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Stastny L, Sommerauer F, Poelzl G, Bonaros N, Grimm M, Dumfarth J. Single Coronary Ostium in a Donor Heart: Case Report of Successful Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.627] [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: 04/05/2023] Open
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Verheyen N, Ungericht M, Paar L, Danninger K, Schneiderbauer-Porod S, Duca F, Hoeller V, Ablasser K, Kiblboeck D, Frick M, Bonderman D, Dierneder J, Ebner C, Weber T, Poelzl G. Diagnostic accuracy of amyloid scintigraphy for the histopathological diagnosis of cardiac transthyretin amyloidosis – a retrospective Austrian multicenter study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.903] [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
Previous studies indicated that amyloid scintigraphy in combination with free light chain (FLC) assessment yields an excellent diagnostic accuracy for cardiac transthyretin (ATTR) amyloidosis (1). As a consequence, the diagnosis of ATTR amyloidosis is increasingly made without the actual gold-standard method endomyocardial biopsy (EMB). Whether this leads to misdiagnosis in real-world practice is currently underinvestigated. We aimed to describe the diagnostic accuracy of amyloid scintigraphy in a real world setting.
Methods
Seven tertiary care centers throughout Austria agreed to participate in the study and performed a systematic retrospective medical records search from 2017 to 2020. Patients were included in case of available results of amyloid scintigraphy, FLC assessment and EMB, respectively. Amyloid scintigraphy was performed using a 99m-technetium-labelled tracer. Histological analysis was performed using immunohistochemistry. The number of submitted subjects with complete data per center ranged from 2 to 46. The patient number increased with years, with 15 patients investigated in 2017 and 32 in 2020.
Results
We enrolled 101 patients (21% women) with a mean age of 73±9 years and median NT-proBNP (IQR) of 2694 (1601–5239) pg/ml (Table 1). An abnormal Perugini Score (ie. grade II or III) was present in 57 patients (56%) and FLC assessment was overall indicative of monoclonal protein in 60 patients (59%). Among patients with abnormal Perugini Score, 29 had FLC assessment indicative of monoclonal protein. The most common histopathological diagnoses were ATTR in 60 patients (59%) and cardiac light chain (AL) amyloidosis in 20 patients (20%). One further patient was diagnosed with concomitant AL and ATTR amyloidosis. Further diagnoses included ApoA4 (n=2) and AA amyloidosis (n=1), while cardiac amyloidosis was ruled out in 17 patients (17%).
ATTR was diagnosed in 54 patients with Perugini Score II or III compared with 6 patients with Perugini < II, yielding a sensitivity of abnormal Perugini score for ATTR amyloidosis of 90%. Among patients with abnormal Perugini Score (n=57), ATTR was diagnosed in 55 patients, and AL amyloidosis in 3 (one had concomitant ATTR and AL), yielding a positive predictive value (PPV) of abnormal Perugini Score of 97% (Table 2). Two AL patients had Perugini Score of II and one had Perugini Score of III. When excluding patients with monoclonal gammopathy, the PPV of abnormal Perugini Score was 100%.
Conclusion
Our data confirm a PPV of abnormal amyloid scintigraphy of 100% for cardiac ATTR amyloidosis when monoclonal gammopathy was excluded. mong patients with monoclonal gammopathy, one of ten patients with abnormal scintigraphy had AL amyloidosis as the underlying condition. Our data underscore that tissue biopsy and histopathological analysis should be performed in every patient with suspected amyloidosis and monoclonal gammopathy even in case of Perugini Score II or III.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Verheyen
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - M Ungericht
- Medical University of Innsbruck, Department of Cardiology , Innsbruck , Austria
| | - L Paar
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - K Danninger
- Klinikum Wels-Grieskirchen, Department of Cardiology , Wels , Austria
| | | | - F Duca
- AKH Wien, Department of Cardiology , Vienna , Austria
| | - V Hoeller
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - K Ablasser
- Medical University of Graz, Clinical Department of Cardiology , Graz , Austria
| | - D Kiblboeck
- Kepler University Hospital Linz, Department of Cardiology , Linz , Austria
| | - M Frick
- Academic Teaching Hospital Feldkirch, Department of Internal Medicine , Feldkirch , Austria
| | - D Bonderman
- Klinik Favoriten, Department of Internal Medicine , Vienna , Austria
| | - J Dierneder
- Ordensklinikum Linz Elisabethinen, Department of Nuclear Medicine , Linz , Austria
| | - C Ebner
- Ordensklinikum Linz Elisabethinen, Department of Internal Medicine , Linz , Austria
| | - T Weber
- Klinikum Wels-Grieskirchen, Department of Cardiology , Wels , Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Cardiology , Innsbruck , Austria
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3
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Ungericht M, Groaz V, Messner M, Zaruba MM, Lener D, Stocker E, Kroiss A, Poelzl G. Histological validation of cardiac 99mTc-DPD uptake in patients with cardiac transthyretin amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.933] [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
Cardiac transthyretin (ATTR) amyloidosis is a progressive and fatal disease caused by the extracellular deposition of misfolded ATTR protein in the myocardium. In an era where new therapies are rapidly emerging, development of non-invasive imaging modalities to quantify amyloid burden over time is of utmost importance. Although endomyocardial biopsy (EMB) remains the gold standard in amyloid detection and typing, 99mTc-DPD scintigraphy is a widely available and accurate tool for non-invasive diagnosis of cardiac ATTR amyloidosis. However, it remains to be determined whether the degree of cardiac 99mTc-DPD uptake correlates with the histological amyloid infiltration on EMB – thus, justifying 99mTc-DPD scintigraphy as a disease monitoring tool.
Aim
This single-centre observational study aimed to compare the extent of histologic amyloid burden on EMB with the quantification of cardiac 99mTc-DPD uptake on scintigraphic planar images and SPECT/CT acquisitions in cardiac ATTR amyloidosis.
Methods
26 patients with cardiac ATTR amyloidosis were enrolled. Patients were included in case of (1) EMB-proven ATTR amyloidosis and (2) availability of 99mTc-DPD scintigraphy (reference activity: 550 MBq). Visual interpretation using the Perugini score, quantitative analysis of cardiac 99mTc-DPD uptake by planar whole-body imaging and SPECT/CT using regions of interest (ROI) were performed, and heart to whole-body ratio (H/WB) was measured. Histological amyloid load was quantified as percentage of the analysed myocardial tissue using Sulfated Alcyan Blue staining and the Fiji-ImageJ programme. Pearson's and Spearman's correlation were used for correlation analysis and assessment of agreement.
Results
ATTR patients had a median age of 77 [73–79] years and were predominantly male (85%). An abnormal Perugini score (i.e. 2 or 3) was present in 25 patients (96%), whereas 1 patient was assigned Perugini score 1 (4%). Increased cardiac tracer uptake was documented in all patients, both on 99mTc-DPD planar scintigraphy (ROImean 129±37) and SPECT/CT (ROImean 369±142). Histologic amyloid burden on EMB was 32±19% on average. It significantly correlated with Perugini score (r=0.56 p=0.003), as well as with cardiac 99mTc-DPD uptake (planar: r=0.54 p=0.006, SPECT/CT: r=0.48 p=0.018) and H/WB (r=0.41 p=0.046).
Conclusion
We have demonstrated a good correlation between histological amyloid infiltration on EMB and cardiac 99mTc-DPD uptake on scintigraphic planar images and SPECT/CT scans, illustrating the potential of 99mTc-DPD scintigraphy to yield reliable quantitative information on cardiac amyloid burden. Further investigations with a larger number of patients are needed to confirm our findings and to implement thresholds in cardiac 99mTc-DPD uptake for being used for guiding disease and therapy management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ungericht
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
| | - V Groaz
- Bolzano Central Hospital, Department of Internal Medicine , Bolzano , Italy
| | - M Messner
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
| | - M M Zaruba
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
| | - D Lener
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
| | - E Stocker
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
| | - A Kroiss
- Medical University of Innsbruck, Department of Nuclear Medicine , Innsbruck , Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology , Innsbruck , Austria
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Brunelli L, Poelzl L, Hirsch J, Engler C, Naegele F, Egelseer-Bruendl T, Scheffauer T, Rassel C, Schmit C, Nawabi F, Luckner-Hornischer A, Bauer A, Poelzl G. The effectiveness of a telemedical program for COVID-19 positive high-risk patients in domestic isolation. Eur Heart J 2022. [PMCID: PMC9619603 DOI: 10.1093/eurheartj/ehac544.2802] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background For almost two years, the Covid-19 pandemic has posed an enormous challenge to healthcare systems. Recurrent waves of disease brought the health systems to the limit of their resilience. Purpose The Tele-Covid telemedicine care program was installed in December 2020 to monitor high-risk patients in home isolation. Close monitoring allows early detection of disease deterioration and timely intensification of therapy, ideally avoiding intensive care. Conversely, if the course of the disease is stable, unnecessary hospitalisation can be avoided, thus reducing the burden on the healthcare system. Methods Patient acquisition was performed in collaboration with the local public health service and primary care physicians. Covid-19 positive high-risk patients (age >65 years and/or severe comorbidities) from the greater Innsbruck area were fitted with an ear sensor-based home monitoring system. The ear sensor measures SpO2, respiratory rate, body temperature and heart rate. The monitoring team (25 medical students supervised by 6 physicians) provided continuous monitoring of vital signs (24/7). After validation of the measurements, the collected parameters were evaluated using a specially developed risk score. If a defined risk score was exceeded, the patient was contacted by telephone. The combination of the clinical condition and the risk score determined the further course of action: (a) wait and see, (b) notify the primary care physician, or (c) refer for inpatient admission. The program was active from December 2020 to March 2022. In Summer 2021, the program was temporarily paused due to the epidemiological situation. Results A total of 132 patients (59.8% women) were monitored. The median age was 74 years (IQR: [67.3–80.8]). 91 patients (68.9%) had at least one relevant comorbidity. During the monitoring period, hospitalisation was required in 20 patients (15.2%), 3 of whom were transferred to the intensive care unit. Of the hospitalised patients, 3 (15%) patients died. During the same monitoring period, the Austrian Ministry of Health reported a mortality rate of 20.5% of all hospitalised patients in Austria aged 70–79 years. Subjectively, the patients felt safe due to close monitoring. Conclusion The Tele-Covid program is the successful implementation of a remote monitoring system in a pandemic situation. In the future, a broad application of the program is feasible. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Region of the Tyrol
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Affiliation(s)
- L Brunelli
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - L Poelzl
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - J Hirsch
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - C Engler
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - F Naegele
- Medical University of Innsbruck, Department of Cardiac Surgery , Innsbruck , Austria
| | - T Egelseer-Bruendl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - T Scheffauer
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - C Rassel
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - C Schmit
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - F Nawabi
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | | | - A Bauer
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology and Angiology , Innsbruck , Austria
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Messner M, Ghadge SK, Seiringer H, Maurer T, Staggl S, Zeller T, Mueller C, Wenninger WJ, Geyer SH, Sopper S, Krogsdam A, Poelzl G, Bauer A, Zaruba MM. Smooth muscle cell specific ablation of CXCL12 downregulates endothelial CXCR7 leading to defective coronary arteries and cardiac hypertrophy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3290] [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
Aims
The chemokine CXCL12 plays a fundamental role in cardiovascular development, cell trafficking, and myocardial repair. Human genome-wide association studies even have identified novel loci downstream of the CXCL12 gene locus associated with coronary artery disease and myocardial infarction. Nevertheless, cell and tissue specific effects of CXCL12 are barely understood. Since we detected high expression of CXCL12 in smooth muscle (SM) cells, we generated a SM22-alpha-Cre driven mouse model to ablate CXCL12 (SM-CXCL12−/−).
Methods and results
SM-CXCL12−/− mice revealed high embryonic lethality (50%) with developmental defects, including aberrant topology of coronary arteries. Postnatally, SM-CXCL12−/− mice developed severe cardiac hypertrophy associated with fibrosis, apoptotic cell death, impaired heart function, and severe coronary vascular defects characterized by thinned and dilated arteries. Transcriptome analyses showed specific upregulation of pathways associated with hypertrophic cardiomyopathy, collagen protein network, heart-related proteoglycans, and downregulation of the M2 macrophage modulators. CXCL12 mutants showed endothelial downregulation of the CXCL12 co-receptor CXCR7. Treatment of SM-CXCL12−/− mice with the CXCR7 agonist TC14012 attenuated cardiac hypertrophy associated with increased pERK signaling.
Conclusion
Our data suggest a critical role of smooth muscle-specific CXCL12 in arterial development, vessel maturation, and cardiac hypertrophy. Pharmacological stimulation of CXCR7 might be a promising target to attenuate adverse hypertrophic remodeling.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF-Austria
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Affiliation(s)
- M Messner
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - S K Ghadge
- Medical University of Vienna, Vienna, Austria
| | - H Seiringer
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - T Maurer
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - S Staggl
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - T Zeller
- University Medical Center Hamburg Eppendorf, Molecular Cardiology, Hamburg, Germany
| | - C Mueller
- University Medical Center Hamburg Eppendorf, Molecular Cardiology, Hamburg, Germany
| | | | - S H Geyer
- Medical University of Vienna, Vienna, Austria
| | - S Sopper
- Medical University of Innsbruck, Haematology & Oncology, Innsbruck, Austria
| | - A Krogsdam
- Medical University of Innsbruck, Innsbruck, Austria
| | - G Poelzl
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - A Bauer
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - M M Zaruba
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
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6
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Ungericht M, Groaz V, Messner M, Zaruba MM, Doerler J, Lener D, Stocker EM, Mayr A, Kroiss A, Poelzl G. Correlation between invasive and non-invasive quantification of myocardial amyloid load in cardiac transthyretin amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0855] [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
Cardiac transthyretin (ATTR) amyloidosis is an infiltrative disease caused by the extracellular deposition of misfolded ATTR protein in the myocardium. Early disease recognition and accurate description of cardiac involvement are fundamental, as cardiac ATTR amyloidosis is associated with poor prognosis. Although endomyocardial biopsy (EMB) remains the gold standard in amyloid detection and typing, non-invasive imaging can provide an accurate diagnostic tool. Bone scintigraphy enables early disease detection with high accuracy. However, it remains to be determined whether the degree of cardiac tracer uptake on bone scintigraphy correlates with the extent of histologic amyloid burden in EMB.
Aim
This single center observational study aimed to compare the histological amyloid load in endomyocardial biopsies with the quantification of cardiac tracer uptake on 99mTechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy in cardiac ATTR amyloidosis.
Methods
23 patients with cardiac ATTR amyloidosis were enrolled. Diagnosis was obtained with a combination of invasive and non-invasive methods. Perugini score, mean left ventricular tracer uptake (LV uptake) and left ventricular to corpus sterni uptake ratio (LV/CS ratio) on 99mTc-DPD-scintigraphy were measured, while histological amyloid load was quantified as percentage of the analysed myocardial tissue using Sulfated Alcian Blue staining and the Fiji-ImageJ programme. Bivariate correlation and Pearson correlation coefficient were used to study the relationship between EMB and 99mTc-DPD-scintigraphy findings.
Results
We found a statistically significant correlation between histological amyloid load and Perugini score (r=0.47 p=0.02), as well as between Perugini score and LV/CS ratio (r=0.31 p=0.046). Mean LV tracer uptake showed a trend for correlation with histological amyloid load (r=0.37 p=0.08), without reaching statistical significance.
Conclusion
We found a correlation between the extent of histologic amyloid burden in EMB and the degree of cardiac tracer uptake on 99mTc-DPD-scintigraphy. Our results underline the reliability of 99mTc-DPD-scintigraphy as a surrogate of histological amyloid load in the diagnosis of cardiac ATTR amyloidosis. Possible implications for the assessment of prognosis are subject to future studies with a larger number of patients.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer
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Affiliation(s)
- M Ungericht
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - V Groaz
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - M Messner
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - M.-M Zaruba
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - J Doerler
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - D Lener
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - E.-M Stocker
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
| | - A Mayr
- Medical University of Innsbruck, Department of Radiology, Innsbruck, Austria
| | - A Kroiss
- Medical University of Innsbruck, Department of Nuclear Medicine, Innsbruck, Austria
| | - G Poelzl
- Medical University of Innsbruck, Department of Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria
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7
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Poelzl G, Egelseer-Bruendl T, Pfeifer B, Modre-Osprian R, Welte S, Fetz B, Krestan S, Haselwanter B, Zaruba MM, Doerler J, Rissbacher C, Ammenwerth E, Bauer A. Feasibility and effectiveness of a multidimensional post-discharge disease management programme for heart failure patients in clinical practice: the HerzMobil Tirol programme. Clin Res Cardiol 2021; 111:294-307. [PMID: 34269863 DOI: 10.1007/s00392-021-01912-0] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022]
Abstract
AIMS It remains unclear whether transitional care management outside of a clinical trial setting provides benefits for patients with acute heart failure (AHF) after hospitalization. We evaluated the feasibility and effectiveness of a multidimensional post-discharge disease management programme using a telemedical monitoring system incorporated in a comprehensive network of heart failure nurses, resident physicians, and secondary and tertiary referral centres (HerzMobil Tirol, HMT), METHODS AND RESULTS: The non-randomized study included 508 AHF patients that were managed in HMT (n = 251) or contemporaneously in usual care (UC, n = 257) after discharge from hospital from 2016 to 2019. Groups were retrospectively matched for age and sex. The primary endpoint was time to HF readmission and all-cause mortality within 6 months. Multivariable Cox proportional hazard models were used to assess the effectiveness. The primary endpoint occurred in 48 patients (19.1%) in HMT and 89 (34.6%) in UC. Compared with UC, management by HMT was associated with a 46%-reduction in the primary endpoint (adjusted HR 0.54; 95% CI 0.37-0.77; P < 0.001). Subgroup analyses revealed consistent effectiveness. The composite of recurrent HF hospitalization and death within 6 months per 100 patient-years was 64.2 in HMT and 108.2 in UC (adjusted HR 0.41; 95% CI 0.29-0.55; P < 0.001 with death considered as a competing risk). After 1 year, 25 (10%) patients died in HMT compared with 66 (25.7%) in UC (HR 0.38; 95% CI 0.23-0.61, P < 0.001). CONCLUSIONS A multidimensional post-discharge disease management programme, comprising a telemedical monitoring system incorporated in a comprehensive network of specialized heart failure nurses and resident physicians, is feasible and effective in clinical practice.
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Affiliation(s)
- G Poelzl
- Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - T Egelseer-Bruendl
- Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Pfeifer
- Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria
| | - R Modre-Osprian
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Graz, Austria
| | - S Welte
- Center for Health and Bioresources, AIT Austrian Institute of Technology, Graz, Austria
| | - B Fetz
- Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria
| | - S Krestan
- Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria
| | - B Haselwanter
- Landesinstitut für Integrierte Versorgung Tirol, Innsbruck, Austria
| | - M M Zaruba
- Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - J Doerler
- Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - C Rissbacher
- University Hospital Innsbruck, TirolKliniken, Innsbruck, Austria
| | - E Ammenwerth
- Institute of Medical Informatics, UMIT, Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - A Bauer
- Clinical Division of Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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8
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Ghadge S, Messner M, Seiringer H, Zeller T, Boernigen D, Weninger W, Geyer S, Sopper S, Poelzl G, Tepekoeylue C, Zaruba M. Loss of smooth muscle SDF-1/CXCL12 leads to cardiac hypertrophy and aortic valve stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3630] [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
Stromal cell-derived factor-1 (SDF-1 or CXCL12) and its receptors CXCR4/CXCR7 have prominent role in cardiovascular development and myocardial repair following ischemic injury. Nevertheless, detailed mechanisms of the cell specific role of SDF-1 are poorly understood. Since SDF-1-EGFP lineage tracking revealed high expression of SDF-1 in smooth muscle cells, we aimed to investigate the cell specific role by generating a smooth muscle cell specific SDF-1 (SM-SDF-1−/−) knockout mouse model.
Methods
SDF-1 expression was analyzed utilizing SDF-1-EGFP reporter mice. Conditional SM-SDF-1 KO mice were generated using Tagln-Cre; SDF-1fl/fl mice. Hearts were analysed with histology and high-resolution episcopic microscopy. Cardiac function was assessed utilizing echocardiography. RNAseq, qRT-PCR, flow cytometry and western blotting were performed. Cardiac fibrosis, apoptotic index, cell proliferation, aortic valve calcification were analyzed. SM-SDF-1−/− mice were treated with the CXCR7 agonist TC14012 (10mg/kg/I.P).
Results
SDF-1-EGFP lineage tracking and immunofluorescence revealed high expression of SDF-1 particularly in smooth muscle cells and less frequently in perivascular and endothelial cells. Conditional SM-SDF-1−/− mice showed a high pre- and perinatal mortality (50%). Immunohistochemistry of SM-SDF-1−/− mice revealed severe cardiac hypertrophy, associated with increased cardiac fibrosis, apoptotic cell death, thinned and dilated arteries and significantly decreased M2 like CD11b+/CD206+ cells. Echocardiography confirmed concentric hypertrophy, with decreased stroke volume. As a possible reason for cardiac hypertrophy, SDF-1 mutants exhibited aortic stenosis due to aortic valve thickening associated with downregulation of the SDF-1 co-receptor CXCR7. We further noticed increased plasma levels of SDF-1 in aortic stenosis patients suggesting a cardioprotective role. Transcriptome analyses from KO hearts showed an abnormal extracellular matrix (ECM) remodelling with a specific upregulation of the important valve related proteoglycans Versican, Glycan. Western blot analysis revealed activation of AKT and ERK, whereas CXCR7 expression was significantly downregulated in KO mice. To rescue the phenotype we treated KO mice with the CXCR7 agonist (TC14012) which partially attenuated aortic valve remodelling through activation of the ERK signalling pathway.
Conclusion
Our data suggest that SDF-1 is critically involved in maintaining the homeostasis of the aortic valve by regulating CXCR7 signalling. Pharmacological activation of CXCR7 might be a promising therapeutic target to limit the progression of aortic valve stenosis.
Ghadge_SM-SDF-1−/−
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund, Austrian research promotion agency
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Affiliation(s)
- S.K Ghadge
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - M Messner
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - H Seiringer
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - T Zeller
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - D Boernigen
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - W.J Weninger
- Medical University of Vienna, Division of Anatomy, Vienna, Austria
| | - S.H Geyer
- Medical University of Vienna, Division of Anatomy, Vienna, Austria
| | - S Sopper
- Innsbruck Medical University, Department of Hematology and Oncology, Innsbruck, Austria
| | - G Poelzl
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - C Tepekoeylue
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - M.M Zaruba
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
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Messner M, Ghadge SK, Seiringer H, Zeller T, Boernigen D, Poelzl G, Tepekoeylue C, Zaruba MM. 6090Conditional ablation of SDF-1/CXCL12 in smooth muscle cells leads to severe cardiac hypertrophy and aortic valve stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0129] [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
Stromal cell derived factor-1 (SDF-1) and its corresponding receptors CXCR4 & CXCR7 have been shown to play pivotal roles during cardiovascular development, cardiac repair and tissue homeostasis after ischemia. Stabilization of the SDF-1/CXCR4+ axis has been shown to provide beneficial effects on myocardial repair. Nevertheless, detailed mechanisms of the cell specific role of SDF-1 are poorly understood. Since SDF-1-EGFP lineage tracking revealed high expression of SDF-1 in smooth muscle cells, we aimed to investigate the cell specific role by generating a smooth muscle cell specific SDF-1 (SM-SDF-1 KO) knockout mouse model.
Methods
SDF-1 expression was analyzed utilizing SDF-1-EGFP reporter mice. SM-SDF-1 KO mice were generated using Cre/LoxP technology (SM22a-Cre; SDF-1fl/fl). Morphology was analysed with immunohistochemistry and immunofluorescence. Cardiac function was assessed utilizing echocardiography and millar tip catheterization. Whole transcriptome analysis, qRT-PCR and western blotting were performed. Further, apoptotic index and cell proliferation were quantified by TUNEL assay and PH3 immunostaining, respectively.
Results
SDF-1-EGFP lineage tracking and immunofluorescence analysis revealed high expression of SDF-1 particularly in smooth muscle cells and less frequently in perivascular and endothelial cells. Conditional SM-SDF-1 KO mice showed a high pre- and perinatal mortality (50%). Immunohistochemistry in surviving adult SM-SDF-1 KO mice revealed a severe cardiac hypertrophy phenotype, associated with increased cardiac fibrosis and apoptotic cell death. SM-SDF-1 KO mice revealed very thin and dilated arteries. Echocardiography measurements confimed concentric hypertrophy, and decreased stroke volume reflecting restrictive hypertrophic cardiomyopathy. Immunohistochemistry confirmed pronounced hypertrophy of cardiomyocytes. Additionally, we found evidence for enhanced proliferation markers in cardiomyocytes of SM-SDF-1 KO mice. Transcriptome analyses from KO hearts vs. non-ablated littermates identified over 150 significantly up- and downregulated genes. Western blot analysis for HIF-1α, AKT and ERK cell-signalling pathways were significantly elevated, whereas Rho Kinase signalling was specifically downregulated in SM-SDF-1 KO mice. As a possible reason for the hypertrophic phenotype, SDF-1 mutants exhibited aortic stenosis due to aortic valve thickening associated with upregulation of the extracellular proteoglycan versican anddownregulation of the SDF-1 co-receptor CXCR7. We further noticed increased plasma levels of SDF-1 in aortic stenosis patients suggesting a cardioprotective role.
Conclusion
Our data suggest that smooth muscle cell specific expression of SDF-1 plays a prominent role in cardiovascular development leadingto cardiac hypertrophy in adult animals. Our data further suggest that SDF-1 is involved in maintaining the homeostasis of the aortic valve, possibly by regulating versican.
Acknowledgement/Funding
FWF Austria
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Affiliation(s)
- M Messner
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - S K Ghadge
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - H Seiringer
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - T Zeller
- University Medical Center Hamburg Eppendorf, Molecular Cardiology, Hamburg, Germany
| | - D Boernigen
- University Medical Center Hamburg Eppendorf, Molecular Cardiology, Hamburg, Germany
| | - G Poelzl
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
| | - C Tepekoeylue
- Innsbruck Medical University, Department of Cardiac Surgery, Innsbruck, Austria
| | - M M Zaruba
- Innsbruck Medical University, Cardiology, Innsbruck, Austria
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Ghadge SK, Messner M, Seiringer H, Wimmer A, Zeller T, Boernigen D, Poelzl G, Zaruba MM. P926Smooth muscle cell specific SDF-1/CXCL12 KO mice display severe cardiac hypertrophy and vascular defects. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p926] [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)
- S K Ghadge
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - M Messner
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - H Seiringer
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - A Wimmer
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - T Zeller
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - D Boernigen
- University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany
| | - G Poelzl
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
| | - M M Zaruba
- Innsbruck Medical University, Department of Internal Medicine III, Innsbruck, Austria
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Messner M, Ghadge S, Poelzl G, Franz W, Zaruba M. P1608Upregulation of the aging related LMNA splice variant progerin in cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo‐Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L, Crespo‐Leiro M, Anker S, Coats A, Ferrari R, Filippatos G, Maggioni A, Mebazaa A, Piepoli M, Amir O, Chioncel O, Dahlström U, Jimenez JD, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Otljanska M, Seferovic P, Kostovska ES, Temizhan A, Tousoulis D, Andarala M, Ferreira T, Fiorucci E, Gracia G, Laroche C, Pommier C, Taylor C, Cuculici A, Gaulhofer C, Casado EP, Szymczyk E, Ramani F, Mulak G, Schou IL, Semenka J, Stojkovic J, Mehanna R, Mizarienne V, Auer J, Ablasser K, Fruhwald F, Dolze T, Brandner K, Gstrein S, Poelzl G, Moertl D, Reiter S, Podczeck‐Schweighofer A, Muslibegovic A, Vasilj M, Fazlibegovic E, Cesko M, Zelenika D, Palic B, Pravdic D, Cuk D, Vitlianova K, Katova T, Velikov T, Kurteva T, Gatzov P, Kamenova D, Antova M, Sirakova V, Krejci J, Mikolaskova M, Spinar J, Krupicka J, Malek F, Hegarova M, Lazarova M, Monhart Z, Hassanein M, Sobhy M, El Messiry F, El Shazly A, Elrakshy Y, Youssef A, Moneim A, Noamany M, Reda A, Dayem TA, Farag N, Halawa SI, Hamid MA, Said K, Saleh A, Ebeid H, Hanna R, Aziz R, Louis O, Enen M, Ibrahim B, Nasr G, Elbahry A, Sobhy H, Ashmawy M, Gouda M, Aboleineen W, Bernard Y, Luporsi P, Meneveau N, Pillot M, Morel M, Seronde M, Schiele F, Briand F, Delahaye F, Damy T, Eicher J, Groote P, Fertin M, Lamblin N, Isnard R, Lefol C, Thevenin S, Hagege A, Jondeau G, Logeart D, Le Marcis V, Ly J, Coisne D, Lequeux B, Le Moal V, Mascle S, Lotton P, Behar N, Donal E, Thebault C, Ridard C, Reynaud A, Basquin A, Bauer F, Codjia R, Galinier M, Tourikis P, Stavroula M, Tousoulis D, Stefanadis C, Chrysohoou C, Kotrogiannis I, Matzaraki V, Dimitroula T, Karavidas A, Tsitsinakis G, Kapelios C, Nanas J, Kampouri H, Nana E, Kaldara E, Eugenidou A, Vardas P, Saloustros I, Patrianakos A, Tsaknakis T, Evangelou S, Nikoloulis N, Tziourganou H, Tsaroucha A, Papadopoulou A, Douras A, Polgar L, Merkely B, Kosztin A, Nyolczas N, Nagy AC, Halmosi R, Elber J, Alony I, Shotan A, Fuhrmann AV, Amir O, Romano S, Marcon S, Penco M, Di Mauro M, Lemme E, Carubelli V, Rovetta R, Metra M, Bulgari M, Quinzani F, Lombardi C, Bosi S, Schiavina G, Squeri A, Barbieri A, Di Tano G, Pirelli S, Ferrari R, Fucili A, Passero T, Musio S, Di Biase M, Correale M, Salvemini G, Brognoli S, Zanelli E, Giordano A, Agostoni P, Italiano G, Salvioni E, Copelli S, Modena M, Reggianini L, Valenti C, Olaru A, Bandino S, Deidda M, Mercuro G, Dessalvi CC, Marino P, Di Ruocco M, Sartori C, Piccinino C, Parrinello G, Licata G, Torres D, Giambanco S, Busalacchi S, Arrotti S, Novo S, Inciardi R, Pieri P, Chirco P, Galifi MA, Teresi G, Buccheri D, Minacapelli A, Veniani M, Frisinghelli A, Priori S, Cattaneo S, Opasich C, Gualco A, Pagliaro M, Mancone M, Fedele F, Cinque A, Vellini M, Scarfo I, Romeo F, Ferraiuolo F, Sergi D, Anselmi M, Melandri F, Leci E, Iori E, Bovolo V, Pidello S, Frea S, Bergerone S, Botta M, Canavosio F, Gaita F, Merlo M, Cinquetti M, Sinagra G, Ramani F, Fabris E, Stolfo D, Artico J, Miani D, Fresco C, Daneluzzi C, Proclemer A, Cicoira M, Zanolla L, Marchese G, Torelli F, Vassanelli C, Voronina N, Erglis A, Tamakauskas V, Smalinskas V, Karaliute R, Petraskiene I, Kazakauskaite E, Rumbinaite E, Kavoliuniene A, Vysniauskas V, Brazyte‐Ramanauskiene R, Petraskiene D, Stankala S, Switala P, Juszczyk Z, Sinkiewicz W, Gilewski W, Pietrzak J, Orzel T, Kasztelowicz P, Kardaszewicz P, Lazorko‐Piega M, Gabryel J, Mosakowska K, Bellwon J, Rynkiewicz A, Raczak G, Lewicka E, Dabrowska‐Kugacka A, Bartkowiak R, Sosnowska‐Pasiarska B, Wozakowska‐Kaplon B, Krzeminski A, Zabojszcz M, Mirek‐Bryniarska E, Grzegorzko A, Bury K, Nessler J, Zalewski J, Furman A, Broncel M, Poliwczak A, Bala A, Zycinski P, Rudzinska M, Jankowski L, Kasprzak J, Michalak L, Soska KW, Drozdz J, Huziuk I, Retwinski A, Flis P, Weglarz J, Bodys A, Grajek S, Kaluzna‐Oleksy M, Straburzynska‐Migaj E, Dankowski R, Szymanowska K, Grabia J, Szyszka A, Nowicka A, Samcik M, Wolniewicz L, Baczynska K, Komorowska K, Poprawa I, Komorowska E, Sajnaga D, Zolbach A, Dudzik‐Plocica A, Abdulkarim A, Lauko‐Rachocka A, Kaminski L, Kostka A, Cichy A, Ruszkowski P, Splawski M, Fitas G, Szymczyk A, Serwicka A, Fiega A, Zysko D, Krysiak W, Szabowski S, Skorek E, Pruszczyk P, Bienias P, Ciurzynski M, Welnicki M, Mamcarz A, Folga A, Zielinski T, Rywik T, Leszek P, Sobieszczanska‐Malek M, Piotrowska M, Kozar‐Kaminska K, Komuda K, Wisniewska J, Tarnowska A, Balsam P, Marchel M, Opolski G, Kaplon‐Cieslicka A, Gil R, Mozenska O, Byczkowska K, Gil K, Pawlak A, Michalek A, Krzesinski P, Piotrowicz K, Uzieblo‐Zyczkowska B, Stanczyk A, Skrobowski A, Ponikowski P, Jankowska E, Rozentryt P, Polonski L, Gadula‐Gacek E, Nowalany‐Kozielska E, Kuczaj A, Kalarus Z, Szulik M, Przybylska K, Klys J, Prokop‐Lewicka G, Kleinrok A, Aguiar CT, Ventosa A, Pereira S, Faria R, Chin J, De Jesus I, Santos R, Silva P, Moreno N, Queirós C, Lourenço C, Pereira A, Castro A, Andrade A, Guimaraes TO, Martins S, Placido R, Lima G, Brito D, Francisco A, Cardiga R, Proenca M, Araujo I, Marques F, Fonseca C, Moura B, Leite S, Campelo M, Silva‐Cardoso J, Rodrigues J, Rangel I, Martins E, Correia AS, Peres M, Marta L, Silva GF, Severino D, Durao D, Leao S, Magalhaes P, Moreira I, Cordeiro AF, Ferreira C, Araujo C, Ferreira A, Baptista A, Radoi M, Bicescu G, Vinereanu D, Sinescu C, Macarie C, Popescu R, Daha I, Dan G, Stanescu C, Dan A, Craiu E, Nechita E, Aursulesei V, Christodorescu R, Otasevic P, Seferovic P, Simeunovic D, Ristic A, Celic V, Pavlovic‐Kleut M, Lazic JS, Stojcevski B, Pencic B, Stevanovic A, Andric A, Iric‐Cupic V, Jovic M, Davidovic G, Milanov S, Mitic V, Atanaskovic V, Antic S, Pavlovic M, Stanojevic D, Stoickov V, Ilic S, Ilic MD, Petrovic D, Stojsic S, Kecojevic S, Dodic S, Adic NC, Cankovic M, Stojiljkovic J, Mihajlovic B, Radin A, Radovanovic S, Krotin M, Klabnik A, Goncalvesova E, Pernicky M, Murin J, Kovar F, Kmec J, Semjanova H, Strasek M, Iskra MS, Ravnikar T, Suligoj NC, Komel J, Fras Z, Jug B, Glavic T, Losic R, Bombek M, Krajnc I, Krunic B, Horvat S, Kovac D, Rajtman D, Cencic V, Letonja M, Winkler R, Valentincic M, Melihen‐Bartolic C, Bartolic A, Vrckovnik MP, Kladnik M, Pusnik CS, Marolt A, Klen J, Drnovsek B, Leskovar B, Anguita MF, Page JG, Martinez FS, Andres J, Genis A, Mirabet S, Mendez A, Garcia‐Cosio L, Roig E, Leon V, Gonzalez‐Costello J, Muntane G, Garay A, Alcade‐Martinez V, Fernandez SL, Rivera‐Lopez R, Puga‐Martinez M, Fernandez‐Alvarez M, Serrano‐Martinez J, Crespo‐Leiro M, Grille‐Cancela Z, Marzoa‐Rivas R, Blanco‐Canosa P, Paniagua‐Martin M, Barge‐Caballero E, Cerdena IL, Baldomero IFH, Padron AL, Rosillo SO, Gonzalez‐Gallarza RD, Montanes OS, Manjavacas AI, Conde AC, Araujo A, Soria T, Garcia‐Pavia P, Gomez‐Bueno M, Cobo‐Marcos M, Alonso‐Pulpon L, Cubero JS, Sayago I, Gonzalez‐Segovia A, Briceno A, Subias PE, Hernandez MV, Cano MR, Sanchez MG, Jimenez JD, Garrido‐Lestache EB, Pinilla JG, Villa BG, Sahuquillo A, Marques RB, Calvo FT, Perez‐Martinez M, Gracia‐Rodenas M, Garrido‐Bravo IP, Pastor‐Perez F, Pascual‐Figal D, Molina BD, Orus J, Gonzalo FE, Bertomeu V, Valero R, Martinez‐Abellan R, Quiles J, Rodrigez‐Ortega J, Mateo I, ElAmrani A, Fernandez‐Vivancos C, Valero DB, Almenar‐Bonet L, Sanchez‐Lazaro I, Marques‐Sule E, Facila‐Rubio L, Perez‐Silvestre J, Garcia‐Gonzalez P, Ridocci‐Soriano F, Garcia‐Escriva D, Pellicer‐Cabo A, Fuente Galan L, Diaz JL, Platero AR, Arias J, Blasco‐Peiro T, Julve MS, Sanchez‐Insa E, Aured‐Guallar C, Portoles‐Ocampo A, Melin M, Hägglund E, Stenberg A, Lindahl I, Asserlund B, Olsson L, Dahlström U, Afzelius M, Karlström P, Tengvall L, Wiklund P, Olsson B, Kalayci S, Temizhan A, Cavusoglu Y, Gencer E, Yilmaz M, Gunes H. In‐hospital and 1‐year mortality associated with diabetes in patients with acute heart failure: results from the
ESC‐HFA
Heart Failure Long‐Term Registry. Eur J Heart Fail 2016; 19:54-65. [DOI: 10.1002/ejhf.679] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine University and Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Cécile Laroche
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
| | | | | | | | | | - Roberto Ferrari
- Department of Cardiology and LTTA Centre, University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research E.S: Health Science Foundation Cotignola Italy
| | - Stephan Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology University Medical Center Göttingen (UMG) Göttingen Germany
| | - Andrew Coats
- Monash University Australia and University of Warwick Coventry UK
| | | | - Maria G. Crespo‐Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Complexo Hospitalario Universitario A Coruna CHUAC La Coruna Spain
| | - Alexandre Mebazaa
- Inserm 942, Hôpital Lariboisière Université Paris Diderot Paris France
| | - Massimo F. Piepoli
- Department of Cardiology Polichirurgico Hospital G. da Saliceto Piacenza Italy
| | - Aldo Pietro Maggioni
- EURObservational Research Programme European Society of Cardiology Sophia‐Antipolis France
- ANMCO Research Center Florence Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research E.S. Health Science Foundation Cotignola Italy
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Ammenwerth E, Woess S, Baumgartner C, Fetz B, van der Heidt A, Kastner P, Modre-Osprian R, Welte S, Poelzl G. Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease. Methods Inf Med 2015; 54:388-97. [PMID: 26395147 DOI: 10.3414/me15-02-0002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 02/02/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Cardiovascular diseases are the most frequent cause of death in industrialized countries. Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events. The telemonitoring programme MyCor (Myokardinfarkt und Koronarstent Programm in Tirol) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease (CHD). It includes patient education, self-monitoring with goal-setting and feedback, and regular clinical visits. We evaluated the MyCor telemonitoring programme regarding technical feasibility, user acceptance, patient adherence, change in health status, and change in quality of life. METHODS A 4½-month study was conducted with two telemonitoring phases and one interim phase. The study comprised patient surveys, standardized assessment of quality of life using the MacNew questionnaire at study entry and after 4 and 18 weeks, analysis of adherence to medication and physical activity during the two telemonitoring phases, and analysis of reached goals regarding health conditions during the telemonitoring phases. RESULTS Twenty-five patients (mean age: 63 years) participated in the study. Patients showed a high acceptance of the MyCor telemonitoring programme. Patients reported feelings of self-control, motivation for lifestyle changes, and improved quality of life. Adherence to daily measurements was high with 86% and 77% in the two telemonitoring phases. Adherence to medication was also high with up to 87% and 80%. Pre-defined goals for physical activity were reached in up to 86% and 73% of days, respectively. Quality of life improved from 5.5 at study entry to 6.3 at the end (p< 0.01; MacNew questionnaire). Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed. CONCLUSIONS The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients. Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes. Achieving long-term adherence and verifying clinical outcomes, however, remains an open issue. Our findings will promote further studies, addressing different strategies for an optimal mix of patient education, telemonitoring, feedback, and clinical follow-ups.
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Affiliation(s)
- E Ammenwerth
- Elske Ammenwerth, Institute of Biomedical Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer Zentrum 1, 6060 Hall in Tirol, Austria, E-mail:
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Kliebhan J, Trenkler C, Ess M, Wuertinger P, Griesmacher A, Frick M, Poelzl G. Parathyroid hormone is associated with markers of bone metabolism and disease severity in chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Trenkler C, Kliebhan J, Ess M, Wuertinger P, Griesmacher A, Frick M, Poelzl G. Fibroblast growth factor-23 is associated with disease severity in patients with stable heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Oberndorfer T, Frick M, Doerler J, Hoefer D, Antretter H, Poelzl G. 105: In Vivo Characterization of Plaque Composition in Late Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.111] [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: 11/15/2022] Open
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17
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Antretter H, Hintringer F, Hangler H, Gassner E, Hoefer D, Kilo J, Margreiter J, Laufer G, Poelzl G. Electromechanical synchronization of the heterotopic and native heart by dual atrial stimulation following heart transplantation. Europace 2006; 8:279-82. [PMID: 16627454 DOI: 10.1093/europace/eul006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
After heterotopic heart transplantation, a 59-year-old woman presented with remarkable symptoms of breathlessness and fatigue, despite excellent donor heart function. Asynchrony of donor and native heart provoked haemodynamic instability. Dual atrial pacemaker implantation lead to linkage and synchronization of atrial and ventricular contraction in both the donor and native heart with the faster organ executing the synchronization. Remarkable relief of symptoms has been evident during the long-term follow-up.
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Affiliation(s)
- H Antretter
- Department of Cardiac Surgery, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria, Europe.
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18
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Boeckle E, Boesmueller C, Wiesmayr S, Mark W, Rieger M, Tabarelli D, Graziadei I, Hoefer D, Antretter H, Stelzmueller I, Krugmann J, Zangerle R, Huemer H, Poelzl G, Margreiter R, Bonatti H. Kaposi Sarcoma in Solid Organ Transplant Recipients: A Single Center Report. Transplant Proc 2005; 37:1905-9. [PMID: 15919500 DOI: 10.1016/j.transproceed.2005.03.144] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Human herpes virus (HHV8) is associated with Castleman's disease, primary effusion lymphoma, and the Kaposi's sarcoma (KS). PATIENTS AND METHODS Among 3815 solid organ transplants performed at our center between 1977 and 2003, five patients (0.1%) were identified with KS. RESULTS There were one cardiac, one liver, and three renal allograft recipients of median age of 52 (range 38 to 60) years, three of whom were females. Three patients were of Italian and one of Turkish descent; only one patient was a native Austrian. The onset of the disease was 2.0, 7.5, 7.8, 9.4 months, and 22 years posttransplant. Diagnosis of KS was based in all cases on histology. The heart recipient developed a tumor on the planta pedis; one renal recipient, on both legs. The liver and the two remaining renal recipients presented with disseminated disease. Treatment in all cases consisted of reduction in immunosuppression, together with surgery (n = 1), chemotherapy (n = 1), or irradiation (n = 2). Furthermore, immunosuppression was switched in two cases from Tacrolimus to Sirolimus. In the liver recipient a complete response was achieved; he died, however, due to noncompliance followed by graft failure. One renal recipient died without evidence of recurrent disease from myocardial infarction. The cardiac and two renal recipients are alive between 4 months and 17 years with well-functioning grafts and no evidence of recurrent disease. DISCUSSION HHV8-associated lesions seem to be extremely rare in the Central European transplant population. Nevertheless, awareness of KS is important for early diagnosis and optimal treatment.
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Affiliation(s)
- E Boeckle
- Department of General and Transplant Surgery, University Hospital of Innsbruck, Innsbruck, Austria
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19
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Abstract
The occurrence of neoplastic malignancy due to chronic immunosuppression in heart transplant recipients is a well-known threat. Continuous check-ups are therefore mandatory in this patient group. We describe the case of a 58-year-old man transplanted for dilated cardiomyopathy. During regular diagnostic check-up, a solid mass in the left atrium was discovered on the transesophageal echocardiogram. Since the mass became progressively larger over three years and showed features of neither myxoma nor thrombus, a cardiac sarcoma was suspected. A secondary diagnostic magnetic resonance tomography (MRT) investigation was contraindicated due to an implanted pacemaker. Intraoperatively, the mass proved to be an organized thrombus. Surgery had to be performed without an established accurate diagnosis due to a suspected malignancy in chronically immunosuppressed patients.
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Affiliation(s)
- K M Dunst
- Department of Cardiac Surgery, University Hospital Innsbruck, Leopold-Franzens University Innsbruck, Austria.
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20
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Antretter H, Hoefer D, Hangler H, Poelzl G, Margreiter J, Larcher C, Laufer G, Margreiter R, Bonatti H. Long-term outcome of cytomegalovirus high-risk patients after heart transplantation: comparison between two prophylactic regimes – a single-center experience. Eur Surg 2004. [DOI: 10.1007/s10353-004-0042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Ruttmann E, Mueller LC, Kilo J, Poelzl G, Dunst KM, Bonatti JO, Ulmer H, Laufer G. Risk adjusted clinical outcome in ischemic mitral valve disease: Mitral valve repair versus replacement. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Poelzl G, Gattermeier M, Kratzer H, Zeindlhofer E, Kuehn P. Feasibility and accuracy of transthoracic Doppler echocardiographic estimation of pulmonary capillary wedge pressure applying different methods. Eur J Heart Fail 2001; 3:553-60. [PMID: 11595603 DOI: 10.1016/s1388-9842(01)00166-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pulmonary wedge pressure (PWP) is an established index of cardiac function and an essential component in the management of patients with congestive heart failure and in critically ill patients. AIM To evaluate feasibility and accuracy of non-invasive prediction of PWP by Doppler echocardiography in daily clinical practice. METHODS Agreement was assessed between values predicted by Doppler vs. invasively measured PWP. Forty-five consecutive patients [mean (S.D.) age 62 (10) years] with CAD (44%), DCMP (40%) and without structural heart disease (16%) were studied (EF< or =40% in 58% of the patients). Doppler transmitral and pulmonary venous flow velocity profiles were recorded. For binary and quantitative prediction of PWP, four different methods and five different linear equations, suggested previously in the literature, were evaluated. RESULTS Predictive values to identify elevated PWP were highest for pulmonary venous flow reversal exceeding the duration of forward mitral flow during atrial systole (PPV 1 and NPV 0.96). Likewise, agreement with measured PWP was highest for equations comprising both transmitral and pulmonary venous flow variables (relative mean difference 0.11, S.D.+/-4.01 mmHg for the most accurate equation). Feasibility was slightly, but not statistically, lower when pulmonary venous flow was considered vs. transmitral flow parameters alone for binary prediction (87 vs. 93%) as well as for quantitative assessment (82 vs. 93%). CONCLUSION Semiquantitative prediction of elevated PWP by Doppler echocardiography is feasible as well as accurate in daily clinical practice. However, accuracy of numeric estimates is limited. Hence, invasive measurement of PWP is still necessary in certain clinical settings.
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Affiliation(s)
- G Poelzl
- Department of Internal Medicine, Division of Cardiology, University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria.
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23
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Poelzl G, Kasai Y, Mochizuki N, Shaul PW, Brown M, Mendelsohn ME. Specific association of estrogen receptor beta with the cell cycle spindle assembly checkpoint protein, MAD2. Proc Natl Acad Sci U S A 2000; 97:2836-9. [PMID: 10706629 PMCID: PMC16016 DOI: 10.1073/pnas.050580997] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Estrogen receptors (ERs) are ligand-activated transcription factors that regulate gene expression and cell growth. Two ERs now have been identified: ERalpha and the more recently discovered ERbeta. The physiological function of ERbeta remains unclear, but evidence from vascular injury studies and from ERbeta knockout mice suggests that ERbeta may be involved in the regulation of cellular proliferation. Here we show a direct and specific interaction between ERbeta and the cell cycle mitotic spindle assembly checkpoint protein, MAD2 (mitosis arrest-deficient 2). The ERbeta-MAD2 interaction was identified by screening of a yeast two-hybrid system vascular endothelial cell library with ERbeta and confirmed with glutathione S-transferase-fusion protein interaction studies. In contrast, ERalpha did not interact with MAD2 in either the two-hybrid system or in the protein-protein interaction experiments. Amino acids 173-208 in the hinge region of ERbeta were sufficient to mediate the interaction with MAD2 in the two-hybrid system and in glutathione S-transferase-fusion protein studies. These data identify a link between ERbeta and MAD2 of potential importance to regulation of the cell cycle and support a function of ERbeta distinct from the established role of ERs as transcription factors.
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Affiliation(s)
- G Poelzl
- Molecular Cardiology Research Institute, Cardiology Division, Department of Medicine, Tufts University School of Medicine and New England Medical Center, Boston, MA 02111, USA
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24
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Reisinger J, Gatterer E, Heinze G, Wiesinger K, Zeindlhofer E, Gattermeier M, Poelzl G, Kratzer H, Ebner A, Hohenwallner W, Lenz K, Slany J, Kuhn P. Prospective comparison of flecainide versus sotalol for immediate cardioversion of atrial fibrillation. Am J Cardiol 1998; 81:1450-4. [PMID: 9645896 DOI: 10.1016/s0002-9149(98)00223-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study sought to compare the efficacy and safety of intravenous flecainide and sotalol for immediate cardioversion of atrial fibrillation. We performed a prospective, randomized, single-blind, multicenter trial, including 106 hemodynamically stable patients with atrial fibrillation, stratified according to duration of the arrhythmia. Exclusion criteria included severely reduced left ventricular systolic function, recent antiarrhythmic therapy, and hypokalemia. Patients were randomly assigned to receive either intravenous flecainide or intravenous sotalol. Trial medication was given at a dose of 1.5 mg/kg body weight (maximum 150 mg). Overall, 28 of 54 patients (52%) given flecainide and 12 of 52 patients (23%) given sotalol converted to sinus rhythm during the first 2 hours after start of the infusion (p = 0.003). Multivariate analysis confirmed that treatment allocation to flecainide, an arrhythmia duration of < or = 24 hours, higher plasma magnesium level at baseline, higher age for men, and lower age for women independently increases the probability of conversion. The frequency of adverse effects was not significantly different in the 2 treatment groups.
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Affiliation(s)
- J Reisinger
- Department of Internal Medicine, Krankenhaus Barmherzige Schwestern, Linz, Austria
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