BACKGROUND: The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes. METHOD: Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models. RESULTS: The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range. CONCLUSION: This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.

• MeSH
• ambulantní monitorování krevního tlaku MeSH
• dospělí MeSH
• hypertenze * MeSH
• kardiovaskulární nemoci * diagnóza   MeSH
• kohortové studie MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• systola fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH

Arterial compliance (C) is a complex parameter influencing ventricular-arterial coupling depending on structural (arterial wall remodeling) and functional (blood pressure, smooth muscles tone) changes. Based on Windkessel model, C can be calculated as the ratio of a time constant Tau characterizing diastolic blood pressure decay and total peripheral resistance (TPR). The aim of this study was to assess changes of C in the context of systolic arterial pressure (SAP) perturbations during four physiological states (supine rest, head-up tilt, supine recovery, mental arithmetic). In order to compare pressure independent changes of C a new index of C120 was proposed predicting C value at 120 mm Hg of SAP. Eighty-one healthy young subjects (48 f, average age 18.6 years) were examined. Hemodynamic parameters were measured beat-to-beat using volume-clamp photoplethysmographic method and impedance cardiography. We observed that C was strongly related to SAP values on the beat-to-beat time scale. Interestingly, C120 decreased significantly during stress phases. In conclusion, potential changes of SAP should be considered when measuring C. Arterial compliance changes in the opposite direction to TPR pointing towards influence of vascular tone changes on its value.

• MeSH
• arteriální tlak * MeSH
• časové faktory MeSH
• cévní rezistence MeSH
• fyziologická adaptace MeSH
• lidé MeSH
• matematické pojmy MeSH
• mladiství MeSH
• mladý dospělý MeSH
• modely kardiovaskulární MeSH
• polohování pacienta MeSH
• supinační poloha MeSH
• systola MeSH
• test na nakloněné rovině MeSH
• tuhost cévní stěny * MeSH
• zdraví dobrovolníci pro lékařské studie MeSH
• Check Tag
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Sedation is an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on heart function. PURPOSE: To compare the changes in heart function, induced after sedation with either midazolam or dexmedetomidine, using cardiac magnetic resonance imaging (MRI). METHODS: A total number of 30 volunteers were randomized into two groups: 15 participants in the midazolam group (MID) and 15 participants in the dexmedetomidine group (DEX). Every participant underwent a one-session cardiac MRI before and after sedation onset. The following parameters were recorded: left and right ventricle stroke volume (Ao-vol and Pul-vol resp.) and maximum fl ow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). A monitor recorded values of mean blood pressure (MAP), pulse (P) and blood oxygen saturation (SpO2 ) in 5-minute intervals. RESULTS: Dexmedetomidine led to a statistically signifi cant decrease in Ao-vol (p = 0.006) and Pul-vol (p = 0.003), while midazolam decreased E-diast (p = 0.019) Ao-vol (p = 0.001) and Pul-vol (p = 0.01). The late diastolic fi lling was not infl uenced by the sedation technique. CONCLUSION: Both sedation regimens worsened the systolic function of both ventricles. Midazolam moreover attenuated early diastolic fi lling of the left ventricle (Tab. 3, Fig. 4, Ref. 19).

• MeSH
• analgosedace klasifikace   metody   škodlivé účinky   MeSH
• dexmedetomidin * farmakologie   škodlivé účinky   terapeutické užití   MeSH
• funkční vyšetření srdce klasifikace   metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• midazolam * farmakologie   škodlivé účinky   terapeutické užití   MeSH
• minutový srdeční výdej účinky léků   MeSH
• systola účinky léků   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

• Klíčová slova
• rozštěp, klapnutí, Valsavův manévr,
• MeSH
• aortální insuficience diagnóza   klasifikace   patofyziologie   patologie   MeSH
• aortální stenóza diagnóza   etiologie   patofyziologie   patologie   MeSH
• břicho patologie   MeSH
• cyanóza diagnóza   etiologie   klasifikace   patofyziologie   patologie   MeSH
• defekty komorového septa diagnóza   patologie   MeSH
• defekty septa síní diagnóza   patofyziologie   patologie   MeSH
• diastola fyziologie   MeSH
• diferenciální diagnóza MeSH
• Ebsteinova anomálie diagnóza   patofyziologie   patologie   MeSH
• Eisenmengerův syndrom diagnóza   patologie   MeSH
• Fallotova tetralogie diagnóza   patologie   MeSH
• fyzikální vyšetření * klasifikace   MeSH
• hlava patologie   MeSH
• hrudník patologie   MeSH
• insuficience plicnice diagnóza   patofyziologie   patologie   MeSH
• koarktace aorty diagnóza   patofyziologie   patologie   MeSH
• končetiny patologie   MeSH
• kontrakce myokardu fyziologie   MeSH
• kožní manifestace MeSH
• krk patologie   MeSH
• lidé MeSH
• mitrální insuficience diagnóza   etiologie   klasifikace   patofyziologie   patologie   MeSH
• mitrální stenóza diagnóza   etiologie   patofyziologie   patologie   MeSH
• nemoci srdce * diagnóza   etiologie   klasifikace   patofyziologie   patologie   MeSH
• nemoci srdečních chlopní diagnóza   etiologie   klasifikace   patofyziologie   patologie   MeSH
• obstrukce výtoku ze srdeční komory diagnóza   patologie   MeSH
• otevřená tepenná dučej diagnóza   patofyziologie   patologie   MeSH
• palpace MeSH
• perikarditida diagnóza   patologie   MeSH
• perkuse klasifikace   MeSH
• poslech srdce MeSH
• poslech MeSH
• postura těla fyziologie   MeSH
• pulz klasifikace   MeSH
• šelest na srdci diagnóza   etiologie   klasifikace   patologie   MeSH
• srdce - funkce komor MeSH
• srdce - funkce síní MeSH
• srdce patofyziologie   MeSH
• srdeční chlopně umělé klasifikace   MeSH
• srdeční ozvy fyziologie   MeSH
• srdeční selhání diagnóza   etiologie   klasifikace   patofyziologie   patologie   MeSH
• stenóza pulmonální chlopně diagnóza   patologie   MeSH
• stetoskopy MeSH
• systola fyziologie   MeSH
• trikuspidální insuficience diagnóza   etiologie   patologie   MeSH
• trikuspidální stenóza diagnóza   patologie   MeSH
• venae jugulares patologie   MeSH
• vrozené srdeční vady diagnóza   klasifikace   patofyziologie   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

To assess subclinical cardiac function impairment in Duchenne dystrophy (DMD) female carriers. Forty-four female subjects proved as DMD carriers underwent echocardiographic examination including tissue Doppler imaging (TDI) of mitral and tricuspid annulus. Seventeen age-matched healthy female subjects served as controls. A significant differences in peak systolic annular velocity (Sa) between carriers and controls were found for lateral and septal part of the mitral annulus and for tricuspid annulus (0.09 vs. 0.11 m/s, p < 0.001, 0.08 vs. 0.09 m/s, p < 0.01 and 0.13 vs. 0.14 m/s, p = 0.02 respectively). There was also difference in early diastolic velocity (Ea) of the septal part of the mitral annulus (0.11 vs. 0.13 m/s, p = 0.03). The subclinical deterioration of systolic function is presented even in asymptomatic DMD female carriers.

• MeSH
• dopplerovská echokardiografie MeSH
• dospělí MeSH
• Duchennova muskulární dystrofie diagnostické zobrazování   genetika   patofyziologie   MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• heterozygot * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň diagnostické zobrazování   MeSH
• rychlost toku krve MeSH
• studie případů a kontrol MeSH
• systola MeSH
• trikuspidální chlopeň diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Pulsus paradoxus (PP) představuje pokles systolického krevního tlaku při nádechu o více než 10 mmHg. Vzniká patologicky v důsledku alterace fyziologicky se vyskytujících kardiopulmonálních interakcí, které vedou k přechodnému poklesu tepového objemu a tlakové amplitudy (rozdílu mezi systolickým a diastolickým tlakem). PP je snadno zjistitelný fenomén, typický pro řadu patologických stavů (např. srdeční tamponáda, astmatický záchvat, masivní plicní embolie, hypovolemický šok). Změny PP lze orientačně využít i pro hodnocení reakce oběhu na tekutiny. Mimo vlastní palpaci pulzu lze PP objektivizovat na pletyzmografické křivce pulzní oxymetrie.

Pulsus paradoxus (PP) represents a decrease in systolic blood pressure during inspiration of more than 10 mmHg. It is caused by pathologically altered cardiopulmonary interactions that lead to a transient decrease in stroke volume and pressure wave amplitude (systolic – diastolic pressure difference). PP can be easily examined. It is an important sign of a number of pathological conditions (e.g. cardiac tamponade, severe asthma, massive pulmonary embolism, hypovolemic shock). The dynamics of PP can also be used to monitor response to fluid treatment. In addition to the actual pulse palpation, PP can be objectified on the plethysmographic curve of pulse oximetry.

• Klíčová slova
• KLÍČOVÁ SLOVA: pulzus paradoxus – srdeční tamponáda – astma – hypovolémie,
• MeSH
• arteriální tlak MeSH
• bronchiální astma diagnóza   patofyziologie   MeSH
• hypovolemie diagnóza   patofyziologie   MeSH
• konstriktivní perikarditida diagnóza   patofyziologie   MeSH
• lidé MeSH
• pulz * MeSH
• srdeční tamponáda diagnóza   patofyziologie   MeSH
• systola MeSH
• urgentní zdravotnické služby MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Growth differentiation factor-15 (GDF-15) is a stress-inducible cytokine and member of the transforming growth factor-β cytokine superfamily that refines prognostic assessment in subgroups of patients with heart failure (HF). We evaluated its role in HF patients with chronic kidney disease (CKD, estimated glomerular filtration rate <60 mL/min/1.73 m2). METHODS: A total of 358 patients with stable systolic HF were followed for a median of 1121 (interquartile range, 379-2600) days. Comprehensive evaluation including B-type natriuretic peptide (BNP) and GDF-15 testing was performed at study entry; the analysis was stratified according to kidney function. RESULTS: Patients with CKD (33.8%) were older, had more often diabetes, and were less often treated with angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB). GDF-15 was associated with estimated glomerular filtration rate, whereas BNP was associated with left ventricular-end diastolic diameter and ejection fraction (P < 0.01). During follow-up, 244 patients (68.2%) experienced an adverse outcome (death, urgent transplantation, implantation of mechanical circulatory support). In patients with HF and CKD, the Cox proportional hazard model identified BNP, GDF-15, sex, systolic blood pressure, sodium, total cholesterol, and ACEi/ARB treatment as significant variables associated with an adverse outcome (P < 0.05). In multivariable analysis, BNP was replaced by GDF-15. Net reclassification improvement confirmed prognostic superiority of the model encompassing GDF-15 (GDF-15, sodium, total cholesterol, ACEi/ARB treatment) compared with the model without GDF-15 (BNP, sex, sodium, ACEi/ARB treatment), net reclassification improvement 0.62, P = 0.005. In contrast, in patients with HF and normal kidney function, BNP remained superior to GDF-15 in a multivariable model. CONCLUSIONS: In patients with systolic HF and CKD, GDF-15 is more strongly associated with adverse outcomes than the conventionally used BNP.

• MeSH
• antagonisté receptorů pro angiotenzin terapeutické užití   MeSH
• biologické markery krev   MeSH
• cholesterol krev   MeSH
• chronická renální insuficience farmakoterapie   epidemiologie   MeSH
• hodnoty glomerulární filtrace MeSH
• inhibitory ACE terapeutické užití   MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• natriuretický peptid typu B krev   MeSH
• podpůrné srdeční systémy statistika a číselné údaje   MeSH
• proporcionální rizikové modely MeSH
• růstový diferenciační faktor 15 krev   MeSH
• sexuální faktory MeSH
• sodík krev   MeSH
• systola MeSH
• systolické srdeční selhání krev   mortalita   chirurgie   MeSH
• transplantace srdce statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Combined congenic breeding and microarray gene expression profiling previously identified glutathione S-transferase μ-type 1 (Gstm1) as a positional and functional candidate gene for blood pressure (BP) regulation in the stroke-prone spontaneously hypertensive (SHRSP) rat. Renal Gstm1 expression in SHRSP rats is significantly reduced when compared with normotensive Wistar Kyoto (WKY) rats. As Gstm1 plays an important role in the secondary defence against oxidative stress, significantly lower expression levels may be functionally relevant in the development of hypertension. The aim of this study was to investigate the role of Gstm1 in BP regulation and oxidative stress by transgenic overexpression of the Gstm1 gene. METHOD: Two independent Gstm1 transgenic SHRSP lines were generated by microinjecting SHRSP embryos with a linear construct controlled by the EF-1α promoter encoding WKY Gstm1 cDNA [SHRSP-Tg(Gstm1)1 and SHRSP-Tg(Gstm1)2]. RESULTS: Transgenic rats exhibit significantly reduced BP and pulse pressure when compared with SHRSP [systolic: SHRSP 205.2 ± 3.7 mmHg vs. SHRSP-Tg(Gstm1)1 175.5 ± 1.6 mmHg and SHRSP-Tg(Gstm1)2 172 ± 3.2 mmHg, P < 0.001; pulse pressure: SHRSP 58.4 ± 0.73 mmHg vs. SHRSP-Tg(Gstm1)1 52.7 ± 0.19 mmHg and SHRSP-Tg(Gstm1)2 40.7 ± 0.53 mmHg, P < 0.001]. Total renal and aortic Gstm1 expression in transgenic animals was significantly increased compared with SHRSP [renal relative quantification (RQ): SHRSP-Tg(Gstm1)1 1.95 vs. SHRSP 1.0, P < 0.01; aorta RQ: SHRSP-Tg(Gstm1)1 2.8 vs. SHRSP 1.0, P < 0.05]. Renal lipid peroxidation (malondialdehyde: protein) and oxidized : reduced glutathione ratio levels were significantly reduced in both transgenic lines when compared with SHRSP [malondialdehyde: SHRSP 0.04 ± 0.009 μmol/l vs. SHRSP-Tg(Gstm1)1 0.024 ± 0.002 μmol/l and SHRSP-Tg(Gstm1)2 0.021 ± 0.002 μmol/l; (oxidized : reduced glutathione ratio): SHRSP 5.19 ± 2.26 μmol/l vs. SHRSP-Tg(Gstm1)1 0.17 ± 0.11 μmol/l and SHRSP-Tg(Gstm1)2 0.47 ± 0.22 μmol/l]. Transgenic SHRSP rats containing the WKY Gstm1 gene demonstrate significantly lower BP, reduced oxidative stress and improved levels of renal Gstm1 expression. CONCLUSION: These data support the hypothesis that reduced renal Gstm1 plays a role in the development of hypertension.

• MeSH
• aorta metabolismus   MeSH
• geneticky modifikovaná zvířata MeSH
• glutathion metabolismus   MeSH
• glutathiontransferasa genetika   metabolismus   MeSH
• hypertenze genetika   patofyziologie   MeSH
• krevní tlak genetika   MeSH
• krysa rodu rattus MeSH
• ledviny metabolismus   MeSH
• malondialdehyd metabolismus   MeSH
• oxidační stres genetika   MeSH
• peroxidace lipidů MeSH
• potkani inbrední SHR MeSH
• potkani inbrední WKY MeSH
• potkani transgenní MeSH
• systola MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: The aim of our study was to compare the effect of interventricular (VV) delay optimisation in CRT recipients on the basis of systolic dyssynchrony index (SDI) derived from the three-dimensional echocardiography (3DE) versus QRS width assessment on left ventricle volume reduction at the 12-month follow-up. METHODS: We included 63 patients with recently implanted CRT in this randomised, open-label trial. Patients were randomised to VV delay optimisation according to QRS complex width measurement in group 1 (n = 31) to obtain the narrowest QRS complex and SDI in group 2 (n = 32) to achieve its lowest possible value. We evaluated left ventricular end-systolic volume (LVESv), left ventricular ejection fraction (LVEF) and SDI by 3DE before CRT implantation and at a 12-month follow-up in all the patients. We also obtained the New York Heart Association functional class, the 6-minute walk test, the quality of life questionnaire and the level of NT-proBNP. RESULTS: The number of volumetric responders was similar in both groups (17 vs. 20, P = 0.786). There were also no significant differences in the reduction of LVESv (-41 ± 55 mL vs. - 61 ± 51 mL, P = 0.111), improvement in LVEF (+10.1 ± 10.6% vs. + 13.0 ± 9.9%, P = 0.213) or differences in clinical outcomes between both groups at the 12-month follow-up. CONCLUSION: CRT optimisation of interventricular delay using SDI compared with QRS width assessment did not reveal any significant difference in terms of volumetric and clinical response at the 12-month follow-up.

• MeSH
• časové faktory MeSH
• echokardiografie trojrozměrná metody   MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční fyziologie   MeSH
• kvalita života MeSH
• lidé MeSH
• následné studie MeSH
• převodní systém srdeční patofyziologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční arytmie diagnóza   patofyziologie   terapie   MeSH
• srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• srdeční resynchronizační terapie metody   MeSH
• systola MeSH
• výsledek terapie MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

Increased concentration of uric acid (UA) is positively associated with the clinical severity but negatively associated with the prognosis of heart failure (HF). However, data related to the association between UA concentration and N-terminal pro brain natriuretic peptide (NT-proBNP) are still lacking. The aim of the study was to analyze the relationships between UA, NT-proBNP, clearance of creatinine and NYHA function class and echocardiographic variables in the Slovak population of primary care patients diagnosed with HF. The association between UA and NT-proBNP was assessed by multivariate analysis. 848 patients (402 men, 446 women) with HF were included in the study. NT-proBNP correlated with UA in both men and women after adjustment based on age, BMI and glomerular filtration rate (r=0.263, p<0.0001; r=0.293, p<0.0001). UA concentration rose with the severity of the NYHA class and was significantly higher in patients with moderate and severe systolic dysfunctions as well as with diastolic dysfunction in the multivariate analysis. In conclusion, our study in Slovak population with HF has revealed a positive correlation between the concentration of UA and NT-proBNP, and the independency of this association on confounding factors. The results support the role of UA as a biochemical marker of HF severity and prognosis.

• MeSH
• biologické markery krev   MeSH
• diastola MeSH
• faktory vyvracející (epidemiologie) MeSH
• funkce levé komory srdeční MeSH
• kyselina močová krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B krev   MeSH
• peptidové fragmenty krev   MeSH
• prognóza MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční selhání diagnostické zobrazování   krev   patofyziologie   MeSH
• stupeň závažnosti nemoci MeSH
• systola MeSH
• tepový objem 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
• multicentrická studie MeSH
• Geografické názvy
• Slovenská republika MeSH