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De Filippo O, Cammann VL, Pancotti C, Di Vece D, Silverio A, Schweiger V, Niederseer D, Szawan KA, Würdinger M, Koleva I, Dusi V, Bellino M, Vecchione C, Parodi G, Bossone E, Gili S, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Jansen T, Dichtl W, von Lewinski D, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Massoomi M, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Kato K, Ishibashi I, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Budnik M, Opolski G, Thiele H, Bauersachs J, Horowitz JD, Di Mario C, Bruno F, Kong W, Dalakoti M, Imori Y, Münzel T, Crea F, Lüscher TF, Bax JJ, Ruschitzka F, De Ferrari GM, Fariselli P, Ghadri JR, Citro R, D'Ascenzo F, Templin C. Machine learning-based prediction of in-hospital death for patients with takotsubo syndrome: The InterTAK-ML model. Eur J Heart Fail 2023; 25:2299-2311. [PMID: 37522520 DOI: 10.1002/ejhf.2983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/01/2023] [Accepted: 07/26/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine learning (ML)-based model to predict the risk of in-hospital death and to perform a clustering of TTS patients to identify different risk profiles. METHODS AND RESULTS A ridge logistic regression-based ML model for predicting in-hospital death was developed on 3482 TTS patients from the International Takotsubo (InterTAK) Registry, randomly split in a train and an internal validation cohort (75% and 25% of the sample size, respectively) and evaluated in an external validation cohort (1037 patients). Thirty-one clinically relevant variables were included in the prediction model. Model performance represented the primary endpoint and was assessed according to area under the curve (AUC), sensitivity and specificity. As secondary endpoint, a K-medoids clustering algorithm was designed to stratify patients into phenotypic groups based on the 10 most relevant features emerging from the main model. The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.89 (0.85-0.92), a sensitivity of 0.85 (0.78-0.95) and a specificity of 0.76 (0.74-0.79) in the internal validation cohort and an AUC of 0.82 (0.73-0.91), a sensitivity of 0.74 (0.61-0.87) and a specificity of 0.79 (0.77-0.81) in the external cohort for in-hospital death prediction. By exploiting the 10 variables showing the highest feature importance, TTS patients were clustered into six groups associated with different risks of in-hospital death (28.8% vs. 15.5% vs. 5.4% vs. 1.0.8% vs. 0.5%) which were consistent also in the external cohort. CONCLUSION A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed unprecedented discriminative capability for the prediction of in-hospital death.
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Affiliation(s)
- Ovidio De Filippo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Corrado Pancotti
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Angelo Silverio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Victor Schweiger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Iva Koleva
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Veronica Dusi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Guido Parodi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | | | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, Mid-German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Thomas Jansen
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
- Vincentius-Diakonissen Hospital, Karlsruhe, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Massoomi
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n. 8, Cardiology Unit, Vicenza, Italy
| | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U. San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Santa Maria University Hospital, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, Medical Center, University of Ulm, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - William Kong
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mayank Dalakoti
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College and Kings College, London, UK
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
- Department of Cardio-Thoracic-Vascular, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland
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Marquardt MM, Napp LC, Martens A. A Still Functional 50-Year-Old Mechanical Aortic Valve Prosthesis. Dtsch Arztebl Int 2023; 120:767. [PMID: 38051565 PMCID: PMC10745561 DOI: 10.3238/arztebl.m2023.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Affiliation(s)
| | - L. Christian Napp
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover,
| | - Andreas Martens
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover
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Akil A, Napp LC, Rao C, Klaus T, Scheier J, Pappalardo F. Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review. J Clin Med 2022; 11:jcm11205990. [PMID: 36294309 PMCID: PMC9604472 DOI: 10.3390/jcm11205990] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS.
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Affiliation(s)
- Ali Akil
- Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, 49477 Ibbenbueren, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | | | | | | | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, 15100 Alessandria, Italy
- Correspondence:
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Derda AA, Marquardt MM, Martens A, Mirena E, Vogel-Claussen J, Kempf T, Haverich A, Bauersachs J, Napp LC. Cinefluoroscopy for assessment of mechanical heart valves with suspected dysfunction. Front Cardiovasc Med 2022; 9:952255. [PMID: 36148066 PMCID: PMC9486207 DOI: 10.3389/fcvm.2022.952255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mechanical heart valves (MHVs) are preferred prosthesis types in many, especially younger patients who need surgical valve replacement. Although echocardiography is most frequently performed for prosthesis assessment during follow-up, ultrasound artifacts usually preclude a precise investigation of prosthesis function. Cinefluoroscopy (CF) is a simple and effective method to analyze and quantify opening and closing of prosthesis leaflets but requires careful visualization of the valve using optimal viewing angles. Here, we investigated the quality of CF studies in clinical routine and their suitability for quantitative analysis of prosthesis function. Methods and results We retrospectively identified 94 patients with 118 cinefluoroscopies performed by 31 different investigators in one tertiary center from 2012 to 2021. Of 150 MHVs (98% bi-leaflet prostheses), 87 (58%) were aortic, 53 (34%) mitral, 7 (5%) tricuspid, and 5 (3%) pulmonary valve prostheses, respectively. CF studies were categorized by their suitability to quantitatively assess opening and closing angles. Visualization of valve function was “sufficient” in 23%, “suboptimal” in 46%, and “unsuitable” in 31% of the cases. Conclusion In clinical routine, only one-fourth of CF studies allow for a complete assessment of leaflet motion of MHVs. Although this may be in part due to the varying experience of operators, the high number of unsuitable studies suggests that optimal viewing angles may not be achievable in all patients. Further research is required to investigate standard viewing angles and anatomy after MHV implantation to improve the quality of CF studies and reduce radiation exposure of patients and operators.
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Affiliation(s)
- Anselm A. Derda
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Marvin M. Marquardt
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Elion Mirena
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
- *Correspondence: L. Christian Napp,
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Janssen H, Wagner NM, Napp LC, Larmann J. Editorial: Targeting innate and adaptive immunity for improvement of cardiovascular disease. Front Physiol 2022; 13:952837. [PMID: 36035461 PMCID: PMC9405887 DOI: 10.3389/fphys.2022.952837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Henrike Janssen
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nana Maria Wagner
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Muenster, Muenster, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- *Correspondence: Jan Larmann,
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Schmitto JD, Napp LC, Mariani S, Hanke JS, Li T, Vogel-Claussen J, Brandes K, Göttel P, Müller J, Dogan G, Bauersachs J, Haverich A. First-in-man Implantation of a Cardiac Microcurrent Device for Chronic Systolic Heart Failure. ASAIO J 2022; 68:e121-e123. [PMID: 34324448 DOI: 10.1097/mat.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Current therapies significantly improve survival and clinical endpoints in patients suffering from chronic heart failure with reduced ejection fraction (HFrEF), but most are not sufficient to reverse adverse remodeling and improve myocardial contractility. Herein, we report the first-in-man experience with a novel fully implantable device for cardiac electrical microcurrent (C-MIC) application. A 79-year-old man suffering from HFrEF (dilated cardiomyopathy, NYHA class III, left ventricular ejection fraction 30%) successfully underwent implantation of the C-MIC device through left anterolateral thoracotomy. At 30-day follow-up, no device-related complications were observed, demonstrating feasibility of C-MIC implantation in a patient suffering from HFrEF.
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Affiliation(s)
- Jan D Schmitto
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tong Li
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | | | | | - Guenes Dogan
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- From the Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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7
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Napp LC, Medjamia AM, Burkhoff D, Kapur NK, Bauersachs J. The challenge of defining best practice treatment for Takotsubo syndrome with shock. Cardiovasc Revasc Med 2022; 42:183-185. [PMID: 35817687 DOI: 10.1016/j.carrev.2022.06.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
| | - Amin M Medjamia
- Division of Cardiology, Abiomed Inc., Danvers, MA, United States
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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8
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Li T, Mariani S, Bounader K, Boethig D, Schöde A, Homann K, Hanke JS, Napp LC, Merzah AS, Dogan G, Haverich A, Schmitto JD. Is There a Sex Gap in Outcomes of Comparable Patients Supported with Left Ventricular Assist Devices? Artif Organs 2022; 46:2293-2303. [PMID: 35686944 DOI: 10.1111/aor.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Historically, females were described as suffering from worse outcomes after left ventricular assist device (LVAD) implantation. However, females' preoperative conditions are unique, making direct comparisons with males challenging. This study aimed to select through propensity score (PS) matching two preoperatively comparable populations of females and males and test if any real sex-related difference exists regarding survival and adverse events after LVAD implantation. METHODS This retrospective single-center observational study investigated patients who received LVAD implantation between 2010 and 2018. PS matching was applied to balance preoperative heterogeneity between males and females. Primary endpoint was survival at follow-up. Secondary endpoints included perioperative outcomes and LVAD-related adverse events. RESULTS 92 fully comparable females(n=46) and males(n=46) were selected after PS matching (median age:57 years, min-max:18-75). 26.1% of patients required preoperative mechanical circulatory support. Females needed more intraoperative fresh frozen plasma (p<0.001) and platelets transfusions (p=0.008) compared to males, but postoperative outcomes were comparable between groups. In-hospital, 1-year and 2-year survival were 78.3%, 69.6% and 65.2%, respectively, with no differences between groups. Survival probability remained comparable up to 8 years of follow-up(p=0.35). Overall, females showed a higher rate of strokes(p=0.039) compared to males in the follow-up time. CONCLUSIONS After reducing preoperative heterogeneity between females and males, survival after LVAD implantation does not differ based on sex. However, differences might exist in terms of higher transfusions and strokes in females. Reducing preoperative sex disparities and developing intraoperative and anticoagulation strategies which acknowledge sex-related variations might help abolishing differences in LVAD outcomes.
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Affiliation(s)
- Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC+), Maastrichts, Netherlands
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexandra Schöde
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Katharina Homann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ali Saad Merzah
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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9
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Koenig T, Vogel-Claussen J, Bauersachs J, Napp LC. Coincidence of Spontaneous Coronary Artery Dissection With Apical Takotsubo Syndrome. Circ J 2022; 86:1476. [DOI: 10.1253/circj.cj-22-0074] [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: 11/09/2022]
Affiliation(s)
- Tobias Koenig
- Department of Cardiology and Angiology, Hannover Medical School
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School
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10
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Adel J, Akin M, Garcheva V, Vogel-Claussen J, Bauersachs J, Napp LC, Schäfer A. Computed-Tomography as First-line Diagnostic Procedure in Patients With Out-of-Hospital Cardiac Arrest. Front Cardiovasc Med 2022; 9:799446. [PMID: 35187123 PMCID: PMC8850697 DOI: 10.3389/fcvm.2022.799446] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMortality after out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) remains high despite numerous efforts to improve outcome. For patients with suspected coronary cause of arrest, coronary angiography is crucial. However, there are other causes and potentially life-threatening injuries related to cardiopulmonary resuscitation (CPR), which can be detected by routine computed tomography (CT).Materials and MethodsAt Hannover Medical School, rapid coronary angiography and CT are performed in successfully resuscitated OHCA patients as a standard of care prior to admission to intensive care. We analyzed all patients who received CT following OHCA with ROSC over a three-year period.ResultsThere were 225 consecutive patients with return of spontaneous circulation following out-of-hospital cardiac arrest. Mean age was 64 ± 13 years, 75% were male. Of them, 174 (77%) had witnessed arrest, 145 (64%) received bystander CPR, and 123 (55%) had a primary shockable rhythm. Mean time to ROSC was 24 ± 20 min. There were no significant differences in CT pathologies in patients with or without ST-segment elevations in the initial ECG. Critical CT findings qualifying as a potential cause for cardiac arrest were intracranial bleeding (N = 6), aortic dissection (N = 5), pulmonary embolism (N = 17), pericardial tamponade (N = 3), and tension pneumothorax (N = 11). Other pathologies were regarded as consequences of CPR and relevant for further treatment: aspiration (N = 62), rib fractures (N = 161), sternal fractures (N = 50), spinal fractures (N = 11), hepatic bleeding (N = 12), and intra-abdominal air (N = 3).ConclusionEarly CT fallowing OHCA uncovers a high number of causes and consequences of OHCA and CPR. Those are relevant for post-arrest care and are frequently life-threatening, suggesting that CT can contribute to improving prognosis following OHCA.
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Affiliation(s)
- John Adel
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Muharrem Akin
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
- *Correspondence: Muharrem Akin
| | - Vera Garcheva
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - L. Christian Napp
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Cardiac Arrest Centre, Hannover Medical School, Hannover, Germany
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11
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El-Battrawy I, Cammann VL, Kato K, Szawan KA, Di Vece D, Rossi A, Wischnewsky M, Hermes-Laufer J, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, David Arroja J, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Duru F, Borggrefe M, Ghadri JR, Akin I, Templin C. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry. J Am Heart Assoc 2021; 10:e014059. [PMID: 34315238 PMCID: PMC8475688 DOI: 10.1161/jaha.119.014059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non‐AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in‐hospital (P<0.001) and long‐term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long‐term mortality (hazard ratio, 2.31; 95% CI, 1.50–3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in‐hospital and long‐term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in‐hospital and long‐term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
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Affiliation(s)
- Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Victoria L Cammann
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Aurelio Rossi
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Julia Hermes-Laufer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | | | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Eduardo Bossone
- Division of Cardiology "Antonio Cardarelli" Hospital Naples Italy
| | - Michael Neuhaus
- Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Benjamin Meder
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Milosz Jaguszewski
- First Department of Cardiology Medical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Mid-German Heart Center Department of Internal Medicine III Division of Cardiology, Angiology and Intensive Medical Care University Hospital HalleMartin-Luther-University Halle-Wittenberg Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | | | - Behrouz Kherad
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Carsten Tschöpe
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology Department of Medicine University of California-San Francisco San Francisco CA
| | - Jerold Shinbane
- Keck School of Medicine University of Southern California Los Angeles CA
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Department of Cardiology Intensive Care Medicine and Angiology Vincentius-Diakonissen-Hospital Karlsruhe Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Centre for Cardiovascular Research partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Philippe Meyer
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Monika Budnik
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology King's College Hospital London United Kingdom
| | - Philip MacCarthy
- Department of Cardiology King's College Hospital London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Martin Kozel
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Jan Galuszka
- Department of Internal Medicine I-Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | | | | | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Kan Liu
- Division of Cardiology, Heart and Vascular Center University of Iowa Iowa City IA
| | - P Christian Schulze
- Department of Internal Medicine I University Hospital JenaFriedrich-Schiller-University Jena Jena Germany
| | - Matteo Bianco
- Division of Cardiology A.O.U. San Luigi Gonzaga Orbassano, Turin Italy
| | - Lucas Jörg
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Hans Rickli
- Department of Cardiology Kantonsspital St. Gallen St. Gallen Switzerland
| | - Gonçalo Pestana
- Department of Cardiology Centro Hospitalar Universitário de São JoãoE.P.E. Porto Portugal
| | - Thanh H Nguyen
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II Universitätsklinikum Regensburg Regensburg Germany
| | - Fausto J Pinto
- Cardiology Department Santa Maria University HospitalCHLNCAMLCCULFaculty of MedicineUniversity of Lisbon Lisbon Portugal
| | - Petr Widimský
- Cardiocenter Third Faculty of Medicine Charles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
| | - Grzegorz Opolski
- Department of Cardiology Medical University of Warsaw Warsaw Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of UlmMedical Center Ulm Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Burkert M Pieske
- Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany.,German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - John D Horowitz
- Department of Cardiology Basil Hetzel InstituteQueen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Firat Duru
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Jelena R Ghadri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany.,German Center for Cardiovascular Researchpartner site Heidelberg-Mannheim Mannheim Germany
| | - Christian Templin
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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Napp LC, Lebreton G, De Somer F, Supady A, Pappalardo F. Opportunities, controversies, and challenges of extracorporeal hemoadsorption with CytoSorb during ECMO. Artif Organs 2021; 45:1240-1249. [PMID: 34152637 DOI: 10.1111/aor.14025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is frequently used in many centers around the globe for various indications. However, prognosis is often poor even with all supportive therapies, and in many cases, clinical deterioration is associated with inflammation. Hemoadsorption with CytoSorb is a novel approach to limit the inflammatory response, and the device can be safely and easily installed into ECMO circuits. CytoSorb has been used more than 130.000 times to date, but because randomized controlled trials are largely lacking, there is substantial debate on its use. Here, experts from critical care medicine, cardiology, cardiac surgery, and perfusion technology discuss the pros and cons of this novel therapy and outline the future aspects for its clinical application and research.
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Affiliation(s)
- L Christian Napp
- Cardiac Arrest Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Guillaume Lebreton
- Department of Cardiac and Thoracic Surgery, Cardiology Institute, La Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University Medical School, Paris, France
| | - Filip De Somer
- Heart Centre 5K12, University Hospital Ghent, Ghent, Belgium
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy
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13
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Napp LC, Cammann VL, Jaguszewski M, Szawan KA, Wischnewsky M, Gili S, Knorr M, Heiner S, Citro R, Bossone E, D'Ascenzo F, Neuhaus M, Franke J, Sorici-Barb I, Noutsias M, Burgdorf C, Koenig W, Kherad B, Sarcon A, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Hauck C, Paolini C, Bilato C, Imori Y, Kato K, Kobayashi Y, Opolski G, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Polednikova K, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Di Mario C, Prasad A, Rihal CS, Schulze PC, Bianco M, Crea F, Borggrefe M, Maier LS, Pinto FJ, Braun-Dullaeus RC, Rottbauer W, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Bauersachs J, Braunwald E, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Coexistence and outcome of coronary artery disease in Takotsubo syndrome. Eur Heart J 2021; 41:3255-3268. [PMID: 32484517 DOI: 10.1093/eurheartj/ehaa210] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/09/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
AIMS Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. METHODS AND RESULTS Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. CONCLUSIONS Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01947621.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | | | | | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Germany, Hamburg
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose D Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit no. 8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoichi Imori
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Ken Kato
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Karolina Polednikova
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Faculty of Medicine, Santa Maria University Hospital, CHLN, CAML, CCUL, University of Lisbon, Lisbon, Portugal
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Germany, Leipzig
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Eugene Braunwald
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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14
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Bernhardt AM, Potapov E, Schibilsky D, Ruhparwar A, Tschöpe C, Spillmann F, Benk C, Schmack B, Schmitto JD, Napp LC, Mayer-Wingert N, Doll N, Reichenspurner H, Schulte-Eistrup S. First in man evaluation of a novel circulatory support device: Early experience with the Impella 5.5 after CE mark approval in Germany. J Heart Lung Transplant 2021; 40:850-855. [PMID: 34030970 DOI: 10.1016/j.healun.2021.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/06/2021] [Accepted: 04/03/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The Abiomed Impella 5.5 (Danvers, MA) is a newly developed axial flow transaortic cardiac support device mounted on a 9 Fr steering catheter with a 21 Fr pump cannula. Impella 5.5 is intended for longer use and was approved for 30 days in 2018. This study evaluated the first-in-man series at six high-volume mechanical circulatory support centers in Germany after CE approval. METHODS The first 46 consecutive patients worldwide underwent implantation in six German centers between March 2018 and September 2019 for post-CE approval evaluation. The primary end-point was 30 days and 90 days all-cause mortality. RESULTS The mean age of patients was 59.0 ± 11.5 years, and 43 (93.4%) were men. Half of the patients had acute on chronic heart failure. The main indication for Impella 5.5 implantation was ischemic cardiomyopathy and acute myocardial infarction (47.8%). The mean support time was 15.5 ± 24.2 days (range 0-164, median 10 days (IQR = 7-19)) with a total of 712 patient-days on support. The 30 days and 90 days survival rates were 73.9% (95% CI: 63.3-88.9%) and 71.7% (95% CI: 60.7-87.1%), respectively. Additionally, 16 patients (34.8%) were weaned from the device for native heart recovery, and 19 (41.3%) were bridged to a durable device. Fifteen patients (32.6%) were mobilized to a chair, and 15 (32.6%) were ambulatory. We only noted one stroke and found no other thromboembolic complications. No aortic valve damage was observed in the study cohort. Finally, seven patients (15.2 %) had pump thrombosis, and nine (19.6 %) underwent device exchange. Sixteen patients (34.8 %) suffered from bleeding requiring transfusions during the whole treatment course. In ten patients (21.7%), the inflow cannula dislocated into the aortic root. CONCLUSIONS The first version of the Impella 5.5 presents promising early outcomes for patients with acute heart failure and expands the spectrum of available devices. The adverse event profile is favorable for short-term devices. Dislocations have been addressed by design changes. With increasing experience with this device, our study suggests that the indications for use will expand to other cardiac shock etiologies and may improve myocardial recovery and survival in patients with cardiogenic shock.
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Affiliation(s)
- Alexander M Bernhardt
- University Heart and Vascular Center Hamburg, Germany/ Department of Cardiovascular Surgery, Germany.
| | - Evgenij Potapov
- German Heart Center Berlin, Germany/ Department of Thoracic and Cardiovascular Surgery, Germany
| | - David Schibilsky
- University Heart Center, Freiburg, Bad Krozingen, Germany/ Department of Cardiovascular Surgery Faculty of Medicine, University Freiburg, Germany
| | - Arjang Ruhparwar
- The West German Heart Center, Essen, Germany/ Department of Cardiovascular Surgery, Germany
| | - Carsten Tschöpe
- Charité - Universitätsmedizin Berlin, Germany/ Campus Virchow/ Department of Cardiology, Germany; Charité - Universitätsmedizin Berlin, Germany/Berlin Institute of Health (BIH) Berlin Brandenburger Center For Regenerative Therapies (BCRT), Germany
| | - Frank Spillmann
- Charité - Universitätsmedizin Berlin, Germany/ Campus Virchow/ Department of Cardiology, Germany
| | - Christoph Benk
- University Heart Center, Freiburg, Bad Krozingen, Germany/ Department of Cardiovascular Surgery Faculty of Medicine, University Freiburg, Germany
| | - Bastian Schmack
- The West German Heart Center, Essen, Germany/ Department of Cardiovascular Surgery, Germany
| | - Jan D Schmitto
- Hannover Medical School, Hannover, Germany/ Department of Cardiovascular Surgery, Germany
| | - L Christian Napp
- Hannover Medical School, Hannover, Germany/ Department of Cardiology and Angiology, Germany
| | - Nadja Mayer-Wingert
- Schüchtermann clinic, Bad Rothenfelde, Germany/ Department of Cardiology, Germany
| | - Nicolas Doll
- Schüchtermann clinic, Bad Rothenfelde, Germany/ Department of Cardiovascular Surgery, Germany
| | - Hermann Reichenspurner
- University Heart and Vascular Center Hamburg, Germany/ Department of Cardiovascular Surgery, Germany
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15
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Mariani S, Napp LC, Kraaier K, Li T, Bounader K, Hanke JS, Dogan G, Schmitto JD, Lorusso R. Prophylactic mechanical circulatory support for protected ventricular tachycardia ablation: A meta-analysis of the literature. Artif Organs 2021; 45:987-997. [PMID: 33616221 DOI: 10.1111/aor.13945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/30/2020] [Accepted: 02/14/2021] [Indexed: 12/15/2022]
Abstract
Acute hemodynamic decompensation (AHD) during ventricular tachycardia (VT) ablation occurs in about 11% of cases. Prophylactic use of temporary mechanical circulatory support (pro-tMCS) has been applied to prevent AHD during VT ablation, but evidence supporting this practice is still lacking. This systematic review and meta-analysis assessed the procedural characteristics and outcomes of pro-tMCS for VT ablation. PubMed/Medline was screened until February 2020. Articles including adults receiving pro-tMCS for VT ablation were included, and a meta-analysis to compare proMCS and no-tMCS was performed. Primary outcome was in-hospital/30-day mortality. Five observational studies presenting 400 procedures (pro-tMCS: n = 187; no-tMCS: n = 213) were included. Baseline characteristics were comparable between groups. Impella and TandemHeart were used in 86.6% and 13.4% of cases, respectively. In the pro-tMCS group, more VTs were induced (mean difference: 0.52, confidence interval [CI]: 0.26-0.77, P < .0001), and patients remained in VT on average for 24.04 minutes longer (CI: 18.28-29.80, P < .00001). Procedural success was comparable between groups, as was VT recurrence. Pro-tMCS patients had an odds ratio of 0.55 (CI: 0.28-1.05, P = .07) for in-hospital/30-day mortality and 0.55 (CI: 0.32-0.94, P = .03) for mortality at follow-up. Sixty-four percent of no-tMCS patients received rescue tMCS. The most common tMCS-related complications were bleeding events. Pro-tMCS allowed for a prolonged time on VTs and the induction of more VTs. Although these advantages were not associated with differences in procedural success, VT recurrence, or in-hospital/30-day mortality in the overall population, pro-tMCS might improve long-term survival. Further prospective studies are urgently needed to confirm these results.
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Affiliation(s)
- Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karin Kraaier
- Department of Cardiology, Hart-en Vaatcentrum Leeuwarden, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Günes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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16
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Kato K, Cammann VL, Napp LC, Szawan KA, Micek J, Dreiding S, Levinson RA, Petkova V, Würdinger M, Patrascu A, Sumalinog R, Gili S, Clarenbach CF, Kohler M, Wischnewsky M, Citro R, Vecchione C, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Sano M, Ishibashi I, Takahara M, Himi T, Kobayashi Y, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry. ESC Heart Fail 2021; 8:1924-1932. [PMID: 33713566 PMCID: PMC8120351 DOI: 10.1002/ehf2.13165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. METHODS AND RESULTS Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002). CONCLUSIONS The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.
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Affiliation(s)
- Ken Kato
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Sara Dreiding
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rena A Levinson
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Vanya Petkova
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Michael Würdinger
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Alexandru Patrascu
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Rafael Sumalinog
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | | | | | - Malcolm Kohler
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Carmine Vecchione
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Jerold Shinbane
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Mathias Wolfrum
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Masanori Sano
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa, USA
| | - P Christian Schulze
- Department of Internal Medicine I, JenaUniversity Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL), Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University of Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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17
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Mariani S, Li T, Bounader K, Boethig D, Schöde A, Hanke JS, Michaelis J, Napp LC, Berliner D, Dogan G, Lorusso R, Haverich A, Schmitto JD. Sex differences in outcomes following less-invasive left ventricular assist device implantation. Ann Cardiothorac Surg 2021; 10:255-267. [PMID: 33842220 DOI: 10.21037/acs-2020-cfmcs-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures. Methods This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events. Results Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47-61); male (median, 58.5; IQR, 49-66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71-146); male (median, 126; IQR, 9-168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similar probability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sex-related differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVAD-related infections remained the most common complication with males experiencing more pump infections than women (P=0.050). Conclusions Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.
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Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.,Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Tong Li
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karl Bounader
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexandra Schöde
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jana Michaelis
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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18
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Cammann VL, Szawan KA, Stähli BE, Kato K, Budnik M, Wischnewsky M, Dreiding S, Levinson RA, Di Vece D, Gili S, Citro R, Bossone E, Neuhaus M, Franke J, Meder B, Jaguszewski M, Noutsias M, Knorr M, Heiner S, D'Ascenzo F, Dichtl W, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Roffi M, Banning A, Wolfrum M, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Poledniková K, Toušek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Kobayashi Y, Shoji T, Ishibashi I, Takahara M, Himi T, Din J, Al-Shammari A, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Pestana G, Nguyen TH, Böhm M, Maier LS, Pinto FJ, Widimský P, Felix SB, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Horowitz JD, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Opolski G, Templin C. Age-Related Variations in Takotsubo Syndrome. J Am Coll Cardiol 2021; 75:1869-1877. [PMID: 32327096 DOI: 10.1016/j.jacc.2020.02.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. OBJECTIVES This study aimed to investigate age-related differences in TTS. METHODS Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. RESULTS Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. CONCLUSIONS A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.
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Affiliation(s)
- Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara E Stähli
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sara Dreiding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, California
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marco Roffi
- Service de cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Mathias Wolfrum
- Department of Internal Medicine, Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Karolina Poledniková
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Christian Hauck
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshihiro Shoji
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | - Iwao Ishibashi
- Department of Cardiology, Chiba Emergency Medical Center, Chiba, Japan
| | | | - Toshiharu Himi
- Division of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan
| | - Jehangir Din
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Ali Al-Shammari
- Dorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, Iowa
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gonçalo Pestana
- Department of Cardiology, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Santa Maria University Hospital, CHULN, Center of Cardiology of the University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisboa, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic
| | - Stephan B Felix
- Department of Cardiology and Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany; Local Health Unit n.8, Cardiology Unit, Arzignano, Vicenza, Italy
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim, Mannheim, Germany
| | - Holger Thiele
- Heart Center Leipzig - University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John D Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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Richter J, Vogel-Claussen J, Bobylev D, Horke A, Westhoff-Bleck M, Bauersachs J, Napp LC. Separate Origin of Four Major Coronary Arteries. Cardiovasc Revasc Med 2020; 25:86-88. [PMID: 33317947 DOI: 10.1016/j.carrev.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jannik Richter
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mechthild Westhoff-Bleck
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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20
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Boeken U, Ghanem A, Michels G, Napp LC, Preusch MR, Staudacher DL, Thiele H, Wengenmayer T. [Extracorporeal life support (ECLS)-Update 2020]. Med Klin Intensivmed Notfmed 2020; 116:56-58. [PMID: 33146748 DOI: 10.1007/s00063-020-00755-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Udo Boeken
- Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Alexander Ghanem
- Innere Medizin II, Kardiologie & internistische Intensivmedizin, Asklepios Klinik Nord - Heidberg, Hamburg, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - L Christian Napp
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Michael R Preusch
- Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Dawid L Staudacher
- Klinik für Kardiologie und Angiologie I, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig - Universitätsklinik für Kardiologie, Leipzig, Deutschland
| | - Tobias Wengenmayer
- Klinik für Kardiologie und Angiologie I, Universitätsklinikum Freiburg, Freiburg, Deutschland
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21
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Gili S, Cammann VL, Schlossbauer SA, Kato K, D'Ascenzo F, Di Vece D, Jurisic S, Micek J, Obeid S, Bacchi B, Szawan KA, Famos F, Sarcon A, Levinson R, Ding KJ, Seifert B, Lenoir O, Bossone E, Citro R, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Gaita F, Di Mario C, Wischnewsky MB, Bax JJ, Prasad A, Böhm M, Ruschitzka F, Lüscher TF, Ghadri JR, Templin C. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J 2020; 40:2142-2151. [PMID: 31098611 PMCID: PMC6612368 DOI: 10.1093/eurheartj/ehz170] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
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Affiliation(s)
- Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Susanne A Schlossbauer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Flurina Famos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles CA, USA
| | - Rena Levinson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Olivia Lenoir
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Eduardo Bossone
- Division of Cardiology 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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22
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Karamasis G, Napp LC, Dogan G, Ruhparwar A, Schmack B, Reitan O, Zundorf I, Giering T, Walker T, Keeble T. TCT CONNECT-179 In Vivo Safety of the 10-F Reitan Catheter Temporary Percutaneous Mechanical Circulatory Support (pMCS) Device. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Klinke A, Schubert T, Müller M, Legchenko E, Zelt JGE, Shimauchi T, Napp LC, Rothman AMK, Bonnet S, Stewart DJ, Hansmann G, Rudolph V. Emerging therapies for right ventricular dysfunction and failure. Cardiovasc Diagn Ther 2020; 10:1735-1767. [PMID: 33224787 PMCID: PMC7666928 DOI: 10.21037/cdt-20-592] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
Therapeutic options for right ventricular (RV) dysfunction and failure are strongly limited. Right heart failure (RHF) has been mostly addressed in the context of pulmonary arterial hypertension (PAH), where it is not possible to discern pulmonary vascular- and RV-directed effects of therapeutic approaches. In part, opposing pathomechanisms in RV and pulmonary vasculature, i.e., regarding apoptosis, angiogenesis and proliferation, complicate addressing RHF in PAH. Therapy effective for left heart failure is not applicable to RHF, e.g., inhibition of adrenoceptor signaling and of the renin-angiotensin system had no or only limited success. A number of experimental studies employing animal models for PAH or RV dysfunction or failure have identified beneficial effects of novel pharmacological agents, with most promising results obtained with modulators of metabolism and reactive oxygen species or inflammation, respectively. In addition, established PAH agents, in particular phosphodiesterase-5 inhibitors and soluble guanylate cyclase stimulators, may directly address RV integrity. Promising results are furthermore derived with microRNA (miRNA) and long non-coding RNA (lncRNA) blocking or mimetic strategies, which can target microvascular rarefaction, inflammation, metabolism or fibrotic and hypertrophic remodeling in the dysfunctional RV. Likewise, pre-clinical data demonstrate that cell-based therapies using stem or progenitor cells have beneficial effects on the RV, mainly by improving the microvascular system, however clinical success will largely depend on delivery routes. A particular option for PAH is targeted denervation of the pulmonary vasculature, given the sympathetic overdrive in PAH patients. Finally, acute and durable mechanical circulatory support are available for the right heart, which however has been tested mostly in RHF with concomitant left heart disease. Here, we aim to review current pharmacological, RNA- and cell-based therapeutic options and their potential to directly target the RV and to review available data for pulmonary artery denervation and mechanical circulatory support.
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Affiliation(s)
- Anna Klinke
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Torben Schubert
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marion Müller
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Ekaterina Legchenko
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Jason G. E. Zelt
- Division of Cardiology, University of Ottawa Heart Institute and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Tsukasa Shimauchi
- Pulmonary Hypertension Research Group, Centre de recherche de IUCPQ/Laval University, Quebec, Canada
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Sébastien Bonnet
- Pulmonary Hypertension Research Group, Centre de recherche de IUCPQ/Laval University, Quebec, Canada
| | - Duncan J. Stewart
- Division of Cardiology, University of Ottawa Heart Institute and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Georg Hansmann
- Department of Pediatric Cardiology and Critical Care, Hannover Medical School, Hannover, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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24
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Napp LC, Sanchez Martinez C, Akin M, Garcheva V, Kühn C, Bauersachs J, Schäfer A. Use of extracorporeal membrane oxygenation for eCPR in the emergency room in patients with refractory out-of-hospital cardiac arrest. PLoS One 2020; 15:e0239777. [PMID: 32986781 PMCID: PMC7521699 DOI: 10.1371/journal.pone.0239777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) refractory to conventional high-quality cardiopulmonary resuscitation (CPR) may be rescued by extracorporeal CPR (eCPR) using veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Even when trying to identify eCPR candidates based on criteria assumed to be associated with a favourable neurological outcome, reported survival rates are frequently below 10%. Methods All patients undergoing implantation of V-A ECMO for eCPR between January 2018 and December 2019 (N = 40) were analysed (age 53±13 years; 75% male). Patients with refractory OHCA and potentially favourable circumstances (initial shockable rhythm, witnessed arrest, bystander CPR, absence of limiting comorbidities, age <75 years) were transported under mechanical chest compression. Candidates for eCPR should have a pH ≥6.9, arterial lactate ≤15 mmol/L and time-to-ECMO should be ≤60 minutes. Results Overall 30-day survival was 12.5%, with 3 of 5 survivors having a favourable neurological outcome (cerebral performance category (CPC) 1 or 2), representing 7.5% of the total eCPR population. No patient selected for eCPR met all pre-defined criteria (median of unfavourable criteria: 3). Importantly, time-to-ECMO most often (39/40) exceeded 60 minutes (mean 102 ±32 min.), and lactate was >15mmol/L in 30 out of 40 patients. Moreover, 22 out of 40 patients had a non-shockable rhythm on the first ECG. Conclusions Despite our intention to select patients with potentially advantageous circumstances to achieve acceptable eCPR outcomes, the imminent deadly consequence of withholding eCPR obviously prompted individual physicians to perform the procedure also in presumably more unfavourable settings, resulting in similar mortality rates of eCPR as reported before.
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Affiliation(s)
- L. Christian Napp
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Muharrem Akin
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Vera Garcheva
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christian Kühn
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinischen Hochschule Hannover, Hannover, Germany
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Andreas Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
- * E-mail:
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25
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König T, Hanke JS, Dogan G, Kempf T, Sieweke JT, Schäfer A, Bauersachs J, Schmitto JD, Napp LC. Advanced Preconditioning: Impella 5.5 Support for Decompensated Heart Failure Before Left Ventricular Assist Device Surgery. Cardiovasc Revasc Med 2020; 28S:189-192. [PMID: 32950404 DOI: 10.1016/j.carrev.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
Left ventricular assist devices (LVAD) are increasingly used in patients with advanced heart failure, and available devices and surgical techniques have strongly evolved over time. Adequate recompensation of patients before surgery is important for optimal surgical outcomes. However, patients with terminal heart failure frequently suffer from cardiorenal syndrome, which complicates recompensation by medical means. Here, we report on the use of an Impella 5.5 microaxial pump for supporting a patient with severely decompensated heart failure before LVAD implantation, which resulted in hemodynamic stabilization and effective recompensation prior to surgery.
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Affiliation(s)
- Tobias König
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Guenes Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tibor Kempf
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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26
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Mariani S, Napp LC, Lo Coco V, Delnoij TS, Luermans JG, ter Bekke RM, Timmermans C, Li T, Dogan G, Schmitto JD, Maessen J, Maesen B, Lorusso R. Mechanical circulatory support for life-threatening arrhythmia: A systematic review. Int J Cardiol 2020; 308:42-49. [DOI: 10.1016/j.ijcard.2020.03.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 02/06/2023]
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27
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Mariani S, Richter J, Pappalardo F, Bělohlávek J, Lorusso R, Schmitto JD, Bauersachs J, Napp LC. Mechanical circulatory support for Takotsubo syndrome: a systematic review and meta-analysis. Int J Cardiol 2020; 316:31-39. [PMID: 32473281 DOI: 10.1016/j.ijcard.2020.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiogenic shock occurs in 10%-15% of patients with Takotsubo syndrome (TS). For several reasons catecholamines, and especially inotropes, should be avoided in TS. Temporary mechanical circulatory support (MCS) appears attractive as bridge-to-recovery, but prospective studies are lacking. Here we analyze the available literature on MCS use in patients with TS. METHODS AND RESULTS PubMed/Medline was systematically screened until December 2019. 18 studies reporting pooled data of 5629 TS patients, of whom 227 had received MCS, were considered for a qualitative synthesis. 81 articles from 2003 through 2019 reporting individual data of 93 MCS cases were included in a meta-analysis. Median age was 57 (IQR: 43-68) years, 83.9% were women, and a physical trigger could be identified in 74.1% of cases. Median left ventricular ejection fraction (LVEF) before MCS was 20% (IQR: 15-25) and comparable between groups defined by MCS device. An apical TS type was present in 76.1% of cases. The overall number of publications on MCS for TS increased over time, as did those using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella, while those using intra-aortic balloon pump declined. MCS-related complications were not regularly reported. Median time on MCS was 3 (IQR: 2-7) days, with an overall survival of 94.6%. CONCLUSIONS MCS for TS-related shock is increasingly reported, with a growing use of V-A ECMO and Impella. Currently available clinical data support this approach. Prospective studies are needed to evaluate safety and efficacy of different devices as well as timing of MCS in this special patient population.
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Affiliation(s)
- Silvia Mariani
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jannik Richter
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, Palermo, Italy
| | - Jan Bělohlávek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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28
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Affiliation(s)
- L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan Bělohlávek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 08, Praha 2, Czech Republic
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29
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Abstract
Takotsubo syndrome (TS) is an acute cardiac condition characterized by transient wall motion abnormalities mostly of the left ventricle. First described in 1990, TS has gained substantial attention during the past 15 years. However, the disease is still underdiagnosed. Prospective studies on TS are largely lacking, and the condition remains incompletely understood. In addition, significant misconceptions and misunderstandings are evident, contributing to potentially severe underestimation. Here, we review important aspects of TS with a focus on pitfalls, misinterpretations, and knowledge gaps considered important during diagnosis and management of the disease.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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30
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Tongers J, Sieweke JT, Kühn C, Napp LC, Flierl U, Röntgen P, Schmitto JD, Sedding DG, Haverich A, Bauersachs J, Schäfer A. Early Escalation of Mechanical Circulatory Support Stabilizes and Potentially Rescues Patients in Refractory Cardiogenic Shock. Circ Heart Fail 2020; 13:e005853. [DOI: 10.1161/circheartfailure.118.005853] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 11/16/2022]
Abstract
Background:
Limited progress has been made in the management of cardiogenic shock (CS). Morbidity and mortality of refractory CS remain high. The effects of mechanical circulatory support (MCS) are promising, although many aspects are elusive. We evaluated efficacy and safety of early combined MCS (Impella microaxial pump + venoarterial extracorporeal membrane oxygenation [VA-ECMO]) in refractory CS and aimed to determine factors for decision-making in combined MCS.
Methods and Results:
We analyzed 69 consecutive patients with refractory CS from our registry requiring combined MCS. In 12 cases, therapy was actively withdrawn according to patient’s will. Patients were severely sick (Survival After Venoarterial ECMO score mean±SD, –8.9±4.4) predicting 30% in-hospital survival; ventilation 94%, dialysis 56%. Impella pumps and VA-ECMO were combined early (duration of combined MCS: median 94 hours; interquartile range, 49–150 hours). Early MCS escalation stabilized patients rapidly, reducing number and doses of catecholamines (
P
<0.05 versus baseline) while hemodynamics improved. Reflecting an improved microcirculation, lactate levels normalized within 24 hours (
P
<0.05 versus baseline). Despite refractory CS and disease severity, survival was favorable (on MCS 61%, 30 days 49%, 6 months 40%). In multivariate Cox-regression, duration of shock-to-first device (hours, hazard ratio, 1.05 [95% CI, 1.01–1.08];
P
=0.007) and lactate levels after 12 hours of MCS (hazard ratio, 1.28 [95% CI, 1.09–1.51];
P
=0.002) independently predicted survival. Additional right ventricular failure predisposed to futility (hazard ratio, 8.48 [95% CI, 1.85–38.91];
P
=0.006).
Conclusions:
The early and consequent combination of MCS by Impella microaxial pumps and VA-ECMO enables stabilization and may rescue high-risk patients with refractory CS at low overall risk. Independent predictors of survival may guide prognostication, decision-making, and allocation of medical resources.
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Affiliation(s)
- Jörn Tongers
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Jan-Thorben Sieweke
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Christian Kühn
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - L. Christian Napp
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Ulrike Flierl
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Philipp Röntgen
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Jan D. Schmitto
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - Daniel G. Sedding
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany (D.G.S.)
| | - Axel Haverich
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - Johann Bauersachs
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Andreas Schäfer
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
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31
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D'Ascenzo F, Gili S, Bertaina M, Iannaccone M, Cammann VL, Di Vece D, Kato K, Saglietto A, Szawan KA, Frangieh AH, Boffini B, Annaratone M, Sarcon A, Levinson RA, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun‐Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, El‐Battrawy I, Akin I, Borggrefe M, Horowitz JD, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Biondi‐Zoccai G, Winchester DE, Ukena C, Neuhaus M, Bax JJ, Prasad A, Di Mario C, Böhm M, Gasparini M, Ruschitzka F, Bossone E, Citro R, Rinaldi M, De Ferrari GM, Lüscher T, Ghadri JR, Templin C. Impact of aspirin on takotsubo syndrome: a propensity score‐based analysis of the InterTAK Registry. Eur J Heart Fail 2020; 22:330-337. [PMID: 31863563 DOI: 10.1002/ejhf.1698] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | | | - Maurizio Bertaina
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Victoria L. Cammann
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Konrad A. Szawan
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Antonio H. Frangieh
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | | | | | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of MedicineUniversity of California‐San Francisco San Francisco CA USA
| | - Rena A. Levinson
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Division of Biological SciencesUniversity of California San Diego San Diego CA USA
| | - Jennifer Franke
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | - L. Christian Napp
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Milosz Jaguszewski
- First Department of CardiologyMedical University of Gdansk Gdansk Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1University Medical Center Mainz Mainz Germany
| | - Hugo A. Katus
- Department of CardiologyHeidelberg University Hospital Heidelberg Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/CardiologyHeart Center Leipzig – University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Carsten Tschöpe
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M. Pieske
- Department of CardiologyCharité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine IIIHeart Center University of Cologne Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and PneumologyGeorg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional CardiologyUniversity Heart Center Hamburg Hamburg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II – CardiologyUniversity of Ulm, Medical Center Ulm Germany
| | - Samir M. Said
- Internal Medicine/Cardiology, Angiology, and PneumologyMagdeburg University Magdeburg Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe HospitalOxford University Hospitals Oxford UK
| | - Florim Cuculi
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of CardiologyKantonsspital Lucerne Lucerne Switzerland
| | - Thomas A. Fischer
- Department of CardiologyKantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart CenterTurku University Hospital and University of Turku Turku Finland
| | | | - Grzegorz Opolski
- Department of CardiologyMedical University of Warsaw Warsaw Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College HospitalKings Health Partners London UK
| | - Christoph Kaiser
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of CardiologyUniversity Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli, IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Wolfgang M. Franz
- University Hospital for Internal Medicine III (Cardiology and Angiology)Medical University Innsbruck Innsbruck Austria
| | - Klaus Empen
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging CenterUniversity Hospital of Rangueil Toulouse France
| | - Ibrahim El‐Battrawy
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany
- DZHK (German Center for Cardiovascular Research), partner site, Heidelberg‐Mannheim Mannheim Germany
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth HospitalUniversity of Adelaide Adelaide Australia
| | - Martin Kozel
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Petr Widimský
- Cardiocenter, Third Faculty of MedicineCharles University in Prague and University Hospital Královské Vinohrady Prague Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Giuseppe Biondi‐Zoccai
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of Rome Latina Italy
| | - David E. Winchester
- Department of Medicine, College of MedicineUniversity of Florida Gainesville FL USA
| | - Christian Ukena
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Michael Neuhaus
- Department of CardiologyKantonsspital Frauenfeld Frauenfeld Switzerland
| | - Jeroen J. Bax
- Department of CardiologyLeiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | - Carlo Di Mario
- Structural Interventional CardiologyUniversity Hospital Careggi Florence Italy
| | - Michael Böhm
- Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
| | - Mauro Gasparini
- Department of Mathematical SciencesPolitecnico di Torino Turin Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Eduardo Bossone
- Division of Cardiology‘Antonio Cardarelli’ Hospital Naples Italy
| | - Rodolfo Citro
- Heart DepartmentUniversity Hospital ‘San Giovanni di Dio e Ruggi d'Aragona’ Salerno Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della ScienzaUniversity of Turin Turin Italy
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental CardiologyIRCCS Fondazione Policlinico San Matteo Pavia Italy
| | - Thomas Lüscher
- Center for Molecular Cardiology, Schlieren CampusUniversity of Zurich Zurich Switzerland
- Royal Brompton and Harefield Hospitals Trust and Imperial College London UK
| | - Jelena R. Ghadri
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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32
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Wang Y, Dembowsky K, Chevalier E, Stüve P, Korf-Klingebiel M, Lochner M, Napp LC, Frank H, Brinkmann E, Kanwischer A, Bauersachs J, Gyöngyösi M, Sparwasser T, Wollert KC. C-X-C Motif Chemokine Receptor 4 Blockade Promotes Tissue Repair After Myocardial Infarction by Enhancing Regulatory T Cell Mobilization and Immune-Regulatory Function. Circulation 2020; 139:1798-1812. [PMID: 30696265 PMCID: PMC6467561 DOI: 10.1161/circulationaha.118.036053] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute myocardial infarction (MI) elicits an inflammatory response that drives tissue repair and adverse cardiac remodeling. Inflammatory cell trafficking after MI is controlled by C-X-C motif chemokine ligand 12 (CXCL12) and its receptor, C-X-C motif chemokine receptor 4 (CXCR4). CXCR4 antagonists mobilize inflammatory cells and promote infarct repair, but the cellular mechanisms are unclear. METHODS We investigated the therapeutic potential and mode of action of the peptidic macrocycle CXCR4 antagonist POL5551 in mice with reperfused MI. We applied cell depletion and adoptive transfer strategies using lymphocyte-deficient Rag1 knockout mice; DEREG mice, which express a diphtheria toxin receptor-enhanced green fluorescent protein fusion protein under the control of the promoter/enhancer region of the regulatory T (Treg) cell-restricted Foxp3 transcription factor; and dendritic cell-depleted CD11c-Cre iDTR mice. Translational potential was explored in a porcine model of reperfused MI using serial contrast-enhanced magnetic resonance imaging. RESULTS Intraperitoneal POL5551 injections in wild-type mice (8 mg/kg at 2, 4, 6, and 8 days) enhanced angiogenesis in the infarct border zone, reduced scar size, and attenuated left ventricular remodeling and contractile dysfunction at 28 days. Treatment effects were absent in splenectomized wild-type mice, Rag1 knockout mice, and Treg cell-depleted DEREG mice. Conversely, treatment effects could be transferred into infarcted splenectomized wild-type mice by transplanting splenic Treg cells from POL5551-treated infarcted DEREG mice. Instructive cues provided by infarct-primed dendritic cells were required for POL5551 treatment effects. POL5551 injections mobilized Treg cells into the peripheral blood, followed by enhanced Treg cell accumulation in the infarcted region. Neutrophils, monocytes, and lymphocytes displayed similar mobilization kinetics, but their cardiac recruitment was not affected. POL5551, however, attenuated inflammatory gene expression in monocytes and macrophages in the infarcted region via Treg cells. Intravenous infusion of the clinical-stage POL5551 analogue POL6326 (3 mg/kg at 4, 6, 8, and 10 days) decreased infarct volume and improved left ventricular ejection fraction in pigs. CONCLUSIONS These data confirm CXCR4 blockade as a promising treatment strategy after MI. We identify dendritic cell-primed splenic Treg cells as the central arbiters of these therapeutic effects and thereby delineate a pharmacological strategy to promote infarct repair by augmenting Treg cell function in vivo.
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Affiliation(s)
- Yong Wang
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | | | | | - Philipp Stüve
- Institute of Infection Immunology, TWINCORE, Hannover, Germany (P.S., M.L., T.S.).,The current affiliation for P.S. and T.S. is Department of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Mortimer Korf-Klingebiel
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Matthias Lochner
- Institute of Infection Immunology, TWINCORE, Hannover, Germany (P.S., M.L., T.S.)
| | - L Christian Napp
- Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Heike Frank
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Eva Brinkmann
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Anna Kanwischer
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
| | - Mariann Gyöngyösi
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria (M.G.)
| | - Tim Sparwasser
- Institute of Infection Immunology, TWINCORE, Hannover, Germany (P.S., M.L., T.S.).,The current affiliation for P.S. and T.S. is Department of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology (Y.W., M.K.-K., H.F., E.B., A.K., K.C.W.), Hannover Medical School, Germany.,Department of Cardiology and Angiology (Y.W., M.K.-K., L.C.N., H.F., E.B., A.K., J.B., K.C.W.), Hannover Medical School, Germany
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Ding KJ, Cammann VL, Szawan KA, Stähli BE, Wischnewsky M, Di Vece D, Citro R, Jaguszewski M, Seifert B, Sarcon A, Knorr M, Heiner S, Gili S, D’Ascenzo F, Neuhaus M, Napp LC, Franke J, Noutsias M, Burgdorf C, Koenig W, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KJ, Paolini C, Bilato C, Carrilho-Ferreira P, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Widimský P, Winchester DE, Galuszka J, Ukena C, Horowitz JD, Di Mario C, Prasad A, Rihal CS, Pinto FJ, Crea F, Borggrefe M, Braun-Dullaeus RC, Rottbauer W, Bauersachs J, Katus HA, Hasenfuß G, Tschöpe C, Pieske BM, Thiele H, Schunkert H, Böhm M, Felix SB, Münzel T, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Bossone E, Templin C. Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome. Arterioscler Thromb Vasc Biol 2020; 40:279-287. [DOI: 10.1161/atvbaha.119.313491] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective:
Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified.
Approach and Results:
TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0–38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10
3
cells/μL emerged as independent predictors for thrombus formation or embolism.
Conclusions:
Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk.
Clinical Trial Registration:
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01947621.
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Affiliation(s)
- Katharina J. Ding
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Victoria L. Cammann
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Konrad A. Szawan
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Barbara E. Stähli
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Germany (M.W.)
| | - Davide Di Vece
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy (R.C.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland (B.S.)
| | - Annahita Sarcon
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco (A. Sarcon)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | | | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.)
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Switzerland (M. Neuhaus)
| | - L. Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M. Noutsias)
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Behrouz Kherad
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Lawrence Rajan
- T.J. Health Partners Heart and Vascular, Glasgow, KY (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus “Maria Hilf” Medizinische Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M. Karakas)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Luebeck (M. Karakas)
| | - Alexander Pott
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Philippe Meyer
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Jose D. Arroja
- Service de cardiologie, Hôpitaux Universitaires de Genève, Switzerland (P. Meyer, J.D.A.)
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F. Cuculi, R.K.)
| | - Thomas A. Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K.E. Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Carla Paolini
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Claudio Bilato
- Local Health Unit No. 8, Cardiology Unit, Arzignano, Vicenza, Italy (C.P., C. Bilato)
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Philip MacCarthy
- Department of Cardiology, King’s College Hospital, London, United Kingdom (R.D., P. MacCarthy)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria (W.D.)
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, New Zealand (C.C., P.B.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia (E.G., A. Shilova, M.G.)
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Czech Republic (M. Kozel, P.T., P.W.)
| | - David E. Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Jan Galuszka
- Department of Internal Medicine I–Cardiology, University Hospital Olomouc, Czech Republic (J.G.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - John D. Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.D.H.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Charanjit S. Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A. Prasad, C.S.R.)
| | - Fausto J. Pinto
- Cardiology Department, Santa Maria University Hospital, Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon, Lisbon School of Medicine, Universidade de Lisboa, Portugal (P.C.-F., F.J.P.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F. Crea)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Germany (I.E.-B., I.A., M. Borggrefe)
- German Center for Cardiovascular Research, Partner Site, Heidelberg-Mannheim (I.E.-B., I.A., M. Borggrefe)
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II–Cardiology, University of Ulm, Medical Center, Germany (A. Pott, W.R.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Hugo A. Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Germany (C.J., G.H.)
| | - Carsten Tschöpe
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
| | - Burkert M. Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Germany (B.K., C. Tschöpe, B.M.P.)
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Germany (B.K., C. Tschöpe, B.M.P.)
- German Center for Cardiovascular Research, Partner Site Berlin (B.M.P.)
- Berlin Institute of Health, Germany (B.M.P.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Germany (H.T.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany (W.K., H.S.)
- German center for Cardiovascular Research, Partner Site Munich Heart Alliance (W.K., H.S.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M. Böhm)
| | - Stephan B. Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.)
- German Centre for Cardiovascular Research, Partner Site Greifswald (S.B.F.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (M. Knorr, S.H., T.M.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Centre, the Netherlands (J.J.B.)
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.)
- Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L.)
| | - Frank Ruschitzka
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | - Jelena R. Ghadri
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
| | | | - Christian Templin
- From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin)
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Akin M, Sieweke JT, Zauner F, Garcheva V, Tongers J, Napp LC, Friedrich L, Treptau J, Bahntje MU, Flierl U, Sedding DG, Bauersachs J, Schäfer A. Mortality in Patients With Out-of-Hospital Cardiac Arrest Undergoing a Standardized Protocol Including Therapeutic Hypothermia and Routine Coronary Angiography: Experience From the HACORE Registry. JACC Cardiovasc Interv 2019; 11:1811-1820. [PMID: 30236353 DOI: 10.1016/j.jcin.2018.06.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study sought to analyze the impact of mandatory therapeutic hypothermia and cardiac catheterization in the absence of overt noncardiac cause of arrest as part of the Hannover Cardiac Resuscitation Algorithm before intensive care admission. BACKGROUND Despite advanced therapies, out-of-hospital cardiac arrest (OHCA) is still associated with high mortality rates. Recently, the TTM (Target Temperature Management 33°C Versus 36°C After Out-of-Hospital Cardiac Arrest)-trial caused severe uncertainty about the efficacy of and need for therapeutic hypothermia. Furthermore, the role of early coronary angiography in OHCA survivors without ST-segment elevation remains undetermined. METHODS In the HACORE (HAnnover Cooling REgistry) we investigated 233 consecutive patients (median age 64 [interquartile range: 53 to 74] years) with OHCA admitted to our institution between January 2011 and December 2015 who were treated according to the algorithm. RESULTS A total of 73% had ventricular fibrillation as primary rhythm. Return of spontaneous circulation was achieved after 20 (interquartile range: 10 to 30) min. Immediate percutaneous coronary angiography was performed in 96% and coronary angioplasty in 59% of all cases. ST-segment elevation was present in 47%. Critical coronary stenosis requiring percutaneous coronary intervention was present in 67% of patients with and 52% of patients without ST-segment elevation. Overall 30-day intrahospital mortality in this real-world registry was 37%. Patients in our local registry who matched the inclusion/exclusion criteria of the TTM-trial (n = 145) had a markedly lower 30-day mortality (27%) compared with the published trial (44%). CONCLUSIONS Standardized treatment of patients with OHCA following a strict protocol incorporating computed tomography, cardiac catheterization and revascularization, liberal use of active hemodynamic support in presence of shock, and mandatory therapeutic hypothermia results in mortality rates lower than previously reported.
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Affiliation(s)
- Muharrem Akin
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Florian Zauner
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Vera Garcheva
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jörn Tongers
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Friedrich
- Department of Anaesthesiology, Hannover Medical School, Hannover, Germany
| | - Jens Treptau
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Max-Udo Bahntje
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Ulrike Flierl
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Daniel G Sedding
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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Jurisic S, Gili S, Cammann VL, Kato K, Szawan KA, D'Ascenzo F, Jaguszewski M, Bossone E, Citro R, Sarcon A, Napp LC, Franke J, Noutsias M, Knorr M, Heiner S, Burgdorf C, Koenig W, Pott A, Kherad B, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Dworakowski R, Kaiser C, Osswald S, Galiuto L, Dichtl W, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, Kozel M, Tousek P, Winchester DE, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Galuszka J, Ukena C, Poglajen G, Paolini C, Bilato C, Carrilho-Ferreira P, Pinto FJ, Opolski G, MacCarthy P, Kobayashi Y, Prasad A, Rihal CS, Widimský P, Horowitz JD, Di Mario C, Crea F, Tschöpe C, Pieske BM, Hasenfuß G, Rottbauer W, Braun-Dullaeus RC, Felix SB, Borggrefe M, Thiele H, Bauersachs J, Katus HA, Schunkert H, Münzel T, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry. J Am Heart Assoc 2019; 8:e011194. [PMID: 31672100 PMCID: PMC6898832 DOI: 10.1161/jaha.118.011194] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide‐ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut‐off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In‐hospital outcomes and 1‐year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1‐year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1‐year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
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Affiliation(s)
- Stjepan Jurisic
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Sebastiano Gili
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Centro Cardiologico Monzino IRCCS Milan Italy
| | - Victoria L Cammann
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Ken Kato
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Konrad A Szawan
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy
| | | | - Eduardo Bossone
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany
| | - Maike Knorr
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Alexander Pott
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | - Behrouz Kherad
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Philippe Meyer
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Jose David Arroja
- Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
| | - Adrian Banning
- Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Turku Finland
| | | | - Rafal Dworakowski
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | - Christina Chan
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Paul Bridgman
- Department of Cardiology Christchurch Hospital Christchurch New Zealand
| | - Daniel Beug
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - David E Winchester
- Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology University Hospital Olomouc Olomouc Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia
| | - Carla Paolini
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Claudio Bilato
- Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy
| | - Pedro Carrilho-Ferreira
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | - Fausto J Pinto
- Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal
| | | | - Philip MacCarthy
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - John D Horowitz
- Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia
| | | | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italy
| | - Carsten Tschöpe
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | - Burkert M Pieske
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin Germany.,Berlin Institute of Health (BIH) Berlin Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany
| | | | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany
| | - Thomas Münzel
- Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Switzerland.,Cardiology Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
| | - Frank Ruschitzka
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jelena R Ghadri
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Christian Templin
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
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37
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Di Vece D, Citro R, Cammann VL, Kato K, Gili S, Szawan KA, Micek J, Jurisic S, Ding KJ, Bacchi B, Schwyzer M, Candreva A, Bossone E, D'Ascenzo F, Sarcon A, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuβ G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz J, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Di Mario C, Prasad A, Böhm M, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome. Circulation 2019; 139:413-415. [PMID: 30586690 DOI: 10.1161/circulationaha.118.036164] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Rodolfo Citro
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Moritz Schwyzer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Eduardo Bossone
- Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy (R.C., E.B.)
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, Italy (F.D.A.)
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles (A.S.)
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Poland (M.J.)
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Germany (M.N.)
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Germany (T.M., M.K., S.H.)
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Germany (J.F., H.A.K.)
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Germany (H.T.)
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Germany (L.C.N., J.B.)
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany (C.T., B.M.P.)
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky (L.R.)
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Germany (G.M., R.P.)
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinsche Klinik, Stadtlohn, Germany (A.C.)
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Gerd Hasenfuβ
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany (C.J., G.H.)
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (M.K.)
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Germany (H.S., W.K.).,German Centre for Cardiovascular Research, Munich Heart Alliance, Germany (H.S., W.K.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Germany (W.R.)
| | - Samir M Said
- Department of Cardiac Electrophysiology, Helios St Marienberg, Hospital Helmstedt, Germany (S.M.S.)
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, United Kingdom (A.B.)
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Switzerland (F.C., R.K.)
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Switzerland (T.A.F.)
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - K E Juhani Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Finland (T.V., K.E.J.A.)
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Poland (G.O.)
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom (R.D., P.M.)
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Switzerland (C.K., S.O.)
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Italy (L.G., F.C.)
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Austria (W.D.)
| | - Klaus Empen
- Department of Internal Medicine, Kreiskrankenhaus Wolgast, Germany (K.E.)
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Germany (S.B.F.).,German Centre for Cardiovascular Research, Greifswald, Germany (S.B.F.)
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France (C.D., O.L.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany (I.E, I.A., M.B).,German Center for Cardiovascular Research, Heidelberg-Mannheim, Germany (I.E, I.A., M.B.)
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital, Russia (E.G., A.S., M.G.)
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Australia (J.H.)
| | - Martin Kozel
- German Centre for Cardiovascular Research, Hamburg/Kiel/Luebeck, Germany (M.K.).,Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Tousek
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - Petr Widimský
- Charles University, University Hospital Kralovske Vinohrady, Czech Republic (M.K., P.T., P.W.)
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville (D.E.W.)
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy (C.D.M.)
| | - Abhiram Prasad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester MN (A.P.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany (C.U., M.B.)
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, The Netherlands (J.J.B.)
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland (T.F.L.).,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom (T.F.L)
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (D.D.V., V.L.C., K.K., S.G., K.A.S., J.M., S.J., K.J.D., B.B., M.S., A.C., F.R., J.R.G., C.T.)
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Napp LC, Halbe M, Pappalardo F. The tightrope walk between temporary and permanent mechanical circulatory support. J Thorac Dis 2019; 11:S2046-S2047. [PMID: 31632825 DOI: 10.21037/jtd.2019.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Maximilian Halbe
- University Hospital Zurich, Department of Cardiovascular Surgery, Zurich, Switzerland
| | - Federico Pappalardo
- Cardiac Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Scientific Institute, Milan, Italy
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Napp LC, Dogan G, Hanke J, Mariani S, Göttel P, Brandes K, Sarikouch S, Bara C, Müller J, Schmitto J. TCT-338 Electrical Microcurrent Therapy for Treatment of Chronic Systolic Heart Failure: Animal and First-in-Man Data. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Akin M, Garcheva V, Sieweke JT, Tongers J, Napp LC, Flierl U, Bauersachs J, Schaefer A. P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0461] [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
Purpose
To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.
Methods
Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.
Results
Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.
Conclusion
Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.
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Affiliation(s)
- M Akin
- Hannover Medical School, Hannover, Germany
| | - V Garcheva
- Hannover Medical School, Hannover, Germany
| | | | - J Tongers
- Hannover Medical School, Hannover, Germany
| | - L C Napp
- Hannover Medical School, Hannover, Germany
| | - U Flierl
- Hannover Medical School, Hannover, Germany
| | | | - A Schaefer
- Hannover Medical School, Hannover, Germany
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41
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Ghadri JR, Kato K, Cammann VL, Gili S, Jurisic S, Di Vece D, Candreva A, Ding KJ, Micek J, Szawan KA, Bacchi B, Bianchi R, Levinson RA, Wischnewsky M, Seifert B, Schlossbauer SA, Citro R, Bossone E, Münzel T, Knorr M, Heiner S, D'Ascenzo F, Franke J, Sarcon A, Napp LC, Jaguszewski M, Noutsias M, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Horowitz J, Kozel M, Tousek P, Widimský P, Gilyarova E, Shilova A, Gilyarov M, Winchester DE, Ukena C, Bax JJ, Prasad A, Böhm M, Lüscher TF, Ruschitzka F, Templin C. Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol 2019; 72:874-882. [PMID: 30115226 DOI: 10.1016/j.jacc.2018.06.016] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. OBJECTIVES This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. METHODS Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. RESULTS Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. CONCLUSIONS Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).
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Affiliation(s)
- Jelena R Ghadri
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Sebastiano Gili
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stjepan Jurisic
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Davide Di Vece
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Alessandro Candreva
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Katharina J Ding
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Jozef Micek
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Bianchi
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rena A Levinson
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Biological Sciences, University of California, San Diego, La Jolla, California
| | - Manfred Wischnewsky
- Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Susanne A Schlossbauer
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Rodolfo Citro
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Eduardo Bossone
- Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Thomas Münzel
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, California
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Heart Center Leipzig, University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Lawrence Rajan
- TJ Health Partners Heart and Vascular, Glasgow, Kentucky
| | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohne, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, United Kingdom
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- University Medicine Greifswald, Department of Internal Medicine B, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital #1 named after N. Pirogov, Moscow, Russia
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic, Rochester, Minnesota
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals Trust and Imperial College, London, United Kingdom
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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42
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Wischnewsky MB, Candreva A, Bacchi B, Cammann VL, Kato K, Szawan KA, Gili S, D'Ascenzo F, Dichtl W, Citro R, Bossone E, Neuhaus M, Franke J, Sorici-Barb I, Jaguszewski M, Noutsias M, Knorr M, Heiner S, Burgdorf C, Kherad B, Tschöpe C, Sarcon A, Shinbane J, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Koenig W, Pott A, Meyer P, Arroja JD, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Napp LC, Budnik M, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Chan C, Bridgman P, Beug D, Delmas C, Lairez O, El-Battrawy I, Akin I, Gilyarova E, Shilova A, Gilyarov M, Kozel M, Tousek P, Winchester DE, Galuszka J, Ukena C, Poglajen G, Carrilho-Ferreira P, Hauck C, Paolini C, Bilato C, Prasad A, Rihal CS, Liu K, Schulze PC, Bianco M, Jörg L, Rickli H, Nguyen TH, Kobayashi Y, Böhm M, Maier LS, Pinto FJ, Widimský P, Borggrefe M, Felix SB, Opolski G, Braun-Dullaeus RC, Rottbauer W, Hasenfuß G, Pieske BM, Schunkert H, Thiele H, Bauersachs J, Katus HA, Horowitz J, Di Mario C, Münzel T, Crea F, Bax JJ, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Prediction of short- and long-term mortality in takotsubo syndrome: the InterTAK Prognostic Score. Eur J Heart Fail 2019; 21:1469-1472. [PMID: 31452320 DOI: 10.1002/ejhf.1561] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Eduardo Bossone
- Division of Cardiology, 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Michael Neuhaus
- Department of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ioana Sorici-Barb
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | | | - Behrouz Kherad
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Alexander Pott
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Philippe Meyer
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jose David Arroja
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Monika Budnik
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Christina Chan
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Paul Bridgman
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Daniel Beug
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive Coronary Care Unit, Moscow City Hospital No. 1 named after N. Pirogov, Moscow, Russia
| | - Martin Kozel
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jan Galuszka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Gregor Poglajen
- Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Pedro Carrilho-Ferreira
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Christian Hauck
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carla Paolini
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kan Liu
- Division of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matteo Bianco
- Division of Cardiology, A.O.U San Luigi Gonzaga, Turin, Italy
| | - Lucas Jörg
- Department of Cardiology, Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Gallen, Switzerland
| | - Thanh H Nguyen
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Hamburg/Saar, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Fausto J Pinto
- Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Petr Widimský
- Cardiocenter, Third Faculty of Medicine, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg-Mannheim, Mannheim, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin; and Berlin Institute of Health (BIH), Berlin, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - John Horowitz
- Department of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Carlo Di Mario
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Napp LC, Martens A. ECPR in acute aortic dissection – Really a no-go? Am J Emerg Med 2019; 37:1590-1591. [DOI: 10.1016/j.ajem.2019.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/22/2019] [Indexed: 10/27/2022] Open
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44
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Cammann VL, Sarcon A, Ding KJ, Seifert B, Kato K, Di Vece D, Szawan KA, Gili S, Jurisic S, Bacchi B, Micek J, Frangieh AH, Napp LC, Jaguszewski M, Bossone E, Citro R, D'Ascenzo F, Franke J, Noutsias M, Knorr M, Heiner S, Burgdorf C, Koenig W, Thiele H, Tschöpe C, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Karakas M, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Dworakowski R, Kaiser C, Osswald S, Galiuto L, Dichtl W, Delmas C, Lairez O, Horowitz JD, Kozel M, Widimský P, Tousek P, Winchester DE, Gilyarova E, Shilova A, Gilyarov M, El-Battrawy I, Akin I, Ukena C, Bauersachs J, Pieske BM, Hasenfuß G, Rottbauer W, Braun-Dullaeus RC, Opolski G, MacCarthy P, Felix SB, Borggrefe M, Di Mario C, Crea F, Katus HA, Schunkert H, Münzel T, Böhm M, Bax JJ, Prasad A, Shinbane J, Lüscher TF, Ruschitzka F, Ghadri JR, Templin C. Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry. J Am Heart Assoc 2019; 8:e010881. [PMID: 31311438 PMCID: PMC6761645 DOI: 10.1161/jaha.118.010881] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Clinical characteristics and outcomes of takotsubo syndrome (TTS) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short- and long-term outcomes in TTS patients with or without malignancy. Methods and Results TTS patients were enrolled from the International Takotsubo Registry. The TTS cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short- and long-term mortality. A subanalysis was performed comparing long-term mortality between a subset of TTS patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604 TTS patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long-term mortality was higher in patients with malignancy (P<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01947621.
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Affiliation(s)
- Victoria L Cammann
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Annahita Sarcon
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - Katharina J Ding
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute University of Zurich Switzerland
| | - Ken Kato
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Davide Di Vece
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Konrad A Szawan
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Sebastiano Gili
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Centro Cardiologico Monzino IRCCS Milan Italy
| | - Stjepan Jurisic
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Beatrice Bacchi
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jozef Micek
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Antonio H Frangieh
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.,Deutsches Herzzentrum München Technische Universität München Munich Germany
| | - L Christian Napp
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | | | - Eduardo Bossone
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Rodolfo Citro
- Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy
| | - Jennifer Franke
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Michel Noutsias
- Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany
| | - Maike Knorr
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | - Susanne Heiner
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | | | - Wolfgang Koenig
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig- University Hospital Leipzig Germany
| | - Carsten Tschöpe
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | | | - Guido Michels
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | - Roman Pfister
- Department of Internal Medicine III Heart Center University of Cologne Germany
| | | | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck Hamburg Germany
| | - Adrian Banning
- Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom
| | - Florim Cuculi
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Richard Kobza
- Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
| | - Thomas A Fischer
- Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
| | - Tuija Vasankari
- Heart Center Turku University Hospital and University of Turku Finland
| | | | - Rafal Dworakowski
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Christoph Kaiser
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Stefan Osswald
- Department of Cardiology University Hospital Basel Basel Switzerland
| | - Leonarda Galiuto
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
| | - John D Horowitz
- Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia
| | - Martin Kozel
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Widimský
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Tousek
- Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - David E Winchester
- Department of Medicine College of Medicine University of Florida Gainesville FL
| | - Ekaterina Gilyarova
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Alexandra Shilova
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia
| | - Ibrahim El-Battrawy
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Christian Ukena
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Burkert M Pieske
- Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II - Cardiology University of Ulm, Medical Center Ulm Germany
| | | | | | - Philip MacCarthy
- Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom
| | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,DZHK (German Centre for Cardiovascular Research), partner site Greifswald Greifswald Germany
| | - Martin Borggrefe
- First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.,DZHK (German Center for Cardiovascular Research), partner site, Heidelberg-Mannheim Mannheim Germany
| | - Carlo Di Mario
- Structural Interventional Cardiology Careggi University Hospital Florence Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy
| | - Hugo A Katus
- Department of Cardiology Heidelberg University Hospital Heidelberg Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München Technische Universität München Munich Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Thomas Münzel
- Cardiology 1 Center for Cardiology University Medical Center Mainz Mainz Germany
| | - Michael Böhm
- Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany
| | - Jeroen J Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | - Abhiram Prasad
- Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Jerold Shinbane
- University of Southern California, Keck School of Medicine Los Angeles CA
| | - Thomas F Lüscher
- Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland.,Cardiology Royal Brompton & Harefield Hospital and Imperial College London United Kingdom
| | - Frank Ruschitzka
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jelena R Ghadri
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Christian Templin
- University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland
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45
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Schäfer A, Werner N, Westenfeld R, Møller JE, Schulze PC, Karatolios K, Pappalardo F, Maly J, Staudacher D, Lebreton G, Delmas C, Hunziker P, Fritzenwanger M, Napp LC, Ferrari M, Tarantini G. Clinical scenarios for use of transvalvular microaxial pumps in acute heart failure and cardiogenic shock - A European experienced users working group opinion. Int J Cardiol 2019; 291:96-104. [PMID: 31155332 DOI: 10.1016/j.ijcard.2019.05.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 01/14/2023]
Abstract
For patients with myocardial infarct-related cardiogenic shock (CS), urgent percutaneous coronary intervention is the recommended treatment strategy to limit cardiac and systemic ischemia. However, a specific therapeutic intervention is often missing in non-ischemic CS cases. Though drug treatment with inotropes and/or vasopressors may be required to stabilize the patient initially, their ongoing use is associated with excess mortality. Coronary intervention in unstable patients often leads to further hemodynamic compromise either during or shortly after revascularization. Support devices like the intra-aortic balloon pump failed to improve clinical outcomes in infarct-related CS. Currently, more powerful and active hemodynamic support devices unloading the left ventricle such as transvalvular microaxial pumps are available and are being increasingly used. However, as for other devices large randomized trials are not yet available, and device use is based on registry data and expert consensus. In this article, a multidisciplinary group of experienced users of transvalvular microaxial pumps outlines the pathophysiological background on hemodynamic changes in CS, the available mechanical support devices, and current guideline recommendations. Furthermore, different hemodynamic situations in several case-based scenarios are used to illustrate candidate settings and to provide the theoretic and scientific rationale for left-ventricular unloading in these scenarios. Finally, organization of shock networks, monitoring, weaning, and typical complications and their prevention are discussed.
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Affiliation(s)
- Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
| | - Nikos Werner
- Department of Cardiology, University Heart Center, Bonn, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | - Federico Pappalardo
- Department of Cardiothoracic Vascular Anesthesia and Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Dawid Staudacher
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Guillaume Lebreton
- Department of Cardiovascular Surgery, Hospital Pitié-Salpêtrière, Paris, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Patrick Hunziker
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Markus Ferrari
- Department of Cardiology and Intensive Care Medicine, Dr. Horst Schmidt Hospital, Wiesbaden, Germany
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Napp LC, Ziegeler S, Kindgen-Milles D. Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support. Blood Purif 2019; 48:203-214. [PMID: 31096211 PMCID: PMC6878728 DOI: 10.1159/000500015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 01/09/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Cardiac Arrest Center, Advanced Heart Failure Unit, Hannover Medical School, Hannover, Germany,
| | - Stephan Ziegeler
- Department of Anesthesiology, Operative Intensive Care Medicine, Pain Management and Emergency Medicine, Hospital Ibbenbüren, Ibbenbüren, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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47
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Konstantinou K, Keeble TR, Kelly PA, Alsanjari O, Napp LC, Karamasis GV, Davies JR. Protected percutaneous coronary intervention with Impella CP in a patient with left main disease, severe left ventricular systolic dysfunction and established hemolysis. Cardiovasc Diagn Ther 2019; 9:194-199. [PMID: 31143642 DOI: 10.21037/cdt.2019.02.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of the Impella device in patients with left ventricular (LV) systolic impairment undergoing left main (LM) percutaneous coronary intervention (PCI) has been growing exponentially. Data from observational studies and registries demonstrate that Impella-assisted high-risk PCI is safe and effective with a low rate of peri-procedural complications. Hemolysis is a potential limitation of virtually all mechanical circulatory support devices and a small incidence of hemolysis has been associated with Impella use. The safety and feasibility of Impella use in patients with established hemolysis has not been previously evaluated. We report the first described case in the literature of Impella-assisted left main stem (LMS) PCI in a patient with severe LV systolic dysfunction and autoimmune hemolytic anemia (AIHA). Despite the patient's high bleeding risk (active hemolysis, thrombocytopenia, impaired renal function, use of steroids), Impella placement and PCI were successfully performed without complication. Haemoglobin, bilirubin and lactate dehydrogenase (LDH) levels were closely monitored peri-procedurally with no evidence of exacerbation of the patient's hemolysis. We briefly discuss the mechanism of Impella-induced hemolysis and factors that can exacerbate hemolysis.
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Affiliation(s)
- Klio Konstantinou
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University School of Medicine, Faculty of Medical Science, Chelmsford, UK
| | - Thomas R Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University School of Medicine, Faculty of Medical Science, Chelmsford, UK
| | - Paul A Kelly
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK
| | - Osama Alsanjari
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University School of Medicine, Faculty of Medical Science, Chelmsford, UK
| | - L Christian Napp
- Cardiac Arrest Centre, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Grigoris V Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University School of Medicine, Faculty of Medical Science, Chelmsford, UK
| | - John R Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals, Basildon, UK.,Anglia Ruskin University School of Medicine, Faculty of Medical Science, Chelmsford, UK
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48
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49
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Tongers J, Flierl U, Sieweke JT, Bauersachs J, Schäfer A, Napp LC. Safe Exchange of a Transfemoral Impella Pump. Cardiovasc Revasc Med 2018; 20:827-828. [PMID: 30651215 DOI: 10.1016/j.carrev.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022]
Abstract
Mechanical circulatory support with the Impella pump is established in many centers treating patients with cardiogenic shock. While Impella pumps usually run very stable, it may still be possible that one needs to remove the pump for using the same vascular access for different reasons. Unfortunately, until now it had been nearly impossible to remove the pump while preserving arterial access without severe bleeding. Here we describe a prototypical approach of exchanging an Impella pump in a 47-year-old female supported with veno-arterial ECMO for cardiogenic shock from myocarditis. The dysfunctional Impella pump was safely removed and replaced by a new one through the same arterial access site. Continuation of active LV unloading resolved pulmonary edema, and the patient was finally bridged to ventricular assist device surgery with favorable outcome. In general, the described approach is applicable for virtually all large-bore devices with arterial access.
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Affiliation(s)
- Jörn Tongers
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
| | - Ulrike Flierl
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan-Thorben Sieweke
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andreas Schäfer
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - L Christian Napp
- Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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50
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Dias A, Núñez Gil IJ, Santoro F, Madias JE, Pelliccia F, Brunetti ND, Salmoirago-Blotcher E, Sharkey SW, Eitel I, Akashi YJ, El-Battrawy I, Franco E, Akin I, Jaguszewski M, Dawson D, Figueredo VM, Napp LC, Christensen TE, Hebert K, Ben-Dor I, Ozaki Y, García-Garcia HM, Kajita AH, Akasaka T, Kurisu S, Lerman A, Waksman R. Takotsubo syndrome: State-of-the-art review by an expert panel - Part 1. Cardiovasc Revasc Med 2018; 20:70-79. [PMID: 30528096 DOI: 10.1016/j.carrev.2018.11.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/30/2022]
Abstract
Takotsubo syndrome (TTS) is an acute cardiac condition independent of epicardial coronary obstruction that mimics acute coronary syndrome and is characterized by acute heart failure with reversible ventricular motion abnormalities. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. Experts in the field provide a thorough and detailed review of this syndrome. Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. In part 1 of this two-part manuscript, we discuss how TTS came to be known, several patterns and forms it can take in patients, epidemiology and pathophysiology of the syndrome, and clinical presentation.
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Affiliation(s)
- Andre Dias
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Ivan J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesco Santoro
- Department of Medical & Surgery Sciences, University of Foggia, Foggia, Italy
| | - John E Madias
- Icahn School of Medicine at Mount Sinai/Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States of America
| | | | | | - Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Scott W Sharkey
- Minneapolis Heart Institute Foundation, Minneapolis, MN, United States of America
| | - Ingo Eitel
- Cardiology, Angiology, Intensive Care Medicine, University Lübeck, Schleswig-Holstein, Germany
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ibrahim El-Battrawy
- Department of Internal Medicine, University Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Germany
| | - Emiliana Franco
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - Ibrahim Akin
- Department of Internal Medicine, University Heidelberg, Mannheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Germany
| | | | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Vincent M Figueredo
- Department of Cardiology, Einstein Medical Center, Philadelphia, PA, United States of America
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Kathy Hebert
- GE Healthcare, Miami, FL, United States of America
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Yuichi Ozaki
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Héctor M García-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Alexandre H Kajita
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
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