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Biomedical subjects

J Veselka

Publications and source records attributed to J Veselka.

At least 19 recordsLinked to original sources
PubMed2007

Pregnancy-associated plasma protein A and proform eosinophilic major basic protein in the detection of different types of coronary artery disease.

Kryptor system was proven to be a rapid, standard method for pregnancy-associated plasma protein A and proform eosinophilic major basic protein (PAPP-A/proMBP) complex detection in coronary artery disease (CAD). No age and/or gender differences in 51 controls and 110 stable coronary artery disease (SCAD) patients were found. SCAD patients did not differ from controls and no difference in PAPP-A/proMBP levels with regards to the number of affected vessels was found. In 21 unstable angina pectoris (UAP), in 35 without and 66 with ST elevation acute myocardial infarctions (NSTEMI, STEMI respectively) patients PAPP-A/proMBP levels were increased (P=0.004 and P<0.0005, respectively). PAPP-A/proMBP levels did not correlate with cardiac troponin I (cTnI) in STEMI and NSTEMI patients. PAPP-A/ proMBP increase was more frequent than cTnI (P=0.036) within the early phase of STEMI. In NSTEMI patients PAPP-A/proMBP positivity was present in 50% of cTnI negative cases. Receiver operating characteristic (ROC) analysis revealed the highest diagnostic accuracy of PAPP-A/proMBP (0.919) in STEMI cTnI positive cases. The highest specificity/sensitivity PAPP-A/proMBP levels for particular acute coronary syndrome (ACS) types were 10.65-14.75 mIU/l. Combination of PAPP-A/proMBP with cTnI increases their diagnostic efficacy within the early phase of ACS. Our results suggest that PAPP-A/proMBP complex is involved in processes preceding vulnerable plaque development in ACS.

Acute Coronary Syndrome↗
PubMed2006

The role of tissue factor in thrombosis and hemostasis.

The tissue factor (TF) is one of the most important regulators of arterial thrombosis. Because arterial thrombosis is the pathophysiologic background of acute coronary syndrome, the possible impact of blocking the arterial thrombosis on its onset is a challenging problem. The investigations of TF brought a new concept of "cell-based coagulation model" which highlighted the question of blood-borne TF as a source of TF in circulating blood. In this review we summarize essential information on the pathophysiology, molecular structure, expression and distribution of TF and we propose a novel concept of blood-borne TF, suggesting the possibilities of inhibition of the coagulation cascade with newly synthetized drugs.

Animals↗
PubMed2006

[Role of Doppler echocardiography in the diagnostics and therapy of hypertrophic cardiomyopathy].

Hypertrophic cardiomyopathy (HCM) is a complex and relatively common genetic heart disease. HCM is caused by mutations of genes encoding sarcomeric contractile proteins and it is characterized by heterogeneous pattern of left ventricular hypertrophy with dynamic obstruction of left ventricular outflow tract. HCM is associated with both impaired left ventricular contractility and diastolic function. Using Doppler echocardiography, we are able to assess left ventricular diastolic function and measure left ventricular outflow gradient. Tissue Doppler imaging of mitral annulus is able to discriminate genotype-positive patients which allows us to improve diagnostic sensitivity of echocardiography. The Tei index is a new Doppler index, combining systolic and diastolic time intervals as an expression of global myocardial performance ("index of myocardial performance"). Non-pharmacologic treatment of obstructive HCM (alcohol septal ablation) is associated with improvement of Tei index. Doppler echocardiography is an indispensable tool in the management of HCM.

Cardiomyopathy, Hypertrophic↗
PubMed2006

[Tako-tsubo syndrome--new addition in the family of acute states in cardiology. Current report].

Tako-tsubo syndrome is most often described as temporary disorder in the kinetics in the apical part of the left ventricle. Typical of this state is pronounced dyskinesis, coupled in certain cases with intraventricular obstruction. The symptom can be accompanied by a dramatic clinical picture resembling myocardial infarction. However, the findings on the coronary veins tend to be normal and the patient's prognosis is favourable. To do a proper diagnosis, it is of primary importance to bear in mind the possibility of tako-tsubo syndrome.

Acute Disease↗
PubMed2005

[Distal protection during primary coronary angioplasty in patients with acute myocardial infarction].

BACKGROUND: The aim of the study was to assess the safety, feasibility and efficacy of mechanical distal protection during primary angioplasty using FilterWire EZ (FW). METHOD AND RESULTS: Thirty-one patients with acute myocardial infarction (AMI) were treated by primary angioplasty with distal protection using FW. The results were compared with a matched control group consisting of 33 patients with AMI treated by primary angioplasty alone. Successful FW positioning was obtained in 30 patients (97%). In these patients a lower rate of distal embolisation (3 vs. 18%, p=0.04) was found and a more effective reperfusion was assessed by ST elevation's resolution >50% immediately after the procedure (83 vs. 61%, p=0.05). A higher number of patients with corrected TIMI frame count <27 in FW group supported more effective reperfusion to but this difference did not reached statistical significance (87 vs. 73%, p=0.09). There were no differences between groups regarding average peak CK and CK-MB. However, there is a trend to lower release in FW group (32.1+/-24.5 vs. 35.3+/-31.0, p=0.33; 4.2+/-3 vs. 4.4+3.7, p=0.44). CONCLUSIONS: The presented study confirmed that distal embolisation during primary angioplasty is a frequent phenomenon. In this setting, adjunctive use of the FW is feasible and save, and it may improve myocardial reperfusion by reducing the embolic events.

Aged↗
PubMed2002

[Intravascular ultrasound guided direct stent implantation in the treatment of significant stenosis of the left coronary artery].

The authors present the case of a 52-year-old patient with the symptomatology of unstable angina pectoris where they diagnosed a major stenosis of the trunk of the left coronary artery as the only significant lesion in the coronary circulation. The patient was successfully treated by means of an intravascular ultrasound--guided coronary stent implanted into the trunk of the left coronary artery. The authors discuss the possibilities and trends of contemporary catheterization treatment of major coronary affections.

Angina, Unstable↗
PubMed2002

[Risk stratification in unstable angina pectoris and non-Q myocardial infarct: anamnesis, physical examination, electrocardiography, specific cardiac markers].

Patients with unstable angina pectoris or non Q-infarction of the myocardium are a very heterogeneous group. It comprises patients with angina pectoris which developed for the first time in their life and had only an episodic character, as well as patients with a severe clinical course and prognostically serious coronary finding. In this connection risk stratification of patients is useful as a provision from which the further diagnostic and therapeutic procedure develops. Based on an analysis of anamnestic data, physical examination, electrocardiogram and examination of cardiospecific, biochemical markers we can divide the patients into groups with a high, medium and low risk. In patients with a high risk the authors use in addition to standard medicamentous treatment also an early invasive examination with possible revascularization. Coronary angiography without the necessity of immediate implementation is also indicated in the majority of patients with medium risk. Conversely low risk patients do not require hospital admission in some cases, or they may be discharged soon.

Angina, Unstable↗
PubMed2001

[Transcatheter embolization of a coronary fistula in the treatment of ischemic heart disease].

The authors present the case of a 71-year-old female patient with clinical signs of ischaemic heart disease where they diagnosed a coronary fistula between the ramus interventricularis anterior and the trunk of the pulmonary artery. Because of the marked symptomatology they made a transcatheter embolisation of the fistula by introduction of embolisation spirals which led to the elimination of ischaemic symptomatology. Because of the unusual character, pretentious technical aspects and possible risks this operation is indicated only in adult symptomatic patients.

Aged↗
PubMed2001

[Percutaneous transluminal septal myocardial ablation in the treatment of hypertrophic obstructive cardiomyopathy: short-term study].

In 18 patients with symptomatic hypertrophic obstructive cardiomyopathy 18 procedures involving percutaneous transluminal myocardial ablation were performed. The patients were followed up for three months after the procedure. The mean intraventricular peak gradient declined during the intervention from 51 +/- 26 mm Hg to 11 +/- 12.2 mm Hg (p < 0.001). On average 2.7 +/- 1.1 ml ethanol were administered, as a rule into the first septal branch. The target artery was detected in 13 instances by means of myocardial contrast echocardiography and in five instances by haemodynamic investigation. In one instance the procedure was combined with subsequent balloon angioplasty of the ramus circumflexus. In one patient it was necessary to implant ex post a permanent pacemaker on account of AV bloc grade III. In one instance when myocardial contrast echocardiography was not used) infarsation not only of the basal interventricular septum occurred but also of the posterolateral left ventricular wall. During the three-month follow-up the incidence of stenocardias assessed according to CCS declined from grade 2.6 +/- 0.8 to 0.8 +/- 0.8 (p < 0.0001). Dyspnoea evaluated according to NYHA declined from grade 2.9 +/- 0.5 to 1.4 +/- 0.6 (p < 0.0001). The maximal intraventricular gradient evaluated by Doppler echocardiography declined from 57.2 +/- 42 mm Hg before the procedure to 19.7 +/- 12 mm Hg (p < 0.001). An identical gradient after stimulation with one dose of isosorbide dinitrate spray (1.25 mg) declined from 82.3 +/- 27 mm Hg to 25 +/- 6 mm Hg (p < 0.0001). The diastolic thickness of the IVS in the intervened segment declined from 21.2 +/- 3 mm to 14.7 +/- 2 mm (p < 0.0001). No significant change in the size of the left ventricle was recorded, nor in its ejection fraction and size of the left atrium. One patient died suddenly during the follow up period. Percutaneous transluminal septal myocardial ablation leads during short-term follow-up to a significant weakening of the basal segment of the interventricular septum, a decline of the intraventricular gradient and symptomatology of hypertrophic obstructive cardiomyopathy.

Adult↗
PubMed2001

[Aspects of treatment of hypertrophic obstructive cardiomyopathy with emphasis on the role of percutaneous transluminal ablation of the myocardial septum].

The prevalence of hypertrophic cardiomyopathy is approximately 0.2% whereby the obstructive form accounts for one quarter. The basic treatment involves administration of negatively inotropic drugs (beta-blockers and/or verapamil), which reduce the intraventricular pressure gradient and have a positive impact on the symptomatology. In patients refractory or intolerant to medicamentous treatment surgical or catheterization is used. Percutaneous transluminal septal myocardial ablation reduces significantly the symptomatology of dyspnoea and stenocardia, increases load tolerance and improves the left ventricular diastolic function. In none of the mentioned therapeutic approaches so far a favourable effect on the prognosis of patients with a risk profile associated with hypertrophic obstructivel cardiomyopathy was proved.

Adrenergic beta-Antagonists↗
PubMed2000

Direct stenting without predilatation: a new approach to coronary intervention.

BACKGROUND: Implantation of coronary stents after predilatation is a standard approach in the treatment of most coronary lesions. Stenting without predilatation could be a possible alternative way of treating a certain subset of patients. OBJECTIVE: To identify a group of patients suitable for this optional method, to evaluate their immediate clinical and angiographic outcomes and to test the feasibility and safety of this new therapeutic concept. METHODS: Ninety selected patients with 91 lesions were treated by implantation of coronary stents without predilatation. RESULTS: The mean duration of this procedure was 12.3 +/- 9.1 min and the fluoroscopic time was 3.6 +/- 2.9 min. The stenoses before and after this procedure were 77 +/- 10 and 5 +/- 9%, respectively. Predilatation, postdilatation or implantation of an additional stent was necessary for seven patients. Primary success rate was 92% with an excellent immediate clinical and angiographic outcome. No major complications occurred during direct stenting. CONCLUSION: Direct stenting is feasible using commercially available stents and could be performed for about 20% of patients for whom coronary intervention is indicated. The proper selection of lesions is of crucial importance. Lesions eligible for direct stenting should be without visible calcifications and on vessels without proximal tortuosity. This procedure proved to be safe and successful in this series of coronary interventions.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Intracoronary ultrasound: the "platinum standard" in evaluating the morphology of coronary stenoses. Does it have a role in clinical practice?].

The authors present the case of a 45-year-old man with a history of myocardial infarction of the anterior wall and unstable angina pectoris where they detected a critical stenosis of the proximal segment of the ramus, interverticularis anterior by intracoronary ultrasound examination. The subsequent coronary angioplasty with implantation of a stent was also implemented under ultrasound control. The authors discuss the contemporary position of intravascular ultrasound in coronary interventions in particular with regard to the development of restenosis.

Coronary Disease↗
PubMed2000

[Adult patients after surgery of ostium primum type of atrial septal defects in childhood: echocardiography study].

The authors examined, using transthoracic and transoesophageal echocardiography, 36 adult patients (15 men) aged 22 +/- 3.1 years (18-29 years) who were operated 12.2 +/- 3.7 years previously on account of a defect of the atrial septum type ostium primum. In these patients no other congenital cardiac defect was present. In addition to closure of the defect in the patients complete suture of the "cleft" of the anterior cusp of the mitral valve was performed, in 7 partial suture of the "cleft" of the anterior cusp of the mitral valve and in 4 commissuroplasty. In one instance later reoperation with replacement of the mitral valve by a mechanical prosthesis was performed. The control group was formed by 16 healthy volunteers (5 men) aged 22.1 +/- 3 years (19-31 years). Patients operated in childhood on account of an atrial defect of the ostium primum type have on echocardiographic examination, as compared with healthy volunteers, larger atria and the left ventricle, a thicker interventricular septum and left ventricular wall and a higher velocity of left ventricular filling during the late diastole. Higher values of parameters of the size and volume of the left ventricle are associated with the presence of mitral regurgitation. More marked changes of systolic or diastolic left ventricular function are not present, there are not even any echocardiographic signs of higher pressure in the atria and pulmonary artery. In none of the patients a residual shunt at the level of the atrial septum is present. Mitral regurgitation is found in two thirds of the patients, only in one case it was however moderately severe (grade 3). From the results it does not ensue which type of surgery of the "cleft" of the mitral valve has the best long-term results. In none of the patients tricuspid regurgitation of a higher grade than grade 1 is present.

Adolescent↗
PubMed2000

[Catheter therapy in patients with stable angina pectoris. Results of 662 coronary angioplasties].

Coronary angioplasty supplemented by implantation of a stent has become a standard therapeutic method in patients with stable angina pectoris. The authors analyzed the spectrum of patients indicated for this treatment, its successfulness and complications of catheterizations. In the course of a two-year period the authors implemented 662 catheterizations in 602 patients with stable angina. 58% patients indicated for coronary angioplasty on account of stable angina had a history of myocardial Q infarction, 93% had angina grade II or III according to CCS. Affection of one artery was diagnosed in 56% patients, complete revascularization was achieved in 59% of the operations. The clinical rate of success of catheterization was 97% in stenoses of the coronary arteries and 61% in coronary occlusions. In 57% of the treated lesions a coronary stent was implanted. Serious clinical complications developed in 1% of the interventions, none of the patients died. Catheterization treatment of stable angina is very successful and safe.

Adult↗
PubMed1999

Detection of viable myocardium: comparison of dobutamine echocardiography and echocardiography after hyperbaric oxygenation.

The study concerned the possibility of using echocardiography after hyperbaric oxygenation (HBO2) to detect viable myocardium. Results were compared with dobutamine stress echocardiography (DSE). Seventeen patients with left ventricular dysfunction were enrolled in this study. The regional wall motion of the left ventricle was assessed for every patient and a wall motion score index was calculated. A resting wall motion abnormality was found in 204 segments (75%), of which 119 segments (58%) improved during DSE, and 59 (29%) after HBO2. Of 119 segments with evidence of viability in DSE, HBO2 showed viability in 58 segments. Of 85 segments non-viable in DSE, 84 segments were also non-viable after HBO2. The positive and negative predictive values of HBO2 compared to DSE were 98 and 58%, respectively. Comparing the wall motion score index at rest with the index after DSE 5 and 10 micrograms.kg-1.min-1 dobutamine and after HBO2, there was significant improvement (P < 0.005). Differences between DSE 5 micrograms.kg-1.min-1 dobutamine and DSE 10 micrograms.kg-1.min-1 dobutamine and between HBO2 and DSE 10 micrograms.kg-1.min-1 dobutamine were also significant (P < 0.005). There was no significant difference between DSE 5 micrograms.kg-1.min-1 and HBO2. Echocardiography after HBO2 is a new method for the detection of viable myocardium. It appears similar in accuracy to DSE 5 micrograms.kg-1.min-1, but is inferior to DSE 10 micrograms.kg-1.min-1.

Cardiotonic Agents↗
PubMed1999

[The basis of chronic ischemic reversible left ventricular dysfunction (hibernating myocardium)].

The term "Hibernating myocardium" refers to the presence of a chronic left ventricular dysfunction that could be partially or completely improved after revascularization. Formerly, the myocardial hibernation was considered to be an adaptive response to a sustained reduction of the resting myocardial blood flow. Recently, several studies with positron emission tomography have revealed a normal or almost normal resting myocardial blood flow. The reduced coronary flow reserve of the hibernating myocardium brings about multiple episodes of demand-induced ischemia and may evoce recurrent stunning of the myocardium. It is the basis of structural changes in the myocardium and the contractile dysfunction. Cellular degeneration rather than adaptation prevails in the hibernating myocardium. The longer the process continues, the smaller is the chance for a complete structural and functional recovery after the reperfusion. Thus the early revascularization becomes important for the patients with hibernating myocardium.

Chronic Disease↗