[Prevention of sudden death during sport activity in view of new recommendations]. / Prevence náhlé srdecní smrti pri sportu ve svetle nových doporucení

The study deals with the prevention of sudden death in sportsmen. It analyzes the influence of ECG examination on reducing the risk of sudden death. It presents new recommendations for ECG assessment in sportsmen and a new algorithm for examination of middle- aged and senior subjects.

[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.

[Analysis of the sudden heart death causes in selected sample of dead]. / Rozbor prícin náhlé srdecní smrti ve vybraném vzorku zemrelých.

Sudden cardiac death (SCD) is death from cardiac causes within one hour of the onset of symptoms. In the Czech Republic, there is no SCD registry, analyses of SCD causes are rare and there is no functional connection between the results of an autopsy on a person with SCD and examination of relatives who are at risk of a similar disease. The authors reviewed available autopsy records of the Department of Forensic Medicine and Medical Law of the University Hospital Olomouc over a specified period of time to find persons with severe coronary artery disease, heart failure or deaths from unknown causes in a specific age range. Subsequently, the available information about the circumstances of SCD was analyzed.

[Risk stratification by cardiac gated SPECT combined with coronary artery calcium score in patients with diabetes mellitus and/or renal failure]. / Stratifikace rizika pomocí zátezového SPECT zobrazení myokardu v kombinaci se stanovenim koronárního kalciového skóre u rizikových pacientu s diabetem a/nebo ledvinným selháním.

AIM: The aim of this study was to evaluate added value of coronary artery calcium score (CAC) measurement as an adjunct to cardiac gated SPECT for risk stratification in population of patients with diabetes mellitus (DM) and/or chronic renal failure on hemodialysis (CHRF-HD). METHODS: Retrospective analysis of 67 patients, who were referred for stress gated myocardial perfusion SPECT and CAC. Characteristics of study population: 40 men, mean age 59 +/- 12 years, DM (n = 28), CHRF-HD (n = 22), DM and CHRF-HD simultaneously (n = 17). Perfusion summed stress and different scores (SSS, SDS), the left ventricle ejection fraction (LVEF) and enddiastolic/endsystolic volumes (EDV/ESV) were automatically calculated using 4D-MSPECT software. The hard cardiac event was defined as sudden cardiac death or myocardial infarction (MI); angina or other symptoms requiring coronary revascularization were also calculated. RESULTS: During the average period of 18 +/- 10 months, we registered 8 cardiac deaths, 4 nonfatal MI and 7 patients underwent revascularization. In the subgroup of 19 patients with cardiac events, the observed parameters were significantly worse concerning perfusion (SSS 9 +/- 11 vs 2 +/- 3 and SDS 6 +/- 9 vs 1 +/- 2, P < 0.05), the left ventricle function (stress LVEF 53% +/- 13% vs 59% +/- 13%, rest LVEF 55% +/- 14% vs 59% +/- 12%, stress EDV/ESV 144 ml/71 ml vs 128 ml/59 ml, P < 0.05), and CAC score (1 965 +/- 1 772 vs 387 +/- 740, P < 0.05) in comparison with patients without cardiac event. In patients without a reversible perfusion abnormality (SDS < 2), we observed lower annual hard event rate (8% vs 19.6%, P < 0.05) and revascularization procedures (4% vs 19.6%, P < 0.05) in comparison with patients with SDS > or = 2. In patients with or without reversible defects, we registered significantly higher annual hard event rate in the setting of post-stress worsening of the LVEF > 5% and/or severe CAC score > or = 709 (23.8% vs 1.9% in patients with SDS < 2, and 26.7% vs 9.5% in patients with SDS > or = 2, P < 0.05). CONCLUSION: The findings of highly elevated CAC score as well as the post-stress left ventricle stunning enable further risk stratification in patients with or without reversible perfusion abnormalities.

[Chronic benign exsudative pericarditis--a case of familiar incidence]. / Chronická exsudativní benigní perikarditida--popis familiárního výskytu.

Pericarditis is a common disease caused by a number of factors. Chronic pericarditis is defined as the presence of pericardial effusion for more than 3 or 6 months. The case study reports a case of familiar incidence of chronic exsudative pericarditis in a young woman, her sister and her mother, with an analysis of diagnostic and therapeutic options. According to available literature, this is the second case described of such form of familiar incidence.

[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.

[The ovarian hyperstimulation syndrome with pericardial and pleural effusions complicated by supraventricular arrhythmia]. / Ovariální hyperstimulacní syndrom s perikardiálním a pleurálním výpotkem komplikovaný supraventrikulární arytmií.

Problems which arise in conjunction with the use of assisted reproduction methods are no longer resolved only by the gynaecologist. The authors demonstrate on the case of a female patient the necessity of interdisciplinary collaboration in the diagnosis and therapy of developed ovarian hyperstimulation syndrome (OHSS)--the most serious complication of assisted reproduction.

[What is the health status of cardiology health care personnel in 2001?]. / Jaký je zdravotní stav pracovníku zabývajících se kardiologií v roce 2001?

The prevention of cardiovascular diseases belongs to priorities of the Czech public health care. Medical personnel should therefore set the example in the healthy way of life. At the meeting of the Working Group for Arrhythmia and Permanent Cardiostimulation at the Czech Cardiological Society, a questionnaire-based investigation for the evaluation of basic risk factors in workers engaged in cardiology (physicians, nurses, technicians) was performed. Our employees represent a paragon for the population in terms of motion activities and smoking in men. All of them also evaluate their subjective health better than the general population does. However, they consume larger amounts of alcohol and keep correct nutrition habits at a lower standard than the general population practices.

[Comparison of two types of devices for long-term Holter monitoring of the ECG in detection of heart arrhythmias]. / Srovnání pouzití dvou typu prístroju pro dlouhodobou Holterovu monitoraci EKG pri vysetrování srdecních arytmií.

UNLABELLED: The objective of the work was to compare the use of two types of long-term ECG monitors in examinations of cardiac arrhythmias and to find out whether their yields differed significantly when patients with a history of palpitations and syncope are examined. Two recorders, King of Heart with manual operation of the ECG tracing were used and the R test with continuous recording of the ECG tracing. For statistical processing contingence tables were used. For examination by the King of Heart recorders 111 patients (40 men and 71 women) were indicated, average age 48 years (14-84 years). 108 patients were examined. Yield I (number of patients with complaints)--89%. Yield II (number of patients with pathological ECG)--50%. In indications for palpitation pathological findings were recorded in 52% patients. In indication for syncope or presyncope pathological findings were recorded in 46% patients. Yield II in these two groups does not differ significantly (p = 0.9). For examination with an R test recorders 74 patients (30 men and 44 women) were indicated with a mean age of 52 years (18-85). Yield I (number of patients with complaints)--66%. Yield II (number of patients with complaints and a pathological ECG)--40%. Yield III (total number of pathological ECG findings)--79%. Yield IV (number of patients without complaints with a pathological ECG)--29%. In indication on account of palpitation there were pathological findings in 69% patients. In indication on account of syncope and presyncope pathological findings were recorded in 71% patients. Yield II does not differ significantly in these sub-groups (p = 1.0). Statistical comparison of the yield of the two instruments: in the basic indication on account of palpitation the yield of these methods does not differ significantly (p = 0.09). In the basic indication on account of syncope and presyncope the yield of the two methods does not differ significantly (p = 0.33). CONCLUSION: The yield of the two instruments for long-term Holter monitoring does not differ significantly, both can be recommended for examination of patients with suspected cardiac arrhythmias. The future belongs to instruments with continual ECG recording because of detection of asymptomatic arrhythmias.

[ECG Holter monitoring in the detection of cardiac arrhythmias yesterday, today and tomorrow]. / Holterova monitorace EKG pri vysetrování srdecních arytmií vcera, dnes a zítra.

The paper summarizes contemporary knowledge and technical possibilities of the use of Holter systems of 24-hour and long-term ECG monitoring in the diagnosis of cardiac arrhythmias. It evaluates the development of different types of equipment and indications for their use. It summarizes the yield of different types and mentions detailed limitations for their use and deals with the economic evaluation of different methods. Finally it summarizes contemporary technical possibilities and future perspectives such as transmission of data over the internet and combination of ECG monitoring with other non-invasive examinations.

[New trends in ECG Holter monitoring]. / Novejsí smery v Holterove monitorování EKG.

The authors review contemporary possibilities of Holter ECG monitoring. In the first group of patients they emphasize possibilities and the yield of long-term ambulatory ECG monitoring by means of an apparatus started by the patient. The second group of patients was examined by Holter monitoring, using an oesophageal lead. It is a method hitherto not used in the Czech Republic, which if properly indicated, improves the non-invasive diagnosis of cardiac arrhythmias.

[Echoccardiographic hyperventilation test in patients with negative coronarography]. / Echokardiografický hyperventilacní test u pacientu s negativní koronarografií.

Opportunities to examine patients with spastic angina pectoris are at present, due to the inaccessibility of ergonovine, very limited. The authors demonstrate on a small group of patients the application of echocardiographic hyperventilation test for assessment of the diagnosis of spastic angina pectoris.

[Magnetic resonance in cardiology--a new alternative in noninvasive diagnosis]. / Magnetická rezonance v kardiologii--nová alternativa v neinvazivní diagnostice.

The authors describe their initial experience with examination of the heart by magnetic resonance (MR) and discuss its position in the diagnostic algorithm of cardiac examinations:. They made 31 MR examinations of the heart in 30 patients. Echocardiography preceded 29 examinations. MR proved to be particularly useful where echocardiography did not lead to a decisive conclusion and called for confirmation by another method, or where it could not be carried out or its result was not consistent with the patient's clinical condition or the results of other examinations. The quality of the MR image was influenced most by the possibility of ECG gating. The latter was not possible in 16 patients (51.6%). In three of these (18.8%) the images were of such poor quality that they did not provide adequate diagnostic information. Images suitable for evaluation were obtained in 28 examinations (90.3%)--in these patients the MR information was valuable for establishment of the diagnosis. Magnetic resonance is a new possible method in the non-invasive diagnosis of heart disease. In the majority of cases it follows after echocardiographic examination which remains due to its accessibility the basic non-invasive method for examination of the heart.

[Ovarian hyperstimulation syndrome as a rare cause of pericardial effusion. 2 case reports]. / Ovariální hyperstimulacní syndrom jako vzácná prícina perikardiálního výpotku. Dve kazuistiky.

Assisted reproduction techniques (ART) are modern medical methods which should help infertile couples to resolve their problems. With the introduction of ART new ethical and technical problems arise. The authors wish to demonstrate on the submitted two case-histories the need of interdisciplinary collaboration of the specialist in internal medicine and gynaecologist when dealing with a serious complication of ART--ovarian hyperstimulation syndrome (OHSS).

[Latent tetany in patients with a negative coronarographic finding]. / Výskyt latentní tetanie u pacientu s negativním koronarografickým nálezem.

UNLABELLED: Chest pain, constriction of the throat and palpitations are symptoms common to tetany and ischaemic heart disease. The objective of the work was to assess the latent prevalence of tetany in patients with typical chest pain and a negative outcome of coronarographic examination. The group comprised 20 patients (5 men and 15 women), mean age 54 years (28-74) with a history of chest pain, who had selective coronarography with a negative or minimal (up to 30% stenosis) outcome. In this group EMG, the ischaemic and hyperventilation test for latent tetany was made. A metabolic cause of tetany was ruled out. The results of the EMG test were positive in 10 patients (50%, 8 women, 2 men). Patients with a positive finding were treated with magnesium lactate by the oral route. All patients reported after one month regression of complaints. CONCLUSION: With regard to the high rate of positive EMG tests in patients with a history of chest pain and a negative coronarographic finding the authors recommend to add this simple test to the algorithm of examinations of these patients and supplement treatment according to its results.

[Correction of morphology and indicators of atrial function using long-term physiologic cardiac pacing in patients with prior chronic atrioventricular dissociation or VVI pacing]. / Uprava morfologických a funkcních ukazatelu srdecních predsíní vlivem dlouhodobé fyziologické kardiostimulace u pacientu s predchozí chronickou atrioventrikulární disociací nebo VVI stimulací.

UNLABELLED: In patients with atrioventricular dissociation associated with complete atrioventricular block or reverse synchronization and preservation of the sinus rhythm the atria are mechanically over-burdened by contraction in an inept stage of the cardiac cycle (against a closed atrioventricular valve). Prolonged overburdening leads to dilatation of the atria and a higher incidence of supraventricular arrhythmias incl. atrial fibrillation. The objective of the trial was to assess whether these changes are reversible. METHOD: In 26 patients where atrioventricular dyssynchronization as the only detectable reason of atrial dilatation was eliminated by implantation of sequential atrioventricular stimulation, the authors investigated by echocardiography the dimensions, volumes and ejection fractions of the atria and left ventricle at baseline (A), after 24 hours following implantation (B), after 8 weeks (C), after one year (D). RESULTS: Left atrium: during the first 24 hours diminution in the long axis occurred (AxB: -4.28, p = 0.023), the difference remained significant even after eight weeks (AxC: -6.1, p = 0.050). The ejection fraction was after eight weeks also significantly greater (BxC: +8.29, p = 0.039). Right atrium: within 24 hours the long axis was reduced (AxB: -4.70 p = 0.033), the difference was apparent also after 8 weeks (AxC: -5.60 p = 0.028). Within 8 weeks (AxC) the mean enddiastolic pressure diminished significantly (-11.01, p = 0.032) as well as the endsystolic volume (-9.01, p = 0.018, while the ejection fraction increased (+7.50, p = 0.031). The right ventricular volume during diastole increased between the 8th week and the check-up after one year (+6, -1, +17.77, p = 0.046). Left ventricle: the ejection fraction had a rising trend, after one year a significant difference was found as compared with the baseline value (AxD: +10.20%, p = 0.007) and as compared with the value assessed 8 weeks after implantation (CxD: +9.44%, p = 0.018). The change of the ejection fraction was inversely proportional to the value of the ejection fraction immediately after implantation (r -0.83, p < 0.01). CONCLUSION: The authors provided evidence of the reversibility of the morphological and functional atrial damage and the favourable effect of atrioventricular synchronization on left ventricular function.

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.

Acute ischemia as a complication by transoesophageal echocardiography.

Transoesophageal echocardiography (TEE) is a safe procedure with a low complication rate. We present a patient with severe coronary artery stenosis or disease who developed acute coronary ischemia of the anterior wall as a complication of TEE procedure. The possible mechanism can be stress during the procedure.

Incidence and significance of chronotropic incompetence in patients with indications for primary pacemaker implantation or pacemaker replacement.

This prospective study was undertaken to evaluate the incidence and significance of chronotropic incompetence in 211 patients [age 71.1 6 10.6 years (mean 6 SD)] by means of maximum exercise test in order to determine the indication for rate-responsive pacing before primary pacemaker implantation (147 patients) or pacemaker replacement (64 patients). There were 112 (53%) patients with second- or third-degree AV block, 63 (30%) with sick sinus syndrome, and 36 (17%) with chronic atrial fibrillation. Chronotropic incompetence was defined as maximum heart rate lower than age-adjusted norm calculated by the formula: 0.7x(220 - age) and its significance as the difference between the two rates. The overall incidence of chronotropic incompetence was 42%. The incidence was significantly higher in patients with atrial fibrillation (67%, P<0.0005) and sick sinus syndrome (49%, P<0.012) than in those with AV block (30%). The mean difference between maximum heart rate and the age-adjusted norm was 18% (range 2%-63%). The mean difference was significantly higher in patients with atrial fibrillation (27%, range 8-63%) than in those with sick sinus syndrome (19%, range 2%-45%, P<0.01), or with AV block (12%, range 6%-26%, P<0.000001). The rate-responsive pacemakers were implanted in 44% of 211 patients studied and in 43% of 196 patients excluded from the study due to the apparent (contra)indication of rate-responsive pacing (NS). Thus, chronotropic incompetence seems to be common in the pacemaker patient population. The highest incidence and significance was found in patients with chronic atrial fibrillation. Systematic evaluation of chronotropic competence can double the rate of implantation of rate-responsive pacemakers; however, further studies are needed to clarify relation between the significance of chronotropic incompetence and functional benefit of rate-responsive pacing.