Clinical predictors of complications in patients with left-sided infective endocarditis: A retrospective study of 206 episodes.

PURPOSE: Early identification of specific patient subgroups at high risk of developing life-threatening infective endocarditis (IE) complications is of paramount importance. Better stratification may allow more intensive treatment of these patients and positively influences clinical outcomes. METHODS: We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p<0.0001). Valve prolapse/perforation during IE episodes was significantly associated with mitral valve IE (OR 2.136, p=0.026) and vegetation length (OR 1.055, p=0.009). Septic shock was significantly related to two main risk factors: S. aureus infection (OR 8.459, p=<0.0001) and smoking (OR 8.403, p=0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p=0.001), followed by S. aureus infection (OR 3.59, p=0.002). Finally, septic shock (OR 6.000, p=0.001) represented the most important risk factor of in-hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left-sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).

Intraventricular placement of a spring expander does not attenuate cardiac atrophy of the healthy heart induced by unloading via heterotopic heart transplantation.

An important complication of the prolonged left ventricle assist device support in patients with heart failure is unloading-induced cardiac atrophy which proved resistant to various treatments. Heterotopic heart transplantation (HTx) is the usual experimental model to study this process. We showed previously that implantation of the newly designed intraventricular spring expander can attenuate the atrophy when examined after HTx in the failing heart (derived from animals with established heart failure). The present study aimed to examine if enhanced isovolumic loading achieved by implantation of the expander would attenuate cardiac post-HTx atrophy also in the healthy heart. Cardiac atrophy was assessed as the ratio of the transplanted-to-native heart weight (HW) and its degree was determined on days 7, 14, 21 and 28 after HTx. The transplantation resulted in 32±3, 46±2, 48±3 and 46±3 % HW loss when measured at the four time points; implantation of the expander had no significant effect on these decreases. We conclude that enhanced isovolumic loading achieved by intraventricular implantation of the expander does not attenuate the development of cardiac atrophy after HTx in the healthy heart. This indicates that such an approach does not represent a useful therapeutic measure to attenuate the development of unloading-induced cardiac atrophy.

Renal sympathetic denervation in resistant arterial hypertension: long term and updated results.

The present paper is an extension to our earlier publication (Sochman et al. 2016) documenting a beneficial effect of renal sympathetic denervation on pharmacologically uncontrollable hypertension in a group of seven patients followed up for 1-2 years post-procedure. The same patients remained on ambulatory follow-up for another 5-6 years, with the beneficial effect persisting throughout the follow-up period while on the same medication.

Effects of increased myocardial tissue concentration of myristic, palmitic and palmitoleic acids on the course of cardiac atrophy of the failing heart unloaded by heterotopic transplantation.

The present experiments were performed to evaluate if increased heart tissue concentration of fatty acids, specifically myristic, palmitic and palmitoleic acids that are believed to promote physiological heart growth, can attenuate the progression of unloading-induced cardiac atrophy in rats with healthy and failing hearts. Heterotopic abdominal heart transplantation (HT(x)) was used as a model for heart unloading. Cardiac atrophy was assessed from the ratio of the native- to-transplanted heart weight (HW). The degree of cardiac atrophy after HT(x) was determined on days 7, 14, 21 and 28 after HT(x) in recipients of either healthy or failing hearts. HT(x) of healthy hearts resulted in 23+/-3, 46+/-3, 48+/-4 and 46+/-4 % HW loss at the four time-points. HT(x) of the failing heart resulted in even greater HW losses, of 46+/-4, 58+/-3, 66+/-2 and 68+/-4 %, respectively (P<0.05). Activation of "fetal gene cardiac program" (e.g. beta myosin heavy chain gene expression) and "genes reflecting cardiac remodeling" (e.g. atrial natriuretic peptide gene expression) after HT(x) was greater in failing than in healthy hearts (P<0.05 each time). Exposure to isocaloric high sugar diet caused significant increases in fatty acid concentrations in healthy and in failing hearts. However, these increases were not associated with any change in the course of cardiac atrophy, similarly in healthy and post-HT(x) failing hearts. We conclude that increasing heart tissue concentrations of the fatty acids allegedly involved in heart growth does not attenuate the unloading-induced cardiac atrophy.

Renal denervation in the most serious form of resistant arterial hypertension.

The aim of our observation was to establish whether or not renal sympathetic denervation (RSD) may help control blood pressure (BP) levels in patients with severe hypertension refractory to pharmacological therapy. Out of a group of 12 patients, candidates for RSD, with uncontrolled hypertension and a systolic BP over 190 mm Hg on repeated measurements despite optimal medication, four patients were excluded for multiple renal arteries and one for hyperaldosteronism. Seven patients had RSD using a Symplicity device (5M, 2 F) with a mean age of 64.9 years. While all were followed up for a minimum of 6 months, follow-up duration in the majority of them was substantially longer (12-20 months). At six months post-RSD, six of the seven patients showed a decrease in systolic BP by at least 15 mm Hg while receiving the same or fewer doses of antihypertensive agents. A similar response was seen in diastolic BP. The BP decrease was maintained throughout whole follow-up. In a small group of patients with severe hypertension, we demonstrated that renal sympathetic denervation is capable of reducing blood pressure even in patients with severe hypertension.

Reverse endoventricular artificial obturator in tricuspid valve position. Experimental feasibility research study.

The concept of vena contracta space reduction in tricuspid valve position was tested in an animal model. Feasibility of specific artificial obturator body (REMOT) fixed to the right ventricular apex and interacting with tricuspid valve leaflets was evaluated in three different animal studies. Catheter-based technique was used in three series of experiment in 7 sheep. First acute study was designed for evaluation if the screwing mode of guide wire anchoring to the right ventricular apex is feasible for the whole REMOT body fixing. Longer study was aimed to evaluate stability of the REMOT body in desired position when fixing the screwing wire on its both ends (to the right ventricular apex and to the skin in the neck area). X-ray methods and various morphological methods were used. The third acute study was intended to the REMOT body deployment without any fixing wire. In all of 7 sheep the REMOT was successfully inserted into the right heart cavities and then fixed to the right ventricular apex area. When the REMOT was left in situ more than 6 months it was stable, induced adhesion to the tricuspid valve leaflet and was associated with a specific cell invasion. Releasing of the REMOT from the guiding tools was also successfully verified. Deployment of the obturator body in the aim to reduce the tricuspid valve orifice is feasible and well tolerated in the short and longer term animal model. Specific cell colonization including neovascularization of the obturator body was observed.

Hepatocyte growth factor and antibodies to HLA and MICA antigens in heart transplant recipients.

Recent unconfirmed literature data suggest that elevated concentrations of the multifunctional cytokine hepatocyte growth factor (HGF) might be a marker of increased incidence of acute rejection after organ transplantation. The aim of this study was to test the hypothesis that HGF levels may correlate with the rejection and/or with the production of HLA and MHC Class I chain-related antigens A (MICA) specific antibodies. Sixty-three heart transplant recipients were included into the study. Hundred and eighty-five endomyocardial biopsies (EMB) obtained up to 6 months after transplantation were retrospectively analyzed for signs of cellular (CR) and antibody-mediated rejection (AMR). Pre- and post-transplant sera were tested for HGF concentrations and antibodies to HLA class I, class II and MICA antigens by xMap technology (Luminex). Pre-transplant HGF did not correlate with the incidence of CR or AMR. However, higher HGF concentrations correlated significantly with HLA antibody production before and after transplantation (P = 0.006 and P < 0.0001 respectively). Patients with both HLA class I and class II antibodies before transplantation had significantly lower AMR-free survival. Furthermore, recipients with pre-transplant donor-specific antibodies (DSA) had significantly lower AMR-free survival (50%) than recipients without pre-transplant HLA antibodies (90%) and patients with antibodies not specific to donor antigens (92%) (P = 0.005). Post-transplant MICA antibodies tended to be more frequent in patients with AMR (P = 0.063). In conclusion, elevated HGF concentrations in our study were not associated with the incidence of CR and/or AMR but with the presence of HLA-specific antibodies. Testing for DSA before heart transplantation by Luminex may be helpful for the identification of patients with increased risk of AMR.

[High sensitivity cardiac troponin assays 2009: clinical potential, current practice and benefits, the future]. / High-sensitivity metody stanovení srdecních troponinu 2009: klinický potenciál, soucasná praxe a prínos, perspektiva.

At present, determination of cardiac troponins (cTn) is the biomarker method of choice for diagnostics and risk stratification in patients with a myocardial injury. Past clinical practice had provided sound evidence that low cTn concentrations, measured with unacceptable imprecision by the currently used methods, hold important clinical, diagnostic and stratification potential. The new generation cTn assays, so called high-sensitivity assays, enable determination of very low cTn concentrations with satisfactory analytical precision and open the way to early identification of small but often prognostically important myocardial damage. Introduction of high-sensitivity cTn assays in practice is, however, associated with some difficulties: their superior diagnostic sensitivity to identify small injuries to myocardium is often linked to lower specificity, higher incidence of elevated cTn concentrations is frequently associated with less obvious clinical symptomatology (overdiagnosis), resulting in greater demand for further patient assessment (overcrowding), repeated analyses and trend monitoring of cTn fluctuation. These initial difficulties cannot lessen the by now indisputable, established benefit of high-sensitivity cTn assays that we briefly describe in the present paper.

Catheter-based management of aortic valve regurgitation in experimental cardiology.

Non-surgical management of aortic valve disease has been given considerable attention. Several recent publications have already reported its use in clinical practice. The main issue is to get an understanding of the pathophysiological processes and, most importantly, extensive experimental activity. In addition to testing various animal models, technical and material aspects are also being intensively investigated. It is not clear yet whether the durability and applicability of this promising development will be comparable with the standard of current cardiac surgery. Nonetheless, even the use of some models as a temporary approach helping to improve the circulatory status, not allowing safe surgery, is certainly justified. At any rate, a new stage of research and clinical application has been set off. However, experimental background continues to be simply indispensable. The paper is a short review of the issue.

[Silent ischemia and noisy stunning: a perspective of the cause and hints of associations]. / Nemá ischémie a hlucné omrácení: pohled na vec a tusení souvislostí.

The significance of ST-segment changes in an electrocardiogram need not be always as clear-cut as we used to think. Minor problems usually represent only the ST-segment depressions in the presence of typically manifested problems and established coronary artery disease. The same holds true for ST-segment elevations: in addition, they definitively superior to ST-segment depressions. Among other categories, silent ischemia denotes only a part of what is or can be seen. This article deals with other conditions associated with changes in ST segments and variable symptoms with changeable clinical implications.

[Repeated thrombosis of the mechanical heart valve prosthesis]. / Opakovaná trombóza mechanické chlopenní náhrady.

Paper presents the cause of 54-year-old patient with implanted mechanical heart valve prosthesis in the mitral position admitted to the hospital with a serious left ventricle (LV) systolic dysfunction. Patient underwent repeated attacks of acute left-sided heart insufficiency on the basis of verified thrombosis of the mechanical heart valve prosthesis. Pharmacological treatment was not effective and the systemic thrombolysis failed. Patient was twice reoperated--thrombectomy was performed during the first surgery, mechanical heart valve prosthesis was replaced with biological prosthesis during the second one. Patient was permanently treated with anticoagulants. The combination of bioprosthesis in the mitral position with the anticoagulant treatment appears to be a final therapy of the patient.

[Serious manifestation of primary hypothyroidism]. / Závazná manifestace primární hypotyreózy.

Thyroid gland diseases are the most frequent endocrinopathy and can be often seen in adult population. They occur at least by 5% of the population and the occurence increases with age, in females aging 45 and more, as thyroid gland diseases in this age group are represented approximately by 20%. Due to a complex influence of thyroid hormones in humans, diagnosis of thyroid disease may remain unsuspected under other disease with typical symptoms; the most serious of them is cardiogenic manifestation. When thyroid disease suspected, methods of diagnostics are very comprehensive and broad. Treatment on time can prevent serious complications. Case-study presenting a female patient with untreated primary hypothyroidism that had caused serious cardiac symptoms.

[Fatty liver disease and statins--which discipline the problem belongs to?]. / Nemoc tucných jater a statiny--kterému oboru patrí tento problém?

While fatty liver disease is a well-characterized entity, it is currently getting a completely new image. Its treatment is clearly an interdisciplinary challenge. The number of patients with fatty liver disease will be by no means negligible. The issue of fatty liver disease is not infrequently referred to in association with statin therapy instituted in an effort to treat metabolic syndrome and to reduce cardiovascular risks as part of preventive therapy. The attention focused on the increase in alanin aminotransferase levels during statin therapy is absolutely inadequate. The study includes an overview of the topic showing the induced rise in alanin aminotransferase is merely an accompanying phenomenon, mostly of no clinical relevance. An acceptable increase in alanin aminotransferase should not provide a reason for statin withdrawal in the usual spectrum of patients with metabolic syndrome and fatty liver disease. A distinct advantage is cooperation among a hepatologist, a cardiologist, and a diabetes expert.

[The electrocardiogram in acute myocardial infarction with reperfusion: current concepts regarding Q waves and their dynamics]. / Elektrokardiogram u akutního infarktu myokardu s reperfuzí: Co s Q kmity a jejich dynamikou v dnesní dobe?

The formation of Q waves in patients with myocardial infarction with primary ECG - documented ST elevations has been the subject of considerable attention. Less widely known, however, has been the fact that Q waves need not be a permanent feature and may disappear or decrease in quantity in some patients. For some time, the Q wave was perceived as a transmural extent of predominantly non-viable myocardial structures (scars or fibrosis). A most effective method for infarct-related artery recanalization is now available and the latest techniques have demonstrated beyond any doubt that even an invariable Q wave need not necessarily indicate loss of myocardial viability. Even in the era of thrombolysis, successful recanalization of an infarctrelated artery led to a specific ECG pattern in patients undergoing artery recanalization or reperfusion of the corresponding myocardial segment. The main features included a decrease in Q waves and, possibly, an increase in R waves in the ECG leads reflecting the respective ischemic events. This overview provides evidence of the significance of the Q wave in the ECG. It therefore comes as a surprise that modern cardiology has given so little attention to the above facts.

[Impact factors and bibliometrics of science. Does pure science really exist?]. / Impaktové faktory a scientometrie. Existuje skutecne cistá veda?

The impact factor is an artificially created indicator which when applied separately does not achieve the value attributed to it. In its assessment a number of different influences are projected which cause partial mistakes with a cumulative effect. It can have an even worse effect if the impact factor is incorrectly conceived or inadequately handled. Only in a long-term review using specific corrections it can serve to determine really top class periodicals but only within the framework of a single scientific discipline. It is not suitable for comparison of interdisciplinary journals. It should be used very carefully in the evaluation of authors. However it is still used in various types of administrative management. From the submitted paper it may seen that with a certain amount of overstatement it is personified and acts on its own. Its personification is homo sapiens scientometricus who evaluates himself as well as his environment which is represented by mere homo sapiens scientificus. In addition to the impact factor the authors discuss also other indicators and some aspects of scientometry.

The cutting pericardiotome: another option for pericardiopleural draining in recurrent pericardial effusion. Initial experience.

Large recurrent pericardial effusion can be managed by repeat pericardiocentesis or by surgery. A relatively new, catheter-based method uses a balloon catheter (percutaneous balloon pericardiotomy) for drainage from the pericardial sac to the pleural space. As an alternative, we present a newly developed device: Cutting pericardiotome.

Percutaneous transcatheter aortic disc valve prosthesis implantation: a feasibility study.

PURPOSE: Over the past 30 years there have been experimental efforts at catheter-based management of aortic valve regurgitation with the idea of extending treatment to nonsurgical candidates. A new catheter-based aortic valve design is described. METHODS: The new catheter-delivered valve consists of a stent-based valve cage with locking mechanism and a prosthetic flexible tilting valve disc. The valve cage is delivered first followed by deployment and locking of the disc. In acute experiments, valve implantation was done in four dogs. RESULTS: Valve implantation was successful in all four animals. The implanted valve functioned well for the duration of the experiments (up to 3 hr). CONCLUSION: The study showed the implantation feasibility and short-term function of the tested catheter-based aortic disc valve. Further experimental studies are warranted.

Insertion/deletion polymorphism in the angiotensin-converting enzyme gene in myocardial infarction survivors.

INTRODUCTION: Insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene influenced the plasma concentration of the ACE, and is D allele have been repetitively suggested as a risk factor for myocardial infarction (MI). MATERIAL AND METHODS: Two hundert thirty six male myocardial infarction survivors under 65 years and with body mass index and total plasma cholesterol levels under 95% of the Czech population were included in the study. As control group, 302 male controls (1% randomly selected group from the Czech population) were genotyped. I/D polymorphism in the ACE gene was determined using polymerase chain reaction. RESULTS: The prevalence of the I/I, I/D and D/D genotypes was 0.218, 0.494 and 0.288, in the control group, and 0.178, 0.538 and 0.284, in the myocardial survivors, respectively. The male Czech population has the similar frequency of insertion and deletion alleles compared to other Caucasian populations. The frequencies of the alleles and genotypes of the ACE gene did not differ significantly between MI survivors and a control sample of the Czech population. CONCLUSION: It was shown that the I/D polymorphism in the gene for ACE is not a genetic risk factor for myocardial infarction in the Czech population.

Catheter-based fixation of the mitral valve after acute papillary muscle rupture: a new technique for temporary hemodynamic stabilization.

We describe a new, catheter-based method for temporary management of hemodynamic instability after papillary muscle rupture in a patient with an acute myocardial infarction.

Infarct Size Limitation: acute N-acetylcysteine defense (ISLAND trial): preliminary analysis and report after the first 30 patients.

Our previous experimental research and initial clinical observations regarding the use of N-acetylcysteine in the treatment of ischemic and reperfusion injury in acute myocardial infarction gave rise to a study entitled the Infarct Size Limitation: Acute N-acetylcysteine Defense (ISLAND) trial. Today, this randomized, echocardiographically and angiographically controlled study includes the first 30 patients with a first anterior wall myocardial infarction: Group A (n = 10) consisting of patients with successful recanalization of the infarct-related left anterior descending artery by streptokinase without any further treatment, Group B (n = 10) consisting of patients with failed infarct-related artery recanalization, and Group C (n = 10) comprising patients who had successful streptokinase-induced recanalization of the left anterior descending artery plus N-acetylcysteine administration at a dose of 100 mg/kg body weight. The parameters monitored in our study include changes in global and regional left ventricular ejection fraction of the infarct-related segment using echocardiography and, using electrocardiograms and the Wagner QRS scoring system, the amounts of acutely jeopardized and finally infarcted myocardium. In Group A, global left ventricular ejection fraction rose nonsignificantly within 2 weeks from 37.5 +/- 9.6% to 38.5 +/- 13.8%; it declined significantly in Group B from 36.2 +/- 6.1% to 30.1 +/- 6.7% (p < 0.05), while it considerably improved in Group C from 41.7 +/- 4.1% to 59.6 +/- 8.1% (p < 0.001). Regional left ventricular ejection fraction changed significantly only in Group C: from -4.5 +/- 27.3 to 45.6 +/- 16.3 (p < 0.001). In Group A, in which the amount of acutely jeopardized myocardium was 21.7 +/- 7.2, infarction actually occurred in 20.4 +/- 9.7% (practically no myocardial salvage). In Group B, risk area was 18.1 +/- 4.3%, but infarct size rose to a resulting 29.1 +/- 6.0%. Significant myocardial salvage was accomplished only in Group C: of 26.2 +/- 8.1% of jeopardized myocardium, infarct size was reduced to 10.8 +/- 7.1% (salvage by 58.8%). Also, basic division of patients by therapy showed that, although those with nonidentical findings on their coronary arteries were included into the same groups, patients treated with streptokinase plus N-acetylcysteine had significantly more favorable values of the monitored parameters than those treated with streptokinase alone. We conclude our interim analysis suggests that N-acetylcysteine has a beneficial effect, reducing the functional and structural impacts of myocardial infarction.