Cardiovascular disease, mainly through coronary artery disease (CAD), is the number one killer in... more Cardiovascular disease, mainly through coronary artery disease (CAD), is the number one killer in men and women in Europe even though most deaths and disabilities from CAD could be avoided by adopting healthy lifestyles. Because most CAD risk factors usually have no warning signs, continuous and intensive education on a healthy lifestyle at a population level is of enormous importance. The European Society of Cardiology (ESC), together with its National Cardiac Societies and the support of the European Union and other professional organizations, initiated the pan-European EuroHeart prevention project, with the aim of reducing the burden of CAD in Europe. The first year of the project clearly established the undisputable role of National Cardiac Societies in CAD prevention.
Background— During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term A... more Background— During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial, 2 doses of dabigatran etexilate were shown to be effective and safe for the prevention of stroke or systemic embolism in patients with atrial fibrillation. There is a need for longer-term follow-up of patients on dabigatran and for further data comparing the 2 dabigatran doses. Methods and Results— Patients randomly assigned to dabigatran in RE-LY were eligible for the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) trial if they had not permanently discontinued study medication at the time of their final RE-LY study visit. Enrolled patients continued to receive the double-blind dabigatran dose received in RE-LY, for up to 28 months of follow up after RE-LY (median follow-up, 2.3 years). There were 5851 patients enrolled, representing 48% of patients originally randomly assigned to receive dabi...
Background– The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial compared... more Background– The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial compared dabigatran 110 mg BID (D110) and 150 mg BID (D150) with warfarin for stroke prevention in 18 113 patients with nonvalvular atrial fibrillation. Methods and Results– Cardioversion on randomized treatment was permitted. Precardioversion transesophageal echocardiography was encouraged, particularly in dabigatran-assigned patients. Data from before, during, and 30 days after cardioversion were analyzed. A total of 1983 cardioversions were performed in 1270 patients: 647, 672, and 664 in the D110, D150, and warfarin groups, respectively. For D110, D150, and warfarin, transesophageal echocardiography was performed before 25.5%, 24.1%, and 13.3% of cardioversions, of which 1.8%, 1.2%, and 1.1% were positive for left atrial thrombi. Continuous treatment with study drug for ≥3 weeks before cardioversion was lower in D110 (76.4%) and D150 (79.2%) compared with warfarin (85.5%; P <0.01 for both...
The authors examined 112 subjects free from cardiac disease, with essential hypertension and myoc... more The authors examined 112 subjects free from cardiac disease, with essential hypertension and myocardial infarction. In all subjects a 12-lead ECG at rest was made as well as a polycardiographic and echocardiographic examination. The authors found that in the group of healthy subjects there is a direct significant linear correlation between the size of the systole of the left atrium and age. The size of the left atrium and the atrial filling fraction were significantly smaller in healthy subjects than in subjects with hypertension and myocardial infarction. The authors draw attention to the necessity to re-evaluate the accepted norm of left atrial size in patients with hypertension and myocardial infarction. The authors found that between the magnitude of the systole of the left atrium and the ejection fraction of the left ventricle a significant relationship of parabolic shape exists. The mentioned correlations suggest that with deterioration of left ventricular function the ratio o...
Twenty-nine patients with essential hypertension and thirty-seven without cardiac disease were ex... more Twenty-nine patients with essential hypertension and thirty-seven without cardiac disease were examined electrocardiographically, polycardiographically and echocardiographically. Both the proportion of the left atrial systole in the hemodynamics and the size of the left atrium were significantly greater in hypertonics compared to healthy subjects. The parameters of left ventricular systolic function did not differ significantly, the parameters of diastolic function were significantly lower in hypertonics. Evaluation of the size and function of the left atrium supplements the clinical assessment of the functional state of the left ventricle at a period of its normal global systolic function but diminished diastolic function. The insufficient informative value of the electrocardiographic criteria of changes in the size of the left atrium (so-called Morris's index) and of the presence of the 4th heart sound in evaluating the severity of hypertension is pointed out. Since the presen...
Of 815 patients referred for echocardiographic examination 77 were examined also by the transoeso... more Of 815 patients referred for echocardiographic examination 77 were examined also by the transoesophageal route. The most frequent reason were pathological processes where standard echocardiography provides relatively limited information as well as technically inadequate transthoracic examinations, if the echogenicity of the patient is low. The reasons for examination were complications of myocardial infarctions, a cardiac source of embolization bacterial endocarditis, congenital heart defects, cardiac formations, aortal disease and comatose conditions. Transthoracic echocardiography was positive in 25 cases (32.4%), transoesophageal echocardiography in 44 cases (57.1%). In 15 patients the transthoracic approach was not conclusive from the diagnostic aspect (19.5%). From the results ensues that transesophageal echocardiography has a ca 30% higher sensitivity than transthoracic echocardiography, the specificity being equal. The authors emphasize that the transoesophageal approach is t...
The review evaluates the contribution of transoesophageal echocardiography as to the improvement ... more The review evaluates the contribution of transoesophageal echocardiography as to the improvement of management of patients with atrial fibrillation. It emphasises the severity of fibrillation arrhythmia regarding the haemodynamic complications, but especially those arising from embolism causing significant morbidity and mortality, especially in the aged patients with organic heart diseases. An essential improvement in the imaging of the left atrium, but especially of its auricle has enabled a significant progress in the conception of the origin of thromboembolic complications after cardioversion of atrial fibrillation. The detection of thrombi in the left atrial auricle which had until now been impossible, enabled to postpone the patients, by use of transoesophageal echocardiography, for the considered cardioversion, thus reducing the risk of thromboembolism. On the other hand, the transoesophageal examination of the left atrial auricle by use of two-dimensional and doppler echocard...
The authors' own experience as well as literary information on stress echocardiography in dia... more The authors' own experience as well as literary information on stress echocardiography in diagnosis of ischemic heart disease is presented. Besides dynamic postexercise echocardiography, which they consider to be the most adequate form of stress echocardiography, the authors analyze the possibilities of so-called alternative approaches, i.e. dipyridamole echocardiographic test and the use of transesophageal atrial pacing. The results of the three echocardiographic stress modalities show that their overall informative value is comparable. The practical performance is most favorable in the pharmacologic test, the highest safety is warranted in transesophageal atrial pacing, and tolerance proved to be best in the dynamic postexercise test. On choosing the actual stress modality, the authors recommend to weigh the advantages against the drawbacks before deciding on the approach of choice in the given situation so as to obtain optimal results.
Cardiovascular disease, mainly through coronary artery disease (CAD), is the number one killer in... more Cardiovascular disease, mainly through coronary artery disease (CAD), is the number one killer in men and women in Europe even though most deaths and disabilities from CAD could be avoided by adopting healthy lifestyles. Because most CAD risk factors usually have no warning signs, continuous and intensive education on a healthy lifestyle at a population level is of enormous importance. The European Society of Cardiology (ESC), together with its National Cardiac Societies and the support of the European Union and other professional organizations, initiated the pan-European EuroHeart prevention project, with the aim of reducing the burden of CAD in Europe. The first year of the project clearly established the undisputable role of National Cardiac Societies in CAD prevention.
Background— During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term A... more Background— During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial, 2 doses of dabigatran etexilate were shown to be effective and safe for the prevention of stroke or systemic embolism in patients with atrial fibrillation. There is a need for longer-term follow-up of patients on dabigatran and for further data comparing the 2 dabigatran doses. Methods and Results— Patients randomly assigned to dabigatran in RE-LY were eligible for the Long-term Multicenter Extension of Dabigatran Treatment in Patients with Atrial Fibrillation (RELY-ABLE) trial if they had not permanently discontinued study medication at the time of their final RE-LY study visit. Enrolled patients continued to receive the double-blind dabigatran dose received in RE-LY, for up to 28 months of follow up after RE-LY (median follow-up, 2.3 years). There were 5851 patients enrolled, representing 48% of patients originally randomly assigned to receive dabi...
Background– The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial compared... more Background– The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial compared dabigatran 110 mg BID (D110) and 150 mg BID (D150) with warfarin for stroke prevention in 18 113 patients with nonvalvular atrial fibrillation. Methods and Results– Cardioversion on randomized treatment was permitted. Precardioversion transesophageal echocardiography was encouraged, particularly in dabigatran-assigned patients. Data from before, during, and 30 days after cardioversion were analyzed. A total of 1983 cardioversions were performed in 1270 patients: 647, 672, and 664 in the D110, D150, and warfarin groups, respectively. For D110, D150, and warfarin, transesophageal echocardiography was performed before 25.5%, 24.1%, and 13.3% of cardioversions, of which 1.8%, 1.2%, and 1.1% were positive for left atrial thrombi. Continuous treatment with study drug for ≥3 weeks before cardioversion was lower in D110 (76.4%) and D150 (79.2%) compared with warfarin (85.5%; P <0.01 for both...
The authors examined 112 subjects free from cardiac disease, with essential hypertension and myoc... more The authors examined 112 subjects free from cardiac disease, with essential hypertension and myocardial infarction. In all subjects a 12-lead ECG at rest was made as well as a polycardiographic and echocardiographic examination. The authors found that in the group of healthy subjects there is a direct significant linear correlation between the size of the systole of the left atrium and age. The size of the left atrium and the atrial filling fraction were significantly smaller in healthy subjects than in subjects with hypertension and myocardial infarction. The authors draw attention to the necessity to re-evaluate the accepted norm of left atrial size in patients with hypertension and myocardial infarction. The authors found that between the magnitude of the systole of the left atrium and the ejection fraction of the left ventricle a significant relationship of parabolic shape exists. The mentioned correlations suggest that with deterioration of left ventricular function the ratio o...
Twenty-nine patients with essential hypertension and thirty-seven without cardiac disease were ex... more Twenty-nine patients with essential hypertension and thirty-seven without cardiac disease were examined electrocardiographically, polycardiographically and echocardiographically. Both the proportion of the left atrial systole in the hemodynamics and the size of the left atrium were significantly greater in hypertonics compared to healthy subjects. The parameters of left ventricular systolic function did not differ significantly, the parameters of diastolic function were significantly lower in hypertonics. Evaluation of the size and function of the left atrium supplements the clinical assessment of the functional state of the left ventricle at a period of its normal global systolic function but diminished diastolic function. The insufficient informative value of the electrocardiographic criteria of changes in the size of the left atrium (so-called Morris's index) and of the presence of the 4th heart sound in evaluating the severity of hypertension is pointed out. Since the presen...
Of 815 patients referred for echocardiographic examination 77 were examined also by the transoeso... more Of 815 patients referred for echocardiographic examination 77 were examined also by the transoesophageal route. The most frequent reason were pathological processes where standard echocardiography provides relatively limited information as well as technically inadequate transthoracic examinations, if the echogenicity of the patient is low. The reasons for examination were complications of myocardial infarctions, a cardiac source of embolization bacterial endocarditis, congenital heart defects, cardiac formations, aortal disease and comatose conditions. Transthoracic echocardiography was positive in 25 cases (32.4%), transoesophageal echocardiography in 44 cases (57.1%). In 15 patients the transthoracic approach was not conclusive from the diagnostic aspect (19.5%). From the results ensues that transesophageal echocardiography has a ca 30% higher sensitivity than transthoracic echocardiography, the specificity being equal. The authors emphasize that the transoesophageal approach is t...
The review evaluates the contribution of transoesophageal echocardiography as to the improvement ... more The review evaluates the contribution of transoesophageal echocardiography as to the improvement of management of patients with atrial fibrillation. It emphasises the severity of fibrillation arrhythmia regarding the haemodynamic complications, but especially those arising from embolism causing significant morbidity and mortality, especially in the aged patients with organic heart diseases. An essential improvement in the imaging of the left atrium, but especially of its auricle has enabled a significant progress in the conception of the origin of thromboembolic complications after cardioversion of atrial fibrillation. The detection of thrombi in the left atrial auricle which had until now been impossible, enabled to postpone the patients, by use of transoesophageal echocardiography, for the considered cardioversion, thus reducing the risk of thromboembolism. On the other hand, the transoesophageal examination of the left atrial auricle by use of two-dimensional and doppler echocard...
The authors' own experience as well as literary information on stress echocardiography in dia... more The authors' own experience as well as literary information on stress echocardiography in diagnosis of ischemic heart disease is presented. Besides dynamic postexercise echocardiography, which they consider to be the most adequate form of stress echocardiography, the authors analyze the possibilities of so-called alternative approaches, i.e. dipyridamole echocardiographic test and the use of transesophageal atrial pacing. The results of the three echocardiographic stress modalities show that their overall informative value is comparable. The practical performance is most favorable in the pharmacologic test, the highest safety is warranted in transesophageal atrial pacing, and tolerance proved to be best in the dynamic postexercise test. On choosing the actual stress modality, the authors recommend to weigh the advantages against the drawbacks before deciding on the approach of choice in the given situation so as to obtain optimal results.
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Papers by Gabriel Kamenský