Slovo úvodem

MUDr. Jan František Vojáček, DrSc, FESC, FACC

Interv Akut Kardiol. 2018;17(2):55  

TAVI v roce 2018: standard v léčbě aortální stenózy

Michael Želízko

Interv Akut Kardiol. 2018;17(2):56-57 | DOI: 10.36290/kar.2018.036  

One hour protocols in differential diagnosis of chest pain: what is new in 2018?

Radek Pudil

Interv Akut Kardiol. 2018;17(2):58-60 | DOI: 10.36290/kar.2018.037  

Differential diagnosis of chest pain represents an important issue in acute care. The introduction into the clinical practice ofhigh-sensitive methods of troponin assessment has provided a shortening of the diagnostic process, especially with the use of1-hour protocols, where the change in the troponin level (two values in 60 minutes) allows identification of patients with acutecoronary syndromes with high specificity and sensitivity. This protocol can significantly improve the diagnostic process, whichremains to be based on analysis of patient history data, physical examination and careful evaluation of ECG.

iFR and FFR – present possibilities of establishing a functional significance of coronary stenosis

Jan F. Vojáček

Interv Akut Kardiol. 2018;17(2):62-65 | DOI: 10.36290/kar.2018.038  

The hyperemic stenosis resistance index is the best parameter correlating with the induction of myocardial ischemia, it provides amore accurate assessment of the severity of coronary stenosis than FFR, similarly, the CFR has a high predictive value. The principleof the iFR (instant wave-free ratio) is the determination of the ratio of the distal and aortic pressure during the wave-free periodin the consecutive cardiac cycles. Due to the minimal microvascular resistance in this period, administration of adenosine is notrequired. More accurate results of iFR are mainly due to false positive results of FFR in nonsignificant coronary stenoses withnormal...

Cardiologic evaluation in Fabry disease

Lubor Goláň

Interv Akut Kardiol. 2018;17(2):67-70 | DOI: 10.36290/kar.2018.039  

Fabry disease is an inherited metabolic storage disease. The majority of patients present with heart involvement that is typicallymanifested as myocardial hypertrophy. Successful treatment requires a correct diagnosis and thorough evaluation which, inaddition to patient history and physical examination, also involves ECG, echocardiography, and magnetic resonance imaging.Enzyme replacement therapy is a specific type of treatment.

Cardiogenic shock

Jiří Kettner

Interv Akut Kardiol. 2018;17(2):71-74 | DOI: 10.36290/kar.2018.040  

Cardiogenic shock (CS) is a serious condition of systemic hypoperfusion due to impaired cardiac pump function, often resulting inmultiple organ failure. The most common cause of CS is left ventricular failure resulting from extensive acute myocardial infarction(AMI); other causes of CS include mechanical complications of AMI, right ventricular infarction, terminal-stage cardiomyopathy,arrhythmias, acute fulminant myocarditis, and post-cardiac arrest states. Despite early revascularization, the mortality of CS asa complication of AMI remains to be around 50%, making it one of the leading causes of death among the patients with AMI.Every patient with...

Infective endocarditis in 2018

Radek Pelouch

Interv Akut Kardiol. 2018;17(2):75-81 | DOI: 10.36290/kar.2018.041  

Infective endocarditis (IE) remains a serious illness. The incidence is rising slowly, the mortality has not improved and approaches30%. The main characteristics of the disease have changed significantly. The patients are older, frailer, and with increasing comorbidities.The proportion of health care associated with IE has been increasing, too. Staphylococci have become the predominantcausative organisms, particularly Staphylococcus aureus. Blood cultures and echocardiography are still the cornerstones in thediagnosis of IE. Especially in patients with suspected prosthetic valve endocarditis and cardiac device infections additional methodshave proved...

Catheter ablation of atrial fibrillation in heart failure patients

Luděk Haman

Interv Akut Kardiol. 2018;17(2):82-84 | DOI: 10.36290/kar.2018.042  

Atrial fibrillation is an underappreciated reversible cause of left ventricular systolic dysfunction despite adequate rate control. Therestoration of sinus rhythm with catheter ablation results in an improvement in the ventricular function and is associated withlower rates of death and hospital admission for heart failure. These outcomes challenge the current treatment paradigm that ratecontrol is the appropriate strategy in patients with atrial fibrillation and heart failure.

Catheter ablation of ventricular tachycardia in structural heart disease: current perspectives

Petr Peichl, Josef Kautzner

Interv Akut Kardiol. 2018;17(2):85-91 | DOI: 10.36290/kar.2018.043  

As in other arrhythmias, the strategies for ablation of ventricular tachycardias (VTs) in patients with structural heart disease areevolving. The current dominant strategy is substrate ablation, because it is associated with better outcomes than conventionalapproach and activation mapping during VT. The progress in imaging has enabled a more detailed characterization of the arrhythmogenicsubstrate in these patients. Likewise, novel techniques of ablation have been proposed that allow modification ofthe substrate in previously inaccessible sites. Despite the improvements, treatment of these patients still represents a challenge.For patients with an...

Aortic valve repair: a standard procedure in dedicated centers

Jan Vojáček, Pavel Žáček, Jan Dominik, Mikita Karalko, Martin Tuna, Pavel Nedbal, Jiří Vondrák, Jan Harrer

Interv Akut Kardiol. 2018;17(2):93-99 | DOI: 10.36290/kar.2018.044  

Aortic valve repair and valve sparing procedures enable restoration of competence in a regurgitant aortic valve, thus avoid therisks related to valve replacement. Successful aortic valve repair requires profound understanding of static and dynamic geometryof the aortic valve and aortic root. Aortic regurgitation originates from a malposition of the aortic leaflets and is also frequentlyassociated with dilation of the aortic root and ascending aorta. The surgical techniques for aortic regurgitation have evolvedhistorically and are currently moving toward simplification and standardization. The basic principles involve morphological normalizationat the...

Aortic dissection and its endovascular therapy

Miroslav Bulvas

Interv Akut Kardiol. 2018;17(2):100-106 | DOI: 10.36290/kar.2018.045  

Within the last fifteen years, endovascular therapy has become the treatment of choice for complicated distal aortic dissection,distal arch repair and blunt thoracic aortic injuries. The identification and early detection of patients who are at risk of deathor disease progression is a major part of aortic dissection management. Even those with clinically silent uncomplicated distaldissection, long- term data suggest survival benefit from stent-induced remodelling of dissected aorta. Recent developmentsin the knowledge of factors predicting aortic expansion enable lesion-specific management tailored to the patient and aorticlesion. Further work is required...

Recent advances in the pharmacotherapy of cardiovascular diseases

Jan Bultas

Interv Akut Kardiol. 2018;17(2):108-112 | DOI: 10.36290/kar.2018.046  

The present review of advances in the treatment of cardiovascular diseases deals with three areas: anti-inflammatory treatment of atherosclerosis,current effect of acetylsalicylic acid, and comparison of strategies for LDL-cholesterol reduction. The first part demonstratesthe possibility of anti-inflammatory treatment of atherogenesis with a monoclonal antibody (canakinumab) inactivating interleukin1β. The effect of inflammation in atherogenesis and thrombogenesis is demonstrated using additional examples – periodontitis oracute viral infection. The current effect of acetylsalicylic acid in women, the elderly, or diabetics has been confirmed...

Anticoagulation therapy 2018

Jan Novotný, Jana Michalcová, Miroslav Penka

Interv Akut Kardiol. 2018;17(2):113-122 | DOI: 10.36290/kar.2018.047  

Hypercoagulable states are among the most frequent causes of morbidity and mortality in the developed countries. Hemostasisplays an important role not only in the stopping of bleeding, but is also involved in immunity, wound healing, and the processesof growth, progression, and metastasizing of malignant tumors. This is the reason why many research teams pay great attention tothe issue of hemostasis, including the development of new antithrombotic drugs. Hemostasis is being explored in detail on manylevels, this creating a basis for the development and testing of new drugs in both preclinical and clinical trials. At present, pentasacharides,direct...

Update of antithrombotic treatment

Petr Kala

Interv Akut Kardiol. 2018;17(2):123-125 | DOI: 10.36290/kar.2018.048  

Rapid development of antithrombotic treatment has significantly improved the quality of care of patients with ischemic heartdisease as well as contributed to the development of cardiovascular medicine and interventional cardiology, in particular. In thispaper, individualized therapy based on risk stratifications, treatment strategy, algorithms for dual antiplatelet therapy and itscombination with oral anticoagulation will be discussed.

Unclear „hazy“ lesion managed with OCT-guided PCI and optimization of drug therapy after myocardial infarction

Karel Lábr, Ladislav Groch, Jan Sitar, Jaroslav Blažek, Lenka Špinarová

Interv Akut Kardiol. 2018;17(2):127-130 | DOI: 10.36290/kar.2018.049  

Introduction: A patient with suspected non-ST elevation myocardial infarction is indicated for early coronary angiography. Inthe case of an unclear finding or “hazy” lesion it is advisable to supplement the examination with optical coherence tomography(OCT) or intravascular ultrasound (IVUS) to confirm the diagnosis and to consider the indication of revascularization. Aftermyocardial infarction, long-term pharmacotherapy includes angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, dualantiplatelet therapy and statins.Case presentation: A 58-year-old male smoker with typical stenocardial pain with suspected acute myocardial infarction...