Lubomír Elbl

Late anthracycline cardiotoxicity protection by dexrazoxane (ICRF-187) in pediatric patients: echocardiographic follow-up.

BackgroundThe authors conducted a retrospective study to determine whether dexrazoxane (ICRF-187) would reduce late anthracycline-induced cardiotoxicity in patients treated in childhood for hematological malignancy.Patients and methodsThe authors examined 108 patients (63 male, 45 female) 5–29 years old, (median 15 years). All patients were in long-term remission of their malignancy. The cardioprotection was given to 68 patients (39 male, 29 female), and standard treatment was used in 40 patients (24 male, 16 female). Dexrazoxane (cardioxane, Chiron Company, The Netherlands) was given in 20:1 ratio to anthracycline. The follow-up time was 2–20 years (mean 7 years). The control group consisted of 41 volunteers (22 males, 19 females) 4–31 years old (median 18 years). The cardiotoxicity has been defined as the presence of heart failure or the decline of shortening fraction below 30% or ejection fraction (EF) below 55%. The end-systolic wall stress (ESS), myocardial performance index (MPI; Tei index), and parameters of left ventricular diastolic filling were also assessed.ResultsThe anthracycline cardiomyopathy with the presence of heart failure was diagnosed in only one patient treated with a standard regimen. The pathological decline of fractional shortening was present in three (5%) and six (15%) patients with and without cardioprotection given, respectively. Similarly, none of the patients with cardioprotection revealed a pathological value of EF, while four (10%) patients without cardioprotection showed an EF decrease. Finally, ESS and isovolumic relaxation time were pathologically increased in the group without cardioprotection in comparison to the controls and to the group with cardioprotection. However, the MPI was significantly increased in both groups of patients.ConclusionsDexrazoxane reduces the risk of late clinical and subclinical cardiotoxicity and does not affect the response rates to chemotherapy and overall survival during the median follow-up period of 7 years (follow-up period 2–20 years).

Cardiopulmonary exercise testing in the evaluation of functional capacity after treatment of lymphomas in adults

The present study assessed several parameters of cardiopulmonary function in patients, after treatment for aggressive non-Hodgkins lymphoma and Hodgkins disease, to determine the influence of these parameters on patients performance status. One hundred and six patients (66 male and 40 female) aged 40 ± 15 years were examined 1–2 years (median 14 months) after anticancer treatment. The patients were examined by means of rest and dynamic stress echocardiography and cardiopulmonary exercise. The rest and post-exercise ejection fraction (EF), Doppler parameters of left ventricular diastolic function and peak oxygen consumption (pVO2) were used as parameters of cardiopulmonary performance. The cumulative dose (CD) of doxorubicin (DOX) given was 240 ± 70 (240 mg/m2). Thirty-seven percent of patients received mediastinal irradiation in accordance with the used treatment protocol. Sixty-four patients (60%) experienced fatigue after the treatment. Three patients (3%) demonstrated an decreased EF <50%, 34 (32%) demonstrated impaired diastolic function, 14 (13%) demonstrated decreased pVO2<20 ml/kg/min and 15 (14%) demonstrated a value of pVO2 below the reference value, respectively. None of the patients exhibited clinical signs of heart failure. Apart from three patients with a rest EF<50%, all the other patients responded to stress echocardiography with an increment of EF > 5%. The parameter pVO2 significantly correlated with stress EF (0.58, P < 0.0002). A significant relationship was found with all parameters of diastolic function: to index E/A of diastolic filling (r = 0.67, P < 0.0001), isovolumic relaxation time (r = −0.56, P < 0.0009) and to deceleration time (r = −0.54, P < 0.009), respectively. A negative relationship was found with age (r = −0.74, P < 0.0001), CD of DOX (r = −0.53, P < 0.003) and radiotherapy-involving mediastinum (r = − 0.44, P < 0.04), respectively. Using multivariate analysis, a significant relationship was found between pVO2 and parameters of diastolic filling, age, female sex and CD of DOX, respectively (r = 0.58, P < 0.0001). Diastolic dysfunction was correlated with age, CD of DOX and radiotherapy-involving mediastinum, respectively (r = 0.51, P < 0.01). The results show that diastolic dysfunction was the most affected parameter of cardiopulmonary function in cancer survivors. This parameter negatively influenced cardiopulmonary performance and was significantly correlated with the cumulative dose of doxorubicin given and radiotherapy on mediastinum. Despite a high number of patients experiencing fatigue, the study demonstrates that only a relatively small number of patients show a depressed pVO2 on a cardiopulmonary stress test and other cardiac abnormalities. The results of the tests support the introduction of regular aerobic exercise for cancer survivors to increase their cardiopulmonary performance and well-being. Hypothetically, aerobic training may also positively influence diastolic function. However, this assumption warrants a prospective follow-up.

Modeling effect of the septic condition and trauma on C-reactive protein levels in children with sepsis: a retrospective study.

IntroductionSepsis is the main cause of morbidity and mortality in intensive care units and its early diagnosis is not straightforward. Many studies have evaluated the usefulness of various markers of infection, including C-reactive protein (CRP), which is the most accessible and widely used. CRP is of weak diagnostic value because of its low specificity; a better understanding of patterns of CRP levels associated with a particular form of infection may improve its usefulness as a sepsis marker. In the present article, we apply multilevel modeling techniques and mixed linear models to CRP-related data to assess the time course of CRP blood levels in association with clinical outcome in children with different septic conditions.MethodsWe performed a retrospective analysis of 99 patients with systemic inflammatory response syndrome, sepsis, or septic shock who were admitted to the Pediatric Critical Care Unit at the University Hospital, Brno. CRP blood levels were monitored for 10 days following the onset of the septic condition. The effect of different septic conditions and of the surgical or nonsurgical diagnosis on CRP blood levels was statistically analyzed using mixed linear models with a multilevel modeling approach.ResultsA significant effect of septic condition and diagnosis on the course of CRP levels was identified. In patients who did not progress to septic shock, CRP blood levels decreased rapidly after reaching peak values – in contrast to the values in patients with septic shock in whom CRP protein levels decreased slowly. Moreover, CRP levels in patients with a surgical diagnosis were higher than in patients with a nonsurgical condition. The magnitude of this additional elevation in surgical patients did not depend on the septic condition.ConclusionUnderstanding the pattern of change in levels of CRP associated with a particular condition may improve its diagnostic and prognostic value in children with sepsis.

Exercise intensity prescription after myocardial infarction in patients treated with beta-blockers.

PURPOSE The aim of our study was to answer the following questions: (1) Is it possible to estimate the exercise training intensity according to heart rate in patients treated with beta-blockers after myocardial infarction? and (2) Are there any other appropriate alternate possibilities to estimate the training intensity? METHODS This study involved 112 men (60.2 +/- 8.6 years) with a previous myocardial infarction treated with beta-blockers. Patients underwent exercise echocardiography and also completed a symptom-limited cardiopulmonary ramp test to determine peak exercise capacity, maximal heart rate, heart rate (HR) at the anaerobic threshold (AT), peak oxygen uptake (VO2peak) VO2 consumption at AT, and exercise capacity at AT. RESULTS The mean value of HR at AT was 104.7 +/- 13.3 bpm, corresponding to 81.0% +/- 8% of VO2peak and 87.9% +/- 5.6% of HRpeak. The mean HR at 80% HRpeak was 96 +/- 13.7 bpm, at 70% heart rate reserve (HRR) 103.3 +/- 13.1 bpm and at 80% HRR 108 +/- 14.4 bpm. A close correlation was observed between HR at AT and values at 80% HRpeak (r = 0.86, P < .01). A similar correlation was found also for 70% and 80% HRR (r = 0.87 and 0.88, respectively, P < .01). Exercise intensity at AT occurred close to the value of 1 W/kg(bodyweight). CONCLUSIONS As an upper limit in determining training intensities, the assessment of AT is the gold standard. However, findings suggest that %HRpeak, %HRR, and %VO2peak can be used alternatively. The use of workload expressed as in W/kg also appears useful.

Relation between the insertion/deletion polymorphism in the gene coding for receptor associated protein (RAP) and plasma apolipoprotein AI (apoAI) and high-density lipoprotein cholesterol (HDL) levels.

In summary, the presented data indicate that a common polymorphism in the LRPAP1 gene coding for RAP is associated with variations in the plasma concentration of apoAI and HDL in Czech CAD patients.

Apolipoprotein B signal peptide polymorphism in relation to lipids and diabetes in male CAD patients

Our findings show that the apo B Ins/Del polymorphism affects plasma lipoprotein and apolipoprotein levels in male CAD patients and that the Ins allele is associated with the type II diabetes mellitus in these patients with a marginal significance.

392 Echocardiographic assessment of coronary flow reserve in patients with borderline stenosis of LAD. Comparison with exercise echocardiography

Backgrounds and Objectives: The effects of smoking on coronary blood flow has not been well evaluated. Coronary blood flow velocity (CFV) can be measured directly with transthoracic Doppler echocardiography (TTDE) and conducted immediately after smoking. The purpose of this study was to evaluate the chronic and acute effects of smoking on CFV and coronary blood flow reserve (CFR). Methods: The study population consisted of 20 healthy men (11 smokers and 9 non-smokers). None of this study participants had a history of cardiovascular disease or other risk factors for coronary artery disease except smoking. Smoking was abstained at least 4 hours before study in smokers. CFV was measured at the distal left anterior descending coronary artery by TTDE at baseline and during intravenous adenosine infusion (140ug/kg/min) in all subjects. In smokers, immediately after two consecutive cigarettes smoking, CFV was measured repeatedly at baseline and during adenosine infusion. CFR after smoking was corrected with rate pressure product (RPP) because of marked alteration of heart rate and blood pressure after smoking. Results: Before smoking, CFR and coronary vascular resistance index (CVRI) did not differ between non-smokers and smokers (CFR:3.5 ± 0.8 vs 3.6 ± 0.6, p>0.05, CVRI:0.28 vs 0.28, p>0.05). The acute effect of smoking on coronary blood flow is shown below.