1
|
Schloeglhofer T, Gross C, Abart T, Schaefer A, Widhalm G, Marko C, Röhrich M, Weigel I, Kaufmann F, Karner B, Riebandt J, Wiedemann D, Laufer G, Schima H, Granegger M, Zimpfer D. Beyond the Limits of Current Pump Monitoring - HeartMate 3 SNOOPY in Echocardiographic Speed Ramp Tests. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1273] [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: 04/05/2023] Open
|
2
|
Dona C, Kammerlander A, Karner B, Keil A, Seitlhuber M, Furgler S, Nitsche C, Koschutnik M, Hengstenberg C, Mascherbauer J. Quantification of fluid status by bioelectrical impedance spectroscopy in patients with valvular heart disease: sex matters. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1894] [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
Background
Fluid overload, which may finally lead to cardiac decompensation, is a major threat in valvular heart disease (VHD) patients. In clinical practice, leg edema, pulmonary congestion, and rapid weight gain indicate fluid overload. However, these parameters lack both specificity and sensitivity. Bioelectrical impedance spectroscopy (BIS) is an easy, non-invasive and reliable way to determine the extent of fluid overload. BIS it already used in patients on chronic haemodialysis to guide therapy. Whether fluid status as measured by BIS is associated with outcome in VHD patients is unknown.
Methods
Stable patients with moderate or severe VHD as diagnosed by transthoracic echocardiography underwent fluid status assessment by BIS at baseline and were prospectively followed. The primary endpoint was a composition of heart failure hospitalisation and cardiovascular death. Patients with overt cardiac decompensation or on intra-venous diuretic therapy were excluded from this study. Kaplan-Meier estimates and multivariable Cox-regression analysis were used to identify sex-specific factors associated with outcome. This study was registered at clinicaltrials.gov (NCT03372512).
Results
336 patients (51.8% female, 76±13 years) were included in the study. 26.2% (3.5% moderate, 22.7% severe) suffered from aortic stenosis, 50.9% from mitral regurgitation (16.1% moderate, 34.2%severe) and 11.8% (6.2% moderate, 5.6% severe) from aortic regurgitation. A total of 68.5% of the patients additionally presented with tricuspid regurgitation.
Mean overhydration was +0.6l with no significant differences between men and women (p=0.076). We did not observe sex-specific differences in baseline characteristics with the exception of higher left-ventricular ejection fraction (p=0.007) as well as better renal function (p=0.003) in women compared to men.
During a follow-up of 433±364 days, a total of 153 events (45.7%) occurred. 102 patients (30.4%) underwent valve intervention, which was not considered as an event, and were censored from the analysis.
Sex-specific stratification of patients based on OH tertiles revealed that overhydration was associated with significantly higher event-rates in men (log-rank p=0.002, see Figure 1), but not in women (p=0.127, see Figure 2). Similarly, in the multivariate cox-regression, OH was significantly associated with outcome only in men (p=0.009) after adjustment for cardiac size and function, NT-proBNP, diabetes, coronary artery disease, NYHA functional class, renal function, and history of cardiac decompensation. In female patients, only NT-proBNP (p=0.001) was significantly associated with outcome whereas OH was not (p=0.849).
Conclusions
Fluid status, as determined with BIS, is significantly associated with outcome in male but not in female patients with VHD. Sex-specific approaches for risk assessment and fluid management should be further examined.
Survival in VHD patients
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- C Dona
- Medical University of Vienna, Wien, Austria
| | | | - B Karner
- Medical University of Vienna, Wien, Austria
| | - A Keil
- Medical University of Vienna, Wien, Austria
| | | | - S Furgler
- Medical University of Vienna, Wien, Austria
| | - C Nitsche
- Medical University of Vienna, Wien, Austria
| | | | | | | |
Collapse
|
3
|
Kammerlander A, Karner B, Keil A, Seitlhuber M, Dona C, Nitsche C, Duca F, Beitzke D, Binder C, Koschutnik M, Aschauer S, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. P139Feature tracking by cardiovascular magnetic resonance: left ventricular dysfunction predicts outcome in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.002] [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)
- A Kammerlander
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Karner
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Keil
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Seitlhuber
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Dona
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - D Beitzke
- Medical University of Vienna, Department of Radiology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Koschutnik
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Loewe
- Medical University of Vienna, Department of Radiology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| |
Collapse
|
4
|
Richtig E, Berghold A, Schwantzer G, Ott A, Wölfelmaier F, Karner B, Ludwig R, Denk H, Stering R, Leitner G, Lax S, Okcu M, Gerger A, Kerl H, Smolle J. Clinical epidemiology of invasive cutaneous malignant melanoma in the Austrian province Styria in the years 2001-2003 and its relationship with local geographical, meteorological and economic data. Dermatology 2007; 214:246-52. [PMID: 17377387 DOI: 10.1159/000099590] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 10/17/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Melanoma incidence rates vary within Europe. The highest incidences are reported in Scandinavia, the lowest in the southern parts, but incidences themselves also vary within the different countries. OBJECTIVE We investigated the incidence of invasive cutaneous melanoma in Styria, a province of Austria, in the years 2001-2003. METHODS Data from 1,082 patients, 511 males and 571 females (mean age 58.2 years) with primary melanoma were collected. For each patient, information regarding residence was available, and therefore the geographic distribution of melanoma on district level was investigated with particular reference to the mean number of sun hours, mean altitude, number of companies with more than 200 employees and median income. RESULTS The mean annual incidence (age-standardized rate) was 24.5 per 100,000 (95% CI: 22.4-26.6), lifetime risk 1 in 52. Districts with a higher number of sun hours and higher altitude showed lower melanoma incidences. Higher median income was associated with higher melanoma incidence (p<0.001). CONCLUSION The high incidence of invasive melanoma in Styria is unclear and a causal relationship between higher income and melanoma incidence remains speculative. Further investigations, especially concerning lifestyle and environmental factors, may unravel additional causative factors.
Collapse
Affiliation(s)
- Erika Richtig
- Department of Dermatology, Medical University of Graz, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Schoppmann SF, Schindl M, Breiteneder-Geleff S, Soleima A, Breitenecker G, Karner B, Birner P. Inflammatory stromal reaction correlates with lymphatic microvessel density in early-stage cervival cancer. Anticancer Res 2001; 21:3419-23. [PMID: 11848503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND In early-stage cervical cancer, high lymphatic microvessel density (LMVD) indicates favorable prognosis. This unexpected finding was thought to be an effect of local immunological response, although no data supported this thesis. MATERIALS AND METHODS LMVD and lymphovascular invasion (LVI) were assessed in 85 specimens of cervical cancer stage pT1b by immunostaining for podoplanin, a marker for lymphatic endothelia. Local immunological response, evident by inflammatory stromal reaction (ISR), was determined in H&E-stained slides and rated from grade 1 (absent or weak) to 3 (strong) RESULTS A good correlation of LMVD and ISR was found (p=0.002). While a strong correlation between LMVD and the presence of LVI was found (p<0.001), no association between LMVD and pelvic lymph node involvement (p=0.732) was observed. ISR indicated favourable prognosis of patients (p=0.0247, log-rank test). CONCLUSION Our findings suggest that ISR might play a role in the induction of lymphangiogenesis in early stage cervical cancer.
Collapse
Affiliation(s)
- S F Schoppmann
- Institute of Clinical Pathology, University of Vienna, Austria
| | | | | | | | | | | | | |
Collapse
|
6
|
Schindl M, Oberhuber G, Obermair A, Schoppmann SF, Karner B, Birner P. Overexpression of Id-1 protein is a marker for unfavorable prognosis in early-stage cervical cancer. Cancer Res 2001; 61:5703-6. [PMID: 11479201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Inhibitor of differentiation/DNA binding (Id) proteins are transcription factors, involved in cell cycle regulation and neoangiogenesis. Using immunohistochemistry, we investigated the prognostic influence of Id-1, Id-2, and Id-3 expression in 89 patients with cervical cancer stage pT(1b). In univariate and multivariate analysis, patients with strong or moderate expression of Id-1 had a significant shorter overall survival time (P = 0.0144, log-rank test) and disease-free survival time (P = 0.0107, log-rank test) compared with those with low or absent Id-1 expression. Id-1 expression is an independent prognostic marker in early-stage cervical cancer.
Collapse
Affiliation(s)
- M Schindl
- Institute of Clinical Pathology, University of Vienna, Waeringer Guertel 18-20, A-1090 Vienna, Austria
| | | | | | | | | | | |
Collapse
|
7
|
Schindl M, Bachtiary B, Dreier B, Birner P, Latinovic L, Karner B, Breitenecker G, Oberhuber G. Impact of human papillomavirus infection on the expression of the KAI1 metastasis suppressor protein in invasive cervical cancer. Cancer Lett 2001; 162:261-6. [PMID: 11146234 DOI: 10.1016/s0304-3835(00)00672-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 10/17/2022]
Abstract
Downregulation of KAI1 metastasis suppressor protein is associated with dismal prognosis in a variety of cancers. Mutation of p53 was suggested to be involved in KAI1-downregulation. In cervical cancer, p53 is inactivated by human papillomavirus (HPV) oncoprotein E6 with the grade of inactivation depending on the HPV type. KAI1-expression was immunohistochemically determined in 67 specimens of cervical cancer, HPV-typing was performed using polymerase chain reaction (PCR), cloning, and sequencing. KAI1-downregulation was found in 68.1% of patients, HPV-infection in 91%. There was no association of KAI1-downregulation and infection with a particular HPV type. KAI1-downregulation in cervical cancer seems independent of HPV-E6 induced p53 inactivation.
Collapse
Affiliation(s)
- M Schindl
- Institute of Clinical Pathology, Department of Gynecopathology and Cytology, AKH, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|