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Baranyi A, Meinitzer A, von Lewinski D, Rothenhäusler HB, Amouzadeh-Ghadikolai O, Harpf H, Harpf L, Traninger H, Hödl R, Harb BM, Obermayer-Pietsch B, Schweinzer M, Braun CK, Enko D. Sex-specific differences in trimethylamine N-oxide (TMAO) concentrations before and after cardiac rehabilitation in acute myocardial infarction patients. EXCLI J 2022; 21:1-10. [PMID: 35145364 PMCID: PMC8822301 DOI: 10.17179/excli2021-4366] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022]
Abstract
Trimethylamine N-oxide (TMAO) is a biomarker of cardiovascular risk and may enhance the progression of atherosclerosis. The aim of the study was to determine whether there are sex-specific differences in TMAO concentrations before and after cardiac rehabilitation in acute myocardial infarction (AMI) patients. A total of 56 participants [45/56 (80.4 %) males, 11/56 (19.6 %) females] were drawn from AMI inpatients hospitalized at the Division of Cardiology, Medical University of Graz, Austria. For the assessment of TMAO, serum samples were collected within the first day after hospital admission due to AMI and at the start and end of cardiac rehabilitation. Shortly after hospital admission due to AMI, females had significantly higher TMAO blood concentrations than males. These initially high TMAO levels remained almost unchanged in the female AMI patients until the start of cardiac rehabilitation and only reached the lower TMAO concentrations observed in the male patients after rehabilitation [female patients: TMAO (acute myocardial infarction) = 5.93 μmol/L (SE = 1.835); TMAO (start of rehabilitation) = 5.68 μmol/L (SE = 1.217); TMAO (end of rehabilitation) = 3.89 μmol/L (SE = 0.554); male patients: TMAO (acute myocardial infarction) = 3.02 μmol/L (SE = 0.255), TMAO (start of rehabilitation) = 3.91 μmol/L (SE = 0.346), TMAO (end of rehabilitation) = 4.04 μmol/L (SE = 0.363)]. After AMI, women might be at higher cardiovascular risk due to persistently higher levels of TMAO. High TMAO levels in women might decrease after cardiac rehabilitation due to cardiac rehabilitation-associated lifestyle modifications. These lifestyle modifications after AMI might also prevent increases in TMAO concentrations in men.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria,*To whom correspondence should be addressed: Dirk von Lewinski, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Tel: +43-316-385-80684, E-mail:
| | - Hans-Bernd Rothenhäusler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Hanns Harpf
- ZARG Zentrum für ambulante Rehabilitation GmbH, Graz, Austria
| | - Leonhard Harpf
- ZARG Zentrum für ambulante Rehabilitation GmbH, Graz, Austria
| | - Heimo Traninger
- ZARG Zentrum für ambulante Rehabilitation GmbH, Graz, Austria
| | - Ronald Hödl
- Ordination Hödl, Ordinationszentrum Privatklinik Graz Ragnitz, Berthold-Linder-Weg 15, 8047 Graz, Austria
| | - Birgit M. Harb
- Pensionsversicherungsanstalt, SKA-RZ St. Radegund für Herz-Kreislauferkrankungen, St. Radegund, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Endocrinology Lab Platform, Medical University of Graz, Graz, Austria
| | - Melanie Schweinzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Celine K. Braun
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Dietmar Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Krämer J, Fischer L, Braun CK, Meinhardt M, Henrichs C, Winter B, Kaestner M. [False interpretation of a treatment recommendation given via telephone consultation]. Monatsschr Kinderheilkd 2021; 170:304-307. [PMID: 34545257 PMCID: PMC8444170 DOI: 10.1007/s00112-021-01315-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J Krämer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland.,Interdisziplinäre Kinderschutzgruppe, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - L Fischer
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland
| | - C K Braun
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland
| | - M Meinhardt
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland
| | - C Henrichs
- Sozialpädiatrisches Zentrum Memmingen, Memmingen, Deutschland
| | - B Winter
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland.,Interdisziplinäre Kinderschutzgruppe, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Kaestner
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ulm, Eythstr. 24, 89075 Ulm, Deutschland
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Baranyi A, Enko D, von Lewinski D, Rothenhäusler HB, Amouzadeh-Ghadikolai O, Harpf H, Harpf L, Traninger H, Obermayer-Pietsch B, Schweinzer M, Braun CK, Meinitzer A. Assessment of trimethylamine N-oxide (TMAO) as a potential biomarker of severe stress in patients vulnerable to posttraumatic stress disorder (PTSD) after acute myocardial infarction. Eur J Psychotraumatol 2021; 12:1920201. [PMID: 34104352 PMCID: PMC8168738 DOI: 10.1080/20008198.2021.1920201] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a frequently observed stress-related disorder after acute myocardial infarction (AMI) and it is characterized by numerous symptoms, such as flashbacks, intrusions and anxiety, as well as uncontrollable thoughts and feelings related to the trauma. Biological correlates of severe stress might contribute to identifying PTSD-vulnerable patients at an early stage. Objective: Aims of the study were (1) to determine whether blood levels of trimethylamine N-oxide (TMAO) vary immediately after AMI in patients with/without AMI-induced PTSD symptomatology, (2) to investigate whether TMAO is a potential biomarker that might be useful in the prediction of PTSD and the PTSD symptom subclusters re-experiencing, avoidance and hyperarousal, and (3) to investigate whether TMAO varies immediately after AMI in patients with/without depression 6 months after AMI. Method: A total of 114 AMI patients were assessed with the Hamilton-Depression Scale after admission to the hospital and 6 months later. The Clinician Administered PTSD Scale for DSM-5 was used to explore PTSD-symptoms at the time of AMI and 6 months after AMI. To assess patients' TMAO status, serum samples were collected at hospitalization and 6 months after AMI. Results: Participants with PTSD-symptomatology had significantly higher TMAO levels immediately after AMI than patients without PTSD-symptoms (ANCOVA: TMAO(PTSD x time), F = 4.544, df = 1, p = 0.035). With the inclusion of additional clinical predictors in a hierarchical logistic regression model, TMAO became a significant predictor of PTSD-symptomatology. No significant differences in TMAO levels immediately after AMI were detected between individuals with/without depression 6 months after AMI. Conclusions: An elevated TMAO level immediately after AMI might reflect severe stress in PTSD-vulnerable patients, which might also lead to a short-term increase in gut permeability to trimethylamine, the precursor of TMAO. Thus, an elevated TMAO level might be a biological correlate for severe stress that is associated with vulnerability to PTSD.
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Affiliation(s)
- Andreas Baranyi
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Dietmar Enko
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Dirk von Lewinski
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hans-Bernd Rothenhäusler
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | | | - Hanns Harpf
- ZARG Zentrum Für Ambulante Rehabilitation GmbH, Graz, Austria
| | - Leonhard Harpf
- ZARG Zentrum Für Ambulante Rehabilitation GmbH, Graz, Austria
| | - Heimo Traninger
- ZARG Zentrum Für Ambulante Rehabilitation GmbH, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Schweinzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Celine K Braun
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
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Kalbitz M, Schwarz S, Weber B, Bosch B, Pressmar J, Hoenes FM, Braun CK, Horst K, Simon TP, Pfeifer R, Störmann P, Hummler H, Gebhard F, Pape HC, Huber-Lang M, Hildebrand F. Cardiac Depression in Pigs after Multiple Trauma - Characterization of Posttraumatic Structural and Functional Alterations. Sci Rep 2017; 7:17861. [PMID: 29259232 PMCID: PMC5736586 DOI: 10.1038/s41598-017-18088-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 06/14/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022] Open
Abstract
The purpose of this study was to define the relationship between cardiac depression and morphological and immunological alterations in cardiac tissue after multiple trauma. However, the mechanistic basis of depressed cardiac function after trauma is still elusive. In a porcine polytrauma model including blunt chest trauma, liver laceration, femur fracture and haemorrhage serial trans-thoracic echocardiography was performed and correlated with cellular cardiac injury as well as with the occurrence of extracellular histones in serum. Postmortem analysis of heart tissue was performed 72 h after trauma. Ejection fraction and shortening fraction of the left ventricle were significantly impaired between 4 and 27 h after trauma. H-FABP, troponin I and extracellular histones were elevated early after trauma and returned to baseline after 24 and 48 h, respectively. Furthermore, increased nitrotyrosine and Il-1β generation and apoptosis were identified in cardiac tissue after trauma. Main structural findings revealed alteration of connexin 43 (Cx43) and co-translocation of Cx43 and zonula occludens 1 to the cytosol, reduction of α-actinin and increase of desmin in cardiomyocytes after trauma. The cellular and subcellular events demonstrated in this report may for the first time explain molecular mechanisms associated with cardiac dysfunction after multiple trauma.
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Affiliation(s)
- M Kalbitz
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany.
| | - S Schwarz
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - B Weber
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - B Bosch
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - J Pressmar
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - F M Hoenes
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - C K Braun
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - K Horst
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
| | - T P Simon
- Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany
| | - R Pfeifer
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P Störmann
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany
| | - H Hummler
- Division of Neonatology and Pediatric Critical Care, University of Ulm, Ulm, Germany
| | - F Gebhard
- Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, Center of Surgery, University of Ulm, Ulm, Germany
| | - H C Pape
- Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
| | - F Hildebrand
- Department of Orthopaedic Trauma, RWTH Aachen University, Aachen, Germany
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