[Specific complications in the treatment with implantable cardioverter-defibrillators].

Background: Using implantable cardioverter-defibrillators in treatment of malignant ventricular arrhythmias revealed new complications specific to this therapy. Inappropriate therapy, arrhythmic storm and device related proarrhythmia belong to the most significant complications. The authors describe specific complications in a group of ICD patients, analyze their etiology and prognostic value.

[Diabetes mellitus and chronic heart failure].

Diabetes mellitus is one of the significant risk factors for many cardiovascular diseases. Diabetes mellitus is 3-4 times more frequent in patients with heart failure compared to patients without heart failure. Prognosis of patients with heart failure and diabetes mellitus is worse than prognosis of non-diabetic patients with the same left ventricular dysfunction.

Big endothelin in chronic heart failure: marker of disease severity or genetic determination?

The first objective of the study was to compare the levels of big endothelin and endothelin-1 and other noninvasive parameters used for evaluation of disease severity in patients with stable chronic heart failure (CHF). Endothelin-1 and big endothelin plasma concentrations were measured in 124 chronic heart failure patients. The second objective of the study was to prove an association between endothelin-1 and big endothelin plasma levels and two frequent polymorphisms in the endothelin-1 coding gene (6p21-23) -3A/-4A and G (8002) A in patients with chronic heart failure.

[Atrial fibrillation].

Atrial fibrilation is the most frequent arrhythmia, the occurrence increasing with age and associated diseases. The incidence at the age below 60 years is markedly lower than one per cent, whereas in persons above 80 years of age it exceeds six per cent. The occurrence in patients with heart failure is from 10% (NYHA II) up to 50% (NYHA IV).

Two MMP-2 promoter polymorphisms (-790T/G and -735C/T) in chronic heart failure.

Remodelling of extracellular matrix by activated matrix metalloproteinases is considered to contribute to progression of ventricle remodelling during chronic heart failure. The aim of this study was to associate two promoter polymorphisms, -790T/G and -735C/T, in the gene for matrix metalloproteinase (MMP)-2 (gelatinase A) with chronic heart failure (CHF). For this purpose, 164 patients (124 men, 40 women, median age 56 years, range 21-91 years) with CHF (functional class NYHA II-IV, ejection fraction median 25%, cardiothoracic index more than 50%) were compared with 196 control subjects without clinical signs of cardiovascular disease (131 men and 65 women, median age 56 years, range 27-84 years) in -790T/G and -735C/T MMP-2 genotype distributions and allelic frequencies.

Association of two angiotensinogen gene polymorphisms, M235T and G(-6)A, with chronic heart failure.

The aim of the study was to focus on the relationship between the angiotensinogen (AGT) gene polymorphisms, M235T and promoter G(-6)A, and chronic heart failure in the Czech population. A total of 158 patients with chronic heart failure (functional class NYHA II-IV, ejection fraction <40%, cardiothoracic index >50%) were compared with a control group of 200 subjects of similar age and sex distribution, without any personal history of cardiovascular diseases. The AGT gene polymorphisms were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods.

[The ECG and acute coronary syndromes in patients under 40 years of age--case reports of an obese smoker in comparison with an active female athlete].

The authors describe two cases of acute coronary syndrome by patients to the age of 40, of which anamnestical data and clinical manifestation were quite different. According to present recommendation of European Society of Cardiology neither one of them fulfilled standards for acute or created myocardial infarction. The discovery of ECG changes or echocardiographical findings lead to an introducing of coronarography examination that proved the important stenosis of coronary arteries and both cases were closed as a created (case 1) and acute (case 2) myocardial infarction.

Acute and 3-month treatment effects of candesartan cilexetil on hemodynamics, neurohormones, and clinical symptoms in patients with congestive heart failure.

Background: This study evaluated the short-term and long-term effects of the angiotensin II type 1 receptor antagonist candesartan cilexetil on hemodynamics, neurohormones, and clinical symptoms in patients with congestive heart failure (CHF).

Methods: In this multicenter, double-blind, parallel-group study, 218 patients with CHF (New York Heart Association class II or III) with impaired left ventricular function (ejection fraction < or =40%) and pulmonary capillary wedge pressure > or =13 mm Hg were randomly assigned to 12 weeks of treatment with placebo (n = 44) or candesartan cilexetil (2 mg [n = 45], 4 mg [n = 46], 8 mg [n = 39], or 16 mg [n = 44]) once daily after a 2-week placebo run-in period. Hemodynamic measurements were performed by right heart catheterization over a 24-hour period after single (day 1) and repeated (3-month) treatment with the study drug.

The double heterozygote of two endothelin-1 gene polymorphisms (G8002A and -3A/-4A) is related to big endothelin levels in chronic heart failure.

The aim of this study was to focus on the relationship among the associated genotypes of G (8002) A and -3A/-4A endothelin-1 (ET-1) gene polymorphisms and some clinical and/or biochemical parameters in Czech (Caucasian) patients with chronic heart failure. Included in the study were 103 patients with chronic heart failure (functional classes NYHA II-IV, ejection fraction < 40%). The ET-1 gene polymorphisms were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism methods.

[Acetylsalicylic acid (ASA)--is everything clear?].

The authors summarize results of trials with acetysalicyl acid (ASA) in patients with ischaemic heart disease and in particular with chronic cardiac failure. They draw attention to the relatively frequent use this drug in common practice, although so far not a single trial was completed which would prove the effect of acetylsalicyl acid on long-term mortality. The authors discuss also possible interactions of acetylsalicyl acid and ACE inhibitors which in retrospective analyses indicate possible veakening of the ACE-I when administered concurrently with ASA in cardiac failure.

[Big endothelin and chronic heart failure].

In a group of 124 patients the authors investigated the importance of assessment of plasma levels of big endothelin and endothelin 1 in patients with chronic heart failure as compared with other currently used non-invasive parameters. A six fold increase of plasma levels of both substances was found in patients in functional class NYHA IV as compared with patients in class NYHA II-III. But even patients in the milder stage of NYHA had twice as high values as compared with the standard of the healthy population.

[Ambulatory blood pressure monitoring in a young population].

Ambulatory twenty four hour blood pressure monitoring (ABPM) is an exact method, enabling by repeated measurements to create blood pressure profile, which shows a close correlation with end organ damage. Normal values were taken from clinical trials, where the mean age of probands was highly above 30 years. The aim of this trial was to determine mean values for ABPM in population aged 18-30 years and to create "normal values" for this population.

[Lipids and chronic heart failure].

The causes of chronic heart failure at the end of the 20th century are quite different from those 30 or 50 years ago. The last data from the Framingham study indicate that ischaemic heart disease and/or hypertension are the main cause in as many as 90% patients. The prevalence of chronic heart failure in European countries, 0.

First dose hypotension after angiotensin converting enzyme inhibitor captopril and angiotensin II blocker losartan in patients with acute myocardial infarction.

Background: First dose hypotension after the administration of an angiotensin-converting enzyme inhibitor in patients with acute myocardial infarction is one of the most important adverse events of this type of treatment. There is no information about first dose hypotension after angiotensin type 1-receptor blocker in this type of patient.

Aim: To compare the first dose responses to low dose captopril and losartan in patients with acute myocardial infarction.

[Imidazole receptor agonists--a new advance in the treatment of hypertension?].

Agonists of I1 imidazolin receptors are a new drug groups which was registered for the treatment of hypertension. Their antihypertensive action is comparable with current antihypertensives (hydrochlorothiazide, enalapril, atenolol, nifedipine retard) and causes a drop of the systolic BP by cca 15-20 mm Hg and a drop of the diastolic BP by 10-15 mm Hg with a probable normalization of the blood pressure in cca 60% patients with mild to moderate hypertension. Agonists of I1 imidazoline receptors are suitable in particular for the treatment of hypertension associated with metabolic syndrome.

[Beta-blockers in the treatment of chronic heart failure. How should results of clinical studies be introduced into clinical practice].

The long-term action of elevated catecholamine concentrations on the heart muscle causes a number of adverse effects from apoptosis to malignant arrhythmia or terminal failure of the cardiac pump. Recently completed mortality studies with beta-blockers (BB) in chronic heart failure CIBIS II and MERIT HF confirmed the conclusions of pilot studies with carvedilol that in stabilized chronic heart failure BB reduces the mortality rate as well as the need of hospital admission on account of deteriorating heart failure. Proper selection of patients for administration of BB is necessary, assessment of absolute and relative contraindications.

First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group.

Background: First-dose hypotension refers to an observed reduction in blood pressure after the administration of the first dose of ACE inhibitors in patients with congestive heart failure.

Aim: To compare the first-dose responses of low-dose enalapril and perindopril in patients with stable symptomatic chronic heart failure.

Methods: Single blind, randomised, multicenter, parallel, prospective study.

A comparison of intervention with losartan or captopril in acute myocardial infarction.

Aim Of Study: Angiotensin-converting enzyme (ACE) inhibitors prolong life, lower the progression of heart failure, and decrease the need for hospitalizations in patients after myocardial infarctions. It is still unclear whether these effects could also be achieved by blocking the angiotensin II (ATII) type 1 receptor.

Methods And Results: We randomized 201 patients with acute myocardial infarction treated with either direct angioplasty, thrombolysis, or heparin alone to the ACE inhibitor captopril or the ATII antagonist losartan.

Implantable left ventricular assist systems (LVAS): recent results. A report from a series of meetings sponsored by the Study Group on Advanced Heart Failure of the Working Group on Heart Failure.

Implantable left ventricular assist systems (LVAS) consist of implantable pumps with small control consoles and power sources that can be worn externally. These systems provide far greater patient mobility and independence than external pumps with bulky control consoles. Patients with implantable LVAS can be discharged from hospital and are able to return to work and resume active sports.

Effects of prostaglandin E1, dobutamine and placebo on hemodynamic, renal and neurohumoral variables in patients with advanced heart failure.

Excessive neurohumoral activity remains a major burden to the circulation of patients with advanced heart failure. Prostaglandin E1 (PGE1), a balanced i.v.

[Beta blockers in the treatment of chronic cardiac failure].

The authors present contemporary findings on the treatment with beta-blockers in patients with chronic heart failure. It is important to differentiate acute and chronic administration. The authors discuss theoretical prerequisites for the administration of beta-blockers in chronic heart failure.