National Cardiovascular Institute

Bratislava, Slovakia

National Cardiovascular Institute

Bratislava, Slovakia
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Bacova B.,Slovak Academy of Sciences | Sec P.,Slovak Academy of Sciences | Radosinska J.,Comenius University | Certik M.,Slovak University of Technology in Bratislava | And 2 more authors.
Physiological Research | Year: 2013

Polyunsaturated omega-3 fatty acids (ω-3 PUFA) are important components of cell membrane affecting its function and their deficiency is deleterious to health. We have previously shown that spontaneously hypertensive rats (SHR) are prone to lifethreatening arrhythmias that are reduced by ω-3 PUFA intake. Purpose of this study was to explore plasma and red blood cells (RBC) profile of ω-3 and ω-6 PUFA as well as to determine ω-3 index, a risk factor for sudden cardiac death, in aged SHR and the effect of ω-3 PUFA intake. Male and female 12-month-old SHR and age-matched Wistar rats fed with ω-3 PUFA (200 mg/kg BW/day/2 month) were compared with untreated rats. Composition of ω-3 PUFA: alfa linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as well as ω-6 PUFA: linoleic acid and arachidonic acid was analyzed by gas chromatography. Results showed sex- and strain-related differences of basal ω-3 and ω-6 PUFA levels in plasma and RBC as well as in response to ω-3 PUFA intake. Comparing to Wistar rats ω-3 index, expressed as a percentage of EPA+DHA of total fatty acids, was lower in SHR and it increased due to consumption of ω-3 PUFA. Findings support our hypothesis that lower ω-3 index may be also a marker of increased propensity of the hypertensive rat heart to malignant arrhythmias.

Goncalvesova E.,National Cardiovascular Institute
Acta Facultatis Pharmaceuticae Universitatis Comenianae | Year: 2013

Pulmonary arterial hypertension (PAH) is a rare disease with average median survival rate about 3 years from the establishment of the diagnosis, except for PAH associated with congenital heart diseases. Diagnosis and management of PAH concentrate in the dedicated centres (reference centres, centres of expertise). The purpose of a reference centre is to undertake assessment and investigation of all causes of pulmonary hypertension, PAH-specific drug therapy, cooperation with other healthcare specialist, and to undertake research and education. In general, high volume centres achieve best outcomes, because of effective concentration of the specific experience and skills needed for rare disease management. The paper brings brief characteristic of the reference centre for PAH according the guideline of European Society of Cardiology as well as own experience in this field.

Goncalvesova E.,National Cardiovascular Institute
Cor et Vasa | Year: 2013

Growing population of advanced heart failure patients represents one of the major burden for health care system. Heart transplantation is the gold standard for a severe HF but contraindications and lack of donors are ultimate hurdles for its widespread use. Heart replacement using durable mechanical circulatory support, e.g. continuous-flow left ventricular assist devices (LVAD), has grown fast in recent years. It is reasonable to assume that the number of LVAD implantations will continue to grow and will soon exceed the number of HTx. The review is intended to provide essential information on the results of clinical trials with continuous flow left ventricular assist devices, indications and implantation timing. General and specific risks of LVAD surgery, short and long term courses are described, and risk assessment is outlined. © 2013 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Hlivak P.,Institute for Clinical and Experimental Medicine | Hlivak P.,National Cardiovascular Institute | Mlcochova H.,Institute for Clinical and Experimental Medicine | Peichl P.,Institute for Clinical and Experimental Medicine | And 3 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2011

Robotic Navigation in Ablation of Paroxysmal AF. Introduction: Remote navigation systems represent a novel strategy for catheter ablation of atrial fibrillation (AF). The goal of this study is to describe a single-center experience with the electromechanical robotic system (Sensei, Hansen Medical) in treatment of patients with paroxysmal AF. Methods: Out of 200 patients who underwent robotically guided ablation for AF between 2007 and 2009 at our institute, 100 patients (29 women, age 56.5 ± 10 years) had paroxysmal AF refractory to antiarrhythmic drugs. Electroanatomic mapping using NavX system (St. Jude Medical) provided anatomical shell for subsequent circumferential ablation with robotic catheter (Artisan) loaded with a 3.5-mm, open-irrigation, cooled-tip ablation catheter. Results: A mean of 69 radiofrequency current applications (duration 2082 ± 812 seconds) were delivered to achieve circumferential electrical isolation of pulmonary venous antra. Total procedural time reached 222 ± 54 minutes. The mean fluoroscopic time was 11.9 ± 7.8 minutes. There were no major procedure-related complications. After a median follow-up of 15 months (range 3-28 months), 63% of the patients were free from any atrial arrhythmias ≥ 30 seconds after the single procedure. Success rate increased to 86% after 1.2 procedures. Multivariate analysis revealed that only predictor of recurrent AF/AT was shorter overall procedural time (207 ± 36 vs 236 ± 64 minutes in patients with and without recurrences, respectively, P = 0.0068). Conclusions: This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow-up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium. (J Cardiovasc Electrophysiol, Vol. 22, pp. 534-540 May 2011) © 2010 Wiley Periodicals, Inc.

Radosinska J.,Slovak Academy of Sciences | Radosinska J.,Comenius University | Bacova B.,Slovak Academy of Sciences | Knezl V.,Slovak Academy of Sciences | And 7 more authors.
Journal of Hypertension | Year: 2013

Objective: Hypertension-induced myocardial remodeling is known to be associated with increased risk for malignant arrhythmias and alterations in electrical coupling protein, connexin-43 (Cx43), may be involved. We investigated whether omega-3 fatty acids intake affects abnormalities of Cx43 as well as protein kinase C (PKC) signaling and myosin heavy chain (MyHC) profile at the early and late stage of hypertension in the context of the heart's susceptibility to ventricular fibrillation and ability to restore sinus rhythm. Methods: Untreated young and old male spontaneously hypertensive rats (SHRs) and age-matched normotensive rats were compared with animals supplemented by omega-3 (eicosapentaneoic acid Rdocosahexaneoic acid, 200 mg/kg body weight/day) for 2 months. Left ventricular tissues were taken for examination of subcellular integrity of gap junctions, Cx43 mRNA and protein expression, PKCe and PKCδ as well as MyHC determination. Electrically inducible ventricular fibrillation and sinus rhythm restoration (SRR) were examined on Langedorff-perfused heart preparation. Results: Omega-3 intake significantly reduced cardiovascular risk factors, suppressed inducible ventricular fibrillation, and facilitated SRR in hypertensive rats. Supplementation attenuated lateralization and internalization of Cx43, suppressed elevated Cx43 mRNA, enhanced total Cx43 protein expression and/or expression of its functional phosphorylated forms as well as the expression of cardioprotective PKC-ε and suppressed pro-apoptotic PKC-δ isoform. Moreover, the omega-3 diet normalized MyHC profiles in SHR at early stage of disease and old nonhypertensive rats, but failed to do so in old SHR at late stage of disease. Conclusion: Findings suggest that amelioration of myocardial Cx43-related abnormalities, positive modulation of PKC pathways, and normalization of MyHC can significantly contribute to the antiarrhythmic effects of omega-3 in rat model mimicking human essential hypertension. Our results support the prophylactic use of omega-3 to minimize cardiovascular risk and sudden arrhythmic death. © 2013 Wolters Kluwer Health Lippincott Williams & Wilkins.

Altaner C.,Slovak Academy of Sciences | Altaner C.,St Elisabeth Cancer Institute | Altanerova V.,Slovak Academy of Sciences | Altanerova V.,St Elisabeth Cancer Institute | And 7 more authors.
PLoS ONE | Year: 2013

Background:Application of autologous bone marrow mononuclear cells to "no option" patients with advanced critical limb ischemia (CLI) prevented major limb amputation in 73% patients during the 6-month follow-up. We examined which properties of bone marrow stromal cells also known as bone-marrow derived mesenchymal stem cells of responding and non-responding patients are important for amputation-free survival.Methods and Findings:Mesenchymal stem cells of 41 patients with CLI unsuitable for revascularisation were isolated from mononuclear bone marrow concentrate used for their treatment. Based on the clinical outcome of the treatment, we divided patients into two groups: responders and non-responders. Biological properties of responders' and non-responders' mesenchymal stem cells were characterized according to their ability to multiply, to differentiate in vitro, quantitative expression of cell surface markers, secretion of 27 cytokines, chemokines and growth factors, and to the relative expression of 15 mesenchymal stem cells important genes. Secretome comparison between responders (n=27) and non-responders (n=14) revealed significantly higher secretion values of IL-4, IL-6 and MIP-1b in the group of responders. The expression of cell markers CD44 and CD90 in mesenchymal stem cells from responders was significantly higher compared to non-responders (p<0.01). The expression of mesenchymal stem cells surface markers that was analyzed in 22 patients did not differ between diabetic (n=13) and non-diabetic (n=9) patient groups. Statistically significant higher expression of E-cadherin and PDX-1/IPF1 genes was found in non-responders, while expression of Snail was higher in responders.Conclusions:The quality of mesenchymal stem cells shown in the expression of cell surface markers, secreted factors and stem cell genes plays an important role in therapeutic outcome. Paracrine mechanisms are main drivers in the induction of reparatory processes in CLI patients. Differences in mesenchymal stem cells properties are discussed in relation to their involvement in the reparatory process. © 2013 Altaner et al.

Solik P.,National Cardiovascular Institute | Lesny P.,National Cardiovascular Institute | Luknar M.,National Cardiovascular Institute | Varga I.,National Cardiovascular Institute | Goncalvesova E.,National Cardiovascular Institute
Bratislava Medical Journal | Year: 2013

Pulmonary arterial hypertension (PAH) is a disease characterised by a gradual increase in resistance of pulmonary circulation leading to right ventricular failure and death. In only 10 % of cases, there is a response to acute vasoreactivity testing with a significant reduction in mean pulmonary artery pressure (PAP), while in this group of patients, less than one half of cases benefit from long-term treatment with calcium channel blockers (CCB). This paper describes a case report of a young patient with dyspnoea and suspicion of pulmonary hypertension who was referred to a specialised centre. The complex evaluation of her clinical state led to confirmed diagnosis of idiopathic pulmonary arterial hypertension (IPAH). Because there was a positive response to vasoreactivity testing, the treatment for IPAH was initiated with a high dose of CCB. This treatment markedly improved her clinical state as well as echocardiographic and hemodynamic findings. In this study, the authors present a diagnostic algorithm in pulmonary hypertension and emphasise the role of CCB in treatment of PAH in carefully selected patients.

HlivUk P.,Institute for Clinical and Experimental Medicine | HlivUk P.,National Cardiovascular Institute | Peichl P.,Institute for Clinical and Experimental Medicine | CihUk R.,Institute for Clinical and Experimental Medicine | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2012

Catheter Ablation of Idiopathic Ventricular Tachycardia. We present a 34-year-old woman with idiopathic ventricular tachycardia that resisted 2 previous attempts for catheter ablation and was successfully ablated in the myocardial extension within the noncoronary aortic cusp. © 2011 Wiley Periodicals, Inc.

PubMed | Adolescent Clinic, Slovak Medical University and National Cardiovascular Institute
Type: Journal Article | Journal: Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia | Year: 2016

Patients with advanced heart failure (HF) represent a pool of candidates for heart transplantation and long-term mechanical circulatory support devices. The aim of our study was to determine simple and reliable markers of one-year mortality for selection of the most suitable patients for heart replacement therapy.One thousand consecutive patients with HF (mean age 49 10.9 years; 86.8% males) referred to a single tertiary centre from January 1998 to January 2010 in order to assess the indication for heart transplantation were enrolled. Kaplan-Meier survival analysis was performed. Independent mortality predictors were established using logistic regression analysis. The mean follow-up was 4.3 2.7 years (range 1-12 years). Cumulative survival was as follows: 1-year survival 83%, 3-year 63%, 5-year 50%, 7-year 39%, and 10-year 23%. Independent predictors of 1-year mortality included coronary artery disease, left ventricular diastolic diameter >79 mm, plasma sodium <135 mmol/L, the need for intravenous treatment at hospital admission (diuretics and/or inotropes), and furosemide dose at discharge >240 mg/day.Short-term prognosis of HF patient can be estimated based on simple parameters. Patients with signs of poor prognosis should be referred to tertiary centres to be considered for heart replacement therapy.

PubMed | Semmelweis University, University of Zürich, Medical University of Graz, National and Kapodistrian University of Athens and 24 more.
Type: Journal Article | Journal: European journal of heart failure | Year: 2016

The European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT-R) was set up with the aim of describing the clinical epidemiology and the 1-year outcomes of patients with heart failure (HF) with the added intention of comparing differences between participating countries.The ESC-HF-LT-R is a prospective, observational registry contributed to by 211 cardiology centres in 21 European and/or Mediterranean countries, all being member countries of the ESC. Between May 2011 and April 2013 it collected data on 12440 patients, 40.5% of them hospitalized with acute HF (AHF) and 59.5% outpatients with chronic HF (CHF). The all-cause 1-year mortality rate was 23.6% for AHF and 6.4% for CHF. The combined endpoint of mortality or HF hospitalization within 1year had a rate of 36% for AHF and 14.5% for CHF. All-cause mortality rates in the different regions ranged from 21.6% to 36.5% in patients with AHF, and from 6.9% to 15.6% in those with CHF. These differences in mortality between regions are thought reflect differences in the characteristics and/or management of these patients.The ESC-HF-LT-R shows that 1-year all-cause mortality of patients with AHF is still high while the mortality of CHF is lower. This registry provides the opportunity to evaluate the management and outcomes of patients with HF and identify areas for improvement.

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