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Voigt I, Rott N, Kersken M, Mügge A, Böttiger BW, Preusch M, Wengenmayer T, Michels G. [Role of German cardiac arrest centers in mediating basic life support]. Med Klin Intensivmed Notfmed 2024; 119:116-122. [PMID: 37269312 PMCID: PMC10239037 DOI: 10.1007/s00063-023-01024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite a measurable increase in recent years, the bystander resuscitation rate in Germany lags behind the European comparison. Special centers for the care of patients after cardiac arrest, so-called cardiac arrest centers (CAC), have been established. The aim of this work is to evaluate the role of CACs, in addition to in-hospital patient care, in improving the bystander resuscitation rate in Germany and what obstacles exist in the implementation of resuscitation training. MATERIALS AND METHODS Online survey by the working group cardiopulmonary resuscitation (AG42) of the German Society of Cardiology (DGK) and the German Resuscitation Council (GRC) RESULTS: Of the 74 participating clinics (78.4% certified as CAC), 23 (31.1%) conduct lay resuscitation training. These mainly take place within the framework of action days for resuscitation (82.6%) or in schools (39.1%). Permanent cooperation with at least one school existed in 52.2%. Basic life support (BLS) resuscitation dummies are available in 63.5% of these clinics and an automated external defibrillator (AED) demonstration device in 43.2%. According to the interviewees, the biggest obstacles to the consistent implementation of resuscitation courses in schools include lack of qualified instructors, lack of refinancing and difficulties with regard to coordinating activities between schools and providers. CONCLUSIONS Direct training of lay rescuers by hospitals faces several obstacles. To increase the bystander resuscitation rate, focusing on targeted training of teachers as multipliers (train-the-trainer) can be a good approach for cardiac arrest centers.
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Affiliation(s)
- Ingo Voigt
- Klinik für Akut- und Notfallmedizin, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Deutschland.
| | - Nadine Rott
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
- Deutscher Rat für Wiederbelebung bzw. German Resuscitation Council e. V. (GRC), Ulm, Deutschland
| | - Meike Kersken
- Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
| | - Andreas Mügge
- Klinik für Kardiologie und Angiologie, Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Bernd W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
- Deutscher Rat für Wiederbelebung bzw. German Resuscitation Council e. V. (GRC), Ulm, Deutschland
| | - Michael Preusch
- Sektion Internistische Intensivmedizin, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Tobias Wengenmayer
- Interdisziplinäre Medizinische Intensivtherapie (IMIT), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, Akademisches Lehrkrankenhaus der RWTH Aachen, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
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2
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Müller MP, Ganter J, Busch HJ, Trummer G, Sahlmann J, Brettner F, Reden M, Elschenbroich D, Preusch M, Rusnak J, Katzenschlager S, Nauheimer D, Wunderlich R, Pooth JS. Out-of- Hospital cardiac arrest & Smartphon E Resp Ond Er S trial ( HEROES Trial): Methodology and study protocol of a pre-post-design trial of the effect of implementing a smartphone alerting system on survival in out-of-hospital cardiac arrest. Resusc Plus 2024; 17:100564. [PMID: 38328746 PMCID: PMC10847368 DOI: 10.1016/j.resplu.2024.100564] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Since 2021, international guidelines for cardiopulmonary resuscitation recommend the implementation of so-called "life-saving systems". These systems include smartphone alerting systems (SAS), which enable dispatch centres to alert first responders via smartphone applications, who are in proximity of a suspected out-of-hospital cardiac arrest (OHCA). However, the effect of SAS on survival remains unknown. Aim The aim is to assess the rate of survival to hospital discharge in adult patients with OHCA not witnessed by emergency medical services (EMS): before and after SAS implementation. Design Multicentre, prospective, observational, intention-to-treat, pre-post design clinical trial. Population Adults (aged ≥ 18 years), OHCA not witnessed by EMS, no traumatic cause for cardiac arrest, cardiopulmonary resuscitation initiated or continued by EMS. Setting Dispatch-centre-based. Outcomes Primary: survival to hospital discharge. Secondary: time to first compression, rate of basic life support measures before EMS arrival, rate of patients with shockable rhythm at EMS arrival, Cerebral Performance Category at hospital discharge, and duration of hospital stay. Sample size Assuming an absolute difference in survival rates to hospital discharge of 4% in the two groups (11% before implementation of the SAS versus 15% after) and 80% power, and a type 1 error rate of 0.05, the required sample size is N = 1,109 patients per group (at least N = 2,218 evaluated patients in total). Conclusions The HEROES trial will investigate the effects of a SAS on the survival rate after OHCA. Trial registration German Clinical Trials Register (DRKS, ID: DRKS00032920).
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Affiliation(s)
- Michael P. Müller
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany
| | - Julian Ganter
- Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jörg Sahlmann
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine − University Medical Center Freiburg, Freiburg, Germany
| | - Florian Brettner
- Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany
| | - Maria Reden
- Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Daniel Elschenbroich
- Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Preusch
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
| | - Jonas Rusnak
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
| | - Stephan Katzenschlager
- Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany
| | - Dirk Nauheimer
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| | - Robert Wunderlich
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Jan-Steffen Pooth
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - HEROES Investigators2
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, St. Josefs Hospital, Freiburg, Germany
- Department of Anaesthesiology and Critical Care, Medical Centre – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Department of Emergency Medicine, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Cardiovascular Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine − University Medical Center Freiburg, Freiburg, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Barmherzige Brüder Hospital St. Barbara, Schwandorf, Germany
- Department of Anaesthesiology and Intensive Care, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
- Charite Universitätsmedizin Berlin, Corporate Member of Freie Unversität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Internal Medicine III, Intensive Care, University of Heidelberg Heidelberg, Germany
- Department of Anesthesiology, Heidelberg University, Medical Faculty Heidelberg, Heidelberg, Germany
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
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3
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Freundt GV, von Samson-Himmelstjerna FA, Nitz JT, Luedde M, Waltenberger J, Wieland T, Frey N, Preusch M, Hippe HJ. The orphan receptor GPRC5B activates pro-inflammatory signaling in the vascular wall via Fyn and NFκB. Biochem Biophys Res Commun 2022; 592:60-66. [PMID: 35033869 DOI: 10.1016/j.bbrc.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Atherosclerosis is driven by an inflammatory process of the vascular wall. The novel orphan G-protein coupled receptor 5B of family C (GPRC5B) is involved in drosophila sugar and lipid metabolism as well as mice adipose tissue inflammation. Here, we investigated the role of GPRC5B in the pro-atherogenic mechanisms of hyperglycemia and vascular inflammation. METHODS Immortalized and primary endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) were used for stimulation with high glucose or different cytokines. Adenoviral- or plasmid-driven GPRC5B overexpression and siRNA-mediated knockdown were performed in these cells to analyze functional and mechanistic pathways of GPRC5B. RESULTS In ECs and VSMCs, stimulation with high glucose, TNFα or LPS induced a significant upregulation of endogenous GPRC5B mRNA and protein levels. GPRC5B overexpression and knockdown increased and attenuated, respectively, the expression of the pro-inflammatory cytokines TNFα, IL-1β, IL-6 as well as the pro-atherogenic vascular adhesion molecules ICAM-1 and VCAM-1. Furthermore, the expression and activity of the metalloproteinase MMP-9, a component of atherosclerotic plaque stabilization, were significantly enhanced by GPRC5B overexpression. Mechanistically, GPRC5B increased the phosphorylation of ERK1/2 and activated NFκB through a direct interaction with the tyrosine kinase Fyn. CONCLUSIONS Our findings demonstrate that GPRC5B is upregulated in response to high glucose and pro-inflammatory signaling. GPRC5B functionally modulates the inflammatory activity in cells of the vascular wall, suggesting a pro-atherogenic GPRC5B-dependent positive feedback loop via Fyn and NFκB. Thus, GPRC5B warrants further attention as a novel pharmacological target for the treatment of vascular inflammation and possibly atherogenesis.
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Affiliation(s)
- Greta Verena Freundt
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105, Kiel, Germany
| | | | - Jan-Thorge Nitz
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105, Kiel, Germany
| | - Mark Luedde
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105, Kiel, Germany
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, Medical Faculty, University of Münster, D- 48149, Münster, Germany
| | - Thomas Wieland
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim, University of Heidelberg, Maybachstr. 14, D-68169, Mannheim, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105, Kiel, Germany
| | - Michael Preusch
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Hans-Jörg Hippe
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, D-24105, Kiel, Germany.
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4
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Lüsebrink E, Krogmann A, Tietz F, Riebisch M, Okrojek R, Peltz F, Skurk C, Hullermann C, Sackarnd J, Wassilowsky D, Toischer K, Scherer C, Preusch M, Testori C, Flierl U, Peterss S, Hoffmann S, Kneidinger N, Hagl C, Massberg S, Zimmer S, Luedike P, Rassaf T, Thiele H, Schäfer A, Orban M. Percutaneous dilatational tracheotomy in high-risk ICU patients. Ann Intensive Care 2021; 11:116. [PMID: 34319491 PMCID: PMC8319261 DOI: 10.1186/s13613-021-00906-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Percutaneous dilatational tracheotomy (PDT) has become an established procedure in intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. Therefore, the purpose of this study, including such a high proportion of patients on antithrombotic therapy, was to investigate whether PDT in high-risk ICU patients is associated with elevated procedural complications and to analyse the risk factors for bleeding occurring during and after PDT. Methods PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed and the predictors of bleeding occurrence were analysed. Results In total, 671 patients receiving PDT were included and stratified into four clinically relevant antithrombotic treatment groups: (1) intravenous unfractionated heparin (iUFH, prophylactic dosage) (n = 101); (2) iUFH (therapeutic dosage) (n = 131); (3) antiplatelet therapy (aspirin and/or P2Y12 receptor inhibitor) with iUFH (prophylactic or therapeutic dosage) except for triple therapy (n = 290) and (4) triple therapy (DAPT with iUFH in therapeutic dosage) (n = 149). Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related. Bleeding occurrence during and after PDT was independently associated with low platelet count (OR 0.73, 95% CI [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). Conclusion In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Low platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT but not triple therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00906-5.
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Affiliation(s)
- Enzo Lüsebrink
- Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Alexander Krogmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Franziska Tietz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Rainer Okrojek
- Medizinische Klinik und Poliklinik I, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany
| | - Friedhelm Peltz
- Medizinische Klinik und Poliklinik I, Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany
| | - Carsten Skurk
- Klinik Für Kardiologie, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Hullermann
- Klinik Für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Jan Sackarnd
- Klinik Für Kardiologie I: Koronare Herzkrankheit, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Münster, Germany
| | - Dietmar Wassilowsky
- Klinik Für Anästhesiologie, Klinikum der Universität München, Munich, Germany
| | - Karl Toischer
- Klinik Für Kardiologie, Angiologie und Pneumologie, Herzzentrum Göttingen, Göttingen, Germany
| | - Clemens Scherer
- Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Preusch
- Klinik Für Kardiologie, Angiologie und Pneumologie, Universitätsklinikums Heidelberg, Heidelberg, Germany
| | | | - Ulrike Flierl
- Klinik Für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Sabine Hoffmann
- Institut Für Medizinische Informationsverarbeitung Biometrie und Epidemiologie, Klinikum der Universität München, Munich, Germany
| | - Nikolaus Kneidinger
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Munich, Germany.,German Center for Lung Research (DZL), Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Schäfer
- Klinik Für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martin Orban
- Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377, Munich, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
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5
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Salbach C, Mueller-Hennessen M, Biener M, Stoyanov K, Preusch M, Kihm L, Merle U, Schnitzler P, Katus HA, Giannitsis E. Interpretation of myocardial injury subtypes in COVID-19 disease per fourth version of Universal Definition of Myocardial Infarction. Biomarkers 2021; 26:401-409. [PMID: 33998352 DOI: 10.1080/1354750x.2021.1921031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Application of the 4th version of Universal Definition of Myocardial Infarction (UDMI) to characterize rates and prognostic relevance of myocardial injury in COVID-19 disease. METHODS This retrospective, single-centre observational study enrolled 104 patients hospitalized with SARS-CoV-2 infection. Kaplan-Meier analysis and multivariate Cox regression were used to identify influence of acute or chronic myocardial injury on a composite primary (mortality, incident acute respiratory distress syndrome, incident mechanical ventilation) and secondary endpoint (mortality, incident acute myocardial injury during hospitalization, incident venous thrombosis, pulmonary embolism or stroke). RESULTS A total of 27 (26.0%) patients presented with chronic myocardial injury, and 19 (18.3%) with acute myocardial injury. 42 patients(40.4%) developed an incident myocardial injury during hospitalization. The presence of acute or chronic myocardial injury on admission and incident myocardial injury during hospitalization were associated with higher rates of endpoints. Independent predictors for the primary endpoint were higher severity stages according to Siddiqi et al. classification system and history of dyslipidaemia. Maximal hs-cTnT and D-dimer concentrations during hospitalization showed an association (r = 0.61). CONCLUSIONS Objective description of myocardial injury according to the 4th UDMI in the current COVID-19 pandemic is crucial in order to discriminate patients with acute myocardial infarction and acute, chronic or incident myocardial injury.
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Affiliation(s)
- Christian Salbach
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Moritz Biener
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Kiril Stoyanov
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Michael Preusch
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Lars Kihm
- Department Internal Medicine I, Endocrinology, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, Gastroenterology, University of Heidelberg, Heidelberg, Germany
| | - Paul Schnitzler
- Department for Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, University of Heidelberg, Heidelberg, Germany
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6
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Thiele H, Freund A, Gimenez MR, de Waha-Thiele S, Akin I, Pöss J, Feistritzer HJ, Fuernau G, Graf T, Nef H, Hamm C, Böhm M, Lauten A, Schulze PC, Voigt I, Nordbeck P, Felix SB, Abel P, Baldus S, Laufs U, Lenk K, Landmesser U, Skurk C, Pieske B, Tschöpe C, Hennersdorf M, Wengenmayer T, Preusch M, Maier LS, Jung C, Kelm M, Clemmensen P, Westermann D, Seidler T, Schieffer B, Rassaf T, Mahabadi AA, Vasa-Nicotera M, Meincke F, Seyfarth M, Kersten A, Rottbauer W, Boekstegers P, Muellenbach R, Dengler T, Kadel C, Schempf B, Karagiannidis C, Hopf HB, Lehmann R, Bufe A, Baumanns S, Öner A, Linke A, Sedding D, Ferrari M, Bruch L, Goldmann B, John S, Möllmann H, Franz J, Lapp H, Lauten P, Noc M, Goslar T, Oerlecke I, Ouarrak T, Schneider S, Desch S, Zeymer U. Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial. Am Heart J 2021; 234:1-11. [PMID: 33428901 DOI: 10.1016/j.ahj.2021.01.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In acute myocardial infarction complicated by cardiogenic shock the use of mechanical circulatory support devices remains controversial and data from randomized clinical trials are very limited. Extracorporeal life support (ECLS) - venoarterial extracorporeal membrane oxygenation - provides the strongest hemodynamic support in addition to oxygenation. However, despite increasing use it has not yet been properly investigated in randomized trials. Therefore, a prospective randomized adequately powered clinical trial is warranted. STUDY DESIGN The ECLS-SHOCK trial is a 420-patient controlled, international, multicenter, randomized, open-label trial. It is designed to compare whether treatment with ECLS in addition to early revascularization with percutaneous coronary intervention or alternatively coronary artery bypass grafting and optimal medical treatment is beneficial in comparison to no-ECLS in patients with severe infarct-related cardiogenic shock. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoint of ECLS-SHOCK is 30-day mortality. Secondary outcome measures such as hemodynamic, laboratory, and clinical parameters will serve as surrogate endpoints for prognosis. Furthermore, a longer follow-up at 6 and 12 months will be performed including quality of life assessment. Safety endpoints include peripheral ischemic vascular complications, bleeding and stroke. CONCLUSIONS The ECLS-SHOCK trial will address essential questions of efficacy and safety of ECLS in addition to early revascularization in acute myocardial infarction complicated by cardiogenic shock.
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Affiliation(s)
- Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany.
| | - Anne Freund
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Maria Rubini Gimenez
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Janine Pöss
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | - Tobias Graf
- University Heart Center Luebeck, Luebeck, Germany
| | - Holger Nef
- University Clinic Giessen, Giessen, Germany
| | - Christian Hamm
- University Clinic Giessen, Giessen, Germany; Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | | | | | | | - Ingo Voigt
- Contilia Elisabeth-Krankenhaus, Essen, Germany, Essen, Germany
| | | | - Stephan B Felix
- Dept. of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Peter Abel
- Dept. of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Baldus
- Heart Center Cologne, University Clinic Cologne, Cologne, Germany
| | | | | | | | | | - Burkert Pieske
- Charité University Medicine, Campus Virchow Klinikum and German Heart Center and Berlin Brandenburger Center for Regenerative Therapies (BCRT) of the Berlin Institute of Health (BIH), Berlin, Germany
| | - Carsten Tschöpe
- Charité University Medicine, Campus Virchow Klinikum and German Heart Center and Berlin Brandenburger Center for Regenerative Therapies (BCRT) of the Berlin Institute of Health (BIH), Berlin, Germany
| | | | | | | | - Lars S Maier
- University Clinic Regensburg, Regensburg, Germany
| | | | - Malte Kelm
- University Clinic Düsseldorf, Düsseldorf, Germany
| | | | | | - Tim Seidler
- Heart Center Göttingen, University Medicine Göttingen, Göttingen, Germany
| | | | - Tienush Rassaf
- Dept. of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, Germany
| | - Amir-Abbas Mahabadi
- Dept. of Cardiology and Vascular Medicine, West German Heart- and Vascular Center, University Hospital Essen, Germany
| | | | | | - Melchior Seyfarth
- Heart Center Wuppertal; Witten-Herdecke University, Wuppertal, Germany
| | | | | | | | | | - Thomas Dengler
- SLK Clinic Bad Friedrichshall, Bad Friedrichshall, Germany
| | | | | | | | | | | | - Alexander Bufe
- Helios Clinic Krefeld, Krefeld, University Witten/Herdecke, Germany
| | | | | | - Axel Linke
- Heart Center Dresden - Technical University Dresden, Dresden, Germany
| | | | | | | | | | - Stefan John
- Paracelsius Private University, Clinic Nuremberg, Campus South, Nuremberg, Germany
| | | | | | | | | | - Marko Noc
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Tomaz Goslar
- University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | | | | | - Steffen Desch
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen, Germany
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. [Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR) : Consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC]. Anaesthesist 2019; 67:607-616. [PMID: 30014276 DOI: 10.1007/s00101-018-0473-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Wengenmayer
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - C Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - C Dohmen
- LVR-Klinik Bonn, Bonn, Deutschland
| | - B W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | - A Bauer
- MediClin Herzzentrum Coswig, Coswig, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - A Ghanem
- Abteilung Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - U Kreimeier
- Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - A Beckmann
- Herzzentrum Duisburg, Klinik für Herz- und Gefäßchirurgie, Evangelisches Krankenhaus Niederrhein, Duisburg, Deutschland
| | - M Fischer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ALB FILS KLINIKEN GmbH, Klinik am Eichert, Göppingen, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Essen, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - F Born
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - H M Hoffmeister
- Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Solingen, Deutschland
| | - M Preusch
- Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - U Boeken
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - R Riessen
- Department für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - H Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universitätsklinik, Leipzig, Deutschland
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Z Herz- Thorax- Gefäßchir 2019. [DOI: 10.1007/s00398-018-0262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Desch S, Freund A, Graf T, Fichtlscherer S, Haake H, Preusch M, Hammer F, Akin I, Christ M, Liebetrau C, Skurk C, Steiner S, Voigt I, Schmitz R, Mudra H, Ledwoch J, Menck N, Horstkotte J, Pels K, Lahmann AL, Otto S, Lenk K, Ohlow MA, Hassager C, Nordbeck P, Zeymer U, Jobs A, de Waha-Thiele S, Olbrich D, König I, Klinge K, Thiele H. Immediate unselected coronary angiography versus delayed triage in survivors of out-of-hospital cardiac arrest without ST-segment elevation: Design and rationale of the TOMAHAWK trial. Am Heart J 2019; 209:20-28. [PMID: 30639610 DOI: 10.1016/j.ahj.2018.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/05/2018] [Indexed: 11/24/2022]
Abstract
Patients experiencing out-of-hospital cardiac arrest (OHCA) without ST-segment elevation are a heterogenic group with a variety of underlying causes. Up to one-third of patients display a significant coronary lesion compatible with myocardial infarction as OHCA trigger. There are no randomized data on patient selection and timing of invasive coronary angiography after admission. METHODS AND RESULTS: The TOMAHAWK trial randomly assigns 558 patients with return of spontaneous circulation after OHCA with no obvious extracardiac origin of cardiac arrest and no ST-segment elevation/left bundle-branch block on postresuscitation electrocardiogram to either immediate coronary angiography or initial intensive care assessment with delayed/selective angiography in a 1:1 ratio. The primary end point is 30-day all-cause mortality. Secondary analyses will be performed with respect to initial rhythm, electrocardiographic patterns, myocardial infarction as underlying cause, neurological outcome, as well as clinical and laboratory markers. Clinical follow-up will be performed at 6 and 12 months. Safety end points include bleeding and stroke. CONCLUSION: The TOMAHAWK trial will address the unresolved issue of timing and general indication of angiography after OHCA without ST-segment elevation.
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Med Klin Intensivmed Notfmed 2018; 113:478-486. [DOI: 10.1007/s00063-018-0452-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Tilemann L, Mohr SK, Preusch M, Chorianopoulos E, Giannitsis E, Katus HA, Müller OJ. Platelet function monitoring for stent thrombosis in critically III patients with an acute Coronary syndrome. J Interv Cardiol 2017; 31:277-283. [DOI: 10.1111/joic.12474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Lisa Tilemann
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Heidelberg/Mannheim; Germany
| | - Sarah K. Mohr
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
| | - Michael Preusch
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
| | | | - Evangelos Giannitsis
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
| | - Hugo A. Katus
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Heidelberg/Mannheim; Germany
| | - Oliver J. Müller
- Department of Internal Medicine III; University Hospital Heidelberg; Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research); Partner Site Heidelberg/Mannheim; Germany
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Kern H, Stiepak J, Popp E, Spaich S, Zelniker T, Giannitsis E, Katus H, Preusch M. First real-world experience with CardioSecur® in the preclinical setting – When time does matter. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kern H, Stiepak J, Popp E, Spaich S, Zelniker T, Giannitsis E, Katus H, Preusch M. First real-world experience with CardioSecur® in the preclinical setting – When time does matter. Resuscitation 2017. [DOI: 10.1016/j.resuscitation.2017.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dufner MC, Andre F, Stiepak J, Zelniker T, Chorianopoulos E, Preusch M, Katus HA, Leuschner F. Therapeutic hypothermia impacts leukocyte kinetics after cardiac arrest. Cardiovasc Diagn Ther 2016; 6:199-207. [PMID: 27280083 DOI: 10.21037/cdt.2016.02.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patients admitted to the hospital after primarily successful cardiopulmonary resuscitation (CPR) are at a very high risk for neurologic deficits and death. Targeted temperature management (TTM) for mild therapeutic hypothermia has been shown to improve survival compared to standard treatment. Acute cardiovascular events, such as myocardial infarction (MI), are a major cause for cardiac arrest (CA) in patients who undergo CPR. Recent findings have demonstrated the importance and impact of the leukocyte response following acute MI. METHODS In this retrospective, single center study we enrolled 169 patients with CA due to non-traumatic causes and primarily successful CPR. A total of 111 subjects (66%) underwent TTM aiming for a target temperature of 32-34 °C. RESULTS Analysis of 30 day follow up showed a significantly improved survival of all patients who received TTM compared to patients without hypothermia (P=0.0001). Furthermore TTM was an independent variable of good neurological outcome after 6 months (P=0.0030). Therapeutic hypothermia was found to be beneficial independent of differences in age and sex between both groups. While a higher rate of pneumonia was observed with TTM, this diagnosis had no additional impact on survival or neurological outcome. The beneficial effect on mortality remained significant in patients with the diagnosis of an acute cardiac event (P=0.0145). Next, we evaluated the kinetics of leukocytes in this group over the course of 7 days after CA. At presentation, patients showed a mean level of 16.5±6.7 of leukocytes per microliter. While this level stayed stable in the group of patients without hypothermia, patients who received TTM showed a significant decline of leukocyte levels resulting in significantly lower numbers of leukocytes on days 3 and 5 after CPR. Interestingly, these differences in leukocyte counts remained beyond the time period of TTM while C-reactive protein (CRP) levels were suppressed only during ongoing cooling, but differences between the groups were diminished after TTM was terminated (from day 3 on, P>0.2). Finally, patients who received TTM and showed a leukocyte count of less than 12.7/µL on day 3 had an improved survival (P=0.0214) and neurological outcome (P=0.0049) compared to patients above that level. CONCLUSIONS Our data underline the beneficial effects of TTM and demonstrate an impact of hypothermia on leukocyte counts after CA.
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Affiliation(s)
- Matthias C Dufner
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Andre
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Jan Stiepak
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Thomas Zelniker
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Michael Preusch
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Florian Leuschner
- Department of Internal Medicine III, University of Heidelberg, 69120 Heidelberg, Germany ; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
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15
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Zelniker T, Uhlmann L, Spaich S, Friedrich J, Preusch M, Meyer FJ, Katus HA, Giannitsis E. Novel biomarkers for risk stratification in pulmonary arterial hypertension. Pneumologie 2016. [DOI: 10.1055/s-0036-1572121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Tilemann LM, Stiepak J, Zelniker T, Chorianopoulos E, Giannitsis E, Katus HA, Müller OJ, Preusch M. Efficacy of enteral ticagrelor in hypothermic patients after out-of-hospital cardiac arrest. Clin Res Cardiol 2015; 105:332-40. [PMID: 26508414 PMCID: PMC4805699 DOI: 10.1007/s00392-015-0925-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/02/2015] [Indexed: 11/25/2022]
Abstract
Introduction Delivery of crushed ticagrelor via a nasogastric tube is a widely spread off-label use in unconscious patients following out-of-hospital cardiac arrest (OHCA). Notwithstanding the importance of a potent dual antiplatelet therapy in these patients, the efficacy of crushed ticagrelor after OHCA has not been established yet. Methods In a prospective, single-center, observational trial, 38 consecutive MI patients after OHCA were included. 27 patients (71.1 %) underwent mild induced hypothermia. The primary outcome was platelet inhibition at 24h measured by impedance aggregometry. Results There was sufficient platelet inhibition in most patients after OHCA. In all hypothermic patients, there was an adequate platelet inhibition by ticagrelor at 24 h (p < 0.001). 15 patients (39.5 %) had significant gastroesophageal reflux and one patient with significant reflux had inadequate platelet inhibition at 24 h. There were no stent thrombosis or recurrent atherothrombotic events in these patients. Conclusion Administration of crushed ticagrelor via a nasogastric tube reliably inhibited platelet function in vitro and in vivo regardless of the presence of hypothermia in MI patients. Thus, platelet inhibition can be reliably achieved in MI patients during neuroprotective hypothermia following OHCA.
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Affiliation(s)
- Lisa M Tilemann
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Jan Stiepak
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Thomas Zelniker
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Emanuel Chorianopoulos
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany
| | - Oliver J Müller
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg/Mannheim, Germany.
| | - Michael Preusch
- Department of Internal Medicine III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Cabbage S, Ieronimakis N, Preusch M, Lee A, Ricks J, Janebodin K, Hays A, Wijelath ES, Reyes M, Campbell LA, Rosenfeld ME. Chlamydia pneumoniae infection of lungs and macrophages indirectly stimulates the phenotypic conversion of smooth muscle cells and mesenchymal stem cells: potential roles in vascular calcification and fibrosis. Pathog Dis 2014; 72:61-9. [PMID: 24833344 DOI: 10.1111/2049-632x.12185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/27/2014] [Accepted: 05/05/2014] [Indexed: 01/14/2023] Open
Abstract
Two hallmarks of advanced atherosclerosis are calcification and fibrosis. We hypothesized that Chlamydia pneumoniae infection may contribute to atherosclerosis by inducing the conversion of vascular smooth muscle cells to calcifying cells or by converting mesenchymal stem cells to osteochondrocytic or fibroblastic phenotypes. In this study, direct infection of bovine aortic smooth muscle cells (BSMCs) did not induce the expression of alkaline phosphatase or the deposition of extracellular calcium phosphate. However, conditioned media from C. pneumoniae-infected macrophages accelerated conversion of BSMCs to a calcifying phenotype. Treatment of the conditioned media with an anti-TNF-alpha blocking antibody abrogated this stimulatory effect. Treatment of perivascular Sca-1+, CD31-, CD45- cells from apoE-/- mouse aortas with the conditioned media from infected macrophages induced the Sca-1+ cells to produce collagen II, an additional marker of an osteochondrocytic phenotype. Treatment of mouse coronary perivascular Sca-1+, CD31-, CD45- cells with the supernatant from homogenates of C. pneumoniae-infected mouse lungs as compared to noninfected lungs induced expression of the Collagen 1α1 gene and deposition of collagen. Therefore, an increase in plasma cytokines or other factors in response to respiratory infection with C. pneumoniae or infection of macrophages within the blood vessel could contribute to both calcification and fibrosis of advanced atherosclerotic lesions.
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Affiliation(s)
- Sarah Cabbage
- Department of Pathology, University of Washington, Seattle, WA, USA
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Stiepak J, Fastner C, Kuhner M, Nikendei C, Preusch M. Chest compression in resuscitation – Actual performance and self-assessment of final-year medical students. Resuscitation 2014. [DOI: 10.1016/j.resuscitation.2014.03.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Roggenbach J, Saur P, Hofer S, Bruckner T, Preusch M, Carbone R, Walther A. Incidence of perioperative sleep-disordered breathing in patients undergoing major surgery: a prospective cohort study. Patient Saf Surg 2014; 8:13. [PMID: 24624978 PMCID: PMC3995597 DOI: 10.1186/1754-9493-8-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 03/07/2014] [Indexed: 01/18/2023] Open
Abstract
Background Major surgery might have a modulating effect on nocturnal breathing patterns. The incidence and course of perioperative sleep-disordered breathing in individuals without a previous diagnosis of obstructive sleep apnea has not been investigated sufficiently so far. Methods In this study, polygraphic recordings have been obtained from 37 inpatients without a diagnosis of obstructive sleep apnea syndrome during the preoperative night before and six nights following major surgical procedures. Eligible patients consenting to participate in this study underwent polygraphic recordings including four items (O2-saturation, pulse, nasal air flow and snoring) during the study period. Polygraphic data obtained from the postoperative recordings were compared to preoperative recordings. Results Median (IQR [range]) apnea-hypopnea-index (AHI) for the whole group was 6,0 (2,5 - 14,7 [0–32,6]) in the preoperative night and increased in the following six nights post surgery: second night: 5,6 (2,6-15,0 [1,1 - 59,3]); third night: 16,9 (5,6 - 38,8 [2,9 - 64,3]); fourth night: 11,6 (5,9 - 17,3 [0,4 - 39,3]); fifth night: 15,2 (5,7 - 22,2 [0,2 - 55,5]); sixth night: 22,5 (5,2 - 35,4 [0,2 - 67,7]). AHI-scores of the third to sixth night post surgery differed significantly from data observed in the preoperative night. Conclusion A significant increase in the AHI occurred frequently after major surgical procedures in the late postoperative period. Sleep-disordered breathings in the late postoperative period deserve attention, as they potentially increase the risk of postoperative complications.
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Affiliation(s)
- Jens Roggenbach
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Patrick Saur
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Stefan Hofer
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Michael Preusch
- Department of Cardiology, Angiology, Pneumology, University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Remo Carbone
- Department of Anaesthesiology and Intensive Care Medicine, Katharinen-Hospital, Klinikum Stuttgart, Germany
| | - Andreas Walther
- Department of Anaesthesiology and Intensive Care Medicine, Katharinen-Hospital, Klinikum Stuttgart, Germany
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Stiepak J, Schwöbel K, Lossnitzer D, Katus H, Preusch M. AP078 Ready for the emergency? Experiences and self-assessment of first-and second-year medical students at the University of Heidelberg. Resuscitation 2011. [DOI: 10.1016/s0300-9572(11)70110-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Albasanz-Puig A, Murray J, Preusch M, Coan D, Namekata M, Patel Y, Dong ZM, Rosenfeld ME, Wijelath ES. Oncostatin M is expressed in atherosclerotic lesions: a role for Oncostatin M in the pathogenesis of atherosclerosis. Atherosclerosis 2011; 216:292-8. [PMID: 21376322 DOI: 10.1016/j.atherosclerosis.2011.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 01/19/2011] [Accepted: 02/01/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic inflammation plays a pivotal role in the development and progression of atherosclerosis. The inflammatory response is mediated by cytokines. The aim of this study was to determine if Oncostatin M (OSM), a monocyte and T-lymphocyte specific cytokine is present in atherosclerotic lesions. We also investigated the roles of signal transducer and activator of transcription (STAT)-1 and STAT-3 in regulating OSM-induced smooth muscle cell (SMC) proliferation, migration and cellular fibronectin (cFN) synthesis. METHODS AND RESULTS Immunostaining of atherosclerotic lesions from human carotid plaques demonstrated the expression of OSM antigen in both macrophages and SMCs. Explanted SMCs from human carotid plaques expressed OSM mRNA and protein as determined by RT-PCR and Western blotting. Using the chow-fed ApoE(-/-) mouse model of atherosclerosis, we observed that OSM was initially expressed in the intima at 20 weeks of age. By 30 weeks, OSM was expressed in both the intima and media. In vitro studies show that OSM promotes SMC proliferation, migration and cFN synthesis. Lentivirus mediated-inhibition of STAT-1 and STAT-3 prevented OSM-induced SMC proliferation, migration and cellular fibronectin synthesis. CONCLUSIONS These findings demonstrate that OSM is expressed in atherosclerotic lesions and may contribute to the progression of atherosclerosis by promoting SMC proliferation, migration and extracellular matrix protein synthesis through the STAT pathway.
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Affiliation(s)
- Adaia Albasanz-Puig
- Department of Surgery, Division of Vascular Surgery, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA, USA
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22
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Frutkin AD, Otsuka G, Stempien-Otero A, Sesti C, Du L, Jaffe M, Dichek HL, Pennington CJ, Edwards DR, Nieves-Cintrón M, Minter D, Preusch M, Hu JH, Marie JC, Dichek DA. TGF-[beta]1 limits plaque growth, stabilizes plaque structure, and prevents aortic dilation in apolipoprotein E-null mice. Arterioscler Thromb Vasc Biol 2009; 29:1251-7. [PMID: 19325140 DOI: 10.1161/atvbaha.109.186593] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Impairment of transforming growth factor (TGF)-beta1 signaling accelerates atherosclerosis in experimental mice. However, it is uncertain whether increased TGF-beta1 expression would retard atherosclerosis. The role of TGF-beta1 in aneurysm formation is also controversial. We tested whether overexpression of active TGF-beta1 in hyperlipidemic mice affects atherogenesis and aortic dilation. METHODS AND RESULTS We generated apolipoprotein E-null mice with transgenes that allow regulated overexpression of active TGF-beta1 in their hearts. Compared to littermate controls, these mice had elevated cardiac and plasma TGF-beta1, less aortic root atherosclerosis (P< or =0.002), fewer lesions in the thoracic and abdominal aortae (P< or =0.01), less aortic root dilation (P<0.001), and fewer pseudoaneurysms (P=0.02). Mechanistic studies revealed no effect of TGF-beta1 overexpression on plasma lipids or cytokines, or on peripheral lymphoid organ cells. However, aortae of TGF-beta1-overexpressing mice had fewer T-lymphocytes, more collagen, less lipid, lower expression of inflammatory cytokines and matrix metalloproteinase-13, and higher expression of tissue inhibitor of metalloproteinase-2. CONCLUSIONS When overexpressed in the heart and plasma, TGF-beta1 is an antiatherogenic, vasculoprotective cytokine that limits atherosclerosis and prevents aortic dilation. These actions are associated with significant changes in cellularity, collagen and lipid accumulation, and gene expression in the artery wall.
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Affiliation(s)
- Andrew D Frutkin
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195-7710, USA
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23
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Klingenberg R, Nofer JR, Rudling M, Bea F, Blessing E, Preusch M, Grone HJ, Katus HA, Hansson GK, Dengler TJ. Sphingosine-1-Phosphate Analogue FTY720 Causes Lymphocyte Redistribution and Hypercholesterolemia in ApoE-Deficient Mice. Arterioscler Thromb Vasc Biol 2007; 27:2392-9. [PMID: 17761943 DOI: 10.1161/atvbaha.107.149476] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Resident immune cells are a hallmark of atherosclerotic lesions. The sphingolipid analogue drug FTY720 mediates retrafficking of immune cells and inhibits their homing to inflammatory sites. We have evaluated the effect of FTY720 on atherogenesis and lipid metabolism.
Methods and Results—
ApoE
−/−
mice on a normal laboratory diet received oral FTY720 for 12 weeks, which led to a 2.4-fold increase in serum cholesterol (largely VLDL fraction) and a 1.8-fold increase in hepatic HMGCoA reductase mRNA. FTY720 increased plasma sphingosine-1-phosphate and induced marked peripheral blood lymphopenia. A discoordinate modulation of B, T and monocyte cell numbers was found in peripheral lymphoid organs. Overall depletion of T cells was accompanied by a relative (2-fold) increase in regulatory T cell content paralleled by a similar increase in effector memory T cells (CD4+CD44hiCD62lo) as absolute numbers of both subpopulations remained essentially unchanged. Lymphocyte function was unaltered as indicated by anti-OxLDL antibodies and T cell proliferation. There were no changes in atherosclerotic lesions in early and established atherosclerosis.
Conclusions—
FTY720 mediated peripheral lymphocyte depletion and retrafficking without altering function and overall balance of pro- and antiatherogenic lymphocyte populations. A net decrease in lymphocyte numbers occurred concomitantly with a more proatherogenic hypercholesterolemia resulting in unaltered atherogenesis.
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Bea F, Kreuzer J, Preusch M, Schaab S, Isermann B, Rosenfeld ME, Katus H, Blessing E. Melagatran Reduces Advanced Atherosclerotic Lesion Size and May Promote Plaque Stability in Apolipoprotein E– Deficient Mice. Arterioscler Thromb Vasc Biol 2006; 26:2787-92. [PMID: 16990551 DOI: 10.1161/01.atv.0000246797.05781.ad] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Inflammatory mechanisms are involved in atherosclerotic plaque rupture and subsequent thrombin formation. Thrombin not only plays a central role in thrombus formation and platelet activation, but also in the induction of inflammatory processes. We assessed the hypothesis that melagatran, a direct thrombin inhibitor, attenuates plaque progression and promotes stability of advanced atherosclerotic lesions. METHODS AND RESULTS Melagatran (500 micromol/kg/d) or control diet was administered to apolipoprotein E-deficient mice (n=54) with advanced atherosclerotic lesions. Treatment reduced lesion progression in brachiocephalic arteries (P<0.005). Morphometric analysis confirmed that thrombin inhibition promoted plaque stability and resulted in thicker fibrous caps (28.4+/-14.2 microm versus 20.8+/-12.0 microm; P<0.05), increased media thickness (29.3+/-9.6 microm versus 24.4+/-6.7 microm; P<0.05), and smaller necrotic cores (73,537+/-41,301 microm2 versus 126,819+/-51,730 microm2; P<0.0005). Electro mobility shift assays revealed reduced binding activity of nuclear factor kappaB (P<0.05) and activator protein-1 (P<0.05) in aortas of treated mice. Furthermore, immunohistochemistry demonstrated reduced staining for matrix metalloproteinase (MMP)-9 (P<0.05). Melagatran had no significant effect on early lesion formation in C57BL/6J mice. CONCLUSIONS The direct thrombin inhibitor melagatran reduces lesion size and may promote plaque stability in apolipoprotein E-deficient mice, possibly through reduced activation of proinflammatory transcription factors and reduced synthesis of MMP-9.
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Affiliation(s)
- Florian Bea
- Medizinische Klinik III, Universität Heidelberg, 69120 Heidelberg, Germany
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25
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Klingenberg R, Bea F, Blessing E, Preusch M, Groene HJ, Brinkmann V, Picard F, Katus H, Hansson G, Dengler T. We-P11:276 The immunomodulator FTY720 inhibits early atherosclerosis in APOE-/- mice. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Kamimura M, Viedt C, Dalpke A, Rosenfeld ME, Mackman N, Cohen DM, Blessing E, Preusch M, Weber CM, Kreuzer J, Katus HA, Bea F. Interleukin-10 suppresses tissue factor expression in lipopolysaccharide-stimulated macrophages via inhibition of Egr-1 and a serum response element/MEK-ERK1/2 pathway. Circ Res 2005; 97:305-13. [PMID: 16037570 DOI: 10.1161/01.res.0000177893.24574.13] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atherosclerosis is considered to be an inflammatory disease. Tissue factor (TF), a prothrombotic molecule expressed by various cell types within atherosclerotic plaques, is thought to play an essential role in thrombus formation after atherosclerotic plaque rupture. Recent studies suggest that the antiinflammatory cytokine interleukin-10 (IL-10) has many antiatherosclerotic properties. Therefore, the effects of IL-10 on TF expression in response to inflammation were investigated. Mouse macrophages were stimulated with lipopolysaccharide (LPS) in the presence or absence of IL-10. Pretreatment with IL-10 resulted in a 50% decrease in TF mRNA expression and TF promoter activity. Binding of early growth response gene-1 (Egr-1) to the consensus DNA sequence, a key transcriptional activator of TF expression in response to inflammation, and the expression of Egr-1 mRNA were also inhibited by IL-10. This inhibition was independent of the induction of suppressor of cytokine signaling protein-3 by IL-10. Macrophages that had been transfected with luciferase reporter constructs containing the murine Egr-1 5'-flanking sequence exhibited reduced reporter gene activity in response to LPS stimulation with IL-10 pretreatment. Studies with deletion constructs of the Egr-1 promoter identified the proximal serum response element SRE3 as a potential regulatory site for the IL-10 mediated suppression of Egr-1 expression. Furthermore, activation of the upstream signal-transduction elements, such as mitogen-activated protein kinase kinase (MEK) 1/2, extracellular signal-regulated kinase 1/2, and Elk-1 were also inhibited by IL-10 pretreatment. Taken together, these results demonstrate a pathway for the IL-10 mediated inhibition of TF expression during inflammation and may explain the antiatherosclerotic effects of IL-10.
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Affiliation(s)
- Motohiro Kamimura
- Department Internal Medicine III, University of Heidelberg, Heidelberg, Germany
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Kristen A, Szalai P, Preusch M, Dengler TJ, Katus HA, Borst MM, Meyer FJ. Dysfunktion der Atemmuskulatur bei Leichtkettenamyloidose. Pneumologie 2005. [DOI: 10.1055/s-2005-864263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dörfer CE, Becher H, Ziegler CM, Kaiser C, Lutz R, Jörss D, Lichy C, Buggle F, Bültmann S, Preusch M, Grau AJ. The association of gingivitis and periodontitis with ischemic stroke. J Clin Periodontol 2004; 31:396-401. [PMID: 15086623 DOI: 10.1111/j.1600-051x.2004.00579.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of this study was to assess the associations of different periodontal parameters with cerebral ischemia. METHODS In a case-control study, 303 consecutive patients with ischemic stroke or transient ischemic attack, and 300 representative population controls received a complete clinical and radiographic dental examination. Patients were examined on average 3 days after ischemia. The individual mean clinical attachment loss measured at four sites per tooth was used as indicator variable for periodontitis. RESULTS Patients had higher clinical attachment loss than population (p<0.001). After adjustment for age, gender, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions and lifestyle factors, a mean clinical attachment loss >6 mm had a 7.4 times (95% confidence interval 1.55-15.3) a gingival index >1.2 a 18.3 times (5.84-57.26) and a radiographic bone loss a 3.6 times (1.58-8.28) higher risk of cerebral ischemia than subjects without periodontitis or gingivitis, respectively. CONCLUSION Periodontitis is an independent risk factor for cerebral ischemia and acute exacerbation of inflammatory processes in the periodontium might be a trigger for the event of cerebral ischemia.
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Affiliation(s)
- Christof E Dörfer
- Policlinic for Conservative Dentistry and Periodontology, University of Heidelberg Dental School, Germany.
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Abstract
BACKGROUND AND PURPOSE Chronic infectious diseases may increase the risk of stroke. We investigated whether periodontal disease, including periodontitis and gingivitis, is a risk factor for cerebral ischemia. METHODS We performed a case-control study with 303 patients examined within 7 days after acute ischemic stroke or transient ischemic attack, 300 population controls, and 168 hospital controls with nonvascular and noninflammatory neurological diseases. All subjects received a complete clinical and radiographic dental examination. The individual mean clinical attachment loss measured at 4 sites per tooth served as the main indicator for periodontitis. RESULTS Patients had higher clinical attachment loss than population (P<0.001) and hospital (P=0.010) controls. After adjustment for age, sex, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions, and lifestyle factors, the risk of cerebral ischemia increased with more severe periodontitis. Subjects with severe periodontitis (mean clinical attachment loss >6 mm) had a 4.3-times-higher (95% confidence interval, 1.85 to 10.2) risk of cerebral ischemia than subjects with mild or without periodontitis (<or=3 mm). Severe periodontitis was a risk factor in men but not women and in younger (<60 years) but not older subjects. Periodontitis increased the risk of cerebral ischemia caused by large-artery atherosclerosis, cardioembolism, and cryptogenic etiology. Gingivitis and severe radiologic bone loss were also independently associated with the risk of cerebral ischemia, whereas caries was not. CONCLUSIONS Our study indicates that periodontal disease, a treatable condition, is an independent risk factor for cerebral ischemia in men and younger subjects.
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Affiliation(s)
- Armin J Grau
- Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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