79 study patients within 30 days. The duration of hospital stay was 105 +/- 45 hours (group A) and 29 +/- 3 hours (P < 0.0001) in group B. Ejection fraction after 30 days was 56.8 +/- 6.5% in group A versus 57.3 +/- 7% in group B (NS). A patient comfort questionnaire showed a clear preference of first day discharge in all patients randomized into group B. The results indicate that next day discharge after successful p-PCI is feasible and safe in selected uncomplicated STEMI patients.

• MeSH
• balónková koronární angioplastika MeSH
• délka pobytu MeSH
• elektrokardiografie MeSH
• infarkt myokardu terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• propuštění pacienta MeSH
• průzkumy a dotazníky MeSH
• spokojenost pacientů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The aim of the present prospective, single centre observational study was to describe the profile and prognosis of patients hospitalised with chronic heart failure and to determine the value of discharge blood pressure and cholesterol for long-term survival. From among 2,346 hospitalised patients, 320 (13.6%) suffered from chronic heart failure and 28 (8.8%) died during hospitalisation. The in-patient mortality rate was similar to that in patients not suffering from chronic heart failure (P = 0, 3). Of 292 patients who were discharged, 162 (55%) died during the subsequent 5 years. The predetermined parameters of pure prognosis were associated with lower diastolic blood pressure (P = 0.008) and lower cholesterol (P = 0.012). A poor prognosis was associated with lower systolic blood pressure plus lower cholesterol and lower diastolic blood pressure and lower cholesterol. Other independent prognostic parameters were older age (P < 0.001), higher heart rate (P = 0.02), higher creatinine (P < 0.001), higher urea (P < 0.001), higher uric acid (P < 0.001), lower hemoglobin (P = 0.02), lower ejection fraction (P = 0.080), and a history of ischemic heart disease (P < 0.01). Patients suffering from chronic heart failure and discharged home have a worse prognosis if their systolic and/or diastolic blood pressures and/or cholesterol levels are too low. The optimal values seem to be levels that are around the recommended targets, that is a systolic BP of 140 mmHg, diastolic BP of 90 mmHg, and a cholesterol level of 5 mmol/L.

• MeSH
• cholesterol MeSH
• chronická nemoc MeSH
• hemoglobiny analýza   MeSH
• ischemická choroba srdeční komplikace   MeSH
• kreatinin krev   MeSH
• krevní tlak MeSH
• kyselina močová MeSH
• lidé MeSH
• močovina krev   MeSH
• prognóza MeSH
• propuštění pacienta MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční frekvence MeSH
• srdeční selhání mortalita   patofyziologie   MeSH
• tepový objem MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

Infective endocarditis (IE) is a relatively rare but serious complication of hypertrophic obstructive cardiomyopathy. Currently, antibiotic prophylaxis is not generally recommended in these patients. We report a case of infective endocarditis in a patient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy with residual left ventricle outflow tract obstruction. To the best of our knowledge, this is the first case in the medical literature demonstrating this complication in the late postprocedural period following alcohol septal ablation.

• MeSH
• endokarditida etiologie   patologie   MeSH
• financování organizované MeSH
• hypertrofická kardiomyopatie chirurgie   ultrasonografie   MeSH
• katetrizační ablace škodlivé účinky   MeSH
• lidé MeSH
• senioři MeSH
• srdeční septum MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Although in many cardiac surgery centers pharmacological strategies based on fibrinolytic inhibitors are used on a routine basis, detailed knowledge of fibrinolysis during various settings of coronary surgery is still limited. Sixty-five patients scheduled for coronary surgery were randomized into 3 groups: group A--conventional coronary artery bypass grafting, group B--off-pump surgery, and group C--coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of reinfusion of cardiotomy blood into the circuit. The sampling time points for rotation thromboelastographic evaluations were as follows: preoperatively, 15 minutes after sternotomy, on the completion of peripheral bypass anastomoses, at the end of the procedures, and 24 hours after the end of surgery. D-dimer levels were evaluated before surgery, at the end of procedures, and 24 hours after surgery. Thromboelastographic signs of fibrinolysis (evaluated by Lysis Onset Time-intergroup differences at 60 and 150 minutes of assessment: P = 0.003 and P < 0.001, respectively) were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C. At the other sampling times all thromboelastographic parameters were similar in all groups. In group A, no exceptional bleeding tendency (during 24 hours), as compared to groups B and C (geometric means and 95% confidence intervals: group A: 686.7 [570.8; 826.1] mL, group B: 555.3 [441.3; 698.9] mL, group C: 775.6 [645.1; 932.3] mL, P = 0.157), and no significant correlations between Lysis Onset Time, postoperative blood loss, and D-dimer levels were found. No significant differences in postoperative blood loss related to cardiac surgeons and assistant surgeons were detected. Thromboelastographic signs of increased fibrinolysis were detectable in the important proportion of coronary surgery patients operated on with the use of conventional cardio-pulmonary bypass, but not in off-pump patients and those operated on with the biocompatible surface-modified circuit without reinfusion of cardiotomy suction blood. These signs resolved spontaneously at the end of surgery and were not associated with increased postoperative bleeding. No significant correlation with D-dimer levels was found.

• MeSH
• fibrin-fibrinogen - produkty degradace analýza   MeSH
• fibrinolýza fyziologie   MeSH
• financování organizované MeSH
• koronární bypass bez mimotělního oběhu MeSH
• koronární bypass metody   MeSH
• lidé MeSH
• pooperační krvácení MeSH
• prospektivní studie MeSH
• senioři MeSH
• tromboelastografie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH

Health care associated with cardiac arrest exhibits a significant economic burden, rather than effectiveness. Hypothesis: The time of the out-of-hospital cardiac arrest (OHCA) onset during a diurnal period alters the survival chance. Professionally resuscitated patients for witnessed OHCA (n = 495) from the study were prospectively followed for 12 months. The distribution of the onset of cardiac arrest during the 24-hour period was tested in the survivors (the total group, the other groups). In the ultrashort-term survivors (n = 136, follow-up = admission to hospital) the highest incidence was seen between 18:01-22:00 h. The same trend was seen in both the short-term (n = 48, follow-up = discharge from hospital) and the long-term survivors (n = 39, follow-up = 1 year). Furthermore, when the ultrashort-, short-, and long-term survivors were analysed according to indicators of prehospital care (early electrical defibrillation < or =5 min, bystander cardiopulmonary resuscitation, ambulance response time < or =10 min; locations of arrest; initial cardiac rhythms) an OHCA peak was observed for early defibrillation and ambulance response time (ultrashort-term survivors, 18:01-22:00 h) and/or in the case of OHCA that occurred in a public place (short-term survivors, 18:01-22:00 h). The lowest incidence of cardiac arrest was between 22:01-06:00 h in all groups. The evening incidence of OHCA reflects a higher chance of survival in our study area (East Bohemian region).

• MeSH
• časové faktory MeSH
• cirkadiánní rytmus MeSH
• dospělí MeSH
• financování organizované MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• náhlá srdeční smrt epidemiologie   MeSH
• následné studie MeSH
• přežívající MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční zástava epidemiologie   MeSH
• urgentní zdravotnické služby MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

The aim of this preliminary, prospective, randomized study was to compare rotation thromboelastography (roTEG) results and D-dimer levels in off-pump versus on-pump coronary surgery in order to identify the activation of fibrinolysis. Twenty patients scheduled for coronary bypass grafting were assessed (off-pump group A, n = 10; on-pump group B, n = 10). Blood samples for roTEG examination were taken preoperatively (t0), 15 minutes after sternotomy (t1), on the completion of peripheral bypass anastomoses (t2), and at the end of procedures (t3). The time points for D-dimer levels analyses were before operation, at the end of procedures, and 24 hours later. A certain degree of roTEG signs of fibrinolysis was noticed at time t2 in both groups and in group B these marks were quite widely, but not significantly expressed (P for intergroup differences for Lysis on Set Time at 60 and 150 minutes were P = 0.190 and P = 0.122, respectively), borderline differences were found for Maximum Clot Firmness (P = 0.082) with a lower mean value for group B (arithmetic means [95% confidence intervals]--57.7 [54.2; 61.2] mm). Completely expressed roTEG signs of hyperfibrinolysis were observed in 2 patients from group B. In group B also the highest geometric means of D-dimers (1326.0 [943.5; 1863.6] ng mL(-1)) and thus a dramatic intergroup difference (P < 0.001) were observed at the end of surgery; 24 hours later the significantly elevated D-dimer levels in both groups (A: 1070.0 [723.5; 1582.6] versus B: 1093.3 [732.0; 1632.9] ng mL(-1)) were equalized (P = 0.932). Our roTEG results display a slightly greater, but fairly subtle activation of fibrinolysis during the course of cardiopulmonary bypass, compared to off-pump cardiac surgery.

• MeSH
• fibrin-fibrinogen - produkty degradace metabolismus   MeSH
• fibrinolýza fyziologie   MeSH
• financování organizované MeSH
• infarkt myokardu chirurgie   krev   MeSH
• kardiopulmonální bypass metody   MeSH
• koronární bypass bez mimotělního oběhu metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• peroperační monitorování MeSH
• prospektivní studie MeSH
• senioři MeSH
• tromboelastografie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH

The aim of this study was to investigate whether electrical stimulation of skeletal muscles could represent a rehabilitation alternative for patients with chronic heart failure (CHF). Thirty patients with CHF and NYHA class II-III were randomly assigned to a rehabilitation program using either electrical stimulation of skeletal muscles or bicycle training. Patients in the first group (n = 15) had 8 weeks of home-based low-frequency electrical stimulation (LFES) applied simultaneously to the quadriceps and calf muscles of both legs (1 h/day for 7 days/week); patients in the second group (n = 15) underwent 8 weeks of 40 minute aerobic exercise (3 times a week). After the 8-week period significant increases in several functional parameters were observed in both groups: maximal VO2 uptake (LFES group: from 17.5 +/- 4.4 mL/kg/min to 18.3 +/- 4.2 mL/kg/min, P < 0.05; bicycle group: from 18.1 +/- 3.9 mL/kg/min to 19.3 +/- 4.1 mL/kg/min, P < 0.01), maximal workload (LFES group: from 84.3 +/- 15.2 W to 95.9 +/- 9.8 W, P < 0.05; bicycle group: from 91.2 +/- 13.4 W to 112.9 +/- 10.8 W, P < 0.01), distance walked in 6 minutes (LFES group: from 398 +/- 105 m to 435 +/- 112 m, P < 0.05; bicycle group: from 425 +/- 118 m to 483 +/- 120 m, P < 0.03), and exercise duration (LFES group: from 488 +/- 45 seconds to 568 +/- 120 seconds, P < 0.05; bicycle group: from 510 +/- 90 seconds to 611 +/- 112 seconds, P < 0.03). These results demonstrate that an improvement of exercise capacities can be achieved either by classical exercise training or by home-based electrical stimulation. LFES should be considered as a valuable alternative to classical exercise training in patients with CHF.

• MeSH
• chronická nemoc MeSH
• cyklistika fyziologie   MeSH
• elektrostimulační terapie metody   MeSH
• financování organizované MeSH
• kosterní svaly fyziologie   MeSH
• krevní tlak MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• spotřeba kyslíku MeSH
• srdeční frekvence fyziologie   MeSH
• srdeční selhání patofyziologie   rehabilitace   MeSH
• tepový objem fyziologie   MeSH
• terapie cvičením metody   MeSH
• tolerance zátěže fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH