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Schmiady MO, Jashari R, Lenherr R, Regenscheit S, Hitendu D, Wendt M, Schiess S, Schweiger M, Hofmann M, Sromicki J, Flammer A, Wilhelm MJ, Cesnjevar R, Carrel T, Vogt PR, Mestres CA. How to counteract the lack of donor tissue in cardiac surgery? Initial experiences with a newly established homograft procurement program. Cell Tissue Bank 2024; 25:1-10. [PMID: 37097383 PMCID: PMC10126547 DOI: 10.1007/s10561-023-10087-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
Homograft heart valves may have significant advantages and are preferred for the repair of congenital valve malformations, especially in young women of childbearing age, athletes and in patients with active endocarditis. A growing problem, however, is the mismatch between tissue donation and the increasing demand. The aim of this paper is to describe the initiation process of a homograft procurement program to attenuate the shortage of organs. A comprehensive description of the infrastructure and procedural steps required to initiate a cardiac and vascular tissue donation program combined with a prospective follow-up of all homografts explanted at our institution. Between January 2020 and May 2022, 28 hearts and 12 pulmonary bifurcations were harvested at our institution and delivered to the European homograft bank. Twenty-seven valves (19 pulmonary valves, 8 aortic valves) were processed and allocated for implantation. The reasons for discarding a graft were either contamination (n = 14), or morphology (n = 13) or leaflet damage (n = 2). Five homografts (3 PV, 2 AV) have been cryopreserved and stored while awaiting allocation. One pulmonary homograft with a leaflet cut was retrieved by bicuspidization technique and awaits allocation, as a highly requested small diameter graft. The implementation of a tissue donation program in cooperation with a homograft bank can be achieved with reasonable additional efforts at a transplant center with an in-house cardiac surgery department. Challenging situations with a potential risk of tissue injury during procurement include re-operation, harvesting by a non-specialist surgeon and prior central cannulation for mechanical circulatory support.
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Affiliation(s)
- Martin O Schmiady
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland.
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland.
| | - Ramadan Jashari
- European Homograft Bank (EHB), University Hospital St. Luc, Brussels, Belgium
| | - Renato Lenherr
- Donor Care Association, University Hospital Zurich, Zurich, Switzerland
| | | | - Dave Hitendu
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Martin Wendt
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Schiess
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Martin Schweiger
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Michael Hofmann
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Juri Sromicki
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Andreas Flammer
- Clinic for Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Markus J Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Robert Cesnjevar
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Paul R Vogt
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Carlos A Mestres
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
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2
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Wu F, Nägele M, Cleres D, Haider T, Fleisch E, Ruschitzka F, Flammer A, Barata F. Trends in voice characteristics in patients with heart failure (VENTURE) in Switzerland: Protocol for a longitudinal observational pilot study. PLoS One 2023; 18:e0283052. [PMID: 37018236 PMCID: PMC10075432 DOI: 10.1371/journal.pone.0283052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Heart Failure (HF) is a major health and economic issue worldwide. HF-related expenses are largely driven by hospital admissions and re-admissions, many of which are potentially preventable. Current self-management programs, however, have failed to reduce hospital admissions. This may be explained by their low predictive power for decompensation and high adherence requirements. Slight alterations in the voice profile may allow to detect decompensation in HF patients at an earlier stage and reduce hospitalizations. This pilot study investigates the potential of voice as a digital biomarker to predict health status deterioration in HF patients. METHODS AND ANALYSIS In a two-month longitudinal observational study, we collect voice samples and HF-related quality-of-life questionnaires from 35 stable HF patients. Patients use our developed study application installed on a tablet at home during the study period. From the collected data, we use signal processing to extract voice characteristics from the audio samples and associate them with the answers to the questionnaire data. The primary outcome will be the correlation between voice characteristics and HF-related quality-of-life health status. ETHICS AND DISSEMINATION The study was reviewed and approved by the Cantonal Ethics Committee Zurich (BASEC ID:2022-00912). Results will be published in medical and technical peer-reviewed journals.
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Affiliation(s)
- Fan Wu
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Matthias Nägele
- Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - David Cleres
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Thomas Haider
- Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Elgar Fleisch
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Frank Ruschitzka
- Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Flammer
- Cardiovascular Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Filipe Barata
- Center for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
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3
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Pugliese NR, De Biase N, Mazzola M, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug BA, Ruschitzka F, Masi S. The relationship of epicardial adipose tissue with hemodynamics and cardiopulmonary fitness in heart failure with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.380] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Recent evidence shows epicardial adipose tissue (EAT) acts as a paracrine organ and may directly alter myocardial function by exerting mechanical compression.
Purpose. We evaluated EAT thickness through transthoracic echocardiography and investigated its relationship with cardiopulmonary fitness and cardiovascular haemodynamics at rest and during exercise in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction.
Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance, together with 44 healthy controls. We performed a resting state-of-the-art echocardiographic evaluation, followed by combined cardiopulmonary-echocardiography exercise stress.
Results. EAT thickness was higher in HFpEF (median 8 mm, interquartile range [IQR] 4–12 mm) and progressively reduced in controls (median 5 mm, IQR 3–7 mm; p < 0.0001) and HFrEF (median 3 mm, IQR 2–6 mm). In HFpEF, EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff), while a direct association was observed for the same parameters in HFrEF (Figure 1). Furthermore, EAT independently predicted peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index and waist circumference. These relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p = 0.02; SRC for peak AVO2diff: 0.17, p = 0.03) and indirect in HFpEF (SRC for peak VO2: -0.33, p < 0.0001; SRC for peak AVO2diff: -0.25, p < 0.0001).
As there are no definite cut-off values to define increased EAT, patients were divided based on the median EAT value (5 mm) of the overall population. Thinner EAT (≤5 mm) was associated with worse LV systolic dysfunction (peak average S’) and remodeling (3D LV mass index) in HFrEF. In HFpEF, on the other hand, increased EAT (>5 mm) was related to worse right ventricular systolic dysfunction (3D right ventricular ejection fraction) and more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).
Conclusion. In HFpEF, increased EAT thickness is associated with a worse hemodynamic profile and functional capacity. Conversely, in HFrEF, EAT thinning portends more advanced LV dysfunction and impaired cardiopulmonary fitness. Abstract Figure 1 Abstract Figure 2
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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4
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Pugliese NR, De Biase N, Mazzola M, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug BA, Ruschitzka F, Masi S. The association between epicardial adipose tissue and prognosis in heart failure with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.381] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Recent evidence shows that increased epicardial adipose tissue (EAT) thickness is associated with metabolic syndrome, microvascular dysfunction and enhanced pericardial restraint.
Purpose. We measured echocardiography-derived EAT thickness in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction to examine the relationship between EAT and prognosis at clinical follow-up.
Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. We considered a composite endpoint of cardiovascular death and HF-related hospitalization during follow-up.
Results. Patients with HFpEF displayed greater EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm) than HFrEF (median 3 mm, IQR 2–6 mm; p < 0.0001). During a median follow-up of 20.9 months (IQR 15-25 months), 34 cardiovascular deaths and 146 HF hospitalizations were reported, with no significant differences between the two HF phenotypes. EAT was shown to predict adverse events independently from body mass index, waist circumference and other well-established prognostic markers in HF (such as NT-proBNP and peak oxygen consumption). The risk of adverse events increased with increasing EAT thickness in HFpEF and with EAT thinning in HFrEF. Kaplan-Meier analyses for the composite endpoint showed that in HFpEF, the survival probability was significantly lower in patients with thicker EAT than those with thinner EAT. In HFrEF, conversely, patients with increased EAT thickness had a higher survival probability than those with reduced EAT thickness (Figure 1).
Conclusion. EAT accumulation is increased in HFpEF compared to HFrEF and carries different prognostic meanings in the two subsets. In HFpEF, EAT thickening portends adverse outcomes, which may be due to the secretion of pro-inflammatory and pro-atherogenic adipokines and increased mechanical restraint. In HFrEF, EAT thinning is associated with a worse prognosis, probably reflecting a more advanced catabolic state (e.g., cardiac cachexia). Larger studies are needed to determine whether or not EAT has a causal role in influencing progression and survival in the different HF phenotypes. Abstract Figure 1
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Affiliation(s)
- NR Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - BA Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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5
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Pugliese N, De Biase N, Mazzola M, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug B, Ruschitzka F, Masi S. Prognostic significance of epicardial adipose tissue in heart failure with preserved and reduced ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/14/2022] Open
Abstract
Abstract
Background
Increased epicardial adipose tissue (EAT) thickness correlates with metabolic syndrome, insulin resistance, microvascular dysfunction and enhanced pericardial restraint.
Purpose
We measured echocardiographic EAT thickness in heart failure (HF) patients with reduced (HFrEF) or preserved (HFpEF) ejection fraction to determine whether EAT could bear prognostic significance at clinical follow-up.
Methods
We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) referred to our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. A composite of cardiovascular death and HF-related hospitalization was chosen as endpoint during follow-up.
Results
Patients with HFpEF displayed higher EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm) than HFrEF (median 3 mm, IQR 2–6 mm; p<0.0001). During a median follow-up of 20.9 months (IQR 15–25 months), we reported 34 cardiovascular deaths and 146 HF hospitalizations, with no significant differences between the two HF subsets. EAT predicted adverse events independently from body mass index and well-established markers of poor prognosis (e.g., NT-proBNP, peak oxygen consumption). The risk of adverse events increased with increasing EAT thickness in HFpEF and with EAT thinning in HFrEF. Kaplan-Meier analyses for the composite endpoint showed that in HFpEF, the survival probability was significantly lower in patients with thicker EAT than those with thinner EAT. In HFrEF, conversely, patients with thicker EAT had a higher survival probability than those with reduced EAT thickness (Figure 1).
Conclusion
EAT accumulation is more marked in HFpEF than HFrEF and carries different prognostic meanings in the two subsets. In HFpEF, EAT thickening portends adverse outcome, which may be due to increased mechanical restraint and secretion of pro-inflammatory and pro-atherogenic adipokines. In HFrEF, greater EAT thickness seems to have a protective role, while EAT thinning is associated with a worse prognosis, likely reflecting a catabolic state (i.e. cardiac cachexia). Larger studies will clarify whether EAT is a bystander or an active player in the different HF phenotypes.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- N.R Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - B.A Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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6
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Pugliese N, Mazzola M, De Biase N, Paneni F, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug B, Ruschitzka F, Masi S. Epicardial adipose tissue, cardiovascular hemodynamics and metabolic profile in heart failure with preserved and reduced ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0878] [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
Epicardial adipose tissue (EAT) acts as a paracrine organ and could exert direct mechanical compression on the myocardium.
Purpose
We investigated the impact of echocardiographic EAT thickness on metabolic profile and cardiovascular hemodynamics at rest and during exercise in heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction
Methods
We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) referred to the our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. The protocol also included 44 healthy controls.
Results
Patients with HFpEF displayed the greatest EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm), while those with HFrEF had thinner EAT (median 3 mm, IQR 2–6 mm) than controls (median 5 mm, IQR 3–7 mm; p<0.0001). In HFrEF, EAT thickness was inversely associated with natriuretic peptides, Troponin T, and C-reactive protein levels. In HFpEF, it was directly correlated with Troponin-T and C-reactive protein levels. EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff) in HFpEF, while a direct association was observed in HFrEF (Fig 1). EAT resulted in an independent predictor of peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index, but the relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p=0.02; SRC for peak AVO2diff: 0.17, p=0.03) and indirect in HFpEF (SRC for peak VO2: −0.33, p<0.0001; SRC for peak AVO2diff: −0.25, p<0.0001).
The analysis of cardiac mechanics revealed that thinner EAT was associated with worse left ventricle systolic dysfunction (average S') and remodeling (3D left ventricle mass) in HFrEF. In HFpEF, increased EAT was related to more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).
Conclusion
In HFpEF, EAT accumulation is associated with worse hemodynamic and metabolic profile. In HFrEF, conversely, EAT thinning portends more severe LV dysfunction and impaired global functional capacity.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- N.R Pugliese
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M Mazzola
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - N De Biase
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - F Paneni
- University Heart Center, Zurich, Switzerland
| | - L Del Punta
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Gargani
- Institute of Clinical Physiology (IFC), Pisa, Italy
| | - A Mengozzi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Virdis
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - L Nesti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Taddei
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - B.A Borlaug
- Mayo Clinic, Rochester, United States of America
| | | | - S Masi
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Moura B, Aimo A, Al-Mohammad A, Flammer A, Barberis V, Bayes-Genis A, Brunner-La Rocca HP, Fontes-Carvalho R, Grapsa J, Hülsmann M, Ibrahim N, Knackstedt C, Januzzi JL, Lapinskas T, Sarrias A, Matskeplishvili S, Meijers WC, Messroghli D, Mueller C, Pavo N, Simonavičius J, Teske AJ, van Kimmenade R, Seferovic P, Coats AJS, Emdin M, Richards AM. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1577-1596. [PMID: 34482622 DOI: 10.1002/ejhf.2339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 03/26/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating biomarkers and imaging techniques provide independent and complementary information to guide management of heart failure (HF). This consensus document by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) presents current evidence-based indications relevant to integration of imaging techniques and biomarkers in HF. The document first focuses on application of circulating biomarkers together with imaging findings, in the broad domains of screening, diagnosis, risk stratification, guidance of treatment and monitoring, and then discusses specific challenging settings. In each section we crystallize clinically relevant recommendations and identify directions for future research. The target readership of this document includes cardiologists, internal medicine specialists and other clinicians dealing with HF patients.
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Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- Medical School, University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar de Vila Nova Gaia/Espinho, Espinho, Portugal
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, UK
| | - Martin Hülsmann
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nasrien Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Axel Sarrias
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Noemi Pavo
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Justas Simonavičius
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
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8
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Pugliese NR, Paneni F, Mazzola M, De Biase N, Del Punta L, Gargani L, Mengozzi A, Virdis A, Nesti L, Taddei S, Flammer A, Borlaug BA, Ruschitzka F, Masi S. Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure. Eur J Heart Fail 2021; 23:1858-1871. [PMID: 34427016 DOI: 10.1002/ejhf.2337] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [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: 06/06/2021] [Revised: 08/09/2021] [Accepted: 08/21/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS We evaluated the impact of echocardiographic epicardial adipose tissue (EAT) on cardiovascular haemodynamics, metabolic profile and prognosis in heart failure (HF) using combined cardiopulmonary-echocardiography exercise stress. METHODS AND RESULTS We analysed EAT thickness of HF patients with reduced (HFrEF, n = 205) and preserved (HFpEF, n = 188) ejection fraction, including 44 controls. HFpEF patients displayed the highest EAT, while HFrEF patients had lower values than controls. EAT showed an inverse correlation with natriuretic peptides, troponin T and C-reactive protein in HFrEF, while having a direct association with troponin T and C-reactive protein in HFpEF. EAT was independently associated with peak oxygen consumption (VO2 ) and peripheral extraction (AVO2 diff), regardless of body mass index. EAT was inversely correlated with peak VO2 and AVO2 diff in HFpEF, while a direct association was observed in HFrEF, where lower EAT values were associated with worse left ventricular systolic dysfunction. In HFpEF, increased EAT was related to right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) uncoupling. After 21 months of follow-up, 146 HF hospitalizations and 34 cardiovascular deaths were recorded in the HF population. Cox multivariable analysis supported an independent differential role of EAT in HF cohorts (interaction P = 0.01): higher risk of adverse events for increasing EAT in HFpEF [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.37] and for decreasing EAT in HFrEF (HR 0.75, 95% CI 0.54-0.91). CONCLUSION In HFpEF, EAT accumulation is associated with worse haemodynamic and metabolic profile, also affecting survival. Conversely, lower EAT values imply higher left ventricular dysfunction, global functional impairment and adverse prognosis in HFrEF.
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Affiliation(s)
- Nicola R Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Matteo Mazzola
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - CNR, Pisa, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Barry A Borlaug
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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9
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Hermes-Laufer J, Hofer D, Flammer A, Ruschitzka F, Steffel J, Winnik S. Right ventricular only pacing for cardiac resynchronization therapy. Europace 2021; 24:70-71. [PMID: 34389862 PMCID: PMC8742625 DOI: 10.1093/europace/euab145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Daniel Hofer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Flammer
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Winnik
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
- Corresponding author. Tel: +41 44 255 47 82. E-mail address:
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10
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Puspitasari Y, Diaz-Canestro C, Sudano I, Flammer A, Bonetti N, Wuest P, Liberale L, Constantino S, Paneni F, Ruschitzka F, Beer J, Hermann M, Luscher T, Camici G. The role of matrix metalloproteinase-2 on age-dependent arterial stiffness. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3778] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Arterial stiffness is a well-characterized sign of vascular aging. It strongly predicts the development of several cardiovascular diseases (CVD), such as hypertension, stroke and heart failure. The age-dependent stiffening of elastic arteries is primarily attributed to the loss of interlaminar elastic fibers and the increase of collagen fibers. This process is regulated by matrix metalloproteinases (MMPs), including MMP-2. A strong correlation between MMP-2 levels and arterial stiffness has been previously described. However, the causative link between age-dependent arterial stiffness and MMP-2 remains unclear.
Purpose
In this study, we aimed to prospectively investigate the effect of MMP-2 gene silencing on the development of age-dependent carotid stiffness in wild type (WT) mice.
Methods
Pulse Wave Velocity (PWV), as the gold standard technique to assess arterial stiffness, was assessed in the right common carotid artery (RCCA) of C57BL/6 WT mice of various ages ranging between 3 and 25 months. Plasma and vascular levels of MMP-2 on RCCA were also measured and correlate with PWV. Moreover, aged WT male mice (18–21-month-old) were treated for 4 weeks with either MMP-2 siRNA or Scr siRNA via tail vein injection every 4 days and PWV was assessed at baseline, 2 and 4 weeks.
Results
Mouse carotid PWV increased and was positively correlated with age in our in vivo longitudinal study. Increases of vascular and circulating MMP-2 levels were also observed in this study. MMP-2 knockdown by siRNA treatment reduced vascular MMP-2 level (Fig. 1), which in turn attenuated age-dependent carotid stiffening (data not shown). siMMP-2 treated animals also showed an increase of elastin to collagen ratio. Furthermore, enhanced phosphorylation of the activatory eNOS Ser1177 was observed in the siMMP-2 group without affecting the level of total eNOS and Akt phosphorylation. Interestingly, co-immunoprecipitation experiments demonstrated that MMP-2 directly interacts with eNOS and this interaction is augmented with age.
Conclusion
The silencing of MMP-2 attenuates age-dependent carotid stiffness by affecting elastin to collagen ratio and interfering with eNOS activation. Thus, MMP-2 may mediate ECM remodeling and endothelial-dependent vasorelaxation in the development of age-dependent vascular stiffness.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Foundation for Cardiovascular Research-Zurich Heart House
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Affiliation(s)
- Y.M Puspitasari
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - C Diaz-Canestro
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - I Sudano
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - A Flammer
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - N.R Bonetti
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - P Wuest
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - L Liberale
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - S Constantino
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - F Paneni
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - J.H Beer
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - M Hermann
- University Hospital Zurich, Department of Cardiology, Zurich, Switzerland
| | - T.F Luscher
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
| | - G.G Camici
- University of Zurich, Center for Molecular Cardiology, Schlieren, Switzerland
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11
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Costa S, Medeiros-Domingo A, Gasperetti A, Breitenstein A, Steffel J, Guidetti F, Flammer A, Odening K, Ruschitzka F, Duru F, Saguner AM. Familial dilated cardiomyopathy associated with a novel heterozygous RYR2 early truncating variant. Cardiol J 2020; 28:173-175. [PMID: 32748945 DOI: 10.5603/cj.a2020.0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sarah Costa
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | | | | | - Jan Steffel
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Federica Guidetti
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Andreas Flammer
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Katja Odening
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland.
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12
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Benz D, Kaufmann PA, von Felten E, Benetos G, Rampidis G, Messerli M, Giannopoulos AA, Fuchs TA, Gräni C, Gebhard C, Pazhenkottil A, Flammer A, Kaufmann PA, Buechel RR. MYOCARDIAL FLOW RESERVE FROM POSITRON EMISSION TOMOGRAPHY PREDICTS TREATMENT RESPONSE IN PATIENT WITH ISCHEMIC HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)34291-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Kahr PC, Kaufmann P, Kuster J, Tonko J, Breitenstein A, Flammer A, Ruschitzka F, Steffel J, Winnik S. P4525Differential effect of CRT in ischemic and non-ischemic cardiomyopathy: longterm follow-up data from a single center cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0918] [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
Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in selected symptomatic patients with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. However, some patients fail to benefit from CRT. Data on the differential role of baseline and follow-up left ventricular ejection fraction (LVEF) on outcome in patients with ischemic compared to non-ischemic cardiomyopathy (ICM, N-ICM) is controversial.
Purpose
To test, whether ICM and N-ICM patients differ in outcome after CRT during long-term follow-up and whether predictors for survival after CRT differ between the two groups.
Methods
All patients undergoing CRT implantation at our institution between November 2000 and January 2015 were evaluated (n=418). All ICM/N-ICM patients with follow-up echocardiography within 1 year after CRT implantation (FU1) and a second echocardiography >1 year after FU1 (FU2) were included in the analysis (n=253). Primary post-hoc defined study endpoint was the composite of all-cause death, heart transplantation or implantation of a ventricular assist device.
Results
Compared to patients with N-ICM (n=160, median age 64 years [IQR 54–71], 71% male), ICM patients (n=93, median age 70 years [IQR 61–75], 84% male) were significantly older and had a higher prevalence of male gender, concomitant diabetes mellitus and arterial hypertension. There were no significant differences in pre-implantation echocardiographic features (LVEF, LVEDV, RV-FAC, severity of mitral regurgitation), QRS width and NT-proBNP levels between the groups. However, the hazard for reaching the primary endpoint was significantly higher in patients with ICM compared to N-ICM both on univariate analysis (HR 1.62 [95% CI 1.09–2.42], p=0.018) and after multivariate correction (aHR 2.13 [1.24–3.66], p=0.006). While higher NT-proBNP levels and greater right ventricular fractional area change were positively correlated with the hazard of death in both ICM and N-ICM (see Figure), lower LVEF at baseline was associated with an increased risk of death only in ICM but not in N-ICM (HR 0.95 [0.91–0.99], p=0.029 vs. HR 1.00 [0.96–1.04], p=0.945). Male gender, lower BMI and NYHA class ≥ III were positively correlated with the endpoint in N-ICM, but not in ICM. Importantly, LVEF at FU1 (median 4.7 months after implantation) and FU2 (median 47.1 months after implantation) were found to correlate signficantly with the endpoint in both ICM and N-ICM.
Conclusion
Our findings highlight important differences in ischemic and non-ischemic patient populations undergoing CRT. While overall survival of patients with N-ICM exceeds survival in ICM, several other factors (including LVEF) have differential effects on response to CRT in these two patient groups.
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Affiliation(s)
- P C Kahr
- University Hospital Zurich, Zurich, Switzerland
| | - P Kaufmann
- University Hospital Zurich, Zurich, Switzerland
| | - J Kuster
- University Hospital Zurich, Zurich, Switzerland
| | - J Tonko
- University Hospital Zurich, Zurich, Switzerland
| | | | - A Flammer
- University Hospital Zurich, Zurich, Switzerland
| | | | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - S Winnik
- University Hospital Zurich, Zurich, Switzerland
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14
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Kahr PC, Kaufmann P, Kuster J, Tonko J, Breitenstein A, Flammer A, Ruschitzka F, Steffel J, Winnik S. P3806Very long-term and late response to CRT: is left ventricular ejection fraction a powerful indicator of sustained and late response? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0651] [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: 11/12/2022] Open
Abstract
Abstract
Background
Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in selected symptomatic patients with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. While many patients demonstrate a response to CRT within the first year of follow-up, sustained or late response to CRT is highly relevant but poorly characterized.
Purpose
To characterize the patient population that demonstrates improvements of LVEF late after CRT implantation, irrespective of the primary response, and to identify factors associated with beneficial long-term outcome.
Methods
All patients undergoing CRT implantation at our institution between Nov 2000 and Jan 2015 with at least two follow-up echocardiographic studies were included. Primary follow-up (FU1) was performed within one year after CRT implantation (median 6.1 months [IQR: 3.5–10.7]). The most recent echocardiography at a median follow-up time of 3.9 years [27.3–70.4] was considered as long-term follow-up (FU2). LVEF-based response to CRT was stratified into 4 categories: non-response (ΔLVEF <−5%), non-progression (−5% to +5%), response (+6 to +15%) and super-response (>+15%). Primary study endpoint was the composite of all-cause death, heart transplantation or implantation of a ventricular assist device.
Results
Out of 362 patients (median age 65.9 years, 23% female, 41% with ischemic cardiomyopathy), 99 (27.3%) demonstrated LVEF improvements beyond their primary response to CRT (blue bars in figure). At baseline, late responders demonstrated lower LVEF (23.4% [19.0–30.0] vs. 27.0 [22.0–32.0], p=0.005) and an increased prevalence of non-ischemic cardiomyopathy (67.8% vs. 55.9%, p=0.042) compared to the remaining patients. Reduction in LVEDV(I) at FU1 correlated positively with late response (ΔLVEDV −28.5 ml [−71.8; −3.25] vs. 18.0 [−46.0; 3.0], p=0.033). Importantly, late responders were seen amongst all types of primary response, including patients demonstrating a negative response with substantially worsened LVEF at first follow-up after CRT implantation. Finally, patients with late response demonstrated significantly better survival compared to patients with late progression of heart failure or continued non-progression (median survival 7.8 [7.1–8.5] vs. 7.0 [6.6–7.5] years, aHR 0.54 [0.33–0.88] p=0.013 on multivariate cox regression analysis).
Conclusions
A significant proportion of patients achieves LVEF improvements beyond the initial phase after CRT implantation indicating a substantial limitation in categorizing patients into “responders” and “non-responders” based on the initial response to CRT. Further prospective studies are required to validate these findings and optimize treatment strategies for CRT patients.
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Affiliation(s)
- P C Kahr
- University Hospital Zurich, Zurich, Switzerland
| | - P Kaufmann
- University Hospital Zurich, Zurich, Switzerland
| | - J Kuster
- University Hospital Zurich, Zurich, Switzerland
| | - J Tonko
- University Hospital Zurich, Zurich, Switzerland
| | | | - A Flammer
- University Hospital Zurich, Zurich, Switzerland
| | | | - J Steffel
- University Hospital Zurich, Zurich, Switzerland
| | - S Winnik
- University Hospital Zurich, Zurich, Switzerland
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15
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Müller S, Tanner FC, Gruner C, Ruschitzka F, Flammer A, Nowak A. Kardiomyopathie bei Morbus Fabry. Cardiovasc Med 2018. [DOI: 10.4414/cvm.2018.00578] [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: 11/19/2022] Open
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16
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Gastl M, Peereboom S, Gotschy A, Fuetterer M, Von Deuster C, Boenner F, Kelm M, Flammer A, Manka R, Kozerke S. 1162Quantification of cardiac creatine and triglycerides in amyloidosis using proton MR spectroscopy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Gastl
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - S Peereboom
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - A Gotschy
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - M Fuetterer
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - C Von Deuster
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
| | - F Boenner
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology, Düsseldorf, Germany
| | - M Kelm
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology, Düsseldorf, Germany
| | - A Flammer
- University Heart Center, Zurich, Switzerland
| | - R Manka
- University Heart Center, Zurich, Switzerland
| | - S Kozerke
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Institute for Biomedical Engineering, Zurich, Switzerland
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17
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Spieker L, Flammer A, Amacker N, Sudano I, Badimon J, Ruschitzka F, Lüscher T, Noll G, Corti R. C-reactive protein influences shear stress-dependent platelet adhesion in patients with familiar hypercholesterolemia and coronary artery disease undergoing LDL apheresis. Thromb Haemost 2017. [DOI: 10.1160/th06-03-0130] [Citation(s) in RCA: 6] [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] [Indexed: 11/05/2022]
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18
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Cas LD, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network. Turk Kardiyol Dern Ars 2017; 45:377-384. [PMID: 28595212 DOI: 10.5543/tkda.2017.92725] [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: 11/04/2022] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology.
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Felipe Moreira L, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek J, Varga A, Lüscher TF. Data sharing: A new editorial initiative of the International Committee of Medical Journal Editors. Implications for the editors' network. Egypt Heart J 2017; 69:89-94. [PMID: 29622961 PMCID: PMC5839351 DOI: 10.1016/j.ehj.2017.05.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors' Network of the European Society of Cardiology.
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Affiliation(s)
| | | | - Jean-Yves Artigou
- Editor in Chief Archives des maladies du cœur et des vaisseaux Pratique
| | | | | | | | | | - Ariel Cohen
- Editor in Chief Archives of Cardiovascular Diseases
| | | | | | | | | | - Nuray Enç
- Editor in Chief Kardiyovaskuler Hemsirelik Dergisi
| | | | | | | | | | | | | | | | | | | | - Gerd Heusch
- Editor in Chief Basic Research in Cardiology
| | - Kurt Huber
- Editor in Chief Austrain Journal of Cardiology
| | | | | | | | - Chu-Pak Lau
- Editor in Chief Journal of the Hong Kong Colleage of Cardiology
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dilek Ural
- Editor in Chief Archives of the Turkish Society of Cardiology
| | - J.J. Piek
- Editor in Chief Netherlands Heart Journal
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors' Network. Kardiol Pol 2017; 75:512-517. [PMID: 28530030 DOI: 10.5603/kp.2017.0086] [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] [Received: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022]
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability - have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors' Network of the European Society of Cardiology.
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Affiliation(s)
- Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación sanitaria IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain.
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors' Network. Rev Port Cardiol 2017; 36:397-403. [PMID: 28477978 DOI: 10.1016/j.repc.2017.02.001] [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: 11/28/2022] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship -emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors' Network of the European Society of Cardiology.
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Affiliation(s)
| | | | - Jean-Yves Artigou
- Editor in Chief Archives des maladies du cœur et des vaisseaux Pratique
| | | | | | | | | | - Ariel Cohen
- Editor in Chief Archives of Cardiovascular Diseases
| | | | | | | | | | - Nuray Enç
- Editor in Chief Kardiyovaskuler Hemsirelik Dergisi
| | | | | | | | | | | | | | | | | | | | - Gerd Heusch
- Editor in Chief Basic Research in Cardiology
| | - Kurt Huber
- Editor in Chief Austrain Journal fo Cardiology
| | | | | | | | - Chu-Pak Lau
- Editor in Chief Journal of the Hong Kong Colleage of Cardiology
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dilek Ural
- Editor in Chief Archives of the Turkish Society of Cardiology
| | - J J Piek
- Editor in Chief Netherlands Heart Journal
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22
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Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Felipe Moreira L, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF, Alfonso F. Data Sharing. Eur Heart J 2017; 38:1361-1363. [DOI: 10.1093/eurheartj/ehx206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Cas LD, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors' Network. Arch Cardiol Mex 2017; 87:101-107. [PMID: 28473184 DOI: 10.1016/j.acmx.2017.03.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability -, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors' Network of the European Society of Cardiology.
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Affiliation(s)
| | | | - Jean-Yves Artigou
- Archives des maladies du cœur et des vaisseaux Pratique, Bobigny, France
| | | | | | | | | | - Ariel Cohen
- Archives of Cardiovascular Diseases, Paris, France
| | | | - Mirza Dilic
- Medicinski Zurnal, Sarajevo, Bosnia and Herzegovina
| | | | | | - Nuray Enç
- Kardiyovaskuler Hemsirelik Dergisi, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | - Gerd Heusch
- Basic Research in Cardiology, Essen, Germany
| | - Kurt Huber
- Austrain Journal of Cardiology, Vienna, Austria
| | - Ivan Hulín
- Cardiology Letters, Bratislava, Slovak Republic
| | | | | | - Chu-Pak Lau
- Journal of the Hong Kong College of Cardiology, Hong Kong, China
| | | | | | | | | | | | | | | | | | | | - Se-Joong Rim
- Korean Circulation Journal, Seoul, Republic of Korea
| | | | | | | | - Evgeny Shlyakhto
- Russian Journal of Cardiology, St. Petersburg, Russian Federation
| | | | | | - Dilek Ural
- Archives of the Turkish Society of Cardiology, Istanbul, Turkey
| | - J J Piek
- Netherlands Heart Journal, Amsterdam, Netherlands
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek J, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors’ Network. Revista Portuguesa de Cardiologia (English Edition) 2017. [DOI: 10.1016/j.repce.2017.05.006] [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: 10/19/2022] Open
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25
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Cas LD, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek JJ, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors´ Network. Arq Bras Cardiol 2017; 108:390-395. [PMID: 28591318 PMCID: PMC5444884 DOI: 10.5935/abc.20170054] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The International Committee of Medical Journal Editors (ICMJE) provides recommendations to improve the editorial standards and scientific quality of biomedical journals. These recommendations range from uniform technical requirements to more complex and elusive editorial issues including ethical aspects of the scientific process. Recently, registration of clinical trials, conflicts of interest disclosure, and new criteria for authorship - emphasizing the importance of responsibility and accountability-, have been proposed. Last year, a new editorial initiative to foster sharing of clinical trial data was launched. This review discusses this novel initiative with the aim of increasing awareness among readers, investigators, authors and editors belonging to the Editors´ Network of the European Society of Cardiology. Resumo O Comitê Internacional de Editores de Revistas Médicas (ICMJE) fornece recomendações para aprimorar o padrão editorial e a qualidade científica das revistas biomédicas. Tais recomendações variam desde requisitos técnicos de uniformização até assuntos editoriais mais complexos e elusivos, como os aspectos éticos do processo científico. Recentemente, foram propostos registro de ensaios clínicos, divulgação de conflitos de interesse e novos critérios de autoria, enfatizando a importância da responsabilidade e da responsabilização. No último ano, lançou-se uma nova iniciativa editorial para fomentar o compartilhamento dos dados de ensaios clínicos. Esta revisão discute essa nova iniciativa visando a aumentar a conscientização de leitores, investigadores, autores e editores filiados à Rede de Editores da Sociedade Europeia de Cardiologia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chu-Pak Lau
- Journal of the Hong Kong Colleage of Cardiology
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dilek Ural
- Archives of the Turkish Society of Cardiology
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Alfonso F, Adamyan K, Artigou JY, Aschermann M, Boehm M, Buendia A, Chu PH, Cohen A, Dei Cas L, Dilic M, Doubell A, Echeverri D, Enç N, Ferreira-González I, Filipiak KJ, Flammer A, Fleck E, Gatzov P, Ginghina C, Goncalves L, Haouala H, Hassanein M, Heusch G, Huber K, Hulín I, Ivanusa M, Krittayaphong R, Lau CP, Marinskis G, Mach F, Moreira LF, Nieminen T, Oukerraj L, Perings S, Pierard L, Potpara T, Reyes-Caorsi W, Rim SJ, Rødevand O, Saade G, Sander M, Shlyakhto E, Timuralp B, Tousoulis D, Ural D, Piek J, Varga A, Lüscher TF. Data Sharing: A New Editorial Initiative of the International Committee of Medical Journal Editors. Implications for the Editors’ Network. Revista Colombiana de Cardiología 2017. [DOI: 10.1016/j.rccar.2017.06.001] [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: 10/19/2022] Open
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27
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Frank M, Oberhuber D, Flammer A. [Not Available]. Praxis (Bern 1994) 2017; 106:1239-1240. [PMID: 29088963 DOI: 10.1024/1661-8157/a002792] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Montero D, Diaz-Cañestro C, Flammer A, Lundby C. Unexplained Anemia in the Elderly: Potential Role of Arterial Stiffness. Front Physiol 2016; 7:485. [PMID: 27826252 PMCID: PMC5078728 DOI: 10.3389/fphys.2016.00485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Montero
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | | | - Andreas Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich Zurich, Switzerland
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Ballocca F, Gili S, D'Ascenzo F, Marra WG, Cannillo M, Calcagno A, Bonora S, Flammer A, Coppola J, Moretti C, Gaita F. HIV Infection and Primary Prevention of Cardiovascular Disease: Lights and Shadows in the HAART Era. Prog Cardiovasc Dis 2016; 58:565-76. [PMID: 26943980 DOI: 10.1016/j.pcad.2016.02.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 12/20/2022]
Abstract
With the progressive increase in life-expectancy of human immunodeficiency virus (HIV)-positive patients in the "highly active antiretroviral therapy" (HAART) era, co-morbidities, particularly cardiovascular (CV) diseases (CVD) are emerging as an important concern. The pathophysiology of CVD in this population is complex, due to the interaction of classical CV risk factors, viral infection and the effects of antiretroviral therapy (ARV). The role of ARV drugs in HIV is double edged. While these drugs reduce systemic inflammation, an important factor in CV development, they may at the same time be proatherogenic by inducing dyslipidemia, body fat redistribution and insulin resistance. In these patients primary prevention is challenging, considering the lower median age at which acute coronary syndromes occur. Furthermore prevention is still limited by the lack of robust evidence-based, HIV-specific recommendations. Therefore we performed a comprehensive evaluation of the literature to analyze current knowledge on CVD prevalence in HIV-infected patients, traditional and HIV-specific risk factors and risk stratification, and to summarize the recommendations for primary prevention of CVD in this HIV population.
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Affiliation(s)
- Flavia Ballocca
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Sebastiano Gili
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy.
| | - Walter Grosso Marra
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Margherita Cannillo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Calcagno
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Andreas Flammer
- University Heart Center, University Hospital Zurich, Switzerland
| | - John Coppola
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Claudio Moretti
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
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Pazhenkottil AP, Rudiger A, Flammer A, Enseleit F, Jacobs S, Falk V, Ruschitzka F, Bettex D. Left Main Artery Thrombus Complicating Heart Transplantation in a Patient With Heparin-Induced Thrombocytopenia. J Cardiothorac Vasc Anesth 2015; 30:1334-6. [PMID: 27431594 DOI: 10.1053/j.jvca.2015.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Nägele M, Sudano I, Flammer A, Ruschitzka F. [New Aspects and Controversies in the Current European and American Hypertension Guidelines]. Praxis (Bern 1994) 2015; 104:575-580. [PMID: 26098154 DOI: 10.1024/1661-8157/a002015] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
At the end of 2013, the long-awaited guidelines of the Eighth Joint National Committee (JNC8) were published. These guidelines developed nine specific recommendations for the management of arterial hypertension. The harmonization of blood pressure treatment thresholds and goals represents a convenient simplification for the practicing physician. However, the recommendations did not come without controversy. Especially the raise of the treatment goal in patients aged 60 years or older was criticized. In this and other aspects, the 2013 guidelines of the European Society of Cardiology and European Society of Hypertension (ESC/ESH 2013) share a different point of view. The article tries to summarize the different viewpoints and to provide an overview over the increasing number of hypertension guidelines.
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Affiliation(s)
- Matthias Nägele
- 1 Universitäres Herzzentrum, Klinik für Kardiologie, Universitätsspital Zürich
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Li J, Rihal C, Matsuo Y, Elrashidi M, Flammer A, Lee MS, Cassar A, Lennon R, Herrmann J, Bell M, Holmes D, Bresnahan J, Hua Q, Lerman LO, Lerman A. TCT-607 Sex-related differences in fractional flow reserve guided treatment. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Collin J, Goessl M, Matsuo Y, Flammer A, Loeffler D, Lennon R, Khosla S, Simari R, Spoon D, Lerman L, Lerman A. RETENTION OF OSTEOGENIC CD14–MONOCYTES WITHIN THE CORONARY CIRCULATION CORRELATES WITH CORONARY CALCIFICATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)62089-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hermann M, Enseleit F, Fisler AE, Flammer A, Lüscher TF, Noll G, Ruschitzka F. Cyclosporine C0- versus C2-monitoring over three years in maintenance heart transplantation. Swiss Med Wkly 2011; 141:w13149. [PMID: 21293979 DOI: 10.4414/smw.2011.13149] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There is an ongoing discussion as to whether monitoring of cyclosporine (CsA)-based immunosuppression with plasma levels two hours after medication intake (C2) offers clinical benefit over the measurement of CsA trough levels (C0) in patients after heart transplantation (HTx). In particular, data from long-term maintenance patients are not available. METHODS C0 monitoring was performed during 19 months in 65 stable maintenance patients after HTx. During the following 19 months all patients were switched to C2 monitoring. During both periods biopsy proven acute rejections (BPAR), daily CsA dose, plasma creatinine, estimated creatinine clearance and blood pressure values for both periods were analysed. RESULTS Data from 65 patients (9.2 ± 3.9 years post HTx) were included. No differences were observed for BPAR ≥2 between C0 (13 pts; 20%) and C2 (12 pts; 18.4%). C2 was associated with lower daily CsA doses (C0 208.7 mg/d vs. C2 182.3 mg/d, p <0.0001) while dose reduction over time was not different during both periods (C0 -13.3 mg/d vs. C2 -22.5 mg/d, p = 0.259). No difference was observed for blood pressure and creatinine clearance. CONCLUSION In long term maintenance patients C2 monitoring was not associated with immediate beneficial effects on number of rejections, blood pressure levels, and renal parameters. However, patients received lower daily CsA doses.
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Affiliation(s)
- Matthias Hermann
- Cardiovascular Center Cardiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland.
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Abstract
Hypertension is a major risk factor for cardiovascular disease, and reduction of elevated blood pressure significantly reduces the risk of cardiovascular events. Endothelial dysfunction, which is characterized by impairment of nitric oxide (NO) bioavailability, is an important risk factor for both hypertension and cardiovascular disease and may represent a major link between the conditions. Evidence suggests that NO plays a major role in regulating blood pressure and that impaired NO bioactivity is an important component of hypertension. Mice with disruption of the gene for endothelial NO synthase have elevated blood pressure levels compared with control animals, suggesting a genetic component to the link between impaired NO bioactivity and hypertension. Clinical studies have shown that patients with hypertension have a blunted arterial vasodilatory response to infusion of endothelium-dependent vasodilators and that inhibition of NO raises blood pressure. Impaired NO bioactivity is also implicated in arterial stiffness, a major mechanism of systolic hypertension. Clarification of the mechanisms of impaired NO bioactivity in hypertension could have important implications for the treatment of hypertension.
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Affiliation(s)
- Matthias Hermann
- From the Department of Cardiology, the Cardiovascular Center, University Hospital Zurich, Switzerland
| | - Andreas Flammer
- From the Department of Cardiology, the Cardiovascular Center, University Hospital Zurich, Switzerland
| | - Thomas F. Lüscher
- From the Department of Cardiology, the Cardiovascular Center, University Hospital Zurich, Switzerland
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Sudano I, Flammer A, Noll G, Lüscher TF. Der hohe Blutdruck. Herz 2006; 31:81-2. [PMID: 16502276 DOI: 10.1007/s00059-006-2759-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Isabella Sudano
- Kardiovaskuläres Zentrum, Kardiologie, UniversitätsSpital Zürich, Schweiz.
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Sudano I, Spieker LE, Hermann F, Flammer A, Corti R, Noll G, Lüscher TF. Protection of endothelial function: targets for nutritional and pharmacological interventions. J Cardiovasc Pharmacol 2006; 47 Suppl 2:S136-50; discussion S172-6. [PMID: 16794451 DOI: 10.1097/00005344-200606001-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The vascular endothelium synthesizes and releases a spectrum of vasoactive substances and therefore plays a fundamental role in the basal and dynamic regulation of the circulation. Nitric oxide (NO)-originally described as endothelium-derived relaxing factor-is released from endothelial cells in response to shear stress produced by blood flow, and in response to activation of a variety of receptors. After diffusion from endothelial to vascular smooth muscle cells, NO increases intracellular cyclic guanosine-monophosphate concentrations by activation of the enzyme guanylate cyclase leading to relaxation of the smooth muscle cells. NO has also antithrombogenic, antiproliferative, leukocyte-adhesion inhibiting effects, and influences myocardial contractility. Endothelium-derived NO-mediated vascular relaxation is impaired in spontaneously hypertensive animals. NO decomposition by free oxygen radicals is a major mechanism of impaired NO bioavailability. The resulting imbalance of endothelium-derived relaxing and contracting substances disturbs the normal function of the vascular endothelium. Endothelin acts as the natural counterpart to endothelium-derived NO. Besides its arterial blood pressure rising effect in humans, endothelin-1 induces vascular and myocardial hypertrophy, which are independent risk factors for cardiovascular morbidity and mortality. Current therapeutic strategies concentrate mainly on lowering low-density lipoprotein cholesterol and an impressive reduction in the risk for cardiovascular morbidity and mortality has been achieved. Inflammatory mechanisms play an important role in vascular disease and inflammatory plasma markers correlate with prognosis. The production of reactive oxygen species under pathological conditions may represent an important inflammatory trigger. Novel therapeutic strategies specifically targeting inflammation thus bear great potential for the prevention and treatment of atherosclerotic vascular disease. In this context, the vascular actions of flavanol-rich cocoa, particularly with regard to enhanced NO synthesis and endothelial function observed in humans following consumption, warrants further attention. This review discusses pharmacological and dietary intervention.
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Affiliation(s)
- Isabella Sudano
- Cardiovascular Center, Cardiology, University Hospital and Cardiovascular Research, Institute of Physiology, University Zurich-Irchel, Zürich, Switzerland
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