Cílem studie je predikce ICHS, zejména rizikových forem plátů pro vznik akutního koronárního syndrom na základě neinvazivních vyšetření. Rozsah a rizikovost koronárního postižení bude stanovena zhotovením 3 D rekonstrukce tepen na základě angiografického a ultrazvukového vyšetření . Tento způsob zobrazení koronárních tepen umožňuje detailní popis postižení a vzájemných závislostí jednotlivých studovaných parametrů. Změny ve složení plátu při hypolipidemické terapii jsou stále nejasné a proto je jedním z cílů studie vyhodnocení léčby rosuvastatinem na velikost a složení plátů se zaměřením na nejvíce rizikovu složku - nekrotickou tkáň. Ve studii bude zkoumáno, zda je možno nalezené změny v plátech predikovat podle změn zjištěných neinvazivními vyšetřeními. Bylo by tak možno určit skupinu nemocných s malou reakcí na léčbu.; Aim of the study is coronary artery disease prediction, mainly plaques types with high risk for acute coronary syndrome development based on non-invasive examinations. Extent and risk profile of coronary impairment will be investigated from 3D reconstruction of coronary arteries done by angiography and ultrasound examinations. This type of imaging enables detailed description of coronary arteries and relationship between all investigated parameters. Changes of plaque composition during lipid-lowering therapy are still unclear; therefore one of the targets is assessment of rosuvastatin influence on plaque volume and plaque composition with main focus on the most danger component – necrotic core. Study will analyze, whether changes in coronary arteries correlate with changes in non-invasive examination. The positive finding could help with identification of patients with low response to statin therapy.

• MeSH
• Acute Coronary Syndrome diagnosis   MeSH
• Coronary Angiography MeSH
• Tomography, Optical Coherence MeSH
• Hydroxymethylglutaryl-CoA Reductase Inhibitors MeSH
• Ultrasonography MeSH
• Imaging, Three-Dimensional MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• angiologie
• cévní chirurgie
• kardiologie
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

Iatrogenní disekce aorty je sice vzácnou, ale život ohrožující komplikací perkutánních koronárních intervencí (PCI). V případě spontánní disekce aorty typu A je doporučena urgentní chirurgická léčba, pro iatrogenní disekce specifická doporučení formulována nebyla. V prvotních studiích dosahovala mortalita chirurgicky léčených pacientů s iatrogenní disekcí aorty až 50 %, dle aktuálních dostupných dat z registrů se však zdá srovnatelná s mortalitou pacientů operovaných pro spontánní disekci aorty typu A (přibližně 16 %). Řada autorů však prezentovala kazuistiky pacientů úspěšně léčených konzervativně s kompletním zhojením disekce, a to i v případě rozsáhlého poškození aortální stěny.

Iatrogenic aortic dissection is a rare but life-threatening complication of percutaneous coronary intervention (PCI). Emergency surgical treatment is recommended for spontaneous type A aortic dissection, but no specific recommendations have been formulated for iatrogenic dissections. In early studies, the mortality rate of surgically treated patients with iatrogenic aortic dissection was as high as 50%, but according to the currently available registry data, the mortality rate seems comparable to that of patients operated on for spontaneous type A aortic dissection (approximately 16%). However, case reports have been presented of patients successfully treated conservatively with complete healing of the dissection, including cases with extensive aortic wall damage.

• MeSH
• Angiography MeSH
• Aortic Valve Stenosis diagnostic imaging   MeSH
• Aortic Dissection * diagnostic imaging   etiology   classification   physiopathology   pathology   therapy   MeSH
• Iatrogenic Disease MeSH
• Percutaneous Coronary Intervention * adverse effects   MeSH
• Humans MeSH
• Aged MeSH
• Rare Diseases diagnostic imaging   etiology   physiopathology   pathology   therapy   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH
• Review MeSH

• Publication type
• Meeting Abstract MeSH

Tako-tsubo kardiomyopatie je relativně vzácný syndrom, pro který jsou charakteristické reverzibilní lokalizované poruchy kinetiky, zejména apikálních a středních segmentů levé komory. Velmi často imituje akutní koronární syndrom. Přesné patofyziologické mechanismy nejsou zcela známy. Za hlavní příčinu této kardiomyopatie je považována silná stresová zátěž. V ojedinělých případech může být tako-tsubo kardiomyopatie způsobena i jinými faktory. Prezentujeme vzácný případ stresové kardiomyopatie vzniklý v souvislosti s léčbou anagrelidem. Anagrelid je nejčastěji podáván pacientům s esenciální trombocytemií. Patří mezi inhibitory fosfodiesterázy III a prostřednictvím specifických signálních drah působí i na myokard. Naše kasuistické sdělení jako první v České republice popisuje případ tako-tsubo kardiomyopatie vzniklé v souvislosti s podáváním vysokých dávek anagrelidu.

Takotsubo cardiomyopathy is a rare syndrome. Most often imitates acute coronary syndrome. It is characterized by transient wall motion abnormalities, especially in the apical segments of the left ventricle. Less frequently it is possible to find transient akinesis or dyskinesis in the mid-ventricular segments of the left ventricle. Pathophysiological mechanisms are not completely clear. The main cause of stress cardiomyopathy is stress insult. But in rare cases takotsubo cardiomyopathy can be caused by other conditions. We reported a rare case of takotsubo cardiomyopathy caused by high dose anagrelide therapy. Anagrelide is most often used in patients with thrombocythemia. It belongs to phosphodiesterase III inhibitors and through specific pathways has certain effects on myocardium. It is the first case of takotsubo cardiomyopathy resulting from anagrelide therapy in the Czech Republic.

• MeSH
• Aspirin administration & dosage   MeSH
• Quinazolines administration & dosage   pharmacology   adverse effects   MeSH
• Platelet Aggregation Inhibitors pharmacology   adverse effects   therapeutic use   MeSH
• Clopidogrel administration & dosage   MeSH
• Coronary Angiography MeSH
• Middle Aged MeSH
• Humans MeSH
• Drug Substitution MeSH
• Takotsubo Cardiomyopathy diagnostic imaging   chemically induced   MeSH
• Thrombocytopenia * drug therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

INTRODUCTION AND OBJECTIVES: Pathologic intimal thickening (PIT) has been considered a benign plaque phenotype. We report plaque phenotypic changes in a baseline/follow-up intravascular ultrasound-based virtual histology study. METHODS: A total of 61 patients with stable coronary artery disease were analyzed from the HEAVEN trial (89 patients randomized between routine statin therapy vs atorvastatin 80mg and ezetimibe 10mg) with serial intravascular ultrasound imaging of nonculprit vessels. We compared changes in 693 baseline and follow-up 5-mm long segments in a novel risk score, Liverpool Active Plaque Score (LAPS), plaque parameters, and plaque composition. RESULTS: The PIT showed the highest increase of risk score and, with fibrous plaque, also the LAPS. Necrotic core (NC) abutting to the lumen increased in PIT (22 ± 51.7; P = .0001) and in fibrous plaque (17.9 ± 42.6; P = .004) but decreased in thin cap fibroatheroma (TCFA) (⿿15.14 ± 52.2; P = .001). The PIT was the most likely of all nonthin cap fibroatheroma plaque types to transform into TCFA at follow-up (11% of all TCFA found during follow-up and 35.9% of newly-developed TCFA), but showed (together with fibrous plaque) the lowest stability during lipid-lowering therapy (24.7% of PIT remained PIT and 24.5% of fibrous plaque remained fibrous plaque). CONCLUSIONS: Over the 1-year follow-up, PIT was the most dynamic of the plaque phenotypes and was associated with an increase of risk score and LAPS (together with fibrous plaque), NC percentage (together with fibrous plaque) and NC abutting to the lumen, despite a small reduction of plaque volume during lipid-lowering therapy. The PIT was the main source for new TCFA segments.

• MeSH
• Anticholesteremic Agents administration & dosage   MeSH
• Plaque, Atherosclerotic blood   diagnosis   drug therapy   MeSH
• Atorvastatin administration & dosage   MeSH
• Time Factors MeSH
• Ezetimibe administration & dosage   MeSH
• Ultrasonography, Interventional methods   MeSH
• Drug Therapy, Combination MeSH
• Coronary Vessels diagnostic imaging   MeSH
• Cholesterol, LDL blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Coronary Artery Disease blood   diagnosis   drug therapy   MeSH
• Disease Progression MeSH
• Severity of Illness Index MeSH
• User-Computer Interface * MeSH
• Dose-Response Relationship, Drug MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH

• MeSH
• Humans MeSH
• Extracorporeal Membrane Oxygenation methods   MeSH
• Oxygen Inhalation Therapy methods   MeSH
• Pulmonary Embolism * therapy   MeSH
• Vasoconstrictor Agents therapeutic use   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

The effect of pulsatile blood flow on microcirculation during extracorporeal cardiopulmonary resuscitation (ECPR) is not elucidated; therefore, we designed an observational study comparing sublingual microcirculation in patients with refractory cardiac arrest (CA) with spontaneously pulsatile or low/nonpulsatile blood flow after treatment with ECPR. Microcirculation was assessed with Sidestream Dark Field technology in 12 patients with CA who were treated with ECPR and 12 healthy control subjects. Microcirculatory images were analyzed offline in a blinded fashion, and consensual parameters were determined for the vessels ≤20 μm. The patients' data, including actual hemodynamic parameters, were documented. Pulsatile blood flow was defined by a pulse pressure (PP) ≥ 15 mm Hg. Compared with the healthy volunteers, the patients who were treated with ECPR exhibited a significantly lower proportion of perfused capillaries (PPC); other microcirculatory parameters did not differ. The groups of patients with pulsatile (n = 7) versus low/nonpulsatile (n = 5) blood flow did not differ in regards to the collected data and hemodynamic variables (except for the PP and ejection fraction of the left ventricle) as well as microcirculatory parameters. In conclusion, microcirculation appeared to be effectively supported by ECPR in our group of patients with CA with the exception of the PPC. We found only nonsignificant contribution of spontaneous pulsatility to extracorporeal membrane oxygenation-generated microcirculatory blood flow.

• MeSH
• Adult MeSH
• Cardiopulmonary Resuscitation methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Microcirculation physiology   MeSH
• Extracorporeal Membrane Oxygenation methods   MeSH
• Pilot Projects MeSH
• Pulsatile Flow physiology   MeSH
• Aged MeSH
• Heart Arrest therapy   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cystatin C (CysC), an endogenous inhibitor of cysteine proteases and a sensitive and accurate marker of renal function, is associated with the severity of coronary atherosclerosis assessed by angiography and future cardiovascular events according to previous studies. We aimed to evaluate the association between CysC levels and coronary plaque volume, composition and phenotype assessed by intravascular ultrasound and intravascular ultrasound-derived virtual histology in patients with preserved renal function. Forty-four patients with angiographically documented coronary artery disease and complete intravascular imaging were included in the study. Patients were categorized into tertiles by CysC levels. Subjects in the high CysC tertile had significantly higher mean plaque burden (48.0 % ± 6.9 vs. 42.8 % ± 7.4, P = 0.029), lower mean lumen area (8.1 mm2 ± 1.7 vs. 9.9 mm2 ± 3.1, P = 0.044) and a higher number of 5-mm vessel segments with minimum lumen area < 4 mm2 (17.9 ± 18.9 vs. 6.8 ± 11.7, P = 0.021) compared to patients in the lower tertiles. In addition, CysC levels demonstrated significant positive correlation with the mean plaque burden (r = 0.35, P = 0.021). Neither relative, nor absolute plaque components differed significantly according to CysC tertiles. The Liverpool Active Plaque Score was significantly higher in the high CysC tertile patients (0.91 ± 1.0 vs. 0.18 ± 0.92, P = 0.02). In conclusion, our study demonstrated a significant association of increased CysC levels with more advanced coronary artery disease and higher risk plaque phenotype in patients with preserved renal function.

• MeSH
• Plaque, Atherosclerotic metabolism   physiopathology   MeSH
• Biomarkers metabolism   MeSH
• Vascular Cell Adhesion Molecule-1 metabolism   MeSH
• Cystatin C metabolism   MeSH
• Phenotype MeSH
• Glomerular Filtration Rate MeSH
• Kidney metabolism   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Coronary Artery Disease metabolism   physiopathology   MeSH
• Tumor Necrosis Factor-alpha metabolism   MeSH
• Kidney Function Tests * MeSH
• Inflammation pathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The prediction of coronary vessel involvement by means of noninvasive tests is one of the fundamental objectives of preventive cardiology. This review describes the current possibilities of coronary vessel involvement prediction by means of ultrasonographic examination of carotid arteries, analysis of polymorphisms in the genes encoding enzymes responsible for production of nitric oxide and carbon monoxide and assessment of levels of certain proinflammatory cytokines. In the presented work these noninvasive markers are correlated with the extent of coronary vessel involvement as assessed by coronary angiography, intravascular ultrasound and virtual histology (Fig. 5, Ref. 40).

• MeSH
• Risk Assessment MeSH
• Humans MeSH
• Coronary Artery Disease diagnosis   epidemiology   MeSH
• Prognosis MeSH
• Risk Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

OBJECTIVE: Prediction of coronary atherosclerosis in patients with stable angina based on non-invasive examinations. METHODS: Pro-inflammatory markers, heme oxygenase-1 (HO-1) polymorphism, lipid levels, Framingham risk score (FRS), and carotid ultrasound were analyzed and compared to grayscale and virtual histology intravascular ultrasound (VH-IVUS). RESULTS: A total of 101 patients were included, and genetic analysis was performed on 81 patients (80.2%). The HO-1 risk polymorphism was more frequent in patients post-myocardial infarction (61.3% vs 32%; P=.0097), or with diabetes (68.4% vs 35.5%; P=.011) or a higher FRS (21.5 vs 15.7; P=.014). Plaques in patients with the HO-1 risk polymorphism contained less fibro-fatty tissue (17.1% vs 23.2%; P=.005) and more necrotic core (NC; 17.1% vs 12.7%; P=.02) and calcification (10.2% vs 5.7%; P=.035) compared to patients without the HO-1 risk polymorphism. Carotid intima media thickness (P=.05) and carotid bulb plaque (P=.008) predicted plaque burden. The level of Apo A inversely correlated with NC (P=.047; r = -0.27) and was lower in patients with VH-thin-cap fibroatheroma (VH-TCFA; 1.19 mmol/L vs 1.3 mmol/L; P=.04). FRS correlated with NC (P=.007; r = 0.2), with angiographic disease severity (P=.032; r = 0.21) and was higher in patients with VH-TCFA (9.1 vs 7.8; P=.03). CONCLUSION: Carotid ultrasound and HO-1 polymorphism improve coronary atherosclerosis prediction.

• MeSH
• Apolipoproteins A blood   MeSH
• Biomarkers MeSH
• Physical Examination MeSH
• Genetic Predisposition to Disease epidemiology   MeSH
• Heme Oxygenase-1 genetics   MeSH
• Carotid Intima-Media Thickness MeSH
• Middle Aged MeSH
• Humans MeSH
• Carotid Artery Diseases ultrasonography   MeSH
• Coronary Artery Disease * epidemiology   genetics   pathology   MeSH
• Polymorphism, Genetic * MeSH
• Predictive Value of Tests MeSH
• Risk Factors MeSH
• Aged MeSH
• Angina, Stable * diagnosis   genetics   pathology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Comparative Study MeSH