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Thomsen M, Marth K, Loens S, Everding J, Junker J, Borngräber F, Ott F, Jesús S, Gelderblom M, Odorfer T, Kuhlenbäumer G, Kim HJ, Schaeffer E, Becktepe J, Kasten M, Brüggemann N, Pfister R, Kollewe K, Krauss JK, Lohmann E, Hinrichs F, Berg D, Jeon B, Busch H, Altenmüller E, Mir P, Kamm C, Volkmann J, Zittel S, Ferbert A, Zeuner KE, Rolfs A, Bauer P, Kühn AA, Bäumer T, Klein C, Lohmann K. Large-Scale Screening: Phenotypic and Mutational Spectrum in Isolated and Combined Dystonia Genes. Mov Disord 2024; 39:526-538. [PMID: 38214203 DOI: 10.1002/mds.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pathogenic variants in several genes have been linked to genetic forms of isolated or combined dystonia. The phenotypic and genetic spectrum and the frequency of pathogenic variants in these genes have not yet been fully elucidated, neither in patients with dystonia nor with other, sometimes co-occurring movement disorders such as Parkinson's disease (PD). OBJECTIVES To screen >2000 patients with dystonia or PD for rare variants in known dystonia-causing genes. METHODS We screened 1207 dystonia patients from Germany (DysTract consortium), Spain, and South Korea, and 1036 PD patients from Germany for pathogenic variants using a next-generation sequencing gene panel. The impact on DNA methylation of KMT2B variants was evaluated by analyzing the gene's characteristic episignature. RESULTS We identified 171 carriers (109 with dystonia [9.0%]; 62 with PD [6.0%]) of 131 rare variants (minor allele frequency <0.005). A total of 52 patients (48 dystonia [4.0%]; four PD [0.4%, all with GCH1 variants]) carried 33 different (likely) pathogenic variants, of which 17 were not previously reported. Pathogenic biallelic variants in PRKRA were not found. Episignature analysis of 48 KMT2B variants revealed that only two of these should be considered (likely) pathogenic. CONCLUSION This study confirms pathogenic variants in GCH1, GNAL, KMT2B, SGCE, THAP1, and TOR1A as relevant causes in dystonia and expands the mutational spectrum. Of note, likely pathogenic variants only in GCH1 were also found among PD patients. For DYT-KMT2B, the recently described episignature served as a reliable readout to determine the functional effect of newly identified variants. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Mirja Thomsen
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katrin Marth
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
| | - Judith Everding
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johanna Junker
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Fabian Ott
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Odorfer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jos Becktepe
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Meike Kasten
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Psychiatry, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Ebba Lohmann
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE)-Tübingen, Tübingen, Germany
| | - Frauke Hinrichs
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Hauke Busch
- Medical Systems Biology Group, Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Eckart Altenmüller
- Institute of Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain
| | - Christoph Kamm
- Department of Neurology, University Hospital Rostock, Rostock, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kirsten E Zeuner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arndt Rolfs
- Medical Faculty, University of Rostock, Rostock, Germany
- Agyany Pharmaceuticals, Jerusalem, Israel
| | | | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, CBBM, University of Lübeck, Lübeck, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Rare Diseases, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Catho G, Rosa Mangeret F, Sauvan V, Chraïti MN, Pfister R, Baud O, Harbarth S, Buetti N. Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters. J Hosp Infect 2023; 139:6-10. [PMID: 37343772 DOI: 10.1016/j.jhin.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the risk of catheter-associated bloodstream infection (CABSI) among different catheter types using a large prospective database in the neonatal intensive care unit (NICU) of a tertiary care centre in Switzerland. METHODS We included all neonates admitted to the NICU with at least one central intravascular catheter inserted between January 2017 and December 2020. We used marginal Cox model to determine the risk of CABSI among different catheter types. RESULTS A total of 574 neonates and 1103 intravascular catheters were included in the study: 581 venous umbilical catheters, 198 arterial umbilical catheters and 324 peripherally inserted central catheters (PICCs). We identified 17, four and four CABSIs in neonates with venous umbilical catheters, arterial umbilical catheters and PICCs, respectively. The risk of CABSI increased after two days of umbilical catheter maintenance. Using univariable Cox models, and adjusting for sex and gestational age, we observed a similar CABSI risk between venous and arterial umbilical catheters (HR 0.57; 95% CI 0.16e2.08). Birth weight was associated with CABSI, with higher weight being protective (HR 0.37, 95% CI 0.16e0.81). CONCLUSIONS Strategies aimed at reducing umbilical catheter dwell time, particularly in low and very low birth weight neonates, may be effective in decreasing the incidence of CABSI in this population.
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Affiliation(s)
- G Catho
- Infection Control Division, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland.
| | - F Rosa Mangeret
- Neonatal Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - V Sauvan
- Infection Control Division, Geneva University Hospitals, Geneva, Switzerland
| | - M-N Chraïti
- Infection Control Division, Geneva University Hospitals, Geneva, Switzerland
| | - R Pfister
- Neonatal Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - O Baud
- Neonatal Intensive Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - S Harbarth
- Infection Control Division, Geneva University Hospitals, Geneva, Switzerland
| | - N Buetti
- Infection Control Division, Geneva University Hospitals, Geneva, Switzerland; IAME U 1137, INSERM, Université Paris-Cité, Paris, France
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Pfister R. Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom. Sprache · Stimme · Gehör 2022. [DOI: 10.1055/a-1941-3571] [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: 12/03/2022]
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Iliadis C, Weber M, Horn P, Harr C, Gavazzoni M, Nickenig G, Westenfeld R, Alessandrini H, Taramasso M, Baldus S, Pfister R. Echocardiography and computed tomography predictors of successful transcatheter direct annuloplasty for mitral regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1640] [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
Secondary mitral regurgitation (SMR) is associated with adverse outcomes and the optimal treatment modality remains challenging due to extensive variety in the pathology of SMR. Percutaneous direct annuloplasty using the Cardioband system emerged as a promising treatment in selected patients. However, success predictors of this intervention and their association with prognosis remain unclear.
Purpose
To investigate the role of echocardiographic and computed tomography (CT) data in patients with SMR undergoing percutaneous direct annuloplasty.
Methods
We retrospectively analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband system for SMR at five tertiary centres in Germany and Switzerland between 2013 and 2020. Patients with procedural success (defined as postprocedural MR grade ≤2+) were compared to those with MR >2+ with respect to baseline echocardiographic data and outcome.
Results
We included 130 patients (median age 75.5 [71–79], 37% female). Most patients were severely symptomatic (NYHA class III/IV 86.9%), had a median EF of 39 (29–52) with an ischaemic etiology in 39%. Procedural success was achieved in 68%. Procedural time was 178.5 (147.5–214.5) minutes. Patients with and without procedural success differed significantly in measures of MR severity (defined as postprocedural SMR severity (grade, vena contracta (VC), effective regurgitation orifice area and regurgitation volume), annular dilatation (leaflet length, LA sphericity index at end-systole and CT-derived intercommissural distance) and leaflet tethering (tenting area, regurgitation jet direction). In multivariable analysis of echocardiographic parameters including significant measures of annular dilatation and leaflet tethering, predictors of procedural treatment success were tenting area (OR 0.54; 95% CI 0.33–0.98 per mm2, p=0.016) and central regurgitation jet direction (OR 2.96; 95% CI 1.06–8.25, p=0.038). After adding CT data in the multivariable model, intercommissural distance proved to be the most significant predictor (OR 0.96; 0.92–0.99, p=0.009), whereas VC was the only echo predictor (OR 0.84; 0.73–0.98, p=0.03).
NYHA class III/IV at last follow up was significantly different between groups, with 34.1% vs. 55.2% of patients with vs. without procedural success, respectively (p=0.04). The combined endpoint of mortality or reintervention at 1 year was significantly lower in patients with procedural success (27% vs. 63%, p=0.002), whereas the association of procedural success with 1-year mortality was of borderline significance (13% vs. 32%, p=0.05).
Conclusion
Two thirds of patients undergoing transcatheter direct annuloplasty for SMR had procedural success. Careful patient selection by assessment of mitral valve anatomy is helpful to predict procedural success, which translates into less symptom burden and better clinical outcome.
Funding Acknowledgement
Type of funding sources: None.
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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
| | - M Weber
- University Hospital Bonn, Heart Centre, Department of Medicine II, University Hospital Bonn , Bonn , Germany
| | - P Horn
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty , Duesseldorf , Germany
| | - C Harr
- Asklepios St. Georg Clinic, Department of Cardiology , Hamburg , Germany
| | - M Gavazzoni
- Italian Auxological Institute San Luca Hospital, Istituto Auxologico Italiano , Milan , Italy
| | - G Nickenig
- University Hospital Bonn, Heart Centre, Department of Medicine II, University Hospital Bonn , Bonn , Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty , Duesseldorf , Germany
| | - H Alessandrini
- Asklepios St. Georg Clinic, Department of Cardiology , Hamburg , Germany
| | - M Taramasso
- Hirslanden Heart Center, Herzzentrum Hirslanden , Zurich , Switzerland
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany , Cologne , 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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5
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Pfister R, Ihle P, Ruhnke T, Guenster C, Michels G, Seuthe K, Hellmich M, Ney S. Epidemiology of cardiac amyloidosis and burden on health care system in Germany: a retrospective analysis from 2009 to 2018. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.848] [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
Aims
Improved imaging modalities contributed to increasing disease awareness of cardiac amyloidosis. Contemporary data on frequency trends and impact on health system are lacking.
Methods and results
In a retrospective study using health claims data of the largest German statutory health insurance patients with a diagnostic code of amyloidosis and concomitant heart failure or cardiomyopathy between 2009 and 2018 were identified. Temporal trends in frequency, patient characteristics, all-cause mortality and measures of health care burden were examined.
8,279 patients were identified of whom 5,618 were incident without diagnosis of amyloidosis within the previous year. Prevalence increased from 15.5 to 47.6 per 100,000 person-years, and incidence increased from 4.8 to 11.6 per 100,000 person-years, with a continuous steepening in the slope of incidence trend. Age and male gender significantly increased whereas prevalence of myeloma and nephrotic syndrome significantly decreased over time. Median (IQR) survival time after first diagnosis was 2.5 years (0.5 to 6 years), with a 9% (95% CI 2–15%, p=0.008) reduced risk of death in the second compared to the first five years of observation. In the first year after diagnosis mean total health care costs were 21,955 € (median 9,873 €, IQR 3,922 to 24,714 €) per person.
Conclusion
The rise in patients with cardiac amyloidosis has continuously accelerated in the last decade which, based on patient characteristics, is mainly driven by underlying wildtype transthyretin amyloidosis. Considering the adverse outcome and high health care burden further effort should be put on early detection of the disease to implement treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Pfister
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine , Cologne , Germany
| | - P Ihle
- University of Cologne, PMV Forschungsgruppe , Cologne , Germany
| | - T Ruhnke
- WIdO, AOK Research Institute , Berlin , Germany
| | - C Guenster
- WIdO, AOK Research Institute , Berlin , Germany
| | - G Michels
- St.-Antonius-Hospital, Klinik für Akut- und Notfallmedizin , Eschweiler , Germany
| | - K Seuthe
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine , Cologne , Germany
| | - M Hellmich
- University of Cologne, Institute for Medical Statistics and Bioinformatics , Cologne , Germany
| | - S Ney
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine , Cologne , Germany
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Metze C, Kavsur R, Sugiura A, Tanaka T, Becher U, Nickenig G, Baldus S, Koerber MI, Pfister R, Iliadis C. Validation of expert criteria proposed by the “German Cardiac Society” for predicting procedural complexity in transcatheter edge-to-edge mitral valve repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2123] [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
Following up on the original EVEREST criteria and several years of procedural experience, the German Cardiac Society (GCS) proposed refined criteria indicating morphological complexity in transcatheter edge-to-edge mitral valve repair (TEER) procedures which so far have not been validated.
Methods
In a retrospective analysis of transesophageal echocardiography images of consecutive patients undergoing TEER in two high-volume centres, complexity was classified according to GCS criteria as optimal (neither characteristics of “complex” nor “very complex', see Table 1), complex (any of the “complex” criteria but no “very complex” criteria) and very complex (any of the “very complex” criteria). Associations with the procedural outcome, reintervention, survival, and heart failure rehospitalization were tested.
Results
633 patients (mean age 79 years, range 50 to 96 years, 59% male) were included, with 35% having dominant primary and 65% having dominant secondary mitral regurgitation (MR). 19% of patients were classified as having optimal, 40% as complex, and 41% as very complex morphologies. Successful clip implantation and reduction in MR ≤2 at discharge were achieved in 100% and 97% in the optimal, in 96% and 88% in the complex, and in 95% and 88% in the very complex morphologies, respectively (p for difference 0.13 and 0.42). The rate of successful clip deployment was significantly lower and the rate of reintervention significantly higher in patients with a mitral valve orifice area ≤3 cm2, compared to patients with a mitral valve orifice area >3 cm2. Pathology extent of MR likely requiring >2 clips was significantly associated with a lower rate of MR reduction to grade ≤2. Midterm (median follow-up time 640 days) mortality or hospitalization due to heart failure was significantly higher in patients with a posterior mitral leaflet length of 7–10 mm.
Conclusion
In the setting of experienced heart valve centres only a few of the complexity criteria proposed by the GCS impact on procedural and clinical outcomes. Even in the case of complex or very complex mitral valve morphology, TEER can be performed effectively with reduction of MR to ≤2 in 88% of cases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Metze
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - R Kavsur
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - A Sugiura
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - T Tanaka
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - U Becher
- Municipal Clinic Solingen non-profit GmbH , Solingen , Germany
| | - G Nickenig
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - S Baldus
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - M I Koerber
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - C Iliadis
- Cologne University Hospital - Heart Center , Cologne , Germany
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Stolz L, Karam N, Von Bardeleben RS, Pfister R, Petronio A, Butter C, Melica B, Praz F, Massberg S, Kalbacher D, Lurz P, Adamo M, Metra M, Bax JJ, Hausleiter J. Staging heart failure patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2124] [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
Heart failure with reduced ejection fraction (HFrEF) and secondary mitral regurgitation (SMR) are closely related. Progression of HFrEF-SMR is associated with characteristic pathophysiological changes. Recently, staging of HFrEF-SMR patients showed prognostic value in a SMR cohort on medical therapy. Whether these stages are prognostic for SMR patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) in addition to drug therapy is unknown.
Purpose
The present study aimed at classifying HFrEF-SMR patients undergoing M-TEER into progressive disease stages based on cardiac and extracardiac involvement. We sought to evaluate the impact of the disease stages on survival outcome and symptomatic improvement after M-TEER
Methods
Based on echocardiographic transthoracic evaluation, patients were assigned into one of the following subsequent HFrEF-SMR stages representing disease progression (Figure 1): left ventricular (LV) dysfunction alone (Stage 1, LV end diastolic volume ≥159 ml and/or LV ejection fraction <50%); left atrial (LA) involvement (Stage 2, history of atrial fibrillation and/or indexed LA volume >34 ml/m2); right ventricular (RV) pressure/volume overload (Stage 3, tricuspid regurgitation ≥3+ and/or systolic pulmonary artery pressure >65 mmHg); biventricular failure (Stage 4, RV to pulmonary artery coupling <0.274 mm/mmHg). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on two-year all-cause mortality and symptomatic outcome was assessed with New York Heart Association (NYHA) functional class at follow-up.
Results
Among a total of 849 included patients who underwent M-TEER for symptomatic MR from 2008 until 2019, 9.5% (n=81) presented with LV dysfunction alone, 46% (n=393) with LA involvement, 15% (n=129) with pressure/volume overload and 29% (n=246) with biventricular failure. At baseline and follow-up, successive HFrEF-SMR stages were associated with more severe heart failure symptoms as expressed by NYHA functional class. An increase in HFrEF-SMR stage was associated with increased two-year all-cause mortality rates after M-TEER (Hazard ratio 1.39, confidence interval 1.23–1.58, p<0.01, Figure 2).
Conclusions
Classifying HFrEF-SMR patients undergoing M-TEER into subsequent disease stages provides prognostic value regarding heart failure symptoms and survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - N Karam
- European Hospital Georges Pompidou, Department of Cardiology , Paris , France
| | - R S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology , Mainz , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department of Cardiology , Cologne , Germany
| | - A Petronio
- University of Pisa, Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department , Pisa , Italy
| | - C Butter
- Brandenburg Heart Center, Department of Cardiology , Bernau bei Berlin , Germany
| | - B Melica
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology , Vila Nova de Gaia , Portugal
| | - F Praz
- Inselspital - University of Bern, Department of Cardiology , Bern , Switzerland
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - P Lurz
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - M Adamo
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - M Metra
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - J J Bax
- Leiden University Medical Center, Department of Cardiology , Leiden , The Netherlands
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
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Tonn S, Pfister R, Klaffehn AL, Weller L, Schwarz KA. Two faces of temporal binding: Action- and effect-binding are not correlated. Conscious Cogn 2021; 96:103219. [PMID: 34749157 DOI: 10.1016/j.concog.2021.103219] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/08/2023]
Abstract
Research on the sense of agency has proliferated a range of explicit and implicit measures. However, the relation of different measures is poorly understood with especially mixed findings on the correlation between explicit judgments of agency and the implicit perceptual bias of temporal binding. Here, we add to the conundrum by showing that the two sub-components of temporal binding - action-binding and effect-binding, respectively - are not correlated across participants either, suggesting independent processes for both components. Research on inter-individual differences regarding the sense of agency is thus well-advised to rely on other implicit measures until the phenomenon of temporal binding is better understood.
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Affiliation(s)
- S Tonn
- Institute of Psychology, University of Würzburg, Würzburg, Germany.
| | - R Pfister
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - A L Klaffehn
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - L Weller
- Institute of Psychology, University of Würzburg, Würzburg, Germany
| | - K A Schwarz
- Institute of Psychology, University of Würzburg, Würzburg, Germany
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9
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Iliadis C, Kalbacher D, Lurz P, Petrescu A, Orban M, Karam N, Lubos E, Thiele H, Von Bardeleben S, Hausleiter J, Pfister R. Association of left atrial volume index with outcomes after transcatheter mitral valve repair for secondary mitral regurgitation: results from the EuroSMR registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1695] [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 benefit of transcatheter edge-to-edge mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation (SMR) shows large heterogeneity. A potential explanation might be the burden and chronicity of left-ventricular backward failure which is reflected by left atrial (LA) size.
Purpose
To investigate the role of LA volume index (LAVi) in real-world SMR patients undergoing TMVr.
Methods
SMR patients in a European multicenter registry were evaluated. Outcomes were evaluated according to LAVi at baseline. Main analysis was performed for all-cause mortality; residual mitral regurgitation, improvement of NYHA class and heart failure hospitalization were analyzed for patients available.
Results
823 included patients were divided according to LAVi into quintiles (≤42, 43–52, 53–62, 63–78, ≥79). A higher hazard for mortality occurred in the four upper quintiles compared to the lower quintile (HR [95% CI] 1.61 [1.08–2.4], 1.65 [1.11–2.46], 1.52 [1.02–2.26] and 1.35 [0.89–2.05]). The incidence of all-cause mortality per 100 patient-years was 14.6, 23, 23.9, 21.7 and 19.5, respectively. Consequently, a cut-off of 42ml/m2 was adopted, which was associated with a significantly higher hazard for mortality after a mean of 589 days (HR 1.54 [95%-CI 1.1–2.1], p=0.01). Technical success rate (postprocedural MR ≤2+) was higher in large LAVi group (95% vs. 91%, p=0.045). The endpoints of heart failure hospitalization, improvement of NYHA class were not different among groups. Multivariable Cox regression analysis including age, EF<30%, diabetes mellitus and NTproBNP showed LAVi >42ml/m2 to be an independent predictor of mortality.
Conclusion
LA dilatation defined by LAVi>42 ml/m2 was associated with higher mortality hazard in SMR patients undergoing TMVr after multivariable adjustment. Our findings warrant further study on whether timely TMVr intervention in patients with SMR and small LAVi can modify outcome.
Funding Acknowledgement
Type of funding sources: None.
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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
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Lurz
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - A Petrescu
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - M Orban
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology and Paris Cardiovascular Research Center, Paris, France
| | - E Lubos
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Thiele
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, 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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10
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Zweck E, Spieker M, Horn P, Iliadis C, Metze C, Kavsur R, Tiyerili V, Nickenig G, Baldus S, Kelm M, Becher MU, Pfister R, Westenfeld R. Machine learning identifies clinical parameters to predict mortality in patients undergoing transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter Mitral Valve Repair (TMVR) with MitraClip is an important treatment option for patients with severe mitral regurgitation. The lack of appropriate, validated and specific means to risk stratify TMVR patients complicates the evaluation of prognostic benefits of TMVR in clinical trials and practice.
Purpose
We aimed to develop an optimized risk stratification model for TMVR patients using machine learning (ML).
Methods
We included a total of 1009 TMVR patients from three large university hospitals, of which one (n=317) served as an external validation cohort. The primary endpoint was all-cause 1-year mortality, which was known in 95% of patients. Model performance was assessed using receiver operating characteristics. In the derivation cohort, different ML algorithms, including random forest, logistic regression, support vectors machines, k nearest neighbors, multilayer perceptron, and extreme gradient boosting (XGBoost) were tested using 5-fold cross-validation in the derivation cohort. The final model (Transcatheter MITral Valve Repair MortALIty PredicTion SYstem; MITRALITY) was tested in the validation cohort with respect to existing clinical scores.
Results
XGBoost was selected as the final algorithm for the MITRALITY Score, using only six baseline clinical features for prediction (in order of predictive importance): blood urea nitrogen, hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), mean arterial pressure, body mass index, and creatinine. In the external validation cohort, the MITRALITY Score's area under the curve (AUC) was 0.783, outperforming existing scores which yielded AUCs of 0.721 and 0.657 at best. 1-year mortality in the MITRALITY Score quartiles across the total cohort was 0.8%, 1.3%, 10.5%, and 54.6%, respectively. Odds of mortality in MITRALITY Score quartile 4 as compared to quartile 1 were 143.02 [34.75; 588.57]. Survival analyses showed that the differences in outcomes between the MITRALITY Score quartiles remained even over a timeframe of 3 years post intervention (log rank: p<0.005). With each increase by 1% in the MITRALITY score, the respective proportional hazard ratio for 3-year survival was 1.06 [1.05, 1.07] (Cox regression, p<0.05).
Conclusion
The MITRALITY Score is a novel, internally and externally validated ML-based tool for risk stratification of patients prior to TMVR. These findings may potentially allow for more precise design of future clinical trials, may enable novel treatment strategies tailored to populations of specific risk and thereby serve future daily clinical practice.
Funding Acknowledgement
Type of funding sources: None. Summary Figure
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Affiliation(s)
- E Zweck
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Spieker
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - P Horn
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Iliadis
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - C Metze
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Kavsur
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - S Baldus
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M U Becher
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - R Pfister
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
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11
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Fortmeier V, Lachmann M, Gercek M, Roder F, Friedrichs KP, Rudolph TK, Iliadis C, Koerber MI, Pfister R, Baldus S, Rudolph V. Predicting procedural success in patients treated with Cardioband system for severe tricuspid regurgitation by employing a random forest algorithm. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1705] [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
Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality despite optimal medical treatment. Transcatheter tricuspid valve intervention (TTVI) is therefore emerging as a novel treatment option, fueling the hope to prolong survival and reduce rehospitalization for heart failure. Obviously, procedural success of TTVI is an important determinant of survival, but predictors for procedural success in patients treated with Cardioband system, which mimics the surgical approach by implanting an annular reduction system and hence targets tricuspid annulus dilatation as the central pathology in most patients, are largely elusive.
Purpose
This study aims to refine prediction of procedural success in patients with severe TR undergoing TTVI with Cardioband system by employing a random forest algorithm.
Methods
Procedural success was evaluated in 72 patients enrolled at two tertiary centers in Germany between 2018 and 2020. Key inclusion criterion was TR ≥ III/V° with high symptomatic burden despite optimal medical treatment. Procedural success war defined as patient alive at the end of the procedure, successful Cardioband implantation, and TR reduction ≥ II/V° as assessed on transthoracic echocardiography before discharge. Since 66.7% of patients were classified as “success”, a synthetic minority over-sampling technique was applied in order to train the random forest algorithm on a balanced data set.
Results
A random forest algorithm reached 85.4% accuracy (AUC: 0.923) in predicting procedural success in a balanced data set using eight parameters from pre-procedural echocardiography as input variables. Partial dependence analysis revealed that enlargement of the tricuspid valve (TV) anteroseptal diameter was most important for model accuracy. Applied to the real-world data set (24 patients classified as “failure” and 48 patients classified as “success”), the now trained random forest algorithm predicted procedural success with high sensitivity (70.8%) and specificity (100.0%), significantly outperforming the no information rate (p-value: 0.0069). Patients with low probability for success were characterized by impaired right ventricular function (TAPSE: 15.5±3.63 mm) and enlarged right sided cardiac diameters (basal right ventricular diameter: 51.6±3.79 mm; TV anteroseptal diameter: 45.0±5.10 mm). Notably, systolic pulmonary artery pressure (sPAP) and TV effective regurgitant orifice area were negatively correlated (R: −0.3004, p-value: 0.0322), and elevation in sPAP was attenuated in patients with low probability for procedural success (sPAP: 34.0±11.7 mmHg).
Conclusion
A random forest algorithm enables precise prediction of procedural success in patients treated with Cardioband system. TR reduction ≥ II/V° appears less achievable in patients with advanced stages of right heart failure, emphasizing the importance of adequate patient selection and timing of intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Fortmeier
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - M Lachmann
- Klinikum rechts der Isar, Technical University of Munich, First Department of Medicine, Munich, Germany
| | - M Gercek
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - F Roder
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - K P Friedrichs
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - T K Rudolph
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - C Iliadis
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - M I Koerber
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - R Pfister
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - S Baldus
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - V Rudolph
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
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12
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Abel M, Pfister R, Hussein I, Alsalloum F, Onyinzo C, Kappl S, Zech M, Demmel W, Staudt M, Kudernatsch M, Berweck S. Deep Brain Stimulation in KMT2B-Related Dystonia: Case Report and Review of the Literature With Special Emphasis on Dysarthria and Speech. Front Neurol 2021; 12:662910. [PMID: 34054706 PMCID: PMC8160374 DOI: 10.3389/fneur.2021.662910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: KMT2B-related dystonia is a progressive childhood-onset movement disorder, evolving from lower-limb focal dystonia into generalized dystonia. With increasing age, children frequently show prominent laryngeal or facial dystonia manifesting in dysarthria. Bilateral deep brain stimulation of the globus pallidus internus (GPi-DBS) is reported to be an efficient therapeutic option. Especially improvement of dystonia and regaining of independent mobility is commonly described, but detailed information about the impact of GPi-DBS on dysarthria and speech is scarce. Methods: We report the 16-months outcome after bilateral GPi-DBS in an 8-year-old child with KMT2B-related dystonia caused by a de-novo c.3043C>T (p.Arg1015*) non-sense variant with special emphasis on dysarthria and speech. We compare the outcome of our patient with 59 patients identified through a PubMed literature search. Results: A remarkable improvement of voice, articulation, respiration and prosodic characteristics was seen 16 months after GPi-DBS. The patients' speech intelligibility improved. His speech became much more comprehensible not only for his parents, but also for others. Furthermore, his vocabulary and the possibility to express his feelings and wants expanded considerably. Conclusion: A positive outcome of GPi-DBS on speech and dysarthria is rarely described in the literature. This might be due to disease progression, non-effectiveness of DBS or due to inadvertent spreading of the electrical current to the corticobulbar tract causing stimulation induced dysarthria. This highlights the importance of optimal lead placement, the possibility of horizontal steering of the electrical field by applying directional stimulation with segmented leads as well as the use of the lowest possible effective stimulation intensity.
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Affiliation(s)
- Maria Abel
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Robert Pfister
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Iman Hussein
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Fahd Alsalloum
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Christina Onyinzo
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Simon Kappl
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Michael Zech
- Helmholtz Centre Munich, Institute of Neurogenomics, Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, Munich, Germany
| | - Walter Demmel
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Martin Staudt
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Department of Neurosurgery and Epilepsy Surgery, Spine- and Scoliosis Surgery, Schön Klinik Vogtareuth, Vogtareuth, Germany.,Research Institute Rehabilitation, Transition, Palliation, Paracelsus Medical University, Salzburg, Austria
| | - Steffen Berweck
- Departmemt of Pediatric Neurology, Neuro-Rehabilitation and Epileptology, Schön Klinik Vogtareuth, Vogtareuth, Germany.,Dr. Von Hauner Children's Hospital, Ludwig-Maximilians- University Munich, Munich, Germany
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13
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Trauzeddel RF, Ertmer M, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter D, Scheeren TWL, Berger C, Treskatsch S. Perioperative echocardiography-guided hemodynamic therapy in high-risk patients: a practical expert approach of hemodynamically focused echocardiography. J Clin Monit Comput 2021; 35:229-243. [PMID: 32458170 PMCID: PMC7943502 DOI: 10.1007/s10877-020-00534-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Abstract
The number of high-risk patients undergoing surgery is growing. To maintain adequate hemodynamic functioning as well as oxygen delivery to the vital organs (DO2) amongst this patient population, a rapid assessment of cardiac functioning is essential for the anesthesiologist. Pinpointing any underlying cardiovascular pathophysiology can be decisive to guide interventions in the intraoperative setting. Various techniques are available to monitor the hemodynamic status of the patient, however due to intrinsic limitations, many of these methods may not be able to directly identify the underlying cause of cardiovascular impairment. Hemodynamic focused echocardiography, as a rapid diagnostic method, offers an excellent opportunity to examine signs of filling impairment, cardiac preload, myocardial contractility and the function of the heart valves. We thus propose a 6-step-echocardiographic approach to assess high-risk patients in order to improve and maintain perioperative DO2. The summary of all echocardiographic based findings allows a differentiated assessment of the patient's cardiovascular function and can thus help guide a (patho)physiological-orientated and individualized hemodynamic therapy.
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Affiliation(s)
- R. F. Trauzeddel
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M. Ertmer
- Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - M. Nordine
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H. V. Groesdonk
- Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Hospital Erfurt, Erfurt, Germany
| | - G. Michels
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R. Pfister
- Department of Internal Medicine III, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D. Reuter
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - T. W. L. Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - C. Berger
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S. Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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14
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Trauzeddel RF, Nordine M, Groesdonk HV, Michels G, Pfister R, Reuter DA, Scheeren TWL, Berger C, Treskatsch S. [Perioperative optimization using hemodynamically focused echocardiography in high-risk patients-A practice guide]. Anaesthesist 2021; 70:772-784. [PMID: 33660043 DOI: 10.1007/s00101-021-00934-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DO2) in this patient population, a timely assessment of cardiac function and the underlying pathophysiological causes of hemodynamic instability is essential for the anesthesiologist. A variety of hemodynamic monitoring procedures are available for this purpose; however, due to method-immanent limitations they are often not able to directly identify the underlying cause of cardiovascular impairment. OBJECTIVE To present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography. METHODS AND RESULTS Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves. CONCLUSION Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.
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Affiliation(s)
- R F Trauzeddel
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - M Nordine
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - H V Groesdonk
- Klinik für Interdisziplinäre Intensivmedizin und Intermediate Care, Helios Klinikum Erfurt, Erfurt, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - D A Reuter
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - T W L Scheeren
- Klinik für Anästhesiologie, Universitätsmedizin Groningen, Groningen, Niederlande
| | - C Berger
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland.
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15
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Iliadis C, Metze C, Spieker M, Kavsur R, Horn P, Westenfeld R, Tiyerili V, Becher M, Kelm M, Nickenig G, Baldus S, Pfister R. Association of the get with the guidelines heart failure risk score with mortality in patients undergoing transcatheter edge-to-edge mitral valve repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2640] [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
Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients.
Methods
Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the “Get with the Guidelines Heart Failure Risk Score” (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of COPD) with all-cause mortality.
Results
Among 815 patients with available data 177 patients died during a mean follow-up time of 419 days. Estimated one-year mortality by quartiles of the score (0–37; 38–42, 43–47 and more than 47 points) was 6%, 10%, 23% and 30%, respectively (p<0.001). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06–1.11%, p<0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, renal function and LogEuroscore, and was equally predictive in primary and secondary mitral regurgitation.
Conclusion
The “Get with the Guidelines Heart Failure Risk Score” showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible.
Funding Acknowledgement
Type of funding source: None
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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
| | - C Metze
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - M Spieker
- University hospital Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf,, Duesseldorf, Germany
| | - R Kavsur
- University Hospital Bonn, Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - P Horn
- University hospital Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf,, Duesseldorf, Germany
| | - R Westenfeld
- University hospital Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf,, Duesseldorf, Germany
| | - V Tiyerili
- University Hospital Bonn, Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - M.U Becher
- University Hospital Bonn, Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - M Kelm
- University hospital Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University, Düsseldorf,, Duesseldorf, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, 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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16
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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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17
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Kavsur R, Iliadis C, Metze C, Spieker M, Tiyerili V, Horn P, Baldus S, Kelm M, Nickenig G, Pfister R, Westenfeld R, Becher M. Prognostic impact and post-procedural development of severe tricuspid regurgitation in patients undergoing transcatheter edge-to-edge mitral valve repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1926] [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
Purpose
The aim of this study was to investigate the clinical impact and post-procedural development of tricuspid regurgitation (TR) in patients undergoing the MitraClip procedure for severe mitral regurgitation.
Methods
In this present multicentre study, we included 940 patients undergoing MitraClip implantation for symptomatic mitral regurgitation from August 2010 to September 2018. Patients were categorized according to concomitant TR (none or mild vs moderate vs severe) and the prognostic impact of TR on 1-year mortality was evaluated. Moreover, in 377 patients, we assessed 3-months echocardiographic controls to further analyse the post-procedural development of TR.
Results
At baseline, concomitant TR was graded none/mild in 393 (42%), moderate in 316 (34%), and severe in 231 (25%) patients. During 1-year follow-up, 141 of 940 (15%) patients died. According to mild/none, moderate and severe TR, mortality rates were 13%, 12%, and 23%, respectively, revealing a higher prevalence of death in patients with severe TR (p=0.001). Kaplan-Meier analysis and log-rank test confirmed inferior survival rates for patients with severe TR (p=0.001), while there were no significant difference in survival rates between patients with none/mild vs moderate TR (p=0.561). Regarding 1-year mortality, multivariate cox regression analysis, revealed an odds ratio of 1.739 (1.024–2.953; p=0.041), associated with severe TR. After 3-months follow-up, echocardiography in 377 patients showed following TR grade distributions: 44% none/mild, 37% moderate and 19% severe TR. In 100 patients (27%), TR improved by one or more grades, while 64 patients (17%) showed a TR worsening. In patients with severe TR at baseline, 42 of 91 (46%) patients showed a reduction in TR of one or more grades. Patients with severe TR at baseline, who showed a TR improvement during 3-months follow-up, had lower rates of 1-year mortality (p=0.025). For these patients, in regression analysis, right atrial area was revealed as only predictor of TR improvement after MitraClip procedure [odds ratio 0.958 (0.918–0.999); p=0.046].
Conclusion
One-fourth of patients undergoing MitraClip procedure for mitral regurgitation had concomitant severe tricuspid regurgitation which was predictive for worse prognosis. Post-procedural TR improvement of one or more grades was frequent in these patients and was associated with higher survival-rates.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Kavsur
- University hospital Bonn, Bonn, Germany
| | - C Iliadis
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - C Metze
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - M Spieker
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - P Horn
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Baldus
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - R Pfister
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
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18
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Kavsur R, Iliadis C, Metze C, Spieker M, Tiyerili V, Horn P, Baldus S, Kelm M, Nickenig G, Pfister R, Westenfeld R, Becher M. MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1965] [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
Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR).
Aim
We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure.
Methods
In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation.
Results
During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p<0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029).
Conclusion
The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Kavsur
- University hospital Bonn, Bonn, Germany
| | - C Iliadis
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - C Metze
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - M Spieker
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - P Horn
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - S Baldus
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - M Kelm
- University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - R Pfister
- Heart Center at the University of Cologne, Cardiology, Angiology, Pneumology and Medical Intensive Care, Cologne, Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Duesseldorf, Germany
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19
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. [Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR) : Consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC]. Anaesthesist 2019; 67:607-616. [PMID: 30014276 DOI: 10.1007/s00101-018-0473-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Extracorporeal cardiopulmonary resuscitation (eCPR) may be considered as a rescue attempt for highly selected patients with refractory cardiac arrest and potentially reversible etiology. Currently there are no randomized, controlled studies on eCPR, and valid predictors of benefit and outcome which might guide the indication for eCPR are lacking. Currently selection criteria and procedures differ across hospitals and standardized algorithms are lacking. Based on expert opinion, the present consensus statement provides a proposal for a standardized treatment algorithm for eCPR.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Wengenmayer
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - C Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - C Dohmen
- LVR-Klinik Bonn, Bonn, Deutschland
| | - B W Böttiger
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universität zu Köln, Köln, Deutschland
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | | | - A Bauer
- MediClin Herzzentrum Coswig, Coswig, Deutschland
| | - J-T Gräsner
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - A Ghanem
- Abteilung Kardiologie, II. Medizinische Klinik, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - U Kreimeier
- Klinik für Anästhesiologie, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - A Beckmann
- Herzzentrum Duisburg, Klinik für Herz- und Gefäßchirurgie, Evangelisches Krankenhaus Niederrhein, Duisburg, Deutschland
| | - M Fischer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, ALB FILS KLINIKEN GmbH, Klinik am Eichert, Göppingen, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsmedizin Essen, Essen, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - F Born
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Deutschland
| | - H M Hoffmeister
- Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen gGmbH, Solingen, Deutschland
| | - M Preusch
- Zentrum für Innere Medizin, Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - U Boeken
- Klinik für Kardiovaskuläre Chirurgie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - R Riessen
- Department für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - H Thiele
- Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universitätsklinik, Leipzig, Deutschland
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20
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Tichelbäcker T, Dumitrescu D, Gerhardt F, Stern D, Wissmüller M, Adam M, Schmidt T, Frerker C, Pfister R, Halbach M, Baldus S, Rosenkranz S. Pulmonary hypertension and valvular heart disease. Herz 2019; 44:491-501. [PMID: 31312873 DOI: 10.1007/s00059-019-4823-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pulmonary hypertension (PH) is an important contributor to morbidity and mortality in patients with left-sided heart disease, including valvular heart disease. In this context, elevated left atrial pressure primarily leads to the development of post-capillary PH. Despite the fact that repair of left-sided valvular heart disease by surgical or interventional approaches will improve PH, recent studies have highlighted that PH (pre- or post-interventional) remains an important predictor of long-term outcome. Here, we review the current knowledge on PH in valvular heart disease taking into account new hemodynamic PH definitions, and the distinction between post- and pre-capillary components of PH. A specific focus is on the precise characterization of hemodynamics and cardiopulmonary interaction, and on potential strategies for the management of residual PH after mitral or aortic valve interventions. In addition, we highlight the clinical significance of tricuspid regurgitation, which may occur as a primary condition or as a consequence of PH and right heart dilatation (functional). In this context, proper patient selection for potential tricuspid valve interventions is crucial. Finally, the article highlights gaps in evidence, and points toward future perspectives.
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Affiliation(s)
- T Tichelbäcker
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Dumitrescu
- Klinik für Allgemeine und Interventionelle Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | - F Gerhardt
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Stern
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Wissmüller
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Adam
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - T Schmidt
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - C Frerker
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - R Pfister
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - M Halbach
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Baldus
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Rosenkranz
- Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany.
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21
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Papadimitriou V, Tosello B, Pfister R. Effect of written outcome information on attitude of perinatal healthcare professionals at the limit of viability: a randomized study. BMC Med Ethics 2019; 20:74. [PMID: 31640670 PMCID: PMC6806555 DOI: 10.1186/s12910-019-0413-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/27/2019] [Indexed: 11/11/2022] Open
Abstract
Background Differences in perception and potential disagreements between parents and professionals regarding the attitude for resuscitation at the limit of viability are common. This study evaluated in healthcare professionals whether the decision to resuscitate at the limit of viability (intensive care versus comfort care) are influenced by the way information on incurred risks is given or received. Methods This is a prospective randomized controlled study. This study evaluated the attitude of healthcare professionals by testing the effect of information given through graphic fact sheets formulated either optimistically or pessimistically. The written educational fact sheet included three graphical presentations of survival and complication/morbidity by gestational age. The questionnaire was submitted over a period of 4 months to 5 and 6-year medical students from the Geneva University as well as physicians and nurses of the neonatal unit at the University Hospitals of Geneva. Our sample included 102 healthcare professionals. Results Forty-nine responders (48%) were students (response rate of 33.1%), 32 (31%) paediatricians (response rate of 91.4%) and 21 (20%) nurses in NICU (response rate of 50%). The received risk tended to be more severe in both groups compared to the graphically presented facts and current guidelines, although optimistic representation favoured the perception of “survival without disability” at 23 to 25 weeks. Therapeutic attitudes did not differ between groups, but healthcare professionals with children were more restrained and students more aggressive at very low gestational ages. Conclusion Written information on mortality and morbidity given to healthcare professionals in graphic form encourages them to overestimate the risk. However, perception in healthcare staff may not be directly transferable to parental perception during counselling as the later are usually naïve to the data received. This parental information are always communicated in ways that subtly shape the decisions that follow.
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Affiliation(s)
- V Papadimitriou
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland
| | - B Tosello
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland. .,Aix-Marseille Université, CNRS, EFS, ADES, Marseille, France.
| | - R Pfister
- Neonatal and Paediatric Intensive Care Unit, University Hospitals of Geneva, and Geneva University, 1211, Genève, Switzerland
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22
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Abstract
Recent advances in the medical oncological treatment options for cancer have led to a clear improvement in the survival rate worldwide; however, many of the recently developed new drugs are directly or indirectly associated with cardiovascular side effects. Cardiovascular diseases are already the most frequent non-cancerous cause of death in tumor patients. Prevention, early detection of these complications, correct management and timely initiation of specific cardiac medical treatment are the key for an improvement of the cardiovascular prognosis. This article provides an overview and comprehensive summary of the possible cardiotoxic side effects of important oncological therapies and offers possible practical strategies with respect to risk stratification, cardiological follow-up care and management approaches for chemotherapy-induced left ventricular dysfunction.
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Affiliation(s)
- C Hohmann
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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23
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Iliadis C, Metze C, Koerber MI, Baldus S, Pfister R. P4725Prognostic relevance of the COAPT inclusion criteria in real-world patients with secondary mitral regurgitation undergoing mitraclip implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1102] [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
The recently published Cardiovascular Outcomes Assessment of the mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) randomized trial has shown a huge benefit in the survival of patients with systolic heart failure and functional mitral regurgitation treated with MitraClip. However, patients in COAPT were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear.
Methods
Our study examined the clinical outcome in consecutive patients from our Heart Centre with reduced left-ventricular ejection fraction (EF<50%) undergoing mitraclip for mitral regurgitation of dominant functional etiology by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction >20%, left ventricular end-systolic dimension <70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure <70 mmHg, mitral valve orifice area >4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). The composite endpoint of all-cause mortality or heart failure hospitalization and the endpoint of heart failure hospitalization were analysed.
Results
Among 123 patients who underwent mitraclip implantation 60.2% fulfilled the inclusion criteria of COAPT. Overall, 54 patients (46.6%) died or were hospitalized for heart failure during a median follow-up time of 19 months. The composite endpoint was significantly less frequent (p=0.01) in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria, with an estimated 1-year event rate of 24.6% vs 49.1%. Patients with COAPT inclusion criteria had a 49% lower hazard of the composite endpoint (95% CI 12–70%, p=0.015). Heart failure hospitalization was significantly less frequent (p=0.039) in patients fulfilling COAPT selection criteria than in those who did not, with an estimated 1-year event rate of 19% vs. 36.8%. Patients with COAPT inclusion criteria had a 50% lower hazard for heart failure hospitalization (95% CI 1–75%, p=0.046). Of note, the 1-year all-cause mortality in our patients fulfilling COAPT inclusion criteria was lower compared to the renowned COAPT trial (10% vs. 19%).
Conclusion
In this single center study the outcome of patients with functional mitral regurgitation undergoing mitraclip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility. The remarkable difference in outcome between real-world patients and COAPT trial patients warrants further study to elucidate underlying causes, which might affect the transferability of the COAPT results.
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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
| | - C Metze
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - M I Koerber
- 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
| | - 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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24
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Koerber MI, Schaefer M, Vimalathasan R, Baldus S, Pfister R. P4722Using the multidimensional prognostic index (MPI) to predict outcome in patients undergoing transcatheter mitral valve repair with MitraClip: a prospective observational single centre study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1100] [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
Selection of patients who benefit from percutaneous mitral valve repair (PMVR) is challenging. We used the multidimensional prognostic index (MPI) to evaluate patients' prognosis.
Methods
We conducted a prospective observational single centre study, including patients who did undergo PMVR from 11/2017 to 07/2018. MPI score was used for geriatric assessment and calculated from 63 separate items distributed in eight domains including instrumental activities of daily living, mental status, nutrition, risk of pressure ulcers, comorbidity, medication and marital/cohabitation status.
Results
82 patients were included. Mean MPI-Score was 0.22±0.21. 41 patients (50%) belonged to MPI-1 group (low risk), 37 (45.1%) to MPI-2 group (medium risk) und 4 patients (4.9%) to MPI-3 group (high risk). Due to the low number of patients in MPI-3 group, MPI-2 group and MPI-3 group were combined for statistical analysis. Baseline characteristics, functional assessment and outcome of patients are shown in Table1. During follow-up 4 patients died. All of these belonged to the higher risk group MPI 2/3.
Table1 MPI 1 MPI 2+3 p value Age 73.2±8.8 78.9±7.6 0.002 6 min walk 303±107 175±122 <0.001 EuroScore II (%) 6.61±7.24 7.6±5.55 0.49 EF (%) 43.7±17.2 39.4±15.6 0.36 NT-pro BNP 4611±5413 6045±12670 0.54 Diabetes 7 (17.1) 16 (39) 0.027 Coronary artery disease 25 (61) 26 (63.4) 0.82 Arterial hypertension 26 (63.4) 31 (75.6) 0.23 Barthel index baseline 98±4 80±24 <0.001 Barthel index 30 days 97±5 82±24 <0.001 MLWHFQ baseline 45.7±20.9 49.1±14.5 0.39 MLWHFQ 30 days 38.4±25 34.7±18.2 0.53 ICU stay (days) 1.7±1.2 3.9±7.4 0.069 Death at 30 days 0 4 (10.5) 0.033
Conclusion
The MPI score is associated with age and impaired functional capacity at baseline but not with traditional cardiovascular prognostic markers. Thus, MPI may provide additional prognostic information on mortality and functional outcome of patients beyond established risk scores.
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Affiliation(s)
- M I Koerber
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Schaefer
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - R Vimalathasan
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Cologne, Germany
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Schwarz K, Weller L, Klaffehn A, Pfister R. The effects of action choice on temporal binding, agency ratings, and their correlation. Conscious Cogn 2019; 75:102807. [DOI: 10.1016/j.concog.2019.102807] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/23/2019] [Accepted: 08/22/2019] [Indexed: 01/04/2023]
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Frerker C, Schmidt T, Pfister R, Körber MI, Mauri V, Wösten M, Baldus S. [Cardioband®: Where do we stand, who are suitable patients?]. Herz 2019; 44:596-601. [PMID: 31372675 DOI: 10.1007/s00059-019-4839-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Functional mitral regurgitation (FMR) is characterized by a dilatation of the mitral valve annulus resulting in an insufficient adaptation of the anterior and posterior mitral valve leaflets and/or severe tethering of the leaflets due to dilatation of the left ventricle. The Cardioband® system was introduced in 2015 and is a catheter-based direct mitral valve annuloplasty procedure for treatment of FMR. In the European CE approval study 60 patients with moderate or severe FMR were analyzed per protocol. There were no device or procedure-related deaths. The technical success rate of the procedure, defined as successful implantation and tightening was 97%. At 1 year, the overall survival and survival free of hospital readmission for heart failure were 87% and 66%, respectively. Currently, various interventional treatment procedures are available, such as the edge-to-edge technique as well as direct and indirect annuloplasty. In summary, patients with FMR as a result of a dilatation of the mitral valve annulus appear to be suitable for direct annuloplasty with the Cardioband® system.
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Affiliation(s)
- C Frerker
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Schmidt
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M I Körber
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - V Mauri
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - M Wösten
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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27
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Neefs J, Boekholdt SM, Khaw KT, Luben R, Pfister R, Wareham NJ, Meulendijks ER, Sanders P, de Groot JR. Body mass index and body fat distribution and new-onset atrial fibrillation: Substudy of the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study. Nutr Metab Cardiovasc Dis 2019; 29:692-700. [PMID: 31079869 PMCID: PMC7340538 DOI: 10.1016/j.numecd.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/06/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Obesity is a recognized risk factor for new-onset atrial fibrillation (AF). The association between body fat distribution, which is measured by body mass index (BMI) and waist-hip ratio (WHR), its changes, and new-onset AF is conflicting. METHODS AND RESULTS Participants of the European Prospective Investigation into Cancer and Nutrition in Norfolk cohort study were included, with exclusion criteria of prevalent AF, rheumatic heart disease, and cancer. AF was confirmed by the International Classification of Diseases-10 hospital discharge code I48. Adjusted sex-specific Cox proportional hazards models were used to quantify the AF risk per 1 standard deviation increase and for quintiles of adiposity indices. A total of 10,885 men and 12,857 women were followed up for a median of 19 years, yielding 451,098 person-years. New-onset AF was diagnosed in 1408 (12.9%) men and 1102 (8.6%) women. Multivariable analyses showed that BMI predicted new-onset AF in all, while WHR predicted only in men. New-onset AF risk gradually increased across the range of adiposity indices: for men in the highest BMI quintile, HR: 1.59 (CI 1.32-1.91, p for trend<0.001), whereas for women in the highest BMI quintile, HR: 1.52 (CI 1.23-1.88, p for trend<0.001). Further, for men in the highest WHR quintile, HR: 1.31 (CI 1.09-1.57, p for trend: 0.01), whereas for women in the highest WHR quintile, HR: 1.12 (CI 0.90-1.41, p for trend: 0.17). The change in BMI and WHR was similar in participants with or without new-onset AF. CONCLUSIONS An increased body mass, as measured by BMI, is associated with an increased risk of developing new-onset AF. More abdominal fat distribution, as measured by WHR, is associated with an increased risk of developing new-onset AF in men but not in women.
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Affiliation(s)
- J Neefs
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | - S M Boekholdt
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | - K-T Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - R Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - R Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Germany
| | - N J Wareham
- MRC Epidemiology Unit, Cambridge, United Kingdom
| | - E R Meulendijks
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | - P Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - J R de Groot
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, the Netherlands.
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28
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Z Herz- Thorax- Gefäßchir 2019. [DOI: 10.1007/s00398-018-0262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Hempel D, Schröper T, Pfister R, Michels G. [Ultrasound training in emergency and intensive care medicine : Integration already in medical school?]. Med Klin Intensivmed Notfmed 2019; 114:519-524. [PMID: 30830291 DOI: 10.1007/s00063-019-0550-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Ultrasound is an important diagnostic tool especially in emergency and intensive care medicine. It is always available at the bedside and shortens time to diagnosis. Many specialties have integrated ultrasound into diagnostic algorithms as part of the extended physical exam. Numerous differential diagnoses can be easily excluded using point-of-care ultrasound and therefore adequate treatment is initiated faster. Emergency or focused ultrasound is therefore of outstanding relevance to any emergency or critical care physician. Integration into medical school curricula is becoming more common tough no nationwide standards are in place yet.
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Affiliation(s)
- D Hempel
- Zentrale Notaufnahme und Aufnahmestation, Universitätsklinik Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - T Schröper
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Abstract
Focused echocardiography has become increasingly important for bedside diagnostics in acute medicine. Focused echocardiography can detect various cardiac pathologies, such as pericardial effusion, left ventricular dysfunction, right heart strain, relevant heart valve defects and dissection of the ascending aorta. Echocardiographic findings should be interpreted in the clinical context.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum der Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - D Hempel
- Zentrale Notaufnahme, Medizinische Fakultät, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Magdeburg, Deutschland
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31
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Di Benedetto L, Pfister R, Michels G, Khaw KT, Luben R. P5802Individual and combined impact of modifiable lifestyle factors on atrial fibrillation in apparently healthy men and women: the epic-norfolk prospective population study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5802] [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)
- L Di Benedetto
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - G Michels
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - K T Khaw
- University of Cambridge, Cambridge, United Kingdom
| | - R Luben
- University of Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom
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32
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Hohmann C, Hohnloser SH, Jacob J, Walker J, Baldus S, Pfister R. 4365Non-vitamin K oral anticoagulants in comparison to phenprocoumon in geriatric and non-geriatric patients: a retrospective, observational study on 71,000 patients with non-valvular atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4365] [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)
- C Hohmann
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine, Cologne, Germany
| | - S H Hohnloser
- JW Goethe University, Department of Cardiology, Frankfurt am Main, Germany
| | - J Jacob
- InGef- Institute for applied health research, Berlin, Germany
| | - J Walker
- InGef- Institute for applied health research, Berlin, Germany
| | - S Baldus
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine, Cologne, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Clinic III for Internal Medicine, Cologne, Germany
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33
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Michels G, Wengenmayer T, Hagl C, Dohmen C, Böttiger BW, Bauersachs J, Markewitz A, Bauer A, Gräsner JT, Pfister R, Ghanem A, Busch HJ, Kreimeier U, Beckmann A, Fischer M, Kill C, Janssens U, Kluge S, Born F, Hoffmeister HM, Preusch M, Boeken U, Riessen R, Thiele H. Empfehlungen zur extrakorporalen kardiopulmonalen Reanimation (eCPR). Med Klin Intensivmed Notfmed 2018; 113:478-486. [DOI: 10.1007/s00063-018-0452-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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34
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Hohmann C, Pfister R, Michels G. Sind initialer pH- und Laktatwert nach kardiopulmonaler Wiederbelebung immer entscheidend? Med Klin Intensivmed Notfmed 2018; 114:561-566. [DOI: 10.1007/s00063-018-0432-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/18/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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35
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Michels G, Hempel D, Pfister R, Janssens U. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine. Med Klin Intensivmed Notfmed 2018; 114:434-438. [PMID: 29632969 DOI: 10.1007/s00063-018-0431-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/13/2018] [Accepted: 03/07/2018] [Indexed: 02/07/2023]
Abstract
Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.
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Affiliation(s)
- G Michels
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - D Hempel
- Department of Emergency Medicine, University Hospital Jena, Jena, Germany
| | - R Pfister
- Department III of Internal Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - U Janssens
- Department of Cardiology, St Antonius Hospital, Eschweiler, Germany
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36
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Hempel D, Pfister R, Michels G. Strukturierte bettseitige Sonographie in der Intensivmedizin. Z Herz- Thorax- Gefäßchir 2018. [DOI: 10.1007/s00398-017-0201-y] [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: 11/30/2022]
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37
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Michels G, Ney S, Hoffmann F, Brugada J, Pfister R, Brockmeier K, Sultan A. [Hypothermia-induced ECG changes: characteristic, but not specific]. Med Klin Intensivmed Notfmed 2017; 113:217-220. [PMID: 29138889 DOI: 10.1007/s00063-017-0381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
Hypothermia-induced J‑ or so-called Osborn waves can be detected under therapeutic hypothermia in approximately 20-40% of cases. The occurrence of J‑waves in the context of the targeted temperature management after cardiopulmonary resuscitation is characteristic, but not pathognomonic for hypothermia. An electrocardiographic diagnosis under hypothermia after cardiac arrest should always be done with caution due to the various hypothermia-associated electromechanical changes of the myocardium.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Köln, Deutschland.
| | - S Ney
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Köln, Deutschland
| | - F Hoffmann
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Köln, Deutschland
| | - J Brugada
- Cardiovascular Institute, Hospital Clínic Pediatric Arrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spanien
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Köln, Deutschland
| | - K Brockmeier
- Klinik und Poliklinik für Kinderkardiologie, Herzzentrum der Universität zu Köln, Köln, Deutschland
| | - A Sultan
- Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937 Köln, Köln, Deutschland
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Hempel D, Pfister R, Michels G. [Correction: Structured bedside-ultrasound in intensive caremedicine]. Med Klin Intensivmed Notfmed 2017; 112:759. [PMID: 29101489 DOI: 10.1007/s00063-017-0380-z] [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: 11/30/2022]
Affiliation(s)
- D Hempel
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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39
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Michels G, Kämper A, Hempel D, Pfister R. [Circulatory failure : Out- and inpatient management]. Internist (Berl) 2017; 58:908-915. [PMID: 28765983 DOI: 10.1007/s00108-017-0302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Circulatory insufficiency is often understood as symptomatic hypotension due to various causes. The clinical result of circulatory dysregulation is arterial hypotension. The manifestation of hypotension is often divided into chronic and acute forms. Chronic hypotension can be distinguished etiopathogenetically into primary and secondary hypotension. Acute hypotension is usually equated to circulatory shock. While patients with chronic hypotension should be seen primarily by their general practitioner, patients with acute hypotension and a frequently severe clinical manifestation should be evaluated in the emergency department or, if there is a specific cause, directly in the acute clinic. Standardization of diagnostic and therapeutic pathways in both out- and inpatient care-not only for the management of circulatory weakness-would be an improvement not only in regards to patient care, but also with respect to healthcare economics.
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Affiliation(s)
- G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - A Kämper
- Gemeinschaftspraxis für Innere und Allgemeinmedizin, Köln, Deutschland
| | - D Hempel
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Klinikum der Friedrich-Schiller-Universität, Jena, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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40
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Pfister R, Jacob J, Walker J, Baldus S, Hohmann C. 2874Non-vitamin K antagonist oral anticoagulants in comparison to phenprocoumon in a real-word setting of atrial fibrillation: an analysis of a large German health claims dataset. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.2874] [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: 11/12/2022] Open
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41
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Koerber M, Silwedel J, Friedrichs K, Mauri V, Huntgeburth M, Pfister R, Baldus S, Rudolph V. P151Bleeding complications following percutaneous mitral valve repair with the MitraClip. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p151] [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: 11/12/2022] Open
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Mauri V, Weber T, Friedrichs K, Koerber M, Rudolph T, Pfister R, Baldus S, Rudolph V. P478Hemodynamic characterization of right heart function to predict outcome after MitraClip. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p478] [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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43
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Iliadis C, Lee S, Kuhr K, Metze C, Matzik S, Michels G, Rudolph V, Baldus S, Pfister R. P476Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p476] [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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44
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Michels G, Thiele H, Kluge S, Pfister R. Existieren prognostische Prädiktoren für die extrakorporale kardiopulmonale Reanimation (ECPR) beim außerklinischen Kreislaufstillstand? Med Klin Intensivmed Notfmed 2017; 112:634-636. [DOI: 10.1007/s00063-017-0314-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
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45
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Neefs J, Boekholdt SM, Khaw KT, Luben R, Pfister R, Wareham NJ, De Groot JR. 1668Body fat distribution as risk factor of new-onset atrial fibrillation in The European Prospective Investigation Into Cancer and Nutrition in Norfolk Study. Europace 2017. [DOI: 10.1093/ehjci/eux159.004] [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: 11/14/2022] Open
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Zeriouh M, Sabashnikov A, Choi Y, Deppe A, Mader N, Rahmanian P, Scherner M, Fatullayev J, Pfister R, Wippermann J, Michels G, Wahlers T. Long-term Survival, Freedom from Re-intervention and Costs after MIDCAB Compared to PCI on the LAD. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598805] [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: 10/20/2022]
Affiliation(s)
- M. Zeriouh
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - A. Sabashnikov
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Y.H. Choi
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - A.C. Deppe
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - N. Mader
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - P. Rahmanian
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - M. Scherner
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - J. Fatullayev
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - R. Pfister
- Heart Center, Department of Cardiology, Pneumology and Angiology, University of Cologne, Cologne, Germany
| | - J. Wippermann
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - G. Michels
- Heart Center, Department of Cardiology, Pneumology and Angiology, University of Cologne, Cologne, Germany
| | - T. Wahlers
- Heart Center, Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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Michels G, Ruhparwar A, Pfister R, Welte T, Gottlieb J, Andriopoulos N, Teschner S, Burst V, Mertens J, Stippel D, Herter-Sprie G, Shimabukuro-Vornhagen A, Böll B, von Bergwelt-Baildon M, Theurich S, Vehreschild J, Scheid C, Chemnitz J, Kochanek M. Transplantationsmedizin in der Intensivmedizin. Repetitorium Internistische Intensivmedizin 2017. [PMCID: PMC7193715 DOI: 10.1007/978-3-662-53182-2_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Die Betreuung von Patienten vor und nach einer Organtransplantation gehört zum Gebiet der „speziellen Intensivmedizin“ des jeweiligen Fachbereichs. Die transplantationsspezifische Intensivmedizin setzt daher ein interdisziplinäres Management voraus. Neben der Organprotektion bzw. dem Monitoring von speziellen transplantationsrelevanten Problemen steht die Immunsuppression. Auf das Management mit Immunsuppressiva und von transplantationsassoziierten, intensivmedizinisch relevanten Problemen wird in diesem Kapitel eingegangen. Speziell werden Herz-, Lungen-, Leber-, Nieren- und Stammzelltransplantationen dargestellt.
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Puppe J, van Ooyen D, Neise J, Thangarajah F, Eichler C, Fridrich C, Morgenstern B, Pfister R, Mallmann P, Wirtz M, Michels G. Prospective evaluation of QTc-interval prolongation in patients with advanced ovarian cancer after treatment with carboplatin, paclitaxel and bevacizumab. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kwok CS, Loke YK, Welch AA, Luben RN, Lentjes MAH, Boekholdt SM, Pfister R, Mamas MA, Wareham NJ, Khaw KT, Myint PK. Habitual chocolate consumption and the risk of incident heart failure among healthy men and women. Nutr Metab Cardiovasc Dis 2016; 26:722-734. [PMID: 27052923 PMCID: PMC4987462 DOI: 10.1016/j.numecd.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 10/10/2015] [Revised: 01/07/2016] [Accepted: 01/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to examine the association between chocolate intake and the risk of incident heart failure in a UK general population. We conducted a systematic review and meta-analysis to quantify this association. METHODS AND RESULTS We used data from a prospective population-based study, the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort. Chocolate intake was quantified based on a food frequency questionnaire obtained at baseline (1993-1997) and incident heart failure was ascertained up to March 2009. We supplemented the primary data with a systematic review and meta-analysis of studies which evaluated risk of incident heart failure with chocolate consumption. A total of 20,922 participants (53% women; mean age 58 ± 9 years) were included of whom 1101 developed heart failure during the follow up (mean 12.5 ± 2.7 years, total person years 262,291 years). After adjusting for lifestyle and dietary factors, we found 19% relative reduction in heart failure incidence in the top (up to 100 g/d) compared to the bottom quintile of chocolate consumption (HR 0.81 95%CI 0.66-0.98) but the results were no longer significant after controlling for comorbidities (HR 0.87 95%CI 0.71-1.06). Additional adjustment for potential mediators did not attenuate the results further. We identified five relevant studies including the current study (N = 75,408). The pooled results showed non-significant 19% relative risk reduction of heart failure incidence with higher chocolate consumption (HR 0.81 95%CI 0.66-1.01). CONCLUSIONS Our results suggest that higher chocolate intake is not associated with subsequent incident heart failure.
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Affiliation(s)
- C S Kwok
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - Y K Loke
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - A A Welch
- Department of Population Health & Primary Care, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - R N Luben
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - M A H Lentjes
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - S M Boekholdt
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
| | - M A Mamas
- Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom
| | - N J Wareham
- Medical Research Council Epidemiology Unit, Cambridge, United Kingdom
| | - K-T Khaw
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - P K Myint
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom.
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Hempel D, Pfister R, Michels G. [Hemodynamic monitoring in intensive care and emergency medicine : Integration of clinical signs and ultrasound findings]. Med Klin Intensivmed Notfmed 2016; 111:596-604. [PMID: 27279379 DOI: 10.1007/s00063-016-0172-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/02/2016] [Indexed: 12/29/2022]
Abstract
Hemodynamic monitoring is required in critically ill patients presenting with circulatory shock. Besides the clinical evaluation, noninvasive technologies can be used. Guidelines on volume resuscitation and cardiogenic shock already recommend bedside ultrasound as a diagnostic tool. To differentiate the cause of circulatory shock and monitor the effects of therapies, hemodynamic monitoring is necessary. This review discusses possibilities of the different invasive and noninvasive monitoring tools with a focus on the integration of clinical and sonographic parameters.
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Affiliation(s)
- D Hempel
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Klinikum der Friedrich-Schiller-Universität, Jena, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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