Agresivní protidestičková léčba je základem terapie akutních koronárních syndromů. V akutní fázi je používána v podobě duální protidestičkové léčby (DAPT) s využitím vysoce účinných inhibitorů destičkového receptoru P2Y12. Studie ISAR-REACT 5 přímo srovnala ticagrelor a prasugrel jako součást dvou různých léčebných strategií. Výsledky studie jsou v rozporu s dosud zjištěnými skutečnostmi a jejich další interpretaci bude potřeba věnovat zvýšenou pozornost.

Aggressive antiplatelet therapy is the cornerstone for acute coronary syndrome treatment. Acute phase therapy is based on the dual antiplatelet treatment (DAPT) with highly effective inhibitors of the platelet receptor P2Y12. The ISAR-REACT 5 trial directly compare ticagrelor and prasugrel in two different antiplatelet strategies. The result of both efficacy and safety are contrary to current knowledge and needs to be carefully validated.

• Klíčová slova
• studie ISAR REACT,
• MeSH
• akutní koronární syndrom * farmakoterapie   mortalita   MeSH
• klinická studie jako téma MeSH
• krvácení MeSH
• prasugrel hydrochlorid * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• purinergní receptory P2Y - antagonisté * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• senioři MeSH
• ticagrelor * aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• výsledek terapie MeSH
• Check Tag
• senioři MeSH
• Publikační typ
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

The disease severity of COVID-19, especially in the elderly and patients with co-morbidities, is characterized by hypercytokinemia, an exaggerated immune response associated with an uncontrolled and excessive release of proinflammatory cytokine mediators (cytokine storm). Flavonoids, important secondary metabolites of plants, have long been studied as therapeutic interventions in inflammatory diseases due to their cytokine-modulatory effects. In this review, we discuss the potential role of flavonoids in the modulation of signaling pathways that are crucial for COVID-19 disease, particularly those related to inflammation and immunity. The immunomodulatory ability of flavonoids, carried out by the regulation of inflammatory mediators, the inhibition of endothelial activation, NLRP3 inflammasome, toll-like receptors (TLRs) or bromodomain containing protein 4 (BRD4), and the activation of the nuclear factor erythroid-derived 2-related factor 2 (Nrf2), might be beneficial in regulating the cytokine storm during SARS-CoV-2 infection. Moreover, the ability of flavonoids to inhibit dipeptidyl peptidase 4 (DPP4), neutralize 3-chymotrypsin-like protease (3CLpro) or to affect gut microbiota to maintain immune response, and the dual action of angiotensin-converting enzyme 2 (ACE-2) may potentially also be applied to the exaggerated inflammatory responses induced by SARS-CoV-2. Based on the previously proven effects of flavonoids in other diseases or on the basis of newly published studies associated with COVID-19 (bioinformatics, molecular docking), it is reasonable to assume positive effects of flavonoids on inflammatory changes associated with COVID-19. This review highlights the current state of knowledge of the utility of flavonoids in the management of COVID-19 and also points to the multiple biological effects of flavonoids on signaling pathways associated with the inflammation processes that are deregulated in the pathology induced by SARS-CoV-2. The identification of agents, including naturally occurring substances such as flavonoids, represents great approach potentially utilizable in the management of COVID-19. Although not clinically investigated yet, the applicability of flavonoids against COVID-19 could be a promising strategy due to a broad spectrum of their biological activities.

• MeSH
• antiflogistika farmakologie   terapeutické užití   MeSH
• COVID-19 imunologie   MeSH
• farmakoterapie COVID-19 MeSH
• flavonoidy farmakologie   terapeutické užití   MeSH
• lidé MeSH
• SARS-CoV-2 * MeSH
• syndrom uvolnění cytokinů farmakoterapie   imunologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population. METHODS: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and long-term mortalities, respectively. RESULTS: One hundred ten patients were enrolled (age, 65±11years; 92 men; left ventricular ejection fraction, 31±10%). VF storm occurred at the acute phase of MI (4.5±2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (>1 week) in 48 (44%), and the remote phase (>6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [95% CI, 1.03-1.20]; P=0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction <30% (hazard ratio, 2.54 [95% CI, 1.21-5.32]; P=0.014), New York Heart Association class ≥III (hazard ratio, 2.68 [95% CI, 1.16-6.19]; P=0.021), a history of atrial fibrillation (hazard ratio, 3.89 [95% CI, 1.42-10.67]; P=0.008), and chronic kidney disease (hazard ratio, 2.74 [95% CI, 1.15-6.49]; P=0.023). CONCLUSIONS: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short- and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.

• MeSH
• analýza přežití MeSH
• fibrilace komor etiologie   mortalita   patofyziologie   terapie   MeSH
• infarkt myokardu komplikace   MeSH
• katetrizační ablace metody   MeSH
• komorové extrasystoly komplikace   patofyziologie   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• následné studie MeSH
• proporcionální rizikové modely MeSH
• Purkyňova vlákna patofyziologie   MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tepový objem MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

AIMS: Electrical storm (ES) adversely affects prognosis of patients and may become a life-threatening event. Catheter ablation (CA) has been proposed for the treatment of ES. Our goal was to evaluate the efficacy of CA ablation both in acute and long-term suppression of ES. METHODS AND RESULTS: Fifty consecutive patients with coronary artery disease (38), idiopathic dilated cardiomyopathy (5), arrhythmogenic right ventricular cardiomyopathy (6), and/or with combined aetiology (1) underwent CA for ES. Mean left ventricular ejection fraction (LVEF) was 29 ± 11%. All patients underwent electroanatomical mapping, and CA was performed to abolish all inducible ventricular arrhythmias. The ES was suppressed by CA in 84% of patients. During the follow-up of 18 ± 16 months, 24 patients had no recurrences of any ventricular tachycardia (VT; 48%). Repeated procedure was necessary to suppress the recurrent ES in 13 cases (26%). Statistical analysis revealed that low LVEF (22 ± 3 vs. 31 ± 12%; P < 0.001), increased LVend-diastolic diameter (72 ± 9.1 vs. 64 ± 8.9 mm; P = 0.0135), and renal insufficiency (P < 0.001) were the univariate predictors of early mortality or necessity for heart transplantation. Recurrence of ES despite previous CA procedure was associated with a higher risk of death or heart transplant during follow-up (P < 0.05). CONCLUSION: Catheter ablation is effective in acute suppression of ES and often represents a life-saving therapy. In the long term, it prevents recurrences of any VT in about half of the treated patients.

• MeSH
• dilatační kardiomyopatie komplikace   epidemiologie   MeSH
• fibrilace komor epidemiologie   mortalita   chirurgie   MeSH
• Kaplanův-Meierův odhad MeSH
• katetrizační ablace MeSH
• komorbidita MeSH
• komorová tachykardie epidemiologie   mortalita   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nemoci koronárních tepen komplikace   epidemiologie   MeSH
• nemoci srdce komplikace   epidemiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční arytmie komplikace   epidemiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Introduction Mutations of RyR2 gene encoding calcium channel of sarcoplazmatic reticulum are the cause of congenital catecholaminergic polymorphic ventricular tachycardia. The aim of this study was to test the hypothesis that RyR2 variants can increase occurrence of malignant arrhythmias in patients with structural heart diseases. Methods The investigated group consisted of 36 patients with structural heart diseases with ICD implanted who suffered arrhythmic storm. In the control group there were 141 patients with coronary artery disease who were hospitalized at our department owing to an acute coronary event and they were alive at least 3 years after the index event. Thus, they could be considered as a group with a low risk of sudden cardiac death. In all of them mutation analysis of RyR2 gene was performed. Results We detected 16 different sequence changes of RyR2 gene in both groups. None of the found nucleotide polymorphisms led to amino acid changes, were located close to splice sites or had any similarity to known splicing enhancer motifs. The occurrence of these variants was not different in both groups. Conclusions The prevalence of RyR2 gene variants was not different in cases versus controls suggesting a limited role of this gene in the arrhythmogenesis in structural heart disease patients.

• MeSH
• defibrilátory implantabilní využití   MeSH
• dilatační kardiomyopatie genetika   komplikace   MeSH
• fibrilace komor etiologie   genetika   MeSH
• financování organizované MeSH
• flutter komor etiologie   genetika   MeSH
• funkce levé komory srdeční genetika   MeSH
• genetická predispozice k nemoci genetika   MeSH
• genetické techniky využití   MeSH
• ischemická choroba srdeční genetika   komplikace   MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• mutační analýza DNA MeSH
• náhlá srdeční smrt etiologie   patologie   prevence a kontrola   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• ryanodinový receptor vápníkového kanálu genetika   MeSH
• srdeční arytmie etiologie   genetika   klasifikace   MeSH
• statistika jako téma MeSH
• Check Tag
• lidé MeSH

BACKGROUND: A common ICD therapy-related complication is arrhythmic storm (AS). The objective of our study was to define the impact of AS on patients' prognoses in order to compare the total mortality of AS patients with the rest of the group. MATERIAL/METHODS: We studied 138 patients who received ICDs between 1994 and 2001. Patients who experienced one or more arrhythmic storms were statistically compared with patients who had no accumulation of malignant arrhythmia or no episodes. RESULTS: One thousand four hundred ninety episodes of arrhythmia were analyzed. Arrhythmia recurrence was present in 71% of the patients. The majority of episodes (78%) were ventricular tachycardias and only 3% of episodes were ventricular fibrillation. Seventy percent of all arrhythmic episodes were asymptomatic. The ICD therapy sensitivity was 99.7%. Thirty-eight arrhythmic storms in 19 patients (14%) were observed during follow-up. The occurrence of AS was twice as high among patients with LVEF <35% than the rest of the group (18% vs. 8%). The total survival of patients with AS was significantly lower than that of the ICD patients who did not experience an AS (36.8% vs. 16.8%, p=0.042). All episodes of arrhythmic clusters during the AS were ventricular tachycardias. CONCLUSIONS: Arrhythmic storm is a serious risk marker for cardiac death. Ventricular tachycardia is a basic rhythm disorder of AS episodes and occurs significantly more often than ventricular fibrillation. Arrhythmic storm is responsible for a 4.6 times more frequent re-admission to hospital.

• MeSH
• algoritmy MeSH
• defibrilátory implantabilní MeSH
• dysfunkce levé srdeční komory patofyziologie   terapie   MeSH
• elektrická defibrilace MeSH
• financování organizované MeSH
• lidé MeSH
• senioři MeSH
• srdeční arytmie patofyziologie   terapie   MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• senioři MeSH

AIMS: Certain systems for self-monitoring of blood glucose (SMBG) demonstrate inaccuracy at low and high hematocrit (HCT). Manufacturers define HCT ranges for accurate performance. Our objective was to assess the frequency of HCT values that can lead to clinically relevant errors. METHODS: In this cross-sectional study, we collected real-world data representing over 360,000 outpatients from the Netherlands (NL), the Czech Republic (CZ), and South Africa (ZA). These were subsequently stratified by sex and age and compared to commonly specified HCT range limits, reference intervals, and data from 1780 healthy Czech subjects. RESULTS: HCT values were comparably distributed in NL and CZ. Outpatients had a higher dispersion of values than healthy subjects. Low HCT values in Europe were common in age groups with a high prevalence of diabetes. All ZA age groups showed a higher prevalence of low HCT than in Europe. CONCLUSIONS: Real-world data indicate that SMBG systems specified to perform only within the frequently used 30-55% HCT range would leave 3% of outpatients in Europe and 18% in South Africa at risk of false SMBG results, with individual age strata being substantially higher. This could affect their diabetes management. Adequate SMBG systems should thus be chosen.

• MeSH
• hematokrit MeSH
• krevní glukóza MeSH
• lidé MeSH
• průřezové studie MeSH
• selfmonitoring glykemie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Jihoafrická republika MeSH

Background: In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing these infections. However, structural barriers can limit their effectiveness by hindering access. Methods: Through use of a semi-structured online survey sent to 65 professionals in the region, this study explores the prevalences of age restrictions, user fees or a lack of confidentiality for these programmes as well as HIV/HCV testing programmes. Results: Twenty respondents reported that age restrictions were not widespread in the 11 reporting countries, apart from for OST. User fees were found to be very common in HCV testing and varied for other services. It was stated to be common to inform parents of young IDUs who receive HIV services, but not to inform public authorities when IDUs enter harm reduction programmes. Conclusion: Where access to services is limited or confidentiality is compromised, as reported in this pilot study, it is crucial that health-care guidelines and national legislation are reformed to ensure access to these evidence-based interventions.

• MeSH
• hepatitida C diagnóza   prevence a kontrola   přenos   MeSH
• HIV infekce diagnóza   prevence a kontrola   přenos   MeSH
• internet využití   MeSH
• intravenózní abúzus drog epidemiologie   komplikace   prevence a kontrola   MeSH
• lidé MeSH
• methadon terapeutické užití   MeSH
• pilotní projekty MeSH
• poruchy spojené s užíváním psychoaktivních látek komplikace   prevence a kontrola   MeSH
• preventivní lékařství metody   MeSH
• programy výměny jehel a stříkaček metody   využití   MeSH
• průzkumy a dotazníky využití   MeSH
• společné užívání jehel statistika a číselné údaje   škodlivé účinky   MeSH
• zdravotní politika trendy   zákonodárství a právo   MeSH
• Check Tag
• lidé MeSH
• Geografické názvy
• střední Asie MeSH
• východní Evropa MeSH

• MeSH
• délka pobytu MeSH
• dospělí MeSH
• jednotky intenzivní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tyreotoxická krize diagnóza   mortalita   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• souhrny MeSH

BACKGROUND: Frequent episodes of polymorphic ventricular tachycardias/ventricular fibrillation (VT/VF) in patients with coronary artery disease can be triggered by monomorphic ventricular premature beats (VPBs) and thus, amenable to catheter ablation. The goal of this study was to review single-center experience in catheter ablation of electrical storm caused by focally triggered polymorphic VT/VF. METHODS: Catheter ablation of electrical storm due to focally triggered polymorphic VT/VF was performed in nine patients (mean age, 62+/-7 years; two females). All patients had previous myocardial infarction (interval of 3 days to 171 months). Mean left ventricular ejection fraction was 27+/-6 percent. All patients presented with repeated runs of polymorphic VT/VF triggered by monomorphic VPBs. RESULTS: Based on mapping data, the ectopic beats originated from scar border zone on interventricular septum (n=5), inferior wall (n=3), and lateral wall (n=1). Catheter ablation was performed to abolish the triggering ectopy and to modify the arrhythmogenic substrate by linear lesions within the infarct border zone. The ablation procedure was acutely successful in eight out of nine patients. During the follow-up of 13+/-7 months, two patients died due to progressive heart failure. One patient had late recurrence of electrical storm due to ectopic beats of different morphology and was successfully reablated. CONCLUSION: Electrical storm due to focally triggered polymorphic VT/VF may occur either in subacute phase of myocardial infarction or substantially later after index event. Catheter ablation of ectopic beats triggering these arrhythmias can successfully abolish electrical storm and become a life-saving procedure.

• MeSH
• katetrizační ablace metody   MeSH
• komorová tachykardie komplikace   diagnóza   chirurgie   MeSH
• komorové extrasystoly diagnóza   etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mapování potenciálů tělesného povrchu MeSH
• nemoci koronárních tepen komplikace   diagnóza   chirurgie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH