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Spinar J, Jarkovsky J, Spinarova L, Mebazaa A, Gayat E, Vitovec J, Linhart A, Widimsky P, Miklik R, Zeman K, Belohlavek J, Malek F, Felsoci M, Kettner J, Ostadal P, Cihalik C, Vaclavik J, Taborsky M, Dusek L, Littnerova S, Parenica J. AHEAD score--Long-term risk classification in acute heart failure. Int J Cardiol 2015; 202:21-6. [PMID: 26386914 DOI: 10.1016/j.ijcard.2015.08.187] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/22/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND The role of co-morbidities in the prognosis of patients hospitalized for AHF was examined using the AHEAD (A--atrial fibrillation, H--haemoglobin<130 g/l for men and 120 g/l for women (anaemia), E--elderly (age>70years), A--abnormal renal parameters (creatinine>130 μmol/l), D--diabetes mellitus) scoring system. METHODS AHEAD--multicentre prospective Czech registry of AHF patients; GREAT registry--international cohort of AHF patients. Data from 5846 consecutive patients hospitalized for AHF (AHEAD registry; derivation cohort) were analysed to build the AHEAD score. Each risk factor of the AHEAD score was counted as 1 point. The model was validated externally using an international cohort of similar patients in the GREAT registry (6315). RESULTS Main outcome was one year all-cause mortality. The mean age of patients was 72±12 years, with 61.6% of patients aged >70 years; 43.4% were women. Atrial fibrillation was present in 30.7%, anaemia in 38.2%, creatinine>130 mmol/l (abnormal renal parameters) in 30.1%, and diabetes mellitus in 44.0%. The mean AHEAD score was 2.1. In patients with AHEAD scores of 0-5, the one-year mortality rates were 13.6%, 23.4%, 32.0%, 41.1%, 47.7%, and 58.2%, respectively (p<0.001), and the 90 month mortality rates were 35.1%, 57.3%, 73.5%, 84.8%, 88.0%, and 91.7%, respectively (p<0.001). CONCLUSION The AHEAD is a simple scoring system based on the analysis of co-morbidities for the estimation of the short and long term prognosis of patients hospitalized for AHF.
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Affiliation(s)
- Jindrich Spinar
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Spinarova
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisiere University Hospital, Paris, France; UMR-S 942, Inserm, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Saint Louis Lariboisiere University Hospital, Paris, France; UMR-S 942, Inserm, Paris, France
| | - Jiri Vitovec
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Ales Linhart
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Petr Widimsky
- Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Roman Miklik
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Filip Malek
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Marian Felsoci
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Miloš Taborsky
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Simona Littnerova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic.
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Koller L, Kleber ME, Brandenburg VM, Goliasch G, Richter B, Sulzgruber P, Scharnagl H, Silbernagel G, Grammer TB, Delgado G, Tomaschitz A, Pilz S, Berger R, Mörtl D, Hülsmann M, Pacher R, März W, Niessner A. Fibroblast Growth Factor 23 Is an Independent and Specific Predictor of Mortality in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2015; 8:1059-67. [PMID: 26273098 DOI: 10.1161/circheartfailure.115.002341] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strategies to improve risk prediction are of major importance in patients with heart failure (HF). Fibroblast growth factor 23 (FGF-23) is an endocrine regulator of phosphate and vitamin D homeostasis associated with an increased cardiovascular risk. We aimed to assess the prognostic effect of FGF-23 on mortality in HF patients with a particular focus on differences between patients with HF with preserved ejection fraction and patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS FGF-23 levels were measured in 980 patients with HF enrolled in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study including 511 patients with HFrEF and 469 patients with HF with preserved ejection fraction and a median follow-up time of 8.6 years. FGF-23 was additionally measured in a second cohort comprising 320 patients with advanced HFrEF. FGF-23 was independently associated with mortality with an adjusted hazard ratio per 1-SD increase of 1.30 (95% confidence interval, 1.14-1.48; P<0.001) in patients with HFrEF, whereas no such association was found in patients with HF with preserved ejection fraction (for interaction, P=0.043). External validation confirmed the significant association with mortality with an adjusted hazard ratio per 1 SD of 1.23 (95% confidence interval, 1.02-1.60; P=0.027). FGF-23 demonstrated an increased discriminatory power for mortality in addition to N-terminal pro-B-type natriuretic peptide (C-statistic: 0.59 versus 0.63) and an improvement in net reclassification index (39.6%; P<0.001). CONCLUSIONS FGF-23 is independently associated with an increased risk of mortality in patients with HFrEF but not in those with HF with preserved ejection fraction, suggesting a different pathophysiologic role for both entities.
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Affiliation(s)
- Lorenz Koller
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Marcus E Kleber
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Vincent M Brandenburg
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Georg Goliasch
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Bernhard Richter
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Patrick Sulzgruber
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Hubert Scharnagl
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Günther Silbernagel
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Tanja B Grammer
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Graciela Delgado
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Andreas Tomaschitz
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Stefan Pilz
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Rudolf Berger
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Deddo Mörtl
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Martin Hülsmann
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Richard Pacher
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Winfried März
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.)
| | - Alexander Niessner
- From the Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (L.K., G.G., B.R., P.S., R.B., D.M., M.H., R.P., A.N.); Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (M.E.K., T.B.G., G.D., W.M.) and Mannheim Institute of Public Health, Social and Preventive Medicine (T.B.G.), Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany; Department of Cardiology, University Hospital of the RWTH Aachen, Aachen, Germany (V.M.B.); Clinical Institute of Medical and Chemical Laboratory Diagnostics (G.S.), Division of Cardiology (A.T.) and Division of Endocrinology and Metabolism (S.P.), Department of Internal Medicine, Medical University of Graz, Graz, Austria (H.S., W.M.); Department of Angiology, Inselspital, Bern, Switzerland; Sonderkrankenanstalt Rehabilitationszentrum Bad Aussee: Specialist Clinic for Rehabilitation, PV Bad Aussee, Austria (A.T.); and Synlab Academy, Synlab Services GmbH, Mannheim, Germany (W.M.).
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