[The meaning of the combination of fibrinogen, micro/macroalbuminuria and atheromatosis in the carotid bloodstream for the evaluation of the abnormal finding of the stress myocardial SPECT in the asymptomatic 2nd type diabetic patients]. / Význam kombinace zmen fibrinogenu, mikro/makroalbuminurie a ateromatózy v karotickém recisti pro posouzení rizika abnormálního nálezu zátezového SPECT myokardu u asymptomatických diabetiku 2. typu.

OBJECTIVES: Stress perfusion myocardial scintigraphy (SPECT) is useful in silent ischemia detection in the group of the asymptomatic type 2. diabetic patients. In our paper we present the combinations of the parameters predictive for stress myocardial SPECT result. METHODS: We selected parameters (fibrinogen, micro/macroalbuminuria, ateroma in carotid artery bed) that were significantly associated with stress myocardial SPECT result. We analyzed the combinations of these parameters change and evaluated their significance for stress myocardial SPECT result prediction. RESULTS: We evaluated 121 type 2. diabetic patients without patological ECG changes and with normal left ventricle ejection fraction. Thirty one (26%) had abnormal and 90 (74%) equivocal or normal stress myocardial SPECT result. The combination of ateroma presence in carotid bed and fibrinogen in upper tertile was found in 20 patients. Fifteen of them (75%) had the abnormal SPECT result. The combinations of the ateroma absence, negative micro/macroalbuminuria and fibrinogen in the middle or lower tertile were present almost in the half of all the examined diabetic patients. Such combinations were connected with normal or equivocal SPECT result in 93-96% cases. CONCLUSION: Micro/macroalbuminuria, fibrinogen and ateroma in carotid bed found by sonography are significantly associated with stress myocardial SPECT result. Combinations of these parameters changes lead to the futher stratification that enables the rationale approach in the stress examination indication.

[Inflammatory parameters in patients with a cerebrovascular attack]. / Zánetlivé parametry u nemocných s cévní mozkovou príhodou.

OBJECTIVE: Provide evidence whether there is a difference in the presence of inflammatory parameters in patients with cerebrovascular attacks (CVA) with a thrombotic etiology as compared with a CVA with an embolic etiology. PATIENTS AND METHODS: In 45 patients with an acute CVA the level of C reactive protein (CRP) was assessed, interleukin 6 (IL-6), interleukin 8 (IL-8) and the value of the D-dimer. Patients with clinical signs of inflammation were eliminated. 21 patients had a sinus rhythm (SR) and 24 patients atrial fibrillation (AF). RESULTS: Between the group of patients with SR and AF there was no difference in age or sex distribution. The CRP concentration was in the SR group, as compared with the AF group, increased (4.67 mg/l vs. 3.65 mg/l, p = 0.043), similarly as the concentration of IL-8 (12.53 ng/l vs. 8.1 ng/l, p = 0.039). The IL-6 concentrations in the two groups did not differ (5.45 ng/l vs. 5.014 n.s.), similarly as the number of patients with elevated D-dimer values (29% vs. 35% n.s.). CONCLUSION: The assembled findings of elevated inflammatory parameters in patients with CVA of a thrombotic etiology as compared with patients with CVA with embolic etiology indicate similarly as in patients with acute coronary syndrome - the possible role of inflammation in the etiopathogenesis of thrombotic CVA. The results suggest the possible use of inflammatory markers for the differentiation of the etiology of ischaemic CVA.

[Tactics of hypolipidemic therapy after myocardial revascularization]. / Taktika hypolipidemické lécby po revaskularizaci srdce.

Previous investigations revealed that hypolipidaemic treatment of patients with IHD in the Czech Republic is inadequate. Patients after revascularization operations are discharged from cardiosurgical departments without suitable medication and moreover the values of the lipid spectrum are affected by the surgical intervention. The objective of the investigation was to evaluate the indication of hypolipidaemic treatment during hospitalization or later during check-up examinations by attending physicians. The authors evaluated retrospectively 100 patients after revascularization operations of the heart discharged without hypolipidaemic treatment and 40 patients treated with fluvastatin because of the lipid values before surgery. Using questionnaires it was revealed that in the group without pharmacological intervention in 36% patients the lipid levels were checked and hypolipidaemic treatment was started in 14% of the patients. In the patients with pharmacological treatment 100% adherence to treatment and improvement of the lipid spectrum was found similarly as in comparable trials. Fluvastatin treatment was well tolerated. In the authors view hypolipidaemic treatment after revascularization should be started before discharge from hospital with regard to preoperative results of the lipid spectrum.

[Esophageal echocardiography in patients with cerebrovascular stroke and atrial fibrillation]. / Jícnová echokardiografie u nemocných s cévní mozkovou príhodou a fibrilací síní.

Atrial fibrillation is an important risk factor of embolization into the CNS. Thus affected patients should receive permanent anticoagulant therapy. Oesophageal echocardiography (TEE) can help our decision in patients with relative contraindications of anticoagulant therapy. TEE was performed in 52 patients with atrial fibrillation and cerebrovascular attack (CMP) with an ischaemic aetiology. Transthoracic echocardiography did not reveal the source of embolization. In 10% patients a thrombus was found in the appendage of the left atrium, in another 9% patients a spontaneous echocontrast was found in the left atrium (prethrombotic condition) and in 5% patients an open foramen ovale. The results indicate the highly probable etiology of embolization in patients with cerebrovascular attacks and atrial fibrillation. This supports the recommendation of absolute indication of anticoagulant treatment in patients with cerebrovascular attacks and atrial fibrillation.

Cardiac rhabdomyosarcoma.

Cardiac sarcoma is a very rare neoplasm and is difficult to diagnose. The case of a 51-year-old man with a left atrial tumour, locally recurrent three months after its surgical removal, is presented. Computed tomography showed metastatic spread to the lung parenchyma. On revised histology, the mass extirpated was a sarcoma. Because of the metastatic spread, further therapy was symptomatic only; the patient died 15 months after the first manifestation of his problems. Immunohistochemical staining confirmed cardiac rhabdomyosarcoma with metastatic spread to the lungs. Difficulty in diagnosing and treating cardiac tumours is discussed.