M. Felšöci

University Hospital Brno, Brünn, South Moravian, Czech Republic

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Publications (8)5.52 Total impact

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    ABSTRACT: Background To evaluate in-hospital and long-term mortality of patients with acute coronary syndromes (ACS) not having selective coronary angiography (CAG) during hospitalization and to analyze the reasons for conservative approach. Methods and patients A single-centre retrospective study using registry data. Over the period from January 2005 to April 2009, a total of 193 ACS patients did not have in-hospital CAG. Fifty-five (28.5%) patients had recent CAG (within the last 12 months) or the procedure was planned after discharge (invasive group “I”). In 138 (71.5%) patients, CAG was not considered at all (conservative approach, group “C”). These subgroups were compared in terms of in-hospital parameters and long-term mortality. Results ST-segment elevation myocardial infarction (STEMI) was diagnosed in 50 (25.9%) patients. The most frequent reasons for not performing CAG included serious comorbidities affecting the prognosis (22%) and pharmacological stabilization in very old individuals with non-STEMI (21%). One in ten (11%) patients died before the CAG was performed, the same proportion of patients refused to have CAG or had a long ischaemia time (STEMI subgroup). A temporary contraindication to CAG was found in 8%, a recent CAG finding not suitable for revascularization in 8%, while a limiting neurological disease was present in 6% of patients. In-hospital mortality was 30.1%, being higher in Group C (34.1% vs. 20.0%; p = 0.049), 6-year mortality was as high as 78.8%, also with higher rates in Group C (86.2% vs. 60.2%; p < 0.001). Patients receiving conservative therapy were older, with a higher proportion of limiting comorbidities that contraindicated CAG, and had a more serious course of hospitalization. Conclusion The most common reasons for not performing CAG in ACS patients included advanced age, serious and often extra-cardiac comorbidities, and a complicated hospitalization course. The short- and long-term mortality rates in these patients are high.
    No preview · Article · Aug 2014 · Cor et vasa
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    ABSTRACT: Initial risk stratification in patients with acute heart failure (AHF) is poorly validated. Previous studies tended to evaluate the prognostic significance of only one or two selected ECG parameters. The aim of this study was to evaluate the impact of multiple ECG parameters on mortality in AHF. The Acute Heart Failure Database (AHEAD) registry collected data from 4,153 patients admitted for AHF to seven hospitals with Catheter Laboratory facilities. Clinical variables, heart rate, duration of QRS, QT and QTC intervals, type of rhythm and ST-T segment changes on admission were collected in a web-based database. 12.7 % patients died during hospitalisation, the remainder were discharged and followed for a median of 16.2 months. The most important parameters were a prolonged QRS and a junctional rhythm, which independently predict both in-hospital mortality [QRS > 100 ms, odds ratio (OR) 1.329, 95 % CI 1.052-1.680; junctional rhythm, OR 3.715, 95 % CI 1.748-7.896] and long-term mortality (QRS > 120 ms, OR 1.428, 95 % CI 1.160-1.757; junctional rhythm, OR 2.629, 95 % CI 1.538-4.496). Increased hospitalisation mortality is predicted by ST segment elevation (OR 1.771, 95 % CI 1.383-2.269) and prolonged QTC interval >475 ms (OR 1.483, 95 % CI 1.016-2.164). Presence of atrial fibrillation and bundle branch block is associated with increased unadjusted long-term mortality, but mostly reflects more advanced heart disease, and their predictive significance is attenuated in the multivariate analysis. ECG in patients admitted for acute heart failure carries significant short- and long-term prognostic information, and should be carefully evaluated.
    Full-text · Article · Oct 2012 · Internal and Emergency Medicine
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    ABSTRACT: Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre. From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno. AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia, hyperglycemia, hyperkalemia, and hyponatremia. The paper provides an overview and characteristics of consecutive patients hospitalized in the regional hospital. We identified factors pointing to the adverse short-term prognosis. The work draws attention to social problems, up to 30% of patients hospitalized for acute heart failure were not self-sufficient at discharged.
    No preview · Article · Apr 2012 · Vnitr̆ní lékar̆ství
  • M. Felšöci · J. Pařenica · R. Miklík · J. Jarkovský · J. Špinar
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    ABSTRACT: Purpose: Whether generally accepted predictors of in-hospital mortality in patients with acute heart failure (HF) are effective, also in the sub-population with previous hypertension is unclear. Methods: We used patient data from the single university centre that is participating in the Czech HF registry. Within the study period of December 2004 and August 2007 we enrolled 1253 patients with acute HF. After the selection of those with previous hypertension, we tested the influence of age, body mass index (BMI), laboratory parameters, the level of blood pressure (BP) on admission and left ventricular ejection fraction (LVEF) on in-hospital mortality. Results: In-hospital mortality of patients with acute HF and hypertension (n=843, 67%) was 14.0% with the mean length of hospital stay 6.9 days. Patients deceased during hospitalisation were older, with lower hae- moglobin level, higher entry and maximal serum creatinine, glycaemia and C-reactive protein (CRP), lower BMI, entry BP and LVEF. In univariate analysis in-hospital mortality was worsened by age [odds ratio (OR) 1.28], BP < 120/80 mmHg at entry (OR 6.40), LVEF ≤ 20% (OR 2.09), increasing creatinine level (OR 1.29), glycaemia (OR 2.75) or CRP (OR 1.10) and by the positivity of troponin (OR 2.04). Aprotective influence was found in patients with BMI > 25 kg/m2 (OR 0.48), LVEF ≥ 41% (OR 0.41), entry BP ≥ 140/90 mmHg (OR 0.40) with positive influence even in patients with BP ≥ 180/110 mmHg (OR 0.34). Conclusion: In-hospital mortality of patients with acute HF and previous hypertension is associated with several factors. Probably the most important of these is low blood pressure at admission.
    No preview · Article · Jan 2012 · Cardiology Letters
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    ABSTRACT: Deterioration of renal function occurs in about 30% of patients hospitalized for acute heart failure and it is associated with worse short and long - term prognosis. Precautionary measures are limited. It is necessary to reduce the application of nephrotoxic agents to a minimum. In the case of resistance to loop diuretics use of their combination with thiazide diuretics or aldosterone antagonists, or continuous infusion of furosemide at hyponatraemia with hypertonic saline is possible. Renoprotective effect of low-dose dopamine has not been demonstrated, but may lead to an increase of diuresis. In the case of renal failure early initiation of renal support (intermittent or continuous) is indicated.
    No preview · Article · Jan 2012 · Kardiologicka Revue
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    ABSTRACT: The effect of previous long-term hypertension on mortality in acute heart failure (HF), regardless of blood pressure values, has not been well studied. Acute Heart Failure Database (AHEAD) - Czech HF registry enrolled 4153 consecutive patients with acute HF. We excluded severe forms (cardiogenic shock, pulmonary oedema, right HF) and analysed 2421 patients with known presence or absence of previous hypertension. Demographic, clinical and laboratory profile, treatment and mortality rates were assessed and predictors of outcome were identified. Patients with previous hypertension (71.5%) were older, more of female gender, with worse pre-hospitalisation NYHA class, increased incidence of co-morbidities and higher left ventricular ejection fraction (LVEF). Although in-hospital mortality was similar in both cohorts (2.6%), survival at 1, 2 and 3-year was worse in the hypertensive group (75.6%, 65.9% and 58.7% vs. 80.7%, 74.2% and 69.8%; P<0.001). Nevertheless, hypertension was not associated with mortality in multivariate analysis and stronger predictors of outcome were identified (P<0.05): new-onset acute HF [hazard ratio (HR) 0.62] and increased body mass index (HR 0.68) proved to have a protective role. Advanced age (HR 1.86), diabetes (HR 1.45), lower LVEF (HR 1.28) and admission blood pressure (HR 1.54), elevated serum creatinine (HR 1.63), hyponatremia (HR 1.77) and anaemia (HR 1.40) were associated with worse survival. Antecedent hypertension is frequent in patients with acute HF and contributes to organ and vascular impairment. However its presence has no independent influence on short- and medium-term mortality, which is influenced by other related co-morbidities.
    No preview · Article · Dec 2011 · European Journal of Internal Medicine
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    ABSTRACT: Introduction: Acute heart failure is a serious clinical condition with in-hospital and one-year mortality rates of 5-15% and 30%, respectively. The most common causes of acute heart failure include decompensated chronic coronary heart disease, acute coronary syndrome, cardiomyopathy, hypertensive crisis, arrhythmias, valvular defects, and others. Levosimendan has been used in our department since 2005. The drug has a dual mechanism of action, exerting both positive inotropic and lusitropic effects on the myocardium, and a vasodilator effect on the coronary and peripheral arteries. Levosimendan increases cardiac output and diuresis, decreases pulmonary wedge pressure, and improves the patient's mental state. Aim and methods: To evaluate the profile of a patient with acute heart failure receiving levosimendan, the course of hospitalization, and the short- and long-term outcomes. Using standard statistical tests and Kaplan-Meier survival analysis, we analyzed patients' medical records, with mortality data obtained from the Institute of Health Information and Statistics of the Czech Republic or from hospital databases. Results: In 2005-2007, levosimendan was used in 5.8% of patients with acute heart failure where conventional therapy with furosemide (100%) or/and nitrates (28.9%), despite frequent catecholamine support (68.8%), had failed to stabilize the patient. Those indicated for levosimendan therapy were mostly patients with acute coronary syndrome (36.0%) and decompensated chronic coronary heart disease (30.9%). Over the years, there was a decrease in the proportion of levosimendan-treated patients with de novo acute heart failure and acute coronary syndrome while the numbers of those with acutely decompensated heart failure and dilated cardiomyopathy increased. Mean infusion time was 28.8 (11-69) hours, with the frequency of administering an initial intravenous bolus declining to only 7% in 2007. Levosimendan infusion had to be discontinued prematurely in only 3.1% of patients. In-hospital and one-year mortality rates were 22.3% and 46.5%, respectively. There was no significant difference in mortality rates of patients with acutely decompensated heart failure, de novo acute heart failure, and acute coronary syndrome. Conclusion: The authors present their three-year experience with levosimendan use. While the proportion of levosimendan-treated patients with acute coronary syndrome and de novo acute heart failure tended to decline over the years, the drug has been used preferentially in decompensated chronic heart failure. The one-year mortality rates in patients with de novo acute heart failure, acute heart failure decompensation, and in a selected subgroup of patients with acute heart failure do not differ significantly. If abiding by contraindications to levosimendan use, as discussed below, the authors believe levosimendan can be with reason and safely administered also to patients with acute coronary syndrome with de novo presentations of heart failure.
    No preview · Article · Jul 2009 · Cor et vasa
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    ABSTRACT: Introduction: Thanks to the great variety of clinical signs acute aortic dissection is often difficult to diagnose. The disease, as the initial clinical impression, is presented in only 15% of all cases: even in 30 to 40% of patients the diagnosis remains unrecognized until necropsy. The incidence of the disease is 2,6 to 3,5 cases/100 000 inhabitants/per year, approximately two thirds of which are male. Hypertension is considered as the most important risk factor; the typical congenital condition associated with aortic dissection is Morton syndrome. The most common presenting symptom is severe, chest pain, but dissection can occur anywhere within the aorta, so the clinical manifestation may vary. Case report: The authors report a case of 72-years-old woman with history of hypertension and breast cancer (after oncological treatment during 2005), who was hospitalized for syncope. After initial stabilization she developed acute heart failure with atrial tachyfibrillation and accelerated hypertension with no history of chest pain. Stable pericardiac effusion was found by echocardiographic study and control examination did not show any progression. To explain the etiology of the effusion we employed chest contrast-enhanced computed tomography, which showed dissection of the ascendent aorta. Finally the patient successfully underwent cardiac surgery. Conclusion: The difficulties in diagnostics of acute aortic dissection are discussed, in which symptoms and clinical manifestation may vary and typical symptoms can be missing. It is not satisfactory to be content in the diagnosis with negative results from transthoracic echocardiography. Magnetic resonance imaging, computed tomography or transesophageal echocardiography should be added in any case of suspicion.
    No preview · Article · Jan 2008