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Momcilovic D, Reznakova B, Bosse F, Begrich C, Bernhardt C, Hamiko M, Bakhtiary F, Nickenig G, Skowasch D, Pizarro C. Sleep-disordered breathing and lung function abnormalities in adults with congenital heart disease. Sleep Breath 2024; 28:241-250. [PMID: 37552390 PMCID: PMC10954938 DOI: 10.1007/s11325-023-02899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Advances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this growing cohort of patients. The aim of this study was to evaluate the prevalence of sleep-disordered breathing (SDB) and lung function abnormalities in patients with adult congenital heart disease (ACHD). METHODS Patients with ACHD underwent level 3 sleep testing (Embletta MPR polygraphy) and pulmonary function testing. Results were stratified by the underlying haemodynamic ACHD lesion group. RESULTS Patients with ACHD (n = 100) were middle-aged (42.3 ± 14.6 years), 54% male and slightly overweight (BMI 25.9 ± 5.5 kg/m2). Polygraphy revealed a prevalence of sleep apnoea of 39% with 15% of patients presenting with predominantly obstructive apnoeic episodes, while 23% of patients presenting primarily with central sleep apnoea. The distribution of mild, moderate, and severe sleep apnoea in the total study population was 26%, 7% and 6%, respectively. Comparison of apnoea-hypopnoea index, presence of sleep apnoea, and apnoea severity did not offer significant differences between the four ACHD lesion groups (p = 0.29, p = 0.41 and p = 0.18, respectively). Pulmonary function testing revealed obstructive lung disease in 19 of 100 patients. Concomitant chronic obstructive pulmonary disease and obstructive sleep apnoea were diagnosed in 3% of patients and were associated with profound nocturnal desaturation. CONCLUSION The findings suggest a mild propensity amongst patients with ACHD to develop SDB that seems to be unaffected by the specific underlying congenital lesion.
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Affiliation(s)
- D Momcilovic
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - B Reznakova
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - F Bosse
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Begrich
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Bernhardt
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - M Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - F Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Milger K, Skowasch D, Hamelmann E, Mümmler C, Idzko M, Gappa M, Jandl M, Körner-Rettberg C, Ehmann R, Schmidt O, Taube C, Holtdirk A, Timmermann H, Buhl R, Korn S. Bronchodilator Reversibility in the GAN Severe Asthma Cohort. J Investig Allergol Clin Immunol 2023; 33:446-456. [PMID: 36000830 DOI: 10.18176/jiaci.0850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit a negative BDR response. Aim: To describe the frequency of positive and Negative BDR response in patients with severe asthma and study associations with phenotypic characteristics. METHODS A positive BDR response was defined as an increase in FEV1 >200 mL and >12% upon testing with a short-acting ß-agonist. RESULTS BDR data were available for 793 of the 2013 patients included in the German Asthma Net (GAN) severe asthma registry. Of these, 250 (31.5%) had a positive BDR response and 543 (68.5%) a egative BDR response. Comorbidities significantly associated with a negative response were gastroesophageal reflux disease (GERD) (28.0% vs 40.0%, P<.01) and eosinophilic granulomatosis with polyangiitis (0.4% vs 3.0%; P<.05), while smoking history (active: 2.8% vs 2.2%; ex: 40.0% vs 41.7%) and comorbid chronic obstructive pulmonary disease (COPD) (5.2% vs 7.2%) were similar in both groups. Patients with a positive BDR response had worse asthma control (median Asthma Control Questionnaire 5 score, 3.4 vs 3.0, P<.05), more frequently reported dyspnea at rest (26.8% vs 16.4%, P<.001) and chest tightness (36.4% vs 26.2%, P<.001), and had more severe airway obstruction at baseline (FEV1% predicted, 56 vs 64, P<.001) and higher fractional exhaled nitric oxide (FeNO) levels (41 vs 33 ppb, P<0.05). There were no differences in diffusion capacity of the lung for carbon monoxide, single breath (% pred, 70% vs 71%). Multivariate linear regression analysis identified an association between positive BDR response and lower baseline FEV1% (P<.001) and chest tightness (P<.05) and a negative association between BDR and GERD (P<.05). CONCLUSION In this real-life setting, most patients with severe asthma had a negative BDR response. Interestingly, this was not associated with smoking history or COPD, but with lower FeNO and presence of GERD.
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Affiliation(s)
- K Milger
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - D Skowasch
- Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
| | - E Hamelmann
- University Hospital for Pediatrics and Adolescent Medicine, Children´s Center Bethel, University of Bielefeld, Bielefeld, Germany
| | - C Mümmler
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - M Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - M Gappa
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - M Jandl
- Hamburger Institut für Therapieforschung, Hamburg, Germany
| | | | - R Ehmann
- Ambulante Pneumologie Stuttgart, Stuttgart, Germany
| | - O Schmidt
- Pneumologische Gemeinschaftspraxis Koblenz, Koblenz, Germany
| | - C Taube
- Department of Pulmonary Medicine, University Hospital - Ruhrlandklinik, Essen, Germany
| | | | | | - R Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - S Korn
- IKF Pneumologie Mainz, Mainz, Germany
- Thoraxklinik Heidelberg, Heidelberg, Germany
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Pizarro C, Biener L, Nickenig G, Skowasch D. Overlapping obstructive sleep apnea and chronic obstructive pulmonary disease in patients undergoing percutaneous coronary intervention. Clin Res Cardiol 2023:10.1007/s00392-023-02226-z. [PMID: 37217801 DOI: 10.1007/s00392-023-02226-z] [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] [Received: 02/10/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Affiliation(s)
- C Pizarro
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - L Biener
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II, Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Klein J, Pizarro C, Öztürk C, Nickenig G, Skowasch D. [Test Your Knowledge]. Pneumologie 2021. [PMID: 34662915 DOI: 10.1055/a-1437-9493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Klein
- Medizinische Klinik und Poliklinik II - Kardiologie/Pneumologie, Universitätsklinikum Bonn
| | - C Pizarro
- Medizinische Klinik und Poliklinik II - Kardiologie/Pneumologie, Universitätsklinikum Bonn
| | - C Öztürk
- Medizinische Klinik und Poliklinik II - Kardiologie/Pneumologie, Universitätsklinikum Bonn
| | - G Nickenig
- Medizinische Klinik und Poliklinik II - Kardiologie/Pneumologie, Universitätsklinikum Bonn
| | - D Skowasch
- Medizinische Klinik und Poliklinik II - Kardiologie/Pneumologie, Universitätsklinikum Bonn
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Dejcman D, Skowasch D, Pizarro C, Karakostas P, Brossart P, Schäfer V. AB0152 PROSPECTIVE ANALYSIS OF OBSTRUCTIVE SLEEP APNEA IN NEWLY DIAGNOSED PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS AND PERIPHERAL SPONDYLOARTHRITIS – A SCREENING STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:An increased prevalence of obstructive sleep apnea (OSA) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and partially in peripheral spondylarthritis (pSpA) has been noted and described for nearly two decades. Until now, there is no study yet on the occurrence of OSA in patients with these entities at the point of first diagnosis. Identifying and treating OSA could prove pivotal in improving cardiovascular risk and quality of life. Furthermore, clinicians require insights into whom to screen.Objectives:To assess the prevalence of OSA in early RA, PsA and pSpA and strategies for targeted screening.Methods:We performed a prospective study on patients with first diagnosis of RA, PsA or pSpA, who were screened for day sleepiness (assessed by the Epworth sleepiness scale) and tested for obstructive sleep disorders by out-of-center sleep apnea polygraphy (employing Embletta® MPR-PG devices) at the University Hospital of Bonn, Germany. Findings were assessed by three physicians, always including an attending physician responsible for the certified sleep laboratory.Results:A total of 22 patients with RA (52.38%), 15 with PsA (35.7%), and 5 (11.9%) with pSpA were included. Day sleepiness screening was unremarkable (ESS <10) in 29 (69%) patients and suspicious for a sleep disorder (ESS≥10) in 13 patients (31%). Subsequent sleep studies of five patients (11.9%) were suspicious for severe sleep apnea (AHI >15/h), eight (19.1%) for low-to-moderate sleep apnea (AHI 5-15/h) and 29 (69.1%) were unremarkable (AHI <5). Of the eight low-to-moderate results, none were symptomatic as in ESS ≥10, resulting in a total of five (11.9%) guideline-confirming referrals for inpatient polysomnography/ventilation therapy. In comparison with the PsA/pSpA group, a diagnosis of RA had no significant relationship with ESS results (p≈0.23), nor AHI results ≥5/h (p≈0.14). The male cohort yielded more pathological sleep studies, but the result was not significant (16% vs. ~5.9%, p≈0.32). Higher ESS scores (≥10) were not predictive for findings which require a referral (p≈0.37). Increased BMI (≥25 kg/m2) was not associated with an AHI > 5/h (p≈0.63).Conclusion:From the point of screening, a number needed to screen of 8.4 (6.25 in the male, 17 in the female group), speaks in favor of overall cost-efficient screening for OSA in newly diagnosed male patients with arthritis diseases. A different study design, comparing early vs. established arthritis cohorts is necessary to assess the role of disease duration in the possible development of OSA.References:[1]Chung W-S, Lin C-L. Sleep disorders associated with risk of rheumatoid arthritis. Sleep Breath [Internet]. 2018 Dec 10 [cited 2018 Dec 11];22(4):1083–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29428977.[2]Vakil M, Park S, Broder A. The complex associations between obstructive sleep apnea and auto-immune disorders: A review. Med Hypotheses [Internet]. 2018;110:138–43. Available from: https://doi.org/10.1016/j.mehy.2017.12.004.[3]Wali S, Mustafa M, Manzar D, Bawazir Y, Attar S, Fathaldin O, et al. Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. J Clin Sleep Med. 2020.Table 1.Patient characteristicsTotal (n=42)RA (n=22)PsA (n=15)pSpA (n=5)AgeMedian (IQR)49 (36-61)58 (39-64)43 (30-55)39 (39-46)SexMale25 (59.5%)15 (68.2%)6 (40%)4 (80%)Female17 (40.5%)7 (31.8%)9 (60%)1 (20%)Obesity by BMI (<25/≥25)Normal weight/Underweight19 (45.2%)10 (45.5%)7 (46.6%)2 (40%)Overweight/Obesity23 (54.8%)12 (55.5%)8 (53.3%)3 (60%)ESS Score<1029 (69%)17 (77.3%)8 (53.3%)4 (80%)≥1013 (31%)5 (22.7%)7 (46.7%)1 (20%)AHI<5/h29 (69%)13 (59.1%)12 (80%)4 (80%)5-15/h8 (19.1%)6 (27.3%)1 (6.7%)1 (20%)>15/h5 (11.9%)3 (13.6%)2 (13.3%)0 (0%)RA – rheumatoid arthritis, PsA – psoriatic arthritis, pSpA – peripheral spondyloarthritis, IQR – interquartile range, BMI – body mass index, ESS – Epworth Sleepiness Scale, AHI – Apnea/Hypopnea IndexDisclosure of Interests:None declared
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Zalepugas D, Pizarro C, Kütting D, Tischler V, Schmidt J, Skowasch D. [Test Your Knowledge]. Pneumologie 2021. [PMID: 33728631 DOI: 10.1055/a-1375-5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- D Zalepugas
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Bonn und Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg
| | - C Pizarro
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn
| | - D Kütting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn
| | - V Tischler
- Institut für Pathologie, Universitätsklinikum Bonn
| | - J Schmidt
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Bonn und Klinik für Thoraxchirurgie, Helios Klinikum Bonn/Rhein-Sieg
| | - D Skowasch
- Medizinische Klinik und Poliklinik II - Sektion Pneumologie, Universitätsklinikum Bonn
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Biener L, Kruse J, Tuleta I, Pizarro C, Kreuter M, Birring SS, Nickenig G, Skowasch D. Association of proangiogenic and profibrotic serum markers with lung function and quality of life in sarcoidosis. PLoS One 2021; 16:e0247197. [PMID: 33617593 PMCID: PMC7899331 DOI: 10.1371/journal.pone.0247197] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Sarcoidosis is a systemic inflammatory granulomatous disease, frequently affecting the lung. If left untreated, it may end in lung fibrosis. Proangiogenic and profibrotic vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-β1, fibroblast growth factor (FGF)-2 and platelet-derived growth factor (PDGF)-AB are a known therapeutical target in pulmonary fibrosing diseases, e.g. IPF, but there is no targeted therapy option for pulmonary fibrosis in sarcoidosis. Objectives The aim of our study was to determine the association of these markers’ serum levels on lung function and the patients’ quality of life in a long-term follow-up of sarcoidosis patients, to provide further information for finding targeted therapy options for pulmonary sarcoidosis. Methods 54 patients with sarcoidosis underwent blood sampling, pulmonary function testing and answered the King’s Brief Interstitial Lung Disease (K-BILD) questionnaire at baseline and at three-years follow-up. Serum levels of profibrotic and angiogenic markers were assessed at baseline by enzyme-linked immunosorbent assay. Results Between 2015 and 2018, 54 patients with biopsy proven sarcoidosis were enrolled. Throughout the observation period, there was a significant decrease in the diffusion capacity for carbon monoxide (DLCO) [%] (-6.5504 ± 13,39, p = 0.001) and forced expiratory volume in one second predicted (FEV1) [%] (-6.07 ± 12.09, p = 0.001). Patients with greater impairment of forced vital capacity (FVC) did have significantly higher serum levels of VEGF (p = 0.03) and PDGF-AB (p<0.001). The K-BILD questionnaire did not change significantly during follow-up. However, patients with worsening K-BILD scores did have significantly higher serum-levels of PDGF-AB (2.67 pg/ml ± 0.93 vs. 1.88 pg/ml ± 0.60, p = 0.004) at baseline, compared to those with unchanged or increasing K-BILD scores. Conclusions Among patients with pulmonary sarcoidosis, baseline serum levels of VEGF and PDGF-AB were associated with pulmonary function impairment. Furthermore, PDGF-AB was associated with worsening K-BILD scores. No such association was observed for FGF-2 and TGF-ß1. VEGF and PDGF-AB may be possible prognostic and therapeutic targets in sarcoidosis as a fibrosing ILD beyond IPF.
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Affiliation(s)
- L. Biener
- Department of Internal Medicine II–Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - J. Kruse
- Department of Internal Medicine II–Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - I. Tuleta
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - C. Pizarro
- Department of Internal Medicine II–Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - M. Kreuter
- Centre for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Germany and German Centre for Lung Research, Heidelberg, Germany
| | - S. S. Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - G. Nickenig
- Department of Internal Medicine II–Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
| | - D. Skowasch
- Department of Internal Medicine II–Cardiology, Pneumology and Angiology, University Hospital Bonn, Bonn, Germany
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Leuchte HH, Halank M, Held M, Borst M, Ewert R, Klose H, Lange TJ, Meyer FJ, Skowasch D, Wilkens H, Seyfarth HJ. [Differential Diagnosis of Pulmonary Hypertension Using the Example of Collagenosis-associated PAH in the Context of Chronic Lung and Left Heart Disease]. Pneumologie 2021; 75:122-137. [PMID: 33578434 DOI: 10.1055/a-1204-3248] [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: 10/22/2022]
Abstract
Pulmonary hypertension (PH) can be diagnosed in the context of connective tissue diseases (CTD) as well as in elderly patients with multiple comorbidities. A correct clinical differential diagnosis and classification is essential before adequate therapeutic decisions can be made. Differential diagnosis of PH in CTD comprises associated pulmonary arterial hypertension (APAH), group 2 or 3 PH (PH arising from left heart or chronic lung disease), chronic thromboembolic PH (PH) and group 5 (e. g. in the context of terminal renal insufficiency). This is also true of elderly patients in whom the decision has to be made if the increasing number of coincident diseases lead to PH or have to be interpreted as comorbidities. In this manuscript, the differential diagnosis of PH is elucidated, focusing on CTD, in the context of left heart disease and chronic lung disease. Furthermore, criteria are presented facilitating an objective approach in this context.
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Affiliation(s)
- H H Leuchte
- Klinik der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Lehrkrankenhaus der LMU München, Mitglied des DZL
| | - M Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden
| | - M Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Würzburg
| | - M Borst
- Medizinische Klinik 1 Caritas-Krankenhaus Bad Mergentheim gemeinnützige GmbH, Bad Mergentheim
| | - R Ewert
- Universitätsmedizin Greifswald. Klinik für Innere Medizin B, Bereich Pneumologie, Greifswald
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Pneumologie, Hamburg
| | - T J Lange
- Uniklinik Regensburg, Klinik für Innere Medizin II, Bereich Pneumologie, Regensburg
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik gGmbH, München
| | - D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik II, Sektion Pneumologie, Bonn
| | - H Wilkens
- Pneumologie, Uniklinik Homburg, Homburg
| | - H-J Seyfarth
- Bereich Pneumologie, Universitätsklinikum Leipzig, Leipzig
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Lange TJ, Borst M, Ewert R, Halank M, Klose H, Leuchte H, Meyer FJ, Seyfarth HJ, Skowasch D, Wilkens H, Held M. [Current Aspects of Definition and Diagnosis of Pulmonary Hypertension]. Pneumologie 2020; 74:847-863. [PMID: 32663892 DOI: 10.1055/a-1199-1548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.
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Affiliation(s)
- T J Lange
- Uniklinik Regensburg, Klinik für Innere Medizin II, Bereich Pneumologie, Regensburg
| | - M Borst
- Medizinische Klinik I, Caritas-Krankenhaus, Bad Mergentheim
| | - R Ewert
- Pneumologie, Uniklinik Greifswald, Greifwald
| | - M Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Pneumologie, Hamburg
| | - H Leuchte
- Klinik der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Lehrkrankenhaus der LMU München, München
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik gGmbH, München
| | - H-J Seyfarth
- Bereich Pneumologie, Universitätsklinikum Leipzig, Leipzig
| | - D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik II, Sektion Pneumologie, Bonn
| | - H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - M Held
- Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg
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Lange TJ, Borst M, Ewert R, Halank M, Klose H, Leuchte H, Meyer FJ, Seyfarth HJ, Skowasch D, Wilkens H, Held M. [Current Aspects of Definition and Diagnosis of Pulmonary Hypertension]. Pneumologie 2020. [PMID: 32707587 DOI: 10.1055/a-1221-5775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T J Lange
- Uniklinik Regensburg, Klinik für Innere Medizin II, Bereich Pneumologie, Regensburg
| | - M Borst
- Medizinische Klinik I, Caritas-Krankenhaus, Bad Mergentheim
| | - R Ewert
- Pneumologie, Uniklinik Greifswald, Greifwald
| | - M Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Pneumologie, Hamburg
| | - H Leuchte
- Klinik der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Lehrkrankenhaus der LMU München, München
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik gGmbH, München
| | - H-J Seyfarth
- Bereich Pneumologie, Universitätsklinikum Leipzig, Leipzig
| | - D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik II, Sektion Pneumologie, Bonn
| | - H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - M Held
- Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg
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Greulich T, Fähndrich S, Clarenbach C, Gleiber W, Hautmann H, Heine R, Idzko M, Schmidt-Scherzer K, Skowasch D, Wiewrodt R, Bals R, Koczulla AR. [Alpha-1 Antitrypsin Deficiency (AATD) - D-A-CH-Expert Statement]. Pneumologie 2020; 74:436-442. [PMID: 32492720 DOI: 10.1055/a-1143-8186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- T Greulich
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philips-Universität, Marburg.,PneumoPraxis-Marburg, Marburg
| | - S Fähndrich
- Medizinische Klinik und Poliklinik Innere Medizin V Abteilung Pneumologie, Universitätsklinikum Freiburg, Freiburg
| | - C Clarenbach
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich, Schweiz
| | - W Gleiber
- Medizinische Klinik I: Pneumologie und Allergologie, Universitätsklinikum Frankfurt am Main, Goethe-Universität, Frankfurt am Main
| | - H Hautmann
- Klinik für Innere Medizin und Pneumologie, Klinikverbund Allgäu, Ottobeuren
| | - R Heine
- Krankenhaus St. Elisabeth und St. Barbara, Halle
| | - M Idzko
- Medizinische Universität Wien, Klinik für Innere Medizin II, Wien, Österreich
| | - K Schmidt-Scherzer
- Zweite Medizinische Abteilung mit Pneumologie mit Ambulanz, Wilhelminenspital, Wien, Österreich
| | - D Skowasch
- Medizinische Klinik + Poliklinik II Schwerpunkt Pneumologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelm-Universität, Bonn
| | - R Wiewrodt
- Medizinische Klinik A Schwerpunkt Pneumologie, Universitätsklinikum Münster, Münster
| | - R Bals
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - A R Koczulla
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philips-Universität, Marburg.,Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land, Schönau am Königssee
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12
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Wells AU, Flaherty KR, Brown KK, Inoue Y, Devaraj A, Richeldi L, Moua T, Crestani B, Wuyts WA, Stowasser S, Quaresma M, Goeldner RG, Schlenker-Herceg R, Kolb M, Aburto M, Acosta O, Andrews C, Antin-Ozerkis D, Arce G, Arias M, Avdeev S, Barczyk A, Bascom R, Bazdyrev E, Beirne P, Belloli E, Bergna M, Bergot E, Bhatt N, Blaas S, Bondue B, Bonella F, Britt E, Buch K, Burk J, Cai H, Cantin A, Castillo Villegas D, Cazaux A, Cerri S, Chaaban S, Chaudhuri N, Cottin V, Crestani B, Criner G, Dahlqvist C, Danoff S, Dematte D'Amico J, Dilling D, Elias P, Ettinger N, Falk J, Fernández Pérez E, Gamez-Dubuis A, Giessel G, Gifford A, Glassberg M, Glazer C, Golden J, Gómez Carrera L, Guiot J, Hallowell R, Hayashi H, Hetzel J, Hirani N, Homik L, Hope-Gill B, Hotchkin D, Ichikado K, Ilkovich M, Inoue Y, Izumi S, Jassem E, Jones L, Jouneau S, Kaner R, Kang J, Kawamura T, Kessler R, Kim Y, Kishi K, Kitamura H, Kolb M, Kondoh Y, Kono C, Koschel D, Kreuter M, Kulkarni T, Kus J, Lebargy F, León Jiménez A, Luo Q, Mageto Y, Maher T, Makino S, Marchand-Adam S, Marquette C, Martinez R, Martínez M, Maturana Rozas R, Miyazaki Y, Moiseev S, Molina-Molina M, Morrison L, Morrow L, Moua T, Nambiar A, Nishioka Y, Nunes H, Okamoto M, Oldham J, Otaola M, Padilla M, Park J, Patel N, Pesci A, Piotrowski W, Pitts L, Poonyagariyagorn H, Prasse A, Quadrelli S, Randerath W, Refini R, Reynaud-Gaubert M, Riviere F, Rodríguez Portal J, Rosas I, Rossman M, Safdar Z, Saito T, Sakamoto N, Salinas Fénero M, Sauleda J, Schmidt S, Scholand M, Schwartz M, Shapera S, Shlobin O, Sigal B, Silva Orellana A, Skowasch D, Song J, Stieglitz S, Stone H, Strek M, Suda T, Sugiura H, Takahashi H, Takaya H, Takeuchi T, Thavarajah K, Tolle L, Tomassetti S, Tomii K, Valenzuela C, Vancheri C, Varone F, Veeraraghavan S, Villar A, Weigt S, Wemeau L, Wuyts W, Xu Z, Yakusevich V, Yamada Y, Yamauchi H, Ziora D. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 2020; 8:453-460. [PMID: 32145830 DOI: 10.1016/s2213-2600(20)30036-9] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis. METHODS The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178. FINDINGS Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population. INTERPRETATION The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Athol U Wells
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Bruno Crestani
- Université de Paris, Inserm U1152, APHP, Hôpital Bichat, Centre de reference constitutif pour les maladies pulmonaires rares, Paris, France
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Manuel Quaresma
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | | | | | - Martin Kolb
- McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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Skowasch D, Gaertner F, Marx N, Meder B, Müller-Quernheim J, Pfeifer M, Schrickel JW, Yilmaz A, Grohé C. [Diagnostics and Treatment of Cardiac Sarcoidosis - Consensus Paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)]. Pneumologie 2019; 74:24-34. [PMID: 31863422 DOI: 10.1055/a-1031-4588] [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: 10/25/2022]
Abstract
Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.
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Affiliation(s)
- D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Sektion Pneumologie, Bonn
| | - F Gaertner
- Universitätsklinikum Bonn, Klinik und Poliklinik für Nuklearmedizin, Bonn
| | - N Marx
- Universitätsklinikum Aachen, AöR, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Med. Klinik I), Aachen
| | - B Meder
- Universitätsklinikum Heidelberg, Institut für Cardiomyopathien Heidelberg Abteilung für Kardiologie, Angiologie und Pulmologie, Heidelberg
| | - J Müller-Quernheim
- Universitätsklinikum Freiburg, Abteilung Pneumologie, Freiburg im Breisgau
| | - M Pfeifer
- Klinik Donaustauf, Zentrum für Pneumologie, Psychosomatische Medizin und Psychotherapie, Donaustauf
| | - J W Schrickel
- Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn
| | - A Yilmaz
- Universitätsklinikum Münster, Klinik für Kardiologie I, Sektion für Herzbildgebung, Münster
| | - C Grohé
- Ev. Lungenklinik Berlin, Klinik für Pneumologie, Berlin
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14
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Biener L, Thomas D, Tolkach Y, Skowasch D. Testen Sie Ihr Fachwissen. Pneumologie 2019. [DOI: 10.1055/a-0863-9134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- L. Biener
- Medizinische Klinik II, Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn
| | - D. Thomas
- Medizinische Klinik II, Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn
- Medizinische Klinik II, Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn
| | - Y. Tolkach
- Medizinische Klinik II, Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn
| | - D. Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn
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Skowasch D, Klein J, Homsi R, Pizarro C. Testen Sie Ihr Fachwissen. Pneumologie 2018. [DOI: 10.1055/a-0596-3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. Skowasch
- Medizinische Klinik und Poliklinik II – Sektion Pneumologie
| | - J. Klein
- Medizinische Klinik und Poliklinik II – Sektion Pneumologie
| | - R. Homsi
- Radiologische Klinik, Universitätsklinikum Bonn
| | - C. Pizarro
- Medizinische Klinik und Poliklinik II – Sektion Pneumologie
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Abstract
OBJECTIVE There is limited knowledge about the potential relationship between asthma and heart function. Aim of our present study was to examine if asthma may be associated with manifest or subclinical heart dysfunction. METHODS Seventy-two allergic mild-to-moderate and severe asthma patients and 20 matched controls were enrolled in the study. Depending on the anti-asthmatic therapy, four subgroups of asthma patients were created: patients under long-acting beta2-agonists (LABA) and inhaled cortisone without oral cortisone treatment with (1a) versus without (1b) additional omalizumab therapy; patients with LABA, inhaled cortisone and omalizumab treatment with (2a) versus without (2b) oral cortisone. Standard echocardiographic parameters as well as global longitudinal left and right ventricular strains as determined by ultrasound-based speckle-tracking method were evaluated. Furthermore, NT-pro-brain natriuretic peptide (NT-pro-BNP), immunoglobulin E (IgE), C-reactive protein (CRP), and blood count were assessed in asthma and control groups. RESULTS There were no relevant differences in standard echocardiographic measures between both asthma groups and the control collective. Longitudinal left ventricular strain values were reduced significantly in severe and mild-to-moderate asthma groups (-12.91 ± 0.84% and -13.92 ± 1.55%, respectively), whereas longitudinal right ventricular strain values were additionally relevantly decreased in severe asthma (-10.35 ± 1.04%) compared to the control (-16.55 ± 0.49% and -18.48 ± 1.90%, respectively). Cardiac strains were similar in subgroups 1a and 1b. In contrast, patients from subgroup 2a presented reduced heart strains and decreased lung function compared to those from 2b. CRP, IgE, and eosinophils were significantly increased in asthma versus control individuals. CONCLUSIONS Allergic asthma, especially severe asthma is associated with subclinical impaired left and right ventricular function as determined by speckle-tracking analysis.
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Affiliation(s)
- I Tuleta
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - N Eckstein
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - F Aurich
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - G Nickenig
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - C Schaefer
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - D Skowasch
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
| | - R Schueler
- a Department of Internal Medicine II - Cardiology, Pulmonology and Angiology , University of Bonn , Bonn , Germany
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Kreuter M, Herth FJF, Wacker M, Witt S, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederholf C, Skowasch D, Stolpe C, Joest M, Veitshans S, Leidl R, Hellmann A, Pfeifer M, Behr J, Kauschka D, Mall M, Günther A, Markart P. Diagnostik und Therapie von Patienten mit interstitiellen Lungenerkrankungen in Deutschland – das EXCITING ILD Register. Pneumologie 2018. [DOI: 10.1055/s-0037-1619191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg
| | - M Wacker
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - S Witt
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | | | - L Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen
| | | | - A Esselmann
- Outpatient Center for Pulmonology, Warendorf
| | | | - D Skowasch
- Medical Clinic II, University Hospital Bonn
| | - C Stolpe
- Outpatient Center for Pulmonology, Ibbenbüren
| | - M Joest
- Malteser Center for Pulmonology and Allergology, Bonn
| | - S Veitshans
- Outpatient Center for Pulmonology, Böblingen
| | - R Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - A Hellmann
- Outpatient Center for Pulmonology, Augsburg
| | - M Pfeifer
- Klinik Donaustauf und Universitätsklinikum Regensburg
| | | | | | - M Mall
- Translational Pulmonology, University of Heidelberg, Germany, Member of the German Center for Lung Research (TLRC)
| | - A Günther
- Universitätsklinikum Gießen und Marburg
| | - P Markart
- Medical Clinic II, University Hospital Gießen, Universities of Gießen and Marburg Lung Centre (Ugmlc), Member and Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg
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18
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Kreuter M, Swigris J, Pittrow D, Geier S, Klotsche J, Prasse A, Wirtz H, Koschel D, Andreas S, Grohe C, Wilkens H, Hagmeyer L, Skowasch D, Meyer FJ, Kirschner J, Gläser S, Herth FJF, Welte T, Neurohr C, Schweiblmair M, Held M, Bahmer T, Frankenberger M, Behr J. Quality of life trajectory in patients with idiopathic pulmonary fibrosis (IPF): longitudinal QoL assessment of the INSIGHTS-IPF registry. Pneumologie 2018. [DOI: 10.1055/s-0037-1619192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - J Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
| | - D Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden
| | - S Geier
- Department Market Access, Boehringer Ingelheim
| | - J Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule, Hannover
| | - H Wirtz
- Pneumologie, Universitätsklinikum der Universität Leipzig
| | - D Koschel
- Zentrum für Pneumologie-, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig
| | - S Andreas
- Kardiologie und Pneumologie, Lungenfachklinik Immenhausen und Universitätsmedizin Göttingen
| | - C Grohe
- Klinik für Pneumologie, ELK, Berlin Buch
| | - H Wilkens
- Pneumologie, Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | | | - D Skowasch
- Medical Clinic II, University Hospital Bonn
| | - FJ Meyer
- Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH
| | - J Kirschner
- Center for Internal Medical Studies Cims, Bamberg
| | - S Gläser
- Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Universitätsmedizin Greifswald; Klinik für Innere Medizin – Pneumologie, Greifswald and Vivantes Klinikum Spandau/Berlin
| | - FJF Herth
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Thoraxklinik, Uniklinikum Heidelberg
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - C Neurohr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München
| | | | - M Held
- Abteilung Innere Medizin, Pneumologie, Standort Missioklinik, Klinikum Würzburg Mitte
| | | | - M Frankenberger
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München
| | - J Behr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München and Asklepios Fachkliniken München-Gauting; Member of the German Center for Lung Research (DZL)
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Tuleta I, Pingel S, Biener L, Pizarro C, Hammerstingl C, Öztürk C, Schahab N, Grohé C, Nickenig G, Schaefer C, Skowasch D. Atherosclerotic Vessel Changes in Sarcoidosis. Adv Exp Med Biol 2017; 910:23-30. [PMID: 26820732 DOI: 10.1007/5584_2015_205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Sarcoidosis is a systemic granulomatous disease. Atherosclerosis is a chronic inflammatory vessel disease. The aim of our present study was to investigate whether sarcoidosis could be associated with increased risk of atherosclerotic vessel changes. Angiological analysis and blood tests were performed in 71 sarcoidosis patients and 12 matched controls in this prospective cross-sectional study. Specifically, angiological measurements comprised ankle brachial index (ABI), central pulse wave velocity (cPWV), pulse wave index (PWI), and duplex sonography of central and peripheral arteries. Sarcoidosis activity markers (angiotensin converting enzyme, soluble interleukin-2 receptor) and cardiovascular risk parameters such as cholesterol, lipoprotein(a), C-reactive protein, interleukin 6, fibrinogen, d-dimer, and blood count were analyzed in blood. We found no relevant differences in ABI, cPWV, and plaque burden between the sarcoidosis and control groups (1.10 ± 0.02 vs. 1.10 ± 0.02, 6.7 ± 0.5 vs. 6.1 ± 1.2, 53.7 % vs. 54.5 %, respectively). However, PWI was significantly higher in sarcoidosis patients (146.2 ± 6.8) compared with controls (104.9 ± 8.8), irrespectively of the activity of sarcoidosis and immunosuppressive medication. Except for increased lipoprotein(a) and d-dimer in sarcoidosis, the remaining cardiovascular markers were similar in both groups. We conclude that sarcoidosis is associated with increased pulse wave index, which may indicate an early stage of atherosclerosis.
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Affiliation(s)
- I Tuleta
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany.
| | - S Pingel
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - L Biener
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - C Pizarro
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - C Hammerstingl
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - C Öztürk
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - N Schahab
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - C Grohé
- Evangelische Lungenklinik Berlin-Buch, Berlin, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - C Schaefer
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St., D-53105, Bonn, Germany
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20
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Pizarro C, Klencz C, Grosse-Ophoff H, Nickenig G, Skowasch D. Undiagnosed chronic obstructive pulmonary disease and overlapping obstructive sleep apnoea in patients with coronary heart disease. Pneumologie 2017. [DOI: 10.1055/s-0037-1598395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - G Nickenig
- Medizinische Klinik II, Universitätsklinikum Bonn
| | - D Skowasch
- Medizinische Klinik II, Universitätsklinikum Bonn
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21
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Behr J, Pittrow D, Kreuter M, Prasse A, Klotsche J, Koschel D, Andreas S, Neurohr C, Claussen M, Schwaiblmair M, Grohé C, Wilkens H, Skowasch D, Kirschner J, Meyer FJ, Ewert R, Held M, Huber RM, Bahmer T, Gläser S, Welte T, Randerath WJ, Wirtz H. Klinischer Verlauf von Patienten mit Idiopathischer Lungenfibrose: aktuelle Daten aus dem INSIGHTS-IPF Register. Pneumologie 2017. [DOI: 10.1055/s-0037-1598290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Med. Klinik V, LMU München; Mitglied des Dzl
| | - D Pittrow
- Institut für Klinische Pharmakologie, Med. Fakultät, Technische Universität Dresden
| | - M Kreuter
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc); Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - J Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungszentrum
| | - D Koschel
- Zentrum für Pneumologie, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig GmbH
| | - S Andreas
- Lungenfachklinik Immenhausen, Krs. Kassel; Pneumologische Lehrklinik Univ. Göttingen
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern
| | - M Claussen
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenclinic Großhansdorf
| | - M Schwaiblmair
- I. Medizinsche Klinik, Funktionsbereich Pneumologie, Klinikum Augsburg
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin
| | - H Wilkens
- Medizinische Klinik V, Universitätsklinikum des Saarlandes
| | - D Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie, Uniklinikum Bonn
| | | | - FJ Meyer
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Klinikum München-Harlaching; Städt. Klinikum München GmbH
| | - R Ewert
- Zentrum für Innere Medizin, Klinik für Innere B, Bereich Pneumologie, Universitätsmedizin Greifswald, Körperschaft des Öffentlichen Rechts
| | - M Held
- Abteilung Innere Medizin Pneumologie, Missionsärztliche Klinik, Klinikum Würzburg Mitte
| | - RM Huber
- Sektion Pneumologie Innenstadt und Thorakale Onkologie, Universität München; Thoracic Oncology Centre Munich
| | | | - S Gläser
- Klinik und Poliklinik für Innere Medizin B, Bereich Pneumologie, Universitätsmedizin Greifswald; Klinik für Innere Medizin, Pneumologie, Vivantes Klinikum Spandau
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - WJ Randerath
- Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien GmbH
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig AöR
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22
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Pizarro C, Hollmann S, Tuleta I, Nickenig G, Skowasch D. Impact of lung volume reduction coils on patient's physical activity. Pneumologie 2017. [DOI: 10.1055/s-0037-1598389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - I Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - G Nickenig
- Medizinische Klinik II, Universitätsklinikum Bonn
| | - D Skowasch
- Medizinische Klinik II, Universitätsklinikum Bonn
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23
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Tuleta I, Farrag T, Busse L, Pizarro C, Nickenig G, Schahab N, Schaefer C, Pingel S, Skowasch D. High prevalence of obstructive pulmonary diseases in patients with peripheral artery disease. Pneumologie 2017. [DOI: 10.1055/s-0037-1598536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - T Farrag
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - L Busse
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - G Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - N Schahab
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Schaefer
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - S Pingel
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - D Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
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24
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Pizarro C, Klünker F, Dabir D, Hammerstingl C, Nickenig G, Skowasch D. Speckle-tracking echocardiography for diagnosis of cardiac sarcoidosis: Correlation with CMR. Pneumologie 2017. [DOI: 10.1055/s-0037-1598398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | | | - G Nickenig
- Medizinische Klinik II, Universitätsklinikum Bonn
| | - D Skowasch
- Medizinische Klinik II, Universitätsklinikum Bonn
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25
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Kreuter M, Wacker M, Hammerl P, Wiederhold C, Kabitz HJ, Hagmeyer L, Skowasch D, Leidl R, Hellmann A, Pfeifer M, Behr J, Witt S, Kauschka D, Mall M, Günther A, Herth FJF, Markart P. Interims Analyse des EXCITING-ILD Registers (Registry for Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases). Pneumologie 2017. [DOI: 10.1055/s-0037-1598497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Kreuter
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - M Wacker
- Helmholtz Zentrum München, Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | | | - HJ Kabitz
- II. Medizinische Klinik, Klinikum Konstanz
| | - L Hagmeyer
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien gGmbH
| | - D Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie, Uniklinikum Bonn
| | - R Leidl
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | - M Pfeifer
- Krankenhaus Donaustauf; Universität Regensburg
| | - J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Med. Klinik V, LMU, München, Mitglied des Dzl
| | - S Witt
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München
| | - D Kauschka
- C/O Dagmar Kauschka, 1. Vorsitzende, Lungenfibrose e.V
| | - M Mall
- Zentrum für Kinder- und Jugendmedizin, Sektion Pädiatrische Pneumologie & Allergologie und Mukoviszidose-Zentrum, Universitätsklinikum Heidelberg
| | - A Günther
- Med. Klinik II, Schwerpunkt Pneumologie, Univ.-Klinikum Gießen
| | - FJF Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Markart
- Medizinische Klinik V, Klinikum Fulda
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26
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Tuleta I, Biener L, Pizarro C, Nickenig G, Skowasch D. Alternations of VEGF blood levels in pulmonary sarcoidosis. Pneumologie 2017. [DOI: 10.1055/s-0037-1598366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - L Biener
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - G Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - D Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
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27
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Tuleta I, Biener L, Pizarro C, Nickenig G, Schahab N, Schaefer C, Pingel S, Skowasch D. Preatherosclerotic vessel changes in sarcoidosis patients. Pneumologie 2017. [DOI: 10.1055/s-0037-1598399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - L Biener
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - G Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - N Schahab
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Schaefer
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - S Pingel
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - D Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
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28
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Kreuter M, Wirtz H, Prasse A, Klotsche J, Geier S, Kramps T, Wilkens H, Grohé C, Skowasch D, Huber RM, Neurohr C, Kirschner J, Koschel D, Meyer FJ, Andreas S, Gläser S, Claussen M, Held M, Ewert R, Randerath WJ, Bahmer T, Welte T, Koch A, Herth FJF, Pittrow D, Schwaiblmair M, Behr J. Lebensqualität von Patienten mit idiopathischer Lungenfibrose: Daten aus dem deutschen INSIGHTS-IPF Register. Pneumologie 2017. [DOI: 10.1055/s-0037-1598409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Kreuter
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc); Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig AöR
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule
| | - J Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungszentrum
| | - S Geier
- Boehringer Ingelheim Pharma GmbH & Co. KG
| | - T Kramps
- Boehringer Ingelheim Pharma GmbH & Co. KG
| | - H Wilkens
- Medizinische Klinik V, Universitätsklinikum des Saarlandes
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin
| | - D Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie, Uniklinikum Bonn
| | - RM Huber
- Sektion Pneumologie Innenstadt und Thorakale Onkologie, Universität München
| | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Großhadern; Schwerpunkt Pneumologie, Klinikum Großhadern der LMU
| | | | - D Koschel
- Zentrum für Pneumologie, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig GmbH
| | - FJ Meyer
- Klinik für Pneumologie, Gatsroenterologie, Internistische Intensiv- und Beatmungsmedizin, Klinikum München-Harlaching, Städt. Klinikum München GmbH
| | - S Andreas
- Lungenfachklinik Immenhausen, Krs. Kassel; Pneumologische Lehrklinik Univ. Göttingen
| | - S Gläser
- Pneumologie, Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswaldstation Mosler
| | - M Claussen
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenclinic Großhansdorf
| | - M Held
- Abteilung Innere Medizin Pneumologie, Klinikum Würzburg Mitte gGmbH
| | - R Ewert
- Zentrum für Innere Medizin, Klinik für Innere B, Bereich Pneumologie, Universitätsmedizin Greifswald Körperschaft des Öffentlichen Rechts
| | - WJ Randerath
- Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien GmbH
| | | | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - A Koch
- Medizinische Klinik und Poliklinik V, AG Obstruktive Lungenerkrankungen, Klinikum der LMU München
| | - FJF Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc); Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - D Pittrow
- Medizinische Fakultät, Institut für Klinische Pharmakologie, Technische Universität
| | - M Schwaiblmair
- I. Medizinsche Klinik, Funktionsbereich Pneumologie, Klinikum Augsburg
| | - J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Med. Klinik V, Asklepios Fachkliniken München-Gauting, LMU; Mitglied des Dzl
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29
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Tuleta I, Aurich F, Eckstein N, Pizarro C, Nickenig G, Schahab N, Schaefer C, Pingel S, Juergens U, Skowasch D. Increased detection of atherosclerosis in asthma patients. Pneumologie 2017. [DOI: 10.1055/s-0037-1598537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- I Tuleta
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - F Aurich
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - N Eckstein
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Pizarro
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - G Nickenig
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - N Schahab
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - C Schaefer
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - S Pingel
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - U Juergens
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
| | - D Skowasch
- Department of Internal Medicine II – Cardiology, Pulmonology and Angiology, University of Bonn
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Tuleta I, Skowasch D, Biener L, Pizarro C, Schueler R, Nickenig G, Schahab N, Schaefer C, Pingel S. Impaired Vascular Function in Sarcoidosis Patients. Adv Exp Med Biol 2017; 980:1-9. [PMID: 28132132 DOI: 10.1007/5584_2016_203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A common feature of sarcoidosis and atherosclerosis is a chronic systemic inflammatory reaction. Our hypothesis was that sarcoidosis may negatively influence the vessel status. We addressed the issue by examining preatherosclerotic vascular alternations using an ultrasound-based speckle-tracking method in 72 sarcoidosis patients and 15 matched controls. To find potential factors which may have a deleterious influence on arterial performance, different subgroups of sarcoidosis, such as sarcoidosis with or without cortisone therapy, pulmonary sarcoidosis in early and advanced stages, pulmonary sarcoidosis alone or combined with extrapulmonary sarcoidosis, and sarcoidosis with or without elevated blood levels of angiotensin converting enzyme (ACE)/soluble interleukin 2 receptor (sIL-2R) were investigated. We found in the general collective of sarcoidosis patients that circumferential strain (2.68 ± 0.19%), circumferential strain rate (0.21 ± 0.01 1/s), and radial displacement (0.10 ± 0.01 mm) were significantly decreased compared to controls (3.77 ± 0.35%, 0.28 ± 0.02 1/s, and 0.14 ± 0.02 mm, respectively). Vascular strains were more impaired in patients with cortisone therapy, pulmonary sarcoidosis in stages III-IV, and in pulmonary sarcoidosis accompanied by extrapulmonary involvement. The level of ACE/sIL-2R had no relevant influence on the angiological parameters. In conclusion, sarcoidosis is associated with increased vascular stiffness. Cortisone therapy and advanced stages of pulmonary sarcoidosis with extrapulmonary manifestations may account for the impaired vascular function in this patient collective.
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Affiliation(s)
- I Tuleta
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany.
| | - D Skowasch
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - L Biener
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - C Pizarro
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - R Schueler
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - N Schahab
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - C Schaefer
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
| | - S Pingel
- Department of Internal Medicine II - Cardiology, Pulmonology and Angiology, University of Bonn, 25 Sigmund-Freud-St, D-53105, Bonn, Germany
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31
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Olschewski H, Behr J, Bremer H, Claussen M, Douschan P, Halank M, Held M, Hoeper M, Holt S, Klose H, Krüger S, Lange T, Reichenberger F, Skowasch D, Ulrich S, Wilkens H, Seeger W. Pulmonale Hypertonie bei Lungenkrankheiten: Empfehlungen der Kölner Konsensus-Konferenz 2016. Dtsch Med Wochenschr 2016; 141:S57-S61. [DOI: 10.1055/s-0042-114528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Pizarro C, Jansen F, Werner N, Nickenig G, Skowasch D. Diagnostische und therapeutische Implikationen der Troponinerhöhung bei akut exazerbierter chronisch obstruktiver Lungenerkrankung. Pneumologie 2016; 70:391-6. [DOI: 10.1055/s-0042-105678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C. Pizarro
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II – Kardiologie, Pneumologie, Angiologie
| | - F. Jansen
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II – Kardiologie, Pneumologie, Angiologie
| | - N. Werner
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II – Kardiologie, Pneumologie, Angiologie
| | - G. Nickenig
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II – Kardiologie, Pneumologie, Angiologie
| | - D. Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II – Kardiologie, Pneumologie, Angiologie
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33
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Hübner RH, Grah C, Thieme C, Pizarro C, Herzog D, Temmesfeld-Wollbrück B, Suttorp N, Skowasch D. Endoskopische Lungenvolumenreduktion: Können Ventile sicher entfernt werden? Pneumologie 2016. [DOI: 10.1055/s-0036-1572151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tuleta I, Pizarro C, Molitor E, Kristiansen G, Nickenig G, Skowasch D. Endobronchial detection of Pseudomonas aeruginosa after endoscopic lung volume reduction by means of valve implantation is associated with increased rates of COPD exacerbations. Pneumologie 2016. [DOI: 10.1055/s-0036-1572152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Behr J, Wirtz H, Prasse A, Pittrow D, Klotsche J, Koschel D, Grohé C, Andreas S, Neurohr C, Claussen M, Wilkens H, Skowasch D, Welte T, Kirschner J, Meyer FJ, Ewert R, Schwaiblmair M, Koch A, Huber RM, Held M, Bahmer T, Gläser S, Herth FJF, Randerath WJ, Kreuter M. Klinischer Verlauf von Patienten mit Idiopathischer Lungenfibrose in der klinischen Praxis: aktuelle Daten aus dem INSIGHTS-IPF Register. Pneumologie 2016. [DOI: 10.1055/s-0036-1572077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tuleta I, Pingel S, Biener L, Pizarro C, Schahab N, Nickenig G, Schäfer C, Skowasch D. Sarcoidosis is associated with increased pulse wave index. Pneumologie 2016. [DOI: 10.1055/s-0036-1572025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pizarro C, Herweg-Steffens N, Werner N, Nickenig G, Skowasch D. Angiographically objectified presence of coronary artery disease in patients with exacerbated chronic obstructive pulmonary disease and raised troponin I – The BEETHOVEN Trial. Pneumologie 2016. [DOI: 10.1055/s-0036-1572124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pizarro C, Klünker F, Dabir D, Thomas D, Nickenig G, Skowasch D. Long-term results of cardiovascular magnetic resonance in cardiac sarcoidosis. Pneumologie 2016. [DOI: 10.1055/s-0036-1571995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Skowasch D, Huscher D, Pizarro C, Hoeper MM, Pittrow D, Rosenkranz S, Grohé C. Sarkoidose-assoziierte pulmonale Hypertonie versus idiopathische pulmonal arterielle Hypertonie: Ergebnisse aus dem COMPERA-Register. Pneumologie 2016. [DOI: 10.1055/s-0036-1572123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pizarro C, van Essen F, Schueler R, Nickenig G, Skowasch D. Evaluation of left-ventricular dysfunction in chronic obstructive pulmonary disease by speckle tracking based strain analysis. Pneumologie 2016. [DOI: 10.1055/s-0036-1572026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schwarze-Zander C, Pabst S, Hammerstingl C, Ohlig J, Wasmuth JC, Boesecke C, Stoffel-Wagner B, Carstensen A, Nickenig G, Strassburg CP, Rockstroh JK, Skowasch D, Schueler R. Pulmonary hypertension in HIV infection: a prospective echocardiographic study. HIV Med 2015; 16:578-82. [PMID: 25960172 DOI: 10.1111/hiv.12261] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES While idiopathic pulmonary arterial hypertension (PAH) is a rare disease, it is seen more frequently in patients with HIV infection. The aim of this study was to evaluate the prevalence of pulmonary hypertension (PH) in patients with HIV infection by echocardiographic screening. METHODS Echocardiography and N-terminal of the prohormone brain natriuretic peptide measurement were used to examine the prevalence of PH prospectively in HIV-positive patients (n = 374) during routine follow-up visits for HIV disease. RESULTS In echocardiographic screening, PH was detected in a total of 23 of 374 HIV-infected patients (6.1%). Of these, three patients (13%) presented with symptoms of dyspnoea and fatigue, and diagnosis of PAH was confirmed by right heart catheterization. Patients with systolic pulmonary artery pressure (sPAP) > 30 mmHg were more likely to be female, to have a history of injecting drug use and to originate from high-prevalence countries (HPCs). CONCLUSIONS Echocardiographic screening detected PH in a substantial proportion of HIV-positive patients. Female gender, a history of injecting drug use and HPC origin were associated with a higher prevalence of HIV-associated PH. The relevance and long-term outcome of these findings need to be validated in follow-up studies, which are ongoing.
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Affiliation(s)
- C Schwarze-Zander
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - S Pabst
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - C Hammerstingl
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - J Ohlig
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - C Boesecke
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - B Stoffel-Wagner
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - A Carstensen
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital, University of Bonn, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - J K Rockstroh
- Department of Internal Medicine I, University Hospital, University of Bonn, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
| | - R Schueler
- Department of Internal Medicine II, University Hospital, University of Bonn, Bonn, Germany
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Ewert R, Wilkens H, Skowasch D, Reppel M, Bollmann T, Halank M, Held M, Klose H, Gall H, Lange TJ, Opitz CF, Seyfarth HJ, Winkler J. [Dyspnoea in Patients with Pulmonary Hypertension (PH) - a Survey in Spezialized German PH Centres]. Pneumologie 2015; 69:361-5. [PMID: 25962567 DOI: 10.1055/s-0034-1391893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dyspnoea is the predominant symptom in patients with pulmonary hypertension (PH) at diagnosis. However, since dyspnoea is nonspecific and often occurs in a number of common diseases, the presence of PH can easily be underdiagnosed.In addition, this symptom underlies a high variability in the subjective perception, therefore further diagnostic procedures are often delayed by the patients.A survey of the incidence and severity of dyspnoea in 372 patients with PAH was conducted by questionnaire in German centres. Age, sex distribution and the range of comorbidities corresponded to the findings of national and international registries.Approximately 99 % of patients reported the presence of dyspnoea on exertion, even at low loads.Remarkably, in 13 % of patients dyspnoea occurs as a paroxysmal symptom, which may lead to the differential diagnosis of bronchial asthma. In addition, the patients who were being followed in specialized PH centres reported an increase in dyspnoea during the last year.The results of the survey on the incidence of dyspnoea in patients with PAH are consistent with the findings of international studies.
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Affiliation(s)
- R Ewert
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - H Wilkens
- Universitätsklinikum des Saarlandes/Homburg, Medizinische Klinik V
| | - D Skowasch
- Universitätsklinikum Bonn, Klinik für Innere Medizin II
| | - M Reppel
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck
| | - T Bollmann
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - M Halank
- Universitätsklinikum der Technischen Universität Dresden, Medizinische Klinik I
| | - M Held
- Missionsärztliche Klinik Würzburg, Abteilung Innere Medizin
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf
| | - H Gall
- Abteilung Pneumologie, Medizinische Klinik II, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | - T J Lange
- Universitätsklinikum Regensburg, Klinik für Innere Medizin II
| | - C F Opitz
- DRK Kliniken Berlin Köpenick, Klinik für Innere Medizin, Schwerpunkt Kardiologie und Angiologie
| | - H-J Seyfarth
- Universitätsklinikum Leipzig (AöR), Abteilung Pneumologie
| | - J Winkler
- Praxis für Pneumologie/Allergologie Leipzig
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Oldenburg O, Arzt M, Bitter T, Bonnemeier H, Edelmann F, Fietze I, Podszus T, Schäfer T, Schöbel C, Skobel E, Skowasch D, Penzel T, Nienaber C. Positionspapier „Schlafmedizin in der Kardiologie“. Kardiologe 2015. [DOI: 10.1007/s12181-015-0654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Schaefer CA, Adam L, Weisser-Thomas J, Pingel S, Vogel G, Klarmann-Schulz U, Nickenig G, Pizarro C, Skowasch D. High prevalence of peripheral arterial disease in patients with obstructive sleep apnoea. Clin Res Cardiol 2015; 104:719-26. [PMID: 25725776 DOI: 10.1007/s00392-015-0834-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 11/24/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) merits increasing attention as cardiovascular risk factor. Whereas carotid and coronary artery disease have been associated with OSA, occurrence of peripheral arterial disease (PAD) in OSA remains undefined. METHODS We screened 100 patients with suspected OSA for PAD. After polysomnography, each patient underwent standardized angiological testing including ankle-brachial index (ABI), central pulse wave velocity, pulse wave index and duplex sonography. RESULTS Among total study population, PAD prevalence accounted for 88%, of those 68% had asymptomatic plaques and 20% were symptomatic Fontaine ≥ IIa. In confirmed OSA, prevalence raised up to 98%. Except for smoking habits, distribution of established risk factors did not differ between OSA groups (patients without, mild, intermediate and severe OSA). Presence of plaque, Fontaine PAD stages and intermittent claudication exhibited significant gain with increasing AHI. A logistic regression model revealed that age (OR = 1.199, 95% CI [1.066; 1.348]) and the logarithmically transformed AHI (OR = 5.426, 95% CI [1.068; 27.567]) had the strongest influence on plaque presence. Central pulse wave velocity as marker of arterial stiffness was positively correlated with AHI. CONCLUSION OSA is associated with a high prevalence of PAD. This implies substantial diseasés under-recognition and a presumable atherogenic role of OSA in the pathogenesis of PAD. However, vasoprotective impact of OSA treatment remains to be determined.
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Affiliation(s)
- C A Schaefer
- Department of Internal Medicine II, Cardiology, Pneumology and Angiology, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany,
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Pizarro C, Hammerstingl C, Schaefer C, Grohé C, Nickenig G, Skowasch D. [New therapeutic approaches to pulmonary embolism: trials' results and significance of direct oral anticoagulants]. Pneumologie 2015; 69:99-110. [PMID: 25668610 DOI: 10.1055/s-0034-1391347] [Citation(s) in RCA: 2] [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: 10/24/2022]
Abstract
Venous thromboembolisms (VTE) are frequently encountered emergencies that sometimes run a fatal course. Diagnostic and therapeutic strategies in patients with suspected pulmonary embolism (PE) are based on the presence of shock and hypotension. Oral anticoagulation is recommended for at least three months, extended anticoagulation should be considered for patients with unprovoked PE and low bleeding risk. As an alternative to vitamin K antagonists, direct oral anticoagulants are recommended. The present review discusses the mode of action, current data, and the status of rivaroxaban, dabigatran, apixaban and edoxaban in the treatment of PE - taking into account the new guidelines of the European Society of Cardiology and their clinical implementation.
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Affiliation(s)
- C Pizarro
- Medizinische Klinik und Poliklinik II - Innere Medizin mit den Schwerpunkten Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Bonn
| | - C Hammerstingl
- Medizinische Klinik und Poliklinik II - Innere Medizin mit den Schwerpunkten Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Bonn
| | - C Schaefer
- Medizinische Klinik und Poliklinik II - Innere Medizin mit den Schwerpunkten Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Bonn
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin
| | - G Nickenig
- Medizinische Klinik und Poliklinik II - Innere Medizin mit den Schwerpunkten Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Bonn
| | - D Skowasch
- Medizinische Klinik und Poliklinik II - Innere Medizin mit den Schwerpunkten Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Bonn
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Pizarro C, Goebel A, Grohé C, Pabst S, Klein J, Nickenig G, Thomas D, Skowasch D. Cardiovascular magnetic resonance-guided diagnosis of cardiac affection in a Caucasian sarcoidosis population. Pneumologie 2015. [DOI: 10.1055/s-0035-1544896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pizarro C, Ahmadzadehfar H, Essler M, Nickenig G, Skowasch D. Volumetric and scintigraphic changes following endoscopic lung volume reduction. Pneumologie 2015. [DOI: 10.1055/s-0035-1544693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pizarro C, Schäfer C, Klein J, Kimeu I, Pingel S, Nickenig G, Skowasch D. Underdiagnosis of obstructive sleep apnoea in peripheral arterial disease. Pneumologie 2015. [DOI: 10.1055/s-0035-1544756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kreuz J, Pizarro C, Nickenig G, Schwab JO, Skowasch D. Kasuistik: Seltene Ursache eines Beatmungsnotfalls nach kardiopulmonaler Reanimation. Pneumologie 2015. [DOI: 10.1055/s-0035-1544647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Behr J, Kreuter M, Pittrow D, Hoeper MM, Klotsche J, Koschel D, Andreas S, Neurohr C, Grohé C, Claussen M, Wilkens H, Randerath WJ, Skowasch D, Kirschner J, Koch A, Meyer FJ, Ewert R, Welte T, Held M, Schwaiblmair M, Gamarra F, Herth FJF, Huber RM, Wirtz H. Klinischer Verlauf von Patienten mit Idiopathischer Lungenfibrose in der klinischen Praxis: INSIGHTS-IPF Register. Pneumologie 2015. [DOI: 10.1055/s-0035-1544826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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