1
|
Kelm M, Pistorius R, Germer CT, Reibetanz J. [Abdominal compartment syndrome in visceral surgery and intensive care medicine : Causes, prevention, detection, treatment]. Chirurgie (Heidelb) 2024:10.1007/s00104-024-02079-w. [PMID: 38639826 DOI: 10.1007/s00104-024-02079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
An increased intra-abdominal pressure can result in a manifest abdominal compartment syndrome (ACS) with significant organ damage, which is a life-threatening situation associated with a high mortality. Although the etiology is manifold and critically ill patients on the intensive care unit are particularly endangered, the disease is often not diagnosed even though the measurement of bladder pressure is available as a simple and standardized method; however, particularly the early detection of an increased intra-abdominal pressure is decisive in order to prevent the occurrence of a manifest ACS with (multi)organ failure by means of conservative measures. In cases of a conservative refractory situation, decompressive laparotomy is indicated.
Collapse
Affiliation(s)
- M Kelm
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - R Pistorius
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - J Reibetanz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| |
Collapse
|
2
|
Hou X, Hashemi D, Erley J, Neye M, Bucius P, Tanacli R, Kühne T, Kelm M, Motzkus L, Blum M, Edelmann F, Kuebler WM, Pieske B, Düngen HD, Schuster A, Stoiber L, Kelle S. Noninvasive evaluation of pulmonary artery stiffness in heart failure patients via cardiovascular magnetic resonance. Sci Rep 2023; 13:22656. [PMID: 38114509 PMCID: PMC10730605 DOI: 10.1038/s41598-023-49325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Heart failure (HF) presents manifestations in both cardiac and vascular abnormalities. Pulmonary hypertension (PH) is prevalent in up 50% of HF patients. While pulmonary arterial hypertension (PAH) is closely associated with pulmonary artery (PA) stiffness, the association of HF caused, post-capillary PH and PA stiffness is unknown. We aimed to assess and compare PA stiffness and blood flow hemodynamics noninvasively across HF entities and control subjects without HF using CMR. We analyzed data of a prospectively conducted study with 74 adults, including 55 patients with HF across the spectrum (20 HF with preserved ejection fraction [HFpEF], 18 HF with mildly-reduced ejection fraction [HFmrEF] and 17 HF with reduced ejection fraction [HFrEF]) as well as 19 control subjects without HF. PA stiffness was defined as reduced vascular compliance, indicated primarily by the relative area change (RAC), altered flow hemodynamics were detected by increased flow velocities, mainly by pulse wave velocity (PWV). Correlations between the variables were explored using correlation and linear regression analysis. PA stiffness was significantly increased in HF patients compared to controls (RAC 30.92 ± 8.47 vs. 50.08 ± 9.08%, p < 0.001). PA blood flow parameters were significantly altered in HF patients (PWV 3.03 ± 0.53 vs. 2.11 ± 0.48, p < 0.001). These results were consistent in all three HF groups (HFrEF, HFmrEF and HFpEF) compared to the control group. Furthermore, PA stiffness was associated with higher NT-proBNP levels and a reduced functional status. PA stiffness can be assessed non-invasively by CMR. PA stiffness is increased in HFrEF, HFmrEF and HFpEF patients when compared to control subjects.Trial registration The study was registered at the German Clinical Trials Register (DRKS, registration number: DRKS00015615).
Collapse
Affiliation(s)
- Xuewen Hou
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marthe Neye
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Paulius Bucius
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Radu Tanacli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Titus Kühne
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Laura Motzkus
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Blum
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Lukas Stoiber
- Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| |
Collapse
|
3
|
Kelm M, Reibetanz J. [74/f-Recurrent swelling on the anus : Preparation for the medical specialist examination: part 33]. Chirurgie (Heidelb) 2023; 94:28-31. [PMID: 37286875 DOI: 10.1007/s00104-023-01893-y] [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] [Accepted: 04/25/2023] [Indexed: 06/09/2023]
Affiliation(s)
- M Kelm
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - J Reibetanz
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
| |
Collapse
|
4
|
Schneckmann R, Döring M, Gerfer S, Gorressen S, Heitmeier S, Helten C, Polzin A, Jung C, Kelm M, Fender AC, Flögel U, Grandoch M. Rivaroxaban attenuates neutrophil maturation in the bone marrow niche. Basic Res Cardiol 2023; 118:31. [PMID: 37580509 PMCID: PMC10425524 DOI: 10.1007/s00395-023-01001-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
Pharmacological inhibition of factor Xa by rivaroxaban has been shown to mediate cardioprotection and is frequently used in patients with, e.g., atrial fibrillation. Rivaroxaban's anti-inflammatory actions are well known, but the underlying mechanisms are still incompletely understood. To date, no study has focused on the effects of rivaroxaban on the bone marrow (BM), despite growing evidence that the BM and its activation are of major importance in the development/progression of cardiovascular disease. Thus, we examined the impact of rivaroxaban on BM composition under homeostatic conditions and in response to a major cardiovascular event. Rivaroxaban treatment of mice for 7 days markedly diminished mature leukocytes in the BM. While apoptosis of BM-derived mature myeloid leukocytes was unaffected, lineage-negative BM cells exhibited a differentiation arrest at the level of granulocyte-monocyte progenitors, specifically affecting neutrophil maturation via downregulation of the transcription factors Spi1 and Csfr1. To assess whether this persists also in situations of increased leukocyte demand, mice were subjected to cardiac ischemia/reperfusion injury (I/R): 7 d pretreatment with rivaroxaban led to reduced cardiac inflammation 72 h after I/R and lowered circulating leukocyte numbers. However, BM myelopoiesis showed a rescue of the leukocyte differentiation arrest, indicating that rivaroxaban's inhibitory effects are restricted to homeostatic conditions and are mainly abolished during emergency hematopoiesis. In translation, ST-elevation MI patients treated with rivaroxaban also exhibited reduced circulating leukocyte numbers. In conclusion, we demonstrate that rivaroxaban attenuates neutrophil maturation in the BM, which may offer a therapeutic option to limit overshooting of the immune response after I/R.
Collapse
Affiliation(s)
- R Schneckmann
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - M Döring
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - S Gerfer
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | - S Gorressen
- Institute for Pharmacology Düsseldorf, Medical Faculty, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - S Heitmeier
- Research & Development Pharmaceuticals, Bayer AG, Acute Hospital Research, Wuppertal, Germany
| | - C Helten
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - A Polzin
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - C Jung
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - M Kelm
- Department for Cardiology, Pneumology and Vascular Medicine, University Hospital and Heinrich Heine University, Düsseldorf, Germany
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - A C Fender
- Institute of Pharmacology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - U Flögel
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
- Experimental Cardiovascular Imaging, Institute for Molecular Cardiology, University Hospital and Heinrich Heine University, Düsseldorf, Germany
| | - M Grandoch
- Institute for Translational Pharmacology Düsseldorf, Medical Faculty, University Hospital of the Heinrich Heine University, Universitätsstr. 1, 40225, Düsseldorf, Germany.
- CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| |
Collapse
|
5
|
Petter E, Scheibenbogen C, Linz P, Stehning C, Wirth K, Kuehne T, Kelm M. Correction: Muscle sodium content in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Transl Med 2023; 21:243. [PMID: 37016384 PMCID: PMC10071688 DOI: 10.1186/s12967-023-03948-4] [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: 04/06/2023] Open
Affiliation(s)
- Elisabeth Petter
- Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Peter Linz
- Institute of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | | | - Klaus Wirth
- Institute of General Pharmacology and Toxicology, University Hospital Frankfurt Am Main, Goethe-University, Theodor-Stern Kai 7, Frankfurt am Main, Germany
| | - Titus Kuehne
- Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Marcus Kelm
- Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| |
Collapse
|
6
|
Oehler D, Immohr M, Böttger C, Bruno R, Sigetti D, Haschemi J, Scheiber D, Aubin H, Horn P, Tudorache I, Westenfeld R, Bönner F, Akhyari P, Kelm M, Lichtenberg A, Boeken U. Preoperative Recipient CRP/Albumin Ratio Predicts Survival and Outcome after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
7
|
Oehler D, Immohr M, Böttger C, Bruno R, Sigetti D, Haschemi J, Oehler H, Aubin H, Horn P, Tudorache I, Westenfeld R, Akhyari P, Kelm M, Lichtenberg A, Boeken U. Postoperative Neurological Events are Associated with Worse Outcome and Fatal Midterm Survival after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
8
|
Oehler D, Lang A, Bruno R, Aubin H, Tudorache I, Westenfeld R, Kelm M, Lichtenberg A, Gerdes N, Falk C, Boeken U. Coincidence of Early Graft Rejection and Replication of Human Herpesvirus 6 in the Donor Heart Associated with a CD38+ Lineage of Negative T Cells. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
9
|
Nordmeyer S, Kraus M, Ziehm M, Kirchner M, Schafstedde M, Kelm M, Niquet S, Stephen MM, Baczko I, Knosalla C, Schapranow MP, Dittmar G, Gotthardt M, Falcke M, Regitz-Zagrosek V, Kuehne T, Mertins P. Disease- and sex-specific differences in patients with heart valve disease: a proteome study. Life Sci Alliance 2023; 6:e202201411. [PMID: 36627164 PMCID: PMC9834574 DOI: 10.26508/lsa.202201411] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Pressure overload in patients with aortic valve stenosis and volume overload in mitral valve regurgitation trigger specific forms of cardiac remodeling; however, little is known about similarities and differences in myocardial proteome regulation. We performed proteome profiling of 75 human left ventricular myocardial biopsies (aortic stenosis = 41, mitral regurgitation = 17, and controls = 17) using high-resolution tandem mass spectrometry next to clinical and hemodynamic parameter acquisition. In patients of both disease groups, proteins related to ECM and cytoskeleton were more abundant, whereas those related to energy metabolism and proteostasis were less abundant compared with controls. In addition, disease group-specific and sex-specific differences have been observed. Male patients with aortic stenosis showed more proteins related to fibrosis and less to energy metabolism, whereas female patients showed strong reduction in proteostasis-related proteins. Clinical imaging was in line with proteomic findings, showing elevation of fibrosis in both patient groups and sex differences. Disease- and sex-specific proteomic profiles provide insight into cardiac remodeling in patients with heart valve disease and might help improve the understanding of molecular mechanisms and the development of individualized treatment strategies.
Collapse
Affiliation(s)
- Sarah Nordmeyer
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Institute for Cardiovascular Computer-Assisted Medicine, Berlin, Germany
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Milena Kraus
- Hasso Plattner Institute for Digital Engineering, Digital Health Center, University of Potsdam, Potsdam, Germany
| | - Matthias Ziehm
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Proteomics Platform, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marieluise Kirchner
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Proteomics Platform, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marie Schafstedde
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Institute for Cardiovascular Computer-Assisted Medicine, Berlin, Germany
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Kelm
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Institute for Cardiovascular Computer-Assisted Medicine, Berlin, Germany
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvia Niquet
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Proteomics Platform, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mariet Mathew Stephen
- Hasso Plattner Institute for Digital Engineering, Digital Health Center, University of Potsdam, Potsdam, Germany
| | - Istvan Baczko
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Christoph Knosalla
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthieu-P Schapranow
- Hasso Plattner Institute for Digital Engineering, Digital Health Center, University of Potsdam, Potsdam, Germany
| | - Gunnar Dittmar
- Proteomics of Cellular Signaling, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Michael Gotthardt
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Neuromuscular and Cardiovascular Cell Biology, Berlin, Germany
| | - Martin Falcke
- Max Delbrück Center for Molecular Medicine, Mathematical Cell Physiology, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Titus Kuehne
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Institute for Cardiovascular Computer-Assisted Medicine, Berlin, Germany
- Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Department of Congenital Heart Disease - Pediatric Cardiology, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Mertins
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Proteomics Platform, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
10
|
Kelm M, Wiegering A, Germer CT, Flemming S. [Surgical strategies for hereditary colorectal cancer]. Chirurgie (Heidelb) 2023; 94:412-416. [PMID: 36856815 DOI: 10.1007/s00104-023-01823-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
Hereditary colorectal cancer (hCRC) represents a major diagnostic and therapeutic challenge. In addition to the usual diagnostic methods, the family history, histological confirmation and mutation analysis play an important role in identifying the type of hereditary CRC. The diagnosis and classification of hCRC are carried out based on the anamnesis, clinical presentation and histology and the further treatment is determined depending on the underlying type of hCRC. For familial adenomatous polyposis (FAP) coloproctomucosectomy after the end of puberty is always recommended, whereas the treatment recommendations for other forms, such as attenuated FAP (aFAP), MUTYH-associated polyposis (MAP) and hereditary nonpolyposis colon cancer (HNPCC, Lynch syndrome), range from close surveillance and endoscopic control, through segmental resection up to colectomy. Irrespective of the type of hCRC, the treatment regimens necessitate an individualized approach and require close interdisciplinary cooperation. When colorectal resection is performed, minimally invasive procedures should principally be prioritized and some studies could demonstrate a potential benefit of robotic surgery compared to laparoscopy.
Collapse
Affiliation(s)
- M Kelm
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - A Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - S Flemming
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| |
Collapse
|
11
|
Oehler D, Immohr MB, Bruno R, Sigetti D, Haschemi J, Aubin H, Tudorache I, Westenfeld R, Bönner F, Kelm M, Lichtenberg A, Boeken U. Treatment and Outcome of COVID-19 after Heart Transplantation: Update from a German Transplant Center. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761750] [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: 03/22/2023]
Affiliation(s)
- D. Oehler
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - M. B. Immohr
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - R. Bruno
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - D. Sigetti
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - J. Haschemi
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - H. Aubin
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - I. Tudorache
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - R. Westenfeld
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - F. Bönner
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - M. Kelm
- Department of Cardiology, Pulmonology, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - A. Lichtenberg
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| | - U. Boeken
- Department of Cardiac Surgery, University Hospital of the Heinrich-Heine-University, Düsseldorf, Deutschland
| |
Collapse
|
12
|
Stern M, Schremmer J, Scharm S, Baasen S, Heinen Y, Sansone R, Polzin A, Jung C, Heiss C, Kelm M, Busch L. Microvascular tissue perfusion after postcatheterization pseudoaneurysm treatment. Clin Hemorheol Microcirc 2022; 82:275-282. [PMID: 35938240 DOI: 10.3233/ch-221438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Femoral pseudoaneurysm (PSA) is a severe complication after endovascular procedures. Ultrasound-guided manual compression (MC) and percutaneous thrombin injection (TI) are frequently used treatments. MC is less effective, TI may cause thromboembolic events. OBJECTIVE Up to date, there is no data regarding impairment of microvascular tissue perfusion after PSA treatment. METHODS In this single-center, prospective study 22 patients with PSA were included. We compared macro- and microcirculatory perfusion in the treated and untreated leg at baseline before, after and one day after treatment. Leg perfusion was assessed with ultrasound and ankle-brachial index (ABI). Microcirculatory perfusion of the feet was measured with a near-infrared spectroscopy (NIRS) camera generating StO2-tissue-maps. RESULTS Successful PSA thrombosis was achieved in 16 (100%) patients in TI group and in 4 (66.7%) patients in MC group. There was no evidence of arterial thrombi on ultrasound and the ABI did not differ between groups. NIRS StO2-tissue-maps of the feet showed no significant difference in both groups concerning the treated (p = 0.121) or the untreated (p = 0.198) leg during follow up. CONCLUSIONS In this small exploratory study, there was no evidence of micro- and macrovascular tissue perfusion impairment after treatment of postcatheterization femoral pseudoaneurysm with thrombin injection underscoring the safety of this approach.
Collapse
Affiliation(s)
- M Stern
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - J Schremmer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Scharm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - S Baasen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Y Heinen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - R Sansone
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - A Polzin
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - C Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex NHS Healthcare Trust, Redhill, United Kingdom
| | - M Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.,Cardiovascular Research Institute Duesseldorf (CARID)Duesseldorf, Germany
| | - L Busch
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| |
Collapse
|
13
|
Petter E, Scheibenbogen C, Linz P, Stehning C, Wirth K, Kuehne T, Kelm M. Muscle sodium content in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Transl Med 2022; 20:580. [PMID: 36494667 PMCID: PMC9733289 DOI: 10.1186/s12967-022-03616-z] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Muscle fatigue and pain are key symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Although the pathophysiology is not yet fully understood, there is ample evidence for hypoperfusion which may result in electrolyte imbalance and sodium overload in muscles. Therefore, the aim of this study was to assess levels of sodium content in muscles of patients with ME/CFS and to compare these to healthy controls. METHODS Six female patients with ME/CFS and six age, BMI and sex matched controls underwent 23Na-MRI of the left lower leg using a clinical 3T MR scanner before and after 3 min of plantar flexion exercise. Sodium reference phantoms with solutions of 10, 20, 30 and 40 mmol/L NaCl were used for quantification. Muscle sodium content over 40 min was measured using a dedicated plugin in the open-source DICOM viewer Horos. Handgrip strength was measured and correlated with sodium content. RESULTS Baseline tissue sodium content was higher in all 5 lower leg muscle compartments in ME/CFS compared to controls. Within the anterior extensor muscle compartment, the highest difference in baseline muscle sodium content between ME/CFS and controls was found (mean ± SD; 12.20 ± 1.66 mM in ME/CFS versus 9.38 ± 0.71 mM in controls, p = 0.0034). Directly after exercise, tissue sodium content increased in gastrocnemius and triceps surae muscles with + 30% in ME/CFS (p = 0.0005) and + 24% in controls (p = 0.0007) in the medial gastrocnemius muscle but not in the extensor muscles which were not exercised. Compared to baseline, the increase of sodium content in medial gastrocnemius muscle was stronger in ME/CFS than in controls with + 30% versus + 17% to baseline at 12 min (p = 0.0326) and + 29% versus + 16% to baseline at 15 min (p = 0.0265). Patients had reduced average handgrip strength which was associated with increased average muscle tissue sodium content (p = 0.0319, R2 = 0.3832). CONCLUSION Muscle sodium content before and after exercise was higher in ME/CFS than in healthy controls. Furthermore, our findings indicate an inverse correlation between muscle sodium content and handgrip strength. These findings provide evidence that sodium overload may play a role in the pathophysiology of ME/CFS and may allow for potential therapeutic targeting.
Collapse
Affiliation(s)
- Elisabeth Petter
- grid.6363.00000 0001 2218 4662Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany ,grid.6363.00000 0001 2218 4662Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.418209.60000 0001 0000 0404Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Carmen Scheibenbogen
- grid.6363.00000 0001 2218 4662Institute of Medical Immunology, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Peter Linz
- grid.411668.c0000 0000 9935 6525Institute of Radiology, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | | | - Klaus Wirth
- Institute of General Pharmacology and Toxicology, University Hospital Frankfurt am Main, Goethe-University, Theodor-Stern Kai 7, Frankfurt am Main, Germany
| | - Titus Kuehne
- grid.6363.00000 0001 2218 4662Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.418209.60000 0001 0000 0404Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Marcus Kelm
- grid.6363.00000 0001 2218 4662Institute of Computer-Assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.418209.60000 0001 0000 0404Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany ,grid.484013.a0000 0004 6879 971XBerlin Institute of Health (BIH), Berlin, Germany ,grid.452396.f0000 0004 5937 5237German Centre for Cardiovascular Research (DZHK),
Partner Site, Berlin, Germany
| |
Collapse
|
14
|
Zhu M, Goubergrits L, Kuehne T, Kelm M. Myocardial power predicts 6-minute-walk test outcome after mitral valve surgery in patients with mitral insufficiency: A non-invasive CMR study. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.330] [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: 01/01/2023]
|
15
|
Kelm M, Reibetanz J. [47/m patient with red blood depositions in feces : Preparation for the medical specialist examination: part 3]. Chirurgie (Heidelb) 2022; 93:12-15. [PMID: 36066591 DOI: 10.1007/s00104-022-01711-x] [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] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M Kelm
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - J Reibetanz
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| |
Collapse
|
16
|
Flemming S, Kelm M, Germer CT, Wiegering A. [Ileal pouch after restorative coloproctectomy]. Chirurgie (Heidelb) 2022; 93:1030-1036. [PMID: 36036850 DOI: 10.1007/s00104-022-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
The continuous development of pouch surgery has enabled continence-preserving treatment after coloproctectomy. The ileoanal J‑pouch is nowadays the standard reconstruction after restorative coloproctectomy with excellent functional long-term results. Taking the relative contraindications and a suitable patient selection into consideration, pouch placement can be indicated not only for ulcerative colitis and familial adenomatous polyposis, but also for patients with nonfistular Crohn's disease. Due to a high treatment density with immunosuppressants, the surgical treatment regimen should be subdivided into a multistage procedure, whereby according to current data a modified two-stage procedure should be favored.
Collapse
Affiliation(s)
- S Flemming
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - M Kelm
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - C-T Germer
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland
| | - A Wiegering
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Zentrum für Operative Medizin (ZOM), Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| |
Collapse
|
17
|
Al-Kassou B, Al-Kassou L, Mahn TH, Luetjohann D, Shamekhi J, Willemsen N, Niepmann ST, Baldus S, Kelm M, Nickenig G, Zimmer S. Novel assay for quantifying the cholesterol crystal dissolution capacity of serum predicts outcomes in patients with severe aortic stenosis undergoing TAVR. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is the most common valvular heart disease (VHD) in developed countries. The pathophysiology of calcific AS has several clinical and pathobiological findings in common with atherosclerosis including chronic inflammation and lipoprotein deposition. Histopathological examination has revealed atherosclerosis-like lesions, that mainly contain cholesterol crystals (CC) in resected calcific aortic valve cusps. Previous studies have demonstrated that CCs can activate the NLRP3 inflammasome, resulting in an IL-1 driven systemic inflammation, that leads to the development of atherosclerotic plaques.
Purpose
In this study, we sought to validate a novel assay for measuring the serum capacity to dissolve cholesterol crystals (CCDC) in patients with AS and to examine whether this biomarker may be associated with clinical outcomes.
Methods
Our study cohort included 348 patients with AS undergoing transcatheter aortic valve replacement. The CCDC was measured using flow cytometry to enumerate CC, that were added to a 50% serum solution, at baseline and after two hours of incubation. The dissolution capacity was indicated as percentage change in CC count at baseline and after incubation. The study cohort was stratified according to the median CCDC into high and low CC dissolvers.
Results
The study population was 47.7% female and had a mean age of 80.9±6.2 years. The primary end point, a composite of one-year all-cause mortality and major vascular complication occurred less frequently in the high CCDC group (7.0%) as compared with the low CCDC group (15.3%, p=0.01). This was mainly driven by lower rates of one-year mortality in patients with a high CCDC (7.0% vs 13.6%, p=0.05), as presented in Figure 1. Furthermore, unplanned endovascular interventions were significantly less frequent in high CC dissolvers in contrast to low CC dissolvers (12.2% vs 20.5%, p=0.04). Although LDL cholesterol (101.8±37.3 mg/dL vs 97.9±37.6 mg/dL, p=0.35) and total cholesterol levels (158.1±43.8 mg/dL vs 154.1±40.2, p=0.41) were comparable in the high and low CCDC group, only patients with a low CCDC showed a benefit from statin treatment (Figure 2). In multivariate analysis, only low CCDC (OR: 2.51 [95% CI: 1.02–6.15], p=0.05) and Albumin (OR: 0.88 [95% CI: 0.79–0.98], p=0.03) were independently associated with one-year all-cause mortality
Conclusion
The CCDC is a novel biomarker associated with clinical outcome in patients with AS undergoing TAVR. It may provide new insights into patient's preventative anti-inflammatory capacity and additional prognostic information to identify vulnerable patients beyond classic risk assessment.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
Collapse
Affiliation(s)
| | - L Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - T H Mahn
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - D Luetjohann
- University Hospital Bonn, Institute of Clinical Chemistry und Clinical Pharmacology , Bonn , Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - N Willemsen
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S T Niepmann
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Baldus
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Zimmer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| |
Collapse
|
18
|
Karschnia M, Zweck E, Scheiber D, Heidecke H, Barthuber C, Kelm M, Roden M, Westenfeld R, Szendroedi J, Boege F. Associations of GPCR autoantibodies with clinical, histological, metabolic and hemodynamic features in non-ischemic heart failure patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Roughly one third of cases of chronic heart failure (HF) are caused by genetic predisposition, metabolic stress and cardiac inflammation. Animal studies suggest that heart-reactive autoantibodies, most notably those directed against G-protein-coupled receptors (GPCR), could also play a pathogenetic role in the disease. However, so far, a causal link between humoral GPCR-autoimmunity and human non-ischemic heart failure other than Chagas' cardiomyopathy remains unclear.
Purpose
Here, we investigated possible associations of GPCR autoantibodies with inflammatory, hemodynamic, metabolic and functional parameters in patients with chronic non-ischemic HF unrelated to Chagas' disease.
Methods
We prospectively included 95 patients with newly diagnosed non-ischemic heart failure of unknown origin. Basic cardiac characterization comprised transthoracic echocardiography, cardiac magnetic resonance imaging, coronary angiography and right heart catheterization with endomyocardial biopsy. Mitochondrial oxidative phosphorylation capacity and coupling was measured using high-resolution respirometry in permeabilized myocardial fibers. A panel of candidate GPCR-autoantibodies was determined by validated and certified immune-assays in peripheral venous blood of the HF-patients and 60 matched healthy individuals. Results were normalized to total IgG.
Results
Among 10 candidate GPCR-autoantibodies determined, only autoantibodies for α1-adrenergic receptor (α1AR), β1-adrenergic receptor (β1AR), muscarinic receptor M5 (M5AR), angiotensin II receptor type 1 (AT1R) and type 2 (AT2R) exhibited HF-associated alterations:
Autoantibodies against β1AR, M5R and AT2R were increased. Autoantibodies against α1AR and AT1R were decreased (Figure). These alterations were significant (p<0.01), but not, or only weakly, correlated with markers of cardiac inflammation, cardiac damage, hemodynamics, endomyocardial histology or left ventricular inflammation judged by T2-mapping.
However, in HF-patients, increased AT2R autoantibodies were associated with improved myocardial mitochondrial coupling (r=−0.27, p=0.021), and decreased AT2R autoantibodies were associated with insulin resistance (r=−0.24 p=0.027).
Conclusion(s)
Some previously postulated alterations of GPCR autoantibodies were confirmed in thoroughly characterized HF-patients. However, association of these alterations with cardiac function was not traceable, which argues against a specific pathogenic role. Our data are compatible with multifaceted interactions of GPCR-autoantibodies with the myocardium and potentially with glucose metabolism, possibly indicating a disease-modifying or compensatory role.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Research comission of the Heinrich-Heine University Duesseldorf
Collapse
Affiliation(s)
- M Karschnia
- Heinrich Heine University, Faculty of Medicine , Duesseldorf , Germany
| | - E Zweck
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - D Scheiber
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | | | - C Barthuber
- University Hospital Duesseldorf, Central Institute for Clinical Chemistry and Laboratory Diagnostics , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - M Roden
- University Hospital Duesseldorf, Division of Endocrinology and Diabetology , Duesseldorf , Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - J Szendroedi
- University Hospital of Heidelberg, Department of Endocrinology, Diabetology, Metabolism and Clinical Chemistry , Heidelberg , Germany
| | - F Boege
- University Hospital Duesseldorf, Central Institute for Clinical Chemistry and Laboratory Diagnostics , Duesseldorf , Germany
| |
Collapse
|
19
|
Polzin A, Dannenberg L, Helten C, Metzen D, Duecker C, Marschall U, L Hoest H, Hennig B, Petzold T, Jung C, Levkau B, Zeus T, Schroer K, Hohlfeld T, Kelm M. Excess mortality in Aspirin and Dipyrone (Metamizole) co-medicated in patients with cardiovascular disease: a nationwide study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pain is a serious issue in our aging society. Metamizole is one of the most commonly used analgesics. In addition, metamizole has been shown to attenuate the pharmacodynamics response to aspirin as measured by platelet function tests. However, the extent to which this laboratory effect translates to clinical outcome in patients is unknown.
Methods
We conducted a nationwide analysis based on health insurance database including 9.2 million patients in Germany. All patients with a cardiovascular event in 2014 and subsequent secondary prevention with aspirin were followed up for 36 months. Inverse probability of treatment weighting (IPTW) analysis was performed to examine mortality rates between patients on aspirin-metamizole co-medication and aspirin medication alone. Myocardial infarction (MI) and stroke/transient ischemic attack (TIA) events were also documented.
Results
26,200 patients received continuous aspirin medication alone and 5,946 received co-medication with aspirin and metamizole. In the IPTW analysis, significantly increased mortality was observed in the co-medication group (15.6% vs. 24.4%, hazard ratio (HR)=1.66, 95% confidence interval (CI) 1.56–1.76; p<0.0001). MI and stroke/TIA were also increased (MI: 1,370 [5.2%] vs. 355 [5.9%]; HR=1.18, 95% CI 1.05–1.32; p=0.0066, relative risk (RR) 1.14, absolute risk increase (ARI) 0.71%, number needed to harm (NNH) 140. Stroke/TIA: 1,901 [7.3%] vs. 506 [8.5%]; HR=1.22, 95% CI 1.11–1.35; p<0.0001, RR 1.17, ARI 1.21%, NNH 82).
Conclusion
In this nationwide observational study, aspirin-metamizole co-medication was associated with excess mortality. This was partly due to ischemic events (MI and stroke/TIA), which were also more frequent in the co-medication patients. Therefore, metamizole should be used with caution in aspirin-treated patients for secondary prevention
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Polzin
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - L Dannenberg
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - C Helten
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - D Metzen
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - C Duecker
- Georg-August University, Institute for Clinical Pharmacology , Goettingen , Germany
| | - U Marschall
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - H L Hoest
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - B Hennig
- BARMER Statutory Health Insurance Fund , wuppertal , Germany
| | - T Petzold
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - C Jung
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - B Levkau
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - T Zeus
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - K Schroer
- Heinrich Heine University, Institute for Pharmacology and Clinical Pharmacology , Duesseldorf , Germany
| | - T Hohlfeld
- Heinrich Heine University, Institute for Pharmacology and Clinical Pharmacology , Duesseldorf , Germany
| | - M Kelm
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| |
Collapse
|
20
|
Kuss O, Akbulut C, Schlesinger S, Georgiev A, Kelm M, Roden M, Wolff G. Absolute treatment effects for the primary outcome and all-cause mortality in the cardiovascular outcome trials in type 2 diabetes: a meta-analysis of individual patient data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Treatment effects from the large cardiovascular outcome trials (CVOTs) in diabetes are almost exclusively communicated as hazard ratios, although reporting guidelines recommend to report treatment effects also on an absolute scale, e.g. as numbers needed to treat (NNT). We aimed to analyze NNT in CVOTs of novel oral antidiabetic drugs comparing dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, or sodium-glucose cotransporter-2 (SGLT2) inhibitors to placebo.
Methods and results
We extracted individual time-to-event information for the primary outcome and all-cause mortality from 19 CVOTs that compared DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors to placebo. We estimated Weibull models for each trial and outcome and derived monthly NNTs. NNTs were summarized across all trials and within drug-classes by random effects meta-analysis methods. Treatment effects in the CVOTs appear smaller if they are reported as NNTs: Overall, 60 (95%-CI: 40–124) patients have to be treated for 29 months (the median follow-up time across all trials) to avoid a single event of the primary outcome, and 101 (95%-CI: 69–191) patients have to be treated for 39 months to avoid a single death.
Conclusion
We found that the respective treatment effects of novel oral antidiabetic drugs look less impressive when communicated on an absolute scale, as numbers needed to treat. For a valid overall picture of the benefit of these drugs, trial authors should thus also report treatment effects on an absolute scale.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- O Kuss
- Heinrich Heine University, Institute for Biometrics and Epidemiology , Duesseldorf , Germany
| | - C Akbulut
- Heinrich Heine University, Institute for Health Services Research and Health Economics, Centre for Health and Society , Duesseldorf , Germany
| | - S Schlesinger
- Heinrich Heine University, Institute for Health Services Research and Health Economics, Centre for Health and Society , Duesseldorf , Germany
| | - A Georgiev
- Heinrich Heine University, Institute for Clinical Diabetology , Duesseldorf , Germany
| | - M Kelm
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology , Duesseldorf , Germany
| | - G Wolff
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| |
Collapse
|
21
|
Marjani K, Erkens R, Kramser N, Ipek R, Nienhaus F, Haberkorn W, Wischmann P, Polzin A, Roden M, Jung C, Kelm M, Boenner F, Cramer M. Development of CMR-derived aortic stiffness parameters in patients with metabolic comorbidities after ST-segment elevation myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stiffness has demonstrated an independent prediction of adverse cardiovascular events after ST-segment elevation myocardial infarction (STEMI) [1]. The general impact of the comorbidities diabetes mellitus (DM), chronic kidney disease (CKD), anemia on aortic stiffness is well known [2,3]. Therefore, the present study aimed to investigate the influence of metabolic comorbidities on cardiovascular magnetic resonance (CMR)-derived aortic parameters early and 6 months after STEMI.
Methods
From the prospective STEMI pathway, 161 patients (mean age: 63.7 years; 75% male) with initial CMR 5 days after STEMI were included. 105 patients pursued in a 6-month follow-up CMR. Aortic stiffness was assessed using different parameters: 1) pulse wave velocity (PWV) from velocity-encoded phase-contrast images, 2) aortic distensibility, and 3) radial strain from the ascending aorta obtained from cine images. DM was diagnosed when either pre-existing, HbA1c ≥6.5% at index hospitalization or 2-hour OGCT ≥200 mg/dl. CKD was present when glomeruli filtration rate (GFR) was less than 60 ml/min/m2, Anemia was defined according to WHO classifications.
Results
Of the 161 patients, 46 presented with anemia at admission, 79 with anemia at day 5, 26 with CKD and 57 with DM. Initial anemia resulted in a significantly lower distensibility (p=0.003) and aortic strain (p=0.02). A correlation between initial haemoglobin levels and distensibility (r=0.253; p=0.002) was found. CKD Patients showed a lower distensibility (p=0.012). There were correlations between GFR and PWV (r=−0.298; p<0.001), distensibility (r=0.370; p<0.001), and radial strain (r=−0.388; p<0.001). After 6 month this significant correlation remained. The DM group showed higher PWV values (p=0.02) and a lower radial strain (p=0.003). PWV showed a correlation with the 2-hour OGCT value (r=0.249; p=0.011) while the radial strain correlated with HbA1c (r=0.216; p=0.007). After multivariable analyses, diabetes remained the only significant predictor to show higher PWV (p=0.004) and poorer radial strain values (p=0.0045) while initial anemia remained the only significant predictor of lower distensibility (p=0.0033). Aortic stiffness parameters did not show any changes after 6 months in all groups. Only NTproBNP 5 days after STEMI correlated significantly with 6-months PWV (r=0.247; p=0.02), radial strain (r=0.36; p=0.001), distensibility (r=−0.226; p=0.018).
Conclusion
Anemia, DM and CKD show a detrimental impact on values of aortic stiffness early after STEMI. Diabetes remains the only significant predictor of higher PWV and poorer radial strain values after multivariable analysis while initial anemia remains significant predictor of lower distensibility. After 6 months none of the groups showed improvement in aortic stiffness parameters.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Sonderforschungsbereich 1116
Collapse
Affiliation(s)
- K Marjani
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - R Erkens
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - N Kramser
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - R Ipek
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - F Nienhaus
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - W Haberkorn
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - P Wischmann
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - A Polzin
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research , Duesseldorf , Germany
| | - C Jung
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Kelm
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - F Boenner
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| | - M Cramer
- University Hospital of Düsseldorf, Cardiology, Pneumology and Angiology , Düsseldorf , Germany
| |
Collapse
|
22
|
Spieker M, Sidabras J, Lagarden H, Veulemans V, Horn P, Akhyari P, Kelm M, Westenfeld R. Extent and determinants of pulmonary hypertension unmasked by handgrip exercise in patients with mitral regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is an established prognosticator in patients with mitral regurgitation (MR). However, a substantial proportion of patients with MR presents without PH at rest but may develop PH during exercise. Previous studies already demonstrated the prevalence and prognostic impact of PH during bicycle exercise. Until now, there are no data on exercise PH assessed by handgrip exercise.
Purpose
To assess prevalence and predictors of exercise-induced PH during handgrip exercise in patients with MR.
Methods
We prospectively included patients with MR and at least mild severity that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol. PH was defined by systolic pulmonary artery pressure (SPAP) >50 mmHg.
Results
The final patient cohort included 371 patients with primary and secondary MR. Mean age was 74±11 years, 48% were female and 59% had atrial fibrillation. Median NT-proBNP was 2017 (845–4976) ng/l. Thirty-eight percent of patients had primary MR, while 62% presented with secondary MR. At rest, MR severity was graded as mild in 56% of patients, moderate in 32% and severe in 12%. Mean SPAP at rest was 40±12 mmHg, and 63 patients (17%) revealed PH at rest (SPAP >50 mmHg). Handgrip exercise leads to an increase in SPAP by 7±12 mmHg. Thus, during exercise 137 patients (37%) exhibited SPAP >50 mmHg. Together, 110 patients (32%) of those patients without PH at rest, showed PH during handgrip exercise. Left- (OR 1.021 (1.010 to 1.033); p<0.001), and right atrial volume index (OR 1.020 (1.009 to 1.035); p<0.001), RV fractional area change (OR 0.972 (0.949 to 0.994); p=0.013), tricuspid regurgitation (OR 1.863 (1.434 to 2.445); p<0.001) and SPAP at rest (OR 1.131 (1.100 to 1.167); p<0.001) were the predictors of exercise PH. Moreover, there was a linear correlation between the change in MR severity assessed by effective regurgitant orifice area (r=0.359; p<0.001) and regurgitation volume (r=0.370; p<0.001) and the change in SPAP. Patients with exercise PH and patients with PH at rest were more symptomatic according to NYHA functional class than patients without PH (p=0.008) (Fig. 1).
Conclusion(s)
In patients with primary and secondary MR, handgrip echocardiography unmasks exercise PH in every third patient without PH at rest. Bi-atrial dilatation, right ventricular function, tricuspid regurgitation and SPAP at rest were predictors of exercise PH, while changes in MR severity during handgrip exercise correlate with changes in pulmonary pressures.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf to Maximilian Spieker for a Clinician Scientist Track.
Collapse
Affiliation(s)
- M Spieker
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - J Sidabras
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - H Lagarden
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - V Veulemans
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - P Horn
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - P Akhyari
- Heinrich-Heine University, Department of Cardiac Surgery , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - R Westenfeld
- University Hospital Duesseldorf , Duesseldorf , Germany
| |
Collapse
|
23
|
Spieker M, Lagarden H, Sidabras J, Veulemans V, Akhyari P, Horn P, Kelm M, Westenfeld R. Extent and determinants of dynamic mitral regurgitation unmasked by handgrip exercise in patients with primary mitral regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Bicycle exercise is the exercise modality of choice to unmask the dynamic nature of mitral regurgitation (MR). Handgrip exercise may serve as alternative exercise intervention, as it can be performed physically accomplished by the majority of patients. Until now, there are only scarce data on the prevalence and magnitude of dynamic MR during handgrip exercise.
Purpose
To assess extent and predictors of exercise-induced dynamic MR during handgrip exercise in patients with primary MR.
Methods
We prospectively included patients with primary MR and at least mild severity that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol.
Results
The final patient cohort included 166 patients. Mean age was 72±12 years, 57% were female and 53% had atrial fibrillation. At rest, MR severity was graded as mild in 57% of patients, moderate MR in 27% and severe in 16%. Handgrip exercise led to an increase in at least one grade in MR severity in 31 patients (19%), while 15 patients (9%) experienced a decrease of MR severity (Fig. 1B). Twenty patients (14%) of those with non-severe MR at rest, developed severe MR during handgrip exercise (Fig. 1B). According to a pre-defined cutoff of increase in effective orifice regurgitant area (EROA) >10 mm2 during exercise, 19% of patients revealed a marked exercise-induced increase in MR, irrespective of the severity of MR at rest. Patients with marked exercise-induced increases in MR severity (EROA >10 mm2) had elevated left- (53±22ml/m2 vs. 44±19ml/m2; p=0.036), and right atrial volumes (43±19ml/m2 vs. 34±18ml/m2; p=0.014), more often pathology of the anterior mitral leaflet (e.g. prolapse; flail leaflet) (65% vs. 33%; p<0.001), and increased mitral annulus diameter (38±5mm vs. 36±4mm; p=0.003). The exercise-induced changes in EROA correlated with changes in estimated systolic pulmonary pressure from rest to exercise (r=0.438 (0.287 to 0.568); p<0.001) (Fig. 1C).
Conclusion(s)
In patients with primary MR, handgrip echocardiography unmasks marked exercise-induced increases of MR severity in every fifth patient independent of the severity at rest. A relevant number of patients with non-severe MR at rest developed severe MR during exercise. Dynamic MR is associated with bi-atrial dilatation, increased mitral annulus diameter, and pathology of the anterior mitral valve leaflet. Moreover, changes in MR severity during handgrip exercise correlate with changes in pulmonary pressures.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf Maximilian Spieker for a Clinician Scientist Track.
Collapse
Affiliation(s)
- M Spieker
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - H Lagarden
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - J Sidabras
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - V Veulemans
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - P Akhyari
- Heinrich-Heine University, Department of Cardiac Surgery , Duesseldorf , Germany
| | - P Horn
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - R Westenfeld
- University Hospital Duesseldorf , Duesseldorf , Germany
| |
Collapse
|
24
|
Lu K, Rothe M, Floegel U, Kotzka J, Oehler D, Roden M, Kelm M, Szendroedi J, Westenfeld R. Chronic insulin resistance deteriorates cardiac mitochondrial quality control in a mouse model of SEC-NAFLD-IR. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Insulin resistance and nonalcoholic fatty liver disease (NAFLD) both relate to cardiovascular mortality. Using a mouse model of chronic lipid overload and secondary-NAFLD-induced insulin resistance (SEC-NAFLD-IR), we recently deciphered that SEC-NAFLD-IR already at young age provoked myocardial lipotoxicity with reduced mitochondrial efficiency and increased vulnerability to cardiac ischemia. However, long-term consequences of SEC-NAFLD-IR remain elusive.
Purpose
Here we aimed to elucidate the impact of long-term SEC-NAFLD-IR on multiple mitochondrial quality control (mQC) mechanisms in the heart and its consequences for cardiac function.
Methods
We studied 36 SEC-NAFLD-IR mice (72-week-old). For mechanistic experiments, we applied palmitate-induced insulin resistant murine HL-1 cells. Cardiac mitochondrial dynamics were measured via quantification of mitochondrial morphology and expression of mitochondrial fusion and fission factors (Opa1, Drp1, Fis1, Mfn 1 & 2). Mitophagy level was evaluated via immunofluorescence and protein expression of key mitophagy-related genes (Parkin, NIX, LC3). Mitochondrial biogenesis and mass were examined via quantitation of PGC-1α expression, mtDNA and citrate synthase activity.
Results
72-week-old SEC-NAFLD-IR mice exhibited 21% (p=0.001) and 32% (p<0.001) higher body weight and heart weight compared with controls. Along with elevated oxidative stress, hepatic lipid accumulation and inflammation, 6h-fasted SEC-NAFLD-IR mice were characterized by increased plasma glucose, insulin and cholesterol. SEC-NAFLD-IR mice displayed a cardiac phenotype with 21% higher left ventricular mass (normalized to body weight, p<0.001) and 6% lower ejection fraction compared to controls (73.5% SEM 0.90 vs 69.4% SEM 1.65, p=0.04). We found several advantageous mQC mechanisms suppressed in aged SEC-NAFLD-IR mice including long form OPA1-mediated mitochondrial fusion, Parkin- and NIX-mediated mitophagy. Likewise, mitochondrial biogenesis was suppressed in the aged insulin-resistant heart, which was connected to a 65% downregulation of PGC-1α1 expression (p=0.01). Interestingly, downregulation of cardiac PGC-1α1 in aged SEC-NAFLD-IR mice coincided with upregulation of PARIS, indicating the crucial participation of the Parkin/PARIS pathway in mQC of the insulin-resistant heart. In addition, induction of insulin resistance in murine HL-1 cardiomyocytes also led to increased mitochondrial fragmentation and decreased PGC-1α1 expression.
Conclusion
This study demonstrated that regulation of mitochondrial network and turnover is hampered by SEC-NAFLD-IR in the hearts of aged mice, which may contribute to hypertrophy and cardiac dysfunction in insulin resistance.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Collaborative Research Centre 1116 (German Research Foundation)
Collapse
Affiliation(s)
- K Lu
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - M Rothe
- Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research , Duesseldorf , Germany
| | - U Floegel
- Heinrich Heine University, Department of Molecular Cardiology, Medical Faculty , Duesseldorf , Germany
| | - J Kotzka
- Heinrich Heine University, Institute for Biochemistry and Pathobiochemistry, German Diabetes Center , Duesseldorf , Germany
| | - D Oehler
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - J Szendroedi
- University Hospital of Heidelberg, Internal Medicine I and Clinical Chemistry , Heidelberg , Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| |
Collapse
|
25
|
Polzin A, Dannenberg L, Schroeder N, Benkhoff M, Vogt J, Keul P, Weske S, Sarabhai T, Zeus T, Mueller T, Wolnitzke P, Graele M, Roden M, Kelm M, Levkau B. Impaired Cardioprotection by HDL in CAD and Diabetes in Ischemia/Reperfusion Injury: role of S1P and SR-BI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
HDL dysfunction rather than HDL-cholesterol concentration is involved in the pathogenesis of coronary artery disease (CAD) and type-2 diabetes (T2DM). While causes and consequences of HDL dysfunction are manifold, reduced concentrations of HDL-sphingosine-1-phsophate (S1P) are partially responsible for impaired vasodilation and suppression of inflammation by CAD-HDL. Administration of healthy human HDL prior to coronary ischemia/reperfusion (I/R) in mice reduced infarct size (IS) due to HDL-S1P. The role of major HDL receptor SR-BI is unexplored in this context.
Purpose
In this study, we, a) investigated the cardioprotective properties of healthy versus CAD-HDL and T2DM-HDL in a murine model of acute myocardial infarction (AMI), b) tested the effect of S1P loading of CAD-HDL in cardioprotection, and c) detected the relevant HDL receptor of this cardioprotection.
Methods
HDL were isolated from plasma of healthy volunteers, CAD, and T2DM patients by density ultra-centrifugation and injected (43 mg HDL protein/KG) in the tail vein of C57Bl/6J mice 5 minutes prior to 30 minutes of ischemia. Cardiac function was assessed after 24 hours of reperfusion by echocardiography. IS was analyzed by TTC staining and S1P concentration measured by LC-MS/MS, respectively.
Results
Administration of human healthy HDL reduced IS by 23% and increased ejection fraction (EF) by 22% 24 hours after I/R (IS: Control 43.8±6.9% [n=17] vs. healthy HDL 32.9±3.6% [n=9]; EF: Control 34.5±5.7% vs. healthy HDL 41.9±4.1%). In contrast, CAD-HDL in the same dosage had no protective effect (IS: 40.1±5.7% [n=12]; EF: 31.9±8.4%). As HDL-S1P concentrations were 33% lower in CAD-HDL compared to healthy HDL, we tested whether S1P-loading may correct CAD-HDL's defective cardioprotection. Indeed, S1P-loading (38 μg S1P/kg in 43 mg HDL protein/KG) completely restored CAD-HDL cardioprotection to levels achieved by healthy HDL. S1P-loading of healthy HDL had no additional benefit. Administration of T2DM-HDL prior to I/R led to 28% larger IS and 22% worse EF compared to healthy HDL (IS: healthy HDL 33.0±4.3% [n=6] vs. T2DM-HDL 42.4±8.9% [n=13]; EF: healthy HDL 38.5±5.8% [n=6] vs. T2DM-HDL 33.1±.4.0%). Compared to healthy HDL, T2DM-HDL exhibited a 19% decrease in S1P content. We thus tested whether the major HDL receptor SR-BI is involved in HDL-S1P mediated cardioprotection using global SR-BI deficient mice (Scarb1−/−). Remarkably, cardioprotection by HDL administration was completely absent in Scarb1−/− mice but intact in wild type controls. (IS Scarb1++: Vehicle 38.6±8.3% [n=12] vs. HDL 29.9±8.5% [n=11], Scarb1−/−: Vehicle 31.4±5.6% [n=12] vs. HDL 31.1±6.9% [n=17])
Conclusion
We have identified: (a) impaired cardioprotection after I/R as new characteristic of HDL dysfunction in CAD and T2DM; (b) low HDL-S1P as its cause and the possibility of its therapeutic correction by S1P loading, and (c) SR-BI as the HDL receptor responsible for HDL-S1P-mediated cardioprotection.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Polzin
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - L Dannenberg
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - N Schroeder
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - M Benkhoff
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - J Vogt
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - P Keul
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - S Weske
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - T Sarabhai
- Heinrich Heine University, Department of Endocrinology and Diabetology , Duesseldorf , Germany
| | - T Zeus
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - T Mueller
- University Hospital Jena, Department of Anesthesiology and Intensive Care , Jena , Germany
| | - P Wolnitzke
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - M Graele
- University Hospital Jena, Department of Anesthesiology and Intensive Care , Jena , Germany
| | - M Roden
- Heinrich Heine University, Department of Endocrinology and Diabetology , Duesseldorf , Germany
| | - M Kelm
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - B Levkau
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| |
Collapse
|
26
|
Zweck E, Scheiber D, Schultheiss HP, Kelm M, Roden M, Szendroedi J, Westenfeld R. Prediabetes relates to impaired mitochondrial function in human ventricular myocardium. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
With the growing prevalence of prediabetes in developed countries, complications of this predecessor of diabetes mellitus type 2 become increasingly important for medical research and practice. Prediabetes is defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and may also incorporate elevated hemoglobin A1. While overt type 2 diabetes is a well-established risk factor and can even be the cause of cardiac failure, this is not yet proven for prediabetes. Mitochondrial impairment is a key pathomechanism in heart failure, but it remains uncertain, whether prediabetes impairs myocardial energy metabolism in humans just as type 2 diabetes does.
Purpose
We aimed to scrutinize the impact of prediabetes on myocardial mitochondrial metabolism and cardiac function.
Methods
We included 50 heart transplant recipients with normal glucose tolerance (GT, n=25), prediabetes (n=8, 3 IFG and 5 IGT) or type 2 diabetes mellitus (T2DM, n=17), who had received a healthy donor heart from a non-diabetic donor. In this cohort, the impact of the recipients' metabolism should be displayed in the donor heart after transplantation. We performed oral glucose tolerance tests to assess the diabetes status, and cardiac magnetic resonance imaging to assess cardiac systolic and diastolic function, circulating biomarkers of oxidative stress in serum samples (thiobarbituric acid reactive substances (TBARS) and redox potential), as well as global T2 relaxation times as a marker of myocardial inflammation. In transcatheter endomyocardial biopsies, we assessed myocardial mitochondrial oxidative capacity using high-resolution respirometry and myocardial mRNA expression of nuclear factor kappa B p105 subunit (NFKB1).
Results
GT and IFG/IGT patients exhibited comparable demographic and clinical characteristics, whereas T2DM had higher BMI, glycemia, triglycerides and creatine kinase (all p<0.05). None of systolic (p=0.99), diastolic cardiac function (p=0.81), myocardial NFKB1 expression (p=0.74), circulating oxidative stress markers (p=0.94 and 0.95) or cardiac T2 relaxation times (p=0.99) were altered in IFG/IGT compared to GT, but diastolic strainrate was impaired (p=0.03) and circulating oxidative stress (TBARS: p=0.03, redox potential: p=0.04) were higher in T2DM than in GT. However, myocardial mitochondrial function stood out to be already impaired in IFG/IGT to a similar extend as in T2DM. This particularly applied to substrates of mitochondrial complex I (GT vs. IFG/IGT vs. T2DM: 126±7 vs. 89±12 vs. 93±6 pmol s–1 mg–1. p=0.02) and II (188±13 vs. 123±17 vs. 138±11 pmol s–1 mg–1. p=0.02). Intrinsic uncoupling was not altered in IFG/IGT but tended to be higher in T2DM (leak control ratio: 0.49±0.02 vs. 0.46±0.06 vs. 0.57±0.04 [arbirary units]).
Conclusion
Our findings point towards mitochondrial impairment as a predecessor of overt heart failure in prediabetes and may represent an early footprint of prediabetic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- E Zweck
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - D Scheiber
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT) , Berlin , Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
| | - M Roden
- German Diabetes Center, Leibniz Center for Diabetes Research, Institute for Clinical Diabetology , Dusseldorf , Germany
| | - J Szendroedi
- German Diabetes Center, Leibniz Center for Diabetes Research, Institute for Clinical Diabetology , Dusseldorf , Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine , Dusseldorf , Germany
| |
Collapse
|
27
|
Wolff G, Lin Y, Akbulut C, Brockmeyer M, Parco C, Hoss A, Sokolowski A, Westenfeld R, Kelm M, Roden M, Schlesinger S, Kuss O. Absolute treatment effects of novel oral antidiabetic drugs on cardiovascular mortality and hospitalization for heart failure: a meta-analysis of digitalized individual patient outcomes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Absolute treatment effects of novel oral antidiabetic drugs for cardiovascular outcomes have thus far not been comprehensively evaluated. We thus aimed to perform a meta-analysis of digitalized individual patient data.
Methods and results
Individual patient outcomes from Cardiovascular Outcome Trials (CVOTs) evaluating dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose transporter 2 (SGLT2) inhibitors against placebo with time-to-event information for cardiovascular mortality (CM) and/or hospitalization for heart failure (HHF) endpoints were digitalized from Kaplan-Meier plots; Weibull regression models with random-effects meta-analysis were used to estimate numbers-needed-to-treat (NNT) and Meta-NNT with 95% confidence intervals (CI). Sixteen CVOTs reported time-to-event information (14 in primary diabetes, two in primary heart failure populations). Thirteen studies including 96,860 patients were meta-analyzed for CM: at the median follow-up of 30 months, Meta-NNTs were 178 (64 to ∞ to −223) for DPP-4 inhibitors, 261 (158 to 745) for GLP-1 receptor agonists and 118 (68 to 435) for SGLT2 inhibitors. Ten studies including 96,128 patients were meta-analyzed for HHF: at the median follow-up of 29 months, estimated Meta-NNTs were −644 (229 to ∞ to −134) for DPP-4 inhibitors, 441 (184 to ∞ to −1100) for GLP-1 receptor agonists and 126 (91 to 208) for SGLT2 inhibitors. SGLT2 inhibitors were especially effective for HHF in primary heart failure populations (Meta-NNT 25 (19 to 39)) vs. primary diabetes populations (Meta-NNT 233 (167 to 385)) at 16 months of follow-up.
Conclusion
We found modest treatment benefits of GLP-1 receptor agonists and SGLT2 inhibitors for CM and HHF in primary T2DM populations. In primary heart failure populations, however, SGLT2 inhibitor benefits were substantial and comparable to established heart failure medication.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Wolff
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - Y Lin
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - C Akbulut
- Heinrich Heine University, Institute for Biometrics and Epidemiology , Duesseldorf , Germany
| | - M Brockmeyer
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - C Parco
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - A Hoss
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - A Sokolowski
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - M Kelm
- University Hospital Dusseldorf, Cardiology, Pulmonology and Angiology , Dusseldorf , Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology , Duesseldorf , Germany
| | - S Schlesinger
- Heinrich Heine University, Institute for Biometrics and Epidemiology , Duesseldorf , Germany
| | - O Kuss
- Heinrich Heine University, Institute for Biometrics and Epidemiology , Duesseldorf , Germany
| |
Collapse
|
28
|
Bruno RR, Wernly B, Wolff G, Artigas A, Pinto BB, Schefold JC, Kindgen-Milles D, Baldia PH, Kelm M, Beil M, Leaver S, De Lange DW, Guidet B, Flaatten H, Jung C. The impact of pre-existing chronic heart failure on the intensive care treatment and outcome of old intensive care patients suffering from COVID-19. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients suffering from COVID-19 with pre-existing chronic heart failure (CHF) are considered to have a significant risk regarding morbidity and mortality. Similarly, older patients on the intensive care unit (ICU) constitute another vulnerable subgroup. This study investigated the association between pre-existing CHF and clinical practice in critically ill older ICU patients with COVID-19.
Methods
Patients with severe COVID-19 and who were ≥70 years old were recruited from this prospective multicenter international study. Patients' treatment, follow-up, and pre-existing heart failure data were collected during ICU stay. Univariate and multivariate logistic regression analyses examined the association between pre-existing heart failure and the primary endpoint of 30-day mortality.
Results
The study included 3,917 patients, with 407 patients (17%) evidencing pre-existing CHF. These patients were older (77±5 versus 76±5, p<0.001) and more frail (Clinical Frailty Scale 4±2 versus 3±2, p<0.0001). The other comorbidities were also significantly more common in CHF patients. Before hospital admission, CHF patients suffered fewer days from symptoms (5 days (3–8) versus 7 days (4–10), p<0.001), but there was no difference in the days in the hospital before ICU admission (2 days (1–5) versus 2 (1–5) days, p=0.21). At ICU admission, disease severity assessed by SOFA scores was significantly higher in CHF patients (7±3 versus 5±3). During ICU-stay, intubation, mechanical ventilation, and tracheostomy occurred significantly more often in patients without CHF (63% versus 69%, p=0.017; and 13% versus 18%, p=0.002, respectively). In contrast, there was no difference regarding non-invasive ventilation (28% versus 27%, p=0.20), and the need for vasoactive drugs (66% versus 64, p=0.30). Regarding the limitation of life-sustaining therapy, therapy was significantly more often withheld (32% versus 25%, p=0.001) but not withdrawn (18% versus 17%, p=0.21) in CHF patients. Length of ICU stay was significantly shorter in CHF patients (166 (72–336) hours versus 260 hours (120–528), p<0.001). CHF patients had significantly higher ICU- (52% versus 46%, p=0.007), 30-day mortality (60% vs. 48%, p<0.001; OR 1.87, 95% CI 1.5–2.3) and 3-month mortality (69% vs. 56%, p<0.001). In the univariate regression analysis, having pre-existing CHF was significantly associated with 30-day mortality (OR 1.89, 95% CI 1.5–2.3; p<0.001), but after adjusting for confounders (SOFA, age, gender, frailty), heart failure was not independently associated any more (aOR 1.2, 95% CI 0.5–1.5; p=0.137).
Conclusion
In critically ill old COVID-19 patients, pre-existing chronic heart failure is associated with significantly increased short- and long-term mortality, but heart failure is not independently associated with increased 30-day mortality when adjusted for confounders.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. The support of the study in France by a grant from “Fondation Assistance Publique-Hôpitaux de Paris pour la recherche” is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf, No. 2018-32 to GW and No. 2020-21 to RRB for a Clinician Scientist Track.
Collapse
Affiliation(s)
- R R Bruno
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - B Wernly
- Paracelsus Private Medical University, Department of Anaesthesiology , Salzburg , Austria
| | - G Wolff
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - A Artigas
- Hospital Universitari Parc Tauli de Sabadell , Sabadell , Spain
| | - B B Pinto
- Geneva University Hospitals , Geneva , Switzerland
| | - J C Schefold
- Bern University Hospital, Inselspital , Bern , Switzerland
| | | | - P H Baldia
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Beil
- Hadassah-Hebrew University Medical Center , Jerusalem , Israel
| | - S Leaver
- St George's University Hospital NHS Foundation Trust , London , United Kingdom
| | - D W De Lange
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - B Guidet
- Sorbonne University , Paris , France
| | - H Flaatten
- Haukeland University Hospital , Bergen , Norway
| | - C Jung
- University Hospital Duesseldorf , Duesseldorf , Germany
| |
Collapse
|
29
|
Spieker M, Sidabras JS, Lagarden H, Veulemans V, Akhyari P, Horn P, Kelm M, Westenfeld R. Extent and predictors of exercise-induced changes in ischemic mitral regurgitation during handgrip exercise. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) is frequent in patients with ischemic heart disease and carries a dismal prognosis. Recent studies suggest that ischemic MR is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as mitral valvular deformation. Handgrip exercise may serve as alternative exercise intervention to bicycle exercise.
Purpose
To assess degree and determinants of exercise-induced changes in ischemic MR during handgrip exercise.
Methods
We prospectively enrolled 205 patients with at least mild ischemic MR that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol.
Results
Mean age in our patient cohort was 75±10 years, 30% were female, and 58% suffer from atrial fibrillation. Median NT-proBNP was 2657 (1331–6599) ng/l. Mean left ventricular ejection fraction was 44±14%. At rest, MR severity was graded as mild in 57% of patients, moderate MR in 34% and severe in 9%. Mean effective regurgitant orifice area (EROA) at rest was 15±6 mm2 and regurgitation volume was 25±11 ml. During handgrip exercise, 58 patients (28%) showed an increase in MR severity in at least one grade; 30 patients (15%) with non-severe MR at rest, developed severe MR during handgrip exercise. The EROA decreased (>5 mm2) in 5% of patients, remained unchanged in 50% (between −5 mm2 and +5 mm2), and increased (>5 mm2) in 45% of patients (Fig. 1B). A small increase (5–10 mm2) was observed in 30%, while 15% of patients revealed a marked increase in EROA (>10 mm2) (Fig. 1B). The degree of MR at rest was not associated with exercise-induced increases in EROA (r=−0.03; p=0.641)(Fig. 1C). However, echocardiographic parameters of local (e.g. tenting height) and global (e.g. LVESVi) LV remodeling, as well as mitral valvular deformation correlated with exercise-induced changes in EROA (Table 1).
Conclusion
In patients with secondary MR due to ischemic heart disease, handgrip echocardiography unmasks exercise-induced increases of MR severity in a significant proportion of patients. Dynamic MR during handgrip exercise is associated with parameters of global and local LV remodeling as well with parameters of mitral valvular deformation. Future studies need to address the prognostic importance of exercise-induced changes in MR severity in patients with ischemic cardiomyopathy.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf to Maximilian Spieker for a Clinician Scientist Track.
Collapse
Affiliation(s)
- M Spieker
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - J S Sidabras
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - H Lagarden
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - V Veulemans
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - P Akhyari
- Heinrich-Heine University, Department of Cardiac Surgery , Duesseldorf , Germany
| | - P Horn
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - R Westenfeld
- University Hospital Duesseldorf , Duesseldorf , Germany
| |
Collapse
|
30
|
Oehler D, Immohr M, Boettger C, Erbel-Khurtsidze S, Aubin H, Bruno R, Holst T, Horn P, Westenfeld R, Kelm M, Tudorache I, Akhyari P, Lichtenberg A, Boeken U. Donor hypernatremia is associated with increased mortality after heart transplantation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation and is known to be associated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium deregulation in patient survival after heart transplantation (HTx). This study aims to investigate the impact of donor sodium levels on early morbidity and short- and midterm survival following HTx.
Methods
Between September 2010 and June 2021, a total of n=218 patients underwent HTx in our centre. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut-off levels from 145 to 159 mmol/l were investigated by Kaplan-Meier-analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133–145 mmol/l, n=73), mild hypernatremia (146–156 mmol/l, n=105) and severe hypernatremia (>156 mmol/l, n=35). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival after up to 5 years after transplantation.
Results
All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90-day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (see table 1 and fifgure 1, 90% vs. 71%, p=0.02), but not in mild normonatremia (89%, p=0.89). 1-year survival was comparable in all groups (p>0.28).
Conclusion
Donor hypernatremia was associated with reduced short-term survival, while correlation weakens >1 year after HTx. Future prospective studies are needed to confirm the possible cut-off value of 156 mmol/l for donor-acceptancy.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Oehler
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - M Immohr
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - C Boettger
- University Hospital Duesseldorf, Department of Diagnostic and Interventional Radiology , Duesseldorf , Germany
| | - S Erbel-Khurtsidze
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - H Aubin
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - R Bruno
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - T Holst
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - P Horn
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - M Kelm
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine , Duesseldorf , Germany
| | - I Tudorache
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - P Akhyari
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - A Lichtenberg
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| | - U Boeken
- University Hospital Duesseldorf, Department of Cardiac Surgery , Duesseldorf , Germany
| |
Collapse
|
31
|
Al-Kassou B, Veulemans V, Shamekhi J, Maier O, Aksoy A, Zietzer A, Meertens M, Weber M, Sinning JM, Adam M, Zimmer S, Baldus S, Kelm M, Nickenig G, Sedaghat A. Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR – a multicentre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite major advances, transcatheter aortic valve replacement (TAVR) is associated with procedure-related vascular and bleeding complications, that have a significant impact on mortality. A recently published study has shown that heparin antagonization using protamine resulted in significantly lower rates of serious bleeding events in patients undergoing TAVR as compared to those without heparin reversal. However, the optimal protamine-to-heparin dosing ratio to prevent bleeding complications without increasing ischemic complications in patients undergoing TAVR is unknown. Accordingly, daily clinical practice varies between selective to routine administration of protamine in different dosing ratios.
Purpose
The aim of this observational multicentre study was to compare the safety and efficacy of two different protamine-to-heparin dosing ratios for the prevention of bleeding complications after TAVR.
Methods
The study included 1446 patients undergoing TAVR, of whom 623 (43.1%) received partial and 823 (56.9%) full heparin antagonization (0.4–0.6 mg versus 0.9–1.0 mg protamine/100 units of heparin). The indication for partial or full heparin antagonization was left to the discretion of the operator, who made the decision according to the patient's individual thrombotic and bleeding risk. The primary endpoint was a composite of 30-day mortality, life-threatening and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days.
Results
The overall study population had a mean age of 81.1±6.0 years; 47.9% were of female gender.
The baseline characteristics were well balanced between the two groups. Full antagonization of heparin resulted in significantly lower rates of the primary endpoint as compared to partial heparin reversal (5.6 vs. 10.4%, p<0.01), mainly driven by lower rates of life-threatening (0.5 vs 1.6%, p=0.05) and major bleeding (3.2 vs 7.5%, p<0.01). The incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5 vs 7.5%, p<0.01), as presented in Figure 1. Accordingly, the post-interventional drop in hemoglobin level and the need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin reversal (1.5±1.2 vs 1.7±1.2 g/dl, p<0.01; 10.4 vs 15.9%, p<0.01, respectively). Regarding safety endpoints, no differences were observed in the incidence of stroke and myocardial infarction between the groups (2.2 vs 2.6%, p=0.73 and 0.2 vs 0.4%, p=0.64, respectively). Multivariate regression analyses revealed that full antagonization of heparin (OR: 0.43 [95% CI: 0.24–0.81], p<0.01) was independently associated with the primary end point
Conclusion
Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
Collapse
Affiliation(s)
- B Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - V Veulemans
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - O Maier
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - A Aksoy
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Zietzer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - M Meertens
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Weber
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - J M Sinning
- St Vinzenz-Hospital, Department of Cardiology , Cologne , Germany
| | - M Adam
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - S Zimmer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Baldus
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Sedaghat
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| |
Collapse
|
32
|
Polzin A, Dannenberg L, Benckhoff M, Barcik M, Keul P, Weske S, Ahlbrecht S, Helten C, Haberkorn S, Floegel U, Zeus T, Mueller T, Graeler M, Kelm M, Levkau B. S1P lyase inhibition improves post-ischemic cardiac remodeling independently of infarct size via S1P receptor 1. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2912] [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: 11/15/2022] Open
Abstract
Abstract
Background
Revascularization of the infarct vessel is the golden standard in acute myocardial infarction (AMI). Even in Western countries, more than ten percent of AMI patients are so-called “latecomers” and it is controversial if revascularization of the infarct vessel is beneficial in these patients. Current guidelines even discourage revascularization of the infarcted artery if symptom onset was >48 hours and the patient is asymptomatic. These patients are at high risk for cardiovascular events and heart failure with reduced ejection fraction (HFrEF). HFrEF has an enormous socio-economic impact, high morbidity, and mortality.
Purpose
Therapeutic options targeting post-ischemic cardiac remodeling are sparse. The bioactive sphingolipid sphingosine-1-phosphate (S1P) reduces ischemia/reperfusion injury when administered in advance. However, its impact on post-ischemic remodeling independently of its infarct size (IS)-reducing effect is yet unknown.
Methods
Acute myocardial infarction (AMI) in mice was induced by permanent ligation of the left anterior descending artery (LAD). C57Bl/6J were treated with the S1P lyase inhibitor 4-deoxypyridoxine (DOP) starting seven days prior to AMI to increase endogenous S1P concentrations. Cardiac function and myocardial healing were assessed by cardiovascular magnetic resonance imaging (cMRI), histomorphology and gene expression analysis. DOP effects were investigated in cardiomyocyte-specific S1P receptor 1 deficient (S1PR1 Cardio Cre+ and Cre− control) mice, and S1P concentrations measured by LC-MS/MS.
Results
S1P concentrations in plasma before induction of AMI were increased fourfold by DOP (Control 0.97±0.09μM [n=6] vs. DOP 3,80±0,09μM [n=6]). Scar size determined by MRI, as well as ejection fraction (EF), did not differ 24 h post AMI. In contrast, after 21 days, there was a clear difference between the two groups (scar size vehicle: 19.3±6.2% vs. DOP 13.4±5.7%; EF: Vehicle: 26.4±8.7% vs. DOP 38.2±11.8%). In addition, in the remote area 21 days post AMI in the DOP-treated animals, a reduced gene expression of brain natriuretic peptide, atrial natriuretic peptide and collagen 1a2. Finally, cardiomyocyte diameter in the remote myocardium was 21% smaller in DOP-treated (Vehicle: 21.95±1.59μm vs. DOP 17.35±0.77μm). The benefit of DOP-treatment was abolished in cardiomyocyte-specific S1PR1-deficient mice.
Conclusion
S1P improves cardiac function and myocardial healing post AMI independently of initial infarct size via S1PR1. Hence, in addition to its beneficial effects on I/R injury, S1PR1 may be a promising target in post-infarction myocardial remodeling as adjunctive therapy to revascularization and in patients who are not eligible for standard interventional procedures.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A Polzin
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - L Dannenberg
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Benckhoff
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - M Barcik
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - P Keul
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - S Weske
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - S Ahlbrecht
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - C Helten
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - S Haberkorn
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - U Floegel
- University Hospital Duesseldorf, Department of Molecular Cardiology , Duesseldorf , Germany
| | - T Zeus
- University Hospital Duesseldorf , Duesseldorf , Germany
| | - T Mueller
- University Hospital Jena, Department of Anesthesiology and Intensive Care , Jena , Germany
| | - M Graeler
- University Hospital Jena, Department of Anesthesiology and Intensive Care , Jena , Germany
| | - M Kelm
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - B Levkau
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| |
Collapse
|
33
|
Wildeis L, Ziese J, Helten C, Benkhoff M, Mourikis P, Zako S, Petzold T, Levkau B, Zeus T, Kelm M, Polzin A. Effect of coagulation factors FXIa, FXIIa, F alpha-XIIa, F beta-XIIa and FXIIIa on platelet function. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
FXa has recently been shown to active platelets via protease activated receptor. Direct inhibition of FXa leads to reduced platelet reactivity and arterial thrombosis. It is not known, if other coagulation factors besides FXa and FIIa directly activate platelets. In this study, we hypothesized that FXIa, FXIIa, Fα-XIIa, Fβ-XIIa and FXIIIa directly active platelets.
Purpose
Direct inhibitors of above mentioned factors are currently in clinical trials. Hence, investigation of coagulation factors' non-canonical effects beyond activation of the coagulation cascade are of great importance.
Methods
Platelet reactivity was measured using light transmission aggregometry (LTA) and flow cytometry. Ex-vivo stimulation of washed platelets was conducted using adenosine diphosphate (ADP) and thrombin receptor activator peptide (TRAP).
Results
FXIa, FXIIa, Fα-XIIa, Fβ-XIIa and FXIIIa have no direct effect on platelet function in terms of aggregation (Maximum of aggregation: FXIa: 2.799±1,823%, FXIIa: 1,174±1,080%, Fα-XIIa: 1,663±1,680%, Fβ-XIIa: 1,060±1,356%, Fα-XIIa + Fβ-XIIa 1,790±2,327% and FXIIIa: 1,345±1,060%). Also, incubation of platelets does not cause expression of P-selectin (FXIa: 4,346±4,650%, FXIIa: 7,072±6,098%, Fα-XIIa: 9,124±6,075%, Fβ-XIIa: 4,556±4,693%, Fα-XIIa + Fβ-XIIa 8,070±4,342% and FXIIIa: 5,166±5,512%).
Conclusion
FXIa, FXIIa, Fα-XIIa, Fβ-XIIa and FXIIIa have no direct effect on platelet function in terms of aggregation and P-selectin expression. Thus, existing pharmacological inhibitors of these factors are to be classified as purely anticoagulant and do not exert non-canonical effects on platelet activation.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- L Wildeis
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - J Ziese
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - C Helten
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - M Benkhoff
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - P Mourikis
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - S Zako
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - T Petzold
- Ludwig-Maximilians University, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - B Levkau
- Heinrich Heine University, Institute of Molecular Medicine III , Duesseldorf , Germany
| | - T Zeus
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - M Kelm
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| | - A Polzin
- Heinrich Heine University, Department of Cardiology, Pulmonology, and Vascular Medicine , Duesseldorf , Germany
| |
Collapse
|
34
|
Lewin D, Van Praet KM, Nersesian G, Kelm M, Kofler M, Baumgartner M, Kempfert J, Falk V, Klein C, Unbehaun A. Transcatheter Aortic Valve Replacement in a Patient With Criss-Cross Heart. JACC Case Rep 2022; 4:934-940. [PMID: 35935152 PMCID: PMC9350901 DOI: 10.1016/j.jaccas.2022.06.006] [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: 12/03/2021] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
This paper presents the first transcatheter management of severe aortic regurgitation in a 77-year-old woman with a criss-cross heart—an extremely rare and complex congenital heart disease. The procedure achieved an elimination of aortic regurgitation and resulted in a remarkable improvement of the patient’s physical condition. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Address for correspondence: Daniel Lewin, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Karel M. Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marcus Kelm
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martin Baumgartner
- Department of Cardiac Anaesthesiology and Intensive Care Medicine, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Christoph Klein
- Department of Internal Medicine–Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Axel Unbehaun
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| |
Collapse
|
35
|
Makimoto H, Gerguri S, Hartl S, Kluge S, Clasen L, Bejinariu A, Brinkmeyer C, Schmidt J, Kelm M. Wide antral circumferential re-ablation in case of recurrent atrial fibrillation despite of prior pulmonary vein isolation increases freedom from atrial tachyarrhythmias. Europace 2022. [DOI: 10.1093/europace/euac053.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite repeated pulmonary vein isolation (re-PVI) due to recurrent atrial fibrillation (AF) after PVI has been a standard procedure, the detailed ablation strategy in case of re-PVI remains disputable.
Objective
The aim of this study was to assess the efficacy of re-PVI using wide antral circumferential ablation (WACA) supported by high density mapping (HDM) for recurrent AF after PVI as compared to simple repeated PVI supported by circular mapping catheter.
Methods
Consecutive patients with recurrent AF after PVI were prospectively enrolled in this study, who underwent left atrial HDM and subsequently WACA antral (re-)isolation ("Re-WACA" group). The historical controls with re-PVI between 2016 and 2018 using circular mapping catheter, but without HDM were also enrolled ("control group"). These control patients underwent re-PVI with gap ablation at the pulmonary vein ostium. Primary endpoint was defined as any recurrence and ECG documentation of atrial tachyarrhythmias (AT) including AF or atrial tachycardias over 30 seconds. The patients were routinely followed up for 1 year with at least twice annual holter-monitoring.
Results
In total, 116 patients were enrolled in this study (Re-WACA group [N=56, 68±10 years], control group [N=58, 65±10 years]). There were no significant differences in clinical characteristics including the number of previous left atrial ablation procedures between two groups. In all 56 patients with Re-WACA, residual PV antral potentials were demonstrated (100%), whereas 7 patients (13%) showed no electrical potentials inside any PVs. During a mean follow-up period of 402±71 days, 6 out of 56 Re-WACA patients (11%) and 18 out of 58 controls (31%) experienced AT recurrences. Kaplan-Meier analysis demonstrated that the patients who underwent Re-WACA showed significantly lower AT recurrence after the index Re-PVI procedure as compared to the controls (log-rank, P = 0.010). Multivariate Cox regression showed that Re-WACA was an independent predictor of freedom from AT recurrence (hazard ratio = 0.39; 95% confidence-interval 0.16-0.93; P=0.034). The number of previous PVI procedures predicted AT recurrence during follow-up (hazard ratio = 2.35; 95% confidence-interval 1.20-4.46; P=0.010).
Conclusions
Residual pulmonary vein antral potential in patients with recurrent AF after previously performed PVI is a frequent finding. These antral potentials can be easily visualized by HDM. Repeated isolation of wide PV antrum (Re-WACA) is an effective strategy to reduce further AF recurrence as compared to conventional re-PVI without left atrial HDM.
Collapse
Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Hartl
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Kluge
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| |
Collapse
|
36
|
Bingel A, Messroghli D, Weimar A, Runte K, Salcher-Konrad M, Kelle S, Pieske B, Berger F, Kuehne T, Goubergrits L, Fuerstenau D, Kelm M. Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:718114. [PMID: 35514442 PMCID: PMC9062977 DOI: 10.3389/fcvm.2022.718114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Although disease etiologies differ, heart failure patients with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively) both present with clinical symptoms when under stress and impaired exercise capacity. The extent to which the adaptation of heart rate (HR), stroke volume (SV), and cardiac output (CO) under stress conditions is altered can be quantified by stress testing in conjunction with imaging methods and may help to detect the diminishment in a patient’s condition early. The aim of this meta-analysis was to quantify hemodynamic changes during physiological and pharmacological stress testing in patients with HF. A systematic literature search (PROSPERO 2020:CRD42020161212) in MEDLINE was conducted to assess hemodynamic changes under dynamic and pharmacological stress testing at different stress intensities in HFpEF and HFrEF patients. Pooled mean changes were estimated using a random effects model. Altogether, 140 study arms with 7,248 exercise tests were analyzed. High-intensity dynamic stress testing represented 73% of these data (70 study arms with 5,318 exercise tests), where: HR increased by 45.69 bpm (95% CI 44.51–46.88; I2 = 98.4%), SV by 13.49 ml (95% CI 6.87–20.10; I2 = 68.5%), and CO by 3.41 L/min (95% CI 2.86–3.95; I2 = 86.3%). No significant differences between HFrEF and HFpEF groups were found. Despite the limited availability of comparative studies, these reference values can help to estimate the expected hemodynamic responses in patients with HF. No differences in chronotropic reactions, changes in SV, or CO were found between HFrEF and HFpEF. When compared to healthy individuals, exercise tolerance, as well as associated HR and CO changes under moderate-high dynamic stress, was substantially impaired in both HF groups. This may contribute to a better disease understanding, future study planning, and patient-specific predictive models.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020161212].
Collapse
Affiliation(s)
- Anne Bingel
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Weimar
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Kilian Runte
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Maximilian Salcher-Konrad
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Titus Kuehne
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center Digital Future (ECDF), Berlin, Germany
| | - Daniel Fuerstenau
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Digitalization, Copenhagen Business School, Frederiksberg, Denmark
| | - Marcus Kelm
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- *Correspondence: Marcus Kelm,
| |
Collapse
|
37
|
Bönner F, Gastl M, Nienhaus F, Rothe M, Jahn A, Pfeiler S, Gross U, Schultheiss HP, Ibanez B, Kozerke S, Szendroedi J, Roden M, Westenfeld R, Schrader J, Flögel U, Heusch G, Kelm M. Regional analysis of inflammation and contractile function in reperfused acute myocardial infarction by in vivo 19F cardiovascular magnetic resonance in pigs. Basic Res Cardiol 2022; 117:21. [PMID: 35389088 PMCID: PMC8989832 DOI: 10.1007/s00395-022-00928-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 01/31/2023]
Abstract
Inflammatory cell infiltration is central to healing after acute myocardial infarction (AMI). The relation of regional inflammation to edema, infarct size (IS), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH), and regional and global LV function is not clear. Here we noninvasively characterized regional inflammation and contractile function in reperfused AMI in pigs using fluorine (19F) cardiovascular magnetic resonance (CMR). Adult anesthetized pigs underwent left anterior descending coronary artery instrumentation with either 90 min occlusion (n = 17) or without occlusion (sham, n = 5). After 3 days, in surviving animals a perfluorooctyl bromide nanoemulsion was infused intravenously to label monocytes/macrophages. At day 6, in vivo 1H-CMR was performed with cine, T2 and T2* weighted imaging, T2 and T1 mapping, perfusion and late gadolinium enhancement followed by 19F-CMR. Pigs were sacrificed for subsequent ex vivo scans and histology. Edema extent was 35 ± 8% and IS was 22 ± 6% of LV mass. Six of ten surviving AMI animals displayed both MVO and IMH (3.3 ± 1.6% and 1.9 ± 0.8% of LV mass). The 19F signal, reflecting the presence and density of monocytes/macrophages, was consistently smaller than edema volume or IS and not apparent in remote areas. The 19F signal-to-noise ratio (SNR) > 8 in the infarct border zone was associated with impaired remote systolic wall thickening. A whole heart value of 19F integral (19F SNR × milliliter) > 200 was related to initial LV remodeling independently of edema, IS, MVO, and IMH. Thus, 19F-CMR quantitatively characterizes regional inflammation after AMI and its relation to edema, IS, MVO, IMH and regional and global LV function and remodeling.
Collapse
Affiliation(s)
- Florian Bönner
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - M Gastl
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - F Nienhaus
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - M Rothe
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research, Partner, Düsseldorf, Germany
| | - A Jahn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Central Animal Research Facility, Heinrich Heine University, Düsseldorf, Germany
| | - S Pfeiler
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - U Gross
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H-P Schultheiss
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - B Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
- CIBERCV, Madrid, Spain
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - J Szendroedi
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - M Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Düsseldorf, Germany
- German Center for Diabetes Research, Partner, Düsseldorf, Germany
- Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - R Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Schrader
- Department of Molecular Cardiology, Heinrich Heine University, Düsseldorf, Germany
- Experimental Cardiovascular Imaging, Department of Molecular Cardiology, Heinrich Heine University, Düsseldorf, Germany
| | - U Flögel
- Department of Molecular Cardiology, Heinrich Heine University, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - G Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - M Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| |
Collapse
|
38
|
Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren – Update 2021. Kardiologe 2021. [PMCID: PMC8591966 DOI: 10.1007/s12181-021-00517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. H. Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H. J. Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N. Frey
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kelm
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N. Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H. Thiele
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B. W. Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| |
Collapse
|
39
|
Berndt N, Eckstein J, Wallach I, Nordmeyer S, Kelm M, Kirchner M, Goubergrits L, Schafstedde M, Hennemuth A, Kraus M, Grune T, Mertins P, Kuehne T, Holzhütter HG. CARDIOKIN1: Computational Assessment of Myocardial Metabolic Capability in Healthy Controls and Patients With Valve Diseases. Circulation 2021; 144:1926-1939. [PMID: 34762513 PMCID: PMC8663543 DOI: 10.1161/circulationaha.121.055646] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Many heart diseases can result in reduced pumping capacity of the heart muscle. A mismatch between ATP demand and ATP production of cardiomyocytes is one of the possible causes. Assessment of the relation between myocardial ATP production (MVATP) and cardiac workload is important for better understanding disease development and choice of nutritional or pharmacologic treatment strategies. Because there is no method for measuring MVATP in vivo, the use of physiology-based metabolic models in conjunction with protein abundance data is an attractive approach. METHOD: We developed a comprehensive kinetic model of cardiac energy metabolism (CARDIOKIN1) that recapitulates numerous experimental findings on cardiac metabolism obtained with isolated cardiomyocytes, perfused animal hearts, and in vivo studies with humans. We used the model to assess the energy status of the left ventricle of healthy participants and patients with aortic stenosis and mitral valve insufficiency. Maximal enzyme activities were individually scaled by means of protein abundances in left ventricle tissue samples. The energy status of the left ventricle was quantified by the ATP consumption at rest (MVATP[rest]), at maximal workload (MVATP[max]), and by the myocardial ATP production reserve, representing the span between MVATP(rest) and MVATP(max). Results: Compared with controls, in both groups of patients, MVATP(rest) was increased and MVATP(max) was decreased, resulting in a decreased myocardial ATP production reserve, although all patients had preserved ejection fraction. The variance of the energetic status was high, ranging from decreased to normal values. In both patient groups, the energetic status was tightly associated with mechanic energy demand. A decrease of MVATP(max) was associated with a decrease of the cardiac output, indicating that cardiac functionality and energetic performance of the ventricle are closely coupled. Conclusions: Our analysis suggests that the ATP-producing capacity of the left ventricle of patients with valvular dysfunction is generally diminished and correlates positively with mechanical energy demand and cardiac output. However, large differences exist in the energetic state of the myocardium even in patients with similar clinical or image-based markers of hypertrophy and pump function. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03172338 and NCT04068740.
Collapse
Affiliation(s)
- Nikolaus Berndt
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Eckstein
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Iwona Wallach
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Nordmeyer
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Marcus Kelm
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Marieluise Kirchner
- Berlin Institute of Health (BIH), Berlin, Germany; Proteomics Platform, Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Leonid Goubergrits
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Einstein Center Digital Future, Berlin, Germany
| | - Marie Schafstedde
- Institute of Computer-assisted Cardiovascular Medicine, Charité; Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-assisted Cardiovascular Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Milena Kraus
- Digital Health Center, Hasso Plattner Institute, University of Potsdam, Germany
| | - Tilman Grune
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany; Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Philipp Mertins
- Berlin Institute of Health (BIH), Berlin, Germany; Proteomics Platform, Max Delbrück Center for Molecular Medicine (MDC), Berlin, Germany
| | - Titus Kuehne
- Institute of Computer-assisted Cardiovascular Medicine, Charité; Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Berlin, Germany
| | - Hermann-Georg Holzhütter
- Institute of Biochemistry, Charitá - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
40
|
Maier O, Binneboessel S, Klein K, Piayda K, Polzin A, Westenfeld R, Jung C, Berisha N, Zeus T, Kelm M, Veulemans V. Real-world experience with the cusp overlap deployment technique for procedural optimization during self-expanding transcatheter aortic valve implantation: our city best practice trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic valve stenosis treated by transcatheter aortic valve implantation (TAVI) is a fast-growing section in interventional cardiology. Optimal implantation depth (ID) of self-expanding TAVI devices is an important condition for hemodynamic and clinical outcomes. The cusp overlap technique (COT) offers optimized fluoroscopic projections for TAVI with self-expanding devices due to improved anatomic discrimination by elongation of the left ventricular outflow tract and isolation of the non-coronary cusp (NCC) for better assessment of ID.
Purpose
This single-center observational study aims to investigate short-term clinical performance, safety, and efficiency outcomes regarding optimized ID in patients undergoing transfemoral TAVI with self-expanding prostheses and COT.
Methods
From September 2020 to December 2020, a total of 71 patients underwent TAVI with a newer-generation self-expanding device and COT. The optimal fluoroscopic projection was generated by overlapping the right (RCC) and left coronary cusps (LCC) on the multidetector computed tomography annular plane. Final ID was assessed by the arithmetic mean of distances measured from NCC and LCC to the distal prosthesis end. Outcomes were compared with a control cohort of 339 patients who underwent TAVI from January 2016 to August 2020 with a three-cusp coplanar view only during valve deployment.
Results
ID was significantly reduced in the COT cohort (4.3±1.9 vs. 5.0±2.3 mm; p=0.012) with better achievement of optimal ID (2–4 mm) (63.4% vs. 49.9%; p=0.03) and optimization of delta NCC-LCC ID symmetry (1.4±1.3 vs. 1.7±1.3 mm; p=0.026). The rate of pacemaker implantation following TAVI could be reduced (9.9% vs. 19.4%; p=0.05). Six of the seven patients receiving pacemaker in the COT cohort (85.7%) showed ID above membranous septum length. COT resulted in notably higher rates of device repositioning by recapturing (57.8% vs. 16.2%; p<0.001) compared to control cohort. Though, procedure time was prolonged in the COT cohort (82.0±26.5 vs. 74.9±27.5 min; p=0.05) while radiation dose and amount of contrast medium did not differ between the cohorts. No difference was observed in hemodynamic outcomes regarding transvalvular pressure gradients and at least moderate paravalvular leak. Patients implanted with COT had a shorter length of hospital stay (7.1±6.0 vs. 10.3±6.8 days; p<0.001), possibly due to a lower complication rate regarding new conduction disturbances and pacemaker implantation.
Conclusion
TAVI using the cusp overlap deployment technique is associated with an optimized implantation depth and a low rate of procedural complications. Therefore, a reduction of new pacemaker implantations and shortened length of hospital stay could be achieved.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - K Klein
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Berisha
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
41
|
Foerster R, Stern M, Heinen Y, Baasen S, Sansone R, Heiss C, Kelm M, Busch HL. Impact of peripheral angioplasty on wound oxygenation measured with near-infrared spectroscopy in patients with critical limb ischemia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Impact of peripheral angioplasty on wound oxygenation measured with near-infrared spectroscopy in patients with critical limb ischemia
Abstract
Background
Near-infrared Spectroscopy (NIRS) has been proposed as a promising noninvasive tool for the assessment of hemoglobin oxygen saturation (StO2) in complex wounds in patients with critical limb ischemia (CLI).
Objective
Up today, NIRS measurements are undertaken at single points near the wound, but not in the wound.
Methods
In this prospective, single center study, 34 patients with PAD Rutherford stage 4–6 were included. We analyzed StO2 maps in and around the wound at baseline one day before and one day after angioplasty using a NIRS camera; macrovascular function was assessed by Doppler ultrasound with spectral analysis including ankle-brachial index (ABI).
Results
Baseline StO2 of the wound area was 63% (± 3.66 [SE]) and 34% in the wound (± 4.8 [SE]). After successful angioplasty, wound area StO2 significantly increased to 71% (± 3.09 [SE]; p<0.001) and wound StO2 increased even more pronounced to 42% (± 4,77 [SE]; p<0.001). Likewise, ABI increased in the treated leg (before 0.74±0.03 [SE]; after 0.87±0.02 [SE]; p=0.008).
Conclusion
This is the first study to assess oxygenation in the wound using a NIRS camera after peripheral angioplasty. NIRS monitoring of wound oxygenation in patients undergoing endovascular treatment is a promising tool to monitor tissue perfusion.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
Collapse
Affiliation(s)
- R Foerster
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - M Stern
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - Y Heinen
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - S Baasen
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - R Sansone
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - C Heiss
- University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom
| | - M Kelm
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| | - H L Busch
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Duesseldorf, Germany
| |
Collapse
|
42
|
Zweck E, Spieker M, Horn P, Iliadis C, Metze C, Kavsur R, Tiyerili V, Nickenig G, Baldus S, Kelm M, Becher MU, Pfister R, Westenfeld R. Machine learning identifies clinical parameters to predict mortality in patients undergoing transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter Mitral Valve Repair (TMVR) with MitraClip is an important treatment option for patients with severe mitral regurgitation. The lack of appropriate, validated and specific means to risk stratify TMVR patients complicates the evaluation of prognostic benefits of TMVR in clinical trials and practice.
Purpose
We aimed to develop an optimized risk stratification model for TMVR patients using machine learning (ML).
Methods
We included a total of 1009 TMVR patients from three large university hospitals, of which one (n=317) served as an external validation cohort. The primary endpoint was all-cause 1-year mortality, which was known in 95% of patients. Model performance was assessed using receiver operating characteristics. In the derivation cohort, different ML algorithms, including random forest, logistic regression, support vectors machines, k nearest neighbors, multilayer perceptron, and extreme gradient boosting (XGBoost) were tested using 5-fold cross-validation in the derivation cohort. The final model (Transcatheter MITral Valve Repair MortALIty PredicTion SYstem; MITRALITY) was tested in the validation cohort with respect to existing clinical scores.
Results
XGBoost was selected as the final algorithm for the MITRALITY Score, using only six baseline clinical features for prediction (in order of predictive importance): blood urea nitrogen, hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), mean arterial pressure, body mass index, and creatinine. In the external validation cohort, the MITRALITY Score's area under the curve (AUC) was 0.783, outperforming existing scores which yielded AUCs of 0.721 and 0.657 at best. 1-year mortality in the MITRALITY Score quartiles across the total cohort was 0.8%, 1.3%, 10.5%, and 54.6%, respectively. Odds of mortality in MITRALITY Score quartile 4 as compared to quartile 1 were 143.02 [34.75; 588.57]. Survival analyses showed that the differences in outcomes between the MITRALITY Score quartiles remained even over a timeframe of 3 years post intervention (log rank: p<0.005). With each increase by 1% in the MITRALITY score, the respective proportional hazard ratio for 3-year survival was 1.06 [1.05, 1.07] (Cox regression, p<0.05).
Conclusion
The MITRALITY Score is a novel, internally and externally validated ML-based tool for risk stratification of patients prior to TMVR. These findings may potentially allow for more precise design of future clinical trials, may enable novel treatment strategies tailored to populations of specific risk and thereby serve future daily clinical practice.
Funding Acknowledgement
Type of funding sources: None. Summary Figure
Collapse
Affiliation(s)
- E Zweck
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Spieker
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - P Horn
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Iliadis
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - C Metze
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Kavsur
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - S Baldus
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M U Becher
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - R Pfister
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | | |
Collapse
|
43
|
Lin Y, Parco C, Karathanos A, Krieger T, Schulze V, Chernyak N, Icks A, Kelm M, Brockmeyer M, Wolff G. Clinical efficacy and safety outcomes of bempedoic acid for LDL-C lowering therapy in patients at high cardiovascular risk: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Bempedoic acid (BA) is a novel oral low-density lipoprotein cholestrol (LDL-C) lowering drug. Its efficacy and safety for clinical outcomes in high cardiovascular risk patients remains unknown.
Objectives and methods
A systematic review was performed and randomized controlled trials (RCTs) of BA vs. placebo in high cardiovascular risk patients reporting clinical efficacy and safety outcomes were included in a meta-analysis. Cumulative odds ratios (OR) and mean differences with 95% confidence intervals (CI) were reported as summary statistics.
Results
Six RCTs with a total of 3,956 patients and follow-ups of four to 52 weeks were identified. There was no difference in MACE (OR 0.84; CI 0.61, 1.15), all-cause mortality (OR 2.37; CI 0.80, 6.99) and cardiovascular mortality (OR 1.66; CI 0.45, 6.04) for BA vs. placebo. BA showed beneficial trends for nonfatal myocardial infarction (OR 0.57; CI 0.32, 1.00) and was associated with a lower risk of new-onset or worsening of diabetes mellitus (OR 0.68; CI 0.49, 0.94) and non-coronary revascularization (OR 0.41; CI 0.18, 0.95), but higher risk of gout (OR 3.29; CI 1.28, 8.46) and a trend for worsening of renal function (OR 4.24; CI 0.98, 18.39) and muscular disorders (OR 2.60; CI 1.15, 5.91).
Conclusion
Bempedoic acid in high cardiovascular risk patients showed no significant effects on major cardiovascular outcomes in short-term follow-up. Unfavourable effects on muscular disorders, renal function and the incidence of gout sound a note of caution. Hence, further studies with longer-term follow-up are needed to clarify the risk/benefit ratio of this novel therapy.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- Y Lin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Parco
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Karathanos
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Krieger
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Schulze
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Chernyak
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Icks
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Brockmeyer
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - G Wolff
- University Hospital Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
44
|
Makimoto H, Shiraga T, Kohlmann B, Magnisali CE, Schenk R, Gerguri S, Motoyama N, Clasen L, Bejinariu A, Schmidt J, Brinkmeyer C, Westenfeld R, Zeus T, Kelm M. On-device artificial intelligence: mobile solution for detecting severe aortic valve stenosis based on heart sounds. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis is still one of the major causes of sudden cardiac death in the elderly. Noninvasive screening for severe aortic valve stenosis (AS) may result in early cardiac diagnostic leading to an appropriate and timely medical intervention.
Purpose
The aims of this study were 1) to develop an artificial intelligence to detect severe AS based on heart sounds and 2) to build an application to screen patients using electronic stethoscope and smartphones, which will provide an efficient diagnostic workflow for screening as a complementary tool in daily clinical practice.
Methods
We enrolled 100 patients diagnosed with severe AS and 200 patients without severe AS (no echocardiographic sign of AS [n=100], mild AS [n=50], moderate AS [n=50]). The heart sounds were recorded in 4000 Hz waveform audio format at the following 3 sites of each patient; the 2nd intercostal right sternal border, the Erb's area and the apex. Each record was divided into multiple data of 4 seconds duration, which built 10800 sound records in total. We developed multiple convolutional neural networks (CNN) designed to recognize severe AS in heart sounds according to the recorded 3 sites. We adopted a stratified 4-fold cross-validation method by which the CNN was trained with 60% of the whole data, validated with 20% data and tested with the remaining 20% data not used during training and validation. As performance metrics we adopted the accuracy, F1 value and the area under the curve (AUC) calculated as the average of all cross-validation folds.
For the smartphone application, we combined the best CNN-models from each recorded site for the best performance. Further 40 patients were newly enrolled for its clinical validation (no AS [n=10], mild AS [n=10], moderate AS [n=10], severe AS [n=10]).
Results
The accuracy, F1 value and AUC of each model were 88.9±5.7%, 0.888±0.006 and 0.953±0.008, respectively. The sensitivity and specificity were 87.9±2.2% and 89.9±2.4%. The recognition accuracy of moderate AS was significantly lower as compared to the other AS grades (moderate AS 74.1±6.1% vs no AS 98.0±1.4%, mild AS 97.6±1.2%, severe AS 87.9±2.2%, respectively, P<0.05).
Our smartphone application showed a sensitivity of 100% (10/10), a specificity of 73.3% (22/30), and an accuracy of 80.0% (32/40), which implicated a good utility for screening. In the detailed analysis of 8 mistaken decisions, these were highly affected by the presence of severe mitral or tricuspid valve regurgitation despite of non-severe AS (7/8 [87.5%]).
Conclusions
This study demonstrated the promising possibility of an end-to-end screening for severe aortic valve stenosis using an electronic stethoscope and a smartphone application. This technology may improve the efficacy of daily medicine particularly where the human resource is limited or support a remote medical consultation. Further investigations are necessary to increase accuracy.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- H Makimoto
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Shiraga
- Mitsubishi Electric Inc., Kamakura, Japan
| | - B Kohlmann
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C.-E Magnisali
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Schenk
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - S Gerguri
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - N Motoyama
- Mitsubishi Electric Inc., Kamakura, Japan
| | - L Clasen
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - A Bejinariu
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - J Schmidt
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Brinkmeyer
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - R Westenfeld
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - T Zeus
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, CARID, Dusseldorf, Germany
| |
Collapse
|
45
|
Veulemans V, Maier O, Piayda K, Berning KL, Binneboessel S, Polzin A, Afzal S, Dannenberg L, Horn P, Jung C, Westenfeld R, Kelm M, Zeus T. Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.
Purpose
Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.
Methods
562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.
Results
The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p<0.0001*).
Conclusion
Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- V Veulemans
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - O Maier
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - K Piayda
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - K L Berning
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - S Binneboessel
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - A Polzin
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - S Afzal
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - L Dannenberg
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - P Horn
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - C Jung
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - R Westenfeld
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - M Kelm
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| | - T Zeus
- University Hospital Düsseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
46
|
Baasen S, Stern M, Heinen Y, Goerdes L, Sansone R, Heiss C, Kelm M, Busch L. Angioplasty of flow limiting stenosis improves left ventricular diastolic dysfunction in patients with peripheral artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Peripheral artery disease (PAD) is associated with hypertension and left ventricular diastolic dysfunction (LVDD).
Objective
We hypothesized that endovascular treatment of flow limiting peripheral stenosis may improve LVDD.
Methods
In this prospective single center trial, 23 patients with PAD Rutherford stage 2–4 were included. Augmentation index (AIx), central systolic blood pressure (cSBP) and ankle brachial index (ABI) were measured at baseline one day before, one day after and at follow up 4 months after angioplasty. LVDD was assessed by echocardiography at baseline and at follow up.
Results
Mean E/E' ratio was significantly lower at follow up (11.9±4.4 to 10.2±4.4; p<0.01). Likewise, left atrial size (17.2±5.3 to 13.6±4.7 mm; p=0.014) decreased significantly, but not left atrial volume index (LAVI, 49.73±21.6 to 38.29±17.3 mL/m2; p=0.062). ABI acutely increased in the intervened leg and remained stable at follow up (0.71±0.13 to 0.84±0.13 to 0.89±0.18; p<0.001). AIx (from 30.5±6.1 to 26.5±9.2; p=0.03) and cSBP (from 133±21 to 126±20 mmHg; p=0.05) acutely decreased after angioplasty. At follow up, there was no significant change in central hemodynamics (AIx, cSBP) as compared to baseline.
Conclusion
Chronic effects of angioplasty are associated with favorable improvement of diastolic function but not central hemodynamics.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Baasen
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - M Stern
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - Y Heinen
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - L Goerdes
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - R Sansone
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - C Heiss
- University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom
| | - M Kelm
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - L Busch
- University Hospital Duesseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| |
Collapse
|
47
|
Maier O, Afzal S, Piayda K, Polzin A, Westenfeld R, Jung C, Zeus T, Kelm M, Veulemans V. Electrocardiographic predictors of recovery from pacemaker dependency after transcatheter aortic valve implantation: a meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. The occurrence of electrical conduction disturbances with the need for permanent pacemaker (PPM) implantation remains one of the most frequent complications of the procedure. But PPM dependency after TAVI is often transient and conduction abnormalities may improve over time.
Purpose
We performed a meta-analysis to summarize available studies that reported the incidence of new PPM after TAVI and investigated the rate and possible predictors of recovery from PPM dependency during follow-up.
Methods
The authors conducted a literature search in PubMed and MEDLINE databases from January of 2012 until February of 2021. Eleven observational studies (n=6794) met inclusion criteria for the final analysis. The effect size was estimated using a random-effects model with 95% confidence interval (CI).
Results
PPM implantation was performed in 902 patients after TAVI (13.3%), mostly due to high degree atrioventricular (AV) block (81.3%). A follow-up of 683 patients was performed after a median period of 139 days. 322 of the patients examined during follow-up (48.6%) showed recovery from PPM dependency. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) predictors of PPM recovery during follow-up were female sex (RR 1.37; 95% CI 1.10–1.71; p=0.006), preexisting coronary artery disease (RR 1.12; 95% CI 0.99–1.27; p=0.08) and reduced left ventricular ejection fraction (MD −2.08%; 95% CI 0.23–3.93%; p=0.03). ECG predictors for long-term PPM dependency after TAVI appeared to be preexisting right bundle branch block (RBBB) (RR 1.84; 95% CI 1.38–2.45; p<0.0001), bifascicular block (RR 4.41; 95% CI 1.64–11.86; p=0.003) and prolonged QRS duration (MD 8.69 ms; 95% CI 0.11–17.28 ms; p=0.05). While postprocedural complete heart block was highly predictive for long-term PPM dependency after TAVI (RR 1.35; 95% CI 0.97–1.89; p<0.0001), patients with recovery of PPM dependency showed more indications other than complete heart block for PPM implantation like lower degree AV block or sick sinus syndrome (RR 2.28; 95% CI 1.53–3.38; p<0.0001). Especially postprocedural AV block grade I (RR 1.73; 95% CI 0.96–3.14; p=0.07) and new left bundle branch block (LBBB) (RR 1.94; 95% CI 1.22–3.08; p=0.005) turned out to be predictors of PPM recovery during follow-up.
Conclusion
This structured meta-analysis proved new PPM implantation in 13.3% of patients following TAVI with half of the cases (48.6%) recovering from PPM dependency during follow-up. Therefore, it should be considered to carefully reassess the indication for PPM rather than to immediately implant PPM after TAVI, especially regarding postprocedural ECG predictors for early pacemaker recovery (lower degree AV block, postprocedural LBBB).
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- O Maier
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Afzal
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - K Piayda
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Polzin
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - T Zeus
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - V Veulemans
- University Hospital Duesseldorf, Duesseldorf, Germany
| |
Collapse
|
48
|
Moos C, Scheiber D, Zweck E, Horn P, Boeken U, Akhyari P, Kelm M, Roden M, Szendroedi J, Westenfeld R. Time dependent deterioration of mitochondrial oxidative capacity in heart transplantat recipients with type 2 diabetes mellitus. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetic cardiomyopathy is defined as Heart failure in patients with Type 2 Diabetes (T2DM) in absence of traditional risk factors.
Following HTX, a substantial number of recipients develop insulin resistance or T2DM, associated with cardiac allograft vasculopathy and with increased mortality.
Recently we have shown that endomyocardial biopsies of heart transplant (HTX) recipients with T2DM express reduced mitochondrial respiration.
Purpose
The current study analyses time depended impact of T2DM on myocardial mitochondrial respiration of a priorly non-diabetic heart.
We hypothesized that myocardial mitochondrial oxidative phosphorylation capacity declines in patients with T2DM compared to glucose tolerant heart transplant recipients and that reduced mitochondrial respiration leads to impairment of cardiac function.
Methods
We included 101 HTX recipients who underwent routine endomyocardial biopsy. Patients with T1DM or a Donor with DM were excluded. Patients were classified according to criteria of the American Diabetes Association as non-diabetic (n=23), prediabetic (n=38) or T2DM (n=40), by either Fasting Plasma Glucose, 2h Plasma Glucose, HbA1c or intake of antidiabetic medication. We performed ex vivo high resolution respirometry on permeabilized fibres to assess myocardial mitochondrial respiration. Left ventricular ejection fraction (LV-EF) was assessed by cardiac-MRI or Echocardiography.
Results
Groups were of comparable age (p=0.06), sex (p=0.25) and time since HTX (p=0.91). Mean time since HTX was 29 months. Current rejection episodes (p=0.37) or corticoid pulse therapy (p=0.46) did not significantly differ between groups.
Linear regression in T2DM patients revealed an inverse relationship between time since HTX and mitochondrial respiration at state III conditions supported by the substrates octanoyl-carnitine and ADP (R2=0.16, F(1,38)=6.97, p=0.01). Regression analyses for non-DM group and Prediabetes group revealed no significant relationship between time since HTX and mitochondrial function (non-DM: R2=0.04, F(1,21)=0.9, p=0.35; Prediabetes: R2=0.01, F(1,36)=0.27, p=0.61). Exclusion of patients with cellular allograft rejection (ISHLT ≥1) or of patients with recent corticoid pulse therapy did not alter these results.
Linear correlation revealed a significant relationship (r=0.33, p=0.04) between declining mitochondrial state III respiration and left ventricular ejection fraction (n=39), suggesting associated functional consequences.
Conclusions
Our results suggest a T2DM associated decline of mitochondrial oxidative capacity in HTX recipients. Reduced mitochondrial respiration is associated to lower LV-EF. Targeting mitochondrial respiration might be a promising novel therapeutic approach to address T2DM associated mortality.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Research Counsil
Collapse
Affiliation(s)
- C Moos
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - D Scheiber
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - E Zweck
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - P Horn
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - U Boeken
- Heinrich Heine University, Clinic for Cardiovascular Surgery, Duesseldorf, Germany
| | - P Akhyari
- Heinrich Heine University, Clinic for Cardiovascular Surgery, Duesseldorf, Germany
| | - M Kelm
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| | - M Roden
- Heinrich Heine University, Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Duesseldorf, Germany
| | - J Szendroedi
- University Hospital of Heidelberg, Department of Medicine I Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemisty, Heidelberg, Germany
| | - R Westenfeld
- Heinrich Heine University, Division of Cardiology, Pulmonology and Vascular Medicine, Duesseldorf, Germany
| |
Collapse
|
49
|
Rott N, Scholz KH, Busch HJ, Frey N, Kelm M, Thiele H, Böttiger BW. Criteria for the certification of Cardiac Arrest Centers in Germany. Resuscitation 2021; 169:1-3. [PMID: 34627867 DOI: 10.1016/j.resuscitation.2021.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- N Rott
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - K H Scholz
- German Resuscitation Council (GRC), Ulm, Germany; Department of Cardiology and Intensive Care Medicine, St. Bernward Hospital, Treibestr. 9, 31134 Hildesheim, Germany
| | - H J Busch
- German Resuscitation Council (GRC), Ulm, Germany; Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - N Frey
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University of Kiel/UKSH, Campus Kiel, Arnold Heller-Str. 6, 24105 Kiel, Germany
| | - M Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmology, Vascular Diseases, Heinrich Heine University Hospital, Moorenstr 5, 40225 Düsseldorf, Germany
| | - H Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
| | - B W Böttiger
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
50
|
Puder L, Roth S, Krabusch P, Wiegand S, Opitz R, Bald M, Flück C, Schulz E, Voss E, Markó L, Linz P, Berger F, Müller DN, Kuehne T, Litt MJ, Cone RD, Kühnen P, Kelm M. Cardiac Phenotype and Tissue Sodium Content in Adolescents With Defects in the Melanocortin System. J Clin Endocrinol Metab 2021; 106:2606-2616. [PMID: 34036349 PMCID: PMC8372645 DOI: 10.1210/clinem/dgab368] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Pro-opiomelanocortin (POMC) and the melanocortin-4 receptor (MC4R) play a pivotal role in the leptin-melanocortin pathway. Mutations in these genes lead to monogenic types of obesity due to severe hyperphagia. In addition to dietary-induced obesity, a cardiac phenotype without hypertrophy has been identified in MC4R knockout mice. OBJECTIVE We aimed to characterize cardiac morphology and function as well as tissue Na+ content in humans with mutations in POMC and MC4R genes. METHODS A cohort of 42 patients (5 patients with bi-allelic POMC mutations, 6 heterozygous MC4R mutation carriers, 19 obese controls without known monogenic cause, and 12 normal weight controls) underwent cardiac magnetic resonance (CMR) imaging and 23Na-MRI. RESULTS Monogenic obese patients with POMC or MC4R mutation respectively had a significantly lower left ventricular mass/body surface area (BSA) than nonmonogenic obese patients. Left ventricular end-diastolic volume/BSA was significantly lower in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. Subcutaneous fat and skin Na+ content was significantly higher in POMC- and MC4R-deficient patients than in nonmonogenic obese patients. In these compartments, the water content was significantly higher in patients with POMC and MC4R mutation than in control groups. CONCLUSION Patients with POMC or MC4R mutations carriers had a lack of transition to hypertrophy, significantly lower cardiac muscle mass/BSA, and stored more Na+ within the subcutaneous fat tissue than nonmonogenic obese patients. The results point towards the role of the melanocortin pathway for cardiac function and tissue Na+ storage and the importance of including cardiologic assessments into the diagnostic work-up of these patients.
Collapse
Affiliation(s)
- Lia Puder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Sophie Roth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
| | - Philipp Krabusch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Department for Pediatric Endocrinology and Diabetology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin 13353, Germany
| | - Susanna Wiegand
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Berlin 13353, Germany
| | - Robert Opitz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
| | - Martin Bald
- Pediatric Endocrinology, Olgahospital, Klinikum Stuttgart, Stuttgart 70174, Germany
| | - Christa Flück
- Department of Paediatrics and Department of BioMedical Research, Pediatric Endocrinology, Diabetology and Metabolism, Bern University Hospital Inselspital and University of Bern, Bern 3010, Switzerland
| | - Esther Schulz
- Pediatric Endocrinology, AKK Altonaer Kinderkrankenhaus GmbH, Hamburg 22763, Germany
| | - Egbert Voss
- Cnopfsche Kinderklinik, Nürnberg 90419, Germany
| | - Lajos Markó
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Felix Berger
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Dominik N Müller
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
- Experimental and Clinical Research Center, a cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, Berlin 13125, Germany
- Max Delbruck Center for Molecular Medicine in the Helmholtz Association, Berlin 13125, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin 13353, Germany
| | - Michael J Litt
- Brigham and Women’s Hospital, Harvard University, Boston, MA 02115, USA
| | - Roger D Cone
- Life Sciences Institute, and Department of Molecular and Integrative Physiology, School of Medicine, University of Michigan, Ann Arbor, MI 48109-5624, USA
| | - Peter Kühnen
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Institute for Experimental Pediatric Endocrinology, Berlin 13353, Germany
- Correspondence: Peter Kühnen, MD, Institute for Experimental Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Marcus Kelm
- Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin 13353, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin 13353, Germany
- Berlin Institute of Health (BIH), Berlin 10178, Germany
- Marcus Kelm, MD, Department of Congenital Heart Disease, German Heart Centre Berlin, Augustenburger Platz 1, 13353 Berlin, Germany,
| |
Collapse
|