Mihály Medvegy - Academia.edu (original) (raw)
Papers by Mihály Medvegy
International Journal of Cardiology, Aug 1, 2011
Background: The electrocardiographic diagnosis of significant coronary artery stenosis (CAD) is o... more Background: The electrocardiographic diagnosis of significant coronary artery stenosis (CAD) is often based on the investigation of the left ventricular repolarization changes during exercise ECG stress test (EST). Our aim was to prove that the electric activity of the left atrium can indicate the ischemic damage of the left ventricle, and furthermore, it is able to indicate CAD without exercise. Methods and results: Patients with chest complaints but without evidence of acute coronary syndrome were investigated by EST and body surface potential mapping (BSPM, 63 leads). CAD was proven in 45 cases (32 men, years 40-76) and excluded in 50 cases (35 men, years 38-72) with coronary angiography. Left atrial electric potentials (EP-LA) before and after 0.08 mg sublingual nitroglycerine administration differed significantly (p b 0.001) in the two groups. According to Fischer linear discriminant analysis, this difference in % (EP-LA d%) was the best separating parameter: below limit of −14.17% (CAD prevalence was considered) this parameter predicted CAD with 93% sensitivity, 100% specificity, N 10 positive and 0.05 negative likelihood ratio (weighted for prevalence). The EST predicted CAD with 71% sensitivity, 78% specificity, 2.43 positive and 0.28 negative likelihood ratios. Conclusion: The electrical activity changes of the left atrium seemed to be suitable to predict CAD as an ESTalternative resting method.
European Heart Journal, Aug 1, 2017
Hypertension drug treatment 359 tion (wSD) of the mean BP, or as average real variability (ARV). ... more Hypertension drug treatment 359 tion (wSD) of the mean BP, or as average real variability (ARV). BP control was assessed by smoothness index (SI, 24h average hourly BP reduction divided by its SD) and treatment-on-variability index (TOVI, 24h avearge hourly BP reduction divided by 24h wSD or ARV under treatment). Results: Placebo had no effect on 24h BPV, small effects were observed under monotherapies, whereas the greatest effect was observed with the OLM triple combination [
Journal of Hypertension, 2010
Objective: The masked hypertension (MH) is a clinical situation in which the blood pressure (BP) ... more Objective: The masked hypertension (MH) is a clinical situation in which the blood pressure (BP) is normal in the office but elevated by ambulatory blood pressure monitoring (ABPM). The ABPM is the suitable method to corroborate the MH diagnosis in hypertensive patients (HP). We analyzed the prevalence and the vascular risk in the MH.
International Journal of Cardiology, 2008
International Journal of Cardiology, 2008
European Heart Journal, 2013
gene transcription (RVX-208), nuclear hormone receptor agonists, HDL delipidation, whole HDL part... more gene transcription (RVX-208), nuclear hormone receptor agonists, HDL delipidation, whole HDL particle infusion with CER-001, MDCO-216, or CSL-112, and gene therapy using HDL-related proteins such as Apo A-I. 5,21 Further clinical evaluation of direct infusion of mutant (Apo A-1 Milano) or wild-type Apo A-1, linked with a phospholipid carrier, appears warranted since their vascular benefits have been repeatedly demonstrated in animal models and small clinical studies. 5,21 Despite well-established cardiovascular benefits of statins in CAD, there remains a substantial residual CHD risk which may be mitigated by the right HDL-based intervention and, therefore, we should not give up on HDL despite its split personality.
Bakony természetföldrajzi tájbeosztása az UTM hálóval (Kaizer Miklós és M. Buczkó Emmi után módos... more Bakony természetföldrajzi tájbeosztása az UTM hálóval (Kaizer Miklós és M. Buczkó Emmi után módosítva) /. Balaton-felvidék Ide tartozik a Veszprém-Várpalotai-fennsík, a Balaton-felvidék, a Tapolcai-medence és a Keszthelyi-hegy ség déli, Balaton-parti része. Északnyugatról a veszprémi Séd-és az Eger-patak határolja, délnyugatról a Keszthelyi-hegység. Átlagos tengerszint feletti magassága 150-200 m, kiemelkedőbb csúcsok a Badacsony (438 m), a Recsek-hegy (430 m), és a Szent-György-hegy (417 m). Éghajlatában a j^egkifejezettebb a szub mediterrán jelleg. Évi középhőmérséklet 10-10,5 C, a nyári hónapokban 20-21 C. Évi csapadék 650-700 mm. Többféle alapkőzetén (dolomit, mészkő, homok, homokkő, bazalt, lösz) változatos növényzet alakult ki. Az egész Bakonybol ez a legmelegebb, legszárazabb terület, sok déli állatfaj itt éri el elterjedésé nek északnyugati-nyugati határát.
Cardiology and Therapy, 2021
Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomen... more Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomenon in severe cases of coronavirus disease 2019 (COVID-19). Its causes are capillary endothelial cell dysfunction, associated carditis, low oxygenization, and increased sympathetic tone, which all worsen myocardial stiffness and microvascular dysfunction (MD). They lead to severe myocardial dysfunction, arrhythmia, acute congestive heart failure, and a significant rise in death cases. During COVID-19, no
Supplementary Therapeutic Possibilities to Alleviate Myocardial Damage Due to The Microvascular Dysfunction in Coronavirus Disease 2019 (COVID-19)
<strong>Article full text</strong> The article associated with this page has been acc... more <strong>Article full text</strong> The article associated with this page has been accepted for online publication and is in the final stages of production. The link to the full text will be made available on this page in the next few days. The above summary slide represents the opinions of the authors. For a full list of declarations, including funding and author disclosure statements, please see the full text online (see "read the peer-reviewed publication" opposite). © The authors, CC-BY-NC 2021.
Orvosi Hetilap, 2020
Absztrakt: Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történ... more Absztrakt: Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelésekor a terápiahűség igen jelentős tényező a stroke-prevencióban. Célkitűzés: OAK-terápiában részesülő, PF-ban szenvedő betegek esetében az antikoaguláns-terápiák (K-vitamin-antagonista [KVA] és az új orális antikoagulánsok [NOAK]) egyéves perzisztenciájának vizsgálata. Módszer: A szerzők pitvarfibrilláció-indikációban a Nemzeti Egészségbiztosítási Alapkezelő adatbázisában, 2016 második félévében (bevonási időszak) valamilyen orális antikoaguláns- (OAK = KVA/NOAK) terápiában részesülő betegek perzisztenciáját vizsgálták a vényforgalmi adatok felhasználásával, az első kiváltástól számított 12 hónapig (60 napos ’grace’ periódussal). Eredmények: A bevonási kritériumoknak 122 870 beteg felelt meg. A betegek közül 18 650 beteg kezdett újonnan, míg 104 220 beteg volt már valamelyik OAK-terápián. Az új betegek között a NOAK-terápia egyéves perzisztenciája 65,7%, míg a KVA-terápiáé 39,0%...
Orvosi Hetilap, 2019
Bevezetés: A legfrissebb európai hypertoniaajánlás a magas vérnyomás kezelésére első terápiás leh... more Bevezetés: A legfrissebb európai hypertoniaajánlás a magas vérnyomás kezelésére első terápiás lehetőségnek javasolja a renin-angiotenzin-aldoszteron rendszer antagonistáknak (RAAS-gátlók) a kalciumcsatorna-blokkolókkal (CCB) vagy diuretikumokkal alkotott fix kombinációit (FDC). Az antihypertensiv terápia során a terápiahűség az egyik jelentős tényező a nemkívánatos cardiovascularis események csökkentésében. Célkitűzés: A szerzők célja a hypertonia indikációjában indított angiotenzinkonvertálóenzim-gátlók (ACE-gátlók)/ CCB FDC-k egyéves perzisztenciájának összehasonlítása volt. Módszer: A retrospektív vizsgálatban a szerzők a 2012. október 1. és 2013. szeptember 30. közötti időszakban első alkalommal, bármely ACE-gátló/CCB FDC-k receptjeit kiváltó betegeket választottak ki, akik a megelőző 12 hónapban hasonló készítményekkel nem részesültek antihypertensiv terápiában. A vénykiváltási adatokat az Országos Egészségbiztosítási Pénztár vényforgalmi adatbázisa szolgáltatta. A perzisztencia modellezésére a túlélés-analízis klasszikus eszköztárát alkalmazták, ahol a 'túlélési' idő a gyógyszer szedésének abbahagyásáig eltelt idő volt. Eredmények: A bevonási követelményeknek 124 388 beteg felelt meg. A ramipril/amlodipin FDC egyéves perzisztenciája 54% volt, amelyet a perindopril/amlodipin FDC 47%-os, a lizinopril/amlodipin 36%-os, a ramipril/felodipin 26%-os és a trandolapril/verapamil 12%-os eredménye követett. A ramipril/amlodipin FDC-hez képest (referencia) a perindopril/amlodipin FDC elhagyásának kockázata 30%-kal (HR = 1,30, p<0,0001), a lizinopril/amlodipin FDC-é 79%-kal (HR = 1,79, p<0,0001) volt magasabb, míg a ramipril/felodipin FDC-é (HR = 2,28, p<0,0001) mintegy kétszeres, a trandolapril/verapamil FDC-é (HR = 4,13, p<0,0001) pedig több mint négyszeres volt. A 360 napra korlátozott átlagos gyógyszerszedési idő 270,2 nap volt a ramipril/amlodipin FDC, 242,7 nap a perindopril/amlodipin FDC, 211,2 nap a lizinopril/amlodipin FDC, 186,3 nap a ramipril/felodipin FDC, míg 125,7 nap a trandolapril/verapamil FDC esetén. Következtetések: A szerzők igazolták, hogy a hypertonia indikációjában alkalmazott ACE-gátló/CCB FDC-k egyéves perzisztenciája jelentősen különbözött. A betegadherencia szempontjából a legelőnyösebbnek a ramipril/amlodipin FDC bizonyult.
Orvosi Hetilap, 2019
Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelések... more Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelésekor a terápiahűség igen jelentős tényező a stroke prevenciójában. Célkitűzések: A szerzők célja a már OAK-terápiában részesülő PF-ban szenvedő betegeknél a K-vitamin-antagonista (KVA) és a direkt orális antikoagulánsok (DOAK) egyéves perzisztenciájának vizsgálata. Módszer: A Nemzeti Egészségbiztosítási Alapkezelő adatbázisából a vényforgalmi adatokra támaszkodva pitvarfibrilláció indikációjában, 2015 második félévében valamely orális antikoaguláns (OAK = KVA/DOAK) receptjét ki váltó olyan betegeket választottak ki, akiknek a vizsgálati időszakot megelőzően-a vizsgálati időszakban történt kiváltási dátumhoz képest-12 hónappal korábban volt (DOAK/KVA összes) vénykiváltásuk. A perzisztencia modellezésére a túlélés-analízis klasszikus eszköztárát alkalmazták, ahol a "túlélési" idő a gyógyszer szedésének abbahagyásáig eltelt idő volt, 60 napos 'grace' periódussal.
European Heart Journal, 2018
to OAC status. Next, a diverse group of clinicians involved in AF care were questioned through a ... more to OAC status. Next, a diverse group of clinicians involved in AF care were questioned through a web-based survey. Items included factors, not included in the CHA2DS2-VASc score, that may influence prescription of OAC therapy in AF. Results: In the GARFIELD-AF registry (n=52,014), 2,123 patients had a low CHA2DS2-VASc score. OAC therapy was prescribed in 950 (45%). Permanent [OR (95%) = 2.32 (1.52-3.56)] or persistent AF [OR (95%) = 3.08 (2.17-4.38)] and increasing age <65 years [OR (95%) = 1.34 (1.20-1.50)] demonstrated a significant increase in odds for OAC use, while concomitant antiplatelet therapy [OR (95%) = 0.083 (0.065-0.105)] and female gender [OR (95%) = 0.714 (0.561-0.907)] showed a significant decrease in odds. Crude event rates were low for those with as well as without OAC therapy: all-cause mortality (14 versus 20), ischemic stroke or systemic embolism (6 versus 5), and major bleeding (4 versus 3). When clinicians (n=229) were questioned about decision-making regarding OAC therapy for AF patients with low thromboembolic risk, an enlarged left atrium or spontaneous echo contrast was the most frequently cited reason (reach: 59.8%). Adding cardioversion or ablation procedures, rheumatic heart disease, and subjective fear of stroke by the patient increased the reach to 83.8% (Table 1). Table 1 Risk factor combinations Reach, n (%) Enlarged left atrium or spontaneous echo contrast 137 (59.8) Previous + cardioversion or ablation procedures 165 (72.1) Previous + rheumatic heart disease 183 (79.9) Previous + subjective fear of stroke by the patient 192 (83.8) Reach is the number (percentage) of respondents reporting some or strong preference to prescribe oral anticoagulation therapy when the risk factor combination is present.
Orvosi Hetilap, 2017
Szentendre főútján, bevezetett, ÁNTSZ engedéllyel rendelkező orvosi rendelőben, bőrgyógyászati re... more Szentendre főútján, bevezetett, ÁNTSZ engedéllyel rendelkező orvosi rendelőben, bőrgyógyászati rendelésre teljesen felszerelve, rendelési idő kiadó. A rendelő utcai bejáratú, betegparkolóval rendelkezik. Kiterjedt pacientúra! Heti rendelés feltöltése megoldott, csak rendelni kell!
Annals of Noninvasive Electrocardiology, 2015
In coronary artery disease (CAD), body surface potential mapping (BSPM) may reveal minor electric... more In coronary artery disease (CAD), body surface potential mapping (BSPM) may reveal minor electrical potential changes appearing in the depolarization phase even if pathological changes are absent on the conventional 12-lead ECG. We hypothesized that a simple BSPM parameter, Max/Min signifies successful percutaneous coronary intervention (PCI). Methods: Ninety-two adult Caucasian patients with stable CAD and positive exercise test underwent coronary angiography. Seventy patients (age, 59 ± 8; 46 males) were revascularized by PCI (left anterior descending [LAD] in 38, right [RCA] in 17 and left circumflex [LCX] coronary artery in 15). Control groups contained 22 patients (age, 60 ± 8; 14 males) without intervention and 35 healthy subjects (age, 58 ± 2; 15 males). Left ventricular ejection fraction (LVEF, transthoracic echocardiography) and Max/Min BSPM parameter (63-lead Montreal system) were evaluated before and 4-40 days following coronary angiography. Max/Min was defined by the ratio of the highest maximum to the deepest minimum potential of all leads recorded by BSPM. Results: Before PCI, Max/Min value of patients with LAD lesion (0.83 [0.74; 0.93]) was significantly lower while that with RCA lesion (1.63 [1.35; 1.99]) was significantly higher than that of healthy group (1.01 [0.970; 1.13]) (P < 0.05) and LVEF was significantly lower in LAD lesion (46.50% [43.00; 51.00]) than in the healthy group (55.00% [50.00; 58.75]) (P < 0.01). Max/Min value significantly increased from 0.83 [0.74; 0.93] to 0.92 [0.82; 0.99] (P < 0.01) following LAD PCI while significantly decreased from 1.63 [1.35; 1.98] to 1.35 [1.21; 1.43] (P < 0.01) post-RCA PCI. It did not vary significantly, however, either following LCX PCI or without intervention. LVEF significantly increased (from 46.50% [43.00; 51.00] to 49.00% [46.00; 51.00]) only after LAD PCI. Conclusion: Max/Min parameter is suitable to follow patients after LAD and RCA PCI. Ann Noninvasive Electrocardiol 2016;21(2):161-168 catheterization; mapping; ischemic heart disease; hibernating myocardium; electrophysiology Despite many preventive lifestyle and pharmacological interventions, ischemic heart disease (IHD) remained the leading cause of mortality in the developed Western world. 1 The desired decline in coronary artery disease (CAD) mortality necessitates the accurate diagnosis and assessment
[Rivaroxaban in prevention of stroke in patients with atrial fibrillation]
Ideggyógyászati szemle, Jan 30, 2012
Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thrombopr... more Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism....
[Case of a young woman successfully operated on for acute pulmonary embolism and right ventricular thrombus after urogenital infection]
Orvosi hetilap, Jan 2, 2005
The authors report a case of a 22-year-old women operated on for pulmonary embolism with success.... more The authors report a case of a 22-year-old women operated on for pulmonary embolism with success. The venous embolism developed in two phases one week apart. The first clinical sign was a dyspnea of abrupt onset limiting physical activity even after a mild exertion. However, relevant diagnostic tests were performed after one week when the patient fainted, her dyspnea worsened. The results of ECG, echocardiography and pulmonary perfusion scintigraphy indicated the presence of a thrombus residing in the right ventricle and the embolism of the right pulmonary artery. Chest CT and pneumo-angiography findings show the embolus completely blocking the main right branch of the pulmonary artery and partially blocking the left lower lobe artery. On the basis of their experiences published earlier the patient was brought to a stable cardio-respiratory state prior to surgery. Both the adherent right ventricular thrombus and the fresh embolus residing in the right branch of the pulmonary artery ...
Simple, quantitative body surface potential map parameters in the diagnosis of remote Q wave and non-Q wave myocardial infarction
The Canadian journal of cardiology, 2004
Body surface potential mapping has been shown to be a useful tool in the diagnosis and localizati... more Body surface potential mapping has been shown to be a useful tool in the diagnosis and localization of remote non-Q wave and Q wave myocardial infarction, but human expertise is required to interpret the maps. To identify quantitative body surface potential mapping parameters that could enable a computer-based diagnosis. Body surface isopotential maps (63 unipolar leads) were recorded in 86 patients with remote Q wave and 71 patients with remote non-Q wave myocardial infarction. Twenty-four healthy adults served as control subjects. Myocardial infarctions were classified using standard electrocardiogram leads in the acute and chronic phases, and were validated by coronary angiography, ventriculography and thallium scintigraphy. Two simple quantitative parameters with high diagnostic power were identified: the time interval between the peak minimum and the peak maximum potentials (time-shift), and the ratio of these potentials (maximum to minimum ratio [max/min]). Both parameters sho...
Assessment of the Diastolic Function by Body Surface Potential Maps in Ischemic Heart Disease
Advances in Electrocardiology 2004, 2005
The Effect of Percutaneous Coronary Artery Intervention on Body Surface Potential Maps
Advances in Electrocardiology 2004 - Proceedings of the 31st International Congress on Electrocardiology, 2005
International Journal of Cardiology, Aug 1, 2011
Background: The electrocardiographic diagnosis of significant coronary artery stenosis (CAD) is o... more Background: The electrocardiographic diagnosis of significant coronary artery stenosis (CAD) is often based on the investigation of the left ventricular repolarization changes during exercise ECG stress test (EST). Our aim was to prove that the electric activity of the left atrium can indicate the ischemic damage of the left ventricle, and furthermore, it is able to indicate CAD without exercise. Methods and results: Patients with chest complaints but without evidence of acute coronary syndrome were investigated by EST and body surface potential mapping (BSPM, 63 leads). CAD was proven in 45 cases (32 men, years 40-76) and excluded in 50 cases (35 men, years 38-72) with coronary angiography. Left atrial electric potentials (EP-LA) before and after 0.08 mg sublingual nitroglycerine administration differed significantly (p b 0.001) in the two groups. According to Fischer linear discriminant analysis, this difference in % (EP-LA d%) was the best separating parameter: below limit of −14.17% (CAD prevalence was considered) this parameter predicted CAD with 93% sensitivity, 100% specificity, N 10 positive and 0.05 negative likelihood ratio (weighted for prevalence). The EST predicted CAD with 71% sensitivity, 78% specificity, 2.43 positive and 0.28 negative likelihood ratios. Conclusion: The electrical activity changes of the left atrium seemed to be suitable to predict CAD as an ESTalternative resting method.
European Heart Journal, Aug 1, 2017
Hypertension drug treatment 359 tion (wSD) of the mean BP, or as average real variability (ARV). ... more Hypertension drug treatment 359 tion (wSD) of the mean BP, or as average real variability (ARV). BP control was assessed by smoothness index (SI, 24h average hourly BP reduction divided by its SD) and treatment-on-variability index (TOVI, 24h avearge hourly BP reduction divided by 24h wSD or ARV under treatment). Results: Placebo had no effect on 24h BPV, small effects were observed under monotherapies, whereas the greatest effect was observed with the OLM triple combination [
Journal of Hypertension, 2010
Objective: The masked hypertension (MH) is a clinical situation in which the blood pressure (BP) ... more Objective: The masked hypertension (MH) is a clinical situation in which the blood pressure (BP) is normal in the office but elevated by ambulatory blood pressure monitoring (ABPM). The ABPM is the suitable method to corroborate the MH diagnosis in hypertensive patients (HP). We analyzed the prevalence and the vascular risk in the MH.
International Journal of Cardiology, 2008
International Journal of Cardiology, 2008
European Heart Journal, 2013
gene transcription (RVX-208), nuclear hormone receptor agonists, HDL delipidation, whole HDL part... more gene transcription (RVX-208), nuclear hormone receptor agonists, HDL delipidation, whole HDL particle infusion with CER-001, MDCO-216, or CSL-112, and gene therapy using HDL-related proteins such as Apo A-I. 5,21 Further clinical evaluation of direct infusion of mutant (Apo A-1 Milano) or wild-type Apo A-1, linked with a phospholipid carrier, appears warranted since their vascular benefits have been repeatedly demonstrated in animal models and small clinical studies. 5,21 Despite well-established cardiovascular benefits of statins in CAD, there remains a substantial residual CHD risk which may be mitigated by the right HDL-based intervention and, therefore, we should not give up on HDL despite its split personality.
Bakony természetföldrajzi tájbeosztása az UTM hálóval (Kaizer Miklós és M. Buczkó Emmi után módos... more Bakony természetföldrajzi tájbeosztása az UTM hálóval (Kaizer Miklós és M. Buczkó Emmi után módosítva) /. Balaton-felvidék Ide tartozik a Veszprém-Várpalotai-fennsík, a Balaton-felvidék, a Tapolcai-medence és a Keszthelyi-hegy ség déli, Balaton-parti része. Északnyugatról a veszprémi Séd-és az Eger-patak határolja, délnyugatról a Keszthelyi-hegység. Átlagos tengerszint feletti magassága 150-200 m, kiemelkedőbb csúcsok a Badacsony (438 m), a Recsek-hegy (430 m), és a Szent-György-hegy (417 m). Éghajlatában a j^egkifejezettebb a szub mediterrán jelleg. Évi középhőmérséklet 10-10,5 C, a nyári hónapokban 20-21 C. Évi csapadék 650-700 mm. Többféle alapkőzetén (dolomit, mészkő, homok, homokkő, bazalt, lösz) változatos növényzet alakult ki. Az egész Bakonybol ez a legmelegebb, legszárazabb terület, sok déli állatfaj itt éri el elterjedésé nek északnyugati-nyugati határát.
Cardiology and Therapy, 2021
Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomen... more Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomenon in severe cases of coronavirus disease 2019 (COVID-19). Its causes are capillary endothelial cell dysfunction, associated carditis, low oxygenization, and increased sympathetic tone, which all worsen myocardial stiffness and microvascular dysfunction (MD). They lead to severe myocardial dysfunction, arrhythmia, acute congestive heart failure, and a significant rise in death cases. During COVID-19, no
Supplementary Therapeutic Possibilities to Alleviate Myocardial Damage Due to The Microvascular Dysfunction in Coronavirus Disease 2019 (COVID-19)
<strong>Article full text</strong> The article associated with this page has been acc... more <strong>Article full text</strong> The article associated with this page has been accepted for online publication and is in the final stages of production. The link to the full text will be made available on this page in the next few days. The above summary slide represents the opinions of the authors. For a full list of declarations, including funding and author disclosure statements, please see the full text online (see "read the peer-reviewed publication" opposite). © The authors, CC-BY-NC 2021.
Orvosi Hetilap, 2020
Absztrakt: Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történ... more Absztrakt: Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelésekor a terápiahűség igen jelentős tényező a stroke-prevencióban. Célkitűzés: OAK-terápiában részesülő, PF-ban szenvedő betegek esetében az antikoaguláns-terápiák (K-vitamin-antagonista [KVA] és az új orális antikoagulánsok [NOAK]) egyéves perzisztenciájának vizsgálata. Módszer: A szerzők pitvarfibrilláció-indikációban a Nemzeti Egészségbiztosítási Alapkezelő adatbázisában, 2016 második félévében (bevonási időszak) valamilyen orális antikoaguláns- (OAK = KVA/NOAK) terápiában részesülő betegek perzisztenciáját vizsgálták a vényforgalmi adatok felhasználásával, az első kiváltástól számított 12 hónapig (60 napos ’grace’ periódussal). Eredmények: A bevonási kritériumoknak 122 870 beteg felelt meg. A betegek közül 18 650 beteg kezdett újonnan, míg 104 220 beteg volt már valamelyik OAK-terápián. Az új betegek között a NOAK-terápia egyéves perzisztenciája 65,7%, míg a KVA-terápiáé 39,0%...
Orvosi Hetilap, 2019
Bevezetés: A legfrissebb európai hypertoniaajánlás a magas vérnyomás kezelésére első terápiás leh... more Bevezetés: A legfrissebb európai hypertoniaajánlás a magas vérnyomás kezelésére első terápiás lehetőségnek javasolja a renin-angiotenzin-aldoszteron rendszer antagonistáknak (RAAS-gátlók) a kalciumcsatorna-blokkolókkal (CCB) vagy diuretikumokkal alkotott fix kombinációit (FDC). Az antihypertensiv terápia során a terápiahűség az egyik jelentős tényező a nemkívánatos cardiovascularis események csökkentésében. Célkitűzés: A szerzők célja a hypertonia indikációjában indított angiotenzinkonvertálóenzim-gátlók (ACE-gátlók)/ CCB FDC-k egyéves perzisztenciájának összehasonlítása volt. Módszer: A retrospektív vizsgálatban a szerzők a 2012. október 1. és 2013. szeptember 30. közötti időszakban első alkalommal, bármely ACE-gátló/CCB FDC-k receptjeit kiváltó betegeket választottak ki, akik a megelőző 12 hónapban hasonló készítményekkel nem részesültek antihypertensiv terápiában. A vénykiváltási adatokat az Országos Egészségbiztosítási Pénztár vényforgalmi adatbázisa szolgáltatta. A perzisztencia modellezésére a túlélés-analízis klasszikus eszköztárát alkalmazták, ahol a 'túlélési' idő a gyógyszer szedésének abbahagyásáig eltelt idő volt. Eredmények: A bevonási követelményeknek 124 388 beteg felelt meg. A ramipril/amlodipin FDC egyéves perzisztenciája 54% volt, amelyet a perindopril/amlodipin FDC 47%-os, a lizinopril/amlodipin 36%-os, a ramipril/felodipin 26%-os és a trandolapril/verapamil 12%-os eredménye követett. A ramipril/amlodipin FDC-hez képest (referencia) a perindopril/amlodipin FDC elhagyásának kockázata 30%-kal (HR = 1,30, p<0,0001), a lizinopril/amlodipin FDC-é 79%-kal (HR = 1,79, p<0,0001) volt magasabb, míg a ramipril/felodipin FDC-é (HR = 2,28, p<0,0001) mintegy kétszeres, a trandolapril/verapamil FDC-é (HR = 4,13, p<0,0001) pedig több mint négyszeres volt. A 360 napra korlátozott átlagos gyógyszerszedési idő 270,2 nap volt a ramipril/amlodipin FDC, 242,7 nap a perindopril/amlodipin FDC, 211,2 nap a lizinopril/amlodipin FDC, 186,3 nap a ramipril/felodipin FDC, míg 125,7 nap a trandolapril/verapamil FDC esetén. Következtetések: A szerzők igazolták, hogy a hypertonia indikációjában alkalmazott ACE-gátló/CCB FDC-k egyéves perzisztenciája jelentősen különbözött. A betegadherencia szempontjából a legelőnyösebbnek a ramipril/amlodipin FDC bizonyult.
Orvosi Hetilap, 2019
Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelések... more Bevezetés: A nonvalvularis pitvarfibrilláció (PF) orális antikoagulánssal (OAK) történő kezelésekor a terápiahűség igen jelentős tényező a stroke prevenciójában. Célkitűzések: A szerzők célja a már OAK-terápiában részesülő PF-ban szenvedő betegeknél a K-vitamin-antagonista (KVA) és a direkt orális antikoagulánsok (DOAK) egyéves perzisztenciájának vizsgálata. Módszer: A Nemzeti Egészségbiztosítási Alapkezelő adatbázisából a vényforgalmi adatokra támaszkodva pitvarfibrilláció indikációjában, 2015 második félévében valamely orális antikoaguláns (OAK = KVA/DOAK) receptjét ki váltó olyan betegeket választottak ki, akiknek a vizsgálati időszakot megelőzően-a vizsgálati időszakban történt kiváltási dátumhoz képest-12 hónappal korábban volt (DOAK/KVA összes) vénykiváltásuk. A perzisztencia modellezésére a túlélés-analízis klasszikus eszköztárát alkalmazták, ahol a "túlélési" idő a gyógyszer szedésének abbahagyásáig eltelt idő volt, 60 napos 'grace' periódussal.
European Heart Journal, 2018
to OAC status. Next, a diverse group of clinicians involved in AF care were questioned through a ... more to OAC status. Next, a diverse group of clinicians involved in AF care were questioned through a web-based survey. Items included factors, not included in the CHA2DS2-VASc score, that may influence prescription of OAC therapy in AF. Results: In the GARFIELD-AF registry (n=52,014), 2,123 patients had a low CHA2DS2-VASc score. OAC therapy was prescribed in 950 (45%). Permanent [OR (95%) = 2.32 (1.52-3.56)] or persistent AF [OR (95%) = 3.08 (2.17-4.38)] and increasing age <65 years [OR (95%) = 1.34 (1.20-1.50)] demonstrated a significant increase in odds for OAC use, while concomitant antiplatelet therapy [OR (95%) = 0.083 (0.065-0.105)] and female gender [OR (95%) = 0.714 (0.561-0.907)] showed a significant decrease in odds. Crude event rates were low for those with as well as without OAC therapy: all-cause mortality (14 versus 20), ischemic stroke or systemic embolism (6 versus 5), and major bleeding (4 versus 3). When clinicians (n=229) were questioned about decision-making regarding OAC therapy for AF patients with low thromboembolic risk, an enlarged left atrium or spontaneous echo contrast was the most frequently cited reason (reach: 59.8%). Adding cardioversion or ablation procedures, rheumatic heart disease, and subjective fear of stroke by the patient increased the reach to 83.8% (Table 1). Table 1 Risk factor combinations Reach, n (%) Enlarged left atrium or spontaneous echo contrast 137 (59.8) Previous + cardioversion or ablation procedures 165 (72.1) Previous + rheumatic heart disease 183 (79.9) Previous + subjective fear of stroke by the patient 192 (83.8) Reach is the number (percentage) of respondents reporting some or strong preference to prescribe oral anticoagulation therapy when the risk factor combination is present.
Orvosi Hetilap, 2017
Szentendre főútján, bevezetett, ÁNTSZ engedéllyel rendelkező orvosi rendelőben, bőrgyógyászati re... more Szentendre főútján, bevezetett, ÁNTSZ engedéllyel rendelkező orvosi rendelőben, bőrgyógyászati rendelésre teljesen felszerelve, rendelési idő kiadó. A rendelő utcai bejáratú, betegparkolóval rendelkezik. Kiterjedt pacientúra! Heti rendelés feltöltése megoldott, csak rendelni kell!
Annals of Noninvasive Electrocardiology, 2015
In coronary artery disease (CAD), body surface potential mapping (BSPM) may reveal minor electric... more In coronary artery disease (CAD), body surface potential mapping (BSPM) may reveal minor electrical potential changes appearing in the depolarization phase even if pathological changes are absent on the conventional 12-lead ECG. We hypothesized that a simple BSPM parameter, Max/Min signifies successful percutaneous coronary intervention (PCI). Methods: Ninety-two adult Caucasian patients with stable CAD and positive exercise test underwent coronary angiography. Seventy patients (age, 59 ± 8; 46 males) were revascularized by PCI (left anterior descending [LAD] in 38, right [RCA] in 17 and left circumflex [LCX] coronary artery in 15). Control groups contained 22 patients (age, 60 ± 8; 14 males) without intervention and 35 healthy subjects (age, 58 ± 2; 15 males). Left ventricular ejection fraction (LVEF, transthoracic echocardiography) and Max/Min BSPM parameter (63-lead Montreal system) were evaluated before and 4-40 days following coronary angiography. Max/Min was defined by the ratio of the highest maximum to the deepest minimum potential of all leads recorded by BSPM. Results: Before PCI, Max/Min value of patients with LAD lesion (0.83 [0.74; 0.93]) was significantly lower while that with RCA lesion (1.63 [1.35; 1.99]) was significantly higher than that of healthy group (1.01 [0.970; 1.13]) (P < 0.05) and LVEF was significantly lower in LAD lesion (46.50% [43.00; 51.00]) than in the healthy group (55.00% [50.00; 58.75]) (P < 0.01). Max/Min value significantly increased from 0.83 [0.74; 0.93] to 0.92 [0.82; 0.99] (P < 0.01) following LAD PCI while significantly decreased from 1.63 [1.35; 1.98] to 1.35 [1.21; 1.43] (P < 0.01) post-RCA PCI. It did not vary significantly, however, either following LCX PCI or without intervention. LVEF significantly increased (from 46.50% [43.00; 51.00] to 49.00% [46.00; 51.00]) only after LAD PCI. Conclusion: Max/Min parameter is suitable to follow patients after LAD and RCA PCI. Ann Noninvasive Electrocardiol 2016;21(2):161-168 catheterization; mapping; ischemic heart disease; hibernating myocardium; electrophysiology Despite many preventive lifestyle and pharmacological interventions, ischemic heart disease (IHD) remained the leading cause of mortality in the developed Western world. 1 The desired decline in coronary artery disease (CAD) mortality necessitates the accurate diagnosis and assessment
[Rivaroxaban in prevention of stroke in patients with atrial fibrillation]
Ideggyógyászati szemle, Jan 30, 2012
Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thrombopr... more Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism....
[Case of a young woman successfully operated on for acute pulmonary embolism and right ventricular thrombus after urogenital infection]
Orvosi hetilap, Jan 2, 2005
The authors report a case of a 22-year-old women operated on for pulmonary embolism with success.... more The authors report a case of a 22-year-old women operated on for pulmonary embolism with success. The venous embolism developed in two phases one week apart. The first clinical sign was a dyspnea of abrupt onset limiting physical activity even after a mild exertion. However, relevant diagnostic tests were performed after one week when the patient fainted, her dyspnea worsened. The results of ECG, echocardiography and pulmonary perfusion scintigraphy indicated the presence of a thrombus residing in the right ventricle and the embolism of the right pulmonary artery. Chest CT and pneumo-angiography findings show the embolus completely blocking the main right branch of the pulmonary artery and partially blocking the left lower lobe artery. On the basis of their experiences published earlier the patient was brought to a stable cardio-respiratory state prior to surgery. Both the adherent right ventricular thrombus and the fresh embolus residing in the right branch of the pulmonary artery ...
Simple, quantitative body surface potential map parameters in the diagnosis of remote Q wave and non-Q wave myocardial infarction
The Canadian journal of cardiology, 2004
Body surface potential mapping has been shown to be a useful tool in the diagnosis and localizati... more Body surface potential mapping has been shown to be a useful tool in the diagnosis and localization of remote non-Q wave and Q wave myocardial infarction, but human expertise is required to interpret the maps. To identify quantitative body surface potential mapping parameters that could enable a computer-based diagnosis. Body surface isopotential maps (63 unipolar leads) were recorded in 86 patients with remote Q wave and 71 patients with remote non-Q wave myocardial infarction. Twenty-four healthy adults served as control subjects. Myocardial infarctions were classified using standard electrocardiogram leads in the acute and chronic phases, and were validated by coronary angiography, ventriculography and thallium scintigraphy. Two simple quantitative parameters with high diagnostic power were identified: the time interval between the peak minimum and the peak maximum potentials (time-shift), and the ratio of these potentials (maximum to minimum ratio [max/min]). Both parameters sho...
Assessment of the Diastolic Function by Body Surface Potential Maps in Ischemic Heart Disease
Advances in Electrocardiology 2004, 2005
The Effect of Percutaneous Coronary Artery Intervention on Body Surface Potential Maps
Advances in Electrocardiology 2004 - Proceedings of the 31st International Congress on Electrocardiology, 2005