BACKGROUND: Management and treatment of severe aortic stenosis (AS) may differ considerably in European countries. To investigate these differences in France, Germany, and the UK, the IMPULSE enhanced registry was established. Previous data revealed differences in how patients were managed in specialist (hub) versus primary/secondary care (satellite) centres. METHODS: The IMPULSE enhanced registry sub-analysis aimed to determine if there were gender-specific differences for patients with severe AS at centres with and without access to intervention. RESULTS: Among the 790 patients, 594 and 196 were recruited at hub and satellite centres, respectively; 44 % of patients were female. In both settings, women were older than men (hubs: 78.7 vs. 76.2, p = 0.007; satellites: 79.8 vs. 75.1, p = 0.002). Symptoms at the presentation were comparable. Males had more often undergone previous cardiac surgery. Females had a smaller left ventricular (LV) outflow tract, smaller LV cavities, and, more often, a preserved ejection fraction (>50 %). There was no gender-based difference in time to intervention. At one year, the cumulative incidence of aortic valve replacement in females was higher than in males in hubs (p = 0.012) but not in satellites (p = 0.600); surgical AVR was more common in males in hubs only (p = 0.008), while transcatheter aortic valve implantation was more common in females in both settings (hubs: p < 0.001; satellites: p = 0.022). One-year survival was comparable in both genders, regardless of setting. CONCLUSIONS: A better understanding of gender-specific differences in patients with severe AS, according to the diagnostic setting, could improve patient stratification and earlier diagnosis.

• Klíčová slova
• Aortic stenosis, Aortic valve replacement, Europe, Gender, Intervention,
• MeSH
• aortální stenóza * epidemiologie   diagnóza   terapie   chirurgie   MeSH
• lidé MeSH
• management nemoci * MeSH
• následné studie MeSH
• pohlavní dimorfismus * MeSH
• primární zdravotní péče * trendy   MeSH
• registrace * MeSH
• sekundární péče * trendy   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• stupeň závažnosti nemoci * MeSH
• Check Tag
• 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
• Francie epidemiologie   MeSH
• Německo epidemiologie   MeSH
• Spojené království epidemiologie   MeSH

BACKGROUND: The optimal number of septal branches to target during initial alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) remains a subject of debate. It is unclear whether to proceed with ASA of additional septal branches if a satisfactory hemodynamic effect has not been achieved following ablation of the first branch. METHODS: Using propensity score matching analysis, we compared patients who achieved satisfactory outcomes after ASA of a single septal branch with those in whom additional branches were ablated. RESULTS: A total of 457 patients were included in the study, with a median follow-up of 5.61 years (interquartile range 2.08-10.91 years). Propensity score matching identified 92 pairs (184 patients), divided into the single-ablated-branch and more-ablated-branches groups. No significant differences were found in the incidence of major cardiovascular adverse events within the first 30 days between the two groups. Similarly, there were no differences in long-term outcomes between the matched single-ablated-branch and multiple-ablated-branches groups regarding all-cause mortality (3.77 vs.2.90 deaths per 100 patient-years, log-rank p = 0.649), re-intervention rates (12 % vs. 8 %; log-rank p = 0.345), left ventricular outflow gradient (14 ± 13 mmHg vs. 16 ± 15 mmHg; p = 0.209), or NYHA functional class (1.7 ± 0.6 vs. 1.6 ± 0.7; p = 0.629). CONCLUSIONS: In both short- and long-term follow-ups, ASA targeting single or multiple septal branches showed comparable efficacy and safety in patients with hypertrophic obstructive cardiomyopathy.

• Klíčová slova
• Alcohol ablation, Hypertrophic cardiomyopathy, Obstruction, Symptoms,
• MeSH
• ablace * metody   MeSH
• ethanol * aplikace a dávkování   MeSH
• hypertrofická kardiomyopatie * chirurgie   diagnostické zobrazování   diagnóza   patofyziologie   mortalita   MeSH
• katetrizační ablace * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční septum * chirurgie   diagnostické zobrazování   MeSH
• tendenční skóre 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
• srovnávací studie MeSH
• Názvy látek
• ethanol * MeSH

BACKGROUND AND AIMS: Myocardial infarction (MI) in multivessel disease (MVD) and chronic total occlusion (CTO) is associated with high mortality. However, all-cause mortality of matched cohort without a CTO is unclear. Our aim was to analyse clinical characteristics, presenting symptoms, and survival of patients with MI in MVD and the possible impact of CTO on 1-year mortality. METHODS: All MI patients with MVD (two or three vessel disease) hospitalized in our center from January 2020 to September 2022 (1309 patients) were selected. We conducted a propensity score matching (PSM) analysis based on age, gender, type of MI, and compared patients with CTO (CTO group, n = 90) and without CTO (Control group, n = 90). RESULTS: We observed no difference in presenting clinical symptoms and initial heart rhythm between the groups. 1-year follow-up shows all-cause mortality rate of 23.3 % (n = 21) in the CTO group (Mean survival [MS] = 292.1 days, 95 % CI = 263.8 to 320.4) and 18.9 % (n = 17) in the Control group (MS = 310.2 days, 95 % CI = 285.3 to 335.2), p = 0.44. PCI alone was performed in 64.4 % (n = 58) in both groups, CABG in 18.8 % (n = 17) and 24.4 % (n = 22) (CTO vs. Control group respectively). Combination of PCI and CABG occurred in 8.8 % (n = 8) in both groups. Conservative treatment was chosen for 7 CTO and 2 Control group patients. CONCLUSION: We observed no 1-year mortality difference in patients with MI, MVD and a CTO compared to a matched cohort of patients with MI, MVD without CTO. Excellent 1-year survival was observed in patients treated by CABG, irrespective of CTO presence.

• Klíčová slova
• Chronic total occlusion, Multivessel disease, Myocardial infarction, Percutaneous coronary intervention,
• MeSH
• chronická nemoc MeSH
• infarkt myokardu * mortalita   diagnóza   MeSH
• kohortové studie MeSH
• koronární angioplastika metody   MeSH
• koronární okluze * diagnóza   mortalita   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• následné studie MeSH
• nemoci koronárních tepen mortalita   diagnóza   chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tendenční skóre MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• Genetics, Hypertrophic cardiomyopathy, Inheritance, Outcomes,
• MeSH
• hypertrofická kardiomyopatie * genetika   diagnóza   MeSH
• lidé MeSH
• mutace * MeSH
• prediktivní hodnota testů MeSH
• sarkomery * genetika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• úvodníky MeSH

OBJECTIVE: Management of patients with severe aortic stenosis (AS) may differ according to the patient sex. This study aimed to describe patterns of aortic valve replacement (AVR) for severe AS across Europe, including stratification by sex. METHODS: Procedure volume data for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) for six years (2015-2020) were extracted from national databases for Austria, Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland and stratified by sex. Patients per million population (PPM) undergoing AVR per year were calculated using population estimates from Eurostat. RESULTS: Between 2015 and 2019, AVR procedures grew at an average annual rate of 3.9%. In 2020, the average total PPM undergoing AVR across all countries was 339, with 51% of procedures being TAVI and 49% SAVR. AVR PPM varied widely between countries, with the highest and lowest in Germany and Poland, respectively. The average total PPM was higher for men than women (423 vs. 258), but a higher proportion of women (62%) than men (44%) received TAVI. The proportion of TAVI among total AVR procedures increased with age, with an overall average of 96% of men and 98% of women aged ≥85 years receiving TAVI; however, adoption of TAVI varied by country. CONCLUSIONS: The analysis of temporal trends in the adoption of TAVI vs. SAVR across Europe showed significant variations. Despite the higher use of TAVI vs. SAVR in women, overall rates of AV intervention in women were lower compared to men.

• Klíčová slova
• Aortic valve replacement, Europe, Sex, Transcatheter aortic valve implantation,
• MeSH
• aortální chlopeň chirurgie   MeSH
• aortální stenóza * chirurgie   epidemiologie   MeSH
• chirurgická náhrada chlopně trendy   statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• transkatetrální implantace aortální chlopně trendy   statistika a číselné údaje   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
• Evropa epidemiologie   MeSH

BACKGROUND: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta. METHODS: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments. RESULTS: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060). CONCLUSION: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04831073.

• Klíčová slova
• Aortic dissection, Diameter, Genetic syndrome, Loeys-Dietz syndrome, Marfan syndrome, Reoperation, Size, Type A aortic dissection, Vascular Ehlers-Danlos syndrome,
• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta abdominalis diagnostické zobrazování   chirurgie   MeSH
• aortální aneurysma * chirurgie   MeSH
• azidy * MeSH
• cévy - implantace protéz * škodlivé účinky   MeSH
• deoxyglukosa analogy a deriváty   MeSH
• disekce aorty * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• 1,3,4,6-tetra-O-acetyl-2-azido-2-deoxyglucopyranose MeSH Prohlížeč
• azidy * MeSH
• deoxyglukosa MeSH

• MeSH
• hypertrofická kardiomyopatie * komplikace   diagnóza   MeSH
• lidé MeSH
• náhlá srdeční smrt epidemiologie   etiologie   MeSH
• rizikové faktory MeSH
• umělá inteligence * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodníky MeSH

BACKGROUND: Anderson-Fabry disease (AFD) is an X-linked inherited lysosomal disease caused by a defect in the gene encoding lysosomal enzyme α-galactosidase A (GLA). Atrio-ventricular (AV) nodal conduction defects and sinus node dysfunction are common complications of the disease. It is not fully elucidated how frequently AFD is responsible for acquired AV block or sinus node dysfunction and if some AFD patients could manifest primarily with spontaneous bradycardia in general population. The purpose of study was to evaluate the prevalence of AFD in male patients with implanted permanent pacemaker (PM). METHODS: The prospective multicentric screening in consecutive male patients between 35 and 65 years with implanted PM for acquired third- or second- degree type 2 AV block or symptomatic second- degree type 1 AV block or sinus node dysfunction was performed. RESULTS: A total of 484 patients (mean age 54 ± 12 years at time of PM implantation) were enrolled to the screening in 12 local sites in Czech Republic. Out of all patients, negative result was found in 481 (99%) subjects. In 3 cases, a GLA variant was found, classified as benign: p.Asp313Tyr, p.D313Y). Pathogenic GLA variants (classical or non-classical form) or variants of unclear significance were not detected. CONCLUSION: The prevalence of pathogenic variants causing AFD in a general population sample with implanted permanent PM for AV conduction defects or sinus node dysfunction seems to be low. Our findings do not advocate a routine screening for AFD in all adult males with clinically significant bradycardia.

• Klíčová slova
• Bradycardia, Fabry disease, Permanent pacing, Screening,
• MeSH
• atrioventrikulární blokáda * diagnóza   epidemiologie   terapie   MeSH
• bradykardie komplikace   terapie   MeSH
• dospělí MeSH
• Fabryho nemoc * diagnóza   epidemiologie   genetika   MeSH
• kardiostimulátor * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• syndrom chorého sinu diagnóza   epidemiologie   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE), but data about characterization and prognosis of IE in CHD patients is scarce. METHODS: The ESC-EORP-EURO-ENDO study is a prospective international study in IE patients (n = 3111). In this pre-specified analysis, adult CHD patients (n = 365, 11.7%) are described and compared with patients without CHD (n = 2746) in terms of baseline characteristics and mortality. RESULTS: CHD patients (73% men, age 44.8 ± 16.6 years) were younger and had fewer comorbidities. Of the CHD patients, 14% had a dental procedure before hospitalization versus 7% in non-CHD patients (p < 0.001) and more often had positive blood cultures for Streptococcus viridans (16.4% vs 8.8%, p < 0.001). As in non-CHD patients, IE most often affected the left-sided valves. For CHD patients, in-hospital mortality was 9.0% vs 18.1% in non-CHD patients (p < 0.001), and also, during the entire follow-up of 700 days, survival was more favorable (log-rank p < 0.0001), even after adjustment for age, gender and major comorbidities (Hazard Ratio (HR) 0.68; 95%CI 0.50-0.92). Within the CHD population, multivariable Cox regression revealed the following effects (HR and [95% CI]) on mortality: fistula (HR 6.97 [3.36-14.47]), cerebral embolus (HR 4.64 [2.08-10.35]), renal insufficiency (HR 3.44 [1.48-8.02]), Staphylococcus aureus as causative agent (HR 2.06 [1.11-3.81]) and failure to undertake surgery when indicated (HR 5.93 [3.15-11.18]). CONCLUSIONS: CHD patients with IE have a better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE warrants further studies about the current use, need and efficacy of antibiotic prophylaxis in CHD patients.

• Klíčová slova
• Adult congenital heart disease, Endocarditis,
• MeSH
• bakteriální endokarditida * diagnóza   epidemiologie   komplikace   MeSH
• dospělí MeSH
• endokarditida * diagnóza   epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• vrozené srdeční vady * komplikace   diagnóza   epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• hypertrofická kardiomyopatie * diagnóza   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• úvodníky MeSH