This study aims to explore: (1) the validity of post-exercise ultra-short-term heart rate variability (HRVust) after two different bouts of repeated sprint ability test (RSA), and (2) the relationship between HRVust measure and RSA performance. Twenty adolescent male futsal players voluntarily participated in this study (age: 17.65 ± 1.81 years, body height: 170.88 ± 4.98 cm, body weight: 61.78 ± 4.67 kg). The participants performed a standard RSA test (RSAstandard) and an RSA test with a 10% decrement of the best sprint time test (RSA10%decrement) on two separate occasions within a week. On both occasions, a 5-min resting electrocardiography was administered pre- and post-RSA exercise protocols. The first 30-s (HRVust30s), 60-s (HRVust60s), and 60-120-s (HRVust1-2min) were extracted and used to compare with the standard of 5-min HRV recording (HRVcriterion). The natural logarithm (ln) of the standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive normal-to-normal interval differences (RMSSD) HRV indices were utilised to establish intraclass correlation coefficient (ICC2,1), coefficient of variation (%CV), and Pearson product-moment correlation (r). Results revealed the ICC values of HRVust lnSDNN (RSAstandard = 0.77-0.88; RSA10%decrement = 0.41-0.71) and lnRMSSD (RSAstandard = 0.81-0.86; RSA10%decrement = 0.57-0.82). Furthermore, significantly positive correlations between best sprint time and post-exercise HRVust indices were found in lnSDNN (r = 0.47-0.62; p < 0.05) and lnRMSSD (r = 0.45; p < 0.05). Additionally, a large CV of lnSDNN (RSAstandard = 32%-45%; RSA10%decrement = 29%-39%), lnRMSSD (RSAstandard = 50%-66%; RSA10%decrement = 48%-52%), and ratio (RSAstandard = 45%-126%; RSA10%decrement = 27%-45%) was found after the RSA protocols. In conclusion, the number of bouts of RSA exercise potentially influences the agreement of post-exercise time-domain HRVust indices to standard HRV measure.

• MeSH
• běh * fyziologie   MeSH
• cvičení fyziologie   MeSH
• elektrokardiografie MeSH
• lidé MeSH
• mladiství MeSH
• sportovní výkon fyziologie   MeSH
• srdeční frekvence * fyziologie   MeSH
• zátěžový test * metody   MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

This study examined the prevalence of acute and chronic myocardial injury according to standard criteria in patients after acute ischaemic stroke (AIS) and its relation to stroke severity and short-term prognosis. Between August 2020 and August 2022, 217 consecutive patients with AIS were enrolled. Plasma levels of high-sensitive cardiac troponin I (hs-cTnI) were measured in blood samples obtained at the time of admission and 24 and 48 h later. The patients were divided into three groups according to the Fourth Universal Definition of Myocardial Infarction: no injury, chronic injury, and acute injury. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later, and on the day of hospital discharge. A standard echocardiographic examination was performed within the first 7 days of hospitalization in patients with suspected abnormalities of left ventricular function and regional wall motion. Demographic characteristics, clinical data, functional outcomes, and all-cause mortality were compared between the three groups. The National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following hospital discharge were used to assess stroke severity and outcome. Elevated hs-cTnI levels were measured in 59 patients (27.2%): 34 patients (15.7%) had acute myocardial injury and 25 patients (11.5%) had chronic myocardial injury within the acute phase after ischaemic stroke. An unfavourable outcome, evaluated based on the mRS at 90 days, was associated with both acute and chronic myocardial injury. Myocardial injury was also strongly associated with all-cause death, with the strongest association in patients with acute myocardial injury, at 30 days and at 90 days. Kaplan-Meier survival curves showed that all-cause mortality was significantly higher in patients with acute and chronic myocardial injury than in patients without myocardial injury (P < 0.001). Stroke severity, evaluated with the NIHSS, was also associated with acute and chronic myocardial injury. A comparison of the ECG findings between patients with and without myocardial injury showed a higher occurrence in the former of T-wave inversion, ST segment depression, and QTc prolongation. In echocardiographic analysis, a new abnormality in regional wall motion of the left ventricle was identified in six patients. Chronic and acute myocardial injury with hs-cTnI elevation after AIS are associated with stroke severity, unfavourable functional outcome, and short-term mortality.

• Publikační typ
• časopisecké články MeSH

Increases in beat-to-beat variability of electrocardiographic QT interval duration have repeatedly been associated with increased risk of cardiovascular events and complications. The measurements of QT variability are frequently normalized for the underlying RR interval variability. Such normalization supports the concept of the so-called immediate RR effect which relates each QT interval to the preceding RR interval. The validity of this concept was investigated in the present study together with the analysis of the influence of electrocardiographic morphological stability on QT variability measurements. The analyses involved QT and RR measurements in 6,114,562 individual beats of 642,708 separate 10-s ECG samples recorded in 523 healthy volunteers (259 females). Only beats with high morphology correlation (r > 0.99) with representative waveforms of the 10-s ECG samples were analyzed, assuring that only good quality recordings were included. In addition to these high correlations, SDs of the ECG signal difference between representative waveforms and individual beats expressed morphological instability and ECG noise. In the intra-subject analyses of both individual beats and of 10-s averages, QT interval variability was substantially more strongly related to the ECG noise than to the underlying RR variability. In approximately one-third of the analyzed ECG beats, the prolongation or shortening of the preceding RR interval was followed by the opposite change of the QT interval. In linear regression analyses, underlying RR variability within each 10-s ECG sample explained only 5.7 and 11.1% of QT interval variability in females and males, respectively. On the contrary, the underlying ECG noise contents of the 10-s samples explained 56.5 and 60.1% of the QT interval variability in females and males, respectively. The study concludes that the concept of stable and uniform immediate RR interval effect on the duration of subsequent QT interval duration is highly questionable. Even if only stable beat-to-beat measurements of QT interval are used, the QT interval variability is still substantially influenced by morphological variability and noise pollution of the source ECG recordings. Even when good quality recordings are used, noise contents of the electrocardiograms should be objectively examined in future studies of QT interval variability.

• Publikační typ
• časopisecké články MeSH

Monitoring of QTc interval is mandated in different clinical conditions. Nevertheless, intra-subject variability of QTc intervals reduces the clinical utility of QTc monitoring strategies. Since this variability is partly related to QT heart rate correction, 10 different heart rate corrections (Bazett, Fridericia, Dmitrienko, Framingham, Schlamowitz, Hodges, Ashman, Rautaharju, Sarma, and Rabkin) were applied to 452,440 ECG measurements made in 539 healthy volunteers (259 females, mean age 33.3 ± 8.4 years). For each correction formula, the short term (5-min time-points) and long-term (day-time hours) variability of rate corrected QT values (QTc) was investigated together with the comparisons of the QTc values with individually corrected QTcI values obtained by subject-specific modelling of the QT/RR relationship and hysteresis. The results showed that (a) both in terms of short-term and long-term QTc variability, Bazett correction led to QTc values that were more variable than the results of other corrections (p < 0.00001 for all), (b) the QTc variability by Fridericia and Framingham corrections were not systematically different from each other but were lower than the results of other corrections (p-value between 0.033 and < 0.00001), and (c) on average, Bazett QTc values departed from QTcI intervals more than the QTc values of other corrections. The study concludes that (a) previous suggestions that Bazett correction should no longer be used in clinical practice are fully justified, (b) replacing Bazett correction with Fridericia and/or Framingham corrections would improve clinical QTc monitoring, (c) heart rate stability is needed for valid QTc assessment, and (d) development of further QTc corrections for day-to-day use is not warranted.

• MeSH
• algoritmy MeSH
• dospělí MeSH
• elektrokardiografie metody   MeSH
• kardiologie metody   normy   MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačové zpracování signálu MeSH
• reprodukovatelnost výsledků MeSH
• srdeční frekvence fyziologie   MeSH
• syndrom dlouhého QT diagnóza   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Variabilita srdcovej frekvencie (HRV) je v súčasnosti považovaná za významný indikátor funkcie autonómneho nervového systému (ANS). Kým vysoké hodnoty HRV sú spojené s dobrou adaptabilitou ANS, znížené HRV môže byť negatívnym prognostickým faktorom niektorých kardiovaskulárnych ochorení. Cieľom príspevku bolo preskúmať vzťah HRV a osobnostného modelu Big Five. Úroveň osobnostných premenných sme zisťovali pomocou dotazníka NEO-FFI a HRV bolo získané z 5-minútových okien pokojových EKG záznamov. Výsledky odhalili pozitívny vzťah medzi extroverziou a HRV a svedomitosťou a HRV a negatívny vzťah medzi neuroticizmom a HRV. Tieto zistenia poukazujú na to, že vysoké skóre svedomitosti a extroverzie je spojené s vyšším HRV a potenciálne nižším rizikom vzniku kardiovaskulárnych chorôb a naopak vysoké skóre neuroticizmu súvisí s nižším HRV a môže byť považované za potenciálnu kardiovaskulárnu záťaž.

Heart rate variability (HRV) is currently considered to be a relevant indicator of the autonomic nervous system (ANS) function. While high HRV is associated with good ANS adaptability, reduced HRV has been established as a significant cardiovascular risk factor. HRV is affected by several factors, such as age, gender, body mass index (BMI), circadian changes, body position, respiratory and also psychosocial factors, e.g. mental stress or personality. The purpose of the present paper is to identify and explore the relationship between HRV and the Big Five personality model. Previous studies have suggested associations between HRV and some of the Big Five traits, but the results are less comprehensive; they exclude some of the personality dimensions or HRV measures. The main aim of this study is to bring some clarity into the area using the full version of the Big Five personality model and employing time (HR, SDNN, RMSSD), frequency (HF, LF), and also nonlinear measures (SD1, SD2) of HRV. A total of seventy-eight healthy subjects (63 women, 15 men) reported to be free of cardiovascular or neurological load and were not using any medication that would interfere with cardiovascular or autonomic activity. All subjects signed an informed consent form prior to participating in the study. They all completed the NEO-FFI questionnaire and were connected to portable two-electrode ECG devices. The subjects were monitored in the sitting position under resting conditions, in a group. HRV was obtained from a short-term, 5-minute time window of rest ECG records. The HRV analysis was performed using publicly available software – Kubios HRV. The results showed that extraversion was correlated positively with many of the HRV variables (SDNN, RMSSD, LF, HF, SD1 and SD2) which refer to high HRV. By contrast, high neuroticism exhibited reduced HRV, increased mean HR and decreased RMSSD and HF, which indicates a lower cardiac vagal component of HRV. Significant correlations were also found between conscientiousness and HRV (negatively with mean HR and positively with RMSSD, HF and SD1), which indicates increased parasympathetic activity and higher HRV. The relation between autonomic markers and conscientiousness is still largely unexplored and there are no studies linking autonomic regulation to conscientiousness. Therefore, the present findings reveal valuable and novel insights into the relationship between conscientiousness and HRV. There were no significant correlations between openness to experience and HRV, and between agreeableness and HRV. In conclusion, this study clearly indicates that specific personality traits, such as neuroticism, extraversion and conscientiousness are associated with autonomic regulation expressed though HRV. Moreover, the findings suggest that high conscientiousness and extraversion are associated with high HRV and potentially lower risk of cardiovascular disease, and by contrast, high neuroticism correlated with reduced HRV and could be potentially considered as a cardiovascular risk. The results are also useful in psychological practice because relations between HRV and personality might provide physiological indices that are potentially suited to personality assessment.

• MeSH
• autonomní nervový systém MeSH
• lidé MeSH
• osobnost MeSH
• psychosomatické poruchy MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• srdeční frekvence MeSH
• Check Tag
• lidé MeSH

OBJECTIVE: Use of wearable ECG devices for arrhythmia screening is limited due to poor signal quality, small number of leads and short records, leading to incorrect recognition of pathological events. This paper introduces a novel approach to classification (normal/'N', atrial fibrillation/'A', other/'O', and noisy/'P') of short single-lead ECGs recorded by wearable devices. APPROACH: Various rhythm and morphology features are derived from the separate beats ('local' features) as well as the entire ECGs ('global' features) to represent short-term events and general trends respectively. Various types of atrial and ventricular activity, heart beats and, finally, ECG records are then recognised by a multi-level approach combining a support vector machine (SVM), decision tree and threshold-based rules. MAIN RESULTS: The proposed features are suitable for the recognition of 'A'. The method is robust due to the noise estimation involved. A combination of radial and linear SVMs ensures both high predictive performance and effective generalisation. Cost-sensitive learning, genetic algorithm feature selection and thresholding improve overall performance. The generalisation ability and reliability of this approach are high, as verified by cross-validation on a training set and by blind testing, with only a slight decrease of overall F1-measure, from 0.84 on training to 0.81 on the tested dataset. 'O' recognition seems to be the most difficult (test F1-measures: 0.90/'N', 0.81/'A' and 0.72/'O') due to high inter-patient variability and similarity with 'N'. SIGNIFICANCE: These study results contribute to multidisciplinary areas, focusing on creation of robust and reliable cardiac monitoring systems in order to improve diagnosis, reduce unnecessary time-consuming expert ECG scoring and, consequently, ensure timely and effective treatment.

• MeSH
• elektrokardiografie přístrojové vybavení   metody   MeSH
• fibrilace síní diagnóza   MeSH
• lidé MeSH
• nositelná elektronika * MeSH
• reprodukovatelnost výsledků MeSH
• rozhodovací stromy MeSH
• support vector machine * MeSH
• určení tepové frekvence přístrojové vybavení   metody   MeSH
• víceúrovňová analýza MeSH
• vlnková analýza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• práce podpořená grantem MeSH

Úvod: Variabilita srdeční frekvence (VSF) je uznávaným ukazatelem při diagnostice kardiální autonomní neuropatie (KAN) a je využitelná jako nezávislý prognostický ukazatel rizika náhlé smrti na arytmii. Přes důležitost včasné diagnostiky je zjištění KAN, zejména u diabetiků, často pozdní diagnózou. Důvodem vedle dlouhé subklinické fáze je i velká diverzifikace metodik, absence jednotných normálových hodnot, zejména co se týče VSF stanovené metodou spektrální analýzy (SAVSF) v krátkých záznamech elektrokardiogramu (EKG). Cíl: Cílem práce bylo pomocí průřezové studie u diabetiků 2. typu posoudit potenciál metodiky diagnostikující KAN pomocí SAVSF v krátkých záznamech EKG při autonomní zátěži - ortoklinostatickém testu (test leh1-stoj-leh2, pětiminutové záznamy) v modifikaci rozdílných normativních přístupů k postprocessingové analýze získaných dat podle tří různých autorů. Sekundárními cíli bylo zhodnotit význam přídatné autonomní zátěže hlubokou ventilací a porovnat naměřená data VSF s vybranými klinickými a laboratorními ukazateli vyšetřovaných pacientů. Materiál a metody: Soubor tvořilo 43 diabetiků 2. typu (12 žen, 31 mužů, průměrný věk 51,1 ± 10,7 roku) bez manifestních projevů KAN, bez závažné kardiovaskulární anamnézy, vyjma nekomplikované hypertenze. Pomocí diagnostického systému DiANS PF8 s telemetrickým přenosem EKG a dechové frekvence byla provedena série reflexních zkoušek podle Ewinga a SAVSF (fourierovská analýza tachogramu, okno 256) při autonomní zátěži při testu leh1-stoj-leh2 (test LSL) a při pětiminutové frekvenčně kontrolované neprohlubované ventilaci 12 cyklů/min. Získané spektrální ukazatele byly porovnávány s normativy tří různých autorů používajících sice stejný algoritmus záznamu EKG (test LSL), ale rozdílné postprocessingové zpracování dat: 1. stanovení závažnosti KAN podle porovnání komplexního ukazatele - tzv. funkčního věku autonomního nervového systému (ANS) vyšetřovaného a věkové normy, 2. hodnocení závažnosti KAN podle věkově stratifikovaných hodnot mediánu a percentilů, 3. hodnocení závažnosti KAN podle kumulativního spektrálního výkonu v průběhu celého testu (cumLFHF). Výsledky: Hodnocením podle celkového Ewingova skóre (ETS) bylo bez podezření na KAN (ETS = 0) 11,6 %, s možnou KAN (ETS = 1) 32,6 %, s manifestní KAN (ETS = 2-3) u 55,8 % pacientů. Byla prokázána střední korelační závislost mezi ETS a jednotlivými ukazateli SAVSF po ortoklinostáze (test LSL) v poloze leh2 (ms2): TP (celkový výkon, f = 0,02-0,5 Hz): r = -0,4, p < 0,006, komponenta LF (nízké frekvence, 0,05-0,15 Hz): r = -0,31, p < 0,04, komponenta HF (vysoké frekvence, 0,15-0,5 Hz): r = -0,45, p < 0,003 i za podmínek kontrolované ventilace (PB), a to pro TP (ms2): r = -0,56, p < 0,0001, LF: r = -0,38, p < 0,018, HF: r = -0,52, p < 0,001. Byla nalezena střední korelační závislost mezi ETS a hodnocením VSF pomocí komplexního ukazatele - "funkční věk ANS" (r = 0,37, p < 0,015), ETS a cumLFHF, ETS a ln(cumLFHF) (ms2): r = -0,46, p < 0,002. Byl potvrzen významný rozdíl mezi "funkčním věkem ANS" a kalendářním věkem u většiny pacientů (průměr 21,8 ± 12,9 roku, medián 23,5 roku, p < 0,0001). Nepodařilo se aplikovat hodnocení závažnosti KAN podle věkově stratifikovaných hodnot mediánu a percentilů ukazatelů TP, LF, HF, LF/HF. Mezi ukazateli SAVSF a klinickými ukazateli (antropometrické, echokardiografické, QTc, laboratorní testy) vynikala střední závislost mezi hodnotou glykovaného hemoglobinu (HbA1c) a základními ukazateli SAVSF (TP, LF, HF, LF/HF), "funkčním věkem ANS" a cumLFHF (r = 0,36-0,53, při p < 0,0004 až p < 0,02). Závěr: Pro diagnostiku KAN pomocí VSF je optimální a v praxi dobře průchodnou metodikou SAVSF analyzovaná z krátkodobých záznamů EKG v podmínkách autonomní zátěže pomocí ortoklinostatického testu leh-stoj-leh, a to metodikou stratifikující závažnost KAN pomocí komplexního ukazatele - tzv. funkčního věku ANS. V detailním posouzení sympatovagální rovnováhy doplňuje diagnostiku pomocí reflexních autonomních testů (Ewingova baterie). Vedle ortoklinostatické zátěže je doporučeno ke zvýšení výtěžnosti metody SAVSF doplnění vyšetřovacího algoritmu o vagovou provokaci frekvenčně kontrolovaným neprohlubovaným dýcháním 12 cyklů/min. Hodnocení závažnosti KAN podle kumulativního ukazatele celkové VSF (cumLFHF) ukázalo dobrou diskriminační schopnost pro prvotní screeningovou diagnostiku KAN, i když bez možnosti rozlišení poruchy mezi sympatickou a vagovou větví ANS. Prezentovaná průřezová práce na souboru diabetiků 2. typu prokázala významnou autonomní dysfunkci u většiny souboru bez závislosti na délce trvání diabetu. Jednoznačně podporuje doporučení, že posouzení integrity ANS u diabetu 2. typu má být provedeno již při stanovení diagnózy choroby v rámci vstupního stagingu nemoci. Závažnost postižení KAN dobře koreluje s metabolickou kompenzací diabetu vyšetřovanou pomocí HbA1c.

Introduction: Heart rate variability (HRV) is a respected measure used in the assessment of cardiac autonomic neuropathy (CAN) and it can serve as an independent prognostic indicator of sudden arrhythmic death risk. Despite the importance of early detection, the diagnosis of CAN is often made too late, especially in diabetics. Beside the long subclinical phase of CAN, reasons for this include great diversification of employed diagnostic methods and absence of universally accepted normal values; the latter applies mostly in HRV evaluated using short-term spectral analysis (SAHRV). Aim: The aim of this cross-sectional study involving patients with type 2 diabetes was to summarize the real potential of using a testing method for CAN diagnosis by short-term SAHRV, including an autonomic load imposed during an orthoclinostatic test (Supine1 - Standing - Supine2, short 5-min recordings). Three different normative approaches to the postprocessing analysis of acquired data described by different authors were employed. Secondary aim of the study was to assess the benefit of rate-controlled breathing. The next aim was to compare the HRV data measured with the selected clinical and laboratory indices in patient examined. Materials and methods: The study included 43 patients with type 2 diabetes (12 women, 31 men, mean age 51.1 ± 10.7 y) and no history of manifest CAN or serious cardiovascular illness, except uncomplicated hypertension. Using a diagnostic system DiANS PF8 with telemetric transfer of ECG and respiratory rate, series of reflex tests according to Ewing and SAHRV (Fourier tachogram analysis, window 256) during autonomic load imposed by Supine1 - Standing - Supine2 test (SSS test) and during 5 minutes of rate-controlled, non-deepened breathing (PB, 12 cycles/min) were performed. Acquired spectral indices were analyzed and compared with normatives of 3 authors using the same recording algorithm, SSS test, but different data postprocessing analysis. These were 1. so called "functional age" of autonomic nervous system (ANS), 2. assessment of CAN severity according to age-stratified medians and percentiles, 3. assessment of CAN severity according to cumulative spectral power during the entire test (cumLFHF). Results: According to the total Ewing score (ETS), 11.6% patients were categorized as CAN-free (ETS = 0), 32.6% were diagnosed with possible CAN (ETS = 1), and 55.8% labeled with manifest CAN (ETS = 2 to 3). Moderate correlation between ETS and individual SAHRV parameters following orthoclinostasis (test SSS) in Supine2 position was described [ms2]: TP (total power, f = 0.02-0.5 Hz): r = -0.4, p < 0.006; LF component (low frequency, 0.05-0.15 Hz): r = -0.31, p < 0.04; HF component (high frequency, 0.15-0.5 Hz): r = -0.45, p < 0.003) and the same applied to rate-controlled breathing PB (TP, [ms2]: r = -0.56, p < 0.0001; LF: r = -0.38, p < 0.018; HF: r = -0.52, p < 0.001). Moderate correlation was also found between ETS and HRV assessment using a complex indicator - "functional age of ANS" (r = 0.37, p < 0.015), ETS a cumLFHF, ETS a ln(cumLFHF) [ms2]: r = -0.46, p < 0.002. In most patients, significant difference between functional age of ANS and calendar age was confirmed (mean 21.8 ± 12.9 y, median 23.5 years, p < 0.0001). An attempt to assess the severity CAN using age-stratified medians and percentiles of TP, LF, HF, and LF/HF was not successful. As for SAHRV and clinical indices (anthropometric, echocardiographic, QTc, laboratory), moderate correlation between the glycated haemoglobin on one side and basic SAHRV indices (TP, LF, HF, LF/HF), functional age of ANS and cumLFHF on the other side was prominent (r = 0.36 to 0.53, p < 0.0004 to p < 0.02). Conclusion: Assessment of CAN using evaluation of HRV can optimally be performed (and simply realized in clinical practice) using SAHRV based on short ECG recordings during autonomic load imposed by orthoclinostatic test (Supine1 - Standing - Supine2) and on postprocessing data analysis using complex indicator called "functional age of ANS". In the detailed evaluation of sympathovagal balance, it complements the screening assessment with cardiovascular reflex tests (Ewing's battery). Beside the orthoclinostatic load, pronounced vagal provocation using rate-controlled, non-deepened breathing (12 cycles/min) represents a recommended facultative load option increasing the yield of the SAHRV method. The detection and assessment of CAN severity while applying the cumulative indicator of HRV (cumLFHF) showed a good discrimination power in the frontline screening for CAN, albeit without the possibility to distinguish between the sympathetic and vagal branch of ANS. Presented cross-sectional study in type 2 diabetes mellitus demonstrated a significant autonomic dysfunction in the majority of patients examined, independently of diabetes duration. It supports the recommendation to assess the ANS integrity in type 2 diabetes already at diagnosis, within the initial staging of the illness. The severity of CAN correlates well with metabolic control of diabetes as evaluated by HbA1c.

• MeSH
• diabetes mellitus 2. typu MeSH
• diabetické neuropatie * diagnóza   patofyziologie   MeSH
• dospělí MeSH
• individuální biologická variabilita MeSH
• komplikace diabetu MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci autonomního nervového systému diagnóza   MeSH
• referenční hodnoty MeSH
• spektrální analýza MeSH
• srdeční frekvence * MeSH
• statistika jako téma MeSH
• zátěžový test metody   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinické zkoušky MeSH

BACKGROUND: Acute heart failure negatively affects short-term outcomes of patients with acute coronary syndrome (ACS). Therefore, reliable and non-invasive assessment of pulmonary congestion is needed to select patients requiring more intensive monitoring and therapy. Since plasma levels of natriuretic peptides are influenced by myocardial ischemia, they might not reliably reflect congestion in the context of ACS. The novel endothelial biomarker, soluble CD146 (sCD146), presents discriminative power for detecting the cardiac origin of acute dyspnea similar to that of natriuretic peptides and is associated with systemic congestion. We evaluated the performance of sCD146 for the assessment of pulmonary congestion in the early phase of ACS. METHODS: One thousand twenty-one consecutive patients with ACS were prospectively enrolled. Plasma levels of sCD146, brain natriuretic peptide (BNP), and high-sensitive troponin T were measured within 24 hr after the onset of chest pain. Pulmonary congestion on chest radiography was determined and classified in three groups according to the degree of congestion. RESULTS: Nine hundred twenty-seven patients with ACS were analyzed. Ninety-two (10%) patients showed signs of pulmonary edema on chest radiography. Plasma levels of sCD146 reflected the radiological severity of pulmonary congestion. Higher plasma levels of sCD146 were associated with the worse degree of pulmonary congestion. In contrast to BNP, sCD146 levels were not affected by the level of troponin T. CONCLUSIONS: The novel endothelial biomarker, sCD146, correlates with radiological severity of pulmonary congestion in the early phase of ACS and, in contrast to BNP, is not affected by the amount of myocardial cell necrosis.

• MeSH
• akutní koronární syndrom diagnóza   diagnostické zobrazování   MeSH
• antigen CD146 krev   MeSH
• biologické markery krev   MeSH
• bolesti na hrudi diagnostické zobrazování   patologie   MeSH
• elektrokardiografie MeSH
• ELISA MeSH
• infarkt myokardu diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B krev   MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• troponin T krev   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: ST-elevated myocardial infarction (STEMI) holds the highest early mortality among patients with acute coronary syndromes. Despite numerous claims of clinical benefits and superiority over clopidogrel, there are no head-to-head outcome randomized clinical trials (RCTs) directly comparing novel antithrombotic agents in STEMI. Moreover, since most regulatory approvals are based on a single RCT's results, their meta-analyses are rare to compare death rates. We analyzed the 30-day mortality in STEMI patients who underwent percutaneous coronary intervention (PCI) and were treated with antithrombotic agents compared to clopidogrel as a reference. METHODS AND RESULTS: Altogether, 10 RCT's and 1 retrospective study with a total number of 26,658 STEMI patients were included. Random-effects model with Mantel-Heanszel weighting was used to pool outcomes into a meta-analysis. Therapy with clopidogrel was associated with 2.76% 30-day STEMI mortality which was similar to that of ticagrelor (2.6%; OR=0.9395 [CI=0.76 to 1.17; p=0.58]), and for bivalirudin (2.8%; OR=1.02 [CI=0.82 to 1.27; p=0.86]), but was slightly higher for heparin (3.0%; OR=1.08 [CI=0.86 to 1.35; p=0.52]). There was a trend towards lower mortality after tirofiban (2.1%; OR=0.77 [CI=0.52 to 1.13; p=0.20]), and cangrelor (1.7%; OR=0.59 [CI=0.29 to 1.20; p=0.19]), although the sample size for both agents was woefully small. The only agent which offers a significant 30-day mortality benefit in STEMI was prasugrel with significant lowest 1.75% death rate (OR=0.63 [CI=0.46 to 0.86; p=0.03]). CONCLUSIONS: Among antithrombotic agents, prasugrel, but not ticagrelor, offers significant 30-day mortality benefit over clopidogrel in PCI-treated STEMI patients justifying short-term use in such a high-risk population.

• MeSH
• adenosin analogy a deriváty   farmakologie   MeSH
• analýza přežití MeSH
• elektrokardiografie metody   MeSH
• hodnocení výsledků zdravotní péče MeSH
• infarkt myokardu diagnóza   farmakoterapie   mortalita   chirurgie   MeSH
• inhibitory agregace trombocytů farmakologie   MeSH
• koronární angioplastika metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prasugrel hydrochlorid farmakologie   MeSH
• randomizované kontrolované studie jako téma MeSH
• tiklopidin analogy a deriváty   farmakologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

At present, analysis of heart rate variability (HRV) is becoming widely used as a clinical or research tool. Supported reliability studies for HRV measurement are, however, still limited. The main purpose was to perform an assessment of the absolute and relative reliability of HRV parameters from short-term recordings by means of orthoclinostatic stimulation and to investigate, whether there is a difference in repeating the retest immediately or after several days. The study group consisted of 99 participants (mean age 22 ± 1.24 years). Standard HRV indexes were computed: PT (total spectral power), PHF (high frequency spectral power), PLF (low frequency spectral power) and LF/HF. Absolute reliability was assessed by the standard error of measurement and 95% limits of agreement; relative reliability was assessed by the intraclass correlation coefficient. There was also an estimate of the sample size needed to detect the mean difference ≥ 30% of the between-subject standard deviation. In conclusion, a large random variation (within individuals) of HRV parameters was revealed, regardless of whether the retest was repeated immediately or with an interruption. For most HRV parameters (particularly in the immediately repeated test-retest), however, random variation represents a limited portion of the between-subject variability.

• MeSH
• analýza rozptylu MeSH
• cirkadiánní rytmus * MeSH
• elektrokardiografie MeSH
• lidé MeSH
• mladý dospělý MeSH
• postura těla fyziologie   MeSH
• referenční hodnoty MeSH
• reprodukovatelnost výsledků MeSH
• srdeční frekvence fyziologie   MeSH
• velikost vzorku MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH