Association between the heart rate early after heart transplantation and the long term clinical outcomes.

BACKGROUND: A strong correlation between a lower heart rate and survival has been demonstrated in various patient populations. The optimal heart rate for heart transplant patients is still unknown. The aim of our study was to evaluate the association between an early heart rate and survival after heart transplantation. MATERIAL AND METHODS: We retrospectively analysed a group of 330 patients, who underwent heart transplantation in our institution from 1994 to 2014 and complete datasets, including 24-hour heart rate monitoring one month after the heart transplantation. Patients were divided in 2 groups: Group A (n = 278) with the average 24-hour heart rate <90 bpm, and Group B (n = 52) with ≥ 90 bpm. RESULTS: The average period of monitoring was 7.5 ± 5.3 years. No differences in baseline characteristics were observed in both groups of recipients and respective donors. One-year survival in groups A and B was 92 % and 81 %, respectively; 5-year survival was 79 % and 60 %, respectively; and 10-year survival was 66 % and 50 %, respectively (p = 0.001). CONCLUSION: Increased heart rate in the early post-transplant period was significantly associated with a poorer survival rate in patients after heart transplantation (Tab. 2, Fig. 1, Ref. 25).

Adsorption-desorption oscillations of nanoparticles on a honeycomb-patterned pH-responsive hydrogel surface in a closed reaction system.

A new type of pH-responsive hydrogel surface with varying nanoparticle adsorptivities was fabricated to form a micro-patterned film. To increase its responsivity to environmental pH changes, we incorporated graphene oxide (GO) into a poly(methacrylic acid)-polyethylene glycol copolymer. Incorporating GO in the pH-responsive hydrogel significantly increased the adsorption-desorption responsivity of Ag nanoparticles on the gel surface. A pH oscillator in a closed reaction system composed of BrO3(-)-Fe(CN)6(4-)-SO3(2-) facilitated the self-oscillating adsorption-desorption of Ag nanoparticles on the GO-incorporated gel surface. The reversible adsorption-desorption of Ag nanoparticles on the patterned hydrogel surface in response to pH oscillations was determined using UV-visible spectroscopy in aqueous solution. The observed heterogeneous oscillations indicated that the adsorptivity of the gel surface can be reversibly changed on the patterned pH-responsive gel. This phenomenon is similar to various natural biological systems.

Prasugrel vs clopidogrel in cardiogenic shock patients undergoing primary PCI for acute myocardial infarction. Results of the ISAR-SHOCK registry.

There is limited clinical data comparing different P2Y12-receptor inhibitors in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. The aim of the ISAR-SHOCK registry was to compare the clinical outcome of patients treated with clopidogrel vs prasugrel in this setting. Patients (n=145) with AMI complicated by cardiogenic shock and undergoing primary PCI in two centres (Deutsches Herzzentrum München and Klinikum rechts der Isar, Technical University Munich) between January 2009 and May 2012 were included in this registry. The use of prasugrel for patients within this registry reflected co-morbidities and platelet function testing results during the acute AMI phase. Early outcome at 30-days was reported with regard to all-cause mortality, myocardial infarction (MI), stent thrombosis (ST) and bleeding events. With regard to antiplatelet treatment in the 145 cardiogenic shock patients, 50 patients were initially treated or immediately switched to prasugrel while 95 patients were treated with clopidogrel. All-cause mortality was lower in prasugrel- vs clopidogrel-treated patients (30 % vs 50.5%, HR: 0.51, 95% CI [0.29-0.92], p=0.025). No significant differences in prasugrel- vs clopidogrel-treated patients were observed for the occurrence of MI (p=0.233), ST (p=0.306) or TIMI major bleedings (p=0.571). Results of the ISAR-SHOCK registry suggest that the use of prasugrel in AMI patients complicated by cardiogenic shock might be associated with a lower mortality risk as compared to clopidogrel therapy without increasing the risk of bleeding. These findings, however, need confirmation from specifically designed randomised studies in this high-risk cohort of patients.

[Interventional Mitral valve repair with the MitraClip® procedure. Patient selection criteria]. / Interventionelle Mitralklappenrekonstruktion mit dem MitraClip®-Verfahren. Patientenauswahlkriterien.

In current practice the MitraClip® procedure is increasingly being used for patients unsuitable or at high risk for cardiac surgery. This article initially describes the patient groups that are suitable for percutaneous edge-to-edge repair. For this purpose the echocardiographic criteria for severe mitral regurgitation are first characterized and treatment algorithms for patients with primary as well as secondary mitral regurgitation according to current guidelines are illustrated. Basic anatomical requirements for the successful implantation of a MitraClip® are described and a distinction is made between various valve morphologies ranging from optimal to unsuitable anatomical conditions. Finally, three patient groups eligible for percutaneous edge-to-edge repair considering clinical and anatomical criteria are defined: (1) optimal for MitraClip®, (2) MitraClip® could be considered and (3) MitraClip® only in exceptional cases.

Potent P2Y12 receptor inhibitors in patients with acute coronary syndrome. Agents, indications, issues to consider in clinical practice.

Blood platelets are highly activated in the setting of an acute coronary syndrome (ACS). This fact mandates the need for potent platelet inhibition in ACS patients and especially in patients undergoing a percutaneous coronary intervention (PCI). The 2 nd generation thienopyridine clopidogrel has been the standard of treatment in the past. Due to its pharmacological properties including a delayed onset of action, a large response variability and an insufficient antiplatelet action in some patients (low responsiveness or high on-treatment platelet reactivity), there was a need to develop, to study and to introduce more potent agents with a fast, reliable and potent antiplatelet action. With the 3rd generation thienopyridine prasugrel and with ticagrelor two potent agents for antiplatelet treatment of ACS patients are available now. Both drugs have demonstrated their superiority compared to clopidogrel in terms of thrombotic risk reduction in large-scale randomized trials. However, for these agents and in line with the expectations towards a more potent antiplatelet treatment regimen, a higher risk for bleeding was observed for prasugrel and ticagrelor. Further on, the new antiplatelet agents have their own and characteristic contraindications and numerous issues to be considered in clinical practice.This review aims to provide an overview on the state of the art P2Y12 receptor directed inhibition in ACS patients with a focus on patients undergoing a coronary stenting procedure.

[Cardiac tumor in a pregnant patient]. / Tumor srdce u gravidní pacientky.

Cardiac myxoma represents the most frequent cardiac tumor with a relatively low overall incidence. Clinical symptoms are hetereogeneous and therefore nonspecific. With regard to high success of the surgical treatment, early diagnosis is crucial. We present a case of cardiac myxoma in a pregnant woman, which was succesfully sugically removed.

Dendritic cell-based vaccination combined with gemcitabine increases survival in a murine pancreatic carcinoma model.

BACKGROUND: Tumour-specific cytotoxic T lymphocytes (CTLs) can be activated in vivo by vaccination with dendritic cells (DCs). However, clinical responses to DC-based vaccination have only been observed in a minority of patients with solid cancer. Combination with other treatment modalities such as chemotherapy may overcome immunoresistance of cancer cells. It has been shown previously that gemcitabine sensitises human pancreatic carcinoma cells against CTL-mediated lysis. Here, a murine pancreatic carcinoma model was used to investigate whether combination with gemcitabine increases therapeutic efficacy of DC-based vaccination. METHODS: Bone marrow-derived DCs from C57BL/6 mice were loaded with UV-irradiated, syngeneic Panc02 carcinoma cells and were administered subcutaneously. For prophylactic vaccination, mice were vaccinated three times at weekly intervals prior to tumour challenge with Panc02 cells. Therapeutic vaccination was started when tumours formed a palpable nodule. Gemcitabine was administered intraperitoneally twice weekly. RESULTS: Prophylactic DC-based vaccination completely prevented subcutaneous and orthotopic tumour development and induced immunological memory as well as tumour antigen-specific CTLs. In the subcutaneous tumour model, therapeutic DC-based vaccination was equally effective as gemcitabine (14% vs 17% survival at day 58 after tumour challenge; controls, 0%). Combination of the two strategies significantly increased survival of tumour-bearing mice (50% at day 58 after tumour challenge). DC-based vaccination also prevented death from pulmonary metastatisation after intravenous injection of Panc02 cells. CONCLUSION: DC-based immunotherapy may not only be successfully combined with gemcitabine for the treatment of advanced pancreatic carcinoma, but may also be effective in preventing local recurrence or metastatisation in tumour-free patients.

[Massive pulmonary embolism--attempt at embolectomy following the failure of thrombolytic treatment]. / Masivní plicni embolizace--pokus o embolektomii po selháni trombolytické lécby.

We report a case of a 61-year-old woman with progressive dyspnoea, fatigue and tiredness over the last two weeks. Based on physical examination on admission, ECHO and CT exams, a diagnosis of massive pulmonary embolism was confirmed and the patient received thrombolytic treatment. Since no response to thrombolysis was apparent and the patient was clinically unstable with persisting signs of right ventricular dysfunction in echocardiography, a rescue surgical embolectomy was ordered and performed using cardiopulmonary bypass. Multiple large clots were removed from both pulmonary arteries. Following embolectomy, severe irreversible right ventricular failure developed and the patient died. Autopsy revealed large blood clots in peripheral pulmonary circulation causing terminal right-heart failure. We discuss the therapeutic options in massive pulmonary embolism and the potential role of rescue surgical embolectomy.

[Local vascular complications in patients with acute myocardial infarct treated with direct percutaneous coronary intervention]. / Lokální cévní komplikace u pacientu s akutním infarktem myokardu reseným direktní perkutánní koronární intervencí.

OBJECTIVES: We assessed the rate and identified risk factors for postprocedure vascular complications following direct percutaneous intervention (dPCI). METHODS: Data were collected on 881 consecutive patients who underwent dPCI in our cath-lab from January 2002 to December 2003. Multivariate regression was used to identify characteristics associated with vascular complications. RESULTS: Out of 881 patients, hematoma was found in 148 (16.8%) cases. Pseudoaneurysm was detected by ultrasound in 40 (4.5%) patients, 5 (0.6%) patients underwent surgery. Variables associated with increased risk included age, female sex, low body mass index (BMI) and body surface area (BSA) and presence of diabetes mellitus. CONCLUSIONS: Predicting the risk of post-PCI vascular complications is feasible. This information may be useful for clinical decision-making and institutional efforts at quality improvement.

Pseudo-aneurysms after iatrogenic affection of artery--experiences and recommendations for procedures to prevent their incidence and potential treatment.

In the present modern times we see that the population is gradually ageing and along with it also the incidence of civilisation diseases, including those of the cardiovascular system, is increasing. As the care of these patients develops, so does the number of surgeries of invasive cardiology. Even though the development in this area is still dynamic, the techniques are improving and new technologies are appearing. However, these invasive methods are still associated with certain risks for the patient. In terms of vascular surgery, the most frequent complications are iatrogenic pseudo-aneurysms and large haematomas. The objective of the present study was to evaluate the development in the incidence of pseudo-aneurysms (PSA) appearing after punctures of femoral artery due to coronarography or PTCA, to verify the hypothesis that the ratio of the number of PSA to the total number of invasive-cardiologic diagnostic and therapeutic surgeries is decreasing and to indicate possible solutions of complications associated with catheterisation. The study presents a retrospective account of the number of invasive surgeries conducted at the 1st Department of Medicin - Cardioangiology of the St. Anne's University Hospital Brno (UH) from 1996 to 2004. Summarised are numbers of PSA's conducted in this period by surgeons of the 2nd Department of Surgery of the St. Anne's University Hospital Brno (Tab. 1, Fig. 5, Ref. 17).

Assessment of infarcted myocardium with real time myocardial contrast echocardiography: comparison with technetium-99m sestamibi single photon emission computed tomography.

BACKGROUND: Little is known about the relation between the extent of microvascular damage and infarct size in patients after successful mechanical reperfusion of acute myocardial infarction. OBJECTIVE: To compare the spatial extent of reduced myocardial signal between real time myocardial contrast echocardiography (MCE) and single photon emission computed tomography (SPECT) after successful mechanical reperfusion of acute myocardial infarction and to test the hypothesis that MCE can be used for clinical infarct size assessment. METHODS: 10 days after successful mechanical reperfusion of acute myocardial infarction, 117 patients underwent MCE (power pulse inversion technique, slow contrast bolus injection) and SPECT (technetium-99m sestamibi). Location and number of segments with normal myocardial signal intensity and with mild and severe reduction were registered and the concordance between the techniques was calculated. RESULTS: Segmental concordance between MCE and SPECT was 83% (kappa = 0.64). On average, the difference in the number of segments with reduced myocardial signal intensity between MCE and SPECT did not exceed one segment (p < 0.001). Sensitivity and specificity of MCE for the detection of an abnormal segment on SPECT were 87% and 91%, respectively. Intraobserver and interobserver agreement were 94% (kappa = 0.84) and 92% (kappa = 0.83), respectively. CONCLUSIONS: Real time MCE is a promising technique for infarct size assessment after successful mechanical reperfusion of acute myocardial infarction.

[Primary pulmonary hypertension--aspects of diagnosis and therapy]. / Primární plicní hypertenze--aktuální pohled na diagnostiku a lécbu.

Primary Lung Hypertension is a serious disease of unknown cause. Various genetic, vasoconstriction, proliferation and procoagulation factor participate in etiology and pathogenesis. In establishing the diagnosis it is necessary to exclude secondary, particularly embolic cause of pulmonary hypertension. There are diseases with associated primary pulmonary hypertension. Present therapy improves symptoms of the disease, three years after the diagnosis is established, 75% of patients survive. In the therapy of primary pulmonary hypertension, the recommended drugs are calcium channel blockers, epoprostenol, oxygen therapy and anticoagulant drugs. The new, clinically tested drugs include inhalation and oral analogs of prostacyclins, endothelin receptor antagonists and phosphodiesterase blockers.

A new chemical system for studying pattern formation: bromate-hypophosphite-acetone-dual catalyst.

A modified version of the short-lived BrO3(-)-H2PO2(-)-Mn(II)-N2 oscillator, the BrO3(-)-H2PO2(-)-acetone-dual catalyst system, where the catalyst pair can be Mn(II)-Ru(bpy)3SO4, or Mn(II)-ferroin, or Mn(II)-diphenylamine, shows long-lasting batch oscillations in the potential of a Pt electrode and in colour, accompanying periodic transitions between the oxidised and reduced forms of the catalysts. Experimental conditions for the oscillations are established. The origin of the batch oscillations and the role of the catalyst pair in the oscillatory behaviour are discussed. The new system is ideally suited to the study of waves and patterns in reaction-diffusion systems, since in addition to the longevity of its spatial behaviour in batch, it produces no gaseous or solid products and exhibits significant photosensitivity.

[Post-Doc (post-graduate training for medical doctors in Europe). The use of the Internet in the continuing education of general practice physicians: a European project of multimedia continuing medical education. The University of Aachen, Maastricht, Catholic University Leuven and the Central University Limburg (Diepenbeek) and EUREGIONET]. / Post doc (post graduate training for medical doctors in Europe). L'utilisation d'Internet dans la formation continue des médecins généralistes: un projet européen de formation médicale continue (FMC) multimedia. Universités de Aachen, Maastricht, la Katholieke Universiteit Leuven et l'Universitair Centrum Limburg (Diepenbeek) et EUREGIONET.

The continuing formation of the General Practitioners (GP) must stay in stride with the rapid evolution of society, technology, science and needs of the population. The Web allows on-line a rapid access to a pertinent and practical information whenever needed. PostDoc is a joint venture of the Universities of Aachen, Maastricht, Leuven and Diepenbeek. The Department of general medicine is associated with the Service of Technology of Education in this project. The interactivity of an Internet Website introduces a cooperative dimension in the work of the GP's centred on formation and discussion of problems encountered. This tool allows each GP to contribute to clinical cases and information.

Kinetic analysis of immunointeractions with covalently immobilized fatty acid-binding protein using a grating coupler sensor.

Application of a grating coupler sensor (GCS) to the real time investigation of the interaction kinetics of covalently immobilized recombinant bovine heart-type fatty acid-binding protein (H-FABP) and corresponding antibody is described. The immobilization of the antigen is performed by activating the matrix hydroxyl groups with p-toluenesulfonyl chloride (TSC) and afterwards coupling the protein by reaction with its nucleophilic aminogroups. Covalent coupling via TSC permits reproducible measurements of immunointeractions on the same grating coupler sensor chip and complete regeneration after each binding cycle with glycine-hydrochloride. We demonstrate the analysis of binding data obtained on a GCS by linearization as well as direct curve fitting using the integrated rate equation for the determination of apparent rate and affinity constants. With both analysis methods we studied H-FABP/monoclonal anti-H-FABP-antibody interactions and obtained an average apparent association rate constant ka = 4.2 X 10(3) M(-1) s(-1) a dissociation rate constant of kd=1.3 X 10(-4) s(-1) and an equilibrium constant of KD=3 X 10(-8) M.