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Brand A, Hornig C, Crayen C, Hamann A, Martineck S, Leistner DM, Dreger H, Sündermann S, Unbehaun A, Sherif M, Haghikia A, Bischoff S, Lueg J, Kühnle Y, Paul O, Squier S, Stangl K, Falk V, Landmesser U, Stangl V. Medical graphics to improve patient understanding and anxiety in elderly and cognitively impaired patients scheduled for transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 2023:10.1007/s00392-023-02352-8. [PMID: 38117299 DOI: 10.1007/s00392-023-02352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Anxiety and limited patient comprehension may pose significant barriers when informing elderly patients about complex procedures such as transcatheter aortic valve implantation (TAVI). OBJECTIVES We aimed to evaluate the utility of medical graphics to improve the patient informed consent (IC) before TAVI. METHODS In this prospective, randomized dual center study, 301 patients were assigned to a patient brochure containing medical graphics (Comic group, n = 153) or sham information (Control group, n = 148) on top of usual IC. Primary outcomes were patient understanding of central IC-related aspects and periprocedural anxiety assessed by the validated Spielberger State Trait Anxiety Inventory (STAI), both analyzed by cognitive status according to the Montreal Cognitive Assessment (MoCA). RESULTS Patient understanding was significantly higher in the Comic group [mean number of correct answers 12.8 (SD 1.2) vs. 11.3 (1.8); mean difference 1.5 (95% CI 1.2-1.8); p < 0.001]. This effect was more pronounced in the presence of cognitive dysfunction (MoCA < 26) [12.6 (1.2) in the Comic vs. 10.9 (1.6) in the Control group; mean difference 1.8 (1.4-2.2), p < 0.001]. Mean STAI score declined by 5.7 (95% CI 5.1-6.3; p < 0.001) in the Comic and 0.8 points (0.2-1.4; p = 0.015) in the Control group. Finally, mean STAI score decreased in the Comic group by 4.7 (3.8-5.6) in cognitively impaired patients and by 6.6 (95% CI 5.8 to 7.5) in patients with normal cognitive function (p < 0.001 each). CONCLUSIONS Our results prove beneficial effects for using medical graphics to inform elderly patients about TAVI by improving patient understanding and reducing periprocedural anxiety (DRKS00021661; 23/Oct/2020). Medical graphics entailed significant beneficial effects on the primary endpoints, patient understanding and periprocedural anxiety, compared to the usual patient informed consent (IC) procedure. Patient understanding of IC-related aspects was significantly higher in the Comic group, with a more pronounced benefit in patients with cognitive impairment (p for IC method and cognitive status < 0.001, respectively; p for IC method x MoCA category interaction = 0.017). There further was a significant decline of periprocedural anxiety in patients with and without cognitive impairment (p for IC method x measuring time point < 0.001; p for IC method x MoCA category x measuring time point interaction = 0.018).
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Affiliation(s)
- A Brand
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany.
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany.
| | - C Hornig
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - C Crayen
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany
| | - A Hamann
- Mintwissen-Science Communication Agency and Publishing House, Paulusstr. 11, 40237, Düsseldorf, Germany
| | | | - D M Leistner
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Goethe University Hospital, Universitäres Herz- und Gefässzentrum Frankfurt, Frankfurt am Main, 60590, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Munich, Germany
| | - H Dreger
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - S Sündermann
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - A Unbehaun
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - M Sherif
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - A Haghikia
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - S Bischoff
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - J Lueg
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - Y Kühnle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - O Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
| | - S Squier
- Brill Professor Emeritus of English and Women's, Gender and Sexuality Studies, The Pennsylvania State University, University Park, PA, 16802, USA
| | - K Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
| | - V Falk
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - U Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
| | - V Stangl
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Charité Mitte, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner Site Berlin, Berlin, Germany
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Rai H, Harzer F, Raeber L, Leistner DM, Alfonso F, Xhepa E, Nef H, Laugwitz KL, Byrne RA, Kastrati A, Joner M. Assessment of stent optimization in clinical practice using optical coherence tomography: a multicentric observational study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Stent under-expansion obtained at the time of percutaneous coronary intervention (PCI) has been shown to be associated with worse outcomes.
Purpose
We sought to define OCT assessed optimal stent expansion index which associates with lower incidence of major adverse cardiac events (MACE) during follow-up in a sample of patients stented at five high volume centers of central Europe.
Methods
We analyzed 370 lesions stented during the period between 2012 and 2018, with their final procedural results imaged using optical coherence tomography (OCT). QIvus Research Edition v3.1 (Medis, Leiden, NL) was used for OCT analysis. The stented segment was split in two equal halves. Stent expansion index (SEI) was calculated for both halves separately by dividing minimum stent area by the mean reference lumen area [(proximal reference area + distal reference area)/2]. Smallest of the two prevailed as the SEI of that case. MACE during post-PCI follow-up was defined as composite of all-cause death, myocardial infarction, stent thrombosis and target lesion revascularization. Data is expressed as mean±SD or median (Interquartile range). Incidence of subsequent MACE is expressed as crude rates (%).
Results
A total of 316 cases (370 lesions), aged 64.6±11.7 years were included for OCT analysis. Of them, 78.8% were males, 22.8% were diabetics, 75.9% were hypertensives while 35.1% had family history of coronary artery disease. 38.0% of the cases had acute coronary syndrome at presentation. 62.4% of treated lesions were complex (Type B2/C). A mean of 1.11±0.34 stents/scaffolds were implanted per treated lesion. Analyzed segment length was 20.4 (15.17, 27.0) mm.
Minimal stent area (MSA) in the overall stented segment was 6.02 mm2 (4.65, 7.93). Median stent expansion index (minimum) was 0.79 (0.71, 0.86). Median follow-up duration was 557 days (326, 1,096). 47 lesions (12.7%) suffered MACE during follow-up. Receiver operating characteristic (ROC) curve analysis using Youden's rule identified 0.84 as SEI cut-off powered to predict post-PCI MACE (AUC= 0.60, sensitivity= 0.85, specificity= 0.34). MACE was observed in 38/249 (15.3%) of lesions with SEI≤0.84 and in 9/121 (7.4%) of lesions with SEI>0.84 (p=0.03). Univariate regression analysis of MACE revealed significant association with SEI≤0.84 (OR=2.2, 95% CI=1.1–4.8, p=0.04) Adaptive Lasso regression identified SEI≤0.84 (OR=4.1, 95% CI=1.3–12.6, p=0.02) and coronary calcification at baseline (OR=2.7, 95% CI=1.1–6.6, p=0.03) as independent predictors of MACE during follow-up. Kaplan-meier curve for MACE free survival with optimal SEI (n=121) and sub-optimal SEI (n=249) subgroups using SEI cut-off of 0.84, however showed modest separation (p=0.11).
Conclusions
The present study identified SEI>0.84 associated with lower incidence of MACE as optimal cut-off in daily practice. Along with SEI of ≤0.84, coronary calcification was also significantly associated with MACE during post PCI follow-up.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Rai
- Mater Private Hospital, Dublin, Ireland
| | - F Harzer
- Deutsches Herzzentrum Muenchen, Technical University of Munich, Munich, Germany
| | - L Raeber
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - D M Leistner
- Charite Universitatsmedizin Berlin, Cardiology, Berlin, Germany
| | - F Alfonso
- Hospital Universitario La Princesa, Madrid, Spain
| | - E Xhepa
- Deutsches Herzzentrum Muenchen, Technical University of Munich, Munich, Germany
| | - H Nef
- University Hospital Giessen and Marburg, Giessen, Germany
| | | | - R A Byrne
- Mater Private Hospital, Dublin, Ireland
| | - A Kastrati
- Deutsches Herzzentrum Muenchen, Technical University of Munich, Munich, Germany
| | - M Joner
- Deutsches Herzzentrum Muenchen, Technical University of Munich, Munich, Germany
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Roessler J, Zimmermann F, Schmidt D, Escher U, Jasina A, Heimesaat M, Gast M, Poller W, Giral-Arnal H, Schumann P, Leistner D, Landmesser U, Haghikia A. Impact of the gut microbiome on the atorvastatin-dependent modulation of the serum lipidome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aims
The modulation of serum lipids, in particular of the low-density lipoprotein cholesterol (LDL-C), by statins varies between individuals. The mechanisms regulating this interindividual variation are only poorly understood. Here, we investigated the relation between the gut microbiome and the regulatory properties of atorvastatin on the serum lipidome using mice with depleted gut microbiome.
Methods
Over a period of 6 weeks, mice (C57BL/6) with either an intact (conventional mice, CONV, n=24) or antibiotic-based depleted gut microbiome (antibiotic treated mice, ABS, n=16) were put on standard chow diet (SCD) or high fat diet (HFD), respectively. During the last 4 weeks of treatment atorvastatin (Ator, 10mg/kg body weight/day) or control vehicle was administered via daily oral gavage. Blood lipids (total cholesterol, VLDL, LDL-C, HDL-C) and serum sphingolipids were compared among the groups. The expressions of hepatic and intestinal genes involved in cholesterol metabolism were analyzed by qRT-PCR. Alterations in the gut microbiota profile of mice with intact gut microbiome were examined using 16S RNA qRT-PCR.
Results
In CONV mice, HFD led to significantly increased blood LDL-C levels as compared with SCD (HFD: 36.8±1.4 mg/dl vs. SCD: 22.0±1.8 mg/dl; P<0.01). In CONV mice atorvastatin treatment significantly reduced blood LDL-C levels after HFD, whereas in ABS mice the LDL-C lowering effect of atorvastatin was markedly attenuated (CONV+HFD+Ator: 31.0±1.8 mg/dl vs. ABS+HFD+Ator: 46.4±3 mg/dl; P<0.01). A significant reduction in the abundance of several plasma lipids, in particular sphingolipids and glycerophospholipids upon atorvastatin treatment was observed in CONV mice, but not in ABS mice. The expressions of distinct hepatic and intestinal cholesterol-regulating genes (ldlr, srebp2, pcsk9 and npc1l1) upon atorvastatin treatment were significantly altered in gut microbiota depleted mice. In response to HFD a decrease in the relative abundance of the bacterial phyla Bacteroides and an increase in the relative abundance of Firmicutes was observed. The altered ratio between Bacteroides and Firmicutes in HFD fed mice was partly reversed upon atorvastatin treatment.
Conclusions
Our findings indicate a crucial role of the gut microbiome for the regulatory properties of atorvastatin on the serum lipidome and, in turn, support a critical impact of atorvastatin on the gut microbial composition. The results provide novel insights into potential microbiota related mechanisms underlying interindividual variation in modulation of the serum lipidome by statins, given interindividual differences in microbiome composition and function.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Heart Research Foundation
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Affiliation(s)
- J Roessler
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - F Zimmermann
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - D Schmidt
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - U Escher
- Charite Universitatsmedizin Berlin, Insitute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - A Jasina
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - M.M Heimesaat
- Charite Universitatsmedizin Berlin, Insitute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
| | - M Gast
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - W Poller
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - H Giral-Arnal
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - P Schumann
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - D.M Leistner
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - A Haghikia
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
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Alushi B, Beckhoff F, Leistner DM, Staehli BE, Jamaluddin M, Bigalke B, Latib A, Falk V, Grubitzch H, Landmesser U, Hahn R, Lauten A. 5938Mortality risk stratification in patients with severe tricuspid regurgitation - Insights from the Tricuspid Regurgitation REgistry (TRuE). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0088] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Severe tricuspid regurgitation (TR) is associated with progressive right atrial (RA) and ventricular (RV) dilation, dysfunction and increased mortality. Risk factors impacting the long-term prognosis in patients with severe TR are largely undetermined.
Purpose
Herein, we aimed to identify risk factors associated with long-term mortality in patients with severe TR and implement a novel risk stratification strategy based on an individual five-year mortality prediction score.
Methods
From January 2013 to December 2017, 1238 patients with severe functional TR were enrolled in the TRuE-registry, of which 914 with a complete dataset were included in the present study. Echocardiographic quantification of RV-function and size included measurements of tricuspid annular plane systolic excursion (TAPSE), the end-diastolic basal (RVDbasal) and longitudinal diameters (RVDlong) and the RA-volume index (RAVI). The cohort was randomly divided into a development (n=610) and validation (n=304) sample. A risk stratification model was developed using a multivariable Cox regression.
Results
The variables statistically significant to predict five-year-mortality, included in the final model and used as score parameters were: age, COPD, dialysis, pulmonary artery systolic pressure, RAVI, TAPSE RVDbasal, RVDlong and systolic hepatic vein flow reversal (sHVFR). Progressive enlargement of RV and RA and concomitant sHVFR was associated with higher values of hazard ratios (HR, Figure A). Based on the HR values, a risk score with 3 categories was developed (Figure B): low (0–2), intermediate (3–5), high (6–16). Among the risk groups, Kaplan Meier estimates of all-cause mortality at 5 years were 18%, 52% and 84% respectively (p<0.001; https://thetruerisk.com). The score showed good discrimination, with a concordance index of 0.75. At internal validation, a good agreement between the derivation and validation datasets indicated a good calibration of the survival curves.
Implementation of a long term risk score
Conclusion
The present study demonstrates the prognostic impact of comorbidities and right heart remodeling on long-term mortality in patients with severe TR. The presented risk score provides an easy and accurate estimation of long-term mortality and may thus help to guide therapeutic decision-making in this difficult group of patients.
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Affiliation(s)
- B Alushi
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - F Beckhoff
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - D M Leistner
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - B E Staehli
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - M Jamaluddin
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - A Latib
- Montefiore Medical Center (Bronx), New York, United States of America
| | - V Falk
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - H Grubitzch
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - R Hahn
- Columbia University Medical Center, New York, United States of America
| | - A Lauten
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
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Engel LC, Landmesser U, Abdelwahed Y, Gigengack K, Manes C, Wurster TH, Skurk C, Leistner DM, Lauten A, Schuster A, Noutsias M, Hamm B, Botnar RM, Makowski M, Bigalke B. P5249Comprehensive invasive and non-invasive assessment of coronary artery lesions with and without hemodynamic significance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is limited knowledge about specific morphological parameters beyond the degree of stenosis to further characterize hemodynamically relevant coronary lesions.
Objective
The goal of this study was to identify certain morphological or molecular characteristics that distinguish hemodynamically significant from non-significant coronary lesions using various invasive and non-invasive measures.
Methods
This clinical study included patients with symptoms suggestive of CAD who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography between 2015 and 2016. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-Angio). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability respectively.
Results
Overall 13 patients (n=28 coronary segments) were included, whose invasive coronary angiograms projections were eligible for QFR analysis. Segments containing lesions with a QFR <0.8 (n=9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a hemodynamically non-relevant lesions (lesion-QFR>0.8; n=19) (7.0±4.9 vs. 3.0±2.6; p=0.02). No differences in signal enhancement were seen on native T1-weighted CMR (2.1±4.3 vs. 3.3±4.1; p=0.24). 66,7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions.
Conclusion
The findings of this small feasibility study suggest that hemodynamically significant lesions are more advanced and associated with a higher grade of endothelial permeability while the presence of intraplaque hemorrhage may not be associated with hemodynamically relevant coronary lesions.
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Affiliation(s)
- L C Engel
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - Y Abdelwahed
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - K Gigengack
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - C Manes
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - T.-H Wurster
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - D.-M Leistner
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - A Lauten
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - A Schuster
- Royal North Shore Hospital, Cardiology, Sydney, Australia
| | - M Noutsias
- University Clinic Halle (Saale), cardiology, Halle, Germany
| | - B Hamm
- Charite - Campus Mitte (CCM), Radiology, Berlin, Germany
| | - R M Botnar
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - M Makowski
- Charite - Campus Mitte (CCM), Radiology, Berlin, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
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Zimmermann F, Schmidt D, Escher U, Jasina A, Roessler J, Heimesaat MM, Gast M, Poller W, Kratzer A, Giral Arnal H, Schumann P, Leistner DM, Landmesser U, Haghikia A. 54Role of the gut microbiome for the cholesterol lowering effect of atorvastatin. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aims
Statins show interindividual differences in the extent of low-density lipoprotein cholesterol (LDL-C) reduction. The mechanisms of this interindividual variation are not fully understood. Here, we examined the potential role of the gut microbiome for the LDL-C lowering property of atorvastatin.
Methods
Mice (C57BL/6) with either intact (conventional mice, CONV, n=24) or with antiobiotic depleted gut microbiome (gnotobiotic, n=16), were put on standard chow diet (SCD) (n=11) or high fat diet (HFD) (n=29) for 6 weeks. During the last 4 weeks atorvastatin (Ator, 10mg/kg body weight/day) or control vehicle was orally applied via gavage. Blood levels of LDL-C and glucose and body weight after 6 weeks of treatment were compared between the groups. Expression of genes involved in hepatic and intestinal cholesterol-metabolism were examined. Faeces of CONV mice were analyzed for alteration of the gut microbiota profile upon atorvastatin treatment using 16S rRNA qPCR.
Results
HFD fed mice with intact gut microbiome showed significantly increased blood LDL-C levels as compared to SCD (HFD: 36.8±1.4 mg/dl vs. SCD: 22.0±1.8 mg/dl; P<0.01). Bodyweight gain or blood glucose levels after HFD were not significantly different between CONV and gnotobiotic mice. While in CONV mice atorvastatin significantly reduced LDL-C levels after HFD, in gnotobiotic mice the LDL-C lowering effect of atorvastatin was attenuated (CONV+HFD+Ator: 31.0±1.8 mg/dl vs. gnotobiotic mice+HFD+Ator: 46.4±3 mg/dl; P<0.01). The expression of genes involved in hepatic cholesterol synthesis was not significantly altered in gnotobiotic mice as compared to CONV mice. In CONV mice HFD decreased the relative abundance of the bacterial phyla Bacteroidetes and increased the abundance of Firmicutes as compared to SCD. The ratio between Firmicutes to Bacteroidetes was shifted towards control conditions upon atorvastatin treatment.
Conclusions
The results of this study suggest a regulatory impact of atorvastatin on the gut-microbial profile and, in turn, a crucial role of the gut-microbiome for the LDL-C lowering effect of atorvastatin independent of its regulation of hepatic cholesterol synthesis. Our findings provide novel insight into potential microbiota-related mechanisms causing interindividual variation in LDL-C lowering effects of statins.
Acknowledgement/Funding
German Heart Research Foundation
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Affiliation(s)
- F Zimmermann
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - D Schmidt
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - U Escher
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - A Jasina
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - J Roessler
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | | | - M Gast
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - W Poller
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - A Kratzer
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | | | - P Schumann
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - D M Leistner
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - A Haghikia
- Charite - Campus Benjamin Franklin, Berlin, Germany
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7
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Skurk C, Hartung JJ, Leistner DM, Landmesser U. [Catheter-based atrial appendage closure-current data and future developments]. Internist (Berl) 2018; 59:1028-1040. [PMID: 30182193 DOI: 10.1007/s00108-018-0483-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Germany more than 1.6 million patients suffer from atrial fibrillation (AF). Within the next decades this number will substantially increase due to current demographic trends with the increasing average age of the population. When untreated, patients with atrial fibrillation have a five times higher risk for stroke as compared with a control cohort. A potent stroke prevention therapy reducing the risk of stroke by approximately 70-80% is primarily treatment with new oral anticoagulants (NOACs). The risk scores for stroke (CHA2DS2-VASc) and major bleeding (HAS-BLED) in patients with atrial fibrillation share common variables, so that patients with the highest stroke risk often carry a very high bleeding risk. A significant number of patients (ca. 20-30%) are, however, not eligible for long-term anticoagulation, e.g. because of a high bleeding risk. For this population there is an urgent need for alternative stroke prevention strategies, such as catheter-based percutaneous left atrial appendage closure. Current data about the efficiency and safety of this treatment as well as a discussion of ongoing recruitment for randomized studies are discussed in this review.
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Affiliation(s)
- C Skurk
- Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland
| | - J J Hartung
- Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland
| | - D M Leistner
- Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Berlin Institute of Health (BIH), Berlin, Deutschland
| | - U Landmesser
- Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12003, Berlin, Deutschland. .,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland. .,Berlin Institute of Health (BIH), Berlin, Deutschland.
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8
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Jakob P, Kacprowski T, Abdelwahed YS, Riedel M, Staehli BE, Kraenkel N, Renikunta H, Meteva D, Seppelt C, Lauten A, Skurk C, Voelker U, Ameling S, Landmesser U, Leistner DM. P767Identification of circulating miRNA-abundances in ruptured versus eroded lesions: A combined optical coherence tomography and miRNA-profiling approach in patients with acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Jakob
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - T Kacprowski
- University Medicine of Greifswald, Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - Y S Abdelwahed
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - M Riedel
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - B E Staehli
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - N Kraenkel
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - H Renikunta
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - D Meteva
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - C Seppelt
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - A Lauten
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - U Voelker
- University Medicine of Greifswald, Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - S Ameling
- University Medicine of Greifswald, Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, Greifswald, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - D M Leistner
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
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9
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Riedel M, Abdelwahed Y, Seppelt C, Meteva D, Steinbeck L, Lauten A, Staehli BE, Skurk C, Froehlich G, Rauch-Kroehnert U, Mochmann HC, Kraenkel N, Landmesser U, Leistner DM. P572Angiographic guided PCI of ACS causing culprit lesions - Just a gamble? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Riedel
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - Y Abdelwahed
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - C Seppelt
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - D Meteva
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - L Steinbeck
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - A Lauten
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - B E Staehli
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - G Froehlich
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | | | - H C Mochmann
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - N Kraenkel
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - D M Leistner
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
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10
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Leistner DM, Seeger FH, Dimmeler S, Zeiher AM, Assmus B. [Regenerative treatment of advanced heart disease]. Dtsch Med Wochenschr 2012; 137:732-7. [PMID: 22454205 DOI: 10.1055/s-0031-1299037] [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 M Leistner
- Medizinische Klinik III, Kardiologie, Klinikum der Goethe-Universität, Frankfurt/Main
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11
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Klotsche J, Leistner DM, Pieper L, Pittrow D, Zeiher AM, Wittchen HU. The DETECT adherence score--structure and psychometric exploration of a novel approach to measure adherence to drug and non-drug interventions in primary care. Int J Methods Psychiatr Res 2011; 20:82-92. [PMID: 21618327 PMCID: PMC6878574 DOI: 10.1002/mpr.341] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
There is substantial evidence that patient compliance or rather adherence to medical measures and recommendations for lifestyle changes can pivotally influence the prognosis of the patients or disease progression. However, the scientific evaluation and the statistical analysis of "patient adherence" are extremely difficult due to the fact that the construct of "adherence" is complex and comprised of many layers, and varies greatly in different disease groups. With this paper, we describe the development and structure of this novel assessment tool that takes past and prospective information on different facets of drug and behavioural adherence into account, expected to result in considerably improved prediction of future cardiovascular risk. We suggest a simple scoring scheme and explore the psychometric properties and the higher order factorial structure. In this exploratory study the "Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment" (DETECT) adherence score revealed good psychometric properties in terms of internal consistency and factorial structure, suggesting that its further exploration in terms of external validity is promising. Findings also underline that it is useful and informative to cover within one score both, pharmacologic and non-pharmacologic interventions in primary care. Our combination in this respect is unique, as most studies conducted on this subject so far aimed at assessing solely drug adherence or behavioural adherence.
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Affiliation(s)
- J Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
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