Publications (12)24.43 Total impact
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Article: Troponin T in Acute Ischemic Stroke.
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ABSTRACT: Multiple interactions are considered to occur among the various forms of cardiovascular and cerebrovascular diseases. The aim of this study was to assess the serum level profile of cardiac troponin T (cTnT) in patients with acute ischemic stroke (AIS) to evaluate factors associated with increased serum levels of cTnT. Patients with AIS enrolled in this prospective observational study were admitted to the hospital <12 hours after stroke onset. At admission, and 4 hours later, all patients were subjected to neurologic examinations and brain computed tomography or magnetic resonance imaging; standard laboratory tests, including cTnT and other cardiac markers; and repeated electrocardiography. Correlations between cTnT and several baseline parameters were tested, and multivariate regression analysis was used to assess the predictors of cTnT elevation. In total, 107 consecutive patients with AIS (65 men, mean age 67.2 ± 14.2 years) were enrolled. Thirty-nine patients (36.4%) presented with elevated cTnT above the upper limit of normal. The cTnT levels were correlated significantly with age (r = 0.448) and the levels of N-terminal pro-brain natriuretic peptide (r = 0.528), cystatin C (r = 0.457), creatine kinase-MB mass (r = 0.253), urea (r = 0.281), and albumin (r = -0.219). Multiple logistic regression analysis found creatinine >90 μmol/L (odds ratio 3.45, 95% confidence interval 1.09 to 10.85), N-terminal pro-brain natriuretic peptide (odds ratio 100 μg/L increase 1.09, 95% confidence interval 1.03 to 1.16), and creatine kinase-MB mass (odds ratio per 1 μg/L increase 1.45, 95% confidence interval 1.04 to 2.04) were associated with cTnT elevation in patients with AIS. In conclusion, elevated cTnT can be frequently detected in patients with AIS. To reliably identify patients with current acute myocardial impairment, more in-depth clinical investigation is needed.The American journal of cardiology 04/2013; · 3.58 Impact Factor -
Article: Speckle tracking echocardiography derived systolic longitudinal strain is better than rest single photon emission tomography perfusion imaging for nonviable myocardium identification.
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ABSTRACT: BACKGROUND: The aim was to compare the speckle tracking echocardiography (STE) derived systolic longitudinal strain (SL(Smax)) with rest single photon emission computed tomography (SPECT) perfusion imaging (Q(REST)), and to define the optimal cut-offs for SL(Smax) to discriminate transmural scar on contrast-enhanced magnetic resonance imaging (ceCMR). METHODS AND RESULTS: In 100 patients with chronic ischemic left ventricular (LV) dysfunction, myocardial viability was assessed using STE and rest SPECT to predict LV segmental relative extent of delayed enhancement (DE) >75% on ceCMR. Correlation was found between regional SL(Smax) (r=-0.59, P<0.0001) and DE on ceCMR. The SL(Smax) optimal cut-off -5.3% identified segments with DE>75% on ceCMR (sensitivity 83.1%, specificity 84.6%). Optimal cut-offs SL(Smax) for segments corresponding to individual perfusion territories (-3.6%, -5.3% and -4.7% for LAD, LCx resp. RCA perfusion territories) were identified. There was a significant difference (AUC 0.866 vs. 0.822 for SL(Smax) resp. Q(REST), p=0.036) in the accuracy of predicting non-viable segment due to the greater accuracy of SL(Smax) than Q(REST) in the RCA perfusion territory (AUC 0.893 vs. 0.75 for SL(Smax) resp. Q(REST), P=0.001). CONCLUSIONS: STE enabled identification of LV non-viable segments. Cut-off values derived for perfusion territories of individual coronary arteries improve the accuracy of predicting a transmural scar presence. In comparison with rest myocardial SPECT perfusion imaging, STE is more accurate in predicting non-viable myocardium.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 09/2012; -
Article: Comparison of two-dimensional longitudinal strain with rest single photon emission tomography perfusion imaging for transmural scar identification in patients with ischemic left ventricular systolic dysfunction.
International journal of cardiology 02/2012; 156(3):331-2. · 7.08 Impact Factor -
Article: Prediction of long-term reverse left ventricular remodeling after revascularization or medical treatment in patients with ischemic cardiomyopathy: a comparative study between SPECT and MRI.
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ABSTRACT: Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow-up (>5%-responders). MRI with ≤5 segments with DE/wall thickness ratio (DEWTR) ≥50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of ≤2 segments with the DEWTR ≥75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT <16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preoperative number of segments with the DE/wall thickness ratio of ≥50 and ≥75% obtained by MRI, was found to be a better predictor of left ventricular reverse remodeling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improvement at 24 months after CABG.The international journal of cardiovascular imaging 03/2011; 27(3):343-53. · 2.15 Impact Factor -
Article: Persistent left superior vena cava connected through the left upper pulmonary vein to the left atrium: an unusual pathway for paradoxical embolization and a rare cause of recurrent transient ischaemic attack.
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ABSTRACT: Ischaemic stroke, especially in the younger population, is an important cause of morbidity and mortality. When compared with the older population, the underlying aetiology of stroke in the young includes higher rates of cardioembolic disease and congenital heart anomalies. Paradoxical embolism may be an important cause of ischaemic cerebral events, which has to be ruled out in patients with no other evident stroke aetiology. A persistent left superior vena cava (PLSVC) that drains into the left atrium is a very rare congenital anomaly occurring in postnatal life and may be the cause of embolic events such as ischaemic stroke with potentially devastating consequences. For diagnostic purposes, we recommend the use of contrast transthoracic and transesophageal echocardiography with contrast agent application through the left arm peripheral intravenous line, which makes it possible to ascertain the presence of a right-to-left shunt. Computed tomography of the chest is recommended for a PLSVC with atypical left atrial drainage confirmation. Consequent endovascular occlusion of the PLSVC is feasible and can be performed with minimal procedural risk. If this cause of paradoxical embolism is not taken into consideration, the first manifestation of this clinical entity could be underestimated, increasing the likelihood of ischaemic stroke recurrence with potentially disabling or fatal consequences. We report the diagnosis and successful endovascular repair of this anomaly. This case report also aims to highlight the importance of close collaboration between neurologists, cardiologists and radiologists needed for accurate identification of stroke aetiology in young patients.European Heart Journal – Cardiovascular Imaging 10/2010; 11(9):E35. · 2.32 Impact Factor -
Article: Segmental color Doppler myocardial imaging derived pre-ejection velocities are not clinically useful in the assessment of post-infarction scar transmurality.
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ABSTRACT: The presence of a velocity in isovolumic contraction phase (Vivc) evaluated using tissue Pulse wave Doppler myocardial imaging (PWDMI) correlates with a transmural extent of scar after myocardial infarction. The possible clinical usefulness of Vivc evaluated using color Doppler myocardial imaging (CDMI) in detection of a scar after myocardial infarction extent in patients with coronary heart disease (CHD) and low LV systolic function remains to be clarified. 57 patients with CHD (average LVEF 33.5±5%), examined echocardiographicaly (17-segment LV model, 689 segments evaluated) and by cardiac magnetic resonance. All segments were scanned for Vivc presence using CDMI. Vivc presence/absence was correlated with signs of a scar after MI in all segments and in akinetic segments separately. We found significantly larger values of wall thickness (8.2±2,2 vs. 7.1±1.9, p<0.0001), significantly lower values of average late enhancement (LE) extent (1.32±1.78 vs. 1.66±1.98, p=0.041) and LE/wall thickness ratio (20.1±29.8 vs. 29.6±36.7, p=0.008) in segments with present Vivc. Vivc presence in a segment with an abnormal wall motion had a sensitivity of 72.9% and a specificity of 35.7% in recognizing a segment without a transmural scar (LE/ wall thickness ratio ≤75%). Vivc absence in a segment with an abnormal wall motion had a sensitivity of 72.7% and a specificity of 41.2% in recognizing a segment with a transmural scar (LE/wall thickness ratio ≥75%). Isovolumic velocities evaluation assessed using color Doppler myocardial imaging is not applicable in a real-world clinical setting. The presence or absence of a velocity pattern during LV isovolumic contraction is not useful in in the assessment of a post-infarction scar transmurality.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 09/2010; 154(3):251-6. -
Article: Is atrial fibrillation associated with poor outcome after thrombolysis?
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ABSTRACT: Atrial fibrillation (AF) is considered a predictor for severe stroke and poor outcome. The aim was to evaluate whether AF is associated with poor outcome in acute ischemic stroke (IS) patients treated with intravenous thrombolysis (IVT). In a retrospective study, 157 consecutive IS patients (98 males, mean age 67.3 +/- 10.2 years), treated with IVT within 3 hours from stroke onset, were divided into two groups according to presence/absence of AF. Neurological deficit was evaluated using the NIHSS on admission, 24 hours, and 7 days later, while the 90-day clinical outcome was assessed using the modified Rankin Scale (mRS). A total of 66 patients (38 males) presented with AF. The baseline NIHSS was 13.3 +/- 5.4 in AF and 11.0 +/- 5.1 points in non-AF patients (P = 0.006). AF patients had arterial occlusions more frequently in the baseline MRA (54.5% in AF versus 25.3% in non-AF, P = 0.0002). No differences were found between groups in clinical improvement after 24 hours and 7 days or in rate of achieved recanalizations. AF patients had significantly poorer 90-day clinical outcome than non-AF patients (median mRS 2.5 vs. 1.0). Patients with AF had significantly worse 90-day clinical outcome after IVT compared to those without AF, probably due to more severe baseline neurological deficits and the greater number of arterial occlusions in the MRA before IVT.Journal of Neurology 06/2010; 257(6):999-1003. · 3.47 Impact Factor -
Article: Comparison of left ventricular volumes and ejection fraction assessment by two-dimensional echocardiography compared with gated myocardial spect in patients with ischemic cardiomyopathy.
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ABSTRACT: The aim of this study was to assess accuracy of echocardiography in the measurement of left ventricular ejection fraction (LVEF), enddiastolic volume (EDV) and endsystolic volume (ESV) compared with gated SPECT. A total of 70 patients with left ventricular systolic dysfunction were enrolled to study. Median of the time interval between gated SPECT and echocardiography was 1 hour. Echocardiography was in good agreement with gated SPECT for quantification of LVEF by using Simpson's method in triplane (r=0.88, p<0.001), biplane (r=0.83, p<0.001) and monoplane apical four chamber projections (A4CH) (r=0.71, p<0,001). LVEF measured by SPECT (36.6+/-11.5%) was non-significantly higher then triplane (35.9+/-10%, median dif. 0.4%), biplane (35.7+/-10%, median dif. 0.7%), A4CH monoplane (36.6+/-12.2%, median dif. 0.1%). Echocardiography correlated with SPECT in quantification of EDV using triplane (r=0.8, p<0.001), biplane (r=0.81, p<0.001) and monoplane echocardiography (r=0.76, p<0.001). EDV measured by SPECT (201.1+/-72.5 ml) was significantly different and higher then triplane (174.4,5+/-60.8 ml, median dif. 22.8), biplane (170.9+/-58.4, median dif. 28 ml) and monoplane echocardiography (173.7+/-59.3, median dif. 85.7 ml). Echocardiography correlated with SPECT in quantification of ESV by triplane (r=0.87, p<0.001), biplane (r=0.86, p<0.001) and monoplane echocardiography (r=0.83, p<0.001). ESV measured by SPECT (133.1+/-64.3) was significantly different then triplane (115.1+/-52.1, median dif. 17 ml), biplane (113.2+/-51.5, median dif. 15.5 ml) and A4CH monoplane echocardiography (112.5+/-48.8, median dif. 17.2 ml). Echocardiography is a valid tool for LVEF assessment and systematically underestimates LV volumes compared with gated SPECT in patients with LV systolic dysfunction.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 03/2010; 154(1):47-54. -
Article: Development of Löffler's endocarditis in FIP1L1-PDGFRalpha-positive hypereosinophilic syndrome despite continuous imatinib mesylate therapy and continuous complete remission.
American Journal of Hematology 01/2010; 85(4):296-9. · 4.67 Impact Factor -
Article: Echocardiographic and cardiac single photon emission computed tomography predictors of left ventricle reverse remodeling after surgical revascularization in patients with ischemic cardiomyopathy and left ventricle systolic dysfunction.
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ABSTRACT: The extent of scar or viable hypocontractile myocardial tissue determines postinfarction left ventricle remodeling. The aim of this pilot study was to evaluate the revascularization effect in a group of patients with ischemic cardiomyopathy and LV systolic dysfunction indicated for surgical revascularization, based on evidence for multivessel disease on coronarography and viable myocardium (CMR, SPECT). To evaluate the revascularization effect in patients with ischemic LV systolic dysfunction and to find preoperative predictors of revascularization effect. 33 patients (64+/-11 years) with baseline LVEF 34.9+/-9.3 % were included in the study. After a follow-up of 10.7+/-1.2 months, ECHO and SPECT were performed again. The whole group of patients was divided according to revascularization effect (postoperative increase LVEF > 5 % and postoperative decrease LVESV > 5 % compared with baseline) into revascularization responders (R, n = 22) and nonresponders (NR, n = 11). At baseline there was no difference between the subgroups in LVEF (R = 35.7+/-11.0 % vs. NR = 34.3+/-8.2 %), EDV (R = 183.6+/-43.2 vs. NR = 180.2+/-80.5 ml), ESV (R = 118.5+/-40.4 vs. NR = 119.7+/-55.2 ml). The responders showed in a revascularization effect subanalysis differences in the values of LVEF (+9.8+/-8.1 %, p < 0.009), reduction of EDV (-39.9+/-50.9 ml, p = 0.05) and ESV (-35.4+/-42.6 ml, p = 0,002) compared with baseline. The only preoperative parameters predicting LV reverse remodeling were the T(E-Em) (R = -10.6+/-44.1 vs. NR = 29.7+/-43.7 ms, p = 0.037) and the size of fixed perfusion defect (FPD) (R = 11.9+/-13.5 vs. NR = 22.9+/-15.3 % of LV, p = 0.044). Patients with ischemic LV systolic dysfunction with a preoperatively determined myocardial viability develop LV reverse remodeling. The only preoperative parameters predicting LV reverse remodeling were echocardiographic T(E-Em) and FPD on SPECT.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 07/2008; 152(1):129-37. -
Article: Acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction.
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ABSTRACT: Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction. The aim of this paper is to present a case report of a 65-year old women with acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction. The transthoracic echocardiography was obtained at the bedside and showed a posterior mitral valve prolapse with a severe mitral regurgitation. During this examination the patient developed acute pulmonary oedema and a consequent cardiogenic shock. Transthoracic echocardiography was then reevaluated and completed. New findings of bi-leaflet mitral flail and progression of massive mitral regurgitation were documented. The complete rupture of a papilary muscle was then considered as a cause of an acute clinical deterioration. Intraoperative findings showed a complete transection of both heads of anterolateral and necrotic regions of basis of posteromedial papillary muscle. This case confirms the importance of immediate echocardiography in confirming a diagnosis of acute mechanical complications of acute coronary syndromes and this examination is important for the management of a hemodynamically unstable patient. Echocardiography should be done immediately on any patient in whom the diagnosis of mechanical complication of acute coronary syndromes is suspected.Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia 11/2006; 150(2):293-7. -
Article: Case report: Symptoms of advanced heart failure--a case for radiofrequency catheter ablation?
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ABSTRACT: A sixty-year-old man with previous history of coronary artery disease was admitted due to progressive worsening of dyspnoea at exertion (NYHA III functional class) and no angina. Coronary angiography confirmed occlusion of the right coronary artery which was naturally bypassed by homocollaterals with TIMI 3 flow to the peripheral branches. The lesion was not technically suitable for percutaneous angioplasty. The left coronary artery was without stenosis. On echocardiography, both the left ventricle and the left atrium were dilated and hemodynamically significant mitral regurgitation was present. Surface ECG showed a left bundle branch block with repeated runs of monomorphic ventricular ectopic beats (PVC). Radiofrequency catheter ablation of the focus in the posteroseptal region of the left ventricle underneath the mitral valve was performed using electroanatomical mapping system. After the procedure, mitral regurgitation decreased and reverse remodeling of the left ventricle and the left atrium occurred with concomitant significant clinical improvement of the patient. The authors discuss several treatment strategies: mitral valve repair surgery combined with revascularization, implantation of a biventricular ICD system or elimination of the focus of monomorphic VT runs by radiofrequency catheter ablation as a possible causal approach in the treatment of PVC-induced cardiomyopathy.Journal of Interventional Cardiac Electrophysiology 09/2006; 16(2):117-22. · 1.17 Impact Factor
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Institutions
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2010–2012
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Palacký University of Olomouc
- Department of Internal Medicine I - Cardiology
Olomouc, Olomoucky kraj, Czech Republic
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2006–2012
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Fakultní Nemocnice Olomouc
Olomouc, Olomoucky kraj, Czech Republic
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