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Kramuschke M, Renner A, Kersting A. [Burnout : Symptoms, diagnostics and treatment approaches]. Nervenarzt 2024; 95:484-493. [PMID: 38625570 DOI: 10.1007/s00115-024-01649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/17/2024]
Abstract
Burnout syndrome is characterized by the triad of symptoms exhaustion, mental distance from work activities and a feeling of ineffectiveness. The syndrome is not an independent mental disorder but can be coded in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as a problem related to difficulties in coping with life (Z73) and in ICD-11 as a qualifying diagnosis (QD85). This article discusses the prevalence and comorbidities of burnout syndrome, taking the methodological difficulties in conceptualizing and operationalizing the construct into account. In addition, it provides an overview of available measurement instruments and their validation. Furthermore, it discusses work-related and individual factors in the development of burnout syndrome as well as analysis of the effectiveness of treatment options.
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Affiliation(s)
- M Kramuschke
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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Eckstein J, Renner A, Zittermann A, Fink T, Sohns C, Niehaus K, Bednarz H, Neumann JM, Piran M, Kellner U, Gummert J. Impact of left atrial appendage fibrosis on atrial fibrillation in patients following coronary bypass surgery. Clin Cardiol 2022; 45:1029-1035. [PMID: 35864729 PMCID: PMC9574744 DOI: 10.1002/clc.23884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives We aimed to assess the relationship of left atrial appendage (LAA) fibrosis with atrial fibrillation (AF) and postoperative events in patients receiving coronary artery bypass graft surgery (CABG). Background Increased atrial fibrosis has been associated with AF and worse outcome following catheter ablation. Only limited data exists focusing on the impact of LAA fibrosis on AF after CABG. Methods LAA tissue from 164 CABG‐patients was stained with Masson‐Goldner trichrome. The histological landscape was scanned and segmented into superpixels for software analysis (QuPath). A classification algorithm was extensively trained to detect fibrotic superpixels for quantification. In 43 propensity score matched pairs with AF or sinus rhythm (SR), LAA fibrosis was compared. Moreover, subgroups of mitral valve regurgitation (MR) were analyzed as follows: SR, SR + MR, AF and AF + MR. The predictive value of LAA fibrosis postoperative stroke, postoperative AF and mortality was assessed. Results Fibrotic remodeling (%) showed no significant difference for the total cohort between the SR and AF group (SR: 30.8 ± 11.4% and AF: 33.8 ± 16.0%, respectively, p = .32). However, significant fibrotic remodeling was observed for SR and AF subgroups (SR: 27.2 ± 12.2% vs. AF: 35.3 ± 13.7%; respectively, p = .049) and between SR and SR + MR subgroups (SR: 27.2 ± 12.2% vs. SR + MR: 34.9 ± 9.1%, respectively, p = .027). LAA fibrosis was not significantly associated with postoperative stroke, postoperative AF or overall mortality (all p > .05). Conclusion LAA fibrosis may contribute to an individual arrhythmia substrate for AF in patients with AF but also in those with SR and coincidence of MR. LAA fibrosis was not found to be predictive for clinical events in patients after CABG.
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Affiliation(s)
- Jan Eckstein
- Department for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Karsten Niehaus
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany
| | - Hanna Bednarz
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany.,Medical School OWL, AG1: Sustainable Environmental Health Sciences, Bielefeld University, NRW, Bielefeld, Germany
| | - Judith Martha Neumann
- Proteome and Metabolome Research, Center for Biotechnology (CeBiTec), Faculty of Biology, Bielefeld University, NRW, Bielefeld, Germany
| | - Misagh Piran
- Department for Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Udo Kellner
- Institute for Pathology and Molecular Pathology, Johannes Wesling Klinikum, Ruhr-University Bochum, Minden, Germany
| | - Jan Gummert
- Clinic for Cardiovascular and Thoracic Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Omran H, Deutsch MA, Groezinger E, Zittermann A, Renner A, Neumann JT, Westermann D, Myles P, Ramosaj B, Pauly M, Scholtz W, Hakim-Meibodi K, Rudolph TK, Gummert J, Rudolph V. High-sensitivity cardiac troponin I after coronary artery bypass grafting for post-operative decision-making. Eur Heart J 2022; 43:2388-2403. [PMID: 35165695 PMCID: PMC9246661 DOI: 10.1093/eurheartj/ehab918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/09/2023] Open
Abstract
AIMS Current troponin cut-offs suggested for the post-operative workup of patients following coronary artery bypass graft (CABG) surgery are based on studies using non-high-sensitive troponin assays or are arbitrarily chosen. We aimed to identify an optimal cut-off and timing for a proprietary high-sensitivity cardiac troponin I (hs-cTnI) assay to facilitate post-operative clinical decision-making. METHODS AND RESULTS We performed a retrospective analysis of all patients undergoing elective isolated CABG at our centre between January 2013 and May 2019. Of 4684 consecutive patients, 161 patients (3.48%) underwent invasive coronary angiography after surgery, of whom 86 patients (53.4%) underwent repeat revascularization. We found an optimal cut-off value for peak hs-cTnI of >13 000 ng/L [>500× the upper reference limit (URL)] to be significantly associated with repeat revascularization within 48 h after surgery, which was internally validated through random repeated sampling with 1000 iterations. The same cut-off also predicted 30-day major adverse cardiovascular events and all-cause mortality after a median follow-up of 3.1 years, which was validated in an external cohort. A decision tree analysis of serial hs-cTnI measurements showed no added benefit of hs-cTnI measurements in patients with electrocardiographic or echocardiographic abnormalities or haemodynamic instability. Likewise, early post-operative hs-cTnI elevations had a low yield for clinical decision-making and only later elevations (at 12-16 h post-operatively) using a threshold of 8000 ng/L (307× URL) were significantly associated with repeat revascularization with an area under the curve of 0.92 (95% confidence interval 0.88-0.95). CONCLUSION Our data suggest that for hs-cTnI, higher cut-offs than currently recommended should be used in the post-operative management of patients following CABG.
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Affiliation(s)
| | - Marcus A Deutsch
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Elena Groezinger
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Johannes T Neumann
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Paul Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
| | - Burim Ramosaj
- Faculty of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Markus Pauly
- Faculty of Statistics, Technical University of Dortmund, Dortmund, Germany
| | - Werner Scholtz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
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Agaimy A, Haller F, Renner A, Niedermeyer J, Hartmann A, French CA. Misleading Germ Cell Phenotype in Pulmonary NUT Carcinoma Harboring the ZNF532-NUTM1 Fusion. Am J Surg Pathol 2022; 46:281-288. [PMID: 34232599 PMCID: PMC8741879 DOI: 10.1097/pas.0000000000001774] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
NUT carcinoma (aka NUT midline carcinoma) is a rare, still significantly underrecognized aggressive malignancy. Although historically considered a midline malignancy of children and young adults, NUT carcinoma can originate in almost any body site and in any age group. Beside the classic BRD4-NUTM1 fusion, less common fusion partners include BRD3, NSD3, ZNF532, and ZNF592. Other fusions, including CIC, MGA, MXD4, MXD1, and BCORL1 are associated with sarcomas or cancers of unknown histogenesis. Involvement of the Z4 zinc finger protein (ZNF) family members ZNF532 and ZNF592 is exceedingly rare with only 3 recently reported cases. We herein describe a ZNF532-NUTM1-rearranged NUT carcinoma presenting as a 7.5 cm mass in the left lower lung lobe of a 65-year-old woman. Histology revealed undifferentiated monotonous small round cells with focal epithelioid and rhabdoid elements within a variably myxoid stroma. Immunohistochemistry revealed paucity of keratins and variable p63 combined with extensive CD30 and PLAP expression, leading to initial diagnoses of combined small cell carcinoma, CD30-positive unclassified hematolymphoid malignancy and malignant germ cell neoplasm. Negativity for other more specific germ cell markers justified seeking a fourth opinion, which revealed diffuse expression of the NUT antibody. The diagnosis was then confirmed by fluorescence in situ hybridization. Targeted RNA sequencing revealed the ZNF532-NUTM1 fusion. Screening of 7 NUT carcinomas (5 with BRD4-NUTM1 and 2 with NSD3-NUTM1 fusions) for germ cell markers revealed focal SALL4 reactivity in 3 cases (combined with variable AFP expression in 2), but none expressed CD30 or PLAP. An aberrant germ cell immunophenotype should be considered in NUT carcinoma to avoid misinterpretation as genuine germ cell malignancy as both diseases predominantly affect the young population, frequently involve the mediastinum and can be associated with elevated serum AFP.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - Florian Haller
- Institute of Pathology, University Hospital, Erlangen, Germany
| | - André Renner
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Jost Niedermeyer
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital, Erlangen, Germany
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Roehr S, Jung FU, Pabst A, Grochtdreis T, Nagl M, Renner A, Hoffmann R, Koenig HH, Kersting A, Riedel-Heller SG. A self-help app for Syrian refugees with posttraumatic stress (Sanadak): results of a randomized controlled trial. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Syrian refugees often develop posttraumatic stress as a result of the Syrian civil war and migration stressors. However, there is a lack of adequate treatments. The smartphone app Sanadak was developed and evaluated to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress.
Methods
In a randomized controlled trial, eligible individuals were allocated to the intervention group (IG; app) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis.
Results
Of 170 screened individuals (aged 18-65 years), 133 were eligible and randomized to the IG (n = 65) or CG (n = 68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95%CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95%CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d = 0.86, 95%CI 0.46 to 1.25; stereotype application: d = 0.60, 95%CI 0.22 to 0.99) and after 4 months (d = 0.52, 95%CI 0.12 to 0.92; d = 0.50, 95%CI 0.10 to 0.90).
Conclusions
Sanadak reduced mild to moderate posttraumatic stress in Syrian refugees, but not superior to the control condition. Therefore, Sanadak may not be suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach.
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Affiliation(s)
- S Roehr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - FU Jung
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - A Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - T Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - A Renner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - R Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - H-H Koenig
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Leipzig, Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
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Omran H, Deutsch MA, Scholtz S, Renner A, Scholtz W, Hakim Meibodi K, Rudolph TK, Gummert J, Rudolph V. Impact of impaired renal function on kinetics of high-sensitive troponin I (hs-cTnI) following cardiac surgery. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Renal insufficiency might result in increased levels of cardiac troponin due to decreased elimination. Hence, the diagnostic utility of hs-cTnI might be lower in patients with impaired renal function. There is only scarce data on kinetics of high-sensitivity cardiac troponin I (hs-cTnI) following cardiac surgery with regard to renal function.
Purpose
The aim of this study was to assess the impact of impaired renal function on the kinetics of hs-cTnI following cardiac surgery differentiating between patients with and without postoperative myocardial infarction (PMI) and to analyze the prognostic value of hs-cTnI elevations in patients with impaired renal function.
Methods
We performed a retrospective analysis of all adult patients (>18 years) who underwent cardiac surgery at our hospital between Jan, 1st 2013 and May, 1st 2019.
Serial measurements of high-sensitive cardiac troponin I (hs-cTnI) were assessed from baseline up to 48 hours after surgery. Renal function was assessed based on estimated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) formula with impaired renal function defined by GFR <60 ml/min. Postoperative myocardial infarction was defined by new vessel occlusion on angiography. Predictors of long-term all-cause mortality were assessed by cox regression analysis.
Results
A total of 14,465 patients were included (51.4% underwent coronary artery bypass grafting (CABG), 39.4% had valvular procedures and 9.2% thoracic aortic procedures).
Levels of hs-cTnI were higher in patients with impaired renal function in the overall collective (figure 1). However, in patients with postoperative myocardial infarction levels of hs-cTnI did not differ with regard to renal function (figure 2).
Cox regression analysis showed postoperative elevation of hs-cTnI to be a significant predictor of long-term all-cause mortality over a median follow-up of 3.0 years regardless of baseline kidney function (Hazards ratio 1.67, 95% Confidence interval [1.46–1.91], p<0.001).
Conclusion
Renal function had an impact on postoperative hs-cTnI kinetics only in patients with an uneventful postoperative course. In patients with postoperative myocardial infarction kinetics of hs-cTnI were not affected by baseline renal function. Moreover, elevated hs-cTnI levels were a significant predictor of all-cause mortality regardless of baseline renal function.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Omran
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - M A Deutsch
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - S Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - A Renner
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - W Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - K Hakim Meibodi
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - T K Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Gummert
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - V Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
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Renner A, Jäckle D, Kaiser J, Hoffmann R, Kersting A. IPSA-Studie: Posttraumatischer Stress nach belastenden Ereignissen im Arztberuf. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - D Jäckle
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - J Kaiser
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - R Hoffmann
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig
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Deutsch MA, Zittermann A, Renner A, Schramm R, Götte J, Börgermann J, Fox H, Rojas SV, Gyoten T, Morshuis M, Koster A, Hulde N, Hinse D, Hakim-Meibodi K, Gummert JF. Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting. Interact Cardiovasc Thorac Surg 2021; 33:857-865. [PMID: 34333605 DOI: 10.1093/icvts/ivab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Recent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort. METHODS A total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis. RESULTS In the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87-1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32-0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47-0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87-1.08; P = 0.59 and HR 1.01, 95% CI 0.90-1.13; P = 0.91, respectively). CONCLUSIONS Data do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.
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Affiliation(s)
- Marcus-André Deutsch
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - René Schramm
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Julia Götte
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Department of Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | - Henrik Fox
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Sebastian V Rojas
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Takayuki Gyoten
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Andreas Koster
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology and Pain Therapy, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Dennis Hinse
- Institute of Laboratory and Transfusion Medicine, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, University Hospital Ruhr-University Bochum, Bad Oeynhausen, Germany
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Opacic D, Ibishi A, Radakovic D, Irimi A, Deutsch MA, Renner A, Sitzer M, Gummert J. Off-Pump Coronary Artery Bypass Surgery Reduces Perioperative Stroke Rate in Patients with Asymptomatic Internal Carotid Artery Stenosis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Omran H, Deutsch M, Groezinger E, Renner A, Neumann J, Westermann D, Scholtz W, Rudolph T, Gummert J, Rudolph V, Hakim-Meibodi K. Usefulness of troponin in selecting patients for invasive coronary angiography after cardiac surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Great uncertainty exists about the indication for invasive coronary angiography (ICA) in patients with suspected acute coronary syndrome following cardiac surgery.
Aim
The aim of this study was to define clinical criteria that best identify patients who benefit from ICA after cardiac surgery.
Methods
We performed a retrospective analysis of all patients who underwent cardiac surgery between January 2009 and May 2019 at our center. Exclusion criteria included pediatric patients as well as pacemaker, TAVR and LVAD implantation and heart transplantation procedures. The primary outcome was usefulness of ICA as defined by consequent PCI or re-operation due to ICA findings. ECG changes (ST-elevations) and high-sensitivity Troponin I (hsTrop I) were analyzed.
Results
48,136 patients were screened and after applying exclusion criteria 29,359 patients were finally included in the analysis (mean age 67.8±11.0 years, 31.1% females, Euroscore II 5.14±8.9%). A total of 1,171 patients (4%) underwent post-op ICA. The primary outcome occurred in 440 patients (1.5%) of which 290 underwent consequent PCI and 214 underwent consequent re-operation. Baseline characteristics are shown in table 1. Unadjusted analyses did not identify significant differences in the level of cardiac biomarkers between useful-ICA and unuseful-ICA groups.
In multivariate regression analysis, only ST-elevation on ECG predicted the primary outcome (OR 1.33, 95% CI 1.003–1.76).
Dichotomizing hsTrop I concentrations by applying the guideline-specified cut-off (>70x URL) resulted in correct classification of useful-ICA patients in 95.7%. However, the false-positive rate was also extremely high (83.6%) with a positive predictive value (PPV) of 1.6% and a negative predictive value (NPV) of 99.6% (accuracy 17.5%).
Using area under the curve (ROC) analysis following optimal cut-off values for hsTrop I were identified: in CABG patients a cut-off value of >650x URL (corresponding absolute value 17000 ng/L) was defined with a corresponding sensitivity of 83.3%, specificity of 83.6%, PPV of 8.9% and NPV of 99.6% (accuracy 83.6%). In non-CABG patients (i.e. valve or aortic procedures), the cut-off was about twice as high as that for CABG patients (1,350x URL or 35,000 ng/L) with a corresponding sensitivity of 84.1%, specificity of 89.2%, PPV of 5.9% and NPV of 99.9% (accuracy 89.1%).
Conclusion
Our study demonstrates that currently recommended cut-off concentrations of high-sensitivity troponin are not useful for guiding clinical decision-making in patients with suspected acute coronary syndrome following cardiac surgery, while substantially higher cut-off values might be useful. Those cut-off values critically depend on the type of cardiac surgery performed (CABG vs. non-CABG).
Troponin_Curves post-op
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Omran
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - M.A Deutsch
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - E Groezinger
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - A Renner
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Neumann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Clinic for Cardiology, Hamburg, Germany
| | - W Scholtz
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - T Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - J Gummert
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - V Rudolph
- Clinic for General and Interv Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
| | - K Hakim-Meibodi
- Clinic for Thorac Cardiovasc Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Univ Bochum, Bad Oeynhausen, Germany
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11
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Vishlenkova EA, Renner A. [Historical study of medical geography in Russia]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2019; 27:924-929. [PMID: 31765548 DOI: 10.32687/0869-866x-2019-27-5-924-929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
This article provides an overview of the change of topics in the medical-geographical studies in Russia. It highlights the conventional nature of this science, its dependence on political, ideological and scientific demands as well as institutional difficulties. It concludes that the goal of further historical research is to focus on the restoration of synchronous meanings of medical geography, its links with other disciplines and the elucidation of Russia's participation in the transnational project of medico-geographical research.
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Affiliation(s)
- E A Vishlenkova
- National Research University Higher School of Economics; 107000, Moscow, Russia,
| | - A Renner
- Ludwig-Maximilians-Universität in Munich, Germany
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12
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Dybkova N, Ahmad S, Pabel S, Tirilomis P, Hartmann N, Fischer TH, Bengel P, Tirilomis T, Ljubojevic S, Renner A, Gummert J, Ellenberger D, Wagner S, Frey N, Maier LS, Streckfuss-Bömeke K, Hasenfuss G, Sossalla S. Differential regulation of sodium channels as a novel proarrhythmic mechanism in the human failing heart. Cardiovasc Res 2019; 114:1728-1737. [PMID: 29931291 DOI: 10.1093/cvr/cvy152] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
Aims In heart failure (HF), enhanced persistent Na+ current (INaL) exerts detrimental effects on cellular electrophysiology and can induce arrhythmias. However, the underlying regulatory mechanisms remain unclear. Our aim was to potentially investigate the regulation and electrophysiological contribution of neuronal sodium channel NaV1.8 in failing human heart and eventually to reveal a novel anti-arrhythmic therapy. Methods and results By western blot, we found that NaV1.8 protein expression is significantly up-regulated, while of the predominant cardiac isoform NaV1.5 is inversely reduced in human HF. Furthermore, to investigate the relation of NaV1.8 regulation with the cellular proarrhythmic events, we performed comprehensive electrophysiology recordings and explore the effect of NaV1.8 on INaL, action potential duration (APD), Ca2+ spark frequency, and arrhythmia induction in human failing cardiomyocytes. NaV1.8 inhibition with the specific blockers A-803467 and PF-01247324 decreased INaL, abbreviated APD and reduced cellular-spontaneous Ca2+-release and proarrhythmic events in human failing cardiomyocytes. Consistently, in mouse cardiomyocytes stressed with isoproterenol, pharmacologic inhibition and genetically knockout of NaV1.8 (SCN10A-/-), were associated with reduced INaL and abbreviated APD. Conclusion We provide first evidence of differential regulation of NaV1.8 and NaV1.5 in the failing human myocardium and their contribution to arrhythmogenesis due to generation of INaL. We propose inhibition of NaV1.8 thus constitutes a promising novel approach for selective anti-arrhythmic therapy in HF.
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Affiliation(s)
- Nataliya Dybkova
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Shakil Ahmad
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany.,Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Steffen Pabel
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany.,Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Petros Tirilomis
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Nico Hartmann
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Thomas H Fischer
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Philipp Bengel
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Theodoros Tirilomis
- Department of Thoracic, Cardiac and Vascular Surgery, Georg-August University Goettingen, Germany
| | | | - André Renner
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - David Ellenberger
- Department of Medical Statistics, University Medical Center Goettingen, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Molecular Cardiology and Angiology, University Medical Center, Campus Kiel, Schleswig-Holstein, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany
| | - Samuel Sossalla
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, DZHK (German Centre for Cardiovascular Research), partner site Goettingen, Germany.,Department of Internal Medicine II, University Medical Center Regensburg, Germany
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13
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Aboud A, Farha K, Hsieh WC, Brasch F, Ensminger S, Gummert J, Renner A. Prognostic Factors for Long-Term Survival after Surgical Resection of Primary Cardiac Sarcoma. Thorac Cardiovasc Surg 2019; 67:665-671. [PMID: 31250414 DOI: 10.1055/s-0039-1692409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary cardiac sarcoma (CS) is an extremely rare disease. This study aims to identify possible prognostic factors for long-term survival. METHODS A total of 17 consecutive patients who were treated for primary CS between 2003 und 2018 at two cardiac centers were investigated. Clinical data and histological characteristics of the tumors were analyzed. Long-term follow-up of all patients were performed. RESULTS The median age was 54 years (range: 23-74). The tumors originated from the left side of the heart in nine patients. Histologically, there were four angiosarcomas, three intimal sarcomas, and three synovial sarcomas. One- and 7-year survivals were 81.9 and 18.2%, respectively. Low expression levels of Ki-67 tended to be associated with increased survival (log-rank p = 0.06). Adjuvant chemotherapy but not radiotherapy regardless of existing metastases was associated with significantly increased survival (log-rank p = 0.001). CONCLUSION Angiosarcoma was the most common type of CS. The survival of CS patients is poor but prognostic factors, such as Ki-67, may help estimate the course of the disease. Survival could be improved significantly with chemotherapy.
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Affiliation(s)
- Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - Kassar Farha
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Wan Chin Hsieh
- Department of Cardiovascular Surgery, First Faculty of Medicine, General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Frank Brasch
- Department of Pathology, Academic Teaching Hospital Bielefeld, Bielefeld, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University of Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
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14
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Renner A, Rausch I, Cal Gonzalez J, Frass-Kriegl R, de Lara LN, Sieg J, Laistler E, Glanzer M, Dungl D, Moser E, Beyer T, Figl M, Birkfellner W. A head coil system with an integrated orbiting transmission point source mechanism for attenuation correction in PET/MRI. Phys Med Biol 2018; 63:225014. [PMID: 30418935 DOI: 10.1088/1361-6560/aae9a9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The combination of positron emission tomography (PET) and magnetic resonance imaging (MRI) provides a benefit for diagnostic imaging. Still, attenuation correction (AC) is a challenge in PET/MRI compared to stand-alone PET and PET-computed tomography (PET/CT). In the absence of photonic transmission sources, AC in PET/MRI is usually based on retrospective segmentation of MR images or complex additional MR-sequences. However, most methods available today are still challenged by either the incorporation of cortical bone or substantial anatomical variations of subjects. This leads to a bias in quantification of tracer concentration in PET. Therefore, we have developed a fully integrated transmission source system for PET/MRI of the head to enable direct measurement of attenuation coefficients using external positron emitters, which is the reference standard in AC. Based on a setup called the 'liquid drive' presented by Jones et al (1995) two decades ago, we built a head coil system consisting of an MR-compatible hydraulic system driving a point source on a helical path around a 24-channel MR-receiver coil to perform a transmission scan. Sinogram windowing of the moving source allows for post-injection measurements. The prototype was tested in the Siemens Biograph mMR using a homogeneous water phantom and a phantom with air cavities and a Teflon (PTFE) cylinder. The second phantom was measured both with and without emission activity. For both measurements air, water and Teflon were clearly distinguishable and homogeneous regions of the phantom were successfully reproduced in the AC map. For water the linear attenuation coefficient was measured as (0.096 ± 0.005) cm-1 in accordance with the true physical value. This combined MR head coil and transmission source system is, to our knowledge, the first working example to use an orbiting point source in PET/MRI and may be helpful in providing fully-quantitative PET data in neuro-PET/MRI.
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Affiliation(s)
- A Renner
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria. Institute of Applied Physics, Vienna University of Technology, 1040 Vienna, Austria
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15
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Pabel S, Wagner S, Bollenberg H, Bengel P, Kovács Á, Schach C, Tirilomis P, Mustroph J, Renner A, Gummert J, Fischer T, Van Linthout S, Tschöpe C, Streckfuss-Bömeke K, Hasenfuss G, Maier LS, Hamdani N, Sossalla S. Empagliflozin directly improves diastolic function in human heart failure. Eur J Heart Fail 2018; 20:1690-1700. [PMID: 30328645 DOI: 10.1002/ejhf.1328] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
AIMS Empagliflozin, a clinically used oral antidiabetic drug that inhibits the sodium-dependent glucose co-transporter 2, has recently been evaluated for its cardiovascular safety. Surprisingly, empagliflozin reduced mortality and hospitalization for heart failure (HF) compared to placebo. However, the underlying mechanisms remain unclear. Therefore, our study aims to investigate whether empagliflozin may cause direct pleiotropic effects on the myocardium. METHODS AND RESULTS In order to assess possible direct myocardial effects of empagliflozin, we performed contractility experiments with in toto-isolated human systolic end-stage HF ventricular trabeculae. Empagliflozin significantly reduced diastolic tension, whereas systolic force was not changed. These results were confirmed in murine myocardium from diabetic and non-diabetic mice, suggesting independent effects from diabetic conditions. In human HF cardiomyocytes, empagliflozin did not influence calcium transient amplitude or diastolic calcium level. The mechanisms underlying the improved diastolic function were further elucidated by studying myocardial fibres from patients and rats with diastolic HF (HF with preserved ejection fraction, HFpEF). Empagliflozin beneficially reduced myofilament passive stiffness by enhancing phosphorylation levels of myofilament regulatory proteins. Intravenous injection of empagliflozin in anaesthetized HFpEF rats significantly improved diastolic function measured by echocardiography, while systolic contractility was unaffected. CONCLUSION Empagliflozin causes direct pleiotropic effects on the myocardium by improving diastolic stiffness and hence diastolic function. These effects were independent of diabetic conditions. Since pharmacological therapy of diastolic dysfunction and HF is an unmet need, our results provide a rationale for new translational studies and might also contribute to the understanding of the EMPA-REG OUTCOME trial.
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Affiliation(s)
- Steffen Pabel
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.,Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Hannah Bollenberg
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Philipp Bengel
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Árpád Kovács
- Department of Systems Physiology, Ruhr University Bochum, Bochum, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Petros Tirilomis
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - André Renner
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Center), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Thomas Fischer
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Sophie Van Linthout
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin-Brandenburg Center for Regenerative Therapies and German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin-Brandenburg Center for Regenerative Therapies and German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Katrin Streckfuss-Bömeke
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Nazha Hamdani
- Department of Systems Physiology, Ruhr University Bochum, Bochum, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.,Clinic for Cardiology & Pneumology, Georg-August University Goettingen, and German Center for Cardiovascular Research (DZHK), partner site Goettingen, Germany
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16
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Fischer TH, Eiringhaus J, Dybkova N, Saadatmand A, Pabel S, Weber S, Wang Y, Köhn M, Tirilomis T, Ljubojevic S, Renner A, Gummert J, Maier LS, Hasenfuß G, El-Armouche A, Sossalla S. Activation of protein phosphatase 1 by a selective phosphatase disrupting peptide reduces sarcoplasmic reticulum Ca 2+ leak in human heart failure. Eur J Heart Fail 2018; 20:1673-1685. [PMID: 30191648 DOI: 10.1002/ejhf.1297] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 07/11/2018] [Accepted: 07/14/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disruption of Ca2+ homeostasis is a key pathomechanism in heart failure. CaMKII-dependent hyperphosphorylation of ryanodine receptors in the sarcoplasmic reticulum (SR) increases the arrhythmogenic SR Ca2+ leak and depletes SR Ca2+ stores. The contribution of conversely acting serine/threonine phosphatases [protein phosphatase 1 (PP1) and 2A (PP2A)] is largely unknown. METHODS AND RESULTS Human myocardium from three groups of patients was investigated: (i) healthy controls (non-failing, NF, n = 8), (ii) compensated hypertrophy (Hy, n = 16), and (iii) end-stage heart failure (HF, n = 52). Expression of PP1 was unchanged in Hy but greater in HF compared to NF while its endogenous inhibitor-1 (I-1) was markedly lower expressed in both compared to NF, suggesting increased total PP1 activity. In contrast, PP2A expression was lower in Hy and HF compared to NF. Ca2+ homeostasis was severely disturbed in HF compared to Hy signified by a higher SR Ca2+ leak, lower systolic Ca2+ transients as well as a decreased SR Ca2+ load. Inhibition of PP1/PP2A by okadaic acid increased SR Ca2+ load and systolic Ca2+ transients but severely aggravated diastolic SR Ca2+ leak and cellular arrhythmias in Hy. Conversely, selective activation of PP1 by a PP1-disrupting peptide (PDP3) in HF potently reduced SR Ca2+ leak as well as cellular arrhythmias and, importantly, did not compromise systolic Ca2+ release and SR Ca2+ load. CONCLUSION This study is the first to functionally investigate the role of PP1/PP2A for Ca2+ homeostasis in diseased human myocardium. Our data indicate that a modulation of phosphatase activity potently impacts Ca2+ cycling properties. An activation of PP1 counteracts increased kinase activity in heart failure and successfully seals the arrhythmogenic SR Ca2+ leak. It may thus represent a promising future antiarrhythmic therapeutic approach.
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Affiliation(s)
- Thomas H Fischer
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany.,Medizinische Klinik II, Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Germany.,Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany
| | - Jörg Eiringhaus
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany.,Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany
| | - Nataliya Dybkova
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany.,Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany
| | - Alireza Saadatmand
- Abt. Molekulare Kardiologie und Epigenetik, Universitätsklinikum Heidelberg, Germany
| | - Steffen Pabel
- Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany.,Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Silvio Weber
- Institut für Pharmakologie, Technische Universität Dresden, Germany
| | - Yansong Wang
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Maja Köhn
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany.,Centre for Biological Signalling Studies (BIOSS) and Faculty of Biology, University of Freiburg, Germany
| | - Theodor Tirilomis
- Klinik für Thorax-, Herz-, Gefäßchirurgie, Georg-August-Universität Göttingen, Germany
| | - Senka Ljubojevic
- Abteilung für Kardiologie, Medizinische Universität Graz, Austria
| | - André Renner
- Abteilung für Herz- und Transplantationschirurgie, Herz- und Diabeteszentrum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Abteilung für Herz- und Transplantationschirurgie, Herz- und Diabeteszentrum, Bad Oeynhausen, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Gerd Hasenfuß
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany.,Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany
| | - Ali El-Armouche
- Institut für Pharmakologie, Technische Universität Dresden, Germany
| | - Samuel Sossalla
- Klinik für Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Germany.,Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK), Standort Göttingen, Germany.,Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
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17
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Renner A, Kaluza I, Marth K, Moeslinger T, Pohl W. P112 Exhaled nitric oxide is a possible biomarker for predicting complications in cystic fibrosis patients. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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18
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Trummer U, Novak-Zezula S, Renner A, Wilczewska I. 2.10-P10Cost savings through timely treatment for irregular migrants and European Union citizens without insurance. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- U Trummer
- Center For Health And Migration, Vienna, Austria
| | | | - A Renner
- Center For Health And Migration, Vienna, Austria
| | - I Wilczewska
- Center For Health And Migration, Vienna, Austria
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19
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Renner A, Neukam K, RÖsner T, Elert O, Lange V. Pumpless Extracorporeal Lung Assist as Supportive Therapy in a Patient with Diffuse Alveolar Hemorrhage. Int J Artif Organs 2018; 31:279-81. [DOI: 10.1177/039139880803100313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our 18-year old female patient suffered from microscopic polyangiitis. After invasive diagnostics, a diffuse alveolar hemorrhage occurred, leading to acute lung failure. In spite of differential ventilation, respiratory insufficiency and lactate-acidosis increased quickly. Due to the massive hemorrhage, a pumpless extracorporeal lung assist was implanted and, after six hours, low-dose heparinization was started. In response to this therapy, hypercapnia and acidosis improved quickly and were completely eliminated within 24 hours. Simultaneously, treatment with prednisolon and cyclophosphamid was started. After 7 days, the patient's conditions allowed weaning from the pumpless extracorporeal lung assist and after 9 days she was extubated. In conclusion, the pumpless lung assist was shown to be a very practical option to treat the most serious forms of hypercapnia, especially for patients disposed to diffuse bleeding.
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Affiliation(s)
- A. Renner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - K. Neukam
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - T. RÖsner
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - O. Elert
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
| | - V. Lange
- Clinic and Polyclinic of Cardiothoracic Surgery, University of Wuerzburg, Wuerzburg - Germany
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20
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Haddad S, Wang Y, Galy B, Korf-Klingebiel M, Hirsch V, Baru AM, Rostami F, Reboll MR, Heineke J, Flögel U, Groos S, Renner A, Toischer K, Zimmermann F, Engeli S, Jordan J, Bauersachs J, Hentze MW, Wollert KC, Kempf T. Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. Eur Heart J 2017; 38:362-372. [PMID: 27545647 DOI: 10.1093/eurheartj/ehw333] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 07/12/2016] [Indexed: 12/28/2022] Open
Abstract
Aims Iron deficiency (ID) is associated with adverse outcomes in heart failure (HF) but the underlying mechanisms are incompletely understood. Intracellular iron availability is secured by two mRNA-binding iron-regulatory proteins (IRPs), IRP1 and IRP2. We generated mice with a cardiomyocyte-targeted deletion of Irp1 and Irp2 to explore the functional implications of ID in the heart independent of systemic ID and anaemia. Methods and results Iron content in cardiomyocytes was reduced in Irp-targeted mice. The animals were not anaemic and did not show a phenotype under baseline conditions. Irp-targeted mice, however, were unable to increase left ventricular (LV) systolic function in response to an acute dobutamine challenge. After myocardial infarction, Irp-targeted mice developed more severe LV dysfunction with increased HF mortality. Mechanistically, the activity of the iron-sulphur cluster-containing complex I of the mitochondrial electron transport chain was reduced in left ventricles from Irp-targeted mice. As demonstrated by extracellular flux analysis in vitro, mitochondrial respiration was preserved at baseline but failed to increase in response to dobutamine in Irp-targeted cardiomyocytes. As shown by 31P-magnetic resonance spectroscopy in vivo, LV phosphocreatine/ATP ratio declined during dobutamine stress in Irp-targeted mice but remained stable in control mice. Intravenous injection of ferric carboxymaltose replenished cardiac iron stores, restored mitochondrial respiratory capacity and inotropic reserve, and attenuated adverse remodelling after myocardial infarction in Irp-targeted mice but not in control mice. As shown by electrophoretic mobility shift assays, IRP activity was significantly reduced in LV tissue samples from patients with advanced HF and reduced LV tissue iron content. Conclusions ID in cardiomyocytes impairs mitochondrial respiration and adaptation to acute and chronic increases in workload. Iron supplementation restores cardiac energy reserve and function in iron-deficient hearts.
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Affiliation(s)
- Saba Haddad
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Yong Wang
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Bruno Galy
- European Molecular Biology Laboratory, Meyerhofstraße 1, 69117 Heidelberg, Germany.,Division of Virus-associated Carcinogenesis, German Cancer Research Centre, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Mortimer Korf-Klingebiel
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Valentin Hirsch
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Abdul M Baru
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Fatemeh Rostami
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marc R Reboll
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Jörg Heineke
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Ulrich Flögel
- Department of Molecular Cardiology, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Stephanie Groos
- Institute of Cell Biology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, University of Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, University of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Fabian Zimmermann
- Department of Analytical Chemistry, Leibniz University Hannover, Callinstraße 1, 30167 Hannover, Germany
| | - Stefan Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Jens Jordan
- Institute of Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Matthias W Hentze
- European Molecular Biology Laboratory, Meyerhofstraße 1, 69117 Heidelberg, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tibor Kempf
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Furukawa N, Kuss O, Preindl K, Renner A, Aboud A, Hakim-Meibodi K, Benzinger M, Pühler T, Ensminger S, Fujita B, Becker T, Gummert JF, Börgermann J. Anaortic off-pump versus clampless off-pump using the PAS-Port device versus conventional coronary artery bypass grafting: mid-term results from a matched propensity score analysis of 5422 unselected patients†. Eur J Cardiothorac Surg 2017; 52:760-767. [DOI: 10.1093/ejcts/ezx235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 05/22/2017] [Indexed: 02/04/2023] Open
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Schotola H, Sossalla ST, Renner A, Gummert J, Danner BC, Schott P, Toischer K. The contractile adaption to preload depends on the amount of afterload. ESC Heart Fail 2017; 4:468-478. [PMID: 29154423 PMCID: PMC5695189 DOI: 10.1002/ehf2.12164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/27/2017] [Accepted: 03/15/2017] [Indexed: 11/21/2022] Open
Abstract
Aims The Frank–Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility of the heart muscle is influenced by pre‐load and after‐load. Because of the effect of pre‐load vs. after‐load on these mechanisms in not completely understood, we studied the effect in isolated muscle strips. Methods and results Progressive stretch lead to an increase in shortening/force development under isotonic (only pre‐load) and isometric conditions (pre‐ and after‐load). Muscle length with maximal function was reached earlier under isotonic (Lmax‐isotonic) compared with isometric conditions (Lmax‐isometric) in nonfailing rabbit, in human atrial and in failing ventricular muscles. Also, SR after stretch from slack to Lmax‐isotonic was comparable under isotonic and isometric conditions (human: isotonic 10 ± 4%, isometric 10 ± 4%). Moreover, a switch from isotonic to isometric conditions at Lmax‐isometric showed no SR proving independence of after‐load. To further analyse the degree of SR on the total contractile performance at higher pre‐load muscles were stretched from slack to 98% Lmax‐isometric under isotonic conditions. Thereby, the SR was 60 ± 9% in rabbit and 51 ± 14% in human muscle strips. Conclusions This work shows that the acute contractile response largely depends on the degree and type of mechanical load. Increased filling of the heart elevates pre‐load and prolongs the isotonic part of contraction. The reduction in shortening at higher levels of pre‐load is thereby partially compensated by the pre‐load‐induced SR. After‐load shifts the contractile curve to a better ‘myofilament function’ by probably influencing thin fibers and calcium sensitivity, but has no effect on the SR.
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Affiliation(s)
- Hanna Schotola
- Department of Anesthesiology, Georg-August-University, Goettingen, Germany
| | - Samuel T Sossalla
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany
| | - André Renner
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Peter Schott
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, Georg-August-University, Goettingen, Germany.,DZHK (German Center for Cardiovascular Research) partnersite Göttingen, Germany
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23
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Puehler T, Dia M, Ibishi A, El-Hashem G, Renner A, Hakim-Meibodi K, Ensminger S, Boergermann J, Zittermann A, Gummert J. Carotid Artery Stenosis does not Increase the Perioperative Risk of Stroke in Patients Undergoing Aortic Non-Clamping and No-touch off-pump Surgery- A Retrospective Single-Center Analysis. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T. Puehler
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - M. Dia
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Ibishi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - G. El-Hashem
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Renner
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - K. Hakim-Meibodi
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - S. Ensminger
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Boergermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - A. Zittermann
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
| | - J. Gummert
- HDZ NRW, Ruhr Universität Bochum, Klinik für Thorax- und Kardiovaskularchirurgie, Bad Oeynhausen, Germany
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24
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Tanios A, Braunegger-Kallinger G, Loder C, Renner A. Effectiveness of community health promotion targeting children and adolescents in rural areas. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Pühler T, Fujita B, Renner A, Hakim-Meibodi K, Bögermann J, Morshuis M, Gummert J, Ensminger S. Operative Myokardrevaskularisation bei schlechter linksventrikulärer Funktion – STICH forever? Aktuel Kardiol 2016. [DOI: 10.1055/s-0042-114219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T. Pühler
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - B. Fujita
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - A. Renner
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - K. Hakim-Meibodi
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Bögermann
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - M. Morshuis
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - J. Gummert
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
| | - S. Ensminger
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Klinik für Thorax- und Kardiovaskularchirurgie, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
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26
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Hartmann N, Pabel S, Herting J, Schatter F, Renner A, Gummert J, Schotola H, Danner BC, Maier LS, Frey N, Hasenfuss G, Fischer TH, Sossalla S. Antiarrhythmic effects of dantrolene in human diseased cardiomyocytes. Heart Rhythm 2016; 14:412-419. [PMID: 27650424 DOI: 10.1016/j.hrthm.2016.09.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cardiac type 2 ryanodine receptors (RyR2s) play a pivotal role in cellular electrophysiology and contractility. Increased RyR2-mediated diastolic sarcoplasmic reticulum (SR) Ca2+ release is linked to heart failure (HF) and arrhythmias. Dantrolene, a drug used for the treatment of malignant hyperthermia, is known to stabilize RyRs in skeletal muscle. OBJECTIVE The purpose of this study was to investigate the effects of dantrolene on arrhythmogenic triggers and contractile function in human atrial fibrillation (AF) and HF cardiomyocytes (CM). METHODS Human CM were isolated from either patients with HF (ventricular) or patients with AF (atrial), and Ca2+ imaging, patch-clamp, or muscle strip experiments were performed. RESULTS After exposure to dantrolene, human atrial AF and left ventricular HF CM showed significant reductions in proarrhythmic SR Ca2+ spark frequency and diastolic SR Ca2+ leak. Moreover, dantrolene decreased the frequency of Ca2+ waves and spontaneous Ca2+ transients in HF CM. Patch-clamp experiments revealed that dantrolene significantly suppressed delayed afterdepolarizations in HF and AF CM. Importantly, dantrolene had no effect on action potential duration in AF or in HF CM. In addition, dantrolene had neutral effects on contractile force of human isometrically twitching ventricular HF trabeculae. CONCLUSION Our study showed that dantrolene beneficially influenced disrupted SR Ca2+ homeostasis in human HF and AF CM. Cellular arrhythmogenic triggers were potently suppressed by dantrolene, whereas action potential duration and contractility were not affected. As a clinically approved drug for the treatment of malignant hyperthermia, dantrolene may be a potential antiarrhythmic drug for patients with rhythm disorders and merits further clinical investigation.
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Affiliation(s)
- Nico Hartmann
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Steffen Pabel
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Jonas Herting
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Felix Schatter
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Hanna Schotola
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University Göttingen, Göttingen, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III: Cardiology and Angiology, University of Kiel, Kiel, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Thomas H Fischer
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | - Samuel Sossalla
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany; Department of Internal Medicine III: Cardiology and Angiology, University of Kiel, Kiel, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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Khalil M, Renner A, Langkammer C, Enzinger C, Ropele S, Stojakovic T, Scharnagl H, Bachmaier G, Pichler A, Archelos JJ, Fuchs S, Seifert-Held T, Fazekas F. Cerebrospinal fluid lipocalin 2 in patients with clinically isolated syndromes and early multiple sclerosis. Mult Scler 2016; 22:1560-1568. [DOI: 10.1177/1352458515624560] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/06/2015] [Indexed: 11/17/2022]
Abstract
Background: Lipocalin 2 (LCN2) may be involved in the immunopathogenesis of multiple sclerosis (MS) and might further impact on iron homoeostasis. Brain iron accumulates in MS; however, the association to iron-related proteins is still unsolved. Objective: To investigate cerebrospinal fluid (CSF) and serum LCN2, transferrin (Trf) and ferritin in early MS in relation to disease evolution and longitudinal brain iron accumulation. Methods: We analysed CSF and serum LCN2 by enzyme-linked immunosorbent assay (ELISA) and Trf and ferritin by nephelometry in 55 patients (45 clinically isolated syndrome (CIS), 10 MS, median clinical follow-up 4.8 years) and 63 controls. In patients, we assessed sub-cortical grey matter iron by 3T magnetic resonance imaging (MRI) R2* relaxometry (median imaging follow-up 2.2 years). Results: Compared to controls serum ( p < 0.01), CSF ( p < 0.001) LCN2 and CSF Trf ( p < 0.001) levels were reduced in the patients. CSF LCN2 correlated with CSF Trf ( r = 0.5, p < 0.001). In clinically stable patients, CSF LCN2 levels correlated with basal ganglia iron accumulation ( r = 0.5, p < 0.05). In CIS, higher CSF LCN2 levels were associated with conversion to clinically definite MS ( p < 0.05). Conclusion: We demonstrate altered LCN2 regulation in early MS and provide first evidence for this to be possibly linked to both clinical MS activity and iron accumulation in the basal ganglia.
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Affiliation(s)
- M Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - A Renner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Langkammer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - C Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria/Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - S Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - H Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - G Bachmaier
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - A Pichler
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - JJ Archelos
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - S Fuchs
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - T Seifert-Held
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - F Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
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Affiliation(s)
- A. Renner
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg
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29
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Hartmann N, Mason FE, Braun I, Pabel S, Voigt N, Schotola H, Fischer TH, Dobrev D, Danner BC, Renner A, Gummert J, Belardinelli L, Frey N, Maier LS, Hasenfuss G, Sossalla S. The combined effects of ranolazine and dronedarone on human atrial and ventricular electrophysiology. J Mol Cell Cardiol 2016; 94:95-106. [PMID: 27056421 DOI: 10.1016/j.yjmcc.2016.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/20/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pharmacological rhythm control of atrial fibrillation (AF) in patients with structural heart disease is limited. Ranolazine in combination with low dose dronedarone remarkably reduced AF-burden in the phase II HARMONY trial. We thus aimed to investigate the possible mechanisms underlying these results. METHODS AND RESULTS Patch clamp experiments revealed that ranolazine (5μM), low-dose dronedarone (0.3μM), and the combination significantly prolonged action potential duration (APD90) in atrial myocytes from patients in sinus rhythm (prolongation by 23.5±0.1%, 31.7±0.1% and 25.6±0.1% respectively). Most importantly, in atrial myocytes from patients with AF ranolazine alone, but more the combination with dronedarone, also prolonged the typically abbreviated APD90 (prolongation by 21.6±0.1% and 31.9±0.1% respectively). It was clearly observed that neither ranolazine, dronedarone nor the combination significantly changed the APD or contractility and twitch force in ventricular myocytes or trabeculae from patients with heart failure (HF). Interestingly ranolazine, and more so the combination, but not dronedarone alone, caused hyperpolarization of the resting membrane potential in cardiomyocytes from AF. As measured by confocal microscopy (Fluo-3), ranolazine, dronedarone and the combination significantly suppressed diastolic sarcoplasmic reticulum (SR) Ca(2+) leak in myocytes from sinus rhythm (reduction by ranolazine: 89.0±30.7%, dronedarone: 75.6±27.4% and combination: 78.0±27.2%), in myocytes from AF (reduction by ranolazine: 67.6±33.7%, dronedarone: 86.5±31.7% and combination: 81.0±33.3%), as well as in myocytes from HF (reduction by ranolazine: 64.8±26.5% and dronedarone: 65.9±29.3%). CONCLUSIONS Electrophysiological measurements during exposure to ranolazine alone or in combination with low-dose dronedarone showed APD prolongation, cellular hyperpolarization and reduced SR Ca(2+) leak in human atrial myocytes. The combined inhibitory effects on various currents, in particular Na(+) and K(+) currents, may explain the anti-AF effects observed in the HARMONY trial. Therefore, the combination of ranolazine and dronedarone, but also ranolazine alone, may be promising new treatment options for AF, especially in patients with HF, and merit further clinical investigation.
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Affiliation(s)
- Nico Hartmann
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany
| | - Fleur E Mason
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany
| | - Inga Braun
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany
| | - Steffen Pabel
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany
| | - Niels Voigt
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Hanna Schotola
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Georg August University Göttingen, Göttingen, Germany
| | - Thomas H Fischer
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg August University Göttingen, Göttingen, Germany
| | - André Renner
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Luiz Belardinelli
- Department of Biology, Cardiovascular, Therapeutic Area, Gilead Sciences, Foster, City, CA, USA
| | - Norbert Frey
- Department of Internal Medicine III: Cardiology and Angiology, University of Kiel, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany
| | - Samuel Sossalla
- Department of Cardiology and Pneumology, Georg August University Göttingen, Göttingen, Germany; Department of Internal Medicine III: Cardiology and Angiology, University of Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Germany.
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Fischer TH, Kleinwächter A, Herting J, Eiringhaus J, Hartmann N, Renner A, Gummert J, Haverich A, Schmitto JD, Sossalla S. Inhibition of CaMKII Attenuates Progressing Disruption of Ca2+Homeostasis Upon Left Ventricular Assist Device Implantation in Human Heart Failure. Artif Organs 2016; 40:719-26. [DOI: 10.1111/aor.12677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas H. Fischer
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Astrid Kleinwächter
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Jonas Herting
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - Jörg Eiringhaus
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
| | - Nico Hartmann
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
| | - André Renner
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Jan Gummert
- Department for Heart and Transplantation Surgery; Heart Center; Bad Oeynhausen Germany
| | - Axel Haverich
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Jan D. Schmitto
- Department for Thoracic and Heart Surgery; Medical University of Hannover; Hannover Germany
| | - Samuel Sossalla
- Department for Cardiology and Pulmonology; Georg-August University; Göttingen Germany
- German Center for Cardiovascular Research (DZHK); Göttingen Germany
- Department for Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine; University Medical Center; Kiel Germany
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Pühler T, Dia M, Zittermann A, Börgermann J, Renner A, Ensminger S, Gummert J. Off-pump Revascularization with Bilateral Mammary Artery -Single Center Proof of Concept after 5 Years. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Helms S, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Renner A, Gummert J. Coronary Revascularization in Diabetic Patients: 3-year Survival Data for Off-pump and on-pump Technique. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Börgermann J, Preindl K, Renner A, Aboud A, Hakim K, Benzinger M, Pühler T, Ensminger S, Becker T, Zittermann A, Kuss O, Gummert J. Midterm Outcome after Anaortic and Clampless Off-pump and Conventional Coronary Artery Bypass Grafting - Analysis of 5,422 Unselected Patients. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer TH, Herting J, Eiringhaus J, Pabel S, Hartmann NH, Ellenberger D, Friedrich M, Renner A, Gummert J, Maier LS, Zabel M, Hasenfuss G, Sossalla S. Sex-dependent alterations of Ca2+ cycling in human cardiac hypertrophy and heart failure. Europace 2015; 18:1440-8. [PMID: 26493982 DOI: 10.1093/europace/euv313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/19/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Clinical studies have shown differences in the propensity for malignant ventricular arrhythmias between women and men suffering from cardiomyopathies and heart failure (HF). This is clinically relevant as it impacts therapies like prophylactic implantable cardioverter-defibrillator implantation but the pathomechanisms are unknown. As an increased sarcoplasmic reticulum (SR) Ca(2+) leak is arrhythmogenic, it could represent a cellular basis for this paradox. METHODS/RESULTS We evaluated the SR Ca(2+) leak with respect to sex differences in (i) afterload-induced cardiac hypertrophy (Hy) with preserved left ventricular (LV) function and (ii) end-stage HF. Cardiac function did not differ between sexes in both cardiac pathologies. Human cardiomyocytes isolated from female patients with Hy showed a significantly lower Ca(2+) spark frequency (CaSpF, confocal microscopy, Fluo3-AM) compared with men (P < 0.05). As Ca(2+) spark width and duration were similar in women and men, this difference in CaSpF did not yet translate into a significant difference of the calculated SR Ca(2+) leak between both sexes at this stage of disease (P = 0.14). Epifluorescence measurements (Fura2-AM) revealed comparable Ca(2+) cycling properties (diastolic Ca(2+) levels, amplitude of systolic Ca(2+) transients, SR Ca(2+) load) in patients of both sexes suffering from Hy. Additionally, the increased diastolic CaSpF in male patients with Hy did not yet translate into an elevated ratio of cells showing arrhythmic events (Ca(2+) waves, spontaneous Ca(2+) transients) (P = 0.77). In the transition to HF, both sexes showed an increase of the CaSpF (P < 0.05) and the sex dependence was even more pronounced. Female patients had a 69 ± 10% lower SR Ca(2+) leak (P < 0.05), which now even translated into a lower ratio of arrhythmic cells in female HF patients compared with men (P < 0.001). CONCLUSION These data show that the SR Ca(2+) leak is lower in women than in men with comparable cardiac impairment. Since the SR Ca(2+) leak triggers delayed afterdepolarizations, our findings may explain why women are less prone to ventricular arrhythmias and confirm the rationale of therapeutic measures reducing the SR Ca(2+) leak.
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Affiliation(s)
- Thomas H Fischer
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Jonas Herting
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Jörg Eiringhaus
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Steffen Pabel
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Nico H Hartmann
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - David Ellenberger
- Institut für Medizinische Statistik, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Martin Friedrich
- Abt. Thorax-, Herz- und Gefäßchirurgie, Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany
| | - André Renner
- Abt. Thorax-, Herz-, Gefäßchirurgie, Herz- und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany
| | - Jan Gummert
- Abt. Thorax-, Herz-, Gefäßchirurgie, Herz- und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Zabel
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Germany
| | - Gerd Hasenfuss
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Germany
| | - Samuel Sossalla
- Klinik für Kardiologie und Pneumologie/Herzzentrum, Georg-August-Universität Göttingen, Göttingen, Germany Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Germany
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Ostermann H, Renner A, Schneider P, Bobek J, Vogler S. A cost/benefit analysis of self-care initiatives in the European Union – who benefits, who gains? Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv170.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schmidt-Wiborg P, Renner A. Kompetenzen für Prävention in der Gesundheitsselbsthilfe – Praxisbeispiele für die Entwicklung und den Transfer von Kompetenzen in die Praxis. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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37
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Franz M, Doll F, Grün K, Richter P, Köse N, Ziffels B, Schubert H, Figulla HR, Jung C, Gummert J, Renner A, Neri D, Berndt A. Targeted delivery of interleukin-10 to chronic cardiac allograft rejection using a human antibody specific to the extra domain A of fibronectin. Int J Cardiol 2015; 195:311-22. [PMID: 26056964 DOI: 10.1016/j.ijcard.2015.05.144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS Management of chronic rejection is challenging since there are not sufficient preventive or therapeutic strategies. The rejection process leads to overexpression of ED-A(+) fibronectin (ED-A(+) Fn). The human antibody F8, specific to ED-A(+) Fn, may serve as a vehicle for targeted delivery of bioactive payloads, e.g. interleukin 10 (IL-10). The aim of this study was to investigate the therapeutic effects of the fusion protein F8-interleukin-10 (F8-IL10) in the process of chronic rejection development. METHODS A heterotopic rat heart transplantation model was used to induce chronic rejection. For therapeutic interventions, the immunocytokines F8-humanIL10 (DEKAVIL), F8-ratIL10 as well as KSF-humanIL10 (irrelevant antigen-specificity) were used. Treatment was performed weekly for 10 weeks starting at day 7 after transplantation (1mg/animal). RESULTS In the cardiac allografts, treatment with F8-huIL10 or F8-ratIL10 was associated with increased heart weights, a higher grade of chronic rejection, increased CIF, higher protein expression levels of alpha-smooth muscle actin (α-SMA), an augmented infiltration with inflammatory cells (CD4+, CD8+ and CD68+ cells) and higher serum levels of brain natriuretic peptide (BNP) compared to the control groups. CONCLUSIONS All observed treatment effects are transplantation-specific since the F8 antibody is specific to ED-A(+) Fn that is not expressed in healthy hearts. A clear targeting effect of F8-huIL10 as well as F8-ratIL10 could be proven. Against that background, a further study is needed to address the question, if F8-IL10 treatment is capable to reduce CAV and CIF starting at a time point when chronic rejection has fully developed (therapeutic approach).
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Affiliation(s)
- Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany.
| | - Fabia Doll
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Katja Grün
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Petra Richter
- Institute of Pathology, Jena University Hospital, Jena, Germany
| | - Nilay Köse
- Institute of Pathology, Jena University Hospital, Jena, Germany
| | - Barbara Ziffels
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Science and Welfare, Jena University Hospital, Jena, Germany
| | - Hans R Figulla
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Christian Jung
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - André Renner
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Dario Neri
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
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Renner A, Zittermann A, Aboud A, Hakim-Meibodi K, Börgermann J, Gummert JF. Early and mid-term clinical outcome in younger and elderly patients undergoing mitral valve repair with or without tricuspid valve repair. Interact Cardiovasc Thorac Surg 2014; 20:85-9. [PMID: 25320141 DOI: 10.1093/icvts/ivu337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data regarding durability and midterm benefits of mitral valve (MV) repair in elderly patients are scarce. To evaluate the feasibility and safety of MV repair in elderly patients, we performed a retrospective data analysis. METHODS We compared clinical outcomes in younger patients (<75 years: n = 462) and older patients (≥75 years: n = 100) undergoing MV repair with or without tricuspid valve (TV) repair. The primary end-point was 30-day mortality. RESULTS The preoperative risk profile (EuroSCORE, NYHA class, percentage pulmonary hypertension, percentage diabetes) was higher in older patients compared with younger patients. Nevertheless, operative complications such as low cardiac output syndrome, stroke, infections, the need of haemofiltration and IABP use did not differ significantly between the two groups. The thirty-day mortality rate was 0% in older patients and 1% in younger patients (P = 0.30). In the subgroup of patients with double valve repair, the 30-day mortality rate in older patients (n = 28) and younger patients (n = 46) was 0 and 4%, respectively (P = 0.27). In older and younger patients, the 6-month mortality rate was 4 and 2%, respectively (P = 0.16), and the 1-year mortality rate was 10 and 3%, respectively (P = 0.001). The propensity score-adjusted odds ratio of 1-year mortality with the group of younger patients as a reference was 2.04 (95% confidence interval: 0.77-5.40; P = 0.15) for older patients. Freedom from 1-year reoperation did not differ significantly between age groups. CONCLUSIONS Data demonstrate excellent postoperative mortality rates in older patients undergoing MV repair with or without TV repair. Consequently, even in older patients with numerous comorbidities, MV repair should be considered a suitable surgical method.
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Affiliation(s)
- André Renner
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Armin Zittermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Anas Aboud
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kavous Hakim-Meibodi
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany
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Fischer TH, Eiringhaus J, Dybkova N, Förster A, Herting J, Kleinwächter A, Ljubojevic S, Schmitto JD, Streckfuß‐Bömeke K, Renner A, Gummert J, Hasenfuss G, Maier LS, Sossalla S. Ca
2+
/calmodulin‐dependent protein kinase
II
equally induces sarcoplasmic reticulum Ca
2+
leak in human ischaemic and dilated cardiomyopathy. Eur J Heart Fail 2014; 16:1292-300. [DOI: 10.1002/ejhf.163] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Thomas H. Fischer
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Jörg Eiringhaus
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Nataliya Dybkova
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Anna Förster
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Jonas Herting
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Astrid Kleinwächter
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - Senka Ljubojevic
- Abteilung Kardiologie Medizinische Universitätsklinik Graz Austria
| | - Jan D. Schmitto
- Abteilung Herz‐, Thorax‐, Gefäß‐ und Transplantationschirurgie Medizinische Hochschule Hannover Germany
| | - Katrin Streckfuß‐Bömeke
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
| | - André Renner
- Abteilung Thorax‐, Herz‐, Gefäßchirurgie Herz‐ und Diabeteszentrum Nordrheinwestfalen Bad Oeynhausen Germany
| | - Jan Gummert
- Abteilung Thorax‐, Herz‐, Gefäßchirurgie Herz‐ und Diabeteszentrum Nordrheinwestfalen Bad Oeynhausen Germany
| | - Gerd Hasenfuss
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Goettingen Germany
| | - Lars S. Maier
- Klinik und Poliklinik für Innere Medizin II Uiversitätsklinikum Regensburg Germany
| | - Samuel Sossalla
- Abteilung Kardiologie und Pneumologie/Herzzentrum Georg‐August‐Universität Göttingen Germany
- German Center for Cardiovascular Research (DZHK) Partner Site Goettingen Germany
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Franz M, Matusiak-Brückner M, Richter P, Grün K, Ziffels B, Neri D, Maschek H, Schulz U, Pfeil A, Jung C, Figulla HR, Gummert J, Berndt A, Renner A. De novo expression of fetal ED-A(+) fibronectin and B (+) tenascin-C splicing variants in human cardiac allografts: potential impact for targeted therapy of rejection. J Mol Histol 2014; 45:519-32. [PMID: 24792713 DOI: 10.1007/s10735-014-9573-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/22/2014] [Indexed: 02/06/2023]
Abstract
Management of acute and especially chronic rejection after human cardiac transplantation is still challenging. Chronic rejection, represented by allograft vasculopathy (CAV) and cardiac interstitial fibrosis (CIF) is known to cause severe long-term complications. Rejection associated tissue-remodelling entails the reoccurrence of fetal variants of Fibronectin (Fn) and Tenascin-C (Tn-C), which are virtually absent in adult human organs. In a rat model, an extensive re-expression could be demonstrated for ED-A(+) Fn with spatial association to CAV and CIF. Thus, it is of great interest to investigate the cardiac tissue expression and distribution in human samples. From 48 heart transplanted patients, 64 tissue specimens derived from right ventricular biopsies were available. Histopathological analysis was performed according to the International Society for Heart and Lung Transplantation (ISHLT) guidelines for the detection of acute rejection. By immunohistochemistry, protein expression of ED-A(+) Fn, B(+) Tn-C, alpha-smooth muscle actin, CD31 and CD45 was assessed and analysed semiquantitatively. Co-localisation studies were performed by means of immunofluorescence double labelling. Histopathological analysis of the 64 samples revealed different ISHLT grades (0R in 36 cases, 1R in 20 cases and 2R in 8 cases). There was a distinct and quantitatively relevant re-occurrence of ED-A(+) Fn and B(+) Tn-C in most samples. Semi-quantitative evaluation did not show any correlation to the acute rejection grade for all markers. Interestingly, significant correlations to the extent of inflammation could be shown for ED-A(+) Fn (r = 0.442, p = 0.000) and B(+) Tn-C (r = 0.408, p = 0.001) as well as between both proteins (r = 0.663, p = 0.000). A spatial association of ED-A(+) Fn and B(+) Tn-C to CAV and CIF could be demonstrated. A relevant re-occurrence of ED-A(+) Fn and B(+) Tn-C following human heart transplantation could be demonstrated with spatial association to signs of rejection and a significant correlation to tissue inflammation. These data might contribute to the identification of novel biomarkers reflecting the rejection process and to the development of promising strategies to image, prevent or treat cardiac rejection.
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Affiliation(s)
- Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Germany,
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Franz M, Berndt A, Matusiak-Brückner M, Grün K, Maschek H, Richter P, Schulz U, Gummert J, Figulla H, Renner A. Early reoccurrence of fetal ED-A+ Fibronectin and B+ Tenascin-C splicing variants after human cardiac transplantation: potential impact for targeted therapy of chronic rejection. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Özpeker C, Morshuis M, Schönbrodt M, Börgermann J, Renner A, Gummert J. Aortic insufficiency development in 391 patients supported with four different cf-LVADs: A single center experience. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Puehler T, Ensminger S, Schulz U, Fuchs U, Tigges-Limmer K, Börgermann J, Morshuis M, Hakim K, Oldenburg O, Niedermeyer J, Renner A, Gummert J. [Heart and combined heart-lung transplantation. Indications, chances and risks]. Herz 2014; 39:66-73. [PMID: 24452762 DOI: 10.1007/s00059-013-4042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orthotopic heart transplantation (HTX) is nowadays the worldwide accepted gold standard for the treatment of terminal heart failure. The main indications for HTX are non-ischemic dilatative (54%) and ischemic (37%) heart failure. In the acute phase after HTX the survival rate is approximately 90%. Good short and long-term results with survival rates ranging from 81% after 1 year to more than 50% after 11 years demonstrate that there is currently no real treatment alternative to HTX for treatment of end-stage heart failure. In the case of irreversible pulmonary hypertension in combination with end-stage heart failure or complex congenital heart syndromes, a combined heart and lung transplantation (HLTX) is necessary. Compared with HTX the short-term survival of HLTX is reduced, mostly for technical reasons. Improved long-term results after HTX and HLTX are a result of highly specialized transplantation units and effective immunosuppression. However, a major problem is the shortage of organ donors in Germany and the resulting long waiting times for patients with frequently occurring blood groups of up to 10 months for transplantation. The consequence of the latter is the ever increasing number of implanted cardiac assist devices in patients not only as a bridge to transplant but also as destination therapy.
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Affiliation(s)
- T Puehler
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland,
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Furukawa N, Kuss O, Aboud A, Schonbrodt M, Renner A, Hakim Meibodi K, Becker T, Zittermann A, Gummert JF, Borgermann J. Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients. Eur J Cardiothorac Surg 2014; 46:221-6; discussion 226-7. [DOI: 10.1093/ejcts/ezt616] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Furukawa N, Aboud A, Schonbrodt M, Renner A, Hakim K, Becker T, Zittermann A, Oliver K, Gummert JF, Borgermann J. 316 * MINISTERNOTOMY VERSUS CONVENTIONAL STERNOTOMY FOR AORTIC VALVE REPLACEMENT: PROPENSITY SCORE ANALYSIS OF 808 PATIENTS. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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46
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Fischer TH, Herting J, Tirilomis T, Renner A, Neef S, Toischer K, Ellenberger D, Förster A, Schmitto JD, Gummert J, Schöndube FA, Hasenfuss G, Maier LS, Sossalla S. Ca
2+
/Calmodulin-Dependent Protein Kinase II and Protein Kinase A Differentially Regulate Sarcoplasmic Reticulum Ca
2+
Leak in Human Cardiac Pathology. Circulation 2013; 128:970-81. [DOI: 10.1161/circulationaha.113.001746] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Sarcoplasmic reticulum (SR) Ca
2+
leak through ryanodine receptor type 2 (RyR2) dysfunction is of major pathophysiological relevance in human heart failure (HF); however, mechanisms underlying progressive RyR2 dysregulation from cardiac hypertrophy to HF are still controversial.
Methods and Results—
We investigated healthy control myocardium (n=5) and myocardium from patients with compensated hypertrophy (n=25) and HF (n=32). In hypertrophy, Ca
2+
/calmodulin-dependent protein kinase II (CaMKII) and protein kinase A (PKA) both phosphorylated RyR2 at levels that were not different from healthy myocardium. Accordingly, inhibitors of these kinases reduced the SR Ca
2+
leak. In HF, however, the SR Ca
2+
leak was nearly doubled compared with hypertrophy, which led to reduced systolic Ca
2+
transients, a depletion of SR Ca
2+
storage and elevated diastolic Ca
2+
levels. This was accompanied by a significantly increased CaMKII-dependent phosphorylation of RyR2. In contrast, PKA-dependent RyR2 phosphorylation was not increased in HF and was independent of previous β-blocker treatment. In HF, CaMKII inhibition but not inhibition of PKA yielded a reduction of the SR Ca
2+
leak. Moreover, PKA inhibition further reduced SR Ca
2+
load and systolic Ca
2+
transients.
Conclusions—
In human hypertrophy, both CaMKII and PKA functionally regulate RyR2 and may induce SR Ca
2+
leak. In the transition from hypertrophy to HF, the diastolic Ca
2+
leak increases and disturbed Ca
2+
cycling occurs. This is associated with an increase in CaMKII- but not PKA-dependent RyR2 phosphorylation. CaMKII inhibition may thus reflect a promising therapeutic target for the treatment of arrhythmias and contractile dysfunction.
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Affiliation(s)
- Thomas H. Fischer
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Jonas Herting
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Theodor Tirilomis
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - André Renner
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Stefan Neef
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Karl Toischer
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - David Ellenberger
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Anna Förster
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Jan D. Schmitto
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Jan Gummert
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Friedrich A. Schöndube
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Gerd Hasenfuss
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Lars S. Maier
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
| | - Samuel Sossalla
- From Abteilung Kardiologie und Pneumologie/Herzzentrum (T.H.F., J.H., S.N., K.T., A.F., G.H., L.S.M., S.S.), Abteilung Thorax, Herz, Gefäßchirurgie/Herzzentrum (T.T., F.A.S.), and Abteilung Medizinische Statistik (D.E.), Georg August Universität Göttingen, Göttingen, Germany; Abteilung Thorax, Herz, Gefäßchirurgie, Herz und Diabeteszentrum Nordrheinwestfalen, Bad Oeynhausen, Germany (A.R., J.G.); Abteilung Herz, Thorax, Gefäßchirurgie und Transplantationschirurgie, Medizinische Hochschule Hannover,
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Franz M, Berndt A, Neri D, Galler K, Grün K, Porrmann C, Reinbothe F, Mall G, Schlattmann P, Renner A, Figulla HR, Jung C, Küthe F. Matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, B⁺ tenascin-C and ED-A⁺ fibronectin in dilated cardiomyopathy: potential impact on disease progression and patients' prognosis. Int J Cardiol 2013; 168:5344-51. [PMID: 23998545 DOI: 10.1016/j.ijcard.2013.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/23/2013] [Accepted: 08/03/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is associated with heart failure and increased mortality and there is no reliable biomarker to estimate patients' prognosis. During cardiac remodeling, an extensive reorganization of the extracellular matrix occurs. The study was aimed to investigate matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1) and fetal tenascin-C (B(+) Tn-C) and fibronectin (ED-A(+) Fn) variants known to be involved in that process. METHODS AND RESULTS In 187 patients with DCM, levels of MMP-9, TIMP-1 and B(+) Tn-C in serum as well as B(+) Tn-C and ED-A(+) Fn in tissue were quantified and subjected to univariate analysis. For all serum markers, concentrations above a calculated threshold were associated with decreased survival (MMP-9: p = 0.008, TIMP-1: p = 0.001, B(+) Tn-C: p < 0.001) and a significantly higher risk to die or undergo transplantation. In tissue, a reexpression of B(+) Tn-C and ED-A(+) Fn could be shown. Protein deposition levels of ≥4.5% for B(+) Tn-C and ≥2.1% for ED-A(+) Fn were associated with a significantly decreased survival (p = 0.001 for B(+) Tn-C, p = 0.031 for ED-A(+) Fn) and an increased risk to die or undergo transplantation. In a multivariate analysis, TIMP-1 is the superior parameter to predict transplantation free survival (p = 0.027). CONCLUSIONS Serum levels of MMP-9, TIMP-1 and B(+) Tn-C and tissue levels of B(+) Tn-C and ED-A(+) Fn are promising markers for risk assessment. The reoccurrence of ED-A(+) Fn and the availability of a human antibody usable as a vehicle for targeted drug delivery might be the basis for novel therapeutic strategies.
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Affiliation(s)
- Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Erlanger Allee 101, 07740 Jena, Germany.
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Renner A, Zittermann A, Aboud A, Pühler T, Hakim-Meibodi K, Quester W, Tschoepe D, Börgermann J, Gummert JF. Coronary Revascularization in Diabetic Patients: Off-Pump Versus On-Pump Surgery. Ann Thorac Surg 2013; 96:528-34. [DOI: 10.1016/j.athoracsur.2013.04.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
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49
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Franz M, Hilger I, Grün K, Kossatz S, Richter P, Petersen I, Jung C, Gummert J, Figulla HR, Kosmehl H, Neri D, Berndt A, Renner A. Selective imaging of chronic cardiac rejection using a human antibody specific to the alternatively spliced EDA domain of fibronectin. J Heart Lung Transplant 2013; 32:641-50. [DOI: 10.1016/j.healun.2013.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 03/06/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
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50
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Börgermann J, Furukawa N, Aboud A, Schönbrodt M, Renner A, Hakim-Meibodi K, Becker T, Zittermann A, Kuss O, Gummert JF. Ministernotomy versus conventional sternotomy for aortic valve replacement: Propensity score analysis of 808 patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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