On the basis of Custodiol preservation and cardioplegic solution a novel cardioplegic solution was developed to improve the postischemic cardiac and endothelial function. In this study, we investigated whether its reduced cytotoxicity and its ability to reduce reactive oxygen species generation during hypoxic condition have beneficial effects in a clinically relevant canine model of CPB. 12 dogs underwent cardiopulmonary bypass with 60 minutes of hypothermic cardiac arrest. Dogs were divided into 2 groups: Custodiol (n = 6) and Custodiol-N (n = 6) (addition of L-arginin, N-α-acetyl-L-histidine and iron-chelators: deferoxamine and LK-614). Left ventricular hemodynamic variables were measured by a combined pressure-volume conductance catheter at baseline and after 60 minutes of reperfusion. Coronary blood flow, myocardial ATP content, plasma nitrate/nitrite and plasma myeloperoxidase levels were also determined. The use of Custodiol-N cardioplegic solution improved coronary blood flow (58 ± 7 ml/min vs. 26 ± 3 ml/min) and effectively prevented cardiac dysfunction after cardiac arrest. In addition, the myocardial ATP content (12,8 ± 1,0 μmol/g dry weight vs. 9,5 ± 1,5 μmol/g dry weight) and plasma nitrite (1,1 ± 0,3 ng/ml vs. 0,5 ± 0,2 ng/ml) were significantly higher after application of the new cardioplegic solution. Furthermore, plasma myeloperoxidase level (3,4 ± 0,4 ng/ml vs. 4,3 ± 2,2 ng/ml) significantly decreased in Custodiol-N group. The new HTK cardioplegic solution (Custodiol-N) improved myocardial and endothelial function after cardiopulmonary bypass with hypothermic cardiac arrest. The observed protective effects imply that the Custodiol-N could be the next generation cardioplegic solution in the protection against ischemia-reperfusion injury in cardiac surgery.

Making benefit from the epigenetic effects of environmental factors such as physical activity may result in a considerable improvement in the prevention of chronic civilization diseases. In our chronic swimming rat model, the expression levels of such microRNAs were characterized, that are involved in skeletal muscle differentiation, hypertrophy and fine-tuning of metabolism, which processes are influenced by chronic endurance training, contributing to the metabolic adaptation of skeletal muscle during physical activity. After chronic swimming, the level of miR-128a increased significantly in EDL muscles, which may influence metabolic adaptation and stress response as well. In SOL, the expression level of miR-15b and miR-451 decreased significantly after chronic swimming, which changes are opposite to their previously described increment in insulin resistant skeletal muscle. MiR-451 also targets PGC-1α mRNA, whiches expression level significantly increased in SOL muscles, resulting in enhanced biogenesis and oxidative capacity of mitochondria. In summary, the microRNA expression changes that were observed during our experiments suggest that chronic swim training contributes to a beneficial metabolic profile of skeletal muscle.

A Lyme-kór az egyik leggyakoribb antropozoonosis, a Borrelia kórokozója kullancs csípésével kerül az emberi szervezetbe, Magyarországon évente 10000 friss fertőzést okozva. A Lyme-kór tünetei és lefolyása változatosak, késői formában nemritkán carditist okoz. Esetünkben szerológiailag igazolt borreliosis okozott teljes atrioventricularis blokkot fiatal férfinél, aki praesyncope miatt került intézetünkbe. A blokk hátterében, a közeli kullancscsípésre való tekintettel, Lyme-carditist gyanítottunk, antibiotikum adását és monitoros obszervációt kezdtünk. A betegségre jellemző bőrtünetek nem jelentkeztek, a laborvizsgálat kórosat nem igazolt. Elektrofiziológiai vizsgálattal domináló supra-His atrioventricularis blokkot regisztráltunk. Az obszerváció másnapjától a blokk regressziót mutatott, később teljesen megjavult. Szerológiai vizsgálat egy évnél régebbi borreliosist igazolt. Terápiás ajánlás a potenciálisan reverzíbilis Lyme-carditisben egyelőre nincs. Fiataloknál rizikófaktor nélkül jelentkező ingerületvezetési zavar esetén is célszerű Lyme-carditisre gondolni, segítséget a pontos anamnézis felvétele és megfelelő labordiagnosztika jelenthet, amellyel elkerülhető a pacemakerbeültetés. Orv. Hetil., 2010, 39, 1585–1590.

Introduction Atrial fibrillation (AF) and heart failure (HF) often coexist due to the common elements of the pathomechanism they share. The potential significance of the order these entities present in the same patient is ill-defined. Herein, we report our results from a nationwide database on the occurrence of various sequences AF and HF may present, the time delays between the two conditions and all-cause mortality associated with different scenarios. Methods Patients diagnosed with both AF and HF between 2015 and 2021 were enrolled from the Hungarian National Health Insurance Fund (NHIF) database. The order the two entities followed each other, and the time delay in between were registered. Median survival rates were calculated in AF → HF; HF → AF and simultaneous scenarios. Results A total of 109,075 patients were enrolled: 29,937 with AF → HF, 38,171 with HF → AF, and 40,967 diagnosed simultaneously. Time delays between AF → HF and HF → AF were 6 and 10 months, respectively. The median survival was 46 months in the AF → HF, 38 months in the HF → AF, and 21 months in the simultaneous group. Patients with HF → AF, and with simultaneous presentations had 5% and 16% greater mortality risk as compared to the AF → HF sequence, with hazard ratios (95% confidence intervals) of 0.95 (0.93–0.97) and 0.84 (0.82–0.85), respectively (P < 0.0001). Conclusions HF occurred significantly earlier after the diagnosis of AF than vice versa. Patients diagnosed simultaneously had the worst, while the AF → HF sequence had the best prognosis. These data should have implications for the intensification of monitoring and therapy in different scenarios.

Transcatheter aortic valve implantation (TAVI) is an effective treatment option for patients suffering from symptomatic, severe aortic valve stenosis. Previously, only patients with prohibitive or high surgical risk were TAVI candidates; however, current guidelines already recommend TAVI as a treatment alternative for patients with intermediate surgical risk. Multidetector computed tomography (MDCT) has gained great importance in the periprocedural assessment of patients who undergo TAVI. Due to the three-dimensional image visualization, MDCT allows the evaluation of anatomical structures in a more comprehensive manner compared to echocardiography, the traditional tool used in TAVI patient work-up. By providing accurate measurements of the aortic root, MDCT helps to avoid potential patient-prosthesis mismatch throughout transcatheter valve sizing. Moreover, MDCT is also a feasible tool for access route evaluation and to determine the optimal projection angles for the TAVI procedure. Although the routine MDCT follow-up of patients is currently not recommended in clinical practice, if performed, it could provide invaluable information about valve integrity and asymptomatic leaflet thrombosis. Post-procedural MDCT can provide details about the position of the prosthesis and complications such as leaflet-thrombosis, aortic regurgitation, coronary occlusion, and other vascular complications that can represent major cardiac emergencies. The aim of the current review is to overview the role of MDCT in the pre- and post-procedural assessment of TAVI patients. In the first part, the article presents the role of pre-TAVI imaging in the complex anatomical assessment of the aortic valve and the selection of the most appropriate device. The second part of the review describes the role of MDCT in patients who underwent TAVI to assess potential complications, some of them leading to a major cardiovascular emergency.

Introduction: Atrial fibrillation (AF) is associated with a higher risk of mortality; however, detailed analysis on the excess risk of death of patients diagnosed with AF compared to a non-AF population has not been carried out. Material and methods: In our nationwide study, all AF patients...