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Schupp T, Weidner K, Lau F, Forner J, Schmitt A, Reinhardt M, Abel N, Ayasse N, Bertsch T, Akin M, Weiß C, Akin I, Behnes M. Effect of severity and etiology of chronic kidney disease in patients with heart failure with mildly reduced ejection fraction. Clin Res Cardiol 2024:10.1007/s00392-024-02453-y. [PMID: 38709336 DOI: 10.1007/s00392-024-02453-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The study investigates the prognostic impact of the severity and etiology of chronic kidney disease (CKD) in patients with heart failure with mildly reduced ejection fraction (HFmrEF). BACKGROUND Data regarding the outcomes in patients with CKD in HFmrEF is scarce. METHODS Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Prognosis of patients with different stages and etiologies of CKD was investigated with regard to the primary endpoint of all-cause mortality at 30 months. RESULTS A total of 2155 consecutive patients with HFmrEF were included with an overall prevalence of CKD of 31%. Even milder stages of CKD (i.e., KDIGO stage 3a) were associated with an increased risk of 30-months all-cause mortality (HR = 1.242; 95% CI 1.147-1.346; p = 0.001). However, long-term prognosis did not differ in patients with KDIGO stage 5 compared to patients with stage 4 (HR = 0.886; 95% CI 0.616-1.275; p = 0.515). Furthermore, the highest risk of HF-related rehospitalization was observed in patients with KDIGO stages 3b and 4 (log rank p ≤ 0.015), whereas patients with KDIGO stage 5 had a lower risk of HF-related rehospitalization compared to patients with KDIGO stage 4 (HR = 0.440; 95% CI 0.228-0.849; p = 0.014). In contrast, the etiology of CKD was not associated with the risk of 30-month all-cause mortality (log rank p ≥ 0.347) and HF-related rehospitalization (log rank p ≥ 0.149). CONCLUSION In patients with HFmrEF, even milder stages of CKD were independently associated with increased risk of 30-months all-cause mortality.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Niklas Ayasse
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Rheumatology, Pneumology) & Transplant Center Mannheim, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Muharrem Akin
- Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791, Bochum, Germany
| | - Christel Weiß
- Department of Statistical Analysis, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Schupp T, Abumayyaleh M, Weidner K, Lau F, Schmitt A, Reinhardt M, Abel N, Forner J, Akin M, Ayoub M, Mashayekhi K, Bertsch T, Akin I, Behnes M. Diagnostic and Prognostic Value of Aminoterminal Prohormone of Brain Natriuretic Peptide in Heart Failure with Mildly Reduced Ejection Fraction Stratified by the Degree of Renal Dysfunction. J Clin Med 2024; 13:489. [PMID: 38256622 PMCID: PMC10816452 DOI: 10.3390/jcm13020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Limited data concerning the diagnostic and prognostic value of blood-derived biomarkers in heart failure with mildly reduced ejection fraction (HFmrEF) is available. This study investigates the diagnostic and prognostic value of aminoterminal prohormone of brain natriuretic peptide (NT-proBNP) in patients with HFmrEF, stratified by the estimated glomerular filtration rate (eGFR). Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. First, the diagnostic value of NT-proBNP for acute decompensated heart failure (ADHF) was tested. Thereafter, the prognostic value of NT-proBNP levels was tested for 30-months all-cause mortality in patients with ADHF. From a total of 755 patients hospitalized with HFmrEF, the rate of ADHF was 42%. Patients with ADHF revealed higher NT-proBNP levels compared to patients without (median 5394 pg/mL vs. 1655 pg/mL; p = 0.001). NT-proBNP was able to discriminate ADHF with an area under the curve (AUC) of 0.777 (p = 0.001), with the highest AUC in patients with eGFR ≥ 60 mL/min (AUC = 0.800; p = 0.001), and no diagnostic value was seen in eGFR < 30 mL/min (AUC = 0.576; p = 0.210). Patients with NT-proBNP levels > 3946 pg/mL were associated with higher rates of all-cause mortality at 30 months (57.7% vs. 34.4%; HR = 2.036; 95% CI 1.423-2.912; p = 0.001), even after multivariable adjustment (HR = 1.712; 95% CI 1.166-2.512; p = 0.006). In conclusion, increasing NT-proBNP levels predicted the risk of ADHF and all-cause mortality in patients with HFmrEF and preserved renal function; however, NT-proBNP levels were not predictive in patients with HFmrEF and eGFR < 30 mL/min.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791 Bochum, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
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Schupp T, Rusnak J, Weidner K, Bertsch T, Mashayekhi K, Tajti P, Akin I, Behnes M. Prognostic Impact of Different Types of Ventricular Tachyarrhythmias Stratified by Underlying Cardiac Disease. J Pers Med 2022; 12:jpm12122023. [PMID: 36556245 PMCID: PMC9784877 DOI: 10.3390/jpm12122023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Limited data regarding the outcome of patients with different types of ventricular tachyarrhythmias is available. This study sought to assess the prognostic impact of different types of ventricular tachyarrhythmias stratified by underlying cardiac disease. A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with non-sustained VT (ns-VT), sustained VT (s-VT) and VF were compared using uni- and multivariable Cox regression models. Risk stratification was performed after stratification by underlying cardiac disease (i.e., acute myocardial infarction (AMI), ischemic heart disease (IHD), non-ischemic cardiomyopathy (NICM) and patients considered as lower-risk for ventricular tachyarrhythmias). The primary endpoint was defined as all-cause mortality at 2.5 years. Secondary endpoints were cardiac death at 24 h, all-cause mortality at 5 years, cardiac rehospitalization and a composite arrhythmic endpoint at 2.5 years. In 2422 consecutive patients with ventricular tachyarrhythmias, most patients were admitted with VF (44%), followed by ns-VT (30%) and s-VT (26%). Patients with VF suffered most commonly from AMI (42%), whereas heart failure was more common in s-VT patients (32%). In patients with AMI (HR = 1.146; 95% CI 0.751-1.750; p = 0.527) and in the lower-risk group (HR = 1.357; 95% CI 0.702-2.625; p = 0.364), the risk of all-cause mortality did not differ in VF and s-VT patients. In IHD patients, VF was associated with impaired prognosis compared to s-VT (HR = 2.502; 95% CI 1.936-3.235; p = 0.001). In conclusion, VF was associated with worse long-term prognosis compared to s-VT in IHD patients, whereas the risk of all-cause mortality among VF and s-VT patients did not differ in patients with AMI, NICM and in patients considered at lower risk for ventricular tachyarrhythmias.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Péter Tajti
- Gottsegen György National Cardiovascular Center, 1096 Budapest, Hungary
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-621-383-6239
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Special Issue: Sudden Cardiac Death: Clinical Updates and Perspectives. J Clin Med 2022; 11:jcm11113120. [PMID: 35683506 PMCID: PMC9181130 DOI: 10.3390/jcm11113120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 12/11/2022] Open
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Weidner K, Behnes M, Schupp T, Hoppner J, El-Battrawy I, Ansari U, Saleh A, Taton G, Reiser L, Bollow A, Reichelt T, Ellguth D, Engelke N, Bertsch T, Große Meininghaus D, Hoffmann U, Akin I. Cardiac disease and prognosis associated with ventricular tachyarrhythmias in young adults and adults. BMC Cardiovasc Disord 2022; 22:136. [PMID: 35361107 PMCID: PMC8973880 DOI: 10.1186/s12872-022-02552-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study evaluates cardiac diseases and prognosis in young adults and adults presenting with ventricular tachyarrhythmias (VTA). METHODS The present longitudinal, observational, registry-based, monocentric cohort study includes all consecutive patients 45 years old or younger presenting with VTA at admission from 2002 to 2016. Rates of coronary angiography, coronary artery disease (CAD) and need for percutaneous coronary intervention (PCI), cardiac diseases associated with VTA, and differences in long-term prognostic endpoints for young adults (20-34 years old) were analyzed and compared to those of adults (35-45 years old), for whom multivariable risk prediction models were developed. Kaplan-Meier analyses were performed according to age and type of VTA. RESULTS A total of 259 consecutive patients were included in the study (36% young adults and 64% adults). At admission, 38% of young adults had VTA due to CAD that required PCI. Furthermore, VTA in young adults was commonly idiopathic (27%), or had underlying channelopathies (18%), primary cardiomyopathies (13%) or acute myocardial infarction (AMI, 11%). In adults, VTA was mostly associated with AMI (28%), though the rate of idiopathy was still high (20%). A total 41% of all patients received cardiopulmonary resuscitation (CPR), for whom AMI (STEMI 17%, NSTEMI 24%) was most frequently observed. Irrespective of the type of VTA, all-cause mortality was similar for young adults and adults. In young adults, left ventricular ejection fraction (LVEF) < 35% (HR = 33.590) was associated with increased long-term all-cause mortality. CONCLUSION Despite high rates of idiopathic ventricular tachyarrhythmias, CAD and AMI are common causes of VTA and CPR in adults 45 years old and younger. Young adults and adults had comparable survival at index hospitalization and after 2.5 years irrespective of the type of VTA. Clinical trial registration clinicaltrials.gov identifier: NCT02982473.
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Affiliation(s)
- Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ahmad Saleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | | | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for Angio Science (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Prognostic Effect of Underlying Chronic Kidney Disease and Renal Replacement Therapy on the Outcome of Patients after Out-of-Hospital Cardiac Arrest: A Nationwide Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030444. [PMID: 35334620 PMCID: PMC8948889 DOI: 10.3390/medicina58030444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: This study assessed the prognostic value of underlying chronic kidney disease (CKD) and renal replacement therapy (RRT) on the clinical outcomes from out-of-hospital cardiac arrest (OHCA). Materials and Methods: This retrospective study was conducted utilizing the population-based OHCA data of South Korea between 2008 and 2018. Adult (>18 years) OHCA patients with a medical cause of cardiac arrest were included and classified into three categories based on the underlying CKD and RRT: (1) non-CKD group; (2) CKD without RRT group; and (3) CKD with RRT group. A total of 13,682 eligible patients were included (non-CKD, 9863; CKD without RRT, 1778; CKD with RRT, 2041). From the three comparison subgroups, data with propensity score matching were extracted. The influence of CKD and RRT on patient outcomes was assessed using propensity score matching and multivariate logistic regression analyses. The primary outcome was survival at hospital discharge and the secondary outcome was a good neurological outcome at hospital discharge. Results: The two CKD groups (CKD without RRT and CKD with RRT) showed no significant difference in survival at hospital discharge compared with the non-CKD group (CKD without RRT vs. non-CKD, p > 0.05; CKD with RRT vs. non-CKD, p > 0.05). The non-CKD group had a higher chance of having good neurological outcomes than the CKD groups (non-CKD vs. CKD without RRT, p < 0.05; non-CKD vs. CKD with RRT, p < 0.05) whereas there was no significant difference between the two CKD groups (CKD without RRT vs. CKD with RRT, p > 0.05). Conclusions: Compared with patients without CKD, the underlying cause of CKD—regardless of RRT—may be linked to poor neurological outcomes. Underlying CKD and RRT had no effect on the survival at hospital discharge.
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Müller J, Behnes M, Schupp T, Reiser L, Taton G, Reichelt T, Ellguth D, Borggrefe M, Engelke N, Bollow A, Kim SH, Weidner K, Ansari U, Mashayekhi K, Akin M, Halbfass P, Meininghaus DG, Akin I, Rusnak J. Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias. Heart Vessels 2021; 37:828-839. [PMID: 34783873 PMCID: PMC8986738 DOI: 10.1007/s00380-021-01976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
Limited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002-2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.
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Affiliation(s)
- Julian Müller
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kathrin Weidner
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Halbfass
- Department of Interventional Electrophysiology, Heart Centre Bad, Neustadt, Germany
| | | | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Rusnak
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), European Centre for AngioSience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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8
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Weidner K, von Zworowsky M, Schupp T, Hoppner J, Kittel M, Rusnak J, Kim SH, Abumayyaleh M, Borggrefe M, Barth C, Ellguth D, Taton G, Reiser L, Bollow A, Meininghaus DG, Bertsch T, El-Battrawy I, Akin I, Behnes M. Effect of Anemia on the Prognosis of Patients with Ventricular Tachyarrhythmias. Am J Cardiol 2021; 154:54-62. [PMID: 34247729 DOI: 10.1016/j.amjcard.2021.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/01/2022]
Abstract
This study evaluates the prognostic impact of anemia in patients presenting with ventricular tachyarrhythmias. The present longitudinal, observational, registry-based, monocentric cohort study included retrospectively all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016. Anemic patients (hemoglobin levels <12.0 g/dl) were compared with non-anemic patients (hemoglobin levels ≥12.0 g/dl). The primary endpoint was all-cause mortality at 2.5 years. Secondary endpoints were cardiac death at 24 hours, all-cause mortality at index hospitalization, and the composite endpoint of cardiac death at 24 hours, recurrent ventricular tachyarrhythmias, and appropriate ICD therapies at 2.5 years. A total of 2,184 consecutive patients were included, of whom 30% were anemic and 70% non-anemic. Anemia was associated with the primary endpoint of all-cause mortality at 2.5 years (65% vs 29%, p = 0.001; HR = 2.441; 95% CI 2.086 to 2.856), cardiac death at 24 hours (26% vs 11%, p = 0.001), all-cause mortality at index hospitalization (45% vs 20%, p = 0.001), and the composite endpoint (35% vs 27%, p = 0.001; HR = 2.923; 95% CI 2.564 to 4.366). After multivariable adjustment, anemia was no longer associated with the composite endpoint. Predictors of adverse prognosis for anemics were CKD (HR = 2.191), LVEF <35% (HR = 1.651), cardiogenic shock (HR = 1.591), CPR (HR = 1.460), male gender (HR = 1.379), and age (HR = 1.017). In conclusion, anemic patients presenting with ventricular tachyarrhythmias were associated with increased long-term mortality at 2.5 years but not with the composite arrhythmic endpoint at 2.5 years. Predictors of adverse prognosis at 2.5 years were CKD, LVEF <35%, cardiogenic shock, CPR, male gender, and age.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Max von Zworowsky
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Tobias Schupp
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Jorge Hoppner
- Clinic for Diagnostic and Interventional Radiology Heidelberg, University Heidelberg, Germany
| | - Maximilian Kittel
- Institute of Clinical Chemistry and Laboratory Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Jonas Rusnak
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Seung-Hyun Kim
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Mohammad Abumayyaleh
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Christian Barth
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Dominik Ellguth
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Gabriel Taton
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Linda Reiser
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Armin Bollow
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | | | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany
| | - Michael Behnes
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany.
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Darma A, Bertagnolli L, Dinov B, Shamloo AS, Torri F, Efimova E, Dagres N, Husser-Bollmann D, Bollmann A, Hindricks G, Arya A. Role of assist device implantation and heart transplantation in the long-term outcome of patients with structural heart disease after catheter ablation of ventricular tachycardia. Herzschrittmacherther Elektrophysiol 2021; 32:353-358. [PMID: 34269843 PMCID: PMC8413170 DOI: 10.1007/s00399-021-00787-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Introduction Ablation of ventricular tachycardias (VTs) in patients with structural heart disease (SHD) has been associated with advanced heart failure and poor survival. Methods and results This matched case-control study sought to assess the difference in survival after left ventricular assist device (LVAD) implantation and/or heart transplantation (HTX) in SHD patients undergoing VT ablation. From the initial cohort of 309 SHD patients undergoing VT ablation (187 ischemic cardiomyopathy, mean age 64 ± 12 years, ejection fraction of 34 ± 13%), 15 patients received an LVAD and nine patients HTX after VT ablation during a follow-up period of 44 ± 33 months. Long-term survival after LVAD did not differ from the matched control group (p = 0.761), although the cause of lethal events was different. All post-HTX patients survived during follow-up. Conclusion In this matched case-control study on patients with SHD undergoing VT ablation, patients that received LVAD implantation had similar survival compared to the control group after 4‑year follow-up, while the patients with HTX had a significantly better outcome.
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Affiliation(s)
- Angeliki Darma
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany.
| | - Livio Bertagnolli
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Alireza Sepehri Shamloo
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Federica Torri
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Elena Efimova
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Daniela Husser-Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center University Leipzig, Struempellstraße 39, 04289, Leipzig, Germany
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Kavsur R, Becher MU, Nassan W, Sedaghat A, Aksoy A, Schrickel JW, Nickenig G, Tiyerili V. CHA 2DS 2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator. IJC HEART & VASCULATURE 2021; 34:100802. [PMID: 34095451 PMCID: PMC8165543 DOI: 10.1016/j.ijcha.2021.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
AIM The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). METHODS A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. RESULTS A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07-2.80)]. The Area under curve was 0.64 (0.56-72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17-4.14). CONCLUSIONS CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.
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Key Words
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CAD, Coronary artery disease
- CK-MB, Creatine Kinase MB Isoenzyme
- Coronary angiography
- Coronary artery disease
- ICD, Implantable Cardioverter-Defibrillator
- Implantable Cardioverter Defibrillator
- LDL, Low-Density Lipoprotein
- LVEF, Left Ventricular Ejection Fraction
- PCI, Percutaneous Coronary Intervention
- VA, Ventricular Arrhythmia
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
- Ventricular fibrillation
- Ventricular tachycardia
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Affiliation(s)
- Refik Kavsur
- Corresponding author at: Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
| | | | - Welat Nassan
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Sedaghat
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wilko Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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11
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Weidner K, Behnes M, Schupp T, Hoppner J, Ansari U, Mueller J, Lindner S, Borggrefe M, Kim SH, Huseyinov A, Ellguth D, Akin M, Meininghaus DG, Bertsch T, Taton G, Bollow A, Reichelt T, Engelke N, Reiser L, Akin I. Chronic kidney disease impairs prognosis in electrical storm. J Interv Card Electrophysiol 2021; 63:13-20. [PMID: 33483805 PMCID: PMC8755690 DOI: 10.1007/s10840-020-00924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
Background The study sought to assess the prognostic impact of chronic kidney disease (CKD) in patients with electrical storm (ES). ES represents a life-threatening heart rhythm disorder. In particular, CKD patients are at risk of suffering from ES. However, data regarding the prognostic impact of CKD on long-term mortality in ES patients is limited. Methods All consecutive ES patients with an implantable cardioverter–defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with CKD (MDRD-GFR < 60 ml/min/1.73 m2) were compared to patients without CKD. The primary endpoint was all-cause mortality at 3 years. Secondary endpoints were in-hospital mortality, cardiac rehospitalization, recurrences of electrical storm (ES-R), and major adverse cardiac events (MACE) at 3 years. Results A total of 70 consecutive ES patients were included. CKD was present in 43% of ES patients with a median glomerular filtration rate (GFR) of 43.3 ml/min/1.73 m2. CKD was associated with increased all-cause mortality at 3 years (63% vs. 20%; p = 0.001; HR = 4.293; 95% CI 1.874–9.836; p = 0.001) and MACE (57% vs. 30%; p = 0.025; HR = 3.597; 95% CI 1.679–7.708; p = 0.001). In contrast, first cardiac rehospitalization (43% vs. 45%; log-rank p = 0.889) and ES-R (30% vs. 20%; log-rank p = 0.334) were not affected by CKD. Even after multivariable adjustment, CKD was still associated with increased long-term mortality (HR = 2.397; 95% CI 1.012–5.697; p = 0.047), as well as with the secondary endpoint MACE (HR = 2.520; 95% CI 1.109–5.727; p = 0.027). Conclusions In patients with ES, the presence of CKD was associated with increased long-term mortality and MACE.
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Affiliation(s)
- Kathrin Weidner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland.
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Jorge Hoppner
- Clinic for Diagnostic and Interventional Radiology Heidelberg, University Heidelberg, Heidelberg, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Julian Mueller
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Simon Lindner
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Seung-Hyun Kim
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Aydin Huseyinov
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, 68167, Deutschland
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12
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Braumann S, Nettersheim FS, Hohmann C, Tichelbäcker T, Hellmich M, Sabashnikov A, Djordjevic I, Adler J, Nies RJ, Mehrkens D, Lee S, Stangl R, Reuter H, Baldus S, Adler C. How long is long enough? Good neurologic outcome in out-of-hospital cardiac arrest survivors despite prolonged resuscitation: a retrospective cohort study. Clin Res Cardiol 2020; 109:1402-1410. [DOI: 10.1007/s00392-020-01640-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
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13
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Schupp T, Bertsch T, von Zworowsky M, Kim SH, Weidner K, Rusnak J, Barth C, Reiser L, Taton G, Reichelt T, Ellguth D, Engelke N, Bollow A, Akin M, Mashayekhi K, Große Meininghaus D, Borggrefe M, Akin I, Behnes M. Prognostic impact of potassium levels in patients with ventricular tachyarrhythmias. Clin Res Cardiol 2020; 109:1292-1306. [PMID: 32236716 DOI: 10.1007/s00392-020-01624-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The study sought to assess the prognostic impact of potassium levels (K) in patients with ventricular tachyarrhythmias. METHODS A large retrospective registry was used including all consecutive patients presenting with ventricular tachyarrhythmias on admission from 2002 to 2016. Patients with hypokalemia (i.e., K < 3.3 mmol/L), normokalemia (i.e., K 3.3-4.5 mmol/L), and hyperkalemia (i.e., K > 4.5 mmol/L) were compared applying multi-variable Cox regression models and propensity-score matching for evaluation of the primary endpoint of all-cause mortality at 3 years. Secondary endpoints were early cardiac death at 24 h, in-hospital death, death at 30 days, as well as the composite endpoint of early cardiac death at 24 h, recurrences of ventricular tachyarrhythmias, and appropriate ICD therapies at 3 years. RESULTS In 1990 consecutive patients with ventricular tachyarrhythmias, 63% of the patients presented with normokalemia, 30% with hyperkalemia, and 7% with hypokalemia. After propensity matching, both hypokalemic (HR = 1.545; 95% CI 0.970-2.459; p = 0.067) and hyperkalemic patients (HR = 1.371; 95% CI 1.094-1.718; p = 0.006) were associated with the primary endpoint of all-cause mortality at 3 years compared to normokalemic patients. Hyperkalemia was associated with even worse prognosis directly compared to hypokalemia (HR = 1.496; 95% CI 1.002-2.233; p = 0.049). In contrast, potassium measurements were not associated with the composite endpoint at 3 years. CONCLUSION In patients presenting with ventricular tachyarrhythmias, normokalemia was associated with best short- and long-term survival, whereas hyperkalemia and hypokalemia were associated with increased mortality at 30 days and at 3 years.
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Affiliation(s)
- Tobias Schupp
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Max von Zworowsky
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Seung-Hyun Kim
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Christian Barth
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Gabriel Taton
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | | | - Martin Borggrefe
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany.
| | - Michael Behnes
- Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site, University Medical Centre Mannheim (UMM), University of Heidelberg, Heidelberg/Mannheim, Mannheim, Germany
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Tomaniak M, Chichareon P, Klimczak-Tomaniak D, Takahashi K, Kogame N, Modolo R, Wang R, Ono M, Hara H, Gao C, Kawashima H, Rademaker-Havinga T, Garg S, Curzen N, Haude M, Kochman J, Gori T, Montalescot G, Angiolillo DJ, Capodanno D, Storey RF, Hamm C, Vranckx P, Valgimigli M, Windecker S, Onuma Y, Serruys PW, Anderson R. Impact of renal function on clinical outcomes after PCI in ACS and stable CAD patients treated with ticagrelor: a prespecified analysis of the GLOBAL LEADERS randomized clinical trial. Clin Res Cardiol 2020; 109:930-943. [PMID: 31925529 DOI: 10.1007/s00392-019-01586-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Impaired renal function (IRF) is associated with increased risks of both ischemic and bleeding events. Ticagrelor has been shown to provide greater absolute reduction in ischemic risk following acute coronary syndrome (ACS) in those with versus without IRF. METHODS A pre-specified sub-analysis of the randomized GLOBAL LEADERS trial (n = 15,991) comparing the experimental strategy of 23-month ticagrelor monotherapy (after 1-month ticagrelor and aspirin dual anti-platelet therapy [DAPT]) with 12-month DAPT followed by 12-month aspirin after percutaneous coronary intervention (PCI) in ACS and stable coronary artery disease (CAD) patients stratified according to IRF (glomerular filtration rate < 60 ml/min/1.73 m2). RESULTS At 2 years, patients with IRF (n = 2171) had a higher rate of the primary endpoint (all-cause mortality or centrally adjudicated, new Q-wave myocardial infarction [MI](hazard ratio [HR] 1.64, 95% confidence interval [CI] 1.35-1.98, padj = 0.001), all-cause death, site-reported MI, all revascularization and BARC 3 or 5 type bleeding, compared with patients without IRF. Among patients with IRF, there were similar rates of the primary endpoint (HR 0.82, 95% CI 0.61-1.11, p = 0.192, pint = 0.680) and BARC 3 or 5 type bleeding (HR 1.10, 95% CI 0.71-1.71, p = 0.656, pint = 0.506) in the experimental versus the reference group. No significant interactions were seen between IRF and treatment effect for any of the secondary outcome variables. Among ACS patients with IRF, there were no between-group differences in the rates of the primary endpoint or BARC 3 or 5 type bleeding; however, the rates of the patient-oriented composite endpoint (POCE) of all-cause death, any stroke, MI, or revascularization (pint = 0.028) and net adverse clinical events (POCE and BARC 3 or 5 type bleeding) (pint = 0.045), were lower in the experimental versus the reference group. No treatment effects were found in stable CAD patients categorized according to presence of IRF. CONCLUSIONS IRF negatively impacted long-term prognosis after PCI. There were no differential treatment effects found with regard to all-cause death or new Q-wave MI after PCI in patients with IRF treated with ticagrelor monotherapy. CLINICAL TRIAL REGISTRATION The trial has been registered with ClinicalTrials.gov, number NCT01813435.
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Affiliation(s)
- Mariusz Tomaniak
- Department of Cardiology, Erasmus University Medical Centre, Erasmus University, Rotterdam, The Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ply Chichareon
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Dominika Klimczak-Tomaniak
- Department of Immunology, Transplantation and Internal Medicine, Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Cardiology Division, University of Campinas (UNICAMP), Campinas, Brazil
| | - Rutao Wang
- Department of Cardiology, Xijing Hospital, Xi'an, China.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Masafumi Ono
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hironori Hara
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Chao Gao
- Department of Cardiology, Xijing Hospital, Xi'an, China.,Department of Cardiology, Radboud University, Nijmegen, The Netherlands
| | - Hideyuki Kawashima
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Scot Garg
- Royal Blackburn Hospital, Blackburn, UK
| | - Nick Curzen
- University Hospital Southampton NHSF, Southampton, UK
| | - Michael Haude
- Department of Cardiology, Städtische Kliniken Neuss, Neuss, Germany
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tommaso Gori
- Deutsches Zentrum für Herz und Kreislauf Forschung, Standort Rhein-Main, University Medical Center Mainz, Mainz, Germany
| | - Gilles Montalescot
- Cardiology Department, ACTION Study Group, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Davide Capodanno
- Division of Cardiology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Cardiology and Cardiothoracic Surgery Directorate, Sheffield Teaching Hospitals NHS Foundation Trust, Cardiovascular Research Unit, Centre for Biomedical Research, Northern General Hospital, Sheffield, UK
| | | | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt, Belgium
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- NHLI, Imperial College London, London, UK. .,Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, H91 TK33, Ireland.
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