AIM: To evaluate any differences in haemodynamic and echocardiographic parameters in patients with both left (LV) and right ventricular (RV) systolic dysfunction and in patients with isolated LV systolic dysfunction. STUDY GROUP: One hundred patients with RV systolic dysfunction defined as peak velocity of tricuspid annular motion in systole (Sa)<11.5 cm/s, and 55 patients without RV systolic dysfunction Sa>11.5 cm/s. All patients had LV systolic dysfunction, LV ejection fraction (EF) below 40%, NYHA II-IV. METHODS: LV diameters, volumes and EF were measured by echocardiography. Patients underwent tissue Doppler imaging (TDI) of tricuspid annular motion with measurement of peak systolic velocity (Sa), peak early (Ea) and peak late (Aa) diastolic velocities. Right heart catheterization was also performed. RESULTS: Patients with RV systolic dysfunction did not differ from those without RV systolic dysfunction in terms of LV function. Patients with RV systolic dysfunction had larger RV dimension 30.6+/-5.8 vs. 33.9+/-6.7 mm, p<0.002. The patients with RV systolic dysfunction had higher values on right heart catheterization: MPAP 29.6+/-12.1 vs. 24.9+/-11.4 mm Hg, p<0.02, PCWP 20.8+/-10.0 vs. 17.3+/-9.3 mm Hg, p<0.03, PVR 189.9+/-123.3 vs. 137.7+/-94.9 dyn s cm(-5), p<0.008, CVP 7.7+/-5.6 vs. 5.1+/-3.9 mm Hg, p<0.002. The patients with RV systolic dysfunction had more pronounced diastolic dysfunction measured by TDI: Ea 9.9+/-2.3 vs. 11.4+/-2.5 cm/s, p<0.0001 and Aa 13.1+/-4.0 vs. 16.5+/-4.7 cm/s, p<0.000007. CONCLUSION: Patients with heart failure and both left and right ventricular systolic dysfunction showed more serious findings on central haemodynamics as well as more pronounced right ventricular diastolic dysfunction than those with isolated left ventricular systolic dysfunction.

• MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• dysfunkce pravé srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• srdeční selhání diagnostické zobrazování   patofyziologie   MeSH
• ultrasonografie dopplerovská MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

AIMS: In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients. METHODS AND RESULTS: We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end-diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5-year follow-up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007-1.196), logBNP level (OR 2.02, CI 1.14-3.56), and PR interval (OR 1.02, CI 1.006-1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow-up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end-diastolic volume index (OR 0.97, CI 0.946-0.988), LVEF (OR 0.89, CI 0.83-0.96), and diastolic blood pressure (OR 1.04, CI 1.01-1.08) (P < 0.05 for all). CONCLUSIONS: LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5-year follow-up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.

• Klíčová slova
• Dilated cardiomyopathy, Endomyocardial biopsy, Left ventricular systolic dysfunction, Mortality, Reverse remodelling,
• MeSH
• dilatační kardiomyopatie * MeSH
• dysfunkce levé srdeční komory * komplikace   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• lidé MeSH
• prognóza MeSH
• srdeční selhání * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Left ventricular hypertrophy may be a consequence of a hemodynamic overload or a manifestation of several diseases affecting different structural and functional proteins of cardiomyocytes. Among these, sarcomeric hypertrophic cardiomyopathy (HCM) represents the most frequent cause. In addition, several metabolic diseases lead to myocardial thickening, either due to intracellular storage (glycogen storage and lysosomal diseases), extracellular deposition (TTR and AL amyloidosis) or due to abnormal energy metabolism (mitochondrial diseases). The recognition of these rare causes of myocardial hypertrophy is important for family screening strategies, risk assessment, and treatment. Moreover, as there are specific therapies for some forms of HCM including enzyme substitution and chaperone therapies and specific treatments for TTR amyloidosis, a differential diagnosis should be sought in all patients with unexplained left ventricular hypertrophy. Diastolic dysfunction is a key feature of HCM and its phenocopies. Its assessment is complex and requires evaluation of several functional parameters and structural changes. Severe diastolic dysfunction carries a negative prognostic implication and its value in differential diagnosis is limited.

• Klíčová slova
• Amyloidosis, Anderson Fabry disease, Danon disease, Hypertrophic cardiomyopathy, Left ventricular hypertrophy, Myocardial storage,
• MeSH
• amyloidóza diagnostické zobrazování   epidemiologie   patofyziologie   MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   epidemiologie   patofyziologie   MeSH
• hypertrofická kardiomyopatie diagnostické zobrazování   epidemiologie   patofyziologie   MeSH
• hypertrofie levé komory srdeční diagnostické zobrazování   epidemiologie   patofyziologie   MeSH
• lidé MeSH
• vzácné nemoci diagnostické zobrazování   epidemiologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: Following myocardial infarction (MI), left ventricular function is determined by cardiac remodeling occurring in both infarcted and noninfarcted myocardium (NIM). Unipolar voltage mapping may detect remodeling changes in NIM that are associated with the left ventricular ejection fraction (LVEF). We aimed to identify (1) unipolar voltage characteristics in patients with chronic MI, and (2) association of voltage abnormalities with degree of left ventricular dysfunction (LVD). METHODS AND RESULTS: Two groups of patients with ischemic cardiomyopathy (ICM) who underwent LV endocardial mapping during catheter ablation for ventricular tachycardia (VT) between January 2010 and December 2012 were studied. The first group (19 males) had mild to moderate LVD (M-LVD, LVEF >35%) and was matched for age, sex, infarction size, and infarction location with 10 males who had severe LVD (S-LVD, LVEF <35%). Both bipolar and unipolar endocardial abnormal voltage areas were measured and compared between groups. Abnormal bipolar area was comparable in both groups (30 ± 8% in the S-LVD group vs 28 ± 8% in the M-LVD group; P = 0.5). Total abnormal unipolar voltage area was significantly larger in the S-LVD group (57 ± 14% vs 43 ± 13%; P = 0.02). The abnormal unipolar voltage area within the normal bipolar voltage area was greater in the S-LVD group (26 ± 11% vs 15 ± 16%; P = 0.03). In receiver operating characteristic curve analysis, an 18.0% cut-off value for abnormal unipolar area within NIM identified severe LVD, with 90% sensitivity and 79% specificity (area under the curve 0.821). CONCLUSIONS: Patients with ICM and severe LVD have larger areas of unipolar voltage abnormality in the noninfarcted tissue than patients with M-LVD.

• Klíčová slova
• bipolar voltage, electroanatomic mapping, ischemic cardiomyopathy, left ventricular dysfunction, unipolar voltage,
• MeSH
• dysfunkce levé srdeční komory diagnóza   patofyziologie   chirurgie   MeSH
• ischemická choroba srdeční diagnóza   patofyziologie   chirurgie   MeSH
• kardiomyopatie diagnóza   patofyziologie   chirurgie   MeSH
• katetrizační ablace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mapování potenciálů tělesného povrchu metody   MeSH
• senioři 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
• práce podpořená grantem MeSH

OBJECTIVES: The aim of this study was to prove that the incidence of the more unusual and largely under-researched cardiac dysfunction, i.e. diastolic, is more frequent in patients with alcoholic cirrhosis. Comparison of the incidence of left ventricular diastolic dysfunction in medical-ward patients with no prior history of cardiovascular disease to that of the patients with hepatic cirrhosis caused by alcohol abuse was carried out. The study is original from the point of view of examination of patients with cirrhosis of solely alcoholic aetiology in one Central-European university hospital. METHODS: Three methods of echocardiographic examination were used: (i) pulse Doppler echocardiography to assess blood flow through the mitral valve and in the pulmonary veins, (ii) tissue Doppler imaging (TDI) to assess mitral annular motion, and (iii) colour M-mode Doppler echocardiography to assess blood flow from the left atrium into the left ventricle. RESULTS: The results found confirmed that the incidence of left ventricular diastolic dysfunction in patients with alcohol-related liver cirrhosis, classified as Child-Pugh grade A and B, was significantly higher than in the controls without any prior liver disease. Furthermore, our research team has newly noticed how the severity of diastolic dysfunction affects the morbidity and mortality of patients undergoing such treatments as the transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation and other surgical interventions resulting from different indications. CONCLUSION: The high incidence of diastolic dysfunction in cirrhotic alcoholics should not be underestimated. Examination of diastolic dysfunction should be a standard procedure for making clinical decisions about these patients.

• MeSH
• alkoholická cirhóza jater diagnostické zobrazování   epidemiologie   MeSH
• diastola MeSH
• dopplerovská echokardiografie MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rizikové faktory MeSH
• rychlost toku krve MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Mitochondrial (mt) dysfunction in gliomas has been linked to abnormalities of mt energy metabolism, marked by a metabolic shift from oxidative phosphorylation to glycolysis ("Warburg effect"), disturbances in mt membrane potential regulation and apoptotic signaling, as well as to somatic mutations involving the Krebs cycle enzyme isocitrate dehydrogenase. Evolving biological concepts with potential therapeutic implications include interaction between microtubule proteins and mitochondria (mt) in the control of closure of voltage-dependent anion channels and in the regulation of mt dynamics and the mt-endoplasmic reticulum network. The cytoskeletal protein βIII-tubulin, which is overexpressed in malignant gliomas, has emerged as a prosurvival factor associated in part with mt and also as a marker of chemoresistance. Mt-targeted therapeutic strategies that are discussed include the following: (1) metabolic modulation with emphasis on dichloroacetate, a pyruvate dehydrogenase kinase inhibitor; (2) tumor cell death via apoptosis induced by tricyclic antidepressants, microtubule-modulating drugs, and small molecules or compounds capable of inflicting reactive oxygen species-dependent tumor cell death; and (3) pretreatment mt priming and mt-targeted prodrug cancer therapy.

• MeSH
• cílená molekulární terapie MeSH
• endoplazmatické retikulum metabolismus   MeSH
• gliom * komplikace   farmakoterapie   genetika   metabolismus   patologie   MeSH
• lidé MeSH
• mikrotubuly metabolismus   MeSH
• mitochondriální nemoci * komplikace   farmakoterapie   genetika   metabolismus   patologie   MeSH
• mitochondrie účinky léků   genetika   metabolismus   patologie   MeSH
• mutace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The prevalence of the left ventricular hypertrophy (LVH) is very high in end-stage renal disease treated by hemodialysis. Diastolic dysfunction is a frequent consequence and leads to the development of heart failure with preserved ejection fraction. New American/European echocardiographic guidelines for the assessment of diastolic function simplified the evaluation and were published recently. The aim of this study was to reveal if the new guidelines stratify asymptomatic hemodialysis patients by the levels of brain-natriuretic peptide (BNP). A cohort of 46 patients hemodialyzed in one center with the lack of overt heart failure, systolic dysfunction, arrhythmia or significant valvular disease were examined by echocardiography before and after a single hemodialysis and blood samples for BNP analysis were drawn at both occasions. The LVH was present in 53% of patients, concentric remodeling in another 17%. Higher indexed left ventricular mass was related to higher BNP levels (r = 0.58, p = 0.0001). Before hemodialysis, diastolic dysfunction was present in 61%: grade 1 in 25%, grade 2 in 21% and grade 3 in 8%. The higher grade of diastolic dysfunction was associated with the incremental increase of BNP. The post-dialysis echocardiography did not allow the assessment of diastolic function in as many as 37% of patients. Our study has shown that the application of the current guidelines for the assessment of diastolic function based on simple four criteria differentiate hemodialysis symptomless patients with preserved systolic function according to BNP levels. BNP levels also rose together with the left ventricular mass. The ratio E/e' medial seemed to be a better predictor of increased BNP than E/e' lateral or E/e' averaged.

• Klíčová slova
• Chronic kidney disease, Diastolic dysfunction, Echocardiography, Heart failure, Hemodialysis,
• MeSH
• asymptomatické nemoci MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• chronické selhání ledvin komplikace   diagnóza   patofyziologie   terapie   MeSH
• dialýza ledvin * škodlivé účinky   MeSH
• diastola MeSH
• dopplerovská echokardiografie * MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   etiologie   patofyziologie   MeSH
• funkce levé komory srdeční * MeSH
• hypertrofie levé komory srdeční diagnostické zobrazování   etiologie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B krev   MeSH
• prediktivní hodnota testů MeSH
• remodelace komor MeSH
• rizikové faktory MeSH
• senioři MeSH
• tepový objem 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
• Názvy látek
• biologické markery MeSH
• natriuretický peptid typu B MeSH

OBJECTIVES: The purpose of this study was to determine the impact of autologous transplantation of mononuclear bone marrow cells on myocardial function in patients with left ventricular (LV) dysfunction due to an acute myocardial infarction. METHODS: The randomized study included 82 patients with a first acute myocardial infarction treated with a stent implantation. This presentation is a subanalysis of 47 patients with left ventricular dysfunction-EF (ejection fraction)

• MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   etiologie   chirurgie   MeSH
• infarkt myokardu komplikace   diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• transplantace kostní dřeně * MeSH
• ultrasonografie 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
• randomizované kontrolované studie MeSH

Cardiac damage in severe aortic stenosis (AS) is not limited to the aortic valve and left ventricle, but is a systemic disease characterized by a significant alteration in cardiac structure and function. Therefore, a new classification of AS based on the degree of myocardial damage was proposed. A significant number of patients with AS have right ventricular dysfunction likely due to ventricular interdependence. Relationship between right ventricular dysfunction and increased mortality in both symptomatic and asymptomatic patients with severe AS was demonstrated. These patients could benefit more from intervention. Therefore, a standardized echocardiographic examination of a patients with severe aortic stenosis should provide a detailed analysis of right ventricular function.

• Klíčová slova
• TAVI, aortic stenosis, right ventricular dysfunction,
• MeSH
• aortální chlopeň MeSH
• aortální stenóza * komplikace   diagnostické zobrazování   chirurgie   MeSH
• chirurgická náhrada chlopně * MeSH
• dysfunkce levé srdeční komory * MeSH
• dysfunkce pravé srdeční komory * diagnostické zobrazování   MeSH
• echokardiografie MeSH
• funkce levé komory srdeční MeSH
• lidé MeSH
• srdeční komory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: This retrospective study evaluates early and midterm results in patients with severe left ventricular dysfunction. TECHNIQUE: Ninety-seven consecutive patients with coronary artery disease and ejection fraction of left ventricle (LVEF) less or equal to 25 % underwent elective coronary artery bypass graft procedure between September 1998 and December 2001. Mean age at operation was 66 (47-86) years. The main symptoms were angina class III-IV Canadian Cardiovascular Society (CCS) in 78 patients (80 %) and dyspnoea class III-IV New York Heart Association (NYHA) in 43 patients (44 %). The major indications for surgery were severe angina, dyspnoea in 90 patients (93 %). Cardiac index (CI), echocardiography (ECHO), planimetry, end-diastolic pressure of left ventricle (LVEDP), end-diastolic diameter of left ventricle (LVEDd) were used to access left ventricular function preoperatively. ECHO was also used to access left ventricular function postoperatively. RESULTS: Early postoperative (30 days) mortality was 4.1 %. Complications had 25 patients (26 %) postoperatively. Two years survival was 95.7 %. Class III-IV CCS and/or NYHA had 17 patients (17.5 %) two years after surgery. LVEF (assessed by ECHO) improved from 23.1 % preoperatively to 36.0 % postoperatively (p < 0.05). CONCLUSION: The study showed that elective myocardial revascularisation in patients with severe left ventricular dysfunction and signs of myocardial viability is not necessarily associated with high operative mortality. It can be performed safely with respectable midterm survival in concordance with left ventricular function improvement, symptom relief and quality of life improvement.

• MeSH
• dysfunkce levé srdeční komory komplikace   patofyziologie   MeSH
• koronární bypass * MeSH
• koronární nemoc komplikace   mortalita   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• pooperační komplikace MeSH
• senioři nad 80 let MeSH
• senioři 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