Petr Němec

Detection of Cardiobacterium valvarum in a patient with aortic valve infective endocarditis by broad-range PCR.

Cardiobacterium valvarum, a fastidious Gram-negative bacterium, was detected in the aortic valve of a previously healthy 63-year-old man by broad-range PCR and 16S rRNA gene sequencing. In contrast to the patients in five previously published cases, our patient had neither a congenital bicuspid nor a prosthetic aortic valve. Here, we present a case of C. valvarum native tricuspid aortic valve infective endocarditis and a review of the literature.

Embolus Entrapped in Patent Foramen Ovale: Impending Paradoxical Embolism

An impending paradoxical embolism is a rare finding, with fewer than 200 cases being documented so far. A 68-year-old woman, who presented with 3 weeks of increasing exertional dyspnea and exercise intolerance, underwent transesophageal echocardiography with a finding of an embolus in both right and left atria. At an emergent cardiac surgery, a worm-shaped, 5-cm-long thrombus was found in the right atrium, it was protruding to left atrium through the foramen ovale. The thrombus was removed intact, and the foramen ovale was closed. By our experience, an emergent cardiac surgery should always be considered as a treatment option for impending paradoxical embolism.

Value of PCR in surgically treated patients with staphylococcal infective endocarditis: a 4-year retrospective study

The aim of the study was to establish a diagnostic value for broad-range polymerase chain reaction (br-PCR) and staphylococci-specific multiplex PCR (ssm-PCR) performed on surgical material from patients with staphylococcal infective endocarditis (IE). Data were analysed retrospectively from 60 patients with suspected staphylococcal IE and 59 controls who were surgically treated at three cardiosurgery centres over 4 years. Both PCR tests showed high agreement and could be aggregated. In patients with definite and rejected IE, the clinical sensitivity and specificity of PCR reached 89 and 95%, respectively. Tissue culture (TC) and PCR agreed with blood culture (BC) in 29% and 67% of IE cases. TC helped to determine aetiology in five BC negative cases while PCR aided in nine cases. Out of 52 patients with conclusive staphylococcal IE, 40 were diagnosed with S. aureus and 12 with coagulase-negative staphylococci. PCR was shown to be highly superior to TC in confirming preoperative diagnosis of IE. In addition to aid in culture negative patients, PCR helped to establish or refine aetiology in inconclusive cases. We suggest that simultaneous br-PCR and ssm-PCR performed on surgical material together with histopathology could significantly increase the performance of current Duke criteria.

Circulating cytokine pattern and factors describing rheumatoid arthritis: IL-15 as one of the biomarkers for RA?

The aim of study was to examine relationship among levels of cytokines (IL-6, IL-13, IL-15, TNF-α) and chemokine (IL-8), production of autoantibodies, radiographic progression, and factors describing rheumatoid arthritis (RA). A total of 156 RA patients according to ACR criteria, and 55 control subjects were recruited into study. We observed higher levels of IL-15 within RA patients compared to healthy controls. Correlations among cytokine levels and the measures of rheumatoid factors, anti-CCP, measures of disease activity, and radiographic progression were observed. We conclude that IL-15 level in circulation could serve as one of the biomarkers for RA detection.

Impact of cardiopulmonary bypass surgery on cytokines in epicardial adipose tissue: comparison with subcutaneous fat

Background: Cardiac surgery and cardiopulmonary bypass (CPB) have been shown to stimulate a systemic inflammatory response which has been associated with adverse postoperative outcomes. Adipose tissue, both epicardial (EAT) and subcutaneous (SAT), is a known source of inflammatory cytokines, but its role in the pathophysiology of surgery- and CPB-induced systemic inflammatory response has not been fully elucidated. Therefore, we conducted a study to establish levels of selected cytokines in EAT and SAT prior to and after surgery with CPB. Methods: Adipose tissue samples were obtained from patients undergoing planned cardiac surgery on CPB. Samples from EAT and SAT were collected before and immediately after CPB. Levels of tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), adipocyte fatty acid-binding protein (AFABP), leptin and adiponectin were determined by ELISA, which were adjusted for a total concentration of proteins in the individual samples. Results: Samples from 77 patients (mean age 67.68 ± 11.5 years) were obtained and analysed. Leptin, adiponectin, TNF-α and AFABP were shown to decrease their concentrations statistically significantly in the EAT after CPB while no statistically significant drop was observed in the SAT. On the contrary, IL-6 showed only a slight and statistically insignificant decrease in the EAT after CPB and it was in the SAT where a statistically significant drop was observed. Discussion: One of the most relevant findings of this study was the marked decrease in EAT levels of TNF-α, AFABP, leptin and adiponectin after the CPB termination. Our results suggest that EAT might serve as a pool of cytokines which are released into the circulation in reaction to surgery with CPB. Should these novel findings be confirmed, new strategies to assess and possibly reduce EAT contribution on adverse outcomes of cardiac surgery may be developed.

Do the presence and amount of dysfunctional but viable myocardium affect the perioperative outcome of coronary artery bypass graft surgery

The aim of our study was to assess the influence of the presence and amount of dysfunctional but viable myocardium on the perioperative outcomes in patients with coronary artery disease and moderate-to-severe left ventricular systolic dysfunction, who underwent coronary artery bypass graft surgery. Viability evaluation with low-dose dobutamine echocardiography was performed in 302 consecutive patients with coronary artery disease and left ventricular ejection fraction < or =40%, who were referred for coronary angiography and potential coronary revascularization. To quantify the amount of dysfunctional but viable myocardium, wall motion was scored using a 16-segment model. The dysfunctional segments were defined as viable if they exhibited improvement in their thickening by at least one grade. One hundred and twenty-seven patients underwent coronary artery bypass graft surgery. The perioperative outcomes were evaluated in 122 of them. Five patients were excluded because of inability to revascularize all vessels supplying dysfunctional but viable myocardial segments. Twenty-five patients exhibited a large amount of dysfunctional but viable myocardium (> or =6 segments, group A), 59 patients had a small amount of such myocardium (2-5 segments, group B), and 38 patients were found to have their dysfunctional myocardium irreversibly damaged (group C). The perioperative mortality in groups A, B, and C was 4, 10, and 11% (all P = NS), respectively. The rate of perioperative Q-wave myocardial infarction was 8, 10, and 3% (all P = NS), respectively. Similarly, there were no significant differences among the groups with respect to perioperative outcome variables including ventricular arrhythmias, duration and magnitude of catecholamine support, renal failure, pulmonary edema, and need for mechanical ventricular support or artificial ventilation. In patients with coronary artery disease and moderate-to-severe left ventricular dysfunction who underwent coronary artery bypass graft surgery, the presence and amount of dysfunctional but viable myocardium did not influence the perioperative outcome.

Value of autopsy in cardiac surgery

Uvod: Se zdokonalovanim předoperacni diagnostiky a pooperacni pece zůstava otazkou, zda ma pitva stale svůj význam. Cilem nasi studie bylo prospektivni posouzeni soucasneho významu pitvy po srdecni operaci.Metodika: Od ledna 2007 do prosince 2013 byla na nasem pracovisti provedena srdecni operace u 7 800 pacientů. Po operaci zemřelo 213 pacientů (mortalita 2,7 %). Pitva byla provedena u 158 pacientů (74,1 %). Přicina umrti byla analyzovana z pohledu klinickeho a srovnana s pitevnim nalezem.Výsledky: Předoperacnimi rizikovými faktory umrti byla nutnost uměle plicni ventilace, inotropni podpora, třida NYHA IV a renalni selhani. Operace pro poinfarktový defekt komoroveho septa nebo akutni disekci, výkon na třech chlopnich, nutnost urgentni operace a oběhove zastavy byly nejvýznamnějsimi peroperacnimi rizikovými faktory umrti. Nejcastějsi přicinou umrti bylo srdecni selhani a sepse a/nebo multiorganove selhani. Nepoznana významna diagnoza (třida I a II dle Goldmana) byla zjistěna u 21 pacientů (13,3 %), nepoznana nevýznamna diagnoza byla zjistěna u 17 pacientů (10,4 %). Ze sedmi pacientů s chybnou diagnozou třidy I zemřelo sest z důvodů nepoznaných břisnich komplikaci.Zavěr: Pitva zůstava nejspecifictějsim indikatorem chyb v diagnostice pacientů po srdecni operaci. Je cenným prostředkem pro posouzeni kvality pece a může přispět ke zlepseni pece o pacienty. Zvlastni pozornost by u pacientů po srdecni operaci měla být věnovana břisni symptomatologii, protože břisni onemocněni byly hlavnim důvodem diagnostických omylů.

Biopsy Based Diagnosis of Inflammatory Cardiomyopathy in a Patient with Negative Magnetic Resonance Image Finding

This article describes a case of the patient hospitalized for a sudden heart failure with severe left ventricular dysfunction. This case report presents a history of biopsy-proven inflammatory cardiomyopathy with negative MRI findings. Inflammatory Cardiomyopathy (ICM) is a potentially reversible disease, in which targeted treatment may be considered.

THU0003 Correlation of MIR-124 to Extracellular Matrix Protein MMP-3 in Patients with Rheumatoid Arthritis

Background MicroRNAs (miRNAs) are a 21 to 25 nucleotide long, small non-coding RNAs that post-transcriptionally regulate the expression of target genes, and thus modulate biological processes including cell differentiation, proliferation, apoptosis and invasion. Objectives The aim of the study was to examine the relation among miR-124 and serum levels of selected cytokines and chemokines (IL-6, IL-13, IL-15, TNF-alpha, MCP-1, RANTES), MMP (MMP-3), production of auto-antibodies, and factors describing rheumatoid arthritis (RA) including DAS28 and Total Sharp score. Methods A total of 80 RA patients according to the ACR criteria, and 10 control subjects were recruited into the study. The measurements of miR-124 and U-6 expression, CRP, anti-CCP, presence of rheumatoid factors (RFs), radiographs of both hands with calculation of Total Sharp score (TSS), DAS28 and cytokines, chemokines and MMP levels in serum were obtained from all RA patients. Results miR-124 was down-regulated in RA patients compared to controls. The miR-124 expression correlated to MMP-3 levels (p < 0.001). No relation of miR-124 expression to measures of RA activity (DAS28 score, p = 0.51; TSS, p = 0.89; X-ray stage, p = 0.58) and auto-antibodies (anti-CCP, p = 0.14; RF, p = 0.29; RF IgG, p = 0.63; RF IgA, p = 0.92; RF IgM, p = 0.70) was observed. Also no association to acute inflammatory markers (CRP, p = 0.25; IL-6, p = 0.91), other cytokine and chemokines (IL-13, p = 0.62; IL-15, p = 0.57; IL-8, p = 0.78; MCP-1, p = 0.37; RANTES, p = 0.47) was found. Conclusions In conclusion, we present a down-regulation of miR-124 in RA patients and its correlation to MMP-3 levels. Disclosure of Interest None Declared