1
|
Heinemann FM, Baumgart C, Binder C, Börger V, Fischer JC, Heinold A, Jiménez Klingberg C, Lenz V, Riebschläger S, Zeiler T, Horn PA, Kordelas L. Recruiting refugees and migrants as potential hematopoietic stem cell donors to serve patients of comparable ethnicities with rare human leucocyte antigen patterns - The BluStar.NRW project in North Western Germany. Transpl Immunol 2024; 82:101985. [PMID: 38184211 DOI: 10.1016/j.trim.2024.101985] [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: 09/15/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Currently, approximately 19 million people with a migration background live in Germany. The majority of those descend from regions where the population has a genetically different distribution of HLA antigens when compared to the HLA frequencies usually found in North Western Europe. In case of severe haematological disorders of these individuals, allogeneic stem cell transplantation may be the treatment of choice. However, finding appropriate histocompatible hematopoietic stem cell donors continues to be a major challenge. If no matching sibling donors are available, there are only few suitable donors with a similar genetic background available in international blood stem cell donor registries. The "BluStar.NRW" project aimed to recruit new blood and hematopoietic stem cell donors with a migration background and to noticeably increase the number of suitable donors for patients within this group. Since December 2017, a total number of 9100 blood and stem cell donors with a migration background were recruited and typed for this project. HLA typing for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 was performed by Next Generation Sequencing. We assessed the proportion of rare alleles according to HLA frequency tables, as defined by a frequency of <1:1000. The rare HLA allele frequencies according to HLA frequency tables of the BluStar.NRW cohort were compared with a matched control donor cohort: Rare HLA-A, -B, -C, -DRB1 and -DQB1 alleles occurred three times more frequent than in the control group, but rare HLA-DPB1 alleles occurred more frequently in the control cohort. This difference was highly significant for all HLA alleles (p < 0.0001 for HLA-A, -B, -C, -DRB1, -DPB1; p = 0.0002 for HLA-DQB1). In addition, the distribution of rare alleles differed between the two groups. To date, 29 work-ups were initiated, 12 PBSC, one BM and three DLI were collected so far out of the BluStar.NRW cohort. The apheresis probability is twofold higher (0.18% vs. 0.07%) compared to the control group which clearly shows a serious medical need. However, 13 work-ups were cancelled in the BluStar.NRW donor cohort which represents an almost twice as higher cancellation rate (45% vs. 25%). This single registry analysis with a large sample cohort clearly indicates that hematopoietic stem cell donors with a migration background represent an adequate donor pool to serve patients of comparable ethnicity.
Collapse
Affiliation(s)
- F M Heinemann
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany.
| | - C Baumgart
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - C Binder
- Westdeutsche SpenderZentrale WSZE, Ratingen, Germany
| | - V Börger
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - J C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Heinold
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - C Jiménez Klingberg
- German Red Cross Blood Service West, Hagen, Breitscheid, Münster and Bad-Salzuflen, Germany
| | - V Lenz
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - S Riebschläger
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - T Zeiler
- German Red Cross Blood Service West, Hagen, Breitscheid, Münster and Bad-Salzuflen, Germany
| | - P A Horn
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - L Kordelas
- Westdeutsche SpenderZentrale WSZE, Ratingen, Germany; Clinic for Hematology and Stem Cell Transplantation, University Medicine Essen, Essen, Germany
| |
Collapse
|
2
|
Schrutka L, Seirer B, Dusik F, Rettl R, Duca F, Dalos D, Dachs TM, Binder C, Badr-Eslam R, Kastner J, Hengstenberg C, Stix G, Bonderman D. Validation of an electrocardiographic algorithm for the detection of cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1686] [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
Despite new therapies, diagnosis of cardiac amyloidosis (CA) is often delayed. We recently developed a simple electrocardiographic (ECG) algorithm to suspect CA without the aid of advanced imaging modalities (Figure).
Methods
The aim of this study was to validate the algorithms' usefulness in clinical practice. ECG readings from patients with CA, heart failure with preserved ejection fraction (HFpEF), and hypertrophic cardiomyopathy (HCMP) were analyzed in a blinded fashion.
Results
884 patients were included. Patients with pacemakers were excluded, leaving 827 ECGs (237 CA, 407 HFpEF, 183 HCMP) for final analysis. A characteristic pattern defined by the algorithm was visually perceptible in 165 ECGs (69.6%) of the amyloidosis patients vs. 114 (28%) of HFpEF vs. 22 (12.0%) of HCMP patients (p<0.001). The area under the curve (AUC) for the detection CA was 0.75 with a sensitivity of 69.6% and a specificity of 76.9% (Figure). Binary logistic regression analysis revealed that the presence of a distinctive pattern increased the probability of CA with an odds ratio of 7.66 (CI: 5.47–10.72; p<0.001).
Conclusion
This easy-to-use ECG algorithm has proven helpful to suspect CA. Our tool may significantly improve the treatment of heart failure patients by identifying those with amyloidosis-related disease.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - B Seirer
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - F Dusik
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - R Rettl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - F Duca
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - D Dalos
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - T M Dachs
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Binder
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - R Badr-Eslam
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - J Kastner
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - G Stix
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology , Vienna , Austria
| |
Collapse
|
3
|
Rettl R, Duca F, Binder C, Dachs T, Cherouny B, Camuz Ligios L, Mann C, Schrutka L, Dalos D, Charwat-Resl S, Badr Eslam R, Kastner J, Bonderman D. Two-dimensional speckle-tracking echocardiography in tafamidis-treated patients with transthyretin amyloid cardiomyopathy: a glimmer of hope for viable therapy monitoring? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1756] [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
Treatment with Tafamidis in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) has been shown to have beneficial effects on the left ventricle (LV), as assessed by cardiac magnetic resonance (CMR) imaging. Although CMR represents the gold standard among imaging modalities, its limited availability in clinical practice makes it unfeasible for routine therapy monitoring.
Purpose
We aimed to determine Tafamidis-induced changes using two-dimensional (2D) speckle-tracking echocardiography and to identify echocardiographic imaging parameters that could be used for specific therapy monitoring.
Methods
We subjected a series of ATTR-CM patients to transthoracic echocardiography (TTE) at baseline and follow-up and compared patients treated with Tafamidis 61mg once daily (QD) to a historical control cohort treated with Tafamidis 20mg QD, as well as to a historical treatment-naïve control cohort reflecting the natural course of the disease.
Results
Patients receiving Tafamidis 61mg (n=62) or 20mg (n=21) QD showed stable measurements at follow-up [61mg: 8.5 months, 20mg: 7.0 months] in LV global longitudinal strain (GLS) (61mg: −11.75% vs. −11.58%, p=0.534; 20mg: −10.61% vs. −10.12%, p=0.309), right ventricular (RV) GLS (61mg: −14.18% vs. −13.72%, p=0.377; 20mg: −14.53% vs. −13.99%, p=0.452) and left atrial (LA) reservoir strain (LASr; 61mg: 8.80% vs. 9.42%, p=0.283; 20mg: 8.23% vs. 8.67%, p=0.589), whereas treatment-naïve ATTR-CM patients (n=54) had clear signs of disease progression at the end of the observation period [10.5 months; LV-GLS: −11.71% vs. −10.59%, p=0.001; RV-GLS: −14.36% vs. −12.99%, p=0.038; LASr: 10.67% vs. 8.41%, p=0.005]. Between-group comparison at follow-up revealed beneficial effects of Tafamidis 61mg on LASr (p=0.003), LV-GLS (p=0.030) and interventricular septum (IVS) thickness (p=0.006), resulting in clinical benefits (six-minute walk distance (6-MWD): p=0.006, NT-proBNP: p≤0.001), while patients treated with Tafamidis 20mg QD showed positive effects on LASr (p=0.039) but no differences in LV-GLS (p=0.274), IVS thickness (p=0.068) and clinical status (6-MWD: p=0.124, NT-proBNP: p=0.053) compared to the natural course.
Conclusion
Treatment with Tafamidis 61mg in ATTR-CM patients delays the increase in IVS thickness and the deterioration of LA and LV longitudinal function, resulting in significant clinical benefits compared with natural history. Serial TTE with 2D speckle-tracking imaging may be appropriate for disease-specific therapy monitoring.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This work was supported by the Pfizer Inc. However, Pfizer Inc. did not have influence on study design, data processing, or statistical analysis.
Collapse
Affiliation(s)
- R Rettl
- Medical University of Vienna , Vienna , Austria
| | - F Duca
- Medical University of Vienna , Vienna , Austria
| | - C Binder
- Medical University of Vienna , Vienna , Austria
| | - T Dachs
- Medical University of Vienna , Vienna , Austria
| | - B Cherouny
- Medical University of Vienna , Vienna , Austria
| | | | - C Mann
- Medical University of Vienna , Vienna , Austria
| | - L Schrutka
- Medical University of Vienna , Vienna , Austria
| | - D Dalos
- Medical University of Vienna , Vienna , Austria
| | | | | | - J Kastner
- Medical University of Vienna , Vienna , Austria
| | | |
Collapse
|
4
|
Niebauer J, Binder C, Iscel A, Klenk S, Capelle C, Kahr M, Cadjo S, Lichtenauer M, Toma A, Zoufaly A, Hoffman S, Charwat-Resl S, Krestan C, Wenisch C, Bonderman D. Cardiopulmonary long-term effects in patients after hospitalization due to COVID-19 infection. Eur Heart J 2022. [PMCID: PMC9619510 DOI: 10.1093/eurheartj/ehac544.249] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac and pulmonary effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and possible long-term impairments after hospitalization because of Covid-19 infection as well as to try to identify predictors for Long-Covid. Methods This was a prospective, multicenter registry study. Patients with verified Covid-19 infection, who were treated as in-patients at our dedicated Covid hospital (Clinic Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During the study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), chest computed tomography (CT) scan, lung function test and a comprehensive list of laboratory parameters including cardiac bio markers. Results Between July 2020 and October 2021, 150 patients were recruited. Sixty patients (40%) were female and the average age was 53.5±14.5 years. Of all patients, 92% had been admitted to our general ward and 8% had a severe course of disease, requiring admission to our intensive care unit. Six months after discharge the majority of patients still experienced symptoms and 75% fulfilled the criteria for Long-Covid. Only 24% were completely asymptomatic (figure 1). Echocardiography detected reduced global longitudinal strain (GLS) in 11%. Cardiac MRI revealed pericardial effusion in 18%. Furthermore, cardiac MRI showed signs of former peri- or myocarditis in 4%. Pulmonary CT scans identified post-infectious residues, such as bilateral ground glass opacities and fibrosis in 22%. Exertional dyspnea was associated with either reduced forced vital capacity measured during pulmonary function tests in 11%, with reduced GLS and/or diastolic dysfunction, thus providing evidence for a cardiac and/or pulmonary cause. Independent predictors for Long-Covid were markers of a more severe disease course like length of in-hospital stay, admission to an intensive care unit, type of ventilation as well as higher NT-proBNP and/or troponin levels. Conclusion Even 6 months after recovery from Covid-19 infection, the majority of previously hospitalized patients still suffer from at least one symptom, such as chronic fatigue and/or exertional dyspnea. While there was no association between fatigue and cardiopulmonary abnormalities, impaired lung function, reduced GLS and/or diastolic dysfunction were significantly more prevalent in patients presenting with exertional dyspnea. On chest CT approximately one fifth of all patients showed post infectious changes in chest CT including evidence for myo- and pericarditis as well as accumulation of pericardial effusions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Major fund
Collapse
Affiliation(s)
- J Niebauer
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Binder
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - A Iscel
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - S Klenk
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Capelle
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - M Kahr
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - S Cadjo
- AKH Wien, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - M Lichtenauer
- Salzburg university hospital, Department of Cardiology, internal intensive medicine and emergency medicine , Salzburg , Austria
| | - A Toma
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - A Zoufaly
- Klinik Favoriten, Department of Infectious Diseases , Vienna , Austria
| | - S Hoffman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - S Charwat-Resl
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| | - C Krestan
- Klinik Favoriten, Department of Radiology , Vienna , Austria
| | - C Wenisch
- Klinik Favoriten, Department of Infectious Diseases , Vienna , Austria
| | - D Bonderman
- Klinik Favoriten, Department of Cardiology and Emergency Medicine , Vienna , Austria
| |
Collapse
|
5
|
Rettl R, Wollenweber T, Mann C, Duca F, Dachs TM, Binder C, Stojanovic M, Camuz Ligios L, Schrutka L, Dalos D, Charwat-Resl S, Badr Eslam R, Kastner J, Hacker M, Bonderman D. Quantification of myocardial amyloid deposition in tafamidis-treated patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1811] [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
Tafamidis kinetically stabilizes the tetrameric form of transthyretin (TTR) and thus may halt disease progression in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). However, the effect of tafamidis treatment on the progression of myocardial amyloid deposition is still unclear.
Methods
In our explorative analysis, we aimed to investigate the treatment effect of tafamidis on myocardial amyloid deposition measured by myocardial standardized uptake value (SUV) peak and SUV retention index using quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) of the thorax and to observe its association with clinical parameters. Therefore, clinical, laboratory, imaging, and SPECT/CT examinations were performed in twenty consecutive ATTR-CM patients who started treatment with tafamidis 61mg, both at baseline and at a median of 6 months.
Results
Main results are summarized in Table 1. In brief, we observed a significant reduction of mean myocardial SUV peak (baseline: 15.50 vs. follow-up: 11.61, p<0.001) and mean SUV retention index (5.64 vs. 3.58, p=0.001) after treatment with tafamidis (Figure 1A). Interestingly, a higher percentage decrease in the SUV retention index is more likely to be associated with clinical benefit, with a threshold of −30% distinguishing between patients who respond clinically (n=12) and those who do not (n=8, Figure 1B). Clinical response is demonstrated by improvement in exertional dyspnea (NYHA class III: 83.3% vs. 41.7%, p=0.047) and mean functional capacity as measured by 6-minute walk distance (349.5m vs. 356.7m, p=0.736). Cardiac biomarkers analysis showed a clear reduction in median NT-proBNP levels in the responder cohort (2765.0 pg/mL vs. 1904.0 pg/mL, p=0.041) compared to an increase in the non-responder cohort (1825.0 pg/mL vs. 1944.0 pg/mL, p=0.208; cohort comparison: p=0.026, Figure 1C). Echocardiographic findings revealed improvement in mean left ventricular (LV) strain (−12.0% vs. −13.5%, p=0.049) and mean LV ejection fraction (LVEF, 48.5% vs. 52.7%, p=0.287) in the responder cohort, while significant deterioration in mean LV function (LV strain: −13.9 vs. −10.5, p=0.035; LVEF: 53.2% vs. 46.5%, p=0.012) was observed in the non-responder cohort, with an additional substantial deterioration in right ventricular (RV) function as measured by tricuspid annular plane systolic excursion (TAPSE, mean, BL: 19.2mm vs. FU: 12.6mm, p=0.037) in those patients. These results are consistent with changes in the LV and RV function in cardiac magnetic resonance imaging parameters in each of the two cohorts.
Conclusion
Treatment with tafamidis in patients with ATTR-CM results in a significant reduction in myocardial amyloid deposition as measured by the SUV retention index, with a threshold of −30% distinguishing patients who respond clinically from those who do not. However, a larger patient sample is needed to verify these results.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer Inc.
Collapse
Affiliation(s)
- R Rettl
- Medical University of Vienna, Vienna, Austria
| | | | - C Mann
- Medical University of Vienna, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Vienna, Austria
| | - T.-M Dachs
- Medical University of Vienna, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Vienna, Austria
| | | | | | - L Schrutka
- Medical University of Vienna, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Vienna, Austria
| | | | | | - J Kastner
- Medical University of Vienna, Vienna, Austria
| | - M Hacker
- Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
6
|
Schrutka L, Anner P, Seirer B, Rettl R, Duca F, Dalos D, Dachs TM, Binder C, Badr-Eslam R, Kastner J, Loewe C, Hengstenberg C, Stix G, Dorffner G, Bonderman D. A machine learning-derived electrocardiographic algorithm for the detection of cardiac amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1801] [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
The diagnosis of cardiac amyloidosis (CA) requires advanced imaging techniques. Typical surface ECG patterns have been described, but their diagnostic value is limited.
Purpose
The aim of this study was to perform a comprehensive electrophysiological characterization in CA patients and to develop a robust, easy-to-use diagnostic tool.
Methods
First, we applied electrocardiographic imaging (ECGI) to generate detailed electroanatomical maps in CA patients and controls. Then, a machine learning approach was used to generate a surface ECG-based diagnostic algorithm from the complex dataset.
Results
Areas of low voltage were localized in the basal inferior regions of both ventricles and the remaining right ventricular segments in CA. The earliest epicardial breakthrough of myocardial activation was visualized in the right ventricle. Potential maps showed an accelerated and diffuse propagation pattern. We correlated the results from ECGI with 12-lead ECG recordings. Ventricular activation correlated best with R-peak timing in leads V1 to V3. Epicardial voltage showed a strong positive correlation with R-peak amplitude in inferior leads II, III, aVF. Ten blinded cardiologists were then asked to identify CA patients by analyzing 12-lead ECGs before and after training for the defined ECG patterns. Training resulted in significant improvements in the detection rate of CA with an AUC of 0.69 before and 0.97 after training (Figure).
Conclusion
Using a machine learning approach, a robust ECG-based tool was developed to detect CA from detailed electroanatomical mapping of CA patients. The developed tool proved to be a simple and reliable diagnostic tool to suspect CA without the aid of advanced imaging modalities.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - P Anner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - B Seirer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Rettl
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - T M Dachs
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Badr-Eslam
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Kastner
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Loewe
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - G Stix
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - G Dorffner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology, Vienna, Austria
| |
Collapse
|
7
|
Rettl R, Mann C, Duca F, Dachs TM, Binder C, Kronberger C, Schrutka L, Dalos D, Dona C, Kammerlander A, Beitzke D, Charwat-Resl S, Kastner J, Badr Eslam R, Bonderman D. Cardiac imaging in tafamidis-treatment patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1814] [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
Tafamidis kinetically stabilizes the tetrameric form of transthyretin (TTR) and thus may halt disease progression in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). In our explorative analysis, we aimed to investigate the treatment effect on functional capacity and cardiac biomarkers as well as cardiac function and structure using echocardiography and cardiac magnetic resonance imaging (CMR), and to compare patients treated with tafamidis with an untreated control cohort.
Methods
Consecutive ATTR-CM patients either received tafamidis 61mg (n=64) or tafamidis 20mg (n=23) or were assigned to an untreated control cohort (n=54) reflecting the natural history of the disease. Subsequently, we performed clinical, laboratory, echocardiography and CMR follow-up at a median of 9 to 12.5 months.
Results
Main results are summarized in Table 1. In brief, we observed evidence of improvement in functional capacity as measured by the 6-minute walk distance (6MWD) in tafamidis 61mg treated patients (baseline: 377.1m vs. follow-up: 383.2m, p=0.678) compared to a significant decline in mean 6MWD in untreated patients (388.1m vs. 336.4m, p=0.002; cohort comparison: p=0.005). Analysis of cardiac biomarkers revealed evidence of therapeutic response by a decrease in median NT-proBNP levels in patients treated with tafamidis 61mg (2633.0pg/mL vs. 2244.0pg/mL, p=0.366), whereas a significant increase was observed in untreated patients (2798.0pg/mL vs. 3422.0pg/mL, p<0.001; cohort comparison: p<0.001). Echocardiographic findings revealed evidence of approximate stabilization in mean left ventricular (LV) strain (−11.75% vs. −11.58%, p=0.534) and mean right ventricular (RV) strain (−14.18% vs. −13.72, p=0.377) in the tafamidis 61mg treatment cohort compared to significant deterioration of mean LV longitudinal function (−11.71% vs. −10.59%, p=0.001) and mean RV longitudinal function (−14.36% vs. −12.99%, p=0.038) in the untreated cohort (cohort comparison: p=0.030 and p=0.269). Furthermore, cardiac structural assessment by CMR showed a significant increase in mean LV mass (199.1g vs. 214.3g, p=0.040) and mean extracellular volume (50.52% vs. 55.96%, p=0.026) in untreated patients, suggesting increased progression of myocardial amyloid deposition.
Conclusion
Treatment with tafamidis in patients with ATTR-CM results in significant improvements in functional capacity and cardiac biomarkers, and shows marked benefits in functional as well as structural imaging parameters compared with an untreated control cohort.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Pfizer Inc.
Collapse
Affiliation(s)
- R Rettl
- Medical University of Vienna, Vienna, Austria
| | - C Mann
- Medical University of Vienna, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Vienna, Austria
| | - T.-M Dachs
- Medical University of Vienna, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Vienna, Austria
| | | | - L Schrutka
- Medical University of Vienna, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Vienna, Austria
| | - C Dona
- Medical University of Vienna, Vienna, Austria
| | | | - D Beitzke
- Medical University of Vienna, Vienna, Austria
| | | | - J Kastner
- Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
8
|
Schrutka L, Seirer B, Frommlet F, Binder C, Duca F, Rettl R, Dachs T, Dalos D, Badr-Eslam R, Kastner J, Hengstenberg C, Bonderman D. Recurrent heart failure hospitalizations in patients with preserved ejection fraction: predictors and outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0737] [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
Heart failure with preserved ejection fraction (HFpEF) is the most common form of HF and its prevalence is approaching epidemic proportions. Current treatment strategies aim to improve clinical status and reduce mortality rates. Episodes of acute HF are one of the main reasons for hospitalization in people over 65 years; however, they have not been well studied in HFpEF patients yet.
Objectives
The aim of this study was to investigate the impact of recurrent HF hospitalizations on long-term outcomes and to find predictors for subsequent events.
Methods
Between December 2010 and December 2019, 422 patients with confirmed HFpEF were enrolled in this study and prospectively followed.
Results
During follow-up, 190 HFpEF patients (45%) experienced HF hospitalizations with a median frequency of 2 (IQR: 1–4). Those presenting with acute HF had higher body mass indices (p=0.018), worse performance in 6-minute walking tests (p<0.001), higher levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP, p<0.001) and, compared to stable patients, a larger proportion suffered from New York Heart Association functional class ≥ III (p<0.001). Furthermore, baseline left ventricular diastolic dysfunction (early mitral inflow velocity/early diastolic mitral annular velocity; p=0.002) as well as right ventricular afterload (pulmonary artery wedge pressure; p<0.001) were more pronounced in patients with acute deteriorations. Over the observation period 107 patients (25%) died. Kaplan-Meier curves revealed increasingly worse survival in patients with recurrent HF events (5-years survival: 1 HF event 66% vs ≥3 HF events 53%, p<0.001; Figure). Time to last hospitalization was a strong predictor of survival with an adjusted HR of 2.5 (95% CI 1.63–3.98; p<0.001) in multivariate Cox regression analysis. Predictors of recurrent HF hospitalization were 6-minute walking distance (OR: 0.07, CI 0.02–0.22; p=0.001), systolic pulmonary artery pressure (OR: 1.05, CI 1.03–1.07, p=0.001) and NT-pro BNP (OR: 4.92, CI: 2.68–9.04, p=0.001)
Conclusions
HFpEF patients experiencing recurrent HF hospitalizations have worse long-term outcome. Intensive efforts should be made to maintain HFpEF patients compensated over time.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
Collapse
Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - B Seirer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - F Frommlet
- Medical University of Vienna, Institute of Medical Statistics, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Rettl
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - T.M Dachs
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Badr-Eslam
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Kastner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| |
Collapse
|
9
|
Binder C, Aurich J, Scarlet D, Reichart U, Walter I, Aurich C. Expression of nuclear progesterone receptor, progesterone receptor membrane components 1 and 2 and prostaglandin-endoperoxide synthase 2 in the endometrium and oviduct of spontaneously ovulating cats. Theriogenology 2021; 172:200-206. [PMID: 34271496 DOI: 10.1016/j.theriogenology.2021.06.017] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/25/2022]
Abstract
Although ovulations not followed by pregnancy occur regularly in cats, differences in endometrial function between cats in the luteal and non-luteal phase have not been studied so far. Progesterone exerts its effects through a nuclear progesterone receptor (PGR) and via cell-membrane bound receptors referred to as progesterone receptor membrane component (PGRMC) 1 and 2. Progesterone receptor expression is regulated by gonadal steroid hormones and therefore may change throughout the oestrous cycle. Protein expression of PGR, PGRMC-1 and 2 and prostaglandin-endoperoxide synthase 2 (PTGS2) was analysed in the endometrium and oviduct of non-pregnant female cats in the follicular (n = 8) and luteal phase (n = 9). We hypothesized that the presence of corpora lutea (CL) is associated with downregulation of progesterone receptors and PTGS2. Cells of the luminal endometrial epithelium, endometrial stroma and oviductal epithelium were assessed by immunohistochemistry. The PGR protein expression was more pronounced in the endometrial epithelium than stroma (p < 0.001) and less pronounced in cats with a CL than without CL (p < 0.001) but did not differ between groups in the oviduct. The PTGS2 was localized only in the endometrial and oviductal epithelium and its expression was reduced in cats with CL (p = 0.001). In the endometrial epithelium, PGRMC-1 expression was reduced in cats with CL (p < 0.05). Expression of PGRMC-2 was highest in the endometrial epithelium and lowest in the endometrial stroma (p = 0.01) but did not differ between cats with and without CL. In conclusion, progesterone receptor and PTGS2 downregulation in the female cat closely resembles findings in other spontaneously ovulating domestic animal species.
Collapse
Affiliation(s)
- C Binder
- Obstetrics and Reproduction, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria.
| | - J Aurich
- Obstetrics and Reproduction, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| | - D Scarlet
- Obstetrics and Reproduction, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| | - U Reichart
- VetCore Facility for Research, Vetmeduni Vienna, Vienna, Austria
| | - I Walter
- VetCore Facility for Research, Vetmeduni Vienna, Vienna, Austria; Institute of Pathology, Department for Pathobiology, Vetmeduni Vienna, Vienna, Austria
| | - C Aurich
- Artificial Insemination and Embryo Transfer, Department for Small Animals and Horses, Vetmeduni Vienna, Vienna, Austria
| |
Collapse
|
10
|
Schäfer-Somi S, Binder C, Burak J, Papadopoulos N, Ilas J, Boersma A, Aurich C. Using egg yolk in a TRIS-Equex STM paste extender for freezing of dog semen is superior to egg yolk plasma, also after addition of lecithin and catalase. Cryobiology 2021; 100:63-71. [PMID: 33826944 DOI: 10.1016/j.cryobiol.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
We compared the results of using egg yolk plasma (EYP) instead of egg yolk (EY) in a TRIS-based Equex STM Paste freezing extender system for dog semen [25]. We also tested whether the addition of lecithin and catalase to the EYP extenders would improve results. Fractionated semen collection was done in 17 stud dogs and the sperm rich fraction diluted with different extenders in 2 steps: (I) TRIS-fructose-citric acid extender (TRIS) containing 20% egg yolk (EY) and 3% glycerol [25], (II) TRIS containing 20% egg yolk plasma (EYP) and 3% glycerol, and (III) TRIS containing 20% EYP and 0.8% lecithin (EYP-L) and 3% glycerol. After equilibration the second dilution step was done: samples with (I) were diluted with TRIS-EY with 7% glycerol and 1% Equex STM paste [25]; samples with (II) and (III) were divided in 2 aliquots each, and one part diluted with TRIS-EYP or TRIS-EYP-L, both containing 7% glycerol and 1% Equex STM paste, and the other one part with the same extenders containing additionally 300 I.U./mL catalase. After freezing and thawing, samples were analyzed by CASA and sperm chromatin structure assay (SCSA); reactive oxygen species (ROS), degree of apoptosis and zona binding ability were determined. Semen samples with TRIS-EY with a final concentration of 5% glycerol and 0.5% Equex STM paste [25] showed best post thaw progressive motility (P), most intact cells, lowest percentage of ROS, acrosome damages, dead and apoptotic cells. Curvilinear velocity (VCL), DNA fragmentation, morphological abnormalities and zona binding ability did not differ between groups. Replacement of egg yolk by EYP increased the ROS and late apoptotic cells. Addition of lecithin and catalase to EYP containing extenders decreased motility and increased complete apoptosis. We conclude that egg yolk is superior to EYP in the here investigated extenders. The TRIS-based extender [25] with EYP could not be improved by addition of lecithin and catalase; however, in-vivo fertilization capacity of the here examined extenders remains to be investigated.
Collapse
Affiliation(s)
- Sabine Schäfer-Somi
- Department of Small Animals and Horses, Platform for AI and ET, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| | - C Binder
- Clinic for Obstetrics, Gynecology and Andrology, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| | - J Burak
- Platform for AI and ET, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| | - N Papadopoulos
- Platform for AI and ET, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| | - J Ilas
- Takeda Pharma Austria, Vienna, Austria.
| | - A Boersma
- Institute of In-vivo and In-vitro Models, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| | - C Aurich
- Platform for AI and ET, University of Veterinary Medicine Vienna, Veterinärplatz 1, Vienna, Austria.
| |
Collapse
|
11
|
Rettl R, Mann C, Dachs T, Duca F, Binder C, Dusik F, Seirer B, Badr Eslam R, Hengstenberg C, Bonderman D. Effects of tafamidis on exercise capacity, cardiac function and myocardial amyloid deposition in patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1029] [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: 11/12/2022] Open
Abstract
Abstract
Background
Transthyretin amyloid cardiomyopathy (ATTR-CA) is caused by deposition of amyloid fibrils in the myocardium. Tafamidis is a kinetic stabilizer of TTR that prevents tetramer dissociation and amyloidogenesis.
Methods
Thirty-eight patients with diagnosis of ATTR-CA were treated with tafamidis (20mg or 61mg) for a period of six months. In our explorative analysis we aimed to evaluate the effects of tafamdis by changes from baseline of the serum NT-proBNP concentration, 6MWD, as well as cardiac structure and function, compared to untreated amyloidosis patients.
Results
The analysis showed a significant reduction in the serum NT-proBNP concentration in tafamidis-treated patients compared to untreated patients (median difference, −1042.5 pg/mL, p=0.015). Tafamidis also improved the walking distance at month six, while reduction in untreated patients was observed (mean difference, +29.27 m, p=0.175). Echocardiographic findings revealed a decrease in LV size (mean, −1.56 mm) as well as improvements regarding the LA size (mean difference, −2.51 mm) and the GLS (mean difference, 0.80%) in tafamidis-treated patients. T1 mapping in cardiac MRI showed a decrease in ECV (mean, −1.79%) in patients receiving tafamidis, while an increase in ECV in untreated patients was observed (mean, +0.41%).
Conclusion
Treatment with tafamidis for a period of six months in patients with ATTR-CA results in a significant improvement in NT-proBNP levels and may have positive effects on exercise capacity, cardiac function and myocardial amyloid deposition compared to untreated amyloidosis patients.
Picture 1. Change from baseline.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- R Rettl
- Medical University of Vienna, Vienna, Austria
| | - C Mann
- Medical University of Vienna, Vienna, Austria
| | - T Dachs
- Medical University of Vienna, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Vienna, Austria
| | - F Dusik
- Medical University of Vienna, Vienna, Austria
| | - B Seirer
- Medical University of Vienna, Vienna, Austria
| | | | | | - D Bonderman
- Medical University of Vienna, Vienna, Austria
| |
Collapse
|
12
|
Binder C, Poglitsch M, Rettl R, Dachs T, Seirer B, Capelle C, Dusik F, Duca F, Dalos D, Schrutka L, Badr-Eslam R, Bonderman D. A novel SGLT-2 score to identify HFpEF patients who may benefit from SGLT-2 inhibitors. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1141] [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
Established heart failure (HF) treatments have shown no effects in HF and preserved ejection fraction (HFpEF). Subgroup analyses of the HFpEF populations suggest that certain patients benefit from HF treatments. This underlines the importance of individualized therapy regimens in HFpEF. Sodium-glucose transporter 2 (SGLT-2) inhibitors are emerging as a promising treatment of HF. The mechanisms leading to improved outcomes include 1) treatment of diabetes, 2) osmodiuresis preventing volume overload, 3) enhancement of the cardio protective Angiotensin (Ang) 1–7 pathway, instead of Ang II. We aimed to characterize patients by factors which are modified by SGLT-2 inhibitors to identify individuals who may benefit from these drugs.
Methods
HFpEF patients were included in a single center registry. Baseline evaluation included assessment of HbA1c, fluid status measured by body composition monitor and plasma angiotensin concentration. A “SGLT-2 score” with a maximum of 3 points was calculated using the following parameters: 1) HbA1c >6.5%, 2) overhydration, defined as a fluid overload of >1,5L and 3) plasma renin activity (PRA) levels above the median as a parameter of over-all RAS activity. Primary outcome was defined as all-cause death or HF hospitalization. All parameters used in the “SGLT-2 score” were independently predictive for the chosen endpoint. Kaplan Meier analyses was used to show the association between the score and outcomes.
Results
90 patients were included in this registry. Median HbA1c was 6.0%, median fluid status was 1.2L and the median Ang II levels in the “high PRA-group” were 5.35.1 pmol/L. After a mean follow up time of 44.0±38.7 months, 60 patients (66.6%) reached the endpoint. Kaplan Meier analysis showed an association between SGLT-2 score and outcome (p=0.003).
Conclusion
Patients with HbA1c >6.5%, overhydration and high RAS activity have poor outcomes. We propose the future use of this score to identify a subgroup of HFpEF patients who may benefit from SGLT-2 inhibitors.
Kaplan Meier analysis
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- C Binder
- Medical University of Vienna AKH, Vienna, Austria
| | | | - R.R Rettl
- Medical University of Vienna AKH, Vienna, Austria
| | - T Dachs
- Medical University of Vienna AKH, Vienna, Austria
| | - B Seirer
- Medical University of Vienna AKH, Vienna, Austria
| | - C Capelle
- Medical University of Vienna AKH, Vienna, Austria
| | - F Dusik
- Medical University of Vienna AKH, Vienna, Austria
| | - F Duca
- Medical University of Vienna AKH, Vienna, Austria
| | - D Dalos
- Medical University of Vienna AKH, Vienna, Austria
| | - L Schrutka
- Medical University of Vienna AKH, Vienna, Austria
| | - R Badr-Eslam
- Medical University of Vienna AKH, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna AKH, Vienna, Austria
| |
Collapse
|
13
|
Rettl R, Duca F, Binder C, Capelle C, Aschauer S, Badr Eslam R, Mascherbauer J, Hengstenberg C, Bonderman D. P896Effects of tafamidis in patients with transthyretin amyloid cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
Transthyretin amyloid cardiomyopathy (ATTR-CA) is caused by deposition of amyloid fibrils in the myocardium. The deposition occurs when transthyretin (TTR) becomes unstable and misfolds. Tafamidis is a kinetic stabilizer of TTR that prevents tetramer dissociation and amyloidogenesis by TTR.
Methods
Eighteen patients with diagnosis of ATTR-CA (hATTR or wtATTR) from our national amyloidosis registry were treated with 20 mg of tafamidis for a period of six months. In our explorative analysis we aimed to evaluate the effects of tafamdis by changes from baseline of the serum NT-proBNP concentration, 6-minute walking distance, as well as cardiac structure and function.
Results
The exploratory analysis showed a decrease in serum NT-proBNP concentration in tafamidis treated patients, compared to increase in untreated patients (median difference, −481.0 pg/mL). Tafamidis improved the walking distance during the 6-minute walk test at month six, compared to baseline (mean, 31.25 m). Echocardiographic findings revealed an improvement of the global longitudinal strain (mean, 0.77%), a decrease in left atrial size (mean, −1.65 mm) and a decrease in left ventricular size (mean, −4.13 mm) in tafamidis treated patients compared to untreated patients. Due to insufficient power the results did not differ significantly between tafamidis treated patients and untreated patients.
Change from baseline Tafamidis No treatment Treatment Difference p-value Cardiac Biomarkers n=18 n=15 NT-proBNP, ng/L Baseline, median 2740.0 2835.0 CFB to 6 months, median −207.0 274.0 −481.0 0.329 Functional Status n=8 n=7 6MWT, m Baseline, mean 441.00 420.50 CFB to 6 months, mean 31.25 −16.50 +47.75 0.373 Echocardiogram n=17 n=15 LA, mm Baseline, mean 63.41 61.33 CFB to 6 months, mean −1.65 0.60 −2.25 LV, mm Baseline, mean 44.13 41.80 CFB to 6 months, mean −4.13 0.33 −4.46 0.075 LV wall thickness, mm Baseline, mean 22.06 18.47 CFB to 6 months, mean 0.68 −0.60 +1.28 0.055 Longitudinal strain, % Baseline, mean −10.66 −12.42 CFB to 6 months, mean 0.77 −1.03 +1.80 0.652 MRI n=7 n=6 ECV, % Baseline, mean 52.26 44.22 CFB to 6 months, mean 0.81 3.70 − 2.89 0.493 LV mass, g Baseline, mean 187.71 170.33 CFB to 6 months, mean 24.29 19,67 +4.62 0.612
Conclusion
Treatment with tafamidis for a period of six months in patients with ATTR-CA leads to positive effects on NT-proBNP level, 6-minute walking distance, as well as cardiac structure and function compared to untreated patients.
Collapse
Affiliation(s)
- R Rettl
- Medical University of Vienna, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Vienna, Austria
| | - C Capelle
- Medical University of Vienna, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, Vienna, Austria
| | | | | | | | - D Bonderman
- Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
Duca F, Snidat A, Aschauer S, Rettl R, Binder C, Agis H, Kain R, Hengstenberg C, Mascherbauer J, Bonderman D. P2727Hemodynamic profiles in patients with cardiac amyloidosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1044] [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
Intracardiac filling and pulmonary arterial pressures play a central role in various heart failure entities, as they are strong predictors of outcome. However, their role in patients with cardiac amyloidosis (CA) is less clear.
Purpose
We aimed to characterize hemodynamic profiles of CA patients and assess their association with outcomes.
Methods
The present study was conducted within a prospective, national CA registry.
Patients underwent invasive hemodynamic, clinical, laboratory, and echocardiography assessment, as well cardiac magnetic resonance imaging with T1-mapping. The main outcome measure was a combined endpoint consisting of hospitalization for heart failure or cardiovascular death.
Results
Between March 2012 and October 2018, 63 consecutively recruited CA patients underwent invasive hemodynamic profiling. Of those, 36 had cardiac transthyretin amyloidosis (ATTR) and 25 cardiac light-chain amyloidosis (AL). In two patients amyloid subtyping was not possible.
Median age of the study population was 74.0 years and the majority were male (61.9%). Almost half of the patients were in New York Heart Association (NYHA) class ≥III (47.6%) and showed elevated N-terminal prohormone of brain natriuretic peptides (NT-proBNP) with a median of 3222 pg/mL. In comparison to AL, cardiac TTR patients were older (75.0 years versus 69.0 years, p=0.004), more often male (80.6% versus 40.0%, p=0.001), less symptomatic (NYHA class ≥III: 38.9% versus 64.0%, p=0.021), and had lower NT-proBNP values (2324pg/mL versus 5151pg/mL, p=0.004).
Hemodynamic profiling revealed significantly increased intracardiac as well as pulmonary arterial pressures (PAP). On an average, pulmonary artery wedge pressure was 20.0mmHg [interquartile range (IQR): 17.0–25.0], mean PAP (mPAP) was 30.0mmHg (IQR: 25.0–37.0), and mean right atrial pressure (mRAP) was 11.0mmHg (IQR: 7.0–16.0). No differences between ATTR and AL patients could be detected (p=0.148, p=0.398, p=0.620). During a median follow-up of 63.0 weeks, 28 study participants (44.4%) reached the combined endpoint. Moreover, cardiac AL patients had significantly more events as their ATTR counterparts (72.0% versus 27.8%, p=0.001). In cardiac ATTR patients, mPAP was significantly associated with outcome [hazard ratio (HR): 1.083, p=0.034, Figure 1A], which was not the case in the AL group (HR: 1.024, p=0.186, Figure 1B). Cardiac output and pulmonary vascular resistance were not associated with outcome. Neither in the ATTR (p=0.144; p=0.063) nor in AL cohort (p=0.420; p=0.115).
Figure 1
Conclusion
Despite differences in the severity of symptoms between cardiac AL and cardiac ATTR patients, no differences with regards to hemodynamic profiles could be detected.
Furthermore, intracardiac filling and pulmonary arterial pressures seem to be of greater clinical importance in cardiac ATTR as compared to cardiac AL, as these parameters were associated with outcome in the first, but not the latter group.
Collapse
Affiliation(s)
- F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - A Snidat
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Rettl
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - H Agis
- Medical University of Vienna, Oncology, Vienna, Austria
| | - R Kain
- Medical University of Vienna, Oncology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology, Vienna, Austria
| |
Collapse
|
15
|
Kammerlander A, Kraiger J, Nitsche C, Dona C, Duca F, Zotter-Tufaro C, Binder C, Koschutnik M, Aschauer S, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. P5261Feature tracking by CMR: left ventricular dysfunction predicts outcome in heart failure with preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0232] [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
Objectives
To investigate the association between global longitudinal strain (GLS) using feature tracking (FT) cardiovascular magnetic resonance imaging (CMR) and prognosis in patients with heart failure and preserved ejection fraction (HFpEF).
Background
Echocardiography-based studies have demonstrated that in HFpEF left ventricular (LV) strain analyses can detect impaired systolic function despite preserved ejection fraction and might also predict outcome. CMR also allows strain analysis using FT and is furthermore the gold standard for assessment of ventricular volumes and ejection fractions. In addition, T1-mapping allows non-invasive tissue characterization. However, the prognostic relevance of FT-CMR is unknown. In addition right ventricular (RV) FT-CMR is poorly investigated.
Methods
Consecutive patients with confirmed diagnosis of HFpEF underwent CMR on a 1.5T scanner. We used dedicated software (cvi42, Circle Cardiovascular Imaging Inc.) for global longitudinal left ventricular strain (LV-GLS) in a 3D and global longitudinal RV strain (RV-GLS) in a 2D model using feature tracking (FT). In addition, we performed uni- and multivariable Cox regression using a combined endpoint of heart failure hospitalizations, and cardiovascular death to determine the prognostic relevance of FT-CMR.
Results
We included a total of 131 HFpEF patients (70.4±8.6 years old, 70.2% female). Median LV-GLS by FT-CMR was −8% [IQR: −10% to 5%] and median RV-GLS was −11.9% [IQR: −16.57% to −12.23%]. LV and RV GLS values were significantly correlated with LV and RV ejection fractions (r=−0.463, p<0.001 for LV, and r=−0.306, p=0.001 and RV, respectively). 77 (58.8%) events were recorded during a follow-up of 42.0±31.4 months. Patients with an LV-GLS worse than the median (−8%) showed a significantly reduced event-free survival rate (log-rank, p=0.009).In a multivariable Cox-regression model correcting for the strongest clinical variables, including age (HR 1.018 [0.985–1.052], p=0.290), GFR (HR 0.987 [0.975–1.000], p=0.055), diabetes (HR 1.696 [1.028–2.799], p=0.039), and 6-min-walking distance (HR 0.997 [0.995–0.999)], p=0.014), LV-GLS remained significantly associated with outcome (HR 1.093 [1.039–1.150], p=0.001) while RV-GLS had no effect on outcome (p>0.05).
Conclusions
In patients with HFpEF, LV-GLS but not RV-GLS by FT-CMR is significantly associated with cardiovascular events.
Collapse
Affiliation(s)
- A Kammerlander
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Kraiger
- 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
| | - C Dona
- 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
| | - C Zotter-Tufaro
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, 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
|
16
|
Agibetov A, Seirer B, Aschauer S, Dalos D, Rettl R, Duca F, Agis H, Kain R, Binder C, Mascherbauer J, Hengstenberg C, Samwald M, Dorffner G, Bonderman D. P2726Extremely boosted prediction of cardiac amyloidosis by routine laboratory paramaters. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1043] [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/Introduction
Cardiac amyloidosis (CA) is a rare and complex condition with poor prognosis. Novel therapies have been shown to improve outcome, however, most of the affected individuals remain undiagnosed, mainly due to a lack in awareness among clinicians. One approach to overcome this issue is to use automated diagnostic algorithms that act based on routinely available laboratory results.
Purpose
We tested the performance of flexible machine learning and traditional statistical prediction models for non-invasive CA diagnosis based on routinely collected laboratory parameters. Since laboratory routines vary between hospitals or other health care providers, special attention has been taken to adaptive and dynamic parameter selection, and to dealing with the frequent occurrence of missing values.
Methods
Our cohort consisted of 376 clinically accepted patients with various types of heart failure. Of these, 69 were diagnosed with CA via endomyocardial biopsy (positives), and 307 had unrelated cardiac disorders (negatives). A total of 63 routine laboratory parameters were collected from these patients, with a high incidence of missing values (on average 60% of patients for each parameter). We tested the performance of two prediction models: logistic regression, and extreme gradient boosting with regression trees. To deal with missing values we adopted two strategies: a) finding an optimal overlap of parameters and deleting all patients with missing values (reduction of parameters and samples), and b) retaining all features and imputing missing values with parameter-wise means. To fairly assess the performance of prediction models we employed a 10-fold cross validation (stratified to preserve sample class ratio). Finally, area under curve for receiver-operator characteristic (ROC AUC) was used as our final performance measure.
Results
A complex machine learning model based on forests of regression trees proved to be the most performant (ROC AUC 0.94±4%) and robust to missing values. The best regression model was obtained with the 25 most frequent variables and patient deletion in case of missing values (ROC AUC 0.82±0.8%). While progressive inclusion of predictor variables worsened the performance of the logistic regression, it increased that of the machine learning approach.
Conclusions
Extreme gradient boosting of regression trees by routine laboratory parameters achieved staggering accuracy results for the automated diagnosis of CA. Our data suggest that implementations of such algorithms as independent interpreters of routine laboratory results may help to establish or suggest the diagnosis of CA in patients with heart failure symptoms, even in the absence of specialized experts.
Collapse
Affiliation(s)
- A Agibetov
- Medical University of Vienna, Section for Artificial Intelligence and Decision Support; CeMSIIS, Vienna, Austria
| | - B Seirer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Rettl
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - H Agis
- Medical University of Vienna, Oncology, Vienna, Austria
| | - R Kain
- Medical University of Vienna, Pathology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - M Samwald
- Medical University of Vienna, Section for Artificial Intelligence and Decision Support; CeMSIIS, Vienna, Austria
| | - G Dorffner
- Medical University of Vienna, Section for Artificial Intelligence and Decision Support; CeMSIIS, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology, Vienna, Austria
| |
Collapse
|
17
|
Nitsche C, Kammerlander A, Binder C, Duca F, Aschauer S, Koschutnik M, Snidat A, Beitzke D, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. P5258Native T1 time of right ventricular insertion points by CMR: relation with invasive hemodynamics and outcome in HFPEF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0229] [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
Increased afterload to the right ventricle (RV) has been shown to induce myocardial fibrosis at the RV insertion points (RVIPs). Such changes can be discrete but potentially detected by cardiac magnetic resonance (CMR) T1-mapping. Whether RVIP fibrosis is associated with prognosis in heart failure with preserved ejection fraction (HFpEF) is unknown.
Methods
We prospectively investigated 167 consecutive HFpEF patients, a population frequently suffering from postcapillary pulmonary hypertension (PH), who underwent CMR including T1-mapping. 92,8% also underwent right heart catheterization for hemodynamic assessment. Kaplan–Meier analysis, cox regression analysis and Spearman's rank order correlation were applied as statistical methods. The parameter with the strongest discriminative power of each group (clinical, hemodynamic and CMR) by receiver operating curve analysis was selected to the enter the multivariate cox model.
Results
Native T1 times were 995±73 ms at the anterior and 1040±90 ms at the inferior RVIP. By Spearman's rank order testing, RVIP T1 times were significantly correlated with pulmonary artery pressure (mean PAP, r=0.313 and 0.311 for anterior and inferior RVIP, respectively), pulmonary artery wedge pressure (r=0.301 and 0.251) and right atrial pressure (r=0.245 and 0.185; p for all<0.05). During a mean follow-up of 43.2±22.6 months, 30 (18.0%) subjects died. By multivariable Cox regression, NTproBNP (Hazard ratio [HR] 2.105, 95% confidence interval [CI] 1.332–3.328; p=0.001), systolic PAP (HR 1.618, 95% CI 1.175–2.230; p=0.003), and native T1 time of the anterior RVIP (HR 1.659, 95% CI 1.125–2.445; p=0.011) were significantly associated with outcome. Also, by Kaplan-Meier analysis, T1 time at the anterior RVIP had a significant effect on survival (log-rank, p=0.002).
Kaplan Meier Curve
Conclusions
Interstitial expansion of the anterior RVIP as detected by CMR T1-mapping reflects hemodynamic alterations, and is independently related with prognosis in HFpEF.
Collapse
Affiliation(s)
- C Nitsche
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - A Kammerlander
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - C Binder
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - F Duca
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - M Koschutnik
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - A Snidat
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - D Beitzke
- Medical University of Vienna, Vienna, Austria
| | - C Loewe
- Medical University of Vienna, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna- AKH of Vienna- Cardiology Clinic, Vienna, Austria
| |
Collapse
|
18
|
Schoenbauer R, Kammerlander AA, Duca F, Aschauer S, Binder C, Zotter-Tufaro C, Nitsche C, Fiedler L, Roithinger FX, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. 131Left atrial phasic function in heart failure with preserved ejection fraction: cardiac magnetic resonance myocardial feature tracking, invasive hemodynamics and outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0047] [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
Global left atrial (LA) size and function have been shown to be associated with adverse events in heart failure with preserved ejection fraction (HFpEF). The machanism of coupling from left heart failure to pulmonary circulation is still controversially discussed.
Purpose
To study the prognostic most relevant determinant of LA size and function and its backward and forward interplay.
Methods
188 HFpEF patients were prospectively enrolled and underwent baseline clinical assessment, cardiac magnetic resonance imaging (CMR) and invasive hemodynamic assessment. Coronary artery disease was ruled out by coronary angiography. 92 patients were in atrial fibrillation (AF), 96 in sinus rhythm. LA size and function were assessed by CMR including LA strain imaging by myocardial feature tracking (Figure 1A & B).
Results
Patients in AF had more pronounced dilatation of all phasic LA volumes and reduction of all phasic LA functions when compared to sinus rhythm (each p<0.001 respectively).
After 31 (9–57) months 66 patients reached the combined endpoint defined as combination from hospitalization due to heart failure and cardiovascular death. In AF no atrial functional or volume parameter was correlated to outcome. In contrast in sinus rhythm several phasic LA volume and functional parameters were associated with outcome. After multivariate cox regression analysis only reduced total LA ejection fraction and conduit strain rate were still predictive for worse outcome (p=0.031 and <0.001 respectively). After adjustment for known risk factors in HFpEF like age, six minute walking distance (6MWD), systolic pulmonary artery pressure (sPAP) and right ventricular ejection fraction as derived by CMR only impaired LA conduit strain rate remained predicitve for cardiovascular events (p=0.001). In contrast to LA booster pump function LA conduit function parameters were significantly correlated to reduced 6MWD (Figure 1C) and coupled backwards to pulmonary vasculature via correlation to sPAP and pulmonary vascular resistance (PVR) but without coupling to CMR derived elevated LV extracellular volume and left ventricular end diastolic pressure.
Conclusion
Total LA ejection fraction plays a key role in the prognosis of HFpEF. This effect seems to be mainly related to its LA conduit function but not to LA booster pump function. LA conduit function correlates to impaired 6MWD, sPAP and PVR.
Collapse
Affiliation(s)
- R Schoenbauer
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - A A Kammerlander
- 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
| | - S Aschauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Zotter-Tufaro
- 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
| | - L Fiedler
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - F X Roithinger
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - C Loewe
- Medical University of Vienna, Department of Bioimiging and Image-Guided Therapy, 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
|
19
|
Douna H, Smit V, Puijvelde van G, Binder C, Bot I, Kuchroo V, Lichtman A, Kuiper J, Foks A. Tim-1 Mucin Domain-Mutant Mice Display Exacerbated Atherosclerosis. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.074] [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]
|
20
|
Douna H, Amersfoort J, Schaftenaar F, Bot I, Binder C, Yagita H, van Puijvelde G, Kuiper J, Foks A. Btla Stimulation Protects Against Atherosclerosis By Regulating Follicular B Cells. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.290] [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: 11/16/2022]
|
21
|
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
|
22
|
Distelmaier K, Roth C, Schrutka L, Binder C, Steinlechner B, Heinz G, Lang IM, Maurer G, Koinig H, Niessner A, Hülsmann M, Speidl W, Goliasch G. Beneficial effects of levosimendan on survival in patients undergoing extracorporeal membrane oxygenation after cardiovascular surgery. Br J Anaesth 2018; 117:52-8. [PMID: 27317704 DOI: 10.1093/bja/aew151] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of levosimendan treatment on clinical outcome in patients undergoing extracorporeal membrane oxygenation (ECMO) support after cardiovascular surgery is unknown. We hypothesized that the beneficial effects of levosimendan might improve survival when adequate end-organ perfusion is ensured by concomitant ECMO therapy. We therefore studied the impact of levosimendan treatment on survival and failure of ECMO weaning in patients after cardiovascular surgery. METHODS We enrolled a total of 240 patients undergoing veno-arterial ECMO therapy after cardiovascular surgery at a university-affiliated tertiary care centre into our observational single-centre registry. RESULTS During a median follow-up period of 37 months (interquartile range 19-67 months), 65% of patients died. Seventy-five per cent of patients received levosimendan treatment within the first 24 h after initiation of ECMO therapy. Cox regression analysis showed an association between levosimendan treatment and successful ECMO weaning [adjusted hazard ratio (HR) 0.41; 95% confience interval (CI) 0.22-0.80; P=0.008], 30 day mortality (adjusted HR 0.52; 95% CI 0.30-0.89; P=0.016), and long-term mortality (adjusted HR 0.64; 95% CI 0.42-0.98; P=0.04). CONCLUSIONS These data suggest an association between levosimendan treatment and improved short- and long-term survival in patients undergoing ECMO support after cardiovascular surgery.
Collapse
Affiliation(s)
| | - C Roth
- Department of Internal Medicine II
| | | | - C Binder
- Department of Internal Medicine II
| | - B Steinlechner
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - G Heinz
- Department of Internal Medicine II
| | - I M Lang
- Department of Internal Medicine II
| | - G Maurer
- Department of Internal Medicine II
| | - H Koinig
- Department of Anaesthesia and Intensive Care Medicine, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | | | - W Speidl
- Department of Internal Medicine II
| | | |
Collapse
|
23
|
William A, Rössler C, Binder C. Atypische retinale Vaskulitis. Ophthalmologe 2018; 115:683-688. [DOI: 10.1007/s00347-017-0600-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
24
|
Schneider M, Aschauer S, Mascherbauer J, Ran H, Binder C, Lang I, Goliasch G, Binder T. P5635Visual assessment of right ventricular function in echocardiography: how good are we? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2022] Open
Affiliation(s)
- M Schneider
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China People's Republic of
| | - C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - I Lang
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - T Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| |
Collapse
|
25
|
Duca F, Aschauer S, Zotter-Tufaro C, Binder C, Kammerlander AA, Boerries B, Agis H, Kain R, Mascherbauer J, Bonderman D. 5070Riociguat in transthyretin cardiac amyloidosis-data from a named patient use program in austria. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5070] [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: 11/14/2022] Open
Affiliation(s)
- F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | | | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | | | - B Boerries
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - H Agis
- Medical University of Vienna, Oncology, Vienna, Austria
| | - R Kain
- Medical University of Vienna, Pathology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology, Vienna, Austria
| |
Collapse
|
26
|
Even G, Kiss M, Laschet J, Ozvar Kozma M, Simon T, Wigren M, Gaston A, Procopio E, Le Borgne-Moynnier M, Nilsson J, Kuiper J, Nicoletti A, Binder C, Caligiuri G. Vaccination with Prevenar® boosts the production of anti-phosphorylcholine antibodies and protects APOE knockout mice from atherosclerosis. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.903] [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: 10/28/2022]
|
27
|
Binder C, Poglitsch M, Duca FD, Zotter-Tufaro C, Nitsche C, Aschauer S, Kammerlander AA, Mascherbauer J, Bonderman DB. P5652Renin activity is an independent predictor of outcome in patients with heart failure and preserved ejection fraction independent of RAAS blocker therapy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5652] [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: 11/14/2022] Open
Affiliation(s)
- C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | | | - F D Duca
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Zotter-Tufaro
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - A A Kammerlander
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - D B Bonderman
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| |
Collapse
|
28
|
Binder C, Poglitsch M, Duca FD, Zotter-Tufaro C, Nitsche C, Aschauer SA, Masherbauer J, Kammerlander AA, Bonderman D. P5651Angiotensin converting enzyme 2 activity predicts outcome in heart failure with preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5651] [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: 11/14/2022] Open
Affiliation(s)
- C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | | | - F D Duca
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Zotter-Tufaro
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S A Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Masherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - A A Kammerlander
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| |
Collapse
|
29
|
Schoenbauer R, Kammerlander AA, Duca F, Aschauer S, Binder C, Zotter-Tufaro C, Nitsche C, Fiedler L, Roithinger FX, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. P6506Prognostic impact of left atrial function in heart failure with preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6506] [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: 11/14/2022] Open
Affiliation(s)
- R Schoenbauer
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - A A Kammerlander
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - F Duca
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - S Aschauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Binder
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Zotter-Tufaro
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - C Nitsche
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - L Fiedler
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - F X Roithinger
- Landesklinikum Wiener Neustadt, Cardiology, Wiener Neustadt, Austria
| | - C Loewe
- Medical University of Vienna, Department of Bioimiging and Image-Guided Therapy, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| |
Collapse
|
30
|
Kammerlander A, Kraiger J, Nitsche C, Duca F, Zotter-Tufaro C, Binder C, Aschauer S, Loewe C, Hengstenberg C, Bonderman D, Mascherbauer J. P265Tissue tracking by cardiovascular magnetic resonance imaging is associated with outcome in heart failure with preserved ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p265] [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
| | - J Kraiger
- 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
| | - C Zotter-Tufaro
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Binder
- 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
|
31
|
Schreiber C, Eilenberg M, Binder C, Mascherbauer J, Bergmeister H, Bonderman D. P5420Heart rate variability predicts pulmonary artery pressures in experimental pulmonary arterial hypertension in the rat. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5420] [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: 11/14/2022] Open
|
32
|
Binder C, Aschauer S, Duca F, Stelzer P, Agis H, Kain R, Kammerlander A, Mascherbauer J, Bonderman D. P1080Modes of death in cardiac amyloidosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1080] [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: 11/12/2022] Open
|
33
|
Schoenbauer R, Duca F, Kammerlander A, Aschauer S, Binder C, Zotter-Tufaro C, Koschutnik M, Fiedler L, Roithinger F, Bondermann D, Mascherbauer J. P1460Persistent atrial fibrillation and heart failure with preserved ejection fraction a prospective observational study on extracellular volume accumulation, invasive hemodynamics, and outcome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1460] [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: 11/13/2022] Open
|
34
|
Schoenbauer R, Duca F, Kammerlander AA, Aschauer S, Binder C, Zotter-Tufaro C, Koschutnik M, Fiedler L, Roithinger FX, Bondermann D, Mascherbauer J. P1372Prognostic impact of persistent atrial fibrillation in heart failure patients with preserved ejection fraction a prospective observational study. Europace 2017. [DOI: 10.1093/ehjci/eux158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
Binder C, Crilly R, Brown S, Skalet A, Hung A. Plaque Size and Dose in I-125 Eye Plaque Brachytherapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Haiden N, Pimpel B, Assadian O, Binder C, Kreissl A, Repa A, Thanhäuser M, Roberts C, Berger A. Comparison of bacterial counts in expressed breast milk following standard or strict infection control regimens in neonatal intensive care units: compliance of mothers does matter. J Hosp Infect 2016; 92:226-8. [DOI: 10.1016/j.jhin.2015.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
|
37
|
Pocivalnik M, Urlesberger B, Ziehenberger E, Binder C, Schwaberger B, Schmölzer GM, Avian A, Pichler G. Oropharyngeal suctioning in neonates immediately after delivery: influence on cerebral and peripheral tissue oxygenation. Early Hum Dev 2015; 91:153-7. [PMID: 25618390 DOI: 10.1016/j.earlhumdev.2015.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 11/25/2014] [Accepted: 01/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine oropharyngeal suctioning in term vigorous neonates immediately after birth is a questionable practice. Current recommendations favor suctioning only in the presence of considerable obstruction due to secretions, blood or other matter. We aimed to analyze the influence of oropharyngeal suctioning on cerebral and peripheral muscle oxygenation in term neonates during transition immediately after birth. METHODS We included term neonates after elective cesarean section for this prospective observational study. Oropharyngeal suctioning was performed based on the clinicians' judgment of threatening airway obstruction. From a total of 138 enrolled neonates, 36 were suctioned and then compared to 36 controls matched for gestational age. Heart rate (HR) and pre/postductal arterial oxygen saturation (SpO2pre/SpO2post) were measured by pulse oximetry. Cerebral (rSO2brain) and pre/postductal peripheral muscle tissue oxygenation (rSO2pre/rSO2post) were measured by near infrared spectroscopy during the first 15min of life. RESULTS All neonates in both groups experienced normal postnatal transition with normal Apgar scores (Apgar 9/10/10) and with no events of apnea or bradycardia induced by suctioning. SpO2pre values were slightly lower at 2 and 4min after birth. Suctioning had no main and interaction effect on HR, SpO2post, rSO2brain, rSO2pre and rSO2post in the first 15min after birth. CONCLUSION In the present study we were able to show that, in term neonates, when correctly indicated, immediate postnatal oropharyngeal suctioning does not compromise cerebral and peripheral muscle tissue oxygenation. However, any suction maneuver must be performed with caution and strict indication during neonatal transition.
Collapse
Affiliation(s)
- M Pocivalnik
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
| | - B Urlesberger
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria
| | - E Ziehenberger
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria
| | - C Binder
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria
| | - B Schwaberger
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria
| | - G M Schmölzer
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Canada
| | - A Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - G Pichler
- Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria
| |
Collapse
|
38
|
Szilagyi K, Gijbels M, Pottgens C, van Gorp P, Binder C, Kraal G, de Winther M, van den Berg T. Defective signal regulatory protein alpha (sirpa) signaling reduces atherosclerosis in mice. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
39
|
Schmitz J, Pichler G, Schwaberger B, Urlesberger B, Baik N, Binder C. Feasibility of long-term cerebral and peripheral regional tissue oxygen saturation measurements. Physiol Meas 2014; 35:1349-55. [DOI: 10.1088/0967-3334/35/7/1349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
40
|
Binder C, Ziepert M, Pfreundschuh M, Dührsen U, Eimermacher H, Aldaoud A, Rosenwald A, Loeffler M, Schmitz N, Truemper L. CHO(E)P-14 followed by alemtuzumab consolidation in untreated peripheral T cell lymphomas: final analysis of a prospective phase II trial. Ann Hematol 2013; 92:1521-8. [PMID: 23978945 PMCID: PMC3790248 DOI: 10.1007/s00277-013-1880-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/06/2013] [Indexed: 12/16/2022]
Abstract
The rate of long-term remissions after treatment of peripheral T cell lymphomas (PTCL) with standard CHOP-like protocols is unsatisfactory. A prospective multicenter phase II trial was initiated in untreated patients with PTCL of all International Prognostic Index-risk groups, evaluating alemtuzumab consolidation in patients with complete or good partial remission after CHO(E)P-14 induction. Twenty-nine (70.7 %) of the 41 enrolled patients received alemtuzumab consolidation (133 mg in total). The main grades 3–4 toxicities during alemtuzumab therapy were infections and neutropenia with one potentially treatment-related death. Complete responses were seen in 58.5 %, partial responses in 2.4 % and 29.3 % had progressive disease. After a median observation time of 46 months, 19 patients have died, 16 of them due to lymphoma and/or salvage therapy complications. Event-free and overall survival at 3 years in the whole intent to treat population are 32.3 and 62.5 %, respectively, and 42.4 and 75.1 % in the patients who received alemtuzumab. In conclusion, application of a short course of alemtuzumab after CHO(E)P-14 induction is feasible although complicated by severe infections. A current phase III trial, applying alemtuzumab as part of the initial chemotherapy protocol to avoid early progression, will further clarify its significance for the therapeutic outcome.
Collapse
Affiliation(s)
- C Binder
- Department of Haematology and Oncology, Göttingen Comprehensive Cancer Center (G-CCC), Georg-August-University, 37099, Goettingen, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Bleckmann A, Siam L, Klemm F, Rietkötter E, Wegner C, Kramer F, Beissbarth T, Binder C, Stadelmann C, Pukrop T. Nuclear LEF1/TCF4 correlate with poor prognosis but not with nuclear β-catenin in cerebral metastasis of lung adenocarcinomas. Clin Exp Metastasis 2012; 30:471-82. [PMID: 23224985 PMCID: PMC3616220 DOI: 10.1007/s10585-012-9552-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/12/2012] [Indexed: 01/15/2023]
Abstract
An essential function of the transcription factors LEF1/TCF4 in cerebral metastases of lung adenocarcinomas has been described in mouse models, suggesting a WNT/β-catenin effect as potential mechanism. Their role in humans is still unclear, thus we analyzed LEF1, TCF4, β-catenin, and early stage prognostic markers in 25 adenocarcinoma brain metastases using immunohistochemistry (IHC). IHC revealed nuclear TCF4 in all adenocarcinoma samples, whereas only 36 % depicted nuclear LEF1 and nuclear β-catenin signals. Samples with nuclear LEF1 as well as high TCF4 (++++) expression were associated with a shorter survival (p = 0.01, HR = 6.68), while nuclear β-catenin had no significant impact on prognosis and did not significantly correlate with nuclear LEF1. High proliferation index Ki67 was associated with shorter survival in late-stage disease (p = 0.03, HR 3.27). Additionally, we generated a LEF1/TCF4 as well as an AXIN2 signature, the latter as representative of WNT/β-catenin activity, following a bioinformatics approach with a gene expression dataset of cerebral metastases in lung adenocarcinoma. To analyze the prognostic relevance in primary lung adenocarcinomas, we applied both signatures to a microarray dataset of 58 primary lung adenocarcinomas. Only the LEF1/TCF4 signature was able to separate clusters with impact on survival (p = 0.01, HR = 0.32). These clusters displayed diverging enrichment patterns of the cell cycle pathway. In conclusion, our data show that LEF1/TCF4, but not β-catenin, have prognostic relevance in primary and cerebrally metastasized human lung adenocarcinomas. In contrast to the previous in vivo findings, these results indicate that LEF1/TCF4 act independently of β-catenin in this setting.
Collapse
Affiliation(s)
- A. Bleckmann
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - L. Siam
- Department of Neurosurgery, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - F. Klemm
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - E. Rietkötter
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Chr. Wegner
- Department of Neuropathology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - F. Kramer
- Department of Medical Statistics, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - T. Beissbarth
- Department of Medical Statistics, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - C. Binder
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Chr. Stadelmann
- Department of Neuropathology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - T. Pukrop
- Department of Hematology/Oncology, University Medical Center Göttingen, 37099 Göttingen, Germany
| |
Collapse
|
42
|
Barrett BH, Beck R, Binder C, Cook DA, Engelmann S, Greer RD, Kyrklund SJ, Johnson KR, Maloney M, McCorkle N, Vargas JS, Watkins CL. The right to effective education. Behav Anal 2012; 14:79-82. [PMID: 22478085 DOI: 10.1007/bf03392556] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
43
|
Pocivalnik M, Pichler G, Binder C, Ziehenberger E, Zotter H, Müller W, Urlesberger B. Der Einfluss von postnatalem oropharyngealem Absaugen auf die zerebrale und peripher muskuläre Oxygenierung während der Adaptionsphase. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293303] [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: 10/15/2022]
|
44
|
Brandstätter H, Schulz P, Binder C, Römisch J. Purification and biochemical characterization of complement factor H from human plasma fractions. Mol Immunol 2011. [DOI: 10.1016/j.molimm.2011.06.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
45
|
Klemm F, Bleckmann A, Siam L, Chuang H, Rietkötter E, Behme D, Schulz M, Schaffrinski M, Schindler S, Trümper L, Kramer F, Beissbarth T, Stadelmann C, Binder C, Pukrop T. β-catenin-independent WNT signaling in basal-like breast cancer and brain metastasis. Carcinogenesis 2010; 32:434-42. [DOI: 10.1093/carcin/bgq269] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
46
|
Pukrop T, Bleckmann A, Einspanier A, Binder C. Rapid progression of hormone receptor-negative breast cancer concomitant with ovarian stimulation--a paradoxon? Ann Oncol 2009; 20:2020-2. [PMID: 19773248 DOI: 10.1093/annonc/mdp457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
47
|
Binder C, Nielsen A, Jørgensen K. The Absorption of an Acid and a Neutral Insulin Solution after Subcutaneous Injection into Different Regions in Diabetic Patients. Scandinavian Journal of Clinical and Laboratory Investigation 2009. [DOI: 10.3109/00365516709093496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
48
|
Kjer B, Larsen M, Bendtson I, Binder C, Dalgaard P, Lund-Andersen H. Lens autofluorescence in diabetes compared with the level of glycosylated hemoglobin A1c. Acta Ophthalmol 2009; 182:100-2. [PMID: 2837042 DOI: 10.1111/j.1755-3768.1987.tb02602.x] [Citation(s) in RCA: 5] [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: 01/02/2023]
Abstract
The autofluorescence of the crystalline lens has been measured by an ocular fluorophotometer in two comparable groups of patients with insulin-dependent diabetes mellitus. One group has had a high level of HbA1c since the onset of diabetes (mean 10.1 per cent) and the other group a very low level (mean 6.5 per cent). The group with low HbA1c during the disease period showed a significantly lower lens fluorescence than the group with high HbA1c.
Collapse
Affiliation(s)
- B Kjer
- University Eye Clinic, Gentofte Hospital, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
49
|
|
50
|
Madsbad S, Krarup T, McNair P, Christiansen C, Faber OK, Transbøl I, Binder C. Practical clinical value of the C-peptide response to glucagon stimulation in the choice of treatment in diabetes mellitus. Acta Med Scand 2009; 210:153-6. [PMID: 7027749 DOI: 10.1111/j.0954-6820.1981.tb09793.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In order to discriminate between insulin-dependent and non-insulin-dependent patients, serum C-peptide concentration was determined using antiserum M1230 in the fasting state and 6 min after an i.v. injection of 1 mg glucagon in 215 patients treated with insulin and 53 treated with diet and oral antidiabetics. A patient was considered well controlled without insulin when fasting blood glucose was below 8 mmol/l and when glucosuria was absent. After re-evaluation of therapy in hospital it was found that the majority of patients with a post-stimulatory serum C-peptide concentration above 0.60 pmol/ml appeared to have non-insulin-dependent diabetes mellitus. When fasting C-peptide was used, a great overlap was found between the two treatment groups. During evaluation of therapy in hospital, 6 previously insulin-treated patients could be well treated with diet and tablets and 6 diet- and tablet-treated patients required insulin. The glucagon test seems to be of value in the outpatient clinic to discriminate non-insulin-dependent from insulin-dependent patients.
Collapse
|