Clinical predictors of complications in patients with left-sided infective endocarditis: A retrospective study of 206 episodes.

PURPOSE: Early identification of specific patient subgroups at high risk of developing life-threatening infective endocarditis (IE) complications is of paramount importance. Better stratification may allow more intensive treatment of these patients and positively influences clinical outcomes. METHODS: We carried out a retrospective survey of consecutive left-sided IE adult patients, admitted over a 15-year period to two main tertiary care centres in the Czech Republic. RESULTS: Among a group of 196 patients (155 males; median age 64 years), a total of 206 left-sided IE episodes were identified. Perivalvular extension of infection was most frequently seen in prosthetic aortic valve endocarditis (OR 6.706, p<0.0001). Valve prolapse/perforation during IE episodes was significantly associated with mitral valve IE (OR 2.136, p=0.026) and vegetation length (OR 1.055, p=0.009). Septic shock was significantly related to two main risk factors: S. aureus infection (OR 8.459, p=<0.0001) and smoking (OR 8.403, p=0.001). Mitral valve IE with a vegetation length ≥13 mm was the strongest risk factor for this complication (OR 3.24, p=0.001), followed by S. aureus infection (OR 3.59, p=0.002). Finally, septic shock (OR 6.000, p=0.001) represented the most important risk factor of in-hospital mortality. CONCLUSIONS: This study provides the most detailed profile of complication predictors related to left-sided IE in Central Europe. Early individual stratification of IE related occurrence of complications might help to decrease extremely high morbidity and mortality of this disease (Tab. 5, Ref. 37).

[Chest drain injury of the heart]. / Poranení srdce hrudním drénem.

INTRODUCTION: Injury to the heart during chest drainage is a very rare but potentially fatal complication of the procedure. CASE REPORT: A 56-year-old, polymorbid, poorly co-operative and extremely obese patient with chronic cardiac subcompensation and pleural effusion was admitted to a district hospital. A drain was inserted into the left pleural cavity in order to evacuate the pleural effusion. Fresh oxygenated blood was flowing out from the drain. The drain was clamped immediately. Echocardiography showed drain insertion into the left ventricle. A cardiac surgeon was contacted and indicated patient transfer to a cardiac surgery department followed by an emergency surgery. During the surgery performed through a left thoracotomy, a defect in the left ventricular wall was sutured. The patient was then stabilized, transferred back to the district hospital and, after achieving cardiopulmonary compensation, discharged home. CONCLUSION: Injury to the heart in chest drainage is a very serious iatrogenic complication. If it is to be managed successfully, the site of the insertion of the drain tip needs to be correctly identified and the drain must not be extracted. A surgical department capable of adequately addressing this complication needs to be contacted promptly, as emergency surgery may be the only lifesaving possibility.Key words: chest drainage - complication - heart injury.

Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study.

BACKGROUND: In patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the age of the patient), Ross procedure and mechanical aortic valve replacement. METHODS: Quality of life was studied in 139 patients after aortic valve surgery divided into four study groups (Y - aortic valve-sparing procedure at the age below 50 years, mean age 36.2 years; O - aortic valve-sparing procedure at the age 50 years and over, mean age 59.2 years; R - Ross procedure, mean age 37.8 years and M - mechanical aortic valve replacement at the age below 50 years, mean age 39.2 years). SF-36 Short Form and valve-specific questionnaires were mailed to the patients after 6 months or later following surgery (median 26.9 months). RESULTS: In SF-36, the younger aortic valve repair patients and the Ross patients scored significantly better in 4 of 4 physical subscales and in 2 of 4 mental subscales than the older aortic valve repair and mechanical valve replacement patients. In the valve-specific questionnaire; however, all 3 groups free of anticoagulation (Y, O, and R) displayed greater freedom from negative valve-related concerns. CONCLUSIONS: Postoperative quality of life is influenced by the type of aortic valve procedure and is negatively linked with mechanical prosthesis implantation and long-term anticoagulation. Aortic valve-sparing strategy should be considered in cases with suitable valve morphology due to favorable clinical results and beneficial impact on the long-term quality of life.

Lipoprotein-associated phospholipase A2 mass level is increased in elderly subjects with type 2 diabetes mellitus.

OBJECTIVE. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is extensively expressed by advanced atherosclerotic lesions and may play a role in plaque instability. We selected a group of elderly subjects that underwent transcatheter aortic valve implantation (TAVI) or balloon angioplasty (BA) and separated them into two groups, diabetic and nondiabetic, to compare the level of Lp-PLA2 mass between them. METHODS. 44 patients aged 79.6 ± 5.6 years with symptomatic severe aortic valve stenosis underwent TAVI (n = 35) or BA (n = 9). 21 subjects had confirmed type 2 diabetes mellitus. Lp-PLA2 mass was measured using an enzyme-linked immunosorbent assay kit (USCN Life Science, China) before and 3 days after the procedure. RESULTS. Lp-PLA2 mass was significantly elevated in this population (1296 ± 358 ng/mL before TAVI; 1413 ± 268 ng/mL before BA) and further increased after TAVI (1604 ± 437 ng/mL, P < 0.01) or BA (1808 ± 303 ng/mL, P < 0.01). Lp-PLA2 mass was significantly increased on the diabetic group before these interventions. CONCLUSION. Lp-PLA2 may be a novel biomarker for the presence of rupture-prone atherosclerotic lesions in elderly patients. Levels of Lp-PLA2 in diabetic patients may accompany the higher amount of small dense LDL particles seen in these subjects.

[Minimally invasive video-assisted operations for heart disease]. / Miniinvazivní videoasistované operace srdecních vad.

INTRODUCTION: Minimally invasive surgical access for the treatment of mitral and tricuspid valves has become an alternative method to the conventional approach via median sternotomy. The aim of this paper is to evaluate our experience and results with minimally invasive approach in cardiac surgery at our institution. MATERIAL AND METHODS: A total of 52 patients underwent minimally invasive cardiac surgery between November 2011 and March 2013. Right lateral minithoracotomy and femoral vessels cannulation for cardiopulmonary bypass was used. Follow-up data was collected in a prospective database and analysed retrospectively. RESULTS: The mean age of patients was 60.9 ± 11.6 years (female patients accounted for 63.5%). The procedures performed included mitral valve repair in 44 (85%) patients and tricuspid valve repair in 25 (48%). Atrial septal defect closure was performed in 8 (15%) patients and cryoablation of atrial fibrillation in 26 (50%) patients. There were 75% combined procedures. The median duration of the operation was 235 (155-315) minutes. The median length of cardiopulmonary bypass and crossclamp time was 139 (89-225) and 92 (51-168) minutes, respectively. The median duration of postoperative hospital stay was 12.5 (6-34) days. Hospital and 30-day mortality was 0%. At follow-up (121.3 ± 32.72 days), two patients (3.8%) required reoperation (1 for right haemothorax, 1 for aortic valve insufficiency). CONCLUSION: Minimally invasive access has been adopted as a routine method for the therapy of valve disease. The minithoracotomy approach is a safe and feasible technique with comparable mortality and in-hospital morbidity.

[Bicuspid aortic valve--ethiopathogenesis and natural history]. / Bikuspidální aortální chlopen--etiopatogeneze a prirozený vývoj.

Bicuspid aortic valve is a disease with autosomal dominant inheritance with small penetration. The population of patients with bicuspid aortic valve is heterogenous. In the absence of dilatation of ascending aorta, valvular lesion or degenerative changes of valve leaflets patients are considered to belong to the low risk population. On the other hand patients with the above mentioned characteristics compose a high risk group. Dilatation of the ascending aorta in patients with bicuspid aortic valve has a progressive feature and continues even after replacement of the aortic valve. With progression of aortic dilatation the risk of aortic dissection and rupture increases. The main reasons for aortic dilatation are changes in quality of aortic wall and possibly mechanical stress of aortic wall during asymmetrical and turbulent flow. The progression of aortic dilatation or aortic valve disease is not essentially influenced by farmacologic treatment. Surgery is the treatment of choice. Physiology and pathophysiology of bicuspid and tricuspid aortic valves, prevalence of bicuspid aortic valve in general population and in the group of patients operated on for aortic valve disease, phenotypes of bicuspid aortic valve and follow-up of asymptomatic patients with normal bicuspid valve are reviewed in this article. Indications for operation of dilated ascending aorta according to american, european and czech guidelines are discussed.

Mechanical properties of mitral allografts are not reasonably influenced by cryopreservation in sheep model.

A mitral allograft is used exceptionally in the mitral, as well as in the tricuspid position, mostly as an experimental surgical procedure. The authors decided to evaluate the possibility of inserting a cryopreserved mitral allograft into the tricuspid position in a sheep experimental model. Within the framework of this experimental project the mechanical properties of the cryopreserved mitral allograft were tested. A novel methodology studying the functional unit composed of mitral annulus, leaflet, chordae tendinaea, and papillary muscle is presented. A five-parameter Maxwell model was applied to characterize the viscoelastic behavior of sheep mitral valves. A control group of 39 fresh mitral specimens and a test group of 13 cryopreserved mitral allografts from tissue bank were tested. The testing protocol consisted of six loading cycles with 1 mm elongation every 5 min. There was no significant difference in the mean values of the determined parameters (p>0.05) which confirms the main hypothesis that cryopreservation does not influence significantly material parameters characterizing the tissue mechanics. Slight discrepancy is observed in variances of viscous parameters suggesting that the values of the test group may be spread over larger interval due to the treatment.

[Diabetes mellitus and ischemic heart disease]. / Diabetes mellitus a ischemická choroba srdecní.

Diabetes mellitus (DM) is closely associated with cardiovascular (CV) diseases. These are the main cause of death in patients not only with type 2 but also type 1 diabetes. Apart from the traditional risk factors such as arterial hypertension, dyslipidemia and obesity, hyperglycaemia is an independent risk factor for the development of ischemic heart disease (IHD). Long-term hyperglycaemia leads to vascular damage through several mechanisms. These include oxidative stress, formation of advanced glycation end products, activation of the nuclear factor kappa B and decreased production of nitrogen monoxide (NO). Insulin resistance is believed to have an important bearing on pathogenesis of IHD in type 2 diabetes (DM2) patients. The course of IHD in diabetic patients is usually more complicated. Direct percutaneous coronary intervention (PCI) is the gold standard in the treatment of myocardial infarction (MI) in diabetic as well as non-diabetic patients. Drug-eluting stents, associated with fewer reocclusions, have also proved useful. In addition to drug-eluting stent implantation, surgical revascularization, preferably utilizing internal thoracic artery, is a suitable technique in patients without acute coronary syndrome indicated for an intervention. Conservative approach should be applied in less severely affected patients. IHD prevention should include appropriate control of arterial hypertension, dyslipidemia and weigh reduction. Diabetes treatment should be managed individually and with respect to the potential risk of hypoglycaemia in high-risk patients with longer duration of diabetes and known CV disease. Newly diagnosed type 2 diabetes patients should from the onset be treated with metformin and tight compensation should be aimed for with target value for glycated haemoglobin of less than 4.5% (IFCC methodology). Evidence exists that this approach may significantly reduce the CV risk. Intensified insulin regimen is the most suitable treatment approach for the type 1 diabetes patients also with respect to microvascular and macrovascular complication prevention. Treatment of hyperglycaemia is one of the set of measures that may contribute to CV risk reduction in diabetic patients.

[Surgical treatment of ischemic heart disease and diabetes mellitus]. / Chirurgická lécba isthemické thoroby srdecní a diabetes mellitus.

At present, treatment of IHD is relatively frequently surgical. Approximately every fourth patient undergoing surgery for IHD is a diabetic. The surgery itself does not differ from non-diabetic patients except for the specific preparation of a diabetic patient with respect to glycaemia control and with respect to metabolic demands associated with the surgical intervention. Frequent involvement of more extensive as well as more peripheral regions of the coronary arteries makes the surgical intervention more difficult. The differences with respect to mortality have been diminished mainly due to the continuously improving cardiac surgery and expanding knowledge of pathophysiology of DM, enabling better control and correction of glycaemia. However, the differences with respect to morbidity still remain (higher incidence of wound healing problems, higher incidence of strokes, renal failure, longer mean duration of hospitalization). Furthermore, long-term survival in diabetic patients is shorter, particularly due to more rapidly progressing atherosclerosis. The outcomes of IHD treatment in diabetic patients might improve when these well-known issues are fully acknowledged. The best possible diabetes treatment might contribute to this. Surgical treatment of IHD, particularly arterial grafting and use of as gentle as possible approaches (myocardial revascularization from mini-invasive entry pathways, possibly without extracorporeal circulation) also encompass great potential for outcome improvement.

[The results of the RE-lY study promise more effective, safer and easier prevention of embolic complications in patients with non-valvular atrial fibrillation]. / Výsledky studie RE-LY slibují úcinnejsí, bezpecnejsí a jednodussí prevenci embolických komplikací u nemorných s nevalvulární fibrilací síní.

The RE-LY study compared dabigatran in the dose of 150 mg and 110 mg twice daily, without laboratory monitoring, with the conventional treatment with warfarin dosed according to INR in 18,113 patients with non-valvular atrial fibrillation and high risk of embolisation. The incidence of cerebrovascular events and systemic embolisation was 1.69% per year in the warfarin group, compared to 1.53% per year in the 110 mg dabigatran group (relative risk 0.91; 95% CI 0.74-1.11; p < 0.001 for non-inferiority) and 1.11% per year in the 150 mg dabigatran (relative risk 0.66; 95% CI 0.53-0.82; p < 0.001 for superiority). Major bleeding occurred in 3.36% of patients per year in the warfarin group, compared to 2.71% of patients per year in the 110 mg dabigatran group (p = 0.003) and 3.11% of patients per year in the 150 mg dabigatran group (p = 0.31). Cerebral haemorrhagic events occurred in 0.38% of patients on warfarin per year, compared to 0.12% per year in the 110 mg dabigatran group (p < 0.001) and 0.10% per year in the 150 mg dabigatran group (p < 0.001). Mortality was 4.13% per year in the warfarin group, compared to 3.75% per year in patients on 110 mg dabigatran (p = 0.13) and 3.64% per year in patients on 150mg dabigatran (p = 0.051). In conclusion, administration of dabigatran to patients with atrial fibrillation in the dose of 110 mg in the RE-LY study was associated with the same incidence of cerebrovascular events and systemic embolisations as with warfarin, while there was lower incidence of major bleeding complications. Dabigatran in the dose of 150mg compared to warfarin led to reduction in the incidence of cerebral events and systemic embolisations with the same incidence of haemorrhagic complications.

[Some current views on chronic ischemic heart disease]. / Nekteré soucasné názory na chronickou ischemickou srdecní chorobu.

Chronic myocardial ischemia results from a temporary disbalance between supply of oxygen to myocardium and consumption of oxygen by myocardium. The most frequent cause of ischemic heart disease is atherosclerosis of the coronary arteries. At present, diagnosis of coronary impairment is for practical reasons not possible until myocardial ischemia is detectable. Despite the current pharmacological treatments, data from the recent studies justify stratification of prognosis of patients with chronic ischemic heart disease into subgroups with low, medium and high risk. Mean annual mortality is below 1% in patients with low risk, 1-2% in patients with medium risk and above 2% in patients with high risk. Revascularization procedures might improve prognosis in certain subgroups of patient with chronic ischemic heart disease. Revascularization also decreases the incidence of ischemic episodes and improves the left ventricle function in some subgroups.

[Midterm results aortic valve replacement with allograft]. / Strednedobé výsledky implantací aortálního alograftu.

INTRODUCTION: Aortic allograft implantation into the aortic position in adults is standard procedure with some controversary. The most popular indication is bacterial endocarditis. We would like to present our midterm results. RESULTS: We implanted 61 allografts in 60 patients (between 10/2002 and 04/2008). Men were 46 (76.8%) and average age was 57 +/- 10.76 year. 30 days mortality was 9 people (15.0%, all with bacterial endocarditis). Late mortality 1 man (1.6%). Follow up 1-66 months, average 39.18 SD +/- 14.3 months, median 42 months. CONCLUSION: Implantation of aortic allograft into the aortic position is standard procedure with good midterm results. Relative high early mortality is dependent on preoperative status in patiens with acute bacterial endocarditis--all early death people were people with acute bacterial endocarditis and minimally one vital organ severe dysfunction.

[Aortic valve sparing operations and reconstruction--from anatomy to the long-term results]. / Záchovné operate a plastiky aortální chlopne--od anatomie chlopne az k dlouhodobým výsledkum.

The implantation of an artificial heart valve (a mechanical valve or a xenograft valve) involves the risk of serious and life-threatening complications for the patient, such as hemorrhagic complications, thromboembolic complications, the risk of endocarditis, the risk of premature degeneration of the xenograft valve, etc. Preserving the patient's own aortic valve eliminates or at least significantly reduces the above complications. On the other hand, it brings about the disadvantage of a technically more demanding surgery and the possible risk of reoperation due to failure of the spared aortic valve. The authors present a comprehensive and up-to-date view ofthe issue of aortic valve sparing surgeries and plastic corrections, beginning with the basics of aortic root anatomy and ending with the indications and principles of cardiosurgical techniques, and long-term results.

[Replacement of aortic valva and ascending aorta in patient with Takayasu's arteritis]. / Náhrada aortální chlopne a vzestupné aorty u pacienta s Takayasuovou arteritidou.

Takayasu's arteritis (TA) is a rare vascular disorder, which predominantlly affects aorta and its primary branches. TA has a worldwide distribution and it is most frequent in young women. We report the case report of 36-year-old women, who underwent replacement of aortic valve and ascending aorta due to signifiant aortic regurgitation and dilatation of ascending aorta as a consequence of TA.

Time-course of tissue factor plasma level in patients with acute coronary syndrome.

Enhanced expression of tissue factor (TF) may result in thrombosis contributing to acute clinical consequences of coronary artery disease. Several studies demonstrated elevated plasma levels of TF in patients with acute coronary syndrome (ACS). The aim of our study was to compare the concentrations of TF in coronary sinus (CS), proximal part of the left coronary artery (LCA) and peripheral vein (PV) of patients with ACS and stable coronary artery disease (SCAD). Time course of the TF plasma levels in PV was followed on day 1 and day 7 after index event of ACS presentation and was compared to day 0 values. No heparin was given prior to the blood sampling. Twenty-nine patients in the ACS group (age 63.6+/-10.8 years, 20 males, 9 females) and 24 patients with SCAD (age 62.3+/-8.1 years, 21 males, 3 females) were examined. TF plasma level was significantly higher in patients with ACS than in those with SCAD (239.0+/-99.3 ng/ml vs. 164.3+/-114.2 ng/ml; p=0.016). There was no difference in TF plasma levels in PV, CS and LCA (239.0+/-99.3 ng/ml vs. 253.7+/-131.5 ng/ml vs. 250.6+/-116.4 ng/ml, respectively). TF plasma levels tended to decrease only non-significantly on the day 7 (224.4+/-109.8 ng/ml). Significant linear correlation between TF and high sensitivity CRP (hs-CRP) levels on day 0 was found. In conclusion, TF plasma levels are elevated in patients with ACS not only locally in CS but also in systematic circulation. Our data support the relationship between TF production and proinflammatory mediators.

[Endovascular treatment of spontaneous hemothorax in patient with neurofibromatosis type I]. / Endovaskulárni lécba spontánního hemotoraxu u neurofibromatózy I. typu.

Authors present possibility of endovascular treatment of spontaneous hemothorax in the patient with neurofibromatosis type I. CT angiography was crucial in diagnostic algorithm because revealed false aneurysm of the thyreocervical artery. This artery was embolised with acrylic glue. The patient has been without signs of recurrent bleeding.

[Biomarkers of myocardial ischemia and necrosis in 2008]. / Biomarkery ischemie a nekrózy myokardu v roce 2008.

In the review article, the authors present current knowledge of biomarkers of myocardial ischemia and necrosis. They comment new definition of myocardial infarction resulted as consensus of European Society of Cardiology and American Heart Association. They added clinically interested data about routinely used cardiomarkers (cardiac troponins and creatinkinase). At the second part, the authors focused on new biomarkers (fatty acids binding proteins, ischemia-modified albumin, glycogen phosphorylase isoenzyme BB) and its significance in diagnosis of myocardial ischemia/necrosis and their prognostic significance. Some of new promising molecules are discussed in the last part of the article.

Cryopreserved semilunar heart valve allografts: leaflet surface damage in scanning electron microscopy.

OBJECTIVE: Allograft heart valves (AHV), biological valves of human origin, offer potential advantages over conventional xenografts in terms of superior hemodynamics and, perhaps, better durability. The most important factors for long-term AHV clinical performance are the processing and cryopreservation methods. The aim of this study was to evaluate the impact of current processing protocol on valve tissue morphology, mainly to address the effect of successive processing steps on the leaflet surface structure. For the detection of fine changes in endothelial covering and underlying layers, our own modification of the scanning electron microscopy (SEM) technique was utilized. MATERIAL AND METHODS: The study was based on an investigation of 20 AHV (40 specimens). Fourteen valves came from heart-beating donors (multiorgan harvesting) when the heart could not be transplanted for any reason (donor criteria, availability of recipient and/or logistics). Six were obtained at the time of routine postmortems--non heart-beating donors (NHBD). All specimens were initially fixed in Baker's solution. Tissue samples were dissected, dried with hexamethyldisilazane (HMDS), gold-coated, studied and photographed by SEM (Tesla BS 301). In order to define the integrity of the endothelium, subendothelial layers and the quality of the surface under SEM, a special six-level score system was introduced: 1-intact endothelium, 2-confluent endothelium with structural inhomogeneity, 3-disruption of intercellular contacts, 4-separation of endothelial cells, 5-complete loss of endothelium, 6-damage of subendothelial layers). AHV samples were divided into 4 groups for comparison. One aortic AHV "fresh" control sample obtained from a heart-beating donor was evaluated without any processing and was compared with (i) tissue from AHV obtained from NHBD with warm ischemia of 12 and 48 hours, (ii) samples stored at +4 degrees C in saline for 24 h, (iii) antibiotic-treated tissue for 24 h at 37 degrees C and finally with (iv) cryopreserved valves stored in liquid nitrogen (-196 degrees C) for 6-38 months. RESULTS: Our alternative for drying samples by the HMDS method proved to be suitable for thin membranes of human semilunar valves. We were able to detect early changes in the endothelium after harvesting and denudation of the endothelial covering during preservation with and without freezing. The surface of the AHV samples revealed the typical features and score system determined endothelial cell damage. Control "fresh" sample: score 2, (i) NHBD samples with warm ischemia of 12 h: score 3-4, with warm ischemia of 48 h: score 4-5, (ii) samples stored at +4 degrees C in saline for 48 h: score 5-6, (iii) antibiotic-treated tissue for 24 h at 37 degrees C: score 5, (iv) cryopreserved valves stored in liquid nitrogen for 6-38 months: score 5-6. CONCLUSION: SEM (using HMDS drying) together with other methods may be helpful for the morphological control of processing, cryopreservation and liquid nitrogen storage of AHV. Severe AHV leaflet endothelial destruction was proven on AHV grafts. These changes arose already in the initial steps of tissue processing, just after the donor heart harvesting and then at the time of antibiotic valve graft treatment. These results are considered as the starting point for the development of a better preservation protocol.

Monitoring of the very early changes of left ventricular diastolic function in patients with acute leukemia treated with anthracyclines.

AIM: To analyze the very early changes of diastolic LV function during and after chemotherapy (CT) in patients with newly diagnosed acute leukemia. METHODS: 26 patients with acute leukemia have been studied. The cardiac echo evaluation was performed at the baseline (before CT), after the first CT (mean cumulative anthracyclines dose 136.3-/+28.3 mg m(-2)), after the last CT (mean cumulative anthracyclines dose 464.3-/+117.5 mg m(-2)) and circa 6 months after the completion of CT. RESULTS: We found a significant decrease in LVEF (65.3-/+4.5' vs 60.2-/+5.7', p<0.01), the fractional shortening of the LV (34.8-/+3.7', vs 29.5-/+5.0', p<0.01), but the mitral flow rapid filling velocity (E-wave) was not changed (0.74-/+0.18 ms(-1), vs 0.67-/+0.17 ms(-1), p ns), and atrial filling velocity (A-wave) increased (0.66-/+0.15 ms(-1) vs 0.78-/+0.18 ms(-1), p<0.01). E/A ratio significantly decreased (1.18-/+0.35 vs 0.89-/+0.27, p<0.01). IVRT increased (71.5-/+11.6 ms vs 84.0-/+11.6 ms, p<0.01). DT E-wave velocity increased (162.3-/+25.8 ms vs 206.7-/+25.5 ms, p<0.01). After the first CT, the signs of LV diastolic dysfunction were detected in 5 (19.2') patients. 6 months after the last CT, two of these patients (7.7') developed LV systolic dysfunction with the clinical symptoms of heart failure. Six months after the last CT, 12 (46.2') patients developed the signs of LV diastolic dysfunction. CONCLUSION: Chemotherapy can induce early changes of diastolic left ventricular function. We consider using Doppler echocardiography as the election tool not only for baseline cardiologic screening but also for the monitoring of the earliest subclinical signs of cardiotoxicity.

Plasma tissue factor in coronary artery disease: further step to the understanding of the basic mechanisms of coronary artery thrombosis.

Tissue factor is a cell surface protein that is expressed constitutively by monocytes, macrophages and fibroblasts, but also by some other cells in response to a variety of stimuli. The main function of the tissue factor is to form a complex with factor VII/VIIa that converts factors IX and X to their active forms. Tissue factor is also involved in the pathophysiology of systemic inflammatory disorders, coagulopathies, atherosclerotic disease, tumor angiogenesis and metastasis. Increased tissue factor expression either locally in the coronary plaques or systematically on circulating blood elements of patients with acute coronary syndromes may be responsible for increased thrombin generation, thus leading to platelet activation and fibrin formation. Tissue factor therefore plays a pivotal role in the initiation of thrombotic complications in patients with coronary artery disease.