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Häussler S, Ghaffari MH, Seibt K, Sadri H, Alaedin M, Huber K, Frahm J, Dänicke S, Sauerwein H. Blood and liver telomere length, mitochondrial DNA copy number, and hepatic gene expression of mitochondrial dynamics in mid-lactation cows supplemented with l-carnitine under systemic inflammation. J Dairy Sci 2023; 106:9822-9842. [PMID: 37641324 DOI: 10.3168/jds.2023-23556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
The current study was conducted to examine the effect of l-carnitine (LC) supplementation on telomere length and mitochondrial DNA copy number (mtDNAcn) per cell in mid-lactation cows challenged by lipopolysaccharide (LPS) in blood and liver. The mRNA abundance of 31 genes related to inflammation, oxidative stress, and the corresponding stress response mechanisms, the mitochondrial quality control and the protein import system, as well as the phosphatidylinositol 3-kinase/protein kinase B pathway, were assessed using microfluidics integrated fluidic circuit chips (96.96 dynamic arrays). In addition to comparing the responses in cows with or without LC, our objectives were to characterize the oxidative and inflammatory status by assessing the circulating concentration of lactoferrin (Lf), haptoglobin (Hp), fibrinogen, derivates of reactive oxygen metabolites (dROM), and arylesterase activity (AEA), and to extend the measurement of Lf and Hp to milk. Pluriparous Holstein cows were assigned to either a control group (CON, n = 26) or an LC-supplemented group (CAR; 25 g LC/cow per day; d 42 ante partum to d 126 postpartum (PP), n = 27). On d 111 PP, each cow was injected intravenously with LPS (Escherichia coli O111:B4, 0.5 µg/kg). The mRNA abundance was examined in liver biopsies of d -11 and +1 relative to LPS administration. Plasma and milk samples were frequently collected before and after the challenge. After LPS administration, circulating plasma fibrinogen and serum dROM concentrations increased, whereas AEA decreased. Moreover, serum P4 initially increased by 3 h after LPS administration and declined thereafter irrespective of grouping. The Lf concentrations increased in both groups after LPS administration, with the CAR group showing greater concentrations in serum and milk than the CON group. After LPS administration, telomere length in blood increased, whereas mtDNAcn per cell decreased; however, both remained unaffected in liver. For mitochondrial protein import genes, the hepatic mRNA abundance of the translocase of the mitochondrial inner membrane (TIM)-17B was increased in CAR cows. Moreover, TIM23 increased in both groups after LPS administration. Regarding the mRNA abundance of genes related to stress response mechanisms, 7 out of 14 genes showed group × time interactions, indicating a (local) protective effect due to the dietary LC supplementation against oxidative stress in mid-lactating dairy cows. For mtDNAcn and telomere length, the effects of the LPS-induced inflammation were more pronounced than the dietary supplementation of LC. Dietary LC supplementation affected the response to LPS primarily by altering mitochondrial dynamics. Regarding mRNA abundance of genes related to the mitochondrial protein import system, the inner mitochondrial membrane translocase (TIM complex) seemed to be more sensitive to dietary LC than the outer mitochondrial membrane translocase (TOM complex).
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Affiliation(s)
- S Häussler
- Institute of Animal Science, Physiology Unit, University of Bonn, 53115 Bonn, Germany
| | - M H Ghaffari
- Institute of Animal Science, Physiology Unit, University of Bonn, 53115 Bonn, Germany.
| | - K Seibt
- Institute of Animal Science, Physiology Unit, University of Bonn, 53115 Bonn, Germany
| | - H Sadri
- Department of Clinical Science, Faculty of Veterinary Medicine, University of Tabriz, 516616471 Tabriz, Iran
| | - M Alaedin
- Institute of Animal Science, Physiology Unit, University of Bonn, 53115 Bonn, Germany
| | - K Huber
- Institute of Animal Science, Functional Anatomy of Livestock, University of Hohenheim, 70599 Stuttgart, Germany
| | - J Frahm
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 38116 Braunschweig, Germany
| | - S Dänicke
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, 38116 Braunschweig, Germany
| | - H Sauerwein
- Institute of Animal Science, Physiology Unit, University of Bonn, 53115 Bonn, Germany
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Kar S, Doshi SK, Alkhouli M, Camm AJ, Coylewright M, Gibson MC, Granger CB, Gurol ME, Huber K, Mansour M, Nair DG, Natale A, Pocock SJ, Reddy VR, Saliba W, Christen T, Allocco DJ, Ellenbogen KA, Leon MB. Rationale and design of a randomized study comparing the Watchman FLX device to DOACs in patients with atrial fibrillation. Am Heart J 2023; 264:123-132. [PMID: 37279840 DOI: 10.1016/j.ahj.2023.05.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Percutaneous left atrial appendage (LAA) closure (LAAC) was developed as a nonpharmacologic alternative to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) who are at an increased risk for stroke or systemic embolism. The Watchman device permanently seals off the LAA to prevent thrombi from escaping into the circulation. Previous randomized trials have established the safety and efficacy of LAAC compared to warfarin. However, direct OACs (DOACs) have become the preferred pharmacologic strategy for stroke prevention in patients with AF, and there is limited data comparing Watchman FLX to DOACs in a broad AF patient population. CHAMPION-AF is designed to prospectively determine whether LAAC with Watchman FLX is a reasonable first-line alternative to DOACs in patients with AF who are indicated for OAC therapy. STUDY DESIGN A total of 3,000 patients with a CHA2DS2-VASc score ≥2 (men) or ≥3 (women) were randomized to Watchman FLX or DOAC in a 1:1 allocation at 142 global clinical sites. Patients in the device arm were to be treated with DOAC and aspirin, DOAC alone, or DAPT for at least 3 months postimplant followed by aspirin or P2Y12 inhibitor for 1-year. Control patients were required to take an approved DOAC for the duration of the trial. Clinical follow-up visits are scheduled at 3- and 12-months, and then annually through 5 years; LAA imaging is required at 4 months in the device group. Two primary end points will be evaluated at 3 years: (1) composite of stroke (ischemic/hemorrhagic), cardiovascular death, and systemic embolism compared for noninferiority, and (2) nonprocedural bleeding (International Society on Thrombosis and Haemostasis [ISTH] major and clinically relevant nonmajor bleeding) tested for superiority in the device arm against DOACs. The third primary noninferiority end point is the composite of ischemic stroke and systemic embolism at 5 years. Secondary end points include 3- and 5-year rates of (1) ISTH-defined major bleeding and (2) the composite of cardiovascular death, all stroke, systemic embolism, and nonprocedural ISTH bleeding. CONCLUSIONS This study will prospectively evaluate whether LAAC with the Watchman FLX device is a reasonable alternative to DOACs in patients with AF. CLINICAL TRIAL REGISTRATION NCT04394546.
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Affiliation(s)
- Saibal Kar
- Los Robles Medical Center, Thousand Oaks, CA.
| | | | | | - A John Camm
- St. Georges University of London, London, United Kingdom
| | | | - Michael C Gibson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Mahmut E Gurol
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth Huber
- St Luke's Mid America Heart Institute, Kansas City, MO
| | | | - Devi G Nair
- St Bernard's Medical Center & Arrhythmia Research Group, Jonesboro, AR
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX
| | - Stuart J Pocock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vivek R Reddy
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Martin B Leon
- Columbia University Medical Center/NewYork Presbyterian Hospital, New York, NY
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Frers F, Delarocque J, Huber K, Feige K, Warnken T. Comparison of a modified 2-step insulin response test performed with porcine zinc insulin and an oral glucose test to detect hyperinsulinemic Icelandic horses. Vet J 2023; 298-299:106012. [PMID: 37348701 DOI: 10.1016/j.tvjl.2023.106012] [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: 09/23/2022] [Revised: 06/10/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Both, oral and intravenous (IV) testing protocols, are recommended and still used to detect insulin dysregulation (ID) in equids. However, IV tests mainly focus on peripheral insulin resistance (IR), while oral tests assess hyperinsulinemia (HI), which are different aspects of ID. The objective of this study was to describe if horses with HI also demonstrate IR and consequently can be detected by a modified 2-step insulin response test (2-step IRT) performed with a veterinary approved porcine zinc insulin (PZI). Twelve Icelandic horses were subjected to an OGT and 2-step IRT in a crossover study. Serum insulin concentrations during the OGT revealed that six horses were hyperinsulinemic (HI) while six were not (NON-HI). To describe the glucose response to IV injected PZI, the decline of plasma glucose concentration within the first 30 min was analyzed. Glucose reduction was similar in horses with and without HI during the 2-step IRT over time. Additionally, none of the horses reached a glucose reduction of ≥ 50% at 30 min. The results of the present study indicated that a comparable insulin mediated glucose uptake may be observed in horses with and without HI during a modified 2-step IRT. While six out of twelve horses were identified as HI by the OGT, all twelve horses were identified as IR by the modified 2-step IRT performed with PZI underlining the importance, but difficulty in choosing the right diagnostic tool in clinical settings to assess ID.
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Affiliation(s)
- F Frers
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hanover, Germany.
| | - J Delarocque
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hanover, Germany
| | - K Huber
- Institute of Animal Science, Faculty of Agricultural Sciences, University of Hohenheim, Fruwirthstr. 35, 70599 Stuttgart, Germany
| | - K Feige
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hanover, Germany
| | - T Warnken
- Clinic for Horses, University of Veterinary Medicine Hannover, Foundation, Buenteweg 9, 30559 Hanover, Germany
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Huber K, Dreos R, Geller S, Barquissau V, Ziegler D, Tavernari D, Giralt A, Gallart-Ayala H, Ciriello G, Ivanisevic J, Pichler M, Fajas L. 57P Deciphering the role of E2F transcription factor-1 in glutamine metabolism. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100915] [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: 03/11/2023] Open
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian V, Al Mahmeed WAR, Kzhdryan H, Dumont C, Geppert A, Bajramovic NS, Cader FA, Beauloye C, Quesada D, Hlinomaz O, Liebetrau C, Marandi T, Shokry K, Bueno H, Kovacevic M, Crnomarkovic B, Cankovic M, Dabovic D, Jarakovic M, Pantic T, Trajkovic M, Pupic L, Ruzicic D, Cvetanovic D, Mansourati J, Obradovic I, Stankovic M, Loh PH, Kong W, Poh KK, Sia CH, Saw K, Liška D, Brozmannová D, Gbur M, Gale CP, Maxian R, Kovacic D, Poznic NG, Keric T, Kotnik G, Cercek M, Steblovnik K, Sustersic M, Cercek AC, Djokic I, Maisuradze D, Drnovsek B, Lipar L, Mocilnik M, Pleskovic A, Lainscak M, Crncic D, Nikojajevic I, Tibaut M, Cigut M, Leskovar B, Sinanis T, Furlan T, Grilj V, Rezun M, Mateo VM, Anguita MJF, Bustinza ICM, Quintana RB, Cimadevilla OCF, Fuertes J, Lopez F, Dharma S, Martin MD, Martinez L, Barrabes JA, Bañeras J, Belahnech Y, Ferreira-Gonzalez I, Jordan P, Lidon RM, Mila L, Sambola A, Orvin K, Sionis A, Bragagnini W, Cambra AD, Simon C, Burdeus MV, Ariza-Solé A, Alegre O, Alsina M, Ferrando JIL, Bosch X, Sinha A, Vidal P, Izquierdo M, Marin F, Esteve-Pastor MA, Tello-Montoliu A, Lopez-Garcia C, Rivera-Caravaca JM, Gil-Pérez P, Nicolas-Franco S, Keituqwa I, Farhan HA, Silva L, Blasco A, Escudier JM, Ortega J, Zamorano JL, Sanmartin M, Pereda DC, Rincon LM, Gonzalez P, Casado T, Sadeghipour P, Lopez-Sendon JL, Manjavacas AMI, Marin LAM, Sotelo LR, Rodriguez SOR, Bueno H, Martin R, Maruri R, Moreno G, Moris C, Gudmundsdottir I, Avanzas P, Ayesta A, Junco-Vicente A, Cubero-Gallego H, Pascual I, Sola NB, Rodriguez OA, Malagon L, Martinez-Basterra J, Arizcuren AM, Indolfi C, Romero J, Calleja AG, Fuertes DG, Crespín Crespín M, Bernal FJC, Ojeda FB, Padron AL, Cabeza MM, Vargas CM, Yanes G, Kitai T, Gonzalez MJG, Gonzalez Gonzalez J, Jorge P, De La Fuente B, Bermúdez MG, Perez-Lopez CMB, Basiero AB, Ruiz AC, Pamias RF, Chamero PS, Mirrakhimov E, Hidalgo-Urbano R, Garcia-Rubira JC, Seoane-Garcia T, Arroyo-Monino DF, Ruiz AB, Sanz-Girgas E, Bonet G, Rodríguez-López J, Scardino C, De Sousa D, Gustiene O, Elbasheer E, Humida A, Mahmoud H, Mohamed A, Hamid E, Hussein S, Abdelhameed M, Ali T, Ali Y, Eltayeb M, Philippe F, Ali M, Almubarak E, Badri M, Altaher S, Alla MD, Dellborg M, Dellborg H, Hultsberg-Olsson G, Marjeh YB, Abdin A, Erglis A, Alhussein F, Mgazeel F, Hammami R, Abid L, Bahloul A, Charfeddine S, Ellouze T, Canpolat U, Oksul M, Muderrisoglu H, Popovici M, Karacaglar E, Akgun A, Ari H, Ari S, Can V, Tuncay B, Kaya H, Dursun L, Kalenderoglu K, Tasar O, Kalpak O, Kilic S, Kucukosmanoglu M, Aytekin V, Baydar O, Demirci Y, Gürsoy E, Kilic A, Yildiz Ö, Arat-Ozkan A, Sinan UY, Dagva M, Gungor B, Sekerci SS, Zeren G, Erturk M, Demir AR, Yildirim C, Can C, Kayikcioglu M, Yagmur B, Oney S, Xuereb RG, Sabanoglu C, Inanc IH, Ziyrek M, Sen T, Astarcioglu MA, Kahraman F, Utku O, Celik A, Surmeli AO, Basaran O, Ahmad WAW, Demirbag R, Besli F, Gungoren F, Ingabire P, Mondo C, Ssemanda S, Semu T, Mulla AA, Atos JS, Wajid I, Appelman Y, Al Mahmeed WAR, Atallah B, Bakr K, Garrod R, Makia F, Eldeeb F, Abdekader R, Gomaa A, Kandasamy S, Maruthanayagam R, Nadar SK, Nakad G, Nair R, Mota P, Prior P, Mcdonald S, Rand J, Schumacher N, Abraheem A, Clark M, Coulding M, Qamar N, Turner V, Negahban AQ, Crew A, Hope S, Howson J, Jones S, Lancaster N, Nicholson A, Wray G, Donnelly P, Gierlotka M, Hammond L, Hammond S, Regan S, Watkin R, Papadopoulos C, Ludman P, Hutton K, Macdonald S, Nilsson A, Roberts S, Monteiro S, Garg S, Balachandran K, Mcdonald J, Singh R, Marsden K, Davies K, Desai H, Goddard W, Iqbal N, Chalil S, Dan GA, Galasko G, Assaf O, Benham L, Brown J, Collins S, Fleming C, Glen J, Mitchell M, Preston S, Uttley A, Radovanovic M, Lindsay S, Akhtar N, Atkinson C, Vinod M, Wilson A, Clifford P, Firoozan S, Yashoman M, Bowers N, Chaplin J, Reznik EV, Harvey S, Kononen M, Lopesdesousa G, Saraiva F, Sharma S, Cruddas E, Law J, Young E, Hoye A, Harper P, Balghith M, Rowe K, Been M, Cummins H, French E, Gibson C, Abraham JA, Hobson S, Kay A, Kent M, Wilkinson A, Mohamed A, Clark S, Duncan L, Ahmed IM, Khatiwada D, Mccarrick A, Wanda I, Read P, Afsar A, Rivers V, Theobald T, Cercek M, Bell S, Buckman C, Francis R, Peters G, Stables R, Morgan M, Noorzadeh M, Taylor B, Twiss S, Widdows P, Brozmannová D, Wilkinson V, Black M, Clark A, Clarkson N, Currie J, George L, Mcgee C, Izzat L, Lewis T, Omar Z, Aytekin V, Phillips S, Ahmed F, Mackie S, Oommen A, Phillips H, Sherwood M, Aleti S, Charles T, Jose M, Kolakaluri L, Ingabire P, Karoudi RA, Deery J, Hazelton T, Knight A, Price C, Turney S, Kardos A, Williams F, Wren L, Bega G, Alyavi B, Scaletta D, Kunadian V, Cullen K, Jones S, Kirkup E, Ripley DP, Matthews IG, Mcleod A, Runnett C, Thomas HE, Cartasegna L, Gunarathne A, Burton J, King R, Quinn J, Sobolewska J, Munt S, Porter J, Christenssen V, Leng K, Peachey T, Gomez VN, Temple N, Wells K, Viswanathan G, Taneja A, Cann E, Eglinton C, Hyams B, Jones E, Reed F, Smith J, Beltrano C, Affleck DC, Turner A, Ward T, Wilmshurst N, Stirrup J, Brunton M, Whyte A, Smith S, Murray V, Walker R, Novas V, Weston C, Brown C, Collier D, Curtis K, Dixon K, Wells T, Trim F, Ghosh J, Mavuri M, Barman L, Dumont C, Elliott K, Harrison R, Mallinson J, Neale T, Smith J, Toohie J, Turnbull A, Parker E, Hossain R, Cheeseman M, Balparda H, Hill J, Hood M, Hutchinson D, Mellows K, Pendlebury C, Storey RF, Barker J, Birchall K, Denney H, Housley K, Cardona M, Middle J, Kukreja N, Gati S, Kirk P, Lynch M, Srinivasan M, Szygula J, Baker P, Cruz C, Derigay J, Cigalini C, Lamb K, Nembhard S, Price A, Mamas M, Massey I, Wain J, Delaney J, Junejo S, Martin K, Obaid D, Hoyle V, Brinkworth E, Davies C, Evans D, Richards S, Thomas C, Williams M, Dayer M, Mills H, Roberts K, Goodchild F, Dámaso ES, Greig N, Kundu S, Donaldson D, Tonks L, Beekes M, Button H, Hurford F, Motherwell N, Summers-Wall J, Felmeden D, Tapia V, Keeling P, Sheikh U, Yonis A, Felmeden L, Hughes D, Micklewright L, Summerhayes A, Sutton J, Panoulas V, Prendergast C, Poghosyan K, Rogers P, Barker LN, Batin P, Conway D, Exley D, Fletcher A, Wright J, Nageh T, Hadebe B, Kunhunny S, Mkhitaryan S, Mshengu E, Karthikeyan VJ, Hamdan H, Cooper J, Dandy C, Parkinson V, Paterson P, Reddington S, Taylor T, Tierney C, Adamyan M, Jones KV, Broadley A, Beesley K, Buckley C, Hellyer C, Pippard L, Pitt-Kerby T, Azam J, Hayes C, Freshwater K, Boyadjian S, Johnson L, Mcgill Y, Redfearn H, Russell M, Alyavi A, Alyavi B, Uzokov J, Hayrapetyan H, Azaryan K, Tadevosyan M, Poghosyan H, Kzhdryan H, Vardanyan A, Huber K, Geppert A, Ahmed A, Weidinger F, Derntl M, Hasun M, Schuh-Eiring T, Riegler L, Haq MM, Cader FA, Dewan MAM, Fatema ME, Hasan AS, Islam MM, Khandoker F, Mayedah R, Nizam SU, Azam MG, Arefin MM, Jahan J, Schelfaut D, De Raedt H, Wouters S, Aerts S, Batjoens H, Beauloye C, Dechamps M, Pierard S, Van Caenegem O, Sinnaeve F, Claeys MJ, Snepvangers M, Somers V, Gevaert S, Schaubroek H, Vervaet P, Buysse M, Renders F, Dumoulein M, Hiltrop N, De Coninck M, Naessens S, Senesael I, Hoffer E, Pourbaix S, Beckers J, Dugauquier C, Jacquet S, Malmendier D, Massoz M, Evrard P, Collard L, Brunner P, Carlier S, Blockmans M, Mayne D, Timiras E, Guédès A, Demeure F, Hanet C, Domange J, Jourdan K, Begic E, Custovic F, Dozic A, Hrvat E, Kurbasic I, Mackic D, Subo A, Durak-Nalbantic A, Dzubur A, Rebic D, Hamzic-Mehmedbasic A, Redzepovic A, Djokic-Vejzovic A, Hodzic E, Hujdur M, Musija E, Gljiva-Gogic Z, Serdarevic N, Bajramovic NS, Brigic L, Halilcevic M, Cibo M, Hadžibegic N, Kukavica N, Begic A, Iglica A, Osmanagic A, Resic N, Grgurevic MV, Zvizdic F, Pojskic B, Mujaric E, Selimovic H, Ejubovic M, Pojskic L, Stimjanin E, Sut M, Zapata PS, Munoz CG, Andrade LAF, Upegui MPT, Perez LE, Chavarria J, Quesada D, Alvarado K, Zaputovic L, Tomulic V, Gobic D, Jakljevic T, Lulic D, Bacic G, Bastiancic L, Avraamides P, Eftychiou C, Eteocleous N, Ioannou A, Lambrianidi C, Drakomathioulakis M, Groch L, Hlinomaz O, Rezek M, Semenka J, Sitar J, Beranova M, Kramarikova P, Pesl L, Sindelarova S, Tousek F, Warda HM, Ghaly I, Habiba S, Habib A, Gergis MN, Bahaa H, Samir A, Taha HSE, Adel M, Algamal HM, Mamdouh M, Shaker AF, Shokry K, Konsoah A, Mostafa AM, Ibrahim A, Imam A, Hafez B, Zahran A, Abdelhamid M, Mahmoud K, Mostafa A, Samir A, Abdrabou M, Kamal A, Sallam S, Ali A, Maghraby K, Atta AR, Saad A, Ali M, Lotman EM, Lubi R, Kaljumäe H, Uuetoa T, Kiitam U, Durier C, Ressencourt O, El Din AA, Guiatni A, Bras ML, Mougenot E, Labeque JN, Banos JL, Capendeguy O, Mansourati J, Fofana A, Augagneur M, Bahon L, Pape AL, Batias-Moreau L, Fluttaz A, Good F, Prieur F, Boiffard E, Derien AS, Drapeau I, Roy N, Perret T, Dubreuil O, Ranc S, Rio S, Bonnet JL, Bonnet G, Cuisset T, Deharo P, Mouret JP, Spychaj JC, Blondelon A, Delarche N, Decalf V, Guillard N, Hakme A, Roger MP, Biron Y, Druelles P, Loubeyre C, Lucon A, Hery P, Nejjari M, Digne F, Huchet F, Neykova A, Tzvetkov B, Larrieu M, Quaino G, Armangau P, Sauguet A, Bonfils L, Dumonteil N, Fajadet J, Farah B, Honton B, Monteil B, Philippart R, Tchetche D, Cottin M, Petit F, Piquart A, Popovic B, Varlot J, Maisuradze D, Sagirashvili E, Kereselidze Z, Totladze L, Ginturi T, Lagvilava D, Hamm C, Liebetrau C, Haas M, Hamm C, Koerschgen T, Weferling M, Wolter JS, Maier K, Nickenig G, Sedaghat A, Zachoval C, Lampropoulos K, Mpatsouli A, Sakellaropoulou A, Tyrovolas K, Zibounoumi N, Argyropoulos K, Toulgaridis F, Kolyviras A, Tzanis G, Tzifos V, Milkas A, Papaioannou S, Kyriazopoulos K, Pylarinou V, Kontonassakis I, Kotakos C, Kourgiannidis G, Ntoliou P, Parzakonis N, Pipertzi A, Sakalidis A, Ververeli CL, Kafkala K, Sinanis T, Diakakis G, Grammatikopoulos K, Papoutsaki E, Patialiatos T, Mamaloukaki M, Papadaki ST, Kanellos IE, Antoniou A, Tsinopoulos G, Goudis C, Giannadaki M, Daios S, Petridou M, Skantzis P, Koukis P, Dimitriadis F, Savvidis M, Styliadis I, Sachpekidis V, Pilalidou A, Stamatiadis N, Fotoglidis A, Karakanas A, Ruzsa Z, Becker D, Nowotta F, Gudmundsdottir I, Libungan B, Skuladottir FB, Halldorsdottir H, Shetty R, Iyengar S, Bs C, G S, Lakshmana S, S R, Tripathy N, Sinha A, Choudhary B, Kumar A, Kumar A, Raj R, Roy RS, Dharma S, Siswanto BB, Farhan HA, Yaseen IF, Al-Zaidi M, Dakhil Z, Amen S, Rasool B, Rajeeb A, Amber K, Ali HH, Al-Kinani T, Almyahi MH, Al-Obaidi F, Masoumi G, Sadeghi M, Heshmat-Ghahdarijani K, Roohafza H, Sarrafzadegan N, Shafeie M, Teimouri-Jervekani Z, Noori F, Kyavar M, Sadeghipour P, Firouzi A, Alemzadeh-Ansari MJ, Ghadrdoost B, Golpira R, Ghorbani A, Ahangari F, Salarifar M, Jenab Y, Biria A, Haghighi S, Mansouri P, Yadangi S, Kornowski R, Orvin K, Eisen A, Oginetz N, Vizel R, Kfir H, Pasquale GD, Casella G, Cardelli LS, Filippini E, Zagnoni S, Donazzan L, Ermacora D, Indolfi C, Polimeni A, Curcio A, Mongiardo A, De Rosa S, Sorrentino S, Spaccarotella C, Landolina M, Marino M, Cacucci M, Vailati L, Bernabò P, Montisci R, Meloni L, Marchetti MF, Biddau M, Garau E, Barbato E, Morisco C, Strisciuglio T, Canciello G, Lorenzoni G, Casu G, Merella P, Novo G, D'Agostino A, Di Lisi D, Di Palermo A, Evola S, Immordino F, Rossetto L, Spica G, Pavan D, Mattia AD, Belfiore R, Grandis U, Vendrametto F, Spagnolo C, Carniel L, Sonego E, Gaudio C, Barillà F, Biccire FG, Bruno N, Ferrari I, Paravati V, Torromeo C, Galasso G, Peluso A, Prota C, Radano I, Benvenga RM, Ferraioli D, Anselmi M, Frigo GM, Sinagra G, Merlo M, Perkan A, Ramani F, Altinier A, Fabris E, Rinaldi M, Usmiani T, Checco L, Frea S, Mussida M, Matsukawa R, Sugi K, Kitai T, Furukawa Y, Masumoto A, Miyoshi Y, Nishino S, Assembekov B, Amirov B, Chernokurova Y, Ibragimova F, Mirrakhimov E, Ibraimova A, Murataliev T, Radzhapova Z, Uulu ES, Zhanyshbekova N, Zventsova V, Erglis A, Bondare L, Zaliunas R, Gustiene O, Dirsiene R, Marcinkeviciene J, Sakalyte G, Virbickiene A, Baksyte G, Bardauskiene L, Gelmaniene R, Salkauskaite A, Ziubryte G, Kupstyte-Kristapone N, Badariene J, Balciute S, Kapleriene L, Lizaitis M, Marinskiene J, Navickaite A, Pilkiene A, Ramanauskaite D, Serpytis R, Silinskiene D, Simbelyte T, Staigyte J, Philippe F, Degrell P, Camus E, Ahmad WAW, Kassim ZA, Xuereb RG, Buttigieg LL, Camilleri W, Pllaha E, Xuereb S, Popovici M, Ivanov V, Plugaru A, Moscalu V, Popovici I, Abras M, Ciobanu L, Litvinenco N, Fuior S, Dumanschi C, Ivanov M, Danila T, Grib L, Filimon S, Cardaniuc L, Batrinac A, Tasnic M, Cozma C, Revenco V, Sorici G, Dagva M, Choijiljav G, Dandar E, Khurelbaatar MU, Tsognemekh B, Appelman Y, Den Hartog A, Kolste HJT, Van Den Buijs D, Van'T Hof A, Pustjens T, Houben V, Kasperski I, Ten Berg J, Azzahhafi J, Bor W, Yin DCP, Mbakwem A, Amadi C, Kushimo O, Kilasho M, Oronsaye E, Bakracheski N, Bashuroska EK, Mojsovska V, Tupare S, Dejan M, Jovanoska J, Razmoski D, Marinoski T, Antovski A, Jovanovski Z, Kocho S, Markovski R, Ristovski V, Samir AB, Biserka S, Kalpak O, Peovska IM, Taleska BZ, Pejkov H, Busljetik O, Zimbakov Z, Grueva E, Bojovski I, Tutic M, Poposka L, Vavlukis M, Al-Riyami A, Nadar SK, Abdelmottaleb W, Ahmed S, Mujtaba MS, Al-Mashari S, Al-Riyami H, Laghari AH, Faheem O, Ahmed SW, Qamar N, Furnaz S, Kazmi K, Saghir T, Aneel A, Asim A, Madiha F, Sobkowicz B, Tycinska A, Kazimierczyk E, Szyszkowska A, Mizia-Stec K, Wybraniec M, Bednarek A, Glowacki K, Prokopczuk J, Babinski W, Blachut A, Kosiak M, Kusinska A, Samborski S, Stachura J, Szastok H, Wester A, Bartoszewska D, Sosnowska-Pasiarska B, Krzysiek M, Legutko J, Nawrotek B, Kasprzak JD, Klosinska M, Wiklo K, Kurpesa M, Rechcinski T, Cieslik-Guerra U, Gierlotka M, Bugajski J, Feusette P, Sacha J, Przybylo P, Krzesinski P, Ryczek R, Karasek A, Kazmierczak-Dziuk A, Mielniczuk M, Betkier-Lipinska K, Roik M, Labyk A, Krakowian M, Machowski M, Paczynska M, Potepa M, Pruszczyk P, Budaj A, Ambroziak M, Omelanczuk-Wiech E, Torun A, Opolski G, Glowczynska R, Fojt A, Kowalik R, Huczek Z, Jedrzejczyk S, Roleder T, Brust K, Gasior M, Desperak P, Hawranek M, Farto-Abreu P, Santos M, Baptista S, Brizida L, Faria D, Loureiro J, Magno P, Monteiro C, Nédio M, Tavares J, Sousa C, Almeida I, Almeida S, Miranda H, Santos H, Santos AP, Goncalves L, Monteiro S, Baptista R, Ferreira C, Ferreira J, Goncalves F, Lourenço C, Monteiro P, Picarra B, Santos AR, Guerreiro RA, Carias M, Carrington M, Pais J, de Figueiredo MP, Rocha AR, Mimoso J, De Jesus I, Fernandes R, Guedes J, Mota T, Mendes M, Ferreira J, Tralhão A, Aguiar CT, Strong C, Da Gama FF, Pais G, Timóteo AT, Rosa SAO, Mano T, Reis J, Selas M, Mendes DE, Satendra M, Pinto P, Queirós C, Oliveira I, Reis L, Cruz I, Fernandes R, Torres S, Luz A, Campinas A, Costa R, Frias A, Oliveira M, Martins V, Castilho B, Coelho C, Moura AR, Cotrim N, Dos Santos RC, Custodio P, Duarte R, Gomes R, Matias F, Mendonca C, Neiva J, Rabacal C, Almeida AR, Caeiro D, Queiroz P, Silva G, Pop-Moldovan AL, Darabantiu D, Mercea S, Dan GA, Dan AR, Dobranici M, Popescu RA, Adam C, Sinescu CJ, Andrei CL, Brezeanu R, Samoila N, Baluta MM, Pop D, Tomoaia R, Istratoaie O, Donoiu I, Cojocaru A, Oprita OC, Rocsoreanu A, Grecu M, Ailoaei S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Zweiker D, Pogran E, Gargiulo L, El-Razek A, Vosko I, Rechberger S, Bugger H, Christ G, Bonderman D, Kunschitz E, Zirlik A, Bauer A, Metzler B, Steinwender C, Huber K. Neutrophile-lymphocyte ratio and outcome in takotsubo syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Takotsubo syndrome (TTS) is an important form of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients by concentrating on routine laboratory parameters at admission.
Methods
In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of identified predictors with long-term survival was evaluated.
Results
A total of 338 patients (median age 72 years, 86.9% female) from 6 centres were included. Severe in-hospital complications occurred in 14.5% of patients, including cardiogenic shock (9.8%), death (3.3%) and intubation (1.2%), respectively. Patients with complications during the hospital stay had more prevalent chronic kidney disease (CKD), were less often previous smokers and TTS was less often preceded by an emotional trigger. C-reactive protein and neutrophile lymphocyte ratio (NLR) was higher in patients with complications, and midventricular ballooning and reduced left ventricular ejection fraction (LVEF) were more prevalent. In multivariable analysis, high NLR (OR 1.04 [95% CI 1.02–1.07], p=0.009) and low LVEF (OR 0.92 [0.90–0.95] per %, p<0.001) remained significant predictors for severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were associated with significantly reduced 5-year survival.
Discussion
Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short and long-term outcome after TTS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Zweiker
- Ottakring Clinic, 3rd Medical Department, Cardiology and Intensive Care Medicine , Vienna , Austria
| | - E Pogran
- Ottakring Clinic, 3rd Medical Department, Cardiology and Intensive Care Medicine , Vienna , Austria
| | - L Gargiulo
- Sigmund Freud University, Medical School , Vienna , Austria
| | - A El-Razek
- Medical University of Innsbruck, Clinic for Internal Medicine III - Cardiology and Angiology , Innsbruck , Austria
| | - I Vosko
- Medical University of Graz, Division of Cardiology , Graz , Austria
| | - S Rechberger
- Kepler University Hospital Linz, Department of Cardiology and Intensive Medicine , Linz , Austria
| | - H Bugger
- Medical University of Graz, Division of Cardiology , Graz , Austria
| | - G Christ
- Clinic Favoriten, 5th Medical Department for Cardiology , Vienna , Austria
| | - D Bonderman
- Clinic Favoriten, 5th Medical Department for Cardiology , Vienna , Austria
| | - E Kunschitz
- Hanusch Hospital, 2nd Medical Department , Vienna , Austria
| | - A Zirlik
- Medical University of Graz, Division of Cardiology , Graz , Austria
| | - A Bauer
- Medical University of Innsbruck, Clinic for Internal Medicine III - Cardiology and Angiology , Innsbruck , Austria
| | - B Metzler
- Medical University of Innsbruck, Clinic for Internal Medicine III - Cardiology and Angiology , Innsbruck , Austria
| | - C Steinwender
- Kepler University Hospital Linz, Department of Cardiology and Intensive Medicine , Linz , Austria
| | - K Huber
- Ottakring Clinic, 3rd Medical Department, Cardiology and Intensive Care Medicine , Vienna , Austria
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7
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Mendieta Badimon G, Mehta S, Baber U, Collier T, Dangas G, Sharma SK, Cohen DJ, Angiolillo D, Briguori C, Escaned J, Gabriel Steg P, Huber K, Michael Gibson C, Pocock S, Mehran R. Effect of aspirin discontinuation according to individualised patient bleeding and ischemic risks after PCI: a TWILIGHT trial sub-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The TWILIGHT trial demonstrated a reduction in BARC 2, 3 or 5 (BARC-235) bleeding without an increase in ischemic events at 1-year in high-risk PCI patients randomized to placebo or aspirin (ASA) on a background of ticagrelor 3-months after PCI. However, the effect of ASA discontinuation according to baseline risk of bleeding and ischemic events remain unclear.
Purpose
To a) develop separate models to predict the risk of bleeding and ischemic events, and b) to assess treatment effect of ASA discontinuation across the risk strata.
Methods
Using the TWILIGHT patient database (N=7,119), two multivariable models, one for BARC-235 bleeding and one for CV death, nonfatal MI or nonfatal ischemic stroke (ischemic endpoint) were developed, and their predictive capacity was assessed. The effect of randomized treatment on bleeding and ischemic events across different patient risk-group categories as determined by the risk scores was investigated.
Results
At 1-year, 350 (5.4%) patients experienced a BARC-235 bleeding event and 258 (3.6%) experienced an ischemic event. Independent predictors of BARC-235 included haemoglobin levels at index PCI, proton-pump inhibitor non-use at discharge, age, liver disease and active smoking (c-statistic 0.64). Independent predictors of the ischemic outcome included a positive troponin ACS, prior CABG, diabetes, age, peripheral artery disease, prior PCI, a history of congestive heart failure, active smoking, the level of index PCI complexity, and prior MI (c-statistic 0.71). The risk of a BARC-235 almost doubled between patients in lower versus higher bleeding risk categories (4.3% versus 7.9%) and ischemic risk more than tripled between patients in lower versus higher ischemic risk categories (2.0% versus 7.0%) (see Figure 1). There was no evidence of a differential treatment effect for dual antiplatelet therapy versus ticagrelor monotherapy across the different risk categories of bleeding (interaction P=0.54) and ischemic risk (interaction P=0.95) (Table 1).
Conclusion
Individual patient bleeding and ischemic risks after PCI can both be readily characterised with good discrimination. The effect of ASA discontinuation in preventing bleeding in ticagrelor-treated patients was consistent regardless of baseline bleeding risk. There was no evidence for increased ischemic events with ASA discontinuation according to baseline ischemic risk.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZenecaIcahn School of Medicine at Mount Sinai
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Affiliation(s)
| | - S Mehta
- Population Health Research Institute, McMaster University and Hamilton Health Sciences , Hamilton , Canada
| | - U Baber
- The University of Oklahoma Health Sciences Center, Cardiology , Oklahoma City , United States of America
| | - T Collier
- London School of Hygiene and Tropical Medicine, Medical Statistics , London , United Kingdom
| | - G Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York City , United States of America
| | - S K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York City , United States of America
| | - D J Cohen
- Cardiovascular Research Foundation, New York, NY 10019, USA & St. Francis Hospital, Roslyn, NY 11576 , New York , United States of America
| | - D Angiolillo
- University of Florida College of Medicine, Cardiology , Jacksonville , United States of America
| | - C Briguori
- Mediterranea Cardiocentro , Naples , Italy
| | - J Escaned
- Hospital Clínico San Carlos IDISCC, Complutense University of Madrid , Madrid , Spain
| | - P Gabriel Steg
- Université de Paris, AP-HP, Hôpital Bichat, French Alliance for Cardiovascular Trials and INSERM , Paris , France
| | - K Huber
- Wilhelminen Hospital, Sigmund Freud University, Medical Faculty, 3rd Department of Medicine, Cardiology and Intensive Care Medicine , Vienna , Austria
| | - C Michael Gibson
- Beth Israel Deaconess Medical Center & Harvard Medical School, Cardiovascular Medicine , Boston , United States of America
| | - S Pocock
- London School of Hygiene and Tropical Medicine, Medical Statistics , London , United Kingdom
| | - R Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai , New York City , United States of America
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8
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Shukla U, Sueyoshi M, Diamond B, Chowdhury I, Stambaugh C, Wazer DE, Chowdhary M, Huber K. Disparities in Radiotherapy: Practice Patterns Analysis of DIBH use in Non-English Speakers. Int J Radiat Oncol Biol Phys 2022; 113:21-25. [PMID: 34986382 DOI: 10.1016/j.ijrobp.2021.12.171] [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] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE/OBJECTIVES To examine current practice patterns in non-English speaking patients with breast cancer undergoing Deep Inspiratory Breath Hold (DIBH). MATERIALS/METHODS An anonymous, voluntary REDCap survey was distributed to 60 residency program coordinators of U.S. radiation oncology departments to survey their faculty and recent graduates. Eligibility was limited to board-certified radiation oncologists who have treated breast cancer within the prior 6 months. RESULTS There were 69 respondents, 53 of whom were eligible. 42% (n=22) of eligible respondents were from the main site at an academic center, with 28% (n=15) representing a satellite site, and 30% (n=16) from private practice. 53% reported at least 10% of their patients were non-English speaking. 90% offered DIBH at their institution and of those, 74% used DIBH for at least 1/4th of their patients with breast cancer. 98% of those who use DIBH performed coaching at simulation, with 32% answering they would be "less likely" to utilize DIBH for non-English speakers. When utilized, 94% take into consideration potential language barriers for proper execution of DIBH. However, 51% had an interpreter present 76-100% of the time at CT simulation, which decreased to 31% at first fraction, and 11% at subsequent treatments. For non-English speaking patients undergoing DIBH coaching without a certified interpreter, 55% of respondents indicated that they provided verbal coaching in English, 32% indicated "not applicable" because they always use a certified interpreter, 11% used visual aids, and 32% indicated "other." Of those who answered other, the most commonly cited response was utilizing therapists or staff who spoke the patient's native language. CONCLUSIONS Disparities in the application of DIBH exist despite its established utility in reducing cardiac dose. This study provides evidence that language barriers may impact physician treatment practices from initial consideration of DIBH to subsequent delivery. This data suggests that breast cancer treatment considerations and subsequent execution are negatively affected in non-English speaking patients.
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Affiliation(s)
- U Shukla
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - M Sueyoshi
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - B Diamond
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - I Chowdhury
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI.
| | - C Stambaugh
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
| | - D E Wazer
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA; Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - M Chowdhary
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI
| | - K Huber
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA
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9
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Castiglione V, Chiriaco' M, Aimo A, Januzzi J, Richards A, Lam C, Latini R, Anand I, Ueland T, Brunner-La Rocca H, Bayes-Genis A, De Boer R, Huber K, Emdin M, Vergaro G. Prognostic value of sST2 in heart failure patients with diabetes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Soluble suppression of tumorigenesis-2 (sST2) is released in response to inflammation and vascular injury, and holds prognostic value in heart failure (HF). Type 2 diabetes (T2D) is characterized by a pro-inflammatory status and is highly prevalent among HF patients, with adverse impact on outcomes. The clinical value of sST2 in HF patients with T2D has never been characterized.
Purpose
We aimed to assess sST2 clinical correlates and prognostic value in HF patients with T2D.
Methods
Individual data of 3476 patients with stable chronic HF from 5 cohorts from the BIOS (Biomarkers In Heart Failure Outpatient Study) dataset were analysed, with available N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and sST2 levels.
Results
Mean age was 65±12 years (75% males). T2D was present in 1386 patients (40%), who had higher body mass index (BMI, 27 [24–30] vs. 26 [23–29] kg/m2, p<0.001), lower estimated glomerular filtration rate (eGFR, 56±22 vs. 60±19 mL/min/1,73 m2, p<0.001), higher sST2 (33 [24–47] vs. 27 [20–40] ng/mL, p<0.001), NT-proBNP (1735 [742–3963] vs. 1450 [514–3299] ng/L, p<0.001), hs-TnT (28 [16.2–51.5] vs. 17 [9–31] ng/L, p<0.001) and high-sensitivity C-reactive protein (hs-CRP, 6 [2–11] vs. 4. [2–9] mg/L, p=0.003) (Figure). Differences between sST2 levels in patients with or without T2D were influenced by hs-CRP (p for interaction=0.010) and hs-TnT (p=0.031), but not by NT-proBNP and eGFR. At multivariate linear regression analysis, NT-proBNP, hs-TnT and hs-CRP were independently associated with sST2 levels in both T2D and non-T2D patients. Compared with patients without T2D, those with T2D showed higher 1-year all-cause mortality (12% vs. 10%, p=0.034), cardiovascular mortality (9% vs. 7%, p=0.011), and HF hospitalization rate (22% vs. 12%, p<0.001). In a prognostic model including age, sex, eGFR, ischemic vs- non-ischemic aetiology, left ventricular ejection fraction class, New York Heart Association class, NT-proBNP, hs-TnT, and hs-CRP, sST2 retained independent prognostic value in both patients with or without T2D for 1-year all-cause and cardiovascular mortality, and 1-year HF hospitalization, with higher optimal cut-offs for mortality prediction in T2D vs. non-T2D (39 and 45 vs. 29 and 29 ng/mL respectively for 1-year all-cause and cardiovascular mortality).
Conclusions
sST2 is higher in HF patients with T2D and likely linked to a pro-inflammatory status. sST2 maintains its prognostic value both in diabetic and non-diabetic HF patients, independently of NT-proBNP, hs-TnT and hs-CRP.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
| | | | - A Aimo
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - J Januzzi
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - A.M Richards
- University of Otago Christchurch, Christchurch, New Zealand
| | - C.S.P Lam
- Singapore General Hospital, Singapore, Singapore
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I.S Anand
- University of Minnesota, Minneapolis, United States of America
| | - T Ueland
- University of Oslo, Oslo, Norway
| | | | - A Bayes-Genis
- Germans Trias i Pujol University Hospital, Barcelona, Spain
| | - R.A De Boer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Emdin
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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10
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Kleeberger JA, Ouarrak T, Freund A, Fuernau G, Geissler T, Huber K, Noc M, Montalescot G, Clemmensen P, Zeymer U, Desch S, Schneider S, Hausleiter J, Thiele H, Orban M. ADP-receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
The purpose of this pooled analysis is to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated with either clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor. Patients from the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial were included.
Methods and results
For the current analysis, the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. Eight hundred fifty-six patients were eligible for analysis. Of these, five hundred seven patients (59.2%) received clopidogrel, one hundred seventy-eight patients (20.8%) prasugrel and one hundred seventy-one patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60–1.09, padj=0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65–1.15, padj=0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20–0.69, padj=0.002) and not different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43–1.24, padj=0.24), see Table 1.
Conclusion
This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that an acute therapy with either clopidogrel, prasugrel or ticagrelor is no predictor of 1-year mortality. Treatment with ticagrelor seems to be associated with less in-hospital moderate and severe bleeding events in comparison to clopidogrel.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Heart FoundationEuropean Union 7th Framework Program
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Affiliation(s)
| | - T Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - A Freund
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - T Geissler
- University Hospital of Tuebingen, Tuebingen, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - G Montalescot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - P Clemmensen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - U Zeymer
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - S Schneider
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
| | - M Orban
- University Hospital of Munich, Munich, Germany
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11
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Clemmensen P, Schrage BN, Zeymer U, Montalecot G, Windecker S, Serpytis P, Stepinska J, Savonitto S, Desch S, Fuernau G, Huber K, Noc M, Ouarrak T, Blankenberg S, Thiele H. Impact of center-volume on outcomes in myocardial infarction complicated by cardiogenic shock – a CULPRIT-SHOCK sub-study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1479] [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
Little is known about the impact of center-volume on outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). The aim of this study was to investigate the association between center-volume, treatment strategies and subsequent outcome in patients with AMI-CS.
Methods
In this subanalysis of the randomized CULPRIT-SHOCK trial, study sites were categorized based on the annual volume of AMI-CS into low/intermediate/high volume centers (<50; 50–100;>100 cases/year). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment and 1-year all-cause mortality were compared across categories.
Results
N=1032 patients were included in this study (537 treated at low-volume, 240 at intermediate-volume and 255 at high volume centers). Baseline risk profile of patients across the volume categories was similar, although high volume centers included more older patients. Low/intermediate-volume centers had more resuscitated patients (57.5%/58.8% vs. 42.2%; p<0.01), and more patients on mechanical ventilation in comparison to high volume centers. Mechanical circulatory support differed with more use in low/intermediate-volume centers and overall lower use in high-volume centers (30.7%/36.7% vs. 19.2%; p<0.001). There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies (figure 1). There was no difference in 1-year all-cause mortality across volume categories (51.1% vs. 56.5% vs. 54.4%; p=0.34).
Conclusion
In this study of patients with AMI-CS, considerable differences in adjunctive medical and mechanical support therapies was observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CULPRIT-SHOCK trial was funded by European Union, Seventh Framework Programme (FP7/2007-2013) Grant agreement n°602202, German Heart Research Foundation Treatment according to center volumeLong-term survival
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Affiliation(s)
- P Clemmensen
- University Heart Center Hamburg, Hamburg, Germany
| | - B N Schrage
- University Heart Center Hamburg, Hamburg, Germany
| | - U Zeymer
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - G Montalecot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - J Stepinska
- National Institute of Cardiology, Warsaw, Poland
| | | | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
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12
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Röhm K, Gonzalez-Uarquin F, Harmel RK, Nguyen Trung M, Diener M, Fiedler D, Huber K, Seifert J. Investigation of a potential electrogenic transport-system for myo-inositol in the small intestine of laying hens. Br Poult Sci 2021; 63:91-97. [PMID: 34297639 DOI: 10.1080/00071668.2021.1958301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
1. Myo-inositol (MI) is an essential metabolite for cell function in animals and humans. The aim of this study was to characterise the transport mechanism of MI in the small intestine of laying hens as there is a lack of knowledge about the MI uptake mechanisms. The hypothesised secondary active, cation coupled transport of MI was assessed by electrophysiological measurements with Ussing chambers, and was compared to the electrophysiology of glucose transport.2. Twenty-six laying hens were used. The potential ion-dependent transport was tested in tissue of the small intestine. Barrier function of the tissue was shown by determining the transepithelial resistance. During the experiments, mucosal and serosal buffers were sampled to measure time-dependent changes in MI concentrations. Samples from eight hens were further used for Western blot analyses of the jejunal apical membranes.3. Active MI transport, indicated by changes in the short circuit current after MI addition, could not be demonstrated in the Ussing chambers experiments. MI was further not detectable in the serosal buffer, nor in the lysates of mucosal tissue cytoplasm nor lipids. Thus, there was no evidence for a MI transport or absorption. However, Western blot analyses of the jejunal apical membrane revealed signals indicated the expression of the MI transport proteins SMIT-1 and SMIT-2.4. In conclusion, the MI transport process in the chicken intestine is more complex than it was presumed and is probably influenced by still unknown regulations or metabolic processes.
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Affiliation(s)
- K Röhm
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
| | - F Gonzalez-Uarquin
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
| | - R K Harmel
- Department of Chemical Biology I, Leibniz-Forschungsinstitut für Molekulare Pharmakologie, Berlin, Germany
| | - M Nguyen Trung
- Department of Chemical Biology I, Leibniz-Forschungsinstitut für Molekulare Pharmakologie, Berlin, Germany
| | - M Diener
- Institute of Veterinary Physiology and Biochemistry, Justus-Liebig University Giessen, Giessen, Germany
| | - D Fiedler
- Department of Chemical Biology I, Leibniz-Forschungsinstitut für Molekulare Pharmakologie, Berlin, Germany
| | - K Huber
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
| | - J Seifert
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
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13
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Alaedin M, Ghaffari MH, Sadri H, Meyer J, Dänicke S, Frahm J, Huber K, Grindler S, Kersten S, Rehage J, Muráni E, Sauerwein H. Effects of dietary l-carnitine supplementation on the response to an inflammatory challenge in mid-lactating dairy cows: Hepatic mRNA abundance of genes involved in fatty acid metabolism. J Dairy Sci 2021; 104:11193-11209. [PMID: 34253361 DOI: 10.3168/jds.2021-20226] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022]
Abstract
This study aimed at characterizing the effects of dietary l-carnitine supplementation on hepatic fatty acid (FA) metabolism during inflammation in mid-lactating cows. Fifty-three pluriparous Holstein dairy cows were randomly assigned to either a control (CON, n = 26) or an l-carnitine supplemented (CAR; n = 27) group. The CAR cows received 125 g of a rumen-protected l-carnitine product per cow per day (corresponding to 25 g of l-carnitine/cow per day) from d 42 antepartum (AP) until the end of the trial on d 126 postpartum (PP). Aside from the supplementation, the same basal diets were fed in the dry period and during lactation to all cows. In mid lactation, each cow was immune-challenged by a single intravenous injection of 0.5 μg of LPS/kg of BW at d 111 PP. Blood samples were collected before and after LPS administration. The mRNA abundance of in total 39 genes related to FA metabolism was assessed in liver biopsies taken at d -11, 1, and 14 relative to LPS (d 111 PP) and also on d 42 AP as an individual covariate using microfluidics integrated fluidic circuit chips (96.96 dynamic arrays). In addition to the concentrations of 3 selected proteins related to FA metabolism, acetyl-CoA carboxylase α (ACACA), 5' AMP-activated protein kinase (AMPK), and solute carrier family 25 member 20 (SLC25A20) were assessed by a capillary Western blot method in liver biopsies from d -11 and 1 relative to LPS from 11 cows each of CAR and CON. On d -11 relative to LPS, differences between the mRNA abundance in CON and CAR were limited to acyl-CoA dehydrogenase (ACAD) very-long-chain (ACADVL) with greater mRNA abundance in the CAR than in the CON group. The liver fat content decreased from d -11 to d 1 relative to the LPS injection and remained at the lower level until d 14 in both groups. One day after the LPS challenge, lower mRNA abundance of carnitine palmitoyltransferase 1 (CPT1), CPT2, ACADVL, ACAD short-chain (ACADS), and solute carrier family 22 member 5 (SLC22A5) were observed in the CAR group as compared with the CON group. However, the mRNA abundance of protein kinase AMP-activated noncatalytic subunit gamma 1 (PRKAG1), ACAD medium-chain (ACADM), ACACA, and FA binding protein 1 (FABP1) were greater in the CAR group than in the CON group on d 1 relative to LPS. Two weeks after the LPS challenge, differences between the groups were no longer detectable. The altered mRNA abundance before and 1 d after LPS pointed to increased transport of FA into hepatic mitochondria during systemic inflammation in both groups. The protein abundance of AMPK was lower in CAR than in CON before the LPS administration. The protein abundance of SLC25A20 was neither changing with time nor treatment and the ACACA protein abundance was only affected by time. In conclusion, l-carnitine supplementation temporally altered the hepatic mRNA abundance of some genes related to mitochondrial biogenesis and very-low-density lipoprotein export in response to an inflammatory challenge, but with largely lacking effects before and 2 wk after LPS.
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Affiliation(s)
- M Alaedin
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany
| | - M H Ghaffari
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany
| | - H Sadri
- Department of Clinical Science, Faculty of Veterinary Medicine, University of Tabriz, 516616471 Tabriz, Iran
| | - J Meyer
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - S Dänicke
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - J Frahm
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - K Huber
- Institute of Animal Science, Functional Anatomy of Livestock, University of Hohenheim, Fruwirthstraße 35, 70593 Stuttgart, Germany
| | - S Grindler
- Institute of Animal Science, Functional Anatomy of Livestock, University of Hohenheim, Fruwirthstraße 35, 70593 Stuttgart, Germany
| | - S Kersten
- Institute of Animal Nutrition, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Bundesallee 37, 38116 Braunschweig, Germany
| | - J Rehage
- Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - E Muráni
- Research Institute for the Biology of Farm Animals (FBN), Research Unit Molecular Biology, Wilhelm-Stahl-Allee 2, 18196 Dummerstorf, Germany
| | - H Sauerwein
- Institute of Animal Science, Physiology Unit, University of Bonn, Katzenburgweg 7-9, 53115 Bonn, Germany.
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Koenig C, Hellebart P, Koch J, Egger F, Puntus T, Kriz R, Huber K, Nuernberg M, Zweiker D. Is diversity harmful? - Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging. Europace 2021. [DOI: 10.1093/europace/euab116.480] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Many patients with cardiac implantable electronic devices (CIED) need to undergo magnetic resonance imaging (MRI). However, a significant proportion has a CIED system in place that has not been classified "MRI-conditional" because of generators and leads from different brands ("mixed-brand" group), although the individual components per se are MRI-conditional. There is only limited data available concerning the outcome of these patients with "mixed-brand" CIED systems undergoing MRI.
Purpose
To analyse complications or adverse effects in "mixed-brand" CIED patients undergoing MRI, compared to patients with a fully "MRI-conditional" CIED system.
Methods
A retrospective single-centre study was performed, including patients undergoing MRI between January 2013 until May 2020. Short- and long-term outcomes were compared between both groups. We defined the primary endpoint as death or any adverse event necessitating hospitalization or CIED revision in association with the MRI examination. Secondary endpoints were the occurrence of any surrogate for beginning device or lead failure or patient discomfort during MRI.
Results
A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with a range of 1-9 MRIs per patient. Mean age was 73 years and 52 (32.9%) patients were female. We identified 38 patients undergoing 54 procedures in the "mixed-brand" group and 89 patients undergoing 134 MRI procedures in the "MRI-conditional" group. In 31 patients undergoing 39 MRI examinations the MRI-conditionality could not be determined. "Mixed-brand" patients were older than MRI-conditional patients (mean 77 vs. 72 years, p = 0.003). The primary endpoint occurred in 0% in the "mixed-brand" group and in 2.2% in the "MRI conditional" group (p = 1.000). Complications were as follows: Two patients had first diagnosed atrial fibrillation directly associated with the procedure, of whom one additionally had a transient CIED dysfunction. No patient in the "mixed-brand" group and three patients (3.4%) in the "MRI conditional" group met the secondary endpoints (p = 0.554). In patients with undeterminable MRI conditionality the complication rate was similar (0% for both the primary and secondary endpoints).
Conclusion
The complication rate of CIED patients undergoing MRI was low. There was no signal for increased risk of adverse events in patients with a CIED without MRI certification due to mixed brands systems compared to patients with "MRI-conditional" CIED systems.
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Affiliation(s)
| | | | - J Koch
- Klinik Ottakring, Wien, Austria
| | - F Egger
- Klinik Ottakring, Wien, Austria
| | | | - R Kriz
- Klinik Ottakring, Wien, Austria
| | - K Huber
- Klinik Ottakring, Wien, Austria
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15
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Zweiker D, Puntus T, Egger F, Kriz R, Koch J, Hellebart P, Huber K, Nuernberg M. Lower pacemaker implantation rates for atrioventricular block during COVID-19. Europace 2021. [PMCID: PMC8194865 DOI: 10.1093/europace/euab116.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction The first wave of the COVID-19 crisis was associated with a reduction of patients presenting with acute cardiovascular disease. However, there is only limited data showing the trend of pacemaker implantations and their indications. Purpose To evaluate pacemaker implantations before, during and after the first COVID-19 wave, stratified by indication. Methods We analysed the weekly rates of pacemaker implantation at our centre during the first national lockdown for COVID-19 at the between 16 March 2020 and 29 April 2020 (weeks 12-17 / 2020), compared to the implantation rates 6 weeks before (weeks 6-11 / 2020), 6 weeks afterwards (weeks 18-23 / 2020), and the same time frame in 2017-2019. To reduce bias due to postponed planned procedures, we stratified pacemaker implantations into the following groups: total implantations (including box changes), new pacemaker implantations, implantation due to AV block, implantation due to supraventricular conduction disturbances, and other implantations. Results The total number of total weekly implantations was reduced from 10.7 (weeks 6-11 / 2020) to 4.2 (weeks 12-17 / 2020; -60.1%, p = 0.02). We found no significant reduction in the same time frame in 2017-2019 (6.5 vs. 6.1 per week, p = 0.29). We found a similar effect in "new" pacemaker implantations (8.5 vs. 3.2 per week, -62.7%, p = 0.02) and AV block (5.0 vs. 1.5 per week, -70%, p = 0.03). There was no reduction in pacemaker implantation due to sick sinus syndrome (2.5 vs. 0.8 per week, -66.7%, p = 0.12) and other indications (1.0 vs. 0.8 per week, -16.7%, p = 0.86). In the six following weeks (18-23 / 2020), the total numbers (6.0 per week) and indications other than AV block rose to baseline (p > 0.05), but patients with AV block were still less prevalent (1.7 per week, p = 0.04). Conclusion The reduction of total and new pacemaker implantations during the COVID-19 lockdown was mainly based on a reduced pacemaker implantation rate for AV block. This effect persisted even after the national lockdown. This analysis implies that a significant number of patients with AV block may have avoided medical contact during and after the lockdown and therefore have experienced increased mortality.
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Affiliation(s)
- D Zweiker
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - T Puntus
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - F Egger
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - R Kriz
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - J Koch
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - P Hellebart
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - K Huber
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
| | - M Nuernberg
- Klinik Ottakring, Third Medical Department for Cardiology and Intensive Care, Vienna, Austria
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16
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Krychtiuk KA, Lenz M, Hohensinner P, Distelmaier K, Schrutka L, Kastl SP, Huber K, Hengstenberg C, Wojta J, Speidl WS. Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with monocyte subsets in patients with stable coronary artery disease. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.278] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF
Background and aims
Proprotein convertase subtilisin/kexin type-9 (PCSK9) is an enzyme promoting the degradation of low-density lipoprotein receptors (LDL-R) in hepatocytes. Inhibition of PCSK9 has emerged as a novel target for lipid-lowering therapy. Monocytes are crucially involved in the pathogenesis of atherosclerosis and can be divided into three subsets. The aim of this study was to examine whether circulating levels of PCSK9 are associated with monocyte subsets.
Methods
We included 69 patients with stable coronary artery disease. PCSK9 levels were measured and monocyte subsets were assessed by flow cytometry and divided into classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14 + CD16++; NCM).
Results
Mean age was 64 years and 80% of patients were male. Patients on statin treatment (n = 55) showed higher PCSK9-levels (245.4 (206.0-305.5) ng/mL) as opposed to those without statin treatment (186.1 (162.3-275.4) ng/mL; p = 0.05). In patients on statin treatment, CM correlated with circulating PCSK9 levels (R = 0.29; p = 0.04), while NCM showed an inverse correlation with PCSK9 levels (R=-0.33; p = 0.02). Patients with PCSK9 levels above the median showed a significantly higher proportion of CM as compared to patients with PCSK-9 below the median (83.5 IQR 79.2-86.7 vs. 80.4, IQR 76.5-85.2%; p = 0.05). Conversely, PCSK9 levels >median were associated with a significantly lower proportion of NCM as compared to those with PCSK9 <median (10.2, IQR 7.3-14.6 vs. 14.3, IQR 10.9-18.7%; p = 0.02). In contrast, IM showed no association with PCSK-9 levels.
Conclusions
We hereby provide a novel link between PCSK9 regulation, innate immunity and atherosclerotic disease in statin-treated patients.
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Affiliation(s)
- KA Krychtiuk
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Lenz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - P Hohensinner
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - K Distelmaier
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - L Schrutka
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - SP Kastl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Wojta
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - WS Speidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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17
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Gentile F, Aimo A, Januzzi J, Richards A, Lam C, Latini R, Anand I, Ueland T, Brunner-La Rocca H, Bayes-Genis A, De Boer R, Huber K, Passino C, Emdin M, Vergaro G. Prognostic value of NT-proBNP and best cut-offs for risk prediction in obese patients with chronic systolic heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of outcome in chronic systolic heart failure (CHF). Although plasma NT-proBNP has been reported to display an inverse correlation with body-mass-index (BMI), its prognostic value in obese patients has been poorly investigated so far.
Objectives
To evaluate the prognostic value and the best cut-offs for risk prediction of NT-proBNP in obese individuals from a multinational cohort of patients with systolic CHF.
Methods
We analyzed data from the BIOS (Biomarkers In Heart Failure Outpatient Study) Consortium. Patients with left ventricular ejection fraction (LVEF) ≤50% were selected and classified as nonobese (BMI <30 kg/m2), mildly obese (BMI 30–35 kg/m2), moderately obese (BMI 35–40 kg/m2), or severely obese (BMI ≥40 kg/m2), according to standard nomenclature. Clinical and bio-humoral data, including NT-proBNP testing, were retrieved, and 5-year cardiac and all-cause mortality status were considered as primary and secondary outcome, respectively. The independent prognostic role of NT-proBNP was evaluated through Cox regression analysis, adjusting the model for age, gender, New York Heart Association class, ischaemic aetiology, LVEF, and estimated glomerular filtration rate (eGFR).
Results
The study population included 11,574 patients (age 65±12 years, LVEF 30±9%, males 78%). Most of patients were nonobese (n=8,937, 77%), while mildly, moderately, and severely obese patients were 1,887 (16%), 499 (4%), and 251 (3%), respectively. Median values of plasma NT-proBNP were progressively lower from nonobese to mildly, moderately, and severely obese patients (1455 ng/L, 903 ng/L, 767 ng/L, 660 ng/L, respectively) and BMI was predictive of NT-proBNP independently from age, LVEF, and eGFR (r=−0.152, p<0.001). The best NT-proBNP cut-offs to predict 5-year cardiac mortality were significantly lower in mildly [1044 ng/L; AUC 0.663 (Sen 66%; Spe 59%), p<0.001] moderately [736 ng/L; AUC 0.670 (Sen 76%; Spe 52%), p<0.001]), and severely [1060 ng/L; AUC 0.635 (Sen 57%; Spe 69%), p=0.021] obese patients compared to nonobese individuals [2034 ng/L; AUC 0.714 (Sens. 65%; Spec. 66%), p<0.001]. Further, NT-proBNP independently predicted 5-year cardiac death in nonobese, mildly and moderately obese patients (all p<0.001), but not in severely obese patients (p=0.457). Similar findings were observed for the secondary endpoint of 5-year all-cause mortality.
Conclusions
Compared to nonobese CHF patients, obese patients have lower circulating NT-proBNP levels, which retain independent prognostic significance for cardiac and all-cause mortality across most categories of obesity. BMI-adjusted NT-proBNP cut-offs might be considered for prognostic stratification in obese patients with CHF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Gentile
- Università di Pisa, Scuola di Specializzazione in Malattie dell'Apparato Cardiovascolare, Pisa, Italy
| | - A Aimo
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - J.L.J Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, United States of America
| | | | - C.S.P Lam
- National University of Singapore, Singapore, Singapore
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I.S Anand
- University of Minnesota, Minneapolis, United States of America
| | - T Ueland
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | - R.A De Boer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - C Passino
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - M Emdin
- Sant'Anna School of Advanced Studies, Pisa, Italy
| | - G Vergaro
- Sant'Anna School of Advanced Studies, Pisa, Italy
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18
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Vargas K, Tajsic M, Latsuzbaia A, Andric T, Kassem M, Jaeger B, Huber K. Sex-based differences of copeptin for early rule-out of non-ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
There is paucity of data on the role of sex in the dual biomarker strategy using copeptin and conventional troponin for the early rule-out of non-ST-elevation myocardial infarction (NSTEMI). We aimed to evaluate sex-based differences on copeptin levels, combined negative predictive value (NPV) and predictors of copeptin elevation at admission.
Methods
Biomarkers were measured in 852 adult patients presenting to the emergency department with chest pain and suspected NSTEMI. Logistic regression analyses on predictors of copeptin elevation were evaluated by sex.
Results
Overall, 362 women (42.5%) and 490 men (57.5%) were included. Copeptin levels were higher in men (median 7.36 pmol/L vs. 4.8 pmol/L; P<0.001). Men had a similar NPV (100%) as women (99.6%, CI: 98.8–100) using the dual biomarker rule-out strategy and when compared to troponin alone (men, NPV=98.7%, CI: 97.5–99.8; and women, NPV=98.7%, CI: 97.5–100). Multivariate logistic regression showed positive association of male sex with copeptin elevation (OR=2.37; CI: 1.61–3.49; P<0.001). In men, diastolic blood pressure was a negative predictor of copeptin elevation (OR=0.98, 95% CI: 0.96–0.99), while positive predictors were current MI (OR=2.16, 95% CI: 1.19–3.91), chronic renal insufficiency (OR=3.58, 95% CI: 1.33–9.62), and atrial fibrillation (OR=2.56, 95% CI: 1.23–5.32), respectively (all P<0.05). In women, current MI (OR=2.98, CI: 1.23–7.24), atrial fibrillation (OR=2.90, CI: 1.26–6.70) and syncope (OR=7.56, CI: 2.26–25.30) were significant predictors of copeptin elevation.
Conclusions
Men with suspected NSTEMI have higher copeptin levels. The dual biomarker rule-out strategy has a similar performance in both male and female patients. Certain predictors of copeptin elevation are sex-specific.
Copeptin levels at presentation
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
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Affiliation(s)
- K.G Vargas
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - M Tajsic
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - A Latsuzbaia
- National Health Laboratory, Epidemiology and Microbial Genomics, Dudelange, Luxembourg
| | - T Andric
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - M Kassem
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - B Jaeger
- Wilhelminenhospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - K Huber
- Wilhelminenhospital, 3rd Department of Cardiology and Sigmund Freud University, Medical Faculty, Vienna, Austria
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19
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Krychtiuk K, Lenz M, Richter B, Huber K, Wojta J, Hengstenberg C, Heinz G, Speidl W. Monocyte subsets predict mortality after cardiac arrest. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1855] [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
After successful cardiopulmonary resuscitation with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. Monocytes are a heterogenous cell population that can be distinguished into three subsets.
Purpose
The aim of this prospective, observational study was to analyze whether monocyte subset distribution is associated with mortality at 6 months in patients after cardiac arrest.
Methods
We included 53 patients admitted to our medical ICU after cardiac arrest. Blood was taken on admission and monocyte subset distribution was analyzed by flow cytometry and distinguished into classical monocytes (CM; CD14++CD16-), intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-).
Results
Median age was 64.5 (IQR 49.8–74.3) years and 75.5% of patients were male. Mortality at 6 months was 50.9% and survival with good neurological outcome was 37.7%. Of interest, monocyte subset distribution upon admission to the ICU did not differ according to survival. However, patients that died within 6 months showed a strong increase in the pro-inflammatory subset of intermediate monocytes (8.3% (3.8–14.6)% vs. 4.1% (1.5–8.2)%; p=0.025), and a decrease of classical monocytes (87.5% (79.9–89.0)% vs. 90.8% (85.9–92.7)%; p=0.036) 72 hours after admission. In addition, intermediate monocytes were predictive of outcome independent of initial rhythm and time to ROSC and correlated with the CPC-score at 6 months (R=0.32; p=0.043).
Discussion
Monocyte subset distribution is associated with outcome in patients surviving a cardiac arrest. This suggests that activation of the innate immune system may play a significant role in patient outcome after cardiac arrest.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): FWF - Fonds zur Förderung der wissenschaftlichen Forschung
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Affiliation(s)
- K.A Krychtiuk
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Lenz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Richter
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Vienna, Austria
| | - J Wojta
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Heinz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - W.S Speidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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20
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Aimo A, Vergaro G, Januzzi J, Richards A, Lam C, Latini R, Anand I, Ueland T, Brunner-La Rocca H, Bayes-Genis A, De Boer R, Gaggin H, Huber K, Passino C, Emdin M. Chronic obstructive pulmonary disease in heart failure: influence on circulating biomarkers and outcome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is common in patients with chronic heart failure (CHF).
Purpose
We aimed to explore the impact of COPD on HF biomarkers (N-terminal fraction of pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T [hs-TnT], and soluble suppression of tumorigenesis-2 [sST2]) and outcome.
Methods
Individual data from 14 cohorts of patients with stable chronic HF and NT-proBNP and hs-TnT values were analysed. Patients with known COPD status were evaluated.
Results
Patients (n=13,178) were aged 67 years (58–75), 75% males, and 76%, 11%, 13% with HF with reduced, mid-range, or preserved ejection fraction (HFrEF/HFmrEF/HFpEF), respectively. Patients with COPD were older than those without COPD (age 71 years [64–77] vs. 66 [57–75]; p<0.001), more frequently males (79% vs. 74%; p<0.001), had more often ischaemic HF (54% vs. 52%; p<0.001), and HFpEF (14% vs. 12%; p=0.011), but not HFpEF (12% vs. 11%; p=0.097). COPD patients had also more severe dyspnoea (44% in NYHA class III-IV vs. 31%; p<0.001), and slightly worse renal function (median estimated glomerular filtration rate [eGFR] 58 mL/min/1.73 m2 [44–74] vs. 60 [46–67]; p<0.001). Patients with COPD had higher NT-proBNP (1501 ng/L [642–3333] vs. 1225 ng/L [476–2902]; p<0.001), hs-TnT (22 ng/L [13–38] vs. 17 ng/L [9–30]; p<0.001), and sST2 (30 ng/mL [22–45] vs. 29 [21–43]; p<0.001).
Over a median follow-up of 2.1 years (1.5–3.7, range 0–18 years), 3,865/12,489 patients (31%) died; among them, 2,443/12,450 (20%) died for cardiovascular causes; 3,373/12,469 patients (27%) were hospitalized for HF over 35 months (15–63, range 0–216 months). Patients with COPD had a significantly higher all-cause mortality, cardiovascular mortality, and worse survival free from HF hospitalization (all p<0.001; Figure). In a model including age, gender, ischaemic vs. non-ischaemic aetiology, eGFR, HFrEF/HFmrEF/HFpEF, and NYHA class III-IV, COPD retained independent prognostic significance from NT-proBNP for 1-year all-cause (p=0.009) and cardiovascular mortality (p=0.022), 5-year all-cause (p<0.001) and cardiovascular mortality (p=0.011) as well as 3- (p=0.033), 6- (p=0.019) and 12-month HF hospitalization (p=0.033). COPD lost its independent prognostic significance when hs-TnT and sST2 were included in the model.
Conclusions
COPD in HF is characterized by higher NT-proBNP, hs-TnT and sST2 levels. COPD adds prognostic significance over NT-proBNP alone, but not over the combination of NT-proBNP, hs-TnT, and sST2.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - J Januzzi
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - A.M Richards
- University of Otago Christchurch, Christchurch, New Zealand
| | - C.S.P Lam
- Singapore General Hospital, Singapore, Singapore
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I.S Anand
- University of Minnesota, Minneapolis, United States of America
| | - T Ueland
- University of Oslo, Oslo, Norway
| | | | | | - R.A De Boer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - H.K Gaggin
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - C Passino
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
| | - M Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy, Pisa, Italy
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21
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Rubini Gimenez M, Millet E, Alviar C, Van Diepen S, Granger C, Windecker S, Serpytis P, Oldroyd K, Fuernau G, Huber K, Sandri M, De Waha-Thiele S, Zeymer U, Desch S, Thiele H. Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial infarction: a substudy of the culprit-shock trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1847] [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
Respiratory insufficiency with the need for mechanical ventilation (MV) is one of the most common indications for admission to intensive care units. However, little is known about the clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) who require mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population.
Methods
Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored clinical outcome within 30 days in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission.
Results
Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV were younger, more frequently non-smokers, had higher body mass indices, presented more often with clinical signs of impaired organ perfusion including worse renal function, higher burden of coronary artery disease, were more likely to have experienced resuscitation within 24h before admission, had worse left ventricular function, and presented more often with non-ST-segment elevation myocardial infarction. The primary endpoint of all-cause death or need for renal replacement therapy occurred in 21.8% of patients without MV, in 53.3% of patients with MV at admission (adjusted odds ratio [aOR] 6.03, 95% confidence interval (CI) 3.17–11.47, p=0.002, compared to patients without) and 65.4% of patients with MV initiated within the first day after admission (aOR 8.09 95% CI 4.32–15.16, p<0.001, compared to patients without). Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24h before admission, elevated heart rate and evidence of triple vessel disease.
Conclusions
Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Swiss National Foundation
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Affiliation(s)
| | - E Millet
- Yale University, New Haven, United States of America
| | - C Alviar
- New York Medical College, New York, United States of America
| | | | - C Granger
- Duke University, Durham, United States of America
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - P Serpytis
- University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - K Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Sandri
- Heart Center of Leipzig, Leipzig, Germany
| | | | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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22
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Feistritzer H, Desch S, Freund A, Poess J, Zeymer U, Ouarrak T, Schneider S, De Waha-Thiele S, Fuernau G, Eitel I, Noc M, Stepinska J, Huber K, Thiele H. Prognostic impact of active mechanical circulatory support in cardiogenic shock complicating acute myocardial infarction: results from the CULPRIT-SHOCK trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Active mechanical circulatory support (MCS) devices are increasingly used in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). However, data derived from randomized controlled trials on the efficacy and safety of these devices are still limited.
Purpose
To analyze the prognostic impact of active MCS devices in a large prospective contemporary cohort of patients with CS complicating AMI.
Methods
This is a predefined subanalysis of the Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups; (1) use of at least one active MCS device, vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or need of renal replacement therapy at 30 days.
Results
Two hundred of 1055 (19%) patients received at least one active MCS device (n=112 Impella®; n=95 extracorporeal membrane oxygenation [ECMO]; n=6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared to those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p<0.001). All-cause mortality at 30 days and 1 year as well as bleeding rates were significantly higher in the active MCS group (all p<0.001). After multivariable adjustment the use of active MCS was significantly associated with the primary endpoint (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.7–5.9; p<0.001).
Conclusion
In the CULPRIT-SHOCK randomized trial and prospective registry approximately one fifth of patients was treated with active MCS devices. Compared to patients without active MCS, patients treated with active MCS devices showed worse outcome at 30 days and 1 year.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Supported by a grant (FP7/2007-2013) from the European Union 7th Framework Program and by the German Heart Research Foundation and the German Cardiac Society.
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Affiliation(s)
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | - J Poess
- Heart Center of Leipzig, Leipzig, Germany
| | - U Zeymer
- Stiftung Institut, Ludwigshafen, Germany
| | - T Ouarrak
- Stiftung Institut, Ludwigshafen, Germany
| | | | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - G Fuernau
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - M Noc
- University Medical Centre Ljubljana, Cardiology, Ljubljana, Slovenia
| | - J Stepinska
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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23
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Doerler J, Edlinger M, Alber H, Berger R, Frick M, Hammerer M, Hasun M, Huber K, Lamm G, Lassnig E, Von Lewinski D, Roithinger F, Siostrzonek P, Steinwender C, Weidinger F. Prasugrel compared to ticagrelor in primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1737] [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
Prasugrel and ticagrelor have similar recommendations in the setting of primary PCI by current guidelines. Data comparing both in daily clinical practice of primary PCI for ST-elevation myocardial infarction is limited.
Purpose
To compare the effect of prasugrel and ticagrelor on in-hospital outcomes after primary PCI.
Methods and results
We prospectively enrolled 5365 patients treated with prasugrel (n=2785, 51.9%) or ticagrelor (n=2580; 48.1%) in the setting of primary PCI from January 2011 to December 2018 in a nationwide registry. In-hospital outcomes were compared and multiple logistic regression analysis was performed. Prasugrel treated patients were younger, less often in cardiogenic shock, with lower rates of previous stroke and had shorter ischemic time. Both groups showed similar rates of previous MI, diabetes and current resuscitation. In the univariate analysis mortality was lower in patients with prasugrel (2.5% vs. 4.4% p<0.01). Similarly, MACE (3.3% vs. 5.3%, p<0.01) and NACE (4.0% vs. 5.7% p<0.01) were lower in prasugrel treated patients, whereas major bleeding events did not differ (0.4% vs. 0.6% p=0.24).
After adjustment in multivariable analysis mortality (0.99 95% CI 0.57 to 1.72), MACE (OR 0.99 95% CI 0.65 to 1.52) as well as NACE (0.86 95% CI 0.61 to 1.22) did not differ in patients treated with prasugrel compared to ticagrelor.
Conclusion
Patients treated with prasugrel showed improved outcomes compared to ticagrelor in a large cohort of primary PCI. However, after adjustment for confounders the Advantage of prasugrel in primary PCI did not persist.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Austrian Society of Cardiology
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Affiliation(s)
- J Doerler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - M Edlinger
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - H Alber
- Hospital Klagenfurt, Department of Internal Medicine and Cardiology, Klagenfurt, Austria
| | - R Berger
- Hospital Brothers of Mercy, Department of Internal Medicine I, Eisenstadt, Austria
| | - M Frick
- Academic Teaching Hospital, Department of Internal Medicine I, Feldkirch, Austria
| | - M Hammerer
- Paracelsus Medical University, Department of Internal Medicine II, Salzburg, Austria
| | - M Hasun
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Vienna, Austria
| | - G Lamm
- University Hospital St. Polten, Department of Internal Medicine III, St. Polten, Austria
| | - E Lassnig
- Klinikum Wels-Grieskirchen, Department of Internal Medicine II, Wels, Austria
| | - D Von Lewinski
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - F.X Roithinger
- Landesklinikum Wiener Neustadt, Department of Internal Medicine, Cardiology and Nephrology, Wiener Neustadt, Austria
| | - P Siostrzonek
- Ordensklinikum Barmherzige Schwestern, Department of Internal Medicine II, Linz, Austria
| | - C Steinwender
- Kepler University Hospital Linz, Department of Internal Medicine I, Linz, Austria
| | - F Weidinger
- Rudolfstiftung Hospital, 2nd Medical Department with Cardiology and intensive Care Medicine, Vienna, Austria
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24
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Gragnano F, Zwahlen M, Vranckx P, Juni P, Heg D, Hamm C, Steg P, Hagenbuch N, Gargiulo G, Van Geuns R, Huber K, Van Amsterdam R, Serruys P, Valgimigli M, Windecker S. Ticagrelor monotherapy beyond 1 month versus standard dual antiplatelet therapy after drug-eluting coronary stenting: a pre-specified per-protocol analysis of the GLOBAL LEADERS trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2577] [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
In the GLOBAL LEADERS trial, the intention-to-treat (ITT) effect of ticagrelor monotherapy after 1 month of dual antiplatelet therapy (DAPT) was not superior to that of 12-month DAPT followed by aspirin alone in the prevention of 2-year all-cause mortality or new Q-wave myocardial infarction (MI) after coronary stenting. Intention-to-treat analyses can be affected by incomplete protocol adherence. We present a pre-specified per-protocol analysis.
Purpose
To determine whether 1 month of ticagrelor plus aspirin followed by 23 months of ticagrelor monotherapy is superior to 12 months of DAPT followed by aspirin alone in the per-protocol population of the GLOBAL LEADERS (NCT01813435).
Methods
The GLOBAL LEADERS compared two antiplatelet strategies after drug-eluting stenting for stable coronary artery disease or acute coronary syndromes. Per-protocol population consisted of randomized patients fulfilling enrollment criteria and receiving protocol-mandated treatment. Adherence to the allocated antiplatelet therapy was evaluated at discharge, 30 days, and 3, 6, 12, 18, and 24 months, with non-adherence reasons categorized following a hierarchical approach. A protocol-deviation was defined in the case of high perceived bleeding/thrombotic risk, a medical decision without evident clinical reason, patients unwilling to take study drugs, prescription error, logistical issues, unclear reasons. Baseline characteristics, including (but not limited to) age, sex, diabetes, prior PCI, were used to construct time-varying inverse probabilities for not deviation from the protocol to reconstruct a study population with no protocol-deviations. Protocol deviators were artificially censored at the time at which they deviated. The primary endpoint was the composite of 2-year all-cause mortality or non-fatal new Q-wave MI. We used a weighted pooled logistic regression to estimate the per-protocol rate ratio (RR) of experimental vs. control treatment for the primary endpoint.
Results
Of the 15,968 randomized patients, 805 out of 7,980 (10.1%) in experimental group and 537 out of 7,988 (6.7%) in control group were classified as protocol deviators and artificially censored by month 12, not contributing events in the second year. The events for the adherence-adjusted analysis were 279 in experimental group and 325 in control group (25 and 24 less than in ITT analysis, respectively). The estimated adherence-adjusted RR was 0.87 (95% CI: 0.74–1.02; p=0.09), comparable to the ITT RR (0.87; 95% CI: 0.75–1.01; p=0.07).
Conclusion
At per-protocol analysis, ticagrelor monotherapy after 1 month of DAPT was not superior to conventional treatment, in line with the previously reported ITT effect. Similar per-protocol and ITT effects can be accounted for similar per-protocol and ITT populations, as a substantial proportion of patients were non-adherent due to clinically grounded reasons (anticipated in the protocol) and, accordingly, not considered as protocol deviators.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): GLOBAL LEADERS was sponsored by the European Clinical Research Institute, which received funding from Biosensors International, AstraZeneca, and the Medicines Company.
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Affiliation(s)
- F Gragnano
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - M Zwahlen
- University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland
| | - P Vranckx
- Heart Centre Hasselt, Department of Cardiology and Critical Care Medicine, Hasselt, Belgium
| | - P Juni
- St. Michael's Hospital, Department of Medicine, Applied Health Research Centre (AHRC), Toronto, Canada
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine (ISPM) and Clinical Trials Unit, Bern, Switzerland
| | - C Hamm
- Justus-Liebig University of Giessen, Department of Cardiology and Angiology, Giessen, Germany
| | - P.G Steg
- Bichat APHP Site of Paris Nord University Hospital, Department of Cardiology, Paris, France
| | - N Hagenbuch
- University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland
| | - G Gargiulo
- Federico II University of Naples, Department of Advanced Biomedical Sciences, Naples, Italy
| | - R.J Van Geuns
- Radboud University Medical Center, Department of Cardiology, Nijmegen, Netherlands (The)
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department, Cardiology, Vienna, Austria
| | | | - P.W Serruys
- Imperial College London, Department of Cardiology, London, United Kingdom
| | - M Valgimigli
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
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25
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Micheletti SJ, Bryc K, Ancona Esselmann SG, Freyman WA, Moreno ME, Poznik GD, Shastri AJ, Beleza S, Mountain JL, Agee M, Aslibekyan S, Auton A, Bell R, Clark S, Das S, Elson S, Fletez-Brant K, Fontanillas P, Gandhi P, Heilbron K, Hicks B, Hinds D, Huber K, Jewett E, Jiang Y, Kleinman A, Lin K, Litterman N, McCreight J, McIntyre M, McManus K, Mozaffari S, Nandakumar P, Noblin L, Northover C, O’Connell J, Petrakovitz A, Pitts S, Shelton J, Shringarpure S, Tian C, Tung J, Tunney R, Vacic V, Wang X, Zare A. Genetic Consequences of the Transatlantic Slave Trade in the Americas. Am J Hum Genet 2020; 107:265-277. [PMID: 32707084 PMCID: PMC7413858 DOI: 10.1016/j.ajhg.2020.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023] Open
Abstract
According to historical records of transatlantic slavery, traders forcibly deported an estimated 12.5 million people from ports along the Atlantic coastline of Africa between the 16th and 19th centuries, with global impacts reaching to the present day, more than a century and a half after slavery's abolition. Such records have fueled a broad understanding of the forced migration from Africa to the Americas yet remain underexplored in concert with genetic data. Here, we analyzed genotype array data from 50,281 research participants, which-combined with historical shipping documents-illustrate that the current genetic landscape of the Americas is largely concordant with expectations derived from documentation of slave voyages. For instance, genetic connections between people in slave trading regions of Africa and disembarkation regions of the Americas generally mirror the proportion of individuals forcibly moved between those regions. While some discordances can be explained by additional records of deportations within the Americas, other discordances yield insights into variable survival rates and timing of arrival of enslaved people from specific regions of Africa. Furthermore, the greater contribution of African women to the gene pool compared to African men varies across the Americas, consistent with literature documenting regional differences in slavery practices. This investigation of the transatlantic slave trade, which is broad in scope in terms of both datasets and analyses, establishes genetic links between individuals in the Americas and populations across Atlantic Africa, yielding a more comprehensive understanding of the African roots of peoples of the Americas.
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26
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Zweiker D, Puntus T, Egger F, Kriz R, Koch J, Hellebart P, Huber K, Nurnberg M. P1147Complications in young ICD patients - a retrospective analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.143] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In specific situations implantable cardioverter defibrillator (ICD) therapy is recommended for patients under the age of 40 years. Due to the active lifestyle of this patient population, complication rates in devices with conventional transvenous electrodes may be higher than for the remaining population.
Methods
The ICD-YOUNG study is a retrospective analysis of consecutive patients ≤ 40 years undergoing transvenous or subcutaneous ICD (s-ICD) implantation, device change or lead revision at our centre between July 2006 and December 2017. Rehospitalization for lead failure or device battery depletion was documented.
Results
Out of 586 patients undergoing ICD implantation, 35 patients (6.0%) were ≤ 40 years. Mean age was 30.0 ± 7.2 years, 48.6% were female, 37.1% received ICD therapy for primary prevention and 11.4% primarily received s-ICD. Median follow up was 7.3 (interquartile range, 1.8-12.0) years, with a lower follow up duration in s-ICD patients than conventional ICD patients (median, 2.9 vs. 9.0 years). Over the course of follow-up, 37.1% received successful anti-tachycardia therapy. 19.4% of patients in the conventional ICD group had right ventricular lead problems requiring intervention, while none of the s-ICD patients had to be revised. Time to first device change due to battery depletion and/or device upgrade was similar in young and remaining patients (median 5.4 vs 6.0 years, p = 0.23).
Discussion
Young patients requiring ICD have a high rate of lead problems. In most young patients, s-ICD therapy is an encouraging alternative to conventional ICD therapy with a lower lead failure rate.
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Affiliation(s)
- D Zweiker
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - T Puntus
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - F Egger
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - R Kriz
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - J Koch
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - P Hellebart
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
| | - M Nurnberg
- Wilhelminen Hospital, Third Department for Cardiology and Intensive Care, Vienna, Austria
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27
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Rizas K, Farhan S, Huczek Z, Merkely B, Hein-Rothweiler R, Vogel B, Massberg S, Huber K, Aradi D, Sibbing D. 3293Atherothrombotic risk and outcomes following guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome:a post-hoc analysis of the TROPICAL-ACS trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0058] [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
A de-escalation of P2Y12-inhibitor treatment guided by platelet function testing (PFT) has been identified as a safe and alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, no specific data are available on the efficacy of such strategy in patients with high atherothrombotic risk (ATR).
Purpose
To investigate the safety and efficacy of guided de-escalation of P2Y12-inhibitor treatment in patients with low- vs. high-ATR.
Methods
The TROPICAL-ACS trial randomized 2,610 biomarker-positive ACS patients 1:1 to either conventional treatment with prasugrel for 12 months (control group) or to a PFT guided de-escalation treatment strategy (guided de-escalation group). The primary endpoint was defined as the composite of cardiovascular mortality (CVM), myocardial infarction (MI), stroke, and clinically overt bleeding (bleeding ≥ grade 2 according to the BARC criteria). The ischemic endpoint was defined as the composite of CVM, MI or stroke. We used semi-parametric Cox regression analysis and interaction testing to assess the effect of low- vs. high-ATR on the primary and ischemic endpoints. High-ATR was defined as one of the following: (i) age ≥65 years or (ii) age <65 and either history of peripheral artery disease or at least two of the following risk-factors: diabetes mellitus, current smoking or renal dysfunction.
Results
Patients with high- (n=990) versus low-ATR (n=1,620) exhibited a higher risk for the primary endpoint (11.0% vs. 6.7%; HR 1.67; 95% CI 1.28–2.18; p<0.001). Guided de-escalation was non-inferior to conventional treatment for the primary endpoint in both patients with high- (10.5% vs. 11.5%; pnon-inferiority = 0.029; Figure 1A) and low-ATR (5.6% vs. 7.7%; pnon-inferiority=0.001; Figure 1B). Moreover, there was no significant interaction in the prognostic value of guided de-escalation between high- and low-ATR groups for both the primary (HR 0.90 [0.61–1.32]; p=0.586 in patients with high-ART vs. 0.71 [0.48–1.04; p=0.082 in patients with low-ATR; pinteraction= 0.394) and combined ischemic endpoints (HR 0.83 [0.44–1.56]; p=0.567 in patients with high-ATR vs. 0.68 [0.35–1.34]; p=0.262 in patients with low-ATR; pinteraction =0.666).
Kaplan-Meier curves
Conclusion
A guided DAPT de-escalation strategy appears to be safe and effective in ACS patients regardless of the atherothrombotic risk. Further studies are needed for refining antiplatelet treatment strategies in ACS patients with varying levels of atherothrombotic risk.
Acknowledgement/Funding
Klinikum der Universität München, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo.
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Affiliation(s)
- K Rizas
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - S Farhan
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - R Hein-Rothweiler
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - B Vogel
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - S Massberg
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - K Huber
- Wilhelminenspital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Wien, Austria
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - D Sibbing
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I, Munich, Germany
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Aimo A, Januzzi J, Vergaro G, Latini R, Anand IS, Cohn JN, Gravning J, Brunner-La Rocca HP, Bayes-Genis A, De Boer RA, Takeishi Y, Eggers KM, Huber K, Passino C, Emdin M. P3515Gender differences in plasma levels and prognostic value of NT-proBNP in chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Natriuretic peptides are established biomarkers of heart failure (HF). The existence of gender-related differences in circulating levels and prognostic value are still controversial.
Methods
Individual patient data from studies assessing cardiac biomarkers (N-terminal fraction of pro-B-type natriuretic peptide - NT-proBNP - and high-sensitivity troponin T) for risk prediction in stable chronic HF were analysed.
Results
Women (n=1964, 23%) had higher median [interquartile interval] NT-proBNP concentrations than men (1678 [659–4215] vs. 1294 [522–2973] ng/L, p<0.001). Female gender predicted higher NT-proBNP independently from age, body mass index, glomerular filtration rate, left ventricular ejection fraction (LVEF), and atrial fibrillation.
Over a 2.4-year follow-up (1.6–3.2), 2351 patients (27%) died, and cardiovascular death occurred in 1558/8271 (19%). HF hospitalization was recorded in 2088/7944 (26%) over 2.0 years (1.3–2.6). Women and men had similar areas under the curve for the 3 endpoints, with higher cut-offs among women: all-cause death, 2328 ng/L vs. 1319 ng/L; cardiovascular death, 2328 ng/L vs. 1413 ng/L; HF hospitalization, 1265 ng/L vs. 907 ng/L. In the prognostic model above, the risk of the three endpoints increased by 32%, 35%, and 17%, respectively, per doubling of NT-proBNP in women, and by 41%, 45%, and 30% in men.
Conclusions
Women with chronic HF display higher NT-proBNP levels than men in the whole population as well as across many patient subgroups. This difference is not entirely explained by heterogeneity in age, BMI, or renal function. NT-proBNP holds independent prognostic significance in both genders, although alternative prognostic cut-offs might be considered for women.
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Affiliation(s)
- A Aimo
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - J Januzzi
- Massachusetts General Hospital, Boston, United States of America
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I S Anand
- University of Minnesota, Minneapolis, United States of America
| | - J N Cohn
- University of Minnesota, Minneapolis, United States of America
| | | | | | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
| | - R A De Boer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - Y Takeishi
- Fukushima Medical University, Fukushima, Japan
| | - K M Eggers
- Uppsala University Hospital, Uppsala, Sweden
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - C Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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29
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Stanetic B, Ostojic M, Kovacevic-Preradovic T, Kos LJ, Nikolic A, Bojic M, Campos C, Huber K. P4587Impact of diabetes mellitus on myocardial revascularisation method in the light of the 2018 ESC/EACTS guidelines: Results from the PROUST Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0973] [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/Introduction
Results of currently available randomized trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The 2018 ESC/EACTS guidelines on myocardial revascularization do not recommend PCI in patients with diabetes and SYNTAX score ≥23.
Purpose
We aimed to compare the all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics.
Methods
The study group comprised consecutive diabetics with angiographically proven three-vessel CAD (≥50% diameter stenosis) and/or unprotected left main CAD (≥50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG between 2008 and 2010. All-cause mortality was ascertained by telephone contacts and/or from Mortality Registries.
Results
Using the hospital data system, 5145 patients were screened and 4803 elected not to follow the inclusion criteria. Out of 342 included patients, 177 patients underwent PCI and 165 patients were referred for CABG. Patients with whom CABG was performed were significantly older (64.69±8.8 vs. 62.6±9.4, p=0.03), more often on insulin treatment (91/165=55.2% vs. 26/177=14.7%, p<0.01), had more complex anatomical characteristics i.e. higher SYNTAX scores (32.5 IQR (15) vs. 18.0 IQR (15), p<0.01) and with left main stenosis (70/165=42.4% vs. 7/177=4.0%, p<0.01), compared to patients treated with PCI. The cumulative incidence rates of all-cause death were significantly different between PCI and CABG at 4 years (16/177=9.0% vs. 26/165=15.7%, respectively, log-rank p=0.03). There was a higher incidence of all-cause mortality in PCI patients with intermediate (23–32) and high (≥33) SYNTAX scores compared with those with low (0–22) SYNTAX scores (6/32=18.8% vs. 6/124=4.8%, log-rank p=0.01; 4/21=19.1% vs. 6/124=4.8%, log-rank p=0.02, respectively). On the contrary, patients who underwent CABG displayed similar morality rates irrespective of the SYNTAX scores (SYNTAX 0–22: 5/34=14.7%; SYNTAX 23–32: 9/54=16.7%; SYNTAX ≥33: 12/77=15.6%; log-rank p=0.9). Finally, when compared with CABG, more deaths were observed following PCI with intermediate and high SYNTAX scores (intermediate SYNTAX (23–32) PCI: 6/32=18.8% vs. CABG: 26/165=15.8%, log-rank p=0.94; high SYNTAX (≥33) PCI: 4/21=19.1% vs. CABG 26/165=15.8%, log-rank p=0.87).
Conclusions
During a 4-year follow-up, CABG in comparison with PCI was associated with a higher rate of all-cause death, which can be accounted for by older age and comorbidities. In diabetics, our analysis is suggestive that PCI probably should be avoided in patients with SYNTAX ≥23, which is in concordance with the most recent guidelines. Individualized risk assessment as well as quantification of CAD by SYNTAX score remains essential in choosing appropriate revascularization method in patients with diabetes and complex CAD.
Acknowledgement/Funding
None
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Affiliation(s)
- B Stanetic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - M Ostojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - T Kovacevic-Preradovic
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - L J Kos
- University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - A Nikolic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - M Bojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - C Campos
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
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30
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Rutella S, Church S, Vadakekolathu J, Reeder S, Sullivan A, Warren S, Baughman J, Muth J, Park H, Uronis H, Kang YK, Ng M, Enzinger P, Lee K, Huber K, Wynter-Horton A, Li D, Bang YJ, Davidson-Moncada J, Catenacci D. Evaluation of tumour microenvironment identifies immune correlates of response to combination immunotherapy with margetuximab (M) and pembrolizumab (P) in HER2+ gastroesophageal adenocarcinoma (GEA). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Zeymer U, Desch S, Ouarrak T, Akin I, De Waha-Thiele S, Montalescot G, Piek JJ, Huber K, Thiele H. P1725Current spectrum and 1-year mortality of cardiogenic shock in Europe. Results of the CULPRIT-SHOCK randomized clinical trial and registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0480] [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
An early invasive strategy with coronary revascularization has been shown to improve prognosis in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Little is known about the current spectrum, treatment and 1-year mortality in patients with CS undergoing early angiography in Europe.
Methods
We evaluated baseline characteristics, treatments and 1-year outcome in a large number of patients with CS included into the prospective CULPRIT-SHOCK randomized trial and the accompanying registry. Between April 2013 and April 2017, a total of 1075 patients with cardiogenic shock were screened at 83 European centers, of whom 706 (65.6%) were included in the randomized trial RCTand 369 into the registry.
Results
The median age was 67 years and 25% were female. In total, 55% of patients had pre-hospital resuscitation, 6% underwent fibrinolysis before angiography, 65% presented with ST-elevation myocardial infarction, 15% with left bundle branch block, and 20% with non-ST-elevation myocardial infarction. The majority of patients (80%) needed mechanical ventilation. Catecholamines were used in 90% and mechanical support in 29.5% of the patients (IABP 38.5%, ECMO 22%, Impella 33%, other 7%). Total 30-day and 1-year mortality was 46% and 52%, respectively. Mechanical complications were observed in 2.1% of patients, the latter had a 30-day and 1-year mortality of 62% and 67%, respectively. The mortality related to the extent of coronary artery disease is shown in the table.
1-vessel (14%) 2-vessel (31%) 3-vessel (55%) Left main (15%) 30-day mortality 36% 44% 51% 53% 1-year mortality 39% 50% 57% 64%
Conclusions
This first report including data of the prospective CULPRIT-SHOCK randomized trial as well as the accompanying registry demonstrates the high-risk clinical characteristics of patients with AMI complicated by CS undergoing contemporary treatment. Despite an early invasive strategy mortality in patients with AMI complicated by CS in Europe is still high and is related to the extent of coronary artery disease.
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - T Ouarrak
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | | | | | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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32
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Haller P, Jaeger B, Piackova E, Sztulman L, Spittler A, Wojta J, Kiss A, Podesser BK, Huber K. P2580Changes in extracellular vesicles during and after STEMI and potential influences of remote ischemic conditioning. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0906] [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
Due to their role in transportation of different molecules, such as microRNAs and mRNAs, extracellular vesicles (EVs) enable inter-cellular communication. Therefore, they are potential biomarkers in several kinds of disease. Information on their kinetics during acute and subacute ST-elevation myocardial infraction (STEMI) is limited and potential influence of remote ischemic conditioning (RIC) has not been investigated in humans so far.
Methods
We conducted a randomized, controlled trial in patients with first-ever STEMI; all patients received primary percutaneous coronary intervention (PCI). Additionally, the interventional group received a protocol of RIC (5 min inflation of a blood pressure cuff on the left upper arm to 200mmHg, 5 min deflation, 4 repetitions in total), whereas controls received sham-intervention (cuff placement). Citrate-plasma for EV analysis was taken prior to (baseline) and immediately after PCI, as well as after 24 hours, 4 days and 1 months. EVs were characterized by a high-sensitive flow cytometer using fluorescence-triggering. EVs were defined as being positive for the intra-vesicular marker CalceinAM or superficial expression of phosphatidylserine (PS; target of Lactadherin) in addition to another superficial epitope. Mixed-models were used to investigate changes over time; time and RIC were treated as fixed effects, patients were treated as random effects to account for the multiple testing design.
Results
We included 32 patients (16 RIC, 16 control). There was a significant impact of RIC on the changes in platelet (CD41) EVs from baseline (P=0.03, Figure). Furthermore, pro-coagulatory platelet EV (PS+/CD41+) were influenced by time after STEMI (after PCI P=0.017; 24h P=0.005) with significant interaction with RIC immediately and 24h after PCI (P for interaction of time with RIC; after PCI P=0.024, after 24h P=0.008). Likewise, monocyte (CD14) EVs increased significantly with time (4 days P=0.005, 1 Month P<0.001) with significant reduced levels of monocyte EVs by RIC at these time points (P for interaction at 4 days = 0.0493; and 1 month <0.001). There was also a significant change from baseline without any effect of RIC observed in inflammatory/leucocyte EVs (CD66b+; P for change from baseline for all time points <0.001). Pro-coagulatory and inflammatory (PS+/CD15+) EVs were significantly reduced over time (at 24h P=0.007; at 4 days P=0.049, at 1 month P=0.002). Finally, endothelial (CD31+/CD41-) EVs were significantly increased at 1 month after STEMI (P=0.032).
Conclusion
Several circulating EV sub-population are influenced by the acute phase of STEMI. RIC significantly impacts on the changes in platelet EVs during the initial phase after STEMI. Future studies are needed to clarify the functional importance of theses changes and whether this influence is part of a cardioprotective effect of RIC.
Acknowledgement/Funding
LBC for Cardiovascular Research Vienna; ATVB Vienna, a grant of the “Medical Scientific Fund of the Mayor of the City of Vienna”
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Affiliation(s)
- P Haller
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - B Jaeger
- Wilhelminen Hospital, Vienna, Austria
| | | | | | - A Spittler
- Medical University of Vienna, Vienna, Austria
| | - J Wojta
- Medical University of Vienna, Vienna, Austria
| | - A Kiss
- Medical University of Vienna, Vienna, Austria
| | | | - K Huber
- Wilhelminen Hospital, Vienna, Austria
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Aimo A, Januzzi J, Vergaro G, Latini R, Anand IS, Cohn JN, Gravning J, Brunner-La Rocca HP, Bayes-Genis A, De Boer RA, Egstrup M, Takeishi Y, Huber K, Passino C, Emdin M. P4542Revisiting the obesity paradox in heart failure: percent body fat as predictor of biomarkers and outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obesity defined by body mass index (BMI) is characterized by better prognosis and lower plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF). We assessed whether another anthropometric measure, percent body fat (PBF), reveals different associations with outcome and HF biomarkers (NT-proBNP, high-sensitivity troponin T [hs-TnT], soluble suppression of tumorigenesis-2 [sST2]).
Methods
In an individual patient dataset, BMI was calculated as weight (kg)/height (m)2, and PBF through the Jackson-Pollock and Gallagher equations.
Results
Out of 6468 patients (median 68 years, 78% men, 76% ischaemic HF, 90% reduced EF), 24% died over 2.2 years (1.5–2.9), 17% from cardiovascular death. Median PBF was 26.9% (22.4–33.0%) with the Jackson-Pollock equation, and 28.0% (23.8–33.5%) with the Gallagher equation, with an extremely strong correlation (r=0.996, p<0.001). Patients in the first PBF tertile had the worst prognosis, while patients in the second and third tertile had similar survival. The risks of all-cause and cardiovascular death decreased by up to 36% and 27%, respectively, per each doubling of PBF. Furthermore, prognosis was better in the second or third PBF tertiles than in the first tertile regardless of model variables. Both BMI and PBF were inverse predictors of NT-proBNP, but not hs-TnT. In obese patients (BMI ≥30 kg/m2, third PBF tertile), hs-TnT and sST2, but not NT-proBNP, independently predicted outcome.
Conclusion
Patient prognosis improves with either BMI or PBF. Obesity, assessed with BMI or PBF, is associated with lower NT-proBNP but not hs-TnT or sST2. hs-TnT or sST2 are stronger prognostic predictors than NT-proBNP among obese patients.
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Affiliation(s)
- A Aimo
- Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - J Januzzi
- Massachusetts General Hospital, Boston, United States of America
| | - G Vergaro
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - R Latini
- IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - I S Anand
- University of Minnesota, Minneapolis, United States of America
| | - J N Cohn
- University of Minnesota, Minneapolis, United States of America
| | | | | | - A Bayes-Genis
- Germans Trias i Pujol Hospital, Badalona (Barcelona), Spain
| | - R A De Boer
- University Medical Center Groningen, Groningen, Netherlands (The)
| | - M Egstrup
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Y Takeishi
- Fukushima Medical University, Fukushima, Japan
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - C Passino
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Krychtiuk KA, Lenz M, Huber K, Hengstenberg C, Wojta J, Heinz G, Speidl WS. P789TLR-4 expression predicts mortality in patients with acute heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0388] [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
Inflammation is regarded as an important trigger for disease progression in heart failure (HF) and activation of the inflammatory system was implicated in the pathophysiology of acute heart failure (AHF).
Toll-like receptors (TLRs) play an important role in acute inflammatory processes in critically ill patients by binding to pathogen associated molecular patterns (PAMP) and danger associated molecular patterns (DAMP). However, it is not known whether the expression patterns of TLRs on neutrophils and monocytes are associated with outcome in patients with severe AHF requiring intensive care unit (ICU) admission.
The aim of this prospective, observational study was to analyze whether TLR-expression on monocytes or neutrophils is associated with 30-day survival in patients with severe AHF.
Methods
We included 84 patients with severe AHF admitted to a cardiac ICU. Blood was taken at admission and mean fluorescence activity (MFI) of TLR-2, TLR-4 and TLR-9 on monocytes and neutrophils was analyzed by flow cytometry.
Results
Median age was 64 (IQR 48–74) years and 76.2% of patients were male. Median NT-proBNP was 4941 (IQR 1298–12273) pg/mL and 30-day mortality was 33.3%. TLR-4 expression on monocytes in survivors (740 IQR 694–854) was significantly lower than in non-survivors (871 IQR 723–979; p<0.05). TLR-2 and TLR-9 expression on monocytes and TLR expression on neutrophils was not associated with survival. TLR-4 expression on monocytes was significantly associated with survival independent of age, sex, creatinine and NT-proBNP levels.
Conclusion
Monocyte TLR-4 expression predicts mortality in patients admitted to a cardiac ICU for severe acute heart failure. This suggests that activation of the innate immune system by TLR-binding of DAMPS may play a significant role in critically ill acute heart failure patients.
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Affiliation(s)
- K A Krychtiuk
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - M Lenz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Wojta
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Heinz
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - W S Speidl
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
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35
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Catenacci D, Park H, Uronis H, Kang YK, Ng M, Enzinger P, Lee K, Lim K, Gold P, Lacy J, Park S, Huber K, Wynter-Horton A, Nordstrom J, Wu T, Wigginton J, Baughman J, Rosales M, Davidson-Moncada J, Bang YJ. Margetuximab (M) + pembrolizumab (P) for treatment of patients (pts) with HER2+ gastroesophageal adenocarcinoma (GEA) post-trastuzumab (T): Survival analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Feistritzer HJ, Desch S, Zeymer U, Fuernau G, De Waha-Thiele S, Dudek D, Huber K, Stepinska J, Schneider S, Ouarrak T, Thiele H. P1724Prognostic impact of atrial fibrillation in acute myocardial infarction and cardiogenic shock: results from the CULPRIT-SHOCK trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It is unclear whether atrial fibrillation (AF) influences prognosis in patients with cardiogenic shock (CS) and multivessel disease.
Purpose
To investigate the prognostic impact of AF in patients with CS complicating acute myocardial infarction (AMI).
Methods
In a subanalysis of the Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial, patients were grouped according to the presence of AF during index hospital stay. The primary endpoint was all-cause death at 30 days and the key secondary endpoint was all-cause death at 1 year.
Results
AF was documented in 142 (21%) of 686 patients. AF was not a significant predictor of 30-day (adjusted OR 1.01, 95% CI 0.66–1.56, p=0.95) and 1-year (adjusted OR 0.89, 95% CI 0.58–1.37, p=0.59) all-cause mortality. Patients with AF already on admission showed higher all-cause mortality at 30 days (52 of 90, 58% vs. 19 of 52, 37%; p=0.02) and 1 year (57 of 90, 63% vs. 20 of 52, 39%; p=0.004) compared to patients with newly detected AF during hospital stay. AF was significantly associated with the need for renal replacement therapy (adjusted OR 1.76, 95% CI 1.05–2.94, p=0.03) and longer time to hemodynamic stabilization (4, IQR 1–8 days vs. 3, IQR 1–6 days; p=0.04) at 30 days.
Conclusions
In CS complicating AMI all-cause mortality is similar in patients with and without AF. Adverse outcome was detected in the subgroup of patients showing AF already on hospital admission.
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Affiliation(s)
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - U Zeymer
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - G Fuernau
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - D Dudek
- University Hospital of Krakow, Krakow, Poland
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | | | - S Schneider
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - T Ouarrak
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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37
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Kenéz Á, Ruda L, Dänicke S, Huber K. Insulin signaling and insulin response in subcutaneous and retroperitoneal adipose tissue in Holstein cows during the periparturient period. J Dairy Sci 2019; 102:11718-11729. [PMID: 31563314 DOI: 10.3168/jds.2019-16873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/28/2019] [Accepted: 08/14/2019] [Indexed: 01/12/2023]
Abstract
Adipose tissue response to endocrine stimuli, such as insulin, is crucial for metabolic adaptation at the onset of lactation in dairy cows. However, the exact molecular mechanisms behind this response are not well understood. Thus, the aim of this study was to determine the dynamics in protein expression and phosphorylation of key components in insulin signaling in subcutaneous (SCAT) and retroperitoneal (RPAT) adipose tissues of Holstein dairy cows. Furthermore, by ex vivo examinations, response to insulin was assessed in SCAT and RPAT at different time points during the periparturient period. Biopsy samples were taken 42 d prepartum, and 1, 21, and 100 d postpartum. Insulin and glucose concentrations were measured in blood serum in consecutive serum samples from d -42 until d +100. After parturition, the majority of the key components were downregulated in both adipose tissues but recovered by d +100. The extent of hormone-sensitive lipase phosphorylation increased postpartum and remained high throughout the experimental period. Strong differences in molecular response were observed between the 2 depots. The RPAT expressed a remarkably greater extent of AMP-activated kinase phosphorylation compared with SCAT, indicating that AMP-activated kinase as an energy sensor is highly active particularly in RPAT in times of energy scarcity. Consequently, this depot expressed a greater extent of hormone-sensitive lipase phosphorylation over the whole experimental period. Insulin response after parturition appeared to be greater in RPAT too, due to the significantly greater expression of the insulin receptor at d +21 and +100. Although insulin concentrations in plasma were low postpartum, the depot-specific changes in molecular modulation of insulin signaling and insulin response suggested that both adipose tissue depots studied were contributing to the periparturient homeorhetic adaptation, although most likely to a different extent.
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Affiliation(s)
- Á Kenéz
- Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong SAR
| | - L Ruda
- Institute of Animal Science, University of Hohenheim, Stuttgart 70599, Germany
| | - S Dänicke
- Institute of Animal Nutrition, Friedrich-Loeffler-Institute (FLI), Federal Research Institute for Animal Health, Braunschweig 38116, Germany
| | - K Huber
- Institute of Animal Science, University of Hohenheim, Stuttgart 70599, Germany.
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Kenéz Á, Koch C, Korst M, Kesser J, Eder K, Sauerwein H, Huber K. Different milk feeding intensities during the first 4 weeks of rearing dairy calves: Part 3: Plasma metabolomics analysis reveals long-term metabolic imprinting in Holstein heifers. J Dairy Sci 2018; 101:8446-8460. [DOI: 10.3168/jds.2018-14559] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022]
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Freynhofer MK, Hein-Rothweiler R, Aradi D, Dezsi DA, Gross L, Orban M, Trenk D, Geisler T, Haller P, Huczek Z, Massberg S, Huber K, Sibbing D. 5915Diurnal variability of on-treatment platelet reactivity in clopidogrel vs. prasugrel treated acute coronary syndrome patients: a pre-specified TROPICAL-ACS sub-study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5915] [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)
| | | | - D Aradi
- Balatonfured State Cardiology Hospital, Balatonfured, Hungary
| | - D A Dezsi
- Balatonfured State Cardiology Hospital, Balatonfured, Hungary
| | - L Gross
- Ludwig-Maximilians University, Munich, Germany
| | - M Orban
- Ludwig-Maximilians University, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Geisler
- University Hospital of Tubingen, Tubingen, Germany
| | - P Haller
- Wilhelminen Hospital, Vienna, Austria
| | - Z Huczek
- Medical University of Warsaw, Warsaw, Poland
| | - S Massberg
- Ludwig-Maximilians University, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - D Sibbing
- Ludwig-Maximilians University, Munich, Germany
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Hein-Rothweiler R, Sibbing D, Gross L, Trenk D, Gori T, Geisler T, Huber K, Felix SB, Ince H, Mudra H, Huczek Z, Aradi D, Hausleiter J, Massberg S, Hadamitzky M. 6128A head-to-head comparison of uniform prasugrel treatment vs. clopidogrel treatment for confirmed responders in acute coronary syndrome patients: results from the randomized TROPICAL-ACS trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6128] [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)
- R Hein-Rothweiler
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Gori
- University Medical Center of Mainz, Zentrum für Kardiologie, Mainz, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - S B Felix
- University Medicine of Greifswald, Department for Internal Medicine B, Greifswald, Germany
| | - H Ince
- Vivantes Klinikum Am Urban, Klinik fuer Kardiologie und Internistische Intensivmedizin, Berlin, Germany
| | - H Mudra
- Klinikum Neuperlach, Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Munich, Germany
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - D Aradi
- Semmelweis University, Heart Center Balatonfüred, Budapest, Hungary
| | - J Hausleiter
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
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Lip GYH, Al-Saady N, Hjortshoj SP, Goudev A, Huber K, Cohen AA, Jin J, Merino M, Winters SM, Goette A. P1923Edoxaban vs warfarin in vitamin K antagonist experienced and naive patients from the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomized trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1923] [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)
- G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
| | - N Al-Saady
- Covance Inc., Maidenshead, United Kingdom
| | | | - A Goudev
- Queen Giovanna University Hospital, Sofia, Bulgaria
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - A.-A Cohen
- University Pierre & Marie Curie Paris VI, Paris, France
| | - J Jin
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Merino
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - A Goette
- St. Vincenz-Hospital, Paderborn, Germany
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Tscharre M, Bruno V, Rohla M, Farhan S, Weiss TW, Willheim M, Huebl W, Wojta J, Huber K, Freynhofer MK. P771Impact of platelet turnover on long-term adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Tscharre
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
| | - V Bruno
- Wilhelminen Hospital, Vienna, Austria
| | - M Rohla
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
| | - S Farhan
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
| | - T W Weiss
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
| | | | - W Huebl
- Wilhelminen Hospital, Vienna, Austria
| | - J Wojta
- Medical University of Vienna, AKH – Vienna, Cardiology Clinic, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
| | - M K Freynhofer
- Wilhelminen Hospital, 3. Medical Department with Cardiology and Intensive Care Medicine, Vienna, Austria
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Hein R, Gross L, Trenk D, Jacobshagen C, Geisler T, Hadamitzky M, Huber K, Nagy F, Dezsi CA, Merkely B, Huczek Z, Koltowski L, Massberg S, Aradi D, Sibbing D. P2267De-escalation of antiplatelet therapy after percutaneous coronary intervention in acute coronary syndrome patients: outcome of diabetics in the randomized TROPICAL-ACS trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2267] [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: 11/15/2022] Open
Affiliation(s)
- R Hein
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - F Nagy
- University of Szeged, First Department of Internal Medicine, Szeged, Hungary
| | - C A Dezsi
- Petz Aladár County Teaching Hospital, Department of Cardiology, Gyor, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - L Koltowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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Cavallari I, Patti G, Pecen L, Lucerna M, Huber K, Rohla M, Renda G, Siller-Matula J, Ricci F, Kirkhhof P, De Caterina R. P3837Net clinical benefit of NOACs vs. VKAs in elderly patients with atrial fibrillation: a pooled analysis from the real-world PREFER in AF and PREFER in AF PROLONGATION registries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I Cavallari
- University Campus Bio-Medico of Rome, Rome, Italy
| | - G Patti
- University Campus Bio-Medico of Rome, Rome, Italy
| | - L Pecen
- Charles University of Pilsen, Pilsen, Czech Republic
| | - M Lucerna
- Daiichi Sankyo Europe, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Rohla
- Wilhelminen Hospital, Vienna, Austria
| | - G Renda
- G. d'Annunzio University, Chieti, Italy
| | | | - F Ricci
- G. d'Annunzio University, Chieti, Italy
| | - P Kirkhhof
- University of Birmingham, Birmingham, United Kingdom
| | - R De Caterina
- University of Birmingham, Birmingham, United Kingdom
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Bauer T, Zeymer U, Diallo A, Vicaut E, Bolognese L, Cequier A, Huber K, Montalescot G, Hamm CW, Van 'T Hof AW. P5602Impact of preprocedural TIMI flow on clinical outcome in low-risk patients with ST-elevation myocardial infarction: results from the ATLANTIC study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5602] [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)
- T Bauer
- Justus-Liebig University of Giessen, Giessen, Germany
| | - U Zeymer
- Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany
| | - A Diallo
- Hospital Lariboisiere, Paris, France
| | - E Vicaut
- Hospital Lariboisiere, Paris, France
| | | | - A Cequier
- University Hospital of Bellvitge, Barcelona, Spain
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | | | - C W Hamm
- Justus-Liebig University of Giessen, Giessen, Germany
| | - A W Van 'T Hof
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
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46
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Goette A, Merino J, De Caterina R, Huber K, Heidbuchel H, Jin J, Melino M, Winters SM, Lip GYH. P1003Effect of concomitant antiplatelet agents on clinical outcomes in the Edoxaban versus Warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomised trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Goette
- St. Vincenz-Hospital, Paderborn, Germany
| | - J Merino
- University Hospital La Paz, Madrid, Spain
| | | | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | | | - J Jin
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - M Melino
- Daichii Sankyo Pharma Development, Basking Ridge, United States of America
| | - S M Winters
- Daiichi Sankyo, Inc, Global Medical Affairs, Basking Ridge, United States of America
| | - G Y H Lip
- University of Birmingham, Birmingham, United Kingdom
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47
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Kassem M, Andric T, Tajsic MK, Soysal H, Tscharre MK, Vargas K, Huber K. P1741Copeptin plasma level in type 1 and type 2 myocardial infarctions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Kassem
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - T Andric
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - M K Tajsic
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - H Soysal
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - M K Tscharre
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - K Vargas
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
| | - K Huber
- Wilhelminen Hospital, 3rd medical department, Cardiology and Intensive medicine, Vienna, Austria
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48
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Orban M, Trenk D, Rieber J, Geisler T, Hadamitzky M, Komosa A, Gross L, Orban MW, Huber K, Felix SB, Huczek Z, Jacobshagen C, Aradi D, Massberg S, Sibbing D. P3669Smoking and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS smoking substudy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Klinische Pharmakologie, Bad Krozingen, Germany
| | - J Rieber
- Heart Centre Munich-Bogenhausen, Department of Cardiology and Intensive Care Medicine, Munich, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- Deutsches Herzzentrum Technische Universitat, Radiology, Munich, Germany
| | - A Komosa
- Poznan University of Medical Sciences, 1st Department of Cardiology, Poznan, Poland
| | - L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M W Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - S B Felix
- University Hospital Rostock, Department of Internal Medicine B, Rostock, Germany
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - D Aradi
- Balatonfured State Cardiology Hospital, Cardiology, Balatonfured, Hungary
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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49
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Gross L, Trenk D, Geisler T, Hadamitzky M, Loew A, Orban M, Huber K, Kiss RG, Merkely B, Huczek Z, Beuthner BEC, Massberg S, Aradi D, Jacobshagen C, Sibbing D. P5107Gender and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients: the TROPICAL-ACS gender substudy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5107] [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: 11/15/2022] Open
Affiliation(s)
- L Gross
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Geisler
- University Hospital of Tubingen, Department of Cardiology, Tubingen, Germany
| | - M Hadamitzky
- German Heart Center of Munich, Department of Radiology, Munich, Germany
| | - A Loew
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - K Huber
- Wilhelminen Hospital, 3rd Medical Department for Cardiology and Emergency Medicine, Vienna, Austria
| | - R G Kiss
- Military Hospital, Department of Cardiology, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Centre, Budapest, Hungary
| | - Z Huczek
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - B E C Beuthner
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - D Aradi
- Semmelweis University, Heart Centre Balatonfüred and Heart and Vascular Centre, Budapest, Hungary
| | - C Jacobshagen
- University Medical Center Gottingen (UMG), Department of Cardiology and Pneumology, Gottingen, Germany
| | - D Sibbing
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
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Abstract
SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.
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Affiliation(s)
- J C Kirchheimer
- The Laboratory for Clinical Experimental Physiologiy, Department of Medical Physiology, University of Vienna, Austria
| | - K Huber
- The II. Department of Gastroenterology and Hepatology, University of Vienna, Austria
| | - P Polterauer
- The II. Department of Gastroenterology and Hepatology, University of Vienna, Austria
| | - B R Binder
- The Laboratory for Clinical Experimental Physiologiy, Department of Medical Physiology, University of Vienna, Austria
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