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Scheidhauer H, Moebius-Winkler S, Aftanski P, Schulze PC, Kretzschmar D. Analysis of interventional treatment options of the common femoral artery - a retrospective single center experience. VASA 2024. [PMID: 38738466 DOI: 10.1024/0301-1526/a001125] [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: 05/14/2024]
Abstract
Background: Due to the rapid development of treatment techniques of peripheral arterial disease (PAD) treatment is nowadays predominantly interventional. An exception are lesions of the common femoral artery (CFA), which should be treated surgically according to vascular guidelines. However, recent evidence has shown that endovascular techniques, e.g. stenting, have comparable clinical outcomes while causing fewer complications. The aim of the present analysis was to evaluate the therapeutic success of endovascular therapy of CFA lesions in a single center, all - comers registry. Patients and methods: All patients who were treated for a CFA lesion at the Department of Internal Medicine I of the University Hospital Jena in the period from 01/2017 to 12/2020 were included. Treatment success was determined by evaluating the ankle-brachial-index (ABI) pre- and post-interventional as well as after follow-up (FU), measuring walking distance (WD) and by target revascularization rate (TLR) and primary patency rate (PPR). Results: The analysis included 109 patients with a mean age of 73.4 years, with 67% (73) of those being men. 72 patients received interventional treatment, whereas 33 were treated surgically and 4 conservatively. Resting ABI in the overall cohort showed an increase from 0.5 to 0.7 post intervention (p=<0.05; mean FU-time: 6.5 months). In the interventional cohort ABI increases from 0.6 to 0.8 (p=<0.05; mean FU-time: 5,8 months) at FU and from 0.3 to 0.6 (p=<0.05; mean FU-time: 8,8 month) in the surgically treated group. The WD improved in the whole collective from 116.5 meter (m) to 152.5 m (p=<0.05). The TLR showed no significant difference with 8.1% after interventional treatment and 6.1% after vascular surgery in the present analysis (p=0.72) as well as PPR with 89.8% after EVT and 90.9% after surgical approach (p=0.87). The intra-/postinterventional complication rate was 5.5% in the intervention group, compared to postoperative complication rate of 15.2% in the surgically treated group. Conclusions: The present analysis demonstrates that even in a real-world, all-comers collective, interventional therapy for CFA lesions was safe and equally effective as the surgically treated patient cohort. Continuing to generate registry data is important to eventually initiate a paradigm shift.
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Affiliation(s)
- Hendrik Scheidhauer
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Germany
| | - Sven Moebius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Germany
| | - Pawel Aftanski
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Germany
- HUGG-Heart- and vascular medicine Goslar, Goslar, Germany
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Klein F, Dinesh S, Fiedler D, Grün K, Schrepper A, Bogoviku J, Bäz L, Pfeil A, Kretzschmar D, Schulze PC, Möbius-Winkler S, Franz M. Identification of Serum Interleukin-22 as Novel Biomarker in Pulmonary Hypertension: A Translational Study. Int J Mol Sci 2024; 25:3985. [PMID: 38612795 PMCID: PMC11012889 DOI: 10.3390/ijms25073985] [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] [Received: 03/03/2024] [Revised: 03/30/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
Growing evidence suggests the crucial involvement of inflammation in the pathogenesis of pulmonary hypertension (PH). The current study analyzed the expression of interleukin (IL)-17a and IL-22 as potential biomarkers for PH in a preclinical rat model of PH as well as the serum levels in a PH patient collective. PH was induced by monocrotalin (60 mg/kg body weight s.c.) in 10 Sprague Dawley rats (PH) and compared to 6 sham-treated controls (CON) as well as 10 monocrotalin-induced, macitentan-treated rats (PH_MAC). Lung and cardiac tissues were subjected to histological and immunohistochemical analysis for the ILs, and their serum levels were quantified using ELISA. Serum IL levels were also measured in a PH patient cohort. IL-22 expression was significantly increased in the lungs of the PH and PH_MAC groups (p = 0.002), whereas increased IL17a expression was demonstrated only in the lungs and RV of the PH (p < 0.05) but not the PH_MAC group (p = n.s.). The PH group showed elevated serum concentrations for IL-22 (p = 0.04) and IL-17a (p = 0.008). Compared to the PH group, the PH_MAC group demonstrated a decrease in IL-22 (p = 0.021) but not IL17a (p = n.s.). In the PH patient collective (n = 92), increased serum levels of IL-22 but not IL-17a could be shown (p < 0.0001). This elevation remained significant across the different etiological groups (p < 0.05). Correlation analysis revealed multiple significant relations between IL-22 and various clinical, laboratory, functional and hemodynamic parameters. IL-22 could serve as a promising inflammatory biomarker of PH with potential value for initial diagnosis, functional classification or even prognosis estimation. Its validation in larger patients' cohorts regarding outcome and survival data, as well as the probability of promising therapeutic target structures, remains the object of further studies.
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Affiliation(s)
- Friederike Klein
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Sandesh Dinesh
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Desiree Fiedler
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Katja Grün
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jürgen Bogoviku
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Laura Bäz
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Herz-und Gefäßmedizin Goslar (HUGG), Goslar, Fleischscharren 4, 38640 Goslar, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
| | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; (F.K.)
- Department of Cardiology, Angiology and Intensive Care Medicine, Cardiovascular Center Rotenburg Klinikum Hersfeld-Rotenburg, Heinz-Meise-Straße 100, 36199 Rotenburg an der Fulda, Germany
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3
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Haertel F, Kaluza M, Bogoviku J, Westphal J, Fritzenwanger M, Pfeifer R, Kretzschmar D, Doenst T, Moebius-Winkler S, Schulze PC. The Jena Method: Perfusionist Independent, Standby Wet-Primed Extracorporeal Membrane Oxygenation (ECMO) Circuit for Immediate Catheterization Laboratory and/or Hybrid Operating Room Deployment. J Clin Med 2024; 13:1292. [PMID: 38592110 PMCID: PMC10932279 DOI: 10.3390/jcm13051292] [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] [Received: 01/09/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Background: The timely initiation of extracorporeal membrane oxygenation (ECMO) is crucial for providing life support. However, delays can occur when perfusionists are not readily available. The Jena Method aims to address this issue by offering a wet-primed ECMO system that can be rapidly established without the perfusionist's presence. Methods: The goal was to ensure prompt ECMO initiation while maintaining patient safety. The method focuses on meeting hygienic standards, safe primed storage of the circuit, staff training, and providing clear step-by-step instructions for the ECMO unit. Results: Since implementing the Jena Method in 2015, 306 patients received VA-ECMO treatment. Bacterial tests confirmed the sterility of the primed ECMO circuits during a 14-day period. The functionality of all the components of the primed ECMO circuit after 14 days, especially the pump and oxygenator, were thoroughly checked and no malfunction was found to this day. To train staff for independent ECMO initiation, a step-by-step system involves safely bringing the ECMO unit to the intervention site and establishing all connections. This includes powering up, managing recirculation, de-airing the system, and preparing it for cannula connection. A self-developed picture-based guide assists in this process. New staff members learn from colleagues and receive quarterly training sessions by perfusionists. After ECMO deployment, the perfusionist provides a new primed system for a potential next patient. Conclusions: Establishing a permanently wet-primed on-demand extracorporeal life support circuit without direct perfusionist support is feasible and safe. The Jena Method enables rapid ECMO deployment and has the potential to be adopted in emergency departments as well.
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Affiliation(s)
- Franz Haertel
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Mirko Kaluza
- Department of Cardiothoracic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jurgen Bogoviku
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Julian Westphal
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Michael Fritzenwanger
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ruediger Pfeifer
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Heart and Vascular Medicine (HUGG), Fleischscharren 4, 38642 Goslar, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sven Moebius-Winkler
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Haertel F, Lehmann T, Heller T, Fritzenwanger M, Pfeifer R, Kretzschmar D, Otto S, Bogoviku J, Westphal J, Bruening C, Gecks T, Kaluza M, Moebius-Winkler S, Schulze PC. Impact of a VA-ECMO in Combination with an Extracorporeal Cytokine Hemadsorption System in Critically Ill Patients with Cardiogenic Shock-Design and Rationale of the ECMOsorb Trial. J Clin Med 2023; 12:4893. [PMID: 37568295 PMCID: PMC10420280 DOI: 10.3390/jcm12154893] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Cardiogenic shock and arrest present as critical, life-threatening emergencies characterized by severely compromised tissue perfusion and inadequate oxygen supply. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) serves as a mechanical support system for patients suffering shock refractory to conventional resuscitation. Despite the utilization of VA-ECMO, clinical deterioration due to systemic inflammatory response syndrome (SIRS) resulting from the underlying shock and exposure of blood cells to the artificial surfaces of the ECMO circuit may occur. To address this issue, cytokine adsorbers offer a valuable solution by eliminating blood proteins, thereby controlling SIRS and potentially improving hemodynamics. Consequently, a prospective, randomized, blinded clinical trial will be carried out with ECMOsorb. METHODS AND STUDY DESIGN ECMOsorb is a single-center, controlled, randomized, triple-blinded trial that will compare the hemodynamic effects of treatment with a VA-ECMO in combination with a cytokine adsorber (CytoSorb®, intervention) to treatment with VA-ECMO only (control) in patients with cardiogenic shock (with or without prior cardiopulmonary resuscitation (CPR)) requiring extracorporeal, hemodynamic support. Fifty-four patients will be randomized in a 1:1 fashion to the intervention or control group over a 36-month period. The primary endpoint of ECMOsorb is the improvement of the Inotropic Score (IS) 72 h after the intervention. Prognostic indicators, including mortality rates, hemodynamic parameters, laboratory findings, echocardiographic assessments, quality of life measurements, and clinical parameters, will serve as secondary outcome measures. The safety evaluation encompasses endpoints such as air embolisms, allergic reactions, peripheral ischemic complications, vascular complications, bleeding incidents, and stroke occurrences. CONCLUSIONS The ECMOsorb trial seeks to assess the efficacy of a cytokine adsorber (CytoSorb®; CytoSorbents Europe GmbH, Berlin, Germany) in reducing SIRS and improving hemodynamics in patients with cardiogenic shock who are receiving VA-ECMO. We hypothesize that a reduction in cytokine levels can lead to faster weaning from inotropic and mechanical circulatory support, and ultimately to improved recovery.
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Affiliation(s)
- Franz Haertel
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Lehmann
- Center of Clinical Studies, University Hospital Jena, Salvador-Allende-Platz 27, 07747 Jena, Germany
| | - Tabitha Heller
- Center of Clinical Studies, University Hospital Jena, Salvador-Allende-Platz 27, 07747 Jena, Germany
| | - Michael Fritzenwanger
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ruediger Pfeifer
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sylvia Otto
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jurgen Bogoviku
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Julian Westphal
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Christiane Bruening
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Gecks
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Mirko Kaluza
- Department of Cardiothoracic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sven Moebius-Winkler
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P. Christian Schulze
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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5
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Aftanski P, Thieme M, Klein F, Schulze PC, Möbius-Winkler S, Kretzschmar D. Intravascular Lithotripsy in Calcified Peripheral Lesions: Single-Center JEN-Experience. Int J Angiol 2023; 32:11-20. [PMID: 36727147 PMCID: PMC9886450 DOI: 10.1055/s-0042-1751229] [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: 02/04/2023] Open
Abstract
Peripheral artery disease (PAD) shows increasing need for revascularization therapy. Interventional success in calcified lesions is limited. Here, intravascular lithotripsy (IVL), modifying intimal and medial calcium, is a promising treatment approach. A single-center, prospective all-comers registry for patients undergoing peripheral IVL was established to examine treatment success in PAD with severe vessel calcification. Periprocedural safety events as well as short-term and intermediate follow-up clinical data were evaluated. Between December 2018 and January 2021 all consecutive patients receiving peripheral lithotripsy at our center were analyzed. Clinical and angiographic data were evaluated. Angiographic images were analyzed using a semiautomatic software for quantitative vessel analysis. Eighty-five lesions in 61 limbs were treated with IVL in 51 patients presenting with Rutherford classes 2 to 5. Most lesions (68%) were localized in the superficial femoral artery. Mean calcified lesion length was 102.5 mm (10-390 mm), with a median peripheral arterial calcium score of 3, indicating a highly calcified status. In 58% of the patients, IVL was used as a stand-alone therapy. IVL resulted in a mean acute luminal gain of 2.6 ± 0.9 mm, resulting in stenosis reduction by 42.1 ± 15%. Mean ankle brachial index (ABI) improved significantly from 0.6 to 0.8 ( p < 0.0001) on day 1 after the intervention and remained stable at 6 months. This large real-world data of peripheral IVL reports compelling safety in a complex patient cohort. For the first time, clinical follow-up data demonstrated a sustained significant improvement in ABI after 6 months.
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Affiliation(s)
- Pawel Aftanski
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - Marcus Thieme
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Friederike Klein
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller University Jena, Jena, Germany
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6
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Aftanski P, Thieme M, Schulze PC, Klein F, Moebius-Winkler S, Kretzschmar D. Course of ankle-brachial-index 12 months after intravascular lithotripsy in calcified peripheral lesions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1943] [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
Intravascular lithotripsy (IVL) is a relatively novel treatment option for calcified lesions in peripheral artery disease. Little is known about the mid to long-term functional status of the patients and target lesion revascularization rate (TLR) after IVL only procedure.
Purpose
To evaluate the course of ankle-brachial-index (ABI) and to assess the rate of revascularization 1 year after intravascular lithotripsy performed on calcified peripheral lesions.
Methods
Between December 2018 and January 2021 IVL was performed on 61 limbs of 51 patients presenting with Rutherford classes 2–5. Ankle-brachial-index (ABI) was documented before the procedure as well as 1 day, 6 months and 1 year after the procedure within a single center real-life registry. Further endpoint was revascularization with PTA or peripheral bypass surgery. The vast majority of cases were done as IVL only procedure (58%) All procedures were done in upper leg/pelvic stenosis.
Results
ABI measurement after 12 months was done in 42 of 51 patients (82%). Three pts were missed due to media sclerosis. Due to loss of follow-up, ABI after 6 months could not be performed on 4/61 patients (7,8%) and 12-month-ABI in another 8/51 cases (15,6%). Initial baseline ABI of 0.6±0.26 before the procedure increased to 0.8±0.25 (p<0.0001) one day afterward. After 6 months, the ABI of 0.8±0.27 (n=49; p<0.0001) was still significantly improved compared to baseline. After 1 year, ABI with 0.7±0.22 was still improved, however not significantly different from baseline (Figure 1). Target lesion revascularization was needed in 7 patients (13%), 4 with subsequent IVL, 3 with PTA and 2 with peripheral bypass surgery.
Conclusions
In our large single center registry, IVL performed mainly as a stand-alone procedure was safe and effective even after a mid-term follow up. TLR was necessary in 13%, which is lower than in previous published IVL data (20,7% as in DISRUPT-PAD-II) [1]. ABI after 12 months improved but did maintain statistical significance, compared with other procedure like scoring balloon [2].
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Aftanski
- University hospital Jena , Jena , Germany
| | - M Thieme
- University hospital Jena , Jena , Germany
| | | | - F Klein
- University hospital Jena , Jena , Germany
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Boxhammer E, Gharibeh SX, Wernly B, Kelm M, Franz M, Kretzschmar D, Hoppe UC, Lauten A, Lichtenauer M. Conundrum of Classifying Subtypes of Pulmonary Hypertension-Introducing a Novel Approach to Classify "Borderline" Patients in a Population with Severe Aortic Stenosis Undergoing TAVI. J Cardiovasc Dev Dis 2022; 9:jcdd9090294. [PMID: 36135439 PMCID: PMC9505198 DOI: 10.3390/jcdd9090294] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) is an established therapeutic option in patients with severe aortic valve stenosis (AS) and a high surgical risk profile. Pulmonary hypertension (PH)—often co-existing with severe AS—is associated with a limited factor for prognosis and survival. The purpose of this study was to evaluate the prevalence of PH in patients undergoing TAVI, classify these patients based on right heart catheter (RHC) measurements in different PH subtypes, and analyze prognostic values on survival after TAVI. Methods: 284 patients with severe AS underwent an RHC examination for hemodynamic assessment prior to TAVI and were categorized into subtypes of PH according to the 2015 European Society of Cardiology (ESC) guidelines. TAVI patients were followed-up with for one year with regard to 30-days and 1-year mortality as primary endpoints. Results: 74 of 284 participants showed a diastolic pressure gradient (DPG) < 7 mmHg and a pulmonary vascular resistance (PVR) > 3 Wood units (WU) and could not be formally allocated to either isolated post-capillary PH (ipc-PH) or combined pre- and post-capillary PH (cpc-PH). Therefore, a new subgroup called “borderline post-capillary PH” (borderlinepc-PH) was introduced. Compared with TAVI patients with pre-capillary PH (prec-PH), ipc-PH patients suffering from borderlinepc-PH (HR 7.114; 95% CI 2.015−25.119; p = 0.002) or cpc-PH (HR 56.459; 95% CI 7.738−411.924; p < 0.001) showed a significantly increased 1-year mortality. Conclusions: Postcapillary PH was expanded to include the so-called “borderlinepc-PH” variant in addition to the ipc-PH and cpc-PH subtypes. The one-year survival after TAVI was significantly different between the subgroups, with the worst prognosis for borderlinepc-PH and cpc-PH.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Sarah X. Gharibeh
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany
| | - Marcus Franz
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Departement of Cardiology, Friedrich Schiller University, 07737 Jena, Germany
| | - Daniel Kretzschmar
- Universitätsherzzentrum Thüringen, Clinic of Internal Medicine I, Departement of Cardiology, Friedrich Schiller University, 07737 Jena, Germany
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
| | - Alexander Lauten
- Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, 99084 Erfurt, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, 10115 Berlin, Germany
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria
- Correspondence:
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8
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Haertel F, Lenk K, Fritzenwanger M, Pfeifer R, Franz M, Memisevic N, Otto S, Lauer B, Weingärtner O, Kretzschmar D, Dannberg G, Westphal J, Baez L, Bogoviku J, Schulze PC, Moebius-Winkler S. Rationale and Design of JenaMACS-Acute Hemodynamic Impact of Ventricular Unloading Using the Impella CP Assist Device in Patients with Cardiogenic Shock. J Clin Med 2022; 11:jcm11154623. [PMID: 35956238 PMCID: PMC9369529 DOI: 10.3390/jcm11154623] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cardiogenic shock due to myocardial infarction or heart failure entails a reduction in end organ perfusion. Patients who cannot be stabilized with inotropes and who experience increasing circulatory failure are in need of an extracorporeal mechanical support system. Today, small, percutaneously implantable cardiac assist devices are available and might be a solution to reduce mortality and complications. A temporary, ventricular, continuous flow propeller pump using magnetic levitation (Impella®) has been approved for that purpose. METHODS AND STUDY DESIGN JenaMACS (Jena Mechanical Assist Circulatory Support) is a monocenter, proof-of-concept study to determine whether treatment with an Impella CP® leads to improvement of hemodynamic parameters in patients with cardiogenic shock requiring extracorporeal, hemodynamic support. The primary outcomes of JenaMACS are changes in hemodynamic parameters measured by pulmonary artery catheterization and changes in echocardiographic parameters of left and right heart function before and after Impella® implantation at different support levels after 24 h of support. Secondary outcome measures are hemodynamic and echocardiographic changes over time as well as clinical endpoints such as mortality or time to hemodynamic stabilization. Further, laboratory and clinical safety endpoints including severe bleeding, stroke, neurological outcome, peripheral ischemic complications and occurrence of sepsis will be assessed. JenaMACS addresses essential questions of extracorporeal, mechanical, cardiac support with an Impella CP® device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and improve the outcome in those patients. CONCLUSION The JenaMACS study will address essential questions of extracorporeal, mechanical, cardiac support with an Impella CP® assist device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and may improve outcome in those patients. ETHICS AND DISSEMINATION The protocol was approved by the institutional review board and ethics committee of the University Hospital of Jena. Written informed consent will be obtained from all participants of the study. The results of this study will be published in a renowned international medical journal, irrespective of the outcomes of the study. Strengths and Limitations: JenaMACS is an innovative approach to characterize the effect of additional left ventricular mechanical unloading during cardiogenic shock via a minimally invasive cardiac assist system (Impella CP®) 24 h after onset and will provide valuable data for acute interventional strategies or future prospective trials. However, JenaMACS, due to its proof-of-concept design, is limited by its single center protocol, with a small sample size and without a comparison group.
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Affiliation(s)
- Franz Haertel
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
- Correspondence: ; Tel.: +0049-364-1932-4554
| | - Karsten Lenk
- Department of Cardiology, University Hospital Leipzig, Liebigstrasse 20, Haus 4, 04103 Leipzig, Germany
| | - Michael Fritzenwanger
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ruediger Pfeifer
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Marcus Franz
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Nedim Memisevic
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sylvia Otto
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Bernward Lauer
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Oliver Weingärtner
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Gudrun Dannberg
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Julian Westphal
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Laura Baez
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Jurgen Bogoviku
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P. Christian Schulze
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sven Moebius-Winkler
- Department of Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Makhmudova U, Kretzschmar D, Schulze PC, Weingärtner O. Lipid-lowering therapy in patients with peripheral artery disease – a call for action. VASA 2022; 51:193-195. [DOI: 10.1024/0301-1526/a001013] [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: 11/19/2022]
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Abstract
A 45-year-old healthy woman presented with claudication of the right leg. The resting ankle-brachial index (ABI) was reduced to 0.6, and a duplex scan revealed an occlusion of the right popliteal artery. Angiography presented a patent superficial femoral artery that ends above the knee joint. Laterally, there was delayed retrograde contrast filling of the popliteal artery. After exploring the internal iliac artery, we crossed a thrombotic occlusion of a persisting sciatic artery (PSA). Local thrombolysis with recombinant tissue plasminogen activator (1 mg/h) was initiated. The Angiography 18 hours later showed a reduction of thrombotic material and relevant stenosis in the proximal part of the vessel. Residual thrombus and the stenosis were covered by two stentgrafts (Gore Viabahn Endoprosthesis) that were stabilized by an interwoven stent (Supera). Final angiography displayed a patent sciatic artery and a three-vessel run off. Postinterventional ABI was normalized to 1.0. The magnetic resonance imaging 6 days after the intervention demonstrated a patent PSA again and a normal blood flow on the left leg. A PSA should be included in the differential diagnosis of lower limb ischemia or suspected aneurysm formation. We demonstrated the feasibility of an interventional approach with an excellent outcome in this case.
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Affiliation(s)
- Daniel Kretzschmar
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,HUGG-Herz and Gefäßmedizin Goslar, Fleischscharren 4, 38640 Goslar, Germany,Address for correspondence Daniel Kretzschmar, MD HUGG-Herz and Gefäßmedizin GoslarFleischscharren 4, 38640 GoslarGermany
| | - Marcus Thieme
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany,Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Rene Aschenbach
- Department of Radiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Boxhammer E, Mirna M, Bäz L, Alushi B, Franz M, Kretzschmar D, Hoppe UC, Lauten A, Lichtenauer M. Comparison of PCWP and LVEDP Measurements in Patients with Severe Aortic Stenosis Undergoing TAVI-Same Same but Different? J Clin Med 2022; 11:jcm11112978. [PMID: 35683367 PMCID: PMC9181042 DOI: 10.3390/jcm11112978] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure (LVEDP) are often used as equivalents for determination of pulmonary hypertension (PH). PH is a comorbidity in patients with severe aortic valve stenosis (AS) and associated with limited prognosis. The aim of the study was to examine the role of differentiated classification basis of PCWP and LVEDP in patients planning for transcatheter aortic valve implantation (TAVI). METHODS 284 patients with severe AS completed a combined left (LHC) and right heart catheterization (RHC) as part of a TAVI planning procedure. Patients were categorized twice into subtypes of PH according to 2015 European Society of Cardiology (ESC) guidelines-on the one hand with PCWP and on the other hand with LVEDP as classification basis. PCWP-LVEDP relationships were figured out using Kaplan-Meier curves, linear regressions and Bland-Altman analysis. RESULTS Regarding 1-year mortality, Kaplan-Meier analyses showed similar curves in spite of different classification bases of PH subtypes according to PCWP or LVEDP with exception of pre-capillary PH subtype. PCWP-LVEDP association in the overall cohort was barely present (R = 0.210, R2 = 0.044). When focusing analysis on PH patients only a slightly increased linear regression was noted compared to the overall cohort (R = 0.220, R2 = 0.048). The strongest regression was observed in patients with creatinine ≥ 132 µmol/L (R = 0.357, R2 = 0.127) and in patients with mitral regurgitation ≥ II° (R = 0.326, R2 = 0.106). CONCLUSIONS In patients with severe AS, there is a weak association between hemodynamic parameters measured by LHC and RHC. RHC measurements alone are not suitable for risk stratification with respect to one-year mortality. If analysis of hemodynamic parameters is necessary in patients with severe AS scheduled for TAVI, measurement results of LHC and RHC should be combined and LVEDP could serve as a helpful indicator for risk assessment.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (M.M.); (U.C.H.)
| | - Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (M.M.); (U.C.H.)
| | - Laura Bäz
- Universitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, Germany; (L.B.); (M.F.); (D.K.)
| | - Brunilda Alushi
- Department of General and Interventional Cardiology and Rhythmology, Helios Hospital Erfurt, 99089 Erfurt, Germany; (B.A.); (A.L.)
| | - Marcus Franz
- Universitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, Germany; (L.B.); (M.F.); (D.K.)
| | - Daniel Kretzschmar
- Universitäts-Herzzentrum Thüringen, Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University, 07743 Jena, Germany; (L.B.); (M.F.); (D.K.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (M.M.); (U.C.H.)
| | - Alexander Lauten
- Department of General and Interventional Cardiology and Rhythmology, Helios Hospital Erfurt, 99089 Erfurt, Germany; (B.A.); (A.L.)
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, 10785 Berlin, Germany
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (M.M.); (U.C.H.)
- Correspondence:
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Topf A, Mirna M, Paar V, Motloch LJ, Bacher N, Franz M, Hoppe UC, Kretzschmar D, Lichtenauer M. Differential Diagnosis between Takotsubo Syndrome and Acute Coronary Syndrome—A Prospective Analysis of Novel Cardiovascular Biomarkers for a More Selective Triage. J Clin Med 2022; 11:jcm11112974. [PMID: 35683362 PMCID: PMC9180967 DOI: 10.3390/jcm11112974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction: Takotsubo syndrome (TTS) is clinically indistinguishable from an ACS. Despite the implementation of clinical scoring systems and novel biomarkers, coronary angiography currently remains necessary for differential diagnosis. Methods: 93 patients with chest pain and the suspicion of TTS were enrolled in two study centers. Fetuin-A, IGFBP-2, Galectin-3, and TNF α were determined in serum samples, collected within 24 h after the onset of symptoms. Serum levels of biomarkers were analyzed for the differential diagnostic value between TTS and ACS. Results: Compared to TTS, patients with ACS had significantly lower serum levels of Fetuin-A and IGFBP-2. The cut-off value of Fetuin-A for the identification of TTS compared to ACS was 55.74 μg/mL (sensitivity: 100.0%, specificity: 82.6%, PPV: 63.2%, NPV: 100.0%). An optimal cut-off value for IGFBP-2 for the differential diagnosis between TTS and ACS was determined as 171.77 ng/mL (sensitivity: 76.0%, specificity: 82.6%, PPV: 76.4%, NPV 72.7%). Conclusion: Fetuin-A and IGFBP-2 might facilitate the triage between TTS and ACS and could be therefore of great benefit for the guidance of treatment.
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Affiliation(s)
- Albert Topf
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
- Correspondence: ; Tel.: +43-(0)-57-57418; Fax: +43-(0)-57255-4111
| | - Moritz Mirna
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Vera Paar
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Lukas J. Motloch
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Nina Bacher
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07743 Jena, Germany; (M.F.); (D.K.)
| | - Uta C. Hoppe
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07743 Jena, Germany; (M.F.); (D.K.)
| | - Michael Lichtenauer
- Clinic for Internal Medicine II, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, A-5020 Salzburg, Austria; (M.M.); (V.P.); (L.J.M.); (N.B.); (U.C.H.); (M.L.)
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Kretzschmar D, Schulze PC. Right Heart Catheterization and Pulmonary Hemodynamics. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch47] [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: 11/06/2022] Open
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Westphal JG, Oehler M, Schulze PC, Kretzschmar D. A case report of a 37-year-old woman with pulmonary arterial hypertension first presented during her 3rd pregnancy and favourable long-term vasoreactive response. Eur Heart J Case Rep 2022; 6:ytac031. [PMID: 35233488 PMCID: PMC8874844 DOI: 10.1093/ehjcr/ytac031] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022]
Abstract
Background Pulmonary arterial hypertension is a rare disease associated with high rates of mortality and can significantly complicate pregnancy posing health risks for the mother and child alike. Case summary We present the case of a 37-year-old female patient with World Health Organisation functional Class IV symptoms during the 34th week of her 3rd pregnancy. Initial echocardiography showed a significantly elevated estimated systolic pulmonary artery pressure of 86 mmHg + central vein pressure as well as signs of chronic pulmonary hypertension. After a successful emergent caesarean section, pulmonary hypertension was confirmed via right heart catheterization. After exclusion of secondary aetiologies of pulmonary hypertension, the diagnosis of Class 1 pulmonary artery hypertension was made. We initially treated the patient with the phosphodiesterase-5 inhibitor sildenafil (20 mg oral bid trice daily) and later extended the medication with the dual endothelin receptor antagonist Macicentan (10 mg daily). Since the patient remained symptomatic vasodilator testing was performed and showed a significant response to intravenous Epoprostenol. We initiated a high-dose calcium channel blocker (CCB) therapy with amlodipine (20 mg daily) which led to symptomatic relief, increased exercise capacity as well as reduction in mean pulmonary artery pressure and pulmonary vascular resistance as confirmed by another right heart catheterization after therapy initiation. Discussion Since the presentation is usually non-specific, the diagnosis of pulmonary artery hypertension can be challenging and cause a delay in treatment initiation. Even though rare vasodilator testing and invasive haemodynamic measurements should be performed to identify patients with favourable long-term response to high-dose CCB.
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Affiliation(s)
- Julian Georg Westphal
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Friedrich‐Schiller‐University Jena, Am Klinikum 1, 07747 Jena, Germany
- Corresponding author. Tel: +49 3641 9324598,
| | - Matthias Oehler
- Division of Cardiology, Department of Internal Medicine, Hufeland Klinikum Bad Langensalza, Rudolph-Weiss-Straße 1-5, 99947 Bad Langensalza, Germany
| | - Paul Christian Schulze
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Friedrich‐Schiller‐University Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, Friedrich‐Schiller‐University Jena, Am Klinikum 1, 07747 Jena, Germany
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Kretzschmar D, Möbius-Winkler S, Schulze PC, Ferrari MW. Concept and Design of a Novel Pulsatile Left Heart Assist Device-The PERKAT Left Ventricle System. ASAIO J 2022; 68:28-32. [PMID: 33709987 DOI: 10.1097/mat.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiogenic shock is associated with high mortality. Patients often require temporary mechanical circulatory support. We aimed to develop a percutaneously implantable, assist device that unloads the left ventricle (LV) in a pulsatile way. The PERkutane KATheter pump technologie (PERKAT LV) device consists of a nitinol pump chamber, which is covered by foils carrying outflow valves. A flexible tube with a pigtail-shaped tip and inflow holes represents the distal part of the pump. The system is designed for 16F percutaneous implantation. The nitinol chamber is placed in the descending aorta while the flexible tube bypasses aortic arch and ascending aorta with its tip in the LV. An intra-aortic balloon pump is placed into the chamber and connected to a console. Balloon deflation generates a blood flow from the LV into the pump chamber. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Under different afterload settings using a 30 cc intra-aortic balloon pump and varying inflation/deflations rates, we recorded flow rates up to 3.0 L/min. Based on this, we believe that PERKAT LV is a promising approach for temporary LV support. The proposed design and its excellent performance give basis for in vivo tests in an animal model.
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Affiliation(s)
- Daniel Kretzschmar
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Christian Schulze
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Markus W Ferrari
- HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Germany
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Thieme M, Moebius-Winkler S, Franz M, Baez L, Schulze CP, Butter C, Edlinger C, Kretzschmar D. Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience. Front Cardiovasc Med 2021; 8:725079. [PMID: 34869628 PMCID: PMC8634400 DOI: 10.3389/fcvm.2021.725079] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk. The outcome of these patients is mainly determined not only by the interventional procedure itself, but also by its complications. Material and Methods: We analyzed the outcome and procedural events of transfemoral TAVI procedures performed per year at our institution. The mean age of these patients is 79.2 years and 49% are female. All the patients underwent duplex ultrasonography of the iliac arteries and inguinal vessels before the procedure and CT of the aorta and iliac arteries. Results: Transfemoral access route is associated with a number of challenges and complications, especially in the patients suffering from peripheral artery disease (PAD). The rate of vascular complications at our center was 2.76% (19/689). Typical vascular complications (VC) include bleeding and pseudoaneurysms at the puncture site, acute or subacute occlusion of the access vessel, and dissection or perforation of the iliac vessels. In addition, there is the need for primary PTA of the access pathway in the presence of additional PAD of the common femoral artery (CFA) and iliac vessels. Balloon angioplasty, implantation of covered and uncovered stents, lithoplasty, and ultrasound-guided thrombin injection are available to treat the described issues. Conclusion: Interventional therapy of access vessels can preoperatively enable the transfemoral approach and successfully treat post-operative VC in most of the cases. Training the heart team to address these issues is a key focus, and an interventional vascular specialist should be part of this team.
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Affiliation(s)
- Marcus Thieme
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany.,REGIOMED Vascular Center, Sonneberg, Germany
| | | | - Marcus Franz
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Laura Baez
- Clinic for Internal Medicine I, University Hospital Jena, Jena, Germany
| | | | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Immanuel Klinikum Bernau, Bernau, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, Immanuel Klinikum Bernau, Bernau, Germany.,Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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Haertel F, Kretzschmar D, Schulze PC, Neumann T. Immunomodulation in antiphospholipid-antibody-associated endocarditis: a case report and review of the literature. Eur Heart J Case Rep 2021; 5:ytab445. [PMID: 34993401 PMCID: PMC8728721 DOI: 10.1093/ehjcr/ytab445] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/08/2021] [Accepted: 10/25/2021] [Indexed: 12/04/2022]
Abstract
Background Non-infectious endocarditis is a rare complication in patients with systemic lupus erythematosus or antiphospholipid syndrome (APS). The mitral valve is mainly affected, usually showing vegetations on the ventricular and atrial side of the valve. Case summary A 27-year-old female patient with a known APS was referred to our hospital with night sweats, weight loss, reduction in performance, and dizziness. A floating structure associated to the mitral valve was identified in a transoesophageal echocardiogram with typical changes, in accordance with a non-infectious endocarditis (Libman–Sacks). Only a trace of mitral regurgitation was present and a mass on the posterior mitral valve leaflet. Laboratory findings showed antibody and inflammatory marker measurements either negative or within normal range. The patient received therapeutic oral anticoagulation using a vitamin K antagonist and a combined immunosuppression consisting of hydroxychloroquine and prednisolone. The symptoms of the patient resolved within 3 months after starting the initial treatment. The follow-up echocardiogram showed an almost normal mitral valve function with only a slight regional thickening of the posterior mitral leaflet and no stenosis. Following a 7-year period of observation being on a medical regimen of hydroxychloroquine and a vitamin K antagonist, no evidence of clinical and/or echocardiographic recurrence was detected. Discussion This case report represents a successful medical management of non-infectious endocarditis using immunosuppressive and anticoagulation therapies without significant residual lesions. Although optimal management of non-bacterial endocarditis remains in the area of uncertainty, this combination therapy deems promising.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Daniel Kretzschmar
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - P Christian Schulze
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Neumann
- Kantonsspital St. Gallen, Klinik für Rheumatologie, Haus 05, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
- Klinik für Innere Medizin III, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
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Topf A, Mirna M, Paar V, Motloch LJ, Grueninger J, Dienhart C, Schulze PC, Brandt MC, Larbig R, Hoppe UC, Kretzschmar D, Lichtenauer M. Correction to: The differential diagnostic value of selected cardiovascular biomarkers in Takotsubo syndrome. Clin Res Cardiol 2021; 111:241. [PMID: 34854992 PMCID: PMC8816772 DOI: 10.1007/s00392-021-01977-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Albert Topf
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Moritz Mirna
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Vera Paar
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Lukas J Motloch
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Janine Grueninger
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Christiane Dienhart
- Department of Internal Medicine I, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Paul C Schulze
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, 07743, Jena, Germany
| | - Mathias C Brandt
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Robert Larbig
- Devision of Cardiology, Hospital Maria Hilf Moenchengladbach, 41063, Möenchengladbach, Germany
| | - Uta C Hoppe
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - Daniel Kretzschmar
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, 07743, Jena, Germany
| | - Michael Lichtenauer
- Clinic for Internal Medicine II, Department of Internal Medicine II, Paracelsus Medical University, University Hospital Salzburg, Paracelsus University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Mirna M, Holnthoner M, Topf A, Jirak P, Fejzic D, Paar V, Kellermair J, Blessberger H, Reiter C, Kammler J, Motloch LJ, Jung C, Kretzschmar D, Franz M, Alushi B, Lauten A, Hoppe UC, Steinwender C, Lichtenauer M. Tumor necrosis factor alpha-an underestimated risk predictor in patients undergoing transcatheter aortic valve replacement (TAVR)? J Clin Lab Anal 2021; 35:e23977. [PMID: 34562276 PMCID: PMC8605157 DOI: 10.1002/jcla.23977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Systemic inflammation has been identified as a major cardiovascular risk factor in patients undergoing transcatheter aortic valve replacement (TAVR), yet currently, it is not adequately portrayed in scores for pre-interventional risk assessment. The aim of this study was to investigate the predictive ability of TNF-α in TAVR. METHODS A total of 431 patients undergoing transfemoral TAVR were enrolled in this study. Blood samples were drawn prior to intervention, 24 h post-intervention, 4, 5, and 7 days post-intervention, and 1, 3, and 6 months post-TAVR. RESULTS In a univariate Cox proportional hazard analysis, plasma concentrations of TNF-α after 24 h and after 5 days were associated with mortality after 12 months (after 24 h: HR 1.002 (1.000-1.004), p = 0.028; after 5d: HR 1.003 (1.001-1.005), p = 0.013). This association remained significant even after correction for confounders in a multivariate Cox regression analysis. Additionally, cut-offs were calculated. Patients above the cut-off for TNF-α after 5d had a significantly worse 12-month mortality than patients below the cut-off (18.8% vs. 2.8%, p = 0.046). CONCLUSION Plasma levels of TNF-α after 24 h and 5 days were independently associated with 12-month mortality in patients undergoing TAVR. Thus, TNF-α could represent a novel biomarker for enhanced risk stratification in these patients.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Mario Holnthoner
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Peter Jirak
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Dzeneta Fejzic
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jörg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Christian Reiter
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Paracelsus Medical University of Salzburg, Linz, Austria
| | - Lukas J Motloch
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Dusseldorf, Germany
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Brunilda Alushi
- Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, Erfurt, Germany
| | - Alexander Lauten
- Department of General and Interventional Cardiology and Rhythmology, Helios Clinic, Erfurt, Germany
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University Linz, Linz, Austria
- Paracelsus Medical University of Salzburg, Linz, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
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Kretzschmar D, Aftanski P, Thieme M, Schulze PC, Moebius-Winkler S. Intravascular lithotripsy in calcified peripheral lesions: the real-world single-center JEN-experience. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Peripheral vascular disease (PVD) is a major cause of morbidity and mortality with increasing need for interventional therapies. Vascular calcification increases risk of complications and may impair the effect of antiproliferative therapy. Intravascular lithotripsy (IVL) using pulsatile sonic pressure waves to modify intimal and medial calcium is a promising approach for those patients to overcome the drawbacks of vascular calcification.
Purpose
A single-center, prospective registry of patients undergoing peripheral lithotripsy was established. Periprocedural safety events as well as short and long term follow-up clinical data were evaluated.
Methods
A prospective review of cases using IVL was performed for the period from December 2018 to January 2021 at our center. Angiographic images were quantified by using the QVA 8.0 module, Medis Suite Version 3.2.60.4 developed by Medis Imaging Systems.
Results
61 cases of IVL were performed in 51 patients with Rutherford class 3. Mean age was 71 years with 78% (28) of the patients being men. Diabetes was present in 80% and renal insufficiency in 47% of the cases. The median calcified lesion length treated was 82 mm (10; 390 mm) with a PACCS sore of 3 (1; 3), indicating a highly calcified status. In 41% (n=25), predilation was necessary. We treated 8 iliac-, 19 common femoral-, 52 superficial femoral-, 5 deep femoral-, 29 popliteal- and 2 crural- lesions with balloon sizes ranging from 4.0 to 7.0 mm. In 35 (57%) cases IVL was used as a stand-alone therapy, in the remaining 26 an adjunctive therapy (DCB and/or stent) was used. We were able to reach an acute luminal gain of 2.5 mm. A ballon rupture occurred in 6 (10%) cases. There were no other complications. Mean ABI improved from 0.6 to 0.8 (p<0.0001) immediate after the intervention. Follow-up after 6 months again demonstrated an improved ABI of 0.8 (p<0.0001 vs. baseline).
Conclusion
This first real-world data of IVL reports compelling safety of IVL in a complex, difficult-to-treat patient cohort. For the first time, clinical follow-up data were presented and demonstrated a sustained improved ABI after 6 months. This innovative approach will gain more interest in the future, especially since long term effects of paclitaxel eluting devices are controversially discussed.
Funding Acknowledgement
Type of funding sources: None. ABI initial follow-up
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Affiliation(s)
- D Kretzschmar
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - P Aftanski
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - M Thieme
- Regiomed Clinics, Department of Angiology, Sonneberg, Germany
| | - P C Schulze
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - S Moebius-Winkler
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
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21
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Kretzschmar D, Möbius-Winkler S. A Rare Cause of Intermittent Claudication: Persistent Sciatic Artery. Dtsch Arztebl Int 2021; 118:362. [PMID: 34247700 DOI: 10.3238/arztebl.m2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Kretzschmar D, Franz M, Möbius-Winkler S. Indications for Duplex Sonography Should Be More Liberal. Dtsch Arztebl Int 2021; 118:464. [PMID: 34399886 DOI: 10.3238/arztebl.m2021.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Ciprian Cacuci A, Krankenberg H, Ingwersen M, Gayed M, Stein SD, Kretzschmar D, Schulze PC, Thieme M. Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences. J Endovasc Ther 2021; 28:746-754. [PMID: 34137662 DOI: 10.1177/15266028211025044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to investigate predictors and consequences of acute vascular access site complications (ASCs) related to peripheral endovascular diagnostic or interventional procedures. Despite improvement of puncture techniques, access site-related morbidity and mortality is still considerable. MATERIALS AND METHODS A total of 5263 participants who underwent 5385 endovascular procedures at a single center were consecutively included in this prospective, observational study. Primary outcomes were ASCs defined as composite of puncture site hematoma, pseudoaneurysm, arteriovenous fistula, and overt puncture site bleeding on the first day after procedure. RESULTS ASCs occurred in 16.6% of peripheral endovascular procedures (78.6% hematomas, 18.9% pseudoaneurysms, 1.4% arteriovenous fistulas, 1.1% overt bleedings). Independent predictors were advanced age [odds ratio (OR) per 10 years: 1.12, p=0.004], female sex (OR men, 0.77; p=0.001), lysis (OR 3.56; p<0.001), periprocedural heparin (OR 5000 IU, 1.96; p=0.001; OR >5000 IU, 3.56; p=0.02), time to access (OR per 10 seconds, 1.01; p<0.001), sheath size (OR per French, 1.59; p<0.001), brachial artery access (OR vs retrograde transfemoral, 4.58; p<0.001), and compression only (OR Angio-Seal, 0.57, p=0.02; ProGlide, 0.36, p<0.001; FemoSeal, 0.57, p<0.001). Treatment was required in 20.2% and prolonged hospitalization in 17.7% of ASC. Three participants died from access site-related bleeding. CONCLUSION ASCs after peripheral endovascular procedures are associated with advanced age, female sex, periprocedural antithrombotic medication, brachial artery access, postinterventional bleeding, and nonuse of vascular closure devices.
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Affiliation(s)
- Andrei Ciprian Cacuci
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Hans Krankenberg
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Maja Ingwersen
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Department of Radiology, Jena University Hospital, Jena, Germany
| | - Mohamed Gayed
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Sven Daniel Stein
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | | | | | - Marcus Thieme
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Clinic of Internal Medicine I, Jena University Hospital, Jena, Germany
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Kretzschmar D, Schulze P, Ferrari M. Design, concept and first in-vitro results of the percutaneous, pulsatile left ventricular assist device-PERKAT LV. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1232] [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
Introduction
A very high morbidity and mortality is associated with cardiogenic shock due to left ventricular failure despite encouraging developments in interventional cardiology. Patients suffering from cardiogenic shock often require temporary mechanical circulatory support to stabilize organ perfusion. In addition, an increasing number of patients with complex multi-vessel diseases cannot undergo surgical myocardial revascularization as recommended by recent guidelines due to their comorbidities. Those patients could benefit from a protected PCI approach using a temporary mechanical assist device. The available LVAD systems have specific advantages and disadvantages.
Purpose
It was our aim to develop a percutaneous, pulsatile assist device that unloads the left ventricle in a physiologic way.
Methods
The PERKAT-LV (“PERkutane KATheterpumptechnologie”) device consists of a self-expanding nitinol pump chamber which is covered by foils. Those foils carry multiple outflow valves at the proximal part of the pump chamber. A flexible suction tube with a pigtail-shaped tip and inflow holes are attached to its distal part. The system is designed for 16F percutaneous implantation via the femoral artery. Pulling back the outer sheath unfolds the nitinol chamber in the descending aorta while the flexible suction tube bypasses the aortic arch and ascending aorta with its tip in the left ventricle. In the second implantation step, a standard IABP balloon is placed into the pumping chamber and is connected to an external IABP console. Balloon deflation generates a blood flow from the left ventricle into PERKAT LV. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Positioning and schematic drawing of PERKAT-LV is demonstrated in Figure 1.
Results
Preliminary in-vitro studies using a prototype of the PERKAT LV device were performed. It was tested in different afterload settings (0, 40, 80 and 120 mmHg) using a standard 30 ccl IABP balloon and varying inflation/deflations rates (70, 80, 90, 100, 110 and 120/min). We detected flow rates ranging from 2.0 to 3.0 L/min depending on the afterload setting and inflation/deflation rate.
Conclusion
The novel percutaneously implantable and pulsatile working PERKAT-LV device offers left ventricular unloading and circulatory support of up to 3.0 L/min in a first feasibility study. At the moment, the system is extensively studied under in vitro conditions. First in vivo evaluation will follow in the near future.
Based on the current results, we believe that the system is a promising novel approach for percutaneous application of temporary left ventricular mechanical support.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research
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Affiliation(s)
- D Kretzschmar
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - P.C Schulze
- University Hospital Jena, Department of Internal Medicine I, Jena, Germany
| | - M.W Ferrari
- HSK, Helios-Kliniken, Clinic of Internal Medicine I, Wiesbaden, Germany
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Pistulli R, Andreas E, König S, Drobnik S, Kretzschmar D, Rohm I, Lichtenauer M, Heidecker B, Franz M, Mall G, Yilmaz A, Schulze PC. Characterization of dendritic cells in human and experimental myocarditis. ESC Heart Fail 2020; 7:2305-2317. [PMID: 32619089 PMCID: PMC7524053 DOI: 10.1002/ehf2.12767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Abstract
Aims Dendritic cells (DCs) are central mediators of adaptive immunity, and there is growing evidence of their role in myocardial inflammatory disease. We hypothesized that plasmacytoid and myeloid DCs are involved in the mechanisms of myocarditis and analysed these two main subtypes in human myocarditis subjects, as well as in a murine model of experimental autoimmune myocarditis (EAM). Methods and results Circulating DCs were analysed by flow cytometry in patients with acute myocarditis, dilated cardiomyopathy, and controls. Myocardial biopsies were immunostained for the presence of DCs and compared with non‐diseased controls. In a mouse model of acute myocarditis induced through synthetic cardiac myosine peptide injection, effects of immunomodulation including DC inhibition through MCS‐18 versus placebo treatment were tested at the peak of inflammation (Day 21), as well as 1 week later (partial recovery). Circulatory pDCs and mDCs were significantly reduced in myocarditis patients compared with controls (P < 0.01 for both) and remained so even after 6 months of follow‐up. Human myocarditis biopsies showed accumulation of pDCs (two‐fold CD304+/three‐fold CD123+, all P < 0.05) compared with controls. Myocardial pDCs and mDCs accumulated in EAM (P for both <0.0001). MCS‐18 treatment reduced pDC levels (P = 0.009), reduced myocardial inflammation (myocarditis score reduction from 2.6 to 1.8, P = 0.026), and improved ejection fraction (P = 0.03) in EAM at Day 21 (peak of inflammation). This effect was not observed during the partial recovery of inflammation on Day 28. Conclusions Circulating DCs are reduced in human myocarditis and accumulate in the inflamed myocardium. MCS‐18 treatment reduces DCs in EAM, leading to amelioration of inflammation and left ventricular remodelling during the acute phase of myocarditis. Our data further elucidate the role of DCs and their specific subsets in acute inflammatory cardiomyopathies.
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Affiliation(s)
- Rudin Pistulli
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, Münster, 48149, Germany
| | - Elise Andreas
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Jena, Germany
| | | | - Stefanie Drobnik
- Institute of Forensic Medicine, University of Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Jena, Germany
| | - Ilonka Rohm
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Jena, Germany
| | | | - Bettina Heidecker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Jena, Germany
| | - Gita Mall
- Institute of Forensic Medicine, University of Jena, Jena, Germany
| | - Atilla Yilmaz
- Internal Medicine Clinic II, Elisabeth Hospital, Schmalkalden, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Jena, Germany
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Mirna M, Lichtenauer M, Wernly B, Paar V, Jung C, Kretzschmar D, Uhlemann M, Franz M, Hoppe UC, Schulze PC, Hilberg T, Adams V, Sponder M, Möbius-Winkler S. Novel cardiovascular biomarkers in patients with cardiovascular diseases undergoing intensive physical exercise. Panminerva Med 2020; 62:135-142. [PMID: 32309918 DOI: 10.23736/s0031-0808.20.03838-0] [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: 01/10/2023]
Abstract
BACKGROUND In this trial, we analyzed the plasma levels of novel biomarkers that reflect different pathophysiological pathways (sST2: mechanical strain, IGF-BP2: metabolic pathways, suPAR and GDF-15: inflammatory processes) in patients undergoing physical exercise to investigate the effects of training on their plasma concentrations. METHODS Plasma concentrations of novel biomarkers (sST2, IGF-BP2, suPAR and GDF-15) were analyzed by means of ELISA in patients with stable coronary artery disease (CAD) undergoing four weeks of high- and moderate-intensity training (EXCITE Trial) and in patients with one or more cardiovascular risk factors undergoing eight months of intensive physical exercise (IGF-BP2). Plasma levels of sST2 in patients undergoing eight months of intensive exercise have been published previously by our study group (1.13-fold change, P=0.045). RESULTS Four weeks of high-intensity exercise training resulted in a statistically significant change in the plasma level of sST2 (1.106-fold change, P=0.0054) and IGF-BP2 (1.24-fold-change, P=0.0165). Eight months of intensive exercise resulted in a significant increase of IGF-BP2 (median 61.2 ng/mL to 80.7 ng/mL, 1.319-fold change, P=0.006). CONCLUSIONS The significant increase of sST2 after four weeks might be a short-term effect due to the mechanical strain caused by the high-intensity training program, whereas the increase in IGF-BP2 after four weeks and eight months is likely a result of metabolic changes due to physical exercise.
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Affiliation(s)
- Moritz Mirna
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria -
| | - Michael Lichtenauer
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Bernhard Wernly
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Vera Paar
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Faculty of Medicine, Heinrich Heine University, Duesseldorf, Germany
| | - Daniel Kretzschmar
- Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany
| | - Madlen Uhlemann
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Marcus Franz
- Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany
| | - Uta C Hoppe
- Division of Cardiology, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany
| | - Thomas Hilberg
- Faculty II/Sports Science, Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Volker Adams
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technical University, Dresden, Germany
| | - Michael Sponder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Sven Möbius-Winkler
- Division of Cardiology, Department of Internal Medicine I, Friedrich Schiller University, Jena, Germany
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Jirak P, Pistulli R, Lichtenauer M, Wernly B, Paar V, Motloch LJ, Rezar R, Jung C, Hoppe UC, Schulze PC, Kretzschmar D, Braun-Dullaeus RC, Bekfani T. Expression of the Novel Cardiac Biomarkers sST2, GDF-15, suPAR, and H-FABP in HFpEF Patients Compared to ICM, DCM, and Controls. J Clin Med 2020; 9:jcm9041130. [PMID: 32326570 PMCID: PMC7230638 DOI: 10.3390/jcm9041130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) remains an ongoing therapeutic and diagnostic challenge to date. In this study we aimed for an analysis of the diagnostic potential of four novel cardiovascular biomarkers, GDF-15, H-FABP, sST2, and suPAR in HFpEF patients compared to controls as well as ICM, and DCM. Methods: In total, we included 252 stable outpatients and controls (77 DCM, 62 ICM, 18 HFpEF, and 95 controls) in the present study. All patients were in a non-decompensated state and on a stable treatment regimen. Serum samples were obtained and analyzed for GDF-15 (inflammation, remodeling), H-FABP (ischemia and subclinical ischemia), sST2 (inflammation, remodeling) and suPAR (inflammation, remodeling) by means of ELISA. Results: A significant elevation of GDF-15 was found for all heart failure entities compared to controls (p < 0.005). Similarly, H-FABP evidenced a significant elevation in all heart failure entities compared to the control group (p < 0.0001). Levels of sST2 were significantly elevated in ICM and DCM patients compared to the control group and HFpEF patients (p < 0.0001). Regarding suPAR, a significant elevation in ICM and DCM patients compared to the control group (p < 0.0001) and HFpEF patients (p < 0.01) was observed. An AUC analysis identified H-FABP (0.792, 95% CI 0.713–0.870) and GDF-15 (0.787, 95% CI 0.696–0.878) as paramount diagnostic biomarkers for HFpEF patients. Conclusion: Based on their differences in secretion patterns, novel cardiovascular biomarkers might represent a promising diagnostic tool for HFpEF in the future.
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Affiliation(s)
- Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
- Correspondence:
| | - Rudin Pistulli
- Division of Vascular Medicine, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Munster, North Rhine-Westphalia, 48149 Münster, Germany;
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Lukas J. Motloch
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Uta C. Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich Schiller University Jena, 07740 Jena, Germany; (P.C.S.); (D.K.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich Schiller University Jena, 07740 Jena, Germany; (P.C.S.); (D.K.)
| | - Rüdiger C. Braun-Dullaeus
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Gericke University, Magdeburg, 39120 Magdeburg, Germany; (R.C.B.-D.)
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Gericke University, Magdeburg, 39120 Magdeburg, Germany; (R.C.B.-D.)
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Rohm I, Grün K, Müller LM, Bäz L, Förster M, Schrepper A, Kretzschmar D, Pistulli R, Yilmaz A, Bauer R, Jung C, Berndt A, Schulze PC, Franz M. Cellular inflammation in pulmonary hypertension: Detailed analysis of lung and right ventricular tissue, circulating immune cells and effects of a dual endothelin receptor antagonist. Clin Hemorheol Microcirc 2020; 73:497-522. [PMID: 31156142 DOI: 10.3233/ch-180529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/01/2023]
Abstract
Growing evidence suggests that inflammation is crucially involved in the pathogenesis of pulmonary hypertension (PH) and consecutive right heart failure. The present study analyzed the inflammatory response in lung and right ventricle in a rat model of PH and evaluated the effects of the dual endothelin receptor antagonist (ERA) Macitentan. PH was induced by monocrotalin (60 mg/kg body weight s.c.) in Sprague-Dawley rats (PH, n = 10) and compared to healthy controls (CON, n = 10) as well as monocrotalin-induced, macitentan-treated rats (THER, n = 10). Detection of Dendritic cells (DCs), regulatory T cells (Tregs) and others as well as RT-PCR based inflammatory gene expression analysis were performed. Circulating DCs and Tregs were quantified by flow cytometry in the rat model and in PH patients (n = 70) compared to controls (n = 52). Inflammatory cells were increased in lung and right ventricular tissue, whereas DCs and Tregs were decreased in blood. Expression of 17 genes in the lung and 20 genes in the right ventricle were relevantly (>2.0 fold) regulated in the PH group. These effects were, at least in part, attenuated in response to Macitentan treatment. In humans as well as rats, immune cells showed significant correlations to clinical, echocardiographic, and haemodynamic parameters. PH is accompanied by a distinct inflammatory response in lung and right but not left ventricular tissue attenuated by Macitentan. Correlations of circulating DCs as well as tissue resident immune cells with parameters reflecting right ventricular function raise the idea of both, promising biomarkers and novel treatment strategies.
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Affiliation(s)
- Ilonka Rohm
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Katja Grün
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Linda Marleen Müller
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Laura Bäz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Martin Förster
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Andrea Schrepper
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Atilla Yilmaz
- Department of Internal Medicine II, Division of Cardiology, Elisabeth Klinikum Schmalkalden, Schmalkalden, Germany
| | - Reinhard Bauer
- Institute of Molecular Cell Biology, Center for Molecular Biomedicine, Jena University Hospital, Jena, Germany
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Alexander Berndt
- Institute of Pathology, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
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Mirna M, Topf A, Wernly B, Rezar R, Paar V, Jung C, Salmhofer H, Kopp K, Hoppe UC, Schulze PC, Kretzschmar D, Schneider MP, Schultheiss UT, Sommerer C, Paul K, Wolf G, Lichtenauer M, Busch M. Novel Biomarkers in Patients with Chronic Kidney Disease: An Analysis of Patients Enrolled in the GCKD-Study. J Clin Med 2020; 9:jcm9030886. [PMID: 32213894 PMCID: PMC7141541 DOI: 10.3390/jcm9030886] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Chronic kidney disease (CKD) and cardiovascular diseases (CVD) often occur concomitantly, and CKD is a major risk factor for cardiovascular mortality. Since some of the most commonly used biomarkers in CVD are permanently elevated in patients with CKD, novel biomarkers are warranted for clinical practice. Methods: Plasma concentrations of five cardiovascular biomarkers (soluble suppression of tumorigenicity (sST2), growth differentiation factor 15 (GDF-15), heart-type fatty acid-binding protein (H-FABP), insulin-like growth factor-binding protein 2 (IGF-BP2), and soluble urokinase plasminogen activator receptor) were analyzed by means of enzyme-linked immunosorbent assay (ELISA) in 219 patients with CKD enrolled in the German Chronic Kidney Disease (GCKD) study. Results: Except for sST2, all of the investigated biomarkers were significantly elevated in patients with CKD (2.0- to 4.4-fold increase in advanced CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² body surface area (BSA)) and showed a significant inverse correlation with eGFR. Moreover, all but H-FABP and sST2 were additionally elevated in patients with micro- and macro-albuminuria. Conclusions: Based on our findings, sST2 appears to be the biomarker whose diagnostic performance is least affected by decreased renal function, thus suggesting potential viability in the management of patients with CVD and concomitant CKD. The predictive potential of sST2 remains to be proven in endpoint studies.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Richard Rezar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Hermann Salmhofer
- Department of Internal Medicine I, Division of Nephrology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Kristen Kopp
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, 07743 Jena, Germany; (P.C.S.); (D.K.)
| | - Markus P. Schneider
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Ulla T. Schultheiss
- Department of Medicine IV – Nephrology and Primary Care, Institute of Genetic Epidemiology, Medical Center–University of Freiburg, Faculty of Medicine, 79106 Freiburg, Germany;
| | - Claudia Sommerer
- Department of Nephrology, University of Heidelberg, 69117 Heidelberg, Germany;
| | - Katharina Paul
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Gunter Wolf
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.M.); (A.T.); (B.W.); (R.R.); (V.P.); (K.K.); (U.C.H.)
- Correspondence:
| | - Martin Busch
- Department of Internal Medicine III, Friedrich Schiller University Jena, 07743 Jena, Germany; (K.P.); (G.W.); (M.B.)
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Edlinger C, Mösenlechner T, Krizanic F, Wernly B, Kretzschmar D, Hoppe UC, Butter C, Neuss M, Noutsias M, Granitz C, Schernthaner C, Wintersteller W, Lichtenauer M. Emerging trends in cardiovascular research: HFpEF in the spotlight. A bibliometric analysis of the years 2009-2016. Minerva Med 2020; 112:506-513. [PMID: 32166930 DOI: 10.23736/s0026-4806.20.06447-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Up to 50% of patients suffering from acute decompensated heart failure show normal or slightly reduced left ventricular ejection fraction (LVEF). This syndrome, which is known as heart failure with preserved ejection fraction (HFpEF) is associated with increasing age. Epidemiological studies could portrait an increasing importance and an even emerging prevalence in the past decades. Still, there is currently no evidenced based medical treatment option available. Our aims were to identify upcoming trends and emerging concepts and to point out important centers in the global research of HFpEF. EVIDENCE ACQUISITION We performed a bibliometric study on current science in the field of HFpEF to identify study characteristics, impact factors and the countries of origin of basic and clinical studies that were published within the years 2009 to 2016. We further prepared density equalizing maps for visualization of the obtained data. EVIDENCE SYNTHESIS A total of 5413 studies was screened, of which 794 were found eligible. The scientific output in clinical studies rose from 25 in 2009 to 165 in 2016. Most of the publications had a clinical topic, followed by studies on new imaging techniques. Basic research trials were by far beyond. The USA, Japan and Germany were identified as the most important national contributors to global scientific output. CONCLUSIONS This first bibliometric study in the field of HFpEF shows a substantial increase of research within the last decade, mainly in the USA, Japan, and continental Europe. As an ongoing therapeutic trend in this field, we identified RAAS-blockade and 5-phosphodiesterase-inhibition.
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Affiliation(s)
- Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany - .,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany - .,Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria -
| | - Tobias Mösenlechner
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Florian Krizanic
- Department of Cardiology, Caritas Clinic Pankow, Berlin, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Kretzschmar
- Clinic of Internal Medicine I, Friedrich Schiller University, Jena, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau bei Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christina Granitz
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Christiana Schernthaner
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Wilfried Wintersteller
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
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31
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Mirna M, Rohm I, Jirak P, Wernly B, Bäz L, Paar V, Kretzschmar D, Hoppe UC, Schulze PC, Lichtenauer M, Jung C, Franz M. Analysis of Novel Cardiovascular Biomarkers in Patients With Pulmonary Hypertension (PH). Heart Lung Circ 2020; 29:337-344. [DOI: 10.1016/j.hlc.2019.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/05/2018] [Accepted: 03/06/2019] [Indexed: 02/03/2023]
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Abstract
Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.
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Affiliation(s)
- Markus W Ferrari
- Director of the Clinic Internal Medicine 1, Helios Dr. Horst Schmidt Clinic, Ludwig-Erhard-Strasse 100, Wiesbaden, Hessen, 65199, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital, Friedrich-Schiller-University, Jena, Thüringen, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, University Hospital, Friedrich-Schiller-University, Jena, Thüringen, Germany
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33
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Otto S, Kruse M, Bittner E, Grund S, Herdtle S, Behringer W, Franz M, Kretzschmar D, Moebius-Winkler S, Schulze PC. P1746Prehospital logistics and therapy delays in urban vs. rural regions: implications for quality of acute ST-elevation myocardial infarction care. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Treatment and time goals for STEMI care are clearly defined in national and international guidelines. However, initiation of therapy relies in accurate diagnosis after first medical contact (FMC). Prehospital logistics with fast transfer to the next available 24/7 PCI-center can be challenging, especially in rural areas and for transfers across state-borders in Germany.
Objective
To analyze quality of STEMI care in a high volume PCI center serving a city and a large rural area with focus on EMS (emergency medical service) logistics. Two groups of patients admitted by EMS: (1) direct PCI-center admission vs. (2) secondary admission after transfer from a non-PCI hospital were compared.
Methods
Various administrative, procedural, therapeutic and clinical parameters were registered for each patient including timelines of acute treatment (tables). Inaccurate treatment delays were calculated as cumulative time in any prolongation in timely diagnosis or therapy after FMC.
Results
From 340 consecutive STEMI patients in or registry, 299 patients were transferred by EMS. Reperfusion therapy with PPCI was significantly delayed and required double of the time in patients secondary transferred from a non-PCI hospital (Contact-to-Balloon: 195.6±134.8 min vs. 99.6±45.3 min, p<0.001, table 1). An inaccurate delay in timely treatment (delay in correct diagnosis or deferred therapy) was determined in 45% of the patients transferred from non-PCI hospitals vs 26% of directly admitted patients (p=0.02, table 1). Accordingly, correct STEMI diagnosis was established by EMS physician prehospital only in 7.1% in the transfer group vs. 61.9% in the direct admission group (p<0.001, table 1). Our data suggest different reasons for STEMI patients falsely transferred to non-PCI hospitals: a) lower qualification of EMS personnel with ECG misinterpretation and/or false working diagnosis, b) inadequate prehospital logistics with transfer of patients to the next near-by hospital instead of next PCI-center, c) personal or system “thresholds” of EMS physicians in rural areas preventing a direct transfer to PCI-centers. Further analysis of the transfer group (table 2) showed even longer treatment times for patients transferred across state borders compared to transfers within a state (C2B: 264.8±142.2 vs. 143.7±107.0 min, p<0.05, table 2). Importantly, transfers across state borders were not associated with a longer absolute distance (km) to PCI center. However, a rescue helicopter was used for across-state transfers in one third of the cases.
Conclusion
Quality of acute STEMI care is significantly worse in rural areas predominantly due to suboptimal prehospital logistics and poor prehospital emergency care. Our data underline the importance to establish local STEMI networks irrespective of state borders with clearly defined prehospital transfer strategies, continuous medial education of EMS personnel and assessement of local quality of care.
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Affiliation(s)
- S Otto
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | - M Kruse
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | - E Bittner
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | - S Grund
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | - S Herdtle
- University Hospital of Jena, Emergency Department, Jena, Germany
| | - W Behringer
- University Hospital of Jena, Emergency Department, Jena, Germany
| | - M Franz
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | - D Kretzschmar
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
| | | | - P C Schulze
- Clinic of Internal Medicine I, Cardiology Department, Jena, Germany
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Jirak P, Lichtenauer M, Wernly B, Paar V, Jung C, Yilmaz A, Hoppe U, Schulze PC, Kretzschmar D, Pistulli R. P6287Analysis of novel cardiac markers sST2 and IL-33 in chronic heart failure with reduced ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0885] [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
Soluble (s) ST-2 has been recently evaluated as a monitoring parameter in heart failure (HF). Besides being a marker for cardiac strain and hemodynamic stress, studies also found an influence of ST2 on the immune system, above all mediated through its Janus-Face ligand IL-33, an alarmin released under stress conditions or by cellular death. In contrast to sST2, the role of IL-33 in HF is yet unknown.
Objective
In this project, we aimed for an analysis of the ST2/IL33 pathway in patients with heart failure with reduced ejection fraction (HFrEF).
Methods
In total, 200 patients were included in the study: 59 with ischemic (ICM), 65 with dilated (DCM) cardiomyopathy (mean LVEF 38%), as well as 76 control patients without coronary artery disease or signs of heart failure. Serum samples were analyzed by use of ELISA after informed consent.
Results
sST2 showed a significant elevation in all HF patients (p<0.0001) compared to the control group. No significant differences in levels of sST2 were observed between ICM and DCM patients. In contrast to sST2, no differences between HF patients and control group were observed for IL-33. Furthermore, sST2 showed a significant correlation with CRP (p<0.001, r=0.28), NT-pro-BNP (p<0.0001, r=0.40) and an inverse correlation with ejection fraction (p<0.0001, r=−0.40). Additionally, sST2 showed a significant elevation in patients in NYHA stages I-II (p=0.030) and NYHA stages III-IV (p<0.01). Again, no significant correlations were observed between IL-33 and parameters mentioned above.
Analysis of sST2 in heart failure
Conclusions
We observed a significant increase and correlation with disease severity of sST2 in chronic HFrEF patients of both ischemic and non-ischemic origin, but contrary to our expectations, no significant changes in serum levels of IL-33. Thus, a mechanism independent of ST2/IL33 axis could be responsible of sST2 secretion in HF. Further studies including acute decompensated patients could provide a better understanding of the IL-33 role in HF.
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Affiliation(s)
- P Jirak
- University Clinics Salzburg, Salzburg, Austria
| | | | - B Wernly
- University Clinics Salzburg, Salzburg, Austria
| | - V Paar
- University Clinics Salzburg, Salzburg, Austria
| | - C Jung
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Dusseldorf, Germany
| | - A Yilmaz
- Elisabeth Klinikum, Clinic of Internal Medicine II, Schmalkalden, Germany
| | - U Hoppe
- University Clinics Salzburg, Salzburg, Austria
| | - P C Schulze
- University Hospital of Jena, Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medic, Jena, Germany
| | - D Kretzschmar
- University Hospital of Jena, Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medic, Jena, Germany
| | - R Pistulli
- University Medical Center, Coronary and Peripheral Vascular Disease, Heart Failure, Münster, Germany
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35
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Katte F, Franz M, Jung C, Figulla HR, Leistner D, Jakob P, Stähli BE, Kretzschmar D, Lauten A. Impact of concomitant mitral regurgitation on transvalvular gradient and flow in severe aortic stenosis: a systematic ex vivo analysis of a subentity of low-flow low-gradient aortic stenosis. EUROINTERVENTION 2019; 13:1635-1644. [PMID: 28994654 DOI: 10.4244/eij-d-17-00476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Evaluation of aortic stenosis (AS) is based on echocardiographic measurement of mean pressure gradient (MPG), flow velocity (Vmax) and aortic valve area (AVA). The objective of the present study was to analyse the impact of systemic haemodynamic variables and concomitant mitral regurgitation (MR) on aortic MPG, Vmax and AVA in severe AS. METHODS AND RESULTS A pulsatile circulatory model was designed to study function and interdependence of stenotic aortic (AVA: 1.0 cm², 0.8 cm² and 0.6 cm²) and insufficient mitral prosthetic valves (n=8; effective regurgitant orifice area [EROA] <0.2 cm² vs. >0.4 cm²) using Doppler ultrasound. In the absence of severe MR, a stepwise increase of stroke volume (SV) and a decrease of AVA was associated with a proportional increase of aortic MPG. When MR with EROA <0.2 cm² vs. >0.4 cm² was introduced, forward SV decreased significantly (70.9±1.1 ml vs. 60.8±1.6 ml vs. 47.4±1.1 ml; p=0.02) while MR volume increased proportionally. This was associated with a subsequent reduction of aortic MPG (57.1±9.4 mmHg vs. 48.6±13.8 mmHg vs. 33.64±9.5 mmHg; p=0.035) and Vmax (5.09±0.4 m/s vs. 4.91±0.73 m/s vs. 3.75±0.57 m/s; p=0.007). Calculated AVA remained unchanged (without MR: AVA=0.53±0.04 cm² vs. with MR: AVA=0.52±0.05 cm²; p=ns). In the setting of severe AS without MR, changes of vascular resistance (SVR) and compliance (C) did not impact on aortic MPG (low SVR and C: 66±13.8 mmHg and 61.1±20 mmHg vs. high SVR and C: 60.9±9.2 mmHg and 71.5±13.5 mmHg; p=ns) In concomitant severe MR, aortic MPG and Vmax were not significantly reduced by increased SVR (36.6±2.2 mmHg vs. 34.9±5.6 mmHg, p=0.608; 3.89±0.18 m/s vs. 3.96±0.28 m/s; p=ns). CONCLUSIONS Systemic haemodynamic variables and concomitant MR may potentially affect diagnostic accuracy of echocardiographic AS evaluation. As demonstrated in the present study, MPG and Vmax are flow-dependent and significantly reduced by a reduction of forward SV from concomitant severe MR, resulting in another entity of low-flow low-gradient aortic stenosis. In contrast, calculated AVA appears to be a robust parameter of AS evaluation if severe MR is present. Changes of SVR and C did not affect the diagnostic accuracy of AS evaluation.
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Jirak P, Stechemesser L, Moré E, Franzen M, Topf A, Mirna M, Paar V, Pistulli R, Kretzschmar D, Wernly B, Hoppe UC, Lichtenauer M, Salmhofer H. Clinical implications of fetuin-A. Adv Clin Chem 2019; 89:79-130. [PMID: 30797472 DOI: 10.1016/bs.acc.2018.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/16/2022]
Abstract
Fetuin-A, also termed alpha2-Heremans-Schmid glycoprotein, is a 46kDa hepatocyte derived protein (hepatokine) and serves multifaceted functions.
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Affiliation(s)
- Peter Jirak
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Lars Stechemesser
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Elena Moré
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Franzen
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Friedrich Schiller University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, Salzburg, Austria.
| | - Hermann Salmhofer
- Department of Internal Medicine I, Divisions of Nephrology and Endocrinology, Paracelsus Medical University, Salzburg, Austria
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Wernly B, Eder S, Navarese EP, Kretzschmar D, Franz M, Alushi B, Beckhoff F, Jung C, Lichtenauer M, Datz C, Schulze PC, Landmesser U, Hoppe UC, Falk V, Lauten A. Transcatheter aortic valve replacement for pure aortic valve regurgitation: "on-label" versus "off-label" use of TAVR devices. Clin Res Cardiol 2019; 108:921-930. [PMID: 30737532 DOI: 10.1007/s00392-019-01422-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/20/2018] [Accepted: 01/24/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for aortic stenosis in patients with high surgical risk. Pure aortic regurgitation (PAR) is considered a relative contraindication for TAVR; however, TAVR is increasingly performed in PAR patients with unfavorable risk profile. Herein, we aim to summarize available data on TAVR for PAR with special emphasis on "on-label" versus "off-label" TAVR devices. METHODS AND RESULTS Pubmed was searched for studies of patients undergoing TAVR for PAR. Primary outcome was 30 day-mortality. Pooled estimated event rates were calculated. Twelve studies including a total of 640 patients were identified until December 2017. Among these, 208 (33%) patients were treated with devices with CE-mark approval for PAR ("on-label"; JenaValve and J valve). Overall, the procedural success rate was 89.9% (95% CI 81.1-96.1%; I2 80%). Major bleeding was reported in 6.4% (95% CI 2.9-10.8%; I2 48%). All-cause mortality at 30 days was 10.4% (95% CI 7.1-14.2%; I2 20%). Stroke occurred in 2.2% (95% CI 0.9-3.9%; I2 0%). A permanent pacemaker was required in 10.7% (95% CI 7.3-14.6%; I2 23%). At 30 days after TAVR, ≥ moderate AR post-interventional was observed in 11.5% (95% CI 2.9-23.6%; I2 90%). In the "on-label"-group, success rate was 93.0% (95% CI 85.9-98.1%; I2 52%). 30-day-mortality was 9.1% (95% CI 3.7-16.0%; I2 36%). More than trace AR was present in 2.8% (95% CI 0.1-7.6%; I2 0%). Compared to first-generation devices, second-generation devices were associated with significantly lower 30-day-mortality (r = - 0.10; p = 0.02), and significantly higher procedural success rates (r = 0.28; p < 0.001). Compared to other second-generation devices, the use of J valve or JenaValve was not associated with altered mortality (r = 0.04; p = 0.50), rates of > trace residual AR (r = - 0.05; p = 0.65) but with a significantly higher procedural success (r = 0.15; p = 0.042). CONCLUSION Based on this summary of available observational data TAVR for PAR is feasible and safe in patients deemed inoperable. First-generation TAVR devices are associated with inferior outcome and should be avoided. The "on-label" use of PAR-certified TAVR devices is associated with a significantly higher procedural success rate and might be favorable compared to other second-generation devices.
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Affiliation(s)
- Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sarah Eder
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, USA.,SIRIO MEDICINE Network, Evidence-Based Section, Falls Church, VA, USA.,Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Brunilda Alushi
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany
| | - Frederik Beckhoff
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Düsseldorf, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Christian Datz
- Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of Paracelsus Medical University Salzburg, Oberndorf, Austria
| | - Paul Christian Schulze
- Department of Cardiology, Clinic of Internal Medicine I, Universitaetsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Uta C Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charite Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Alexander Lauten
- Department of Cardiology, University Heart Center Berlin and Charité University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany. .,German Center for Cardiovascular Research (DZHK), Site Berlin, Berlin, Germany.
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Kretzschmar D, Schulze PC, Ferrari MW. Concept, Evaluation, and Future Perspectives of PERKAT® RV-A Novel Right Ventricular Assist Device. J Cardiovasc Transl Res 2018; 12:150-154. [PMID: 30267328 DOI: 10.1007/s12265-018-9834-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
Right heart failure (RHF) is a life-threatening condition. Mechanical right heart support offers an option for critically ill patients. The PERKAT® RV device is designed for percutaneous implantation in acute RHF. It consists of a nitinol chamber covered by foils containing inflow valves. An outlet tube is attached to its distal tip. Using an 18F sheath, it is implanted in the inferior vena cava while the tube bypasses the right heart with its tip in the pulmonary trunk. Then, an IABP balloon is inserted in the pump chamber. Balloon deflation generates blood inflow into the chamber; during inflation, blood is pumped into the pulmonary arteries. The device is capable of achieving flow rates of up to 3.5 l/min under in vitro conditions. In vivo, we were able to increase cardiac output by 59% in a sheep model of acute pulmonary embolism. Based on this, our further research will focus on first-in-human implants.
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Affiliation(s)
- Daniel Kretzschmar
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07740, Jena, Germany.
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07740, Jena, Germany
| | - Markus W Ferrari
- HSK, Department of Internal Medicine I, Helios-Clinics, Wiesbaden, Germany
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Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A. Correction to: Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 2018; 108:117. [PMID: 30182163 DOI: 10.1007/s00392-018-1350-z] [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: 10/28/2022]
Abstract
Unfortunately, an error occurred in the original article.
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Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ann-Katrin Zappe
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany
| | | | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Düsseldorf, Germany
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Stephan Fichtlscherer
- Division of Cardiology, Department of Medicine III, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Brunilda Alushi
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany
| | - Frederik Beckhoff
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany
| | - Charlotte Wewetzer
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany
| | - Marcus Franz
- Department of Cardiology, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Cardiology, Universitätsherzzentrum Thüringen, Friedrich Schiller University Jena, Jena, Germany
| | - Eliano Navarese
- Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Fairfax, VA, USA.,SIRIO MEDICINE Network, Evidence-Based Section, Falls Church, VA, USA.,Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany
| | - Volkmar Falk
- German Heart Center Berlin, Berlin, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany.,Charité-Universitätsmedizin, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Hindenburgdamm 30,, 12203, Berlin, Germany. .,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Germany.
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Mirna M, Wernly B, Paar V, Jung C, Jirak P, Figulla HR, Kretzschmar D, Franz M, Hoppe UC, Lichtenauer M, Lauten A. Multi-biomarker analysis in patients after transcatheter aortic valve implantation (TAVI). Biomarkers 2018; 23:773-780. [PMID: 30041555 DOI: 10.1080/1354750x.2018.1499127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 12/11/2022]
Abstract
BACKGROUND In this study we sought to examine whether transcatheter aortic valve implantation (TAVI) is followed by a change in the plasma levels of novel cardiovascular biomarkers. METHODS We collected blood samples of 79 patients with severe aortic valve stenosis undergoing TAVI before and at 7 days, 1 month, 3 months and 6 months post TAVI and analyzed the plasma concentrations of GDF-15, H-FABP, fetuin-A, galectin 3, sST2 and suPAR by means of ELISA. RESULTS There was a significant increase in the concentration of fetuin-A (median: 52.44 mg/ml to 113.2 mg/ml, p < 0.001) and a significant decrease of H-FABP after TAVI (median: 4.835 ng/ml to 2.534 ng/ml, p < 0.001). The concentrations of suPAR and sST2 showed an initial increase (suPAR median: 2755 pg/ml 3489 pg/ml, p < 0.001; sST2 median: 5832 pg/ml to 7137 pq/ml, p < 0.001) and subsequently decreased significantly. CONCLUSION We hypothesize that the decrease of H-FABP and the increase of fetuin-A could be due to a hemodynamic improvement after valve replacement. The initial increase of suPAR could indicate an inflammatory stimulus and the significant increase in sST2 could be due to the mechanical strain caused by implantation of the valve.
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Affiliation(s)
- Moritz Mirna
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Bernhard Wernly
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Vera Paar
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Christian Jung
- b Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty , University Duesseldorf , Duesseldorf , Germany
| | - Peter Jirak
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Hans-Reiner Figulla
- c Universitätsherzzentrum Thüringen , Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena , Jena , Germany
| | - Daniel Kretzschmar
- c Universitätsherzzentrum Thüringen , Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena , Jena , Germany
| | - Marcus Franz
- c Universitätsherzzentrum Thüringen , Clinic of Internal Medicine I, Department of Cardiology, Friedrich Schiller University Jena , Jena , Germany
| | - Uta C Hoppe
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Michael Lichtenauer
- a Clinic of Internal Medicine II, Department of Cardiology , Paracelsus Medical University of Salzburg , Salzburg , Austria
| | - Alexander Lauten
- d Department of Cardiology , Charité - Universitaetsmedizin Berlin , Berlin , Germany.,e Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) , Berlin , Standort Berlin , Germany
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Pistulli R, Neugebauer S, Kretzschmar T, Kretzschmar D, Heidecker B, Franz M, Kiehntopf M, Schulze PC. 5216Prognostic impact of serum metabolomic profiling of patients with heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Pistulli
- University Hospital of Jena, Internal Medicine I, Dept. of Cardiology, Jena, Germany
| | - S Neugebauer
- University Hospital of Jena, Institute for Clinical Chemistry and Laboratory Medicine, Jena, Germany
| | - T Kretzschmar
- University Hospital of Jena, Internal Medicine I, Dept. of Cardiology, Jena, Germany
| | - D Kretzschmar
- University Hospital of Jena, Internal Medicine I, Dept. of Cardiology, Jena, Germany
| | - B Heidecker
- University Heart Center, Cardiology, Zurich, Switzerland
| | - M Franz
- University Hospital of Jena, Internal Medicine I, Dept. of Cardiology, Jena, Germany
| | - M Kiehntopf
- University Hospital of Jena, Institute for Clinical Chemistry and Laboratory Medicine, Jena, Germany
| | - P C Schulze
- University Hospital of Jena, Internal Medicine I, Dept. of Cardiology, Jena, Germany
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Lichtenauer M, Uhlemann M, Paar V, Wernly B, Hoppe UC, Adams V, Thiele H, Kretzschmar D, Schulze PC, Moebius-Winkler S. P1734Physical exercise induces coronary artery collateral growth and affects cardiovascular biomarkers: A biomarker sub-analysis of the EXCITE trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1734] [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 Lichtenauer
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - M Uhlemann
- Heart Center of Leipzig, Leipzig, Germany
| | - V Paar
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - B Wernly
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - U C Hoppe
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - V Adams
- Dresden University of Technology, Herzzentrum Dresden- Kardiologie, Dresden, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - D Kretzschmar
- University Hospital of Jena, Department of Medicine I, Division of Cardiology, Jena, Germany
| | - P C Schulze
- University Hospital of Jena, Department of Medicine I, Division of Cardiology, Jena, Germany
| | - S Moebius-Winkler
- University Hospital of Jena, Department of Medicine I, Division of Cardiology, Jena, Germany
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Lichtenauer M, Jirak P, Wernly B, Paar V, Rohm I, Jung C, Yilmaz A, Hoppe UC, Schulze PC, Pistulli R, Kretzschmar D. P2793A comparative analysis of the novel cardiac biomarkers sST2, GDF-15, Galectin-3, suPAR, H-FABP and Fetuin-A in heart failure, STEMI and NSTEMI patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Lichtenauer
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - P Jirak
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - B Wernly
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - V Paar
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - I Rohm
- Friedrich Schiller University, Department of Internal Medicine I, Jena, Germany
| | - C Jung
- Medical Faculty, University Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - A Yilmaz
- Elisabeth Klinikum Schmalkalden, Clinic of Internal Medicine II, Schmalkalden, Germany
| | - U C Hoppe
- Paracelsus Private Medical University, Internal Medicine II, Cardiology, Salzburg, Austria
| | - P C Schulze
- University Hospital of Jena, Clinic of Internal Medicine I, Jena, Germany
| | - R Pistulli
- University Hospital of Jena, Clinic of Internal Medicine I, Jena, Germany
| | - D Kretzschmar
- University Hospital of Jena, Clinic of Internal Medicine I, Jena, Germany
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Wernly B, Zappe AK, Unbehaun A, Sinning JM, Jung C, Kim WK, Fichtlscherer S, Lichtenauer M, Hoppe UC, Alushi B, Beckhoff F, Wewetzer C, Franz M, Kretzschmar D, Navarese E, Landmesser U, Falk V, Lauten A. Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves. Clin Res Cardiol 2018; 108:83-92. [DOI: 10.1007/s00392-018-1326-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
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45
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Beckhoff F, Alushi B, Jung C, Navarese E, Franz M, Kretzschmar D, Wernly B, Lichtenauer M, Lauten A. Tricuspid Regurgitation - Medical Management and Evolving Interventional Concepts. Front Cardiovasc Med 2018; 5:49. [PMID: 29892601 PMCID: PMC5985450 DOI: 10.3389/fcvm.2018.00049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/03/2018] [Indexed: 12/27/2022] Open
Abstract
Severe tricuspid regurgitation (TR) is a complex condition of the right ventricle (RV) and tricuspid valve apparatus and is frequently associated with symptomatic heart failure and a significant morbidity and mortality. In these patients, left heart pathologies lead to chronic pressure overload of the RV, eventually causing progressive RV dilatation and functional TR. Therefore, TR cannot be considered as isolated heart valve disease pathology but has to be understood and treated as one component of a complex structural RV pathology and is frequently also a marker of an advanced stage of cardiac disease. In these patients, medical therapy restricted to diuretics and heart failure medication is frequently ineffective. Also, severe TR in the setting of advanced heart failure constitutes a high risk for cardiac surgery. Neither one of these treatment options has demonstrated a beneficial effect on long-term prognosis. The recent innovations in transcatheter technology led to efforts to develop interventional approaches to severe TR. Multiple innovative treatment concepts are currently under preclinical and clinical investigation to replace or repair TV function. However, up to date none of these approaches is established and there is still a lack of clinical data to support the efficacy of transcatheter TR treatment.
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Affiliation(s)
- Frederik Beckhoff
- Department of Cardiology, Charité University Hospital, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Brunilda Alushi
- Department of Cardiology, Charité University Hospital, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Eliano Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, VA, United States.,SIRIO MEDICINE Network, Evidence-Based Section, Falls Church, VA, United States.,Cardiovascular Institute, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcus Franz
- Department of Internal Medicine, Friedrich-Schiller-University Jena, Jena, Germany
| | - Daniel Kretzschmar
- Department of Internal Medicine, Friedrich-Schiller-University Jena, Jena, Germany
| | - Bernhard Wernly
- Department of Cardiology, Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Charité University Hospital, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Berlin, Germany
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Jirak P, Mirna M, Wernly B, Paar V, Thieme M, Betge S, Franz M, Hoppe U, Lauten A, Kammler J, Schulze PC, Lichtenauer M, Kretzschmar D. Analysis of novel cardiovascular biomarkers in patients with peripheral artery disease. Minerva Med 2018; 109:443-450. [PMID: 29652038 DOI: 10.23736/s0026-4806.18.05628-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a common form of manifestation of atherosclerosis. PAD has a considerable impact on morbidity, hospitalization rates and health-care costs. Biomarkers have been introduced in many cardiovascular disease entities over the last years. However, an analysis on the correlation of biomarker levels and PAD is still lacking. METHODS A total of 106 patients were enrolled in this current study, 51 that were diagnosed with PAD and 55 with excluded coronary and peripheral artery disease as controls. During outpatient visits, plasma samples of all patients were obtained and analyzed for sST2 (hemodynamics and inflammation), galectin-3 (fibrosis and remodeling), GDF-15 (remodeling and inflammation), suPAR (inflammation), and fetuin-A (vascular calcification) by use of ELISA after informed consent. RESULTS Compared with controls, patients with PAD showed significantly higher levels of sST2 (5248 vs. 7503 pg/mL, P<0.001), suPAR (2267 vs. 2414 pg/mL, P=0.02), galectin-3 (2795 vs. 4494 pg/mL, P<0.001), and GDF-15 (549 vs. 767 pg/mL, P<0.001). Fetuin-A showed a trend towards lower levels in patients with PAD (117 vs. 100 ng/mL, P=0.119). CONCLUSIONS Circulating levels of sST2, suPAR, galectin-3, and GDF-15 were significantly elevated in PAD patients. In contrast, fetuin-A levels showed a decrease in PAD patients indicating increased vascular calcification. Thus, by incorporating different pathophysiological processes present in PAD, tested novel biomarkers facilitate a more precise diagnosis as well as a more accurate evaluation of disease severity and progression.
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Affiliation(s)
- Peter Jirak
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Marcus Thieme
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Stefan Betge
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Uta Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Charité Medical University, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Linz, Austria
| | - Paul C Schulze
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria -
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
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Abstract
AIMS Mechanical right ventricular (RV) support offers a treatment option for critically ill patients with RV failure (RVF). We developed an assist device for rapid percutaneous implantation. The aim of the present study was to investigate the implantation procedure, haemodynamic performance and possible side effects of the novel right ventricular assist device - PERKAT RV - in an animal model. METHODS AND RESULTS The PERkutane KATheterpumptechnologie RV (PERKAT RV) device consists of a nitinol chamber covered by foil containing inflow valves. An outlet tube is attached to its distal part. The system is designed for 18 Fr percutaneous implantation. The chamber is unfolded in the inferior vena cava while the outlet tube bypasses the right heart with the tip in the pulmonary trunk. An IABP balloon is placed inside. Balloon deflation generates blood flow into the chamber; during inflation, blood is guided into the pulmonary arteries. Acute RVF was induced by venous injection of Sephadex in seven sheep for evaluation of the device. The PERKAT RV was able to improve haemodynamics immediately generating a median increase in cardiac output of 59%. Longer pump support was evaluated in a second study. Four sheep were supported for eight hours without any problems. CONCLUSIONS The percutaneous implantation and explantation of the PERKAT RV device was possible in the designed way. The sheep studies proved beneficial haemodynamic effects in acute RVF. The system offers easy and safe treatment in acute RVF.
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Affiliation(s)
- Daniel Kretzschmar
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
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Rohm I, Sattler S, Atiskova Y, Kretzschmar D, Pistulli R, Franz M, Jung C, Mall G, Kronert T, Schulze PC, Yilmaz A. Increased Number of Mast Cells in Atherosclerotic Lesions Correlates with the Presence of Myeloid but not Plasmacytoid Dendritic Cells as well as Pro-inflammatory T Cells. Clin Lab 2017; 62:2293-2303. [PMID: 28164558 DOI: 10.7754/clin.lab.2016.160517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Atherosclerosis is an inflammatory disease of the vessel wall promoted by different immune cells and inflammatory mediators. METHODS In this study, 26 human plaques and 12 control vessels without atherosclerosis were immunohistochemically stained to analyze the emergence of mast cells dependent on plaque morphology and to correlate mast cell occurrence with the emergence of myeloid as well as plasmacytoid dendritic cells. Also, mast cell emergence was correlated with the number of pro-inflammatory T cells. For this, plaques were classified as stable or unstable according to established histological criteria. RESULTS As expected, atherosclerotic lesions showed significantly higher numbers of tryptase+, chymase+, and cathepsin G+ mast cells compared to control vessels, particularly in lesions with unstable morphology. As a novel finding, we detected significant correlations between mast cells and myeloid dendritic cells (fascin, CD83, r > 0.3, p < 0.01), but not plasmacytoid dendritic cells (CD123, CD304). Also, we observed significant correlations of mast cells and different subgroups of pro-inflammatory T cells (CD3, CD8, CD161, CD25; r > 0.35, p < 0.05). CONCLUSIONS Overall, the higher number of mast cells in plaques, particularly with unstable morphology, suggests that mast cells might be involved in the progression of atherosclerosis. The correlation of mast cells with other immune cells that are pivotal in atherogenesis, e.g., myeloid dendritic cells and pro-inflammatory T cells, also suggests an interplay leading to plaque destabilization. Therefore, modulating local mast cell function and invasion into the plaque might be a therapeutic tool for plaque stabilization.
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Rohm I, Grün K, Müller LM, Kretzschmar D, Fritzenwanger M, Yilmaz A, Lauten A, Jung C, Schulze PC, Berndt A, Franz M. Increased Serum Levels of Fetal Tenascin-C Variants in Patients with Pulmonary Hypertension: Novel Biomarkers Reflecting Vascular Remodeling and Right Ventricular Dysfunction? Int J Mol Sci 2017; 18:ijms18112371. [PMID: 29117120 PMCID: PMC5713340 DOI: 10.3390/ijms18112371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 11/16/2022] Open
Abstract
Pulmonary vascular remodeling is a pathophysiological feature that common to all classes of pulmonary hypertension (PH) and right ventricular dysfunction, which is the major prognosis-limiting factor. Vascular, as well as cardiac tissue remodeling are associated with a re-expression of fetal variants of cellular adhesion proteins, including tenascin-C (Tn-C). We analyzed circulating levels of the fetal Tn-C splicing variants B⁺ and C⁺ Tn-C in serum of PH patients to evaluate their potential as novel biomarkers reflecting vascular remodeling and right ventricular dysfunction. Serum concentrations of B⁺ and C⁺ Tn-C were determined in 80 PH patients and were compared to 40 healthy controls by enzyme-linked immunosorbent assay. Clinical, laboratory, echocardiographic, and functional data were correlated with Tn-C levels. Serum concentrations of both Tn-C variants were significantly elevated in patients with PH (p < 0.05). Significant correlations could be observed between Tn-C and echocardiographic parameters, including systolic pulmonary artery pressure (B⁺ Tn-C: r = 0.31, p < 0.001, C⁺ Tn-C: r = 0.26, p = 0.006) and right atrial area (B⁺ Tn-C: r = 0.46, p < 0.001, C⁺ Tn-C: r = 0.49, p < 0.001), and laboratory values like BNP (B⁺ Tn-C: r = 0.45, p < 0.001, C⁺ Tn-C: r = 0.42, p < 0.001). An inverse correlation was observed between Tn-C variants and 6-minute walk distance as a functional parameter (B⁺ Tn-C: r = -0.54, p < 0.001, C⁺ Tn-C: r = -0.43, p < 0.001). In a multivariate analysis, B⁺ Tn-C, but not C⁺ Tn-C, was found to be an independent predictor of pulmonary hypertension. Both fetal Tn-C variants may represent novel biomarkers that are capable of estimating both pulmonary vascular remodeling and right ventricular load. The potential beneficial impact of Tn-C variants for risk stratification in patients with PH needs further investigation.
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Affiliation(s)
- Ilonka Rohm
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Katja Grün
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Linda Marleen Müller
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Michael Fritzenwanger
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Atilla Yilmaz
- Department of Internal Medicine II, Division of Cardiology, Elisabeth Klinikum Schmalkalden, 98574 Schmalkalden, Germany.
| | - Alexander Lauten
- Department of Cardiology, Charité-Universitätsmedizin Berlin, 12203 Berlin, Germany.
| | - Christian Jung
- Department of Internal Medicine, Division of Cardiology, University Hospital Düsseldorf, Heinrich Heine University, 40225 Düsseldorf, Germany.
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
| | - Alexander Berndt
- Institute of Pathology, Jena University Hospital, Friedrich-Schiller-University, 07743 Jena, Germany.
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Jena University Hospital, Friedrich-Schiller-University, 07747 Jena, Germany.
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Schernthaner C, Paar V, Wernly B, Pistulli R, Rohm I, Jung C, Figulla HR, Yilmaz A, Cadamuro J, Haschke-Becher E, Schulze PC, Hoppe UC, Lichtenauer M, Kretzschmar D. Elevated plasma levels of interleukin-16 in patients with acute myocardial infarction. Medicine (Baltimore) 2017; 96:e8396. [PMID: 29095267 PMCID: PMC5682786 DOI: 10.1097/md.0000000000008396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Interleukin (IL)-16, a polypeptide cytokine, plays a crucial role in the inflammatory process, acting as a chemoattractant for peripheral immune cells and has been linked to various inflammatory diseases. However, its role in patients with acute myocardial infarction (AMI) is unclear.We retrospectively analyzed serum levels of IL-16 in blood of patients with (STEMI, n = 45) and without ST-segment elevation myocardial infarction (NSTEMI, n = 42) compared with controls with excluded coronary artery disease (n = 55). Furthermore, correlation analysis with inflammatory cells, C-reactive protein (CRP) levels, dendritic cell precursors (DCPs), and other clinical and biochemical markers was performed.Compared with controls, patients with STEMI and NSTEMI evidenced higher levels of IL-16 in pg/mL (STEMI: 759.38 ± 471.54, NSTEMI: 677.77 ± 438.8, control: 500.45 ± 432.21; P = .002). IL-16 correlated with CRP (r = 0.26, P = .001), leucocytes (r = 0.38, P < .001), NT-proBNP (r = 0.20, P = .02) and hsTnT (r = 0.25, P = .004). Circulating myeloid DCPs, plasmacytoid DCPs, and total DCPs showed a significant inverse correlation to IL-16 levels (r = -0.21, P = .01; r = -0.23, P = .005; r = -0.26, P = .002, respectively).Interleukin-16 might play an important role in the inflammatory process of patients suffering from AMI and correlates with inflammatory cell activation and clinical and biochemical markers. The cytokine IL-16 might upregulate the proinflammatory response and recruitment of inflammatory cells into infarcted myocardium.
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Affiliation(s)
| | - Vera Paar
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Rudin Pistulli
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Friedrich-Schiller-University Jena, Jena, Germany
| | - Ilonka Rohm
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Hans-Reiner Figulla
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Friedrich-Schiller-University Jena, Jena, Germany
| | - Attila Yilmaz
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Friedrich-Schiller-University Jena, Jena, Germany
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Uta C. Hoppe
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | | | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive MedicalCare, Friedrich-Schiller-University Jena, Jena, Germany
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