Compared with Western Europe, the decline in cardiovascular (CV) mortality has been delayed in former communist countries in Europe, including the Czech Republic. We have assessed longitudinal trends ...in major CV risk factors in the Czech Republic from 1985 to 2016/17, covering the transition from the totalitarian regime to democracy.
There were 7 independent cross-sectional surveys for major CV risk factors conducted in the Czech Republic in the same 6 country districts within the WHO MONICA Project (1985, 1988, 1992) and the Czech post-MONICA study (1997/98, 2000/01, 2007/08 and 2016/2017), including a total of 7,606 males and 8,050 females. The population samples were randomly selected (1%, aged 25-64 years).
Over the period of 31/32 years, there was a significant decrease in the prevalence of smoking in males (from 45.0% to 23.9%; p < 0.001) and no change in females. BMI increased only in males. Systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension, the proportion of individuals treated by antihypertensive drugs and consequently hypertension control improved in both genders. A substantial decrease in total cholesterol was seen in both sexes (males: from 6.21 ± 1.29 to 5.30 ± 1.05 mmol/L; p < 0.001; females: from 6.18 ± 1.26 to 5.31 ± 1.00 mmol/L; p < 0.001).
The significant improvement in most CV risk factors between 1985 and 2016/17 substantially contributed to the remarkable decrease in CV mortality in the Czech Republic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cardiovascular diseases are one of most frequent cause of morbidity and mortality in the world. There is an emerging need for integrated, non-invasive, and easy-to-use clinical tools to assess ...accurately cardiovascular system primarily in the preventative medicine. We present a novel design for a non-invasive pulse wave velocity (PWV) assessment method integrated in a single brachial blood pressure monitor allowing for up to 100 times more sensitive recording of the pressure pulsations based on a brachial occlusion-cuff (suprasystolic) principle. The monitor prototype with built-in proprietary method was validated with a gold standard reference technique SphygmoCor VX device. The blood pressure and PWV were assessed on twenty-five healthy individuals (9 women, age (37 ± 13) years) in a supine position at rest by a brachial cuff blood pressure monitor prototype, and immediately re-tested using a gold standard method. PWV using our BP monitor was (6.67 ± 0.96) m/s compared to PWV determined by SphygmoCor VX (6.15 ± 1.01) m/s. The correlation between methods using a Pearson's correlation coefficient was r = 0.88 (
< 0.001). The study demonstrates the feasibility of using a single brachial cuff build-in technique for the assessment of the arterial stiffness from a single ambulatory blood pressure assessment.
Background 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. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56,
<0.0001) than FFR (R=0.36,
<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64,
<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthase
+heme oxygenase-1
): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%),
=0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase-1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT03033810.
Background
Hypertension is the most common cardiovascular disease which substantially increases cardiovascular morbidity and mortality. Despite the broad availability of antihypertensive medication, ...control of hypertension is not satisfactory worldwide.
Objective
The study aim was to assess longitudinal trends in blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative population sample of the Czechia from 1985 to 2016/2017, focusing on sex differences.
Methods
A total of 7,606 men and 8,050 women aged 25–64 years were screened for major CV risk factors in seven independent cross-sectional surveys run consistently in the same six country districts of the Czechia between 1985 and 2016/2017. The population samples were randomly selected.
Results
Over a study period of 31/32 years, there was a significant decline in systolic and diastolic blood pressure in both sexes, whereas the prevalence of hypertension decreased only in women. There was an increase in hypertension awareness in both sexes over the entire study period with consistently higher rates in women. The proportion of individuals treated with antihypertensive drugs increased significantly in both sexes throughout the study, again with consistently higher rates in women. Control of hypertension increased significantly over the study period with consistently higher rates in women. The age-adjusted trends in blood pressure, prevalence, awareness, and treatment of hypertension were significantly different in men and women, always in favor of women. The age-adjusted trends in control of hypertension in treated patients were equally poor in both sexes.
Conclusion
There are significant differences in longitudinal trends in blood pressure, prevalence, awareness, treatment, and control of hypertension between men and women, always in favor of women except for the control of hypertension in treated patients, where it is equally poor in both sexes.
Background: Severe hypercholesterolemia is associated with an increase in the risk of developing atherosclerotic cardiovascular disease. The aim of this analysis was to assess longitudinal trends in ...severe dyslipidemia (defined as total cholesterol > 8 mmol/L or LDL-cholesterol > 5 mmol/L) in a representative population sample of the Czech Republic and to analyze the longitudinal trends in the basic characteristics of individuals with severe dyslipidemia. Methods: Seven independent cross-sectional surveys were organized in the Czech Republic to screen for major cardiovascular risk factors (from 1985 to 2015–2018). A total of 20,443 randomly selected individuals aged 25–64 years were examined. Results: The overall prevalence of severe dyslipidemia was 6.6%, with a significant downward trend from the fifth survey onwards (2000/2001). Over the study period of 30+ years, the individuals with severe dyslipidemia became older, increased in BMI, and did not change their smoking habits. Total cholesterol and non-HDL-cholesterol decreased significantly in both sexes throughout the duration of the study. Conclusions: Despite a significant improvement in lipids in the Czech Republic from 1985, substantially contributing to the decline in cardiovascular mortality, the number of individuals with severe dyslipidemia remained high, and in most cases, they were newly detected during our screening examinations and were thus untreated.
It is unclear how invasive resuscitative protocols may impact the time-dependent prognosis of out-of-hospital cardiac arrest (OHCA) resuscitations, or the relationship between intra-arrest transport ...and outcomes.
We performed a secondary analysis of the Prague OHCA Study, which randomized refractory OHCAs to “invasive” (intra-arrest transport for possible ECPR initiation) vs. “standard” resuscitation strategies (predominantly performed on-scene). Between groups, we compared outcomes of the initial resuscitation and 180- and 30-day favourable neurological outcomes (CPC 1-2), and within categories based on resuscitation duration (collapse-to-ROSC/ECPR interval). We plotted the dynamic probability of favourable outcomes with increasing durations of unsuccessful resuscitation.
Among invasive and standard groups, respectively: 34/124 (27%) vs. 58/132 (44%) had sustained ROSC (difference -17%, 95%CI -5.0, -28); 38/124 (31%) vs. 24/132 (18%) had 30-day favourable neurological outcomes (difference 12%; 95%CI 2.0, 23); and 39/124 (31%) vs. 29/132 (22%) had 180-day favourable neurological outcomes (difference 9.5%; 95%CI -1.3, 20). For favourable outcome cases: standard group resuscitation durations were right-skewed within the first 60 minutes; for the invasive group the distribution was bimodal, extending to 77 minutes. For invasive- and standard-treated cases, the probability of favourable outcomes among those in refractory arrest at 30 minutes was 28% and 7.6%, respectively; declining to 0% at 77 and 60 minutes.
In comparison to standard resuscitation, invasive strategy cases had fewer achieve sustained ROSC, however improved overall 30-day favourable neurological outcomes. While standard resuscitation yield was limited to <60 minutes, invasive protocols offer a second extended window of potential successful resuscitation.
Abstract only Introduction: Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) has poor outcome. Data about use of extracorporeal membrane oxygenation (ECMO) ...in PE are heterogenous and there is minimal evidence for its use in patients presenting with r-OHCA. Hypothesis: To describe in detail profile, initial settings of cardiac arrest (CA) and clinical course of patients with PE presenting with r-OHCA and its specifics in comparison to patients with r-OHCA of other cause. The special attention was paid to the use of ECMO and its potential benefit for patient prognosis. Methods: We reanalyzed subgroup of patients with PE from Prague OHCA study - a randomized control trial evaluating the effect of hyperinvasive approach including the use of ECMO in r-OHCA. Patients characteristics, the specifics of CA settings and the outcome were compared to the patients with other cause of r-OHCA. The neurologically favorable survival was then compared between PE patients randomized to Hyperinvasive and Standard arm of the study. Results: The PE was identified as a cause of CA in 24 (9.4 %) patients in Prague OHCA study. PE patients were more likely women (12 50 % vs 32 13.8 %) with non-shockable initial rhythm (23 95.8 % vs 77 33.2 %; P < 0.0001). The CA occurs more frequently after arrival of emergency medical service (14 58.3 %, vs 22 9.5 %; P < 0.0001), had shorter time to hospital admission (median in minutes IQR, 40 34.5-57.8 vs 54 46-64; P = 0.01) with more severe acidosis at admission (median pH IQR; 6.83 6.75-6.88 vs 6.98 6.82-7.14 P = 0.0008). The primary outcome of patients with PE - CPC 1 or 2 at 180 days - was significantly worse (2 8.3 % vs 66 28.4 %; P = 0.049). There was non-significant difference in primary outcome - CPC 1 or 2 at 180 days - between PE patients in Hyperinvasive (12 50%) and Standard arm of the study (2 16.7 % vs 0; P = 0.24). Conclusion: The initial profile of patients and the settings of CA in patients with r-OHCA and PE differs from patients with other CA cause and their prognosis is significantly worse. The Hyperinvasive approach did not improved outcome in this subgroup of patients.
Randomized data evaluating the impact of the extracorporeal cardiopulmonary resuscitation (ECPR) approach on long-term clinical outcomes in patients with refractory out-of-hospital cardiac arrest ...(OHCA) are lacking. The objective of this follow-up study was to assess the long-term clinical outcomes of the ECPR-based versus CCPR approach.
The Prague OHCA trial was a single-center, randomized, open-label trial. Patients with witnessed refractory OHCA of presumed cardiac origin, without return of spontaneous circulation, were randomized during ongoing resuscitation on scene to conventional CPR (CCPR) or an ECPR-based approach (intra-arrest transport, ECPR if ROSC is not achieved prehospital and immediate invasive assessment).
From March 2013 to October 2020, 264 patients were randomized during ongoing resuscitation on scene, and 256 patients were enrolled. Long-term follow-up was performed 5.3 (interquartile range 3.8-7.2) years after initial randomization and was completed in 255 of 256 patients (99.6%). In total, 34/123 (27.6%) patients in the ECPR-based group and 26/132 (19.7%) in the CCPR group were alive (log-rank P = 0.01). There were no significant differences between the treatment groups in the neurological outcome, survival after hospital discharge, risk of hospitalization, major cardiovascular events and quality of life. Of long-term survivors, 1/34 (2.9%) in the ECPR-based arm and 1/26 (3.8%) in the CCPR arm had poor neurological outcome (both patients had a cerebral performance category score of 3).
Among patients with refractory OHCA, the ECPR-based approach significantly improved long-term survival. There were no differences in the neurological outcome, major cardiovascular events and quality of life between the groups, but the trial was possibly underpowered to detect a clinically relevant difference in these outcomes. Trial registration ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
Abstract only Introduction: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) may increase the chance of survival. However, in brain death or donation after cardiac ...death scenario, ECPR may also become an important organ donor source. Hypothesis: We hypothesized that 1/ the implementation of ECPR into the daily routine of a high volume cardiac arrest centre might increase the availability of organ donors, and 2/ ECPR might assure the same long-term function of donated organs as non-ECPR care. Methods: We retrospectively evaluated pre-ECPR (2007-2011) and ECPR (2012-2020) periods in terms of donors recruited from the out-of-hospital and in-hospital cardiac arrest population. We assessed the number of donors referred, the number of organs harvested and their one- and five-year survival. Results: In the pre-ECPR period, 11 donors were referred, of which 7 were accepted. During the ECPR period, the number of donors increased to 80, of which 42 were accepted. The number of donated organs in respective periods were 18 and 119, corresponding to 3,6 vs 13,2 (p =0.033) organs per year harvested. One-year survival of transplanted organs was 94.4% vs 100%, and five-year survival was 94.4% vs 87,5%, in relevant periods. Survival of organs obtained from donors after CPR and ECPR at one year (98.9% vs 100%) and five years (90,2% vs 88.9%) was the same. Graft failure was not the cause of death in any single case. Conclusions: Establishing a high volume cardiac arrest/ECPR centre may lead to a higher number of potential and subsequently accepted organ donors. The length of survival of donated organs is high and comparable between ECPR vs non-ECPR cardiac arrest donors.
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