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[The origins of the Czech Society of Cardiology and of Czech cardiology.]
Abstract
The paper presents the origins of the Czech Society of Cardiology on the one hand, and the origins of Czech cardiology on the other. The Czech Society of Cardiology is the third oldest in the world (after the American and German Societies). It was founded in 1929 by Prof. Libenský. As early as in 1933, the Society organised the first international congress of cardiologists in Prague, which was attended by 200 doctors, out of which 50 were from abroad. The most participants came from France and Poland. Other participants came from England, Argentina, Belgium, the Netherlands, Italy, Romania, Spain and Switzerland. The worldwide importance of this congress is apparent from the fact that both the World Society of Cardiology and the European Society of Cardiology (EKS) were founded after World War II in the years 1950 and 1952, i.e. almost 20 years after the first international congress of cardiology in Prague. In 1964, the Fourth Congress of European Society of Cardiology was held in Prague with the participation of 1,500 specialists from 31 countries and chaired by Prof. Pavel Lukl, the later president of EKS (1964- 1968). The paper also presents the work of our specialists in WHO and the history of the international journal Cor et Vasa issued by the Avicenum publishing house in Prague in English and Russian in the years 1958- 1992. An important role in the development of our cardiology was played by certain departments and clinics. In 1951, the Institute for Cardiovascular Research (ÚCHOK) was founded in PrahaKrč, thanks to the initiative of MU Dr. František Kriegl, the Deputy Minister of Health. Its first director was Klement Weber, who published, as early as in 1929, a monograph on arrhythmias - 50 years earlier than arrhythmias started to be at the centre of attention of cardiologists. Klement Weber was one of the doctors of President T. G. Masaryk during his serious disease towards the end of his life. Jan Brod was the deputy of Klement Weber in the Institute and the chair of its Scientific Council. The Institute for Cardiovascular Research was the third institute for cardiovascular diseases in the world. The origins of Czech cardiology are documented in three most important areas - the treatment of hypertension, the development of cardiothoracic surgery and the development of treatment of acute myocardial infarction. Hradec Králové became, thanks to Academician Bedrna, the first centre of cardiac surgery in this country. The development of hypertension treatment was stormy, thanks to the discovery of an effective pharmacotherapy, from the originally incurable malignant hypertension to the well curable benign hypertension. The effective treatment of acute infarction was based on the development of heart defibrillation enabling the establishment of coronary units, and later on the thrombolytic and antiplatelet therapies up to the contemporary PCI as the treatment of choice. During that time, AIM mortality decreased from the original 30% to the present 4- 5%.Key words: Czech Society of Cardiology - origins of Czech cardiology - treatment of hypertension - cardiothoracic surgery - treatment of acute myocardial infarction.
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The Institute for Cardiovascular Disease Research (Ústav pro choroby oběhu krevního, ÚCHOK in Czech) was the first institute specializing in cardiology in what was formerly Czechoslovakia, and the third such in the world (after the National Institute of Cardiology based in Mexico City and National Institute for Cardiovascular Disease in Bethesda, USA). The facility was in fact a predecessor to what later became the Second Research Department of Internal Medicine, Institute for Clinical and Experimental Medicine (IKEM in Czech) and, subsequently, Department of Cardiology, IKEM. The original institute was founded by Prof. Klement Weber and Prof. Jan Brod in 1951, being in existence until 1970, when it became part of the Second Research Department of Internal Medicine, IKEM, specializing in the field of cardiology. The lines of research at ÚCHOK embraced the fields of pathogenesis, pathophysiology, and diagnosis of cardiovascular disease, with major emphasis placed by the Scientific Board of ÚCHOK on original research projects. Special attention was given to essential hypertension, atherogenesis and coronary artery disease, angiology, epidemiology, pulmonary hypertension as well as nephrology. The number of original publications was indeed impressive. Over the years 1951-1966, ÚCHOK-based authors published a total of 238 original papers (abstracts and review articles not included), mostly in international journals with impact factor. Of particular importance were studies in the field of response by regional hemodynamics of hypertensive patients to emotional stress (Brod et al.) and hemodynamics of juvenile hypertension (Widimský et al.). Another pioneering project led to the development of a method for measuring blood flow by local thermodilution (Ganz and Froněk). The first coronary care unit in Czechoslovakia was founded in collaboration with the Institute for Clinical and Experimental Surgery (Ústav klinické a experimentální chirurgie, ÚKECH in Czech) in 1966 (Hammer and Buda). It was also at that time that the first non-selective coronary angiographic procedures were performed. The year 1968 saw the exodus of 14 researchers of ÚCHOK, together with the institute's director, Prof. Brod to live abroad. The high repute of ÚCHOK researchers is perhaps best evidenced by the fact that seven of them became professors at US and Canadian universities.
A double-blind intervention trial was started in 1965 to test the hypothesis that the incidence of ischaemic heart disease in middle-aged men can be reduced by lowering raised serum cholesterol levels. It was carried out in 3 European centres - Edinburgh, Budapest, and Prague. Serum cholesterol was to be lowered by the drug clofibrate (ethyl chlorophenoxyisobutyrate) which was considered to be free from serious side effects. Studies were carried out on 15 745 males, aged 30 to 59 at entry, for an average of 5.3 years, accumulating 83 534 years of experience. The treatment group, of about 5000, Group I, was a randomly chosen half of the men in the upper third of the serum cholesterol distribution in some 30 000 volunteers. The comparable control group, Group II, comprised the other 5000 men of the upper third of the cholesterol distribution, and these were given a placebo. A further control group, Group III, of 5000 men, was selected randomly from the lower third of the cholesterol distribution. These numbers were chosen in order to be 90 per cent certain of detecting a 30 per cent reduction in the incidence of ischaemic heart disease should this occur. Subjects with manifest heart or other major disease were excluded from the trial. No attempt was made to correct other 'risk factors' for IHD, but their presence was monitored and considered in the analysis. Investigators and participants in the trial were unaware of the groups to which individual men belonged. A mean reduction of approximately 9 per cent of the initial serum cholesterol levels was achieved in the treatment group (ranging from 7 to 11% in the 3 centres); this was less than the 15 per cent fall expected. In Edinburgh, during treatment, serum triglyceride concentrations in Group I resembled those naturally occurring in Group III. The incidence of IHD was lower by 20 per cent in the clofibrate group compared with the high cholesterol controls (P< 0.05); this fall was confined to non-fatal myocardial infarcts which were reduced by 25 per cent. The incidence of fatal heart attacks was similar in the 2 high cholesterol groups and there was no significant difference in the incidence of angina. Group III showed substantially lower rates of ischaemic heart disease. The reduction of myocardial infarction in the clofibrate-treated group was greatest in men with the highest levels, and greatest reduction in serum cholesterol. Men with a substantial reduction of cholesterol concentration, who smoked, and also had above average blood pressure levels showed the most benefit. The numbers of deaths, and crude mortality rates from all causes in the clofibrate-treated group significantly exceeded those in the high cholesterol control group (P < 0.05), though the age-standardised mortality rates did not differ significantly between the 3 groups. The numbers of deaths from 'other.