Hypertrophic cardiomyopathy is caused by mutations in the genes that encode sarcomeric proteins and is primarily characterized by unexplained left ventricular hypertrophy, impaired cardiac function, reduced exercise tolerance, and a relatively high incidence of sudden cardiac death, especially in the young. The extent of left ventricular hypertrophy is one of the major determinants of disease prognosis. Angiotensin II has trophic effects on the heart and plays an important role in the development of myocardial hypertrophy. Here in a double-blind, placebo-controlled, randomized study, we show that the long-term administration of the angiotensin II type 1 receptor antagonist candesartan in patients with hypertrophic cardiomyopathy was associated with the significant regression of left ventricular hypertrophy, improvement of left ventricular function, and exercise tolerance. The magnitude of the treatment effect was dependent on specific sarcomeric protein gene mutations that had the greatest responses on the carriers of ß-myosin heavy chain and cardiac myosin binding protein C gene mutations. These data indicate that modulating the role of angiotensin II in the development of hypertrophy is specific with respect to both the affected sarcomeric protein gene and the affected codon within that gene. Thus, angiotensin II type 1 receptor blockade has the potential to attenuate myocardial hypertrophy and may, therefore, provide a new treatment option to prevent sudden cardiac death in patients with hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy (HCM) is a primary cardiac disease characterized by unexplained cardiac hypertrophy and a relatively high incidence of sudden cardiac death, especially in young people.1,2 The extent of left ventricular hypertrophy is one of the major determinants of symptoms and prognosis. 3,4 Angiotensin II has trophic effects on the heart and plays an important role in the development of myocardial hypertrophy. 5,6 Inhibition of angiotensin-converting enzyme (ACE) or the angiotensin II type 1 receptor (AT1-R) induced regression of myocardial hypertrophy in patients with hypertension or after myocardial infarction. [7][8][9] In HCM, ACE and AT1-R gene polymorphisms have been shown to be associated with severity of hypertrophy, a high incidence of atrial fibrillation and the risk of sudden cardiac death. -17Therefore, we designed a double-blind, placebo-controlled, randomized, multicenter study to test the safety and effects of AT1-R antagonist candesartan in patients with nonobstructive HCM. We hypothesized that long-term use of candesartan would be associated with regression of left ventricular (LV) hypertrophy and improvement of LV function. Materials and Methods PatientsThis was a double-blind, placebo-controlled, randomized multicenter study. The study population consisted of 24 consecutive, genetically independent, adult (Ն18 years) patients (age 43 Ϯ 13 yrs; 46% males) with nonobstructive HCM, and normal ejection fraction (Ն60%) and sinus rhythm, who visited the participating in...

EU accession has had an ambiguous impact on regionalization in the Czech Republic. While EU membership necessitated the creation of regional administrative structures to manage the Structural Funds, the role of new regional authorities was often undermined by the centralized nature of the accession process itself. Developments since accession have created a new dynamic in the debate over regional policy and regionalization in the Czech Republic, however. Most significant are the increased political importance of the new regions and changes in partisan attitudes about regionalization. The impact of these developments is evident in the debate over regional policy planning for 2007-2103. Thus, despite its limited initial impact, EU accession has created the structural potential for increased regionalization in the Czech Republic which has been actualized by the changing constellation of political forces and altered preferences of key political actors in the country.

This article explores the Europeanization of Czech politics in the pre-accession period, with a principal focus on the political parties and party system. It argues that Czech political parties and party politics became increasingly Europeanized with the increased integration of the Czech Republic into the EU. In turn, the parties have played a key role in the Europeanization of Czech politics. This role is evident in the outcome of the June 2003 referendum on EU membership, which reflected strong cross-party support for EU accession (excepting the Communists). However, factors other than party support also influenced voters' choices, including regional factors and socio-economic factors such as employment status and level of income and education. Copyright 2006 Blackwell Publishing Ltd.

This article examines the impact of EU enlargement on regionalization in the Czech Republic. It asks whether pre-accession preparations for EU regional policy have promoted regionalization and governmental decentralization in the Czech Republic, a question prompted by the debate about EU regional policy and regionalization in the current Member States. After reviewing Czech preparations for EU regional policy and the administration of pre-accession structural aid programmes, it concludes that the EU's impact on regionalization in the Czech Republic has been both limited and highly ambivalent. The article thus confirms the findings of previous research on EU enlargement and regionalization in the candidate countries.

Background. The Eustachian valve (EV) is an embryonic structure redirecting the blood flow from the inferior vena cava through the foramen ovale. It may persist in adults as a floating membrane in the right atrium. A large EV can be associated with thrombosis, embolization, bacterial endocarditis, etc. The prevalence of EV in the normal population is unknown.Aim. to assess the prevalence and size of EV in unselected patients examined by transoesophageal echo. Methods. 1100 consecutive patients were examined for various reasons by a single operator and interpreter. Routine check was made for the presence of EV in the right atrium. Only patients with a mobile EV and not with a simple rigid rim were counted. Three measurements of the EV length at the level of the aortic valve (i.e. 90°) were made off-line and the longest distance considered. If the EV was not visualized and recorded as a straight line because of its chaotic movement, the picture of the valve was segmented into several separated valve portions and the sum taken as the true length.Results. 46 patients (24 males) with EV were identified out of total 1100 pts examined. The average length of the EV was 23.6 ± 9.7 mm (7-47 mm, median 23 mm).Conclusions. The finding of a persisting Eustachian valve on transoesophageal echo examination is not rare. The prevalence was similar in men and in women. Bearing in mind the possible complications associated with a large valve, we recommend that a proper description of persistent EV is included in routine transoesophageal echo reports.

Patients with ischemic heart disease and depressed left ventricular (LV) ejection fraction (LVEF) develop varying degrees of LV remodeling after cardiac surgical revascularization. Fifty-three patients with stable ischemic heart disease and impaired LV function (LVEF 34.9 ± 4%) were prospectively followed up for 24 months. Thirty-seven patients underwent coronary artery bypass grafting (CABG), 16 patients were treated conservatively. Cardiac magnetic resonance imaging (MRI) and SPECT were performed at baseline and after 12 and 24 months of follow-up. The patients were divided into responders and non-responders depending on the degree of LVEF improvement at 24 months follow-up (>5%-responders). MRI with ≤5 segments with DE/wall thickness ratio (DEWTR) ≥50% predicted LV reverse remodeling with a sensitivity of 86% and a specificity of 75% (AUC 0.81). An MRI finding of ≤2 segments with the DEWTR ≥75% had a corresponding sensitivity of 71% and specificity of 67% (AUC 0.75) while fixed perfusion defect on SPECT <16.5% of LV predicted reverse remodeling with a sensitivity of 64% and a specificity of 69% (AUC 0.64). A preoperative number of segments with the DE/wall thickness ratio of ≥50 and ≥75% obtained by MRI, was found to be a better predictor of left ventricular reverse remodeling than fixed perfusion defect by SPECT. No other MRI or SPECT parameter predicted LVEF improvement at 24 months after CABG.

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Background. In patients indicated for detection of intraatrial thrombus (T), 2-dimensional transesophageal echocardiography (2DTEE) is routinely used but differentiation between T and trabeculae or artifacts in the left atrial appendage (LAA) is often difficult. Aims. To compare the diagnostic value of real time 3D-transesophageal echocardiography (RT3DTEE) and 2DTEE in the assessment of LAA thrombosis. Patients and Methods. One hundred and ten consecutive patients (73M, aged 64+-13) were examined by 2DTEE. In terms of possible T, individual pts were diagnosed as negative (N2), uncertain trabecular finding (U2), other/artifacts (O2), and clearly positive (T2). The RT3DTEE was then applied and the categorization repeated (N3,U3,O3 and T3, resp.). Finally, the operator decided whether the RT3DTEE. A: had an additional diagnostic value, and/or B: changed the definite diagnosis of thrombosis. Results. N2:71; U2:17; O2:19; T2:3; N3:97; U3:1; O3:12; T3:0. Ad A/ RT3DTEE enabled us to refine or change the diagnosis in 26/110 cases. 17 pts were switched from group U2 to N3, 7:O2-N3 and 2:T2-N3. 12 pts from O2 and 1 pt from T2 remained unclarified. Ad B/ Diagnoses were changed in 6 patients after RT3DTEE. A very suspicious T2 was found in 3 patients. In 1, the finding was requalified definitely as musculi pectinati. In the second patient, the finding was recategorized as just a spontaneous echocontrast without T. In another 4 patients, T in LAA was definitely excluded after RT3DTEE (1 patient switched from U2 to N3, 3 from O2 to N3). In another 13, the findings remained unclear, mostly because of poor quality image. No real thrombus was found in this study. Conclusion. RT3DTEE provides additional information, which may be helpful in the differentiation of thrombus from other findings. It is particularly useful in the identification of muscular trabeculae in the left atrial appendage.