Hodnocení srdeční funkce je klíčový prvek pro odhad prognózy srdečních onemocnění. Posouzení srdeční funkce in vivo je však ovlivněno mnoha faktory, univerzální parametr, který by definoval status „mechanicky zdravého srdce“, proto neexistuje. V přehledu jsou nové i stávající ukazatele srdeční funkce rozděleny podle toho, zda vyjadřují kontraktilitu nebo mechanickou energii srdeční činnosti. Je diskutována jejich role v hodnocení srdeční fyziologie, způsoby stanovení, možné klinické využití i nevýhody.

Heart function evaluation is a key element in predicting heart disease prognosis. However, in vivo cardiac function assessment is influenced by many factors, and therefore there is no universal parameter defining the status of a "mechanically healthy heart". In this review, new and existing parameters of heart function are divided according to whether they express contractility or mechanical energy of cardiac function. Their role in the evaluation of cardiac physiology, methods of assessment, possible clinical use and disadvantages are discussed.

• Klíčová slova
• systolická elastance, srdeční kontraktilita, endsystolická elastance, preload recruitable stroke work, srdeční výkon, ejekční frakce,
• MeSH
• funkční vyšetření srdce metody   MeSH
• infarkt myokardu diagnóza   MeSH
• kontrakce myokardu * fyziologie   MeSH
• lidé MeSH
• minutový srdeční výdej fyziologie   MeSH
• srdce - funkce komor * fyziologie   MeSH
• srdeční frekvence fyziologie   MeSH
• systola fyziologie   MeSH
• tepový objem * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: We compared the prognostic capacity of conventional and novel invasive parameters derived from the slope of the preload recruitable stroke work relationship (PRSW) in STEMI patients and assessed their contribution to the TIMI risk score. METHODS: Left ventricular end-diastolic pressure (EDP), ejection fraction (EF), pressure adjusted maximum rate of pressure change in the left ventricle (dP/dt/P), aortic systolic pressure to EDP ratio (SBP/EDP) and end-diastolic volume adjusted stroke work (EW), derived from the slope of the PRSW relationship, were obtained during the emergency cardiac catheterization in 523 STEMI patients. The predictive power of the analyzed parameters for 30-day and 1-year mortality was evaluated using C-statistics and reclassification analysis was adopted to assess the improvement in TIMI score. RESULTS: The highest area under the curve (AUC) values for 30-day mortality were observed for EW (0.872(95% confidence interval 0.801-0.943)), SBP/EDP (0.843(0.758-0.928)) and EF (0.833(0.735-0.931)); p<0.001 for all values. For 1-year mortality the best predictive value was found for EW (0.806(0.724-0.887) and EF (0.793(0.703-0.883)); p<0.001 for both. The addition of EDP, SBP/EDP ratio and EW to TIMI score significantly increased the AUC according to De Long's test. For 30-day mortality, increased discriminative power following addition to the TIMI score was observed for EW and SBP/EDP (Integrated Discrimination Improvement was 0.086(0.033-0.140), p=0.002 and 0.078(0.028-0.128), p=0.002, respectively). CONCLUSIONS: EW and SBP/EDP are prognostic markers with high predictive value for 30-day and 1-year mortality. Both parameters, easily obtained during emergency catheterization, improve the discriminatory capacity of the TIMI score for 30-day mortality.

• MeSH
• hemodynamika MeSH
• hodnocení rizik MeSH
• infarkt myokardu s elevacemi ST úseků diagnóza   mortalita   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tepový objem fyziologie   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
• srovnávací studie MeSH

The aim of the study was to clarify the role of the interplay between hypertension and the renin-angiotensin system (RAS) in the pathophysiology of myocardial ischemia/reperfusion (I/R) injury. We hypothesized that in the late phase of hypertension with already developed signs of end-organ damage, inappropriate RAS activation could impair cardiac tolerance to I/R injury. Experiments were performed in male Cyp1a1-Ren-2 transgenic rats with inducible hypertension. The early phase of ANG II-dependent hypertension was induced by 5 days and the late phase by the 13 days dietary indole-3-carbinol (I3C) administration. Noninduced rats served as controls. Echocardiography and pressure-volume analysis were performed, angiotensins' levels were measured and cardiac tolerance to ischemia/reperfusion injury was studied. The infarct size was significantly reduced (by 50%) in 13 days I3C-induced hypertensive rats with marked cardiac hypertrophy, this reduction was abolished by losartan treatment. In the late phase of hypertension there are indications of a failing heart, mainly in reduced preload recruitable stroke work (PRSW), but only nonsignificant trends in worsening of some other parameters, showing that the myocardium is in a compensated phase. The influence of the RAS depends on the balance between the vasoconstrictive and the opposed vasodilatory axis. In the initial stage of hypertension, the vasodilatory axis of the RAS prevails, and with the development of hypertension the vasoconstrictive axis of the RAS becomes stronger. We observed a clear effect of AT1 receptor blockade on maximum pressure in left ventricle, cardiac hypertrophy and ANG II levels. In conclusion, we confirmed improved cardiac tolerance to I/R injury in hypertensive hypertrophied rats and showed that, in the late phase of hypertension, the myocardium is in a compensated phase.

• Publikační typ
• časopisecké články MeSH