Professor Petr Widimský, MD, DSc, FESC, FACC, sixty-year old

Pavel Gregor

Vnitr Lek 2014, 60(4):267-268  

Development of clinical interest on pulmonary hypertension in the Czech Republic

Pavel Jansa

Vnitr Lek 2014, 60(4):271-274  

Development of clinical interest on the pulmonary hypertension is associated with the development of cardiac catheterization. The first measurement of cardiac output during right heart catheterization was performed by Otto Klein, who worked at the German University in Prague right after Forssmann's pioneering act. The invention of the floating balloon catheter is connected with the name of William Ganz, who was born in Košice and studied medicine in Prague. Some medical centres in Prague, known as Prague School of Pulmonary Circulation have dedicated to the issue of pulmonary hypertension since the 60s of last century. From their initiative was established...

30 years heart transplantation program in Institute for Clinical and Experimental Medicine in Prague

Lenka Hošková, Ivan Málek, Vojtěch Melenovský, Marianna Podzimková, Markéta Hegarová, Zora Dorazilová, Josef Kautzner, Ivan Netuka, Jan Pirk

Vnitr Lek 2014, 60(4):275-281  

Heart transplantation has become in recent decades an established method for the treatment of advanced heart failure. Precisely, it was in January 2014 when 30 years have passed since the start of clinical heart transplantation program at the Institute for Clinical and Experimental Medicine. 936 heart transplants were performed by the end of 2013. The transplant program has reached considerable development since its beginnings. The knowledge of whole issue has deepened, indication criteria have been extended, new immunosuppressives are available and many of them are still in research. Life expectancy of patients has been prolonged and quality of life...

Drug therapy of pulmonary arterial hypertension in 2014

Michael Aschermann, Pavel Jansa

Vnitr Lek 2014, 60(4):282-288  

Pulmonary arterial hypertension (PAH) is a primary pulmonary arteriolar disease, characterized by a progressive increase in pulmonary vascular resistance and pressure in the pulmonary circulation. It progressively leads to hypertrophy of the right ventricle and with no treatment to its failure and patient's death. Etiology of pulmonary hypertension (PH) has been reclassified repeatedly, most recently during the 4^th World Symposium on Pulmonary Hypertension held in 2008 [1]. Currently, the first group contains PAH with either unknown or known cause (systemic connective tissue disease, liver disease, congenital heart disease, HIV infection,...

Unusual intervention of native vessel in patient with coronary artery bypass

Zdeněk Coufal, Martin Gřiva, Robert Náplava

Vnitr Lek 2014, 60(4):289-292  

Coronary artery bypass grafting (CABG) is older method of revascluarization treatment of coronary artery disease (CAD) then percutaneous coronary intervention (PCI), but in some cases, especially in multivessel disease or chronic total occlusions, still used. Extending survival of patients with CAD increases number of recathetrizations and interventions namely in post-CABG subjects. Due to degenerative and atherosclerotic changes of bypasses, especially venous grafts, intervential cardiologists are forced to solve often complicated findings. In other cases patients are reoperated with increased risk. Our task describes unusual, technically challenging...

Optical coherence tomography, delayed stent implantation and primary percutaneous coronary intervention in patients with myocardial infarction and ST segment elevation

Pavel Červinka

Vnitr Lek 2014, 60(4):293-297  

Primary percutaneous coronary intervention (PCI) is an effective treatment for myocardial infarction with ST-segment elevation. However, the stent may slow (slow-flow) or even interrupt the flow (no-reflow) in the infarct-related artery with an increase in short-term and long-term mortality. Due to these limitations there is an effort to search for alternative methods or certain modifications of existing PCI. Present article introduces a modified PCI and results of trombo-aspiration technique by optical coherence tomography (OCT). The article presents the results of our clinical study and brief case report. Our pilot project involved 100 patients with...

Liver in heart failure

Eva Goncalvesová

Vnitr Lek 2014, 60(4):298-303  

Heart failure (HF) is a syndrome with multiple organ manifestations. Liver is due to its high metabolic activity and the resulting demands on oxygenation and also due to its anatomical position close to the heart damaged by heart failure very often. Despite the signs of liver damage are common in heart failure, clinically significant impairment of liver function rarely occurs. Liver lesion is caused by impaired hepatic circulation in terms of congestion and/or hypoperfusion. Congestive lesion is more common. Typically manifests as painful hepatomegaly, increased direct bilirubin and alkaline phosphatase. Pure ischemic lesion is rare. It occurs in a...

Mitral stenosis

Pavel Gregor, Hana Línková

Vnitr Lek 2014, 60(4):304-309  

This paper deals with mitral stenosis in the light of current knowledge. Currently, defect is in developed countries very rare (about 10% of defects). Its etiology has changed over the period of time mainly due to decline in rheumatic fever. Review discusses clinical, echocardiographic and catheterization findings, as well as treatment and prognosis.

Treatment of heart failure in diabetic patients

Jaromír Hradec

Vnitr Lek 2014, 60(4):310-315  

Heart failure occurs in diabetic patients and vice versa, among patients with heart failure is high prevalence of diabetes mellitus. Treatment of heart failure in diabetics is not substantially different from the treatment of heart failure in non-diabetic patients. It is based on ACE-inhibitors, beta-blockers and mineralocorticoid receptor blockers. In advanced heart failure the treatment with various devices reaches importance, for example biventricular pacing for cardiac resynchronization. Recently, it has been discussed the question of long-term cardiovascular safety of hypoglycaemic drugs. Older anti-diabetic agents such as insulin, metformin,...

The role of learning curve on the results of aortic valve implantation for severe aortic stenosis

Petr Kala, Petr Němec, Petr Malík, Jiří Ondrášek, Martin Třetina, Petr Pokorný, Jiří Jarkovský, Milan Bláha

Vnitr Lek 2014, 60(4):316-321  

Introduction:Patients with serious aortic stenoses treated by conservative therapy have significantly worse life expectancy. Besides the surgical aortic valve replacement (AVR) as the gold standard of therapy, the transcatheter aortic valve implantation (TAVI) is indicated in patients at very high risk or who are contraindicated to AVR. The role of learning-curve in TAVI has to be established. Aim:Assessment of the results of consecutive TAVI procedures based on the experience of the team. Methods: 58 high-risk consecutive patients with the average age of 82.2 years were divided into 3 groups based on the TAVI order (≤...

Fully absorbable drug eluting coronary stent: where do we stand in 2014?

Viktor Kočka, Petr Toušek, Libor Lisa, Tomáš Buděšínský

Vnitr Lek 2014, 60(4):322-326  

Coronary stent is routinely used in majority percutaneous coronary interventions for a long time. They have an important role, especially, in the first months after intervention. We can consider as a breakthrough point the development of stent which has ability to absorb in intervened artery after a few years. The review presents current techniques of fully absorbable coronary stents and also provides clinical trials and experiences available in 2014. The article continues with discussion between supporters and opponents of this new technique, but definitive conclusion can't be done yet. The authors conclude the review with their own opinion. There...

Impact of galectin 3 as myofibrosis marker in clinical cardiology

Filip Málek

Vnitr Lek 2014, 60(4):327-330  

Galectin 3 is a protein secreted by activated macrophages and has a role in development of fibrosis in injured tissues. Experimental studies showed increased galectin 3 secretion in the context of cardiac hypertrophy and heart failure models. Several clinical studies identified galectin 3 to be a biomarker of cardiovascular diseases in the field of diagnosis, risk stratification, monitoring therapy response and predicting short-term and long-term prognosis. Particularly, the additional prognostic information of galectin 3 as assessed together with NT-proBNP was established in acute and chronic heart failure.

Surgical therapy of myocardial infarction

Petr Němec, Jiří Ondrášek, Petr Fila, Helena Bedáňová, Petr Pavlík

Vnitr Lek 2014, 60(4):331-334  

Introduction:Coronary artery bypass grafting (CABG) has been replaced by percutaneous coronary interventions in the treatment of myocardial infarction (MI) nowadays. The surgical repair is the only option for mechanical complications of MI. The aim of our study was to assess the results of surgical treatment of MI. Patients and methods:From January 2008 to December 2012 one thousand nine hundred fifty nine patients were operated on at Centre of cardiovascular surgery and transplantations in Brno for coronary artery disease, 103 (5.3 %) of them suffered from acute MI. The interval between MI and operations was longer than 24...

Operation of Ebstein anomaly in adulthood - our experience

Jana Popelová, Roman Gebauer, Petr Pavel, Štěpán Černý, Pavel Jehlička, Petr Plášil, Ivo Skalský

Vnitr Lek 2014, 60(4):335-340  

Introduction:The outcome of the operation of the Ebstein anomaly in adulthood depends on the experience of the surgical team. Methods and results:We operated 38 adult patients with Ebstein anomaly at the age of 34.8 ± 12.7 (19-63) years at the Department of Cardiac Surgery, Hospital Na Homolce, Prague, in the period of 2005-2013. The majority of patients (71 %) had Ebstein anomaly type C or D. The 30-days postoperative mortality was 5.2 %. In the long-term follow-up 2 other patients died. Tricuspid valve repair was performed in 45 %, bioprosthesis was implanted in 53 %. Concomitant bi-directional cavo-pulmonary anastomosis...

Preclinical cardiovascular diseases and aortic stiffness

Mária Potočárová, Jozef Bulas, Marta Filková Karabová, Ján Murín, Ivan Janiga

Vnitr Lek 2014, 60(4):341-347  

Aim:To compare aortic stiffness (represented by aortic pulse wave velocity - PWVao) as a marker of cardiovascular risk with cardiovascular risk estimated by standard scoring systems in treated hypertensive patients. Patients and methods:In a group of 41 hypertensive patients without clinical manifestation of cardiovascular disease (18 men/23 women, mean age 59 years) we investigated the presence of risk factors and preclinical cardiovascular diseases. To estimate cardiovascular risk we have used SCORE-HDL model and categorical risk stratification recommended by ESC/ESH. Linear regression was used for evaluation of relation...

Acute heart failure and cardiogenic shock - trends at the beginning of 21^st century

Richard Rokyta

Vnitr Lek 2014, 60(4):348-353  

Acute heart failure (AHF) is a clinical syndrome of different etiology and several clinical presentations. Cardiogenic shock patients have highest long-term mortality. In contrast to chronic heart failure, we have no evidence of therapeutic benefit for any treatment strategy from randomized clinical trials. Search for new pharmacologic and non-pharmacologic therapies is ongoing. Both causal and symptomatic treatment of AHF episode should be initiated as soon as possible. This review is focused on trends in acute heart failure therapy at the beginning of 21st century.

Treatment of hypertension may affect the incidence of dementia?

Miroslav Souček

Vnitr Lek 2014, 60(4):354-358  

High blood pressure is one of the main risk factor for developing dementia in high age. The connection between treatment of hypertension and reduced risk of cognitive impairment has been studied. Clinical trials have shown reduced risk of dementia after hypertension treatment. Efficacy of antihypertensive drugs varies in their impact on the incidence of dementia. Dementia together with higher life expectancy and prevalence of systolic hypertension will be real issue not only for health care in the near future. Primary and secondary prevention of dementia might be affected by hypertension treatment. Recently, it has been studied possible influence of...

Right ventricle in severe pulmonary hypertension in congenital heart defects - different and specific.

Iveta Šimková, Monika Kaldarárová

Vnitr Lek 2014, 60(4):359-365  

Right ventricle (RV) is frequently neglected in comparison with left ventricle in many aspects - pathogenetic, diagnostic or therapy. In contrast with this, right chamber is pathologically an active part in severe pulmonary arterial hypertension (PAH) associated with congenital heart defects and also importantly influences its course and prognosis. Life expectancy and quality of life do not depend on pulmonary pressure. Inversely, function and status of RV is determining. Eisenmenger's syndrome presents an extreme severe form of PAH. Unique adaptation ability of different and specific RV causes better symptomatic image of patients with Eisenmenger's...

Comparison of American and European (Czech) guidelines for diagnosis and treatment of chronic heart failure

Jindřich Špinar, Lenka Špinarová, Jiří Vítovec, Ondřej Ludka

Vnitr Lek 2014, 60(4):366-374  

The new Czech and European recommendations for diagnosis and treatment of heart failure were published in 2012. The American guidelines ACCF/AHA were published in 2013. Main difference between them is presentation of acute and chronic heart failure in the European guidelines while the American and the Czech guidelines include only chronic heart failure. The American recommendations distinguish heart failure with reduced ejection fraction and with remained ejection fraction. In the beginning, the American guidelines introduce A-D classification which doesn't figure in the European neither Czech guidelines. Class A patients are ill with risk factors,...

Detection of vulnerable atherosclerotic plaque with near-infrared spectroscopy: a systematic review

Cyril Štěchovský, Martin Horváth, Petr Hájek, Josef Veselka

Vnitr Lek 2014, 60(4):375-379  

The term vulnerable atherosclerotic plaque is used to describe an atherosclerotic lesion with a high probability of rupture and thrombosis causing an acute coronary event or stroke. Pathogenesis of the vulnerable plaque has been well described pathologically and on experimental models. Detection of vulnerable plaques in vivo has been limited so far. There has been lack of methods able to predict future event from certain lesion characteristics that were rigorously validated on prospective clinical trials. Intravascular near-infrared spectroscopy is a novel technique that has been intentionally developed for the identification of a lipid core within...

Catheter renal denervation in treatment of resistant hypertension: reality or fiction?

Miloš Táborský

Vnitr Lek 2014, 60(4):380-388  

Catheter renal denervation is one of the most dynamically emerging subspecialties in cardiology in the last five years. Initial indications for the treatment of resistant hypertension have been extended to other research areas - sleep apnea syndrome, heart failure, insulin resistance, atrial fibrillation, ventricular tachycardias and many others. Just as in other areas of cardiology, for example, the issue of stem cells, was unfortunately little space devoted to experimental studies and clinical studies phase II. Clinical application was ahead of a substantial part of the development of new technologies. Originally Symplicity HTN-1 and -2 showed promising...

Practical questions on therapy with new antithrombotic agents

Jan Vojáček

Vnitr Lek 2014, 60(4):389-395  

Recently, new peroral antithrombotic agents have proved better prevention of thrombotic complications in many clinical events such as acute coronary syndrome, tromboembolic disease or atrial fibrillation. New peroral anticoagulants (NPA) were introduced - dabigatran, rivaroxaban and apixaban and new antiplatelet agents - ticagrelol and prasugrel. Outcomes of pilot studies: RE-LY, ROCKET AF, ARISTOTLE, PLATO a TIMI 38 TRITON and subsequent clinical experiences supported their usage. NPA have proved non-inferiority in incidence of stroke or systemic embolism. Moreover, apixaban and dabigatran with administration of 150 mg twice a day have proved superiority....

Combination therapy of hypertension

Jiří Widimský jr.

Vnitr Lek 2014, 60(4):396-400  

Arterial hypertension is not adequately controlled in many countries. One of the main reasons of poor control in clinical praxis is inappropriate use of combination therapy. It is estimated, that combination of at least two antihypertensive drugs is necessary in 70-80 % of all patients suffering from hypertension. The article summarizes current knowledge and recommendation for the use of combination strategy as well as the indications for various modalities of treatment. Combination of two drugs in low doses can be used already at the beginning of pharmacological therapy, especially in moderate to severe hypertension. Early implementation of combination...