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De Filippo O, Cammann VL, Pancotti C, Di Vece D, Silverio A, Schweiger V, Niederseer D, Szawan KA, Würdinger M, Koleva I, Dusi V, Bellino M, Vecchione C, Parodi G, Bossone E, Gili S, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Jansen T, Dichtl W, von Lewinski D, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Massoomi M, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Kato K, Ishibashi I, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Budnik M, Opolski G, Thiele H, Bauersachs J, Horowitz JD, Di Mario C, Bruno F, Kong W, Dalakoti M, Imori Y, Münzel T, Crea F, Lüscher TF, Bax JJ, Ruschitzka F, De Ferrari GM, Fariselli P, Ghadri JR, Citro R, D'Ascenzo F, Templin C. Machine learning-based prediction of in-hospital death for patients with takotsubo syndrome: The InterTAK-ML model. Eur J Heart Fail 2023; 25:2299-2311. [PMID: 37522520 DOI: 10.1002/ejhf.2983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine learning (ML)-based model to predict the risk of in-hospital death and to perform a clustering of TTS patients to identify different risk profiles. METHODS AND RESULTS A ridge logistic regression-based ML model for predicting in-hospital death was developed on 3482 TTS patients from the International Takotsubo (InterTAK) Registry, randomly split in a train and an internal validation cohort (75% and 25% of the sample size, respectively) and evaluated in an external validation cohort (1037 patients). Thirty-one clinically relevant variables were included in the prediction model. Model performance represented the primary endpoint and was assessed according to area under the curve (AUC), sensitivity and specificity. As secondary endpoint, a K-medoids clustering algorithm was designed to stratify patients into phenotypic groups based on the 10 most relevant features emerging from the main model. The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.89 (0.85-0.92), a sensitivity of 0.85 (0.78-0.95) and a specificity of 0.76 (0.74-0.79) in the internal validation cohort and an AUC of 0.82 (0.73-0.91), a sensitivity of 0.74 (0.61-0.87) and a specificity of 0.79 (0.77-0.81) in the external cohort for in-hospital death prediction. By exploiting the 10 variables showing the highest feature importance, TTS patients were clustered into six groups associated with different risks of in-hospital death (28.8% vs. 15.5% vs. 5.4% vs. 1.0.8% vs. 0.5%) which were consistent also in the external cohort. CONCLUSION A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed unprecedented discriminative capability for the prediction of in-hospital death.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Corrado Pancotti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Victor Schweiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Veronica Dusi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Guido Parodi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | | | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Thomas Jansen
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
- Vincentius-Diakonissen Hospital, Karlsruhe, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Massoomi
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n. 8, Cardiology Unit, Vicenza, Italy
| | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - William Kong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College and Kings College, London, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
- Department of Cardio-Thoracic-Vascular, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
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Desch S, Freund A, Akin I, Behnes M, Preusch MR, Zelniker TA, Skurk C, Landmesser U, Graf T, Eitel I, Fuernau G, Haake H, Nordbeck P, Hammer F, Felix SB, Hassager C, Kjærgaard J, Fichtlscherer S, Ledwoch J, Lenk K, Joner M, Steiner S, Liebetrau C, Voigt I, Zeymer U, Brand M, Schmitz R, Horstkotte J, Jacobshagen C, Pöss J, Abdel-Wahab M, Lurz P, Jobs A, de Waha S, Olbrich D, Sandig F, König IR, Brett S, Vens M, Klinge K, Thiele H. Coronary Angiography After Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: One-Year Outcomes of a Randomized Clinical Trial. JAMA Cardiol 2023; 8:827-834. [PMID: 37556123 PMCID: PMC10413219 DOI: 10.1001/jamacardio.2023.2264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/08/2023] [Indexed: 08/10/2023]
Abstract
Importance Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest (OHCA). The long-term effect of early coronary angiography on patients with OHCA with possible coronary trigger but no ST-segment elevation remains unclear. Objective To compare the clinical outcomes of early unselective angiography with the clinical outcomes of a delayed or selective approach for successfully resuscitated patients with OHCA of presumed cardiac origin without ST-segment elevation at 1-year follow-up. Design, Setting, and Participants The TOMAHAWK trial was a multicenter, international (Germany and Denmark), investigator-initiated, open-label, randomized clinical trial enrolling 554 patients between November 23, 2016, to September 20, 2019. Patients with stable return of spontaneous circulation after OHCA of presumed cardiac origin but without ST-segment elevation on the postresuscitation electrocardiogram were eligible for inclusion. A total of 554 patients were randomized to either immediate coronary angiography after hospital admission or an initial intensive care assessment with delayed or selective angiography after a minimum of 24 hours. All 554 patients were included in survival analyses during the follow-up period of 1 year. Secondary clinical outcomes were assessed only for participants alive at 1 year to account for the competing risk of death. Interventions Early vs delayed or selective coronary angiography and revascularization if indicated. Main Outcomes and Measures Evaluations in this secondary analysis included all-cause mortality after 1 year, as well as severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure in survivors at 1 year. Results A total of 281 patients were randomized to the immediate angiography group and 273 to the delayed or selective group, with a median age of 70 years (IQR, 60-78 years). A total of 369 of 530 patients (69.6%) were male, and 268 of 483 patients (55.5%) had a shockable arrest rhythm. At 1 year, all-cause mortality was 60.8% (161 of 265) in the immediate angiography group and 54.3% (144 of 265) in the delayed or selective angiography group without significant difference between the treatment strategies, trending toward an increase in mortality with immediate angiography (hazard ratio, 1.25; 95% CI, 0.99-1.57; P = .05). For patients surviving until 1 year, the rates of severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure were similar between the groups. Conclusions and Relevance This study found that a strategy of immediate coronary angiography does not provide clinical benefit compared with a delayed or selective invasive approach for patients 1 year after resuscitated OHCA of presumed coronary cause and without ST-segment elevation. Trial Registration ClinicalTrials.gov Identifier: NCT02750462.
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Affiliation(s)
- Steffen Desch
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
- University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Anne Freund
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Ibrahim Akin
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- First Department of Medicine, Faculty of Medicine Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael R. Preusch
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Thomas A. Zelniker
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
- Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Carsten Skurk
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- University Clinic Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Ulf Landmesser
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- University Clinic Charité, Campus Benjamin Franklin, Berlin, Germany
| | - Tobias Graf
- University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Georg Fuernau
- Clinic for Internal Medicine II (Cardiology, Angiology, Diabetology, Intensive Care Medicine), Dessau Community General Hospital, Dessau-Rosslau, Germany
| | | | | | - Fabian Hammer
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B. Felix
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Fichtlscherer
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- University Clinic Frankfurt, Frankfurt, Germany
| | - Jakob Ledwoch
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Klinikum rechts der Isar, Technical University, Munich, Germany
| | | | - Michael Joner
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Department of Cardiology, German Heart Center, Munich, Germany
| | - Stephan Steiner
- Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg/Lahn, Germany
| | - Christoph Liebetrau
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Kerckhoff Clinic, Bad Nauheim, Germany
| | - Ingo Voigt
- Department of Acute and Emergency Medicine, Elisabeth Hospital Essen, Essen, Germany
- Department of Cardiology and Angiology, Elisabeth Hospital Essen, Essen, Germany
| | - Uwe Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Michael Brand
- University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne, Germany
| | | | | | - Claudius Jacobshagen
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- University Medicine Göttingen, Göttingen, Germany
- Vincentius-Diakonissen-Hospital, Karlsruhe, Germany
| | - Janine Pöss
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Alexander Jobs
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
- University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Suzanne de Waha
- Heart Center Leipzig at the University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Denise Olbrich
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Center for Clinical Trials, University of Lübeck, Lübeck, Germany
| | - Frank Sandig
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Inke R. König
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Sabine Brett
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Center for Clinical Trials, University of Lübeck, Lübeck, Germany
| | - Maren Vens
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Kathrin Klinge
- DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Center for Clinical Trials, University of Lübeck, Lübeck, Germany
| | - Holger Thiele
- Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute, Leipzig, Germany
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Conzelmann L, Grotherr P, Dapeng L, Würth A, Widder J, Jacobshagen C, Mehlhorn U. Valve-Related Complications in TAVI Leading to Emergent Cardiac Surgery. Thorac Cardiovasc Surg 2023; 71:107-117. [PMID: 36446625 DOI: 10.1055/s-0042-1758073] [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] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is now a standard procedure for the treatment of symptomatic aortic valve stenosis in many patients. In Germany, according to the annual reports from the German Institute for Quality Assurance and Transparency in Healthcare (Institut für Qualitätssicherung und Transparenz im Gesundheitswesen), the rate of serious intraprocedural complications, such as valve malpositioning or embolization, coronary obstruction, aortic dissection, annular rupture, pericardial tamponade, or severe aortic regurgitation requiring emergency cardiac surgery has decreased markedly in recent years from more than 5.5% in 2012 to 2.0% in 2019. However, with increased use, the total number of adverse events remains about 500 per year, about 100 of which require conversion to sternotomy. These, sometimes, fatal events can occur at any time and are still challenging. Therefore, the interdisciplinary TAVI heart team should be prepared and aware of possible rescue strategies.
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Affiliation(s)
- Lars Conzelmann
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
| | - Philipp Grotherr
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Lu Dapeng
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Alexander Würth
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Julian Widder
- Department of Cardiology, Medical Clinic IV, Municipal Hospital Karlsruhe, Karlsruhe, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care Medicine and Angiology, Vincentius-Diakonissen Hospital Karlsruhe, Karlsruhe, Germany
| | - Uwe Mehlhorn
- Department of Cardiac Surgery, HELIOS Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany
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Brandenburg S, Drews L, Schönberger HL, Jacob CF, Paulke NJ, Beuthner BE, Topci R, Kohl T, Neuenroth L, Kutschka I, Urlaub H, Kück F, Leha A, Friede T, Seidler T, Jacobshagen C, Toischer K, Puls M, Hasenfuß G, Lenz C, Lehnart SE. Direct proteomic and high-resolution microscopy biopsy analysis identifies distinct ventricular fates in severe aortic stenosis. J Mol Cell Cardiol 2022; 173:1-15. [PMID: 36084744 DOI: 10.1016/j.yjmcc.2022.08.363] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/03/2022] [Accepted: 08/31/2022] [Indexed: 01/06/2023]
Abstract
The incidence of aortic valve stenosis (AS), the most common reason for aortic valve replacement (AVR), increases with population ageing. While untreated AS is associated with high mortality, different hemodynamic subtypes range from normal left-ventricular function to severe heart failure. However, the molecular nature underlying four different AS subclasses, suggesting vastly different myocardial fates, is unknown. Here, we used direct proteomic analysis of small left-ventricular biopsies to identify unique protein expression profiles and subtype-specific AS mechanisms. Left-ventricular endomyocardial biopsies were harvested from patients during transcatheter AVR, and inclusion criteria were based on echocardiographic diagnosis of severe AS and guideline-defined AS-subtype classification: 1) normal ejection fraction (EF)/high-gradient; 2) low EF/high-gradient; 3) low EF/low-gradient; and 4) paradoxical low-flow/low-gradient AS. Samples from non-failing donor hearts served as control. We analyzed 25 individual left-ventricular biopsies by data-independent acquisition mass spectrometry (DIA-MS), and 26 biopsies by histomorphology and cardiomyocytes by STimulated Emission Depletion (STED) superresolution microscopy. Notably, DIA-MS reliably detected 2273 proteins throughout each individual left-ventricular biopsy, of which 160 proteins showed significant abundance changes between AS-subtype and non-failing samples including the cardiac ryanodine receptor (RyR2). Hierarchical clustering segregated unique proteotypes that identified three hemodynamic AS-subtypes. Additionally, distinct proteotypes were linked with AS-subtype specific differences in cardiomyocyte hypertrophy. Furthermore, superresolution microscopy of immunolabeled biopsy sections showed subcellular RyR2-cluster fragmentation and disruption of the functionally important association with transverse tubules, which occurred specifically in patients with systolic dysfunction and may hence contribute to depressed left-ventricular function in AS.
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Affiliation(s)
- Sören Brandenburg
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Collaborative Research Center SFB1002 "Modulatory Units in Heart Failure", University of Göttingen, Germany.
| | - Lena Drews
- Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany
| | - Hanne-Lea Schönberger
- Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany
| | - Christoph F Jacob
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany
| | - Nora Josefine Paulke
- Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany
| | - Bo E Beuthner
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Rodi Topci
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany
| | - Tobias Kohl
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany
| | - Lisa Neuenroth
- Department of Clinical Chemistry, University Medical Center Göttingen, Germany
| | - Ingo Kutschka
- Clinic of Cardiothoracic & Vascular Surgery, University Medical Center Göttingen, Germany
| | - Henning Urlaub
- Department of Clinical Chemistry, University Medical Center Göttingen, Germany; Bioanalytical Mass Spectrometry Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany; Collaborative Research Center SFB1190 "Compartmental Gates and Contact Sites in Cells", University of Göttingen, Germany
| | - Fabian Kück
- Department of Medical Statistics, University Medical Center Göttingen, Germany
| | - Andreas Leha
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Department of Medical Statistics, University Medical Center Göttingen, Germany
| | - Tim Friede
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Department of Medical Statistics, University Medical Center Göttingen, Germany
| | - Tim Seidler
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Intensive Care & Angiology, Vincentius-Diakonissen-Hospital Karlsruhe, Germany
| | - Karl Toischer
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Collaborative Research Center SFB1002 "Modulatory Units in Heart Failure", University of Göttingen, Germany; Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany
| | - Miriam Puls
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany
| | - Gerd Hasenfuß
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Collaborative Research Center SFB1002 "Modulatory Units in Heart Failure", University of Göttingen, Germany; Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany
| | - Christof Lenz
- Collaborative Research Center SFB1002 "Modulatory Units in Heart Failure", University of Göttingen, Germany; Department of Clinical Chemistry, University Medical Center Göttingen, Germany; Bioanalytical Mass Spectrometry Group, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany; Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany; Leducq Transatlantic Network of Excellence CURE-PLaN, Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany
| | - Stephan E Lehnart
- Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany; Cellular Biophysics & Translational Cardiology Section, Heart Research Center Göttingen, University Medical Center Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Germany; Collaborative Research Center SFB1002 "Modulatory Units in Heart Failure", University of Göttingen, Germany; Collaborative Research Center SFB1190 "Compartmental Gates and Contact Sites in Cells", University of Göttingen, Germany; Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany; Leducq Transatlantic Network of Excellence CURE-PLaN, Clinic of Cardiology & Pneumology, University Medical Center Göttingen, Germany.
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Desch S, Freund A, Akin I, Behnes M, Preusch MR, Zelniker TA, Skurk C, Landmesser U, Graf T, Eitel I, Fuernau G, Haake H, Nordbeck P, Hammer F, Felix SB, Hassager C, Engstrøm T, Fichtlscherer S, Ledwoch J, Lenk K, Joner M, Steiner S, Liebetrau C, Voigt I, Zeymer U, Brand M, Schmitz R, Horstkotte J, Jacobshagen C, Pöss J, Abdel-Wahab M, Lurz P, Jobs A, de Waha-Thiele S, Olbrich D, Sandig F, König IR, Brett S, Vens M, Klinge K, Thiele H. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. N Engl J Med 2021; 385:2544-2553. [PMID: 34459570 DOI: 10.1056/nejmoa2101909] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [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: 11/19/2022]
Abstract
BACKGROUND Myocardial infarction is a frequent cause of out-of-hospital cardiac arrest. However, the benefits of early coronary angiography and revascularization in resuscitated patients without electrocardiographic evidence of ST-segment elevation are unclear. METHODS In this multicenter trial, we randomly assigned 554 patients with successfully resuscitated out-of-hospital cardiac arrest of possible coronary origin to undergo either immediate coronary angiography (immediate-angiography group) or initial intensive care assessment with delayed or selective angiography (delayed-angiography group). All the patients had no evidence of ST-segment elevation on postresuscitation electrocardiography. The primary end point was death from any cause at 30 days. Secondary end points included a composite of death from any cause or severe neurologic deficit at 30 days. RESULTS A total of 530 of 554 patients (95.7%) were included in the primary analysis. At 30 days, 143 of 265 patients (54.0%) in the immediate-angiography group and 122 of 265 patients (46.0%) in the delayed-angiography group had died (hazard ratio, 1.28; 95% confidence interval [CI], 1.00 to 1.63; P = 0.06). The composite of death or severe neurologic deficit occurred more frequently in the immediate-angiography group (in 164 of 255 patients [64.3%]) than in the delayed-angiography group (in 138 of 248 patients [55.6%]), for a relative risk of 1.16 (95% CI, 1.00 to 1.34). Values for peak troponin release and for the incidence of moderate or severe bleeding, stroke, and renal-replacement therapy were similar in the two groups. CONCLUSIONS Among patients with resuscitated out-of-hospital cardiac arrest without ST-segment elevation, a strategy of performing immediate angiography provided no benefit over a delayed or selective strategy with respect to the 30-day risk of death from any cause. (Funded by the German Center for Cardiovascular Research; TOMAHAWK ClinicalTrials.gov number, NCT02750462.).
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Affiliation(s)
- Steffen Desch
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Anne Freund
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Ibrahim Akin
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Michael Behnes
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Michael R Preusch
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Thomas A Zelniker
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Carsten Skurk
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Ulf Landmesser
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Tobias Graf
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Ingo Eitel
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Georg Fuernau
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Hendrik Haake
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Peter Nordbeck
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Fabian Hammer
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Stephan B Felix
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Christian Hassager
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Thomas Engstrøm
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Stephan Fichtlscherer
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Jakob Ledwoch
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Karsten Lenk
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Michael Joner
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Stephan Steiner
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Christoph Liebetrau
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Ingo Voigt
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Uwe Zeymer
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Michael Brand
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Roland Schmitz
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Jan Horstkotte
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Claudius Jacobshagen
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Janine Pöss
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Mohamed Abdel-Wahab
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Philipp Lurz
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Alexander Jobs
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Suzanne de Waha-Thiele
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Denise Olbrich
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Frank Sandig
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Inke R König
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Sabine Brett
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Maren Vens
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Kathrin Klinge
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
| | - Holger Thiele
- From Heart Center Leipzig at the University of Leipzig, Departments of Internal Medicine-Cardiology (S.D., A.F., J.P., M.A.-W., P.L., A.J., H.T.) and Cardiac Surgery (S.W.-T.), Leipzig Heart Institute (S.D., A.F., A.J., H.T.), and University Clinic Leipzig (K.L.), Leipzig, University Heart Center Lübeck (S.D., T.G., I.E., G.F., A.J.) and the Center for Clinical Trials (D.O., S.B., K.K.) and the Institute for Medical Biometry and Statistics (F.S., I.R.K., M.V.), University of Lübeck, Lübeck, the German Center for Cardiovascular Research (S.D., A.F., I.A., M. Behnes, M.R.P., T.A.Z., C.S., U.L., T.G., I.E., G.F., F.H., S.B.F., S.F., J.L., M.J., C.L., C.J., A.J., D.O., F.S., I.R.K., S.B., M.V., K.K.) and University Clinic Charité, Campus Benjamin Franklin (C.S., U.L.), Berlin, University Clinic Mannheim, Mannheim (I.A., M. Behnes), the Department of Cardiology, Angiology, and Pneumology, University Hospital of Heidelberg, Heidelberg (M.R.P., T.A.Z.), Kliniken Maria Hilf, Mönchengladbach (H.H.), University Clinic Würzburg, Würzburg (P.N.), University Clinic Greifswald, Greifswald (F.H., S.B.F.), University Clinic Frankfurt, Frankfurt (S.F.), Rechts der Isar Hospital, Technical University (J.L.), and the Department of Cardiology, German Heart Center (M.J.), Munich, the Department of Cardiology, Pneumology and Intensive Care, St. Vincenz Hospital, Limburg (S.S.), Kerckhoff Clinic, Bad Nauheim (C.L.), the Departments of Acute and Emergency Medicine and of Cardiology and Angiology, Elisabeth Hospital Essen, Essen (I.V.), Klinikum Ludwigshafen, Ludwigshafen (U.Z.), University Clinic Marien Hospital Herne, Klinikum der Ruhr-Universität Bochum, Herne (M. Brand), the University Heart Center, Bad Krozingen (R.S.), Diakonissenkrankenhaus Flensburg, Flensburg (J.H.), University Medicine Göttingen, Göttingen (C.J.), and Vincentius-Diakonissen Hospital, Karlsruhe (C.J.) - all in Germany; the Division of Cardiology, Medical University of Vienna, Vienna (T.A.Z.); and the Department of Cardiology, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen - both in Copenhagen (C.H., T.E.)
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6
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Körber MI, Landendinger M, Gerçek M, Beuthner BE, Friedrichs KP, Puls M, Baldus S, Rudolph V, Jacobshagen C, Arnold M, Pfister R. Transcatheter Treatment of Secondary Tricuspid Regurgitation With Direct Annuloplasty: Results From a Multicenter Real-World Experience. Circ Cardiovasc Interv 2021; 14:e010019. [PMID: 34325531 DOI: 10.1161/circinterventions.120.010019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Maria I Körber
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
| | - Melanie Landendinger
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany (M.L., M.A.)
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Bo E Beuthner
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University Goettingen, Germany (B.E.B.)
| | - Kai P Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Miriam Puls
- Department of Cardiology, Angiology and Intensive Care, Vincentius-Diakonissen Hospital Karlsruhe, Germany (M.P., C.J.)
| | - Stephan Baldus
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany (M.G., K.P.F., V.R.)
| | - Claudius Jacobshagen
- Department of Cardiology, Angiology and Intensive Care, Vincentius-Diakonissen Hospital Karlsruhe, Germany (M.P., C.J.)
| | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany (M.L., M.A.)
| | - Roman Pfister
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Germany (M.I.K., S.B., R.P.)
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7
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El-Battrawy I, Cammann VL, Kato K, Szawan KA, Di Vece D, Rossi A, Wischnewsky M, Hermes-Laufer J, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, David Arroja J, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Duru F, Borggrefe M, Ghadri JR, Akin I, Templin C. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry. J Am Heart Assoc 2021; 10:e014059. [PMID: 34315238 PMCID: PMC8475688 DOI: 10.1161/jaha.119.014059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/26/2023]
Abstract
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in‐hospital (P<0.001) and long‐term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Victoria L Cammann
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Aurelio Rossi
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Julia Hermes-Laufer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Eduardo Bossone
- Division of Cardiology "Antonio Cardarelli" Hospital Naples Italy
| | - Michael Neuhaus
- Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Benjamin Meder
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Milosz Jaguszewski
- First Department of Cardiology Medical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Mid-German Heart Center Department of Internal Medicine III Division of Cardiology, Angiology and Intensive Medical Care University Hospital HalleMartin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | | | - Behrouz Kherad
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Carsten Tschöpe
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology Department of Medicine University of California-San Francisco San Francisco CA
| | - Jerold Shinbane
- Keck School of Medicine University of Southern California Los Angeles CA
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Department of Cardiology Intensive Care Medicine and Angiology Vincentius-Diakonissen-Hospital Karlsruhe Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Centre for Cardiovascular Research partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Philippe Meyer
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Monika Budnik
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology King's College Hospital London United Kingdom
| | - Philip MacCarthy
- Department of Cardiology King's College Hospital London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Martin Kozel
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | | | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Kan Liu
- Division of Cardiology, Heart and Vascular Center University of Iowa Iowa City IA
| | - P Christian Schulze
- Department of Internal Medicine I University Hospital JenaFriedrich-Schiller-University Jena Jena Germany
| | - Matteo Bianco
- Division of Cardiology A.O.U. San Luigi Gonzaga Orbassano, Turin Italy
| | - Lucas Jörg
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Hans Rickli
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Gonçalo Pestana
- Department of Cardiology Centro Hospitalar Universitário de São JoãoE.P.E. Porto Portugal
| | - Thanh H Nguyen
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | - Fausto J Pinto
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Petr Widimský
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Grzegorz Opolski
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Burkert M Pieske
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - John D Horowitz
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Jelena R Ghadri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Christian Templin
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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8
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Gerçek M, Rudolph V, Arnold M, Beuthner B, Pfister R, Landendinger M, Körber M, Friedrichs K, Jacobshagen C. Transient acute right coronary artery deformation during transcatheter interventional tricuspid repair with the Cardioband tricuspid system. EUROINTERVENTION 2021; 17:81-87. [PMID: 32657277 PMCID: PMC9754018 DOI: 10.4244/eij-d-20-00305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/23/2022]
Abstract
BACKGROUND The Cardioband tricuspid valve reconstruction system is a size-adjustable tricuspid reconstruction device for interventional treatment of tricuspid regurgitation (TR). Contraction of the device after successful implantation can be associated with an acute deformation of the right coronary artery (RCA). AIMS The aim of this study was to provide data on the persistence and clinical significance of acute RCA deformation following Cardioband implant procedures. METHODS Data from all patients with intraprocedural RCA deformation during Cardioband implantation were collected from four centres between October 2018 and January 2020. Control angiographies were performed in all of these patients before discharge. RESULTS RCA deformation occurred in 14 out of 51 patients. Follow-up coronary angiography showed a complete resolution of deformation in all cases while patients remained clinically asymptomatic and had an uneventful post-interventional course. Intraprocedural coronary stent implantation was performed in two of the earlier cases according to the personal assessment of the implanters. CONCLUSIONS RCA deformation is relatively frequent following interventional tricuspid annuloplasty but appears to be completely reversible in the absence of flow impairment or vascular damage. Based on our early experience watchful waiting is the most appropriate strategy to avoid unnecessary coronary interventions.
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Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Arnold
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bo Beuthner
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University Goettingen, Goettingen, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Cologne, Germany
| | - Melanie Landendinger
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maria Körber
- Department of Internal Medicine III, Division of Cardiology, Pneumology, Angiology and Intensive Care, University of Cologne, Cologne, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, Heart Center, Georg-August-University Goettingen, Goettingen, Germany
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9
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Puls M, Beuthner BE, Topci R, Vogelgesang A, Bleckmann A, Sitte M, Lange T, Backhaus SJ, Schuster A, Seidler T, Kutschka I, Toischer K, Zeisberg EM, Jacobshagen C, Hasenfuß G. Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis. Eur Heart J 2021; 41:1903-1914. [PMID: 32049275 PMCID: PMC7242071 DOI: 10.1093/eurheartj/ehaa033] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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] [Received: 07/04/2019] [Revised: 11/01/2019] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
Aims Myocardial fibrosis (MF) might represent a key player in pathophysiology of heart failure in aortic stenosis (AS). We aimed to assess its impact on left ventricular (LV) remodelling, recovery, and mortality after transcatheter aortic valve implantation (TAVI) in different AS subtypes. Methods and results One hundred patients with severe AS were prospectively characterized clinically and echocardiographically at baseline (BL), 6 months, 1 year, and 2 years following TAVI. Left ventricular biopsies were harvested after valve deployment. Myocardial fibrosis was assessed after Masson’s trichrome staining, and fibrotic area was calculated as percentage of total tissue area. Patients were stratified according to MF above (MF+) or below (MF−) median percentage MF (≥11% or <11%). Myocardial fibrosis burden differed significantly between AS subtypes, with highest levels in low ejection fraction (EF), low-gradient AS and lowest levels in normal EF, high-gradient AS (29.5 ± 26.4% vs. 13.5 ± 16.1%, P = 0.003). In the entire cohort, MF+ was significantly associated with poorer LV function, higher extent of pathological LV remodelling, and more pronounced clinical heart failure at BL. After TAVI, MF+ was associated with a delay in normalization of LV geometry and function but not per se with absence of reverse remodelling and clinical improvement. However, 22 patients died during follow-up (mean, 11 months), and 14 deaths were classified as cardiovascular (CV) (n = 9 arrhythmia-associated). Importantly, 13 of 14 CV deaths occurred in MF+ patients (CV mortality 26.5% in MF+ vs. 2% in MF− patients, P = 0.0003). Multivariate analysis identified MF+ as independent predictor of CV mortality [hazard ratio (HR) 27.4 (2.0–369), P = 0.01]. Conclusion Histological MF is associated with AS-related pathological LV remodelling and independently predicts CV mortality after TAVI. ![]()
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Affiliation(s)
- Miriam Puls
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Bo Eric Beuthner
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Rodi Topci
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Anja Vogelgesang
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Annalen Bleckmann
- Department of Medical Bioinformatics, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099 Göttingen , Germany.,Department of Hematology and Oncology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Maren Sitte
- Department of Medical Bioinformatics, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099 Göttingen , Germany
| | - Torben Lange
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Sören Jan Backhaus
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany
| | - Andreas Schuster
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Tim Seidler
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Ingo Kutschka
- Department of Cardiovascular Surgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099 Göttingen, Germany
| | - Karl Toischer
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Elisabeth Maria Zeisberg
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Claudius Jacobshagen
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099 Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), site Göttingen, Robert-Koch-Straße 42a, 37075 Göttingen, Germany
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10
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Napp LC, Cammann VL, Jaguszewski M, Szawan KA, Wischnewsky M, Gili S, Knorr M, Heiner S, Citro R, Bossone E, D'Ascenzo F, Neuhaus M, Franke J, Sorici-Barb I, Noutsias M, Burgdorf C, Koenig W, Kherad B, Sarcon A, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Hauck C, Paolini C, Bilato C, Imori Y, Kato K, Kobayashi Y, Opolski G, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Polednikova K, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Di Mario C, Prasad A, Rihal CS, Schulze PC, Bianco M, Crea F, Borggrefe M, Maier LS, Pinto FJ, Braun-Dullaeus RC, Rottbauer W, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Bauersachs J, Braunwald E, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Coexistence and outcome of coronary artery disease in Takotsubo syndrome. Eur Heart J 2021; 41:3255-3268. [PMID: 32484517 DOI: 10.1093/eurheartj/ehaa210] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 08/20/2019] [Revised: 02/09/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. METHODS AND RESULTS Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. CONCLUSIONS Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01947621.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | | | | | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany, Hamburg
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose D Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Karolina Polednikova
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Germany, Leipzig
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eugene Braunwald
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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11
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Kato K, Cammann VL, Napp LC, Szawan KA, Micek J, Dreiding S, Levinson RA, Petkova V, Würdinger M, Patrascu A, Sumalinog R, Gili S, Clarenbach CF, Kohler M, Wischnewsky M, Citro R, Vecchione C, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Sano M, Ishibashi I, Takahara M, Himi T, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry. ESC Heart Fail 2021; 8:1924-1932. [PMID: 33713566 PMCID: PMC8120351 DOI: 10.1002/ehf2.13165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. METHODS AND RESULTS Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002). CONCLUSIONS The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.
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Affiliation(s)
- Ken Kato
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Sara Dreiding
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rena A Levinson
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Vanya Petkova
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Alexandru Patrascu
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rafael Sumalinog
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | | | | | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Carmine Vecchione
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Masanori Sano
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa, USA
| | - P Christian Schulze
- Department of Internal Medicine I, JenaUniversity Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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12
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Cammann VL, Szawan KA, Stähli BE, Kato K, Budnik M, Wischnewsky M, Dreiding S, Levinson RA, Di Vece D, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Shoji T, Ishibashi I, Takahara M, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Opolski G, Templin C. Age-Related Variations in Takotsubo Syndrome. J Am Coll Cardiol 2021; 75:1869-1877. [PMID: 32327096 DOI: 10.1016/j.jacc.2020.02.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. OBJECTIVES This study aimed to investigate age-related differences in TTS. METHODS Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. RESULTS Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. CONCLUSIONS A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.
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Affiliation(s)
- Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sara Dreiding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Mathias Wolfrum
- Department of Internal Medicine, Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshihiro Shoji
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany; Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Heart Center Leipzig - University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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13
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Backhaus S, Lange T, Beuthner B, Topci R, Wang X, Kowallick J, Lotz J, Seidler T, Toischer K, Zeisberg E, Puls M, Jacobshagen C, Uecker M, Hasenfus G, Schuster A. Real-time cardiac magnetic resonance tissue characterisation for fibrosis assessment in aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0231] [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
Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiac magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been adequately validated against standard techniques and histology.
Methods
Patients with severe AS underwent CMR before (n=110) and left ventricular (LV) endomyocardial biopsy (n=46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available 5(3)3 MOLLI and RT single-shot inversion recovery fast low-angle shot (FLASH) with radial undersampling. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses.
Results
RT and MOLLI derived ECV were similar for myocardium (26.2 vs. 26.5, p=0.073) and inter-ventricular septum (26.2 vs. 26.5, p=0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p<0.001). Agreement between RT and MOLLI was best for ECV (ICC >0.91), excellent for post-contrast T1 times (ICC >0.81) and good for native T1 times (ICC >0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r=0.345, p=0.039; MOLLI r=0.40, p=0.010) and LV matrix volumes (RT r=0.45, p=0.005; MOLLI r=0.43, p=0.007) were the only parameters associated with histology.
Conclusions
RT mapping offers precise T1 and ECV assessments with similar agreement with histology as compared to conventional MOLLI techniques. Single-shot real time techniques may be advantageous in sicker patients prone to dyspnoea or arrhythmia.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
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Affiliation(s)
| | - T Lange
- Heart Centre Goettingen, Goettingen, Germany
| | | | - R Topci
- Heart Centre Goettingen, Goettingen, Germany
| | - X Wang
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J.T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Seidler
- Heart Centre Goettingen, Goettingen, Germany
| | - K Toischer
- Heart Centre Goettingen, Goettingen, Germany
| | | | - M Puls
- Heart Centre Goettingen, Goettingen, Germany
| | | | - M Uecker
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - G Hasenfus
- Heart Centre Goettingen, Goettingen, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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14
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Lange T, Backhaus S, Beuthner B, Topci R, Rigorth K, Lotz J, Seidler T, Puls M, Jacobshagen C, Hasenfuss G, Schuster A. Structural and functional reverse myocardial remodeling following transcatheter aortic valve replacement. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial reverse remodeling determines outcome in patients with severe aortic stenosis (AS) following transcatheter aortic valve replacement (TAVR). However, little is known about the interplay of myocardial function and structure after TAVR. Since cardiac magnetic resonance (CMR) imaging allows comprehensive quantification of both structure and function we aimed to assess changes in myocardial tissue composition and deformation before and following TAVR.
Methods
CMR imaging was performed in 40 prospectively enrolled patients with severe AS before and one year after TAVR. Myocardial function was characterized using volumetry and CMR-feature-tracking (FT) deformation imaging of left ventricular (LV) global longitudinal strain (GLS) and atrial function (atrial reservoir ES, conduit Ee and booster pump strain EA). Myocardial structure was assessed using T1 mapping and late gadolinium enhancement (LGE) analysis. LV cellular and matrix volumes were calculated based on extra cellular volume fraction (ECV) and LV mass. CMR-FT results were compared to a control group of twenty patients with normal biventricular function. Moreover, biomarkers (NT-proBNP), functional (six-minute-walking-test) and clinical status (NYHA, Minnesota LIVING WITH HEART FAILURE score) were determined at baseline and one-year follow-up.
Results
Regression of both cellular (−20.6%, p<0.001) and matrix volumes (−12.3%, p=0.003) and subsequently increased ECV (+9.0%, p=0.001) were documented one year after TAVR. Ventricular and atrial strains were impaired at baseline (GLS p=0.004, Es p<0.001, Ee p<0.001) and recovered during follow-up (GLS p<0.001, Es p=0.005, Ee p=0.001). These changes were paralleled by improvements in NYHA (p<0.001) and Minnesota (p<0.001) scores as well as decline in NT-proBNP levels (p=0.001). There was a significant association of LV fibrosis as defined by matrix volume and extent of LGE and ventricular and atrial functional impairment (correlation of matrix volume and: GLS r=0.57, p<0.001, Es r=−0.44, p=0.009; correlation of LGE%LV and: GLS r=0.41, p=0.015, Es: r=−0.4, p=0.02, and Ea: r=−0.41, p=0.02).
Conclusion
Regression of fibrosis and cellular hypertrophy determine improved myocardial function and recovery from heart failure following TAVR. Prognostic implications of the observed changes will need to be explored next to identify makers and therapeutic targets for optimized management of these patients.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation (DFG, CRC 1002, D1)
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Affiliation(s)
- T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S.J Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - B.E Beuthner
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - R Topci
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - K.R Rigorth
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Lotz
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Seidler
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - M Puls
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - C Jacobshagen
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
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15
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Gili S, Cammann VL, Schlossbauer SA, Kato K, D'Ascenzo F, Di Vece D, Jurisic S, Micek J, Obeid S, Bacchi B, Szawan KA, Famos F, Sarcon A, Levinson R, Ding KJ, Seifert B, Lenoir O, Bossone E, Citro R, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Gaita F, Di Mario C, Wischnewsky MB, Bax JJ, Prasad A, Böhm M, Ruschitzka F, Lüscher TF, Ghadri JR, Templin C. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J 2020; 40:2142-2151. [PMID: 31098611 PMCID: PMC6612368 DOI: 10.1093/eurheartj/ehz170] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [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] [Received: 03/15/2018] [Revised: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
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Affiliation(s)
- Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Susanne A Schlossbauer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Flurina Famos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles CA, USA
| | - Rena Levinson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Olivia Lenoir
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Eduardo Bossone
- Division of Cardiology 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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16
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Scholz KH, Lengenfelder B, Jacobshagen C, Fleischmann C, Moehlis H, Olbrich HG, Jung J, Maier LS, Maier SK, Bestehorn K, Friede T, Meyer T. Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks. Eur Heart J Acute Cardiovasc Care 2020; 10:2048872620907323. [PMID: 32723177 DOI: 10.1177/2048872620907323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/24/2020] [Indexed: 02/24/2024]
Abstract
AIMS Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study. METHODS Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007. RESULTS From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients - namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%, p < 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%, p < 0.0001), pre-announcement by telephone (77.0% vs 85.4%, p = 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%, p < 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%, p < 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p = 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976-0.996, p = 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n = 398,027; 6.7% to 9.2%, p < 0.0001). CONCLUSIONS Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management.
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Affiliation(s)
| | - Björn Lengenfelder
- Department of Cardiology, University of Würzburg, Germany
- Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Heart Center, University of Göttingen, Göttingen, Germany
| | | | - Hiller Moehlis
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Langen, Germany
| | - Jens Jung
- Department of Cardiology, Klinikum Worms, Worms, Germany
| | - Lars S Maier
- Department of Cardiology, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Kg Maier
- Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
- Department of Cardiology, Klinikum Straubing, Straubing, Germany
| | - Kurt Bestehorn
- Institute for Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
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17
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Backhaus SJ, Lange T, Beuthner BE, Topci R, Wang X, Kowallick JT, Lotz J, Seidler T, Toischer K, Zeisberg EM, Puls M, Jacobshagen C, Uecker M, Hasenfuß G, Schuster A. Real-time cardiovascular magnetic resonance T1 and extracellular volume fraction mapping for tissue characterisation in aortic stenosis. J Cardiovasc Magn Reson 2020; 22:46. [PMID: 32564773 PMCID: PMC7310147 DOI: 10.1186/s12968-020-00632-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiovascular magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology. METHODS Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available modified Look-Locker Inversion recovery (MOLLI) (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery Fast Low-Angle Shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses. RESULTS RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p < 0.001). Agreement between RT and MOLLI was best for ECV (ICC > 0.91), excellent for post-contrast T1 times (ICC > 0.81) and good for native T1 times (ICC > 0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology. CONCLUSIONS RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS patients. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.
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Affiliation(s)
- Sören J. Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Bo Eric Beuthner
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Rodi Topci
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Xiaoqing Wang
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Tim Seidler
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Karl Toischer
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Elisabeth M. Zeisberg
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Miriam Puls
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Claudius Jacobshagen
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Martin Uecker
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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18
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D'Ascenzo F, Gili S, Bertaina M, Iannaccone M, Cammann VL, Di Vece D, Kato K, Saglietto A, Szawan KA, Frangieh AH, Boffini B, Annaratone M, Sarcon A, Levinson RA, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun‐Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, El‐Battrawy I, Akin I, Borggrefe M, Horowitz JD, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Biondi‐Zoccai G, Winchester DE, Ukena C, Neuhaus M, Bax JJ, Prasad A, Di Mario C, Böhm M, Gasparini M, Ruschitzka F, Bossone E, Citro R, Rinaldi M, De Ferrari GM, Lüscher T, Ghadri JR, Templin C. Impact of aspirin on takotsubo syndrome: a propensity score‐based analysis of the InterTAK Registry. Eur J Heart Fail 2020; 22:330-337. [PMID: 31863563 DOI: 10.1002/ejhf.1698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | | | - Maurizio Bertaina
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Victoria L. Cammann
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Konrad A. Szawan
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Antonio H. Frangieh
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | | | | | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of MedicineUniversity of California‐San Francisco San Francisco CA USA
| | - Rena A. Levinson
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Division of Biological SciencesUniversity of California San Diego San Diego CA USA
| | - Jennifer Franke
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | - L. Christian Napp
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Milosz Jaguszewski
- First Department of CardiologyMedical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Hugo A. Katus
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/CardiologyHeart Center Leipzig – University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Carsten Tschöpe
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M. Pieske
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional CardiologyUniversity Heart Center Hamburg Hamburg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II – CardiologyUniversity of Ulm, Medical Center Ulm Germany
| | - Samir M. Said
- Internal Medicine/Cardiology, Angiology, and PneumologyMagdeburg University Magdeburg Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe HospitalOxford University Hospitals Oxford UK
| | - Florim Cuculi
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Thomas A. Fischer
- Department of CardiologyKantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart CenterTurku University Hospital and University of Turku Turku Finland
| | | | - Grzegorz Opolski
- Department of CardiologyMedical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Christoph Kaiser
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Wolfgang M. Franz
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Klaus Empen
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Ibrahim El‐Battrawy
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Martin Kozel
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Giuseppe Biondi‐Zoccai
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of Rome Latina Italy
| | - David E. Winchester
- Department of Medicine, College of MedicineUniversity of Florida Gainesville FL USA
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Michael Neuhaus
- Department of CardiologyKantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | - Carlo Di Mario
- Structural Interventional CardiologyUniversity Hospital Careggi Florence Italy
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Mauro Gasparini
- Department of Mathematical SciencesPolitecnico di Torino Turin Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Eduardo Bossone
- Division of Cardiology‘Antonio Cardarelli’ Hospital Naples Italy
| | - Rodolfo Citro
- Heart DepartmentUniversity Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental CardiologyIRCCS Fondazione Policlinico San Matteo Pavia Italy
| | - Thomas Lüscher
- Center for Molecular Cardiology, Schlieren CampusUniversity of Zurich Zurich Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College London UK
| | - Jelena R. Ghadri
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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19
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Ding KJ, Cammann VL, Szawan KA, Stähli BE, Wischnewsky M, Di Vece D, Citro R, Jaguszewski M, Seifert B, Sarcon A, Knorr M, Heiner S, Gili S, D’Ascenzo F, Neuhaus M, Napp LC, Franke J, Noutsias M, Burgdorf C, Koenig W, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Paolini C, Bilato C, Carrilho-Ferreira P, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Horowitz JD, Di Mario C, Prasad A, Rihal CS, Pinto FJ, Crea F, Borggrefe M, Braun-Dullaeus RC, Rottbauer W, Bauersachs J, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Bossone E, Templin C. Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome. Arterioscler Thromb Vasc Biol 2020; 40:279-287. [DOI: 10.1161/atvbaha.119.313491] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective:
Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified.
Approach and Results:
TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0–38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10
3
cells/μL emerged as independent predictors for thrombus formation or embolism.
Conclusions:
Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01947621.
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Affiliation(s)
- Katharina J. Ding
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Victoria L. Cammann
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Konrad A. Szawan
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Barbara E. Stähli
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Germany (M.W.)
| | - Davide Di Vece
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy (R.C.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (B.S.)
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco (A. Sarcon)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.)
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Switzerland (M. Neuhaus)
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M. Noutsias)
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Behrouz Kherad
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Lawrence Rajan
- T.J. Health Partners Heart and Vascular, Glasgow, KY (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus “Maria Hilf” Medizinische Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M. Karakas)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck (M. Karakas)
| | - Alexander Pott
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Jose D. Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Thomas A. Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K.E. Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Carla Paolini
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Claudio Bilato
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Philip MacCarthy
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria (W.D.)
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - David E. Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Jan Galuszka
- Department of Internal Medicine I–Cardiology, University Hospital Olomouc, Czech Republic (J.G.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.D.H.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Fausto J. Pinto
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Hugo A. Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Burkert M. Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
- German Center for Cardiovascular Research, Partner Site Berlin (B.M.P.)
- Berlin Institute of Health, Germany (B.M.P.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (H.T.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - Stephan B. Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.)
- German Centre for Cardiovascular Research, Partner Site Greifswald (S.B.F.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Centre, the Netherlands (J.J.B.)
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.)
- Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L.)
| | - Frank Ruschitzka
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Jelena R. Ghadri
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | | | - Christian Templin
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
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20
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Orban M, Trenk D, Geisler T, Rieber J, Hadamitzky M, Gross L, Orban M, Kupka D, Baylacher M, Müller S, Huber K, Koltowski L, Huczek Z, Heyn J, Jacobshagen C, Aradi D, Massberg S, Sibbing D, Hein R. Smoking and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: a substudy from the randomized TROPICAL-ACS trial. European Heart Journal - Cardiovascular Pharmacotherapy 2019; 6:372-381. [DOI: 10.1093/ehjcvp/pvz084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/24/2019] [Accepted: 12/13/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Prior analyses disclosed variations in antiplatelet drug response and clinical outcomes between smokers and non-smokers, thus the safety and efficacy of any dual antiplatelet therapy (DAPT) de-escalation strategy may differ in relation to smoking status. Hence, we assessed the impact of smoking on clinical outcomes and adenosine diphosphate-induced platelet aggregation following guided de-escalation of DAPT in invasively managed acute coronary syndrome (ACS) patients.
Methods and results
The multicentre TROPICAL-ACS trial randomized 2610 biomarker-positive ACS patients 1:1 to standard treatment with prasugrel for 12 months (control group) or a platelet function testing guided de-escalation of DAPT. Current smokers (n = 1182) showed comparable event rates between study groups [6.6% vs. 6.6%; hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.64–1.56, P > 0.99]. In non-smokers (n = 1428), a guided DAPT de-escalation was associated with a lower 1-year incidence of the primary endpoint [cardiovascular death, myocardial infarction, stroke, or bleeding ≥ Grade 2 according to Bleeding Academic Research Consortium (BARC) criteria] compared with control group patients (7.9% vs. 11.0%; HR 0.71, 95% CI 0.50–0.99, P = 0.048). This reduction was mainly driven by a lower rate of BARC ≥ Grade 2 bleedings (5.2% vs. 7.7%; HR 0.68, 95% CI 0.45–1.03, P = 0.066). There was no significant interaction of smoking status with treatment effects of guided DAPT de-escalation (Pint = 0.23). Adenosine diphosphate-induced platelet aggregation values were higher in current smokers [median 28 U, interquartile range (IQR: 20–40)] vs. non-smoker [median 24 U (16–25), P < 0.0001] in the control group and in current smokers [median 42 U, IQR (27–68)] vs. non-smoker [median 37 U, IQR (25–55), P < 0.001] in the monitoring group.
Conclusion
Guided DAPT de-escalation appears to be equally safe and effective in smokers and non-smokers. Regardless of smoking status and especially for those patients deemed unsuitable for 1 year of potent platelet inhibition this DAPT strategy might be used as an alternative antiplatelet treatment regimen.
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Affiliation(s)
- Martin Orban
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076 Tübingen, Germany
| | - Johannes Rieber
- Department of Cardiology and Intensive Care Medicine, Heart Centre Bogenhausen, Englschalkinger Straße 77, 81925 München, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center of Munich, Lazarettstraße 36, 80636 München, Germany
| | - Lisa Gross
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Mathias Orban
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Danny Kupka
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Monika Baylacher
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Susan Müller
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Kurt Huber
- 3 Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, and Sigmund Freud Private University, Medical School, Montleartstrasse 35-37, 1160 Vienna, Austria
| | - Lukasz Koltowski
- 1 Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warszawa, Poland
| | - Zenon Huczek
- 1 Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warszawa, Poland
| | - Jens Heyn
- Department of Anesthesiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, Heart Centre/Georg-August-University Göttingen, 37073 Göttingen, Germany
| | - Dániel Aradi
- Department of Cardiology, Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Gyógy tér 2 8230 Balatonfüred, Budapest, Hungary
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Dirk Sibbing
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
| | - Ralph Hein
- Department of Cardiology, Ludwig-Maximilians University, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Biedersteiner Straße 29, 80802 München, Germany
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21
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Sibbing D, Gross L, Trenk D, Jacobshagen C, Geisler T, Hadamitzky M, Merkely B, Kiss RG, Komócsi A, Parma R, Felix SB, Neumann FJ, Hausleiter J, Baylacher M, Koltowski L, Mehilli J, Huber K, Huczek Z, Aradi D, Massberg S. Age and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: results from the randomized TROPICAL-ACS trial. Eur Heart J 2019; 39:2749-2758. [PMID: 29912422 DOI: 10.1093/eurheartj/ehy332] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/23/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Guided de-escalation of P2Y12-inhibitor treatment was recently identified as an effective alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention. Safety and efficacy of this strategy may differ in relation to patient's age. This pre-specified analysis of the TROPICAL-ACS trial aimed to assess the impact of age on clinical outcomes following guided de-escalation of antiplatelet treatment in ACS patients. Methods and results Patients were randomly assigned in a 1:1 fashion to either standard treatment with prasugrel for 12 months (control group) or to a guided de-escalation regimen (1 week prasugrel followed by 1 week clopidogrel and platelet function testing guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). We used Cox regression models to assess the associations of age on clinical endpoints and interactions. In younger patients (age ≤70, n = 2240), the 1 year incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, or bleeding ≥ grade 2 according to Bleeding Academic Research Consortium criteria) was significantly lower in guided de-escalation vs. control group [5.9% vs. 8.3%; hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.51-0.96; P = 0.03, number needed to treat = 42]. In elderly patients (age >70, n = 370), the absolute risk of events was higher without significant differences between guided de-escalation vs. control group (15.5% vs. 13.6%; HR 1.17, 95% CI 0.69-2.01; P = 0.56). When the impact of age, as a continuous variable, was analysed on outcomes after guided de-escalation vs. control treatment, an increasing relative risk reduction was observed in the primary endpoint by decreasing age (Pint = 0.02), due to significant reductions in bleeding. Conclusion Treatment effects of guided de-escalation for P2Y12 inhibitors depend on patient's age with younger patients deriving a significant net clinical benefit. Although the safety and efficacy of guided de-escalation in the elderly was similar to uniform prasugrel therapy, this should be further investigated due to the limited sample size of this group.
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Affiliation(s)
- Dirk Sibbing
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Lisa Gross
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology und Pneumology, Heart Centre/Georg-August-University Göttingen, Göttingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, Tübingen, Germany
| | - Martin Hadamitzky
- Department of Radiology, Deutsches Herzzentrum München, Munich, Germany
| | - Béla Merkely
- Heart and Vascular Centre, University of Semmelweis, Budapest, Hungary
| | | | - András Komócsi
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Radoslaw Parma
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK, partner site Greifswald, Greifswald, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Jörg Hausleiter
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Monika Baylacher
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Julinda Mehilli
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Sigmund Freud Private University, Medical School, Wien, Austria
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dániel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Steffen Massberg
- Department of Cardiology, LMU München, Marchioninistraße 15, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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22
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Jurisic S, Gili S, Cammann VL, Kato K, Szawan KA, D'Ascenzo F, Jaguszewski M, Bossone E, Citro R, Sarcon A, Napp LC, Franke J, Noutsias M, Knorr M, Heiner S, Burgdorf C, Koenig W, Pott A, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Dworakowski R, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Kozel M, Tousek P, Winchester DE, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Galuszka J, Ukena C, Poglajen G, Paolini C, Bilato C, Carrilho-Ferreira P, Pinto FJ, Opolski G, MacCarthy P, Kobayashi Y, Prasad A, Rihal CS, Widimský P, Horowitz JD, Di Mario C, Crea F, Tschöpe C, Pieske BM, Hasenfuß G, Rottbauer W, Braun-Dullaeus RC, Felix SB, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Schunkert H, Münzel T, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry. J Am Heart Assoc 2019; 8:e011194. [PMID: 31672100 PMCID: PMC6898832 DOI: 10.1161/jaha.118.011194] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/17/2022]
Abstract
Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide‐ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut‐off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In‐hospital outcomes and 1‐year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1‐year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1‐year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
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Affiliation(s)
- Stjepan Jurisic
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Sebastiano Gili
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Centro Cardiologico Monzino IRCCS Milan Italy
| | - Victoria L Cammann
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Ken Kato
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Konrad A Szawan
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy
| | | | - Eduardo Bossone
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | - Behrouz Kherad
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Philippe Meyer
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - Rafal Dworakowski
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - David E Winchester
- Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Fausto J Pinto
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | | | - Philip MacCarthy
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - John D Horowitz
- Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia
| | | | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italy
| | - Carsten Tschöpe
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M Pieske
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | | | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Switzerland.,Cardiology Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jelena R Ghadri
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Christian Templin
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
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23
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Di Vece D, Citro R, Cammann VL, Kato K, Gili S, Szawan KA, Micek J, Jurisic S, Ding KJ, Bacchi B, Schwyzer M, Candreva A, Bossone E, D'Ascenzo F, Sarcon A, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuβ G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz J, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Di Mario C, Prasad A, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome. Circulation 2019; 139:413-415. [PMID: 30586690 DOI: 10.1161/circulationaha.118.036164] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Rodolfo Citro
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Moritz Schwyzer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Eduardo Bossone
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.A.)
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles (A.S.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M.N.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Germany (H.T.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinsche Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Gerd Hasenfuβ
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M.K.)
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Germany (W.R.)
| | - Samir M Said
- Department of Cardiac Electrophysiology, Helios St Marienberg, Hospital Helmstedt, Germany (S.M.S.)
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K E Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria (W.D.)
| | - Klaus Empen
- Department of Internal Medicine, Kreiskrankenhaus Wolgast, Germany (K.E.)
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.).,German Centre for Cardiovascular Research, Greifswald, Germany (S.B.F.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.H.)
| | - Martin Kozel
- German Centre for Cardiovascular Research, Hamburg/Kiel/Luebeck, Germany (M.K.).,Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Tousek
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Widimský
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A.P.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, The Netherlands (J.J.B.)
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.).,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
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24
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Scholz KH, Maier SKG, Maier LS, Lengenfelder B, Jacobshagen C, Jung J, Fleischmann C, Werner GS, Olbrich HG, Ott R, Mudra H, Seidl K, Schulze PC, Weiss C, Haimerl J, Friede T, Meyer T. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J 2019; 39:1065-1074. [PMID: 29452351 PMCID: PMC6018916 DOI: 10.1093/eurheartj/ehy004] [Citation(s) in RCA: 224] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 01/18/2018] [Indexed: 01/06/2023] Open
Abstract
Aims The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability. Methods and results Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001). Conclusions In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients. Clinical Trial Registration NCT00794001. ![]()
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Affiliation(s)
- Karl Heinrich Scholz
- Department of Cardiology, Medizinische Klinik I, St. Bernward Hospital, Treibestraße 9, 31134 Hildesheim, Germany
| | - Sebastian K G Maier
- Department of Cardiology, Medizinische Klinik II, Klinikum Straubing and Comprehensive Heart Failure Center Würzburg, Würzburg, St.-Elisabeth-Straße 23, 94315 Straubing, Germany
| | - Lars S Maier
- Department of Cardiology, Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin II, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Björn Lengenfelder
- Department of Cardiology, Universitätsklinikum Würzburg and Comprehensive Heart Failure Center Würzburg, Medizinische Klinik und Poliklinik I, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, Heart Center, University of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - Jens Jung
- Department of Cardiology, Medizinische Klinik I, Klinikum Worms, Gabriel-von-Seidl-Straße 81, 67550 Worms, Germany
| | - Claus Fleischmann
- Department of Cardiology, Klinikum Wolfsburg, Medizinische Klinik I, Sauerbruchstraße 7, 38440 Wolfsburg, Germany
| | - Gerald S Werner
- Department of Cardiology, Medizinische Klinik I, Klinikum Darmstadt, Grafenstraße 9, 64283 Darmstadt, Germany
| | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Röntgenstraße 20, 63225 Langen, Germany
| | - Rainer Ott
- Department of Cardiology, HELIOS Klinikum Krefeld, Medizinische Klinik I, Lutherplatz 40, 47805 Krefeld, Germany
| | - Harald Mudra
- Department of Cardiology, Klinikum Neuperlach, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Oskar-Maria-Graf-Ring 51, 81737 München, Germany
| | - Karlheinz Seidl
- Department of Cardiology, Klinikum Ingolstadt, Medizinische Klinik I und IV, Krumenauerstraße 25, 85049 Ingolstadt, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Am Klinikum 1, 07740 Jena, Germany
| | - Christian Weiss
- Department of Cardiology, Klinikum Lüneburg, Bögelstraße 1, 21339 Lüneburg, Germany
| | - Josef Haimerl
- Department of Cardiology, Krankenhaus Landshut-Achdorf, Medizinische Klinik I, Achdorfer Weg 3, 84036 Landshut, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, University of Göttingen, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, University of Göttingen, and DZHK, partner site Göttingen, Waldweg 33, 37073 Göttingen, Germany
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Schymik G, Rudolph T, Jacobshagen C, Rothe J, Treede H, Kerber S, Frank D, Sykorova L, Okamoto M, Thoenes M, Deutsch C, Bramlage P, Butter C. Balloon-expandable transfemoral transcatheter aortic valve implantation with or without predilation: findings from the prospective EASE-IT TF multicentre registry. Open Heart 2019; 6:e001082. [PMID: 31673387 PMCID: PMC6803005 DOI: 10.1136/openhrt-2019-001082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Received: 05/04/2019] [Revised: 07/16/2019] [Accepted: 09/12/2019] [Indexed: 11/05/2022] Open
Abstract
Background Predilation of the native valve has long been deemed necessary in transfemoral transcatheter aortic valve implantation (TF-TAVI), despite little trial evidence to support its clinical use. As most evidence is derived from retrospective analyses of observational studies, we conducted a two-armed, prospective multicentre registry. Methods Patients undergoing TF-TAVI with the Edwards SAPIEN 3 valve, with or without balloon aortic valvuloplasty (BAV), were included and their procedural characteristics, short-term safety and short-term efficacy outcomes compared. We hypothesised that BAV may be safely omitted in many patients and omission could be associated with procedural benefits. Results Overall, 196 consecutive patients underwent TF-TAVI, 56 with BAV and 140 without. The mean age was 81.2±6.2 years, and the mean logistic EuroSCORE I was 17.1±13.6. Device success according to Valve Academic Research Consortium-2 (VARC-2) was achieved in 96.4%. The median procedural duration was shorter without BAV (56 min vs 90 min; p=0.001), as was fluoroscopy time (10 min vs 13 min; p=0.001). The need for balloon postdilation was less frequent in patients without BAV (15.7% vs 30.4%, p=0.029). There was no difference in the proportion of patients meeting the VARC-2 defined composite safety endpoint at 30 days (9.3% without vs 8.9% with BAV; adjusted OR (adjOR) 2.55; 95% CI 0.56 to 18.84) and at 6 months (15.2% without vs 16.4% with BAV; adjOR 1.66; 95% CI 0.49 to 6.55). Conclusions In the majority of patients, BAV can be safely omitted from the TAVI procedure without adverse effects. The omission of BAV is associated with shorter procedural duration and could be advantageous for the majority of patients. Trial registration number NCT02760771.
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Affiliation(s)
- Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Karlsruhe, Baden-Württemberg, Germany
| | - Tanja Rudolph
- Heart Center, University of Cologne, Cologne, Germany
| | | | - Jürgen Rothe
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik Treede
- Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle, Halle, Germany
| | | | - Derk Frank
- Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein,Campus Kiel, Kiel, Schleswig-Holstein, Germany.,ZHK (German Centre for Cardiovascular Research), Partner Site Kiel/Hamburg/Lübeck, Hamburg, Germany
| | | | - Maki Okamoto
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg & Medical School Brandenburg Bernau, Bernau, Germany
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg & Medical School Brandenburg Bernau, Bernau, Germany
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26
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Tichelbäcker T, Baldus S, Jacobshagen C, Puls M, Hünlich M. TCT-373 LAA Occlusion With the Amplatzer and AMULET Devices: Long-Term Outcomes in a High-Risk Cohort. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Ghadri JR, Kato K, Cammann VL, Gili S, Jurisic S, Di Vece D, Candreva A, Ding KJ, Micek J, Szawan KA, Bacchi B, Bianchi R, Levinson RA, Wischnewsky M, Seifert B, Schlossbauer SA, Citro R, Bossone E, Münzel T, Knorr M, Heiner S, D'Ascenzo F, Franke J, Sarcon A, Napp LC, Jaguszewski M, Noutsias M, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Horowitz J, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Winchester DE, Ukena C, Bax JJ, Prasad A, Böhm M, Lüscher TF, Ruschitzka F, Templin C. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol 2019; 72:874-882. [PMID: 30115226 DOI: 10.1016/j.jacc.2018.06.016] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [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: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).
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Affiliation(s)
- Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastiano Gili
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stjepan Jurisic
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Katharina J Ding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jozef Micek
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Bianchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Biological Sciences, University of California, San Diego, La Jolla, California
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Susanne A Schlossbauer
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Thomas Münzel
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Heart Center Leipzig, University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohne, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, Minnesota
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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28
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Wischnewsky MB, Candreva A, Bacchi B, Cammann VL, Kato K, Szawan KA, Gili S, D'Ascenzo F, Dichtl W, Citro R, Bossone E, Neuhaus M, Franke J, Sorici-Barb I, Jaguszewski M, Noutsias M, Knorr M, Heiner S, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Nguyen TH, Kobayashi Y, Böhm M, Maier LS, Pinto FJ, Widimský P, Borggrefe M, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz J, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prediction of short- and long-term mortality in takotsubo syndrome: the InterTAK Prognostic Score. Eur J Heart Fail 2019; 21:1469-1472. [PMID: 31452320 DOI: 10.1002/ejhf.1561] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose David Arroja
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Gallen, Switzerland
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin; and Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Cammann VL, Sarcon A, Ding KJ, Seifert B, Kato K, Di Vece D, Szawan KA, Gili S, Jurisic S, Bacchi B, Micek J, Frangieh AH, Napp LC, Jaguszewski M, Bossone E, Citro R, D'Ascenzo F, Franke J, Noutsias M, Knorr M, Heiner S, Burgdorf C, Koenig W, Thiele H, Tschöpe C, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Dworakowski R, Kaiser C, Osswald S, Galiuto L, Dichtl W, Delmas C, Lairez O, Horowitz JD, Kozel M, Widimský P, Tousek P, Winchester DE, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Ukena C, Bauersachs J, Pieske BM, Hasenfuß G, Rottbauer W, Braun-Dullaeus RC, Opolski G, MacCarthy P, Felix SB, Borggrefe M, Di Mario C, Crea F, Katus HA, Schunkert H, Münzel T, Böhm M, Bax JJ, Prasad A, Shinbane J, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry. J Am Heart Assoc 2019; 8:e010881. [PMID: 31311438 PMCID: PMC6761645 DOI: 10.1161/jaha.118.010881] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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]
Abstract
Background Clinical characteristics and outcomes of takotsubo syndrome (TTS) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short- and long-term outcomes in TTS patients with or without malignancy. Methods and Results TTS patients were enrolled from the International Takotsubo Registry. The TTS cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short- and long-term mortality. A subanalysis was performed comparing long-term mortality between a subset of TTS patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604 TTS patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long-term mortality was higher in patients with malignancy (P<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01947621.
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Affiliation(s)
- Victoria L Cammann
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - Katharina J Ding
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute University of Zurich Switzerland
| | - Ken Kato
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Sebastiano Gili
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Centro Cardiologico Monzino IRCCS Milan Italy
| | - Stjepan Jurisic
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Beatrice Bacchi
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jozef Micek
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Antonio H Frangieh
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Deutsches Herzzentrum München Technische Universität München Munich Germany
| | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | | | - Eduardo Bossone
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany
| | - Maike Knorr
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig- University Hospital Leipzig Germany
| | - Carsten Tschöpe
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Adrian Banning
- Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Finland
| | | | - Rafal Dworakowski
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - John D Horowitz
- Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - David E Winchester
- Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Ekaterina Gilyarova
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Christian Ukena
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Burkert M Pieske
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology University of Ulm, Medical Center Ulm Germany
| | | | | | - Philip MacCarthy
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Thomas Münzel
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Cardiology Royal Brompton & Harefield Hospital and Imperial College London United Kingdom
| | - Frank Ruschitzka
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jelena R Ghadri
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Christian Templin
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
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30
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Gross L, Kupka D, Trenk D, Geisler T, Hadamitzky M, Löw A, Orban M, Huber K, Kiss RG, Merkely B, Huczek Z, Beuthner BE, Hein-Rothweiler R, Baylacher M, Rizas K, Massberg S, Aradi D, Sibbing D, Jacobshagen C. Gender and Outcomes following Guided De-Escalation of Antiplatelet Treatment in Acute Coronary Syndrome Patients: The TROPICAL-ACS Gender Substudy. Thromb Haemost 2019; 119:1527-1538. [PMID: 31226717 DOI: 10.1055/s-0039-1692441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This prespecified analysis of the TROPICAL-ACS trial aimed to assess the impact of gender on clinical outcomes and platelet reactivity (PR) following guided de-escalation of dual antiplatelet treatment (DAPT) in acute coronary syndrome (ACS) patients. BACKGROUND Guided de-escalation of DAPT was recently identified as an effective alternative treatment strategy in ACS. METHODS We used Cox proportional hazards models and linear regression analysis to assess the interaction of gender with clinical endpoints and PR. RESULTS In both male (n = 2,052) and female (n = 558) patients, the 1-year incidence of the primary endpoint did not differ in guided de-escalation versus control group patients (male: 7.0% vs. 9.0%; hazard ratio [HR], 0.78, 95% confidence interval [CI], 0.57-1.06, p = 0.11; female: 8.4% vs. 9.2%; HR, 0.92, 95% CI, 0.53-1.62, p = 0.76, p int = 0.60). The 1-year incidence of combined ischemic events (male: 2.5% vs. 3.3%; HR, 0.76, 95% CI, 0.46-1.26, p = 0.29; female: 2.2% vs. 2.8%; HR, 0.78,95% CI, 0.27-2.25, p = 0.65, p int = 0.96) as well as Bleeding Academic Research Consortium ≥ 2 bleeding (male: 4.6% vs. 6.0%; HR, 0.77, 95% CI, 0.52-1.12, p = 0.17; female: 6.2% vs. 6.4%; HR, 0.99, 95% CI, 0.51-1.92, p = 0.97, p int = 0.51) was similar in the guided de-escalation versus control group for both male and female patients. Interaction testing revealed no significant impact of gender on PR levels (prasugrel or clopidogrel) across treatment groups (p int = 0.72). CONCLUSION Guided de-escalation of DAPT appears to be equally safe and effective in women and men. Especially in patients with increased bleeding risk and independent from gender, a guided DAPT de-escalation strategy may be used as an alternative treatment strategy. CLINICAL TRIAL REGISTRATION URL: https//www.clinicaltrials.gov. Unique Identifier: NCT: 01959451.
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Affiliation(s)
- Lisa Gross
- Department of Cardiology, LMU München, Munich, Germany
| | - Danny Kupka
- Department of Cardiology, LMU München, Munich, Germany
| | - Dietmar Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Tobias Geisler
- Department of Cardiology, University Hospital of Tuebingen, Tübingen, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center of Munich, Munich, Germany
| | - Anja Löw
- Department of Cardiology, LMU München, Munich, Germany
| | - Martin Orban
- Department of Cardiology, LMU München, Munich, Germany
| | - Kurt Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, and Sigmund Freud University, Medical School, Vienna, Austria
| | | | - Bela Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | | | | | | | - Steffen Massberg
- Department of Cardiology, LMU München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Daniel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Dirk Sibbing
- Department of Cardiology, LMU München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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31
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Olivotto I, Camici PG, Merlini PA, Rapezzi C, Patten M, Climent V, Sinagra G, Tomberli B, Marin F, Ehlermann P, Maier LS, Fornaro A, Jacobshagen C, Ganau A, Moretti L, Hernandez Madrid A, Coppini R, Reggiardo G, Poggesi C, Fattirolli F, Belardinelli L, Gensini G, Mugelli A. Efficacy of Ranolazine in Patients With Symptomatic Hypertrophic Cardiomyopathy: The RESTYLE-HCM Randomized, Double-Blind, Placebo-Controlled Study. Circ Heart Fail 2019; 11:e004124. [PMID: 29321131 DOI: 10.1161/circheartfailure.117.004124] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [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: 04/10/2017] [Accepted: 12/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The late sodium current inhibitor ranolazine reverses the main electrophysiological and mechanical abnormalities of human hypertrophic cardiomyopathy (HCM) cardiomyocytes in vitro, suggesting potential clinical benefit. We aimed to assess the effect of ranolazine on functional capacity, symptomatic status, diastolic function, and arrhythmias in HCM. METHODS AND RESULTS In this multicenter, double-blind, phase 2 study, 80 adult patients with nonobstructive HCM (age 53±14 years, 34 women) were randomly assigned to placebo (n=40) or ranolazine 1000 mg bid (n=40) for 5 months. The primary end point was change in peak VO2 compared with baseline using cardiopulmonary exercise test. Echocardiographic lateral and septal E/E' ratio, prohormone brain natriuretic peptide levels, 24-hour Holter arrhythmic profile, and quality of life were assessed. Ranolazine was safe and well tolerated. Overall, there was no significant difference in VO2 peak change at 5 months in the ranolazine versus placebo group (delta 0.15±3.96 versus -0.02±4.25 mL/kg per minute; P=0.832). Ranolazine treatment was associated with a reduction in 24-hour burden of premature ventricular complexes compared with placebo (>50% reduction versus baseline in 61% versus 31%, respectively; P=0.042). However, changes in prohormone brain natriuretic peptide levels did not differ in the ranolazine compared with the placebo group (geometric mean median [interquartile range], -3 pg/mL [-107, 142 pg/mL] versus 78 pg/mL [-71, 242 pg/mL]; P=0.251). Furthermore, E/E' ratio and quality of life scores showed no significant difference. CONCLUSIONS In patients with nonobstructive HCM, ranolazine showed no overall effect on exercise performance, plasma prohormone brain natriuretic peptide levels, diastolic function, or quality of life. The drug showed an excellent safety profile and was associated with reduced premature ventricular complex burden. Late sodium current inhibition does not seem to improve functional capacity in HCM. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-004507-20.
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Affiliation(s)
- Iacopo Olivotto
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Paolo G Camici
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Piera Angelica Merlini
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Claudio Rapezzi
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Monica Patten
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Vicent Climent
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Gianfranco Sinagra
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Benedetta Tomberli
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.).
| | - Francisco Marin
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Philipp Ehlermann
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Lars S Maier
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Alessandra Fornaro
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Claudius Jacobshagen
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Antonello Ganau
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Luciano Moretti
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Antonio Hernandez Madrid
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Raffaele Coppini
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Giorgio Reggiardo
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Corrado Poggesi
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Francesco Fattirolli
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Luiz Belardinelli
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Gianfranco Gensini
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
| | - Alessandro Mugelli
- >From the Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (I.O., B.T., A.F.); Vita Salute University and Scientific Institute San Raffaele, Milan, Italy (P.G.C.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy (P.A.M.); Ospedale S. Orsola Malpighi, Bologna, Italy (C.R.); Clinic of General and Interventional Cardiology, University Heart Center, Hamburg, Germany (M.P.); Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain (V.C.); Cardiovascular Department, Ospedale di Cattinara, Trieste, Italy (G.S.); Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (F.M.); University Hospital, Heidelberg, Germany (P.E.); University Hospital Regensburg, Germany (L.S.M.); Herz zentrum Georg-August-Universitaet, Göttingen, Germany (C.J.); Department of Clinical and Experimental Medicine, Cardiology, Sassari Hospital, Sassari, Italy (A.G.); Ospedale Mazzoni, Ascoli Piceno, Italy (L.M.); Hospital Ramòn y Cajal, Alcalá University, Madrid, Spain (A.H.M.); Department Neurofarba, University of Florence, Italy (R.C., A.M.); Medi Service, Genoa, Italy (G.R.); Department of Experimental and Clinical Medicine, University of Florence, Italy (C.P., F.F.); Gilead Sciences, Foster City, CA (L.B.); and CESMAV, Florence, Italy (G.G.)
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Butter C, Okamoto M, Schymik G, Jacobshagen C, Rothe J, Treede H, Kerber S, Frank D, Bramlage P, Sykorova L, Thoenes M, Rudolph TK. Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE-IT TF registry. Catheter Cardiovasc Interv 2019; 94:469-478. [PMID: 30866154 DOI: 10.1002/ccd.28164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/20/2018] [Accepted: 02/09/2019] [Indexed: 12/17/2022]
Abstract
AIMS We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. METHODS AND RESULTS EASE-IT TF was a prospective, observational, multicenter registry of patients undergoing TF-TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre-procedural multi-slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater-than-average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042-38.35) and the need for post-dilation (OR: 3.592; 95% CI: 1.173-12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223-18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114-38.74). No other BAV-dependent effects of calcification on outcomes were observed. CONCLUSIONS In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post-dilation requirements in patients only with a greater degree of leaflet calcification.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Maki Okamoto
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital, Karlsruhe, Germany
| | | | - Jürgen Rothe
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik Treede
- Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle, Halle, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany
| | - Derk Frank
- ZHK (German Centre for Cardiovascular Research), Hamburg, Germany.,Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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33
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Scholz KH, Friede T, Meyer T, Jacobshagen C, Lengenfelder B, Jung J, Fleischmann C, Moehlis H, Olbrich HG, Ott R, Elsässer A, Schröder S, Thilo C, Raut W, Franke A, Maier LS, Maier SK. Prognostic significance of emergency department bypass in stable and unstable patients with ST-segment elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2018; 9:34-44. [PMID: 30477317 PMCID: PMC7047304 DOI: 10.1177/2048872618813907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: In ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention, direct transport from the scene to the catheterisation laboratory bypassing the emergency department has been shown to shorten times to reperfusion. The aim of this study was to investigate the effects of emergency department bypass on mortality in both haemodynamically stable and unstable STEMI patients. Methods: The analysis is based on a large cohort of STEMI patients prospectively included in the German multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial. Results: Out of 13,219 STEMI patients who were brought directly from the scene by emergency medical service transportation and were treated with percutaneous coronary intervention, the majority were transported directly to the catheterisation laboratory bypassing the emergency department (n=6740, 51% with emergency department bypass). These patients had a significantly lower in-hospital mortality than their counterparts with no emergency department bypass (6.2% vs. 10.0%, P<0.0001). The reduced mortality related to emergency department bypass was observed in both stable (n=11,594, 2.8% vs. 3.8%, P=0.0024) and unstable patients presenting with cardiogenic shock (n=1625, 36.3% vs. 46.2%, P<0.0001). Regression models adjusted for the Thrombolysis In Myocardial Infarction (TIMI) risk score consistently confirmed a significant and independent predictive effect of emergency department bypass on survival in the total study population (odds ratio 0.64, 95% confidence interval 0.56–0.74, P<0.0001) and in the subgroup of shock patients (OR 0.69, 95% CI 0.54–0.88, P=0.0028). Conclusion: In STEMI patients, emergency department bypass is associated with a significant reduction in mortality, which is most pronounced in patients presenting with cardiogenic shock. Our data encourage treatment protocols for emergency department bypass to improve the survival of both haemodynamically stable patients and, in particular, unstable patients. Clinical Trial Registration: NCT00794001 ClinicalTrials.gov: NCT00794001
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Affiliation(s)
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Thomas Meyer
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, Germany
| | - Claudius Jacobshagen
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Björn Lengenfelder
- Department of Cardiology, University of Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, Germany
| | - Jens Jung
- Department of Cardiology, Klinikum Worms, Germany
| | | | | | - Hans G Olbrich
- Department of Cardiology, Asklepios Klinik Langen, Germany
| | - Rainer Ott
- Department of Cardiology, Helios Klinikum Krefeld, Germany
| | | | | | | | - Werner Raut
- Department of Cardiology, Community Hospital Buchholz, Germany
| | - Andreas Franke
- Department of Cardiology, Klinikum Siloah Region Hannover, Germany
| | - Lars S Maier
- Department of Cardiology, University Hospital Regensburg, Germany
| | - Sebastian Kg Maier
- Comprehensive Heart Failure Center Würzburg, Germany.,Department of Cardiology, Klinikum Straubing, Germany
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34
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Tichelbäcker T, Bergau L, Puls M, Friede T, Mütze T, Maier LS, Frey N, Hasenfuß G, Zabel M, Jacobshagen C, Sossalla S. Insights into permanent pacemaker implantation following TAVR in a real-world cohort. PLoS One 2018; 13:e0204503. [PMID: 30332419 PMCID: PMC6192571 DOI: 10.1371/journal.pone.0204503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) following TAVR is a frequent post interventional complication and its management remains controversial. OBJECTIVE We sought to elucidate the electrophysiological, procedural, and clinical baseline parameters that are associated with and perhaps predict the need for PPI after TAVR in a heterogeneous-valve-type real-world cohort. METHODS Overall, 494 patients receiving TAVR at our center from April 2009 to August 2015 were screened. ECG analyses and clinical parameters were collected prospectively. RESULTS Overall, 401 patients in this all-comers real-world TAVR cohort with a PPI rate of 16% were included. The mean age was 82 years, and the mean duration to PPI was 5.5 days. A large proportion of Edwards SAPIEN valves (81%), DirectFlow, CoreValve, and Portico were implanted. The main indications for PPI were atrioventricular (AV) block III, AV-block Mobitz type II, bradycardic atrial fibrillation and persistent sinus bradycardia. Between groups with and without PPI, significant differences were noted in the prevalence of post TAVR balloon dilatation, resting heart rate, QRS interval, PR interval with a cut-off of >178 ms, left anterior fascicular block and RBBB in univariate analyses. In the subsequent multiple regression analysis, post TAVR balloon dilatation and a PR interval with a cut-off of >178 ms were significant predictors of PPI. CONCLUSION This real-world cohort differs from others in its size and heterogeneous valve selection, and indicates for the first time that patients with post balloon dilatation or prolonged PR interval are at a higher risk for pacemaker dependency after TAVR.
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Affiliation(s)
- Tobias Tichelbäcker
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Leonard Bergau
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Miriam Puls
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Tobias Mütze
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Lars Siegfried Maier
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg; Regensburg, Germany
| | - Norbert Frey
- Department for Internal Medicine III, University Hospital Kiel, Kiel, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Markus Zabel
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
| | - Samuel Sossalla
- Clinic for Cardiology & Pneumology, University Medical Center Goettingen, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Goettingen, Goettingen, Germany
- Department for Internal Medicine II, Cardiology, Pneumology, Intensive Care, University Hospital Regensburg; Regensburg, Germany
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35
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Hasenfuß G, Jacobshagen C. [InterAtrial Shunt Device in diastolic heart failure]. Internist (Berl) 2018; 59:1054-1062. [PMID: 30194481 DOI: 10.1007/s00108-018-0484-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
All types of heart failure are associated with reduced cardiac output and/or increased left atrial (LA) pressure. In diastolic heart failure (heart failure with preserved ejection fraction [HFpEF]), the increased LA pressure plays a central role, leading to pulmonary venous hypertension (PVH) and increased pulmonary artery pressure. These pressure parameters are presumably decisive for the symptoms and mortally of heart failure, particularly of the diastolic form. This is the basis for treatment with an interarterial shunt to reduce LA pressure in patients with diastolic heart failure and PVH. At first glance, this appears paradoxical, since closure of an atrial septum defect serves to prevent increased pulmonary vascular resistance and paradoxical embolism. Prevention of increased pulmonary vascular resistance and paradoxical embolism is thus an essential aspect in the development of devices for establishing an interarterial shunt. Reports on the InterAtrial Shunt Device (IASD®) and the V‑Wave have been published, both of which can be implanted with a low risk and few complications. The V‑Wave device is equipped with a valve to prevent paradoxical embolisms. However, paradoxical embolisms were also not observed with the IASD®, and the valve of the V‑Wave exhibited considerable degenerative changes and valve closure. Hemodynamic and clinical data of patients with an IASD® or an open V‑Wave device demonstrated a sustained hemodynamic improvement. Physical performance capacity and quality of life were increased. Whether IASD® may be broadly applicable in patients with diastolic heart failure is currently under investigation. In selected highly symptomatic patients with diastolic heart failure and PVH, the IASD® is already in clinal use.
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Affiliation(s)
- G Hasenfuß
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - C Jacobshagen
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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36
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Gross L, Trenk D, Jacobshagen C, Krieg A, Gawaz M, Massberg S, Baylacher M, Aradi D, Stimpfle F, Hromek J, Vogelgesang A, Hadamitzky M, Sibbing D, Geisler T. Genotype-Phenotype Association and Impact on Outcomes following Guided De-Escalation of Anti-Platelet Treatment in Acute Coronary Syndrome Patients: The TROPICAL-ACS Genotyping Substudy. Thromb Haemost 2018; 118:1656-1667. [PMID: 30103241 DOI: 10.1055/s-0038-1667337] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Phenotype-guided de-escalation (PGDE) of P2Y12-inhibitor treatment with an early switch from prasugrel to clopidogrel was identified as an effective alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment for Acute Coronary Syndromes (TROPICAL-ACS) Genotyping Substudy aimed to investigate whether CYP2C19 genotypes correlate with on-treatment platelet reactivity (PR) in ACS patients treated with clopidogrel or prasugrel and thus might be useful for guidance of early de-escalation of anti-platelet treatment. METHODS AND RESULTS A total of 603 ACS consecutive patients were enrolled in four centres (23.1% of the overall TROPICAL-ACS population). Rapid genotyping (Spartan RX) for CYP2C19*2, *3 and *17 alleles was performed. Associations between PR and the primary and secondary endpoints of the TROPICAL-ACS trial and CYP2C19*2 and CYP2C19*17 carrier status were evaluated.For the PGDE group, the on-clopidogrel PR significantly differed across CYP2C19*2 (p < 0.001) and CYP2C19*17 genotypes (p = 0.05). Control group patients were not related (p = 0.90, p = 0.74) to on-prasugrel PR. For high PR versus non-high PR patients within the PGDE group, significant differences were observed for the rate of CYP2C19*2 allele carriers (43% vs. 28%, p = 0.007). CONCLUSION CYP2C19*2 and CYP2C19*17 carrier status correlates with PR in ACS patients treated with clopidogrel and thus might be useful for pre-selecting patients who will and who may not be suitable for PGDE of anti-platelet treatment. Regarding phenotype-guided treatment, we did not observe added benefit of genotyping to predict ischaemic and bleeding risk in patients who underwent a PGDE approach. CLINICAL TRIAL REGISTRATION URL: https//www.clinicaltrials.gov. Unique Identifier: NCT: 01959451.
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Affiliation(s)
- Lisa Gross
- Department of Cardiology, LMU München, Munich, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, University of Freiburg, Bad Krozingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, Heart Centre, Georg-August-University Göttingen, Göttingen, Germany
| | - Anne Krieg
- Department of Cardiology, LMU München, Munich, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Steffen Massberg
- Department of Cardiology, LMU München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Daniel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Fabian Stimpfle
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Julia Hromek
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, University of Freiburg, Bad Krozingen, Germany
| | - Anja Vogelgesang
- Department of Cardiology and Pneumology, Heart Centre, Georg-August-University Göttingen, Göttingen, Germany
| | - Martin Hadamitzky
- Department of Radiology, Deutsches Herzzentrum München, Technical University of Munich, München, Germany
| | - Dirk Sibbing
- Department of Cardiology, LMU München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Disease, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
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37
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Djukic M, Braun LM, Unkel S, Jacobshagen C, Nau R. Introduction of Non-Vitamin K Antagonist Anticoagulants Strongly Increased the Rate of Anticoagulation in Hospitalized Geriatric Patients with Atrial Fibrillation. Drugs Aging 2018; 35:859-869. [PMID: 30066299 DOI: 10.1007/s40266-018-0571-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The benefit of anticoagulative treatment to prevent thromboembolism has been established in patients with atrial fibrillation and flutter of all age groups. Traditionally, anticoagulation was underused in geriatric patients with atrial fibrillation and flutter. OBJECTIVE The aim of this study was to assess whether the broad introduction of non-vitamin K antagonist oral anticoagulants into clinical medicine has changed the rate of older patients treated with anticoagulants for atrial fibrillation and flutter. METHODS Hospitalized geriatric patients treated in 2015 were retrospectively studied for the presence of atrial fibrillation and flutter and the use or non-use of anticoagulation. The risk of stroke and the indication for permanent anticoagulation were assessed using the CHA2DS2-VASc score. RESULTS Five hundred and twelve of 1320 patients showed a clear indication for therapeutic anticoagulation (38.8%). Of these, 431 patients (84.2%) had long-standing persistent (> 1 year)/permanent atrial fibrillation and flutter or paroxysmal/persistent (> 7 days) atrial fibrillation and flutter as well as CHA2DS2-VASc scores of ≥ 2 in men and ≥ 3 in women. In this group, 378 patients (87.7%) received anticoagulative treatment. Of all patients anticoagulated for atrial fibrillation and flutter, 221 received non-vitamin K antagonist oral anticoagulants (58.5%), 176 received apixaban (46.6%), 32 received rivaroxaban (8.5%), and 13 received dabigatran (3.4%). One hundred and seven patients received the vitamin K antagonist phenprocoumon (28.3%) and 50 patients received high-dose low-molecular-weight heparins (13.2%). In 21 patients (5.6% of all anticoagulated patients with atrial fibrillation and flutter), hemorrhagic complications were documented. Eleven complications (52.4; 5.0% of all patients treated with non-vitamin K antagonist oral anticoagulants) occurred during treatment with non-vitamin K antagonist oral anticoagulants, four (19.0%) during anticoagulation with phenprocoumon and six (28.6%) during treatment with low-molecular-weight heparins. No intracranial hemorrhages and no fatal bleeding events occurred. CONCLUSION The introduction of non-vitamin K antagonist oral anticoagulants and an increased awareness of their benefits led to an increased use of anticoagulation from 52.8% (2011) to 87.7% (2015) in geriatric patients with atrial fibrillation and flutter at our institution.
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Affiliation(s)
- Marija Djukic
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany.
- Geriatric Center, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany.
| | - Larissa Maria Braun
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Geriatric Center, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany
| | - Steffen Unkel
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Roland Nau
- Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
- Geriatric Center, Protestant Hospital Göttingen-Weende, An der Lutter 24, Göttingen, 37075, Germany
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Gross L, Trenk D, Jacobshagen C, Krieg A, Gawaz M, Massberg S, Baylacher M, Aradi D, Stimpfle F, Hromek J, Vogelgesang A, Hadamitzky M, Sibbing D, Geisler T. P5731CYP2C19 genotyping as complementary tool for guidance of early de-escalation of antiplatelet treatment in acute coronary syndrome patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5731] [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: 11/12/2022] Open
Affiliation(s)
- L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - A Krieg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M Gawaz
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M Baylacher
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - F Stimpfle
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - J Hromek
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - A Vogelgesang
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
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Hein R, Gross L, Trenk D, Jacobshagen C, Geisler T, Hadamitzky M, Huber K, Nagy F, Dezsi CA, Merkely B, Huczek Z, Koltowski L, Massberg S, Aradi D, Sibbing D. P2267De-escalation of antiplatelet therapy after percutaneous coronary intervention in acute coronary syndrome patients: outcome of diabetics in the randomized TROPICAL-ACS trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2267] [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: 11/15/2022] Open
Affiliation(s)
- R Hein
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - F Nagy
- University of Szeged, First Department of Internal Medicine, Szeged, Hungary
| | - C A Dezsi
- Petz Aladár County Teaching Hospital, Department of Cardiology, Gyor, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - L Koltowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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Orban M, Trenk D, Rieber J, Geisler T, Hadamitzky M, Komosa A, Gross L, Orban MW, Huber K, Felix SB, Huczek Z, Jacobshagen C, Aradi D, Massberg S, Sibbing D. P3669Smoking and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS smoking substudy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3669] [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: 11/12/2022] Open
Affiliation(s)
- M Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Klinische Pharmakologie, Bad Krozingen, Germany
| | - J Rieber
- Heart Centre Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- Deutsches Herzzentrum Technische Universitat, Radiology, Munich, Germany
| | - A Komosa
- Poznan University of Medical Sciences, 1st Department of Cardiology, Poznan, Poland
| | - L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M W Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - S B Felix
- University Hospital Rostock, Department of Internal Medicine B, Rostock, Germany
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - D Aradi
- Balatonfured State Cardiology Hospital, Cardiology, Balatonfured, Hungary
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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Gross L, Trenk D, Geisler T, Hadamitzky M, Loew A, Orban M, Huber K, Kiss RG, Merkely B, Huczek Z, Beuthner BEC, Massberg S, Aradi D, Jacobshagen C, Sibbing D. P5107Gender and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS gender substudy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5107] [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: 11/15/2022] Open
Affiliation(s)
- L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
| | - A Loew
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - R G Kiss
- Military Hospital, Department of Cardiology, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - B E C Beuthner
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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Puls M, Korte KP, Bleckmann A, Huenlich M, Danner BC, Schoendube F, Hasenfuß G, Jacobshagen C, Schillinger W. Long-term outcomes after TAVI in patients with different types of aortic stenosis: the conundrum of low flow, low gradient and low ejection fraction. EUROINTERVENTION 2018; 13:286-293. [PMID: 28462903 DOI: 10.4244/eij-d-16-00801] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/23/2022]
Abstract
AIMS The objective of this study was to examine the impact of guideline-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS Four hundred (400) consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (for up to seven years). One hundred and forty-seven (147) individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40 mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index [SVI] <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient). LEF-LG status was associated with the highest all-cause and cardiovascular mortality and MACCE rate, whereas NEF-HG patients exhibited the best outcome (i.e., median survival 5.1 years in NEF-HG vs. 1.3 years in LEF-LG, p=0.0006; or vs. 3.3 years in PLF-LG, p=0.02). In multivariate analysis, LEF-LG status emerged as the outcome predictor with the highest hazard ratio for all-cause mortality (HR 2.86, p=0.003), cardiovascular mortality (HR 6.53, p<0.0001), and MACCE (HR 2.44, p=0.007), whereas neither baseline EF nor SVI <35 ml/m² independently predicted these endpoints. CONCLUSIONS These findings suggest that an assessment of LV-EF alone for outcome prediction after TAVI is inadequate; it is the guideline-defined subtype of AS that determines outcome.
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Affiliation(s)
- Miriam Puls
- Department of Cardiology, University Medical Center Goettingen, Goettingen, Germany
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43
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Geisler T, Gross L, Stimpfle F, Krieg A, Hadamitzky M, Gawaz M, Massberg S, Aradi D, Jacobshagen C, Trenk D, Sibbing D. GENOYTYPE-PHENOTYPE ASSOCIATION AND IMPACT ON OUTCOMES FOLLOWING GUIDED DE-ESCALATION OF ANTIPLATELET THERAPY IN ACUTE CORONARY SYNDROME PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Sibbing D, Gross L, Trenk D, Jacobshagen C, Geisler T, Hadamitzky M, Merkely B, Kiss R, Komócsi A, Parma R, Gori T, Felix S, Schwinger R, Neumann FJ, Hausleiter J, Baylacher M, Koltowski L, Mehilli J, Huber K, Huczek Z, Aradi D, Massberg S. AGE AND OUTCOMES FOLLOWING GUIDED DE-ESCALATION OF ANTIPLATELET TREATMENT IN ACUTE CORONARY SYNDROME PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: RESULTS OF A RANDOMIZED MULTICENTRE TRIAL. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31744-3] [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: 11/28/2022]
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45
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Bergmann I, Büttner B, Teut E, Jacobshagen C, Hinz J, Quintel M, Mansur A, Roessler M. Pre-hospital transthoracic echocardiography for early identification of non-ST-elevation myocardial infarction in patients with acute coronary syndrome. Crit Care 2018; 22:29. [PMID: 29409525 PMCID: PMC5802056 DOI: 10.1186/s13054-017-1929-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/21/2017] [Indexed: 12/02/2022]
Abstract
Background Non-ST elevation myocardial infarction (NSTEMI) is a common manifestation of acute coronary syndrome (ACS), but delayed diagnosis can increase mortality. In this proof of principle study, the emergency physician performed transthoracic echocardiography (TTE) on scene to determine whether NSTEMI could be correctly diagnosed pre-hospitalization. This could expedite admission to the appropriate facility and reduce the delay until initiation of correct therapy. Methods Pre-hospital TTE was performed on scene by the emergency physician in patients presenting with ACS but without ST-elevation in the initial 12-lead electrocardiography (ECG) (NSTE-ACS). A presumptive NSTEMI diagnosis was made if regional wall motion abnormalities (RWMA) were detected. These patients were admitted directly to a specialist cardiac facility. Patient characteristics and pre-admission and post-admission clinical, pre-hospital TTE data, and therapeutic measures were recorded. Results Patients with NSTE-ACS (n = 53; 72.5 ± 13.4 years of age; 23 female) were studied. The 20 patients with pre-hospital RWMA and presumptive NSTEMI, and two without RWMA were conclusively diagnosed with NSTEMI in hospital. Percutaneous coronary intervention was performed in 50% of the patients presumed to have NSTEMI immediately after admission. The RWMA seen before hospital TTE corresponded with the in-hospital ECG findings and/or the supply regions of the occluded coronary vessels seen during PCI in 85% of the cases. The diagnostic sensitivity of pre-hospital TTE for NSTEMI was 90.9% with 100% specificity. Conclusions Pre-hospital transthoracic echocardiography by the emergency physician can correctly diagnose NSTEMI in more than 90% of cases. This can expedite the initiation of appropriate therapy and could thereby conceivably reduce morbidity and mortality. Trial registration Deutsche Register klinischer Studien, DRKS00004919. Registered on 29 April 2013.
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Affiliation(s)
- Ingo Bergmann
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany.
| | - Benedikt Büttner
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Elena Teut
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, University Medical Center, University of Göttingen, Göttingen, Germany
| | - José Hinz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Markus Roessler
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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46
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Schneider HE, Gravenhorst V, Paul T, Jacobshagen C. Insufficiency of a Damus-Kaye-Stansel anastomosis in a Fontan patient: Transfemoral implantation of an Edwards Sapien 3 valve. Catheter Cardiovasc Interv 2018; 91:292-295. [PMID: 29239142 DOI: 10.1002/ccd.27445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/19/2017] [Revised: 10/28/2017] [Accepted: 11/16/2017] [Indexed: 11/07/2022]
Abstract
We present a 22-year-old patient with a univentricular heart who had already undergone five open heart surgeries including a Damus-Kaye-Stansel procedure, Fontan completion and tricuspid valve replacement. In addition, epimyocardial pacemaker implantation and repeated revisions had been necessary. He developed symptomatic free regurgitation of the pulmonary portion of his DKS anastomosis. To avoid additional high-risk open-heart surgery, we successfully implanted an Edwards Sapien 3 valve transfemorally in the pulmonary portion of the DKS anastomosis relieving insufficiency.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Verena Gravenhorst
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Goettingen, Goettingen, 37075, Germany
| | - Claudius Jacobshagen
- Department for Cardiology and Pneumology, University Medical Center Goettingen, Robert-Koch-Str. 40, Goettingen, 37075, Germany
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47
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Andrási TB, Danner BC, Grossmann M, Schöndube FA, HASENFUß G, Jacobshagen C. Transfemoral aortic valve implantation after cardiac transplantation. J Cardiovasc Surg (Torino) 2017; 59:143-145. [PMID: 29231677 DOI: 10.23736/s0021-9509.17.09788-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Terézia B Andrási
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany -
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
| | - Marius Grossmann
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
| | - Friedrich A Schöndube
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Göttingen, Germany
| | - Gerd HASENFUß
- Department of Cardiology and Pulmonology, Georg-August-University, Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pulmonology, Georg-August-University, Göttingen, Germany
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48
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Jacobshagen C, Gross L, Trenk D, Geisler T, Orban M, Gori T, Hadamitzky M, Merkely B, Kiss R, Komócsi A, Dézsi CA, Thalmeier A, Löw A, Holdt L, Teupser D, Ince H, Felix SB, Parma R, Malek L, Horstkotte J, Baylacher M, Schwinger R, Rieber J, Mudra H, Hausleiter J, Huber K, Neumann FJ, Koltowski L, Huczek Z, Mehilli J, Massberg S, Sibbing D, Aradi D. A randomised trial on platelet function-guided de-escalation of antiplatelet treatment in ACS patients undergoing PCI. Thromb Haemost 2017; 117:188-195. [DOI: 10.1160/th16-07-0557] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/09/2016] [Indexed: 12/21/2022]
Abstract
SummaryOutcomes of acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) have been significantly improved with the use of potent P2Y12 receptor inhibitors like prasugrel. While most of the ischaemic risk reduction for prasugrel versus clopidogrel was demonstrated in the early treatment period, the risk of bleeding became particularly prominent during the chronic course of therapy. It may therefore be a valid approach to substitute prasugrel for clopidogrel in the early phase of chronic antiplatelet treatment after PCI. In the Testing Responsiveness To Platelet Inhibition On Chronic Antiplatelet Treatment For Acute Coronary Syndromes (TROPICAL-ACS) trial, we aim to compare standard prasugrel therapy with a de-escalating antiplatelet treatment approach guided by platelet function testing (PFT). The study is an investigator-initiated European multicentre, randomised clinical trial in biomarker-positive ACS patients after successful PCI. Two thousand six hundred patients will be randomised prior to hospital discharge in a 1:1 fashion to either receive standard prasugrel therapy (control group) or de-escalating therapy (one-week prasugrel followed by one-week clopidogrel and PFT-guided maintenance therapy from day 14 after hospital discharge, monitoring group). Patients of the monitoring group with high on-clopidogrel platelet reactivity (HPR) based on Multiplate analyzer testing (HPR: ≥ 46U per consensus definition) will be switched back to prasugrel, whereas those without HPR (<46 U) will continue clopidogrel treatment. The overall study treatment duration will be one year in both groups. The primary endpoint of the study is net clinical benefit (combined incidence of cardiovascular death, myocardial infarction, stroke and bleeding ≥ grade 2 according to BARC criteria) one-year after randomisation. TROPICAL-ACS is the first large-scale, randomised controlled trial assessing the clinical value of a PFT-guided de-escalation of antiplatelet treatment in biomarker positive ACS patients undergoing PCI.ClinicalTrials.gov Identifier: NCT01959451
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Harada Y, Michel J, Lohaus R, Mayer K, Emmer R, Lena Lahmann A, Colleran R, Giacoppo D, Wolk A, Berg JMT, Neumann FJ, Han Y, Adriaenssens T, Tölg R, Seyfarth M, Maeng M, Zrenner B, Jacobshagen C, Wöhrle J, Kufner S, Morath T, Ibrahim T, Bernlochner I, Fischer M, Schunkert H, Laugwitz KL, Mehilli J, A. Byrne R, Kastrati A, Schulz-Schüpke S. Validation of the DAPT score in patients randomized to 6 or 12 months clopidogrel after predominantly second-generation drug-eluting stents. Thromb Haemost 2017; 117:1989-1999. [DOI: 10.1160/th17-02-0101] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/21/2017] [Indexed: 11/05/2022]
Abstract
SummaryThe DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups. Primary ischaemic (all-cause death, myocardial infarction, definite stent thrombosis or stroke) and bleeding (TIMI major or minor) outcomes were analyzed in the low and high DAPT score groups. Data of 3976 patients were available for DAPT score calculation. 2407 patients (60.5%) were classified in the low DAPT score group and 1569 patients (39.5%) in the high DAPT score group. In the low DAPT score group there were no significant differences between 6 and 12 months DAPT regarding ischaemic (1.0% vs. 1.4%, HR=0.74, 95% CI, 0.35–1.57; p=0.43) or bleeding outcomes (0.3% vs. 0.8%, HR=0.44, 95% CI, 0.13–1.42; p=0.17). In the high DAPT score group there were also no significant differences between 6 and 12 months DAPT regarding ischaemic (1.9% vs. 1.8%, HR=1.02, 95% CI, 0.49–2.14; p=0.96) or bleeding (0.3% vs. 0.5%, HR=0.51, 95% CI, 0.09–2.78; p=0.44) outcomes. In conclusion, the DAPT score failed to show a differential treatment effect in patients receiving 6 or 12 months DAPT after contemporary drug-eluting stent implantation.
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50
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Sibbing D, Aradi D, Jacobshagen C, Gross L, Trenk D, Geisler T, Orban M, Hadamitzky M, Merkely B, Kiss RG, Komócsi A, Dézsi CA, Holdt L, Felix SB, Parma R, Klopotowski M, Schwinger RHG, Rieber J, Huber K, Neumann FJ, Koltowski L, Mehilli J, Huczek Z, Massberg S. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial. Lancet 2017; 390:1747-1757. [PMID: 28855078 DOI: 10.1016/s0140-6736(17)32155-4] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [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] [Received: 07/12/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT). METHODS In this investigator-initiated, randomised, open-label, assessor-blinded, multicentre trial (TROPICAL-ACS) done at 33 sites in Europe, patients were enrolled if they had biomarker-positive acute coronary syndrome with successful PCI and a planned duration of dual antiplatelet treatment of 12 months. Enrolled patients were randomly assigned (1:1) using an internet-based randomisation procedure with a computer-generated block randomisation with stratification across study sites to either standard treatment with prasugrel for 12 months (control group) or a step-down regimen (1 week prasugrel followed by 1 week clopidogrel and PFT-guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). The assessors were masked to the treatment allocation. The primary endpoint was net clinical benefit (cardiovascular death, myocardial infarction, stroke or bleeding grade 2 or higher according to Bleeding Academic Research Consortium [BARC]) criteria) 1 year after randomisation (non-inferiority hypothesis; margin of 30%). Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT01959451, and EudraCT, 2013-001636-22. FINDINGS Between Dec 2, 2013, and May 20, 2016, 2610 patients were assigned to study groups; 1304 to the guided de-escalation group and 1306 to the control group. The primary endpoint occurred in 95 patients (7%) in the guided de-escalation group and in 118 patients (9%) in the control group (pnon-inferiority=0·0004; hazard ratio [HR] 0·81 [95% CI 0·62-1·06], psuperiority=0·12). Despite early de-escalation, there was no increase in the combined risk of cardiovascular death, myocardial infarction, or stroke in the de-escalation group (32 patients [3%]) versus in the control group (42 patients [3%]; pnon-inferiority=0·0115). There were 64 BARC 2 or higher bleeding events (5%) in the de-escalation group versus 79 events (6%) in the control group (HR 0·82 [95% CI 0·59-1·13]; p=0·23). INTERPRETATION Guided de-escalation of antiplatelet treatment was non-inferior to standard treatment with prasugrel at 1 year after PCI in terms of net clinical benefit. Our trial shows that early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with acute coronary syndrome managed with PCI. FUNDING Klinikum der Universität München, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo.
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Affiliation(s)
- Dirk Sibbing
- Department of Cardiology, LMU München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany.
| | - Dániel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Claudius Jacobshagen
- Department of Cardiology und Pneumology, Heart Centre/Georg-August-University Göttingen, Göttingen, Germany
| | - Lisa Gross
- Department of Cardiology, LMU München, Munich, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Tobias Geisler
- University Hospital Tübingen, Department of Cardiology and Cardiovascular Disease, Tübingen, Germany
| | - Martin Orban
- Department of Cardiology, LMU München, Munich, Germany
| | | | - Béla Merkely
- Heart and Vascular Centre, University of Semmelweis, Budapest, Hungary
| | | | - András Komócsi
- Department of Interventional Cardiology, Heart Institute, University of Pécs, Pécs, Hungary
| | - Csaba A Dézsi
- Department of Cardiology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Lesca Holdt
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany and DZHK, Greifswald, Germany
| | - Radoslaw Parma
- 3rd Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Mariusz Klopotowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Robert H G Schwinger
- Medizinische Klinik II, Klinikum Weiden, Kliniken Nordoberpfalz AG, Weiden, Germany
| | - Johannes Rieber
- Heart Centre Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich, Germany
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, and Sigmund Freud Private University, Medical School, Wien, Austria
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Germany
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Julinda Mehilli
- Department of Cardiology, LMU München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Steffen Massberg
- Department of Cardiology, LMU München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
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