MicroRNAs in pathophysiology of acute myocardial infarction and cardiogenic shock.

AIM: Levels of circulating miRNA are considered to be potential biomarkers of acute myocardial infarction and disease progression. METHODS: In this study, the expression levels of circulating miRNA-1, miRNA-133 and miRNA-124a were investigated in a group of patients with acute myocardial infarction (STEMI) and cardiogenic shock (CS) compared to controls. RESULTS: During the hospitalization period, miRNA-133 showed a significant up-regulation in the serum of STEMI and CS patients compared to controls, while the expression of miRNA-1 was significantly different only in CS. The expression of miRNA-124 was significantly higher in STEMI and CS. Furthermore, miRNA-1 expression was related to the level of circulating glucose in patients with STEMI. We also found a negative correlation between miRNA-133 and MMP-9 levels. MiRNA-124 expression was significantly related to the level of soluble ST2; the marker correlated to cardiac damage. CONCLUSION: All selected miRNAs are potential markers of cardiac injury in cardiogenic shock, whereas miRNA-124a and -133 are markers of injury in STEMI. MiRNA-1 expression is related to circulating glucose in STEMI. None of miRNAs could be correlated to the extent of injury, progress of the disease, or prognosis of patient outcome. Therefore, the levels of circulating miRNA have no potential for becoming a biomarker of myocardial damage and as such would bring no further benefit compared to current markers (Tab. 4, Fig. 1, Ref. 47).

Circadian rhythm of cardiac troponin I and its clinical impact on the diagnostic accuracy for acute myocardial infarction.

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) blood concentrations were shown to exhibit a diurnal rhythm, characterized by gradually decreasing concentrations throughout daytime, rising concentrations during nighttime and peak concentrations in the morning. We aimed to investigate whether this also applies to (h)s-cTnI assays and whether it would affect diagnostic accuracy for acute myocardial infarction (AMI). METHODS: Blood concentrations of cTnI were measured at presentation and after 1 h using four different cTnI assays: three commonly used sensitive (s-cTnI Architect, Ultra and Accu) and one experimental high-sensitivity assay (hs-cTnI Accu) in a prospective multicenter diagnostic study of patients presenting to the emergency department with suspected AMI. These concentrations and their diagnostic accuracy for AMI (quantified by the area under the curve (AUC)) were compared between morning (11 p.m. to 2 p.m.) and evening (2 p.m. to 11 p.m.) presenters. RESULTS: Among 2601 patients, AMI was the final diagnosis in 17.6% of patients. Concentrations of (h)s-cTnI as measured using all four assays were comparable in patients presenting in the morning versus patients presenting in the evening. Diagnostic accuracy for AMI of all four (h)s-cTnI assays were high and comparable between patients presenting in the morning versus presenting in the evening (AUC at presentation: 0.90 vs 0.93 for s-cTnI Architect; 0.91 vs 0.94 for s-cTnI Ultra; 0.89 vs 0.94 for s-cTnI Accu; 0.91 vs 0.94 for hs-cTnI Accu). CONCLUSIONS: Cardiac TnI does not seem to express a diurnal rhythm. Diagnostic accuracy for AMI is very high and does not differ with time of presentation. CLINICAL TRIAL REGISTRATION: NCT00470587, http://clinicaltrials.gov/show/NCT00470587.

Central pulse pressure and variability in matrix metalloproteinases genes and their inhibitors in patients with ischemic heart disease.

Matrix metalloproteinases (MMPs) as well as their inhibitors (TIMPs) play a crucial role in controlling extracellular matrix turnover and have recently been associated with atherosclerosis, myocardial and vascular injury. Moreover, the genetic variability of MMP genes has been suggested to play an important role in vascular remodeling and age-related arterial stiffening. This study aims to describe associations of 14 selected polymorphisms in genes for MMPs and TIMPs with selected cardiovascular parameters (including central pulse pressure), clinical conditions and drug treatment profiles in 411 stable ischemic patients with preserved systolic function of the left ventricle. The genotyping of 14 single-nucleotide polymorphisms in 8 genes was carried out either using 5´ exonuclease (TaqMan®) reagents or by restriction analysis. Numerous associations of the investigated polymorphisms with systolic and diastolic blood pressure, maximum left ventricular end diastolic pressure and ejection fraction were observed. While some of the observed effects were found to be age-dependent, associations with clinical conditions (hypertension, diabetes mellitus, angina pectoris) were only observed in women and associations with four groups of drugs (statins, nitrates, calcium channel blockers, anti-aggregation drugs) were only observed in men. The results of this study indicate that the genetic variability of MMPs and TIMPs is an important factor which influences cardiovascular functions and may have important consequences for individual therapy customization in the future.

[Inflammatory response and C -reactive protein value in patient with acute coronary syndrome]. / Zánetlivá reakce a význam C -reaktivního proteinu u pacientu s akutním koronárním syndromem.

Inflammation plays an important role in the pathophysiology of acute coronary syndrome as well as in the process of atherosclerosis in general. At the moment of myocardial ischaemia, local and systemic inflammatory reaction is amplified; in ischaemic myocardium there is increased expression of proinflammatory cytokines, particularly interleukin-6, which mediates C reactive protein (CRP) production by hepatocytes. CRP activates the complement cascade and thereby contributes to the lysis and removal of damaged cardiomyocytes. Whereas in a healthy population CRP levels range from 1.2 to 2.0 mg / l, in patients with ACS the levels of CRP significantly increase with the peak of 2nd to 4th day from the onset of myocardial infarction. Peak CRP levels ranged from 20 to 250 mg / l in patients with STEMI treated conservatively, the median of peak of CRP levels was 79 mg/ l in patients with anterior wall STEMI treated with primary PCI. There is a recommendation of CRP evaluation within the early risk stratification of patients with ACS according to the current ESC guidelines. In patients with NSTEMI, CRP levels > 10 mg/ l are associated with increased longterm mortality. In patients with STEMI treated with primary PCI, CRP levels > 79 mg/ l could predict negative left ventricle remodelation. The predictive value of GRACE risk score was improved using CRP, levels > 22 mg/ l predicted worse prognosis in patients with either STEMI or NSTEMI treated invasively. However, if also cardiac troponin and natriuretic peptides in addition to GRACE risk score were used, CRP levels were useless in further risk stratification improvement. In clinical practice, in terms of coinciding infection, problems with CRP levels interpretation can occur as well. Several patients either in cardiogenic shock or after cardiopulmonary resuscitation have signs of systemic inflammatory response, and sometimes it is very difficult to decide whether there is a necessity to iniciate the antibio-tic therapy because of infectious cause. In patients after cardiopulmonary resuscitation, CRP levels > 180 mg/ l indicate highly probable infection, but with the poor sensitivity. For patients in cardiogenic shock, procalcitonin appears to be more useful for the detection of infection; in this group of patients, procalcitonin levels > 2 ng/ ml are common, and levels > 10 ng/ ml indicate infection undoubtedly.

[S-100B protein elevation in patients with the acute coronary syndrome after resuscitation is a predictor of adverse neurological prognosis]. / Elevace proteinu S-100B u pacientu s akutním koronárním syndromem po resuscitaci je prediktorem nepríznivé neurologické prognózy.

INTRODUCTION: The annual incidence of out-of-hospital cardiac arrest is around 90-190 cases per 100 000 inhabitants. The limiting factor for further prognosis of patients after out-of-hospital arrest is their neurological status. The S100B protein is mainly the nervous system cells product, its glial-specific and mostly expressed by astrocytes. It has been shown that after circulatory arrest its increased level correlates with the prognosis of patients. Work aims to determine the level of protein S100B in the group of patients with acute myocardial infarction without circulatory arrest, and compare it to the value in patients with acute myocardial infarction after out-of-hospital resuscitation. METHODS: 24 patients were evaluated after out-of-hospital resuscitation for the malignant arrhythmias during acute coronary syndrome (ACS). All patients were treated with mild therapeutic hypothermia. The control group consisted of 19 patients with ACS. The sample for the determination of S-100B was taken immediately on admission. Neurological status was evaluated according to the CPC scores (Cerebral Performance Categories) at discharge, patients were divided into 3 groups: CPC1 - good condition, CPC2 - moderate neurological disability, CPC3-5 - serious neurological impairment, coma or death. RESULTS: The values of protein S-100B fluctuated, in patients with no resuscitation, in range between 0.038 to 0.204 pg/ml. In patients after resuscitation without subsequent neurological disability (CPC 1) was range 0.077 to 0.817 pg/ml, in patients with moderate to severe neurological disability (CPC 2) was range 0.132-2.59 pg/ml, patients with severe neurological disabilities or deaths had S-100B levels from 0.70 to 8.53 pg/ml. According to ROC analysis we found the cut-off value for the S-100B. Cut-off value for probably a good neurological condition is < 0.23 pg/ml (specificity 93%, sensitivity 70%), and value testify for supposed severe neurological disability or death is > 1.64 pg/ml (specificity 95%, sensitivity 83%). CONCLUSION: Protein S-100B is one of the early and sensitive markers of severe brain damage in patients after cardiac arrest. Its early determination can help in prediction of patient neurological condition and help doctors to decide further action.

[Short-term prognosis and treatment of patients hospitalized for acute heart failure in a regional hospital without a cardiocentre]. / Krátkodobá prognóza a lécba pacientu hospitalizovaných pro akutní srdecní selhání v regionální nemocnici bez kardiocentra.

BACKGROUND: Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre. PATIENTS AND METHODS: From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno. RESULTS: AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia. CONCLUSION: The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.

[The importance of NGAL and cystatin C biomarkers in cardiovascular diseases]. / Význam biomarkeru NGAL a cystatinu C u kardiovaskulárních onemocnení

Cystatin C is an inhibitor of lysosomal proteases and extracellular cysteine protease, it participates in the regulation of metabolism of extracellular proteins. It is fully glomerular filterable, completely absorbed and catabolised in proximal tubule cells. NGAL (neutrophil gelatinase-associated lipocalin) is an acute phase protein, participating in antibacterial immunity and his important feature is the formation of complex with metalloproteinase 9 (MMP-9), thereby increasing its activity and prevents its degradation. NGAL is freely filtered across the glomerular membrane and is reabsorbed by endocytosis in the proximal tubule. NGAL detected in urine is produced mainly in the distal nephron. The serum cystatin C and NGAL can diagnose acute renal impairment one or two days earlier in the comparison with the monitoring of renal function by serum creatinine. Moreover, compared with the information provided by creatinine or by estimated GFR, the elevated cystatin C gives, in patients with cardiovascular disease, information about worse prognosis. Increased level of NGAL was detected in patients with acute myocardial infarction, heart failure or stroke. There is a lack of data about the prognostic significance of NGAL in patients after myocardial infarction or heart failure, no data about their comparison or interaction with natriuretic peptides exists up today.

[Cost of acute heart failure related readmissions]. / Náklady na rehospitalizaci pacientu s akutním srdecním selháním.

AIM OF STUDY: To assess direct in-patient cost and length of stay in the intensive care unit (ICU) and the standard cardiology unit in acute heart failure (AHF) readmissions. RESULTS: Out of 1 759 patients hospitalized with acute heart failure, 223 patients were readmitted to Faculty Hospital Brno-Bohunice (Czech Republic) during study period (61.4% male; mean age 71.2 years) with mean total cost CZK 85 120 (Euro 3 095) per length of stay 9.2 days and interventions. Comparing to the first hospitalization of study cohort (223 pts.) the decrease was recorded in mean room rate, length of stay and need of ICU stay (from 48% to 42% pts.), nevertheless ICU stay increased (from 3.7 days to 4.1 days). The growth of mean cost was recorded in both procedures in angiology (the decrease in number of coronary angiography which is cheaper was more remarkable than PCI decrease in readmitted patients) and arrhythmology (including device: pacemaker, ICD, CRT) which made 57.5% of total readmission costs. CONCLUSION: The difference in mean in-patient cost between the first and second hospitalization was 18%. The antiarrhytmic procedures had the most significant impact on total readmission cost and its variability, butwe assume that these procedures will reduce within next readmissions and their impact will weaken as in angiology procedures.

[Acute heart failure and early development of left ventricular dysfunction in patients with ST segment elevation acute myocardial infarction managed with primary percutaneous coronary intervention]. / Akutní srdecní selhání a casný rozvoj dysfunkce levé komory a patientu s akutním infarktem myokardu s elevacemi ST lécených primární perkutánní koronární intervencí.

BACKGROUND: Acute heart failure during ST elevation myocardial infarction (STEMI) makes worse prognosis. The aim of the work was to find independent factors with relationship to acute heart failure (AHF) and the early development of left ventricular dysfunction within the prospective followed patients with STEMI. METHODS: A total of 593 patients with STEMI treated by primary PCI (164 patients with AHF) were the study population. The activity of BNP and NT-ProBNP were measured at hospital admission and 24 h after MI onset. Left ventricular angiography was done before PCI; echocardiography was undertaken between the third and fifth day after MI. RESULTS: The patients with AHF had higher level of glycaemia, creatinine, uric acid, HDL-cholesterol, leukocytosis and natriuretic peptid. The total hospital mortality was 3.7%. 0.2% within the patients without AHF, 3.2%, 14.3%, resp. 63.6% within the patients with mild AHF, with pulmonary oedema, resp. with cardiogenic shock. The patients with AHF had lower ejection fraction (45.4 +/- 11.9% vs 53.0 +/- 10.3%). According to the multiple logistic regression we found higher glycaemia, age, heart rate, anterior wall MI, lower aortic pulse pressure and collaterals of infarct related artery as factors with independent relationship to AHF. Higher glycaemia, age, heart rate, anterior wall MI and lower aortic pulse pressure were found as independent factors with relationship to left ventricular dysfunction. According to ROC analysis possible cut off corresponding with AHF we suggested 29.5 mm Hg for LVEDP, 28.5 for dP/dt/P, 9.5 mmol/l for glycaemia, 50 mm Hg for aortic pulse pressure. CONCLUSIONS: Our results found the development of AHF in one third of patients with STEMI. AHF increases the risk of in-hospital mortality and the risk depends upon severity of failure. As the independent factors with relationship to development of AHF or left ventricular dysfunction we detected higher glycaemia, heart rate, anterior wall MI, age. Lower risk had patients with higher aortic pulse pressure.

Difference in angiotensinogen haplotype frequencies between chronic heart failure and advanced atherosclerosis patients - new prognostic factor?

Numerous association studies have been involved in studying the angiotensinogen (AGT) variants, AGT plasma levels and relations to cardiovascular diseases, such as hypertension, myocardial infarction, coronary heart disease. To investigate a role of AGT G(-6)A and M235T genetic variants for chronic heart failure (CHF) and advanced atherosclerosis (AA), a total of 240 patients with CHF and 200 patients with AA of the Czech origin were evaluated for the study. The study shows the role of polymorphism AGT G(-6)A in genetic background among advanced atherosclerosis patients and chronic heart failure patients (Pg=0.001). This difference was also observed in comparison of AA patients with subgroup of CHF with dilated cardiomyopathy (Pg=0.02; Pa=0.009), and ischemic heart disease (Pg=0.007). The greatest difference between triple-vessel disease and chronic heart failure groups was observed in frequency of GT haplotype (P<0.001) and GGMT associated genotype (P<0.001). Retrospectively, we found the same trend when the subgroups of CHF were compared to AA group (AA vs. IHD with CHF P<0.001; AA vs. DCM P<0.001). These results suggest AGT genetic variants as a risk factor for chronic heart failure compared to advanced atherosclerosis disease without heart failure, with a strong difference between IHD patients and chronic heart failure patients with ischemic heart disease, especially in haplotypes and associated genotypes.

Relationship between high aortic pulse pressure and extension of coronary atherosclerosis in males.

A high pulse pressure (PP) is a marker of increased artery stiffness and represents a well-established independent predictor for cardiovascular morbidity and mortality. The objective of the research was to determine whether invasively measured central aortic PP was related to the presence and severity of coronary artery disease. In total 1075 consecutive stable male patients undergoing diagnostic coronary angiography with a preserved left ventricular function were included. Diseased coronary vessel (DCV) was defined by the presence of >50 % stenosis. Men were divided into 3 groups according to the increased value of PP. The average PP in the tertiles was 47.8+/-7.1 vs. 67.0+/-4.9 vs. 91.3+/-12.8 mm Hg (p<0.01). The significant differences of DCV was found among tertiles (1.51+/-1.11 vs 1.80+/-1.04 vs. 1.99+/-0.98 DCV, p<0.01). Aortic PP together with age and hyperlipoproteinemia were found as factors with an independent relationship to DCV according to multivariate linear regression. In conclusions the increased value of aortic PP in the male population is independently connected with more severe atherosclerosis evaluated by the significant number of DCV.

[The prevalence of anemia and its impact on hospitalization mortality in patients with acute heart failure]. / Prevalence anémie a vliv na hospitalizacní mortalitu pacientu prijatých pro akutní srdecní selhání.

AIM OF STUDY: To evaluate the influence of entry hemoglobin level on the hospitalization mortality of the patients admitted with AHF caused by 4 major etiologies--acute coronary syndrome with ST elevation (STEMI, n = 325) and without ST elevation (nonSTEMI, n = 210), decompensated chronic ischaemic heart disease (IHD, n = 206) and dilated cardiomyopathy (CMP, n = 88). RESULTS: We analyzed 1,253 consecutive 1st-time hospitalizations of AHF patients of whom 1,212 had their entry hemoglobin known. Out of these, 829 subjects were of STEMI (1), nonSTEMI (2), IHD (3) and CMP (4) etiology and were included in further analyses. We devided these patients into subgroups according to hemoglobin levels: I--no anemia, II--minor and III--severe anemia. The hospitalization mortality in subgroups (I-II-III) of each etiology was 16.9-24.5-35.3% (1); 12.4-9.8-35.7% (2); 9.0-9.7-18.2% (3); 1.5-21.4-33.3% (4); all etiologies together 12.4-15.0-28.8%, total rate 14.1%. Univariate analysis (chi2) showed significant differencies in hospitalization mortality depending on etiology and hemoglobin level but not type of failure (de novo/decompensation). Other parametres (comorbidities, laboratory and hemodynamic values, medication at entry) had a very variable impact on mortality throughout etiologies and hemoglobin subgroups. CONCLUSION: The presence of anemia increases hospitalization mortality of patients with acute heart failure. The relation between hemoglobin level and mortality seems to be linear, we did not observe "U shape" type of relation. It is necessary to distinguish etiologies of AHF as well as consider effects of laboratory and anamnestic variables when interpreting the results.

[The progress of autonomic parameters in patients after myocardial infarction with ST elevation]. / Vývoj autonomních parametru u pacientu po infarktu myokardu s ST elevacemi.

The patients after myocardial infarction with ST elevation (STEMI) are endangered by the development inception of autonomic dysfunction, decreased baroreflex sensitivity, decreased heart rate variability, and increased blood pressure variability as a result of increased sympathetic activity and/or decreased parasympathetic activity. Thanks to direct angioplasty and optimal pharmacotherapy of coronary artery disease and heart failure, we didn't found any significant changes of these parameters within a one-year follow-up, and mortality due to cardiac etiology was very low in this group. Autonomic dysfunction and negative left ventricular remodeling is related only to a small group of patients after STEMI, whose risk stratification will be difficult.

Nuclear receptors gene polymorphisms and risk of restenosis and clinical events following coronary stenting.

INTRODUCTION: Hereditary factors connected with inflammation and fibroproliferation may play important role in restenotic process after coronary stenting. Peroxisome proliferator-activated receptors (PPAR) and retinoic X receptors (RXR) regulate the transcription of crucial genes involved in the glucose and lipid metabolism, inflammation and cell differentiation. METHODS: In our angiographic and clinical study we assessed the association of gene polymorphisms of L162V for PPAR-alpha, C161T for PPAR-gamma and A(39526)AA for RXR-alpha with the risk of restenosis and cardiac events after coronary stenting. Primary endpoint was diameter stenosis > or = 50% at follow-up angiography. Secondary endpoints were death, myocardial infarction and/or target lesion revascularisation at 12 months, and clinical restenosis. The results were adjusted for known predictors of restenosis. The genotypes were analysed by polymerase chains reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. RESULTS: Control angiography was performed in 477 of 565 patients (84.4%) with following restenosis rates in genotype subgroups: CC 29.0% vs GC/GG 22.6% (p = 0.33) in L162V, CC 29.9% vs TC/TT 24.6% (p = 0.24) in C161T and A/A 26.9% vs A/AA + AA/AA 35.0% (p = 0.14) in A(39526)AA polymorphisms. The T allele ofC161T polymorphism was associated with lower frequency of clinical restenosis (p = 0.015). CONCLUSION: We could not find an association of L162V PPAR-alpha, C161T PPAR-gamma and A(39526)AA RXR-alpha gene polymorphisms with angiographic in-stent restenosis or major cardiac events. However, we found the relationship between C161T PPAR-gamma polymorphism and clinical restenosis deserving further study.

[Acute embolization into the veins in the splanchnic bed--an overview of current methods of diagnosis and therapies]. / Akutní embolizace do tepen splanchnického reciste--prehled soucasných diagnostických prístupu a terapie.

Acute mesentery artery embolization is a rare diagnosis. In case of late recognition the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Unfortunately, the symptoms do not often correlate with clinical findings. Plain X-ray of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the occluded artery. Papaverin vasodilatation and intravenous anticoagulation are also justifiable, catheter aspiration and stent implantation have also been challenged. Our review is to provide a detailed up-to-date information about the issue and is an extensive follow-up of our recently published case report [Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis. Vnitr Lék 2008; 54(9): 871-875].

[Coronary artery disease with premature manifestation in young patients]. / Ischemická choroba srdecní s predcasnou manifestací u mladých pacientu.

INTRODUCTION: Coronary artery disease (CAD) affects in lower percentage even younger individuals. This paper describes group of young patients aged 40 years or less with premature manifestation of CAD, including analysis of risk factors, severity of coronary arteries affection, management and follow-up lasting up to 7 years. PATIENTS AND METHODS: There were 98 patients included retrospectively, in whom macroscopic affection of coronary arteries was diagnosed by coronary angiography within the years 2000-2007. 68 of the patients were indicated to coronary angiography urgently due to acute coronary syndrome (ACS), 44 of them due to acute myocardial infarction with ST elevations. The patients were called for further co-operation and 45 of them (45.9%) were re-examined completely and they will be observed prospectively. The results show overall good short-term prognosis of these patients and confirm importance of early invasive management and revascularisation. One-year mortality of the patients with ACS was 1.9%. 80% out of 45 completely re-examined patients have ejection fraction of left ventricle better than 50% and 84% ofthem is without any anginal symptoms. However, our results show inadequate secondary prevention in these patients. 15 patients (33%) still smoke, 20 (44%) is over-weighted. Only 22 patients (49%) had LDL-cholesterol level bellow 2.5 mmol/l and even only 15 patients (33%) had blood pressure below 130/80 mm Hg. CONCLUSIONS: Management of these basic risk factors should improve even the long-term prognosis of our patients.

[Superior mesentery artery embolization as a complication of the primary angioplasty solved by local thrombolysis]. / Embolizace vetví a. mesenterica superior jako komplikace direktní angioplastiky resená lokální trombolýzou.

Acute mesentery artery embolization is a rare complication of invasive catheterizations. The incidence is unknown. In case of late diagnosis the mortality may reach up to 93%. Acute abdominal pain, vomitus, rapid and sudden bowel evacuation with or without blood are the typical symptoms of the disease. Plain X-Rays of abdomen or CT tomography may show no signs of intestinal ischaemia. The diagnostic method to choose is either spiral CT angiography or contrast angiography, respectively. The most common therapeutical approach is surgical revascularization but in selected cases it is feasible to perform local thrombolysis with a microcatheter placed directly into the artery with embolus. We report a case of a man who was admitted with an acute myocardial infarction who underwent primary angioplasty with implantation ofa bare-metal stent. After the procedure he developed severe and progressive abdominal pain as a result of acute superior mesentery artery embolization. In this patient we performed a local thrombolysis with rt-PA (alteplase) with a great technical success and immediate pain relief, with no need of surgical revision. Our approach was concordant to recommendations cited in this article.

[Factors related to NT-proBNP values in haemodynamically stable patients with normal systolic function of the left ventricle]. / Faktory se vztahem k hodnotám NT-proBNP u hemodynamicky stabilních pacientu s normální systolickou funkcí levé komory.

INTRODUCTION: Increased values ofnatriuretic peptides are considered prognostically significant in normal population with respect to mortality and the incidence of cardiovascular events, regardless of the left ventricular function. The objective of the study is to point out the factors related to NT-proBNP values in patients without the heart failure syndrome and with normal left ventricular systolic function. METHODS: The group consisted of 290 elective patients aged between 50 and 82, with the mean age of 62 years, of whom 47% were women. The enrolled patients were heamodynamically stable, without a history of MI, with a normal left ventricular systolic function and with the serum creatinine level < 150 micromol/l. On the same day, the following procedures were performed: left heart catheterisation, NT-proBNP sampling and echocardiographic examination. Diabetes mellitus, hypertension, coronary heart disease, body mass index, age, sex, left ventricular end-diastolic pressure and aortic pulse pressure were chosen as factors with possible impact on the level of NT-proBNP. We used echo parametres to assess the size of the left ventricle, the left ventricular mass index and the presence of left ventricular diastolic function. RESULTS: The median of NT-proBNP was 110 pg/ml (min. 11; max. 1,943 pg/ml), and higher values were recorded for 116 (i.e. 40%) of the total number of patients. Based on the above-referred factors, a significant relation was demonstrated between NT-proBNP and age (p < 0.01), sex (p < .01), BMI (p = 0.03), left ventricular size (p = 0.02), left ventricular mass index (p = 0.01), and aortic pulse pressure (p < 0.01). CONCLUSION: The study has shown that the level of NT-proBNP in patients does not solely depend on the haemodynamic status and left ventricular function, but is related to many other risk factors of cardiovascular mortality and morbidity.

[Is the left ventricle enddiastolic pressure pathological in the older population?]. / Je zvýsený enddiastolický tlak v levé komore u populace starsího veku patologický?

INTRODUCTION: The percentage of older population has significantly increased in the recent decades. Morphologic and functional changes of the cardiovascular system go together with ageing. The aim of the study should show the correlation between the age and left ventricular enddiastolic pressure (LVDEP) value. METHODS: 106 patients of the age from 23 to 79 years without an organic heart disease and the history of hypertension underwent elective coronary angiography including left ventricle angiography between 1999 and 2002. LVEDP was obtained as an average value from 8 consecutive beats without extrasystoles. According to the relation between increased relative frequency of LVEDP and age patients were divided into two groups: 50 years and older (80 patients) and younger than 50 years (26 patients). RESULTS: An average LVEDP value in older population versus younger population was 12.1 +/- 5.0 mm Hg vs 8.9 +/- 3.4 mm Hg, p < 0.05. Increased LVEDP in yonger population was found in only 11.5 % vs 46.2 % in older group, p < 0.01 and the LVEDP was age dependent, p < 0.05. CONCLUSIONS: In compliance with about mentioned results we suppose that the age is a factor with impact to LVEDP value. LVEDP values > 12 mm Hg in older population may not be pathological and probably are due to the left ventricle diastolic dysfunction in consequence with ageing.

[Restrictive cardiomyopathy as a manifestation of primary amyloidosis]. / Restriktivní kardiomyopatie jako projev primární amyloidózy.

Primary amyloidosis is a rare disease, cardiac involvement occurs in up to 40% of patients. Diffuse amyloid deposits cause an impairment of myocardial systolic and diastolic function. In this paper we are presenting a case of a 54-year-old woman. The woman was admitted because of progressive fatigue, dyspnoea, chest pain, later she experienced hypotension, dyspepsia, and enterorrhagia. ECG showed decrease in QRS amplitude. We have found an echocardiographic evidence of wall hypertrophy. Right cardiac catheterization showed a restrictive situation. Immunobinding of serum and urine revealed monoclonal kappa light chains. The diagnosis was determined by rectal biopsy. Unfortunately, amyloid deposits caused progressive heart failure, hemorrhage, and death just before the diagnosis of primary amyloidosis could be determined on the basis of results of the immunofixations of serum and urine proteins (detection of the monoclonal light chains kappa) and from biopsy specimens taken from rectum (amyloid deposits).