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Biomedical subjects

J Spinar

Publications and source records attributed to J Spinar.

At least 37 records · Page 2Linked to original sources
PubMed2002

The double heterozygote of two endothelin-1 gene polymorphisms (G8002A and -3A/-4A) is related to big endothelin levels in chronic heart failure.

The aim of this study was to focus on the relationship among the associated genotypes of G (8002) A and -3A/-4A endothelin-1 (ET-1) gene polymorphisms and some clinical and/or biochemical parameters in Czech (Caucasian) patients with chronic heart failure. Included in the study were 103 patients with chronic heart failure (functional classes NYHA II-IV, ejection fraction < 40%). The ET-1 gene polymorphisms were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism methods. A significant decrease in the ET-1-associated genotype AG3A4A number (double heterozygote) was observed in CHF patients with plasma big endothelin levels above 0.7 pmol/L compared to those with levels below 0.7 pmol/L (OR = 0.19; 95% confidence interval = 0.06-0.57; P = 0.005; Pcorr = 0.03). We found a significant decrease in the AG3A4A genotype number in the other groups compared to the group of patients with both big endothelin and endothelin-1 levels under 0.7 pmol/L (OR = 0.22; 95% confidence interval = 0.07-0.79; P = 0.02). The double heterozygote variants of two ET-1 gene polymorphisms were associated with significantly less risk for chronic heart failure with higher levels of big endothelin.

Adult↗
PubMed2002

[Big endothelin and chronic heart failure].

In a group of 124 patients the authors investigated the importance of assessment of plasma levels of big endothelin and endothelin 1 in patients with chronic heart failure as compared with other currently used non-invasive parameters. A six fold increase of plasma levels of both substances was found in patients in functional class NYHA IV as compared with patients in class NYHA II-III. But even patients in the milder stage of NYHA had twice as high values as compared with the standard of the healthy population. Similarly patients with interstitial pulmonary oedema had a twice as high level of both parameters as compared with patients who had a normal finding on X-ray or merely a redistribution of the pulmonary vascularization. The sensitivity of assessment of plasma levels is such that this examination could become part of the basic diagnosis.

Biomarkers↗
PubMed2002

[Acetylsalicylic acid (ASA)--is everything clear?].

The authors summarize results of trials with acetysalicyl acid (ASA) in patients with ischaemic heart disease and in particular with chronic cardiac failure. They draw attention to the relatively frequent use this drug in common practice, although so far not a single trial was completed which would prove the effect of acetylsalicyl acid on long-term mortality. The authors discuss also possible interactions of acetylsalicyl acid and ACE inhibitors which in retrospective analyses indicate possible veakening of the ACE-I when administered concurrently with ASA in cardiac failure. The authors mention also other antiaggregation drugs, which similarly as ASA, significantly reduce the mortality in acute coronary syndrome. Their long-term administration is however not associated with further improvement of the diagnosis. Trials are mentioned which compare antiaggregation and anticolagulation treatment in patients with ischaemic heart disease. They analyze also the effect of dosage (benefit vs. risk). After ASA > 300 mg there are more frequent complications, and without a proved effect on total mortality, while doses < or = 100 mg seem to be safer but there is evidence that they are effective in reducing the total mortality of patients with IHD and/or cardiac failure.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

[The ECG and acute coronary syndromes in patients under 40 years of age--case reports of an obese smoker in comparison with an active female athlete].

The authors describe two cases of acute coronary syndrome by patients to the age of 40, of which anamnestical data and clinical manifestation were quite different. According to present recommendation of European Society of Cardiology neither one of them fulfilled standards for acute or created myocardial infarction. The discovery of ECG changes or echocardiographical findings lead to an introducing of coronarography examination that proved the important stenosis of coronary arteries and both cases were closed as a created (case 1) and acute (case 2) myocardial infarction.

Adult↗
PubMed2001

[Ambulatory blood pressure monitoring in a young population].

Ambulatory twenty four hour blood pressure monitoring (ABPM) is an exact method, enabling by repeated measurements to create blood pressure profile, which shows a close correlation with end organ damage. Normal values were taken from clinical trials, where the mean age of probands was highly above 30 years. The aim of this trial was to determine mean values for ABPM in population aged 18-30 years and to create "normal values" for this population. We have examined 162 probands. The mean office blood pressure was 128.18 +/- 11.2/82.91 +/- 8.29 mm Hg, the mean ABPM (24 hours) was 118.51 +/- 9.11/70.59 +/- 6.30 mm Hg. Systolic, mean and pulse pressure was significantly higher in males. Systolic and pulse blood pressure showed a close correlation with height, weight, waist and waist/hip ratio (r = 0.40-0.47). The upper value of 24 hour BP in young population is between 125/75 mm Hg and 130/80 mm Hg according to our results.

Adolescent↗
PubMed2001

[HOTEL P--Hypertension Optimal Treatment with Enalapril Lachema-Pliva. Optimal treatment of hypertension with Enalapril Lachema--Pliva].

The authors investigated in a one-year multicentric open study the effect of enalapril (Enalapril Lachema-Pliva) in 653 patients with mild to moderate hypertension treated in ambulance of 128 general practitioners and specialists in internal medicine. The blood pressure was checked after 6 weeks during the first six months and every 3 months during the second six months. Normal levels of diastolic pressure were achieved in 576 (82%) patients, whereby a combination of antihypertensive drugs had to be used in 383 (59%) patients. Complete renal functions were assessed in 51 patients, microalbuminuria declined from 91.8+/- 37.8 to 72.1 +/- 13.1 mg/l (p < 0.001), glomerular filtration was not affected. Parameters of insulin sensitivity were assessed in 117 patients, the complete lipid spectrum in 253 patients. IRI declined from 12.29 +/- 5.40 to 11.57 +/- 5.42 (p = 0.06) and glycosylated haemoglobin from 6.98 +/- 2.39 to 6.69 +/- 1.97 (p = 0.03), which slows improved insulin sensitivity. Total-cholesterol, LDL-cholesterol and triglycerides decreased significantly and HDL increased (p < 0.001). The left ventricle mass declined significantly after treatment, using Dewereux's calculation, by 17.2 %. The left ventricular diastolic function was not affected by the treatment, however, the lef aulium and left ventricle diminished in volume.

Antihypertensive Agents↗
PubMed2000

First dose hypotension after angiotensin converting enzyme inhibitor captopril and angiotensin II blocker losartan in patients with acute myocardial infarction.

BACKGROUND: First dose hypotension after the administration of an angiotensin-converting enzyme inhibitor in patients with acute myocardial infarction is one of the most important adverse events of this type of treatment. There is no information about first dose hypotension after angiotensin type 1-receptor blocker in this type of patient. AIM: To compare the first dose responses to low dose captopril and losartan in patients with acute myocardial infarction. METHODS: Single blind, randomised, multicentric, prospective study. Patients (n=320) with confirmed acute myocardial infarction, age >18 years, treated by direct percutaneous transluminal coronary angioplasty, thrombolysis and/or heparin, were randomised to receive a single dose of 6.25-12.5 mg captopril or 12.5-25 mg losartan within 24 h of hospital admission. Baseline laboratory and clinical examinations were performed before entering the study. Blood pressure monitoring started at hospital admission and continued for at least 8 h after the medication (second dose of captopril was given after 8 h). RESULTS: The maximal blood pressure fall appeared about 1 h after the first dose of captopril and 3.5 h after the first dose of losartan. Patients in the captopril group had significantly higher incidence of asymptomatic hypotension (38%) than patients treated with losartan (24%) (P<0.001). No difference in hypotension requiring a change in medication was observed. CONCLUSION: Low dose of losartan is safe for initiating therapy in patients with acute myocardial infarction within 24 h of hospital admission.

Aged↗
PubMed2000

Implantable left ventricular assist systems (LVAS): recent results. A report from a series of meetings sponsored by the Study Group on Advanced Heart Failure of the Working Group on Heart Failure.

Implantable left ventricular assist systems (LVAS) consist of implantable pumps with small control consoles and power sources that can be worn externally. These systems provide far greater patient mobility and independence than external pumps with bulky control consoles. Patients with implantable LVAS can be discharged from hospital and are able to return to work and resume active sports. Most patients have received these systems as a bridge to heart transplantation. Clinical status and quality of life improve dramatically after device implantation and survival on support (60-70% after approx. 100 days of support) is acceptable compared with transplant candidates on medical therapy. Patient selection and adverse events, primarily bleeding, thromboembolism and infection, are important issues with LVAS. In the future, long-term support and bridging to myocardial recovery may become important indications for LVAS.

Adolescent↗
PubMed2000

First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group.

BACKGROUND: First-dose hypotension refers to an observed reduction in blood pressure after the administration of the first dose of ACE inhibitors in patients with congestive heart failure. AIM: To compare the first-dose responses of low-dose enalapril and perindopril in patients with stable symptomatic chronic heart failure. METHODS: Single blind, randomised, multicenter, parallel, prospective study. Patients (N=298) with chronic heart failure due to ischemic heart disease or dilated cardiomyopathy, NYHA II-IV, ejection fraction<40%, age>18 years, naive to ACE inhibitors or ATI-receptor blocker, were randomised to receive a single dose of 2. 5 mg enalapril or 2.0 mg perindopril. Baseline laboratory and clinical examinations were performed before entry into the study. Ambulatory blood pressure monitoring started 2 h before the study medication was given, and continued for at least 10 h after the medication. RESULTS: The maximum drop in blood pressure appeared approximately 4 h after dose administration in both groups, and was more pronounced in the enalapril group. Patients in the enalapril group had a significantly higher incidence of asymptomatic hypotension. No symptomatic hypotension requiring a change in medication or a prolongation of hospitalisation was observed. CONCLUSION: A low dose of perindopril is well-tolerated at initiation of ACE inhibitor therapy in patients with chronic heart failure and causes less first-dose hypotension than a low dose of enalapril.

Aged↗
PubMed2000

A comparison of intervention with losartan or captopril in acute myocardial infarction.

AIM OF STUDY: Angiotensin-converting enzyme (ACE) inhibitors prolong life, lower the progression of heart failure, and decrease the need for hospitalizations in patients after myocardial infarctions. It is still unclear whether these effects could also be achieved by blocking the angiotensin II (ATII) type 1 receptor. METHODS AND RESULTS: We randomized 201 patients with acute myocardial infarction treated with either direct angioplasty, thrombolysis, or heparin alone to the ACE inhibitor captopril or the ATII antagonist losartan. The primary endpoints were safety, tolerability, and left ventricular parameters. The patients were followed for at least 15 days. The incidence of severe adverse events was similar in both groups, although cough presented less often in the losartan group. Captopril failed to prevent an increase in end-diastolic volume and did not influence left ventricular end-systolic volume. This effect led to an increase in the left ventricular ejection fraction (P<0. 001) without a change in wall-motion index. Losartan did not affect end-diastolic volume but decreased end-systolic volume (P<0.001), resulting in a significant increase in left ventricular ejection fraction (P<0.001) and a decrease in wall-motion index (P<0.001). CONCLUSION: This study suggests that losartan is safe and well tolerated in patients after myocardial infarction. ATII antagonists seem to have a more pronounced effect on left ventricular remodeling than ACE inhibitors.

Aged↗
PubMed2000

[Beta-blockers in the treatment of chronic heart failure. How should results of clinical studies be introduced into clinical practice].

The long-term action of elevated catecholamine concentrations on the heart muscle causes a number of adverse effects from apoptosis to malignant arrhythmia or terminal failure of the cardiac pump. Recently completed mortality studies with beta-blockers (BB) in chronic heart failure CIBIS II and MERIT HF confirmed the conclusions of pilot studies with carvedilol that in stabilized chronic heart failure BB reduces the mortality rate as well as the need of hospital admission on account of deteriorating heart failure. Proper selection of patients for administration of BB is necessary, assessment of absolute and relative contraindications. It is also necessary to define the initiation and increase of dosage and the target dose of the beta-blocker. The sooner treatment with beta-blockers is started, the greater the foreseen benefit for the patient.

Adrenergic beta-Antagonists↗
PubMed2000

[Imidazole receptor agonists--a new advance in the treatment of hypertension?].

Agonists of I1 imidazolin receptors are a new drug groups which was registered for the treatment of hypertension. Their antihypertensive action is comparable with current antihypertensives (hydrochlorothiazide, enalapril, atenolol, nifedipine retard) and causes a drop of the systolic BP by cca 15-20 mm Hg and a drop of the diastolic BP by 10-15 mm Hg with a probable normalization of the blood pressure in cca 60% patients with mild to moderate hypertension. Agonists of I1 imidazoline receptors are suitable in particular for the treatment of hypertension associated with metabolic syndrome. Their effect in patients with ischaemic heart disease or after a cerebrovascular attack is not known and despite very promising theoretical prerequisites they are not indicated in patients with chronic heart failure.

Antihypertensive Agents↗
PubMed2000

[Lipids and chronic heart failure].

The causes of chronic heart failure at the end of the 20th century are quite different from those 30 or 50 years ago. The last data from the Framingham study indicate that ischaemic heart disease and/or hypertension are the main cause in as many as 90% patients. The prevalence of chronic heart failure in European countries, 0.4-2%, implies 40-200,000 patients in the Czech Republic. Pharmacological treatment during the last 15 years revealed clearly that the drugs of choice which prolong life are inhibitors of the angiotensin converting enzyme (ACE-I) which are combined with other drugs as needed by the patient. A combination of five drug groups (ACE-I, digitalis, diuretics, beta-blockers, and spironolactone) are nowadays the basic treatment. In the 4S study (Scandinavian Simvastatin Survival Study--4,444 patients with ischaemic heart disease followed up for 5.4 years) 412 (9.2%) developed chronic heart failure requiring treatment, i.e. 228 (10.3%) in the placebo group and 184 (8.3%) patients in the group treated with simvastatin (p < 0.015). In the group of patients with signs of heart failure 73 of 228 died the placebo group and 47 of 184 in the simvastatin group (reduction of the relative risk by 19%, p = 0.014), to save one life (NNT) it was necessary to treat 15 patients for a period of 5 years. From the aspect of the number of patients it was necessary to treat six times as many patients without heart failure than with heart failure to save one life in five years. Hypolipidaemic treatment should be an obvious part of treatment of heart failure due to ischaemic heart disease. Hyperlipoproteinaemia is described in 60-80% patients after transplantation of the heart. Treatment involves diet, reduction or discontinuation of corticoids, maintenance of cyclosporin at the lowest effective level and treatment wit statins.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Effects of prostaglandin E1, dobutamine and placebo on hemodynamic, renal and neurohumoral variables in patients with advanced heart failure.

Excessive neurohumoral activity remains a major burden to the circulation of patients with advanced heart failure. Prostaglandin E1 (PGE1), a balanced i.v. vasodilator, was shown to elicit favorable hemodynamic and clinical effects in this cohort. A prospective randomized parallel group trial was performed to evaluate acute, intermediate and chronic changes in hemodynamic, neurohumoral and renal variables in response to PGE1, dobutamine and placebo. Thirty patients with class III and IV heart failure and low cardiac index (mean 1.9 l/min/m2) two hours after oral drugs including high dose enalapril were included. A 7-day-infusion of PGE1 (16.5 +/- 5 ng/kg/min, range 10 to 20 ng/kg/min, group A n = 10), dobutamine (4.5 +/- 1 micrograms/kg/min, range 2.5 to 5 micrograms/kg/min, group B n = 10) or placebo (saline, group C n = 10) was administered via a central venous access line after stepwise titration until intolerable side effects developed with PGE1 or a 20% increase in cardiac index occurred with dobutamine, which was continued on this dose throughout while PGE1 was maintained on 50% peak dose. Hemodynamic data were collected at baseline, at peak dosages, after 12 hours and after 7 days. Of neurohumoral variables plasma norepinephrine, big endothelin (Big ET) and atrial natriuretic peptide (ANP) were simultaneously evaluated using RIA methods. Renal plasma flow (by paraaminohippurate clearance) and glomerular filtration rate (by iothalamate clearance) was measured prior to and during the infusions (after 12 hours and after 7 days). At peak dose and at 12 hours significant drops from baseline of mean pulmonary artery pressure, pulmonary capillary wedge pressure and systemic vascular resistance were observed which were accompanied by a rise in cardiac output with both PGE1 and dobutamine. These changes were maintained through 7 days when pulmonary vascular resistance levels also fell with both active drugs. Blood pressure did not change throughout, but PGE1 increased heart rate slightly at 12 hrs. Both PGE1 and dobutamine enhanced renal plasma flow after 7 days, but only PGE1 decreased glomerular filtration fraction significantly. Glomerular filtration rate did not change with either drug. PGE1 decreased ANP levels at 12 hrs, and dobutamine increased big ET levels at peak, but decreased big ET at 7 days. Norepinephrine levels were unaffected throughout. Except a slight decrease in right atrial pressure after 7 days placebo did not change any measured variable significantly. Taken together, these data suggest that treatment with PGE1 is as efficacious as low-dose dobutamine in improving cardiac performance and renal perfusion in advanced heart failure. Of importance, no deleterious neurohumoral counterregulation was observed with PGE1.

Alprostadil↗
PubMed1998

[Beta blockers in the treatment of arterial hypertension].

The authors present a detailed review on beta-blockers (BB) in the treatment of hypertension. In the introduction they deal with the organ distribution and effects of stimulation of adrenergic receptors, followed by a detailed classification of beta-blockers by selectivity and the presence of internal sympathetic activity (ISA or PAA). The mechanisms of the antihypertensive action of beta-blockers are due mainly to a reduction of the minute volume. However, other possible effects of BB are also mentioned. The authors discuss in detail the use of BB in hypertension and associated diseases, side-effects of BB, contraindications for their administration, possible interaction with other groups of drugs and the strategy of their use in patients with high blood pressure.

Adrenergic beta-Antagonists↗
PubMed1998

Relationship between kidney function, hemodynamic variables and circulating big endothelin levels in patients with severe refractory heart failure.

UNLABELLED: Fluid retention is a major characteristic of symptomatic, progressive heart failure when a main factor implicated in the pathogenesis of renal dysfunction is renal hypoperfusion. This may be a consequence of forward cardiac failure, resulting in a low cardiac output integrating poor left ventricular function secondary to myocardial impairment and increased resistance in the regional renal vasculature secondary to locally released vasoconstrictors, e.g. endothelin. So far, the role of the pulmonary circulation in perpetuating renal dysfunction in heart failure is unclear. METHODS: We investigated the relationship of hemodynamic variables obtained during right heart catheterization and plasma big endothelin levels to renal function variables in 18 male patients aged 52 +/- 3 years, with heart failure in the NYHA function class III-IV, based on idiopathic causes in 8 and ischemic causes in 10 patients. Renal plasma flow (RPF) was established by paraaminohippurate (PAH) clearance and the glomerular filtration rate (GFR) was measured by iothalamate clearance. RESULTS: Plasma big endothelin (ET) levels were increased above the upper normal range (1.8 fmol/ml) in 16 out of 18 patients, averaging 5.0 +/- 0.8 fmol/ml (1.7-11.9 fmol/ml). Positive correlations to big ET plasma levels were detected with mean pulmonary pressure (r = 0.73, p < 0.001) pulmonary capillary wedge pressure (r = 0.56, p < 0.05) and pulmonary vascular resistance index (r = 0.69, p < 0.01). Glomerular filtration rate (70 +/- 7 ml/min) and renal plasma flow (358 +/- 36 ml/min) were considerably reduced and exhibited a tendency to correlate inversely with big ET levels (r = -0.46, p = 0.056 and r = -0.44, p = 0.069, respectively). Contrary to expectations, RPF did not correlate significantly with cardiac index, systemic vascular resistance index or arterial blood pressure. In contrast, significant correlations were detected of RPF with pulmonary capillary wedge pressure (r = -0.69, p < 0.01), mean pulmonary artery pressure (r = -0.65, p < 0.01), right atrial pressure (r = -0.47, p < 0.05) and right ventricular ejection fraction (r = 0.49, p < 0.05). CONCLUSION: The findings suggest a role for endothelin in renal vasoconstriction and accord well with the concept that in severe heart failure renal hypoperfusion--by volume retention--as well as increased endothelin synthesis--by pulmonary vasoconstriction--play a part in the increased pulmonary filling pressures.

Endothelin-1↗