{"id":37400,"date":"2023-10-03T01:11:49","date_gmt":"2023-10-02T23:11:49","guid":{"rendered":"http:\/\/www.infokuryr.cz\/n\/?p=37400"},"modified":"2023-10-02T18:22:33","modified_gmt":"2023-10-02T16:22:33","slug":"i-bez-priznaku-podle-vybusne-studie-jsou-vsichni-ockovani-postizeni-zanetem-srdce","status":"publish","type":"post","link":"https:\/\/www.infokuryr.cz\/n\/2023\/10\/03\/i-bez-priznaku-podle-vybusne-studie-jsou-vsichni-ockovani-postizeni-zanetem-srdce\/","title":{"rendered":"I bez p\u0159\u00edznak\u016f: Podle v\u00fdbu\u0161n\u00e9 studie jsou v\u0161ichni o\u010dkovan\u00ed posti\u017eeni z\u00e1n\u011btem srdce"},"content":{"rendered":"
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Myokarditida po o\u010dkov\u00e1n\u00ed covidem se st\u00e1le prod\u00e1v\u00e1 v m\u00e9di\u00edch jako vz\u00e1cn\u00fd vedlej\u0161\u00ed \u00fa\u010dinek.\u00a0Explozivn\u00ed studie nyn\u00ed konkr\u00e9tn\u011b porovn\u00e1vala data vy\u0161et\u0159en\u00ed srdce od o\u010dkovan\u00fdch lid\u00ed s t\u011bmi od neo\u010dkovan\u00fdch – a poskytla d\u016fkazy o z\u00e1n\u011btliv\u00fdch procesech u v\u0161ech o\u010dkovan\u00fdch lid\u00ed.\u00a0Pikantn\u00ed: V\u0161echny testovan\u00e9 subjekty byly asymptomatick\u00e9 \u2013 tj. nevykazovaly \u017e\u00e1dn\u00e9 zn\u00e1mky myokarditidy.\u00a0Po\u010det nenahl\u00e1\u0161en\u00fdch p\u0159\u00edpad\u016f srde\u010dn\u00edch probl\u00e9m\u016f po o\u010dkov\u00e1n\u00ed by tedy mohl b\u00fdt mnohem vy\u0161\u0161\u00ed, ne\u017e se d\u0159\u00edve p\u0159edpokl\u00e1dalo: posti\u017eeni mohou b\u00fdt v\u0161ichni o\u010dkovan\u00ed lid\u00e9.<\/span><\/strong><\/p>\n

V r\u00e1mci studie \u201e\u00a0<\/span>Hodnocen\u00ed vychyt\u00e1v\u00e1n\u00ed 18F-FDG myokardem na PET\/CT u asymptomatick\u00fdch pacient\u016f o\u010dkovan\u00fdch a neo\u010dkovan\u00fdch proti SARS-CoV-2<\/span><\/a>\u00a0\u201c od Nakahary et al.\u00a0byla pou\u017eita data od neo\u010dkovan\u00fdch a o\u010dkovan\u00fdch pacient\u016f, u kter\u00fdch byly provedeny tzv. 18F-FDG PET a CT skeny.\u00a0Fluorodeoxygluk\u00f3za (FDG) je analog gluk\u00f3zy: tyto studie proto slou\u017e\u00ed k prok\u00e1z\u00e1n\u00ed metabolismu gluk\u00f3zy.\u00a0Pokud srde\u010dn\u00ed sval vy\u017eaduje v\u00edce gluk\u00f3zy, znamen\u00e1 to z\u00e1n\u011btliv\u00e9 procesy.\u00a0<\/span>V\u00fdsledky studie<\/span><\/a> ukazuj\u00ed, \u017ee myokarditidu lze detekovat skenov\u00e1n\u00edm stejn\u011b dob\u0159e jako srde\u010dn\u00ed MRI.<\/span><\/strong><\/p>\n

Auto\u0159i svou studii v abstraktu popisuj\u00ed takto:<\/strong><\/span><\/p>\n

Pozad\u00ed
\n<\/strong>Pacienti, u kter\u00fdch se vyvinula myokarditida po o\u010dkov\u00e1n\u00ed proti SARS-CoV-2, vykazuj\u00ed abnormality na MRI srdce.\u00a0Nen\u00ed v\u0161ak jasn\u00e9, zda u asymptomatick\u00fdch osob po o\u010dkov\u00e1n\u00ed doch\u00e1z\u00ed ke zm\u011bn\u00e1m myokardu.<\/em>
\n\u00da\u010del<\/strong><\/em>
\nVyhodnotit vychyt\u00e1v\u00e1n\u00ed 18-fluor-fluordeoxygluk\u00f3zy (18F-FDG) myokardem na PET\/CT u asymptomatick\u00fdch pacient\u016f o\u010dkovan\u00fdch proti SARS-CoV-2 ve srovn\u00e1n\u00ed s neo\u010dkovan\u00fdmi pacienty.<\/em>
\nMateri\u00e1ly a metody
\n<\/strong>Tato retrospektivn\u00ed studie zahrnovala pacienty, kte\u0159\u00ed podstoupili 18F-FDG-PET\/CT v obdob\u00ed p\u0159ed (1. listopadu 2020 \u2013 16. \u00fanora 2021) a pot\u00e9 (17. \u00fanora 2012 \u2013 31. b\u0159ezna 2022) byly vakc\u00edny proti SARS-CoV-2 dostupn\u00e9 pro indikace nesouvisej\u00edc\u00ed s myokarditidou.\u00a0Vychyt\u00e1v\u00e1n\u00ed FDG v myokardu a v axile bylo kvantitativn\u011b hodnoceno pomoc\u00ed maxim\u00e1ln\u00ed standardizovan\u00e9 hodnoty vychyt\u00e1v\u00e1n\u00ed (SUVmax).\u00a0Hodnoty SUVmax u v\u0161ech pacient\u016f a u pacient\u016f stratifikovan\u00fdch podle pohlav\u00ed (mu\u017e\/\u017eena), v\u011bku (<40, 41-60, >60 let) a \u010dasov\u00e9ho intervalu mezi o\u010dkov\u00e1n\u00edm a PET\/CT byly stanoveny pomoc\u00ed Mann-Whitney U testu nebo Kruskal-Wallis\u016fv test s post-ad hoc v\u00edcen\u00e1sobnou srovn\u00e1vac\u00ed anal\u00fdzou podle Dwass, Steel, Critchlow-Fligner.<\/em><\/p>\n

Nakahara a kol.\u00a02023<\/a><\/cite><\/em><\/p>\n

Zv\u00fd\u0161en\u00e9 vychyt\u00e1v\u00e1n\u00ed FDG u v\u0161ech o\u010dkovan\u00fdch subjekt\u016f<\/span><\/h3>\n

V tomto bod\u011b je t\u0159eba p\u0159ipomenout, \u017ee lid\u00e9 byli trvale p\u0159esv\u011bd\u010deni, \u017ee vakc\u00edna z\u016fst\u00e1v\u00e1 v m\u00edst\u011b vpichu a \u017ee vedlej\u0161\u00ed \u00fa\u010dinky jsou omezeny na bolest a zarudnut\u00ed v m\u00edst\u011b vpichu.\u00a0I kdy\u017e se rychle projevily vedlej\u0161\u00ed \u00fa\u010dinky vakc\u00edny na c\u00e9vn\u00ed a kardiovaskul\u00e1rn\u00ed syst\u00e9m, v\u017edy se tvrdilo, \u017ee se tyto probl\u00e9my vyskytuj\u00ed jen velmi z\u0159\u00eddka a pokud ano, nezp\u016fsob\u00ed n\u00e1sledn\u00e9 po\u0161kozen\u00ed (co\u017e nen\u00ed pravda\u00a0<\/span>)<\/span><\/a>\u00a0.\u00a0Jak jsou n\u00e1sleduj\u00edc\u00ed v\u00fdsledky v souladu s t\u00edmto p\u0159\u00edb\u011bhem?<\/span><\/p>\n

V\u00fdsledky<\/strong><\/span><\/em>
\nDo studie bylo za\u0159azeno 303 neo\u010dkovan\u00fdch pacient\u016f (pr\u016fm\u011brn\u00fd v\u011bk 52,9 let \u00b1 14,9 [SD]; 157 \u017een) a 700 o\u010dkovan\u00fdch pacient\u016f (pr\u016fm\u011brn\u00fd v\u011bk 56,8 let \u00b1 13,7 [SD]; 344 \u017een).\u00a0O\u010dkovan\u00ed pacienti m\u011bli celkov\u011b vy\u0161\u0161\u00ed p\u0159\u00edjem FDG v myokardu ve srovn\u00e1n\u00ed s neo\u010dkovan\u00fdmi pacienty<\/strong>(st\u0159edn\u00ed hodnota SUVmax, 4,8 [IQR: 3,0-8,5] oproti medi\u00e1nu SUVmax, 3,3 [IQR: 2,5-6,2]; P < 0,0001).\u00a0SUVmax myokardu u o\u010dkovan\u00fdch pacient\u016f byl nez\u00e1visl\u00fd na pohlav\u00ed (st\u0159edn\u00ed rozsah, 4,7-4,9 [IQR: 2,9-8,6]) nebo v\u011bku pacienta (st\u0159edn\u00ed rozsah, 4,7-5,6 [IQR: 2,9-8,6]) ve srovn\u00e1n\u00ed s odpov\u00eddaj\u00edc\u00ed neo\u010dkovan\u00e9 skupiny (rozmez\u00ed medi\u00e1nu pohlav\u00ed, 3,2-3,9 [IQR: 2,4-7,2]; rozmez\u00ed medi\u00e1nu v\u011bku, 3,3-3,3 [IQR: 2,3-6,1]; rozmez\u00ed P, <,001-,015) vy\u0161\u0161\u00ed.\u00a0Krom\u011b toho bylo u pacient\u016f vy\u0161et\u0159en\u00fdch 1-30, 31-60, 61-120 a 121-180 dn\u016f po druh\u00e9 vakcinaci pozorov\u00e1no zv\u00fd\u0161en\u00e9 vychyt\u00e1v\u00e1n\u00ed FDG myokardem (st\u0159edn\u00ed rozsah SUVmax, 4,6-5,1 [IQR: 2,9-8,6]) a zv\u00fd\u0161en\u00e9 ipsilater\u00e1ln\u00ed axil\u00e1rn\u00ed vychyt\u00e1v\u00e1n\u00ed bylo pozorov\u00e1no u pacient\u016f ve v\u011bku 1-30, 31-60,<\/em>
\nZ\u00e1v\u011br
\n<\/strong>Ve srovn\u00e1n\u00ed s neo\u010dkovan\u00fdmi pacienty vykazovali asymptomati\u010dt\u00ed pacienti, kte\u0159\u00ed dostali druhou vakcinaci 1-180 dn\u00ed p\u0159ed zobrazen\u00edm, zv\u00fd\u0161en\u00fd p\u0159\u00edjem FDG v myokardu na PET\/CT.<\/em><\/p>\n

Nakahara a kol.\u00a02023<\/a><\/cite><\/em><\/p>\n

Jin\u00fdmi slovy:\u00a0<\/span>Asymptomati\u010dt\u00ed pacienti, kte\u0159\u00ed byli o\u010dkov\u00e1ni proti COVID-19 p\u0159ed PET skenem, m\u011bli p\u0159ibli\u017en\u011b o 40 % vy\u0161\u0161\u00ed aktivitu radioindik\u00e1toru v myokardu ne\u017e neo\u010dkovan\u00ed lid\u00e9.\u00a0<\/span><\/strong>Tento \u00fa\u010dinek byl zjistiteln\u00fd bez ohledu na pohlav\u00ed, v\u011bk a vakc\u00ednu (Pfizer nebo Moderna).\u00a0David A Bluemke, redaktor \u010dasopisu Radiology, kde byla studie publikov\u00e1na, vyz\u00fdv\u00e1 k opatrnosti p\u0159i interpretaci v\u00fdsledk\u016f v \u00favodn\u00edku\u00a0<\/span>a<\/span><\/a>\u00a0sna\u017e\u00ed se uv\u00e9st v\u011bci na pravou m\u00edru ve prosp\u011bch o\u010dkov\u00e1n\u00ed, ale st\u00e1le nem\u016f\u017ee odm\u00edtnout v\u00fdbu\u0161n\u00e9 d\u016fsledky v\u00fdzkumu. sm\u011b\u0159ovat.\u00a0Stejn\u011b jako samotn\u00ed auto\u0159i studie se domn\u00edv\u00e1, \u017ee dal\u0161\u00ed studie o t\u011bchto v\u00fdsledc\u00edch jsou nezbytn\u00e9.<\/span><\/p>\n

Kone\u010dn\u011b z\u016fst\u00e1v\u00e1 nejasn\u00e9, do jak\u00e9 m\u00edry abnormality identifikovan\u00e9 ve studii n\u00e1sledn\u011b povedou ke znateln\u00fdm srde\u010dn\u00edm poruch\u00e1m u o\u010dkovan\u00fdch subjekt\u016f.\u00a0<\/span>Faktem v\u0161ak je, \u017ee l\u00e9ky na genovou terapii, kter\u00e9 zjevn\u011b vyvol\u00e1vaj\u00ed tak znepokojiv\u00e9 v\u00fdsledky test\u016f u v\u0161ech jimi l\u00e9\u010den\u00fdch lid\u00ed, nelze pova\u017eovat za \u201ebezpe\u010dn\u00e9\u201c.\u00a0<\/span><\/strong>Na po\u010d\u00e1tku hromadn\u00e9ho o\u010dkov\u00e1n\u00ed nebyli lid\u00e9 nijak upozor\u0148ov\u00e1ni na mo\u017en\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky p\u0159\u00edpravk\u016f na srde\u010dn\u00ed \u010dinnost a dodnes je toto riziko bagatelizov\u00e1no.\u00a0Je \u0161koda, \u017ee kritick\u00e9 studie, jako je tato, vych\u00e1zej\u00ed teprve nyn\u00ed (i kdy\u017e s v\u00fdhradou editora).<\/span><\/p>\n

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Myokarditida po o\u010dkov\u00e1n\u00ed covidem se st\u00e1le prod\u00e1v\u00e1 v m\u00e9di\u00edch jako vz\u00e1cn\u00fd vedlej\u0161\u00ed \u00fa\u010dinek.\u00a0Explozivn\u00ed studie nyn\u00ed…<\/p>\n","protected":false},"author":2,"featured_media":37401,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[7],"tags":[2340,1556,839,651,6026],"_links":{"self":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/37400"}],"collection":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/comments?post=37400"}],"version-history":[{"count":1,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/37400\/revisions"}],"predecessor-version":[{"id":37402,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/37400\/revisions\/37402"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media\/37401"}],"wp:attachment":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media?parent=37400"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/categories?post=37400"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/tags?post=37400"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}