Single centre 12 year experience with durable mechanical circulatory support: comparison with the EUROMACS registry.

OBJECTIVES: Mechanical circulatory support is an established therapy in end-stage heart failure. The EUROMACS registry was created to promote research in these patients. The aim of this report was to present our 12 year experience with the durable mechanical circulatory support devices and compare it with the EUROMACS registry. METHODS: Data from the entire EUROMACS registry from January 2011 to April 2019 were included (4704 implantations in 4410 patients). During the 12 years of our experience, until April 2019,125 mechanical support devices were implanted, in 122 patients. We compare patients´ characteristics, operative data and results with the EUROMACS registry and we report the major complications during the observational period. RESULTS: Primary end-point (death) occurred in 40 (32.8 %) patients in our cohort during the follow-up period, representing the survival rate 75 %, 68 %, and 58 % for 6, 12, 24 months respectively, which compares favourably with the data, reported by the EUROMACS registry, the survival 66 % and 53 % after 1 and 2 years respectively. Cerebrovascular accident occurred in 7 %, a bleeding event in 32 %, significant infection (driveline) in 78 % and a device malfunction in 13 % of the patients. Forty- three patients underwent a heart transplant with hospital and long-term mortality of 11.6 % and 14 % respectively. CONCLUSION: Mechanical circulatory support is a valuable therapeutic option with excellent survival rates, nevertheless it is associated with clinically significant complications rates. The direct comparison between our cohort and the EUROMACS registry showed that early implantation strategy and mini invasive approach may improve survival rates and decrease postoperative complications (Tab. 3, Fig. 3, Ref. 16).

Altered serum levels of neprilysin in heart failure patients with reduced ejection fraction.

OBJECTIVE: In addition to the recent success of neprilysin inhibition in treatment of heart failure, elevated soluble neprilysin (sNEP) in circulation has been suggested to be a prognostic biomarker in heart failure with a reduced ejection fraction (HFrEF). However, the diagnostic performance of sNEP is nebulous and its levels in HFrEF have not been compared with controls. For the purpose of this study, we determined the role of sNEP levels as a biomarker in routine ambulatory care of HFrEF patients, when compared to the control subjects. METHODS: Ambulant patients with chronic HFrEF (n = 18) were included. Apparently healthy volunteers - hospital physicians (n = 9) were included as the controls. Besides standard diagnostic tools (echocardiographic examination and laboratory biochemical diagnostic tests including NT-proBNP assessment), we analysed serum levels of neprilysin with a commercially available human soluble neprilysin ultrasensitive ELISA kit (Aviscera Bioscience, USA). RESULTS: Concentrations of sNEP were significantly reduced in HFrEF patients (average ± S.E.M.=1038 ± 464 pg/ml) when compared to the controls (1947 ± 613 pg/ml; p < 0.05). Two of eighteen HFrEF samples were below, while two of ten control samples were above the detection limit of the immunoassay. We documented a lack of significant correlation between sNEP and left ventricular ejection fraction (LVEF) and other echocardiographic features as well as NT-proBNP. However, sNEP significantly negatively correlated to serum natrium levels (Spearman r = ‒0.6112, p < 0.05) and to systolic blood pressure (Spearman r = ‒0.4746, p < 0.05) in HFrEF. CONCLUSION: Levels of sNEP were significantly reduced in HFrEF, when compared to the controls, with absent correlations to relevant HF-related features (e.g. LVEF). These findings might contribute to clarification of the diagnostic value of sNEP in HF (Tab. 2, Fig. 2, Ref. 30) Keywords: soluble neprilysin, heart failure, reduced ejection fraction, pharmacotherapy.

Novel biomarkers for prediction of acute kidney injury in acute heart failure.

BJECTIVES: Acute kidney injury (AKI) is a frequent event in patients with an acute heart failure (AHF) and is associated with a poor short and long-term outcome. The aim of this study was to describe diagnostic yield of selected novel biomarkers in prediction of AKI in patients admitted for AHF. METHODS: We performed a prospective cohort study of 72 consecutive patients (46/26 M/F) aged 69±10,3 years admitted for AHF. Renal damage was defined according to KDIGO guidelines. Patients were divided into the two groups: AKI- (without renal injury, n=52) and AKI+ (with renal injury, n=20). Urine samples for AKI biomarkers measurements (NGAL, TIMP2, IGFBP7) were collected at the admission. The ROC and linear logistic regression of new biomarkers and selected clinical variables was performed for the evaluation of the AKI prediction. RESULTS: The patients with AKI+ were older (median age: 75 vs 64 years, p=0.01), had lower BMI (median: 28 vs 29.5 kg/m2, p=0.04), were with a higher proportion of patients with HF with a reduced ejection fraction (55 % vs 23.1 %, p=0.01) and a higher level of serum NTproBNP. Urinary NGAL at admission was significantly higher in the AKI+ compared to the AKI - group (152 vs 19.5 ng/mL, p<0.0001); also median of u-TIMP-2 and u-IGFBP-7 in the AKI+ patients was significantly higher: 194.1 versus 42.5 ng/mL (p<0.0001) and 379 versus 92.4 pg/mL (p<0.0001) resp. Age, u-NGAL, u-TIMP2, u-IGFBP7, s-haemoglobin, NTproBNP and LVEF were associated with the development of AKI. Urine concentration of IGFBP-7 was measured, which is the best marker for the prediction of AKI (AUC 0.94). CONCLUSION: Urine concentrations of NGAL, TIMP2, IGFBP7 at the time of admission for AHF predicted a development of AKI. Age, NTproBNP, LVEF and s-haemoglobin were also associated with AKI in AHF patients (Tab. 3, Fig. 3, Ref. 22). Text in PDF www.elis.sk Keywords: biomarkers, cardiorenal syndrome, acute heart failure.

SynCardia, total artificial heart, as a bridge to transplant.

INTRODUCTION: Implantation of a total artificial heart is an alternative to durable biventricular assist device support in selected patients. We present our initial experience with the implantation of the SynCardia total artificial heart (TAH) in three patients. The first patient, was the first SynCardia (TAH) implantation in the Visegrad Four (V4) countries METHOD: Three patients with severe refractory end stage biventricular heart failure listed for heart transplant were indicated for SynCardia TAH implantationRESULTS: We present in details the perioperative and postoperative outcomes of these patients. The first and the third patient, after 195 and 126 days of TAH support respectively, had a successful heart transplants, the second patient died on 11th postoperative day. The cause of death was brain bleeding due to ruptured undiagnosed brain aneurysm. CONCLUSION:   SynCardia TAH is an alternative therapy in patients with end-stage biventricular heart failure waiting for heart transplantation. The SynCardia TAH with pulsatility resembles the physiologic circulation, improves the condition of the patients and increases survival compared to the biventricular assist devices. It is an intermediate step until the development of genetically modified animal hearts, engineered bioartificial hearts or hearts from induced pluripotent stem cells that would replace the failing heart in the patients with end-stage heart disease (Tab. 2, Fig. 1, Ref. 27).

Targeted next-generation sequencing in Slovak cardiomyopathy patients.

OBJECTIVES: For the first time we used targeted next-generation sequencing to detect candidate pathogenic variants in Slovak cardiomyopathy patients. BACKGROUND: Targeted next-generation sequencing is considered to be the best practice in genetic diagnostics of cardiomyopathies. However, in Slovakia, with high cardiomyopathies prevalence of 1/440, the current diagnostic tests are still based on Sanger sequencing of a few genes. Consequently, little is known about the exact contribution of pathogenic variants in known cardiomyopathy genes in Slovak patients. METHODS: We used a panel of 46 known cardiomyopathy-associated genes to detect genetic variants in 16 Slovak cardiomyopathy patients (6 dilated, 8 hypertrophic, 2 non-compaction subtypes). RESULTS: We identified candidate pathogenic variants in 11 of 16 patients (69 %). Genes with higher count of candidate pathogenic variants were MYBPC3, MYH and TTN, each with 3 different variants. Seven variants ACTC1 (c.329C>T), ANKRD1 (c.683G>T), MYH7 (c.1025C>T), PKP2 (c.2003delA), TTN (c.51655C>T, c.84841G>T, c.101874_101881delAGAATTTG) have been detected for the first time and might represent Slovak-specific genetic cause. CONCLUSIONS: We have performed genetic testing of previously untested Slovak cardiomyopathy patients using next-generation sequencing cardiomyopathy gene panel. Given the high percentage of candidate pathogenic variants it should be recommended to implement this method into routine genetic diagnostic practice in Slovakia (Tab. 4, Ref. 39).

Heart failure affects liver morphology and function. What are the clinical implications?

Liver dysfunction in heart failure is common and usually clinically significant, especially in patients with advanced or severe acute heart failure. Lesions are caused by an impaired hepatic circulation due to congestion and hypoperfusion. Congestive lesions are more common and typically manifested by painful hepatomegaly and increased direct bilirubin and alkaline phosphatase. The inferior vena cava and hepatic veins are usually dilated. Congestive lesions are characterized by dilatation of the central vein with fibrotic changes in the surrounding areas on histological examination. Isolated ischaemic lesions are rare and occur due to severe and prolonged ineffective perfusion, often accompanied by hypoxemia. Ineffective perfusion is reflected by an increase in total bilirubin and significantly increased transaminase levels. The prognosis of ischaemic lesions without an adequate treatment of the cause of hypoperfusion is poor. Increased levels of bilirubin and liver function tests, as well as signs of impaired liver proteosynthetic function, are associated with a poor prognosis. Knowledge of the phenotypes of hepatic lesions in heart failure is important to select the appropriate treatment for an acute decompensation. Changes in biochemical markers, hepatic perfusion or stiffness of the liver can be used to evaluate the effectiveness of diuretic treatment and achieve euvolemic status in the patients with heart failure (Tab. 1, Fig. 3, Ref. 28).

Disordered myocardial Ca(2+) homeostasis results in substructural alterations that may promote occurrence of malignant arrhythmias.

We aimed to determine the impact of Ca(2+)-related disorders induced in intact animal hearts on ultrastructure of the cardiomyocytes prior to occurrence of severe arrhythmias. Three types of acute experiments were performed that are known to be accompanied by disturbances in Ca(2+) handling. Langedorff-perfused rat or guinea pig hearts subjected to K(+)-deficient perfusion to induce ventricular fibrillation (VF), burst atrial pacing to induce atrial fibrillation (AF) and open chest pig heart exposed to intramyocardial noradrenaline infusion to induce ventricular tachycardia (VT). Tissue samples for electron microscopic examination were taken during basal condition, prior and during occurrence of malignant arrhythmias. Cardiomyocyte alterations preceding occurrence of arrhythmias consisted of non-uniform sarcomere shortening, disruption of myofilaments and injury of mitochondria that most likely reflected cytosolic Ca(2+) disturbances and Ca(2+) overload. These disorders were linked with non-uniform pattern of neighboring cardiomyocytes and dissociation of adhesive junctions suggesting defects in cardiac cell-to-cell coupling. Our findings identified heterogeneously distributed high [Ca(2+)](i)-induced subcellular injury of the cardiomyocytes and their junctions as a common feature prior occurrence of VT, VF or AF. In conclusion, there is a link between Ca(2+)-related disorders in contractility and coupling of the cardiomyocytes pointing out a novel paradigm implicated in development of severe arrhythmias.

Functional and circulatory renal changes in advanced heart failure.

OBJECTIVES: The aim of the study was to describe the relations between heart and renal functions and to investigate whether reduced glomerular filtration rate is influenced more by reduced perfusion or venous congestion. METHODS: A prospective cohort study of 101 patients (69 men, 32 women) with chronic heart failure aged 52 (49-54) (median, 95 % confidence interval) years. We analyzed the blood samples, parameters of echocardiography and right heart catheterization. RESULTS: Left ventricular ejection fraction correlated with the estimated glomerular filtration rate eGFR (r = 0.214, p = 0.036) in the whole sample of patients. We found a correlation between cardiac output and renal perfusion pressure in the whole sample (r = 0.232, p = 0.0225) and in patients with chronic heart failure (r = 0.254, p = 0.0278).In the whole sample the mean pulmonary artery pressure (PAP) correlated with the variables determining renal function: PAP and renal perfusion pressure (r = -0.345, p = 0.002),PAP and eGFR (r = -0.299, p = 0.009). In the other two studied groups these correlations were not significant. CONCLUSION: In the group of heart failure patients left and right ventricular functions were the main determinants for renal function. Current cardiac output or right atrial pressure as markers of renal perfusion were not associated with renal functions in advanced but stable heart failure patients with low burden of extracardiac comorbidities (Tab. 1, Fig. 4, Ref. 13).

Clinical implementation of cardiac resynchronization therapy-regional disparities across selected ESC member countries.

BACKGROUND: The present analysis aimed to estimate the penetration of cardiac resynchronization therapy (CRT) on the basis of the prevalence and incidence of eligible patients in selected European countries and in Israel. METHODS AND RESULTS: The following countries were considered: Italy, Slovakia, Greece, Israel, Slovenia, Serbia, the Czech Republic, Poland, Romania, Hungary, Ukraine, and the Russian Federation. CRT penetration was defined as the number of patients treated with CRT (CRT patients) divided by the prevalence of patients eligible for CRT. The number of CRT patients was estimated as the sum of CRT implantations in the last 5 years, the European Heart Rhythm Association (EHRA) White Book being used as the source. The prevalence of CRT indications was derived from the literature by applying three epidemiologic models, a synthesis of which indicates that 10% of heart failure (HF) patients are candidates for CRT. HF prevalence was considered to range from 1% to 2% of the general population, resulting in an estimated range of prevalence of CRT indication between 1000 and 2000 patients per million inhabitants. Similarly, the annual incidence of CRT indication, representing the potential target population once CRT has fully penetrated, was estimated as between 100 and 200 individuals per million. The results showed the best CRT penetration in Italy (47-93%), while in some countries it was less than 5% (Romania, Russian Federation, and Ukraine). CONCLUSION: CRT penetration differs markedly among the countries analyzed. The main barriers are the lack of reimbursement for the procedure and insufficient awareness of guidelines by the referring physicians.

The long-term response to treatment with calcium channel blockers in a patient with idiopathic pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a disease characterised by a gradual increase in resistance of pulmonary circulation leading to right ventricular failure and death. In only 10 % of cases, there is a response to acute vasoreactivity testing with a significant reduction in mean pulmonary artery pressure (PAP), while in this group of patients, less than one half of cases benefit from long-term treatment with calcium channel blockers (CCB). This paper describes a case report of a young patient with dyspnoea and suspicion of pulmonary hypertension who was referred to a specialised centre. The complex evaluation of her clinical state led to confirmed diagnosis of idiopathic pulmonary arterial hypertension (IPAH). Because there was a positive response to vasoreactivity testing, the treatment for IPAH was initiated with a high dose of CCB. This treatment markedly improved her clinical state as well as echocardiographic and hemodynamic findings.In this study, the authors present a diagnostic algorithm in pulmonary hypertension and emphasise the role of CCB in treatment of PAH in carefully selected patients (Tab. 1, Fig. 5, Ref. 7).

ECG signs of right ventricular hypertrophy may help distinguish pulmonary arterial hypertension and pulmonary hypertension due to left ventricular diastolic dysfunction.

OBJECTIVES: Distinguishing pulmonary arterial hypertension (PAH) and pulmonary hypertension due to left ventricular diastolic dysfunction (PHLDD) is essential for the correct disease management. We compared the importance of electrocardiographic (ECG) signs of right ventricular hypertrophy (RVH) in patients with similar degree PAH and PHLDD. METHODS: ECG analysis was retrospectively performed in 17 PHLDD and in 17 PAH patients with catheterization-confirmed moderate pulmonary hypertension. Sensitivity, specificity, and positive and negative predictive values for individual RVH signs were calculated. RESULTS: The PAH group showed a higher prevalence of the following: R/S ratio > 1 in V1 (p < 0.001), R in V1 + S in V6 > 1.05 mV (p < 0.01), R wave peak time > 0.035 s (p < 0.05), right ventricular strain (p < 0.001), and A+R-PL parameter (i. e. R(V1) + S1 - S(V1)) = 0.07 mV (p < 0.05). The sensitivity and negative predictive value (NPV) of RVH signs for distinguishing PAH and PHLDD were low for all signs except right ventricular strain (sensitivity 71%, NPV 77%). The specificity and positive predictive value (PPV) of all six parameters were both 100%. CONCLUSIONS: In patients with pulmonary hypertension detected using echocardiography, ECG presence of RVH/overload may exclude LV diastolic dysfunction as a cause of PH and suggests the diagnosis of PAH (Tab. 3, Ref. 19).

[Heart and kidneys--a fatal relationship]. / Srdce a oblicky--osudový vzt'ah.

Cardiac and renal dysfunction of different degree is common combination in patients in clinical practice. This combination of cardiovascular and renal injury has been defined as a cardiorenal syndrome. The aim of this paper is to offer a comprendious information about actual insights into pathophysiology, terminology, classification and management of cardiorenal syndrome from cardiologist's point of view.

[Characteristics and the prognosis of patients with acute heart failure in current clinical practice]. / Charakteristiky a osud pacientov s akútnym srdcovým zlyhávaním v aktuálnej klinickej praxi.

PURPOSE: Analysis of predefined characteristics and outcomes in a non-selected population of patients hospitalized for acute heart failure (AHF) in Slovakia. METHODS: We conducted a nationwide prospective multicenter survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia--two centres with a non-stop catheterization service, two central and 7 regional hospitals. Relevant data of 78 characteristics in 9 categories were collected during 3 months (between 1 May 2009 and 31 July 2009). There was a specific form designed for this survey. Collected data were then transferred into the electronic database and statistically analysed. RESULTS: Mean age was 72 years, 81% of patients were in NYHA class III/IV (52% male). The majority of patients were admitted with decompensated heart failure (68.4%), frequency of cardiogenic shock was 0.3%. New-onset AHF (AHF de novo) was diagnosed in 31.1%, of which 20.8% was due to acute coronary syndromes. Coronary heart disease was the predominant primary aetiology of AHF (67%), followed by almost equally represented hypertension (10.5%), valvular disease (10%) and dilated cardiomyopathy (9%). Hypertension was referred as the most frequent comorbidity (82%), followed by atrial fibrillation (48%), diabetes mellitus (42%), history of renal failure (31%) and with anaemia at admission (38%). Rales were the dominant physical sign (69.9%). Systolic blood pressure greater than 140 mm Hg was present in 37.8% and QRS length > 120 ms in 21.4% of patients. Preserved left ventricular ejection fraction (> or = 40%) was observed in 57% out of 70% documented cases in the whole survey. 23.3% of patients had a history of coronary angiography. 84.3% of patients received intravenous treatment, diuretics, nitrates and inotropes were given to 82.2%, 18% and 6%, respectively. The number of patients with cardiac resynchronization therapy (CRT), with or without defibrillator function, was 0.9%. Mean length of stay was 9.2 days and in-hospital mortality was 9.1%. At discharge, 76% of patients were on angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), 62% were using beta-blockers (BB), however the doses of drugs were lower then recommended values. CONCLUSIONS: Results of the survey are comparable with other observational studies, surveys and large registries. Although the percentage of patients with ACE-I/ARB and BB at discharge seems promising, there is still area for improvement in AHF patients health care.

Changes of portal flow in heart failure patients with liver congestion.

AIM: The goal of the study was to describe the changes of the portal vein (PV) flow in patients with an exacerbation of advanced chronic congestion heart failure (CHF) in relation to central hemodynamics and biochemical indicators of liver lesion. PATIENTS AND METHODS: 90 pts (76 males) aged 49.2 +/- 11.2 years admitted for an acute exacerbation of chronic heart failure based on severe left ventricular systolic dysfunction (LVEF 20 +/- 4.3%) were evaluated. The PV flow was sampled from the main portal vein using the intercostal approach. Systolic and diastolic flow velocities were measured and the the pulsatility index (PI, max - min/max PV flow velocity) was calculated. RESULTS: The median of PI in all patients was 0.82 (0-2.0). PI > or = 0.5 was found in 77 (86%) of patients. There was a significant linear correlation of PI and right atrium pressure (RAP), pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (mPAP) (p <0.01, r = 0.68, 0.51 and 0.49 resp). Out of 75 patients with RAP > or =8 mmHg, 67 (89%) had the pulsatility index > or = 0.5. The mean RAP was 7.2 +/- 3.1 mmHg in patients with continuous flow, 14.9 +/- 5.9 mmHg in the group with pulsatile flow pattern, and 20.1 +/- 6.3 and 21.1 +/- 6.5 mmHg in intermittent and alternating flow, respectively (p < 0.01). CONCLUSION: The flow pulsatility increases with increasing right ventricular filling pressure so that an analysis of the PV flow can detect the elevation of right atrial pressure and allow a quantitative estimation of RAP. The finding of flat portal vein flow wave patterns in HF patients with signs of congestion draws the attention to concurrent primary liver disease. This information could be important in the risk stratification as well as in the therapeutic decision (Tab. 1, Fig. 6, Ref. 19).

[Is thromboelastography able to influence management of patients in cardiology and cardiosurgery?]. / Môze tromboelastografia ovplyvnit' manazment pacientov v kardiológi a kardiochirurgii?

Thromboelastography (TEG) is perceived as a non-specific test of hemostasis. It evaluates the global hemocoagulation, however by some modifications could be its diagnostic potential greater. With new inovations isTEG except more precise analysis of participation of blood components on final coagulation (for example rotational TEG) capable also to assess the antiplatelet drug nonresponsiveness (for example platelet mapping system). It gives more accurate information about prothrombotic conditions than routine laboratory techniques in state of ventricular assist device implantation.

Cardiovascular diseases and molecular variants of the renin-angiotensin system components in Slovak population.

Cardiovascular diseases associated with molecular variants of individual components of renin-angiotensin system are reported to constitute inherited predisposition in humans. Molecular variant frequencies are race- and population-dependent. We examined frequencies of the M235T variant of angiotensinogen gene and I/D polymorphism of gene for angiotensin-converting enzyme in Slovak population: in hypertensive patients, coronary heart disease (CHD), dilated cardiomyopathy (DCM) and myocardial infarction (MI) patients compared to healthy subjects. Frequency of M235T was significantly increased in hypertensive, CHD and DCM patients compared to controls (0.48 and 0.50 vs. 0.40, p < 0.001). Significant increase in D allele frequency compared to controls was observed in the group of patients after MI (0.58 vs. 0.50, p < 0.001), CHD (0.59 vs. 0.50, p < 0.001) and DCM (0.60 vs. 0.50, p < 0.001). These results correlate with other Caucasian populations. In Slovak population, M235T is associated with increased blood pressure and D allele of ACE gene is associated with MI, chronic CHD and DCM, rather than with hypertension. Our results suggest that in Slovak population, D alelle and M235T variant represent a risk factor for several cardiovascular diseases and these polymorphisms might have a cumulative effect on development of cardiovascular diseases.

Is the ApoE polymorphism associated with dilated cardiomyopathy?

Apolipoprotein E (ApoE) is 34 kDa protein involved in the modulation of cholesterol transport and homeostasis. Polymorphism of the ApoE gene has been implicated in many chronic cardiovascular and neuronal diseases. ApoE epsilon4 allele has been reported to be associated with increased risk of cardiovascular diseases such as myocardial infarction, hypertension, coronary heart disease, etc. Fifty patients with the end-stage dilated cardiomyopathy (DCM) and advanced congestive heart failure were examined in our study. For evaluation of ApoE polymorphism, novel approach of fast screening of ApoE gene polymorphism by combination of PCR and blotting (CVD StripAssay) was used. Individual genotypes were correlated with basic cardiologic clinical parameters. The reported frequency of this allele in Caucasian population is 14.7 %. Our results showed that in patients with DCM frequency of the ApoE epsilon4 allele is 40 %. Frequency of the genotype epsilon2/4 was 58 % and epsilon3/4 was 22 %. Comparison with control Caucasian groups monitored by others clearly revealed that frequency of epsilon4 alelle is increased in patients with advanced stages of DCM. This observation suggests association of ApoE polymorphism with severe form of DCM. Physiological consequences of this observation remain to be clarified.

Phenylethanolamine N-methyltransferase gene expression in transplanted human heart.

BACKGROUND: Phenylethanolamine N-methyltransferase (PNMT) is an enzyme involved in the epinephrine synthesis. The aim of this study was to investigate PNMT gene expression in the transplanted human heart in relation to the time elapsed from heart transplantation (HTx) and selected clinical characteristics. PATIENTS AND METHODS: The messenger RNA (mRNA) levels of PNMT in myocardial tissue were determined in 22 (21 males) patients at 0-12 years after HTx. Relative quantification of mRNA levels was performed using reverse transcription and polymerase chain reaction (RT-PCR) for correlation with heart rate (HR), blood pressure (BP), parameters of heart rate variability, and graft systolic and diastolic functions. RESULTS: During the first 3 years after HTx, PNMT mRNA levels were higher (mean +/- SEM) (0.75 +/- 0.06; n = 12) compared with later years (0.33 +/- 0.06; n = 10); (P < .01). HR variability in the low frequency band of the power spectrum (LF) was lower among patients during the first 3 years after HTx (2.73 +/- 0.31 vs 5.67 +/- 0.69 ms; P < .01). A significant negative linear correlation was observed between PNMT mRNA and LF (P = .05; r = -0.47). No association was noted between HR, BP, parameters of systolic or diastolic function, standard deviation of all RR intervals, or high frequency (0.15-0.40 Hz) bands of the 24-hour RR interval power spectrum. CONCLUSION: This work provides the first evidence of the presence of local PNMT transcription in human heart after HTx. Appearance of PNMT transcription in the myocardium after HTx may reflect autonomous "sympathicotrophy." Decreased PNMT expression with time elapsed after HTx suggests graft reinervation.

The occurrence of symptomatic CMV infections in heart transplant recipients.

BACKGROUND: Human cytomegalovirus is widely spread in the human population and at present it is the most important clinical agent of opportunistic infections in immunocompromised patients. Bone marrow transplant recipients, solid organ transplant recipients and AIDS patients are at risk of the development of a severe systemic disease. Prompt detection of active infection is essential for early initiation of antiviral therapy. AIM: The aim of our work was to follow the occurrence of symptomatic CMV infection in heart recipients. METHODS: We have used antigenemia assay, PCR and serology methods for the detection of CMV infection in heart transplant recipients. RESULTS: We found that the occurrence of symptomatic CMV infections was lower than the literary data. CONCLUSION: Though a small group of patients was examined, we suppose that this was caused by the careful finding of CMV serostatus of donors and recipients, by using of CMV-seronegative, filtered, or leukocytes-poor blood products, by the examination of blood products and prophylaxis of risk patients, too. (Tab. 1, Ref. 37.).

[Electrocardiography after heart transplantation]. / Elektrokardiogram po transplantácii srdca.

In the submitted review the authors describe the position and importance of electrocardiographic examination after transplantation of the heart (HTx). They describe findings recorded in animal experiments, typical ECG characteristics after HTx and their importance as well as the clinical application of this method for diagnosis of electrophysiological abnormalities specially in relation to rejection and reinnervation of the graft. The authors' conclusions are based on a critical analysis of relevant data in the literature as well as their own experimental and clinical experience.