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).

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.

PURPOSE: Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings. RESULTS: Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries. CONCLUSION: A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.

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.

[SAVOR TIMI 53 -  Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus]. / SAVOR-TIMI 53 - Vysledky saxagliptinu a kardiovaskularni vysledky u pacientu s diabetes mellitus 2. typu.

BACKGROUND: The type 2 Diabetes Mellitus treatment is currently effective but still not ideal. A therapy based on the incretins, which represents a significant qualitative progress, is close to an ideal. The first completed mortality study with dipeptidyl peptidase (DPP 4) inhibitors is the study called SAVOR as presented in Amsterdam during the European Cardiology Congress in 2013. METHODOLOGY: SAVOR (Saxagliptin and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus) randomised 16,492 patients with Type 2 Diabetes Mellitus and a high-risk of cardiovascular events treated with current per oral antidiabetics and patients treated with saxagliptin or placebo. Eight thousand eight hundred and twenty patients were randomised to be treated with saxagliptin and 8,212 were randomised to be treated with placebo. The average monitored period was 2.1 years. RESULTS: The primary goal (cardiovascular death, nonfatal myocardial infarction and nonfatal CMP) occurred in 7.3% (613) patients treated with saxagliptin and in 7.2% (609) patients treated with placebo (HR 1.00, p < 0.001 for non inferiority). The main secondary goal (cardiovascular death, myocardial infarction, vascular stroke, hospitalisation for a heart failure or angina pectoris and myocardial revascularisation) occurred in 12.8% (1,059) patients treated with saxagliptin and in 12.4% (1,034) patients treated with placebo. The number of hospitalisations for heart failure was 289 (3.5%) in the group treated with saxagliptin and 228 (2.8%) in the group treated with placebo (p = 0.007). CONCLUSION: DPP 4 inhibitor saxagliptin did not increase the occurrence of ischemic cardiovascular events but it inclined to an increased hospitalisation for heart failure in patients with the already present heart failure. It did not increase the occurrence of pancreatitis. Simultaneously it significantly improved the Diabetes Mellitus control, which could signal a future improvement in cardiovascular goals.

[Cardiorenal syndrome by heart failure]. / Kardiorenální syndrom u srdecního selhání

Cardiorenal (CR) syndrome is defined for the purposes of the following text mainly as primary cardiac dysfunction with a consequent failure of renal haemodynamics. Heart failure leads to a decrease in cardiac output and to the activation of vasoconstrictors; this gradually precipitates a decrease in the level of renal perfusion, the vasoconstriction of renal vessels and a decrease in glomerular filtration with a gradual development of renal failure. The following paper analyses the pathophysiological mechanisms, the characteristics of the patients, the role of medication during CR syndrome, the relationship between proteinuria and anaemia during CR syndrome and the application of bio-markers and pulmonary hypertension in the prognosis of patients with CR syndrome.

[Renal denervation 2013]. / Renální denervace 2013.

Arterial hypertension is a worldwide serious clinical problem. It affects 30- 40% of the adult population. Resistant hypertension is defined as systolic blood pressure that remains 140mmHg while in the doctors surgery and/ or as average systolic blood pressure during a 24- hour monitoring of an outpatient 130mmHg after a combination of three antihypertensive agents (including a diuretic) has been administered in the maximum tolerated dose amounts. Renal denervation is an invasive method of catheter radio frequency ablation of sympathetic nerves located in the walls of renal arteries. The results of the Symplicity HTN 1 and HTN 2 trials proved that renal denervation can safely decrease blood pressure in patients with resistant hypertension. Further research is necessary in order to verify these data, to clarify the questions which remained unanswered and to evaluate future applications of renal denervation. Current experience and recommendations are included, as well as an overview of existing denervation devices and devices which are in development.

[Diuretics in monotherapy and in combination with other diuretics and nondiuretics in the treatment of hypertension]. / Diuretika v monoterapii a v kombinaci s diuretiky a nediuretiky v lécbe hypertenze.

Diuretics belong to the basic group of medicines for the treatment of hypertension and heart failure. In the case of hypertension treatment, their main indication is higher age and isolated systolic hypertension. In the case of heart failure they are used for the treatment of swellings and shortness of breath. The most frequently prescribed group of diuretics is thiazides and similar products. In patients with renal insufficiency, loop diuretics are administered. In the case of hypertension, diuretics are mainly used in the combination treatment. The most frequently used diuretic in combination is again hydrochlorothiazide, which is combined with reninangiotensin system blockers. It is mainly the combination of an ACE inhibitor + indapamide that seems to be modern and promising, and it is, on the basis of large clinical trials, recommended also for diabetics (ADVANCE) or for secondary prevention following a cerebrovascular accident (PROGRESS) or for the elderly (HYVET). Also a combination of two diuretics is popular -  mainly hydrochlorothiazide + amiloride. A combination of a betablocker and diuretic is less suitable.

[AII antagonists in the treatment of hypertension and prevention of CVA]. / All antagonisté v lécbe hypertenze a preventi CMP.

All antagonists (sartans) are considered to be a group of pharmaceuticals with comparable indications and comparable effects as ACE inhibitors, while almost lacking the side effect ofa dry cough. Large clinical trials showed that All antagonists had a comparable (statistically insignificantly smaller) effect on so called "hard targets", i.e. mortality and morbidity, in patients with ischemic heart diseases and/or heart failure. The study of their effect in the treatment of hypertension was first limited to diabetics and patients with microalbuminuria and showed that they had a significant renoprotective effect in said cases. Large clinical trials followed, focusing on hypertension in primary as well as secondary prevention of cardiovascular diseases. Five large clinical trials focusing on All antagonists addressed cerebrovascular accidents and cognitive functions: LIFE, SCOPE, OSCAR, MOSES and POWER. The LIFE study (Losartan Intervention For Endpoint) confirmed that in 9,193 patients with proven left ventricular hypertrophy, losartan led to a lower incidence of cerebrovascular accidents or new development of diabetes mellitus than atenolol, which in turn led to statistically significant lower primary endpoint (fatality, myocardial infarction and cerebrovascular accident) (p = 0.021), while blood pressure dropped at the same rate. The SCOPE study (Study on COgnition and Prognosis in Elderly hypertensives) compared candesartan with another antihypertensive treatment in 4,937 hypertonic patients older than 70. The primary endpoint was a decrease in massive cardiovascular accidents (fatality, MI, CVA). The decrease rate reached 10.9%, which was not considered statistically significant (p = 0.19). However, statistically significant was the decrease in cerebrovascular accidents (p = 0.04). The MOSES study (Morbidity and mortality after stroke) compared eprosartan and nitrendipine in secondary prevention of cerebrovascular diseases in 1,405 patients. Blood pressure was reduced to a comparable extent without showing significant differences between the two groups. During the study period, a total of 461 primary accidents occurred: 206 in patients with eprosartan and 255 in patients with nitrendipine (p = 0.014). Cardiovascular accidents were: 77 with eprosartan and 101 with nitrendipine (p = 0.06); cerebrovascular accidents were: 102 with eprosartan and 134 with nitrendipine (p = 0.03). OSCAR study was an open study with the objective to assess the impact of eprosartan treatment on cognitive functions. Use of eprosartan was associated with a significant reduction in blood pressure from 161.9/93.1 mm Hg to 136.1/80.8 mm Hg after 6 months (p < 0.0001). The total average score of the MMSE test after the completion of the follow-up period was 27.9 - 2.9 compared to 27.1 + 3.4 at the beginning (p < 0.0001). The results of the OSCAR study support the statement that antihypertensive treatment based on drugs that target the reninangiotensin system is associated with the preservation of cognitive functions. The POWER study proved in a large unselected population the suitability and practical aspect ofa reduction in the total cardiovascular risk by means of systematic treatment of high blood pressure.

[Outcomes of catheter ablation of atrial fibrillation in patients over 65 years of age]. / Výsledky katetrové ablace fibrilace síní u pacientu nad 65 let.

PURPOSE: This study assessed ablation techniques, recurrent arrhythmias, long-term outcomes, and complications of catheter ablation for atrial fibrillation (AF) in patients 65 years of age. METHODS: Consecutive patients aged < 65 years (n = 653) vs 65 years (n = 213), who underwent catheter ablation of AF in the course of eight years, were compared. Ablation strategy and procedure endpoints were left at the operators discretion. RESULTS: The group of patients 65 years comprised more females (p < 0.001), and more frequently presented with persistent AF (p = 0.010). These patients less frequently underwent simple pulmonary vein isolation (p = 0.017); on the contrary, extensive ablation including coronary sinus intervention was more common (p = 0.020). There was no difference in repeat ablation procedures (25 % vs 26 % patients; p = 0.823, or 1.4 vs 1.5 ablation procedures/1 patients; p = 0.479, respectively). Spectrum of recurrent arrhythmias did not differ between the groups except for more frequent paroxysmal AF before the first repeat ablation in patients < 65 years (p = 0.050). At the end of 49 ± 26 month total follow-up, stable sinus rhythm (SR) was achieved in 85 % patients < 65 years vs 76 % patients 65 years (p = 0.318). To maintain stable SR, older patients more often continued to take antiarrhythmic medication (p = 0.054). More serious complication occurred in 3.8 % of the patients 65 years vs 2.1 % of the patients < 65 years of age (p = 0.207). CONCLUSION: Patients 65 years of age achieved insignificantly worse long-term outcome after insignificantly fewer repeat ablation procedures, and with more frequent use of antiarrhythmic drugs. SR maintenance and risk of complications were, however, favorable.

[AII antagonists (candesartan and irbesartan) in the treatment of cardiovascular diseases]. / AII antagonisté (candesartan a irbesartan) v lécbe kardiovaskulárních onemocnení

Treatment of hypertension with angiotensin II receptor antagonists (AIIA) was first limited to diabetics and patients with microalbuminuria. So far, results of several large clinical trials with AIIAs were published, confirming significant renoprotective effect of these agents compared to placebo (RENAAL and IRMA), amlodipin (MARVAL and IDNT) and a combination of ACEI and AIIA (CALM). In 2002, results of 2 large comparator studies in hypertension were published: LIFE - Losartan Intervention For Endpoints and SCOPE - the Study on COgnition and Prognosis in Elderly hypertensives. In 2003, a series of the CHARM studies involving patients with heart failure were published and, from than, AIIA have been used as an alternative to ACEI or in a combination with ACEI. MOSES study - Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention - results were published in 2005 and ONTARGET study, focusing on secondary prevention of ischemic heart disease, was published in 2008. The CORD study - Comparison of recommended doses - and the ACTIVE I study (AF Clopidogrel Trial with Irbesartan for prevention of Vascular Events) were published in 2009. Candesartan was used in the CALM, SCOPE, RESOLVED and CHARM studies, irbesartan in the IRMA, IDNT and ACTIVE I.

[Fixed combinations in the treatment of hypertension]. / Fixní kombinace v lécbe hypertenze.

We present an overview of current opinions on combination therapy and the role of fixed combinations in the treatment of hypertension as per the ESH/ESC and CSH guidelines of 2007 and the revised European guidelines of 2009. A renin-angiotensin system blocker (ACE-I or sartan) combined with a calcium channel blocker is the most frequently recommended combination, followed by renin-angiotensin system blocker and a diuretic and a calcium channel blocker and a diuretic. A fixed combination of a calcium channel blocker and a beta-blocker has now been also recommended. Higher patient compliance and thus better control of hypertension is the main advantage of fixed combinations. We present an overview of fixed combinations registered in the Czech Republic until May 2012.

[Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and health related quality of life: results from the SHIFT substudies]. / Snízení srdecní frekvence u srdecního selhání: zmeny funkce levé komory a kvalita zivota v podstudiích SHIFT.

The SHIFT study showed a positive effect of ivabradine in patients with chronic heart failure, sinus rhythm and heart rate at rest above 70 beats per minute. The aim of the first sub-study was to ascertain the effect of ivabradine on changes to the left ventricle function using echocardiography; ivabradine significantly increased ejection fraction of the left ventricle and reduced terminal left ventricular end-systolic and end-diastolic volumes. The second sub-study explored changes to the quality of life in patients treated with ivabradine or placebo. This study also showed statistically significantly improved quality of life after treatment with ivabradine. Both sub-studies confirmed the positive effect of ivabradine on patients with optimal treatment of heart failure, including maximum tolerated dose of beta-blockers and sinus heart rate above 70/min.

[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.

[Pharmacotherapy of chronic heart failure after the first decade of 21st century]. / Farmakoterapie chronického srdecního selhání po prvních 10 letech 21. století.

We provide an overview of the main principles of pharmacological treatment of chronic heart failure. Chronic heart failure is considered to be an epidemic of the 21th century; in the Czech Republic, around 200,000 persons suffer from this condition. Over the last decade, pharmacological and non-pharmacological treatment of heart failure has undergone significant progress and new knowledge arises every year. Generally accepted pharmacological treatment steps include administration of ACE inhibitors, All antagonists (ARB) or beta-blockers, discussions exists on an indication for digoxin, diuretics and lipid-lowering drugs as well as on the importance of ACE-I and ARB. The role of antiarrhythmics is unclear and 2009-2011 have brought about some completely new drug groups-If, channel blockers, factor Xa blockers, thrombin blockers and other agents.

[Pharmacotherapy following myocardial infarction]. / Farmakoterapie po srdecním infarktu.

Early reperfusion is the treatment of choice for acute coronary syndrome. In the Czech Republic, reperfusion therapy is well accessible thanks to the network of 22 catheterization centres. Every year, 28,000 patients are treated using this technique. Successful reperfusion should be followed by life style changes--smoking cessation, maintenance of appropriate body weight etc. These steps than has to be accompanied by effective pharmacotherapy to prevent remodelling of the left ventricle, re-stenosis of the coronary artery, re-thrombosis and arrhythmias. Four drug groups provide the desired effects--renin-angiotensin-aldosterone system blockers, beta-blockers, antiplatelet agents and statins.

[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.