BackgroundPulmonary arterial hypertension (PAH) is a severe and progressive disease characterized by increased pulmonary vascular resistance, ultimately leading to right heart failure and death. Epidemiological data from national registries are growing worldwide, but are still unavailable in Eastern Europe.MethodsA PAH registry was initiated in January 2007 using a nationwide network of echocardiographic centers and four diagnostic centers that specialize in PAH. All patients aged above 18 years, diagnosed with PAH and monitored between January 2000 and December 2007 were included. Patients diagnosed with PAH between January and December 2007 were classified as incident. The survival analyses were performed up to the end of 2010. Prognostic factors at the time of diagnosis were identified using uni- and multivariable Cox proportional hazard models.ResultsOverall, 191 patients were included (100 prevalent cases, 91 incident cases). Patients were predominantly female (n = 125) and had a mean age of 51.9 ± 16.9 years. Incident patients were significantly older at the time of diagnosis than prevalent patients (p < 0.001). Most patients (60.7%) had idiopathic PAH; 20.4% had PAH associated with congenital heart disease and 11.4% had PAH associated with connective tissue disease. Estimates of prevalence and incidence of PAH in adults were 22.4 cases per million and 10.7 cases per million per year, respectively. The 1-, 2- and 3-year survival rates in the incident PAH cohort were 89% (95% confidence intervals [CI] 83–95%), 78% (95% CI 70–87%) and 74% (95% CI 65–83%), respectively. Lower survival rates were significantly associated with higher age (hazard ratio [HR] 6.6 95% CI 1.4–30.9) and lower creatinine clearance (HR 3.3 95% CI 1.1–9.7).ConclusionThis is the first study in Eastern Europe to describe the prevalence, incidence and survival of patients with PAH from a national representative registry. This registry from the Czech Republic highlights that diagnosis of PAH is frequently made late in the disease continuum when patients have significant functional impairment.

Ischemická choroba srdeční je jednou z hlavních příčin morbidity a mortality. Zobrazovací vyšetření představují klíčové metody k posouzení rozsahu a závažnosti onemocnění a k vyhodnocení hemodynamických komplikací. Echokardiografi e provedená zkušeným vyšetřujícím poskytuje užitečné informace pro klinickou praxi a odhad prognózy. Komplexní hodnocení přináší informace o globální a regionální funkci myokardu, viabilitě myokardu, ischemické mitrální regurgitaci a o případných komplikacích, jakými mohou být trombus v levé komoře, ruptura stěny levé komory a perikardiální výpotek. Hlavní nevýhodou echokardiografi e je omezená vyšetřitelnost mnoha pacientů a nesporná závislost na kvalitách vyšetřujícího. Nicméně pro možnost provedení echokardiografi ckého vyšetření u lůžka našich pacientů zůstává echokardiografi e zásadním vyšetřením a její znalosti jsou nepostradatelné pro všechny kardiology.

Introduction: Retrospective studies showed that Haloperidol results in higher incidence of sudden cardiac death and causes QTc prolongation and polymorphic ventricular arrhythmia at high dosage. We performed a prospective observational study in a general teaching hospital evaluating the effects of low-dose haloperidol on QTc-duration in frail admitted elderly patients with delirium. Methods: Inclusion criteria were: age !75y, ECG was made during admission and haloperidol was initiated within 1w. After at least two doses of haloperidol, a second ECG was made. Patients were grouped according to baseline QTc; normal QTc (nQT, male ,430ms, female ,450ms), borderline QTc (bQT, male 431-450ms, female 451-470ms) and abnormal QTc (aQT, male .450ms, female .470ms). Potentially dangerous QTc was defined as an increase in QTc by .50 ms or to a QTc of .500 ms. Results: We included 140 patients (46% male, mean age 85y, nQT n ¼ 93, bQT n ¼ 27, aQT n ¼ 20) who used on average 1.5 mg Haloperidol per 24h (comparable among groups). No patients developed potentially dangerous QTc. On average, patients with normal QTc at baseline experienced no change in QTc (nQT: þ4 + 21 ms) while patients with prolonged QTc showed a decrease (bQT: -16 + 28 ms, aQT: -20 + 27 ms, both p , 0.001 compared to nQT). 17 patients in nQT (18%) developed borderline or abnormal QTc while 24 patients in bQT or aQT (51%) developed a normal QTc after haloperidol use. Conclusion: Low-dose haloperidol appears safe. We did not see potentially dangerous QTc. On average, QTc shortening was seen in patients with borderline and abnormal QTc.