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Bano A, Rodondi N, Beer J, Moschovitis G, Kobza R, Aeschbacher S, Baretella O, Muka T, Stettler C, Franco O, Conte G, Sticherling C, Zuern C, Conen D, Reichlin T. Diabetes is associated with atrial fibrillation phenotype, cardiac and neurological comorbidities: insights from the Swiss-AF study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0442] [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
Diabetes mellitus is a major risk factor for atrial fibrillation (AF). However, it remains unclear whether individual AF phenotype and related comorbidities differ between AF patients with and without diabetes.
Purpose
To investigate the association of diabetes with AF phenotype, cardiac and neurological comorbidities in patients with documented AF.
Methods
Participants of the multicenter Swiss-AF study with available data on diabetes and AF phenotype were eligible. The primary outcomes were parameters of AF phenotype, including AF type (paroxysmal vs non-paroxysmal), AF symptoms (yes vs no), and quality of life (assessed by EQ-5D score). The secondary outcomes were cardiac (ie, history of hypertension, myocardial infarction, heart failure) and neurological comorbidities (ie, history of stroke, cognitive impairment). The cross-sectional association of diabetes with these outcomes was assessed using logistic and linear regression. Results were adjusted for age, sex, and cardiovascular risk factors.
Results
We included 2411 AF patients (27.4% women; median age, 73.6 years). Diabetes was not associated with non-paroxysmal AF (odds ratio [OR]=1.01; 95% confidence interval [CI]=0.81 to 1.27). Patients with diabetes less often perceived AF symptoms (OR=0.73; CI=0.59 to 0.91), but had worse quality of life (predicted mean difference in EQ-5D score: β=−4.54; CI=−6.40 to −2.68) than those without diabetes. Patients with diabetes were more likely to have cardiac comorbidities [history of hypertension (OR=3.04; CI=2.19 to 4.22), myocardial infarction (OR=1.55; CI=1.18 to 2.03), heart failure (OR=1.99; CI=1.57 to 2.51)] and neurological comorbidities [history of stroke (OR=1.39; CI=1.03 to 1.87), cognitive impairment (OR=1.75; CI=1.39 to 2.21)].
Conclusions
In the Swiss-AF cohort population, patients with diabetes less often perceived AF symptoms, but had worse quality of life, more cardiac and neurological comorbidities than those without diabetes. These findings have significant clinical implications. The reduced perception of AF symptoms in patients with diabetes might result in a delayed AF diagnosis and consequently more adverse events, especially cardioembolic stroke. This raises the question whether patients with diabetes should be systematically screened for silent AF. Moreover, patients with concomitant AF and diabetes have increased likelihood of comorbidities and therefore deserve more attentive care.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Bano
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - N Rodondi
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - J Beer
- University Hospital Zurich, Zurich, Switzerland
| | | | - R Kobza
- Luzerner Kantonsspital, Switzerland, Luzern, Switzerland
| | | | - O Baretella
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - T Muka
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - C Stettler
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - O Franco
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - G Conte
- Cardiocentro Ticino, Lugano, Switzerland
| | | | - C Zuern
- University Hospital Basel, Basel, Switzerland
| | - D Conen
- Mcmaster University, Ontario, Canada
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
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Iliadis C, Baldus S, Kalbacher D, Boekstegers P, Schillinger W, Ouarrak T, Zahn R, Butter C, Zuern C, Von Bardeleben R, Senges J, Bekeredjian R, Eggebrecht H, Pfister R. Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions registry (TRAMI). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2632] [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
Left atrium (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.
Methods
Data from the multicenter German transcatheter mitral valve intervention registry “TRAMI” were used to analyse the association of baseline LA diameter by tertiles and efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with the MitraClip.
Results
In 520 of 843 patients prospectively enrolled in TRAMI baseline LA diameter were reported (median [interquartile range] LA diameter in tertiles: 44 [40–46] mm, 51 [48–53] mm and 60 [55–66] mm). Larger LA diameters were significantly associated with secondary etiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all p<0.05). Technical success was not different across tertiles (96%, 95.4%, 98.4% respectively, p=0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke) (1.8%, 1.2% and 4.4%, p=0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7% respectively, p<0.01), as did hospitalization in survivors (60%, 67.6% and 78.9% respectively, p<0.05). The association between LA diameter and all-cause mortality remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.
Conclusion
LA enlargement is a strong and independent predictor of adverse long-term outcome in mitral regurgitation suggesting that timely transcatheter mitral valve repair may have the potential to modify outcome.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott Vascular.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Boekstegers
- Helios Hospital Siegburg-Bonn, Helios Clinic Siegburg, Department of Cardiology and Angiology, Siegburg, Germany
| | - W Schillinger
- Georg-August University, Georg-August-University Göttingen, Heart Center, Department of Cardiology, Goettingen, Germany
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Clinic, Department of Medicine B, Ludwigshafen, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology Department, Heart Center Brandenburg Bernau, Bernau bei Berlin, Germany
| | - C.S Zuern
- University Hospital of Tuebingen, University Clinic Tübingen, Department of Cardiology, Tuebingen, Germany
| | - R.S Von Bardeleben
- University Medical Center Mainz, University Medicine Mainz, Center for Cardiology, Heart Valve Center, Mainz, Germany
| | - J Senges
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Bekeredjian
- Robert Bosch Hospital, Robert-Bosch-Hospital Stuttgart, Cardiology Department, Stuttgart, Germany
| | - H Eggebrecht
- CardioVascular Center Bethanien (CCB), Cardiology Centrum Bethanien – CCB, Frankfurt am Main, Frankfurt, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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Haemmerle P, Eick C, Bauer A, Rizas K, Coslovsky M, Krisai P, Vesin J, Beer J, Moschovitis G, Bonati L, Sticherling C, Conen D, Osswald S, Kuehne M, Zuern C. Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system.
Purpose
We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes.
Methods
We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes.
Results
At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI <15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI<15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN<70ms and MHR<80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure).
Conclusions
Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
- P Haemmerle
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C Eick
- University Hospital of Tuebingen, Cardiology, Tuebingen, Germany
| | - A Bauer
- Medical University of Innsbruck, Cardiology and Angiology, Innsbruck, Austria
| | - K.D Rizas
- Ludwig-Maximilians University, Department of Medicine I, Munich, Germany
| | - M Coslovsky
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - P Krisai
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - J.M Vesin
- Swiss Federal Institute of Technology of Lausanne, Lausanne, Switzerland
| | - J Beer
- Cantonal Hospital of Baden, Department of Medicine, Baden, Switzerland
| | - G Moschovitis
- Lugano Regional Hospital, Cardiology, Lugano, Switzerland
| | - L.H Bonati
- University Hospital Basel, Neurology, Basel, Switzerland
| | - C Sticherling
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - D Conen
- McMaster University, Division of Cardiology, Hamilton, Canada
| | - S Osswald
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - C.S Zuern
- University Hospital Basel, Cardiology, Basel, Switzerland
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Ledwoch J, Puls M, Lubos E, Boekstegers P, Von Bardeleben R, Ouarrak T, Butter C, Zuern C, Bekeredjian R, Nickenig G, Eggebrecht H, Senges J, Schillinger W, Sievert H. P6327Prognostic value of pre-procedural 6 minute walk test in patients undergoing MitraClip implantation - insights from the German mitral valve interventions registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6327] [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
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Thomas C, Schaefer U, Von Bardeleben S, Zuern C, Bekeredjian R, Ouarrak T, Sievert H, Nickenig G, Boekstegers P, Senges J, Schillinger W, Lubos E. P153Risk assessment in patients undergoing MitraClip therapy: the usefulness of NT-proBNP. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p153] [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)
- C. Thomas
- University Heart Center Hamburg, General and Interventional Cardiology, Hamburg, Germany
| | - U. Schaefer
- University Heart Center Hamburg, General and Interventional Cardiology, Hamburg, Germany
| | - S. Von Bardeleben
- University Medical Center of Mainz, Department of cardiology, Mainz, Germany
| | - C. Zuern
- University Hospital of Tubingen, Department of cardiology, Tubingen, Germany
| | - R. Bekeredjian
- University Hospital of Heidelberg, Department of cardiology, angiology and pneumology, Heidelberg, Germany
| | - T. Ouarrak
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - H. Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | - G. Nickenig
- University Hospital Bonn, Department of cardiology and pneumology, Bonn, Germany
| | - P. Boekstegers
- Helios Hospital Siegburg-Bonn, Cardiology and Angiology, Siegburg, Germany
| | - J. Senges
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - W. Schillinger
- Helios Albert-Schweitzer-Klinik, Department of cardiology, Northeim, Germany
| | - E. Lubos
- University Heart Center Hamburg, General and Interventional Cardiology, Hamburg, Germany
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Fahlbusch FB, Ruebner M, Huebner H, Volkert G, Zuern C, Thiel F, Koch M, Menendez-Castro C, Wachter DL, Hartner A, Rascher W. The tumor suppressor gastrokine-1 is expressed in placenta and contributes to the regulation of trophoblast migration. Placenta 2013; 34:1027-35. [PMID: 23993393 DOI: 10.1016/j.placenta.2013.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Gastrokine-1 (GKN1) is a secreted auto-/paracrine protein, described to be expressed in the gastric mucosa. In gastric cancers GKN1 expression is commonly down-regulated. While current research focusses on the exploration of tumor-suppressive properties of GKN1 with regard to its potential clinical use in the treatment of gastroenterologic tumor disease, nothing is known about GKN1 expression and function in other organ systems. We investigated GKN1 expression in placental tissue and cells. MATERIALS AND METHODS GKN1 was localized using immunohistochemistry in first and third trimester placental tissue, hydatidiform moles and various gestational trophoblastic neoplasias. We determined the expression of GKN1 in immunomagnetic bead-separated term placental cells and in choriocarcinoma cell lines. The role of GKN1 for JEG-3 migration was studied using live cell imaging. E-cadherin, MMP-2 and -9, TIMP-1 and -2, as well as urokinase (uPA) expression levels were determined. RESULTS GKN1 is expressed in healthy third trimester placentas. Its expression is specifically limited to the extravillous trophoblast (EVT). GKN1 expression is significantly reduced in choriocarcinoma cell lines and gestational trophoblastic neoplasias. GKN1 attenuates the migration of JEG-3 choriocarcinoma cells in vitro, possibly via AKT-mediated induction of E-cadherin. GKN1 treatment reduced MMP-9 expression in JEG-3. DISCUSSION Besides its role in gastric physiology our results clearly indicate regulatory functions of GKN1 in the EVT at the feto-maternal interface during pregnancy. Based on our findings in the JEG-3 choriocarcinoma cell line, an auto-/paracrine role of GKN1 for EVT motility and villous anchorage at the basal plate is conceivable. Thus, the tumor suppressor GKN1 is expressed in placental EVT and might contribute to the regulation of EVT migration/invasion.
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Affiliation(s)
- F B Fahlbusch
- Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Loschgestrasse 15, 91054 Erlangen, Germany.
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Bauer A, Zuern C, Rizas K, Eick C, Gawaz M. Severe cardiac autonomic failure as risk predictor in patients undergoing aortic valve replacement or transcatheter aortic valve implantation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5410] [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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