BACKGROUND: Physical activity is pivotal in managing heart failure with reduced ejection fraction, and walking integrated into daily life is an especially suitable form of physical activity. This study aimed to determine whether a 6-month lifestyle walking intervention combining self-monitoring and regular telephone counseling improves functional capacity assessed by the 6-minute walk test (6MWT) in patients with stable heart failure with reduced ejection fraction compared with usual care. METHODS: The WATCHFUL trial (Pedometer-Based Walking Intervention in Patients With Chronic Heart Failure With Reduced Ejection Fraction) was a 6-month multicenter, parallel-group randomized controlled trial recruiting patients with heart failure with reduced ejection fraction from 6 cardiovascular centers in the Czech Republic. Eligible participants were ≥18 years of age, had left ventricular ejection fraction <40%, and had New York Heart Association class II or III symptoms on guidelines-recommended medication. Individuals exceeding 450 meters on the baseline 6MWT were excluded. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly telephone counseling from research nurses who encouraged them to use behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The patients in the control group continued usual care. The primary outcome was the between-group difference in the distance walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate to vigorous physical activity as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP (N-terminal pro-B-type natriuretic peptide) and high-sensitivity C-reactive protein biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention to treat. RESULTS: Of 218 screened patients, 202 were randomized (mean age, 65 years; 22.8% female; 90.6% New York Heart Association class II; median left ventricular ejection fraction, 32.5%; median 6MWT, 385 meters; average 5071 steps/day; average 10.9 minutes of moderate to vigorous physical activity per day). At 6 months, no between-group differences were detected in the 6MWT (mean 7.4 meters [95% CI, -8.0 to 22.7]; P=0.345, n=186). The intervention group increased their average daily step count by 1420 (95% CI, 749 to 2091) and daily minutes of moderate to vigorous physical activity by 8.2 (95% CI, 3.0 to 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. CONCLUSIONS: Whereas the lifestyle intervention in patients with heart failure with reduced ejection fraction improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the lack of association between increased physical activity and functional outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03041610.

• MeSH
• chůze MeSH
• dysfunkce levé srdeční komory * MeSH
• funkce levé komory srdeční MeSH
• kvalita života MeSH
• lidé MeSH
• senioři MeSH
• srdeční selhání * terapie   farmakoterapie   MeSH
• tepový objem MeSH
• životní styl MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

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• Publikační typ
• tisková chyba MeSH

AIM: Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population. PATIENTS AND METHODS: National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included. RESULTS: Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%. CONCLUSIONS: The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.

• MeSH
• bakteriální endokarditida * epidemiologie   etiologie   MeSH
• defibrilátory implantabilní * škodlivé účinky   MeSH
• endokarditida * komplikace   etiologie   MeSH
• lidé MeSH
• prospektivní studie MeSH
• registrace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Mezi časté nekardiovaskulární komorbidity srdečního selhání patří anémie a deficit železa. Deficit železa se vyskytuje u pacientů s chronickým srdečním selháním nezávisle na anémii až u 55 % nemocných, v případě akutního srdečního selhání včetně akutní dekompenzace chronického srdečního selhání až u 80 % pacientů. Intravenózní aplikace železa u pacientů se srdečním selháním a deficitem železa je nyní součástí Doporučení pro diagnostiku a léčbu srdečního selhání Evropské kardiologické společnosti 2021 s cílem zlepšit symptomy, toleranci zátěže a kvalitu života nemocných s chronickým srdečním selháním a snížit riziko následné hospitalizace u pacientů po akutní dekompenzaci.

Anemia and iron deficiency are common non-cardiovascular comorbidities of heart failure. The prevalence of iron deficiency is up to 55 % of patients with chronic heart failure and up to 80 % subjects with acute heart failure including acute decompensated heart failure, independently on anemia. The European Society of Cardiology Heart Failure Guidelines 2021 recommend intravenous iron replacement in patients with heart failure and iron deficiency to improve symptoms, stress tolerance and quality of life in chronic heart failure and to reduce risk of subsequent hospitalization after acute decompenstation.

• MeSH
• chronická nemoc MeSH
• hypochromní anemie * farmakoterapie   MeSH
• intravenózní podání MeSH
• klinická studie jako téma MeSH
• komorbidita MeSH
• lidé MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• srdeční selhání komplikace   MeSH
• železo terapeutické užití   MeSH
• znalostní mezera MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• konsensus - konference MeSH

INTRODUCTION: Data describing contemporary profile of infective endocarditis (IE) in the Czech Republic are lacking. The aim of this study was to describe the current profile and outcomes of IE patients. METHODS: Prospectively collected data on consecutive patients admitted for IE diagnosis between April 2016 and March 2018 to 11 main tertiary care cardiac centers in the Czech Republic were used for this analysis. RESULTS: Among 208 patients, 88 patients (42.3 %) had native valve IE (NVIE), 56 patients (26.9 %) had prosthetic valve IE (PVIE), and 57 patients (27.4 %) had intracardiac device-related IE (CDRIE). The mean age was 61.66±15.54 years. Staphylococcus aureus was the most common etiological agent of IE (27.4 %), whereas Culture negative IE was present in 26.4 % patients. Surgery was performed during hospitalization in 112 (53.8 %) patients. In-hospital death occurred in 21.2 % patients, while 1-year mortality was 40.3 %. In patients, who had an indication for surgery, but the procedure was not performed, mortality was significantly higher (p=0.002). CONCLUSION: High proportion of culture negative IE and IE related to artificial intra-cardiac materials calls for action. Furthermore, we show that cardiac surgery should be more often contemplated, especially in the presence of risk factors as septic shock and congestive heart failure (Tab. 6, Fig. 1, Ref. 32).

• MeSH
• bakteriální endokarditida * diagnóza   epidemiologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• prospektivní studie MeSH
• registrace MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• analýza pulzové vlny MeSH
• lidé MeSH
• monitorování fyziologických funkcí MeSH
• oxymetrie metody   přístrojové vybavení   MeSH
• saturace kyslíkem * MeSH
• Check Tag
• lidé MeSH

Kompletní atrioventrikulární (AV) blokáda představuje vzácnou, avšak život ohrožující komplikaci tyreotoxikózy. V literatuře bylo dosud popsáno pouze několik případů s nejistou kauzální souvislostí s hypertyroidním stavem. Vzhledem k nedostatku údajů nepanuje absolutní shoda ohledně reverzibility této abnormality AV převodu, a tedy i nutnosti implantace trvalého kardiostimulátoru. V naší kazuistice popisujeme případ 35leté pacientky, u které se nově diagnostikovaná Gravesova-Basedowova tyreotoxikóza poprvé manifestovala synkopou při kompletní AV blokádě. V úvodu hospitalizace došlo ke spontánní obnově AV převodu v poměru 1 : 1, což vedlo k výrazné sinusové tachykardii s frekvencí 150/min, která byla symptomatická bolestmi na hrudi, prekolapsovým stavem a vedla k rozvoji srdečního selhání v důsledku hyperkinetické cirkulace. Další komplikací byla epizoda asystolie při recidivě úplné AV blokády bez náhradního rytmu s nutností dvouminutové kardiopulmonální resuscitace a emergentní dočasné transvenózní kardiostimulace. Při léčbě tyreostatiky a kortikosteroidy se po 48 hodinách stabilizoval srdeční rytmus se sklonem k sinusové tachykardii. Další průběh byl již nekomplikovaný, včetně dobré tolerance léčby beta-blokátorem. Komplexní vyšetření (včetně magnetické rezonance srdce) neprokázalo žádnou jinou příčinu vysvětlující kompletní AV blokádu. Zvažovanou implantaci trvalého kardiostimulátoru pacientka odmítla. V následujících třech měsících sledování již nebyla recidiva AV blokády zaznamenána.

Complete atrioventricular (AV) block is a rare but life-threatening complication of thyrotoxicosis. In the literature, only a few cases with uncertain causal link to hyperthyroid status have been described so far. Because of the lack of data, there is no clear consensus on the reversibility of AV conduction abnormality and hence on the need for permanent pacemaker implantation. In the case report, we describe a case of a 35-year-old woman with newly diagnosed Graves' thyrotoxicosis complicated by syncope due to complete AV block. Upon admission to hospital, a spontaneous recovery of the AV conduction with 1 : 1 ratio occurred, resulting in significant sinus tachycardia with a heart rate of 150 bpm, which manifested by chest pain and pre-collapse state and led to the development of heart failure due to hyperkinetic circulation. Further complication was an asystole caused by a recurrence of complete AV block without occurrence of escape rhythm, with the need of a 2-minute cardiopulmonary resuscitation and emergency temporary transvenous pacing. After 48 hours of thyrostatic and corticosteroid treatment, the heart rhythm stabilized, with a tendency to sinus tachycardia. The further course was uncomplicated, including a good beta-blocker tolerance. A comprehensive examination (including cardiac magnetic resonance) did not show any other cause explain- ing the complete AV block. The patient refused permanent pacemaker implantation which was considered. During the next 3-month follow-up, a recurrence of AV block did not occur.