Zdravje delovno aktivne populacije / Health of the Working-Age Population, Sep 15, 2017
Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in el... more Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in elderly patients with type 2 diabetes mellitus (T2DM), while no data are available regarding working-age subjects (≤60 years). Methods: Medical records of 192 patients with T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone myocardial perfusion imaging (MPI) between 2010 and 2014 followed by coronary angiography in case of abnormal result, were retrospectively analysed. Results: MPI was positive in 35 patients (18.2%); of those 31 (88.6%) had angiographically confirmed coronary stenosis. The positive predictive value of the MPI for predicting angiographic coronary stenosis in this age subgroup was 88.9%. Univariate analysis revealed post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in stress (p<0.05) to be associated with greater risk of ischemia in workingage T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03) remained an independent predictor of SMI. Conclusion: Prevalence of SMI in diabetic working-age patients was similar to that observed in studies of subjects over 65 years-old. Poststress LVEF drop ≥5% and NT-proBNP levels can contribute to more precise identification of SMI. Our data suggest that "aggressive" management strategy should be implemented to reduce the risk of cardiac events in T2DM patients of working-age.
<p>The comparison of the medians of the “admission-pPCI” interval between the reference gro... more <p>The comparison of the medians of the “admission-pPCI” interval between the reference group from 2015 and the analyzed group from 2016 when using STEMI communication technology (p = 0.144).<sup><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0205832#pone.0205832.s004" target="_blank">S2 S</a></sup></p
<p>The comparison of the share of secondary transportations between the reference group fro... more <p>The comparison of the share of secondary transportations between the reference group from 2015 and the analyzed group from 2016 when STEMI communication technology was used (p<0.001).<sup><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0205832#pone.0205832.s002" target="_blank">S2 A</a></sup></p
Objective: Minimal repolarization ECG changes are quite common in young sportsmen and are general... more Objective: Minimal repolarization ECG changes are quite common in young sportsmen and are generally considered as a benign condition due to cardiovascular adaptation to physical exercise resulting from increased vagal tone. Nevertheless, in some cases other conditions are reasonable and they may have[for full text, please go to the a.m. URL]
In these preliminary results, the OSA seems not be infl uence the aspirin response in patients wi... more In these preliminary results, the OSA seems not be infl uence the aspirin response in patients with diabetes.
protective effects in various models of hypertension. A single bolus of 3.0x108 transfection unit... more protective effects in various models of hypertension. A single bolus of 3.0x108 transfection units of lenti-Ang-(1-7) was injected into the left ventricle chamber of the heart in 5-day-old male Sprague-Dawley rats. At six weeks, MI was induced by ligating the left anterior descending coronary artery. After four weeks, echocardiography and hemodynamic parameters were measured to assess the cardiac function. Heart tissues were collected for histological assessment and subsequent mRNA determination. An in vitro hypoxia experiment was also carried out to test the effects of Ang-(1-7) on rat neonatal cardiac myocytes (RNCM). Ã =p < 0.05 respect to the other drug. Conclusions: According to our results Eprosartan improved much better than Atenolol LVDD in P with mild to moderate HTA having similar reduction of blood pressure levels in the two groups, suggesting that this could be a particular effect of Eprosartan on LVDD independently of HTA reduction. May be necessary other studies to clear better this question.
Objective: Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene ... more Objective: Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene (sodium channel, voltage gated, type V alpha subunit gene; 3p21) belongs to the family of cardiac sodium channel genes. Mutations in SCN5A gene lead to decreased Na+ current and ion unbalance. The SCN5A gene mutations are found in approximately 2% of patients with dilated cardiomyopathy (DCM), and they may be potential phenotype modifiers in hypertrophic cardiomyopathy (HCM). The role of SCN5A gene mutations in cardiomyopathy is not fully elucidated. Methods: Three selected exons (12, 20, and 21) of the SCN5A gene in the cohort of 58 East Slovak patients with dilated and HCM were analyzed by the Sanger sequencing method in order to detect etiopathogenic mutations associated with dilated and HCM. Results: The mutation screening of three selected exons of SCN5A gene in the cohort of 27 DCM, 12 HCM patients, and 16 controls identified 10 missense genetic variants. Three of them (T1247I, A1260D, and G1262S), all in exon 21 of the SCN5A gene, were potentially damaging and disease-causing variants. Conclusion: Data from this study demonstrate that SCN5A gene variants have important role in the etiopathogenesis of dilated and HCM.
Dilated cardiomyopathy (DCM) is a severe<br> cardiovascular disorder characterized by progr... more Dilated cardiomyopathy (DCM) is a severe<br> cardiovascular disorder characterized by progressive systolic<br> dysfunction due to cardiac chamber dilatation and inefficient<br> myocardial contractility often leading to chronic heart failure.<br> Recently, a genome-wide association studies (GWASs) on DCM<br> indicate that the ZBTB17 gene rs10927875 single nucleotide<br> polymorphism is associated with DCM. The aim of the study was to<br> identify the distribution of ZBTB17 gene rs10927875 polymorphism<br> in 50 Slovak patients with DCM and 80 healthy control subjects<br> using the Custom Taqman®SNP Genotyping assays. Risk factors<br> detected at baseline in each group included age, sex, body mass<br> index, smoking status, diabetes and blood pressure. The mean age of<br> patients with DCM was 52.9±6.3 years; the mean age of individuals<br> in control group was 50.3±8.9 years. The distribution of investigate...
The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabo... more The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well a...
Background: Hypertrophic cardiomyopathy is a heterogeneous myocardial disease. Mutations appearin... more Background: Hypertrophic cardiomyopathy is a heterogeneous myocardial disease. Mutations appearing in several genes might be a potential cause of the disease. The aim of the study was to analyze selected exons of the sarcomeric and non-sarcomeric genes, with the purpose to identify potential candidate genetic variants and to understand etiopathogenetic mechanisms of hypertrophic cardiomyopathy in East Slovak patients. Methods: This study recruited 23 unrelated patients with hypertrophic cardiomyopathy, namely, 13 men and 10 women (mean age of 58.09±15.82 years) and 25 healthy controls in order to determine the candidate sequence variants, in the selected exons of six cardiomyopathy genes (MYBPC3, MYH7, NEBL, SCN5A, TNNI3, TNNT2), by conventional capillary-based Sanger sequencing method and standard protocols. Results: Molecular genetic results confirmed the presence of 43 sequence variants in the selected exons of six cardiomyopathy genes, 58.14% of detected variants were novel. The majority of detected sequence variants were confirmed within exon 23 of MYH7 gene. Only 11 genetic alterations were predicted to be potentially pathogenic. Conclusions: In our study, we identified known and novel sequence variants in 23 unrelated patients with hypertrophic cardiomyopathy, but we did not observe any strong mutation hotspot. The results of our study assumed that exon 23 of MYH7 gene can be in potential affinity to hypertrophic cardiomyopathy in our cohort of patients. The sequence variants identified in this study may be further investigated in order to determine their functions in disease pathogenesis and improve management, diagnosis, and treatment in Slovak patients.
A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed... more A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed in preseason. He was found to be normostenic, acyanotic, normotensive with clear lungs and a regular pulse of 60 bp m, with normal dual heart sounds and a grade Levine 2/6 continuous diastolic murmu r in the second intercostal space of the left parasternal area. He had no family history of premature card iac death and his lipids were normal. Rest ECG showed a regular sinus rhythm of 62 bp m with inco mplete right bundle branch block and no significant ST-T changes. A transthoracic ECHO in parasternal short-axis view revealed an anomalous colour flow jet in diastole arising fro m the lateral wall into the main pulmonary artery and coronary artery fistula with non-significant left-to-right shunt (Qp/Qs ratio 1.2).came under suspicion. In contrast, it has not been confirmed clearly by the transoesophageal ECHO. Coronary angiography was without coronary stenosis and confirmed a 'serpentine' anomalous drainage supposedly from left anterior descending artery to the main pulmonary artery. A complex anato my of sacculary dilated fistula that originates fro m the pro ximal left anterio r descending artery and drainages the main pulmonary artery was showed in detail by a 64 slice MDCT scanning. Myocardial Tc-99m Myoview perfusion SPECT imag ing showed no perfusion defects in maximal physical stress and follo w-up without intervention was suggested. In addition, due to the results of holter ECG monitoring, head-up tilt testing, carotid sinus massage and programmed atrial stimulat ion syncope was concluded as vasovagal, but its nature still remains discussible. After a three year follow-up patient remains asympto matic and recently performed control myocardial perfusion SPECT showed no signs of stress related myocardial ischemia. In conclusion, several imaging techniques are needed for an accurate diagnosis of coronary fistula and for the suggestion of proper further management. In some cases syncope may be the first man ifestation of CAF, but it is still unclear if it is directly related to the coronary anomaly.
Introduction: The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood p... more Introduction: The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and predicted 10-year cardiovascular (CV) risk have been demonstrated in low CV risk countries. The Slovak Trial on Cardiovascular Risk Reduction Following National Guidelines with CaDUET ® (amlodipine besylate/atorvastatin calcium; Pfizer, Morrisville, PA, USA; STRONG DUET) study evaluated its clinical utility in Slovakia, one of the highest CV risk regions in Europe. Methods: This was a two-phase study involving 100 outpatient cardiologist and internist departments in Slovakia. Phase 1 assessed BP control and CV risk profiles in adults with treated hypertension, and phase 2 was an open-label, multicenter, observational study. In the phase 2 study, patients with treated but uncontrolled hypertension and three or more coronary heart disease risk factors received single-pill amlodipine/atorvastatin (5/10 or 10/10 mg) for 12 weeks. Major outcomes were the percentage of patients achieving target BP (≤140/90 mmHg) and/or LDL-C (≤3 mmol/L) and reductions in predicted 10-year CV risk. Results: Of the 4,672 phase 1 patients, 80.8% had uncontrolled hypertension and 61.4% had dyslipidemia. Of the 1,406 phase 2 patients, 90.3% of patients achieved target BP at week 12, 66.3% achieved target LDL-C, and 60.7% achieved both. The mean 10-year CV risk was reduced by 49% (P < 0.0001); treatment was well-tolerated and safe. Conclusion: Single-pill amlodipine/atorvastatin
Zdravje delovno aktivne populacije / Health of the Working-Age Population, Sep 15, 2017
Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in el... more Introduction: Data confirm a relatively high prevalence of silent myocardial ischemia (SMI) in elderly patients with type 2 diabetes mellitus (T2DM), while no data are available regarding working-age subjects (≤60 years). Methods: Medical records of 192 patients with T2DM aged ≤60 years (110 male patients; 57.3%), who had undergone myocardial perfusion imaging (MPI) between 2010 and 2014 followed by coronary angiography in case of abnormal result, were retrospectively analysed. Results: MPI was positive in 35 patients (18.2%); of those 31 (88.6%) had angiographically confirmed coronary stenosis. The positive predictive value of the MPI for predicting angiographic coronary stenosis in this age subgroup was 88.9%. Univariate analysis revealed post-stress LVEF drop ≥5% (p<0.03) and NT-proBNP levels detected in stress (p<0.05) to be associated with greater risk of ischemia in workingage T2DM patients. In multivariate analysis, LVEF drop ≥5% (p< 0.03) remained an independent predictor of SMI. Conclusion: Prevalence of SMI in diabetic working-age patients was similar to that observed in studies of subjects over 65 years-old. Poststress LVEF drop ≥5% and NT-proBNP levels can contribute to more precise identification of SMI. Our data suggest that "aggressive" management strategy should be implemented to reduce the risk of cardiac events in T2DM patients of working-age.
<p>The comparison of the medians of the “admission-pPCI” interval between the reference gro... more <p>The comparison of the medians of the “admission-pPCI” interval between the reference group from 2015 and the analyzed group from 2016 when using STEMI communication technology (p = 0.144).<sup><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0205832#pone.0205832.s004" target="_blank">S2 S</a></sup></p
<p>The comparison of the share of secondary transportations between the reference group fro... more <p>The comparison of the share of secondary transportations between the reference group from 2015 and the analyzed group from 2016 when STEMI communication technology was used (p<0.001).<sup><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0205832#pone.0205832.s002" target="_blank">S2 A</a></sup></p
Objective: Minimal repolarization ECG changes are quite common in young sportsmen and are general... more Objective: Minimal repolarization ECG changes are quite common in young sportsmen and are generally considered as a benign condition due to cardiovascular adaptation to physical exercise resulting from increased vagal tone. Nevertheless, in some cases other conditions are reasonable and they may have[for full text, please go to the a.m. URL]
In these preliminary results, the OSA seems not be infl uence the aspirin response in patients wi... more In these preliminary results, the OSA seems not be infl uence the aspirin response in patients with diabetes.
protective effects in various models of hypertension. A single bolus of 3.0x108 transfection unit... more protective effects in various models of hypertension. A single bolus of 3.0x108 transfection units of lenti-Ang-(1-7) was injected into the left ventricle chamber of the heart in 5-day-old male Sprague-Dawley rats. At six weeks, MI was induced by ligating the left anterior descending coronary artery. After four weeks, echocardiography and hemodynamic parameters were measured to assess the cardiac function. Heart tissues were collected for histological assessment and subsequent mRNA determination. An in vitro hypoxia experiment was also carried out to test the effects of Ang-(1-7) on rat neonatal cardiac myocytes (RNCM). Ã =p < 0.05 respect to the other drug. Conclusions: According to our results Eprosartan improved much better than Atenolol LVDD in P with mild to moderate HTA having similar reduction of blood pressure levels in the two groups, suggesting that this could be a particular effect of Eprosartan on LVDD independently of HTA reduction. May be necessary other studies to clear better this question.
Objective: Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene ... more Objective: Mutations in ion channels genes are potential cause of cardiomyopathy. The SCN5A gene (sodium channel, voltage gated, type V alpha subunit gene; 3p21) belongs to the family of cardiac sodium channel genes. Mutations in SCN5A gene lead to decreased Na+ current and ion unbalance. The SCN5A gene mutations are found in approximately 2% of patients with dilated cardiomyopathy (DCM), and they may be potential phenotype modifiers in hypertrophic cardiomyopathy (HCM). The role of SCN5A gene mutations in cardiomyopathy is not fully elucidated. Methods: Three selected exons (12, 20, and 21) of the SCN5A gene in the cohort of 58 East Slovak patients with dilated and HCM were analyzed by the Sanger sequencing method in order to detect etiopathogenic mutations associated with dilated and HCM. Results: The mutation screening of three selected exons of SCN5A gene in the cohort of 27 DCM, 12 HCM patients, and 16 controls identified 10 missense genetic variants. Three of them (T1247I, A1260D, and G1262S), all in exon 21 of the SCN5A gene, were potentially damaging and disease-causing variants. Conclusion: Data from this study demonstrate that SCN5A gene variants have important role in the etiopathogenesis of dilated and HCM.
Dilated cardiomyopathy (DCM) is a severe<br> cardiovascular disorder characterized by progr... more Dilated cardiomyopathy (DCM) is a severe<br> cardiovascular disorder characterized by progressive systolic<br> dysfunction due to cardiac chamber dilatation and inefficient<br> myocardial contractility often leading to chronic heart failure.<br> Recently, a genome-wide association studies (GWASs) on DCM<br> indicate that the ZBTB17 gene rs10927875 single nucleotide<br> polymorphism is associated with DCM. The aim of the study was to<br> identify the distribution of ZBTB17 gene rs10927875 polymorphism<br> in 50 Slovak patients with DCM and 80 healthy control subjects<br> using the Custom Taqman®SNP Genotyping assays. Risk factors<br> detected at baseline in each group included age, sex, body mass<br> index, smoking status, diabetes and blood pressure. The mean age of<br> patients with DCM was 52.9±6.3 years; the mean age of individuals<br> in control group was 50.3±8.9 years. The distribution of investigate...
The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabo... more The metabolic syndrome (MS) is a clustering of cardiovascular risk. The high prevalence of metabolic syndrome among populations of lower socioeconomic status is a cause of concern and calls for an effective public health response. The aim of this study was to determine the prevalence of metabolic syndrome in the Roma population compared with the non-Roma population in the eastern part of Slovakia and to determine the parameter which has the strongest association with metabolic syndrome. 123 Roma and 79 non-Roma patients with metabolic syndrome were evaluated. In the subgroup of Roma men, we found that waist circumference conferred the highest chance of MS (more than 12-times), followed by triglycerides (TG) (3.670-times). In the subgroup of non-Roma men, we found that waist circumference conferred the highest chance of MS (more than 16-times), followed by high-density lipoprotein (HDL) (4.348-times increased risk per one unit decrease in HDL). In the subgroup of Roma women as well a...
Background: Hypertrophic cardiomyopathy is a heterogeneous myocardial disease. Mutations appearin... more Background: Hypertrophic cardiomyopathy is a heterogeneous myocardial disease. Mutations appearing in several genes might be a potential cause of the disease. The aim of the study was to analyze selected exons of the sarcomeric and non-sarcomeric genes, with the purpose to identify potential candidate genetic variants and to understand etiopathogenetic mechanisms of hypertrophic cardiomyopathy in East Slovak patients. Methods: This study recruited 23 unrelated patients with hypertrophic cardiomyopathy, namely, 13 men and 10 women (mean age of 58.09±15.82 years) and 25 healthy controls in order to determine the candidate sequence variants, in the selected exons of six cardiomyopathy genes (MYBPC3, MYH7, NEBL, SCN5A, TNNI3, TNNT2), by conventional capillary-based Sanger sequencing method and standard protocols. Results: Molecular genetic results confirmed the presence of 43 sequence variants in the selected exons of six cardiomyopathy genes, 58.14% of detected variants were novel. The majority of detected sequence variants were confirmed within exon 23 of MYH7 gene. Only 11 genetic alterations were predicted to be potentially pathogenic. Conclusions: In our study, we identified known and novel sequence variants in 23 unrelated patients with hypertrophic cardiomyopathy, but we did not observe any strong mutation hotspot. The results of our study assumed that exon 23 of MYH7 gene can be in potential affinity to hypertrophic cardiomyopathy in our cohort of patients. The sequence variants identified in this study may be further investigated in order to determine their functions in disease pathogenesis and improve management, diagnosis, and treatment in Slovak patients.
A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed... more A 32-year-old active cyclist was referred fo r the evaluation because of syncope he had performed in preseason. He was found to be normostenic, acyanotic, normotensive with clear lungs and a regular pulse of 60 bp m, with normal dual heart sounds and a grade Levine 2/6 continuous diastolic murmu r in the second intercostal space of the left parasternal area. He had no family history of premature card iac death and his lipids were normal. Rest ECG showed a regular sinus rhythm of 62 bp m with inco mplete right bundle branch block and no significant ST-T changes. A transthoracic ECHO in parasternal short-axis view revealed an anomalous colour flow jet in diastole arising fro m the lateral wall into the main pulmonary artery and coronary artery fistula with non-significant left-to-right shunt (Qp/Qs ratio 1.2).came under suspicion. In contrast, it has not been confirmed clearly by the transoesophageal ECHO. Coronary angiography was without coronary stenosis and confirmed a 'serpentine' anomalous drainage supposedly from left anterior descending artery to the main pulmonary artery. A complex anato my of sacculary dilated fistula that originates fro m the pro ximal left anterio r descending artery and drainages the main pulmonary artery was showed in detail by a 64 slice MDCT scanning. Myocardial Tc-99m Myoview perfusion SPECT imag ing showed no perfusion defects in maximal physical stress and follo w-up without intervention was suggested. In addition, due to the results of holter ECG monitoring, head-up tilt testing, carotid sinus massage and programmed atrial stimulat ion syncope was concluded as vasovagal, but its nature still remains discussible. After a three year follow-up patient remains asympto matic and recently performed control myocardial perfusion SPECT showed no signs of stress related myocardial ischemia. In conclusion, several imaging techniques are needed for an accurate diagnosis of coronary fistula and for the suggestion of proper further management. In some cases syncope may be the first man ifestation of CAF, but it is still unclear if it is directly related to the coronary anomaly.
Introduction: The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood p... more Introduction: The efficacy and safety of single-pill amlodipine/atorvastatin for reducing blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and predicted 10-year cardiovascular (CV) risk have been demonstrated in low CV risk countries. The Slovak Trial on Cardiovascular Risk Reduction Following National Guidelines with CaDUET ® (amlodipine besylate/atorvastatin calcium; Pfizer, Morrisville, PA, USA; STRONG DUET) study evaluated its clinical utility in Slovakia, one of the highest CV risk regions in Europe. Methods: This was a two-phase study involving 100 outpatient cardiologist and internist departments in Slovakia. Phase 1 assessed BP control and CV risk profiles in adults with treated hypertension, and phase 2 was an open-label, multicenter, observational study. In the phase 2 study, patients with treated but uncontrolled hypertension and three or more coronary heart disease risk factors received single-pill amlodipine/atorvastatin (5/10 or 10/10 mg) for 12 weeks. Major outcomes were the percentage of patients achieving target BP (≤140/90 mmHg) and/or LDL-C (≤3 mmol/L) and reductions in predicted 10-year CV risk. Results: Of the 4,672 phase 1 patients, 80.8% had uncontrolled hypertension and 61.4% had dyslipidemia. Of the 1,406 phase 2 patients, 90.3% of patients achieved target BP at week 12, 66.3% achieved target LDL-C, and 60.7% achieved both. The mean 10-year CV risk was reduced by 49% (P < 0.0001); treatment was well-tolerated and safe. Conclusion: Single-pill amlodipine/atorvastatin
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