OBJECTIVE: To assess the effect of ramipril on indicators of glucose metabolism, incl. insulin resistance, on renal function with microalbuminuria, changes of some echocardiographic signs of hypertrophy and compliance of the left ventricle in patients with hypertension and type II diabetes mellitus. MATERIAL AND METHODS: The authors examined 32 patients with hypertension grade I and II and with diabetes type II, who had ramipril, 2.5-10 mg/day, for a period of six months. The examination before and after long-term treatment comprised basic biochemical sampling incl. concentrations of immunoreactive insulin, C-peptide and glycated haemoglobin and also complete functional examination of the kidneys, incl. microalbuminuria. Echocardiographic examination was focused on assessment of signs of hypertrophy and compliance of the left ventricle. Treatment of diabetes was not changed in the course of 6 months. RESULTS: In addition to the anticipated drop of blood pressure a declining trend of insulin resistance was recorded, there was a significant decline of microalbuminuria and a rise of natriuresis, the left ventricle mass declined and its compliance improved. CONCLUSION: Ramipril one of the inhibitors of angiotensin converting enzyme is an effective and useful medication for type II diabetics suffering from hypertension.

• MeSH
• albuminurie MeSH
• antihypertenziva farmakologie   MeSH
• diabetes mellitus 2. typu krev   komplikace   patofyziologie   MeSH
• dospělí MeSH
• funkce levé komory srdeční účinky léků   MeSH
• hypertenze komplikace   farmakoterapie   patofyziologie   MeSH
• inhibitory ACE farmakologie   MeSH
• inzulinová rezistence MeSH
• krevní glukóza účinky léků   MeSH
• ledviny účinky léků   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuréza účinky léků   MeSH
• ramipril farmakologie   MeSH
• senioři MeSH
• srdce účinky léků   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• Názvy látek
• antihypertenziva MeSH
• inhibitory ACE MeSH
• krevní glukóza MeSH
• ramipril MeSH

OBJECTIVE: The aim of this study was to evaluate the impact of the optimal diabetes control on the left ventricular parameters and ambulatory blood pressure in women with gestational diabetes mellitus (GDM). METHODS: The patients with GDM were followed up according to predetermined protocol in order to optimize blood glucose and optimal weight gain. Ambulatory blood pressure monitoring (ABPM) and transthoracal and tissue echocardiography were examined in 36th week of pregnancy. RESULTS: The age of 35 women with GDM was 33.1±3 and 30.5±4.4 years in 31 healthy control subjects (p=0.2). Fasting plasma glucose (FPG) in the patients with GDM was 5.0±0.5 mmol/L compared to 4.6±0.3 mmol/L in control subjects (p=0.002). Average weight gain during pregnancy was significantly lower in women with GDM; 10±7.6 kg vs. 13.1±3.7 kg in healthy pregnant women (p=0.05). No significant differences were recorded in 24 hours mean heart rate, systolic and diastolic blood pressure and number of nondippers between both groups. The significant correlation was detected between FPG and blood pressure dipping in subjects with GDM. Interventricular septal, posterior wall and relative wall thickness of the left ventricle were significantly higher in patients with GDM comparing to healthy pregnant women but no significant differences of the left ventricular functions were recorded. CONCLUSION: The optimal control of diabetes in GDM is associated with normal 24 hours blood pressure profile and prevention of the left ventricular function changes in GDM patients. The differences in the left ventricular walls thicknesses may be explained by metabolic changes in GDM.

• MeSH
• ambulantní monitorování krevního tlaku MeSH
• časové faktory MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• gestační diabetes patofyziologie   MeSH
• krevní glukóza analýza   MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• remodelace komor fyziologie   MeSH
• srdeční frekvence fyziologie   MeSH
• srdeční komory patologie   MeSH
• těhotenství MeSH
• třetí trimestr těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• krevní glukóza MeSH

UNLABELLED: The case study describes a case of 49-year-old man with morbid obesity since childhood (BMI 40 kg/m2), arterial hypertension (approx. since aged 15, treated since 2004), dyslipidemia (since 2006), type 2 diabetes mellitus (since 2006, on insulin therapy since 2008) and smoking (until 2011, 20 cigarettes a day). TREATMENT: 16 types of medication, 8 for hypertension, statin, therapy for diabetes, aspirin, allopurinol. In 2010 (when aged 45) hospitalized in our clinic with dyspnoea and chest pain with a high pressure reading of 180/110 mm Hg (identified symptoms of heart failure with LV ejection fraction of 33 %, in NYHA II functional class, echocardiographically: left atrium: 46 mm, left ventricular chamber size in diastole: 70 mm, interventricular septum: 12 mm, septal hypokinesis, Doppler ultrasonography of lower limb arteries (calcification, diffuse atherosclerotic changes, absent stenosis), CT coronary angiography (significant stenosis of the left coronary artery). Treatment started with 40 mg oral dose of furosemide daily. In May 2011 he was hospitalized with an acute coronary syndrome: acute NSTEMI of the inferior wall (coronarography: 2-vascular problems, implemented PKI, implanted DES - ramus circumflexus, paroxysmal atrial fibrillation, NYHA III functional class, left ventricular ejection fraction: 30 %, pulmonary hypertension). In 2012 renal denervation for resistant hypertension was carried out, carotid stent implanted for stenosis of the carotid artery, presence of diabetic nephropathy (KDOQI stage 3, GF 40 ml/min). In August 2014 admitted to our clinic with pulmonary oedema, cardiogenic shock, acute ischemia of the right calf with peripheral embolisation, presence of atrial flutter, impairment of renal parameters, echocardiographically: left atrium: 55 mm, left ventricle size: 75 mm, akinesis of the septum and posterior wall, occlusion of the right leg arteries (given the patients serious state angio-surgical intervention was contraindicated, vitally indicated leg amputation considered), the patient died after 4 days of hospitalization in an intensive care unit after unsuccessful treatment. A combination of diabetes, hypertension and ischemic heart disease is frequent and prognostically serious. Diabetes increases cardiovascular morbidity and mortality and therefore we should check for diabetes in all cardiovascular patients.

• MeSH
• diabetes mellitus 2. typu etiologie   MeSH
• funkce levé komory srdeční * MeSH
• hypertenze komplikace   patofyziologie   MeSH
• ischemická choroba srdeční komplikace   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Epidemiological studies show that maternal diabetes predisposes offspring to cardiovascular and metabolic disorders. However, the precise mechanisms for the underlying penetrance and disease predisposition remain poorly understood. We examined whether hypoxia-inducible factor 1 alpha, in combination with exposure to a diabetic intrauterine environment, influences the function and molecular structure of the adult offspring heart. METHODS AND RESULTS: In a mouse model, we demonstrated that haploinsufficient (Hif1a+/-) offspring from a diabetic pregnancy developed left ventricle dysfunction at 12 weeks of age, as manifested by decreased fractional shortening and structural remodeling of the myocardium. Transcriptional profiling by RNA-seq revealed significant transcriptome changes in the left ventricle of diabetes-exposed Hif1a+/- offspring associated with development, metabolism, apoptosis, and blood vessel physiology. In contrast, both wild type and Hif1a+/- offspring from diabetic pregnancies showed changes in immune system processes and inflammatory responses. Immunohistochemical analyses demonstrated that the combination of haploinsufficiency of Hif1a and exposure to maternal diabetes resulted in impaired macrophage infiltration, increased levels of advanced glycation end products, and changes in vascular homeostasis in the adult offspring heart. CONCLUSIONS: Together our findings provide evidence that a global reduction in Hif1a gene dosage increases predisposition of the offspring exposed to maternal diabetes to cardiac dysfunction, and also underscore Hif1a as a critical factor in the fetal programming of adult cardiovascular disease.

• Klíčová slova
• Echocardiography, Fetal programming, Heart remodelling, Hif1a haploinsufficiency, Maternal diabetes,
• MeSH
• experimentální diabetes mellitus komplikace   metabolismus   patologie   MeSH
• faktor 1 indukovatelný hypoxií - podjednotka alfa genetika   metabolismus   MeSH
• funkce levé komory srdeční MeSH
• gestační diabetes * metabolismus   patologie   MeSH
• haploinsuficience MeSH
• interakce genů a prostředí MeSH
• kardiovaskulární nemoci genetika   metabolismus   patologie   patofyziologie   MeSH
• mutace * MeSH
• myokard metabolismus   patologie   MeSH
• myši knockoutované MeSH
• remodelace komor MeSH
• rizikové faktory MeSH
• těhotenství MeSH
• vývojová regulace genové exprese MeSH
• zpožděný efekt prenatální expozice * MeSH
• zvířata MeSH
• Check Tag
• těhotenství MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• faktor 1 indukovatelný hypoxií - podjednotka alfa MeSH
• Hif1a protein, mouse MeSH Prohlížeč

This study was undertaken to examine the effects of dietary supplementation of cysteine and taurine in rats with diabetes induced with streptozotocin (STZ, 65 mg/kg body weight). Experimental animals were treated orally (by gavage) with cysteine (200 mg/kg) and taurine (400 mg/kg), alone or in combination, daily for 8 weeks. In one group, rats were also pretreated 3 weeks before the induction of diabetes (prevention arm) whereas in the other, the treatment was started 3 days after the induction of diabetes (reversal arm). Diabetes increased heart weight/body weight (HW/BW) ratio, plasma glucose, triglyceride and cholesterol levels as well as depressed heart rate (HR), blood pressure, left ventricular systolic pressure (LVSP), rate of contraction (+dP/dt), rate of relaxation (-dP/dt), fractional shortening (FS) and cardiac output (CO). The left ventricular internal diameter in systole (LViDs) was increased whereas that in diastole (LViDd) was decreased. In the prevention arm, treatment of the diabetic animals with cysteine or taurine decreased HW/BW ratio and improved HR, FS, +dP/dt and -dP/dt, as well as normalized LViDs, without altering the increase in glucose level. Cysteine decreased plasma triglyceride and cholesterol levels and improved LVSP whereas CO was improved by taurine. In the reversal arm, cysteine alone or with taurine did not correct the changes in hemodynamic parameters, FS and plasma triglycerides. Diabetes-induced cardiac dysfunction and increases in plasma triglycerides can be prevented, but not reversed, by dietary cysteine alone or in combination with taurine.

• MeSH
• cholesterol krev   MeSH
• cystein terapeutické užití   MeSH
• diabetická kardiomyopatie diagnostické zobrazování   prevence a kontrola   MeSH
• experimentální diabetes mellitus komplikace   MeSH
• funkce levé komory srdeční účinky léků   MeSH
• funkce pravé komory srdeční účinky léků   MeSH
• hemodynamika účinky léků   fyziologie   MeSH
• inzulin krev   MeSH
• kardiotonika * MeSH
• kombinovaná farmakoterapie MeSH
• krysa rodu Rattus MeSH
• minutový srdeční výdej účinky léků   MeSH
• potkani Sprague-Dawley MeSH
• taurin terapeutické užití   MeSH
• triglyceridy krev   MeSH
• ultrasonografie MeSH
• velikost orgánu MeSH
• zvířata MeSH
• Check Tag
• krysa rodu Rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• cholesterol MeSH
• cystein MeSH
• inzulin MeSH
• kardiotonika * MeSH
• taurin MeSH
• triglyceridy MeSH

Impaired flow through the mitral orifice in diastole is frequently encountered in patients with IHD, hypertension, cardiomyopathies and type II diabetes. The authors examined 40 type I diabetics, age 26 +/- 5.5 years, with a duration of diabetes of 15.8 +/- 7.5 years. The control group was formed by 40 non-diabetic patients comparable as to age and sex. 7.5 years. The control group was formed by 40 non-diabetic patients comparable as to age and sex. During Doppler echocardiography the ratio of early and late peak flow velocity through the mitral orifice (A/E) was evaluated and the time of isovolumic relaxation of the left ventricle (IVRT). The investigated values of A/E and IVRT were higher in diabetics than in controls (p < 0.001). Diabetics with positive microalbuminuria had higher A/E and IVRT values than diabetic with normal microalbuminuria. No relationship was found with the duration of diabetes but there is a relationship of the investigated values and compensation of diabetes (p < 0.05). At a check-up examination after six months no change of the investigated parameters was observed. The authors assume that Doppler echocardiography could become in future a non-invasive method for assessment of late complications of diabetes.

• MeSH
• albuminurie MeSH
• diabetes mellitus 1. typu diagnostické zobrazování   patofyziologie   moč   MeSH
• dopplerovská echokardiografie * MeSH
• dospělí MeSH
• funkce levé komory srdeční * MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The sodium-glucose cotransporter 2 inhibitor empagliflozin reduces the risk of cardiovascular death or heart failure hospitalization in patients with chronic heart failure, but whether empagliflozin also improves clinical outcomes when initiated in patients who are hospitalized for acute heart failure is unknown. In this double-blind trial (EMPULSE; NCT04157751 ), 530 patients with a primary diagnosis of acute de novo or decompensated chronic heart failure regardless of left ventricular ejection fraction were randomly assigned to receive empagliflozin 10 mg once daily or placebo. Patients were randomized in-hospital when clinically stable (median time from hospital admission to randomization, 3 days) and were treated for up to 90 days. The primary outcome of the trial was clinical benefit, defined as a hierarchical composite of death from any cause, number of heart failure events and time to first heart failure event, or a 5 point or greater difference in change from baseline in the Kansas City Cardiomyopathy Questionnaire Total Symptom Score at 90 days, as assessed using a win ratio. More patients treated with empagliflozin had clinical benefit compared with placebo (stratified win ratio, 1.36; 95% confidence interval, 1.09-1.68; P = 0.0054), meeting the primary endpoint. Clinical benefit was observed for both acute de novo and decompensated chronic heart failure and was observed regardless of ejection fraction or the presence or absence of diabetes. Empagliflozin was well tolerated; serious adverse events were reported in 32.3% and 43.6% of the empagliflozin- and placebo-treated patients, respectively. These findings indicate that initiation of empagliflozin in patients hospitalized for acute heart failure is well tolerated and results in significant clinical benefit in the 90 days after starting treatment.

• MeSH
• benzhydrylové sloučeniny škodlivé účinky   MeSH
• diabetes mellitus 2. typu * farmakoterapie   MeSH
• dvojitá slepá metoda MeSH
• funkce levé komory srdeční MeSH
• glifloziny * škodlivé účinky   MeSH
• glukosidy MeSH
• hospitalizace MeSH
• lidé MeSH
• srdeční selhání * MeSH
• tepový objem MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• benzhydrylové sloučeniny MeSH
• empagliflozin MeSH Prohlížeč
• glifloziny * MeSH
• glukosidy MeSH

BACKGROUND: Maternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls. METHODS: In this prospective, longitudinal case-control study - including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women - fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors - including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) - were analyzed across three time periods: the last menstrual period to 13 (V1), 14-22 (V2), and 23-32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed. RESULTS: At 28-32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18-22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28-32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester. CONCLUSION: In women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.

• Klíčová slova
• Diabetes, Echocardiography, Fetal hemodynamics, Glucose control, Hyperglycemia, Hypoglycemia,
• MeSH
• diabetes mellitus 1. typu * komplikace   MeSH
• dopplerovská echokardiografie MeSH
• fetální srdce diagnostické zobrazování   MeSH
• gestační diabetes * MeSH
• glykovaný hemoglobin MeSH
• hemodynamika MeSH
• krevní glukóza MeSH
• lidé MeSH
• longitudinální studie MeSH
• prospektivní studie MeSH
• studie případů a kontrol MeSH
• syndrom Nijmegen breakage * MeSH
• těhotenství MeSH
• ultrasonografie prenatální MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• glykovaný hemoglobin MeSH
• krevní glukóza MeSH

BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) are glucose-lowering agents used for the treatment of type 2 diabetes mellitus, which also improve heart failure and decrease the risk of cardiovascular complications. Epicardial adipose tissue (EAT) dysfunction was suggested to contribute to the development of heart failure. We aimed to elucidate a possible role of changes in EAT metabolic and inflammatory profile in the beneficial cardioprotective effects of SGLT-2i in subjects with severe heart failure. METHODS: 26 subjects with severe heart failure, with reduced ejection fraction, treated with SGLT-2i versus 26 subjects without treatment, matched for age (54.0 ± 2.1 vs. 55.3 ± 2.1 years, n.s.), body mass index (27.8 ± 0.9 vs. 28.8 ± 1.0 kg/m2, n.s.) and left ventricular ejection fraction (20.7 ± 0.5 vs. 23.2 ± 1.7%, n.s.), who were scheduled for heart transplantation or mechanical support implantation, were included in the study. A complex metabolomic and gene expression analysis of EAT obtained during surgery was performed. RESULTS: SGLT-2i ameliorated inflammation, as evidenced by the improved gene expression profile of pro-inflammatory genes in adipose tissue and decreased infiltration of immune cells into EAT. Enrichment of ether lipids with oleic acid noted on metabolomic analysis suggests a reduced disposition to ferroptosis, potentially further contributing to decreased oxidative stress in EAT of SGLT-2i treated subjects. CONCLUSIONS: Our results show decreased inflammation in EAT of patients with severe heart failure treated by SGLT-2i, as compared to patients with heart failure without this therapy. Modulation of EAT inflammatory and metabolic status could represent a novel mechanism behind SGLT-2i-associated cardioprotective effects in patients with heart failure.

• Klíčová slova
• Adipose tissue, Ether lipids, Heart failure, Inflammation, Sodium-glucose cotransporter 2 inhibitors,
• MeSH
• antiflogistika terapeutické užití   farmakologie   MeSH
• biologické markery krev   MeSH
• diabetes mellitus 2. typu farmakoterapie   metabolismus   diagnóza   MeSH
• epikardiální adipózní tkáň MeSH
• funkce levé komory srdeční účinky léků   MeSH
• glifloziny * terapeutické užití   farmakologie   škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediátory zánětu * metabolismus   MeSH
• metabolomika MeSH
• perikard * metabolismus   účinky léků   MeSH
• srdeční selhání * metabolismus   patofyziologie   farmakoterapie   MeSH
• stupeň závažnosti nemoci * MeSH
• tepový objem účinky léků   MeSH
• tuková tkáň * účinky léků   metabolismus   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• antiflogistika MeSH
• biologické markery MeSH
• glifloziny * MeSH
• mediátory zánětu * MeSH

BACKGROUND: The increased diuresis after sodium-glucose cotransporter 2 inhibitor (SGLT2i) was associated with a reduction of the estimated plasma volume (ePV) in type 2 diabetic patients. HYPOTHESIS: We hypothesized that the early effect of SGLT2i on ePV may be monitored by the change of biomarkers of hemoconcentration. PATIENTS AND METHODS: We analyzed the early- and long-term effect of SGLT2i empagliflozin on the ePV as assessed by biomarkers of hemoconcentration in a nondiabetic patient with heart failure and reduced ejection fraction (HFrEF) and a nondiabetic patient with heart failure and preserved ejection fraction (HFpEF). The ePV was calculated from hemoglobin and hematocrit levels by Duarte formula and ePV change was calculated by Strauss formula. RESULTS: The ePV change was -22.56% between baseline and 1 month, and -37.60% between baseline and 12 months follow-up in a patient with HFrEF, and -6.18% and -16.40% in a patient with HFpEF, respectively. CONCLUSION: The early effect of SGLT2i on ePV in patients with heart failure may be monitored by biomarkers of hemoconcentration.

• Klíčová slova
• biomarker, heart failure, hemoconcentration, plasma volume, sodium−glucose co‐transporter‐2 inhibitor,
• MeSH
• benzhydrylové sloučeniny terapeutické užití   MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• diabetes mellitus 2. typu farmakoterapie   komplikace   krev   patofyziologie   MeSH
• funkce levé komory srdeční účinky léků   fyziologie   MeSH
• glifloziny * terapeutické užití   MeSH
• glukosidy terapeutické užití   farmakologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• objem plazmy * MeSH
• senioři MeSH
• srdeční selhání * patofyziologie   farmakoterapie   krev   MeSH
• tepový objem * fyziologie   účinky léků   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
• kazuistiky MeSH
• Názvy látek
• benzhydrylové sloučeniny MeSH
• biologické markery MeSH
• empagliflozin MeSH Prohlížeč
• glifloziny * MeSH
• glukosidy MeSH