1
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Hagendorff A, Helfen A, Brandt R, Knebel F, Altiok E, Ewers A, Haghi D, Knierim J, Merke N, Romero-Dorta E, Ruf T, Sinning C, Stöbe S, Ewen S. Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography. Clin Res Cardiol 2024; 113:393-411. [PMID: 37212864 PMCID: PMC10881739 DOI: 10.1007/s00392-023-02227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
The assessment of valvular pathologies in multiple valvular heart disease by echocardiography remains challenging. Data on echocardiographic assessment-especially in patients with combined aortic and mitral regurgitation-are rare in the literature. The proposed integrative approach using semi-quantitative parameters to grade the severity of regurgitation often yields inconsistent findings and results in misinterpretation. Therefore, this proposal aims to focus on a practical systematic echocardiographic analysis to understand the pathophysiology and hemodynamics in patients with combined aortic and mitral regurgitation. The quantitative approach of grading the regurgitant severity of each compound might be helpful in elucidating the scenario in combined aortic and mitral regurgitation. To this end, both the individual regurgitant fraction of each valve and the total regurgitant fraction of both valves must be determined. This work also outlines the methodological issues and limitations of the quantitative approach by echocardiography. Finally, we present a proposal that enables verifiable assessment of regurgitant fractions. The overall interpretation of echocardiographic results includes the symptomatology of patients with combined aortic and mitral regurgitation and the individual treatment options with respect to their individual risk. In summary, a reproducible, verifiable, and transparent in-depth echocardiographic investigation might ensure consistent hemodynamic plausibility of the quantitative results in patients with combined aortic and mitral regurgitation.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - A Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lunen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - R Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2‑8, 61231, Bad Nauheim, Germany
| | - F Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - E Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, de La Camp-Platz 1, 44789, Bochum, Germany
| | - D Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universitat Mannheim-Ludwig-Guttmann, Strasse 11, 67071, Ludwigshafen, Germany
| | - J Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25‑39, 14055, Berlin, Germany
| | - N Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Romero-Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, University of Berlin, German Heart Center Charité Berlin, Campus Mitte, Chariteplatz 1, 10117, Berlin, Germany
| | - T Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - C Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lubeck, Martinistrasse 52, 20251, Hamburg, Germany
| | - S Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - S Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Homburg, Germany
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2
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Hagendorff A, Helfen A, Brandt R, Altiok E, Breithardt O, Haghi D, Knierim J, Lavall D, Merke N, Sinning C, Stöbe S, Tschöpe C, Knebel F, Ewen S. Expert proposal to characterize cardiac diseases with normal or preserved left ventricular ejection fraction and symptoms of heart failure by comprehensive echocardiography. Clin Res Cardiol 2023; 112:1-38. [PMID: 35660948 PMCID: PMC9849322 DOI: 10.1007/s00392-022-02041-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023]
Abstract
Currently, the term "heart failure with preserved left ventricular ejection fraction (HFpEF)" is based on echocardiographic parameters and clinical symptoms combined with elevated or normal levels of natriuretic peptides. Thus, "HFpEF" as a diagnosis subsumes multiple pathophysiological entities making a uniform management plan for "HFpEF" impossible. Therefore, a more specific characterization of the underlying cardiac pathologies in patients with preserved ejection fraction and symptoms of heart failure is mandatory. The present proposal seeks to offer practical support by a standardized echocardiographic workflow to characterize specific diagnostic entities associated with "HFpEF". It focuses on morphological and functional cardiac phenotypes characterized by echocardiography in patients with normal or preserved left ventricular ejection fraction (LVEF). The proposal discusses methodological issues to clarify why and when echocardiography is helpful to improve the diagnosis. Thus, the proposal addresses a systematic echocardiographic approach using a feasible algorithm with weighting criteria for interpretation of echocardiographic parameters related to patients with preserved ejection fraction and symptoms of heart failure. The authors consciously do not use the diagnosis "HFpEF" to avoid misunderstandings. Central illustration: Scheme illustrating the characteristic echocardiographic phenotypes and their combinations in patients with "HFpEF" symptoms with respect to the respective cardiac pathology and pathophysiology as well as the underlying typical disease.
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Affiliation(s)
- A. Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - A. Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534 Lünen, Germany
| | - R. Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - E. Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - O. Breithardt
- Klinik für Innere Medizin-Kardiologie and Rhythmologie, Agaplesion Diakonie Kliniken Kassel, Herkulesstrasse 34, 34119 Kassel, Germany
| | - D. Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universität Mannheim-Ludwig-Guttmann, Strasse 11, 67071 Ludwigshafen, Germany
| | - J. Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25-39, 14055 Berlin, Germany
| | - D. Lavall
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - N. Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20251 Hamburg, Germany
| | - S. Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - C. Tschöpe
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,BIH Center for Regenerative Therapies (BCRT), Augustenburger Platz 1, 13353 Berlin, Germany ,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365 Berlin, Germany ,Department of Cardiology, University of Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - S. Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse, 66421 Homburg, Germany
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3
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Giertzsch T, Kölbel T, Müller G, Kozlik-Feldmann R, Schneider P, Zengin-Sahm E, Sinning C, Lang N, Redlefsen T, Peldschus K, Weinrich J, Krause A, Rickers C. Unentdeckte Aortenisthmusstenosen (CoAs) als Ursache für ungeklärte arterielle Hypertonien bei Jugendlichen und Erwachsenen. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Giertzsch
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
| | - T. Kölbel
- Vascular Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - G. Müller
- Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - P. Schneider
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
| | - E. Zengin-Sahm
- University Heart Center Hamburg GmbH, Hamburg, Deutschland, Hamburg, Deutschland
| | - C. Sinning
- Department of Cardiovascular Surgery, University Heart Center Hamburg GmbH, Hamburg, Deutschland
| | - N. Lang
- Department of Pediatr Cardiology, Children's Heart Clinic, Univ Med Center Eppendorf, Hamburg, Deutschland
| | - T. Redlefsen
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
| | - K. Peldschus
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - J. Weinrich
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - A. Krause
- University Medical Center Hamburg-Eppendorf, Hamburg, Deutschland
| | - C. Rickers
- University Heart Center Hamburg GmbH, Hamburg, Deutschland
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4
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Yildirim Y, Yildirim S, Petersen J, Alassar Y, Sinning C, Conradi L, Reichenspurner H, Pecha S. Left-Atrial Strain Predicts Rhythm Outcome in Patients with Persistent Atrial Fibrillation Undergoing Left-Atrial Cryoablation during Minimally Invasive Endoscopic Mitral Valve Repair. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Y. Yildirim
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - S. Yildirim
- Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - J. Petersen
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - Y. Alassar
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - C. Sinning
- Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - L. Conradi
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - H. Reichenspurner
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - S. Pecha
- Herzchirurgie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
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5
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Holst T, Petersen J, Waschki B, Sinning C, Rybczynski M, Reichenspurner H, Girdauskas E. Evaluation of Exercise Capacity after Aortic Valve Surgery for Aortic Regurgitation in Nonelderly Patients: Repair versus Replacement. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T. Holst
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - J. Petersen
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - B. Waschki
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - C. Sinning
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - M. Rybczynski
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Kardiologie, Hamburg, Deutschland
| | - H. Reichenspurner
- Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH
- Klinik für Herz- und Gefäßchirurgie, Hamburg, Deutschland
| | - E. Girdauskas
- Klinik für herz- und thoraxchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland
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6
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Qaderi V, Weimann J, Harbaum L, Schrage B, Knappe D, Sinning C, Schnabel R, Blankenberg S, Kirchhof P, Klose H, Magnussen C. Non-invasive risk prediction based on right ventricular function in patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1960] [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
Individual risk assessment in patients with pulmonary arterial hypertension (PAH) is fundamental to improve their outcome. Although right ventricular (RV) dysfunction is a major determinant of outcome in PAH, echocardiographic measures of RV function are poorly represented by current risk models.
Objective
The objective of this study was to identify echocardiographic measures of RV function, which are associated with adverse outcome and to develop a non-invasive, echocardiography-based risk score for PAH patients.
Methods
In 254 patients with PAH we analyzed functional status, laboratory results, pulmonary function and echocardiographic measures. Echocardiographic measures comprised RV chamber diameters, right atrial area, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), 2D RV strain and pericardial effusion. We used Cox regression models to assess the association with the composite endpoint of 5-year all-cause death or lung transplantation. The analyses included a conventional model using only guideline-recommended variables and a model adding significant echocardiographic measures. Based on the final multivariable model a point risk score was derived, indicating the association with the primary outcome.
Results
Median age was 65.5 years, 33.9% were females. During a median follow-up time of 4.18 years 74 patients died (n=63) or underwent lung transplantation (n=11). In univariable analyses low systolic blood pressure (Hazard ratio [HR] 0.99, 95% Confidence Interval [CI] 0.98,1.00), NYHA functional class IV (HR 3.23, 95% CI 1.48,7.07), 6-minute walk distance (HR 1.00, 95% CI 1.00,1.00), NT-proBNP concentrations (HR 1.00, 95% CI 1.00,1.00), renal impairment (HR 0.99, 95% CI 0.98,1.00), reduced diffusion capacity for carbon monoxide (HR 0.99, 95% CI 0.98,1.00), reduced TAPSE (HR 0.90, 95% CI 0.85,0.96) and reduced FAC (HR 0.97, 95% CI 0.94,1.00) were associated with the endpoint. A multivariable, conventional risk model, including NYHA functional class, 6-minute walk distance, NT-proBNP concentrations, pericardial effusion and right atrial area, resulted in a C-Index of 0.539. Adding TAPSE and FAC to this model improved the performance significantly (C-index 0.639, p-value 0.017). This model was translated to a 12-point score with the highest weighting assigned to TAPSE, FAC, pericardial effusion and 6-minute walk distance (Figure).
Conclusion
An easily applicable score integrating non-invasive, echocardiographic parameters of RV function improves prediction of adverse outcome in PAH patients.
Funding Acknowledgement
Type of funding sources: None. Risk prediction chart
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Affiliation(s)
- V Qaderi
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Harbaum
- The University Medical Center Hamburg-Eppendorf, Department of Pulmonology, Hamburg, Germany
| | - B Schrage
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - D Knappe
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Sinning
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schnabel
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - H Klose
- The University Medical Center Hamburg-Eppendorf, Department of Pulmonology, Hamburg, Germany
| | - C Magnussen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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7
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Sinning C, Makarova N, Schnabel R, Ojeda F, Felix SB, Koenig W, Peters A, Rathmann W, Brenner H, Kuulasmaa K, Wilsgaard T, Blankenberg S, Soderberg S, Ferrario MM, Thorand B. Association of glycated haemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE consortium. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2624] [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
Glycated haemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment; however, its role in predicting cardiovascular outcomes in the general population remains uncertain.
Purpose
The additional use of glycated haemoglobin A1c (HbA1c) as a biomarker might highlight subjects of the general population with an increased risk for cardiovascular outcomes with cardiovascular disease, cardiovascular mortality or overall-mortality.
Methods
Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analysed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular diseases (CVD), and overall mortality in the study population, in non-diabetic (N=32,477), and diabetic participants (N=3,703).
Results
Kaplan-Meier curves showed higher event rates with increasing continuous log-transformed HbA1c levels. Cox regression analysis revealed significant associations between HbA1c (in mmol/mol) log-transformed divided by interquartile range and the examined outcomes, with a hazard ratio (HR) of 1.12 (95% confidence interval (CI): 1.04–1.20, p=0.0019) for cardiovascular mortality, 1.10 (95% CI: 1.04–1.16, p<0.001) for CVD, and 1.09 (95% CI: 1.05–1.14, p<0.001) for overall mortality per one unit increase.
An increased risk of CVD was observed in subjects without diabetes with increased HbA1c levels (HR 1.09; 95% CI: 1.01–1.16, p=0.021). An HbA1c cut-off value of 39.89 mmol/mol (5.8%), 36.62 mmol/mol (5.5%), and 38.80 mmol/mol (5.7%) for cardiovascular mortality, CVD, and overall mortality, respectively, was determined for selecting individuals at an increased risk.
Conclusion
HbA1c was demonstrated to be an independent prognostic biomarker for all investigated outcomes in the general European population. An approximately linear relationship was observed between an increase of HbA1c levels and the outcomes. Elevated HbA1c levels were also associated with the outcomes in participants without diabetes (i.e. HbA1c levels <6.5% (<48mmol/mol) which underlines the importance of HbA1c levels in the overall population.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union Seventh Framework ProgrammeEuropean Union FP 7 project CHANCES Kaplan-Meier curves for the outcomesPenalised cubic splines HbA1c/time event
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Affiliation(s)
- C Sinning
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - N Makarova
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - R Schnabel
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - F Ojeda
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S B Felix
- University Hospital of Greifswald, Department of Internal Medicine B, Greifswald, Germany
| | - W Koenig
- Deutsches Herzzentrum Muenchen Technical University of Munich, Department of Cardiology, Munich, Germany
| | - A Peters
- Helmholtz Center Munich - German Research Center for Environment and Health, Institute of Epidemiology, Munich, Germany
| | - W Rathmann
- German Diabetes Centre Duesseldorf, Department of Epidemiology, Duesseldorf, Germany
| | - H Brenner
- German Cancer Research Center, Division of Clinical Epidemiology and Ageing Research, Heidelberg, Germany
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - T Wilsgaard
- UiT The Arctic University of Norway, Epidemiology of Chronic Diseases Research Group, Tromso, Norway
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - S Soderberg
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - M M Ferrario
- University of Insubria, EPIMED Research Centre, Varese, Italy
| | - B Thorand
- Helmholtz Center Munich - German Research Center for Environment and Health, German Centre for Diabetes Research, Munich, Germany
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Böning H, Petersen J, Sinning C, Yildirim S, Yildirim Y, Reichenspurner H, Pecha S. Echocardiographic Evaluation of Different LAA Closure Techniques during Concomitant Surgical AF Ablation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Pausch J, Gross TMS, Müller L, von Stumm M, Kloth B, Sinning C, Reichenspurner H, Girdauskas E. Improved Long-Term Outcome after Standardized Subvalvular Mitral Valve Repair for Type IIIB Functional Mitral Regurgitation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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von Stumm M, Florian D, Holst T, Gross TMS, Mueller L, Pausch J, Sinning C, Reichenspurner H, Girdauskas E. Predicting Clinical Outcome by Indexed Mitral Valve Tenting in Functional Mitral Valve Regurgitation. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Sinning C, Knappe D, Sinning JM, Hagendorff A. Antwort auf den Leserbrief zum Beitrag: Christoph Sinning, Dorit Knappe, Jan-Malte Sinning, Andreas Hagendorff. Differenzialdiagnose der Linksherzhypertrophie. Aktuel Kardiol 2020; 9: 43 – 49. Aktuelle Kardiologie 2020. [DOI: 10.1055/a-1191-2324] [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: 10/24/2022]
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12
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Pausch J, Sequeira Gross TM, Müller L, Kloth B, Sinning C, Reichenspurner H, Girdauskas E. Subannular Repair for Functional Mitral Regurgitation Type IIIb in Patients with Ischemic versus Dilated Cardiomyopathy. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Becher PM, Schrage B, Schmack B, Sinning C, Fluschnik N, Waldeyer C, Seiffert M, Neumann JT, Bernhardt AM, Reichenspurner H, Zeymer U, Thiele H, Blankenberg S, Twerenbold R, Westermann D. 281Impact of complications on VA-ECMO support for cardiopulmonary support: analysis of 8,351 adult patients in Germany from 2007 to 2015. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0086] [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
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for treatment of patients with critical cardiopulmonary failure. However, utilization of VA-ECMO support must be carefully weighed against possible complications. Therefore, we investigated the incidence and impact of complications on VA-ECMO support in one of the largest datasets of VA-ECMO therapy.
Material and methods
We analyzed complications and outcomes of all VA-ECMO procedures performed in Germany from 2007 to 2015 by using administrative data from the German Federal Health Monitoring System. For the present analyses all cases treated with VA-ECMO between 2007 and 2015 were identified and selected by the primary procedural code (OPS) for VA-ECMO (OPS code 8852.3).
Results
Among 8,351 patients undergoing VA-ECMO between 2007 and 2015, there were significant changes in complication rates over time such as increase in acute kidney injury (from 35.9% in 2007–2012 to 44.6% in 2013–2015), major bleeding (from 11.3% in 2007–2012 to 19.5% in 2013–2015 and abdominal ischemia (from 4.5% in 2007–2009 to 7.2% in 2013–2015). The incidence of stroke and limb ischemia did not differ over time. Procedure-related and ischemic complications were more frequently observed in non-survivors as compared to survivors (12.2% versus 15.3%, p<0.001) except for major bleeding (20.9% in survivors versus 15.0% in non-survivors, p<0.001). Multivariate analyses retained stroke and acute kidney injury as being significantly associated with 30-day in-hospital mortality, with respective OR [95% CI] of 1.7 [1.0–2.9] and 1.2 [1.1–1.3].
Conclusion
In one of the largest registries, major bleeding and ischemic events are the most common complications on VA-ECMO support. Ischemic complications seem to influence outcome more than bleeding complications. However, only stroke and acute kidney injury were independently associated with higher mortality rates. These findings should be incorporated in risk-benefit stratification when initiation of VA-ECMO and in prevention of complications to avoid additional morbidity and mortality in these critically ill patients.
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Affiliation(s)
- P M Becher
- University Heart Center Hamburg, Hamburg, Germany
| | - B Schrage
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - B Schmack
- University Hospital of Heidelberg, Department of Cardiac Surgery, Heidelberg, Germany
| | - C Sinning
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - N Fluschnik
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - C Waldeyer
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - M Seiffert
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - J T Neumann
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - A M Bernhardt
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - H Reichenspurner
- University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Cardiology, Ludwigshafen Am Rhein, Germany
| | - H Thiele
- Heart Center of Leipzig, Cardiology, Leipzig, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
| | - R Twerenbold
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Westermann
- University Heart Center Hamburg, Cardiology, Hamburg, Germany
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14
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Neumann JT, Gossling A, Soerensen N, Zeller T, Blankenberg S, Sinning C, Westermann D. P1733Dynamic changes of high-sensitivity troponin I after non-invasive stress-testing. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0488] [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
Objective
In patients with suspected coronary artery disease (CAD) and intermediate pretest probability non-invasive stress-testing is recommended in current guidelines. However, sensitivity and specificity of these tests are limited. We aimed to investigate the additional diagnostic value of high-sensitivity troponin I concentrations measured before and after stress-testing.
Methods
We included patients undergoing non-invasive stress-testing in a prospective cohort study. All patients provided written informed consent, were at least 18 years old and underwent either stress-echocardiography, stress-MRI or myocardial perfusion scintigraphy. Baseline parameters were collected by questionnaire and chart review. Blood samples were collected before, and one hour after the stress-test. Troponin was measured using the Abbott Architect high-sensitivity troponin I (hs-TnI) assay. The diagnostic performance to predict a pathological stress-test was evaluated by calculation of the area under the ROC curve (AUC) using baseline hs-TnI concentrations and the absolute change after one hour. An optimal cutoff was determined by maximization of the Youden Index. Univariate odds ratios (OR) were calculated to identify predictors for a pathological stress-test. Additionally ORs for the optimal hs-TnI cutoff were calculated in a multivarite regression with adjustment for baseline variables.
Results
In total 391 patients with a median age of 70 years were included. 66.8% were males, 83.4% had prevalent hypertension, 55.9% had dyslipidemia and 55.4% had a prior history of CAD. A pathological stress-test was reported in 21.5% and these patients had a higher cardiovascular risk profile, compared to patients with a non-pathological stress-test. The baseline hs-TnI concentrations were 4.7 ng/L in the overall population, 4.2 ng/L in patients with a non-pathological stress-test and 8.4 ng/L (p<0.001) in patients with a pathological stress-test. There was no significant hs-TnI changes one hour after stress-testing. The AUC for the baseline hs-TnI was 0.65 and the optimal cutoff was determined at 7.7 ng/L. Most cardiovascular risk factors were predictors for a pathological stress-test. The OR for an elevated hs-TnI above the optimized cutoff was 3.34 (95% CI 2.03, 5.52). In a multivariate model a baseline hs-TnI above 7.7 ng/L showed an OR of 2.07 (95% CI 1.04, 4.12; p-value 0.039)
Conclusion
In patients undergoing non-invasive stress-testing, hs-TnI concentrations did not significantly change one hour after exercise. However, an elevated troponin concentration is an independent predictor for a pathological stress-test.
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Affiliation(s)
- J T Neumann
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - A Gossling
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - N Soerensen
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - T Zeller
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - S Blankenberg
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - C Sinning
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
| | - D Westermann
- University Heart Center Hamburg, Clinic for General & Interventional Cardiology, Hamburg, Germany
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15
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Bernhardt A, Hakmi S, Sinning C, Lubos E, Reichenspurner H. First-in-Man Implantations of a Newly Developed Transaortic Axial Flow Ventricular Assist Device (Impella 5.5). J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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16
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Subbotina I, Bernhardt M, Girdauskas E, Sinning C, Reichenspurner H, Sill B. Concomitant Surgery of Moderate Tricuspid Regurgitation—An Increase in Perioperative Risk for Elderly Patients? Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I. Subbotina
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - M. Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - E. Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - C. Sinning
- Department of General and Interventional Cardiology, University Heart Center Eppendorf, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - B. Sill
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
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17
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Subbotina I, Bernhardt M, Girdauskas E, Sinning C, Reichenspurner H, Sill B. Outcome of Concomitant Tricuspid Valve Surgery in Patients with Mild or Moderate Tricuspid Valve Regurgitation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- I. Subbotina
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - M. Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - E. Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - C. Sinning
- Department of General and Interventional Cardiology, University Heart Center Eppendorf, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
| | - B. Sill
- Department of Cardiovascular Surgery, University Heart Center Eppendorf, Hamburg, Germany
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18
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Petersen J, Holst T, Krohm S, Neumann N, Sinning C, Reichenspurner H, Girdauskas E. Impact of Postoperative Annular Diameter on Mid-term Outcomes of Aortic Valve Repair. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. Petersen
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - T. Holst
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - S. Krohm
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Neumann
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Sinning
- Department of General and Interventional Cardiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - E. Girdauskas
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, Hamburg, Germany
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19
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von Stumm M, Sequeira T, Dudde F, Sinning C, Reichenspurner H, Girdauskas E. Mid-Term Outcomes of Mitral Valve Annuloplasty in Type I versus Type IIIb Functional Mitral Regurgitation. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- M. von Stumm
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - T. Sequeira
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - F. Dudde
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
| | - C. Sinning
- Universitäres Herzzentrum Hamburg, Kardiologie, Hamburg, Germany
| | | | - E. Girdauskas
- Universitäres Herzzentrum Hamburg, Herzchirurgie, Hamburg, Germany
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20
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Becher M, Sinning C, Schrage B, Fluschnik N, Waldeyer C, Seiffert M, Bernhardt A, Reichenspurner H, Blankenberg S, Twerenbold R, Westermann D. Risk Prediction in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiopulmonary Support: Insights from a European Nationwide Registry. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M. Becher
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Sinning
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - B. Schrage
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - N. Fluschnik
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Waldeyer
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - M. Seiffert
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - A. Bernhardt
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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21
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Harmel E, Pausch J, Kloth B, Sinning C, Kubitz J, Reichenspurner H, Girdauskas E. Subannular Repair in Mitral Valve Surgery for Type IIIb Functional Mitral Regurgitation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E. Harmel
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Pausch
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - B. Kloth
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - C. Sinning
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - J. Kubitz
- Universitäres Herzzentrum Hamburg, Hamburg, Germany
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22
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Subbotina I, Bernhardt A, Sinning C, Reichenspurner H, Sill B. Predictors for Perioperative Mortality following Tricuspid Valve Surgery. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- I. Subbotina
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - A. Bernhardt
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - C. Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - B. Sill
- Department of Cardiovascular Surgery, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
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23
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Gasser S, Reichart D, Sinning C, Blankenberg S, Reichenspurner H, Girdauskas E. Failures after Mitral Valve Repair for Functional Mitral Regurgitation: A Propensity Score Matched Analysis. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S. Gasser
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - D. Reichart
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - C. Sinning
- Department of General and Interventional Cardiology, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - S. Blankenberg
- Department of General and Interventional Cardiology, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - H. Reichenspurner
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
| | - E. Girdauskas
- Department of Cardiovascular Surgery, Universitäres Herzzentrum Hamburg, UKE, Hamburg, Germany
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24
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Waldeyer C, Brunner F, Seiffert M, Kohsiack R, Schrage B, Sinning C, Karakas M, Zeller T, Westermann D, Blankenberg S, Sydow K, Schnabel R. 2853Poor adherence to mediterranean diet is independently associated with the severity of coronary artery disease - contemporary data from the INTERCATH study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2853] [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: 11/14/2022] Open
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25
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Tzikas S, Doundoulakis I, Zeller T, Sinning C, Baldus S, Bickel C, Vassilikos V, Lackner K, Munzel T, Blankenberg S, Keller T. P4698Adding the predictive value of BNP to the GRACE Score in patients presenting with acute chest pain. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4698] [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
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26
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Subbotina I, Girdauskas E, Bernhardt A, Sinning C, Reichenspurner H, Sill B. Outcome of Tricuspid Valve Surgery in Patients with Reduced Right Ventricular Function. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I. Subbotina
- UKE, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - E. Girdauskas
- UKE, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - A. Bernhardt
- UKE, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - C. Sinning
- UKE, Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- UKE, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - B. Sill
- UKE, Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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27
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Gasser S, Reichart D, Sinning C, Blankenberg S, Detter C, Conradi L, Wagner F, Marcsek P, Reichenspurner H, Girdauskas E. Failures in Mitral Valve Repair: Echocardiographic and Surgical Predictors. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Gasser
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - D. Reichart
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - C. Sinning
- UKE, Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - S. Blankenberg
- UKE, Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - C. Detter
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - L. Conradi
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - F. Wagner
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - P. Marcsek
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - H. Reichenspurner
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - E. Girdauskas
- UKE, Department of Cardiothoracic Surgery, University Heart Center Hamburg, Hamburg, Germany
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28
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Bickel C, Schnabel RB, Zengin E, Lubos E, Rupprecht H, Lackner K, Proust C, Tregouet D, Blankenberg S, Westermann D, Sinning C. Homocysteine concentration in coronary artery disease: Influence of three common single nucleotide polymorphisms. Nutr Metab Cardiovasc Dis 2017; 27:168-175. [PMID: 27773468 DOI: 10.1016/j.numecd.2016.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/02/2016] [Revised: 08/20/2016] [Accepted: 09/05/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Whether single nucleotide polymorphisms (SNPs) of homocysteine metabolism enzymes influence the rate of cardiovascular (CV) events in coronary artery disease (CAD) patients remains controversial. METHODS AND RESULTS In this analysis, 1126 subjects from the AtheroGene study with CAD and 332 control subjects without known CAD were included. The following SNPs were investigated: methylentetrahydrofolate reductase (MTHFR-C667T), methionin synthetase (MS-D919G), and cystathionin beta synthetase (CBS-I278T). The endpoint was the combination of cardiovascular death, stroke, and non-fatal myocardial infarction (N = 286). The median follow-up time was 6.4 years. Kaplan-Meier curve analysis showed an increasing event rate with rising homocysteine levels (p < 0.001) in CAD patients. Further, in Cox-Regression analysis homocysteine was a predictor of the endpoint with a hazard ratio (HR) of 6.5 (95% CI: 2.9-14.6, p < 0.001) in the adjusted model including cardiovascular risk factors. Of the three SNPs, homozygous MTHFR SNP increased homocysteine levels significantly in patients with CAD and individuals without CAD (both p < 0.001). The SNPs in MS and CBS were not related to relevant changes in homocysteine levels in CAD patients or controls. The different SNPs of MTHFR, MS, and CBS were not related to an increased event rate. CONCLUSION Homocysteine level is a strong predictor of CV events. Subjects with and without CAD and SNPs in the enzyme MTHFR had increased homocysteine levels. This was not observed for MS and CBS SNPs. Although MTHFR SNPs alter homocysteine levels in patients and controls, these polymorphisms had no impact on prognosis in CAD patients.
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Affiliation(s)
- C Bickel
- Department of Internal Medicine, Federal Armed Forces Central Hospital, Koblenz, Germany
| | - R B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - E Zengin
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - E Lubos
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - H Rupprecht
- Department of Medicine II, GPR Rüsselsheim, Rüsselsheim, Germany
| | - K Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - C Proust
- ICAN Institute for Cardiometabolism and Nutrition, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Paris, France
| | - D Tregouet
- ICAN Institute for Cardiometabolism and Nutrition, Paris, France; Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166, Team Genomics & Pathophysiology of Cardiovascular Diseases, Paris, France
| | - S Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - D Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - C Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
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29
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Kovacs G, Dumitrescu D, Barner A, Greiner S, Grünig E, Hager A, Köhler T, Kozlik-Feldmann R, Kruck I, Lammers A, Mereles D, Meyer A, Meyer FJ, Pabst S, Seyfarth HJ, Sinning C, Sorichter S, Stähler G, Wilkens H, Held M. [Clinical classification and initial diagnosis of pulmonary hypertension: recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S10-S18. [PMID: 27760445 DOI: 10.1055/s-0042-114523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the clinical classification and diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the clinical classification and initial diagnosis of PH. This article summarizes the results and recommendations of this working group.
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30
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Waldeyer C, Karakas M, Scheurle C, Ojeda F, Schnabel RB, Zeller T, Zengin E, Westermann D, Schrage B, Bickel C, Rupprecht HJ, Lackner KJ, Blankenberg S, Seiffert M, Sinning C. The predictive value of different equations for estimation of glomerular filtration rate in patients with coronary artery disease - Results from the AtheroGene study. Int J Cardiol 2016; 221:908-13. [PMID: 27441467 DOI: 10.1016/j.ijcard.2016.07.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Impaired renal function leads to dramatically increased risk for the development and progression of coronary artery disease (CAD). Therefore we aimed to assess the predictive value of different equations for estimated glomerular filtration rate (eGFR) in CAD-patients. METHODS From the AtheroGene study 2135 patients were included. eGFR was calculated using the 4-variable Modification of Diet in Renal Disease (4MDRD) equation for serum creatinine (sCr), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for sCr and cystatin C (CysC) each alone, and in combination (CysC/sCr). eGFR was assessed regarding the combined outcome of cardiovascular death and non-fatal myocardial infarction and regarding complex CAD represented by a SYNTAX score ≥23. Median follow-up was 4.3years. RESULTS Only the CKD-EPI equation using CysC could differentiate between eGFR >90ml/min/1.73m(2) vs. eGFR 60-90ml/min/1.73m(2) according to the occurrence of an endpoint event (log-rank test p=0.009). In the Cox regression analysis only eGFR calculated by CKD-EPI equation for CysC (Hazard ratio per 1 standard deviation (HR) 1.27 (95% CI 1.07-1.50); p=0.007) and for CysC/sCr (HR 1.22 (95% CI 1.02-1.46); p=0.026) were predictive regarding the outcome after adjustment for cardiovascular risk factors and Nt-proBNP. Furthermore, only eGFR calculated by CKD-EPI equation for CysC (odds ratio (OR) 1.57 (95% CI 1.36-1.78); p<0.001) and for CysC/sCr (OR 1.32 (95% CI 1.13-1.53); p<0.001) were significantly associated with a SYNTAX score ≥23. CONCLUSION In patients with CAD the CKD-EPI equation for CysC and for CysC/sCr provided the best predictive value regarding the prognosis and the severity of CAD.
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Affiliation(s)
- C Waldeyer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
| | - M Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - C Scheurle
- Department of Internal Medicine I, Nephrology and Dialysis, St. Franziskus Hospital Münster, Germany
| | - F Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - R B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - T Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - E Zengin
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - D Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - B Schrage
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - C Bickel
- Department of Internal Medicine, Bundeswehrkrankenhaus Koblenz, Germany
| | - H J Rupprecht
- Department of Internal Medicine II, GPR Klinikum Rüsselsheim, Germany
| | - K J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Germany
| | - S Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany; DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung e.V.), Partner site Hamburg, Lübeck, Kiel, Hamburg, Germany
| | - M Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - C Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
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Sinning C, Kozlik-Feldmann R, Demir C, Blankenberg S, Zengin E. Long-term course of a patient with congenital corrected transposition of the great arteries and dextrocardia--The Fisher King. Int J Cardiol 2016; 203:436-7. [PMID: 26547729 DOI: 10.1016/j.ijcard.2015.10.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/24/2015] [Indexed: 01/06/2023]
Affiliation(s)
- C Sinning
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - R Kozlik-Feldmann
- Department of Pediatric Cardiology, University Heart Center Hamburg, Germany
| | - C Demir
- Department of Cardiology, Asklepios Clinic Hamburg-Harburg, Germany
| | - S Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany
| | - E Zengin
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany.
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Zengin E, Sinning C, Schrage B, Mueller G, Klose H, Sachweh J, Goepfert M, Hueneke B, Blankenberg S, Kozlik-Feldmann R. Right heart failure in pregnant women with cyanotic congenital heart disease — The good, the bad and the ugly. Int J Cardiol 2016; 202:773-5. [DOI: 10.1016/j.ijcard.2015.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022]
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Beutel ME, Wiltink J, Kirschner Y, Sinning C, Espinola-Klein C, Wild PS, Münzel T, Blettner M, Zwiener I, Lackner K, Michal M. History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg Health Study. Psychol Med 2014; 44:919-925. [PMID: 23822954 DOI: 10.1017/s0033291713001542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To test the vascular depression hypothesis in the general population, we analyzed the association between current depression, medical history of depression, cognitive and somatic depressive symptom dimensions and measures of atherosclerosis [intima-media thickness (IMT) and carotid plaques]. METHOD We included a representative sample of 5000 participants from the Gutenberg Health Study (GHS). Depression was assessed by the nine-item Patient Health Questionnaire (PHQ-9), and IMT and carotid plaques were measured at both common carotid arteries using an edge detection system. Regression analyses were performed separately for participants with and without cardiovascular disease, adjusting for medical history, cardiovascular risk factors and psychotropic medication. RESULTS Contrary to hypotheses, we found no increased IMT for somatic symptoms of depression; the same was true for depression and cognitive symptoms in the fully adjusted model. Only a moderate relationship between medical history of depression and the presence of atherosclerotic plaques was maintained after correction. CONCLUSIONS The relationship between depression and atherosclerosis may be more complex than previously assumed. Although the vascular depression hypothesis was not supported, our results support the hypothesis that lasting depression leads to arteriosclerosis.
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Affiliation(s)
- M E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - J Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Y Kirschner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - C Sinning
- Department of General and Interventional Cardiology, University Heart Center, Hamburg, Germany
| | - C Espinola-Klein
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - P S Wild
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - T Münzel
- Department of Medicine II, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - M Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - I Zwiener
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - K Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - M Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Seiffert M, Avanesov M, Lunau C, Conradi L, Schirmer J, Kloth B, Sinning C, Adam G, Blankenberg S, Reichenspurner H, Lund G, Diemert P, Treede H. Aortic valve calcium and transcatheter aortic valve implantation with first- and second-generation transcatheter heart valves. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Peitsmeyer P, Schwemer T, Schlueter M, Ojeda F, Zeller T, Sinning C, Keller T, Munzel T, Blankenberg S, Goldmann B. Gender-specific diagnosis of acute myocardial infarction using high-sensitivity assayed cardiac troponin I. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.3512] [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: 11/13/2022] Open
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Sinning C, Keller T, Blankenberg S. Rolle von Biomarkern zur Risikostratifizierung in der Prävention kardiovaskulärer Erkrankungen. Dtsch Med Wochenschr 2009; 134:2019-22. [DOI: 10.1055/s-0029-1237551] [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: 10/20/2022]
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Schnabel R, Messow CM, Lubos E, Espinola-Klein C, Rupprecht HJ, Bickel C, Sinning C, Tzikas S, Keller T, Genth-Zotz S, Lackner KJ, Munzel TF, Blankenberg S. Association of adiponectin with adverse outcome in coronary artery disease patients: results from the AtheroGene study. Eur Heart J 2008; 29:649-57. [DOI: 10.1093/eurheartj/ehn009] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sinning C, Schaefer N, Standop J, Hirner A, Wolff M. Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol 2006; 33:133-9. [PMID: 17071041 DOI: 10.1016/j.ejso.2006.09.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Accepted: 09/06/2006] [Indexed: 12/12/2022] Open
Abstract
AIM The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come. METHODS The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search. RESULTS Patients subjected to distal gastric resection have a 4-7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori. CONCLUSION The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.
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Affiliation(s)
- C Sinning
- Department of Surgery, University of Bonn, Sigmund-Freud-Strasse 25, Bonn D-53105, Germany
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