1
|
Wang H, Ding H, Wang ZY, Zhang K. Research progress on microcirculatory disorders in septic shock: A narrative review. Medicine (Baltimore) 2024; 103:e37273. [PMID: 38394485 DOI: 10.1097/md.0000000000037273] [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] [Indexed: 02/25/2024] Open
Abstract
Hemodynamic coherence plays a critical role in the outcomes of septic shock. Due to the potential negative consequences of microcirculatory disorders on organ failure and clinical outcomes, the maintenance of a balance between the macrocirculation and microcirculation is a topic of significant research focus. Although physical methods and specialized imaging techniques are used in clinical practice to assess microcirculation, the use of monitoring devices is not widespread. The integration of microcirculation research tools into clinical practice poses a significant challenge for the future. Consequently, this review aims to evaluate the impact of septic shock on the microcirculation, the methods used to monitor the microcirculation and highlight the importance of microcirculation in the treatment of critically ill patients. In addition, it proposes an evaluation framework that integrates microcirculation monitoring with macrocirculatory parameters. The optimal approach should encompass dynamic, multiparametric, individualized, and continuous monitoring of both the macrocirculation and microcirculation, particularly in cases of hemodynamic separation.
Collapse
Affiliation(s)
- Hui Wang
- Department of Intensive Care, Affiliated Hospital of Chengde Medical University, Chengde, China
| | | | | | | |
Collapse
|
2
|
Bruno RR, Hernandez G, Wollborn J, Saugel B, Jung C. Microcirculation information in clinical decision making: Rome wasn't built in a day. Intensive Care Med 2023; 49:1272-1273. [PMID: 37695331 PMCID: PMC10556112 DOI: 10.1007/s00134-023-07216-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
- CARID (Cardiovascular Research Institute Düsseldorf), Duesseldorf, Germany.
| |
Collapse
|
3
|
Kanoore Edul VS, Dubin A. Pitfalls in the use of microcirculation as a resuscitation goal. Intensive Care Med 2023; 49:1268-1269. [PMID: 37603099 DOI: 10.1007/s00134-023-07191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Vanina S Kanoore Edul
- Servicio de Terapia Intensiva, Sanatorio Otamendi, Ciudad Autónoma de Buenos Aires, Azcuénaga 870, C1115AAB, Buenos Aires, Argentina
- Cátedras de Terapia Intensiva y Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Arnaldo Dubin
- Servicio de Terapia Intensiva, Sanatorio Otamendi, Ciudad Autónoma de Buenos Aires, Azcuénaga 870, C1115AAB, Buenos Aires, Argentina.
- Cátedras de Terapia Intensiva y Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina.
| |
Collapse
|
4
|
Li Q, Liu X, Jia M, Sun F, Li Y, Zhang H, Liu X, He H, Zhao Z, Yan Z, Zhu Z. Assessment of sublingual microcirculation for the screening of diabetic nephropathy. Diabetol Metab Syndr 2022; 14:90. [PMID: 35794676 PMCID: PMC9258215 DOI: 10.1186/s13098-022-00864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To investigate the potential of employing sublingual microcirculation as an early noninvasive screening technique for diabetic nephropathy (DN). RESEARCH DESIGN AND METHODS We recruited 89 patients with type 2 diabetes mellitus (T2DM) and 41 healthy subjects in this cross-sectional observational study. All participants underwent fluorescein fundus angiography, vibration perception testing, 10 g (Semmes-Weinstein) monofilament examination, nerve conduction velocity, and 24-h urine microalbumin determination. HbA1c, fasting plasma glucose, blood lipid, and estimated glomerular filtration rate(eGFR) were measured. Sublingual microcirculatory images were captured using side-stream dark-field (SDF) microcirculation microscopy, and total and perfused vascular density (TVD and PVD) were calculated. RESULTS The sublingual microcirculatory parameters denoting microvascular density and perfusion were negatively correlated with both fasting plasma glucose (TVD, r = - 0.316, P < 0.001; PVD, r = - 0.350, P < 0.001; PPV, r = - 0.279, P = 0.001) and HbA1c (TVD, r = - 0.367, P < 0.001; PVD, r = - 0.423, P < 0.001; PPV, r = - 0.399, P < 0.001). Diabetes patients already had a reduction in sublingual microcirculation compared with healthy control, and more severe reductions in TVD (7.07 ± 1.64 vs. 9.67 ± 1.94 mm/mm2, P < 0.001) and PVD (5.88 ± 1.82 vs. 8.64 ± 2.46 mm/mm2, P < 0.001) were found in those diabetes patients developed microvascular complications. Sublingual microcirculation impairment was accompanied with higher urinary albumin creatinine ratio (UACR). Receiver operating characteristic (ROC) analysis showed that TVD (area under the curve, AUC = 0.890 [0.836 0.944], P < 0.001) and PVD (AUC = 0.883 [0.826, 0.940], P < 0.001) could be indicators for DN screening. We derived a combined predictor index (CPI) considering both TVD and PVD for screening DN, and both the AUC (0.892, [0.838 0.945], P < 0.001) and cutoff point of 11.30 mm/mm2 showed great improvement (sensitivity: 95.5%, specificity: 67.4%). CONCLUSIONS Diabetes patients experienced impaired sublingual microcirculation, which was closely correlated with UACR. Sublingual microcirculation monitoring could be used for the noninvasive early detection of DN.
Collapse
Affiliation(s)
- Qiang Li
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - XiaoXiao Liu
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Mengxiao Jia
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Fang Sun
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Yingsha Li
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hexuan Zhang
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Xiaoli Liu
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Hongbo He
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zhigang Zhao
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zhencheng Yan
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Zhiming Zhu
- Center for Hypertension and Metabolic Diseases, Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
| |
Collapse
|
5
|
Bruno RR, Wernly B, Hornemann J, Flaatten H, FjØlner J, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Baldia PH, Binneboessel S, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Elhadi M, Joannidis M, Oeyen S, Kondili E, Wollborn J, Marsh B, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Jung C. Early evaluation of organ failure using MELD-XI in critically ill elderly COVID-19 patients. Clin Hemorheol Microcirc 2021; 79:109-120. [PMID: 34487039 DOI: 10.3233/ch-219202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSECritically ill elderly patients who suffer from Sars-CoV-2 disease are at high risk for organ failure. The modified MELD-XI score has not been evaluated for outcome prediction in these most vulnerable patients.METHODSThe Corona Virus disease (COVID19) in Very Elderly Intensive Care Patients study (COVIP, NCT04321265) prospectively recruited patients on intensive care units (ICU), who were = 70 years. Data were collected from March 2020 to February 2021. The MELD-XI score was calculated using the highest serum bilirubin and creatinine on ICU admission. Univariate and multivariable logistic regression analyses were performed to assess associations between the MELD-XI score and mortality. The primary outcome was 30-day-mortality, the secondary outcomes were ICU- and 3-month-mortality.RESULTSIn total, data from 2,993 patients were analyzed. Most patients had a MELD-XI <12 on admission (76%). The patients with MELD-XI = 12 had a significantly higher 30-day-, ICU- and 3-month-mortality (44%vs 64%, and 42%vs. 59%, and 57%vs. 76%, p < 0.001). After adjustment for multiple confounders, MELD-XI = 12 remained significantly associated with 30-day- (aOR 1.572, CI 1.268-1.949, p < 0.001), ICU-, and 3-month-mortality.CONCLUSIONIn critically ill elderly intensive care patients with COVID-19, the MELD-XI score constitutes a valuable tool for an early outcome prediction.
Collapse
Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Johanna Hornemann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jesper FjØlner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Heinrich Baldia
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Dept. of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC Ghent University Hospital, Ghent, Belgium
| | - Eumorfia Kondili
- Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Jakob Wollborn
- Department of Anesthesiolgy, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris, INSERM, UMR S, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitaliére Qualité et Organisation des Soins, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service De Réanimation Médicale, Paris, France
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | |
Collapse
|
6
|
David H, Ughetto A, Gaudard P, Plawecki M, Paiyabhroma N, Zub E, Colson P, Richard S, Marchi N, Sicard P. Experimental Myocardial Infarction Elicits Time-Dependent Patterns of Vascular Hypoxia in Peripheral Organs and in the Brain. Front Cardiovasc Med 2021; 7:615507. [PMID: 33585582 PMCID: PMC7873295 DOI: 10.3389/fcvm.2020.615507] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022] Open
Abstract
Aims: Microvascular alterations occurring after myocardial infarction (MI) may represent a risk factor for multi-organ failure. Here we used in vivo photoacoustic (PA) imaging to track and define the changes in vascular oxygen saturation (sO2) occurring over time after experimental MI in multiple peripheral organs and in the brain. Methods and Results: Experimental MI was obtained in BALB/c mice by permanent ligation of the left anterior descending artery. PA imaging (Vevo LAZR-X) allowed tracking mouse-specific sO2 kinetics in the cardiac left ventricular (LV) anterior wall, brain, kidney, and liver at 4 h, 1 day, and 7 days post-MI. Here we reported a correlation between LV sO2 and longitudinal anterior myocardial strain after MI (r = −0.44, p < 0.0001, n = 96). Acute LV dysfunction was associated with global hypoxia, specifically a decrease in sO2 level in the brain (−5.9%), kidney (−6.4%), and liver (−7.3%) at 4 and 24 h post-MI. Concomitantly, a preliminary examination of capillary NG2DsRed pericytes indicated cell rarefication in the heart and kidney. While the cardiac tissue was persistently impacted, sO2 levels returned to pre-MI levels in the brain and in peripheral organs 7 days after MI. Conclusions: Collectively, our data indicate that experimental MI elicits precise trajectories of vascular hypoxia in peripheral organs and in the brain. PA imaging enabled the synchronous tracking of oxygenation in multiple organs and occurring post-MI, potentially enabling a translational diagnostic modality for the identification of vascular modifications in this disease setting.
Collapse
Affiliation(s)
- Hélène David
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.,Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Aurore Ughetto
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.,Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Philippe Gaudard
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.,Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Maëlle Plawecki
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.,CHU Lapeyronie, Département de Biochimie, Montpellier, France
| | | | - Emma Zub
- Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics (UMR 5203 CNRS - U 1191 INSERM, University of Montpellier), Montpellier, France
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France.,Montpellier University, INSERM, CNRS, Institut de Génomique Fonctionnelle, Montpellier, France
| | - Sylvain Richard
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France
| | - Nicola Marchi
- Cerebrovascular and Glia Research, Department of Neuroscience, Institute of Functional Genomics (UMR 5203 CNRS - U 1191 INSERM, University of Montpellier), Montpellier, France
| | - Pierre Sicard
- INSERM, CNRS, Université de Montpellier, PHYMEDEXP, Montpellier, France.,IPAM, BioCampus Montpellier, CNRS, INSERM, Université de Montpellier, Montpellier, France
| |
Collapse
|
7
|
Bruno RR, Wernly B, Binneboessel S, Baldia P, Duse DA, Erkens R, Kelm M, Mamandipoor B, Osmani V, Jung C. Failure of Lactate Clearance Predicts the Outcome of Critically Ill Septic Patients. Diagnostics (Basel) 2020; 10:diagnostics10121105. [PMID: 33352862 PMCID: PMC7767189 DOI: 10.3390/diagnostics10121105] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose: Early lactate clearance is an important parameter for prognosis assessment and therapy control in sepsis. Patients with a lactate clearance >0% might differ from patients with an inferior clearance in terms of intensive care management and outcomes. This study analyzes a large collective with regards to baseline risk distribution and outcomes. Methods: In total, 3299 patients were included in this analysis, consisting of 1528 (46%) ≤0% and 1771 (54%) >0% patients. The primary endpoint was intensive care unit (ICU) mortality. Multilevel logistic regression analyses were used to compare both groups: A baseline model (model 1) with lactate clearance as a fixed effect and ICU as a random effect was installed. For model 2, patient characteristics (model 2) were included. For model 3, intensive care treatment (mechanical ventilation and vasopressors) was added to the model. Models 1 and 2 were used to evaluate the primary and secondary outcomes, respectively. Model 3 was only used to evaluate the primary outcomes. Adjusted odds ratios (aORs) with respective 95% confidence intervals (CI) were calculated. Results: The cohorts had no relevant differences regarding the gender, BMI, age, heart rate, body temperature, and baseline lactate. Neither the primary infection focuses nor the ethnic background differed between both groups. In both groups, the most common infection sites were of pulmonary origin, the urinary tract, and the gastrointestinal tract. Patients with lactate clearance >0% evidenced lower sepsis-related organ failure assessment (SOFA) scores (7 ± 6 versus 9 ± 6; p < 0.001) and creatinine (1.53 ± 1.49 versus 1.80 ± 1.67; p < 0.001). The ICU mortality differed significantly (14% versus 32%), and remained this way after multivariable adjustment for patient characteristics and intensive care treatment (aOR 0.43 95% CI 0.36–0.53; p < 0.001). In the additional sensitivity analysis, the lack of lactate clearance was associated with a worse prognosis in each subgroup. Conclusion: In this large collective of septic patients, the 6 h lactate clearance is an independent method for outcome prediction.
Collapse
Affiliation(s)
- Raphael Romano Bruno
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, 171 64 Stockholm, Sweden
| | - Stephan Binneboessel
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
| | - Philipp Baldia
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
| | - Dragos Andrei Duse
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
| | - Ralf Erkens
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
| | - Malte Kelm
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
- Cardiovascular Research Institute Düsseldorf (CARID), 40225 Düsseldorf, Germany
| | - Behrooz Mamandipoor
- Fondazione Bruno Kessler Research Institute, 38123 Trento, Italy; (B.M.); (V.O.)
| | - Venet Osmani
- Fondazione Bruno Kessler Research Institute, 38123 Trento, Italy; (B.M.); (V.O.)
| | - Christian Jung
- Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany; (R.R.B.); (S.B.); (P.B.); (D.A.D.); (R.E.); (M.K.)
- Correspondence:
| |
Collapse
|