Reverzibilní defekt na perfuzní scintigrafii myokardu znamená zvýšené riziko srdeční příhody, i když koronární angiografie neodhalí závažnou stenózu koronární tepny. Některé studie prokázaly, že antiischemická léčba může redukovat nebo dokonce normalizovat perfuzní poruchu detekovanou při scintigrafii. Mezi léky, které lze v této indikaci použít, patří také inhibitory enzymu konvertujícího angiotenzin, ACE inhibitory. Stabilizují aterosklerotický plak tím, že inhibují proliferaci hladké svaloviny, mají antioxidativní účinek a inhibují také makrofágy. Kromě toho působí antitromboticky tím, že inhibují agregaci krevních destiček a usnadňují fibrinolýzu.

A reversible defect on MPI study is closely associated with increased risk of cardiac events even if coronary angiography does not demonstrate a significant coronary artery stenosis. Recent studies have shown that anti-ischemic drugs can reduce or even normalize perfusion defects detected on MPI. ACE inhibitors have many properties that may be effective in the treatment of ischemic syndromes. They stabilize atherosclerotic plaques by inhibition of smooth muscle proliferation, by anti-oxidative properties and by inhibition of macrophages. They also prevent thrombotic complications by inhibition of platelet aggregation and facilitation of fibrinolysis.

• MeSH
• Angiotensin-Converting Enzyme Inhibitors administration & dosage   pharmacology   blood   MeSH
• Myocardial Ischemia * diagnostic imaging   drug therapy   blood   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Perindopril * administration & dosage   pharmacology   blood   MeSH
• Myocardial Perfusion Imaging MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

OBJECTIVE: Myocardial perfusion imaging (MPI) can be challenging in some cases of multi vessel involvement. Our aim was to examine specific group of patients with diabetes mellitus (DM), who did not have significant reversible ischaemia diagnosed on perfusion study itself, and asses additional value of functional parameters obtained from gated acquisition and added information from coronary artery calcium score (CACS). SUBJECTS AND METHODS: One hundred and seventy eight patients with a history of DM, with summed difference score (SDS)≤1, were included in the study. All patients underwent gated acquisition with recording of functional parameters and CACS evaluation. During the follow-up, cardiac events (CE) were recorded. RESULTS: During the median follow-up of 20.3 months there were 23 CE encountered. Optimal cut-off value for CACS to predict CE was found at 1427, higher values were significantly related to CE (P<0.001). Low stress left ventricular ejection fraction (LVEF) <45% and induced stress LVEF drop for 5% were also more frequent in CE group (P=0.001, P=0.008). Multivariable Cox analysis revealed low stress LVEF (P=0.001, HR=4.48, 95%CI 1.79-11.22), stress induced LVEF drop (P=0.017, HR 3.13, 95%CI 1.22-8.01) and high CACS (P<0.001, HR 10.52, 95%CI 4.32-25.63) as significant predictors of CE. CONCLUSION: Low stress LVEF under 45%, post-stress LVEF drop for more than 5% and CACS more than or equal to 1427 are significant predictors of CE in patients with DM, who did not have reversible ischemia detected on MPI single photon emission computed tomography (SPECT).

• MeSH
• Diabetes Mellitus * diagnostic imaging   MeSH
• Ventricular Function, Left MeSH
• Tomography, Emission-Computed, Single-Photon methods   MeSH
• Coronary Vessels MeSH
• Humans MeSH
• Coronary Artery Disease * diagnostic imaging   MeSH
• Heart Ventricles MeSH
• Stroke Volume MeSH
• Calcium MeSH
• Myocardial Perfusion Imaging * methods   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Bolesti na hrudi jsou jedním z vedoucích důvodů návštěv urgentního příjmu a hlavním symptomem akutního infarktu myokardu (AIM). Základem diagnostiky AIM je stanovení hodnoty biochemických markerů srdeční ischemie v krvi. Aktuálním zlatým standardem je srdeční troponin. Rozšíření vysoce senzitivních metod umožňujících detekci velmi nízkých hodnot srdečního troponinu představuje výzvu pro správnou interpretaci výsledků. Doporučené postupy Evropské kardiologické společnosti upřednostňují použití validovaných algoritmů rule out/rule in k rychlému a bezpečnému vyloučení AIM a/nebo k časné identifikaci a zahájení léčby pacientů s vysokým rizikem finální diagnózy AIM. Článek předkládá srozumitelné informace o využití vysoce senzitivní metodiky stanovení srdečních troponinů v klinické praxi. Přináší algoritmy preferované Evropskou kardiologickou společností a užitečné informace k interpretaci výsledků v některých specifických skupinách pacientů.

Chest pain is one of the leading reasons for emergency department visits and the chief symptom of acute myocardial infarction (AMI). The measurement of myocardial injury biochemical markers' blood level is essential for the diagnosis of AMI. Cardiac troponin is the current international gold standard marker. The contemporary expansion in the usage of high-sensitivity assays that can detect cardiac troponin at very low levels presents a challenge for accurate interpretation of results. European Society of Cardiology guidelines prioritize the employment of validated rule out/rule in algorithms to rule out AMI safely and rapidly and/or to early identification of patients with high risk for AMI and initiation of their therapy. This article presents comprehensible information about use of high-sensitivity cardiac troponins in clinical practice. It also provides algorithms preferred by European Society of Cardiology and useful information to interpret results in specific groups of patients.

• MeSH
• Acute Coronary Syndrome diagnosis   MeSH
• Biomarkers blood   MeSH
• Myocardial Infarction * diagnosis   MeSH
• Humans MeSH
• Practice Guidelines as Topic MeSH
• Troponin * analysis   blood   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Aging attenuates cardiac tolerance to ischemia/reperfusion (I/R) associated with defects in protective cell signaling, however, the onset of this phenotype has not been completely investigated. This study aimed to compare changes in response to I/R and the effects of remote ischemic preconditioning (RIPC) in the hearts of younger adult (3 months) and mature adult (6 months) male Wistar rats, with changes in selected proteins of protective signaling. Langendorff-perfused hearts were exposed to 30 min I/120 min R without or with prior three cycles of RIPC (pressure cuff inflation/deflation on the hind limb). Infarct size (IS), incidence of ventricular arrhythmias and recovery of contractile function (LVDP) served as the end points. In both age groups, left ventricular tissue samples were collected prior to ischemia (baseline) and after I/R, in non-RIPC controls and in RIPC groups to detect selected pro-survival proteins (Western blot). Maturation did not affect post-ischemic recovery of heart function (Left Ventricular Developed Pressure, LVDP), however, it increased IS and arrhythmogenesis accompanied by decreased levels and activity of several pro-survival proteins and by higher levels of pro-apoptotic proteins in the hearts of elder animals. RIPC reduced the occurrence of reperfusion-induced ventricular arrhythmias, IS and contractile dysfunction in younger animals, and this was preserved in the mature adults. RIPC did not increase phosphorylated protein kinase B (p-Akt)/total Akt ratio, endothelial nitric oxide synthase (eNOS) and protein kinase Cε (PKCε) prior to ischemia but only after I/R, while phosphorylated glycogen synthase kinase-3β (GSK3β) was increased (inactivated) before and after ischemia in both age groups coupled with decreased levels of pro-apoptotic markers. We assume that resistance of rat heart to I/R injury starts to already decline during maturation, and that RIPC may represent a clinically relevant cardioprotective intervention in the elder population.

• MeSH
• Phosphorylation MeSH
• Hemodynamics MeSH
• Ischemic Preconditioning, Myocardial * MeSH
• Glycogen Synthase Kinase 3 beta genetics   metabolism   MeSH
• Rats MeSH
• Myocardium metabolism   MeSH
• Rats, Wistar MeSH
• Protein Kinase C-epsilon genetics   metabolism   MeSH
• Proto-Oncogene Proteins c-akt genetics   metabolism   MeSH
• Myocardial Reperfusion Injury metabolism   pathology   MeSH
• Aging MeSH
• Nitric Oxide Synthase Type III genetics   metabolism   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND: Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS: Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS: Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60.0% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS: The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.

• MeSH
• Anti-Arrhythmia Agents therapeutic use   MeSH
• Atrial Fibrillation * drug therapy   surgery   MeSH
• Catheter Ablation * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Tachycardia, Supraventricular * surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Aims: Although voltage-sensitive dye di-4-ANEPPS is a common tool for mapping cardiac electrical activity, reported effects on electrophysiological parameters are rather. The main goals of the study were to reveal effects of the dye on rabbit isolated heart and to verify, whether rabbit isolated heart stained with di-4-ANEPPS is a suitable tool for myocardial ischemia investigation. Methods and Results: Study involved experiments on stained (n = 9) and non-stained (n = 11) Langendorff perfused rabbit isolated hearts. Electrophysiological effects of the dye were evaluated by analysis of various electrogram (EG) parameters using common paired and unpaired statistical tests. It was shown that staining the hearts with di-4-ANEPPS leads to only short-term sporadic prolongation of impulse conduction through atria and atrioventricular node. On the other hand, significant irreversible slowing of heart rate and ventricular conduction were found in stained hearts as compared to controls. In patch clamp experiments, significant inhibition of sodium current density was observed in differentiated NG108-15 cells stained by the dye. Although no significant differences in mean number of ventricular premature beats were found between the stained and the non-stained hearts in ischemia as well as in reperfusion, all abovementioned results indicate increased arrhythmogenicity. In isolated hearts during ischemia, prominent ischemic patterns appeared in the stained hearts with 3-4 min delay as compared to the non-stained ones. Moreover, the ischemic changes did not achieve the same magnitude as in controls even after 10 min of ischemia. It resulted in poor performance of ischemia detection by proposed EG parameters, as was quantified by receiver operating characteristics analysis. Conclusion: Our results demonstrate significant direct irreversible effect of di-4-ANEPPS on spontaneous heart rate and ventricular impulse conduction in rabbit isolated heart model. Particularly, this should be considered when di-4-ANEPPS is used in ischemia studies in rabbit. Delayed attenuated response of such hearts to ischemia might lead to misinterpretation of obtained results.

• Publication type
• Journal Article MeSH

AIMS: Patients on chronic haemodialysis have a wide range of changes in cardiac function and structure, including left ventricular hypertrophy, dilation and diastolic dysfunction or pulmonary hypertension. All these changes were linked to increased mortality in previous studies. High-flow arteriovenous fistulas (AVF) are supposed to be a factor contributing to their development. This study investigated the early effect of surgical AVF blood flow (Qa) reduction on these changes in patients with or without heart failure changes. METHODS AND RESULTS: Forty-two patients in chronic haemodialysis programme with high-flow AVF (Qa over 1500 mL/min), indicated for surgery for ≥1 of the following indications: 1.manifest heart failure; 2.hand ischemia; 3.advanced structural heart changes detected by echocardiography. The patients underwent echocardiography on selection visit, before blood flow reducing surgery and six weeks thereafter. The Qa reduction led to decrease of left ventricular mass (p = 0.02), end-diastolic volume (p = 0.008), end-diastolic diameter (p = 0.003) and left atrial volume (p = 0.0006). Diastolic function improved. Similarly, right ventricular diameter and right atrial volume decreased (p = 0.000001 and 0.00009, respectively) together with the decrease of estimated pulmonary artery systolic pressure. 81% of patients suffered from pulmonary hypertension prior to surgery, only 36% thereafter. CONCLUSION: The surgical restriction of the hyperkinetic circulation leads to several improvements of heart structure and function, which was linked to higher mortality in other studies. The beneficial effect of Qa reduction is present even in patients without symptoms of heart failure. The contribution of AVF must be considered with structural or functional heart changes.

• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis adverse effects   MeSH
• Echocardiography MeSH
• Hemodynamics MeSH
• Humans MeSH
• Heart Failure * diagnostic imaging   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Akutní koronární syndrom (AKS) vyjádřený jako infarkt myokardu s elevacemi úseku ST na EKG je ve většině případů způsoben trombotickou okluzí koronární tepny. Ve výjimečných případech se na ischemii myokardu podílí i extrakardiální onemocnění. Prezentujeme případ pacienta přijatého na naši kliniku s typickými bolestmi na hrudi a elevacemi úseku ST na EKG. Urgentní selektivní koronarografie prokázala alteraci toku periferie koronární tepny útlakem zvenčí. Následně byla echokardiograficky detekována tumorózní masa v perikardu jako příčina útlaku koronární arterie a následné ischemie myokardu. Příčinou byl karcinom dolního laloku levé plíce. Konečná diagnóza byla stanovena jako infarkt myokardu II. typu

Acute coronary syndrome such as myocardial infarction with ST elevations on the EcG, is mostly caused by thrombotic coronary artery occlusion. In rare cases, extracardiac disease can be a cause of myocardial ischemia. We present a case of a patient admitted to our department with typical chest pain and ST elevation on the EcG. urgent selective coronary angiography proved an alteration in the flow of the periphery of the coronary artery by compression from outside. by echocardiography we detected tumorous mass in the pericardium as the cause of myocardial ischemia. Primary origin was cancer of the lower lobe of the left lung. Final diagnosis was myocardial infarction type 2.

Coronary artery disease (CAD) together with stroke are the leading causes of death worldwide, and together, they pre-sent a health and economic burden. Ischemic stroke survivors and patients who suffered transient ischemic attack (TIA) have a higher prevalence of coronary atherosclerosis, and they have a relatively high risk of myocardial infarcti-on and nonstroke vascular death. Pubmed was searched for studies focused on investigating coronary atherosclerosis in ischemic stroke survivors or patients who suffered TIA and their cardiovascular risk assessment. There were corona-ry plaques in 48%-70% of stroke survivors without a known history of CAD, and significant stenosis of at least one coronary artery can be found in 31% of these patients. CAD is a major cause of morbidity and mortality in stroke survivors. Detection and treatment of silent CAD may improve the long-term outcome and survival of these patients.

• MeSH
• Stroke * MeSH
• Ischemic Stroke * MeSH
• Brain Ischemia * MeSH
• Humans MeSH
• Risk Factors MeSH
• Ischemic Attack, Transient * complications   epidemiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Úvod: Srdeční selhání se zachovanou ejekční frakcí (HFpEF) představuje přibližně polovinu všech případů srdečního selhání a jeho frekvence stále narůstá. Patofyziologické změny jsou velmi komplexní. Patří sem maladaptace, remodeling a hypertrofie, apoptóza, smrt a regenerace svalových buněk myokardu. Porucha funkce myokardu může mít různé příčiny, obvykle se jedná o kombinaci více příčin. Významná je zejména ischemie, porucha metabolizmu, porucha sympatiku a některé další, kvantitativně méně významné příčiny (zánět, restriktivní kardiomyopatie).Metoda: Protože metody nukleární medicíny jsou založené na patofyziologických změnách, mohou se v diagnostice srdečního selhání tohoto typu dobře uplatnit. Z rutinně používaných metod se jedná o radionuklidovou ventrikulografii (RNV), scintigrafii perfuze myokardu (MPI), zobrazení poruch metabolizmu glukózy (FDG), detekce autonomní neuropatie a podíl na diagnostice srdeční sarkoidózy a amyloidózy. Výsledky: RNV slouží zejména k hodnocení funkce levé komory srdeční při zátěži, MPI k detekci ischemie i při nezužující ateroskleróze věnčitých tepen, FDG se používá hlavně pro detekci viability myokardu u pacientů po infarktu myokardu. Autonomní neuropatii detekujeme jako sympatickou dysfunkci. Poměrně významnou roli hrají scintigrafické metody v diagnostice restriktivní kardiomyopatie, pokud je její příčinou sarkoidóza nebo amyloidóza. Scintigrafická diagnostika amyloidózy může dokonce za určitých okolností nahradit endomyokardiální biopsii. Závěr: Scintigrafické metody se mohou v diagnostice HFpEF uplatnit velkou měrou. Musí však být správně indikované, profesionálně provedené a jejich výsledky dobře interpretované.

Introduction: Heart failure with preserved ejection fraction (HFpEF) is responsible for approximately half of all heart failure cases and its frequency is still growing. Pathophysiological changes are very complex. They include maladaptation, remodeling and hypertrophy, apoptosis, death and regeneration of myocardial muscle cells. Functional impairment can be of different origin, there is usually a combination of different causes. Ischemia, metabolic disorders, sympathetic system impairment and some others (inflammation, restrictive cardiomypathy) are the most significant. Method: Nuclear medicine procedures are based on pathophysiological processes so they can play an important role in the diagnosis of this type of HF. Radionuclide ventriculography (RNV), myocardial perfusion imaging (MPI), imaging of glucose metabolism (FDG), autonomous neuropathy and cardiac sarcoidosis and amyloidosis are the routinely used procedures. Results: RNV serves mainly to detect changes of left ventricular function during physical stress, MPI to detect myocardial ischemia even when coronary aterosclerosis in not present, FDG is used to detect myocardial viability in patients after myocardial infarction. Autonomous neuropathy is dected as a sympathetic dysfunction. Scintigrahic procedures play a significant role in resctritive cardiomyopathies if the cause is sarcoidosis or amyloidosis. Scintigraphy of amyloidosis, in some circumstances, can even replace endomyocardial biopsy. Conclusion: Scintigraphic procedures can play a significant role in the diagnosis of HFpEF. But they must be well indicated, profesionally performed and wisely interpreted.

• Keywords
• srdeční selhání se zachovanou ejekční frakcí,
• MeSH
• Humans MeSH
• Positron Emission Tomography Computed Tomography methods   MeSH
• Radionuclide Imaging methods   MeSH
• Single Photon Emission Computed Tomography Computed Tomography methods   MeSH
• Heart Failure * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH