The advantages and limitations of impedance aggregometry in detection of heparin-induced thrombocytopenia.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) represents a serious complication of heparin treatment. IgG antibodies binding platelet factor 4 (PF4) and heparin trigger the clinical manifestations of HIT. However, only a portion of the antibodies have the ability to activate platelets, and these can be identified by a platelet aggregation test (functional testing). Current methods HIPA and SRA are time-consuming and difficult if HIT is clinically suspected; therefore, numerous new methods have recently been developed. METHODS: To determine HIT, impedance aggregometry using the Multiplate analyzer (MEA) as heparin-induced aggregation techniques and the Technozym HIT Ig ELISA test were used. The MEA method uses sensitization of donor platelets with patient plasma in the presence of heparin at a concentration of 0.5 IU/mL. The results were compared with the ELISA test. RESULTS: We examined 190 patients at clinically intermediate and higher risk of HIT according to the 4T score. All samples were examined by the ELISA test and MEA, with positive samples being further confirmed by high-concentration heparin. The methodology was modified with respect to the dilution for high positive samples and assessment has been extended to an index of inhibition. CONCLUSIONS: In the studied group, we demonstrated that MEA has sufficient sensitivity and higher specificity. In the group of patients, 10.0% showed positive results by MEA as compared with 7.3% determined by ELISA. Unlike the ELISA methods of the same quality, MEA is more suitable for detecting platelet-activating HIT antibodies in practice.

Pilot study of A-FABP levels as a predictive factor of SPECT results in asymptomatic relatives of patients with cardiovascular disease.

BACKGROUND: A-FABP is a promising link between metabolic syndrome and atherosclerosis. It is not well known whether level of A-FABP predicts results of SPECT. PATIENTS & METHODS: In 82 subjects (53 males) with a median age of 54 years, who were first-degree relatives of patients with cardiovascular disease, the following tests and examinations were performed: A-FABP, calcium score (CS) and SPECT. RESULTS: Subjects with positive and negative SPECT results differed significantly in the noncategorized CS (p = 0.001), uric acid (p = 0.025) and the total cholesterol:high-density lipoprotein ratio (p = 0.043), but not in other parameters (including A-FABP). To predict SPECT results, the best model proved to be a logistic regression model with gender and noncategorized CS as predictors, with an area under the receiver operating characteristic curve of 0.89 (the sensitivity and specificity based on a CS cutoff of 11.1 were 77.78 and 75.34%, respectively). CONCLUSION: The serum level of A-FABP is not a predictor of a positive SPECT result.

[Is there dependence between the level of adipocyte fatty acid-binding protein and calcium score in asymptomatic relatives of patients with cardiovascular diseases?]. / Existuje závislost mezi hladinou adipocyte fatty acid binding proteinu a kalciovým skóre u asymptomatických príbuzných pacientu s KVO?

UNLABELLED: The objective of our study was to determine a correlation between the level of adipocyte fatty acid-binding protein (A-FABP) (as a possible link between metabolic syndrome and atherosclerosis), the calcium score (CS) and laboratory parameters, including insulin resistance indices in asymptomatic first degree relatives of patients with cardiovascular diseases. SET AND METHODOLOGY: Examination was conducted in 82 persons (53 male) with the average age of 52.79 ± 9.6. The examinations consisted of anthropometric and physical tests (determination of body weight, height, body mass index - BMI and casual blood pressure measurement), laboratory analysis (uric acid, creatinine, lipid panel, insulin, glucose, C-reactive protein, fibrinogen, glycated hemoglobin, adipocyte fatty acid-binding protein - A-FABP) and determination of insulin resistance indices HOMA and QUICKI. Total calcium score (CS) was determined by the Agatston method without the need to administer a contrast agent. RESULTS: The value of the A-FABP level does not show a statistically significant dependence on the categorised CS or on non-categorised CS values. There is a statistically significant positive dependence of the level of A-FABP on the HOMA index (p = 0.00688) and a statistically significant negative dependence on the QUICKI index (p = 0.0068). The A-FABP level is statistically significantly higher in women (p = 0.048), in elder persons (p = 0.043), and in persons with higher BMI values (p = 0.029). Among continuous variables, statistically significant is the difference in the A-FABP level in relation to age (p = 0.002), creatinine (p = 0.026), insulin (p = 0.005), and BMI (p = 0.031). CONCLUSION: Our study confirmed the correlation of the A-FABP level with insulin resistance indices, BMI, age, gender, and insulin and creatinine levels in a group of asymptomatic first degree relatives of patients with cardiovascular diseases. A-FABP could potentially be a marker when determining the risk of CVD; however, this conclusion requires additional clinical trials.

[Hyperventilation echocardiography in vasospastic angina pectoris diagnosing]. / Hyperventilacní echokardiografie v diagnostice vazospastické anginy pectoris.

Hyperventilation echocardiography is an established diagnostic test in patients with suspected variant angina pectoris. It has got sufficient sensitivity (60-80%) and specificity (85-100%). Positive hyperventilation test is rarely found, which relates to low prevalence of variant angina. The diagnostic yield of the test depends on the population selected for testing: positive result can be expected in patients with a history of typical burning chest pain, ST segment elevation/depression and/or inversions of U wave during the chest pain episode, arrhythmias related to the chest pain, coronary artery stenosis less than 50% of artery diameter, multi-vessel disease, high activity of illness at the time of hyperventilation test. We present a case of 37 years old man with typical angina pectoris at rest and non-Q myocardial infarction, in whom the coronary angiography was negative. Variant angina pectoris was diagnosed by hyperventilation echocardiography. The ECG tracings showing typical ischemic patterns during the hyperventilation test are included.

[Infective endocarditis--crucial early diagnosis]. / Infekcní endokarditida--klícová vcasná diagnóza.

A 64-year old female patient with polymorbidity, including diabetes, was admitted to our clinic with a suspicion of silent myocardial infarction. However, no acute coronary lesion was subsequently confirmed. Transthoracal echocardiography performed just after the admission suggested infective endocarditis. The diagnosis was difficult due to a lack of collaboration by the patient who was disoriented and confused. Because of the suspicion ofendocarditis, a therapy with antibiotics was started immediately and the diagnosis was confirmed by oesophageal echocardiography and heart MR performed after the patient was stabilized. An early diagnosis and an intensive antibiotic treatment are crucial for the management of the frequently fatal infective endocarditis.

[The influence of targeted intervention on the incidence of risk factors of cardiovascular diseases at medical staff]. / Vliv cílene intervence na výskyt rizikových faktoru kardiovaskulárních onemocnení u zdravotnických zamestnancu.

INTRODUCTION: The work addresses the targeted intervention of cardiovascular diseases at medical staff. SET AND METHODICS: During 2002-2004 years, within the scope of preventive examination, there was made targeted prevention of risk factors of cardiovascular diseases (CVD) at the big hospital employees at the Centre of preventive care of employees and in the department of preventive cardiology of Ist Internal Clinic of LF UP and FN Olomouc. According to the effective tables, there was stated a CVD risk of these employees. The employees received a personal individual letter which informed them of the level of CVD risk and proposed a targeted intervention of risk factors. The part of the set--427 employees of the average age of 38.93 years (SD 11.39), 69 men (M) of the average age of 40 years (SD 12.47) and 358 women (F) of the average age of 38.7 years (SD 11.18) was examined another time during 2004-2005 years. The methodics of second examination was the same as at the first examination, only the questionnaire was complemented by the questions related to the knowledge of the CVD risk stated at previous examination. RESULTS: There occurred statistically significant decrease of LDL cholesterol in the set (from 2.87 mmol/l to 1.23 mmol/l, p < 0.0001) and BMI decrease (from 24.35 to 24.16, p < 0.05) and at the same time statistically significant increase of total cholesterol (from 5.09 mmol/l to 5.27 mmol/l, p < 0.05) and triglycerides (from 1.27 mmol/l to 3.01 mmol/l, p < 0.0001). There was no significant change in other RFs (BP, WHR, HDL cholesterol, moving activity). The influence on RF of smoking was statistically significant (23 employees quitted smoking, 10 employees started, p < 0.05). 53 F (14.80%) and 3 M (4.34%) know their cardiovascular risk, 235 F (65.64%) and 53 M (76.81%) do not know their cardiovascular risk. CONCLUSION: The work approved the influence of targeted intervention on the incidence of cardiovascular diseases risk factors and at the same time low level of knowledge of one's own individual risk, despite of targeted intervention.