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Biomedical subjects

L Groch

Publications and source records attributed to L Groch.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: experience from the PRAGUE studies.

BACKGROUND: Acute ST-elevation myocardial infarction in patients with normal coronary arteries has previously been described, but coronary angiography in these patients was performed after the acute phase of the infarction. It is possible that these patients did not have normal angiograms during the acute phase (transient coronary thrombosis or spasm were usually suspected to be the cause). Information on the prevalence of truly normal coronary angiograms during the acute phase of a suspected ST-elevation myocardial infarction is lacking. PATIENTS AND METHODS: The Primary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis-1 (PRAGUE-1) and PRAGUE-2 studies enrolled 1150 patients with ST-elevation acute myocardial infarction, in whom 625 coronary angiograms were performed within 2 h of the initial electrocardiogram. A simultaneous registry included an additional 379 coronary angiograms performed during the ST-elevation phase of a suspected myocardial infarction. Thus, a total of 1004 angiograms were retrospectively analyzed. A normal coronary angiogram was defined as one with the absence of any visible angiographic signs of atherosclerosis, thrombosis or spontaneous spasm. RESULTS: Normal coronary angiograms were obtained for 26 patients (2.6%). Among these, the diagnosis at discharge was a small myocardial infarction in seven patients (0.7%), acute (peri)myocarditis in five patients, dilated cardiomyopathy in four patients, hypertension with left ventricular hypertrophy in three patients, pulmonary embolism in two patients and misinterpretation of the electrocardiogram (ie, no cardiac disease) in five patients. Seven patients with small infarctions underwent angiography within 30 min to 90 min of complete relief of the signs of acute ischemia, and thus, angiograms during pain were not taken. None of the 898 patients catheterized during ongoing symptoms of ischemia had a normal coronary angiogram. Spontaneous coronary spasm as the only cause (without underlying coronary atherosclerosis) for the evolving infarction was not seen among these 898 patients. Thus, the causes of the seven small infarcts in patients with normal angiograms remain uncertain. CONCLUSIONS: The observed prevalence of normal coronary angiography in patients presenting with acute chest pain and ST elevations was 2.6%. Most of these cases were misdiagnoses, not infarctions. A normal angiogram during a biochemically confirmed infarction is extremely rare (0.7%) and was not seen during the ongoing symptoms of ischemia.

Adult↗
PubMed2006

[Local vascular complications in patients with acute myocardial infarct treated with direct percutaneous coronary intervention].

OBJECTIVES: We assessed the rate and identified risk factors for postprocedure vascular complications following direct percutaneous intervention (dPCI). METHODS: Data were collected on 881 consecutive patients who underwent dPCI in our cath-lab from January 2002 to December 2003. Multivariate regression was used to identify characteristics associated with vascular complications. RESULTS: Out of 881 patients, hematoma was found in 148 (16.8%) cases. Pseudoaneurysm was detected by ultrasound in 40 (4.5%) patients, 5 (0.6%) patients underwent surgery. Variables associated with increased risk included age, female sex, low body mass index (BMI) and body surface area (BSA) and presence of diabetes mellitus. CONCLUSIONS: Predicting the risk of post-PCI vascular complications is feasible. This information may be useful for clinical decision-making and institutional efforts at quality improvement.

Adult↗
PubMed2006

[Non-pharmacologic therapy of hypertrophic obstructive cardiomyopathy--results of therapy based on percutaneous transluminal septal myocardial ablation compared with results of dual-chamber cardiac pacing].

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) and pacemaker (PM) therapy with apical preexcitation are therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) patients with symptoms despite pharmacological therapy. AIM: evaluation and comparison of treatment results of PTSMA and PM implantation. PATIENTS: 22 HOCM patients (NYHA class III and IV) with left ventricle outflow tract gradient (LVOTG) at rest more than 30 mm Hg. In group A were evaluated 11 patients treated by PTSMA. Left ventricle outflow tract gradient (LVOTG) was 90.5 +/- 16.0 mm Hg, NYHA class 3.1 +/- 0.2. Group B included 11 patients treated by dual chamber PM implantation, LVOTG in this group was 105 +/- 48 mm Hg, NYHA class 3.0 +/- 0.4. RESULTS: NYHA class in the group A decreased after treatment to 1.8 +/- 0.6 (p < 0.01), LVOTG to 24 +/- 12 mm Hg (p < 0.001). There was observed significant decrease in grade of systolic anterior motion (SAM), interventricular septum (IVS) thickness and left atrium (LA) size. Left ventricle end systolic diameter (LV SD) and left ventricle end diastolic diameter (LV DD) increased during follow-up. Decrease of NYHA class in the group B was to 2.1 +/- 0.6 (p < 0.001), LVOTG to 25.5 +/- 21.0 mm Hg (p < 0.001). Changes of other parameters in the group B were not significant, except decrease of SAM. Comparison of both groups: NYHA class change PTSMA/PM: 1.3 +/- 0.6/0.9 +/- 0.4 (p < 0.05), LVOTG change PTSMA/PM: -66 +/- 20/-79 +/- 46 mm Hg (p = n.s.). LV SD assessment comparison of LV SD change PTSMA/PM: 5 +/- 5/1 +/- 5 mm (p < 0.05). LA assessment - comparison of LA change PTSMA/PM: 5 +/- 5/-1 +/- 4 mm (p < 0.05). Other changes were not significant. CONCLUSION: Both therapeutic approaches - PTSMA and PM implantation - resulted in significant improvement of functional capacity assessed by NYHA classification. Decrease of LVOTG was also significant and was similar in both groups, NYHA class improvement as well as LA size decrease and LV DS increase were more expressed in PTSMA group.

Cardiomyopathy, Hypertrophic↗
PubMed2003

Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. METHODS: The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. RESULTS: Five complications (1.2%) occurred during the transport. Randomization-balloon time in the PCI group was 97+/-27 min, and randomization-needle time in the TL group was 12+/-10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). CONCLUSIONS: Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.

Angioplasty, Balloon, Coronary↗
PubMed2001

Methylenetetrahydrofolate reductase polymorphism, type II diabetes mellitus, coronary artery disease, and essential hypertension in the Czech population.

Increased plasma concentrations of homocysteine have been found in patients with coronary artery disease (CAD) and essential hypertension (EH) and in patients with diabetic complications. The 677C/T methylenetetrahydrofolate reductase (MTHFR) gene polymorphism is related to the MTHFR enzyme activity and to the plasma homocysteine concentration. This study was designed to investigate an association of this polymorphism with CAD, EH, and type II diabetes mellitus in the Czech population. The MTHFR genotypes were assessed by the polymerase chain reaction-based methodology in a sample of 1199 unrelated Caucasian subjects with CAD, EH, type II diabetes, or a combination of these diseases, and in healthy subjects. Allele frequencies of the MTHFR polymorphism differed considerably between women with and without type II diabetes mellitus (P = 0.00069), with a higher frequency of the C allele in the diabetic women. In addition, the MTHFR T allele frequency was significantly higher in normotensive subjects with CAD compared with normotensive subjects without this disease (P = 0.020). Both associations were confirmed by multiple logistic regressions. In conclusion, while the C allele of the 677C/T MTHFR polymorphism is associated with type II diabetes mellitus in women, the T allele is associated with CAD only in normotensive subjects of Czech origin.

Aged↗
PubMed2001

[Correlation of a change in the amplitude of the R wave during ergometry with the finding of significant stenosis of the coronary artery].

The authors evaluated retrospectively 224 patients with ischaemic heart disease. These patients were subjected to an ergometric loading test on a bicycle ergometer followed by angiography of the coronary arteries. With regard to the site of the increased amplitude of R waves during the loading test the patients were divided into seven groups which were sub-divided further according to the coronarographic finding. The authors investigated the assumption that patients with pathological changes of R waves above the anterior wall suffer from afflictions of the ramus interventricularis anterior, patients with changes above the lateral wall of the ramus circuflexus and patients with increased R waves above the inferior wall of the right coronary artery. From the work ensues that no localization of increased amplitudes of R waves during the loading test has a statistically significant correlation with the coronarographic finding.

Coronary Angiography↗
PubMed2000

Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study.

BACKGROUND: Primary coronary angioplasty is an effective reperfusion strategy in acute myocardial infarction. However, its availability is limited, and transporting patients to an angioplasty centre in the acute phase of myocardial infarction has not yet been proved safe. METHODS: The PRAGUE study (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis) compared three reperfusion strategies in patients with acute myocardial infarction, presenting within 6 h of symptom onset at community hospitals without a catheterization laboratory: group A - thrombolytic therapy in community hospitals (n=99), group B - thrombolytic therapy during transportation to angioplasty (n=100), group C - immediate transportation for primary angioplasty without pre-treatment with thrombolysis (n=101). RESULTS: No complications occurred during transportation in group C. Two ventricular fibrillations occurred during transportation in group B. Median admission-reperfusion time in transported patients (group B 106 min, group C 96 min) compared favourably with the anticipated >90 min in group A. The combined primary end-point (death/reinfarction/stroke at 30 days) was less frequent in group C (8%) compared to groups B (15%) and A (23%, P<0. 02). The incidence of reinfarction was markedly reduced by transport to primary angioplasty (1% in group C vs 7% in group B vs 10% in group A, P<0.03). CONCLUSIONS: Transferring patients from community hospitals to a tertiary angioplasty centre in the acute phase of myocardial infarction is feasible and safe. This strategy is associated with a significant reduction in the incidence of reinfarction and the combined clinical end-point of death/reinfarction/stroke at 30 days when compared to standard thrombolytic therapy at the community hospital.

Aged↗
PubMed2000

Rupture of the coronary artery after blunt nonpenetrating chest wall trauma detected by color Doppler echocardiography: a case report.

We report a rare case of a ruptured papillary muscle of the anterior leaflet of the tricuspid valve and the rupture of the septal branch of the left anterior descending coronary artery with drainage into the right ventricle after blunt nonpenetrating chest wall trauma. Both abnormalities were detected by transthoracic 2-dimensional and color Doppler echocardiography, and the septal branch rupture was confirmed by coronary angiography. The leading echocardiographic sign of the rupture of the coronary artery was intramyocardial mosaic-colored flow, representing the turbulent high-velocity flow in the ruptured coronary artery. Hypokinesis of the anteroseptal myocardial segments and the presence of Q waves in leads V1 through 4 on the electro-cardiogram were suggestive of anteroseptal myocardial infarction. We conclude that the history of chest trauma, the electrocardiographic changes, and wall motion abnormalities should be stimuli for a careful color Doppler flow "mapping" of the myocardium for possible identification of a coronary artery rupture.

Adult↗
PubMed2000

[Can we determine which coronary artery is affected by the localization of ST depression? Comparison of ergometric and coronarographic results].

The authors evaluated retrospectively 206 patients with ischaemic heart disease. These patients were subjected to an ergometric loading test on a bicycle ergometer followed by angiography of the coronary arteries. With regard to the site of the ST depressions during the loading test the patients were divided into 7 groups which were further subdivided according to the coronographic finding. The authors investigated the hypothesis that patients with depressions of the ST segment above the anterior wall suffer from an affection of the ramus interventricularis anterior, patients with depressions of ST above the lateral wall from affection of the ramus circumflexus and patients with depressions above the lower wall have an affection of the right coronary artery. From the work ensues that no site of the ST depression correlates significantly with the coronary finding. The correlation is not statistically significant even when we compare the site of ST depressions with the affection of one artery regardless of the affection of the other coronaries.

Coronary Angiography↗
PubMed1997

Can dobutamine echocardiography induce myocardial damage in patients with dysfunctional but viable myocardium supplied by a severely stenotic coronary artery?

In animal experiments, dobutamine infusion was found to impair the oxygen supply-demand balance in hypoperfused areas of hibernating myocardium which may induce myocardial damage. The aim of our study was to assess whether dobutamine echocardiography can induce myocardial damage detected by an increase in the cardiac troponin T level in blood. Twenty seven patients with coronary artery disease and severe stenosis of at least one major coronary artery (> or = 90% of luminal diameter narrowing) supplying dysfunctional myocardial segments underwent dobutamine echocardiography. Dobutamine was infused in 3 min dose increments of 5, 10, 20, 30, and 40 microg per kg body weight per minute with the addition of atropine up to 1 mg if ischemia or an 85% predicted maximal heart rate were not achieved. In 15 patients the protocol with prolonged application of 40 microg per kg per minute of dobutamine for 6 min and for the next 5 min with the addition of atropine was used. To exclude minor myocardial damage, an increase in the cardiac troponin T blood level was assessed qualitatively by the TROP T sensitive Rapid Test 20 h after dobutamine echocardiography. In 20 patients the dysfunctional segments were found to be viable with inducible ischemia exhibiting either continuous worsening in systolic thickening or "biphasic" response characterised by the improvement of their systolic thickening with a small dose and by a worsening of the thickening with a high dose of dobutamine. No patient exhibited positive TROP T sensitive Rapid Test result. In patients with coronary artery disease and severe stenosis of a major coronary artery supplying dysfunctional but viable myocardial segments, dobutamine echocardiography does not induce myocardial damage detectable by an increase in cardiac troponin T level.

Adult↗
PubMed1997

[Evaluation of diastolic filling of the left ventricle using Doppler echocardiography in patients with chronic ischemic heart disease and with normal left ventricular function].

Twenty-five patients with chronic ischaemic heart disease and intact left ventricular systolic function who had no other cardiovascular, systemic or metabolic diseases were examined by two-dimensional and Doppler echocardiography. At rest and during an isometric load Doppler parameters of left ventricular diastolic filling were obtained such as: peak transmitral flow velocity in early diastole - E, peak transmitral flow velocity in atrial contraction - A, their ratio E/A and deceleration time of early filling. Based on the coronarographic finding, the patients were divided in two ways: 1. group A - 15 patients with critical narrowing of some major coronary artery (stenosis > or = 90% of the luminal diameter) and group B - 10 patients without critical narrowing (stenosis > or = 50%, but less than 90% of the luminal diameter), 2 group C - 6 patients with triple vessel disease, group D - 8 patients with double vessel disease and group E - 11 patients with single vessel disease. None of the groups differed mutually in any of the investigated Doppler parameters of left ventricular filling at rest, nor after an isometric load. CONCLUSION. Diastolic Doppler parameters of left ventricular filling do not make it possible to detect patients with critical coronary narrowing and they do not help to estimate the number of coronary vessels with significant stenoses.

Blood Flow Velocity↗
PubMed1997

[The ergometry stress test in patients with stenosis of the left main coronary artery].

In 168 patients with ischaemic heart disease an ergometric loading test on a bicycle ergometer was made before coronarography. A total of 19 patients had on coronarography a finding of significant stenosis of the lumen of the trunk of the left coronary artery--group A. These patients were compared with a control group of 20 patients with confirmed coronary heart disease (narrowing of the diameter of the lumen by 50 or more percent) without affection of the trunk of the left coronary artery-group B. As to the investigated parameters of the ergometric test the two groups differed significantly in the total time of the load (group A: 6.21 minutes, group B: 7.94 minutes, p < 0.05), while in all other parameters--total amount of performed work, sum of depressions of the ST segments during a maximum load, time of onset of stenocardias, time since development of 1 mm depressions of the ST segment, maximal depression of the ST segment in lead V5 and number of leads with ST depressions above 1 mm--no significant difference was found. From the work ensues that from the ergometric loading test the finding of stenosis of the left coronary artery on coronarography cannot be predicted.

Coronary Angiography↗
PubMed1995

Dobutamine echocardiography in predicting improvement in global left ventricular systolic function after coronary bypass or angioplasty in patients with healed myocardial infarcts.

The aim of this study was to determine whether low-dose dobutamine echocardiography (DE) could predict quantitative improvement in global left ventricular (LV) systolic function after coronary revascularization. Low-dose DE was performed in 71 consecutive patients with coronary artery disease and LV dysfunction. Successful coronary bypass surgery or angioplasty was performed in 44 patients, 37 of whom had a resting echocardiogram 1 to 3 months afterward. Group A consisted of 20 patients with contractile reserve during DE, and group B consisted of 17 patients without contractile reserve. As expected, regional wall motion score index (mean +/- SD) improved in group A (1.62 +/- 0.39 to 1.38 +/- 0.31, p < 0.01) but not group B (1.56 +/- 0.42 to 1.57 +/- 0.41, p = NS). In addition, LV ejection fraction (LVEF) improved after bypass surgery or angioplasty in group A (38 +/- 5% to 42 +/- 5%, p < 0.01), but not in group B (38 +/- 7% to 39 +/- 8%, p = NS). In group A, a significant linear correlation was observed between the number of segments with contractile reserve and the improvement in LVEF (r = 0.91, p < 0.0001). A good correlation also existed between the improvement in regional wall motion score index during dobutamine infusion and the improvement in LVEF after bypass surgery or angioplasty (r = 0.90, p < 0.0001). In conclusion, low-dose DE can be used to predict quantitative improvement in global LV systolic function after coronary bypass or angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1994

Variability of changes in Doppler transmitral filling pattern during stress echocardiography in patients with stable angina pectoris.

Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure > or = 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure < or = 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure > or = 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the E/A ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Testosterone levels in testicular and epididymal tissue during histopathologic changes in the testes in bulls].

A total of 42 sexual organs of bulls were used to study the relationship between the level of testosterone and the effect of histopathological changes. Genital organs were obtained immediately after slaughter at the Brno abbatoir. Bulls were 14 to 20 months of age and weighed 450 to 650 kg, they were of the Czech Pied, Black and White breeds and their crossbreds. After an assessment of testosterone contents in testicular and epididymal tissues and microscopic examination of organs the concentration of testosterone determined according to the histopathological findings were (Tab. I) as follows. The mean content of testosterone in testicular homogenates was 38.96 +/- 47.0 ng/g. The values for the head, corpus and cauda regions of the epididymal tissue were 5.7 +/- 4.7, 5.3 +/- 5.1 and 3.2 +/- 3.5 ng/g tissue, respectively. The mean level of testosterone in testicular homogenates in the group without histopathological changes of the spermatogenic epithelium was 9.2 +/- 6.77; 5.26 +/- 4.2. In this group the concentration of 5.3 +/- 4.2 from the head 5.4 +/- 5.3 from the corpus and 3.23 +/- 3.26 ng/g tissue were revealed in the cauda of the epididymis. In the group with oedematous infiltration of the interstitium the mean level of testosterone in testicular tissue was determined 16.2 +/- 24.6, in the head of the epididymis it was 6.2 +/- 3.59, in the corpus 4.6 +/- 3.3 and 2.07 +/- 1.2 ng/g of testosterone was obtained from the cauda of the epididymis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

[Tiracizine in the treatment of ventricular arrhythmia (preliminary study)].

Tiracizine a new antiarrhythmic drug class Ia was tested in a open crossover study in a group of 46 patients with more than 2500 ventricular extrasystoles per 24 hours or with ventricular arrhythmias III or a higher Lown class. The authors revealed a statistically significant drop of ventricular extrasystoles and a significant reduction of arrhythmias class IV of Lown's classification with a general shift of arrhythmias to lower classes. Improvement by at least one class occurred in 63%, deterioration without clinical impact in 11%. The drug does not have a clinical effect on haemodynamics. Side-effects of an anticholinergic type were recorded in 13% and a toxic allergic exanthema was observed in 6.5%. Tiracizine extends the spectrum of membrane antiarrhythmic drugs. Its effectiveness is similar as that of propafenon.

Anti-Arrhythmia Agents↗