IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (studie IMPROVE-IT)

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec

Vnitr Lek 2014, 60(12):1095-1101  

Background:The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) is evaluating the potential benefit for reduction in major cardiovascular (CV) events from the addition of ezetimibe versus placebo to 40 mg/d of simvastatin therapy in patients who present with acute coronary syndromes and have low-density lipoprotein cholesterol (LDL-C) ≤ 125 mg/dl. Methods:Randomized double blind clinical trial in patients with acute coronary syndrome and low cholesterol level. The simvastatin monotherapy arm's LDL-C target was < 70 mg/dl, the comparison arm was simvastatin + ezetimibe. Ezetimibe was assumed...

Will the new SGLT2 inhibitor empagliflozin help us reduce the risk of hypoglycemia?

Terezie Pelikánová

Vnitr Lek 2014, 60(12):1102-1108  

The treatment of patients with type 2 diabetes is typically accompanied by hypoglycemia, if insulin or derivatives of sulfonylurea are used within the treatment. Apart from the fact that hypoglycemias are the major obstacle to achieving the desirable compensation of diabetes, hypoglycemia also has a number of serious clinical consequences. A long term serious hypoglycemia may lead to a sudden death, heart attack or irreversible brain damage. Clinically significant are also the light or asymptomatic hypoglycemias which in a considerably negative way affect the patient's quality of life. The use of modern technologies in continuous monitoring of glycemias...

Orienteering from intervention to prevention. Prof. Michael Aschermann celebrates life jubilee

Aleš Linhart

Vnitr Lek 2014, 60(12):1017-1018  

Prof. Michael Aschermann, MD, DSc, FESC, FACC, life jubilee

Petr Widimský

Vnitr Lek 2014, 60(12):1019  

Anticoagulant therapy in secondary prevention of coronary events

Jan Bultas

Vnitr Lek 2014, 60(12):1023-1032  

Secondary prevention of atherothrombotic events is the domain of antiplatelet therapy and according to present risk is used one drug strategy or combination of acetylsalicylic acid with ADP receptor blockers. The importance of the combination of dual antiplatelet therapy together with xabans or dabigatran was investigated in 6 clinical trials. Only one of them (ATLAS ACS 2-TIMI 51) indicated that treatment with small dose of rivaroxaban (2 × 2.5 mg) may be added to dual strategy of acetylsalicylic acid and clopidogrel. The risk of major bleeding event is increased and net clinical benefit is only about 0.5 % per year. Dual therapy with aspirin and...

Anaemia and iron deficiency in clinical practice: from cardiology to gastroenterology and beyond

Richard Češka

Vnitr Lek 2014, 60(12):1033-1039  

Anaemia is one of the most common diseases. Worldwide affects up to 25% of the population. Anaemia with iron deficiency (Fe) is the leading one. It is not surprising that iron deficiency mainly affects women. Generally, anaemia is one of the major problems in every department of internal medicine. There is no ambition to provide a comprehensive review of the diagnosis and treatment of anaemia. The aim is to point out the common (but sometimes neglected) facts from daily practice in internal department and on the other hand, to highlight the news in the treatment focusing on parenteral Fe. The importance of anaemia at the department of internal...

Embolic ischemic strokes

Martin Hutyra, Daniel Šaňák

Vnitr Lek 2014, 60(12):1040-1049  

Treatment of acute phase of ischemic stroke is aimed to limit the amount of damage using reperfusion strategy and subsequently administration of treatment providing pharmacological secondary prevention of recurrence. The early aetiology diagnosis of stroke is crucial for effective secondary prevention as the highest risk of recurrence is within few weeks after stroke. Exclusion of cardiac and vascular source of embolism by imaging methods is an important part in management of patients with ischemic stroke. These embolic sources are categorized as high risk and states are associated with moderate or unclear risk.

Past and present issues of the pulmonary circulation in the General University Hospital in Prague

Pavel Jansa, David Ambrož, Jaroslav Lindner

Vnitr Lek 2014, 60(12):1051-1054  

The development of right heart catheterization is closely connected not only with its pioneer Werner Forssmann but also with the University Hospital in Prague. Shortly after Forssmann's pioneering performance of catheterization, Dr. Otto Klein measured cardiac output using the Fick's principle in 11 patients in University Hospital. In the 60s and 70s of last century, there was established an research group represented by Severin Daum, Frantisek Boudik, Vlastimil Jezek, Alois Ourednik and Zdenek Suso at 2nd Internal Clinic of General Cardiopulmonary Hospital. After 1999, the issue of pulmonary hypertension has been re-emerged by Professor Michal Aschermann...

Catheter ablation of focus triggering ventricular fibrillation in patients with structural heart disease

Josef Kautzner, Petr Peichl

Vnitr Lek 2014, 60(12):1055-1061  

First experiences with ablation of focus triggering ventricular fibrillation were reported in isolated cases of idiopathic ventricular fibrillation. Later, there were described the options in management of an electrical instability triggered by ectopic activity in patients after myocardial infarction. In both cases it was shown that the sources of extrasystoles originate almost exclusively from conducting system of chambers. Subsequently, isolated cases were also reported in other structural diseases. It is important that the urgent catheter ablation is able to remove focus which triggers electric instability. In many cases it is a lifesaving procedure....

Current status of intravascular ultrasound in interventional cardiology

Tomáš Kovárník

Vnitr Lek 2014, 60(12):1062-1067  

Although intravascular ultrasound has been used for decades, its common application in catheterization centres during coronary interventions is very rare and merely reaches few percents. The reason is the lack of randomized trials of its use and often few experiences in evaluation of ultrasound findings. Data based on meta-analysis of observational studies clearly demonstrated the positive effect on the most important parameters for the treatment of patients with ischemic heart disease, such as mortality and incidence of myocardial infarction after coronary interventions. Therefore, according to the latest guidelines for myocardial revascularization...

Obesity and heart

Štěpán Svačina

Vnitr Lek 2014, 60(12):1068-1071  

Cardiovascular complications of obesity are traditionally considered an important complication of obesity. Obesity itself is probably not direct cause of atherosclerosis or coronary heart disease. This may occur indirectly in metabolic complications of obesity, especially diabetes and metabolic syndrome. However, thrombogenicity potential of obesity contributes to embolism and atherosclerosis development. In cardiology is well-known a phenomenon of obesity paradox when obese patients have better prognosis than thin. This is the case of heart failure and some other cardiovascular diseases. Recently, a new concept has emerged of myokines - hormones from...

Carotid artery stenting - history, trends and innovations

Miloslav Špaček, Josef Veselka

Vnitr Lek 2014, 60(12):1072-1075  

Surgical carotid endarterectomy is traditionally considered the standard approach for the treatment of atherosclerotic carotid artery disease based on its long history of favorable outcomes. Many of the patients could, however, be offered carotid artery stenting (CAS), which has over time evolved into an elaborate method. With proper selection of patients, CAS provides comparable long-term outcomes and very low risk of periprocedural complication. This article summarises the current knowledge, trends and innovations in CAS.

Do natriuretic peptides have a new chance in treatment of heart failure?

Lenka Špinarová, Jindřich Špinar, Jiří Vítovec

Vnitr Lek 2014, 60(12):1076-1080  

The effect of natriuretic peptides on cardiovascular and renal system offers a potential benefit in therapy of hypertension and heart failure; however the current results of clinical trials are not encouraging. Synthetic B natriuretic peptide has demonstrated short-term hemodynamic improvement in patients, but in terms of renal function and long-term prognosis the effect was questionable. Nevertheless, new hope is ularitid a dual inhibitor of neprilysin and ARB: LCZ 696, the ongoing clinical studies and previous data from pilot studies appear promising.

Renal denervation in patients with resistant hypertension: is it still possible to resuscitate?

Miloš Táborský, Marcela Schejbalová

Vnitr Lek 2014, 60(12):1081-1085  

Transcatheter renal denervation (RDN) has been markedly applied and developed in clinical practice in past five years and not only for patients with resistant hypertension. The issue that more than 50% patients with so-called resistant hypertension are in fact patients without adherence to this type of mediation has not been resolved in RDN trials till now. The study Symplicity HTN-3 showed no differences in blood pressure change between the patients with RDN and group of patients after false procedure who continued in their drug therapy. Future of RDN is more than questionable and there is a need to return to animal studies that will verify the real...

Modern treatment of acute ischemic stroke

Petr Widimský, Boris Kožnar, Ivana Štětkářová

Vnitr Lek 2014, 60(12):1086-1089  

Acute ischemic stroke is a frequent cause of death and disability. Therepautic scepticism persists both among doctors and lay people. However, modern reperfusion therapy improved outcomes of acute stroke patients - at least of those presenting early after symptom onset. This review presents multidisciplinary approach to acute stroke - cooperation of neurologists, cardiologists and radiologists. Both reperfusion strategies are discussed: catheter-based thrombectomy and thrombolysis.

Percutaneous approach for treating mitral regurgitation with mitral clip (MitraClip)

Michael Želízko, Vladimír Pořízka, Radka Kočková

Vnitr Lek 2014, 60(12):1090-1094  

Mitral regurgitation (MR) is the second most commonly encountered valvular lesion and it has been positively correlated with the subsequent development of heart failure and death. MitraClip therapy is a new percutaneous approach for treating mitral regurgitation which involves mechanical edge-to-edge coaptation of the mitral leaflets that is analogous to the surgical Alfieri technique. Indication for MitraClip in patients with severe degenerative or functional mitral regurgitation is based on clinical symptoms (NYHA II-IV) and specific anatomic criteria including a primary central regurgitant jet associated with the A2/P2 segments, in functional MR...