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Mueller SK, Wendler O, Mayr S, Traxdorf M, Koch M, Mantsopoulos K, Sievert M, Grundtner P, Iro H, Bleier BS. Comparison of mucus and serum biomarker sampling in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2024; 14:887-897. [PMID: 37990964 DOI: 10.1002/alr.23295] [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: 04/10/2023] [Revised: 08/12/2023] [Accepted: 09/14/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE The objective of this study was to analyze advantages and disadvantages of mucus and serum for biomarker analysis. METHODS This study includes prospective study of 61 CRS with nasal polyps patients who were followed over 24 months and over nine time points after functional endoscopic sinus surgery. At each time points, the nasal polyp score (NPS) was assessed and mucus as well as serum was collected. Selected were measured in mucus and serum. Mean, standard deviation and variance, undetectable values, and the correlation of the biomarkers to the NPS over time and to early recurrences were calculated, and the effect of surgery on the biomarkers was assessed. Additionally, the diurnal rhythm of all biomarkers was measures in order to assure stable biomarker values during sampling times. RESULTS All biomarkers showed stable values during sampling times. Serum biomarker levels displayed higher percentages of undetectable values compared to mucus biomarkers. Mucus periostin (p < 0.001, r = 0.89), mucus IgE (p < 0.001, r = 0.51), serum periostin (p < 0.001, r = 0.53), mucus CST1 (p < 0.001, r = 0.27), and serum IgE (p < 0.01, r = -0.18) were the best marker and medium combinations to track the NPS over time and to predict recurrences. Mucus serpinF2 was negatively correlated and predicted early recurrences (p = 0.026, R2 = 0.015). CONCLUSIONS Serum and mucus both represent viable mediums for "liquid biopsies." The most promising biomarker/medium combinations over time to track disease severity were mucus periostin, mucus IgE, serum periostin, mucus CST1, and serum IgE. Mucus serpinF2 was the best biomarker to predict early recurrences.
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Affiliation(s)
- Sarina Katrin Mueller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Olaf Wendler
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Mayr
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Traxdorf
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Koch
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matti Sievert
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Grundtner
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin S Bleier
- Department of Otolaryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Pesold VV, Wendler O, Gröhn F, Mueller SK. Lymphatic Vessels in Chronic Rhinosinusitis. J Inflamm Res 2024; 17:865-880. [PMID: 38348276 PMCID: PMC10860572 DOI: 10.2147/jir.s436450] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/30/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose The purpose of this study was to analyze the nasal lymphatic system in order to uncover novel factors that might be involved in pathogenesis of chronic rhinosinusitis (CRS) with (CRSwNP) and without nasal polyps (CRSsNP). Patients and Methods Lymphatic vessels (LVs) and macrophages were localized and counted in the inferior and middle turbinate, the uncinate process and the ethmoid of CRSwNP and CRSsNP patients, the NP and the inferior turbinate of controls (n≥6 per group). Lysates of the same tissue types (n=7 per group) were analyzed for lymphatic vessel endothelial receptor 1 (LYVE-1), for matrix metalloproteinase 14 (MMP-14) and for Hyaluronic acid (HA) using ELISA. HA was localized in sections of CRSwNP NP, CRSsNP ethmoid and control inferior turbinate (n=6 per group). The results of HA levels were correlated to the number of macrophages in tissues. The nasal secretions of CRSwNP (n=28), CRSsNP (n=30), and control (n=30) patients were analyzed for LYVE-1 and HA using ELISA. Results The number of LVs was significantly lower in tissues of both CRS groups compared to the control. In the tissue lysates, LYVE-1 expression differed significantly between the CRSwNP tissues with a particularly high level in the NP. MMP-14 was significantly overexpressed in CRSwNP uncinate process. There were no significant differences in tissue HA expression. In the mucus LYVE-1 was significantly underexpressed in CRSsNP compared to CRSwNP and control, while HA was significantly underexpressed in both CRS groups. In the NP, HA and macrophages were accumulated particularly below the epithelium. Tissue levels of HA revealed a significant positive correlation with the number of macrophages. Conclusion CRS might be associated with an insufficient clearing of the nasal mucosa through the lymphatics. The accumulation of HA and macrophages might promote inflammation, fluid retention, and polyp formation. These results may provide novel CRS-associated factors.
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Affiliation(s)
- Vanessa-Vivien Pesold
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, BY, Germany
| | - Olaf Wendler
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, BY, Germany
| | - Franziska Gröhn
- Department of Chemistry and Pharmacy, Interdisciplinary Center for Molecular Materials, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, BY, Germany
| | - Sarina K Mueller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, BY, Germany
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Semmler M, Kniesburges S, Pelka F, Ensthaler M, Wendler O, Schützenberger A. Influence of Reduced Saliva Production on Phonation in Patients With Ectodermal Dysplasia. J Voice 2023; 37:913-923. [PMID: 34353685 DOI: 10.1016/j.jvoice.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Patients with ectodermal dysplasia (ED) suffer from an inherited disorder in the development of the ectodermal structures. Besides the main symptoms, i.e. significantly reduced formation/expression of teeth, hair and sweat glands, a decreased saliva production is objectively accounted. In addition to difficulties with chewing/swallowing, ED patients frequently report on the subjective impression of rough and hoarse voices. A correlation between the reduced production of saliva and an affliction of the voice has not yet been investigated objectively for this rare disease. METHODS Following an established measurement protocol, a study has been conducted on 31 patients with ED and 47 controls (no ED, healthy voice). Additionally, the vocal fold oscillations were recorded by high-speed videoendoscopy (HSV@4 kHz). The glottal area waveform was determined by segmentation and objective glottal dynamic parameters were calculated. The generated acoustic signal was evaluated by objective and subjective measures. The individual impairment was documented by a standardized questionnaire (VHI). Additionally, the amount of generated saliva was measured for a defined period of time. RESULTS ED patients displayed a significantly reduced saliva production compared to the control group. Furthermore, the auditory-perceptual evaluation yielded significantly higher ratings for breathiness and hoarseness in the voices of male ED patients compared to male controls. The majority of male ED patients (67%) indicated at least minor impairment in the self-evaluation. Objective acoustic measures like Jitter and Shimmer confirmed the decreased acoustic quality in male ED patients, whereas none of the investigated HSV parameters showed significant differences between the test groups. Statistical analysis did not confirm a statistically significant correlation between reduced voice quality and amount of saliva. CONCLUSIONS An objective impairment of the acoustic outcome was demonstrated for male ED patients. However, the vocal folds dynamics in HSV recordings seem unaffected.
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Affiliation(s)
- Marion Semmler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany.
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Franziska Pelka
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Maria Ensthaler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Olaf Wendler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
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Abu-Own H, Wendler O, Okonko DO. Mitochondrial Respiration and Exercise Performance in Patients With Heart Failure With Preserved Ejection Fraction. JAMA Cardiol 2023; 8:1100. [PMID: 37819645 DOI: 10.1001/jamacardio.2023.3571] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Huda Abu-Own
- School of Cardiovascular and Metabolic Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre of Excellence, London, United Kingdom
- Cardiology Department, King's College Hospital, London, United Kingdom
| | - Olaf Wendler
- School of Cardiovascular and Metabolic Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre of Excellence, London, United Kingdom
- Cardiology Department, King's College Hospital, London, United Kingdom
- Cleveland Clinic, London, United Kingdom
| | - Darlington O Okonko
- School of Cardiovascular and Metabolic Medicine and Sciences, James Black Centre, King's College London British Heart Foundation Centre of Excellence, London, United Kingdom
- Cardiology Department, King's College Hospital, London, United Kingdom
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Cope J, Maclean R, Hota S, Ramage JK, Mullholland N, Clement D, Brown S, Piper S, MaCarthy P, Wendler O, Srirajaskanthan R. Improving outcomes in carcinoid heart disease - learning from a single centre. Nucl Med Commun 2023; 44:968-976. [PMID: 37661777 DOI: 10.1097/mnm.0000000000001749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
INTRODUCTION A significant proportion of patients with carcinoid syndrome develop carcinoid heart disease (CHD). Valve degeneration can lead to right heart failure, and worsening prognosis. Replacement of affected valves is an effective therapy. We reviewed patients treated with valve replacement to assess prognostic factors. METHODS CHD patients records who underwent valve replacement from 2003-2019 were reviewed. RESULTS Twenty-six patients underwent valve replacement. Mean (SD) age was 61 (11) years, 54% female. Eleven tumours were grade G1, with the remaining G2. NYHA pre-surgery mean (SD) 2.0 (0.7); post-surgery mean 1.2; follow-up mean (SD) 1.6 (0.8). Mean NYHA score difference from pre- to post-surgery -0.71 ( P = 0.002). 88.5% two (PR & TR), 3.9% one, 3.9% three and 3.9% four valves replaced. 13 patients received Lu177 oxodotreotide; 27% completed four cycles. Mortality at 1 and 5 years follow up was 42% and 50% respectively. Cox proportional hazards model of survival from surgery, adjusting for age [hazard ratio (HR) 0.96 (0.89-1.03) ( P = 0.25)], four cycles of Lu177 oxodotreotide demonstrated HR 0.087 (0.0079-0.95) ( P = 0.045) indicating improved survival. DISCUSSION Surgical patients were often NYHA grade II, and symptoms improved post-surgery. Four cycles of Lu177 oxodotreotide improved survival, although the confidence interval was wide. Further studies should be performed to assess Lu177 oxodotreotide in CHD.
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Affiliation(s)
- Jack Cope
- Department of Gastroenterology, King's College Hospital
| | - Rory Maclean
- Department of Gastroenterology, King's College Hospital
| | - Shweta Hota
- Department of Gastroenterology, King's College Hospital
| | - John K Ramage
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
- Department of Gastroenterology, Hampshire Hospitals, Basingstoke
| | | | - Dominique Clement
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
| | - Sarah Brown
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
| | - Sue Piper
- Department of Cardiology, King's College Hospital
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Raj Srirajaskanthan
- Department of Gastroenterology, King's College Hospital
- Neuroendocrine Tumour Units, ENETS Centre of Excellence, Institute of Liver Studies, King's College Hospital, London
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Meuris B, Roussel JC, Borger MA, Siepe M, Stefano P, Laufer G, Langanay T, Theron A, Grabenwöger M, Binder K, Demers P, Pessotto R, van Leeuwen W, Bourguignon T, Canovas S, Mariscalco G, Coscioni E, Dagenais F, Wendler O, Polvani G, Eden M, Botta B, Bramlage P, De Paulis R. Durability of bioprosthetic aortic valve replacement in patients under the age of 60 years - 1-year follow-up from the prospective INDURE registry. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad115. [PMID: 37462612 PMCID: PMC10576637 DOI: 10.1093/icvts/ivad115] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/16/2023] [Accepted: 07/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS The INSPIRIS RESILIA Durability Registry is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance and quality of life (QoL) at 1 year were assessed. RESULTS A total of 421 patients were documented with a mean age of 53.5 years, 76.5% being male and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%) and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95% confidence interval 97.1; 99.6) and 81.8% were NYHA I versus 21.9% at baseline. No patient developed structural valve deterioration stage 3 (VARC-3). The mean aortic pressure gradient was 12.6 mmHg at 1 year and the effective orifice area was 1.9 cm2. CONCLUSIONS The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement. CLINICAL TRIAL REGISTRATION clinicaltrials.gov: NCT03666741.
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Affiliation(s)
- Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Michael A Borger
- Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Switzerland
| | - Pierluigi Stefano
- Division of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thierry Langanay
- Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Alexis Theron
- Cardio-Thoracic Surgery Department, Hospital de la Timone, Marseille, France
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, HZH Heart Center Hietzing, Austria
| | - Konrad Binder
- Heart Center University St. Pölten, St. Pölten, Austria
| | - Philippe Demers
- Department of surgery, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Wouter van Leeuwen
- Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Sergio Canovas
- Cardiovascular Surgery Department, Hospital University Virgen de la Arrixaca, Murcia, Spain
| | - Giovanni Mariscalco
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Enrico Coscioni
- Division of Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Cardiology Center Monzino, Milan, Italy
| | - Matthias Eden
- Department for Internal Medicine III, Molecular Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Tur B, Gühring L, Wendler O, Schlicht S, Drummer D, Kniesburges S. Effect of Ligament Fibers on Dynamics of Synthetic, Self-Oscillating Vocal Folds in a Biomimetic Larynx Model. Bioengineering (Basel) 2023; 10:1130. [PMID: 37892860 PMCID: PMC10604794 DOI: 10.3390/bioengineering10101130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Synthetic silicone larynx models are essential for understanding the biomechanics of physiological and pathological vocal fold vibrations. The aim of this study is to investigate the effects of artificial ligament fibers on vocal fold vibrations in a synthetic larynx model, which is capable of replicating physiological laryngeal functions such as elongation, abduction, and adduction. A multi-layer silicone model with different mechanical properties for the musculus vocalis and the lamina propria consisting of ligament and mucosa was used. Ligament fibers of various diameters and break resistances were cast into the vocal folds and tested at different tension levels. An electromechanical setup was developed to mimic laryngeal physiology. The measurements included high-speed video recordings of vocal fold vibrations, subglottal pressure and acoustic. For the evaluation of the vibration characteristics, all measured values were evaluated and compared with parameters from ex and in vivo studies. The fundamental frequency of the synthetic larynx model was found to be approximately 200-520 Hz depending on integrated fiber types and tension levels. This range of the fundamental frequency corresponds to the reproduction of a female normal and singing voice range. The investigated voice parameters from vocal fold vibration, acoustics, and subglottal pressure were within normal value ranges from ex and in vivo studies. The integration of ligament fibers leads to an increase in the fundamental frequency with increasing airflow, while the tensioning of the ligament fibers remains constant. In addition, a tension increase in the fibers also generates a rise in the fundamental frequency delivering the physiological expectation of the dynamic behavior of vocal folds.
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Affiliation(s)
- Bogac Tur
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Lucia Gühring
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Olaf Wendler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany
| | - Samuel Schlicht
- Institute of Polymer Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Am Weichselgarten 10, 91058 Erlangen, Germany
| | - Dietmar Drummer
- Institute of Polymer Technology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Am Weichselgarten 10, 91058 Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany
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Zimmermann FM, Ding VY, Pijls NHJ, Piroth Z, van Straten AHM, Szekely L, Davidavicius G, Kalinauskas G, Mansour S, Kharbanda R, Östlund-Papadogeorgos N, Aminian A, Oldroyd KG, Al-Attar N, Jagic N, Dambrink JHE, Kala P, Angeras O, MacCarthy P, Wendler O, Casselman F, Witt N, Mavromatis K, Miner SES, Sarma J, Engstrøm T, Christiansen EH, Tonino PAL, Reardon MJ, Otsuki H, Kobayashi Y, Hlatky MA, Mahaffey KW, Desai M, Woo YJ, Yeung AC, De Bruyne B, Fearon WF. Fractional Flow Reserve-Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial. Circulation 2023; 148:950-958. [PMID: 37602376 DOI: 10.1161/circulationaha.123.065770] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI. METHODS FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke. RESULTS A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared with CABG (12.0% versus 9.2%; hazard ratio [HR], 1.3 [95% CI, 0.98-1.83]; P=0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 [95% CI, 0.6-1.7]; P=0.88) and stroke (1.6% versus 2.0%; HR, 0.8 [95% CI, 0.4-1.7]; P=0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 [95% CI, 1.1-2.7]; P=0.02). CONCLUSIONS At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02100722.
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Affiliation(s)
- Frederik M Zimmermann
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | - Victoria Y Ding
- Quantitative Sciences Unit (V.Y.D., M.D.), Stanford University, CA
| | - Nico H J Pijls
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | - Zsolt Piroth
- Gottsegen National Cardiovascular Center, Hungary (Z.P., L.S.)
| | | | - Laszlo Szekely
- Gottsegen National Cardiovascular Center, Hungary (Z.P., L.S.)
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania (G.D., G.K.)
- Vilnius University Hospital Santaros Klinikos, Lithuania (G.D., G.K.)
| | - Gintaras Kalinauskas
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania (G.D., G.K.)
- Vilnius University Hospital Santaros Klinikos, Lithuania (G.D., G.K.)
| | - Samer Mansour
- Centre Hospitalier de l'Université de Montréal, Canada (S.M.)
| | | | | | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | - Keith G Oldroyd
- Golden Jubilee National Hospital, Glasgow, UK (K.G.O., N.A.-A.)
| | - Nawwar Al-Attar
- Golden Jubilee National Hospital, Glasgow, UK (K.G.O., N.A.-A.)
| | - Nikola Jagic
- Clinical Hospital Centre Zemun, University of Belgrade, Serbia (N.J.)
| | | | - Petr Kala
- Medical Faculty of Masaryk University and University Hospital Brno, Czech Republic (P.K.)
| | | | | | | | | | - Nils Witt
- Södersjukhuset Hospital, Stockholm, Sweden (N.W.)
- Karolinska Institutet, Solna, Sweden (N.W.)
| | - Kreton Mavromatis
- Atlanta VA Healthcare System, Decatur, GA (K.M.)
- Emory University School of Medicine, Atlanta, GA (K.M.)
| | | | | | | | | | - Pim A L Tonino
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | | | - Hisao Otsuki
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist and Weill Cornell Medical College (Y.K.)
| | - Mark A Hlatky
- Departments of Health Policy and Medicine (M.A.H.), Stanford University, CA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, CA (K.W.M.)
| | - Manisha Desai
- Quantitative Sciences Unit (V.Y.D., M.D.), Stanford University, CA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery (Y.J.W.), Stanford University, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Belgium (F.C., B.D.)
- Lausanne University Centre Hospital, Switzerland (B.D.)
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
- VA Palo Alto Health Care System, CA (W.F.F.)
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9
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Kobayashi Y, Takahashi T, Zimmermann FM, Otsuki H, El Farissi M, Oldroyd KG, Wendler O, Reardon MJ, Woo YJ, Yeung AC, De Bruyne B, Pijls NHJ, Fearon WF. Outcomes Based on Angiographic vs Functional Significance of Complex 3-Vessel Coronary Disease: FAME 3 Trial. JACC Cardiovasc Interv 2023; 16:2112-2119. [PMID: 37704297 DOI: 10.1016/j.jcin.2023.06.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The functional SYNTAX score (FSS), which incorporates functional information as assessed by fractional flow reserve (FFR), is a better predictor of outcome after percutaneous coronary intervention (PCI) in patients with less complex coronary artery disease (CAD). OBJECTIVES This study sought to test the prognostic value of the FSS in patients with complex CAD eligible for coronary artery bypass grafting (CABG). METHODS The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) trial compared FFR-guided PCI with CABG in patients with angiographic 3-vessel CAD. In this prespecified substudy, the angiographic core laboratory calculated the SYNTAX score (SS) and then the FSS by eliminating lesions that were not significant based on FFR. Outcomes in the PCI patients based on the FSS and the SS were compared to each other and to the patients treated with CABG. RESULTS The FSS reclassified more than one-quarter of patients from an SS >22 to an FSS ≤22. In the 50% of PCI patients who had an FSS ≤22, the primary endpoint occurred at a similar rate to patients treated with CABG (P = 0.77). The primary endpoint in patients without functionally significant 3-vessel CAD was similar to the CABG group (P = 0.97). The rate of myocardial infarction and revascularization among all deferred lesions was 0.5% and 3.2%, respectively. CONCLUSIONS By measuring the FSS, one can identify 50% of patients who have a similar outcome at 1 year with PCI compared with CABG. Lesions deferred from PCI based on FFR have a low event rate.
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Affiliation(s)
- Yuhei Kobayashi
- New York-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medical College, Brooklyn, New York, USA.
| | - Tatsunori Takahashi
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Hisao Otsuki
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | | | | | | | | | - Y Joseph Woo
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | - Alan C Yeung
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | | | | | - William F Fearon
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA; VA Palo Alto Medical Systems, Palo Alto, California, USA.
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10
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Semmler M, Lasar S, Kremer F, Reinwald L, Wittig F, Peters G, Schraut T, Wendler O, Seyferth S, Schützenberger A, Dürr S. Extent and Effect of Covering Laryngeal Structures with Synthetic Laryngeal Mucus via Two Different Administration Techniques. J Voice 2023:S0892-1997(23)00228-X. [PMID: 37648625 DOI: 10.1016/j.jvoice.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE The first goal of this study was to investigate the coverage of laryngeal structures using two potential administration techniques for synthetic mucus: inhalation and lozenge ingestion. As a second research question, the study investigated the potential effects of these techniques on standardized voice assessment parameters. METHODS Fluorescein was added to throat lozenges and to an inhalation solution to visualize the coverage of laryngeal structures through blue light imaging. The study included 70 vocally healthy subjects. Fifty subjects underwent administration via lozenge ingestion and 20 subjects performed the inhalation process. For the first research question, the recordings from the blue light imaging system were categorized to compare the extent of coverage on individual laryngeal structures objectively. Secondly, a standardized voice evaluation protocol was performed before and after each administration to determine any measurable effects of typical voice parameters. RESULTS The administration via inhalation demonstrated complete coverage of all laryngeal structures, including the vocal folds, ventricular folds, and arytenoid cartilages, as visualized by the fluorescent dye. In contrast, the application of the lozenge predominantly covered the pharynx and laryngeal surface toward the aryepiglottic fold, but not the inferior structures. All in all, the comparison before and after administration showed no clear effect, although a minor deterioration of the acoustic signal was noted in the shimmer and cepstral peak prominence after the inhalation. CONCLUSIONS Our findings indicate that the inhalation process is a more effective technique for covering deeper laryngeal structures such as the vocal folds and ventricular folds with synthetic mucus. This knowledge enables further in vivo studies on the role of laryngeal mucus in phonation in general, and how it can be substituted or supplemented for patients with reduced glandular activity as well as for heavy voice users.
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Affiliation(s)
- Marion Semmler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Sarina Lasar
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Franziska Kremer
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Laura Reinwald
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Fiori Wittig
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Gregor Peters
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Tobias Schraut
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Olaf Wendler
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stefan Seyferth
- Department of Chemistry and Pharmacy, Chair of Pharmaceutics, Friedrich-Alexander-University Erlangen-Nürnberg, Cauerstr. 4, 91058 Erlangen, Germany.
| | - Anne Schützenberger
- University Hospital Erlangen, Medical School, Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology Head & Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Waldstrasse 1, 91054 Erlangen, Germany.
| | - Stephan Dürr
- University Hospital Regensburg, Department of Otorhinolaryngology, Division of Phoniatrics and Pediatric Audiology, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
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Sandoe JAT, Ahmed F, Arumugam P, Guleri A, Horner C, Howard P, Perry J, Prendergast BD, Schwiebert R, Steeds RP, Watkin R, Wendler O, Chambers JB. Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies. Heart 2023; 109:e2. [PMID: 36898706 PMCID: PMC10423555 DOI: 10.1136/heartjnl-2022-321791] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Infective endocarditis (IE) remains a difficult condition to diagnose and treat and is an infection of high consequence for patients, causing long hospital stays, life-changing complications and high mortality. A new multidisciplinary, multiprofessional, British Society for Antimicrobial Chemotherapy (BSAC)-ledWorking Party was convened to undertake a focused systematical review of the literature and to update the previous BSAC guidelines relating delivery of services for patients with IE. A scoping exercise identified new questions concerning optimal delivery of care, and the systematic review identified 16 231 papers of which 20 met the inclusion criteria. Recommendations relating to endocarditis teams, infrastructure and support, endocarditis referral processes, patient follow-up and patient information, and governance are made as well as research recommendations. This is a report of a joint Working Party of the BSAC, British Cardiovascular Society, British Heart Valve Society, British Society of Echocardiography, Society of Cardiothoracic Surgeons of Great Britain and Ireland, British Congenital Cardiac Association and British Infection Association.
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Affiliation(s)
- Jonathan A T Sandoe
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Fozia Ahmed
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Parthiban Arumugam
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Achyut Guleri
- Microbiology department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Carolyne Horner
- Formerly British Society of Antimicrobial Chemotherapy, Birmingham, UK
| | - Philip Howard
- NHS England North East & Yorkshire, Leeds, UK
- University of Leeds, Leeds, UK
| | - John Perry
- Microbiology department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Bernard D Prendergast
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Cleveland Clinic, London, UK
| | - Ralph Schwiebert
- Microbiology department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Richard Paul Steeds
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Watkin
- Cardiology department, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital, King's Health Partners, London, UK
| | - John B Chambers
- Cardiology department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Malcolm R, Buckley C, Shore J, Stainthorpe A, Marti B, White A, Deckert J, Vernia M, Carapinha JL, López-Marco A, Nikolaidis N, Wendler O. An exploratory cost-effectiveness analysis of a novel tissue valve compared with mechanical valves for surgical aortic valve replacement in subgroups of people aged 55-64 and 65+ with aortic stenosis in the UK. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1087-1099. [PMID: 37638585 DOI: 10.1080/14737167.2023.2249611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Exploratory analysis to conceptualize and evaluate the potential cost-effectiveness and economic drivers of using a novel tissue valve compared with mechanical heart valves for surgical aortic valve replacement (SAVR) in people aged 55-64 and 65+ with aortic stenosis (AS) from a National Health Service (NHS) UK perspective. METHODS A decision-analytic model was developed using a partitioned survival model. Parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to explore the uncertainty around the parameters. RESULTS The novel tissue valve was potentially associated with higher quality-adjusted life years (QALYs) of 0.01 per person. Potential cost savings were greatest for those aged 55-64 (£408) versus those aged 65+(£53). DSA indicated the results to be most dependent on relative differences in general mortality, procedure costs, and reoperation rates. PSA estimated around 75% of the iterations to be cost-effective at £20,000 per QALY for those aged 55-64, and 57% for those aged 65+. CONCLUSIONS The exploratory analysis suggests that the novel tissue valve could be a cost-effective intervention for people over the age of 55 with AS who are suitable for SAVR in the UK.
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Affiliation(s)
- Robert Malcolm
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Ciara Buckley
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Judith Shore
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Angela Stainthorpe
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Belen Marti
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Andrea White
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Jens Deckert
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Matteo Vernia
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - João L Carapinha
- Director, Syenza, Anaheim, CA, USA
- School of Pharmacy, Northeastern University, Boston, Massachusetts, USA
| | - Ana López-Marco
- Cardiothoracic Surgery, St Bartholomew's Hospital London, London, UK
| | | | - Olaf Wendler
- Chair of Heart, Vascular & Thoracic Institute, Cleveland Clinic London Hospital, London, UK
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13
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Pelka F, Ensthaler M, Wendler O, Kniesburges S, Schützenberger A, Semmler M. Mechanical Parameters Based on High-Speed Videoendoscopy of the Vocal Folds in Patients With Ectodermal Dysplasia. J Voice 2023:S0892-1997(23)00084-X. [PMID: 36973131 DOI: 10.1016/j.jvoice.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Patients suffering from ectodermal dysplasia (ED), which is an inherited disorder in the development of the ectodermal structures, have a significantly reduced expression of teeth, hair, sweat glands, and salivary glands in the respiratory tract including the larynx. Previous studies within the framework of the present project showed a significantly reduced saliva production and an impairment of the acoustic outcome in ED patients compared to the control group. However, until now, no statistically significant difference between EDs and controls could be found regarding vocal fold dynamics in the high-speed videoendoscopy (HSV) recordings using representative parameters on closure, symmetry, and periodicity. The aim of this study is to examine the role of tissue characteristics by means of objective mechanical parameters derived from HSV recordings. METHODS This study includes 28 ED patients and 42 controls (no ED, healthy voice). The vocal fold oscillations were recorded by high-speed videoendoscopy (HSV@4kHz). Based on the dynamical measures of the glottal area waveform (GAW), objective glottal dynamic parameters associated with tissue properties like flexibility and stiffness were computed. RESULTS The present evaluation displays a significant difference between male ED patients and male controls concerning the HSV-based mechanical parameters indicating reduced stiffness and increased deformability for the vocal folds of male ED patients. In contrast to strongly amplitude-dependent parameters, the primarily velocity-based parameters showed no statistically significant deviation. CONCLUSIONS The presented data provides the first promising indication toward the underlying causes on the laryngeal level leading to the voice conspicuities in ED patients. The significant difference concerning the mechanical parameters suggests a different composition of the extracellular matrix of the tissue of the vocal folds of ED patients compared to controls.
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Affiliation(s)
- Franziska Pelka
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Maria Ensthaler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Olaf Wendler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany
| | - Marion Semmler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology Head & Neck Surgery, University Hospital Erlangen, Medical School, Erlangen, Germany.
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14
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Mueller SK, Wendler O, Mayr S, Traxdorf M, Hosemann W, Olze H, Steinhart H, Wiegand S, Teymoortash A, Kuehnel T, Hackenberg S, Hummel T, Ambrosch P, Fazel A, Schick B, Baenkler HW, Koch M, Buerner H, Mantsopoulos K, Grundtner P, Nocera A, Agaimy A, Bleier B, Iro H. Effect of postoperative systemic prednisolone on short-term and long-term outcomes in chronic rhinosinusitis with nasal polyps: A multi-centered randomized clinical trial. Front Immunol 2023; 14:1075066. [PMID: 36969262 PMCID: PMC10032209 DOI: 10.3389/fimmu.2023.1075066] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionThe objective of this study was to determine whether postoperative additive systemic steroid administration in chronic rhinosinusitis with nasal polyps (CRSwNP) impacted selected endoscopic, subjective and objective outcome measures.MethodsThis was a prospective, randomized, double-blind, placebo-controlled, noninferiority multicenter trial of n=106 patients with CRSwNP. All patients underwent primary functional endoscopic sinus surgery (FESS) followed by topical nasal steroids. Patients were randomized to a systemic steroid or placebo for 1 month. Patients were followed up for 2 years over 9 time points. The primary outcome measures were the differences between groups with respect to the nasal polyp score (NPS) and sinonasal quality of life (SNQoL). Secondary outcome measures included interactions with respect to the Lund-Kennedy score (LKS), sinonasal symptoms, general quality of life (GQoL), 16-item odor identification test scores, recurrence rates, need for revision surgery and mucus biomarker levels.Results106 patients were randomized to either the placebo or the systemic steroid group (n=53 per group). Postoperative systemic steroids were not superior to placebo with respect to all primary (p= 0.077) and secondary outcome measures (p>0.05 for all). Reported adverse events were similar between the two groups.ConclusionIn conclusion, the addition of postoperative systemic steroids after primary FESS did not confer a benefit over topical steroid nasal spray alone with respect to NPS, SNQOL, LKS, GQOL, sinonasal symptoms, smell scores, recurrence rates, the need for revision surgery or biomarkers over a short-term follow-up of up to 9 months and a long-term follow-up of up to 24 months in CRSwNP patients. Functional endoscopic surgery did, however, show a strong effect on all outcome measures, which remained relatively stable up to the endpoint at 2 years.
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Affiliation(s)
- Sarina K. Mueller
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Sarina K. Mueller,
| | - Olaf Wendler
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Mayr
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Traxdorf
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Werner Hosemann
- Department of Otolaryngology, Head and Neck Surgery, Helios Hanseklinikum Stralsund, Stralsund, Germany
| | - Heidi Olze
- Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Berlin, Berlin, Germany
| | - Helmut Steinhart
- Department of Otolaryngology, Head and Neck Surgery, Marienhospital Stuttgart, Stuttgart, Germany
| | - Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, Phillips Universität Marburg, Marburg, Germany
- Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Afshin Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Phillips Universität Marburg, Marburg, Germany
| | - Thomas Kuehnel
- Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stephan Hackenberg
- Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum Regensburg, Regensburg, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Thomas Hummel
- Department of Otolaryngology, Head and Neck Surgery, Smell and Taste Clinic, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Germany
| | - Petra Ambrosch
- Department of Otolaryngology, Head and Neck Surgery, Christian-Albrechts-Universität (CAU) Kiel, Kiel, Germany
| | - Azita Fazel
- Department of Otolaryngology, Head and Neck Surgery, Christian-Albrechts-Universität (CAU) Kiel, Kiel, Germany
| | - Bernhard Schick
- Department of Otolaryngology, Head and Neck Surgery, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hanns-Wolf Baenkler
- Department of Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Koch
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Buerner
- Department of Otolaryngology, Head and Neck Surgery, Marienhospital Stuttgart, Stuttgart, Germany
| | - Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Grundtner
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Angela Nocera
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Abbas Agaimy
- Department of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Bleier
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Abu-Own H, Pillai K, Roy R, Hussain A, Jakaj G, Mohamed S, Narayana A, Khan H, Deshpande R, Whitaker D, Baghai M, Wendler O, Okonko DO. CARDIAC MITOCHONDRIAL INJURY DURING ON-PUMP CARDIAC SURGERY PRINCIPALLY INVOLVES COMPLEX I OF THE ELECTRON TRANSPORT CHAIN AND RELATES TO POSTOPERATIVE INOTROPIC REQUIREMENTS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01006-9] [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: 03/06/2023]
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Abu-Own H, JAKAJ G, Roy R, Hussain A, MOHAMED SAMEH, Pillai K, Thapliyal P, Narayana A, Khan H, Whitaker D, Deshpande R, Baghai M, Wendler O. BLUNTED TEMPORAL IMPROVEMENTS IN SURVIVAL IN PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION UNDERGOING CARDIAC SURGERY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01059-8] [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: 03/06/2023]
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17
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Traxdorf M, Haferkamp J, Messbacher ME, Mueller SK, Mantsopoulos K, Gostian AO, Iro H, Wendler O, Bauer J. TIMP-1 as a biomarker in obstructive sleep apnea: screening, monitoring, risk stratification, and a step towards precision medicine. Eur Rev Med Pharmacol Sci 2023; 27:1374-1383. [PMID: 36876677 DOI: 10.26355/eurrev_202302_31374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The diagnosis of obstructive sleep apnea (OSA) is a complex time- and resource-intensive diagnostic procedure. Since tissue inhibitors of matrix metalloproteinases (TIMP's) are involved in various pathophysiological processes and are correlated with a high cardiovascular risk, TIMP's appear to be a suitable candidate for an OSA-biomarker. PATIENTS AND METHODS In a prospective controlled diagnostic study, TIMP-1 serum levels of 273 OSA-patients and controls were analyzed for correlation with OSA severity, BMI, age, sex, cardio-/ cerebrovascular comorbidities. Furthermore, longitudinal medium- and long-term effects of CPAP-treatment (n=15) on TIMP-1-levels were investigated. RESULTS TIMP-1 was clearly linked to OSA as well as to disease severity (mild, moderate, severe; each p<0.001) and was not influenced by age, gender, BMI, or cardio-/cerebrovascular comorbidities. ROC curve analysis revealed an AUC of 0.91 ± 0.017 SE (p<0.001), suggesting a TIMP-1 cut-off value of 75 ng/ml (sensitivity 0.78; specificity 0.91) being especially sensitive for patients with severe OSA (sensitivity 0.89; specificity 0.91). The likelihood ratio was 8.88, while the diagnostic odds ratio was 37.14. CPAP-treatment led to a significant decrease of TIMP-1 after 6-8 months (p=0.008). CONCLUSIONS TIMP-1 seems to fulfill the preconditions for a circulating OSA-biomarker: disease-specific with a mandatory presence in affected patients, reversible on treatment, reflects disease severity and provides a cutoff value between the healthy state and disease. In the clinical routine, TIMP 1 may help to stratify the individual OSA-associated cardiovascular risk and to monitor the treatment response to CPAP-therapy as a further step towards providing a personalized therapy.
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Affiliation(s)
- M Traxdorf
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
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Peters G, Jakubaß B, Weidenfeller K, Kniesburges S, Böhringer D, Wendler O, Mueller SK, Gostian AO, Berry DA, Döllinger M, Semmler M. Synthetic mucus for an ex vivo phonation setup: Creation, application, and effect on excised porcine larynges. J Acoust Soc Am 2022; 152:3245. [PMID: 36586828 PMCID: PMC9729017 DOI: 10.1121/10.0015364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 09/23/2022] [Accepted: 11/06/2022] [Indexed: 06/17/2023]
Abstract
Laryngeal mucus hydrates and lubricates the deformable tissue of the vocal folds and acts as a boundary layer with the airflow from the lungs. However, the effects of the mucus' viscoelasticity on phonation remain widely unknown and mucus has not yet been established in experimental procedures of voice research. In this study, four synthetic mucus samples were created on the basis of xanthan with focus on physiological frequency-dependent viscoelastic properties, which cover viscosities and elasticities over 2 orders of magnitude. An established ex vivo experimental setup was expanded by a reproducible and controllable application method of synthetic mucus. The application method and the suitability of the synthetic mucus samples were successfully verified by fluorescence evidence on the vocal folds even after oscillation experiments. Subsequently, the impact of mucus viscoelasticity on the oscillatory dynamics of the vocal folds, the subglottal pressure, and acoustic signal was investigated with 24 porcine larynges (2304 datasets). Despite the large differences of viscoelasticity, the phonatory characteristics remained stable with only minor statistically significant differences. Overall, this study increased the level of realism in the experimental setup for replication of the phonatory process enabling further research on pathological mucus and exploration of therapeutic options.
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Affiliation(s)
- Gregor Peters
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Katrin Weidenfeller
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - David Böhringer
- Biophysics Group, Department of Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Olaf Wendler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - David A Berry
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 90024, USA
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Marion Semmler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Medical School at Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
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Acharya M, Khan H, Chaubey S, Mittal A, Hussain A, Wendler O. Is it safe to perform total arterial grafting in elderly patients lacking vein grafts? A single surgeon comparison. J Card Surg 2022; 37:4278-4284. [PMID: 36208103 DOI: 10.1111/jocs.16996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/28/2022] [Accepted: 08/13/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The results of coronary artery bypass graft (CABG) surgery with total arterial revascularisation (TA-CABG) in elderly patients, who may have insufficient vein graft material for conventional CABG (CO-CABG), have not been fully established. We therefore sought to compare the short- and long-term outcomes of patients >70 years old undergoing CO-CABG and TA-CABG. METHODS We performed a retrospective observational study analyzing all consecutive adult patients aged >70 years undergoing first-time CABG over the 15-year period from 2004 to 2020 under a single surgeon. Primary outcomes of interest were in-hospital mortality, long-term mortality, and re-intervention rate. Secondary outcomes of interest included operative durations and the incidence of peri-operative complications. RESULTS There were 46 patients (age 76 ± 3 SD) in the TA-CABG group and 145 patients (age 76 ± 4 SD) in the CO-CABG group. Cardio-pulmonary bypass and cross-clamp durations were comparable between groups (p = .11 and p = .23, respectively). Stroke occurred in 1.0% undergoing CO-CABG compared to 0% in the TA-CABG group (p = .42). Hospital mortality was 3.0% with CO-CABG (EuroSCORE; mean [SD] 6.81 (5.81)) and 2.0% with TA-CABG (EuroSCORE; mean [SD] 6.38 (6.57)) (p = .93). On long-term follow-up, myocardial infarction occurred in 10.0% of CO-CABG patients compared to 4.0% of TA-CABG patients (p = .25). Re-intervention rates were 7% following CO-CABG, and 2% after TA-CABG (p = .23). There was no significant difference in long-term mortality between patients undergoing CO-CABG and TA-CABG (47% vs. 57%, p = .27). Long-term survival was comparable between grafting techniques (p = .27). CONCLUSIONS There were no significant differences in major adverse cardiac and cerebrovascular events, re-intervention rate, hospital or long-term mortality between CO-CABG and TA-CABG. TA-CABG represents a safe and feasible alternative to CO-CABG in elderly patients offering good long-term outcomes.
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Affiliation(s)
- Metesh Acharya
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Aaina Mittal
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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20
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Ng Yin Ling C, Avci Demir F, Bleetman D, Eskandari M, Khan H, Baghai M, Deshpande R, Monaghan MJ, Wendler O. The impact of complete versus partial preservation of the sub-valvular apparatus on left ventricular function in mitral valve replacement. J Card Surg 2022; 37:4598-4605. [PMID: 36284463 PMCID: PMC10092726 DOI: 10.1111/jocs.17049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In mitral valve replacement (MVR), sudden increases in afterload and disruption of the annular-chordal-papillary-left-ventricular wall causes left ventricular (LV) dysfunction in the early postoperative period. Preservation of the posterior mitral leaflet apparatus (MVR-P) has a favorable outcome on LV function. However, there is paucity of data on the impact of complete preservation of the sub-valvular apparatus (MVR-C). OBJECTIVE We investigated the impact of MVR-P and MVR-C on baseline and 3-months postoperative LV ejection fraction (EF) and global longitudinal strain (GLS). METHODS We retrospectively analyzed a cohort of 29 MVR-P and 19 MVR-C patients with complete echocardiography data at our unit, who were operated between 2008 and 2017. Between-group changes in LVEF and GLS were compared using independent sample T-test. RESULTS Median age was 59 years (IQR 50-69 years). Baseline LVEF was 58% (51%- 60%). Baseline GLS was -18.4 (-21.2 to -15.5). There were no significant between-group differences between all baseline demographics and echocardiographic markers. There was significantly higher absolute postoperative LVEF in MVR-C patients (p = 0.029). There was also significant worsening in LVEF (p = 0.0121) and GLS (p < 0.0001) after MVR-P and not MVR-C, suggesting no reduction in LV function post-MVR-C but a reduction post-MVR-P. There was significantly less postoperative worsening of GLS per patient in MVR-C group as compared to the MVR-P group (p = 0.023), indicating better preservation of LV function. There was also a smaller decline in LVEF per patient in the MVR-C as compared to the MVR-P group, although not statistically significant (p = 0.23). CONCLUSION MVR with complete preservation of the sub-valvular apparatus shows a favorable impact on the longitudinal function of the heart at 3 months. Further studies with larger patient numbers are indicated to investigate the long-term results of this surgical approach.
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Affiliation(s)
| | | | - David Bleetman
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Pesold VV, Wendler O, Morgenthaler L, Gröhn F, Mueller SK. Analysis of CRSsNP Proteome Using a Highly Multiplexed Approach in Nasal Mucus. Am J Rhinol Allergy 2022; 37:348-359. [PMID: 36341722 DOI: 10.1177/19458924221136651] [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: 11/09/2022]
Abstract
BACKGROUND Chronic rhinosinusitis without nasal polyps (CRSsNP) represents a phenotype of CRS, whose immunological mechanisms are still unclear. So far there are neither suitable biomarkers to determine the course of the disease nor an individual therapy. OBJECTIVE The purpose of this study was to characterize the CRSsNP endotype by identifying and validating non-invasive proteomic biomarkers. METHODS A highly-multiplexed proteomic array consisting of antibodies against 2000 proteins was used to identify proteins that are differentially expressed in the nasal mucus of the CRSsNP and control groups (n = 7 per group). The proteins identified to be most differentially expressed were validated in matched nasal mucus samples using western blots and enzyme-linked immunosorbent assay (ELISA). Validation was also done in a second cohort using western blots (CRSsNP n = 25, control n = 23) and ELISA (n = 30 per group). Additionally, immunohistochemistry in CRSsNP and control tissue samples was performed to characterize the selected proteins further. RESULTS Out of the 2000 proteins examined, 7 from the most differentially expressed proteins were chosen to be validated. The validation results showed that 4 proteins were significantly upregulated in CRSsNP mucus, including macrophage inflammatory protein-1beta (MIP-1β), resistin, high mobility group box 1 (HMGB1), and forkhead box protein 3 (FOXP3). Cartilage acidic protein 1 (CRTAC1) was not significantly upregulated. Two proteins were significantly downregulated including scavenger receptor class F member 2 (SCARF2) and P-selectin. All proteins selected are mainly associated with inflammation, cell proliferation/differentiation, apoptosis and cell-cell or cell-matrix interaction. CONCLUSION Proteomic analysis of CRSsNP and control mucus has confirmed known and revealed novel disease-associated proteins that could potentially serve as a new biosignature for CRSsNP. Analysis of the associated pathways will specify endotypes of CRSsNP and will lead to an improved understanding of the pathophysiology of CRSsNP. Furthermore, our data contribute to the development of a reproducible, non-invasive, and quantitative "liquid biopsy" for rhinosinusitis.
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Affiliation(s)
- Vanessa-Vivien Pesold
- Department of Otolaryngology, Head and Neck Surgery, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Olaf Wendler
- Department of Otolaryngology, Head and Neck Surgery, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lisa Morgenthaler
- Department of Otolaryngology, Head and Neck Surgery, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Franziska Gröhn
- Department of Chemistry and Pharmacy, Interdisciplinary Center for Molecular Materials, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarina K Mueller
- Department of Otolaryngology, Head and Neck Surgery, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Benedetto U, Sinha S, Mulla A, Glampson B, Davies J, Panoulas V, Gautama S, Papadimitriou D, Woods K, Elliott P, Hemingway H, Williams B, Asselbergs FW, Melikian N, Krasopoulos G, Sayeed R, Wendler O, Baig K, Chukwuemeka A, Angelini GD, Sterne JAC, Johnson T, Shah AM, Perera D, Patel RS, Kharbanda R, Channon KM, Mayet J, Kaura A. Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction (NIHR Health Informatics Collaborative: TROP-CABG study). Int J Cardiol 2022; 362:14-19. [PMID: 35487318 DOI: 10.1016/j.ijcard.2022.04.067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/05/2022]
Abstract
Implications of elevated troponin on time-to-surgery in non-ST elevation myocardial infarction(NIHR Health Informatics Collaborative:TROP-CABG study). Benedetto et al. BACKGROUND: The optimal timing of coronary artery bypass grafting (CABG) in patients with non-ST elevation myocardial infarction (NSTEMI) and the utility of pre-operative troponin levels in decision-making remains unclear. We investigated (a) the association between peak pre-operative troponin and survival post-CABG in a large cohort of NSTEMI patients and (b) the interaction between troponin and time-to-surgery. METHODS AND RESULTS: Our cohort consisted of 1746 patients (1684 NSTEMI; 62 unstable angina) (mean age 69 ± 11 years,21% female) with recorded troponins that had CABG at five United Kingdom centers between 2010 and 2017. Time-segmented Cox regression was used to investigate the interaction of peak troponin and time-to-surgery on early (within 30 days) and late (beyond 30 days) survival. Average interval from peak troponin to surgery was 9 ± 15 days, with 1466 (84.0%) patients having CABG during the same admission. Sixty patients died within 30-days and another 211 died after a mean follow-up of 4 ± 2 years (30-day survival 0.97 ± 0.004 and 5-year survival 0.83 ± 0.01). Peak troponin was a strong predictor of early survival (adjusted P = 0.002) with a significant interaction with time-to-surgery (P interaction = 0.007). For peak troponin levels <100 times the upper limit of normal, there was no improvement in early survival with longer time-to-surgery. However, in patients with higher troponins, early survival increased progressively with a longer time-to-surgery, till day 10. Peak troponin did not influence survival beyond 30 days (adjusted P = 0.64). CONCLUSIONS: Peak troponin in NSTEMI patients undergoing CABG was a significant predictor of early mortality, strongly influenced the time-to-surgery and may prove to be a clinically useful biomarker in the management of these patients.
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Affiliation(s)
- Umberto Benedetto
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; University Gabriele D'Annunzio Chieti Pescara, Italy
| | - Shubhra Sinha
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Abdulrahim Mulla
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Benjamin Glampson
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Jim Davies
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vasileios Panoulas
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Sanjay Gautama
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Dimitri Papadimitriou
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Kerrie Woods
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul Elliott
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK; Health Data Research UK, London, UK
| | - Harry Hemingway
- Health Data Research UK, London, UK; NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Folkert W Asselbergs
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Narbeh Melikian
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - George Krasopoulos
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rana Sayeed
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Olaf Wendler
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Kamran Baig
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Andrew Chukwuemeka
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Gianni D Angelini
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
| | - Jonathan A C Sterne
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tom Johnson
- NIHR Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ajay M Shah
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and King's College Hospital NHS Foundation Trust, London, UK
| | - Divaka Perera
- NIHR Guy's and St Thomas' Biomedical Research Centre, King's College London and Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Riyaz S Patel
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Rajesh Kharbanda
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Keith M Channon
- NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jamil Mayet
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
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Toff WD, Hildick-Smith D, Kovac J, Mullen MJ, Wendler O, Mansouri A, Rombach I, Abrams KR, Conroy SP, Flather MD, Gray AM, MacCarthy P, Monaghan MJ, Prendergast B, Ray S, Young CP, Crossman DC, Cleland JGF, de Belder MA, Ludman PF, Jones S, Densem CG, Tsui S, Kuduvalli M, Mills JD, Banning AP, Sayeed R, Hasan R, Fraser DGW, Trivedi U, Davies SW, Duncan A, Curzen N, Ohri SK, Malkin CJ, Kaul P, Muir DF, Owens WA, Uren NG, Pessotto R, Kennon S, Awad WI, Khogali SS, Matuszewski M, Edwards RJ, Ramesh BC, Dalby M, Raja SG, Mariscalco G, Lloyd C, Cox ID, Redwood SR, Gunning MG, Ridley PD. Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis: A Randomized Clinical Trial. JAMA 2022; 327:1875-1887. [PMID: 35579641 PMCID: PMC9115619 DOI: 10.1001/jama.2022.5776] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. OBJECTIVE To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. INTERVENTIONS TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. RESULTS Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). CONCLUSIONS AND RELEVANCE Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. TRIAL REGISTRATION isrctn.com Identifier: ISRCTN57819173.
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Affiliation(s)
| | - William D Toff
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Jan Kovac
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, England
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, England
| | - Anita Mansouri
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Ines Rombach
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, England
| | - Keith R Abrams
- Centre for Health Economics, University of York, York, England
- Department of Statistics, University of Warwick, Coventry, England
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Simon P Conroy
- Department of Health Sciences, University of Leicester, Leicester, England
| | - Marcus D Flather
- Norwich Medical School, University of East Anglia, Norwich, England
| | - Alastair M Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, England
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, England
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, England
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, England
| | - Stephen Jones
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England
| | - Cameron G Densem
- Department of Cardiology, Royal Papworth Hospital, Cambridge, England
| | - Steven Tsui
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, England
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Joseph D Mills
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, England
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Ragheb Hasan
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, England
| | - Douglas G W Fraser
- Department of Cardiovascular Medicine, University of Manchester, Manchester, England
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, England
| | - Simon W Davies
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Alison Duncan
- Cardiac Department, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Nick Curzen
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, England
| | | | - Pankaj Kaul
- Department of Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, England
| | - Douglas F Muir
- Department of Cardiology, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, England
| | - Neal G Uren
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - Simon Kennon
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Wael I Awad
- Barts Heart Centre, Barts Health NHS Trust, London, England
| | - Saib S Khogali
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, England
| | | | - Richard J Edwards
- Cardiothoracic Department, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England
| | | | - Miles Dalby
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, England
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Leicester, England
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Clinton Lloyd
- Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, England
| | - Ian D Cox
- Department of Cardiology, Derriford Hospital, Plymouth, England
| | - Simon R Redwood
- Cardiovascular Division, King's College London, British Heart Foundation Centre of Research Excellence, Rayne Institute, St Thomas' Hospital, London, England
| | - Mark G Gunning
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, England
| | - Paul D Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, England
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Barton J, Hussain A, Chaubey S, Mittal A, Khan H, Wendler O. Surgical management and long-term follow-up of aberrant right coronary arteries in adults. J Card Surg 2022; 37:1497-1502. [PMID: 35355326 DOI: 10.1111/jocs.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Anomalous origins of the right coronary artery (RCA) can cause ischaemia and sudden cardiac death, particularly if the RCA runs between the aorta and pulmonary artery. Conventional coronary artery bypass grafting (CABG) can be affected by early graft failure due to collateral blood flow. We present our institutional experience in managing patients with RCA anomalies. METHODS A single-center retrospective review of all patients who underwent surgery for aberrant right coronary arteries between 2005 and 2021 was conducted and in-hospital and long-term outcomes were analysed at our institution. RESULTS A total of 10 patients (5 females, median age: 51 years, 36-62) were identified. They presented with symptoms of chest pain (n = 8), dyspnoea (n = 1) or following cardiac arrest (n = 1). In the majority the RCA originated from the left coronary sinus (n = 9). In one of those patients and one in whom the RCA originated directly from the left anterior descending artery CABG was performed. The other 8 patients were treated using transfer of the RCA ostium. All patients were discharged home (median hospital stay 5 days, range: 4-10). Four patients experienced post-op atrial fibrillation. No other complications were observed. At a median follow-up of 10 years and 9 months, 9 patients were alive and free from cardiac symptoms. One patient died 3 years postsurgery due to liver failure, unrelated to cardiac disease. CONCLUSIONS In patients with an aberrant RCA, transfer of the ostium into the RCS carries a low surgical risk. It overcomes early graft failure in these patients, who present with a dynamic impairment in RCA blood flow. However, if fixed proximal RCA flow-limiting pathology exists, conventional bypass surgery is feasible.
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Affiliation(s)
- James Barton
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Aaina Mittal
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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25
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Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, Davidavičius G, Kalinauskas G, Mansour S, Kharbanda R, Östlund-Papadogeorgos N, Aminian A, Oldroyd KG, Al-Attar N, Jagic N, Dambrink JHE, Kala P, Angerås O, MacCarthy P, Wendler O, Casselman F, Witt N, Mavromatis K, Miner SES, Sarma J, Engstrøm T, Christiansen EH, Tonino PAL, Reardon MJ, Lu D, Ding VY, Kobayashi Y, Hlatky MA, Mahaffey KW, Desai M, Woo YJ, Yeung AC, Pijls NHJ. Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med 2022; 386:128-137. [PMID: 34735046 DOI: 10.1056/nejmoa2112299] [Citation(s) in RCA: 141] [Impact Index Per Article: 70.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. (Funded by Medtronic and Abbott Vascular; FAME 3 ClinicalTrials.gov number, NCT02100722.).
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Affiliation(s)
- William F Fearon
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Frederik M Zimmermann
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Bernard De Bruyne
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Zsolt Piroth
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Albert H M van Straten
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Laszlo Szekely
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Giedrius Davidavičius
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Gintaras Kalinauskas
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Samer Mansour
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Rajesh Kharbanda
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nikolaos Östlund-Papadogeorgos
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Adel Aminian
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Keith G Oldroyd
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nawwar Al-Attar
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nikola Jagic
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Jan-Henk E Dambrink
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Petr Kala
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Oskar Angerås
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Philip MacCarthy
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Olaf Wendler
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Filip Casselman
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nils Witt
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Kreton Mavromatis
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Steven E S Miner
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Jaydeep Sarma
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Thomas Engstrøm
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Evald H Christiansen
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Pim A L Tonino
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Michael J Reardon
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Di Lu
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Victoria Y Ding
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Yuhei Kobayashi
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Mark A Hlatky
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Kenneth W Mahaffey
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Manisha Desai
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Y Joseph Woo
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Alan C Yeung
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nico H J Pijls
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
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Tribouilloy C, Bohbot Y, Kubala M, Ruschitzka F, Popescu B, Wendler O, Laroche C, Bartha E, Ince H, Simajova I, Vahanian A, Iung B. Characteristics, management and outcomes of patients with multiple native valvular heart disease: A substudy of the EURObservational research programme valvular heart disease II survey. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.131] [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: 11/24/2022]
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Bharucha AH, Eskandari M, Wendler O, Baghai M. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:831-832. [PMID: 35137090 PMCID: PMC9070495 DOI: 10.1093/icvts/ivac015] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Olaf Wendler
- The Cardiac Care Group, King’s College Hospital, London, UK
| | - Max Baghai
- The Cardiac Care Group, King’s College Hospital, London, UK
- Corresponding author. The Cardiac Care Group,King’s College Hospital, Denmark Hill, London SE5 9RS, UK. Tel: +44-2032994365; e-mail: (M. Baghai)
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Eugène M, Duchnowski P, Prendergast B, Wendler O, Laroche C, Monin JL, Jobic Y, Popescu BA, Bax JJ, Vahanian A, Iung B. Contemporary Management of Severe Symptomatic Aortic Stenosis. J Am Coll Cardiol 2021; 78:2131-2143. [PMID: 34823655 DOI: 10.1016/j.jacc.2021.09.864] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age-adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians.
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Affiliation(s)
- Marc Eugène
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Piotr Duchnowski
- Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Jean-Luc Monin
- Cardiology Department, Institut Mutualiste Montsouris, Paris, France
| | - Yannick Jobic
- Cardiology Department, Hôpital Cavale Blanche, Brest, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila-Euroecolab, Emergency Institute for Cardiovascular Diseases Prof Dr C. C. Iliescu, Bucharest, Romania
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bernard Iung
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
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Stoehr R, Wendler O, Giedl J, Gaisa NT, Richter G, Campean V, Burger M, Wullich B, Bertz S, Hartmann A. Risk of penile tumor development in Caucasian individuals is independent of the coding variant rs7208422 in the TMC8 (EVER2) gene. Mol Clin Oncol 2021; 15:267. [PMID: 34790351 DOI: 10.3892/mco.2021.2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022] Open
Abstract
Genetic variation in the transmembrane channel-like (TMC)6/TMC8 region has been linked to β-type human papillomavirus (HPV) infection and squamous cell carcinoma (SCC) of the skin and the head and neck, α-type HPV persistence and progression to cervical cancer. The functional variant rs7208422 of the TMC8 gene was suggested to have a high impact on susceptibility to β-papillomaviruses and their oncogenic potential and to also have an influence on α-type HPV-related disease. The aim of the present study was to evaluate a possible influence of rs7208422 on penile cancer risk, a known α-type HPV-related malignancy. Therefore, the distribution of rs7208422 was determined by direct Sanger sequencing of 104 Caucasian penile SCC cases and compared to data of 3,810 controls taken from the literature. HPV detection was performed by usage of GP5+/6+ primers and subtype-specific PCR. It was observed that the distribution of rs7208422 followed the Hardy-Weinberg equilibrium in both cases and controls. HPV DNA was detected in 39% of the penile SCC cases. Overall, there was no significant difference in the distribution of rs7208422 neither between cases and controls (P=0.726) nor between HPV-positive and -negative penile SCC cases (P=0.747). There was also no association between rs7208422 genotypes and age of disease onset (P=0.740). In conclusion, the present data argue against a significant impact of rs7208422 on the risk for the development of penile SCC in Caucasians. Even in combination with the HPV status, the SNP appears not to influence the risk of penile SCC in HPV-positive cases.
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Affiliation(s)
- Robert Stoehr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany
| | - Olaf Wendler
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany.,Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Johannes Giedl
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, RWTH Aachen University, D-52074 Aachen, Germany
| | | | | | - Maximilian Burger
- St. Josef Medical Centre, Department of Urology, University Regensburg, De-93053 Regensburg, Germany
| | - Bernd Wullich
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany.,Department of Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, D-91054 Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), D-91054 Erlangen, Germany
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Birkinshaw A, Kamdar R, Aylwin S, Wendler O, Sado D. Left atrial paraganglioma in a patient with sarcoidosis. Eur Heart J Cardiovasc Imaging 2021; 22:e5. [PMID: 32808020 DOI: 10.1093/ehjci/jeaa211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander Birkinshaw
- Department of Cardiology, Kings College Hospital, Denmark Hill, London, SE59RS, UK
| | - Ravi Kamdar
- Department of Cardiology, Kings College Hospital, Denmark Hill, London, SE59RS, UK.,Department of Cardiology, Croydon University Hospital, 530 London Road, Thornton Heath, CR7 7YE, UK
| | - Simon Aylwin
- Department of Endocrinology, Kings College Hospital, Denmark Hill, London, SE59RS, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London, SE59RS, UK.,Department of Cardiovascular Medicine, Kings College London, Denmark Hill, London, SE59RS, UK
| | - Daniel Sado
- Department of Cardiology, Kings College Hospital, Denmark Hill, London, SE59RS, UK.,Department of Cardiovascular Medicine, Kings College London, Denmark Hill, London, SE59RS, UK
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Maznyczka AM, Barakat M, Aldalati O, Eskandari M, Wollaston A, Tzalamouras V, Dworakowski R, Deshpande R, Monaghan M, Byrne J, Wendler O, MacCarthy P, Okonko D. Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation. Open Heart 2021; 7:openhrt-2020-001477. [PMID: 33361316 PMCID: PMC7759954 DOI: 10.1136/openhrt-2020-001477] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/21/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Congestion can worsen outcomes after transcatheter aortic valve implantation (TAVI), but can be difficult to quantify non-invasively. We hypothesised that preprocedural plasma volume status (PVS), estimated using a validated formula that enumerates percentage change from ideal PV, would provide prognostic utility post-TAVI. Methods This retrospective cohort study identified patients who underwent TAVI (2007–2017) from a prospectively collected database. Actual ([1-haematocrit] × [a + (b × weight (Kg))] and ideal (c × weight (Kg)) PV were quantified from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual – ideal PV)/ideal PV]). Results In 564 patients (mean age 82±7 years, 49% male), mean PVS was −2.7±10.2%, with PV expansion (PVS >0%) evident in 39%. Only logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) independently predicted a PVS >0% (OR 1.85, p=0.002). On Cox analyses, a PVS >0% was associated with greater mortality at 3 (HR 2.29, 95% CI 1.11 to 4.74, p=0.03) and 12 months (HR 2.00, 95% CI 1.23 to 3.26, p=0.006) after TAVI, independently of, and incremental to, the EuroSCORE and New York Heart Association class. A PVS >0% was also independently associated with more days in intensive care (coefficient: 0.41, 95% CI 0.04 to 0.78, p=0.03) and in hospital (coefficient: 1.95, 95% CI 0.48 to 3.41, p=0.009). Conclusion Higher PVS values, calculated simply from weight and haematocrit, are associated with greater mortality and longer hospitalisation post-TAVI. PVS could help refine risk stratification and further investigations into the utility of PVS-guided management in TAVI patients is warranted.
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Affiliation(s)
- Annette Marie Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K, Glasgow, UK.,Cardiology, King's College Hospital, London, UK
| | - Mohamad Barakat
- Cardiology, King's College Hospital, London, UK.,King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, James Black Centre, London, UK
| | | | | | | | | | | | - Ranjit Deshpande
- Cardiothoracic Surgery, Kings College Hospital Kings Health Partners London UK, London, UK
| | - Mark Monaghan
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, James Black Centre, London, UK
| | | | - Olaf Wendler
- Cardiothoracic Surgery, Kings College Hospital Kings Health Partners London UK, London, UK
| | | | - Darlington Okonko
- Cardiology, King's College Hospital, London, UK .,King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, James Black Centre, London, UK
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Wendler O, Baghai M. Transapical aortic valve implantation: never limited by aortic disease or vascular access, but always needed? Eur J Cardiothorac Surg 2021; 59:1181-1182. [PMID: 33772311 DOI: 10.1093/ejcts/ezab120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK.,Cleveland Clinic London, Heart, Vascular and Thoracic Institute, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK
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Tziridis K, Forster J, Buchheidt-Dörfler I, Krauss P, Schilling A, Wendler O, Sterna E, Schulze H. Tinnitus development is associated with synaptopathy of inner hair cells in Mongolian gerbils. Eur J Neurosci 2021; 54:4768-4780. [PMID: 34061412 DOI: 10.1111/ejn.15334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/22/2021] [Accepted: 05/14/2021] [Indexed: 02/06/2023]
Abstract
Human hearing loss (HL) is often accompanied by comorbidities like tinnitus, which is affecting up to 15% of the adult population. Rodent animal studies could show that tinnitus may not only be a result of apparent HL due to cochlear hair cell damage but can also be a consequence of synaptopathy at the inner hair cells (IHCs) already induced by moderate sound traumata. Here, we investigate synaptopathy previously shown in mice in our animal model, the Mongolian gerbil, and relate it to behavioral signs of tinnitus. Tinnitus was induced by a mild monaural acoustic trauma leading to monaural noise induced HL in the animals, quantified by auditory brainstem response (ABR) audiometry. Behavioral signs of tinnitus percepts were detected by measurement of prepulse inhibition of the acoustic startle response in a gap-noise paradigm. Fourteen days after trauma, the cochleae of both ears were isolated, and IHC synapses were counted within several spectral regions of the cochlea. Behavioral signs of tinnitus were only found in animals with IHC synaptopathy, independent of type of HL. On the other hand, animals with apparent HL but without behavioral signs of tinnitus showed a reduction in amplitudes of ABR waves I&II but no significant changes in the number of synapses at the IHC. We conclude-in line with the literature-that HL is caused by damage to the IHC or by other reasons but that the development of tinnitus, at least in our animal model, is closely linked to synaptopathy at the IHC.
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Affiliation(s)
- Konstantin Tziridis
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jan Forster
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Isabelle Buchheidt-Dörfler
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Patrick Krauss
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Achim Schilling
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Olaf Wendler
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elisabeth Sterna
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Holger Schulze
- Experimental Otolaryngology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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34
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Baghai M, Wendler O, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Aortic valve surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 60:1353-1357. [PMID: 34021313 DOI: 10.1093/ejcts/ezab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since the turn of the century, cardiac surgery has evolved quite notably. This study sought to investigate the trends in aortic valve surgery activity and subsequent outcomes in the UK by using a mandatory national cardiac surgical clinical database within the context of a comprehensive public healthcare system (National Health Service). METHODS The UK National Adult Cardiac Surgery Audit database provided data for aortic valve surgery procedures performed between 2002 and 2016, and the data were validated and cleaned using reproducible algorithms. The findings and trends in in activity and outcomes were then analysed by financial year. RESULTS During the study period, a total of 148 862 procedures were performed, with the number of cases per year peaking in 2014/2015 at 12 483. The mean in-hospital mortality rate for all aortic valve surgery has fallen from 5.6% to 3.4%, despite an increase in patient age and mean logistic EuroSCORE. While the number of isolated aortic valve replacements has remained stable at around 5000 per year, aortic valve replacement and coronary artery bypass graft have increased to over 3200 with transcatheter aortic valve implantation activity continuing to increase. CONCLUSIONS This study demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality within all aortic valve surgery procedures performed in the UK over a 15-year period. Increasing catheter-based interventions have not yet resulted in a significant decrease in surgical aortic valve replacements in the UK.
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Affiliation(s)
- Max Baghai
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Olaf Wendler
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Maier RH, Kasim AS, Zacharias J, Vale L, Graham R, Walker A, Laskawski G, Deshpande R, Goodwin A, Kendall S, Murphy GJ, Zamvar V, Pessotto R, Lloyd C, Dalrymple-Hay M, Casula R, Vohra HA, Ciulli F, Caputo M, Stoica S, Baghai M, Niranjan G, Punjabi PP, Wendler O, Marsay L, Fernandez-Garcia C, Modi P, Kirmani BH, Pullan MD, Muir AD, Pousios D, Hancock HC, Akowuah E. Minimally invasive versus conventional sternotomy for Mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral). BMJ Open 2021; 11:e047676. [PMID: 33853807 PMCID: PMC8054102 DOI: 10.1136/bmjopen-2020-047676] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice. METHODS AND ANALYSIS UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery. ETHICS AND DISSEMINATION A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13930454.
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Affiliation(s)
- Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Zacharias
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Richard Graham
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Antony Walker
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Grzegorz Laskawski
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit Deshpande
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Goodwin
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Simon Kendall
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Vipin Zamvar
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Renzo Pessotto
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Clinton Lloyd
- Cardiothoracic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Roberto Casula
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Hunaid A Vohra
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Serban Stoica
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Max Baghai
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gunaratnam Niranjan
- Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Prakash P Punjabi
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Leanne Marsay
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul Modi
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bilal H Kirmani
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark D Pullan
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrew D Muir
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dimitrios Pousios
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Enoch Akowuah
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Tarantini G, Baumgartner H, Frank D, Husser O, Bleiziffer S, Rudolph T, Jeger R, Fraccaro C, Hovorka T, Wendler O. Four-year mortality in women and men after transfemoral transcatheter aortic valve implantation using the SAPIEN 3. Catheter Cardiovasc Interv 2021; 97:876-884. [PMID: 32886851 DOI: 10.1002/ccd.29257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/07/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate 4-year, post-transcatheter aortic valve implantation (TAVI) survival and predictors of survival by sex, in a real-world cohort that underwent transfemoral TAVI with SAPIEN 3 transcatheter heart valve. BACKGROUND Previous TAVI investigations of first-generation devices demonstrated an early- to mid-term survival advantage in women compared with men. METHODS SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) is a post-approval, multicentre, observational registry. Patients (N = 1,694, 49.2% women, age 81.7 ± 6.7 years) with severe aortic stenosis and high surgical risk (logistic EuroSCORE 17.8%) underwent TAVI between 2014 and 2015. Kaplan-Meier event estimates were used to determine mortality by sex. Predictors of overall mortality were identified using a cox multivariate proportional hazard model. RESULTS At 4 years, women had lower all-cause mortality than men (36.0 vs 39.7%; p = .0911; HR: 0.87 [95% CI: 0.75-1.02]). No difference was observed for cardiac mortality between women 24.2% and men 24.7% (p = .76; HR: 0.97 [95% CI: 0.79-1.19]). When adjusted for baseline characteristics (age, height, weight, NYHA functional class, renal insufficiency, EuroScore, and tricuspid regurgitation), sex had no impact on mortality. CONCLUSIONS In this large, real-world cohort, all-cause mortality trended lower in women than men at 4 years post TAVI; however, several baseline factors, but not sex, were predictors of mortality. No difference between sexes was observed for cardiovascular mortality.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Helmut Baumgartner
- Department of Cardiology III, University-Hospital Münster, Münster, Germany
| | - Derk Frank
- University Hospital Schleswig-Holstein, Kiel, Germany and DZHK (German Centre for Cardiovascular Research), Kiel, Germany
| | - Oliver Husser
- Department of Cardiology, Klinik für Innere Medizin, St.-Johannes-Hospital, Dortmund, Germany
| | - Sabine Bleiziffer
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Klinik für Thorax- und Kardiovaskularchirurgie, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Raban Jeger
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Tomas Hovorka
- Statistics Department, Edwards Lifesciences, Prague, Czech Republic
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Peters G, Wendler O, Böhringer D, Gostian AO, Müller SK, Canziani H, Hesse N, Semmler M, Berry DA, Kniesburges S, Peukert W, Döllinger M. Human Laryngeal Mucus from the Vocal Folds: Rheological Characterization by Particle Tracking Microrheology and Oscillatory Shear Rheology. Appl Sci (Basel) 2021; 11. [PMID: 33850630 PMCID: PMC8041056 DOI: 10.3390/app11073011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mucus consistency affects voice physiology and is connected to voice disorders. Nevertheless, the rheological characteristics of human laryngeal mucus from the vocal folds remain unknown. Knowledge about mucus viscoelasticity enables fabrication of artificial mucus with natural properties, more realistic ex-vivo experiments and promotes a better understanding and improved treatment of dysphonia with regard to mucus consistency. We studied human laryngeal mucus samples from the vocal folds with two complementary approaches: 19 samples were successfully applied to particle tracking microrheology (PTM) and five additional samples to oscillatory shear rheology (OSR). Mucus was collected by experienced laryngologists from patients together with demographic data. The analysis of the viscoelasticity revealed diversity among the investigated mucus samples according to their rigidity (absolute G′ and G″). Moreover some samples revealed throughout solid-like character (G′ > G″), whereas some underwent a change from solid-like to liquid-like (G′ < G″). This led to a subdivision into three groups. We assume that the reason for the differences is a variation in the hydration level of the mucus, which affects the mucin concentration and network formation factors of the mucin mesh. The demographic data could not be correlated to the differences, except for the smoking behavior. Mucus of predominant liquid-like character was associated with current smokers.
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Affiliation(s)
- Gregor Peters
- Department of Otorhinolaryngology, Div. of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Olaf Wendler
- Department of Otorhinolaryngology, Div. of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - David Böhringer
- Biophysics Group, Department of Physics, Friedrich-Alexander-University Erlangen-Nürnberg, 91052 Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sarina K Müller
- Department of Otorhinolaryngology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Herbert Canziani
- Department of Chemical and Biological Engineering, Chair of Particle Technology, Friedrich-Alexander-University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Nicolas Hesse
- Department of Chemical and Biological Engineering, Chair of Particle Technology, Friedrich-Alexander-University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Marion Semmler
- Department of Otorhinolaryngology, Div. of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - David A Berry
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Stefan Kniesburges
- Department of Otorhinolaryngology, Div. of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Wolfgang Peukert
- Department of Chemical and Biological Engineering, Chair of Particle Technology, Friedrich-Alexander-University Erlangen-Nürnberg, 91058 Erlangen, Germany
| | - Michael Döllinger
- Department of Otorhinolaryngology, Div. of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Khan H, Hussain A, Chaubey S, Sameh M, Salter I, Deshpande R, Baghai M, Wendler O. Acute aortic dissection type A: Impact of aortic specialists on short and long term outcomes. J Card Surg 2021; 36:952-958. [PMID: 33415734 DOI: 10.1111/jocs.15292] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Acute aortic dissection type-A (AADA) is a life threatening condition which requires emergency surgery. Surgery is usually performed by cardiac surgeons with various levels of aortic surgical experience. We compared the short-term perioperative outcome and long-term survival of patients operated by specialist aortic surgeons (SASs)and those who were operated by surgeons without specialist expertise. METHODS A single center retrospective review of 232 patients who underwent acute surgery for AADA was conducted between 2005 and 2020. The cohort was divided into those operated on by SASs (Group A, n = 186) and those operated on by nonaortic surgeons (Group B, n = 46). Statistical comparison was done using regression modelling and groups were propensity matched. Kaplan-Meier comparison was undertaken using STATA14. RESULTS Of 232 patients, 186 were operated on by an aortic specialist and 46 were operated by a nonaortic specialist. Overall 30-day mortality was 10% in Group A compared to 26.0% in Group B (unadjusted: p = .01, multivariate: p = .02, and propensity matched p = .05). Long-term mortality at 14 years was 26% in Group A compared to 52.0% in Group B (unadjusted: p = .001, multivariate: p = .001, and propensity matched: p = .01). Aortic surgeons performed a significantly higher number of aortic root procedures (43.0% vs. 17.3%, p = .001). The cross-clamp time and bypass time was significantly shorter in Group A patients (89 vs. 105 min, p < .01 and 153 vs. 185, p = < .001). Postoperative requirement for renal filtration was (19% vs. 37%, unadjusted p = .01, multivariate p = .03 and propensity matched p = .04). Although postoperative bleeding was less in Group A (4.0% vs. 11.0%, unadjusted p = .05) after propensity matching it was not statistically significant. CONCLUSIONS In patients with AADA, surgery performed by aortic specialist's results in improved outcomes. Aortic specialists replaced more of dissected aorta, resulting in an increased number of complex procedures, which may explain improved long-term survival after AADA in this cohort. This study adds further support in establishing a specialist aortic surgical service in cardiac centers.
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Affiliation(s)
- Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mohamed Sameh
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Inga Salter
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Navaratnarajah A, Bhan A, Alcock E, Dew T, Monaghan M, Shah AM, Wendler O, MacCarthy P, Dworakowski R. Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation. Cardiol J 2020; 29:824-835. [PMID: 33346373 PMCID: PMC9550344 DOI: 10.5603/cj.a2020.0169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022] Open
Abstract
Background Acute kidney injury (AKI) is a frequent complication of transcatheter aortic valve implantation (TAVI) and has been linked to preexisting comorbidities, peri-procedural hypotension, and systemic inflammation. The extent of systemic inflammation after TAVI is not fully understood. Our aim was to characterize the inflammatory response after TAVI and evaluate its contribution to the mechanism of post-procedural AKI. Methods One hundred and five consecutive patients undergoing TAVI at our institution were included. We analyzed the peri-procedural inflammatory and oxidative stress responses by measuring a range of biomarkers (including C-reactive protein [hsCRP], cytokine levels, and myeloperoxidase [MPO]), before TAVI and 6, 24, and 48 hours post-procedure. We correlated this with changes in renal function and patient and procedural characteristics. Results We observed a significant increase in plasma levels of pro-inflammatory cytokines (hsCRP, interleukin 6, tumor necrosis factor alpha receptors) and markers of oxidative stress (MPO) after TAVI. The inflammatory response was significantly greater after transapical (TA) TAVI compared to transfemoral (TF). This was associated with a higher incidence of AKI in the TA cohort compared to TF (44% vs. 8%, respectively, p < 0.0001). The incidence of AKI was significantly lower when N-acetylcysteine (NAC) was given peri-procedurally (12% vs. 38%, p < 0.005). In multivariate analysis, only the TA approach and no use of NAC before the procedure were independent predictors of AKI. Conclusions TAVI creates a significant post-procedural inflammatory response, more so with the TA approach. Mechanisms of AKI after TAVI are complex. Inflammatory response, hypoperfusion, and oxidative stress may all play a part and are potential therapeutic targets to reduce/prevent AKI.
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Affiliation(s)
- Arunraj Navaratnarajah
- Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Amit Bhan
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Emma Alcock
- Department of Anaesthesia, King's College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Tracy Dew
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Mark Monaghan
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Ajay M Shah
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, SE5 9RS London, United Kingdom. .,1st Department of Cardiology, Medical University of Gdansk, Poland.
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Hussain A, Noorani A, Deshpande R, John L, Baghai M, Wendler O, Whitaker D, Khan H. Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience. Interact Cardiovasc Thorac Surg 2020; 31:540-543. [PMID: 32865193 PMCID: PMC7499637 DOI: 10.1093/icvts/ivaa129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 02/04/2023] Open
Abstract
A significant proportion of patients infected with the novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), require intensive care admission and subsequent mechanical ventilation. Pneumothorax, a potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. We present a case series and a suggested best-practice protocol for how to manage and treat pneumothoraces in COVID-19 patients in an intensive care unit setting.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Alia Noorani
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Lindsay John
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Donald Whitaker
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Kanyal R, Bharucha AH, Papachristidis A, Wendler O, Tzalamouras V. Thrombosis of an Aneurysmal Left Main Coronary Artery in a Young Female. JACC Cardiovasc Interv 2020; 13:e173-e174. [PMID: 32950422 DOI: 10.1016/j.jcin.2020.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Ritesh Kanyal
- Department of Cardiology, King's College Hospital, London, United Kingdom.
| | - Apurva H Bharucha
- Department of Cardiology, King's College Hospital, London, United Kingdom
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
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Schymik G, Wendler O, Hengstenberg C, Ohlmann P, Gilard M, Digne F, Souteyrand G, Letocart V, van Belle E, Bramlage P, Tarantini G. Outcomes of transfemoral balloon expandable transcatheter aortic valve implantation: Comparison of two subsequent valve generations. Catheter Cardiovasc Interv 2020; 96:930-939. [PMID: 31794159 DOI: 10.1002/ccd.28621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/28/2019] [Accepted: 11/11/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND The SAPIEN 3 (S3) addresses several limitations of the SAPIEN XT (SXT) for the performance of transfemoral (TF-) balloon expandable transcatheter aortic valve implantation (TAVI). OBJECTIVES We aimed to determine whether their altered features translate into improved outcomes in a real-world TF-TAVI patient population. METHODS Data for 3,314 patients were extracted from the European registries SOURCE-XT and SOURCE-3. Patients were propensity-score (PS) matched (n = 1,169/group). RESULTS In the PS matched comparison, device success was higher in the S3 (99.2%) compared to the SXT group (98.2%; p = .04). S3 patients experienced a lower rate of procedural death (0.7 vs. 2.6%; p = .0004), moderate/severe paravalvular leakage (PVL; 1.4 vs. 5.5%; p < .0001), and procedure-related stroke (1.2 vs. 2.4%; p = .04) while higher rates of mean aortic valve gradients ≥20 mmHg, and new permanent pacemaker implantations were seen. At 30 days a lower rate of all-cause mortality was seen (2.1% vs. 4.3%; p = .003), which was preserved after 1 year (10.7% vs. 14.9%; p = .002). A Cox regression predicting 1-year mortality resulted in a hazard ratio of 0.684 in favor of S3 (p = .0026). The same was true of stroke (2.8% vs. 5.7%; p = .0007), and moderate/severe PVL (2.7 vs. 7.3%; p = .0002) at 1 year. The rate of new pacemaker implantations (13.6% vs. 9.5%; p = .001) and NYHA III/IV (12.8 vs. 8.6%; p = .004) was higher with the S3. CONCLUSIONS The improved features of the S3 appear to translate into improved survival and reduced rates of adverse complications, with the exception of a higher rate of new pacemaker implantations.
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Affiliation(s)
| | | | - Christian Hengstenberg
- Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Vienna, Austria
| | | | | | - Franck Digne
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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43
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Prendergast BD, Baumgartner H, Delgado V, Gérard O, Haude M, Himmelmann A, Iung B, Leafstedt M, Lennartz J, Maisano F, Marinelli EA, Modine T, Mueller M, Redwood SR, Rörick O, Sahyoun C, Saillant E, Søndergaard L, Thoenes M, Thomitzek K, Tschernich M, Vahanian A, Wendler O, Zemke EJ, Bax JJ. Transcatheter heart valve interventions: where are we? Where are we going? Eur Heart J 2020; 40:422-440. [PMID: 30608523 DOI: 10.1093/eurheartj/ehy668] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022] Open
Abstract
Transcatheter heart valve interventions have transformed the outcomes of patients with valvular heart disease (VHD) who are unfavourable candidates for surgery. Technological advances have allowed extension of these interventions to younger or lower risk patients and those with other forms of VHD and may in the future permit earlier treatment of VHD in less symptomatic patients or those with moderate disease. The balance of risks and benefits is likely to differ between lower and higher risk patients, and more evidence is needed to evaluate the net benefit of transcatheter technology in these groups. As academic researchers, clinicians, industry, and patient stakeholders collaborate to research these broader indications for transcatheter valve interventions, it is essential to address (i) device durability and deliverability, (ii) specific anatomical needs (e.g. bicuspid aortic valves, aortic regurgitation, mitral and tricuspid valve disease), (iii) operator training, and (iv) the reinforced importance of the multidisciplinary Heart Team.
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Affiliation(s)
| | - Helmut Baumgartner
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | | | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Neuss, Germany
| | | | - Bernard Iung
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, Paris, France
| | | | | | - Francesco Maisano
- Klinik für Herz- und Gefässchirurgie, UniversitätsSpital Zürich, Zürich, Switzerland
| | | | - Thomas Modine
- Department of Cardiovascular Surgery, Hopital Cardiologique CHRU de Lille, Lille, France
| | | | - Simon R Redwood
- Department of Cardiology, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | | | | | | | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Alec Vahanian
- AP-HP, Cardiology Department, Bichat Hospital, Paris-Diderot University, Paris, France
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
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44
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Guerrero M, Wang DD, Pursnani A, Eleid M, Khalique O, Urena M, Salinger M, Kodali S, Kaptzan T, Lewis B, Kato N, Cajigas HM, Wendler O, Holzhey D, Pershad A, Witzke C, Alnasser S, Tang GH, Grubb K, Reisman M, Blanke P, Leipsic J, Williamson E, Pellikka PA, Pislaru S, Crestanello J, Himbert D, Vahanian A, Webb J, Hahn RT, Leon M, George I, Bapat V, O’Neill W, Rihal C. A Cardiac Computed Tomography–Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization. JACC Cardiovasc Imaging 2020; 13:1945-1957. [DOI: 10.1016/j.jcmg.2020.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
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Abstract
Abstract
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Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, DHU FIRE, Paris, France.,Université de Paris, Paris, France
| | - Olaf Wendler
- Cleveland Clinic London, King's College Hospital, London, UK
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46
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Neumann FJ, Redwood S, Abdel-Wahab M, Lefèvre T, Frank D, Eltchaninoff H, Caussin C, Stella PR, Hovorka T, Baumgartner H, Tarantini G, Wendler O, Treede H. General Anesthesia or Conscious Sedation for Transfemoral Aortic Valve Replacement with the SAPIEN 3 Transcatheter Heart Valve. Int Heart J 2020; 61:713-719. [PMID: 32684591 DOI: 10.1536/ihj.19-567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Differences in the benefits of conscious sedation (CS) and general anesthesia (GA) during transfemoral aortic valve implantation (TAVI) are unclear.We aimed to assess differences in procedural and clinical outcomes based on the type of anesthesia received during TAVI.We analyzed SOURCE 3 Registry data for patients who received the SAPIEN 3 valve by type of anesthesia used during TAVI.Of the 1694 TAVI patients, 1027 received CS and 667 received GA. Patients were similar at baseline (81.5 years; Society of Thoracic Surgeons risk score 7.0). Compared with the GA group, the CS group had fewer intra-procedural transesophageal echocardiography (TEE) and post implantation dilatations performed, and less contrast medium was used. The CS group had significantly less kidney injury at 7 days post-procedure than the GA group (0.4% versus 1.5%, P = 0.014). Moderate paravalvular leaks (PVL) occurred more frequently in the CS group versus the GA group (2.2% versus 0.8%; P = 0.041). No severe PVL were reported. Median total hospital length of stay (LOS) after TAVI was 10 days in the CS group and 11 days in the GS group. At 30 days, all-cause death was 2.1% in CS and 1.7% in GS (P = 0.47), and myocardial infarction was 0.2% in CS and 0.1% in GS (P = 0.83).Our analyses found no significant major outcome differences between CS and GA during TAVI.
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Affiliation(s)
| | | | | | - Thierry Lefèvre
- Institut Cardiovasculaire Paris Sud, Hopital privé Jacques Cartier
| | - Derk Frank
- University Hospital, Schleswig-Holstein, Kiel and DZHK (German Center for Cardiovascular Research, Kiel/Lübeck/Hamburg)
| | | | | | | | | | - Helmut Baumgartner
- Department of Cardiology III, University Hospital, Adult Congenital & Valvular Heart Disease
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Tarantini G, Nai Fovino L, Le Prince P, Darremont O, Urena M, Bartorelli AL, Vincent F, Hovorka T, Alcalá Navarro Y, Dumonteil N, Ohlmann P, Wendler O. Coronary Access and Percutaneous Coronary Intervention Up to 3 Years After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve. Circ Cardiovasc Interv 2020; 13:e008972. [PMID: 32580586 PMCID: PMC7373469 DOI: 10.1161/circinterventions.120.008972] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Coronary artery disease and aortic stenosis often coexist. Transcatheter aortic valve implantation (TAVI) has emerged as a valid therapeutic option for younger, lower-risk patients who may eventually require coronary artery disease treatment. Thus, post-TAVI coronary access (CA) and percutaneous coronary intervention are expected to increase. The purpose of this study was to retrospectively evaluate patients who were enrolled in the SOURCE 3 (SAPIEN 3 Aortic Bioprosthesis European Outcome) European registry for treatment with the balloon-expandable SAPIEN 3 transcatheter heart valve and underwent CA with or without percutaneous coronary intervention after TAVI. Methods: Baseline characteristics and clinical outcomes of patients with or without CA up to 3 years after TAVI were compared. A Kaplan-Meier estimate with a univariate model determined the impact of CA on cardiac mortality. Results: Of 1936 TAVI patients (mean age 81.6 years, 52% male), 68 (3.5%) had CA within 3 years (mean 441±332 days) after TAVI. At baseline, the logistic EuroSCORE was similar (20.2% versus 18.3%, P=0.2, CA and non-CA groups, respectively). Higher rates of coronary artery disease (76.5% versus 50.6%, P<0.001), myocardial infarction (20.6% versus 11.5%, P=0.03) and previous coronary artery bypass graft (22.1% versus 11.0%, P=0.01) were present in the CA group. In 100% of patients, CA was successfully achieved. The clinical success of percutaneous coronary intervention was 97.9%. Cardiovascular mortality was numerically higher in patients with CA than in those without CA. Conclusions: In the large SOURCE 3 European registry, CA was needed at 3-year follow-up after TAVI with a balloon-expandable valve in 3.5% of patients and was successful in all patients. The clinical success of percutaneous coronary intervention was 97.9%. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02698956.
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Affiliation(s)
- Giuseppe Tarantini
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | - Luca Nai Fovino
- Cardiology Clinic, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health Padova, University of Padua, Italy (G.T., L.N.F.)
| | | | | | | | | | | | - Tomas Hovorka
- Edwards Lifesciences, Prague, Czech Republic (T.H., Y.A.N.)
| | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel (GCVI), Clinique Pasteur, Toulouse, France (N.D.)
| | - Patrick Ohlmann
- Department of Interventional Cardiology, University Hospital of Strasbourg, France (P.O.)
| | - Olaf Wendler
- King's College Hospital, London, United Kingdom (O.W.)
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48
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Meuris B, Borger MA, Bourguignon T, Siepe M, Grabenwöger M, Laufer G, Binder K, Polvani G, Stefano P, Coscioni E, van Leeuwen W, Demers P, Dagenais F, Canovas S, Theron A, Langanay T, Roussel JC, Wendler O, Mariscalco G, Pessotto R, Botta B, Bramlage P, de Paulis R. Durability of bioprosthetic aortic valves in patients under the age of 60 years - rationale and design of the international INDURE registry. J Cardiothorac Surg 2020; 15:119. [PMID: 32460798 PMCID: PMC7251702 DOI: 10.1186/s13019-020-01155-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. METHODS The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INSPIRIS RESILIA aortic valve. INDURE will be conducted across 20-22 sites in Europe and Canada and intends to enrol minimum of 400 patients. Patients will be included if they are scheduled to undergo AVR with or without concomitant root replacement and/or coronary bypass surgery. The primary objectives are to 1) determine VARC-2 defined time-related valve safety at one-year (depicted as freedom from events) and 2) determine freedom from stage 3 structural valve degeneration (SVD) presenting as morphological abnormalities and severe haemodynamic valve degeneration at 5 years. Secondary objectives include the assessment of the haemodynamic performance of the valve, all stages of SVD, potential valve-in-valve procedures, clinical outcomes (in terms of New York Heart Association [NYHA] function class and freedom from valve-related rehospitalisation) and change in patient quality-of-life. DISCUSSION INDURE is a prospective, multicentre registry in Europe and Canada, which will provide much needed data on the long-term performance of bioprosthetic valves in general and the INSPIRIS RESILIA valve in particular. The data may help to gather a deeper understanding of the longevity of bioprosthetic valves and may expand the use of bioprosthetic valves in patients under the age of 60 years. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03666741 (registration received September, 12th, 2018).
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Affiliation(s)
- Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | | | | | - Matthias Siepe
- Heart Center University of Freiburg, Freiburg and Bad Krozingen, Germany
| | | | | | - Konrad Binder
- Heart Center University St. Pölten, St. Pölten, Austria
| | | | | | - Enrico Coscioni
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | | | - Sergio Canovas
- Hospital University Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Olaf Wendler
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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49
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Mueller SK, Nocera AL, Workman A, Libermann T, Dillon ST, Stegmann A, Wurm J, Iro H, Wendler O, Bleier BS. Significant polyomic and functional upregulation of the PAPP-A/IGFBP-4/5/IGF-1 axis in chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2020; 10:546-555. [PMID: 31930684 DOI: 10.1002/alr.22512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is associated with epithelial expansion and polyp survival. However, the molecular mechanism of this aberrant proliferation is unclear. The purpose of this study was to interrogate derangements of the pappalysin-A/insulin-like growth factor binding protein/insulin-like growth factor-1 (PAPP-A/IGFBP-4/5/IGF-1 axis) as a major contributing factor to polyp growth in CRSwNP. METHODS Matched tissue and exosomal proteomic arrays including PAPP-A, IGFBP-4, IGFBP-5, and IGF-1 were quantified using aptamer-based methods/Western blots for proteomic analysis and whole-transcriptome sequencing/quantitative polymerase chain reaction (qPCR) for transcriptomic analysis in CRSwNP and control patients. Functional PAPP-A assays were then performed in both tissue and exosomes (set 1: n = 20 per group; validation set 2: n = 26 per group). RESULTS Tissue and exosomal PAPP-A was significantly overexpressed in CRSwNP compared to controls on both a transcriptomic and proteomic level (p < 0.0001). Known inhibitors of PAPP-A (stanniocalcin-1/-2) were significantly downregulated (p < 0.0001) as were PAPP-A cleavage products (IGFBP-5 p < 0.0001). PAPP-A function was shown to be increased 5-fold to 6-fold in tissue and exosomes. CONCLUSION Upregulated tissue and exosomal PAPP-A signaling is significantly associated with CRSwNP and may be an important factor in the promotion of epithelial proliferation and polyp growth. These data lend further support to the emerging concept of exosomal functional and polyomic analyses as a method to study sinonasal pathology.
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Affiliation(s)
- Sarina K Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Angela L Nocera
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Alan Workman
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Towia Libermann
- Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Division of Interdisciplinary Medicine and Biotechnology, BIDMC, Harvard Medical School, Boston, MA
| | - Simon T Dillon
- Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center, Division of Interdisciplinary Medicine and Biotechnology, BIDMC, Harvard Medical School, Boston, MA
| | - Achim Stegmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Wurm
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Olaf Wendler
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University, Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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Klotz L, Wendler O, Frischknecht R, Shigemoto R, Schulze H, Enz R. Localization of group II and III metabotropic glutamate receptors at pre- and postsynaptic sites of inner hair cell ribbon synapses. FASEB J 2019; 33:13734-13746. [PMID: 31585509 DOI: 10.1096/fj.201901543r] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Glutamate is the major excitatory neurotransmitter in the CNS binding to a variety of glutamate receptors. Metabotropic glutamate receptors (mGluR1 to mGluR8) can act excitatory or inhibitory, depending on associated signal cascades. Expression and localization of inhibitory acting mGluRs at inner hair cells (IHCs) in the cochlea are largely unknown. Here, we analyzed expression of mGluR2, mGluR3, mGluR4, mGluR6, mGluR7, and mGluR8 and investigated their localization with respect to the presynaptic ribbon of IHC synapses. We detected transcripts for mGluR2, mGluR3, and mGluR4 as well as for mGluR7a, mGluR7b, mGluR8a, and mGluR8b splice variants. Using receptor-specific antibodies in cochlear wholemounts, we found expression of mGluR2, mGluR4, and mGluR8b close to presynaptic ribbons. Super resolution and confocal microscopy in combination with 3-dimensional reconstructions indicated a postsynaptic localization of mGluR2 that overlaps with postsynaptic density protein 95 on dendrites of afferent type I spiral ganglion neurons. In contrast, mGluR4 and mGluR8b were expressed at the presynapse close to IHC ribbons. In summary, we localized in detail 3 mGluR types at IHC ribbon synapses, providing a fundament for new therapeutical strategies that could protect the cochlea against noxious stimuli and excitotoxicity.-Klotz, L., Wendler, O., Frischknecht, R., Shigemoto, R., Schulze, H., Enz, R. Localization of group II and III metabotropic glutamate receptors at pre- and postsynaptic sites of inner hair cell ribbon synapses.
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Affiliation(s)
- Lisa Klotz
- Institute for Biochemistry (Emil-Fischer-Zentrum), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Olaf Wendler
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Renato Frischknecht
- Department of Biology, Animal Physiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ryuichi Shigemoto
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Holger Schulze
- Department of Otorhinolaryngology, Head and Neck Surgery, Experimental Otolaryngology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf Enz
- Institute for Biochemistry (Emil-Fischer-Zentrum), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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