Present criteria for prophylactic ICD implantation: Insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project.

BACKGROUND: The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. SUMMARY: The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12­lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. CONCLUSION: The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular.

Autonomic control of blood circulation in patients undergoing elective carotid endarterectomy.

BACKGROUND: Internal carotid artery stenosis (ICAS) is associated with significantly higher risk of stroke. Autonomic function can be impaired in the presence of atheroma in the carotid sinus region. Two parameters of autonomic nervous system (ANS) function e.g. heart rate variability (HRV) and baroreflex sensitivity (BRS) are respected predictors of cardiovascular prognosis. We assessed the effect of elective unilateral carotid endarterectomy (CEA) on cardiovascular autonomic functions as a major prognostic factor for cardiovascular health. METHODS: Nineteen patients indicated for CEA underwent formal autonomic assessment in the laboratory. Hemodynamic profiles, HRV and BRS were evaluated with the dedicated high-tech device Task Force Monitor before surgery (day-1) and postoperatively (day 3±1). Data were obtained during 5 min orthostatic challenge and subsequent 5 min in a supine position. RESULTS: There were no significant early postoperative changes in evaluated parameters after CEA. There was a mild decrease of blood pressure and therefore only a slight increase in BRS. It was also possible to observe a rise in the value of total power and high frequency power. CONCLUSION: In the early postoperative period, healing processes are occurring and the sympatho-vagal interaction is probably still unbalanced. Given the considerable clinical potential of BRS and HRV measurement, further short-term and, more importantly, long-term investigations are needed.

Orthostatic hypotension is associated with decreased cerebrospinal fluid levels of chromogranin A in early stage of Parkinson disease.

An association between the CSF chromogranin A (CgA) and orthostatic blood pressure changes was investigated in 20 patients in the early stage of Parkinson disease (PD). There was a positive correlation between the CSF CgA and diastolic blood pressure change, when CSF CgA levels were lower in patients with orthostatic hypotension (OH). Decreased CSF CgA may be useful in predicting OH in the early stage of PD.

Lipidomic analysis of plasma, erythrocytes and lipoprotein fractions of cardiovascular disease patients using UHPLC/MS, MALDI-MS and multivariate data analysis.

Differences among lipidomic profiles of healthy volunteers, obese people and three groups of cardiovascular disease (CVD) patients are investigated with the goal to differentiate individual groups based on the multivariate data analysis (MDA) of lipidomic data from plasma, erythrocytes and lipoprotein fractions of more than 50 subjects. Hydrophilic interaction liquid chromatography on ultrahigh-performance liquid chromatography (HILIC-UHPLC) column coupled with electrospray ionization mass spectrometry (ESI-MS) is used for the quantitation of four classes of polar lipids (phosphatidylethanolamines, phosphatidylcholines, sphingomyelins and lysophosphatidylcholines), normal-phase UHPLC-atmospheric pressure chemical ionization MS (NP-UHPLC/APCI-MS) is applied for the quantitation of five classes of nonpolar lipids (cholesteryl esters, triacylglycerols, sterols, 1,3-diacylglycerols and 1,2-diacylglycerols) and the potential of matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) is tested for the fast screening of all lipids without a chromatographic separation. Obtained results are processed by unsupervised (principal component analysis) and supervised (orthogonal partial least squares) MDA approaches to highlight the largest differences among individual groups and to identify lipid molecules with the highest impact on the group differentiation.

Determination of nonpolar and polar lipid classes in human plasma, erythrocytes and plasma lipoprotein fractions using ultrahigh-performance liquid chromatography-mass spectrometry.

A novel normal-phase (NP) ultrahigh-performance liquid chromatography-mass spectrometry (UHPLC/MS) method is developed for a separation and quantitation of nonpolar lipid classes occurring in human plasma, erythrocytes and plasma lipoprotein fractions. The baseline class separation of cholesteryl esters (CE), cholesterol, triacylglycerols (TG), regioisomers of 1,2- and 1,3-diacylglycerols (DG) and 1-monoacylglycerols (1-MG) is achieved using an optimized hexane - 2-propanol-acetonitrile mobile phase within 18min for all nonpolar lipid classes or only 9min excluding monoacylglycerols not detected in studied samples. The determination of individual nonpolar lipid classes is performed by the response factor approach and the use of dioleoyl ethylene glycol as a single internal standard. Polar lipid classes, such as phosphatidylglycerols (PG), phosphatidylethanolamines (PE), phosphatidylcholines (PC), sphingomyelins (SM) and lysophosphatidylcholines (LPC), are separated by hydrophilic interaction liquid chromatography (HILIC) using 5mmol/L aqueous ammonium acetate-methanol-acetonitrile gradient within 13minutes. The quantitation of polar lipid classes is done by a similar approach as for nonpolar lipid classes, but a different internal standard (sphingosyl PE d17:1/12:0) is used. The complementary information on fatty acyl profiles after the transesterification of the total lipid extract is obtained by gas chromatography with flame ionization detection (GC/FID). The applicability of developed methodology for fast and comprehensive characterization of blood lipidome is illustrated on samples of human plasma, erythrocytes, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL) fractions.

Self care in patients with chronic heart failure. Pilot study - self care includes problems.

AIM: The goal of this pilot study was to define the scope of therapeutic self-care demand in heart failure (HF) patients according to the concepts of self-care postulated by D.E. Orem and to determine the level of problems experienced and self-care in these patients. METHODS: A questionnaire consisting of 7 areas with closed format questions was developed according to the definition. The level of patient problems and level of self-care actions were mapped in each area. The questionnaire was distributed at the hospital outpatient clinic. The study group consisted of 47 heart failure patients (14 women) with following characteristics: average age 68 years, average BMI 29.4, resynchronization therapy 21%, hypertension 69.8%, diabetes mellitus 25.6%, coronary artery disease 46.5%, dilated cardiomyopathy 46.5%, obesity 46.5%, smoking history 39.5% (present and past smoking together), other cardiac disease 16.28%, condition after myocardial infarction 27.8% (NYHA II 41%, NYHA III 56.8%, NYHA IV 2.2%). RESULTS: The greatest problems were in the area of physical activity, sleep and fatigue, the least were in the area of chest pain and blood circulation. The greatest self-care agency was shown in the area of managing problems with physical activities and sleep, the lowest in the area of liquid intake and output. In the patients' subjective opinion, fatigue and sleep problems had the greatest impact on the quality of life. There were no substantial differences in either area based on gender. CONCLUSIONS: The data can serve as a foundation for modifying the extent and structure of patient education for more comprehensive and more effective out­patient treatment of HF.

What options does the supine-standing-supine test offer to patients with hypertension? Demonstrations of examples.

AIMS: The purpose of the study was to demonstrate autonomic nervous system (ANS) changes associated with treatment in hypertensive patients and utilization of these measurements in practice. METHODS: Hypertensive patients were examined before the start of treatment and after blood pressure compensation. The telemetric system VarCor PF 5 was used for non-invasive heart rate registration and automatic evaluation of heart rate variability (HRV) parameters. The supine-standing-supine test with ortho-clinostatic loading in standard conditions was used for HRV evaluation. RESULTS: The influence of antihypertensive therapy on ANS was demonstrated in two cases. The first was a case of a responder to therapy and the second case was example of a non-responder to monotherapy regarding more therapeutic steps for blood pressure control. Different modes of results presentation are demonstrated: 3D graph, numeric form of standard parameters of HRV, computer interpretation of results by means of complex parameters and indices in numeric, graphic and verbal form with functional age calculation, cross graph of vagal activity index versus sympatho-vagal balance index was used for repeated measurements and follow-up. The increased spectral performance with augmented vagal activity and slope down of sympatho-vagal ratio are evident after blood pressure control achievement. Improvement of functional age parameter associated with blood pressure compensation is visible using a complex age-dependent parameters interpretation. CONCLUSIONS: HRV evaluation in hypertensive patients provides new parameters for patient's examination. These parameters are influenced by both the illness itself and by pharmacotherapy. Such an approach offers more complex information about patient.

Haemotherapy analysis: the Teaching Hospital Olomouc in 2006.

AIMS: Annual evaluation of blood transfusion preparation administration at the University Hospital Olomouc, Czech Republic as a contribution to the European Union haemovigilance system. METHODS: Analysis of blood transfusion preparations released from the Department of Blood Transfusion of the above university hospital and laboratory examination results in receivers of these products for the year 2006. Total hospital consumption and usage in particular medical disciplines in the hospital were assessed. RESULTS: Red cell concentrates: in total 14 347 TU (deleucotised in 20.4 %). Departments according to usage: surgery, haematooncology, anaesthesiology and surgery intensive care department, and internal medicine department. Haemoglobin levels were above 100 g/L before blood transfusion administration in 24 % of cases. Platelets: in total 1 712 TU (100 % manufactured by apheresis, 56 % deleucotised). Platelet counts below 20 x 10(9)/L were found in all cases before platelet concentrate administration. Plasma: in total 5 959 TU to 1 297 of patients. Departments according to usage: surgery, anaesthesiology and surgery intensive care department, internal medicine and haematooncology. Two hundred and forty nine cases without coagulation parameter monitoring and 333 (25.67 %) patients with only 1 TU of administered plasma were found. CONCLUSIONS: The incorrect indications for red cell transfusion preparations were found in eleven patients with haemoglobin levels above 130 g/L. Underdosing in 25.67 % of plasma administrations signifies dubious indications in these cases. Implementation of the haemovigilance system in practice is now mandatory for the Czech Republic after joining the European Union. Therefore more precise data and analysis of questionable cases with further education of staff in clinical departments are essential for the haemovigilance principle to be applied on a hospital basis in the Czech Republic.

Short-term spectral analysis of heart rate variability during supine-standing-supine test in patients with paroxysmal atrial fibrillation.

The aim of the study was to assess the sympathovagal balance in group of 27 patients without significant structural heart disease after an attack of atrial fibrillation. The investigation was performed using spectral analysis of heart rate variability during examination under conditions of different orthostatic loads in single phases, called the supine-standing- supine test. The findings were compared with a group of healthy persons. These revealed a significantly decreased total spectral power (430.7 vs 1558.0 ms(2) supine1; 477.6 vs 1042,5 ms(2) standing; 567.5 vs 1948.5 ms(2) supine2), and spectral power of the high frequency spectral component (140.8 vs 619.3 ms(2) supine1; 96.2 vs 203.3 ms(2) standing; 186.3 vs 739.4 ms(2) supine2) in the studied group of patients in comparison with the control group.

Assessment of spectral analysis of heart rate variability in patients with history of atrial fibrillation by means of age-dependent parameters.

Heart rate variability evaluation is a useful diagnostic tool for autonomic nervous balance assessment. The role of the autonomic nervous system in aetiology of atrial fibrillation is sometimes clear as a trigger from a patient's history, but mostly it acts as a modulating factor which is not easy to detect. The present study demonstrates results of spectral analysis of short-term heart rate variability during ortho-clinostatic tests processed by means of age-dependent parameters. An original telemetric system and a unique method for heart rate variability assessment, developed by the Faculty of Physical Culture, were applied for the first time to examine patients with the history of atrial fibrillation.