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Petzold T, Bagaev E, Herzog H, Born F, Hoechter D, Michel S, Rutkowski S, Lüsebrink E, Thienel M, Massberg S, Hagl C, Guenther SP. Whole blood platelet aggregation kinetics under cardiopulmonary bypass: A pilot study. Int J Artif Organs 2019; 43:208-214. [PMID: 31674867 DOI: 10.1177/0391398819882440] [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: 11/16/2022]
Abstract
Assessing the platelets' functional status during surgery on cardiopulmonary bypass is challenging. This study used multiple electrode impedance aggregometry (Multiplate®) to create a timeline of platelet aggregation changes as induced by cardiopulmonary bypass in antiplatelet-naive patients undergoing elective surgery for mitral valve regurgitation. We performed six consecutive measurements (T1: pre-operatively, T2: after heparinization, T3: 3 min after establishment of cardiopulmonary bypass, T4: immediately after administration of cardioplegia, T5: 5 min after administration of cardioplegia, and T6: 45 min after administration of cardioplegia). Platelet aggregation was determined after stimulation with 3.2-μg/mL collagen, 6.4-μM adenosine diphosphate, and 32-μM thrombin receptor activating peptide. Five patients were included (age: 64 ± 10 years, one female). We observed a decrease in hematocrit levels by -17.1% ± 3.7% (T1 vs T6) with a drop after establishment of cardiopulmonary bypass (T2 vs T3) and slightly decreasing platelet counts by -6.2% ± 7.7% (T1 vs T6). Immediately after establishment of cardiopulmonary bypass (T2 vs T3), we observed reduced platelet aggregation responses for stimulation with adenosine diphosphate (-19.7% ± 12.8%) and thrombin receptor activating peptide (-19.3% ± 6.3%). Interestingly, we found augmented platelet aggregation for all stimuli 45 min after administration of cardioplegia (T5 vs T6) with the strongest increase for collagen (+83.4% ± 42.8%; adenosine diphosphate: +39.0% ± 37.2%; thrombin receptor activating peptide: +34.5% ± 18.5%). Thus, after an initial drop due to hemodilution upon establishment of cardiopulmonary bypass, platelet reactivity increased over time which was not outweighed by decreasing platelet counts due to mechanical platelet destruction and absorption. These findings have implications for rational transfusion, peri-operative antiplatelet therapy, and for the management of patients on other extracorporeal support, such as extracorporeal life support or extracorporeal membrane oxygenation.
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Affiliation(s)
- Tobias Petzold
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Helen Herzog
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Dominik Hoechter
- Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sebastian Michel
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Simon Rutkowski
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Enzo Lüsebrink
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Manuela Thienel
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.,Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sabina Pw Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
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Hoffmann S, Clauss S, Berger IM, Weiß B, Montalbano A, Röth R, Bucher M, Klier I, Wakili R, Seitz H, Schulze-Bahr E, Katus HA, Flachsbart F, Nebel A, Guenther SP, Bagaev E, Rottbauer W, Kääb S, Just S, Rappold GA. Coding and non-coding variants in the SHOX2 gene in patients with early-onset atrial fibrillation. Basic Res Cardiol 2016; 111:36. [PMID: 27138930 PMCID: PMC4853439 DOI: 10.1007/s00395-016-0557-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/18/2016] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia with a strong genetic component. Molecular pathways involving the homeodomain transcription factor Shox2 control the development and function of the cardiac conduction system in mouse and zebrafish. Here we report the analysis of human SHOX2 as a potential susceptibility gene for early-onset AF. To identify causal variants and define the underlying mechanisms, results from 378 patients with early-onset AF before the age of 60 years were analyzed and compared to 1870 controls or reference datasets. We identified two missense mutations (p.G81E, p.H283Q), that were predicted as damaging. Transactivation studies using SHOX2 targets and phenotypic rescue experiments in zebrafish demonstrated that the p.H283Q mutation severely affects SHOX2 pacemaker function. We also demonstrate an association between a 3'UTR variant c.*28T>C of SHOX2 and AF (p = 0.00515). Patients carrying this variant present significantly longer PR intervals. Mechanistically, this variant creates a functional binding site for hsa-miR-92b-5p. Circulating hsa-miR-92b-5p plasma levels were significantly altered in AF patients carrying the 3'UTR variant (p = 0.0095). Finally, we demonstrate significantly reduced SHOX2 expression levels in right atrial appendages of AF patients compared to patients with sinus rhythm. Together, these results suggest a genetic contribution of SHOX2 in early-onset AF.
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Affiliation(s)
- Sandra Hoffmann
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Sebastian Clauss
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich, Germany
| | - Ina M Berger
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Birgit Weiß
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany
| | - Antonino Montalbano
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany
| | - Ralph Röth
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany
| | - Madeline Bucher
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany
| | - Ina Klier
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Reza Wakili
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich, Germany
| | - Hervé Seitz
- Institut de génétique humaine (CNRS UPR 1142), Montpellier, France
| | - Eric Schulze-Bahr
- Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - Hugo A Katus
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg/Mannheim, Heidelberg, Germany.,Department of Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Almut Nebel
- Institute of Clinical Molecular Biology, University of Kiel, Kiel, Germany
| | - Sabina Pw Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | | | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich (LMU), Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich, Germany
| | - Steffen Just
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Gudrun A Rappold
- Department of Human Molecular Genetics, Institute of Human Genetics, University Heidelberg, INF 366, 69120, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg/Mannheim, Heidelberg, Germany.
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