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Memenga F, Rybczynski M, Magnussen C, Goßling A, Kondziella C, Becher N, Becher PM, Bernadyn J, Berisha F, Bremer W, Sinning C, Blankenberg S, Kirchhof P, Knappe D. Heart Rate Reduction and Outcomes in Heart Failure Outpatients. J Clin Med 2023; 12:6779. [PMID: 37959246 PMCID: PMC10648474 DOI: 10.3390/jcm12216779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Aim. Pharmacologic reduction in heart rate with beta-blockers (BB) or ivabradine is associated with improved survival in heart failure (HF) with sinus rhythm. We analyzed the association of different heart rate-reducing drug treatments on outcomes in HF outpatients. Methods. Consecutive patients with HF in sinus rhythm referred to a specialized tertiary service were prospectively enrolled from August 2015 until March 2018. Clinical characteristics were assessed at baseline. We performed Cox regression analyses to examine the effect of the resting heart rate and different heart rate-reducing drug regimens on all-cause mortality and a composite endpoint of "all-cause mortality or heart transplantation" over a mean follow-up of 3.1 years. Results. Of the 278 patients included, 213 (76.6%) were male, the median age was 57.0 years (IQR 49.0-66.1), and 185 (73.7%) had an ejection fraction <40%. Most patients received BB in submaximal [n = 118] or maximum dose [n = 136]. Patients on BB in maximum dose plus ivabradine [n = 24] were younger (53.0 vs. 58.0 years) and had a lower EF (25 vs. 31%). Higher resting heart rate was associated with an increased risk of death or transplantation (HR 1.03 [1.01, 1.06], p = 0.0072), even after adjusting for age and sex. There were no differences between the groups concerning all-cause mortality or the composite endpoint. Conclusion. Our prospective study confirms the association between low heart rate and survival in HF patients receiving various heart rate-reducing medications. We could not identify a specific effect of either regimen.
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Affiliation(s)
- Felix Memenga
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Meike Rybczynski
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Alina Goßling
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Christoph Kondziella
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Nina Becher
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Peter Moritz Becher
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Julia Bernadyn
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Filip Berisha
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Wiebke Bremer
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
| | - Christoph Sinning
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B152TT, UK
| | - Dorit Knappe
- Department of Cardiology, University Heart & Vascular Center Hamburg, 20246 Hamburg, Germany; (M.R.); (C.M.); (A.G.); (C.K.); (N.B.); (P.M.B.); (J.B.); (F.B.); (S.B.); (P.K.); (D.K.)
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Kondziella C, Fluschnik N, Weimann J, Schrage B, Becher PM, Memenga F, Bernhardt AM, Blankenberg S, Reichenspurner H, Kirchhof P, Schnabel RB, Magnussen C. Sex differences in clinical characteristics and outcomes in patients undergoing heart transplantation. ESC Heart Fail 2023. [PMID: 37339937 PMCID: PMC10375178 DOI: 10.1002/ehf2.14413] [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: 01/07/2023] [Revised: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/22/2023] Open
Abstract
AIMS Whether sex affects selection for and outcomes after heart transplantation (HTx) remains unclear. We aimed to show sex differences in pre-transplant characteristics and outcomes after HTx. METHODS AND RESULTS From 1995 to 2019, 49 200 HTx recipients were prospectively enrolled in the Organ Procurement and Transplantation Network. Logistic regression models were used to evaluate clinical characteristics by sex. Multivariable Cox regression models were fitted to assess sex differences in all-cause mortality, cardiovascular mortality, graft failure, cardiac allograft vasculopathy (CAV), and malignancy. In 49 200 patients (median age 55 years, interquartile range 46-62; 24.6% women), 49 732 events occurred during a median follow-up of 8.1 years. Men were older than women, had more often ischaemic cardiomyopathy (odds ratio [OR] 3.26, 95% confidence interval [CI] 3.11-3.42; P < 0.001), and a higher burden of cardiovascular risk factors, whereas women had less malignancies (OR 0.47, CI 0.44-0.51; P < 0.001). Men were more often treated in intensive care unit (OR 1.24, CI 1.12-1.37; P < 0.001) with a higher need for ventilatory (OR 1.24, CI 1.17-1.32; P < 0.001) or VAD (OR 1.53, CI 1.45-1.63; P < 0.001) support. After multivariable adjustment, men had a higher risk for CAV (hazard ratio [HR] 1.21, CI 1.13-1.29; P < 0.001) and malignancy (HR 1.80, CI 1.62-2.00; P < 0.001). There were no differences in all-cause mortality, cardiovascular mortality, and graft failure between sexes. CONCLUSIONS In this US transplant registry, men and women differed in pre-transplant characteristics. Male sex was independently associated with incident CAV and malignancy even after multivariable adjustment. Our results underline the need for better personalized post-HTx management and care.
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Affiliation(s)
- Christoph Kondziella
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Felix Memenga
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Hermann Reichenspurner
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
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Memenga F, Kueppers ST, Borof K, Kirchhof P, Duengelhoef PM, Barten MJ, Lütgehetmann M, Berisha F, Fluschnik N, Becher PM, Kondziella C, Bernhardt AM, Reichenspurner H, Blankenberg S, Magnussen C, Rybczynski M. SARS-CoV-2 Vaccination-Induced Immunogenicity in Heart Transplant Recipients. Transpl Int 2023; 36:10883. [PMID: 36814697 PMCID: PMC9939437 DOI: 10.3389/ti.2023.10883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/19/2023] [Indexed: 02/07/2023]
Abstract
Among heart transplant (HT) recipients, a reduced immunological response to SARS-CoV-2 vaccination has been reported. We aimed to assess the humoral and T-cell response to SARS-CoV-2 vaccination in HT recipients to understand determinants of immunogenicity. HT recipients were prospectively enrolled from January 2021 until March 2022. Anti-SARS-CoV-2-Spike IgG levels were quantified after two and three doses of a SARS-CoV-2 vaccine (BNT162b2, mRNA1273, or AZD1222). Spike-specific T-cell responses were assessed using flow cytometry. Ninety-one patients were included in the study (69% male, median age 55 years, median time from HT to first vaccination 6.1 years). Seroconversion rates were 34% after two and 63% after three doses. Older patient age (p = 0.003) and shorter time since HT (p = 0.001) were associated with lower antibody concentrations after three vaccinations. There were no associations between vaccine types or immunosuppressive regimens and humoral response, except for prednisolone, which was predictive of a reduced response after two (p = 0.001), but not after three doses (p = 0.434). A T-cell response was observed in 50% after two and in 74% after three doses. Despite three vaccine doses, a large proportion of HT recipients exhibits a reduced immune response. Additional strategies are desirable to improve vaccine immunogenicity in this vulnerable group of patients.
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Affiliation(s)
- Felix Memenga
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Thomas Kueppers
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Katrin Borof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Markus Johannes Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg/Lübeck/Borstel/Riems, Hamburg, Germany
| | - Filip Berisha
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christoph Kondziella
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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