Publications by authors named "Tomas Kovarnik"
Background: A considerable number of symptomatic patients leave the cardiac catheterization lab without a definitive diagnosis for their symptoms because no epicardial stenoses are found. The significance of disorders of coronary microvasculature and vasomotion as the cause of symptoms and signs of ischemia has only recently been appreciated. Today we have a wide spectrum of invasive coronary physiology tools but little is known about when and how these tools are used in clinical practice.
View Article and Find Full Text PDFBackground And Aim: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods And Results: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020.
Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.
View Article and Find Full Text PDFBackground: There is conflicting evidence on the role of acetylsalicylic acid (ASA) use in the development of cardiac allograft vasculopathy (CAV).
Methods: A nationwide prospective two-center study investigated changes in the coronary artery vasculature by highly automated 3-D optical coherence tomography (OCT) analysis at 1 month and 12 months after heart transplant (HTx). The influence of ASA use on coronary artery microvascular changes was analyzed in the overall study cohort and after propensity score matching for selected clinical CAV risk factors.
Background: Lipid-rich plaque covered by a thin fibrous cap (FC) has been identified as a frequent morphological substrate for the development of acute coronary syndrome. Optical coherence tomography (OCT) permits the identification and measurement of the FC. Near-infrared spectroscopy (NIRS) has been approved for detection of coronary lipids.
View Article and Find Full Text PDFAims: In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients.
Methods And Results: We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy.
Pancreatic ductal adenocarcinoma (PDAC), the most deadly solid malignancy, is typically detected late and at an inoperable stage. Early or incidental detection is associated with prolonged survival, but screening asymptomatic individuals for PDAC using a single test remains unfeasible due to the low prevalence and potential harms of false positives. Non-contrast computed tomography (CT), routinely performed for clinical indications, offers the potential for large-scale screening, however, identification of PDAC using non-contrast CT has long been considered impossible.
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- The Prague-17 trial compared bleeding events in patients with atrial fibrillation (AF) treated with left atrial appendage closure (LAAC) versus nonvitamin K anticoagulants (NOAC).
- During the study, which involved 402 high-risk AF patients over an average of 3.5 years, bleeding events were lower in the LAAC group (24 events) compared to the NOAC group (40 events).
- The findings suggest that LAAC is associated with reduced nonprocedural major and clinically relevant nonmajor bleeding events, particularly noting gastrointestinal bleeding as the most common type in both treatment groups.
Aims: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) is associated with poor outcomes. The role of extracorporeal cardiopulmonary resuscitation (ECPR) in this patient group is uncertain. This study aims to analyse clinical course, outcomes, and the effect of an invasive procedure, including ECPR, in a randomized population.
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- * A study involving over 16,600 STEMI patients found a 16% reduction in PPCI procedures in 2020 compared to 2019, with the elderly experiencing the most significant delays.
- * Consequently, there was a notable increase in 30-day mortality rates during the pandemic, particularly among older patients, attributed to longer ischemia times and treatment delays.
Article Synopsis
- The COVID-19 pandemic significantly reduced the number of primary percutaneous coronary interventions (PPCIs) for ST-segment elevation myocardial infarction (STEMI) patients by 16% in 2020 compared to 2019.
- Despite this reduction affecting both genders equally, 30-day mortality rates increased notably for female patients during the pandemic, while male patients did not show a significant change.
- The analysis highlights the importance of addressing gender-specific outcomes in cardiac care during public health crises.
Background: The association between genetic polymorphisms and early cardiac allograft vasculopathy (CAV) development is relatively unexplored. Identification of genes involved in the CAV process may offer new insights into pathophysiology and lead to a wider range of therapeutic options.
Methods: This prospective study of 109 patients investigated 44 single nucleotide polymorphisms (SNPs) within the susceptibility loci potentially related to coronary artery disease, carotid artery intima-media thickness (cIMT), and in nitric oxide synthase gene.
Article Synopsis
- The "smoking paradox" refers to lower mortality rates in smokers among STEMI patients, particularly in the context of modern primary PCI protocols during the COVID-19 pandemic.
- A large retrospective study revealed that among 16,083 STEMI patients, active smokers had better postprocedural blood flow and lower mortality rates compared to both non-smokers and previous smokers.
- The findings suggest that despite initial challenges in treatment, active smoking was linked to improved heart health outcomes in this patient population, indicating the need for further investigation into this unexpected relationship.
Article Synopsis
- The study aimed to identify imaging characteristics that predict the progression of stable coronary atherosclerotic lesions using optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
- Patients with stable coronary artery disease were analyzed at baseline and after 12 months, revealing that thicker fibrous caps (FC) significantly reduced the likelihood of plaque progression.
- The findings emphasized that thinner FCs and certain surface area measurements are linked to plaque progression, which could help in predicting disease progression in patients with coronary artery disease.
Background: Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes.
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- - The study examined how SARS-CoV-2 positivity affects outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI), using data from the ISACS-STEMI COVID-19 registry.
- - Results showed that SARS-CoV-2 positive patients were older, more likely to experience cardiogenic shock, and had worse post-procedural outcomes, including lower blood flow and increased need for thrombectomy.
- - Importantly, SARS-CoV-2 positivity was linked to higher in-hospital mortality (25.7% vs 7%) and significantly increased 30-day mortality rates (34.4% vs 8.5%), indicating that the virus
Background: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study.
View Article and Find Full Text PDFBackground The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave-free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips-Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase-1 were analyzed.
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- The study analyzed the medical records of 697 patients who suffered out-of-hospital cardiac arrest (OHCA) between January 2012 and December 2020 to assess coronary angiography (CAG) findings and interventions.
- Among the patients, 23% did not have return of spontaneous circulation (ROSC) upon hospital admission, and those without ROSC were generally younger and experienced longer resuscitation times compared to those with ROSC.
- Although patients without ROSC had higher rates of acute coronary occlusions, PCI was still performed effectively, resulting in a notable but lower 30-day survival rate of 24%, compared to 70% in those with ROSC.
Article Synopsis
- Out-of-hospital cardiac arrest (OHCA) has a low survival rate, and the effectiveness of an early invasive treatment approach compared to standard care is unclear.
- A randomized clinical trial in Prague involved 256 adults with OHCA to assess whether an invasive strategy improves neurologically favorable survival at 180 days.
- The trial was halted early for futility, showing that 31.5% of the invasive group had a good neurologic outcome compared to 22.0% in the standard care group.
Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment.
View Article and Find Full Text PDFBackground: The PRAGUE-17 (Left Atrial Appendage Closure vs Novel Anticoagulation Agents in Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) was noninferior to nonwarfarin direct oral anticoagulants (DOACs) for preventing major neurological, cardiovascular, or bleeding events in patients with atrial fibrillation (AF) who were at high risk.
Objectives: This study sought to assess the prespecified long-term (4-year) outcomes in PRAGUE-17.
Methods: PRAGUE-17 was a randomized noninferiority trial comparing percutaneous LAAC (Watchman or Amulet) with DOACs (95% apixaban) in patients with nonvalvular AF and with a history of cardioembolism, clinically-relevant bleeding, or both CHADS-VASc ≥3 and HASBLED ≥2.
Article Synopsis
- The study aimed to analyze how the COVID-19 pandemic impacted primary percutaneous coronary intervention (PPCI) procedures and patient outcomes for those with ST elevation myocardial infarction (STEMI) compared to the period before the pandemic.
- It involved a retrospective analysis of data from 16,674 patients across various regions, showing a significant decrease in PPCI procedures during the pandemic (16% reduction) along with increases in treatment delays and mortality rates.
- Findings highlight that older adults were particularly affected, and the increased time to treatment likely contributed to both in-hospital and 30-day mortality rates rising during the pandemic.
Article Synopsis
- SARS-CoV-2 infection in patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI is linked to increased thrombotic complications due to inflammation and endothelial dysfunction.
- In a study of 62 SARS-CoV-2 positive STEMI patients compared to 310 matched negative controls, the positive group showed significantly higher in-hospital mortality (29% vs 5.5%) and complications like stent thrombosis and heart failure.
- The findings highlight the need for careful management of STEMI patients infected with SARS-CoV-2, as they may experience worse outcomes compared to non-infected patients.