Cíle: Podle dosavadních studií byla ateroskleróza považována za chronické zánětlivé onemocnění, přičemž složky imunitního systému se podílejí na aterogenezi. Systém receptoru CD40 a ligandu CD40 reguluje řadu fází hormonální a buněčné imunitní odpovědi. Zvláště solubilní ligand CD40 (sCD40) se uvolňuje z aktivovaných krevních destiček. Destičky se podílejí nejen na rozvoji trombózy, ale i na tvorbě aterosklerotických lézí a procesu restenózy. Cílem naší studie bylo zjistit, zda existuje vztah mezi hodnotami ligandu sCD40 a koronarograficky prokázaným rozsahem a závažností ischemické choroby srdeční (ICHS), a porovnat další rizikové faktory kardiovaskulárních onemocnění. Metody: Do studie bylo zařazeno celkem 102 osob; z tohoto počtu bylo 37 pacientů s akutním koronárním syndromem (AKS), u 41 pacientů byla stanovena diagnóza stabilní anginy pectoris (SAP) a 24 jedinců tvořilo kontrolní skupinu. Při příjmu na koronární jednotku byly pacientům s AKS odebrány vzorky periferní žilní krve. U pacientů ze skupiny se SAP a u kontrolních osob se zdravými koronárními tepnami byly vzorky krve odebrány po koronarografickém vyšetření. U každého pacienta bylo vypočítáno Gensiniho skóre, kdy se u každé koronární stenózy určovalo skóre závažnosti podle stupně zúžení a jeho geografického významu. Výsledky: Průměrné hodnoty ligandu sCD40 v séru byly statisticky významně vyšší u pacientů s AKS než u kontrol a pacientů se SAP (p < 0,001), přičemž rozdíl mezi skupinami kontrol a pacientů se SAP nebyl statisticky významný. Při srovnání podskupin s AKS nebyly průměrné hodnoty ligandu sCD40 statisticky významné. U pacientů s AKS ani se SAP nekorelovaly hodnoty ligandu sCD40 v séru s Gensiniho skóre (p > 0,05). Závěr: Naše studie neprokázala vztah mezi hodnotami ligandu sCD40 a Gensiniho skóre u pacientů s různými klinickými podtypy ICHS. Ve skupině s AKS byly hodnoty ligandu sCD40 statisticky významně vyšší než v ostatních skupinách, ale v případě podskupin AKS nebyly statisticky významné rozdíly nalezeny. Z tohoto zjištění lze vyvozovat, že zvýšené hodnoty ligandu sCD40 by mohly sloužit jako ukazatel nestabilních plátů před rupturou a rozvojem nekrózy myokardu.
Objectives: Previous studies have suggested that atherosclerosis is a chronic inflammatory disease and implicate components of the immune system in atherogenesis. The CD40 and CD40 ligand system regulates multiple phases of the humoral and cellular immune response. Soluble CD40 (sCD40) ligand especially releases from activated platelets. Platelets are involved not only in thrombosis, but also in atherosclerotic lesion formation and restenosis processes. The aim of our study is to evaluate whether there is a relationship between the level of sCD40 ligand and angiographic extent and severity of coronary artery disease (CAD) and to compare other cardiovascular risk factors. Methods: 102 participants were included in our study. Among them, 37 patients constituted acute coronary syndrome (ACS) group, 41 patients were diagnosed as stable angina pectoris group (SAP), while 24 subjects served as control group. Peripheral venous blood samples were drawn at the Coronary Care Unit admission of ACS group patients. From SAP group patients and controls who have normal coronary arteries, blood samples collected after coronary angiography. The Gensini score was computed for each patient by assigning the severity score to each coronary stenosis in accordance with the degree of the vessel narrowing and its geographic importance. Results: Mean serum sCD40 ligand level was significantly higher in patients with ACS than the controls and SAP patients (p <0.001), there was no significant difference between SAP and control groups. Mean sCD40 ligand levels were not significantly different, when we compared ACS subgroups. Both in ACS and SAP patients, serum sCD40 ligand levels were not correlated with Gensini scores (p >0.05). Conclusion: Our study doesn’t show relation between sCD40 ligand levels and Gensini scores in patients with different clinical sub-types of CAD. In ACS group sCD40 ligand levels were significantly higher than in other groups, but there was no significant difference between ACS sub-groups. This finding suggests that increased sCD40 ligand levels can be used as a marker for determining the unstable plaque before ruptured and occurring myocardial necrosis.
- MeSH
- akutní koronární syndrom * krev MeSH
- koronární angiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligand CD40 * krev MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- senioři MeSH
- stabilní angina pectoris krev MeSH
- statistika jako téma MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- Geografické názvy
- Turecko MeSH
Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.
- MeSH
- akutní koronární syndrom krev farmakoterapie MeSH
- anticholesteremika škodlivé účinky terapeutické užití MeSH
- ateroskleróza krev farmakoterapie MeSH
- ezetimib škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- lipidy krev MeSH
- management nemoci MeSH
- PCSK9 inhibitory škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. METHODS: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. RESULTS: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths ( P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events ( P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined with achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). CONCLUSIONS: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01663402.
- MeSH
- akutní koronární syndrom krev farmakoterapie mortalita MeSH
- dvojitá slepá metoda MeSH
- humanizované monoklonální protilátky aplikace a dávkování MeSH
- hypercholesterolemie krev farmakoterapie mortalita MeSH
- injekce subkutánní MeSH
- kombinovaná farmakoterapie MeSH
- LDL-cholesterol antagonisté a inhibitory krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- senioři MeSH
- statiny aplikace a dávkování 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
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Studie ODYSSEY OUTCOMES hodnotila vliv léčby alirocumabem na vývoj kardiovaskulární (KV) mortality/morbidity u pacientů po akutním koronárním syndromu. Značná část pacientů utrpí po první kardiovaskulární příhodě další, často opakovaně. Tímto problémem se zabývá předem specifikovaná analýza studie ODYSSEY OUTCOMES a nově dokládá, že: při hodnocení celkového počtu příhod vynikne přínos léčby alirocumabem, která zabrání více než dvojnásobnému množství opakovaných příhod v porovnání s prvními příhodami; existuje silná asociace mezi výskytem nefatálních příhod a rizikem úmrtí; léčebný účinek byl výraznější u pacientů s vyšším vstupním LDL-cholesterolem (≥ 2,6 mmol/l); snížení výskytu nefatálních KV příhod a úmrtí se jeví vhodnějším kritériem posouzení klinického přínosu a účinnosti léčby alirocumabem; po normalizaci na dobu sledování zabránila léčba alirocumabem výskytu 7,2 první příhody, avšak celkový počet příhod, kterým léčba alirocumabem zabránila (tj. opakované příhody), byl ještě vyšší, a to 14,6 příhody na 1 000 pacientoroků léčby.
The ODYSSEY OUTCOMES study evaluated the effect of therapy with alirocumab on the development of cardio-vascular (CV) mortality/morbidity in patients after acute coronary syndrome. Substantial part of these patients suffers a subsequent cardiovascular event after the first, and this often happens on repeated occasions. This pro-blem was approached with an analysis in the ODYSSEY OUTCOMES study specified in advance, and its results bring new evidence6 that:– when the total number of events is evaluated the benefit of therapy with alirocumab comes to the fore, the thera-py preventing more than double the number of repeated events in comparison with first events;– there is a strong association between the occurrence of nonfatal events and the risk of death;– the treatment effect is more pronounced in patients with higher baseline LDL-cholesterol (≥ 2,6 mmol/l);– the reduced occurrence rate of nonfatal CV events and deaths appears to be a more suitable criterion to assess the clinical benefit and efficacy of therapy with alirocumab;– after normalization to the follow-up time therapy with alirocumab prevented the occurrence of 7.2 first events, but the total number of events prevented by alirocumab (i.e. repeated events) was still higher, namely 14.6 events for 1,000 patient-years of treatment.
- MeSH
- akutní koronární syndrom farmakoterapie komplikace krev MeSH
- anticholesteremika MeSH
- ateroskleróza komplikace MeSH
- humanizované monoklonální protilátky terapeutické užití MeSH
- hypercholesterolemie farmakoterapie MeSH
- kardiovaskulární nemoci etiologie mortalita prevence a kontrola MeSH
- LDL-cholesterol účinky léků MeSH
- lidé MeSH
- PCSK9 inhibitory MeSH
- proproteinkonvertasa subtilisin/kexin typu 9 MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- adaptivní imunita MeSH
- akutní koronární syndrom krev diagnóza terapie MeSH
- antigeny CD44 genetika MeSH
- antikoagulancia terapeutické užití MeSH
- aterosklerotický plát komplikace MeSH
- biologické markery krev MeSH
- časná diagnóza MeSH
- diagnostické techniky kardiovaskulární MeSH
- duální protidestičková léčba MeSH
- exprese genu MeSH
- GPI-vázané proteiny genetika MeSH
- hodnocení rizik MeSH
- hyaluronoglukosaminidasa genetika MeSH
- hypolipidemika terapeutické užití MeSH
- infarkt myokardu klasifikace diagnóza terapie MeSH
- koronární angioplastika metody MeSH
- lidé MeSH
- magnetická rezonance kinematografická MeSH
- molekuly buněčné adheze genetika MeSH
- oxygenoterapie MeSH
- přirozená imunita MeSH
- remodelace cév MeSH
- ruptura MeSH
- sexuální faktory MeSH
- srdce diagnostické zobrazování MeSH
- statiny terapeutické užití MeSH
- stenty MeSH
- takotsubo kardiomyopatie klasifikace diagnóza mortalita MeSH
- transportní proteiny krev MeSH
- troponin krev MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Cardiovascular diseases are the most common cause of mortality and morbidity in most populations. As the traditional modifiable risk factors (smoking, hypertension, dyslipidemia, diabetes mellitus, and obesity) were defined decades ago, we decided to analyze recent data in patients who survived acute coronary syndrome (ACS). The Czech part of the study included data from 999 males, and compared them with the post-MONICA study (1,259 males, representing general population). The Lithuanian study included 479 male patients and 456 age-matched controls. The Kazakhstan part included 232 patients and 413 controls. In two countries, the most robust ACS risk factor was smoking (OR 3.85 in the Czech study and 5.76 in the Lithuanian study), followed by diabetes (OR 2.26 and 2.07) and hypertension (moderate risk elevation with OR 1.43 and 1.49). These factors did not influence the ACS risk in Kazakhstan. BMI had no significant effect on ACS and plasma cholesterol was surprisingly significantly lower (P<0.001) in patients than in controls in all countries (4.80+/-1.11 vs. 5.76+/-1.06 mmol/l in Czechs; 5.32+/-1.32 vs. 5.71+/-1.08 mmol/l in Lithuanians; 4.88+/-1.05 vs. 5.38+/-1.13 mmol/l in Kazakhs/Russians). Results from our study indicate substantial heterogeneity regarding major CVD risk factors in different populations with the exception of plasma total cholesterol which was inversely associated with ACS risk in all involved groups. These data reflect ethnical and geographical differences as well as changing pattern of cardiovascular risk profiles.
- MeSH
- akutní koronární syndrom krev diagnóza epidemiologie MeSH
- cholesterol krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Kazachstán MeSH
- Litva MeSH
BACKGROUND: Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. RESULTS: Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications. Special attention was paid to the benefits of CMR in determining the final diagnosis. In total, 136 patients who underwent coronary angiography for chest pain were analysed. The most frequent underlying causes were myocarditis (38%) and perimyocarditis (18%), followed by angiographically unrecognised acute myocardial infarction (18%) and Takotsubo cardiomyopathy (15%). The final diagnosis remained unclear in 6% of the patients. The contribution of CMR in determining the final diagnosis determination was crucial in 57% of the patients. In another 35% of the patients, CMR confirmed the suspicion and, only 8% of the CMR examinations did not help at all and had no influence on diagnosis or treatment. CONCLUSION: CMR provided a powerful incremental diagnostic value in the cohort of patients with suspected ACS and unobstructed coronary arteries. CMR is highly recommended to be incorporated as an inalienable part of the diagnostic algorithms in these patients.
- MeSH
- akutní koronární syndrom krev diagnostické zobrazování patofyziologie MeSH
- algoritmy MeSH
- angina pectoris krev diagnostické zobrazování patofyziologie MeSH
- biologické markery krev MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- koronární angiografie * MeSH
- kritické cesty MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- nemoci koronárních tepen krev diagnostické zobrazování patofyziologie MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- troponin T krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- 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
BACKGROUND: Four strategies for very early rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. METHODS: We prospectively enrolled unselected patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction. The final diagnosis was adjudicated by 2 independent cardiologists. Hs-cTnI levels were measured at presentation and after 1 hour in a blinded fashion. We directly compared all 4 hs-cTnI-based rule-out strategies: limit of detection (LOD, hs-cTnI<2 ng/L), single cutoff (hs-cTnI<5 ng/L), 1-hour algorithm (hs-cTnI<5 ng/L and 1-hour change<2 ng/L), and the 0/1-hour algorithm recommended in the European Society of Cardiology guideline combining LOD and 1-hour algorithm. RESULTS: Among 2828 enrolled patients, acute myocardial infarction was the final diagnosis in 451 (16%) patients. The LOD approach ruled out 453 patients (16%) with a sensitivity of 100% (95% confidence interval [CI], 99.2%-100%), the single cutoff 1516 patients (54%) with a sensitivity of 97.1% (95% CI, 95.1%-98.3%), the 1-hour algorithm 1459 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%), and the 0/1-hour algorithm 1463 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8%-99.2%). Predefined subgroup analysis in early presenters (≤2 hours) revealed significantly lower sensitivity (94.2%, interaction P=0.03) of the single cutoff, but not the other strategies. Two-year survival was 100% with LOD and 98.1% with the other strategies (P<0.01 for LOD versus each of the other strategies). CONCLUSIONS: All 4 rule-out strategies balance effectiveness and safety equally well. The single cutoff should not be applied in early presenters, whereas the 3 other strategies seem to perform well in this challenging subgroup. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00470587.
- MeSH
- akutní koronární syndrom krev diagnóza mortalita MeSH
- algoritmy MeSH
- biologické markery krev MeSH
- časové faktory MeSH
- dospělí MeSH
- elektrokardiografie MeSH
- hodnocení rizik MeSH
- infarkt myokardu krev diagnóza mortalita MeSH
- Kaplanův-Meierův odhad MeSH
- lidé středního věku MeSH
- lidé MeSH
- metody pro podporu rozhodování * MeSH
- prediktivní hodnota testů MeSH
- prognóza MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sexuální faktory MeSH
- troponin I krev MeSH
- upregulace MeSH
- věkové faktory MeSH
- zdravotní stav MeSH
- Check Tag
- dospělí MeSH
- 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
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
OBJECTIVE: Vitamin D deficiency has been associated with cardiovascular disease. The aim of this study was to determine serum concentration of 25 hydroxyvitamin D (25(OH)D) in patients with acute coronary syndrome (ACS) and to assess the prognostic role of serum vitamin D level in ACS patients during 3-year follow up. METHODS: The study included 60 ACS patients hospitalized at cardiology department for ACS between March 2012 and October 2012, and 60 age- and sex-matched control patients without ACS. Standard laboratory testing and vitamin D determination were performed in all study patients. In addition, ACS patients underwent coronarography and were followed-up for 36 months of ACS for major adverse cardiac events (MACE). RESULTS: Patients with ACS had a statistically significantly lower mean 25(OH)D level as compared with control group (35.19 nmol/L vs. 58.08 nmol/L, p<0.001). The lowest mean level of 25(OH)D was recorded in diabetic patients with ACS (30.45 nmol/L). ACS patients were divided into three subgroups according to coronarography findings: single vessel, double vessel and triple vessel coronary artery disease (CAD) with respective serum levels of 25(OH)D of 36.44 nmol/L, 33.65 nmol/L and 31.70 nmol/L. During 36-month follow up, the event-free survival rate was 60% in the ACS group. The ACS patients having sustained MACE during follow up had low serum level of 25(OH)D in the acute phase; however, the difference from ACS patients without MACE during follow up did not reach statistical significance (32.64 nmol/L vs. 37.01 nmol/L). CONCLUSIONS: Patients with ACS have low vitamin D level, which is lowest in diabetic patients with ACS. However, during 3-year follow up, vitamin D failed to prove useful as a prognostic biomarker in ACS patients.
- MeSH
- akutní koronární syndrom krev epidemiologie MeSH
- dospělí MeSH
- kauzalita MeSH
- komorbidita MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhodný nález * MeSH
- následné studie MeSH
- nedostatek vitaminu D krev epidemiologie MeSH
- senioři MeSH
- vitamin D analogy a deriváty krev MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Chorvatsko epidemiologie MeSH
- MeSH
- akutní koronární syndrom * diagnóza krev MeSH
- biologické markery * krev MeSH
- embolie a trombóza krev MeSH
- fibrin-fibrinogen - produkty degradace analýza MeSH
- lidé MeSH
- natriuretické peptidy krev MeSH
- prediktivní hodnota testů MeSH
- referenční hodnoty MeSH
- senzitivita a specificita MeSH
- troponin krev MeSH
- Check Tag
- lidé MeSH