Cor et Vasa, 2019 (vol. 61), issue 4

Original research articles

(Cost-effectiveness analysis of first-line NOAC prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation)

Miloš Táborský, Aleš Tomek, Robert Čihák, Ondřej Škoda, Josef Daněk, Martin Kolek

Cor Vasa 2019, 61(4):e354-e369 | DOI: 10.33678/cor.2019.058

Introduction: Atrial fibrillation (AF) is a cardiac rhythm disorder with a prevalence of 3.37% of the popula- tion, which increases with age.¹ AF patients have a high risk of stroke and systemic embolism, which continues to increase when the patient has undergone transient ischemic attack (TIA) or stroke. Objective: The aim of the pharmacoeconomic evaluation is to compare the cost and benefit of NOAC (novel oral anticoagulants) treatment against warfarin treatment as a first-line prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.Methods: The Markov model evaluates the cost-effectiveness...

Methods for detection of direct oral anticoagulants and their role in clinical practice

Katrina Pukite, Ketija Apsite, Irina Pupkevica, Ilze Cernevska, Oksana Boichuk, Janis Meisters, Dagnija Straupmane, Inga Urtane, Aivars Lejnieks, Oskars Kalejs

Cor Vasa 2019, 61(4):e370-e376 | DOI: 10.33678/cor.2019.050

Introduction: Atrial fibrillation (AF) is the most common arrhythmia that increases by age, doubles for every decade after age of 50 years and reaches about 10% patients ≥ 80 years.¹ Despite direct oral anticoagulants' (DOACs') predictable pharmacokinetics and pharmacodynamics, the laboratory tests are necessary for effective and safe medical treatment, also for prediction and detection of thrombotic and bleeding events, as well as in situations when temporary discontinuation could be desirable.² Aim: The aim of this study was to identify and analyze the need of coagulation tests for AF patients with high cardiovascular...

(Prediction of long-term renal denervation efficacy)

Jan Kvasnička, Lukáš Lambert, Petr Waldauf, Tomáš Zelinka, Ondřej Petrák, Branislav Štrauch, Robert Holaj, Tomáš Indra, Zuzana Krátká, Judita Klímová, Jan Václavík, Eva Kociánová, Igor Nykl, Otakar Jiravský, Gabriela Rappová, Miloš Táborský, Marian Branny, Jiří Widimský Jr., Ján Rosa

Cor Vasa 2019, 61(4):e378-e384 | DOI: 10.1016/j.crvasa.2018.09.007

Diversity of blood pressure response and great variability within studies emphasise the need to identify predictors of renal denervation efficacy. Previous studies identified various predictors within periods of 3-6 months. The goal of the current study is to examine the possible predictors of sustained decline of blood pressure (BP) after renal denervation in a long-term period of 2 years. Evaluated patients were either randomised in the original PRAGUE-15 study or were pilot patients, meeting the same inclusion criteria of true-resistant hypertension. Patients were considered as responsive when the decline of 24h systolic BP ≥ 10 mmHg was present...

(Infective endocarditis in a cardiovascular centre with no cardiac surgery unit: epidemiological changes and mortality predictors)

Petr Coufal, Jan Večeřa, Jan Matějka, Jiří Vondrák, Martin Kubrycht, Petr Vojtíšek

Cor Vasa 2019, 61(4):e386-e395 | DOI: 10.33678/cor.2019.036

Aim: To evaluate the prognosis and changes in the spectrum of patients with infective endocarditis (IE) in a cardiovascular centre with no cardiac surgery unit and to identify predictors of mortality. Patients and methods: A retrospective analysis was used to identify 147 patients meeting the Duke criteria for infective endocarditis who were hospitalised in the Cardiology Unit of the Pardubice Regional Hospital from 2000 till 2016. This interval has been divided in two time periods and the profiles of patients in each one were compared. To identify predictors of mortality, we used Cox regression analysis and constructed Kaplan-Meier survival curves.

NT-proBNP as predictive factor for the conversion of paroxysmal atrial fibrillation of heart to sinus rhythm in non-diabetic and diabetic populations

Jarmila Harvanová, Roman Beňačka, Alexander Hudák

Cor Vasa 2019, 61(4):e397-e402 | DOI: 10.33678/cor.2019.044

Introduction: Atrial fibrillation is considered today as the most common arrhythmia. The NT-proBNP level is provably elevated in patients with atrial fibrillation in atrium of heart, even without documented heart failure. The association between NT-proBNP level and the conversion of atrial fibrillation to sinus rhythm has not been proved so far, and it is unclear whether such a link exists at all. Objective: The aim of the study is to analyze the relationship between NT-proBNP levels and the conversion of atrial fibrillation and to point to the possible predictive value of this marker in relation to rhythm conversion. Material and methods: A total...

Individualized home-based exercise program for idiopathic pulmonary arterial hypertension patients: a preliminary study

Līna Butāne, Daina Šmite, Matīss Šablinskis, Andris Skride

Cor Vasa 2019, 61(4):e403-e410 | DOI: 10.33678/cor.2019.037

Background: Exercise-based rehabilitation has been proved as a beneficial additional non-pharmacological treatment in patients with stable pulmonary arterial hypertension (PAH). Majority of studies include hospital-based supervised programs. To improve patient accessibility to this important intervention and long-term effect the research on home-based programs is warranted. The purpose of our study was to evaluate the adherence, safety, training effects of 12-week individualized home-based exercise program in patients with idiopathic PAH.Methods: This was a prospective pilot uncontrolled interventional study. Six patients with iPAH confirmed...

(The effect of cardiac venting technique for aortic valve replacement surgery on the incidence of postoperative atrial fibrillation)

Tomáš Toporcer, Andrea Kraus, Tomáš Grendel, Milan Bajmoczi, Adrián Kolesár, František Sabol

Cor Vasa 2019, 61(4):e411-e419 | DOI: 10.33678/cor.2019.034

Atrial arrhythmias are the most common complication after open heart surgery. Only a few studies have presented the incidence and risk factors of postoperative atrial fibrillation (POAF) after isolated aortic valve replacement surgery (AVR). Furthermore, the scarring resulting from the side of the vent implantation may create areas of slow conduction that allow a substrate for re-entry. The aim of the study is to compare the effect of the venting technique used during AVR - through the pulmonary artery (PA) or the pulmonary vein (PV) - on POAF incidence. Patients with no history of permanent atrial fibrillation (AF) and no pacemaker implanted (n =...

Impact of contralateral carotid stenosis on brain tissue oxygenation during carotid endarterectomy

Marek Lukeš, Martin Helán, Vladimír Šrámek, Jana Pavlíková, Robert Staffa, Pavel Suk

Cor Vasa 2019, 61(4):e420-e425 | DOI: 10.33678/cor.2019.055

Background: Cerebral oximetry (rSO₂) seems to be a promising technique for assessment the adequacy of cerebral oxygen delivery during carotid endarterectomy (CEA). The purpose of this study was to evaluate the association of the severity of contralateral (non-operated) carotid artery stenosis and the magnitude of rSO₂ changes during CEA. Methods: rSO₂ was monitored in 38 patients undergoing CEA under regional anesthesia. Patients were retrospectively assigned to one of two groups: with (Gdef) or without (Gnodef) change in neurological status. Baseline rSO₂ values (rSO₂base), average (rSO₂avg)...

A numerical analysis on the right and left ventricles with circular and elliptical patches

Pedram Tehrani, Alireza Karimi

Cor Vasa 2019, 61(4):e427-e430 | DOI: 10.33678/cor.2019.020

Purpose: At birth, there is a communication between the right and left ventricles, but this communication disappears after the birth. In some cases, the communication has been continued and ventricles cannot operate independently on each other. This abnormal communication causes problems, such as hypertension and heart valves complications. The purpose of this study was to analyse alterations in stress and strain caused by placement of a patch on junction and offering optimized geometry for it. Methods: For this purpose, finite element (FE) models of two types of circular and elliptical patches with the same material properties were established and...

Case reports

Hyperacute T waves in inferior leads as a dynamic sign of evolving STEMI

Antonio Lippolis, Davide Esposti, Francesco Gentile

Cor Vasa 2019, 61(4):e431-e435 | DOI: 10.1016/j.crvasa.2018.02.008

Introduction: Electrocardiogram is a commonly used tool in the diagnosis of acute myocardial infarction. Among ECG signs of acute cardiac ischemia, tall and broad-based T waves, called hyperacute T waves, may be the earliest and the only ECG sign of ST-elevation myocardial infarction (STEMI). Objective: To underline the importance of early recognition hyperacute T waves as one STEMI equivalent in order to prevent further damage to the myocardium by appropriate treatment. Case report: A 65-year-old female was admitted to the emergency department for chest pain. An electrocardiogram revealed the presence of tall and broad-based T waves in inferior leads,...

Direct-acting oral anticoagulants: Less is not always more

Kamran Majeed, Adam J. Nelson, Peter J. Psaltis, Matthew I. Worthley

Cor Vasa 2019, 61(4):e436-e438 | DOI: 10.1016/j.crvasa.2018.09.002

We report a case in which self-prescribed dose reduction of the orally active, direct factor Xa inhibitor, rivaroxaban, was associated with the unusual thrombo-embolic complication of acute ST-segment elevation myocardial infarction (STEMI) in the setting of a fluctuating renal function and estimated glomerular filtration falling in and out of the range where dose reduction of rivaroxaban is suggested. The case highlights the importance of dosing of rivaroxaban in those patients who sit around the recommended dosage regimen cut offs as they are well known to be at risk of bleeding should their CrCl fall

Images in cardiology

Single coronary artery with double coronary courses: Tips and tricks

Murat Gul, Ozcan Ozeke, Anil Ozen, Fatih Mehmet Ucar, Serkan Cay, Dursun Aras

Cor Vasa 2019, 61(4):e439-e441 | DOI: 10.1016/j.crvasa.2018.07.007

Congenital coronary artery anomalies are uncommon and the vast majority is diagnosed incidentally during coronary angiogram or necropsy. A single coronary artery is one of the most rarely seen coronary artery anomalies. Determination of its course (inter-arterial, intra-septal, pre-pulmonic or retro-aortic) is very important regarding its clinical significance. Avoiding the misdiagnosis of an unsuspected anomalous coronary artery is critical to the patient and it is always the angiographer's responsibility to accurately define the origin and course of the vessel. Cardiologists should be aware of simple clues in order to easily identify coronary anomalies.