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BACKGROUND: Hyperuricemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. METHODS: The prospective acute heart failure registry (AHEAD) was used to select 3160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricemia was defined as UA ≥500 μmoL/L and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricemia, with treated hyperuricemia, and with untreated hyperuricemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricemia, unlike those with hyperuricemia, had a higher left ventricular ejection fraction, a better renal function, and higher hemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or beta-blockers. RESULTS: In a primary analysis, the patients without hyperuricemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricemia had a similar 5-year survival rate as those with untreated hyperuricemia (42.0% vs 39.7%, P = 0.362) whereas those with treated hyperuricemia had a poorer prognosis (32.4% survival rate, P = 0.006 vs non-hyperuricemia group and P = 0.073 vs untreated group). CONCLUSION: Hyperuricemia was associated with an unfavorable cardiovascular risk profile in HF patients. Treatment with low doses of allopurinol did not improve the prognosis of HF patients.

MeSH
akutní nemoc MeSH
alopurinol aplikace a dávkování MeSH
antiuratika aplikace a dávkování MeSH
biologické markery krev MeSH
časové faktory MeSH
hyperurikemie krev komplikace farmakoterapie MeSH
kyselina močová krev MeSH
lidé středního věku MeSH
lidé MeSH
míra přežití trendy MeSH
následné studie MeSH
příčina smrti MeSH
prognóza MeSH
prospektivní studie MeSH
registrace * MeSH
senioři nad 80 let MeSH
senioři MeSH
srdeční selhání komplikace mortalita MeSH
tendenční skóre * MeSH
výsledek terapie MeSH
vztah mezi dávkou a účinkem léčiva 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
Česká republika MeSH

Článek

AHEAD score--Long-term risk classification in acute heart failure

International journal of cardiology. 2016 ; 202 (-) : 21-6. [pub] 20150828

Int J Cardiol
ISSN 1874-1754
Medvik
Zdroj

BACKGROUND: The role of co-morbidities in the prognosis of patients hospitalized for AHF was examined using the AHEAD (A--atrial fibrillation, H--haemoglobin<130 g/l for men and 120 g/l for women (anaemia), E--elderly (age>70years), A--abnormal renal parameters (creatinine>130 μmol/l), D--diabetes mellitus) scoring system. METHODS: AHEAD--multicentre prospective Czech registry of AHF patients; GREAT registry--international cohort of AHF patients. Data from 5846 consecutive patients hospitalized for AHF (AHEAD registry; derivation cohort) were analysed to build the AHEAD score. Each risk factor of the AHEAD score was counted as 1 point. The model was validated externally using an international cohort of similar patients in the GREAT registry (6315). RESULTS: Main outcome was one year all-cause mortality. The mean age of patients was 72±12 years, with 61.6% of patients aged >70 years; 43.4% were women. Atrial fibrillation was present in 30.7%, anaemia in 38.2%, creatinine>130 mmol/l (abnormal renal parameters) in 30.1%, and diabetes mellitus in 44.0%. The mean AHEAD score was 2.1. In patients with AHEAD scores of 0-5, the one-year mortality rates were 13.6%, 23.4%, 32.0%, 41.1%, 47.7%, and 58.2%, respectively (p<0.001), and the 90 month mortality rates were 35.1%, 57.3%, 73.5%, 84.8%, 88.0%, and 91.7%, respectively (p<0.001). CONCLUSION: The AHEAD is a simple scoring system based on the analysis of co-morbidities for the estimation of the short and long term prognosis of patients hospitalized for AHF.

MeSH
akutní nemoc MeSH
časové faktory MeSH
hodnocení rizik metody MeSH
incidence MeSH
lidé MeSH
míra přežití trendy MeSH
mortalita v nemocnicích trendy MeSH
následné studie MeSH
prediktivní hodnota testů MeSH
příčina smrti trendy MeSH
prognóza MeSH
prospektivní studie MeSH
registrace * MeSH
reprodukovatelnost výsledků MeSH
rizikové faktory MeSH
senioři MeSH
srdeční katetrizace MeSH
srdeční selhání klasifikace diagnóza epidemiologie 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
Geografické názvy
Česká republika MeSH

Článek

Co by internista neměl na EKG přehlédnout
[What an internal medicine specialist should not overlook in EKG records]

Čihalík, Čestmír, 1949-
Autor Autorita LF UP v Olomouci, FN Olomouc, I. interní klinika - kardiologická

Postgraduální medicína. 2015 ; 17 (Příloha 2) : 31-38. (Interna)

Postgraduální med.
ISSN 1212-4184
Medvik
Zdroj

Interna. 2015 ; 17 (Příloha 2) : 31-38.

ISSN 1212-4184
Medvik
Zdroj

Abstrakt

Tak dlouho se chodí se džbánem pro vodu, až se ucho utrhne

Pediatrie pro praxi. 2015 ; 16 (Suppl. A) : A12-A13. (Kongres pediatrů a dětských sester, XXXII. dny praktické a nemocniční pediatrie, Olomouc, 15.-16. května 2015)

ISSN 1213-0494
Medvik
Zdroj

Pediatrie pro praxi - kongres pediatrů a dětských sester. 2015 ; () : A12-A13.

ISSN 1803-5892
Medvik
Zdroj

Publikační typ
abstrakt z konference MeSH

Článek

Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure

Biomedical papers of the Medical Faculty of the University Palacký, Olomouc Czech Republic. 2015 ; 159 (3) : 429-436. [pub] 20140313

Biomed. Pap. Fac. Med. Palacký Univ. Olomouc Czech Repub. (Print)
ISSN 1213-8118
Medvik
Zdroj

AIMS: Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. TheAIM of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). METHODS: The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. RESULTS: In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. CONCLUSIONS: Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.

MeSH
akutní nemoc MeSH
alkalická fosfatasa krev MeSH
aspartátaminotransferasy krev MeSH
gama-glutamyltransferasa krev MeSH
jaterní testy MeSH
lidé středního věku MeSH
lidé MeSH
nemoci jater epidemiologie etiologie metabolismus MeSH
prevalence MeSH
retrospektivní studie MeSH
senioři nad 80 let MeSH
senioři MeSH
srdeční selhání komplikace 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
práce podpořená grantem MeSH
Geografické názvy
Česká republika epidemiologie MeSH

Článek

Positive influence of being overweight/obese on long term survival in patients hospitalised due to acute heart failure

PLoS One. 2015 ; 10 (2) : e0117142. [pub] 20150224

ISSN 1932-6203
Medvik
Zdroj

BACKGROUND: Obesity is clearly associated with increased morbidity and mortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the "obesity paradox" on a large cohort with long-term follow-up are lacking. METHODS: Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5-25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters. RESULTS: In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26-1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09-1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11-1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure. CONCLUSION: These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia.

MeSH
akutní nemoc MeSH
analýza přežití MeSH
databáze faktografické MeSH
hospitalizace MeSH
index tělesné hmotnosti MeSH
kohortové studie MeSH
lidé středního věku MeSH
lidé MeSH
nadváha MeSH
následné studie MeSH
obezita komplikace MeSH
proporcionální rizikové modely MeSH
senioři MeSH
srdeční selhání komplikace mortalita patologie 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

Článek

ECG in patients with acute heart failure can predict in-hospital and long-term mortality

Internal and emergency medicine. 2014 ; 9 (3) : 283-91. [pub] 20121006

Intern Emerg Med
ISSN 1970-9366
Medvik
Zdroj

Initial risk stratification in patients with acute heart failure (AHF) is poorly validated. Previous studies tended to evaluate the prognostic significance of only one or two selected ECG parameters. The aim of this study was to evaluate the impact of multiple ECG parameters on mortality in AHF. The Acute Heart Failure Database (AHEAD) registry collected data from 4,153 patients admitted for AHF to seven hospitals with Catheter Laboratory facilities. Clinical variables, heart rate, duration of QRS, QT and QTC intervals, type of rhythm and ST-T segment changes on admission were collected in a web-based database. 12.7 % patients died during hospitalisation, the remainder were discharged and followed for a median of 16.2 months. The most important parameters were a prolonged QRS and a junctional rhythm, which independently predict both in-hospital mortality [QRS > 100 ms, odds ratio (OR) 1.329, 95 % CI 1.052-1.680; junctional rhythm, OR 3.715, 95 % CI 1.748-7.896] and long-term mortality (QRS > 120 ms, OR 1.428, 95 % CI 1.160-1.757; junctional rhythm, OR 2.629, 95 % CI 1.538-4.496). Increased hospitalisation mortality is predicted by ST segment elevation (OR 1.771, 95 % CI 1.383-2.269) and prolonged QTC interval >475 ms (OR 1.483, 95 % CI 1.016-2.164). Presence of atrial fibrillation and bundle branch block is associated with increased unadjusted long-term mortality, but mostly reflects more advanced heart disease, and their predictive significance is attenuated in the multivariate analysis. ECG in patients admitted for acute heart failure carries significant short- and long-term prognostic information, and should be carefully evaluated.

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