- 4 - Abstract Adaptation to hypoxia or exercise training has cardioprotective effects against acute ischemic injury, but can potentially negatively influence heart function. Possible negative changes depend on the degree of hypoxia and exercise training intensity. It is therefore necessary to evaluate the effects of the specific adaptation protocols used. The ideal technique is echocardiography, which enables non-invasive, repeated and long-term measurements of the same individual allowing to study the development of changes in the course of adaptation. The aim of this study was to determine the effects of selected protocols of adaptation to intermittent hypobaric hypoxia (corresponding to the altitude of 4,000 to 8,000 meters above sea level, for 15 weeks in total) and exercise training (running speed 30 m.min-1 for 60 min a day, 4 weeks in total) on the left ventricle geometry and systolic function in rats. We assessed basic echocardiographic parameters of the ventricle geometry and function such as fractional shortening, ejection fraction, stroke volume, cardiac output etc. The adaptation of rats to intermittent hypobaric hypoxia lead neither to the impairment of systolic function nor to the development of left ventricle hypertrophy compared to controls; signs of moderate hypertrophy were observed only...

Myocardial damage is one of the most serious consequences of arterial hypertension. Changes in the heart structure and function develop not only due to pressure overload itself, but many other hemodynamic and neurohumoral factors contribute to their formation. Our work has compared echocardiohraphic strucutural anf functional changes of the left ventricle, caused by essential hypertension and hypertension associated with primary aldosteronism (PA) as the most common reason for secondary hypertension. The first part of our work focused on the differences in left ventricle geometry in men with PA and essential hypertension after separating it's low-renin form (where, similarly to PA, the plasma volume expansion was considered to have the dominant effect on left ventricle remodelation). In men with low-renin forms of hypertension including PA, we observed greater both endsystolic and enddiastolic diameter of the left ventricle, lower relative wall thickness and more frequent eccentric type of hypertrophy when compared to essential hypertensives with normal renin levels. Whereas left ventricle cavity diameters were positively correlated to aldosterone levels, wall thicknesses were associated mainly with hypertension severity expressed as an average 24hour blood pressure and number of antihypertensives....

Studium of the clinical impact of different forms of cardiac resynchronization therapy by patients with chronic heart failure MUDr. Lucie Burianová ABSTRACT: Introduction: Biventricular (BiV) pacing decreases mortality and improves quality of life of patients with severe heart failure. Haemodynamic and short time clinical studies suggest that isolated leftventricular pacing could have the same effect. Aims: Compare the effect of BiV and leftventricular pacing by subjects with dilated cardiomyopathy and severe heart failure with the attention to signs of dyssynchrony and remodelation of the left chamber. In methodical substudy compare the results of left chamber volumes and ejection fraction (EF LK) measured by CT angiography and 2-dimensional echocardiography with use of contrast agent (K-ECHO). Methods: Patients indicated for cardiac resynchronization therapy were randomized for either BiV or leftventricular pacing. After implantation of the device they were examinated clinically and by echocardiography every 3 months in the period of one year. Four years from the onset of the study the major adverse events in both groups were evaluated. The results of left chamber volumes and EF LK measured by K-ECHO and CT angiography were compared. Results: We enrolled 33 patients. We found clinical improvement in both...

Atrial fibrillation is the most prevalent arrhythmia worldwide and remains one of the major causes of morbidity and mortality. Atrial fibrillation is an arrhythmia that has a various etiology and takes number of clinical forms. Due to the heterogenity of atrial fibrillation, it is necessary to individualize the optimal treatment strategy, ie conservative pharmacological therapy or interventional therapy as catheter ablation. Inncorrect indication of catheter ablation of atrial fibrillation leads to low success rate of the procedure and increases the risk of the procedure. The success rate of catheter ablation of atrial fibrillation depends on many clinical parameters, including the size and volume of the left atrium and the presence of pathological tissue in the atrial myocardium. In everyday practice, echocardiography (2D-echocardiography) is the most dominant method in estimation of the left atrial parameters, for it's simplicity, non- invasiveness, financial costs and the absence of ionizing radiation. Different methods for assesment of left atrial parameters are cardiac CT, cardiac magnetic resonance imaging and methods of 3-D echocardiography or 3-D angiography. The results of the present studies show that in patients with non-valvular atrial fibrillation who are indicated for catheter...

Publikationen die in letzter Zeit veröffentlicht wurden zeigten den G Protein-gekoppelte Rezeptor 30 (Gpr30) als neuer potenzieller Östrogen Rezeptor. Dieser Befund wird kontrovers diskutiert, zudem wurde die physiologische Funktion von Gpr30 bisher noch nicht vollständig geklärt. Ziel der vorliegenden Arbeit war die Erforschung der Rolle von Gpr30 in vivo. In einer primären und sekundären Untersuchung wurde eine phänotypische Charakterisierung einer Gpr30-defizienten Mauslinie vorgenommen. Diese Mauslinie wurde generiert, indem eine beta-Galactosidase-Neomycin Vektorkassette in den open reading frame des Gpr30 Gens eingesetzt wurde. Im Rahmen der primären Untersuchung zeigte die immunologische Analyse eine Reduzierung der T-Zellen sowohl bei den männlichen als auch bei den weiblichen mutanten Mäusen. In einer Thymus-Genexpressionanalyse konnten einige Gene identifiziert werden, die möglicherweise in der Regulation der Anzahl an T-Zellen involviert waren. Auf der Grundlage dieser Ergebnisse wurde eine Erhöhung der Kalzium-vermittelten T-Zellen Apoptose hypothetisiert. Gegenstand der sekundären Untersuchung war die Bestimmung eines möglichen metabolischen und kardiovaskulären Phänotyps, da Gpr30 überwiegend in den Blutgefäßen verschiedener Organe, sowie in der Pankreas und im Magen exprimiert ist. Zu diesem Zweck wurden die Mäuse einer Hochfettdiät unterzogen und es wurden metabolische sowie hemodynamische Tests durchgeführt. Um den Phänotyp dieser ersten Mauslinie zu bestätigen, wurde eine zweite Mauslinie ohne Selektionsmarker generiert. Insgesamt tragen die Ergebnisse der vorliegenden Studie zu einem besseren Verständnis der Funktion von Gpr30 in vivo bei. Eine Rolle des Rezeptors bezüglich der Regulation des Körpergewichts konnte widerlegt werden, während ein Einfluss auf den Lipid- und Muskelstoffwechsel angenommen werden kann. Zudem wurde gefunden, dass Gpr30 für einige Östrogen-regulierende, physiologische Prozesse nicht erforderlich ist. / Recent studies identified the G protein-coupled receptor 30 (Gpr30) as a potential new estrogen receptor. However, these findings remain still controversial and the physiological role of Gpr30 has not been clarified yet. In order to decipher the role of Gpr30 in vivo, we investigated the phenotype of a Gpr30 mutant mouse line, generated by the insertion of a beta-galactosidase-neomycin cassette into the Gpr30 open reading frame, in a primary and a secondary screen. The primary screen revealed a decrease of T cell levels in both male and female mutants. Thymus gene expression analysis allowed to detect some of the genes potentially involved in regulating T cell levels in these mice. On this basis a hypothesis of an increase in T cell calcium-mediated apoptosis was formulated. The secondary screen aimed at unraveling a potential metabolic and cardiovascular phenotype, being Gpr30 mainly expressed in the vasculature of several organs, as well as in the pancreas and in the chief gastric cells of the stomach. Therefore, mice were challenged with a defined high fat diet, and metabolic and hemodynamic tests were performed. To confirm the phenotype achieved in this first mouse line, a second one, devoid of any selection marker, was analyzed. Altogether the results achieved may contribute to a better understanding of Gpr30 function in vivo, disproving a role of Gpr30 in body weight regulation, suggesting a role in lipid and muscular metabolism, and providing evidence that Gpr30 may not be required for several estrogen-regulated physiological processes.

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Background: Surgical procedures are invariably accompanied by the use of inhalational and intravenous anesthetics. Both groups have strong influence on cardiovascular system by the interaction with myocardial oxygen supply/demand ratio and cardiomyocyte functions at the level of cell membranes, ion channels and regulatory enzymes. Aims: 1. To examine the effects of different isoflurane concentrations on the left ventricular (LV) dimensions and systolic function in the rat. 2. To examine the effects of isoflurane-induced myocardial preconditioning (APC) on the cardiac tolerance to ischemia- reperfusion (I-R) injury. 3. To compare the influence of anesthesia, based on ketamine- dexmedetomidine (KET-DEX), on the release of biochemical markers of myocardial injury and the early postoperative course with the anesthesia, based on sevoflurane-sufentanil (SEVO), in the patients undergoing coronary artery bypass grafting (CABG). Methods: 1. We carried out transthoracic echocardiographic examination in the rats immobilized by 1.5-3% concentration of isoflurane. 2. After inducing APC by isoflurane (0.5 and 1 MAC), we evaluated ventricular arrhythmias during regional ischemia (45 min), induced by the occlusion of the left anterior descending artery, and subsequent reperfusion (60 min), using the model of...

Background: Surgical procedures are invariably accompanied by the use of inhalational and intravenous anesthetics. Both groups have strong influence on cardiovascular system by the interaction with myocardial oxygen supply/demand ratio and cardiomyocyte functions at the level of cell membranes, ion channels and regulatory enzymes. Aims: 1. To examine the effects of different isoflurane concentrations on the left ventricular (LV) dimensions and systolic function in the rat. 2. To examine the effects of isoflurane-induced myocardial preconditioning (APC) on the cardiac tolerance to ischemia- reperfusion (I-R) injury. 3. To compare the influence of anesthesia, based on ketamine- dexmedetomidine (KET-DEX), on the release of biochemical markers of myocardial injury and the early postoperative course with the anesthesia, based on sevoflurane-sufentanil (SEVO), in the patients undergoing coronary artery bypass grafting (CABG). Methods: 1. We carried out transthoracic echocardiographic examination in the rats immobilized by 1.5-3% concentration of isoflurane. 2. After inducing APC by isoflurane (0.5 and 1 MAC), we evaluated ventricular arrhythmias during regional ischemia (45 min), induced by the occlusion of the left anterior descending artery, and subsequent reperfusion (60 min), using the model of...

Amyloidosis is a term used for a whole group of diseases caused by deposition of a substance called amyloid into different tissues. Amyloid may be produced by a range of pathologic processes. Heart affliction is typical for only several types of amyloidoses. Heart involvement is then the patient`s prognosis major limiting factor. Diagnosis of heart amyloidosis is difficult especially for nonspecific symptoms and nonspecific findings obtained during common diagnostic procedures. The aim of this thesis was to evaluate usefulness of novel diagnostic methods, namely cardiac magnetic resonance with gadolinium enhancement and a simplified echocardiographic evaluation of left ventricular longitudinal strain, in diagnosing amyloid cardiomyopathy. In our first study we examined 22 patients with light chain amyloidosis by echocardiography and also with cardiac magnetic resonance with late gadolinium enhancement. We compared morphologic and functional parameters acquired by magnetic resonance examination, which is considered a gold standard for morphologic and functional measurements, with values obtained by echocardiographic measurement. Afterwards we evaluated the presence and eventually pattern of late gadolinium enhancement during cardiac magnetic resonance exam. From acquired data we conclude that the...

Short summary: Background: High cardiovascular risk in patients with chronic kidney disease is partly due to mineral dysbalance, microinflammation and oxidative stress. CKD patients accumulate traditional and non-traditional CV risk factors. FGF23, MMPs and PlGF belong among these non-traditional biomarkers of CV risk. FGF23 is a phosphaturic hormone and inhibitor of calcitriol synthesis. It is associated with vascular calcifications. Matrix-metalloproteinases (e.g. MMP-2, MMP-9) are proteolytic, proinflammatory enzymes, contributing to myocardial remodelation. Placental growth factor (PlGF) is a proangiogenic cytokine that is associated with LV hypertrophy in animal model. Plasmatic FGF23, MMPs and PlGF are elevated in CKD. Aim: We aimed to describe dynamic changes between several novel biomarkers of CV risk (FGF23, MMP-2, MMP-9 and PlGF) in CKD stages 1-5, to describe their mutual correlations and possible association with traditional CV risk markers. We studied possible association of laboratory and echocardiographic parameters in patients with CKD stages 2-4. Methods: In a cross-sectional study we evaluated 80 patiens with CKD 1-5 and 44 healthy controls. In a prospective study we evaluated echocardiographic and laboratory parameters in 62 patients with CKD 2-4 for an average study period of 36±10...