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Götze M, Ebelt H. Erratum zu: Prävalenz, Inzidenz und prädiktive Faktoren von Vorhofflimmern (VHF) bei geriatrischen Patienten – eine prospektive Beobachtungsstudie. Z Gerontol Geriatr 2024; 57:126. [PMID: 37233778 DOI: 10.1007/s00391-023-02204-0] [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: 05/29/2023]
Affiliation(s)
- Markus Götze
- Fachklinik für Geriatrie, St. Elisabeth Krankenhaus, Bahnhofstraße 19, 99976, Lengenfeld unterm Stein, Deutschland.
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus "St. Johann Nepomuk", Erfurt, Deutschland
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Götze M, Ebelt H. [Prevalence, incidence and predictive factors of atrial fibrillation in geriatric patients-A prospective observational study]. Z Gerontol Geriatr 2024; 57:120-125. [PMID: 37084091 DOI: 10.1007/s00391-023-02177-0] [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: 11/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND QUESTION Atrial fibrillation (AF) is the most common cardiac arrhythmia in the total population, and previous studies have already reported the prevalence of AF; however, AF is of special importance in geriatric patients due to demographic changes. Therefore, the aim of this study was to determine how many geriatric patients have a history of AF (prevalence) and how often AF can be newly diagnosed during an inpatient stay (incidence). Additionally, predictive factors for the incidence of AF in geriatric patients are described. STUDY PARTICIPANTS AND METHODS In a monocentric prospective observational study from April 2021 to April 2022, all admissions to a geriatric clinic were included in the study. Data collection was carried out using the patients' digital files. As part of the admission routine, all patients had a 12-lead ECG recorded. Additionally, a 24‑h long-term electrocardiogram (LTECG) was used in a subset of patients depending on the clinical need. RESULTS A total of 1914 participants were included in the study. At the time of admission, 715 (37.4%) patients had a known history of AF. Of the remaining 1199 patients without a history of AF, AF could be newly detected in 73 cases (6.1%). Multivariate regression analysis identified age > 80 years (odds ratio, OR: 2.3) and heart failure (OR: 3.5) as significant risk factors for the incidence of AF (each p < 0.05). CONCLUSION Despite an already high prevalence, AF was newly diagnosed in 6% of patients during the stay at a geriatric clinic. Heart failure and age above 80 years were significantly associated with the presence of AF. This should be taken into account when screening for AF in this patient population.
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Affiliation(s)
- Markus Götze
- Fachklinik für Geriatrie, St. Elisabeth Krankenhaus, Bahnhofstraße 19, 99976, Lengenfeld unterm Stein, Deutschland.
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus "St. Johann Nepomuk", Erfurt, Deutschland
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Eppinger S, Piayda K, Galea R, Sandri M, Maarse M, Güner A, Karabay CY, Pershad A, Ding WY, Aminian A, Akin I, Davtyan KV, Chugunov IA, Marijon E, Rosseel L, Schmidt TR, Amabile N, Korsholm K, Lund J, Guerios E, Amat-Santos IJ, Boccuzzi G, Ellis CR, Sabbag A, Ebelt H, Clapp B, Assa HV, Levi A, Ledwoch J, Lehmann S, Lee OH, Mark G, Schell W, Della Rocca DG, Natale A, de Backer O, Kefer J, Esteban PP, Abelson M, Ram P, Moceri P, Galache Osuna JG, Alvarez XM, Cruz-Gonzalez I, de Potter T, Ghassan M, Osadchiy A, Chen W, Goyal SK, Giannini F, Rivero-Ayerza M, Afzal S, Jung C, Skurk C, Langel M, Spence M, Merkulov E, Lempereur M, Shin SY, Mesnier J, McKinney HL, Schuler BT, Armero S, Gheorghe L, Ancona MBM, Santos L, Mansourati J, Nombela-Franco L, Nappi F, Kühne M, Gaspardone A, van der Pals J, Montorfano M, Fernández-Armenta J, Harvey JE, Rodés-Cabau J, Klein N, Sabir SA, Kim JS, Cook S, Kornowski R, Saraste A, Nielsen-Kudsk JE, Gupta D, Boersma L, Räber L, Sievert K, Sievert H, Bertog S. Embolization of percutaneous left atrial appendage closure devices: timing, management and clinical outcomes. Cardiovasc Revasc Med 2024:S1553-8389(24)00067-8. [PMID: 38448258 DOI: 10.1016/j.carrev.2024.02.014] [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: 09/11/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Left atrial appendage (LAA) occluder embolization is an infrequent but serious complication. OBJECTIVES We aim to describe timing, management and clinical outcomes of device embolization in a multi-center registry. METHODS Patient characteristics, imaging findings and procedure and follow-up data were collected retrospectively. Device embolizations were categorized according to 1) timing 2) management and 3) clinical outcomes. RESULTS Sixty-seven centers contributed data. Device embolization occurred in 108 patients. In 70.4 % of cases, it happened within the first 24 h of the procedure. The device was purposefully left in the LA and the aorta in two (1.9 %) patients, an initial percutaneous retrieval was attempted in 81 (75.0 %) and surgery without prior percutaneous retrieval attempt was performed in 23 (21.3 %) patients. Two patients died before a retrieval attempt could be made. In 28/81 (34.6 %) patients with an initial percutaneous retrieval attempt a second, additional attempt was performed, which was associated with a high mortality (death in patients with one attempt: 2.9 % vs. second attempt: 21.4 %, p < 0.001). The primary outcome (bailout surgery, cardiogenic shock, stroke, TIA, and/or death) occurred in 47 (43.5 %) patients. Other major complications related to device embolization occurred in 21 (19.4 %) patients. CONCLUSIONS The majority of device embolizations after LAA closure occurs early. A percutaneous approach is often the preferred method for a first rescue attempt. Major adverse event rates, including death, are high particularly if the first retrieval attempt was unsuccessful. CONDENSED ABSTRACT This dedicated multicenter registry examined timing, management, and clinical outcome of device embolization. Early embolization (70.4 %) was most frequent. As a first rescue attempt, percutaneous retrieval was preferred in 75.0 %, followed by surgical removal (21.3 %). In patients with a second retrieval attempt a higher mortality (death first attempt: 2.9 % vs. death second attempt: 24.1 %, p < 0.001) was observed. Mortality (10.2 %) and the major complication rate after device embolization were high.
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Affiliation(s)
| | - Kerstin Piayda
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany; Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | - Roberto Galea
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | | | - Moniek Maarse
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Hospital, Istanbul, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul, Turkey
| | - Ashish Pershad
- Department of Cardiology, Banner Health, Phoenix, AZ, USA
| | - Wern Y Ding
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Adel Aminian
- Department of Cardiology, Centre hospitalier universitaire de Charleroi, Charleroi, Belgium
| | - Ibrahim Akin
- Department of Cardiology, Universitätsmedizin Mannheim, Germany
| | - Karapet V Davtyan
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Ivan A Chugunov
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Eloi Marijon
- Department of Cardiology, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | | | | | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Juha Lund
- Heart Center, Turku University Hospital, Turku, Finland
| | - Enio Guerios
- Department of Cardiology, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - Giacomo Boccuzzi
- Department of Cardiology, Ospedale san Giovanni Bosco, Torino, Italy
| | | | - Avi Sabbag
- Department of Cardiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Henning Ebelt
- Department of Cardiology, Katholisches Krankenhaus St. Nepomuk, Erfurt, Germany
| | - Brian Clapp
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - Sonja Lehmann
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Oh-Hyun Lee
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - George Mark
- The Heart House/Cooper University Camden, NJ, USA
| | - Wendy Schell
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | | | - Andrea Natale
- Department of Cardiology, St David's Medical Center, Austin, TX, USA
| | - Ole de Backer
- Department of Cardiology, Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Joelle Kefer
- Department of Cardiology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pablo P Esteban
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Mark Abelson
- Department of interventional Cardiology, Mediclinic Vergelegen, Cape Town, South Africa
| | - Pradhum Ram
- Department of Cardiology, Emory University, Atlanta, GA, USA
| | - Pamela Moceri
- Department of Cardiology, Hopital Pasteur 1, Nice, France
| | | | | | | | | | - Moubarak Ghassan
- Department of Cardiology, Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Andrey Osadchiy
- Department of Cardiology, City Hospital #40, St. Petersburg, Russia
| | - Weita Chen
- Department of Cardiology, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | | | | | | | - Shazia Afzal
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Heinrich-Heine University, University Hospital, Duesseldorf, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Langel
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Mark Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Trust, Belfast, UK
| | | | | | - Seung Y Shin
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Brian T Schuler
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | | | - Livia Gheorghe
- Department of Cardiology, Puerta del Mar University Hospital, Cadiz, Spain
| | - Marco B M Ancona
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | | | | | | | - Michael Kühne
- Department of Cardiology, University Hospital Basel, Switzerland
| | | | - Jesper van der Pals
- Department of Cardiology, Lund University and Skane University Hospital, Lund, Sweden
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - James E Harvey
- Department of Cardiology, WellSpan York Hospital, York, PA, USA
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Norbert Klein
- Department of Cardiology, Klinikum St. Georg, Leipzig, Germany
| | - Sajjad A Sabir
- Department of Cardiology, Cooper University Hospital, NJ, USA
| | - Jung-Sun Kim
- Department of Cardiology, Yonsei University Hospital, Yongin, Republic of Korea
| | - Stephane Cook
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Antti Saraste
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Lucas Boersma
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Lorenz Räber
- Department of Cardiology, Universitätsspital Bern, Bern, Switzerland
| | - Kolja Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany.
| | - Stefan Bertog
- CardioVascular Center (CVC) Frankfurt, Frankfurt, Germany
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Haertel F, Nuding S, Reisberg D, Peters M, Werdan K, Schulze PC, Ebelt H. The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS). J Clin Med 2024; 13:1039. [PMID: 38398351 PMCID: PMC10888702 DOI: 10.3390/jcm13041039] [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: 11/14/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is common in intensive care units (ICUs) and is associated with high mortality. Although there have been multiple investigations into a multitude of organ dysfunctions, little is known about the role of liver dysfunction. In addition, clinical and laboratory findings of liver dysfunction may occur with a significant delay. Therefore, the aim of this study was to investigate whether a liver function test, based on indocyanine green (ICG)-clearance, contains prognostic information for patients in the early phase of MODS. METHODS The data of this analysis were based on the MODIFY study, which included 70 critically ill patients of a tertiary medical ICU in the early phase of MODS (≤24 h after diagnosis by an APACHE II score ≥ 20 and a sinus rhythm ≥ 90 beats per minute, with the following subgroups: cardiogenic (cMODS) and septic MODS (sMODS)) over a period of 18 months. ICG clearance was characterized by plasma disappearance rate = PDR (%/min); it was measured non-invasively by using the LiMON system (PULSION Medical Systems, Feldkirchen, Germany). The PDR was determined on the day of study inclusion (baseline) and after 96 h. The primary endpoint of this analysis was 28-day mortality. RESULTS ICG clearance was measured in 44 patients of the MODIFY trial cohort, of which 9 patients had cMODS (20%) and 35 patients had sMODS (80%). Mean age: 59.7 ± 16.5 years; 31 patients were men; mean APACHE II score: 33.6 ± 6.3; 28-day mortality was 47.7%. Liver function was reduced in the total cohort as measured by a PDR of 13.4 ± 6.3%/min At baseline, there were no relevant differences between survivors and non-survivors regarding ICG clearance (PDR: 14.6 ± 6.1%/min vs. 12.1 ± 6.5%/min; p = 0.21). However, survivors showed better liver function than non-survivors after 96 h (PDR: 21.9 ± 6.3%/min vs. 9.2 ± 6.3%/min, p < 0.05). Consistent with these findings, survivors but not non-survivors show a significant improvement in the PDR (7.3 ± 6.3%/min vs. -2.9 ± 2.6%/min; p < 0.01) within 96 h. In accordance, receiver-operating characteristic curves (ROCs) at 96 h but not at baseline show a link between the PDR and 28-day mortality (PDR at 96 h: AUC: 0.87, 95% CI: 0.76-0.98; p < 0.01. CONCLUSIONS In our study, we found that ICG clearance at baseline did not provide prognostic information in patients in the early stages of MODS despite being reduced in the total cohort. However, improvement of ICG clearance 96 h after ICU admission is associated with reduced 28-day mortality.
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Affiliation(s)
- Franz Haertel
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sebastian Nuding
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
- Department of Internal Medicine II, Cardiology, Hospital St. Elisabeth and St. Barbara Halle (Saale), Mauerstraße 5, 06110 Halle (Saale), Germany
| | - Diana Reisberg
- Department of pediatrics, Ameos Hospital Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Department of Internal Medicine, Helios Hospital Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Karl Werdan
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Cardiology, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Henning Ebelt
- Department of Internal Medicine III, Cardiology University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle, Germany
- Department of Internal Medicine II, Cardiology, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Goetze M, Knauf T, Ebelt H. Relationship between Pharmacological Treatment Strategy and Cognitive Function in Geriatric Patients with Atrial Fibrillation. J Clin Med 2023; 12:7724. [PMID: 38137793 PMCID: PMC10743707 DOI: 10.3390/jcm12247724] [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: 10/08/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Background and question: Atrial fibrillation (AF) is the most common cardiac arrhythmia in the total population. The aim of this study is to determine how geriatric patients with AF are treated in terms of rhythm or rate control and whether a relationship between the type of treatment and Mini Mental Status (MMS) can be identified. METHODS In this monocentric, prospective, observational study, data including chronic medication as well as demographic parameters were collected from all patients in a geriatric department between April 2021 and April 2022. A 12-lead ECG as well as the Mini Mental Status were recorded for all patients as part of the admission routine, and a 24 h ECG was performed in selected patients on the basis of clinical indication. RESULTS At baseline, 715 out of 1914 patients (37.4%) had a known history of AF. Of these patients, 43 patients (6%) were on rhythm control therapy (RHY) and 672 (94%) were on rate control therapy (RATE). No difference in respect to MMS could be detected between RHY and RATE. However, linear regression analyses showed that age, HASBLED score, creatinine serum level, and an existing antiplatelet medication were associated with a negative influence on MMS, whereas oral anticoagulation (OAC) was associated with improved MMS, respectively (p < 0.05 for all). CONCLUSION The vast majority of geriatric patients with AF are treated with a rate control strategy. Oral anticoagulation is associated with better results in MMS, whereas patients who are treated with antiplatelet medication show worse results in MMS instead.
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Affiliation(s)
- Markus Goetze
- Department for Geriatrics, St. Elisabeth Hospital, Bahnhofstrasse 19, 99976 Lengenfeld unterm Stein, Germany;
| | - Tim Knauf
- Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
| | - Henning Ebelt
- Department of Medicine II, Catholic Hospital “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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Supthut W, Nuding S, Wienke A, Müller-Werdan U, Werdan K, Ebelt H. [Relationship between cardiac output, heart rate and microcirculation in patients with multiorgan dysfunction syndrome]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01086-9. [PMID: 38038767 DOI: 10.1007/s00063-023-01086-9] [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: 06/18/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is one of the main causes of death in intensive care units. There is evidence that microcirculation in sepsis and coronary shock is regulated separately from hemodynamics. This study investigates the relationship between heart rate (HR), cardiac output (CO) and microcirculation in patients with MODS. METHODS This is a partial analysis of the "MODIFY study" (Reducing Elevated Heart Rate in Patients With Multiple Organ Dysfunction Syndrome [MODS] by Ivabradine). During the period 05/2010-09/2011, the microcirculation of 46 patients with septic and coronary MODS was measured using the sidestream dark field technique on the day of inclusion and 96 h later. Patients were randomized into a control and ivabradine treatment group. RESULTS Overall, there is a relevant improvement in microcirculation over time small perfused vessels, SPV [%] on day 0, d0:56.5 ± 34.2/d4:73.2 ± 22.1 (p = 0.03); perfused vessel density, PVDsmall [1/mm2] d0:7.5 ± 5.0/d4:9.8 ± 3.4 (p = 0.04); proportion of perfused vessels, PPVsmall [%] d0:51.6 ± 31.6/d4:66.7 ± 21.8 (p = 0.04); microcirculatory flow index, MFI d0:1.7 ± 1.0/d4:2.2 ± 0.7 (p = 0.05). Administration of ivabradine shows no effect. In patients with coronary MODS, there is a relevant correlation between microcirculatory parameters and cardiac output (SPV [%]: r = 0.98, p = 0.004). Patients with coronary MODS show better microcirculation values at high heart rates (> 100 bpm), while patients with septic MODS show an opposite relationship. CONCLUSION The results indicate that in critically ill patients, depending on the genesis of the MODS, there are different relationships between HF or CO values, on the one hand, and the parameters of the microcirculation, on the other.
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Affiliation(s)
- Wiebke Supthut
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - Sebastian Nuding
- Medizinische Klinik II, Krankenhaus St. Elisabeth und St. Barbara, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin und EGZB, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus St. Johann Nepomuk, Erfurt, Deutschland
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Offhaus A, Linss L, Roehl P, Sakriss C, Pertschy U, Schwenzky A, Ebelt H. CT-Based Preplanning Allows Abstaining from Intraprocedural TEE during Interventional Closure of the LAA in Patients with Atrial Fibrillation. J Clin Med 2023; 12:4019. [PMID: 37373712 DOI: 10.3390/jcm12124019] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine whether the application of a CT-based preplanning algorithm might allow abstaining from TEE during LAAC. BACKGROUND LAAC is an established treatment alternative for patients with atrial fibrillation. Today, most LAAC procedures are guided by TEE, which, however, leads to the need for patient sedation and might even cause direct harm to the patient. CT-based preplanning of the LAAC procedure, in combination with technical improvements in device design and interventional experience, might allow abstaining from TEE. METHODS Fluoro-FLX is a prospective single-center study to evaluate how often TEE leads to a procedural change during interventional LAAC if a dedicated CT planning algorithm is applied. The study hypothesis is that under these circumstances, a sole fluoroscopy-guided LAAC is an alternative to a TEE-guided approach. All procedures are preplanned by cardiac CT and, finally, guided by fluoroscopy only, while TEE is carried out in the background during the intervention for safety reasons. RESULTS In none of the 31 consecutive patients did TEE lead to a change in the preplanned fluoroscopy-guided LAAC (success ratio: 1.00; CI: 0.94-1.00), thereby meeting the primary endpoint (performance goal: 0.90). There were no procedure-related adverse cardiac or cerebrovascular events (no pericardial effusion, TIA, stroke, systemic embolism, device embolism, death). CONCLUSIONS Our data suggest that it is feasible to perform LAAC under sole fluoroscopic guidance if preplanning is performed using cardiac CT. This might be worth considering, especially in patients who are at high risk for TEE-related adverse events.
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Affiliation(s)
- Alexandra Offhaus
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Luisa Linss
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Peter Roehl
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Charlotte Sakriss
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Uta Pertschy
- Department for Radiology and Imaging, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
| | - Henning Ebelt
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, Germany
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Haertel F, Babst J, Bruening C, Bogoviku J, Otto S, Fritzenwanger M, Gecks T, Ebelt H, Moebius-Winkler S, Schulze PC, Pfeifer R. Effect of Hemolysis Regarding the Characterization and Prognostic Relevance of Neuron Specific Enolase (NSE) after Cardiopulmonary Resuscitation with Extracorporeal Circulation (eCPR). J Clin Med 2023; 12:jcm12083015. [PMID: 37109353 PMCID: PMC10146981 DOI: 10.3390/jcm12083015] [Citation(s) in RCA: 3] [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: 02/24/2023] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. METHODS We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. RESULTS 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3-5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1-2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1-2 compared to the group with an unfavorable outcome of CPC 3-5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the prediction of an unfavorable outcome of CPC 3-5. The respective adjusted AUCs of the combined predictive probabilities were significant (48 h: 0.79 // 72 h: 0.76 // 96 h: 0.72; p ≤ 0.05). CONCLUSIONS Our study confirms NSE as a reliable prognostic marker for poor neurological outcomes in resuscitated patients receiving VA-ECMO therapy. Furthermore, our results demonstrate that potential hemolysis during VA-ECMO does not significantly impact NSE's prognostic value. These findings are crucial for clinical decision making and prognostic assessment in this patient population.
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Affiliation(s)
- Franz Haertel
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Josephine Babst
- 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
| | - Jurgen Bogoviku
- 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
| | - Michael Fritzenwanger
- 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
| | - Henning Ebelt
- Department of Cardiology and Intensive Care, University Hospital Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Department for Internal Medicine II, Katholisches Krankenhaus "St. Johann Nepomuk", Haarbergstr. 72, 99097 Erfurt, 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
| | - Ruediger Pfeifer
- Department of Cardiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
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Sakriss C, Roehl P, Schwenzky A, Hoyme M, Ebelt H. Transition from WATCHMAN V.2.5 to WATCHMAN FLX for closure of the left atrial appendage: echocardiographic and clinical findings. Open Heart 2023; 10:openhrt-2022-002246. [PMID: 36918230 PMCID: PMC10016248 DOI: 10.1136/openhrt-2022-002246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Interventional closure of the left atrial appendage (LAAC) has been established as an alternative treatment for patients with atrial fibrillation (AF) and an elevated risk of stroke. The WATCHMAN FLX (WM FLX) as the newest WATCHMAN LAAC device differs in several technical characteristics from its precursor, the WATCHMAN V.2.5 (WM V.2.5). METHODS The data presented here are derived from a retrospective single-centre study. All patients in which an LAAC was performed between February 2017 and March 2021 with either a WM V.2.5 or WM FLX device were included. RESULTS 169 patients were included in this study, of whom 95 had been treated with WM V.2.5 and 74 with WM FLX, respectively. Directly after implantation, only minor differences regarding membrane thickness and connector protrusion were noted, whereas no relevant differences were found regarding device sizing, device compression or peridevice leakage, respectively. However, at 3-month follow-up, device compression was significantly reduced in WM FLX indicating a continued device expansion which was paralleled by a reduced number of peridevice leakage in comparison to WM V.2.5. Additionally, the combined clinical endpoint of death, stroke/transistoric ischaemic attack, tamponade, device embolisation, device-related thrombosis or peridevice leakage was reduced in WM FLX. CONCLUSION LAAC using the WM FLX device results in a continued device expansion over the first 3 months based on differences in radial force in comparison to WM V.2.5. This is accompanied by a reduction in adverse clinical endpoints.
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Affiliation(s)
- Charlotte Sakriss
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Peter Roehl
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Matthias Hoyme
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Henning Ebelt
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
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Vranken NPA, Rasoul S, Luijkx JJP, Pustjens TFS, Postma S, Kolkman EJ, Kedhi E, Rifqi S, Lee MKY, Ebelt H, Merkely B, Verdoia M, Wojakowski W, van ’t Hof AAWJ, Suryapranata H, De Luca G. Short-term dual antiplatelet therapy in diabetic patients admitted for acute coronary syndrome treated with a new-generation drug-eluting stent. Diabetes Metab Res Rev 2022; 38:e3530. [PMID: 35395144 PMCID: PMC9541907 DOI: 10.1002/dmrr.3530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) admitted with acute coronary syndrome (ACS) and treated with a drug-eluting stent (DES) remains unclear. This is a prespecified sub-study from the Randomised Evaluation of short-term DUal antiplatelet therapy in patients with acute Coronary syndromE treated with a new generation DES (REDUCE) trial that was designed to determine the efficacy and safety of short-term versus standard 12 months DAPT in diabetic patients with ACS undergoing percutaneous coronary intervention (PCI) using the COMBO stent. METHODS In this study we included ACS diabetic patients enroled in the REDUCE trial treated with the COMBO stent and randomly assigned to either 3 or 12 months of DAPT. The primary study endpoint was the composite of all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), stroke, target vessel revascularisation (TVR), and bleeding complications at 12 and 24 months follow-up. RESULTS A total of 307 diabetic patients were included, of which 162 (52.8%) in the 3 months DAPT group and 145 (47.2%) in the 12 months DAPT group. Patient characteristics, PCI success, and number of stents used were similar in the 3 and 12 months DAPT groups. Occurrence of the primary study endpoint at 12 and 24 months follow-up was comparable between the two groups (3.1 vs. 3.5%, p = 0.865, and 15.8 vs. 14.9%, p = 0.824, respectively). Moreover, the prevalence of the specific clinical outcome parameters (all-cause mortality), MI, ST, stroke, TVR, and bleeding was similar in both study groups. CONCLUSIONS This sub-analysis shows similar clinical outcomes following 3 months DAPT as compared to 12 months DAPT in diabetic patients undergoing PCI for ACS using the COMBO stent. These results suggest that, even in this particular subset of patients, short duration of DAPT might be considered safe. Future larger studies are warranted to provide more precise estimations in terms of safety and efficacy of short term DAPT in these high-risk patients.
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Affiliation(s)
| | - Saman Rasoul
- Department of CardiologyZuyderland Medical CentreHeerlenThe Netherlands
| | | | | | | | | | - Elvin Kedhi
- Department of CardiologyErasmus HospitalBrusselsBelgium
| | - Sodiqur Rifqi
- Department of CardiologyDr. Kariadi HospitalSemarangIndonesia
| | | | - Henning Ebelt
- Department of CardiologyCatholic Hospital of Johann NepomukErfurtGermany
| | - Béla Merkely
- Department of CardiologySemmelweis University Heart and Vascular CenterBudapestHungary
| | - Monica Verdoia
- Division of CardiologyOspedale degli Infermi, ASL BiellaBiellaItaly
- Division of Clinical and Experimental CardiologyAOU Sassari, University of SassariSassariItaly
| | | | - Arnoud A. W. J. van ’t Hof
- Department of CardiologyZuyderland Medical CentreHeerlenThe Netherlands
- Department of CardiologyIsalaZwolleThe Netherlands
| | - Harry Suryapranata
- Department of CardiologyRadboud University Medical CentreNijmegenThe Netherlands
| | - Giuseppe De Luca
- Division of Clinical and Experimental CardiologyAOU Sassari, University of SassariSassariItaly
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Haertel F, Reisberg D, Peters M, Nuding S, Schulze PC, Werdan K, Ebelt H. Predicting the Need for Renal Replacement Therapy Using a Vascular Occlusion Test and Tissue Oxygen Saturation in Patients in the Early Phase of Multiorgan Dysfunction Syndrome. J Clin Med 2022; 11:jcm11051420. [PMID: 35268511 PMCID: PMC8911273 DOI: 10.3390/jcm11051420] [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: 01/11/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Acute kidney injury (AKI) is associated with an increased mortality in critically ill patients, especially in patients with multiorgan dysfunction syndrome (MODS). In daily clinical practice, the grading of AKI follows the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In most cases, a relevant delay occurs frequently between the onset of AKI and detectable changes in creatinine levels as well as clinical symptoms. The aim of the present study was to examine whether a near infrared spectroscopy (NIRS)-based, non-invasive ischemia–reperfusion test (vascular occlusion test (VOT)) together with unprovoked (under resting conditions) tissue oxygen saturation (StO2) measurements, contain prognostic information in the early stage of MODS regarding the developing need for renal replacement therapy (RRT). Methods: Within a period of 18 months, patients at the medical intensive care unit of a tertiary university hospital with newly developed MODS (≤24 h after diagnosis, APACHE II score ≥20) were included in our study. The VOT occlusion slope (OS) and recovery slope (RS) were recorded in addition to unprovoked StO2. StO2 was determined non-invasively in the area of the thenar muscles using a bedside NIRS device. The VOT was carried out by inflating a blood pressure cuff on the upper arm. AKI stages were determined by the changes in creatinine levels, urinary output, and/or the need for RRT according to KDIGO. Results: 56 patients with MODS were included in the study (aged 62.5 ± 14.4 years, 40 men and 16 women, APACHE II score 34.5 ± 6.4). Incidences of the different AKI stages were: no AKI, 16.1% (n = 9); AKI stage I, 19.6% (n = 11); AKI stage II, 25% (n = 14); AKI stage III, 39.3% (n = 22). Thus, 39.3% of the patients (n = 22) developed the need for renal replacement therapy (AKI stage III). These patients had a significantly higher mortality over 28 days (RRT, 72% (n = 16/22) vs. no RRT, 44% (n = 15/34); p = 0.03). The mean unprovoked StO2 of all patients at baseline was 81.7 ± 11.1%, and did not differ between patients with or without the need for RRT. Patients with RRT showed significantly weaker negative values of the OS (−9.1 ± 3.7 vs. −11.7 ± 4.1%/min, p = 0.01) and lower values for the RS (1.7 ± 0.9 vs. 2.3 ± 1.6%/s, p = 0.02) compared to non-dialysis patients. Consistent with these results, weaker negative values of the OS were found in higher AKI stages (no AKI, −12.7 ± 4.1%/min; AKI stage I, −11.5 ± 3.0%/min; AKI stage II, −11.1 ± 3.3%/min; AKI stage III, −9.1 ± 3.7%/min; p = 0.021). Unprovoked StO2 did not contain prognostic information regarding the AKI stages. Conclusions: The weaker negative values of the VOT parameter OS are associated with an increased risk of developing AKI and RRT, and increased mortality in the early phase of MODS, while unprovoked StO2 does not contain prognostic information in that regard.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Correspondence: ; Tel.: +49-3641-9324-554
| | - Diana Reisberg
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Pädiatrie, Ameos Klinikum Aschersleben, Eislebener Str. 7A, 06449 Aschersleben, Germany
| | - Martin Peters
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin, Helios Klinikum Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | - Sebastian Nuding
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Krankenhaus “St. Elisabeth”, Mauerstr. 5, 06110 Halle (Saale), Germany
| | - P. Christian Schulze
- Klinik für Innere Medizin I, Universitaetsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany;
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
| | - Henning Ebelt
- Klinik für Innere Medizin III, Universitaetsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (D.R.); (M.P.); (S.N.); (K.W.); (H.E.)
- Klinik für Innere Medizin II, Katholisches Krankenhaus “St. Johann Nepomuk”, Haarbergstr. 72, 99097 Erfurt, Germany
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12
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Diab M, Franz M, Hagel S, Guenther A, Struve A, Kuehn H, Ibrahim K, Jahnecke M, Sigusch H, Ebelt H, Faerber G, Lehmann T, Schulze PC, Pletz MW, Doenst T. The impact of establishing a regional infective endocarditis (IE) network on pre-operative IE-related complications and on post-operative outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) requires a high degree of suspicion and advanced level of multidisciplinary management. In 2015, the European guidelines recommended the formation of an endocarditis-team (ET) for optimal treatment of IE. In 2011, we already established an ET within the hospital that was only consulted on demand for certain patients. Since 2015, ET has been increasingly involved in the management of almost all patients with IE. In addition, we established in 2015 a statewide endocarditis- (E) network for the referring hospitals.
Purpose
We investigated the effect of E-network on reducing referral latency and pre-operative IE-related complications. We also investigated the adherence to the ET management recommendations in our hospital and its impact on post-operative stroke and mortality.
Methods
We retrospectively analyzed data from patients operated for IE in our center between 01/2007 and 03/2018. We conducted univariate analysis using Chi-square or Fisher's exact test, Multivariate logistic regression models for in-hospital mortality and post-operative stroke, and Kaplan-Meier estimate of 5-years survival.
Results
Among 630 patients operated for IE in our center, 409 (65%) underwent surgery in the 1st era before 12/2014. S. aureus IE was more frequent in the second era (34% vs 25%, p<0.001). The median time from the onset of symptoms to referral in the 2nd era was halved compared to the first one [7 days (IQR 2–19) vs 15 days (IQR 6–35)]. Patients in the 2nd era were admitted with less IE-related complications, i.e. less preoperative stroke (14% vs 27%, p<0.001), less heart failure (45% vs 69%, p<0.001) less cardiac abscesses (24% vs 34%, p=0.018), less acute renal insufficiency requiring hemodialysis (8% vs 14%, p=0.026). The lack of ET management recommendations was an independent predictor for in-hospital mortality (adjusted OR: 2.13, 95% CI: 1.27–3.53, p=0.004) and post-operative stroke (adjusted OR: 2.23, 95% CI: 1.12–4.39, p=0.02), and was associated with worse 5-years survival (59% compared to 40%, log rank<0.001).
Conclusion
Endocarditis-network led to earlier referral of patients, which resulted in less IE-related complications on admission. Lack of ET management recommendations was an independent predictor for post-operative stroke, in-hospital mortality and was associated with worse 5-years survival.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- M Diab
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - M Franz
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - S Hagel
- University Hospital Jena, Institute for Infectious Diseases and Infection Control, Jena, Germany
| | - A Guenther
- University Hospital Jena, Department of Neurology, Jena, Germany
| | - A Struve
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - H Kuehn
- Thueringen-Kliniken Georgius Agricola, Department of Internal Medicine III, Saalfeld, Germany
| | - K Ibrahim
- Hospital Chemnitz, Department of Internal Medicine I, Chemnitz, Germany
| | - M Jahnecke
- St. Georg Hospital, Department of Internal Medicine I, Eisenach, Germany
| | - H Sigusch
- Heinrich-Braun-Hospital, Department of Internal Medicine I, Zwickau, Germany
| | - H Ebelt
- Catholic Hospital St. Johann Nepomuk, Department of Internal Medicine II, Erfurt, Germany
| | - G Faerber
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Lehmann
- University Hospital Jena, Department of Medical Statistics, Computer Science and Data Science, Jena, Germany
| | - P C Schulze
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - M W Pletz
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Doenst
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
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Haas LEM, Boumendil A, Flaatten H, Guidet B, Ibarz M, Jung C, Moreno R, Morandi A, Andersen FH, Zafeiridis T, Walther S, Oeyen S, Leaver S, Watson X, Boulanger C, Szczeklik W, Schefold JC, Cecconi M, Marsh B, Joannidis M, Nalapko Y, Elhadi M, Fjølner J, Artigas A, de Lange DW, Joannidis M, Eller P, Helbok R, Schmutz R, Nollet J, de Neve N, De Buysscher P, Oeyen S, Swinnen W, Mikačić M, Bastiansen A, Husted A, Dahle BES, Cramer C, Sølling C, Ørsnes D, Thomsen JE, Pedersen JJ, Enevoldsen MH, Elkmann T, Kubisz-Pudelko A, Pope A, Collins A, Raj AS, Boulanger C, Frey C, Hart C, Bolger C, Spray D, Randell G, Filipe H, Welters ID, Grecu I, Evans J, Cupitt J, Lord J, Henning J, Jones J, Ball J, North J, Salaunkey K, De Gordoa LOR, Bell L, Balasubramaniam M, Vizcaychipi M, Faulkner M, Mupudzi M, Lea-Hagerty M, Reay M, Spivey M, Love N, Spittle NSN, White N, Williams P, Morgan P, Wakefield P, Savine R, Jacob R, Innes R, Kapoor R, Humphreys S, Rose S, Dowling S, Leaver S, Mane T, Lawton T, Ogbeide V, Khaliq W, Baird Y, Romen A, Galbois A, Guidet B, Vinsonneau C, Charron C, Thevenin D, Guerot E, Besch G, Savary G, Mentec H, Chagnon JL, Rigaud JP, Quenot JP, Castaneray J, Rosman J, Maizel J, Tiercelet K, Vettoretti L, Hovaere MM, Messika M, Djibré M, Rolin N, Burtin P, Garcon P, Nseir S, Valette X, Rabe C, Barth E, Ebelt H, Fuest K, Franz M, Horacek M, Schuster M, Meybohm P, Bruno RR, Allgäuer S, Dubler S, Schaller SJ, Schering S, Steiner S, Dieck T, Rahmel T, Graf T, Koutsikou A, Vakalos A, Raitsiou B, Flioni EN, Neou E, Tsimpoukas F, Papathanakos G, Marinakis G, Koutsodimitropoulos I, Aikaterini K, Rovina N, Kourelea S, Polychronis T, Zidianakis V, Konstantinia V, Aidoni Z, Marsh B, Motherway C, Read C, Martin-Loeches I, Cracchiolo AN, Morigi A, Calamai I, Brusa S, Elhadi A, Tarek A, Khaled A, Ahmed H, Belkhair WA, Cornet AD, Gommers D, de Lange D, van Boven E, Haringman J, Haas L, van den Berg L, Hoiting O, de Jager P, Gerritsen RT, Dormans T, Dieperink W, Breidablik ABA, Slapgard A, Rime AK, Jannestad B, Sjøbøe B, Rice E, Andersen FH, Strietzel HF, Jensen JP, Langørgen J, Tøien K, Strand K, Hahn M, Klepstad P, Biernacka A, Kluzik A, Kudlinski B, Maciejewski D, Studzińska D, Hymczak H, Stefaniak J, Solek-Pastuszka J, Zorska J, Cwyl K, Krzych LJ, Zukowski M, Lipińska-Gediga M, Pietruszko M, Piechota M, Serwa M, Czuczwar M, Ziętkiewicz M, Kozera N, Nasiłowski P, Sendur P, Zatorski P, Galkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Gola W, Pinto AF, Fernandes AM, Santos AR, Sousa C, Barros I, Ferreira IA, Blanco JB, Carvalho JT, Maia J, Candeias N, Catorze N, Belskiy V, Lores A, Mira AP, Cilloniz C, Perez-Torres D, Maseda E, Rodriguez E, Prol-Silva E, Eixarch G, Gomà G, Aguilar G, Velasco GN, Jaimes MI, Villamayor MI, Fernández NL, Cubero PJ, López-Cuenca S, Tomasa T, Sjöqvist A, Brorsson C, Schiöler F, Westberg H, Nauska J, Sivik J, Berkius J, Thiringer KK, De Geer L, Walther S, Boroli F, Schefold JC, Hergafi L, Eckert P, Yıldız I, Yovenko I, Nalapko Y, Nalapko Y, Pugh R. Frailty is associated with long-term outcome in patients with sepsis who are over 80 years old: results from an observational study in 241 European ICUs. Age Ageing 2021; 50:1719-1727. [PMID: 33744918 DOI: 10.1093/ageing/afab036] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sepsis is one of the most frequent reasons for acute intensive care unit (ICU) admission of very old patients and mortality rates are high. However, the impact of pre-existing physical and cognitive function on long-term outcome of ICU patients ≥ 80 years old (very old intensive care patients (VIPs)) with sepsis is unclear. OBJECTIVE To investigate both the short- and long-term mortality of VIPs admitted with sepsis and assess the relation of mortality with pre-existing physical and cognitive function. DESIGN Prospective cohort study. SETTING 241 ICUs from 22 European countries in a six-month period between May 2018 and May 2019. SUBJECTS Acutely admitted ICU patients aged ≥80 years with sequential organ failure assessment (SOFA) score ≥ 2. METHODS Sepsis was defined according to the sepsis 3.0 criteria. Patients with sepsis as an admission diagnosis were compared with other acutely admitted patients. In addition to patients' characteristics, disease severity, information about comorbidity and polypharmacy and pre-existing physical and cognitive function were collected. RESULTS Out of 3,596 acutely admitted VIPs with SOFA score ≥ 2, a group of 532 patients with sepsis were compared to other admissions. Predictors for 6-month mortality were age (per 5 years): Hazard ratio (HR, 1.16 (95% confidence interval (CI), 1.09-1.25, P < 0.0001), SOFA (per one-point): HR, 1.16 (95% CI, 1.14-1.17, P < 0.0001) and frailty (CFS > 4): HR, 1.34 (95% CI, 1.18-1.51, P < 0.0001). CONCLUSIONS There is substantial long-term mortality in VIPs admitted with sepsis. Frailty, age and disease severity were identified as predictors of long-term mortality in VIPs admitted with sepsis.
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Affiliation(s)
- Lenneke E M Haas
- Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Ariane Boumendil
- Assistance Publique-Hôpital de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale. Paris F-75012, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, Sorbonne Université, INSERM, F75012 Paris, France
| | - Mercedes Ibarz
- Department of Intensive Care Medicine, Universitary Hospital Sagrat Cor Barcelona, Spain
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma. Hospital de São José, Centro Hospitalar, Faculdade de Ciências Médicas de Lisboa (Nova Medical School), Universitário de Lisboa Central, Lisbon, Portugal
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, Hospital Ancelle, Cremona, Italy. Parc Sanitari Pere Virgili and Vall d’Hebrón Institute of Research, Barcelona, Spain
| | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Linköping University Hospital, Linköping, Sweden
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's University Hospital, NHS Foundation Trust, London, UK
| | | | - Carole Boulanger
- Chair NAHP Section ESICM, Intensive Care Unit, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Wojciech Szczeklik
- Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, MI, Italy
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Yuriy Nalapko
- European Wellness International, ICU, Luhansk, Ukraine
| | | | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona. Sabadell, Spain
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
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14
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Wanek F, Meißner S, Nuding S, Hoberück S, Werdan K, Noutsias M, Ebelt H. [Influence of therapeutic temperature management on the clinical course in patients after in-hospital cardiac arrest : A retrospective analysis]. Med Klin Intensivmed Notfmed 2021; 117:297-304. [PMID: 33877423 DOI: 10.1007/s00063-021-00814-3] [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: 12/08/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/25/2022]
Abstract
METHODS Retrospective analysis of all patients with in-hospital cardiac arrest and return of spontaneous circulation (ROSC) in the ICU of the cardiologic department of the University Hospital of Halle (Saale) between 1999 and 2009. RESULTS During the observation period, 169 patients with in-hospital cardiac arrest and information regarding temperature measurements were treated. Invasive therapeutic temperature management (TTM+) was applied in 64 patients (37.9%), while 105 patients (62.1%) underwent no therapeutic temperature management (TTM-). TTM+ and TTM- showed no relevant differences regarding patient age (TTM+: 67.6 ± 12.6 years; TTM-: 69.8 ± 12.6 years; p = 0.257), comorbidities and the initial rhythm; however, there were more men in the TTM+ group (76.6% vs. 58.1%; p = 0.015). All patients had been intubated. Time until ROSC in TTM+ was significantly longer (25.9 ± 25.8 min vs. 15.0 ± 12.4 min; p < 0.005). TTM+ resulted in a lower 30-day survival and an unfavourable neurologic outcome (Glasgow outcome scale I or II: 75% TTM+ vs. 55.2% TTM-). This negative effect persisted after adjustment for age of the patients, but not after adjustment for age and duration of reanimation (nonadjusted odds ratio for adverse neurologic outcome under TTM+: 0.411 (p = 0.011); odds ratio after adjusting for age: 0.361 (p = 0.09); odds ratio after adjusting for age and duration of the reanimation: 0.505 (p = 0.121)).
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Affiliation(s)
- Felix Wanek
- Klinik für Anästhesiologie und Intensivmedizin, Katholisches Krankenhaus Erfurt, Haarbergstraße 72, 99097, Erfurt, Deutschland.
| | - Stefanie Meißner
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Sebastian Nuding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Sebastian Hoberück
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Michel Noutsias
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum der Martin-Luther-Universität, Halle, Deutschland
| | - Henning Ebelt
- Klinik für Kardiologie und internistische Intensivmedizin, Erfurt, Deutschland
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15
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Ebelt H, Goetze S, Weida A, Offhaus A. Impact of ultrasound contrast agent during transoesophageal echocardiography on the sizing of the left atrial appendage. Open Heart 2021; 8:openhrt-2020-001403. [PMID: 33757976 PMCID: PMC7993222 DOI: 10.1136/openhrt-2020-001403] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/19/2020] [Accepted: 03/09/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Interventional closure of the left atrial appendage closure (LAAC) has been established as an alternative treatment in patients with atrial fibrillation (AF) and an increased risk of stroke. So far it is unknown whether the use of ultrasound contrast agent (UCA) would influence the correct sizing of the LAA and thereby have an impact on device selection during interventional LAAC. METHODS Between January 2017 and April 2018, 223 transoesophageal echocardiography (TOE) examinations were prospectively performed in adult patients with non-valvular AF (Impact of the use of ultrasound contrast agent on the detection of thrombi in the left atrial appendage during transesophageal echocardiography (CONDOR) study). LAA was examined both with and without the use of UCA. The following measurements were taken at 0o, 45o, 90o and 135o: diameter of LAA ostium, maximal depth of the LAA, maximal available depth of the LAA orthogonal to the ostial plane and area of the LAA. RESULTS The use of UCA had no relevant influence on the size determination of the LAA. Additionally, Bland-Altman blots demonstrate a high degree of correlation between the measurements with and without UCA with no evidence for a systematic effect arising from the use of UCA. When comparing the measurements of two independent investigators, the use of UCA rather leads to a higher variability than to an improved precision. DISCUSSION Despite the fact that the use of UCA during TOE leads to an improved rule out of thrombi, our study shows that there is no advantageous effect of UCA on the size determination of the LAA and should therefore not be used for this purpose.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Sarah Goetze
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital, Sankt Johann Nepomuk, Erfurt, Thüringen, Germany
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16
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Ebelt H, Domagala T, Offhaus A, Wiora M, Schwenzky A, Hoyme M, Anacker J, Röhl P. Correction to: Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure. Cardiovasc Drugs Ther 2020; 34:789. [PMID: 33108625 PMCID: PMC7674318 DOI: 10.1007/s10557-020-07102-w] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/31/2022]
Abstract
The article "Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure."
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
| | - Thomas Domagala
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Alexandra Offhaus
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Jelena Anacker
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
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17
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Ebelt H, Domagala T, Offhaus A, Wiora M, Schwenzky A, Hoyme M, Anacker J, Röhl P. Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure. Cardiovasc Drugs Ther 2020; 34:781-787. [PMID: 32761486 PMCID: PMC7674364 DOI: 10.1007/s10557-020-07048-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Background Left atrial appendage closure (LAAC) is an alternative treatment strategy for patients with atrial fibrillation who are at risk for thromboembolic events and considered not suitable for oral anticoagulation (OAC). LAAC is mainly performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. The study presented here should analyze whether fusion imaging (FI) of transesophageal echocardiography and X-ray performed during LAAC is feasible and can improve the results of the procedure. Methods The data presented here are from a retrospective single center study. Sample size was defined as 50 patients in which LAAC was performed without fusion imaging (control group) and 25 patients were the LAAC procedure was guided by fusion imaging (treatment group). Inclusion criteria were defined as age > 18 years and completion of an LAAC procedure defined as deployment of a WATCHMAN 2.5 LAA occluder. Study endpoints were procedure time, amount of used contrast medium, radiation dose, final position of the WATCHMAN in TEE (deviation from ideal positioning), and clinical endpoints, respectively. Results LAA closure was successfully performed in all patients. No case of device embolism was occurring, and none of the patients experienced a periprocedural stroke/TIA nor a systemic embolism, respectively. Mean procedure time was 15 min shorter in the group of patients where fusion imaging was applied (p < 0.001). Additionally, the use of fusion imaging was associated with a significant reduction of contrast medium (20.6 ml less than in control; p < 0.045). Regarding the final position of the WATCHMAN, no relevant differences were found between the groups. Summary The use of fusion imaging significantly reduced procedure time and the amount of contrast medium in patients undergoing LAAC.
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
| | - Thomas Domagala
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Alexandra Offhaus
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Jelena Anacker
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
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Bruno RR, Wernly B, Beil M, Muessig JM, Rahmel T, Graf T, Meybohm P, Schaller SJ, Allgäuer S, Franz M, Westphal JG, Barth E, Ebelt H, Fuest K, Horacek M, Schuster M, Dubler S, Schering S, Wolff G, Steiner S, Rabe C, Dieck T, Lauten A, Sacher AL, Brenner T, Bloos F, Jánosi RA, Simon P, Utzolino S, Kelm M, De Lange DW, Guidet B, Flaatten H, Jung C. Therapy limitation in octogenarians in German intensive care units is associated with a longer length of stay and increased 30 days mortality: A prospective multicenter study. J Crit Care 2020; 60:58-63. [PMID: 32769006 DOI: 10.1016/j.jcrc.2020.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/20/2020] [Revised: 06/28/2020] [Accepted: 07/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The approach to limit therapy in very old intensive care unit patients (VIPs) significantly differs between regions. The focus of this multicenter analysis is to illuminate, whether the Clinical Frailty Scale (CFS) is a suitable tool for risk stratification in VIPs admitted to intensive care units (ICUs) in Germany. Furthermore, this investigation elucidates the impact of therapeutic limitation on the length of stay and mortality in this setting. METHODS German cohorts' data from two multinational studies (VIP-1, VIP-2) were combined. Univariate and multivariate logistic regression were used to evaluate associations with mortality. RESULTS 415 acute VIPs were included. Frail VIPs (CFS > 4) were older (85 [IQR 82-88] vs. 83 [IQR 81-86] years p < .001) and suffered from an increased 30-day-mortality (43.4% versus 23.9%, p < .0001). CFS was an independent predictor of 30-day-mortality in a multivariate logistic regression model (aOR 1.23 95%CI 1.04-1.46 p = .02). Patients with any limitation of life-sustaining therapy had a significantly increased 30-day mortality (86% versus 16%, p < .001) and length of stay (144 [IQR 72-293] versus 96 [IQR 47.25-231.5] hours, p = .026). CONCLUSION In German ICUs, any limitation of life-sustaining therapy in VIPs is associated with a significantly increased ICU length of stay and mortality. CFS reliably predicts the outcome.
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Affiliation(s)
- Raphael Romano Bruno
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria; Division of Cardiology, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah University Hospital, En Kerem, Jerusalem, Israel.
| | - Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
| | - Tobias Graf
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany.
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany; Department of Anaesthesiology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany.
| | | | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Julian Georg Westphal
- Department of Internal Medicine I, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
| | - Eberhard Barth
- Division of Intensive Care Medicine, Department of Anesthesiology, University Hospital Ulm, Ulm, Germany.
| | - Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany.
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
| | - Michael Horacek
- Clinic of Cardiology, Alfried Krupp Hospital, Essen, Germany.
| | - Michael Schuster
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany.
| | - Simon Dubler
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Stefan Schering
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Georg Wolff
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany
| | - Stephan Steiner
- Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital Limburg, Auf dem Schafsberg, 65549 Limburg, Germany.
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
| | - Thorben Dieck
- Department of Anesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
| | - Alexander Lauten
- Department of Cardiology, Helios Klinikum Erfurt, Erfurt, Germany.
| | - Anne Lena Sacher
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany.
| | - Rolf A Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Essen, Germany.
| | - Philipp Simon
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Stefan Utzolino
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany; Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Saint Antoine Hospital, AP-HP, Hôpital Saint-Antoine, Service de Réanimation, F75012 Paris, France.
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Germany.
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Ebelt H, Röhl P, Schwenzky A, Hoyme M, Wiora M. A nasty surprise: cardiogenic shock induced by extensive dissection of the left internal mammary artery graft occurring 3 months after coronary angiography-a case report. Eur Heart J Case Rep 2019; 3:ytz149. [PMID: 31660508 PMCID: PMC6764578 DOI: 10.1093/ehjcr/ytz149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Background Acute dissection of the left internal mammary artery (LIMA) graft in patients with previous cardiac bypass surgery is a rare but potentially life-threatening condition. Case summary A 58-year-old man with history of coronary artery disease and bypass surgery 15 years ago presented with acute coronary syndrome (non-ST-elevation myocardial infarction, NSTEMI). Angiography showed severe three-vessel disease with occlusion of a saphenous vein graft (SVG) to the first diagonal branch but patents grafts to left artery descendent (LIMA) and SVG to the right coronary artery. No coronary intervention was performed and the patient was treated medically (aspirin and ticagrelor) and discharged home after 6 days. Three months later, the patient again was admitted to the hospital with acute coronary syndrome (NSTEMI) and developing cardiogenic shock. Angiography now showed an extensive flow limiting dissection of his LIMA graft with the dissection starting at the ostium of the LIMA. After implantation of an Impella 2.5, percutaneous coronary intervention (PCI) of the graft was performed under guidance by optical coherence tomography (OCT) leading to implantation of a drug-eluting stent into the ostium of the LIMA and repeated balloon dilatations of the medial and distal parts of the graft. Antegrade flow was established and the patient’s condition improved so that the Impella was removed in the cath lab. After an uneventful course, the patient was discharged home after 6 days. Elective repeat angiography after 8 weeks showed an excellent functional result without persisting signs of LIMA dissection or stenosis. Discussion Acute dissection of a LIMA graft is a rare event that may lead to a life-threatening condition. According to the literature, LIMA dissection happens during coronary interventions in approximately half of the cases but it also may evolve spontaneously. However, as seen from our case, there might be a substantial delay between LIMA angiography and the clinical onset of dissection. In the vast majority of cases, dissection of LIMA can be treated by PCI. The use of Impella as reported for the first time in this case may improve the safety of the procedure. In accordance to PCI of the native coronary arteries, it seems possible to leave non-flow limiting dissections in cases of extensive disease in order to avoid the late complications of complete stenting of the graft.
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
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Ebelt H, Offhaus A, Wiora M, Roehl P, Schwenzky A, Weida A, Hoyme M, Bindemann-Koecher J, Anacker J. Impact of ultrasound contrast agent on the detection of thrombi during transoesophageal echocardiography. Open Heart 2019; 6:e001024. [PMID: 31673382 PMCID: PMC6803001 DOI: 10.1136/openhrt-2019-001024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/14/2019] [Accepted: 09/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Atrial fibrillation (AF) carries the risk of thrombus formation in the left atrium and especially in the left atrial appendage (LAA). A transoesophageal echocardiography (TOE) is routinely performed in these patients to rule out thrombi before cardioversion or structural interventions like LAA closure or pulmonary vein isolation. However, in a certain number of cases, inconclusive results of the TOE may result. This study was performed to analyse whether the routine use of ultrasound contrast agent (UCA) has an influence on the frequency of thrombus detection. Methods In patients with AF who were scheduled for a subsequent interventional procedure, a TOE was initially performed without contrast agent. Then, the TOE was repeated with the use of UCA. The percentage of diagnostic findings regarding the prevalence of thrombus in the LAA with and without UCA were compared (thrombus present (T+), no thrombus (T−) and inconclusive result (T+/−)). Results 223 patients were prospectively included into the trial. The numbers of thrombus detection were as follows: without UCA: 17 T+ (7.6%), 154 T− (69.1%), 52 T+/− (23,3%); with UCA: 16 T+ (7.2%), 179 T− (80.3%), 28 T+/− (12.6%; χ2: p<0.01). In 29 examinations (13.0%), the use of UCA had an impact on the subsequent treatment strategy. Conclusions The use of UCA during TOE in patients with AF has a significant impact on the subsequent patient management especially due to an improved rule out of LAA thrombi.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Wiora
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Peter Roehl
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Hoyme
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | | | - Jelena Anacker
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
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21
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Muessig JM, Nia AM, Masyuk M, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Jánosi RA, Meybohm P, Simon P, Utzolino S, Rahmel T, Barth E, Schuster M, Kelm M, Jung C. Clinical Frailty Scale (CFS) reliably stratifies octogenarians in German ICUs: a multicentre prospective cohort study. BMC Geriatr 2018; 18:162. [PMID: 30005622 PMCID: PMC6044022 DOI: 10.1186/s12877-018-0847-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 05/01/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs. METHODS This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality. RESULTS Patients had a median age of 84 [IQR 82-87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival. CONCLUSIONS The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany. TRIAL REGISTRATION The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807 ) on May 1, 2017.
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Affiliation(s)
- Johanna M Muessig
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Amir M Nia
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Maryna Masyuk
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité - University Hospital, Berlin, Germany.,German Center for Heart Research (DZHK), Berlin, Germany
| | - Anne Lena Sacher
- Department of Anaesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Thorsten Brenner
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Friedrich-Schiller-University, University Hospital Jena, Jena, Germany
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Erfurt, Germany
| | - Stefan J Schaller
- Department of Anaesthesiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Kristina Fuest
- Department of Anaesthesiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Thorben Dieck
- Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany
| | - Stephan Steiner
- St. Vincenz Hospital, Department of Cardiology, Pneumology and Intensive Care Medicine, Limburg/Lahn, Limburg, Germany
| | - Tobias Graf
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - Rolf A Jánosi
- Medical Faculty, West German Heart and Vascular Center, Department of Cardiology and Vascular Diseases, University Hospital Essen, Essen, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Philipp Simon
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Stefan Utzolino
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Tim Rahmel
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Eberhard Barth
- Division of Intensive Care Medicine, Department of Anaesthesiology, University Hospital Ulm, Ulm, Germany
| | - Michael Schuster
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Mainz, Mainz, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.,CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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22
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Welte T, Dellinger RP, Ebelt H, Ferrer M, Opal SM, Singer M, Vincent JL, Werdan K, Martin-Loeches I, Almirall J, Artigas A, Ignacio Ayestarán J, Nuding S, Ferrer R, Sirgo Rodríguez G, Shankar-Hari M, Álvarez-Lerma F, Riessen R, Sirvent JM, Kluge S, Zacharowski K, Bonastre Mora J, Lapp H, Wöbker G, Achtzehn U, Brealey D, Kempa A, Sánchez García M, Brederlau J, Kochanek M, Reschreiter HP, Wise MP, Belohradsky BH, Bobenhausen I, Dälken B, Dubovy P, Langohr P, Mayer M, Schüttrumpf J, Wartenberg-Demand A, Wippermann U, Wolf D, Torres A. Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study). Intensive Care Med 2018; 44:438-448. [PMID: 29632995 PMCID: PMC5924663 DOI: 10.1007/s00134-018-5143-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 11/10/2017] [Accepted: 03/17/2018] [Indexed: 01/05/2023]
Abstract
Purpose The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). Methods In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). Results Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58–78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. Conclusions No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. Trial registration: NCT01420744. Electronic supplementary material The online version of this article (10.1007/s00134-018-5143-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Welte
- Department of Pneumology and German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - R Phillip Dellinger
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA
| | - Henning Ebelt
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Miguel Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Steven M Opal
- Infectious Disease Division, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO) Wellcome Trust - HRB Clinical Research Facility (CRF) at St. James's Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jordi Almirall
- Unitat de Cures Intensives, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jose Ignacio Ayestarán
- Unidad de Cuidados Intensivos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Sebastian Nuding
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ricard Ferrer
- Hospital Universitario Mútua de Terrassa, SODIR-VHIR Research Group, Barcelona, Spain
| | - Gonzalo Sirgo Rodríguez
- Intensive Care Unit, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain
| | - Manu Shankar-Hari
- Intensive Care Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Reimer Riessen
- Universitätsklinikum Tübingen, Internistische Intensivstation, Tübingen, Germany
| | - Josep-Maria Sirvent
- Servicio de Medicina Intensiva, Hospital U. Girona Dr. Josep Trueta, Avinguda França, Girona, Spain
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Juan Bonastre Mora
- Servicio de Cuidados Intensivos Adultos, Hospital Universitari y Politècnico La Fe, Valencia, Spain
| | - Harald Lapp
- 3 Medizinische Klinik, Kardiologie und Intensivmedizin, Helios Klinikum Erfurt, Erfurt, Germany
| | - Gabriele Wöbker
- Klinik für Intensivmedizin, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ute Achtzehn
- Innere Medizin IV - Pneumologie, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - David Brealey
- Critical Care Unit, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Axel Kempa
- Klinik für Allgemeine Innere Medizin, Katharinenhospital, Stuttgart, Germany
| | | | - Jörg Brederlau
- Helios Klinikum Berlin-Buch, Klinik für Intensivmedizin, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Intensive Care Unit and Hemostasis, University Hospital of Cologne, Cologne, Germany
| | | | - Matthew P Wise
- Critical Care Unit, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Bernd H Belohradsky
- University Children's Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | - Antoni Torres
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona IDIBAPS, CIBERES, Barcelona, Spain
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23
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Pahl C, Ebelt H, Sayahkarajy M, Supriyanto E, Soesanto A. Erratum to: Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories : Usability-Centered Manipulator for Transesophageal Echocardiography. J Med Syst 2017; 41:169. [PMID: 28913679 DOI: 10.1007/s10916-017-0818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christina Pahl
- Biomechatronics Group, Faculty of Mechanical Engineering, Technische Universitaet Ilmenau, 98693, Ilmenau, Germany. .,Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia.
| | - Henning Ebelt
- Klinik für Innere Medizin II/ Kardiologie und Internistische Intensivmedizin Katholisches Krankenhaus, "St. Johann Nepomuk", Haarbergstrasse 72, 99097, Erfurt, Germany
| | - Mostafa Sayahkarajy
- Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Eko Supriyanto
- Advanced Diagnostics and Progressive Human Care Research Group, IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Amiliana Soesanto
- Department Cardiology & Vascular Medicine, Faculty of Medicine Universitas Indonesia/ National Cardiovascular Center "Harapan Kita", Jakarta, 11420, Indonesia
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24
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Pahl C, Ebelt H, Sayahkarajy M, Supriyanto E, Soesanto A. Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories : Usability-Centered Manipulator for Transesophageal Echocardiography. J Med Syst 2017; 41:148. [PMID: 28812247 DOI: 10.1007/s10916-017-0786-4] [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: 03/28/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
This paper proposes a robotic Transesophageal Echocardiography (TOE) system concept for Catheterization Laboratories. Cardiovascular disease causes one third of all global mortality. TOE is utilized to assess cardiovascular structures and monitor cardiac function during diagnostic procedures and catheter-based structural interventions. However, the operation of TOE underlies various conditions that may cause a negative impact on performance, the health of the cardiac sonographer and patient safety. These factors have been conflated and evince the potential of robot-assisted TOE. Hence, a careful integration of clinical experience and Systems Engineering methods was used to develop a concept and physical model for TOE manipulation. The motion of different actuators of the fabricated motorized system has been tested. It is concluded that the developed medical system, counteracting conflated disadvantages, represents a progressive approach for cardiac healthcare.
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Affiliation(s)
- Christina Pahl
- Biomechatronics Group, Faculty of Mechanical Engineering, Technische Universitaet Ilmenau, 98693, Ilmenau, Germany. .,Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia.
| | - Henning Ebelt
- Klinik für Innere Medizin II/ Kardiologie und Internistische Intensivmedizin Katholisches Krankenhaus, "St. Johann Nepomuk", Haarbergstrasse 72, 99097, Erfurt, Germany
| | - Mostafa Sayahkarajy
- Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Eko Supriyanto
- Advanced Diagnostics and Progressive Human Care Research Group, IJN-UTM Cardiovascular Engineering Centre, Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310, Johor Bahru, Malaysia
| | - Amiliana Soesanto
- Department Cardiology & Vascular Medicine, Faculty of Medicine Universitas Indonesia/ National Cardiovascular Center "Harapan Kita", 11420, Jakarta, Indonesia
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25
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Haertel F, Huster D, Peters M, Nuding S, Schroeder J, Werdan K, Schulze C, Ebelt H. P3485Prognostic value of a vascular occlusion test (VOT) using tissue oxygen saturation (StO2) in patients in the early phase of multi organ dysfunction syndrome (MODS). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3485] [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)
- F. Haertel
- University Hospital of Jena, Cardiology, Jena, Germany
| | - D. Huster
- Hospital Aschaffenburg, Paediatrics, Aschaffenburg, Germany
| | - M. Peters
- Helios Hospital Jerichower Land, Internal Medicine/ Intensive Care, Burg, Germany
| | - S. Nuding
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - J. Schroeder
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - K. Werdan
- University Clinic Halle (Saale), Cardiology, Halle, Germany
| | - C. Schulze
- University Hospital of Jena, Cardiology, Jena, Germany
| | - H. Ebelt
- Catholic Hospital “St. Nepomuk”, Internal Medicine/ Cardiology, Erfurt, Germany
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26
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Von Seth M, Hillered L, Otterbeck A, Hanslin K, Larsson A, Sjölin J, Lipcsey M, Cove ME, Chew NS, Vu LH, Lim RZ, Puthucheary Z, Hanslin K, Wilske F, Skorup P, Tano E, Sjölin J, Lipcsey M, Derese I, Thiessen S, Derde S, Dufour T, Pauwels L, Bekhuis Y, Van den Berghe G, Vanhorebeek I, Khan M, Dwivedi D, Zhou J, Prat A, Seidah NG, Liaw PC, Fox-Robichaud AE, Von Seth M, Skorup P, Hillered L, Larsson A, Sjölin J, Lipcsey M, Otterbeck A, Hanslin K, Lipcsey M, Larsson A, Von Seth M, Correa T, Pereira J, Takala J, Jakob S, Skorup P, Maudsdotter L, Tano E, Lipcsey M, Castegren M, Larsson A, Sjölin J, Xue M, Xu JY, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB, Kuzovlev A, Moroz V, Goloubev A, Myazin A, Chumachenko A, Pisarev V, Takeyama N, Tsuda M, Kanou H, Aoki R, Kajita Y, Hashiba M, Terashima T, Tomino A, Davies R, O’Dea KP, Soni S, Ward JK, O’Callaghan DJ, Takata M, Gordon AC, Wilson J, Zhao Y, Singer M, Spencer J, Shankar-Hari M, Genga KR, Lo C, Cirstea MS, Walley KR, Russell JA, Linder A, Boyd JH, Sedlag A, Riedel C, Georgieff M, Barth E, Debain A, Jonckheer J, Moeyersons W, Van zwam K, Puis L, Staessens K, Honoré PM, Spapen HD, De Waele E, de Garibay APR, Bracht H, Ende-Schneider B, Schreiber C, Kreymann B, Bini A, Votino E, Giuliano G, Steinberg I, Vetrugno L, Trunfio D, Sidoti A, Essig A, Brogi E, Forfori F, Conroy M, Marsh B, O’Flynn J, Henne-Bruns D, Gebhard F, Orend K, Halatsch M, Weiss M, Chase M, Freinkman E, Uber A, Liu X, Cocchi MN, Donnino MW, Peetermans M, Liesenborghs L, Claes J, Vanassche T, Hoylaerts M, Jacquemin M, Vanhoorelbeke K, De Meyer S, Verhamme P, Vögeli A, Ottiger M, Meier M, Steuer C, Bernasconi L, Huber A, Christ-Crain M, Henzen C, Hoess C, Thomann R, Zimmerli W, Müller B, Schütz P, Hoppensteadt D, Walborn A, Rondina M, Tsuruta K, Fareed J, Tachyla S, Ikeda T, Ono S, Ueno T, Suda S, Nagura T, Damiani E, Domizi R, Scorcella C, Tondi S, Pierantozzi S, Ciucani S, Mininno N, Adrario E, Pelaia P, Donati A, Andersen MS, Lu S, Lopez G, Lassen AT, Ghiran I, Shapiro NI, Trahtemberg U, Sviri S, Beil M, Agur Z, Van Heerden P, Jahaj E, Vassiliou A, Mastora Z, Orfanos SE, Kotanidou A, Wirz Y, Sager R, Amin D, Amin A, Haubitz S, Hausfater P, Huber A, Kutz A, Mueller B, Schuetz P, Sager RS, Wirz YW, Amin DA, Amin AA, Hausfater PH, Huber AH, Haubitz S, Kutz A, Mueller B, Schuetz P, Gottin L, Dell’amore C, Stringari G, Cogo G, Ceolagraziadei M, Sommavilla M, Soldani F, Polati E, Meier M, Baumgartner T, Zurauskaité G, Gupta S, Mueller B, Devendra A, Schuetz P, Mandaci D, Eren G, Ozturk F, Emir N, Hergunsel O, Azaiez S, Khedher S, Maaoui A, Salem M, Chernevskaya E, Beloborodova N, Bedova A, Sarshor YU, Pautova A, Gusarov V, Öveges N, László I, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Spanuth E, Ebelt H, Ivandic B, Thomae R, Werdan K, El-Shafie M, Taema K, El-Hallag M, Kandeel A, Tayeh O, Taema K, Eldesouky M, Omara A, Winkler MS, Holzmann M, Nierhaus A, Mudersbach E, Schwedhelm E, Daum G, Kluge S, Zoellner C, Greiwe G, Sawari H, Schwedhelm E, Nierhaus A, Kluge S, Kubitz J, Jung R, Daum G, Reichenspurner H, Zoellner C, Winkler MS, Groznik M, Ihan A, Andersen LW, Chase M, Holmberg MJ, Wulff A, Cocchi MN, Donnino MW, Balci C, Haliloglu M, Bilgili B, Bilgin H, Kasapoglu U, Sayan I, Süzer M, Mulazımoglu L, Cinel I, Patel V, Shah S, Parulekar P, Minton C, Patel J, Ejimofo C, Choi H, Costa R, Caruso P, Nassar P, Fu J, Jin J, Xu Y, Kong J, Wu D, Yaguchi A, Klonis A, Ganguly S, Kollef M, Burnham C, Fuller B, Mavrommati A, Chatzilia D, Salla E, Papadaki E, Kamariotis S, Christodoulatos S, Stylianakis A, Alamanos G, Simoes M, Trigo E, Silva N, Martins P, Pimentel J, Baily D, Curran LA, Ahmadnia E, Patel BV, Adukauskiene D, Cyziute J, Adukauskaite A, Pentiokiniene D, Righetti F, Colombaroli E, Castellano G, Wilske F, Skorup P, Lipcsey M, Hanslin K, Larsson A, Sjölin J, Man M, Shum HP, Chan YH, Chan KC, Yan WW, Lee RA, Lau SK, Dilokpattanamongkol P, Thirapakpoomanunt P, Anakkamaetee R, Montakantikul P, Tangsujaritvijit V, Sinha S, Pati J, Sahu S, Adukauskiene D, Valanciene D, Dambrauskiene A, Adukauskiene D, Valanciene D, Dambrauskiene A, Hernandez K, Lopez T, Saca D, Bello M, Mahmood W, Hamed K, Al Badi N, AlThawadi S, Al Hosaini S, Salahuddin N, Cilloniz CC, Ceccato AC, Bassi GLL, Ferrer MF, Gabarrus AG, Ranzani OR, Jose ASS, Vidal CGG, de la Bella Casa JPP, Blasi FB, Torres AT, Adukauskiene D, Ciginskiene A, Dambrauskiene A, Simoliuniene R, Giuliano G, Triunfio D, Sozio E, Taddei E, Brogi E, Sbrana F, Ripoli A, Bertolino G, Tascini C, Forfori F, Fleischmann C, Goldfarb D, Schlattmann P, Schlapbach L, Kissoon N, Baykara N, Akalin H, Arslantas MK, Gavrilovic SG, Vukoja MV, Hache MH, Kashyap RK, Dong YD, Gajic OG, Ranzani O, Shankar-Hari M, Harrison D, Rabello L, Rowan K, Salluh J, Soares M, Markota AM, Fluher JF, Kogler DK, Borovšak ZB, Sinkovic AS, László I, Öveges N, Forgács M, Kiss T, Hankovszky P, Palágyi P, Bebes A, Gubán B, Földesi I, Araczki Á, Telkes M, Ondrik Z, Helyes Z, Kemény Á, Molnár Z, Fareed J, Siddiqui Z, Aggarwal P, Iqbal O, Hoppensteadt D, Lewis M, Wasmund R, Abro S, Raghuvir S, Tsuruta K, Barie PS, Fineberg D, Radford A, Tsuruta K, Casazza A, Vilardo A, Bellazzi E, Boschi R, Ciprandi D, Gigliuto C, Preda R, Vanzino R, Vetere M, Carnevale L, Kyriazopoulou E, Pistiki A, Routsi C, Tsangaris I, Giamarellos-Bourboulis E, Kyriazopoulou E, Tsangaris I, Routsi C, Pnevmatikos I, Vlachogiannis G, Antoniadou E, Mandragos K, Armaganidis A, Giamarellos-Bourboulis E, Allan P, Oehmen R, Luo J, Ellis C, Latham P, Newman J, Pritchett C, Pandya D, Cripps A, Harris S, Jadav M, Langford R, Ko B, Park H, Beumer CM, Koch R, Beuningen DV, Oudelashof AM, Vd Veerdonk FL, Kolwijck E, VanderHoeven JG, Bergmans DC, Hoedemaekers C, Brandt JB, Golej J, Burda G, Mostafa G, Schneider A, Vargha R, Hermon M, Levin P, Broyer C, Assous M, Wiener-Well Y, Dahan M, Benenson S, Ben-Chetrit E, Faux A, Sherazi R, Sethi A, Saha S, Kiselevskiy M, Gromova E, Loginov S, Tchikileva I, Dolzhikova Y, Krotenko N, Vlasenko R, Anisimova N, Spadaro S, Fogagnolo A, Remelli F, Alvisi V, Romanello A, Marangoni E, Volta C, Degrassi A, Mearelli F, Casarsa C, Fiotti N, Biolo G, Cariqueo M, Luengo C, Galvez R, Romero C, Cornejo R, Llanos O, Estuardo N, Alarcon P, Magazi B, Khan S, Pasipanodya J, Eriksson M, Strandberg G, Lipsey M, Larsson A, Rajput Z, Hiscock F, Karadag T, Uwagwu J, Jain S, Molokhia A, Barrasa H, Soraluce A, Uson E, Rodriguez A, Isla A, Martin A, Fernández B, Fonseca F, Sánchez-Izquierdo JA, Maynar FJ, Kaffarnik M, Alraish R, Frey O, Roehr A, Stockmann M, Wicha S, Shortridge D, Castanheira M, Sader HS, Streit JM, Flamm RK, Falsetta K, Lam T, Reidt S, Jancik J, Kinoshita T, Yoshimura J, Yamakawa K, Fujimi S, Armaganidis A, Torres A, Zakynthinos S, Mandragos C, Giamarellos-Bourboulis E, Ramirez P, De la Torre-Prados M, Rodriguez A, Dale G, Wach A, Beni L, Hooftman L, Zwingelstein C, François B, Colin G, Dequin PF, Laterre PF, Perez A, Welte R, Lorenz I, Eller P, Joannidis M, Bellmann R, Lim S, Chana S, Patel S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Thiessen S, Vanhorebeek I, Derde S, Derese I, Dufour T, Albert CN, Langouche L, Goossens C, Peersman N, Vermeersch P, Vander Perre S, Holst J, Wouters P, Van den Berghe G, Liu X, Uber AU, Holmberg M, Konanki V, McNaughton M, Zhang J, Donnino MW, Demirkiran O, Byelyalov A, Luengo C, Guerrero J, Cariqueo M, Scorcella C, Domizi R, Damiani E, Tondi S, Pierantozzi S, Rossini N, Falanga U, Monaldi V, Adrario E, Pelaia P, Donati A, Cole O, Scawn N, Balciunas M, Blascovics I, Vuylsteke A, Salaunkey K, Omar A, Salama A, Allam M, Alkhulaifi A, Verstraete S, Vanhorebeek I, Van Puffelen E, Derese I, Ingels C, Verbruggen S, Wouters P, Joosten K, Hanot J, Guerra G, Vlasselaers D, Lin J, Van den Berghe G, Haines R, Zolfaghari P, Hewson R, Offiah C, Prowle J, Park H, Ko B, Buter H, Veenstra JA, Koopmans M, Boerma EC, Veenstra JA, Buter H, Koopmans M, Boerma EC, Taha A, Shafie A, Hallaj S, Gharaibeh D, Hon H, Bizrane M, El Khattate AA, Madani N, Abouqal R, Belayachi J, Kongpolprom N, Sanguanwong N, Sanaie S, Mahmoodpoor A, Hamishehkar H, Biderman P, Van Heerden P, Avitzur Y, Solomon S, Iakobishvili Z, Carmi U, Gorfil D, Singer P, Paisley C, Patrick-Heselton J, Mogk M, Humphreys J, Welters I, Pierantozzi S, Scorcella C, Domizi R, Damiani E, Tondi S, Casarotta E, Bolognini S, Adrario E, Pelaia P, Donati A, Holmberg MJ, Moskowitz A, Patel P, Grossestreuer A, Uber A, Andersen LW, Donnino MW, Malinverni S, Goedeme D, Mols P, Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W, Manzanares W, Szwec C, Langlois P, Aramendi I, Heyland D, Stankovic N, Nadler J, Uber A, Holmberg M, Sanchez L, Wolfe R, Chase M, Donnino M, Cocchi M, Atalan HK, Gucyetmez B, Kavlak ME, Aslan S, Kargi A, Yazici S, Donmez R, Polat KY, Piechota M, Piechota A, Misztal M, Bernas S, Pietraszek-Grzywaczewska I, Saleh M, Hamdy A, Hamdy A, Elhallag M, Atar F, Kundakci A, Gedik E, Sahinturk H, Zeyneloglu P, Pirat A, Popescu M, Tomescu D, Van Gassel R, Baggerman M, Schaap F, Bol M, Nicolaes G, Beurskens D, Damink SO, Van de Poll M, Horibe M, Sasaki M, Sanui M, Iwasaki E, Sawano H, Goto T, Ikeura T, Hamada T, Oda T, Mayumi T, Kanai T, Kjøsen G, Horneland R, Rydenfelt K, Aandahl E, Tønnessen T, Haugaa H, Lockett P, Evans L, Somerset L, Ker-Reid F, Laver S, Courtney E, Dalton S, Georgiou A, Robinson K, Lam T, Haas B, Reidt S, Bartlett K, Jancik J, Bigwood M, Hanley R, Morgan P, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Zampieri FG, Liborio AB, Besen BA, Cavalcanti AB, Dominedò C, Dell’Anna AM, Monayer A, Grieco DL, Barelli R, Cutuli SL, Maddalena AI, Picconi E, Sonnino C, Sandroni C, Antonelli M, Gucyetmez B, Atalan HK, Tuzuner F, Cakar N, Jacob M, Sahu S, Singh YP, Mehta Y, Yang KY, Kuo S, Rai V, Cheng T, Ertmer C, Czempik P, Hutchings S, Watts S, Wilson C, Burton C, Kirkman E, Drennan D, O’Prey A, MacKay A, Forrest R, Oglinda A, Ciobanu G, Casian M, Oglinda C, Lun CT, Yuen HJ, Ng G, Leung A, So SO, Chan HS, Lai KY, Sanguanwit P, Charoensuk W, Phakdeekitcharoen B, Batres-Baires G, Kammerzell I, Lahmer T, Mayr U, Schmid R, Huber W, Spanuth E, Bomberg H, Klingele M, Thomae R, Groesdonk H, Bernas S, Piechota M, Mirkiewicz K, Pérez AG, Silva J, Ramos A, Acharta F, Perezlindo M, Lovesio L, Antonelli PG, Dogliotti A, Lovesio C, Baron J, Schiefer J, Baron DM, Faybik P, Shum HP, Yan WW, Chan TM, Marouli D, Chatzimichali A, Kolyvaki S, Panteli A, Diamantaki E, Pediaditis E, Sirogianni P, Ginos P, Kondili E, Georgopoulos D, Askitopoulou H, Vicka V, Gineityte D, Ringaitiene D, Sipylaite J, Pekarskiene J, Beurskens DM, Van Smaalen TC, Hoogland P, Winkens B, Christiaans MH, Reutelingsperger CP, Van Heurn E, Nicolaes GA, Schmitt FS, Salgado ES, Friebe JF, Fleming TF, Zemva JZ, Schmoch TS, Uhle FU, Kihm LK, Morath CM, Nusshag CN, Zeier MZ, Bruckner TB, Mehrabi AM, Nawroth PN, Weigand MW, Hofer SH, Brenner TB, Fotopoulou G, Poularas I, Kokkoris S, Brountzos E, Zakynthinos S, Routsi C, Saleh M, Elghonemi M, Nilsson KF, Sandin J, Gustafsson L, Frithiof R, Skorniakov I, Varaksin A, Vikulova D, Shaikh O, Whiteley C, Ostermann M, Di Lascio G, Anicetti L, Bonizzoli M, Fulceri G, Migliaccio ML, Sentina P, Cozzolino M, Peris A, Khadzhynov D, Halleck F, Staeck O, Lehner L, Budde K, Slowinski T, Slowinski T, Kindgen-Milles D, Khadzhynov D, Huysmans N, Laenen MV, Helmschrodt A, Boer W. 37th International Symposium on Intensive Care and Emergency Medicine (part 3 of 3). Crit Care 2017. [PMCID: PMC5374592 DOI: 10.1186/s13054-017-1629-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Westphal E, Pilowski C, Koch S, Ebelt H, Müller-Werdan U, Werdan K, Loppnow H. Endotoxin-activated cultured neonatal rat cardiomyocytes express functional surface-associated interleukin-1α. ACTA ACUST UNITED AC 2016; 13:25-34. [PMID: 17621543 DOI: 10.1177/0968051907078609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/17/2022]
Abstract
Interleukin-1 (IL-1) is a potent regulator of cardiovascular proliferation, apoptosis, contraction or production of inflammatory mediators. Thus, we investigated expression and function of IL-1 in cultured neonatal rat heart cells upon endotoxin stimulation. We show that cultured neonatal rat cardiomyocytes expressed IL—1α and IL—1β mRNA. The cells expressed functional cell-associated IL—1 activity and a specific anti-IL—1α-antibody inhibited the activity. Biologically active IL—1α was present at the cell surface of the cardiomyocytes, as indicated in co-culture experiments. Immunohistochemistry showed IL—1α-staining of the neonatal cardiomyocytes. Although the cells also expressed IL—1β mRNA, we did not detect IL—1β in the supernatants of cultured cardiomyocytes by ELISA or in immunohistochemical staining. Furthermore, neonatal and adult rat heart tissues expressed IL—1α mRNA, whereas fetal, but not adult, human cardiac tissues expressed detectable IL—1α mRNA. In contrast, IL-1β mRNA was present in rat and human fetal and adult samples. Furthermore, in patients with dilated or ischemic cardiomyopathy, we measured IL—1β, but not IL—1α, mRNA. These results provide evidence for the presence of functionally active IL—1α on the cell surface of neonatal rat cardiomyocytes and may suggest a differential role of IL—1α in regulation of cellular functions during development, aging and disease in rat and human heart cells.
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Affiliation(s)
- Elena Westphal
- Martin-Luther-Universität Halle-Wittenberg, Universitätsklinik und Poliklinik für Innere Medizin III, Halle, Germany
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Ebelt H, Geißler I, Ruccius S, Otto V, Hoffmann S, Korth H, Klöckner U, Zhang Y, Li Y, Grossmann C, Rueckschloss U, Gekle M, Stieber J, Frantz S, Werdan K, Müller-Werdan U, Loppnow H. Direct inhibition, but indirect sensitization of pacemaker activity to sympathetic tone by the interaction of endotoxin with HCN-channels. Clin Exp Pharmacol Physiol 2016; 42:874-80. [PMID: 25933122 DOI: 10.1111/1440-1681.12415] [Citation(s) in RCA: 8] [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: 12/10/2014] [Revised: 04/08/2015] [Accepted: 04/19/2015] [Indexed: 01/09/2023]
Abstract
In critically ill patients regulation of heart-rate is often severely disturbed. Interaction of bacterial endotoxin (lipopolysaccharide, LPS) with hyperpolarization-activated cyclic nucleotide-gated cation-(HCN)-channels may interfere with heart-rate regulation. This study analyzes the effect of LPS, the HCN-channel blocker ivabradine or Ca(2+) -channel blockers (nifedipine, verapamil) on pacemaking in spontaneously beating neonatal rat cardiomyocytes (CM) in vitro. In vivo, the effect of LPS on the heart-rate of adult CD1-mice with and without autonomic blockade is analyzed telemetrically. LPS (100 ng/mL) and ivabradine (5 μg/mL) reduced the beating-rate of CM by 20.1% and 24.6%, respectively. Coincubation of CM with both, LPS and ivabradine, did not further reduce the beating-rate, indicating interaction of both compounds with HCN-channels, while coincubation with Ca(2+) -channel blockers and LPS caused additive beating-rate reduction. In CD1-mice (containing an active autonomic-nervous-system), injection of LPS (0.4 mg/kg) expectedly resulted in increased heart-rate. However, if the autonomic nervous system was blocked by propranolol and atropine, in line with the in vitro data, LPS induced a significant reduction of heart-rate, which was not additive to ivabradine. The in vivo and in vitro results indicate that LPS interacts with HCN-channels of cardiomyocytes. Thus, LPS indirectly sensitizes HCN-channels for sympathetic activation (tachycardic-effect), and in parallel directly inhibits channel activity (bradycardic-effect). Both effects may contribute to the detrimental effects of septic cardiomyopathy and septic autonomic dysfunction.
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Affiliation(s)
- Henning Ebelt
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Isabel Geißler
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sara Ruccius
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Volker Otto
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sophie Hoffmann
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Heinrich Korth
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Udo Klöckner
- Julius-Bernstein-Institute of Physiology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Ying Zhang
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Yi Li
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia Grossmann
- Julius-Bernstein-Institute of Physiology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Uwe Rueckschloss
- Julius-Bernstein-Institute of Physiology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Gekle
- Julius-Bernstein-Institute of Physiology, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Juliane Stieber
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen, Erlangen, Germany
| | - Stefan Frantz
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Karl Werdan
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ursula Müller-Werdan
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Chair of Geriatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Harald Loppnow
- Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Geier C, Schröder J, Tamm A, Dietz S, Nuding S, Holder K, Khandanpour Ö, Werdan K, Ebelt H. Influence of the serum levels of immunoglobulins on clinical outcomes in medical intensive-care patients. Med Klin Intensivmed Notfmed 2015; 112:30-37. [PMID: 26681382 DOI: 10.1007/s00063-015-0121-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/27/2015] [Revised: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Endogenous immunoglobulins (Igs) are of fundamental importance in the host defense after microbial infections. However, the therapeutic administration of intravenous IgG (IVIgG) has not yet been shown to improve clinical outcomes in patients suffering from sepsis, and in the case of IgM-containing preparations (IVIgGMA) the positive evidence is only weak. Recently published studies implicate that Ig levels on admission could have an impact on the patient's response to IVIg treatment and on outcomes of critically ill patients. METHODS In this noninterventional study, the serum levels of IgG, IgM, and IgA were determined in 340 medical patients on ICU admission, and clinical outcomes were prospectively recorded (ICU mortality, need for renal replacement therapy (RRT), need for mechanical ventilation, substitution of coagulation factors, and amount of red cell transfusions). Patients were prospectively grouped according to their main reason for ICU admission (sepsis, respiratory failure, cardiovascular diseases, acute renal failure, postoperative condition, state after cardiopulmonal resuscitation, gastrointestinal diseases, and others). RESULTS AND DISCUSSION There was no correlation between the Ig levels on admission and ICU mortality neither in the total cohort of medical ICU patients nor in any prespecified subgroup. However, in a logistic regression model that was adjusted for APACHE II score on admission, an increase in serum IgG was associated with a reduced need for mechanical ventilation in patients suffering from cardiovascular disease. On the other hand, in patients suffering from sepsis, an increased level of IgM was linked to an increased administration of coagulation factors. CONCLUSION Our data do not support the hypothesis that serum levels of immunoglobulins are linked to mortality in medical ICU patients.
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Affiliation(s)
- C Geier
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - J Schröder
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - A Tamm
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - S Dietz
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - S Nuding
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - K Holder
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Ö Khandanpour
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - K Werdan
- Department of Medicine III, University Hospital Halle, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - H Ebelt
- Department of Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
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Braune S, Burchardi H, Engel M, Nierhaus A, Ebelt H, Metschke M, Rosseau S, Kluge S. The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis. BMC Anesthesiol 2015; 15:160. [PMID: 26537233 PMCID: PMC4634813 DOI: 10.1186/s12871-015-0139-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 07/05/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO2R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV). Methods Retrospective ancillary cost analysis of data extracted from a recently published multicentre case–control-study (n = 42) on the use of arterio-venous ECCO2R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO2R system. Results In the group treated with ECCO2R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO2R group (19.610 vs. 46.552 €, p = 0.01). Conclusions Additional costs for the use of arterio-venous ECCO2R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.
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Affiliation(s)
- Stephan Braune
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | | | - Markus Engel
- Department of Cardiology and Intensive Care, Klinikum Bogenhausen, Munich, Germany.
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Henning Ebelt
- Department of Medicine III, University of Halle (Saale), Halle, Germany.
| | - Maria Metschke
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Simone Rosseau
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in Combination with Metoprolol Improves Symptoms and Quality of Life in Patients with Stable Angina Pectoris: A post hoc Analysis from the ADDITIONS Trial. Cardiology 2015; 133:83-90. [PMID: 26501486 DOI: 10.1159/000439584] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/12/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Elevated heart rate can increase myocardial oxygen demand and reduce myocardial perfusion, provoking myocardial ischemia and angina symptoms. We evaluated adding ivabradine to the therapy of patients on metoprolol. METHODS ADDITIONS (prActical Daily efficacy anD safety of Procoralan® In combinaTION with betablockerS) was a multicenter, 4-month, noninterventional, prospective, open-label trial that involved stable-angina patients. Along with metoprolol, patients received ivabradine (5 or 7.5 mg, b.i.d.). We investigated the effect of ivabradine on heart rate, angina attacks, nitrate consumption, quality of life (QoL) and tolerability as well as the influence of baseline heart rate. RESULTS Heart rate fell by 19.7 ± 11.2 bpm, with an 8-fold decrease in weekly angina attacks (1.7 ± 2.2 to 0.2 ± 0.7) and nitrate consumption (2.4 ± 3.4 to 0.3 ± 0.9). Patient numbers in Canadian Cardiovascular Society class I more than doubled (i.e. from 29 to 65%) and QoL improved (the EQ-5D index and visual analog scale scores rose from 0.68 ± 0.27 to 0.84 ± 0.20 and 58.1 ± 18.4 to 72.2 ± 15.5 mm, respectively). The effect of ivabradine was greater in patients with a baseline heart rate ≥70 bpm (mean reduction in heart rate -21.2 ± 10.4 bpm, with a relative reduction in angina attacks and short-acting nitrate consumption of 87.1 and 87.2%, respectively). CONCLUSIONS Ivabradine combined with metoprolol safely and effectively reduces heart rate, angina attacks and nitrate use, and improves QoL in stable-angina patients.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
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Welte T, Dellinger RP, Ebelt H, Ferrer M, Opal SM, Schliephake DE, Wartenberg-Demand A, Werdan K, Löffler K, Torres A. Concept for a study design in patients with severe community-acquired pneumonia: A randomised controlled trial with a novel IGM-enriched immunoglobulin preparation – The CIGMA study. Respir Med 2015; 109:758-67. [DOI: 10.1016/j.rmed.2015.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/11/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, Hennersdorf M, Empen K, Fuernau G, Desch S, de Waha S, Eitel I, Hambrecht R, Böhm M, Kurowski V, Lauer B, Minden HH, Figulla HR, Braun-Dullaeus RC, Strasser RH, Rochor K, Maier SK, Möllmann H, Schneider S, Ebelt H, Werdan K, Zeymer U. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: Design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. Am Heart J 2015; 169:e7-8. [PMID: 25819870 DOI: 10.1016/j.ahj.2015.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in combination with Beta-blockers in patients with chronic stable angina after percutaneous coronary intervention. Adv Ther 2015; 32:120-37. [PMID: 25687888 PMCID: PMC4349945 DOI: 10.1007/s12325-015-0182-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 12/28/2022]
Abstract
Introduction The anti-anginal efficacy of ivabradine is well established. We describe a post hoc analysis in the ADDITIONS database to investigate effectiveness and tolerability of ivabradine in combination with beta-blocker in patients with angina who have had a percutaneous coronary intervention (PCI). Methods ADDITIONS was a non-interventional, multicenter prospective study including 2,330 patients with stable angina. In addition to beta-blocker, patients were treated with ivabradine in approved dosages for 4 months. We divided the population according to whether they had previously had a PCI or not, and explored the effect of ivabradine on heart rate, number of weekly angina attacks, frequency of nitrate consumption, as well as quality of life (QoL) and tolerability. Results Data were available for 2,319 patients, of whom 51.4% had previously had a PCI. There was no difference in the effect of ivabradine on mean heart rate between patients with a previous PCI [64.4 ± 7.6 beats per minute (bpm)] than those without (66.8 ± 8.5 bpm) at 4 months (both P < 0.0001). Similarly, the number of angina attacks decreased from 1.9 ± 2.4 to 0.5 ± 1.5 per week in patients with a previous PCI and 1.5 ± 2.0 to 0.3 ± 1.0 per week in patients without a previous PCI (both P < 0.0001). The frequency of nitrate consumption fell from 2.7 ± 3.7 to 1.0 ± 1.9 per week and 1.8 ± 2.8 to 0.6 ± 1.5 per week (both P < 0.0001) in patients with and without a previous PCI, respectively. There was no difference in the improvements in Canadian Cardiovascular Society class of angina, QoL, and physicians’ assessment of effectiveness and tolerability between patients with a previous PCI and those without. Conclusion Ivabradine is an effective and well-tolerated anti-anginal treatment in patients with stable angina after PCI. Ivabradine reduced the frequency of weekly angina attacks and nitrate consumption, led to an improvement in Canadian Cardiovascular Society class and a substantial improvement in the QoL of stable angina patients. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0182-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
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Hoehn M, Zhang Y, Xu J, Gergs U, Boknik P, Werdan K, Neumann J, Ebelt H. Overexpression of protein phosphatase 2A in a murine model of chronic myocardial infarction leads to increased adverse remodeling but restores the regulation of β-catenin by glycogen synthase kinase 3β. Int J Cardiol 2015; 183:39-46. [PMID: 25662052 DOI: 10.1016/j.ijcard.2015.01.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 07/24/2014] [Revised: 12/24/2014] [Accepted: 01/28/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES Increased activity of cardiac protein phosphatases is an important feature in human heart failure. Several different protein phosphatases (PP) are involved in the regulation of excitation-contraction-coupling of the myocardium. Protein phosphatase 2A (PP2A) is a serine/threonine phosphatase consisting of a dimeric core enzyme and tissue-specific subunits. In this study we used transgenic mice overexpressing PP2A to further investigate the role of PP2A in cardiac remodeling after myocardial infarction. METHODS AND RESULTS Adult male CD-1 mice overexpressing the catalytic subunit α of PP2A (αMHC-PP2A; TG) underwent chronic LAD-ligation or sham surgery, respectively; wildtype littermates (WT) were used as controls. Cardiac function was determined by echocardiography before and 28 days after LAD-ligation. 28 days after MI, the animals were sacrificed and cardiac remodeling was analyzed in histological sections and by Western blots. PP2A overexpression leads to dilated cardiomyopathy in mice, and increased cardiomyocyte hypertrophy and fibrosis of the remote myocardium can be seen after myocardial infarction. However, we found an improved survival of TG in the subacute phase after MI in comparison to WT. On the molecular level, TG shows reduced expression of SERCA and CaMKII alpha both under basal condition as well 28 days after MI. Additionally, the regulation of the Akt/GSK3β/β-catenin pathway is severely disturbed in TG at baseline where a significant activation of Akt is found that coincides with the typical phosphorylation of GSK3β. However, this does not lead to the accumulation of β-catenin - on the contrary: phosphorylation-induced degradation of β-catenin is significantly enhanced. CONCLUSION Transgenic overexpression of myocardial PP2A causes adverse remodeling which coincides with a disruption of the classical Akt/GSK3/β-catenin pathway under baseline conditions that is restored to normal values in chronic myocardial infarction. Even so overall survival of TG after myocardial infarction was not constrained and survival after day 2 post MI was improved.
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Affiliation(s)
- M Hoehn
- Martin Luther University of Halle-Wittenberg, Department of Medicine III, Halle, Germany
| | - Y Zhang
- Martin Luther University of Halle-Wittenberg, Department of Medicine III, Halle, Germany
| | - J Xu
- Martin Luther University of Halle-Wittenberg, Department of Medicine III, Halle, Germany
| | - U Gergs
- Martin Luther University of Halle-Wittenberg, Institute of Pharmacology and Toxicology, Halle, Germany
| | - Peter Boknik
- Institute of Pharmacology and Toxicology, University Hospital, Münster, Germany
| | - K Werdan
- Martin Luther University of Halle-Wittenberg, Department of Medicine III, Halle, Germany
| | - J Neumann
- Martin Luther University of Halle-Wittenberg, Institute of Pharmacology and Toxicology, Halle, Germany
| | - H Ebelt
- Martin Luther University of Halle-Wittenberg, Department of Medicine III, Halle, Germany.
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Kaulen SA, Hübner C, Mieth J, Spindler K, Schwab R, Wimmer R, Wilhelm J, Amoury M, Girndt M, Werdan K, Ebelt H. [Indocyanine green elimination for the evaluation of liver function: prognostic value in patients with community-acquired sepsis]. Med Klin Intensivmed Notfmed 2014; 109:531-40. [PMID: 25179001 DOI: 10.1007/s00063-014-0374-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/26/2014] [Accepted: 04/06/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND The aim of our clinical study was to correlate liver function measured by indocyanine green (ICG) elimination and clinical outcomes in patients with an early stage of community-acquired sepsis (CAS). MATERIALS AND METHODS A total of 341 patients (≥ 18 years) presenting with suspicion of CAS or evidence of an infection and fulfillment of ≥ 2 systemic inflammatory response syndrome (SIRS) criteria were included in the observational study"Prognosis of early sepsis 2" (Prognose der frühen Sepsis 2, ProFS 2). Patients who had been hospitalized within the last 7 days were excluded. In a subgroup of these patients (n = 72) who were transferred to an intensive or intermediate care unit according to the clinical judgment of the treating physicians, ICG elimination (plasma disappearance rate, ICG-PDR; 15 min retention rate, ICG-R15) was assessed by using a noninvasive monitoring system (LiMON, PULSION Medical Systems, Germany). ICG-PDR and -R15 were determined on the day of admission (n = 72) and after 96 h (n = 34). The primary end point of the study was defined as death within 30 days. Secondary endpoints were need for renal replacement therapy, requirement for invasive mechanical ventilation, and length of stay in an intermediate or intensive care unit. RESULTS AND CONCLUSION In contrast to patients with sepsis or severe sepsis, ICG elimination was found to be significantly impaired in patients with septic shock. Furthermore, a significant predictive value of ICG-PDR and -R15 on the day of admission for the need for subsequent renal replacement therapy (n = 12) was observed. In addition, reduced ICG elimination was associated with a longer stay in an intermediate or intensive care unit. However, ICG elimination on admission could not predict 30-day mortality (n = 14) or requirement of mechanical ventilation (n = 20).
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Affiliation(s)
- S A Kaulen
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland,
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Loppnow H, Fu H, Schlecht K, Jaschke C, Riemann D, Bartling B, Hofmann B, Unverzagt S, Großmann J, Spieler F, Koch S, Pilowski C, Hiebl B, Simm A, Silber R, Gielen S, Seliger B, Ebelt H, Müller-Werdan U, Buerke M, Werdan K. Fluvastatin reverses lps-hyporesponsiveness in a monocyte-smc vs. macrophage-smc coculture model. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.235] [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: 10/25/2022]
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Klöckner U, Rueckschloss U, Grossmann C, Matzat S, Schumann K, Ebelt H, Müller-Werdan U, Loppnow H, Werdan K, Gekle M. Inhibition of cardiac pacemaker channel hHCN2 depends on intercalation of lipopolysaccharide into channel-containing membrane microdomains. J Physiol 2013; 592:1199-211. [PMID: 24366264 DOI: 10.1113/jphysiol.2013.268540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Depressed heart rate variability in severe inflammatory diseases can be partially explained by the lipopolysaccharide (LPS)-dependent modulation of cardiac pacemaker channels. Recently, we showed that LPS inhibits pacemaker current in sinoatrial node cells and in HEK293 cells expressing cloned pacemaker channels, respectively. The present study was designed to verify whether this inhibition involves LPS-dependent intracellular signalling and to identify structures of LPS responsible for pacemaker current modulation. We examined the effect of LPS on the activity of human hyperpolarization-activated cyclic nucleotide-gated channel 2 (hHCN2) stably expressed in HEK293 cells. In whole-cell recordings, bath application of LPS decreased pacemaker current (IhHCN2) amplitude. The same protocol had no effect on channel activity in cell-attached patch recordings, in which channels are protected from the LPS-containing bath solution. This demonstrates that LPS must interact directly with or close to the channel protein. After cleavage of LPS into lipid A and the polysaccharide chain, neither of them alone impaired IhHCN2, which suggests that modulation of channel activity critically depends on the integrity of the entire LPS molecule. We furthermore showed that β-cyclodextrin interfered with LPS-dependent channel modulation predominantly via scavenging of lipid A, thereby abrogating the capability of LPS to intercalate into target cell membranes. We conclude that LPS impairs IhHCN2 by a local mechanism that is restricted to the vicinity of the channels. Furthermore, intercalation of lipid A into target cell membranes is a prerequisite for the inhibition that is suggested to depend on the direct interaction of the LPS polysaccharide chain with cardiac pacemaker channels.
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Affiliation(s)
- Udo Klöckner
- Julius Bernstein Institut für Physiologie, Martin Luther Universität Halle-Wittenberg, Magdeburger Strasse 6, 06112 Halle (Saale), Germany.
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Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382:1638-45. [PMID: 24011548 DOI: 10.1016/s0140-6736(13)61783-3] [Citation(s) in RCA: 622] [Impact Index Per Article: 56.5] [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: 12/22/2022]
Abstract
BACKGROUND In current international guidelines the recommendation for intra-aortic balloon pump (IABP) use has been downgraded in cardiogenic shock complicating acute myocardial infarction on the basis of registry data. In the largest randomised trial (IABP-SHOCK II), IABP support did not reduce 30 day mortality compared with control. However, previous trials in cardiogenic shock showed a mortality benefit only at extended follow-up. The present analysis therefore reports 6 and 12 month results. METHODS The IABP-SHOCK II trial was a randomised, open-label, multicentre trial. Patients with cardiogenic shock complicating acute myocardial infarction who were undergoing early revascularisation and optimum medical therapy were randomly assigned (1:1) to IABP versus control via a central web-based system. The primary efficacy endpoint was 30 day all-cause mortality, but 6 and 12 month follow-up was done in addition to quality-of-life assessment for all survivors with the Euroqol-5D questionnaire. A masked central committee adjudicated clinical outcomes. Patients and investigators were not masked to treatment allocation. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00491036. FINDINGS Between June 16, 2009, and March 3, 2012, 600 patients were assigned to IABP (n=301) or control (n=299). Of 595 patients completing 12 month follow-up, 155 (52%) of 299 patients in the IABP group and 152 (51%) of 296 patients in the control group had died (relative risk [RR] 1·01, 95% CI 0·86-1·18, p=0·91). There were no significant differences in reinfarction (RR 2·60, 95% CI 0·95-7·10, p=0·05), recurrent revascularisation (0·91, 0·58-1·41, p=0·77), or stroke (1·50, 0·25-8·84, p=1·00). For survivors, quality-of-life measures including mobility, self-care, usual activities, pain or discomfort, and anxiety or depression did not differ significantly between study groups. INTERPRETATION In patients undergoing early revascularisation for myocardial infarction complicated by cardiogenic shock, IABP did not reduce 12 month all-cause mortality. FUNDING German Research Foundation; German Heart Research Foundation; German Cardiac Society; Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte; University of Leipzig--Heart Centre; Maquet Cardiopulmonary; Teleflex Medical.
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Affiliation(s)
- Holger Thiele
- University of Leipzig-Heart Centre, Leipzig, Germany.
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Abstract
Despite advances in coronary revascularization and widespread use of primary percutaneous interventions, cardiogenic shock complicating an acute ST-elevation myocardial infarction (CSMI) remains a clinical challenge with high mortality rates. Conservative management with catecholamines is associated with serious limitations, including arrhythmias, increased myocardial oxygen consumption, and inadequate circulatory support. Clinicians have therefore turned to mechanical means of circulatory support. Circulatory assist systems for CSMI can be distinguished by the method of placement (i.e. percutaneous vs. surgical), the type of circulatory support (i.e. left ventricular, right ventricular, or biventricular pressure and/or volume unloading), and whether they are combined with extracorporal membrane oxygenation (ECMO). The percutaneous assist systems most commonly used in CSMI are the intra-aortic balloon pump (IABP), venoarterial ECMO, the Impella pump, and the TandemHeart. Decades of clinical studies and experience demonstrated haemodynamic improvement, including elevation of diastolic perfusion pressure and cardiac output. Recently, the large randomized IABP-Shock II Trial did not show a significant reduction in 30-day mortality in CSMI with IABP insertion. There are no randomized study data available for ECMO use in CSMI. Both the Impella pump and the TandemHeart did not reduce 30-day mortality when compared with IABP in small randomized controlled trials (RCTs). In conclusion, despite the need for effective mechanical circulatory support in CSMI, current devices, as tested, have not been demonstrated to improve short- or long-term survival rates. RCTs testing the optimal timing of device therapy and optimal device design are needed to improve outcomes in CSMI.
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Affiliation(s)
- Karl Werdan
- Department of Internal Medicine III, Heart Center, Martin-Luther-University Halle-Wittenberg, University Hospital Halle/Saale, Ernst-Grube-Str. 40, Halle/Saale 06120, Germany
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Werdan K, Ebelt H, Stoeckl G, Nuding S, Hoepfner F, Mueller-Werdan U. Ivabradine in combination with beta-blockers improves ejection fraction and symptom score in patients with stable angina pectoris and left ventricular dysfunction: 1-year follow-up of ADDITIONS study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4016] [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: 11/14/2022] Open
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Werdan K, Ebelt H, Stoeckl G, Nuding S, Hoepfner F, Mueller-Werdan U. Long-term therapy with ivabradine in combination with beta-blockers in patients with stable angina pectoris and effect of beta-blocker background dose: results from the ADDITIONS 1-year follow-up. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tiller D, Russ M, Greiser KH, Nuding S, Ebelt H, Kluttig A, Kors JA, Thiery J, Bruegel M, Haerting J, Werdan K. Prevalence of symptomatic heart failure with reduced and with normal ejection fraction in an elderly general population-the CARLA study. PLoS One 2013; 8:e59225. [PMID: 23555000 PMCID: PMC3598658 DOI: 10.1371/journal.pone.0059225] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 02/14/2013] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES Chronic heart failure (CHF) is one of the most important public health concerns in the industrialized world having increasing incidence and prevalence. Although there are several studies describing the prevalence of heart failure with reduced ejection fraction (HFREF) and heart failure with normal ejection fraction (HFNEF) in selected populations, there are few data regarding the prevalence and the determinants of symptomatic heart failure in the general population. METHODS Cross-sectional data of a population-based German sample (1,779 subjects aged 45-83 years) were analyzed to determine the prevalence and determinants of chronic SHF and HFNEF defined according to the European Society of Cardiology using symptoms, echocardiography and serum NT-proBNP. Prevalence was age-standardized to the German population as of December 31st, 2005. RESULTS The overall age-standardized prevalence of symptomatic CHF was 7.7% (95%CI 6.0-9.8) for men and 9.0% (95%CI 7.0-11.5) for women. The prevalence of CHF strongly increased with age from 3.0% among 45-54- year-old subjects to 22.0% among 75-83- year-old subjects. Symptomatic HFREF could be shown in 48% (n = 78), symptomatic HFNEF in 52% (n = 85) of subjects with CHF. The age-standardized prevalence of HFREF was 3.8 % (95%CI 2.4-5.8) for women and 4.6 % (95%CI 3.6-6.3) for men. The age-standardized prevalence of HFNEF for women and men was 5.1 % (95%CI 3.8-7.0) and 3.0 % (95%CI 2.1-4.5), respectively. Persons with CHF were more likely to have hypertension (PR = 3.4; 95%CI 1.6-7.3) or to have had a previous myocardial infarction (PR = 2.5, 95%CI 1.8-3.5). CONCLUSION The prevalence of symptomatic CHF appears high in this population compared with other studies. While more women were affected by HFNEF than men, more male subjects suffered from HFREF. The high prevalence of symptomatic CHF seems likely to be mainly due to the high prevalence of cardiovascular risk factors in this population.
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Affiliation(s)
- Daniel Tiller
- Institute for Medical Epidemiology, Biostatistics, and Informatics Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Hettwer S, Wilhelm J, Schürmann M, Ebelt H, Hammer D, Amoury M, Hofmann F, Oehme A, Wilhelms D, Kekulé AS, Klöss T, Werdan K. Microbial diagnostics in patients with presumed severe infection in the emergency department. Med Klin Intensivmed Notfmed 2012; 107:53-62. [PMID: 22349478 DOI: 10.1007/s00063-011-0051-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. RESULTS Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only (n=20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0±23.3 vs. 8.8±32.8 ng/ml, p<0.001). This difference was not observed for BC (10.6±25.7 vs. 11.6±44.9 ng/ml, p=0.075). The APACHE II score correlated with PCR (19.2±9.1 vs. 15.8±8.9, p<0.05) and was also higher in positive BC (18.7±8.7 vs. 14.4±8.0, p<0.01). Positive PCR and BC were correlated with negative clinical outcomes (e.g., transfer to ICU, mechanical ventilation, renal replacement therapy, death). CONCLUSION In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.
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Affiliation(s)
- S Hettwer
- Department of Medicine III (Cardiology, Angiology and Medical Intensive Care Medicine), University Clinics Halle Ernst-Grube-Str. 40, 06097 Halle (Saale).
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Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287-96. [PMID: 22920912 DOI: 10.1056/nejmoa1208410] [Citation(s) in RCA: 1628] [Impact Index Per Article: 135.7] [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: 12/13/2022]
Abstract
BACKGROUND In current international guidelines, intraaortic balloon counterpulsation is considered to be a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, evidence is based mainly on registry data, and there is a paucity of randomized clinical trials. METHODS In this randomized, prospective, open-label, multicenter trial, we randomly assigned 600 patients with cardiogenic shock complicating acute myocardial infarction to intraaortic balloon counterpulsation (IABP group, 301 patients) or no intraaortic balloon counterpulsation (control group, 299 patients). All patients were expected to undergo early revascularization (by means of percutaneous coronary intervention or bypass surgery) and to receive the best available medical therapy. The primary efficacy end point was 30-day all-cause mortality. Safety assessments included major bleeding, peripheral ischemic complications, sepsis, and stroke. RESULTS A total of 300 patients in the IABP group and 298 in the control group were included in the analysis of the primary end point. At 30 days, 119 patients in the IABP group (39.7%) and 123 patients in the control group (41.3%) had died (relative risk with IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P=0.69). There were no significant differences in secondary end points or in process-of-care measures, including the time to hemodynamic stabilization, the length of stay in the intensive care unit, serum lactate levels, the dose and duration of catecholamine therapy, and renal function. The IABP group and the control group did not differ significantly with respect to the rates of major bleeding (3.3% and 4.4%, respectively; P=0.51), peripheral ischemic complications (4.3% and 3.4%, P=0.53), sepsis (15.7% and 20.5%, P=0.15), and stroke (0.7% and 1.7%, P=0.28). CONCLUSIONS The use of intraaortic balloon counterpulsation did not significantly reduce 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction for whom an early revascularization strategy was planned. (Funded by the German Research Foundation and others; IABP-SHOCK II ClinicalTrials.gov number, NCT00491036.).
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Affiliation(s)
- Holger Thiele
- University of Leipzig-Heart Center, Department of Internal Medicine/Cardiology, Leipzig, Germany.
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Wilhelm J, Hettwer S, Hammer D, Schürmann M, Christoph A, Amoury M, Klöss T, Finke R, Ebelt H, Werdan K. Outcome prediction using clinical scores and biomarkers in patients with presumed severe infection in the emergency department. Med Klin Intensivmed Notfmed 2012; 107:558-63. [PMID: 22875037 DOI: 10.1007/s00063-012-0147-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/23/2012] [Accepted: 07/03/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND Severe infections play an important role in the emergency department (ED) and early risk stratification is essential. We compared the prognostic value of APACHE II, SOFA, and MEDS scores, and the biomarkers C-reactive protein (CRP), procalcitonin (PCT), and interleukin 6 (IL-6). METHODS We performed a prospective observational study. Patients aged 18 years or older with a severe infection, from whom blood cultures were taken, were included. RESULTS Two hundred and eleven patients were included. The 30-day mortality rate was 8.5%. All scores and biomarkers showed significant area under the curve (AUC) values of receiver operating characteristic curve analysis for death within 30 days: 0.801 for APACHE II, 0.785 for MEDS, 0.708 for SOFA, 0.693 for CRP, 0.651 for PCT, and 0.716 for IL-6. For treatment in an ICU and need for mechanical ventilation, these parameters had significant AUC values, too. For renal replacement therapy, only APACHE II, SOFA, and PCT showed significant AUC values. According to the trend observed, the AUC values were highest for the APACHE II score. CONCLUSIONS All investigated parameters have a predictive value in patients with an infection in the ED. According to the trend observed, the APACHE II score seems to have the best discriminative power. Use of the APACHE II score already at the time of admission to the ED may be useful for stratifying patients at risk for ICU treatment, thereby using the same score in the ED and the ICU.
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Affiliation(s)
- J Wilhelm
- Department of Medicine III, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle (Saale), Germany.
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Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, Hennersdorf M, Empen K, Fuernau G, Desch S, de Waha S, Eitel I, Hambrecht R, Böhm M, Kurowski V, Lauer B, Minden HH, Figulla HR, Braun-Dullaeus RC, Strasser RH, Rochor K, Maier SK, Möllmann H, Schneider S, Ebelt H, Werdan K, Zeymer U. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. Am Heart J 2012; 163:938-45. [PMID: 22709745 DOI: 10.1016/j.ahj.2012.03.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/12/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND In current guidelines, intraaortic balloon pumping (IABP) is considered a class 1 indication in cardiogenic shock complicating acute myocardial infarction. However, evidence is mainly based on retrospective or prospective registries with a lack of randomized clinical trials. Therefore, IABP is currently only used in 20% to 40% of cardiogenic shock cases. The hypothesis of this trial is that IABP in addition to early revascularization by either percutaneous coronary intervention or coronary artery bypass grafting will improve clinical outcome of patients in cardiogenic shock. STUDY DESIGN The IABP-SHOCK II study is a 600-patient, prospective, multicenter, randomized, open-label, controlled trial. The study is designed to compare the efficacy and safety of IABP versus optimal medical therapy on the background of early revascularization by either percutaneous coronary intervention or coronary artery bypass grafting. Patients will be randomized in a 1:1 fashion to 1 of the 2 treatments. The primary efficacy end point of IABP-SHOCK II is 30-day all-cause mortality. Secondary outcome measures, such as hemodynamic, laboratory, and clinical parameters, will serve as surrogate end points for prognosis. Furthermore, an intermediate and long-term follow-up at 6 and 12 months will be performed. Safety will be assessed, by the GUSTO bleeding definition, peripheral ischemic complications, sepsis, and stroke. CONCLUSIONS The IABP-SHOCK II trial addresses important questions regarding the efficacy and safety of IABP in addition to early revascularization in patients with cardiogenic shock complicating myocardial infarction.
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Buerke M, Prondzinsky R, Lemm H, Dietz S, Buerke U, Ebelt H, Bushnaq H, Silber RE, Werdan K. Intra-Aortic Balloon Counterpulsation in the Treatment of Infarction-Related Cardiogenic Shock-Review of the Current Evidence. Artif Organs 2012; 36:505-11. [DOI: 10.1111/j.1525-1594.2011.01408.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kluge S, Braune S, Engel M, Nierhaus A, Frings D, Ebelt H, Uhrig A, Suttorp N, Rosseau S. Intubationsvermeidung bei Patienten mit akutem hyperkapnischem Versagen durch extrakorporale CO2-Eliminierung. Pneumologie 2012. [DOI: 10.1055/s-0032-1302555] [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: 10/28/2022]
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Franke U, Noack F, Bork I, Wollschläger B, Schmidt B, Stiller D, Ebelt H. Ehlers-Danlos-Sydrom und ausgeprägte pulmonale Hypertonie bei rezidivierenden Thrombembolien. Pneumologie 2012. [DOI: 10.1055/s-0032-1302875] [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: 10/28/2022]
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