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Zahn R, Schmidt M, Wallner A, Fischer T, Ohlendorf D, Wanke EM. Work-Related Dermatoses of the Feet in Professional Dancers: A Pilot Study. Med Probl Perform Art 2023; 38:16-22. [PMID: 36854972 DOI: 10.21091/mppa.2023.1003] [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] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The feet of professional dancers are exposed to high work-related stresses. To date, data from the professional dance sector concerning this matter are lacking. The aim of this exploratory project was to analyze and evaluate skin health in the foot area with regard to the prevalence of dermatoses, their locations, as well as gender-specific and load-specific differences. METHODS Professional classical and neo-classical ballet dancers were examined at two time points: in a phase with increased stress (T0: daily training sessions, rehearsals, and high performance frequency) (n=51, 35 females, 16 males) and after a 24-day rest phase (T1: n=35, 28 females, 7 males). In addition, gender-specific and load-specific (T0 and T1) differences were evaluated. RESULTS All professional dancers were affected by skin lesions of the feet at T0. Hyperkeratosis (96.1%), onychomycosis (27.5%), and subungual hematoma (11.8%) were the most frequent dermatoses of the feet of professional dancers. Onychomycosis affected the nails of the big toes in particular (right 15.7%; left 13.7%), and subungual hematomas were found exclusively on the nails of the first toe (right 7.8%; left 7.8%). Women tended to be more frequently affected by hyperkeratosis, men more frequently by onychomycosis. There were no load-specific differences between the stress and rest phases. CONCLUSION The prevalence of work-related dermatoses is equally high among female and male dancers. The results can be used for further research and serve as a basis for specific measures of behavioral and environmental prevention in dance.
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Affiliation(s)
| | | | | | | | | | - E M Wanke
- Institute for Occupational, Social and Environmental Medicine, Johann Wolfgang Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, Haus 9, 60590 Frankfurt am Main, Germany. Tel 00496963016650.
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Milling TJ, Middeldorp S, Xu L, Koch B, Demchuk A, Eikelboom JW, Verhamme P, Cohen AT, Beyer-Westendorf J, Michael Gibson C, Lopez-Sendon J, Crowther M, Shoamanesh A, Coppens M, Schmidt J, Albaladejo P, Connolly SJ, Bastani A, Clark C, Concha M, Cornell J, Dombrowski K, Fermann G, Fulmer J, Goldstein J, Kereiakes D, Milling T, Pallin D, Patel N, Refaai M, Rehman M, Schmaier A, Schwarz E, Shillinglaw W, Spohn M, Takata T, Venkat A, Welker J, Welsby I, Wilson J, Van Keer L, Verschuren F, Blostein M, Eikelboom J, Althaus K, Berrouschot J, Braun G, Doeppner T, Dziewas R, Genth-Zotz S, Greinacher P, Hamann F, Hanses F, Heide W, Kallmuenzer B, Kermer P, Poli S, Royl G, Schellong S, Schnupp S, Schwarze J, Spies C, Thomalla G, von Mering M, Weissenborn K, Wollenweber F, Gumbinger C, Jaschinski U, Maschke M, Mochmann HC, Pfeilschifter W, Pohlmann C, Zahn R, Bouzat P, Schmidt J, Vallejo C, Floccard B, Coppens M, van Wissen S, Arellano-Rodrigo E, Valles E, Alikhan R, Breen K, Hall R, Crowther M, Albaladejo P, Cohen A, Demchuk A, Schmidt J, Wyse D, Garcia D, Prins M, Nakamya J, Büller H, Mahaffey KW, Alexander JH, Cairns J, Hart R, Joyner C, Raskob G, Schulman S, Veltkamp R, Meeks B, Zotova E, Ahmad S, Pinto T, Baker K, Dykstra A, Holadyk-Gris I, Malvaso A, Demchuk A. Final Study Report of Andexanet Alfa for Major Bleeding With Factor Xa Inhibitors. Circulation 2023; 147:1026-1038. [PMID: 36802876 DOI: 10.1161/circulationaha.121.057844] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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] [Indexed: 02/22/2023]
Abstract
BACKGROUND Andexanet alfa is a modified recombinant inactive factor Xa (FXa) designed to reverse FXa inhibitors. ANNEXA-4 (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of Factor Xa Inhibitors) was a multicenter, prospective, phase-3b/4, single-group cohort study that evaluated andexanet alfa in patients with acute major bleeding. The results of the final analyses are presented. METHODS Patients with acute major bleeding within 18 hours of FXa inhibitor administration were enrolled. Co-primary end points were anti-FXa activity change from baseline during andexanet alfa treatment and excellent or good hemostatic efficacy, defined by a scale used in previous reversal studies, at 12 hours. The efficacy population included patients with baseline anti-FXa activity levels above predefined thresholds (≥75 ng/mL for apixaban and rivaroxaban, ≥40 ng/mL for edoxaban, and ≥0.25 IU/mL for enoxaparin; reported in the same units used for calibrators) who were adjudicated as meeting major bleeding criteria (modified International Society of Thrombosis and Haemostasis definition). The safety population included all patients. Major bleeding criteria, hemostatic efficacy, thrombotic events (stratified by occurring before or after restart of either prophylactic [ie, a lower dose, for prevention rather than treatment] or full-dose oral anticoagulation), and deaths were assessed by an independent adjudication committee. Median endogenous thrombin potential at baseline and across the follow-up period was a secondary outcome. RESULTS There were 479 patients enrolled (mean age, 78 years; 54% male, 86% White; 81% anticoagulated for atrial fibrillation at a median time of 11.4 hours since last dose, with 245 (51%) on apixaban, 176 (37%) on rivaroxaban, 36 (8%) on edoxaban, and 22 (5%) on enoxaparin. Bleeding was predominantly intracranial (n=331 [69%]) or gastrointestinal (n=109 [23%]). In evaluable apixaban patients (n=172), median anti-FXa activity decreased from 146.9 ng/mL to 10.0 ng/mL (reduction, 93% [95% CI, 94-93]); in rivaroxaban patients (n=132), it decreased from 214.6 ng/mL to 10.8 ng/mL (94% [95% CI, 95-93]); in edoxaban patients (n=28), it decreased from 121.1 ng/mL to 24.4 ng/mL (71% [95% CI, 82-65); and in enoxaparin patients (n=17), it decreased from 0.48 IU/mL to 0.11 IU/mL (75% [95% CI, 79-67]). Excellent or good hemostasis occurred in 274 of 342 evaluable patients (80% [95% CI, 75-84]). In the safety population, thrombotic events occurred in 50 patients (10%); in 16 patients, this occurred during treatment with prophylactic anticoagulation that began after the bleeding event. No thrombotic episodes occurred after oral anticoagulation restart. Specific to certain populations, reduction of anti-FXa activity from baseline to nadir significantly predicted hemostatic efficacy in patients with intracranial hemorrhage (area under the receiver operating characteristic curve, 0.62 [95% CI, 0.54-0.70]) and correlated with lower mortality in patients <75 years of age (adjusted P=0.022; unadjusted P=0.003). Median endogenous thrombin potential was within the normal range by the end of andexanet alfa bolus through 24 hours for all FXa inhibitors. CONCLUSIONS In patients with major bleeding associated with the use of FXa inhibitors, treatment with andexanet alfa reduced anti-FXa activity and was associated with good or excellent hemostatic efficacy in 80% of patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02329327.
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Affiliation(s)
- Truman J Milling
- Seton Dell Medical School Stroke Institute, Dell Medical School, University of Texas at Austin (T.J.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Nijmegenthe Netherlands (S.M.)
| | - Lizhen Xu
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Bruce Koch
- Alexion, AstraZeneca Rare Disease, BostonMA (B.K.)
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, AlbertaCanada (A.D.)
| | - John W Eikelboom
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Peter Verhamme
- Center for Molecular and Vascular Biology, University of Leuven, Belgium (P.V.)
| | | | - Jan Beyer-Westendorf
- Department of Medicine I, Division of Hematology and Hemostasis, University Hospital Dresden, Germany (J.B-W.)
| | | | - Jose Lopez-Sendon
- Instituto de Investigación Hospital Universitario, La PazMadridSpain (J. L-S.)
| | - Mark Crowther
- Department of Medicine, McMaster University, HamiltonOntario Canada. (J.W.E., M. Crowther)
| | - Ashkan Shoamanesh
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (M. Coppens)
| | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, France (J.S.)
| | | | - Stuart J Connolly
- Population Health Research Institute, McMaster University, HamiltonOntario Canada. (L.X., A.S., S.J.C.)
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Metzner A, Straube F, Tilz RR, Kuniss M, Noelker G, Tebbenjohanns J, Andresen D, Wieneke H, Stellbrink C, Franke J, Dorwarth U, Carion PL, Holbrook R, Hochadel M, Senges J, Hoffmann E, Kuck KH, Garcia-Alberola A, Massa T, Sabin G, Franke A, Souza JJ, Stanley A, Spitzer SG, Willems S, Dierk T, Chun KRJ, Borchard R, Seidl KH, Zahn R, Groschup G, Obel IWP, Brachmann J, Gerds-Li JH, Gopal RR, Schrickel J, Lewalter T, Stanley A, Moshage W, Eckardt L, Jung W, Kremer P, Lubinski A, Schumacher B, Lickfett L, Münzel T, Steinwender C, Efremidis M, Deneke T, Nguyen DQ. Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study. BMC Cardiovasc Disord 2023; 23:8. [PMID: 36624380 PMCID: PMC9830778 DOI: 10.1186/s12872-022-03015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). METHODS The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. RESULTS The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). CONCLUSION CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Cardiology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 70, 20246, Hamburg, Germany.
| | - Florian Straube
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Roland R. Tilz
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany ,grid.412468.d0000 0004 0646 2097Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Centre Luebeck, Lübeck, Germany
| | - Malte Kuniss
- grid.419757.90000 0004 0390 5331Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Georg Noelker
- grid.418457.b0000 0001 0723 8327Herz- Und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Juergen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I – Kardiologie, Hildesheim, Germany
| | - Dietrich Andresen
- grid.417953.d0000 0004 0560 5172Department of Cardiology Paul Gerhardt Diakonie gAG, Evangelisches Krankenhaus Hubertus, Berlin, Germany
| | - Heinrich Wieneke
- Klinik Für Kardiologie und Angiologie, Contilia Herz- Und Gefäßzentrum, Essen, Germany
| | - Christoph Stellbrink
- grid.461805.e0000 0000 9323 0964Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany
| | - Jennifer Franke
- grid.476904.8CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Uwe Dorwarth
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Phuong Lien Carion
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Reece Holbrook
- grid.419673.e0000 0000 9545 2456Medtronic, Inc., Mounds View, MN USA
| | - Matthias Hochadel
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Jochen Senges
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Ellen Hoffmann
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Karl-Heinz Kuck
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Kleemann T, Lampropoulou E, Kouraki K, Strauss M, Fendt A, Mohammad O, Zahn R. The role of trigger factors in the occurrence of appropriate ICD shocks and their prognostic implications. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The role of triggers in the occurrence of appropriate ICD shocks due to ventricular tachyarrhythmias is not well known. The aim of the study was to assess the prevalence of trigger factors in appropriate ICD shocks and to analyze their prognostic impact on clinical outcome.
Methods
A total of 710 consecutive patients of a prospective single-centre ICD-registry who received a first appropriate ICD shock between 2000 and 9/2021 were analyzed.
Results
In 35% of ICD patients with first ICD shock, at least one of the following triggers was found: Ischemia (22%), Compliance (9%), Decompensation (38%), Stress (12%), Technical (5%), Electrolyte/endocrinological disorder (22%) and Medication intoxication (4%) (Table 1). The trigger factors can be summarized under the acronym ICD-STEMi. Patients with trigger associated ICD shocks had a more depressed ejection fraction and presented more often with ventricular fibrillation or electrical storm. The therapy after VT/VF shock in the trigger group comprised trigger optimization in 100% and heart failure optimization in 21% as compared to 0% respectively 10% in the no-trigger group (p<0.001). The ventricular arrhythmia therapy (antiarrhythmics or VT ablation) was not different between both groups (35% in each group). Patients with triggered first ICD shock had an increased 5-year mortality rate (50% versus 38%, p<0.001) (Figure 1).
Conclusions
In one third of ICD patients with first appropriate ICD shock, at least one trigger can be identified. Finding a trigger strongly influenced therapy after VT/VF shock. Patients with triggered ICD shock have a higher 5-year mortality rate. The evaluation of trigger factors after the occurrence of ICD shocks is mandatory and can be systematically evaluated using the acronym ICD-STEMi.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Kleemann
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | | | - K Kouraki
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - M Strauss
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - A Fendt
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - O Mohammad
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - R Zahn
- Klinikum Ludwigshafen , Ludwigshafen , Germany
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Zeymer U, Hochadel M, Schaechinger V, Zahn R. Comparative efficacy and safety of ticagrelor vs. prasugrel in patients undergoing PCI for NSTE-ACS. Results of the prospective ALKK-Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor has become standard of care for patients with NSTE-ACS. Guidelines recommend prasugrel and ticagrelor over clopidogrel. In the ISAR-5 trial prasugrel was superior to ticagrelor in NSTE-ACS patients. We evaluated the outcome of patients undergoing PCI for NSTE-ACS in a large number of patients in real life and compared patients treated with prasugrel and ticagrelor.
Methods
We used the data of the prospective German ALKK-PCI registry and included patients treated with prasugrel or ticagrelor and undergoing PCI for NSTE-ACS treated in 42 centers. Baseline variables, procedural features, antithrombotic therapies and in-hospital outcomes were centrally collected and analysed. Patients with cardiogenic shock were excluded.
Results
Between 2011 and 2020 a total of 7888 patients <75 years without prior stroke undergoing PCI for NSTE-ACS were included. Of these 4905 (62.2%) patients were treated with ticagrelor and 2983 (37.8%) were treated with prasugrel. Baseline characteristics, procedural features and in-hospital outcomes are given in the table.
Conclusion
In clinical practice in patients with NSTE-ACS undergoing PCI ticagrelor was used more often than prasugrel. Ticagrelor treated patients were older and had more comorbidities. Despite this higher risk profile in ticagrelor patients the in-hospital mortality and the short-term safety profile were comparable in both groups.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Institut für Herzinfarktforschung Ludwigshafen
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen , Ludwigshafen , Germany
| | - M Hochadel
- Stiftung Institut fuer Herzinfarktforschung , Ludwigshafen , Germany
| | | | - R Zahn
- Klinikum Ludwigshafen , Ludwigshafen , Germany
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Zahn R, Kment H, Schofer J, Lubos E, Geist V, Eggebrecht H, Butter C, Wolf A, Schaefer U, Schumacher B, Schneider S. Interventional treatment of para-valvular leaks after prosthetic valve replacement with plug devices -first results from a prospective registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Interventional closure of symptomatic paravalvular leaks (PVL) after surgical or interventional valve replacement by plug implantation has emerged as an alternative to surgical correction, which is associated with high morbitity and mortality rates. To date, data on procedural efficacy and clinical outcome after transcatheter closure with plugs is sparse, especially prospective data are missing.
Methods
We analysed data from a multi-center prospective registry on interventional PVL closure with plug devices.
Results
Between 06/2012 and 04/2020 55 interventions were performed with different numbers of plugs (maximal 4) in 51 patients at 9 hospitals. Interventions were performed in 15 women and 36 men at high surgical risk for repeat surgery. 48% of procedures were performed for mitral PVLs and 52% procedures were performed for aortic PVLs. Mean age of the population treated was 69±13 years and mean log. Euro-Score I was 22.5±14.2%. Patients were treated by implantation of Amplatzer Vascular Plug III (80%) and Occlutec occluders (9%). Aortic PVLs were treated using a retrograde transfemoral access, mitral PVLs were treated using either a transseptal (25/26) or transapical access (1/26) with 3-dimensional transesophageal echocardiographic and fluoroscopic guidance. Indication for PVL closure was previous surgery (n=39), high-risk patients (n=24), heart failure (n=22), age (n=20) and hemolysis (n=12). 40 patients had NYHA class III/IV at admission. Interventional closure of PVL was completely successful in 40 procedures (73%), partially successful in 7 procedures (13%) and failed in 7 procedures (13%). NYHA class I/II after PVL closure was achieved in 75% patients. However, 8 out of 12 patients with hemolysis as indication still hemolyzed at discharge. Complications occurred in 16% of patients. In-hospital mortality rate was 4% of procedures (2/51). After hospital discharge no death occurred during 30-day follow-up.
Conclusions
In this prospective interventional PVL registry inclusion rate was lower than expected. There was an equal distribution of aortal and mitral PVLs. At least partial success could be achieved in 86% of patients, with significant functional improvement in most patients. In this high risk population hospital mortaliy was low (4%), indicating that interventional PVL treatment should be the treatment of choice, when discussed by a heart team.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - H Kment
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Schofer
- Medical Care Center Hamburg, Hamburg, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
| | - V Geist
- Segeberger Clinics, Bad Segeberg, Germany
| | - H Eggebrecht
- CCB am Markus Hospital, Frankfurt am Main, Germany
| | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - A Wolf
- Elisabeth-Hospital, Essen, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - S Schneider
- Klinikum Ludwigshafen, Ludwigshafen, Germany
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Bland AR, Zahn R, Elliott R, Taylor JR, Hill J. Patrolling the boundaries of social domains: Neural activations to violations of expectations for romantic and work relationships. Soc Neurosci 2021; 16:513-521. [PMID: 34228605 DOI: 10.1080/17470919.2021.1953134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
According to the social domains hypothesis, we reduce the information-processing demands of complex social cues by classifying them into a limited number of domains, each with distinct sets of expectations. This requires rapid identification of violations of the boundaries between social domains. We hypothesized that these violations are likely to be associated with neural activation of the salience system. Using fMRI we compared responses of 20 adults to expected and unexpected everyday social scenarios in personal and work interactions. The vignettes exemplified different kinds of scenarios presented in the work setting, i.e., task-focused scenarios which are expected at work and scenarios with a personal focus, which are unexpected at work. The key contrast between task and personal focussed scenarios presented in the work setting was associated with fronto-insular activation. Perceived inappropriateness of the unexpected scenarios, and shorter response time to judgment of inappropriateness were also associated with fronto-insular activation, after controlling for unpleasantness. This study indicates specific neural responses to violations of expectations in different social situations. Our findings suggest that the fronto-insular region is implicated in rapid detection of behaviors that cross the boundaries of social domains, which are hypothesized to be necessary for efficient social information processing.
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Affiliation(s)
- A R Bland
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - R Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - R Elliott
- Neuroscience and Psychiatry Unit, University of Manchester, UK.,Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - J R Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - J Hill
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Bovet M, Wadsack D, Kosely F, Zink W, Zahn R. [Fatal course of COVID-19 despite IL-6 receptor blockade in cytokine storm : Perimyocarditis and coagulopathy after administration of tocilizumab]. Anaesthesist 2021; 70:121-126. [PMID: 33064176 PMCID: PMC7563901 DOI: 10.1007/s00101-020-00871-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
A 59-year-old male patient was admitted to hospital diagnosed with moderate pneumonia associated with COVID-19. Upfront treatment with hydroxychloroquine and azithromycin was started. Due to a clinical deterioration (ARDS, circulatory shock) and greatly increased inflammation markers 6 days after admission, a cytokine storm was suspected and off-label treatment with the IL‑6 receptor antagonist tocilizumab was initiated. Subsequently there was a dramatic rise of D‑dimers indicating pulmonary intravascular coagulopathy and respiratory insufficiency worsened. After a second dose of tocilizumab was administered severe perimyocarditis with cardiac arrhythmia, hemodynamic instability and ST elevation occurred. Shortly afterwards the patient died due to multiorgan failure. From our experience, exacerbation of COVID-19 following treatment with tocilizumab cannot be ruled out. Randomized controlled studies are necessary to further investigate the efficacy, safety and patient selection criteria for tocilizumab treatment in COVID-19.
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Affiliation(s)
- M Bovet
- Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland.
| | - D Wadsack
- Klinik für Innere Medizin, Hämato-Onkologie, Nephrologie, Infektiologie und Rheumatologie (Medizinische Klinik A), Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - F Kosely
- Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland
| | - W Zink
- Klinik für Anästhesiologie, Operative Intensivmedizin und Notfallmedizin, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - R Zahn
- Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin (Medizinische Klinik B), Klinikum Ludwigshafen, Bremserstraße 79, 67073, Ludwigshafen, Deutschland
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10
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Zahn R, Hochadel M, Schumacher B, Pauschinger M, Stellbrink C, Schaechinger V, Behrens S, Mudra H, Elsaesser A, Zeymer U. Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts.
Methods
We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access.
Results
Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%).
Conclusions
Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Hochadel
- Stiftung Institut, Ludwigshafen, Germany
| | | | - M Pauschinger
- klinikum Nuernberg - Sued-Nuernberg, Nuremberg, Germany
| | | | - V Schaechinger
- Klinikum Fulda Heart-Thorax-Center Cardiology, Fulda, Germany
| | - S Behrens
- Vivantes Humboldt Klinikum, Berlin, Germany
| | - H Mudra
- Clinic Neuperlach, Munich, Germany
| | | | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
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11
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Gitt A, Horack M, Lautsch D, Zahn R, Ferrieres J. How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from <70mg/dl to <55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target.
Methods
The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended <55mg/dl target.
Results
A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C <55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal.
Conclusion
Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of <55 mg/dl from less than 20% to more than 90% of the population.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD
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Affiliation(s)
- A.K Gitt
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - D Lautsch
- Merck & Co, Inc., Kenilworth, United States of America
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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12
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Iliadis C, Baldus S, Kalbacher D, Boekstegers P, Schillinger W, Ouarrak T, Zahn R, Butter C, Zuern C, Von Bardeleben R, Senges J, Bekeredjian R, Eggebrecht H, Pfister R. Impact of left atrial diameter on outcome in patients undergoing edge-to-edge mitral valve repair: results from the German TRAnscatheter Mitral valve Interventions registry (TRAMI). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrium (LA) dimension is a marker of disease severity and outcome in primary and secondary mitral regurgitation. In transcatheter mitral valve repair LA enlargement might additionally impact on device handling and technical success through an altered anatomy and atrial annular dilatation.
Methods
Data from the multicenter German transcatheter mitral valve intervention registry “TRAMI” were used to analyse the association of baseline LA diameter by tertiles and efficacy, safety and long-term clinical outcome in patients undergoing edge-to-edge repair with the MitraClip.
Results
In 520 of 843 patients prospectively enrolled in TRAMI baseline LA diameter were reported (median [interquartile range] LA diameter in tertiles: 44 [40–46] mm, 51 [48–53] mm and 60 [55–66] mm). Larger LA diameters were significantly associated with secondary etiology of mitral regurgitation, lower ejection fraction, larger left ventricle, male sex and atrial fibrillation (all p<0.05). Technical success was not different across tertiles (96%, 95.4%, 98.4% respectively, p=0.43) as were major in-hospital cardiovascular and cerebral adverse events (mortality, myocardial infarction or stroke) (1.8%, 1.2% and 4.4%, p=0.11 across tertiles). However, 4-year mortality significantly increased with larger LA diameter (32.9%, 46.4% and 51.7% respectively, p<0.01), as did hospitalization in survivors (60%, 67.6% and 78.9% respectively, p<0.05). The association between LA diameter and all-cause mortality remained significant after multivariable adjustment including baseline left ventricular end-diastolic diameter.
Conclusion
LA enlargement is a strong and independent predictor of adverse long-term outcome in mitral regurgitation suggesting that timely transcatheter mitral valve repair may have the potential to modify outcome.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The TRAMI registry has been supported by proprietary means of IHF. Additional funding is provided by “Deutsche Herzstiftung” and a grant from Abbott Vascular.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Boekstegers
- Helios Hospital Siegburg-Bonn, Helios Clinic Siegburg, Department of Cardiology and Angiology, Siegburg, Germany
| | - W Schillinger
- Georg-August University, Georg-August-University Göttingen, Heart Center, Department of Cardiology, Goettingen, Germany
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Clinic, Department of Medicine B, Ludwigshafen, Germany
| | - C Butter
- Brandenburg Heart Center, Cardiology Department, Heart Center Brandenburg Bernau, Bernau bei Berlin, Germany
| | - C.S Zuern
- University Hospital of Tuebingen, University Clinic Tübingen, Department of Cardiology, Tuebingen, Germany
| | - R.S Von Bardeleben
- University Medical Center Mainz, University Medicine Mainz, Center for Cardiology, Heart Valve Center, Mainz, Germany
| | - J Senges
- IHF Gmbh - Institut Fuer Herzinfarktforschung, “Stiftung Institut für Herzinfarktforschung”, Ludwigshafen, Foundation Institute for Myocardial Infa, Ludwigshafen, Germany
| | - R Bekeredjian
- Robert Bosch Hospital, Robert-Bosch-Hospital Stuttgart, Cardiology Department, Stuttgart, Germany
| | - H Eggebrecht
- CardioVascular Center Bethanien (CCB), Cardiology Centrum Bethanien – CCB, Frankfurt am Main, Frankfurt, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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13
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Bland A, Schei T, Roiser J, Mehta M, Zahn R, Seara-Cardoso A, Viding E, Sahakian B, Robbins T, Elliott R. Agency and intentionality-dependent experiences of moral emotions. Personality and Individual Differences 2020. [DOI: 10.1016/j.paid.2020.110125] [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: 10/24/2022]
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Affiliation(s)
- H Thiele
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - R Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
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15
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Zahn R, Lythe K, Gethin J, Green S, Deakin J, Workman C, Moll J. Negative emotions towards others are diminished in remitted major depression. Eur Psychiatry 2020; 30:448-53. [DOI: 10.1016/j.eurpsy.2015.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/01/2014] [Accepted: 02/02/2015] [Indexed: 01/22/2023] Open
Abstract
AbstractBackground:One influential view is that vulnerability to major depressive disorder (MDD) is associated with a proneness to experience negative emotions in general. In contrast, blame attribution theories emphasise the importance of blaming oneself rather than others for negative events. Our previous exploratory study provided support for the attributional hypothesis that patients with remitted MDD show no overall bias towards negative emotions, but a selective bias towards emotions entailing self-blame relative to emotions that entail blaming others. More specifically, we found a decreased proneness for contempt/disgust towards others relative to oneself (i.e. self-contempt bias). Here, we report a definitive test of the competing general negative versus specific attributional bias theories of MDD.Methods:We compared a medication-free remitted MDD (n = 101) and a control group (n = 70) with no family or personal history of MDD on a previously validated experimental test of moral emotions. The task measures proneness to specific emotions associated with different types of self-blame (guilt, shame, self-contempt/disgust, self-indignation/anger) and blame of others (other-indignation/anger, other-contempt/disgust) whilst controlling for the intensity of unpleasantness.Results:We confirmed the hypothesis that patients with MDD exhibit an increased self-contempt bias with a reduction in contempt/disgust towards others. Furthermore, they also showed a decreased proneness for indignation/anger towards others.Conclusions:This corroborates the prediction that vulnerability to MDD is associated with an imbalance of specific self- and other-blaming emotions rather than a general increase in negative emotions. This has important implications for neurocognitive models and calls for novel focussed interventions to rebalance blame in MDD.
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16
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Zahn R. [Interventional therapy of the mitral valve-an update]. Herz 2019; 44:573. [PMID: 31654183 DOI: 10.1007/s00059-019-04858-2] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- R Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
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Zeymer U, Desch S, Akin I, Ouarrak T, De Waha-Thiele S, Montalescot G, Piek JJ, Zahn R, Thiele H. P5737Use of the IMPELLA mechanical support device in patients with acute myocardial infarction complicated by cardiogenic shock - Results of the CULPRIT-SHOCK trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is still high despite the use of early revascularization therapy. While IABP support has been shown not improve outcome more effective mechanical support devices such as the IMPELLA are increasingly used. We sought to study the use of the IMPELLA device in patients with multivessel coronary artery disease and CS.
Methods
The CULPRIT-SHOCK shock trial included 686 patients with AMI complicated by cardiogenic shock and multivessel coronary artery disease treated with early PCI. Patients were randomized to immediate multivessel PCI or culprit lesion only PCI. In the current subanalysis, we investigated the patients treated with an IMPELLA support device compared these to patients without IMPELLA.
Results
Of the 686 patients 82 (12%) were treated with an IMPELLA device, 32 (39%) with IMPELLA 2.5 and 50 (61%) with IMPELLA CP. The device has been implanted in 34 patients before and 48 patients after PCI. The table shows the baseline characteristics of the patients with and without IMPELLA. In an unadjusted analysis mortality was higher with IMPELLA (63% versus 45.5%). Patients with IMPELLA CP had somewhat lower mortality than IMPELLA 2.5 (59.2% versus 68.8%), while there was no difference for pre- and post-PCI implantation.
IMPELLA (n=82) No IMPELLA (n=606) p-value Age (years) 70 68 0.17 Women 22.2% 23.3% 0.88 Diabetes 37.7% 31.8% 0.30 Triple vessel disease 66.7% 62.9% 0.13 Left main disease 28.4% 14.1% 0.001 LV-EF 31% 34% 0.18 Lactate on admission 20 mmol/l 8 mmol/l 0.0001 Multivessel PCI 50.6% 51.1% 0.9 Mechanical ventilation 88.9% 80.2% 0.06 SAPS-2 score 65 55 0.0008
Conclusion
Currently the IMPELLA support device is used primarily in patients with higher risk indicated by a higher incidence of left main disease, higher lactate on admission and higher SAPS II scores. This is associated with a higher mortality. Therefore randomized trials are needed to determine the effect of IMPELLA on outcome in patients with cardiogenic shock.
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - T Ouarrak
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | | | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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18
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Huseynov A, Baumann S, Nef H, Riemer T, Schneider S, Pfannebecker T, Achenbach S, Mehilli J, Gori T, Woehrle J, Zahn R, Schmermund A, Richard G, Hamm C, Akin I. P2809Comparison between treatment of “established” versus complex “off-label” coronary lesions with Absorb bioresorbable scaffold implantation: results from the GABI-R registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The purpose of this study was to compare the clinical outcomes of patients treated with bioresorbable scaffold (BRS) for off-label versus approved indications.
Background
The BRS promised some advantages in terms of complete biodegradation, however, the implication of BRS for off-label indications is not well described.
Methods
The short- and long-term outcome after implantation of a bioresorbable scaffold system (ABSORB, Abbott Vascular, USA) was evaluated in the prospective, non-interventional, multicenter real-world German-Austrian ABSORB RegIstRy (GABI-R).
Results
A total of 3,188 patients were enrolled. Patients were divided into two groups: on-label BRS use (33.0%) and off-label use (66.9%) if at least one off-label use criteria was met. The incidence of scaffold thrombosis in confirmed cases was significantly higher in off-label group (1.36% vs. 0.57%, p=0.04; OR 2.41 (95% CI: 1.00–5.82) with also a trend towards higher myocardial infarction rate (2.39% vs. 1.42%, p=0.077; OR 1.70 (95% CI: 0.95–3.03) and cardiovascular death (1.27% vs. 1.14%, p=0.76, OR 1.11 (95% CI: 0.56–2.21) at 6 months follow up.
Clinical outcome at 6 months Total Off-label On-label p-value* OR (95%-CI) Patients with 6m FU record 99.0% 99.0% 99.1% 0.82 0.92 (0.43–1.95) Confirmed cardiovascular death 1.22% 1.27% 1.14% 0.76 1.11 (0.56–2.21) Confirmed non-cardiovascular death 0.22% 0.14% 0.38% 0.18 0.37 (0.08–1.66) Cause unknown 0.22% 0.28% 0.09% 0.29 2.97 (0.36–24.73) Hospitalisation 27.5% 27.9% 26.7% 0.51 1.06 (0.89–1.27) MI 2.07% 2.39% 1.42% 0.07 1.70 (0.95–3.03) ARC definite scaffold thrombosis 1.10% 1.36% 0.57% 0.04 2.41 (1.00–5.82) TLF 2.70% 3.00% 2.09% 0.13 1.45 (0.89–2.37) TVF 3.98% 4.31% 3.32% 0.18 1.31 (0.88–1.95) MACE 4.33% 4.64% 3.70% 0.22 1.27 (0.87–1.85) Values are mean ± standard deviation (SD) or number and percentage (n, %). *Comparison between off-label and on-label use. The p-values are from Chi-squared test or Mann-Whitney-Wilcoxon test. ARC, academic research consortium; FU, follow up; MACE, major adverse cardiac events; PCI, percutaneous coronary intervention; TLF, target lesion failure; TVF, target vessel failure.
Kaplan-Meyer curve stent thrombosis
Conclusions
The off-label use of BRS compared to confirmed indications appears to be associated with a higher rate of clinical endpoints considering more complex lesions and higher morbidity in this patients' group.
Acknowledgement/Funding
This research was supported by a grant from Abbott Vascular.
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Affiliation(s)
- A Huseynov
- University Medical Centre of Mannheim, Mannheim, Germany
| | - S Baumann
- University Medical Centre of Mannheim, Mannheim, Germany
| | - H Nef
- University Hospital Giessen and Marburg, Giessen, Germany
| | - T Riemer
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | - S Schneider
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | | | - S Achenbach
- University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Mehilli
- Central Hospital Bad Berka, Bad Berka, Germany
| | - T Gori
- University Medical Center of Mainz, Mainz, Germany
| | | | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - A Schmermund
- CardioVascular Center Bethanien (CCB), Frankfurt am Main, Germany
| | - G Richard
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - C Hamm
- University Hospital Giessen and Marburg, Giessen, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
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von Scheidt W, Welz A, Pauschinger M, Fischlein T, Schächinger V, Treede H, Zahn R, Hennersdorf M, Albes JM, Bekeredjian R, Beyer M, Brachmann J, Butter C, Bruch L, Dörge H, Eichinger W, Franke UFW, Friedel N, Giesler T, Gradaus R, Hambrecht R, Haude M, Hausmann H, Heintzen MP, Jung W, Kerber S, Mudra H, Nordt T, Pizzulli L, Sack FU, Sack S, Schumacher B, Schymik G, Sechtem U, Stellbrink C, Stumpf C, Hoffmeister HM. Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI). Clin Res Cardiol 2019; 109:1-12. [DOI: 10.1007/s00392-019-01528-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/03/2019] [Indexed: 11/30/2022]
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Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Brückmann H, Debus ES, Fiehler J, Lang W, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Hetzel A, Bodechtel U, Binder A, Glahn J, Hacke W, Ringleb PA. Angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy compared to best medical treatment: One-year interim results of SPACE-2. Int J Stroke 2019; 15:1747493019833017. [PMID: 30873912 PMCID: PMC7416333 DOI: 10.1177/1747493019833017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treatment of individuals with asymptomatic carotid artery stenosis is still handled controversially. Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis. The aim of the SPACE-2 trial (ISRCTN78592017) was to compare the stroke preventive effects of BMT alone with that of BMT in combination with CEA or carotid artery stenting (CAS), respectively, in patients with asymptomatic carotid artery stenosis of ≥70% European Carotid Surgery Trial (ECST) criteria. METHODS SPACE-2 is a randomized, controlled, multicenter, open study. A major secondary endpoint was the cumulative rate of any stroke (ischemic or hemorrhagic) or death from any cause within 30 days plus an ipsilateral ischemic stroke within one year of follow-up. Safety was assessed as the rate of any stroke and death from any cause within 30 days after CEA or CAS. Protocol changes had to be implemented. The results on the one-year period after treatment are reported. FINDINGS It was planned to enroll 3550 patients. Due to low recruitment, the enrollment of patients was stopped prematurely after randomization of 513 patients in 36 centers to CEA (n = 203), CAS (n = 197), or BMT (n = 113). The one-year rate of the major secondary endpoint did not significantly differ between groups (CEA 2.5%, CAS 3.0%, BMT 0.9%; p = 0.530) as well as rates of any stroke (CEA 3.9%, CAS 4.1%, BMT 0.9%; p = 0.256) and all-cause mortality (CEA 2.5%, CAS 1.0%, BMT 3.5%; p = 0.304). About half of all strokes occurred in the peri-interventional period. Higher albeit statistically non-significant rates of restenosis occurred in the stenting group (CEA 2.0% vs. CAS 5.6%; p = 0.068) without evidence of increased stroke rates. INTERPRETATION The low sample size of this prematurely stopped trial of 513 patients implies that its power is not sufficient to show that CEA or CAS is superior to a modern medical therapy (BMT) in the primary prevention of ischemic stroke in patients with an asymptomatic carotid stenosis up to one year after treatment. Also, no evidence for differences in safety between CAS and CEA during the first year after treatment could be derived. Follow-up will be performed up to five years. Data may be used for pooled analysis with ongoing trials.
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Affiliation(s)
- T Reiff
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - HH Eckstein
- Department for Vascular and
Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - U Mansmann
- Institute of Medical Informatics,
Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich,
Germany
| | - O Jansen
- Department of Radiology and
Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - G Fraedrich
- Department of Vascular Surgery,
University Hospital of Innsbruck, Innsbruck, Austria
| | - H Mudra
- Department of Internal Medicine,
Städtisches Klinikum München-Neuperlach, Munich, Germany
| | - D Böckler
- Department of Vascular Surgery,
University Hospital of Heidelberg, Heidelberg, Germany
| | - M Böhm
- Department of Internal Medicine,
University Hospital of Homburg/Saar, Homburg, Germany
| | - H Brückmann
- Department of Neuroradiology,
Ludwig-Maximilians-Universität, Munich, Germany
| | - ES Debus
- Department of Vascular Surgery,
University Hospital of Hamburg, Hamburg, Germany
| | - J Fiehler
- Department of Neuroradiology,
University Hospital of Hamburg, Hamburg, Germany
| | - W Lang
- Department of Vascular Surgery,
University Hospital Erlangen, Erlangen, Germany
| | - K Mathias
- Department of Radiology, Klinikum
Dortmund, Dortmund, Germany
| | - EB Ringelstein
- Department of Neurology,
University Hospital of Münster, Münster, Germany
| | - J Schmidli
- Department of Vascular Surgery,
University Hospital of Bern, Bern, Switzerland
| | - R Stingele
- Department of Neurology,
University of Kiel, Kiel, Germany
| | - R Zahn
- Department of Internal Medicine,
Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - T Zeller
- Department of Angiology,
University Hospital Freiburg, Bad Krozingen, Germany
| | - A Hetzel
- Department of Neurology,
University Hospital Freiburg, Freiburg, Germany
| | - U Bodechtel
- Department of Neurology,
University Hospital of Dresden, Dresden, Germany
| | - A Binder
- Department of Neurology, UKSH
Campus Kiel, Kiel, Germany
| | - J Glahn
- Department of Neurology, Johannes
Wesling Klinikum, Minden, Germany
| | - W Hacke
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
| | - PA Ringleb
- Department of Neurology, University
Hospital of Heidelberg, Heidelberg, Germany
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22
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Baumann S, Grau A, Senges J, Schneider S, Alonso A, Katus HA, Thomas D, Waldecker B, Haass M, Zahn R, Zeymer U, Akin I, Kruska M, Fischer C, Borggrefe M. [ARENA-Project atrial fibrillation in the Rhein-Neckar region]. Herz 2019; 45:689-695. [PMID: 30643922 DOI: 10.1007/s00059-018-4772-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/15/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
Atrial fibrillation (AF) is the most common form of cardiac tachyarrhythmia. It is estimated that in the Rhein-Neckar region approximately 40,000-50,000 out of 2 million people are affected. Due to demographic changes in the near future there will be a significant increase in the prevalence of AF within the next decades. The ARENA project was initiated by the Foundation Institute for Cardiac Infarction Research (IHF) Ludwigshafen in cooperation with cardiological and neurological departments of neighboring hospitals, resident doctors and pharmacies to improve the awareness and care of patients with AF. The particular aim is the prevention of stroke as one of the most dreaded complications. The project focusses on the following three subtopics: interventions, medication, migration. The aim of the intervention project is to raise awareness of AF as a risk factor for stroke and to improve the diagnostic work-up and care for patients with diagnosed or unknown AF. The subproject medication focusses on the adherence of patients with AF to the prescribed antithrombotic medication. To evaluate differences concerning patients with and without a migration background the subproject migration was initiated.
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Affiliation(s)
- S Baumann
- I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland
| | - A Grau
- Neurologische Klinik, Ludwigshafen, Deutschland
| | - J Senges
- Institut für Herzinfarktforschung, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - S Schneider
- Institut für Herzinfarktforschung, Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - A Alonso
- Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - H A Katus
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland.,Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, Deutschland.,HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Deutschland
| | - D Thomas
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland.,Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, Deutschland.,HCR (Heidelberg Center for Heart Rhythm Disorders), Medical University Hospital Heidelberg, Heidelberg, Deutschland
| | - B Waldecker
- GRN Klinik Schwetzingen, Schwetzingen, Deutschland
| | - M Haass
- Theresienkrankenhaus Mannheim, Mannheim, Deutschland
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - U Zeymer
- Neurologische Klinik, Ludwigshafen, Deutschland.,Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - I Akin
- I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland
| | - M Kruska
- I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland
| | - C Fischer
- Klinikum Ludwigshafen, Ludwigshafen, Deutschland
| | - M Borggrefe
- I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum Mannheim, DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Deutschland.
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Affiliation(s)
- R Zahn
- Med. Klinik B: Kardiologie, Pneumologie, Internistische Intensivmedizin, Klinikum Ludwighafen, Bremserstr. 73, 67063, Ludwigshafen, Deutschland.
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24
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Werner N, Zeymer U, Fraiture B, Kilkowski C, Riedmaier P, Schneider S, Zahn R. P5096Interventional treatment of paravalvular regurgitation by plug implantation following prosthetic valve replacement: a single-center experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5096] [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)
- N Werner
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
| | - B Fraiture
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
| | - C Kilkowski
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
| | - P Riedmaier
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
| | - S Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen Am Rhein, Germany
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Troebs M, Achenbach S, Nef H, Wiebe J, Kastner J, Mehili J, Muenzel T, Naber C, Neumann T, Richard G, Schmermundt A, Woehrle J, Zahn R, Riemer T, Hamm C. P798Outcome of percutaneous coronary intervention with everolimus-eluting bioresorbable vascular scaffolds in patients with STEMI as compared to stable CAD 2 year results from the German-Austrian ABSORB. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Troebs
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - S Achenbach
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - H Nef
- University Hospital Giessen and Marburg, Department of Cardiology, Giessen, Germany
| | - J Wiebe
- German Heart Center of Munich, Deutsches Herzzentrum München, Munich, Germany
| | - J Kastner
- Medical University of Vienna, Vienna, Austria
| | - J Mehili
- Ludwig-Maximilians University, Department of Cardiology, Munich, Germany
| | - T Muenzel
- Johannes Gutenberg University Mainz (JGU), Department of Medicine II, University Medical Center, Mainz, Germany
| | - C Naber
- Elisabeth Hospital, Essen, Germany
| | - T Neumann
- University Hospital of Essen (Ruhr), Department of Cardiology, Essen, Germany
| | - G Richard
- Heart Center Bad Segeberg, Bad Segeberg, Germany
| | - A Schmermundt
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - J Woehrle
- University of Ulm, 11Department of Internal Medicine II, Ulm, Germany
| | - R Zahn
- Hear Center Ludwigshafen, Ludwigshafen, Germany
| | - T Riemer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
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Riedmaier P, Hochadel M, Hoffmeister H, Schumacher B, Darius H, Kerber S, Zahn R, Zeymer U. P6402In-hospital outcome in very elderly patients with NSTEMI undergoing early angiography. Results of the prospective ALKK-registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Riedmaier
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - M Hochadel
- Heart Attack Research Center, Ludwigshafen am Rhein, Germany
| | | | | | - H Darius
- Vivantes Clinics for Health, Berlin, Germany
| | - S Kerber
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Kalbacher D, Schaefer U, Von Bardeleben RS, Eggebrecht H, Sievert H, Nickenig G, Butter C, Ouarrak T, Zahn R, Baldus S, Ince H, Schillinger W, Boekstegers P, Senges J, Lubos E. 1210Long-term follow-up in the German TRAnscatheter mitral valve Interventions (TRAMI) registry: survival and predictors of mortality. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Kalbacher
- University Heart Center Hamburg, Hamburg, Germany
| | - U Schaefer
- University Heart Center Hamburg, Hamburg, Germany
| | | | - H Eggebrecht
- Cardiology Centre Bethanien (CCB), Frankfurt am Main, Germany
| | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt am Main, Germany
| | | | - C Butter
- Brandenburg Heart Center, Bernau bei Berlin, Germany
| | - T Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - R Zahn
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - H Ince
- University Hospital Rostock, Rostock, Germany
| | - W Schillinger
- University Medical Center Gottingen (UMG), Gottingen, Germany
| | | | - J Senges
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - E Lubos
- University Heart Center Hamburg, Hamburg, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. 3296Benefit and harm during 10-year ICD-therapy: temporal trends during the last 25 years. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3296] [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)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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29
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Kleemann T, Nonnenmacher F, Kouraki K, Strauss M, Werner N, Zahn R. P4859Long-term performance data of modern ICD leads compared to older ICD lead models. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - F Nonnenmacher
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Mohammad O, Kouraki K, Strauss M, Zeymer U, Zahn R, Kleemann T. P6234Prognostic value of elevated electromagnetic QRS-fragmentation index on 5-year outcome in patients with acute myocardial infarction undergoing cardiac magnet field imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O Mohammad
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - K Kouraki
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - M Strauss
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
| | - T Kleemann
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Zeymer U, Hochadel M, Hoffmeister HM, Ince H, Kerber S, Zahn R. P2727Success rate and clinical outcome of left main PCI in patients with AMI complicated by cardiogenic shock. Results of the ALKK-registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- U Zeymer
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - M Hochadel
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | - H Ince
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - S Kerber
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen Am Rhein, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P439Incidence and causes of stroke in ICD-patients. Europace 2018. [DOI: 10.1093/europace/euy015.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P1221Prognostic relevance of new onset arrhythmia and ICD shocks in primary prophylactic ICD patients. Europace 2018. [DOI: 10.1093/europace/euy015.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Kleemann T, Strauss M, Kouraki K, Werner N, Zahn R. P463Risk assessment for primary prophylactic ICD implantation in hypertrophic cardiomyopathy using the risk calculator: discrepancy between theory and clinical practice? Europace 2018. [DOI: 10.1093/europace/euy015.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Strauss
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - K Kouraki
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - N Werner
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - R Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. Kardiologe 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
SummaryThe role of GP IIb/IIIa antagonists has been focused on patients with acute coronary syndromes undergoing PCI. In the ISAR-REACT 2 study abciximab given in patients with NSTEACS undergoing PCI already treated with 600 mg clopidogrel improved 30-day death and reinfarction rate in troponin positive patients. In the large EARLY-ACS trial upstream therapy with eptifibatide in high risk with NSTE-ACS did not improve ischaemic complications but was associated with an increase in bleeding complications. Therefore GP IIb/IIIa antagonists should be given after the initial angiography and the decision the perform PCI in troponin positive patients with NSTE-ACS.In patients with STEMI undergoing primary PCI the prehospital administration of tirofiban was associated with an improved myocardial reperfusion. In contrast in the BRAVE 3 trial abciximab in patients with pretreatment with 600 mg clopidogrel did not reduce infarct size or improve clinial outcome. Comparative trials evaluating the effectiveness of abciximab and the small molecules tirofiban and eptifibatide did not show any differences between the three GP IIb/IIIa antagoniosts.
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Gethin JA, Lythe KE, Workman CI, Mayes A, Moll J, Zahn R. Early life stress explains reduced positive memory biases in remitted depression. Eur Psychiatry 2017; 45:59-64. [PMID: 28728096 PMCID: PMC5695977 DOI: 10.1016/j.eurpsy.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/12/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is contradictory evidence regarding negative memory biases in major depressive disorder (MDD) and whether these persist into remission, which would suggest their role as vulnerability traits rather than correlates of mood state. Early life stress (ELS), common in patients with psychiatric disorders, has independently been associated with memory biases, and confounds MDD versus control group comparisons. Furthermore, in most studies negative biases could have resulted from executive impairments rather than memory difficulties per se. METHODS To investigate whether memory biases are relevant to MDD vulnerability and how they are influenced by ELS, we developed an associative recognition memory task for temporo-spatial contexts of social actions with low executive demands, which were matched across conditions (self-blame, other-blame, self-praise, other-praise). We included fifty-three medication-free remitted MDD (25 with ELS, 28 without) and 24 healthy control (HC) participants without ELS. RESULTS Only MDD patients with ELS showed a reduced bias (accuracy/speed ratio) towards memory for positive vs. negative materials when compared with MDD without ELS and with HC participants; attenuated positive biases correlated with number of past major depressive episodes, but not current symptoms. There were no biases towards self-blaming or self-praising memories. CONCLUSIONS This demonstrates that reduced positive biases in associative memory were specific to MDD patients with ELS rather than a general feature of MDD, and were associated with lifetime recurrence risk which may reflect a scarring effect. If replicated, our results would call for stratifying MDD patients by history of ELS when assessing and treating emotional memories.
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Affiliation(s)
- J A Gethin
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - K E Lythe
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - C I Workman
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - A Mayes
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK
| | - J Moll
- Cognitive and Behavioral Neuroscience Unit, D'Or Institute for Research and Education (IDOR), 22280-080 Rio de Janeiro, RJ, Brazil
| | - R Zahn
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester M13 9PL, UK; Institute of Psychiatry, Psychology & Neuroscience, Department of Psychological Medicine, Centre for Affective Disorders, King's College London, London SE5 8AZ, UK.
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Abdel-Wahab M, Werner N, Linke A, Sievert H, Kahlert P, Hambrecht R, Nickenig G, Hauptmann K, Sack S, Schneider S, Gerckens U, Richardt G, Zahn R. 1280Long-term impact of prosthetic valve regurgitation after transcatheter aortic valve implantation: a 5-year follow-up analysis from the German TAVI registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zahn R, Werner N, Linke A, Sievert H, Kahlert P, Hambrecht R, Nickenig G, Hauptmann K, Sack S, Schneider S, Gerckens U. P54495-year follow-up after transcatheter aortic valve implantation (TAVI): does gender matter? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zahn R, Weingartner J, Basilio R, Bado P, Mattos P, Oliveira-Souza SJD, Fontenelle LF, Moll J. 30 Blame rebalance fmri feedback proof-of-concept trial in major depressive disorder. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-bnpa.54] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zeymer U, Hochadel M, Karcher A, Kerber S, Elsaesser A, Brachmann J, Budde T, Hoffmeister H, Zahn R. P2724Inhospital mortality in patients with infarct-relaled cardiogenic shock undergoing coronary angiography treated with and without acute revascularization therapy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zahn R, Werner N, Linke A, Sievert H, Kahlert P, Hambrecht R, Nickenig G, Schneider S, Sack S, Gerckens U. P2965Influence of concomittant mitral regurgitation after transcatheter aortic valve implantation during 5-year follow-up. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p2965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Werner N, Baldus S, Schillinger W, Franzen O, Bekeredjian R, Sievert H, Schofer J, Kuck K, Moellmann H, Hehrlein C, Ouarrak T, Senges J, Zahn R. 4177Gender-related differences in patients undergoing transcatheter mitral valve interventions: 1-year results from the German TRAMI Registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kleemann T, Strauss M, Kouraki K, Schmidt K, Werner N, Zahn R. P1740Prognostic significance of new onset atrial fibrillation in ICD patients. Europace 2017. [DOI: 10.1093/ehjci/eux161.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kleemann T, Kouraki K, Strauss M, Schmidt K, Werner N, Zahn R. P1714Clinical implications for patients with persistent phrenic nerve palsy after cryoballoon ablation of pulmonary veins. Europace 2017. [DOI: 10.1093/ehjci/eux161.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Workman CI, Lythe KE, McKie S, Moll J, Gethin JA, Deakin JFW, Elliott R, Zahn R. A novel resting-state functional magnetic resonance imaging signature of resilience to recurrent depression. Psychol Med 2017; 47:597-607. [PMID: 27821193 PMCID: PMC5426313 DOI: 10.1017/s0033291716002567] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/22/2016] [Accepted: 09/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND A high proportion of patients with remitted major depressive disorder (MDD) will experience recurring episodes, whilst some develop resilience and remain in recovery. The neural basis of resilience to recurrence is elusive. Abnormal resting-state connectivity of the subgenual cingulate cortex (sgACC) was previously found in cross-sectional studies of MDD, suggesting its potential pathophysiological importance. The current study aimed to investigate whether resting-state connectivity to a left sgACC seed region distinguishes resilient patients from those developing recurring episodes. METHOD A total of 47 medication-free remitted MDD patients and 38 healthy controls underwent resting-state functional magnetic resonance imaging (fMRI) at baseline. Over 14 months, 30 patients remained resilient whilst 17 experienced a recurring episode. RESULTS Attenuated interhemispheric left-to-right sgACC connectivity distinguished the resilient from the recurring-episode and control groups and was not correlated with residual depressive symptoms. CONCLUSIONS The current study revealed a neural signature of resilience to recurrence in MDD and thereby elucidates the role of compensatory adaptation in sgACC networks.
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Affiliation(s)
- C. I. Workman
- The University of Manchester & Manchester
Academic Health Sciences Centre, Institute of Brain, Behaviour
and Mental Health, Neuroscience & Psychiatry Unit,
Manchester, UK
- The University of Manchester & Manchester
Academic Health Sciences Centre, School of Psychological
Sciences, Neuroscience and Aphasia Research Unit,
Manchester, UK
| | - K. E. Lythe
- The University of Manchester & Manchester
Academic Health Sciences Centre, School of Psychological
Sciences, Neuroscience and Aphasia Research Unit,
Manchester, UK
| | - S. McKie
- The University of Manchester & Manchester
Academic Health Sciences Centre, Institute of Brain, Behaviour
and Mental Health, Neuroscience & Psychiatry Unit,
Manchester, UK
| | - J. Moll
- Cognitive and Behavioral Neuroscience
Unit, D'Or Institute for Research and Education (IDOR),
Rio de Janeiro, RJ,
Brazil
| | - J. A. Gethin
- The University of Manchester & Manchester
Academic Health Sciences Centre, School of Psychological
Sciences, Neuroscience and Aphasia Research Unit,
Manchester, UK
| | - J. F. W. Deakin
- The University of Manchester & Manchester
Academic Health Sciences Centre, Institute of Brain, Behaviour
and Mental Health, Neuroscience & Psychiatry Unit,
Manchester, UK
| | - R. Elliott
- The University of Manchester & Manchester
Academic Health Sciences Centre, Institute of Brain, Behaviour
and Mental Health, Neuroscience & Psychiatry Unit,
Manchester, UK
| | - R. Zahn
- The University of Manchester & Manchester
Academic Health Sciences Centre, School of Psychological
Sciences, Neuroscience and Aphasia Research Unit,
Manchester, UK
- Department of Psychological Medicine,
Institute of Psychiatry, Psychology, and Neuroscience,
Centre for Affective Disorders, King's College
London, London, UK
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Affiliation(s)
- R Zahn
- Herzzentrum, Kardiologie, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstr. 72, 67263, Ludwigshafen, Deutschland.
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Zahn R, Brütsch R, Winkler R. Therapie der akuten Herzinsuffizienz und des kardiogenen Schockes. Aktuel Kardiol 2016. [DOI: 10.1055/s-0042-106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R. Zahn
- Medizinische Klinik B, Herzzentrum Ludwigshafen
| | - R. Brütsch
- Medizinische Klinik B, Herzzentrum Ludwigshafen
| | - R. Winkler
- Medizinische Klinik B, Herzzentrum Ludwigshafen
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Abstract
Paravalvular leak (PVL) is a relatively rare, but serious complication occurring in up to 10% of patients after prosthetic aortic valve replacement and in up to 17% of patients after prosthetic mitral valve replacement. Up to 5% of patients will present with symptoms of congestive heart failure or mechanical haemolytic anaemia due to PVL and need further surgical or interventional treatment. Surgical repair is often technically challenging and carries a high mortality and morbidity risk. Catheter-based closure of PVL has emerged as an alternative approach especially for patients with relevant comorbidities at high surgical risk. Interventional closure of PVL is a complex procedure, which needs to be performed by an experienced team of interventional cardiologist, echocardiographer and anesthesiologist. To date available clinical results are promising showing low complication rates and high technical or clinical success rates of catheter-based closure of PVL (60-90%). Compared to surgical closure of PVL lower mortality rates (30-days mortality rate: 4,6%) have been documented in patients treated by catheter-based closure of PVL in clinical practice. Therefore interventional closure seems to be a promising option, which need to be discussed with every symptomatic patient suffering from PVL prior to therapeutical decision making. To date only sparse clinical data is available regarding indication and clinical outcome of patients undergoing catheter-based PVL in clinical practice. Therefore interventional closure of PVL should be limited to experienced interventional cardiologist at present. All patients treated should further be enrolled into a clinical registry to evaluate the safety and efficacy of catheter-based closure of PVL in clinical practice.
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Affiliation(s)
- Nicolas Werner
- Klinikum Ludwigshafen, Medizinische Klinik B, Bremserstr. 79, 67063, Ludwigshafen, Deutschland,
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