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von Haehling S, Assmus B, Bekfani T, Dworatzek E, Edelmann F, Hashemi D, Hellenkamp K, Kempf T, Raake P, Schütt KA, Wachter R, Schulze PC, Hasenfuss G, Böhm M, Bauersachs J. Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment. Clin Res Cardiol 2024:10.1007/s00392-024-02396-4. [PMID: 38602566 DOI: 10.1007/s00392-024-02396-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/12/2024]
Abstract
The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Birgit Assmus
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Giessen, Germany
| | - Tarek Bekfani
- Department of Cardiology and Angiology, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Elke Dworatzek
- Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Edelmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Djawid Hashemi
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Berlin, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Raake
- I. Medical Department, Cardiology, Pneumology, Endocrinology and Intensive Care Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Katharina A Schütt
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Godtfredsen SJ, Kragholm KH, Kristensen AMD, Bekfani T, Sørensen R, Sessa M, Torp-Pedersen C, Bhatt DL, Pareek M. Ticagrelor or prasugrel vs. clopidogrel in patients with atrial fibrillation undergoing percutaneous coronary intervention for myocardial infarction. Eur Heart J Open 2024; 4:oead134. [PMID: 38174346 PMCID: PMC10763543 DOI: 10.1093/ehjopen/oead134] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Aims The efficacy and safety of ticagrelor or prasugrel vs. clopidogrel in patients with atrial fibrillation (AF) on oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) for myocardial infarction (MI) have not been established. Methods and results This was a nationwide cohort study of patients on OAC for AF who underwent PCI for MI from 2011 through 2019 and were prescribed a P2Y12 inhibitor at discharge. The primary efficacy outcome was major adverse cardiovascular events (MACE), defined as a composite of death from any cause, stroke, recurrent MI, or repeat revascularization. The primary safety outcome was cerebral, gastrointestinal, or urogenital bleeding requiring hospitalization. Absolute and relative risks for outcomes at 1 year were calculated through multivariable logistic regression with average treatment effect modelling. Outcomes were standardized for the individual components of the CHA2DS2-VASc and HAS-BLED scores as well as type of OAC, aspirin, and proton pump inhibitor use. We included 2259 patients of whom 1918 (84.9%) were prescribed clopidogrel and 341 (15.1%) ticagrelor or prasugrel. The standardized risk of MACE was significantly lower in the ticagrelor or prasugrel group compared with the clopidogrel group (standardized absolute risk, 16.3% vs. 19.4%; relative risk, 0.84, 95% confidence interval, 0.70-0.98; P = 0.02), while the risk of bleeding did not differ (standardized absolute risk, 5.5% vs. 5.1%; relative risk, 1.07, 95% confidence interval, 0.73-1.41; P = 0.69). Conclusion In patients with AF on OAC who underwent PCI for MI, treatment with ticagrelor or prasugrel vs. clopidogrel was associated with reduced ischaemic risk, without a concomitantly increased bleeding risk.
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Affiliation(s)
| | | | | | - Tarek Bekfani
- Department of Cardiology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital—North Zealand Hospital, Hillerød, Denmark
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Manan Pareek
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, Gentofte Hospitalsvej 8, 3. TH, 2900 Hellerup, Denmark
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Kretzschmar T, Westphal J, Neugebauer S, Wu JM, Zeller M, Bogoviku J, Bekhite MM, Bekfani T, Schlattmann P, Kiehntopf M, Franz M, Schulze PC. Metabolic Profiling Identifies 1-MetHis and 3-IPA as Potential Diagnostic Biomarkers for Patients With Acute and Chronic Heart Failure With Reduced Ejection Fraction. Circ Heart Fail 2024; 17:e010813. [PMID: 38179791 PMCID: PMC10782933 DOI: 10.1161/circheartfailure.123.010813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Metabolomics has become a valuable tool for identifying potential new biomarkers and metabolic profiles. It has the potential to improve the diagnosis and prognosis of different phenotypes of heart failure. To generate a distinctive metabolic profile, we assessed and compared the metabolic phenotypes of patients with acute decompensated heart failure (ADHF), patients with chronic heart failure (CHF), and healthy controls. METHODS Plasma metabolites were analyzed by liquid-chromatography mass spectrometry/mass spectrometry and the MxP Quant 500 kit in 15 patients with ADHF, 50 patients with CHF (25 with dilated cardiomyopathy, 25 with ischemic cardiomyopathy), and 13 controls. RESULTS Of all metabolites identified to be significantly altered, 3-indolepropionic acid and 1-methyl histidine showed the highest concentration differences in ADHF and CHF compared with control. Area under the curve-receiver operating characteristic analysis showed an area under the curve ≥0.8 for 3-indolepropionic acid and 1-methyl histidine, displaying good discrimination capabilities between control and patient cohorts. Additionally, symmetrical dimethylarginine (mean, 1.97±0.61 [SD]; P=0.01) was identified as a suitable biomarker candidate for ADHF and kynurenine (mean, 1.69±0.39 [SD]; P=0.009) for CHF when compared with control, both demonstrating an area under the curve ≥0.85. CONCLUSIONS Our study provides novel insights into the metabolic differences between ADHF and CHF and healthy controls. We here identify new metabolites for potential diagnostic and prognostic purposes.
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Affiliation(s)
- Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Julian Westphal
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Sophie Neugebauer
- Institute of Clinical Chemistry and Laboratory Diagnostics (S.N., M.K.), University Hospital Jena, Germany
| | - Jasmine M.F. Wu
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Max Zeller
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Jurgen Bogoviku
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Mohamed M. Bekhite
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Germany (T.B.)
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Science, Centre for Sepsis Control and Care, Jena University Hospital, Germany (P.S.)
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Diagnostics (S.N., M.K.), University Hospital Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology (T.K., J.W., J.M.F.W., M.Z., J.B., M.M.B., M.F., P.C.S.), University Hospital Jena, Germany
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Gertler C, Jauert N, Freyhardt P, Valentova M, Aland SC, Walter-Rittel TC, Unterberg-Buchwald C, Placzek M, Ding-Reinelt V, Bekfani T, Doehner W, Hasenfuß G, Hamm B, Sandek A. Magnetic resonance imaging of organ iron before and after correction of iron deficiency in patients with heart failure. ESC Heart Fail 2023; 10:1847-1859. [PMID: 36907649 DOI: 10.1002/ehf2.14329] [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: 08/24/2022] [Revised: 11/29/2022] [Accepted: 02/06/2023] [Indexed: 03/14/2023] Open
Abstract
AIMS Intravenous iron therapy (IVIT) is known to improve functional status in chronic heart failure (CHF) patients. The exact mechanism is not completely understood. We correlated magnetic resonance imaging (MRI) patterns of T2* iron signal in various organs to systemic iron and exercise capacity (EC) in CHF before and after IVIT. METHODS AND RESULTS We prospectively analysed 24 patients with systolic CHF for T2* MRI pattern of the left ventricle (LV), small and large intestines, spleen, liver, skeletal muscle, and brain for iron. In 12 patients with iron deficiency (ID), we restored iron deficit by IVIT using ferric carboxymaltose. The effects after 3 months were analysed by spiroergometry and MRI. Patients with vs. without ID showed lower blood ferritin, haemoglobin (76 ± 63 vs. 196 ± 82 μg/L and 12.3 ± 1.1 vs. 14.2 ± 1.1 g/dL, all P < 0.002), and in trend a lower transferrin saturation (TSAT) (19.1 [13.1; 28.2] vs. 25.1 [21.3; 29.1] %, P = 0.05). Spleen and liver iron was lower as expressed by higher T2* value (71.8 [66.4; 93.1] vs. 36.9 [32.9; 51.7] ms, P < 0.002 and 33.5 ± 5.9 vs. 28.8 ± 3.9 ms, and P < 0.03). There was a strong trend for a lower cardiac septal iron content in ID (40.6 [33.0; 57.3] vs. 33.7 [31.3; 40.2] ms, P = 0.07). After IVIT, ferritin, TSAT, and haemoglobin increased (54 [30; 104] vs. 235 [185; 339] μg/L, 19.1 [13.1; 28.2] vs. 25.0 [21.0; 33.7] %, 12.3 ± 1.1 vs. 13.3 ± 1.3 g/L, all P < 0.04). Peak VO2 improved (18.2 ± 4.2 vs. 20.9 ± 3.8 mL/min/kg-1 , P = 0.05). Higher peak VO2 at anaerobic threshold was associated with higher blood ferritin, reflecting higher metabolic exercise capacity after therapy (r = 0.9, P = 0.0009). Increase in EC was associated with haemoglobin increase (r = 0.7, P = 0.034). LV iron increased by 25.4% (48.5 [36.2; 64.8] vs. 36.2 [32.9; 41.9] ms, P < 0.04). Spleen and liver iron increased by 46.4 and 18.2%, respectively (71.8 [66.4; 93.1] vs. 38.5 [22.4; 76.9] ms, P < 0.04 and 33.5 ± 5.9 vs. 27.4 ± 8.6 ms, P < 0.007). Iron in skeletal muscle, brain, intestine, and bone marrow remained unchanged (29.6 [28.6; 31.2] vs. 30.4 [29.7; 30.7] ms, P = 0.7, 81.0 ± 6.3 vs. 82.9 ± 9.9 ms, P = 0.6, 34.3 ± 21.4 vs. 25.3 ± 14.1 ms, P = 0.2, 9.4 [7.5; 21.8] vs. 10.3 [6.7; 15.7] ms, P = 0.5 and 9.8 ± 1.5 vs. 13.7 ± 8.9 ms, P = 0.1). CONCLUSIONS CHF patients with ID showed lower spleen, liver, and in trend lower cardiac septal iron. After IVIT, iron signal of the left ventricle as well as spleen and liver increased. Improvement in EC was associated with increase in haemoglobin after IVIT. In ID, liver, spleen, and brain but not heart iron were associated with markers of systemic ID.
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Affiliation(s)
- Christoph Gertler
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Nadja Jauert
- BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Freyhardt
- Department of Diagnostic and Interventional Radiology, Helios Hospital Krefeld, Krefeld, Germany.,School of Medicine, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Sven Christopher Aland
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | | | - Christina Unterberg-Buchwald
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, University of Göttingen Medical Center, Göttingen, Germany
| | - Marius Placzek
- Department of Medical Statistics, University of Göttingen, Göttingen, Germany
| | | | - Tarek Bekfani
- Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
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Abdin A, Barakat A, Alsaadi AR, Katbeh A, Bani Marjeh Y, Bekfani T, Alachkar MN. Application of recommended therapies among patients with heart failure during the Syrian conflict: reality and barriers. ESC Heart Fail 2022; 9:4003-4009. [PMID: 35996985 PMCID: PMC9773769 DOI: 10.1002/ehf2.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Lower socio-economic status may delay and even prevent the application of guideline-directed heart failure (HF) therapy for most patients. This study aims to evaluate the feasibility and possible difficulties facing the application of this treatment during the current Syrian conflict. METHODS AND RESULTS A questionnaire on HF management and feasibility of recommended HF therapy was addressed to physicians practising cardiology in Syria. The questionnaire consisted of 30 questions and focused on the quality of HF management and awareness of recommended drug and device therapy for HF among physicians practising cardiology in Syria. A total of 228 physicians participated in the survey. Awareness of recommended medical and device therapy of HF was very high among participants (98% and 95%, respectively). The majority of participants (>75%) believe that more than half of HF patients do not receive optimal medical HF therapy. Ninety per cent of participants believe that <10% of patients with an appropriate indication for device therapy receive it. More than 75% of participants believe that the cost of medications, alone or in combination with other medical causes, represents the major problem facing the application of optimal HF medical therapy. More than 95% of participants reported that cost alone, or in combination with unavailability, is the primary reason why patients with appropriate indications are not offered device therapy. CONCLUSIONS Despite the high level of awareness of recommended HF therapies among Syrian cardiologists, the majority of HF patients are still undertreated. Financial difficulties and lack of resources are the main causes of this problem.
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Affiliation(s)
- Amr Abdin
- Syrian Cardiovascular AssociationDamascusSyria,Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University Medical Center, Saarland UniversitySaarbrückenGermany
| | - Amer Barakat
- Syrian Cardiovascular AssociationDamascusSyria,Cardiology DepartmentAl Mouwasat University HospitalDamascusSyrian Arab Republic
| | - Ahmad Rasheed Alsaadi
- Syrian Cardiovascular AssociationDamascusSyria,Cardiology DepartmentAl Mouwasat University HospitalDamascusSyrian Arab Republic
| | - Asim Katbeh
- Syrian Cardiovascular AssociationDamascusSyria,Al Bassel Heart InstituteDamascusSyrian Arab Republic
| | - Yassin Bani Marjeh
- Syrian Cardiovascular AssociationDamascusSyria,Al Bassel Heart InstituteDamascusSyrian Arab Republic
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Magdeburg, Otto von Guericke‐UniversityMagdeburgGermany
| | - Mhd Nawar Alachkar
- Syrian Cardiovascular AssociationDamascusSyria,Department of Cardiology and Vascular MedicineKlinikum CoburgCoburgGermany
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6
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Wu JM, Bekfani T, Hinze A, Westphal JG, Steinacker B, Zeller M, Hartmann C, Möbius‐Winkler S, Hochhaus A, Schulze PC, Ernst T. Clonal haematopoiesis of indeterminate potential-related mutations and outcome in dilated and ischaemic cardiomyopathy. ESC Heart Fail 2022; 9:3954-3960. [PMID: 35979940 PMCID: PMC9773636 DOI: 10.1002/ehf2.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/19/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Clonal haematopoiesis of indeterminate potential (CHIP)-associated mutation is a risk factor for the development of ischaemic cardiomyopathy (ICM), but its association with non-ischaemic dilated cardiomyopathy (DCM) remains unclear. We aimed to determine the prevalence of CHIP in patients with DCM and define its risk for disease progression. METHODS AND RESULTS Next-generation sequencing targeting 54 common CHIP-associated genes was performed in 48 ICM and 52 DCM patients. The patients were monitored for a median of 3.1 years, and a COX proportional hazards model was used to examine the association between CHIP and adverse clinical outcome with regard to all-cause death or all-cause hospitalization. Overall, the prevalence of CHIP mutations was 19% and 13% in DCM and ICM, respectively. Seventeen per cent of ICM patients over 75 years were CHIP carriers. In DCM cohort, mutation event had already been observed in the patients who were under the age of 45 (13%). Among 54 genes analysed, DNMT3A had the highest mutation frequency, followed by TET2 and CUX1. Kaplan-Meier curve over a median of 3.1 year tracking period showed a trend towards poor clinical outcome in the DCM patients who carried DNMT3A or TET2 mutation; however, such association was not statistically significant. CONCLUSIONS The prevalence of CHIP is detected at a young age in DCM, and accumulation of mutational frequency in DCM patients is independent of age. However, a larger patient cohort is required to validate the association between CHIP and clinical progression in the DCM patients.
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Affiliation(s)
- Jasmine M.F. Wu
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany,Clinic for Cardiology, Angiology and PneumologyUniversity Hospital Magdeburg A.ö.RMagdeburgGermany
| | - Anna Hinze
- Department of Internal Medicine II, Division of Hematology and OncologyUniversity Hospital Jena, FSU JenaJenaGermany
| | - Julian Georg Westphal
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Berit Steinacker
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Max Zeller
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Charlotte Hartmann
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Sven Möbius‐Winkler
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Andreas Hochhaus
- Department of Internal Medicine II, Division of Hematology and OncologyUniversity Hospital Jena, FSU JenaJenaGermany
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of CardiologyUniversity Hospital Jena, FSU JenaAm Klinikum 107747JenaGermany
| | - Thomas Ernst
- Department of Internal Medicine II, Division of Hematology and OncologyUniversity Hospital Jena, FSU JenaJenaGermany
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7
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Bekfani T, Bekhite M, Neugebauer S, Derlien S, Hamadanchi A, Nisser J, Hilse MS, Haase D, Kretzschmar T, Wu MF, Lichtenauer M, Kiehntopf M, von Haehling S, Schlattmann P, Lehmann G, Franz M, Möbius-Winkler S, Schulze C. Metabolomic Profiling in Patients with Heart Failure and Exercise Intolerance: Kynurenine as a Potential Biomarker. Cells 2022; 11:cells11101674. [PMID: 35626711 PMCID: PMC9139290 DOI: 10.3390/cells11101674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
Aims: Metabolic and structural perturbations in skeletal muscle have been found in patients with heart failure (HF) both with preserved (HFpEF) and reduced (HFrEF) ejection fraction in association with reduced muscle endurance (RME). We aimed in the current study to create phenotypes for patients with RME and HFpEF compared to RME HFrEF according to their metabolomic profiles and to test the potential of Kynurenine (Kyn) as a marker for RME. Methods: Altogether, 18 HFrEF, 17 HFpEF, and 20 healthy controls (HC) were prospectively included in the current study. The following tests were performed on all participants: isokinetic muscle function tests, echocardiography, spiroergometry, and varied blood tests. Liquid chromatography tandem mass spectrometry was used to quantify metabolites in serum. Results: Except for aromatic and branched amino acids (AA), patients with HF showed reduced AAs compared to HC. Further perturbations were elevated concentrations of Kyn and acylcarnitines (ACs) in HFpEF and HFrEF patients (p < 0.05). While patients with HFpEF and RME presented with reduced concentrations of ACs (long- and medium-chains), those with HFrEF and RME had distorted AAs metabolism (p < 0.05). With an area under the curve (AUC) of 0.83, Kyn shows potential as a marker in HF and RME (specificity 70%, sensitivity 83%). In a multiple regression model consisting of short-chain-ACs, spermine, ornithine, glutamate, and Kyn, the latest was an independent predictor for RME (95% CI: −13.01, −3.30, B: −8.2 per 1 µM increase, p = 0.001). Conclusions: RME in patients with HFpEF vs. HFrEF proved to have different metabolomic profiles suggesting varied pathophysiology. Kyn might be a promising biomarker for patients with HF and RME.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, 39120 Magdeburg, Germany;
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Mohamed Bekhite
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Sophie Neugebauer
- Department of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, 07743 Jena, Germany; (S.N.); (M.K.)
| | - Steffen Derlien
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (S.D.); (J.N.)
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Jenny Nisser
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (S.D.); (J.N.)
| | - Marion S. Hilse
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Daniela Haase
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Mei-Fang Wu
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria;
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, 07743 Jena, Germany; (S.N.); (M.K.)
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, 37075 Göttingen, Germany;
- German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer Science and Data Science (IMSID), Jena University Hospital, 07743 Jena, Germany;
| | - Gabriele Lehmann
- Department of Internal Medicine III, Division of Endocrinology, Nephrology and Rheumatology, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany;
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
| | - Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, 07743 Jena, Germany; (M.B.); (A.H.); (M.S.H.); (D.H.); (T.K.); (M.-F.W.); (M.F.); (S.M.-W.)
- Correspondence: ; Tel.: +49-3641-932-4101; Fax: +49-3641-932-4102
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Hamadanchi A, Ijuin S, Haertel F, Bekfani T, Westphal J, Franz M, Moebius-Winkler S, Schulze PC. A Novel Echocardiographic-Based Classification for the Prediction of Peri-Device Leakage Following Left Atrial Appendage Occluder Implantation. J Clin Med 2022; 11:jcm11041059. [PMID: 35207334 PMCID: PMC8877112 DOI: 10.3390/jcm11041059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The assessment of residual peri-device leakages (PDL) after left atrial appendage occlusion (LAAO) remains crucial for post-procedural management. Our study aimed to verify a novel echocardiographic classification for the prediction of PDL. (2) Methods: Echocardiographic data of 72 patients who underwent percutaneous LAAO were evaluated. All echo images were analyzed by two independent investigators using standard analysis software (Image-Arena IA-4.6.4.44 by TomTec®, Munich, Germany). A total number of 127 studies was evaluated. Forty-four patients had baseline studies, at 45 days and at 6 months post-implantation. We propose a morphological classification of LAA devices based on the amount of echodensity inside the devices into three types: type A showing complete homogenous thrombosis, type B incompletely thrombosed device with inhomogeneous echo-free space <50% of device, and type C with partially thrombosed device in which the echo free space was >50% of device in various planes, which we called the “ice-cream cone” sign. Each type was matched to the degree of PDL and clinical outcome parameters. (3) Results: Patients with type C had the highest percentage of PDL at 45 days follow-up (type A: 24%, type B: 31%, type C 100% PDL, p < 0.001) and at 6 months follow-up (type A: 7%, type B: 33%, type C 100% PDL, p < 0.001). Notably, device size in patients with PDL was larger than that in patients without PDL at 6 months follow-up (25.6 ± 3.5 mm vs. 28.7 ± 3.4 mm, p = 0.004). Device size in patients with type C appearance was the largest of the three types (type A: 25.9 ± 3.6 mm, type B: 25.8 ± 3.4 mm, type C 29.8 ± 3.0 mm, type A vs. C; p = 0.019; type B vs. C, p = 0.007). (4) Conclusions: In conclusion, PDL are common post-LAAO, and their frequency is underestimated and under-recognized. PDL are much more common in patients with larger LAA ostial sizes and likely lower longitudinal compression. Type C appearance of the LAAO devices (“ice-cream cone sign”) has a high positive predictive value for PDL. Further studies are needed for better delineation of the clinical importance of this proposed classification.
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Affiliation(s)
- Ali Hamadanchi
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
- Correspondence: ; Tel.: +49-3641-9-32-46-45; Fax: +49-3641-9-32-41-02
| | - Shun Ijuin
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
- Department of Cardiology, National Hospital Organization Kagoshima Medical Center, Kagoshima 892-0853, Japan
| | - Franz Haertel
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Tarek Bekfani
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Magdeburg, Otto von Guericke-University, 39120 Magdeburg, Germany;
| | - Julian Westphal
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Marcus Franz
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - Sven Moebius-Winkler
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
| | - P. Christian Schulze
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, 07747 Jena, Germany; (S.I.); (F.H.); (J.W.); (M.F.); (S.M.-W.); (P.C.S.)
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9
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Bekfani T, Hamadanchi A, Ijuin S, Bekhite M, Nisser J, Derlien S, Westphal J, Bogoviku J, Morris DA, Fudim M, Braun-Dullaeus RC, Möbius-Winkler S, Schulze PC. Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure. ESC Heart Fail 2021; 8:4528-4538. [PMID: 34726343 PMCID: PMC8712812 DOI: 10.1002/ehf2.13656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Aims Both left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO2. Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial emptying fraction (LAEF). Methods and results We analysed echocardiographic measurements, cardiopulmonary exercise testing (CPET), and isokinetic muscle function in 55 subjects with HF and controls [17 heart failure with preserved ejection fraction (HFpEF), 18 heart failure with reduced ejection fraction (HFrEF), and 20 healthy controls]. Patients with reduced LAEF showed reduced peak VO2: 14.3 ± 3.5 vs. 18.5 ± 3.5 mL/min/kg, P = 0.003, and reduced muscle endurance (RME): 64.3 ± 23.9 vs. 88.5 ± 32.3 Nm/kg, P = 0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) was associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59–0.96, P = 0.012 vs. 0.63–0.98, P = 0.006, respectively). In a multiple linear regression, LAEF and working load measured during CPET (watt) were independent factors for RME after adjusting for age, LVGLS, and 6 min walk test (6MWT) [LAEF (B: 0.09, 95% CI: 1.01; 1.18, P = 0.024), working load (B: 0.05, 95% CI: 1.01; 1.08, P = 0.006)]. Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r = −0.6, P = 0.020). Endurance of the left leg was associated with LAEF (r = 0.79, P = 0.001) in patients with HFrEF. Conclusions LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany.,Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Shun Ijuin
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Mohamed Bekhite
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Jenny Nisser
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Steffen Derlien
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Julian Westphal
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Jurgen Bogoviku
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Daniel A Morris
- Department of Internal Medicine, Division of Cardiology, Virchow Klinikum, Charité Medical School, Berlin, Germany
| | - Marat Fudim
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
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10
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Bekfani T, Ijuin S, Hamadanchi A, Bekhite M, Nisser J, Derlien S, Westphal J, Bogoviku J, Morris D, Fudim M, Braun-Dullaeus R, Moebius-Winkler S, Schulze P. Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0983] [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
Left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO2. Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial ejection fraction (LAEF).
Methods
We analysed echocardiographic measurements, cardiopulmonary exercise testing, and isokinetic muscle function in 55 subjects with HF and controls (17 heart failure with preserved ejection fraction -HFpEF, 18 heart failure with reduced ejection fraction-HFrEF and 20 healthy controls).
Results
Patients with reduced LAEF showed reduced peak VO2: 14.3±3.5 vs. 18.5±3.5 ml/min/kg, p=0.003 and reduced muscle endurance (RME): 64.3±23.9 vs. 88.5±32.3 Nm/kg, p=0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) were associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59–0.96, p=0.012 vs. 0.63–0.98, p=0.006, respectively). Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r=−0.6, p=0.020). Endurance of the left leg was associated with LAEF (r=0.79, p=0.001) in patients with HFrEF.
Conclusion
LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Bekfani
- University Hospital Magdeburg A.ö.R., Department of Cardiology, Magdeburg, Germany
| | - S.H Ijuin
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - A Hamadanchi
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - M Bekhite
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - J Nisser
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - S Derlien
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - J Westphal
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - J Bogoviku
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - D.A Morris
- Charite - Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany
| | - M Fudim
- Duke University Medical Center, Department of Cardiology, Durham, United States of America
| | - R.C Braun-Dullaeus
- University Hospital Magdeburg A.ö.R., Department of Cardiology, Magdeburg, Germany
| | - S Moebius-Winkler
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - P.C Schulze
- University Hospital of Jena, Department of Cardiology, Jena, Germany
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11
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Bekfani T, Bekhite M, Neugebauer S, Derlien S, Hamadanchi A, Haase D, Kretzschmar T, Wu M, Lichtenauer M, Kiehntopf M, Von Haehling S, Braun-Dullaeus R, Franz M, Moebius-Winkler S, Schulze P. Kynurenine as a potential biomarker in detecting reduced muscle endurance: metabolomic profiling of patients with heart failure and exercise intolerance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0984] [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
Reduced muscle endurance (RME) in patients with HFpEF and HFrEF is associated with structural and metabolic changes in skeletal muscle. We investigated the role of kynurenine (Kyn) as a potential marker in detecting RME. Additionally, we described the likely distorted metabolic pathways in serum in patients with RME and both preserved (HFpEF) and reduced (HFrEF) ejection fraction.
Methods
Fifty-five participants were prospectively recruited (17 HFpEF, 18 HFrEF outpatients and 20 healthy controls, HC). All participants underwent echocardiography, CPET, isokinetic muscle function tests. Quantification of metabolites in serum was performed using liquid chromatography tandem mass spectrometry.
Results
In a linear regression, Kyn was an independent predictor for RME after adjusting for alanine, glutamate, ornithine, spermine and short-chain-ACs (B: −8.2 per 1μM increase, 95% CI: −13.01, −3.30, p=0.001). Kyn showed 83% sensitivity and 70% specificity (area under the curve 0.83) in detecting RME. Patients with RME and HFpEF showed reduced levels of long-chain-, medium-chain-, medium-/long-chain-ACs ratios and alanine (p<0.05). In patients with RME and HFrEF we observed reduced concentrations of AAs (p<0.05). Compared to HC, patients with HFpEF and HFrEF had reduced amino acid (AA)-concentrations except for branched-chain and aromatic AAs, and higher concentrations of acylcarnitines (ACs) and Kyn (p<0.05).
Conclusions
Kyn shows high potential as biomarker for detecting RME. RME was associated with impaired fatty acid oxidation rates in HFpEF patients and with reduced concentrations of AAs in those with HFrEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Bekfani
- University Hospital Magdeburg A.ö.R., Department of Cardiology, Magdeburg, Germany
| | - M Bekhite
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - S Neugebauer
- University Hospital Jena, Department of Clinical Chemistry, Jena, Germany
| | - S Derlien
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - A Hamadanchi
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - D Haase
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - T Kretzschmar
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - M.F Wu
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - M Lichtenauer
- Salzburg University Hospital, Department of Cardiology, Salzburg, Austria
| | - M Kiehntopf
- University Hospital Jena, Department of Clinical Chemistry, Jena, Germany
| | - S Von Haehling
- University Hospital Gottingen, Department of Cardiology, Goettingen, Germany
| | - R.C Braun-Dullaeus
- University Hospital Magdeburg A.ö.R., Department of Cardiology, Magdeburg, Germany
| | - M Franz
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - S Moebius-Winkler
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - P.C Schulze
- University Hospital of Jena, Department of Cardiology, Jena, Germany
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Hilse MS, Kretzschmar T, Pistulli R, Franz M, Bekfani T, Haase D, Neugebauer S, Kiehntopf M, Gummert JF, Milting H, Schulze PC. Analysis of Metabolic Markers in Patients with Chronic Heart Failure before and after LVAD Implantation. Metabolites 2021; 11:metabo11090615. [PMID: 34564430 PMCID: PMC8465815 DOI: 10.3390/metabo11090615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 12/22/2022] Open
Abstract
Chronic heart failure (HF) is a clinical syndrome characterized by functional impairments of the myocardium. Metabolic and clinical changes develop with disease progression. In an advanced state, left ventricular assist devices (LVADs) are implanted for mechanical unloading. Our study aimed to assess the effects of LVAD implantation on the metabolic phenotypes and their potential to reverse the latter in patients with advanced HF. Plasma metabolites were analyzed by LC–MS/MS in 20 patients with ischemic cardiomyopathy (ICM), 20 patients with dilative cardiomyopathy (DCM), and 20 healthy controls. Samples were collected in HF patients before, 30 days after, and >100 days after LVAD implantation. Out of 188 measured metabolites, 63 were altered in HF. Only three metabolites returned to pre-LVAD concentrations 100 days after LVAD implantation. Pre-LVAD differences between DCM and ICM were mainly observed for amino acids and biogenic amines. This study shows a reversal of metabolite abnormalities in HF as a result of LVAD implantation. The etiology of the underlying disease plays an essential role in defining which specific metabolic parameter is altered in HF and reversed by LVAD implantation. Our findings provide a detailed insight into the disease pattern of ICM and DCM and the potential for reversibility of metabolic abnormalities in HF.
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Affiliation(s)
- Marion S. Hilse
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Rudin Pistulli
- Department of Cardiology I—Coronary and Peripheral Vascular Disease, Heart Failure, Münster University Hospital, 48149 Münster, Germany;
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, 39120 Magdeburg, Germany;
| | - Daniela Haase
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
| | - Sophie Neugebauer
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, 07747 Jena, Germany; (S.N.); (M.K.)
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, 07747 Jena, Germany; (S.N.); (M.K.)
| | - Jan F. Gummert
- Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, Germany; (J.F.G.); (H.M.)
| | - Hendrik Milting
- Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, Germany; (J.F.G.); (H.M.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, 07747 Jena, Germany; (M.S.H.); (T.K.); (M.F.); (D.H.)
- Correspondence: ; Tel.: +49-3641-9-32-41-00
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13
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Bekfani T, Nisser J, Derlien S, Hamadanchi A, Fröb E, Dannberg G, Lichtenauer M, Smolenski UC, Lehmann G, Möbius-Winkler S, Schulze PC. Psychosocial factors, mental health, and coordination capacity in patients with heart failure with preserved ejection fraction compared with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:3268-3278. [PMID: 34121363 PMCID: PMC8318509 DOI: 10.1002/ehf2.13468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Aims Patients with heart failure (HF) suffer from reduced quality‐of‐life (QoL). We aimed to compare QoL, depression, and anxiety scores among outpatients with preserved (HFpEF) and reduced (HFrEF) ejection fraction and non‐HF controls and its relationship to coordination capacity. Methods and results Fifty‐five participants were recruited prospectively at the University Hospital Jena, Germany (17 HFpEF, 18 HFrEF, and 20 non‐HF controls). All participants underwent echocardiography, cardiopulmonary exercise testing (CPET), 10 m walking test (10‐MWT), isokinetic muscle function and coordination tests, and QoL assessments using the short form of health survey (SF‐36), and hospital anxiety and depression scale (HADS). Furthermore, inflammatory biomarkers such as growth differentiation factor‐15 (GDF‐15) were assessed. Patients with HFpEF showed compared with HFrEF and non‐HF controls reduced QoL [mental component score (MCS): 43.6 ± 7.1 vs. 50.2 ± 10.0 vs. 50.5 ± 5.0, P = 0.03), vitality (VT): 47.5 ± 8.4 vs. 53.6 ± 8.6 vs. 57.1 ± 5.2, P = 0.004), and elevated anxiety (6.5 ± 3.2 vs. 3.3 ± 2.8 vs. 3.8 ± 2. 8, P = 0.02) and depression scores (6.5 [3.5–10.0] vs. 3.0 [1.0–6.5] vs. 2.0 [0.75–3.0], P = 0.01)]. After adjusting to multiple comparisons, anxiety remained higher in HFpEF patients compared with HFrEF (ppost‐hoc = 0.009). HFpEF and HFrEF patients showed reduced coordination capacity compared with non‐HF controls (P < 0.05). In a logistic regression, the presence of depression score ≥8 remained an independent factor for predicting reduced coordination capacity after adjusting for peak VO2, GDF‐15, 10‐MWT, physical component score (PCS), and peak torque of the leg [odds ratio (OR): 0.1, 95% confidence interval (CI): 0.004–0.626, P = 0.02]. Conclusion Outpatients with HFpEF had worse QoL and higher anxiety and depression scores compared with HFrEF and non‐HF controls. Depression is associated with reduced QoL and is an independent predictor for reduced coordination capacity.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke-University, Leipziger Str. 44, Magdeburg, 39120, Germany.,Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Jenny Nisser
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Steffen Derlien
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Elisabeth Fröb
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Gudrun Dannberg
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Ulrich C Smolenski
- Institute of Physiotherapy, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Gabriele Lehmann
- Department of Internal Medicine III, Division of Endocrinology, Nephrology and Rheumatology, Friedrich-Schiller-University, Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
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14
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Jorbenadze A, Fudim M, Mahfoud F, Adamson PB, Bekfani T, Wachter R, Sievert H, Ponikowski PP, Cleland JGF, Anker SD. Extra-cardiac targets in the management of cardiometabolic disease: Device-based therapies. ESC Heart Fail 2021; 8:3327-3338. [PMID: 34002946 PMCID: PMC8318435 DOI: 10.1002/ehf2.13361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Heart failure (HF) does not occur in a vacuum and is commonly defined and exacerbated by its co‐morbid conditions. Neurohormonal imbalance and systemic inflammation are some of the key pathomechanisms of HF but also commonly encountered co‐morbidities such as arterial hypertension, diabetes mellitus, cachexia, obesity and sleep‐disordered breathing. A cornerstone of HF management is neurohormonal blockade, which in HF with reduced ejection fraction has been tied to a reduction in morbidity and mortality. Pharmacological treatment effective in patients with HF with reduced ejection fraction did not show substantial effects in HF with preserved ejection fraction. Here, we review novel device‐based therapies using neuromodulation of extra‐cardiac targets to treat cardiometabolic disease.
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Affiliation(s)
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Saarbrücken, Germany
| | | | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
| | - Rolf Wachter
- Clinic and Polyclinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | | | | | - John G F Cleland
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Bekhite M, González-Delgado A, Hübner S, Haxhikadrija P, Kretzschmar T, Müller T, Wu JMF, Bekfani T, Franz M, Wartenberg M, Gräler M, Greber B, Schulze PC. The role of ceramide accumulation in human induced pluripotent stem cell-derived cardiomyocytes on mitochondrial oxidative stress and mitophagy. Free Radic Biol Med 2021; 167:66-80. [PMID: 33705961 DOI: 10.1016/j.freeradbiomed.2021.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
Oversupply of fatty acids (FAs) to cardiomyocytes (CMs) is associated with increased ceramide content and elevated the risk of lipotoxic cardiomyopathy. Here we investigate the role of ceramide accumulation on mitochondrial function and mitophagy in cardiac lipotoxicity using CMs derived from human induced pluripotent stem cell (hiPSC). Mature CMs derived from hiPSC exposed to the diabetic-like environment or transfected with plasmids overexpressing serine-palmitoyltransferase long chain base subunit 1 (SPTLC1), a subunit of the serine-palmitoyltransferase (SPT) complex, resulted in increased intracellular ceramide levels. Accumulation of ceramides impaired insulin-dependent phosphorylation of Akt through activating protein phosphatase 2A (PP2A) and disturbed gene and protein levels of key metabolic enzymes including GLUT4, AMPK, PGC-1α, PPARα, CD36, PDK4, and PPARγ compared to controls. Analysis of CMs oxidative metabolism using a Seahorse analyzer showed a significant reduction in ATP synthesis-related O2 consumption, mitochondrial β-oxidation and respiratory capacity, indicating an impaired mitochondrial function under diabetic-like conditions or SPTLC1-overexpression. Further, ceramide accumulation increased mitochondrial fission regulators such as dynamin-related protein 1 (DRP1) and mitochondrial fission factor (MFF) as well as auto/mitophagic proteins LC3B and PINK-1 compared to control. Incubation of CMs with the specific SPT inhibitor (myriocin) showed a significant increase in mitochondrial fusion regulators the mitofusin 2 (MFN2) and optic atrophy 1 (OPA1) as well as p-Akt, PGC-1 α, GLUT-4, and ATP production. In addition, a significant decrease in auto/mitophagy and apoptosis was found in CMs treated with myriocin. Our results suggest that ceramide accumulation has important implications in driving insulin resistance, oxidative stress, increased auto/mitophagy, and mitochondrial dysfunction in the setting of lipotoxic cardiomyopathy. Therefore, modulation of the de novo ceramide synthesis pathway may serve as a novel therapeutic target to treat metabolic cardiomyopathy.
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Affiliation(s)
- Mohamed Bekhite
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany.
| | - Andres González-Delgado
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Sascha Hübner
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Pëllumb Haxhikadrija
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Tina Müller
- Clinic for Anesthesiology and Intensive Care Medicine, University Hospital Jena, FSU, Jena, Germany
| | - Jasmine M F Wu
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Maria Wartenberg
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Markus Gräler
- Clinic for Anesthesiology and Intensive Care Medicine, University Hospital Jena, FSU, Jena, Germany
| | - Boris Greber
- Max Planck Institute for Molecular Biomedicine, Münster, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
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16
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Peters AE, Pandey A, Ayers C, Wegermann K, McGarrah RW, Grodin JL, Abdelmalek MF, Bekfani T, Blumer V, Diehl AM, Moylan CA, Fudim M. Association of liver fibrosis risk scores with clinical outcomes in patients with heart failure with preserved ejection fraction: findings from TOPCAT. ESC Heart Fail 2021; 8:842-848. [PMID: 33586354 PMCID: PMC8006722 DOI: 10.1002/ehf2.13250] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/12/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Non‐alcoholic fatty liver disease leads to progressive liver fibrosis and appears to be a frequent co‐morbid disease in heart failure with preserved ejection fraction (HFpEF). It is well known that liver fibrosis severity predicts future liver‐related morbidity and mortality, but its impact on outcomes in patients with HFpEF remains unknown. This analysis aimed to describe the prevalence of liver fibrosis, as assessed using surrogate biomarkers, in patients with HFpEF and the association of such biomarkers in predicting clinical outcomes in these patients. Methods and results Patients with HFpEF from TOPCAT Americas were included in the analysis. The non‐alcoholic fatty liver disease fibrosis score (NFS) and fibrosis‐4 (FIB‐4) scores were calculated using a combination of clinical characteristics and laboratory parameters. Risk of advanced fibrosis was classified as low, intermediate, and high. For the 1423 with sufficient data, we used Cox regression analysis to test the association between the risk of fibrosis severity and the combined primary endpoint of all cardiovascular death, aborted cardiac arrest, and hospitalization for heart failure. Advanced fibrosis, as determined by high fibrosis scores, was present in 37.57% by the NFS and 8.02% by the FIB‐4. Higher risk of advanced hepatic fibrosis was associated with older age. In unadjusted models, the risk of advanced fibrosis was associated with the primary cardiovascular outcome [NFS high vs. low, hazard ratio (HR) 1.709 (95% confidence interval, CI 1.238–2.358, P = 0.0011) and FIB‐4 high vs. low, HR 1.561 (95% CI 1.139–2.140, P = 0.0056)]. After multivariable adjustment, this association was diminished [NFS high vs. low, HR 1.349 (95% CI 0.938–1.939, P = 0.1064) and FIB‐4 high vs. low, HR 1.415 (95% CI 0.995–2.010, P = 0.0531)]. Conclusions Our study suggests that advanced liver fibrosis, as estimated by fibrosis risk scores, may not be uncommon in patients with HFpEF, and there appears to be a limited independent association between liver fibrosis risk scores and clinical outcomes related to heart failure events.
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Affiliation(s)
- Anthony E Peters
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Colby Ayers
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kara Wegermann
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Robert W McGarrah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Justin L Grodin
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manal F Abdelmalek
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Magdeburg, Germany
| | - Vanessa Blumer
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Anna Mae Diehl
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Cynthia A Moylan
- Division of Gastroenterology, Duke University Medical Center, Durham, NC, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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17
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Bekfani T, Fudim M, Cleland JGF, Jorbenadze A, von Haehling S, Lorber A, Rothman AMK, Stein K, Abraham WT, Sievert H, Anker SD. A current and future outlook on upcoming technologies in remote monitoring of patients with heart failure. Eur J Heart Fail 2021; 23:175-185. [PMID: 33111389 DOI: 10.1002/ejhf.2033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/04/2020] [Revised: 09/21/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022] Open
Abstract
Heart failure is a major health and economic challenge in both developing and developed countries. Despite advances in pharmacological and device therapies for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure, their quality of life and exercise capacity are often persistently impaired, morbidity and mortality remain high and the health economic and societal costs are considerable. For patients with heart failure and preserved LVEF, diuretic management has an essential role for controlling congestion and symptoms, even if no intervention has convincingly shown to reduce morbidity or mortality. Remote monitoring might improve care delivery and clinical outcomes for patients regardless of LVEF. A great variety of innovative remote monitoring technologies and algorithms are being introduced, including patient self-managed testing, wearable devices, technologies either integrated into established clinically indicated therapeutic devices, such as pacemakers and defibrillators, or as stand-alone are in development providing the promise of further improvements in service delivery and clinical outcomes. In this article, we will discuss unmet needs in the management of patients with heart failure, how remote monitoring might contribute to future solutions, and provide an overview of current and novel remote monitoring technologies.
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Affiliation(s)
- Tarek Bekfani
- Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Magdeburg, Otto von Guericke-University, Magdeburg, Germany
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow and National Heart & Lung Institute, Imperial College, London, UK
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | | | | | | | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
- Anglia Ruskin University, Chelmsford, UK
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Medical School, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité - Medical School Berlin, Berlin, Germany
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18
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Bekfani T, Bekhite Elsaied M, Derlien S, Nisser J, Westermann M, Nietzsche S, Hamadanchi A, Fröb E, Westphal J, Haase D, Kretzschmar T, Schlattmann P, Smolenski UC, Lichtenauer M, Wernly B, Jirak P, Lehmann G, Möbius-Winkler S, Schulze PC. Skeletal Muscle Function, Structure, and Metabolism in Patients With Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2020; 13:e007198. [PMID: 33302709 DOI: 10.1161/circheartfailure.120.007198] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Reduced exercise capacity in patients with heart failure (HF) could be partially explained by skeletal muscle dysfunction. We compared skeletal muscle function, structure, and metabolism among clinically stable outpatients with HF with preserved ejection fraction, HF with reduced ejection fraction, and healthy controls (HC). Furthermore, the molecular, metabolic, and clinical profile of patients with reduced muscle endurance was described. METHODS Fifty-five participants were recruited prospectively at the University Hospital Jena (17 HF with preserved ejection fraction, 18 HF with reduced ejection fraction, and 20 HC). All participants underwent echocardiography, cardiopulmonary exercise testing, 6-minute walking test, isokinetic muscle function, and skeletal muscle biopsies. Expression levels of fatty acid oxidation, glucose metabolism, atrophy genes, and proteins as well as inflammatory biomarkers were assessed. Mitochondria were evaluated using electron microscopy. RESULTS Patients with HF with preserved ejection fraction showed compared with HF with reduced ejection fraction and HC reduced muscle strength (eccentric extension: 13.3±5.0 versus 18.0±5.9 versus 17.9±5.1 Nm/kg, P=0.04), elevated levels of MSTN-2 (myostatin-2), FBXO-32 (F-box only protein 32 [Atrogin1]) gene and protein, and smaller mitochondrial size (P<0.05). Mitochondrial function and fatty acid and glucose metabolism were impaired in HF-patients compared with HC (P<0.05). In a multiple regression analysis, GDF-15 (growth and differentiation factor 15), CPT1B (carnitine palmitoyltransferase IB)-protein and oral anticoagulation were independent factors for predicting reduced muscle endurance after adjusting for age (log10 GDF-15 [pg/mL] [B, -54.3 (95% CI, -106 to -2.00), P=0.043], log10 CPT1B per fold increase [B, 49.3 (95% CI, 1.90-96.77), P=0.042]; oral anticoagulation present [B, 44.8 (95% CI, 27.90-61.78), P<0.001]). CONCLUSIONS Patients with HF with preserved ejection fraction have worse muscle function and predominant muscle atrophy compared with those with HF with reduced ejection fraction and HC. Inflammatory biomarkers, fatty acid oxidation, and oral anticoagulation were independent factors for predicting reduced muscle endurance.
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Affiliation(s)
- Tarek Bekfani
- Division of Cardiology, Angiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine, University Hospital Magdeburg, Otto-von Guericke University, Magdeburg, Germany (T.B.)
| | - Mohamed Bekhite Elsaied
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Steffen Derlien
- University Hospital Jena, Institute of Physiotherapy (S.D., J.N., U.C.S.), Friedrich-Schiller-University, Germany
| | - Jenny Nisser
- University Hospital Jena, Institute of Physiotherapy (S.D., J.N., U.C.S.), Friedrich-Schiller-University, Germany
| | - Martin Westermann
- Center of Electron Microscopy (M.W., S.N.), Friedrich-Schiller-University, Germany
| | - Sandor Nietzsche
- Center of Electron Microscopy (M.W., S.N.), Friedrich-Schiller-University, Germany
| | - Ali Hamadanchi
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Elisabeth Fröb
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Julian Westphal
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Daniela Haase
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Tom Kretzschmar
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer Science and Data Science (IMSID), Jena University Hospital, Germany (P.S., G.L.)
| | - Ulrich C Smolenski
- University Hospital Jena, Institute of Physiotherapy (S.D., J.N., U.C.S.), Friedrich-Schiller-University, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria (M.L., P.W., P.J.)
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria (M.L., P.W., P.J.)
| | - Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Austria (M.L., P.W., P.J.)
| | - Gabriele Lehmann
- Division of Endocrinology, Nephrology and Rheumatology, Department of Internal Medicine III (G.L.), Friedrich-Schiller-University, Germany.,Institute for Medical Statistics, Computer Science and Data Science (IMSID), Jena University Hospital, Germany (P.S., G.L.)
| | - Sven Möbius-Winkler
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
| | - P Christian Schulze
- Division of Cardiology, Pneumology, and Intensive Medical Care, Department of Internal Medicine I (M.B.E., A.H., E.F., J.W., D.H., T.K., S.M.-W., P.C.S.), Friedrich-Schiller-University, Germany
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19
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Haase D, Bäz L, Bekfani T, Neugebauer S, Kiehntopf M, Möbius-Winkler S, Franz M, Schulze PC. Metabolomic profiling of patients with high gradient aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2020; 110:399-410. [PMID: 33057764 PMCID: PMC7907030 DOI: 10.1007/s00392-020-01754-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022]
Abstract
Aim Aim of our study was to evaluate metabolic changes in patients with aortic stenosis (AS) before and after transcatheter aortic valve replacement (TAVR) and to assess whether this procedure reverses metabolomic alterations. Methods 188 plasma metabolites of 30 patients with severe high-gradient aortic valve stenosis (pre-TAVR and 6 weeks post-TAVR) as well as 20 healthy controls (HC) were quantified by liquid chromatography tandem mass spectrometry. Significantly altered metabolites were then correlated to an extensive patient database of clinical parameters at the time of measurement. Results Out of the determined metabolites, 26.6% (n = 50) were significantly altered in patients with AS pre-TAVR compared to HC. In detail, 5/40 acylcarnitines as well as 10/42 amino acids and biogenic amines were mainly increased in AS, whereas 29/90 glycerophospholipids and 6/15 sphingomyelins were mainly reduced. In the post-TAVR group, 10.1% (n = 19) of metabolites showed significant differences when compared to pre-TAVR. Moreover, we found nine metabolites revealing reversible concentration levels. Correlation with clinically important parameters revealed strong correlations between sphingomyelins and cholesterol (r = 0.847), acylcarnitines and brain natriuretic peptide (r = 0.664) and showed correlation of acylcarnitine with an improvement of left ventricular (LV) ejection fraction (r = − 0.513) and phosphatidylcholines with an improvement of LV mass (r = − 0.637). Conclusion Metabolic profiling identified significant and reversible changes in circulating metabolites of patients with AS. The correlation of circulating metabolites with clinical parameters supports the use of these data to identify novel diagnostic as well as prognostic markers for disease screening, pathophysiological studies as well as patient surveillance. Electronic supplementary material The online version of this article (10.1007/s00392-020-01754-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniela Haase
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Laura Bäz
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Tarek Bekfani
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Sophie Neugebauer
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Sven Möbius-Winkler
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Marcus Franz
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.
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20
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von Haehling S, Garfias Macedo T, Valentova M, Anker MS, Ebner N, Bekfani T, Haarmann H, Schefold JC, Lainscak M, Cleland JGF, Doehner W, Hasenfuss G, Anker SD. Muscle wasting as an independent predictor of survival in patients with chronic heart failure. J Cachexia Sarcopenia Muscle 2020; 11:1242-1249. [PMID: 32767518 PMCID: PMC7567155 DOI: 10.1002/jcsm.12603] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Skeletal muscle wasting is an extremely common feature in patients with heart failure, affecting approximately 20% of ambulatory patients with even higher values during acute decompensation. Its occurrence is associated with reduced exercise capacity, muscle strength, and quality of life. We sought to investigate if the presence of muscle wasting carries prognostic information. METHODS Two hundred sixty-eight ambulatory patients with heart failure (age 67.1 ± 10.9 years, New York Heart Association class 2.3 ± 0.6, left ventricular ejection fraction 39 ± 13.3%, and 21% female) were prospectively enrolled as part of the Studies Investigating Co-morbidities Aggravating Heart Failure. Muscle wasting as assessed using dual-energy X-ray absorptiometry was present in 47 patients (17.5%). RESULTS During a mean follow-up of 67.2 ± 28.02 months, 95 patients (35.4%) died from any cause. After adjusting for age, New York Heart Association class, left ventricular ejection fraction, creatinine, N-terminal pro-B-type natriuretic peptide, and iron deficiency, muscle wasting remained an independent predictor of death (hazard ratio 1.80, 95% confidence interval 1.01-3.19, P = 0.04). This effect was more pronounced in patients with heart failure with reduced than in heart failure with preserved ejection fraction. CONCLUSIONS Muscle wasting is an independent predictor of death in ambulatory patients with heart failure. Clinical trials are needed to identify treatment approaches to this co-morbidity.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,Department of Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tarek Bekfani
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Helge Haarmann
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Wolfram Doehner
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany.,BCRT-Berlin Institute of Health Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin Berlin (CVK), Berlin, Germany
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21
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Bekfani T, Schöbel C, Pietrock C, Valentova M, Ebner N, Döhner W, Schulze PC, Anker SD, von Haehling S. Heart failure and sleep-disordered breathing: susceptibility to reduced muscle strength and preclinical congestion (SICA-HF cohort). ESC Heart Fail 2020; 7:2063-2070. [PMID: 32578399 PMCID: PMC7524208 DOI: 10.1002/ehf2.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/28/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Increased sympathetic activation in patients with heart failure (HF) and sleep‐disordered breathing (SDB) provokes cardiac decompensation and protein degradation and could lead to muscle wasting and muscle weakness. The aim of this study was to investigate the differences in body composition, muscle function, and the susceptibility of preclinical congestion among patients with HF and SDB compared with those without SDB. Methods and results We studied 111 outpatients with stable HF who were enrolled into the Studies Investigating Co‐morbidities Aggravating Heart Failure. Echocardiography, short physical performance battery (SPPB), cardiopulmonary exercise testing, dual‐energy X‐ray absorptiometry, bioelectrical impedance analysis (BIA), tests of muscle strength, and polygraphy were performed. SDB was defined as apnoea/hypopnoea index (AHI) >5 per hour of sleep. Central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) were defined as AHI >50% of central or obstructive origin, respectively. A total of 74 patients (66.7%) had any form of SDB [CSA (24 patients, 32.4%), OSA (47 patients, 63.5%)]. Patients with SDB showed increased muscle weakness (chair stand), reduced muscle strength, and lower values of SPPB score (P < 0.05). Patients with SDB did not show overt clinical signs of cardiac decompensation compared with those without SDB (P > 0.05) but had increased amounts of water (total body water, intracellular, and extracellular) measured using BIA (P < 0.05). Increased amounts of total body water were associated with the severity of SDB and inversely with muscle strength and exercise capacity measured by anaerobic threshold (P < 0.05). Altogether, 17 patients had muscle wasting. Of these, 11 (65%) patients had SDB (statistically not significant). Conclusions SDB is highly prevalent in patients with HF. Patients with SDB have lower muscle strength and tend to be more susceptible to preclinical congestion.
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Guericke University, Leipziger Str. 44, Magdeburg, D-39120, Germany
| | - Christoph Schöbel
- Department of Sleep Medicine, Universität Duisburg-Essen, Essen, Germany
| | - Charlotte Pietrock
- Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany.,Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic
| | - Nicole Ebner
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany
| | - Wolfram Döhner
- Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité - Medical School, Berlin, Germany.,Berlin-Brandenburg Centre for Regenerative Therapies (BCRT), Charité Medical School, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, Germany and German Centre for Cardiovascular Research (DZHK), partner site Göttingen, University of Göttingen Medical Centre, Göttingen, Germany
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22
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Bekhite MM, González Delgado A, Menz F, Kretzschmar T, Wu JMF, Bekfani T, Nietzsche S, Wartenberg M, Westermann M, Greber B, Schulze PC. Longitudinal metabolic profiling of cardiomyocytes derived from human-induced pluripotent stem cells. Basic Res Cardiol 2020; 115:37. [PMID: 32424548 DOI: 10.1007/s00395-020-0796-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Human-induced pluripotent stem cells (h-iPSCs) are a unique in vitro model for cardiovascular research. To realize the potential applications of h-iPSCs-derived cardiomyocytes (CMs) for drug testing or regenerative medicine and disease modeling, characterization of the metabolic features is critical. Here, we show the transcriptional profile during stages of cardiomyogenesis of h-iPSCs-derived CMs. CM differentiation was not only characterized by the expression of mature structural components (MLC2v, MYH7) but also accompanied by a significant increase in mature metabolic gene expression and activity. Our data revealed a distinct substrate switch from glucose to fatty acids utilization for ATP production. Basal respiration and respiratory capacity in 9 days h-iPSCs-derived CMs were glycolysis-dependent with a shift towards a more oxidative metabolic phenotype at 14 and 28 day old CMs. Furthermore, mitochondrial analysis characterized the early and mature forms of mitochondria during cardiomyogenesis. These results suggest that changes in cellular metabolic phenotype are accompanied by increased O2 consumption and ATP synthesis to fulfill the metabolic needs of mature CMs activity. To further determine functionality, the physiological response of h-iPSCs-derived CMs to β-adrenergic stimulation was tested. These data provide a unique in vitro human heart model for the understanding of CM physiology and metabolic function which may provide useful insight into metabolic diseases as well as novel therapeutic options.
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Affiliation(s)
- Mohamed M Bekhite
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany.
| | - Andrés González Delgado
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Florian Menz
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Tom Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Jasmine M F Wu
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Sandor Nietzsche
- Electron Microscopy Center Jena, University Hospital Jena, FSU, Jena, Germany
| | - Maria Wartenberg
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
| | - Martin Westermann
- Electron Microscopy Center Jena, University Hospital Jena, FSU, Jena, Germany
| | - Boris Greber
- Max Planck Institue for Molecular Biomedicine, Münster, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, FZL Haus F4, Am Klinikum 1, 07747, Jena, Germany
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23
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Jirak P, Pistulli R, Lichtenauer M, Wernly B, Paar V, Motloch LJ, Rezar R, Jung C, Hoppe UC, Schulze PC, Kretzschmar D, Braun-Dullaeus RC, Bekfani T. Expression of the Novel Cardiac Biomarkers sST2, GDF-15, suPAR, and H-FABP in HFpEF Patients Compared to ICM, DCM, and Controls. J Clin Med 2020; 9:jcm9041130. [PMID: 32326570 PMCID: PMC7230638 DOI: 10.3390/jcm9041130] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) remains an ongoing therapeutic and diagnostic challenge to date. In this study we aimed for an analysis of the diagnostic potential of four novel cardiovascular biomarkers, GDF-15, H-FABP, sST2, and suPAR in HFpEF patients compared to controls as well as ICM, and DCM. Methods: In total, we included 252 stable outpatients and controls (77 DCM, 62 ICM, 18 HFpEF, and 95 controls) in the present study. All patients were in a non-decompensated state and on a stable treatment regimen. Serum samples were obtained and analyzed for GDF-15 (inflammation, remodeling), H-FABP (ischemia and subclinical ischemia), sST2 (inflammation, remodeling) and suPAR (inflammation, remodeling) by means of ELISA. Results: A significant elevation of GDF-15 was found for all heart failure entities compared to controls (p < 0.005). Similarly, H-FABP evidenced a significant elevation in all heart failure entities compared to the control group (p < 0.0001). Levels of sST2 were significantly elevated in ICM and DCM patients compared to the control group and HFpEF patients (p < 0.0001). Regarding suPAR, a significant elevation in ICM and DCM patients compared to the control group (p < 0.0001) and HFpEF patients (p < 0.01) was observed. An AUC analysis identified H-FABP (0.792, 95% CI 0.713–0.870) and GDF-15 (0.787, 95% CI 0.696–0.878) as paramount diagnostic biomarkers for HFpEF patients. Conclusion: Based on their differences in secretion patterns, novel cardiovascular biomarkers might represent a promising diagnostic tool for HFpEF in the future.
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Affiliation(s)
- Peter Jirak
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
- Correspondence:
| | - Rudin Pistulli
- Division of Vascular Medicine, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Munster, North Rhine-Westphalia, 48149 Münster, Germany;
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Lukas J. Motloch
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Richard Rezar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - Christian Jung
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, 40225 Duesseldorf, Germany;
| | - Uta C. Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (M.L.); (B.W.); (V.P.); (L.J.M.); (R.R.); (U.C.H.)
| | - P. Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich Schiller University Jena, 07740 Jena, Germany; (P.C.S.); (D.K.)
| | - Daniel Kretzschmar
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, University Hospital Jena, Friedrich Schiller University Jena, 07740 Jena, Germany; (P.C.S.); (D.K.)
| | - Rüdiger C. Braun-Dullaeus
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Gericke University, Magdeburg, 39120 Magdeburg, Germany; (R.C.B.-D.)
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Magdeburg, Otto von Gericke University, Magdeburg, 39120 Magdeburg, Germany; (R.C.B.-D.)
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24
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Westphal JG, Bekfani T, Schulze PC. What’s new in heart failure therapy 2018?†. Interact Cardiovasc Thorac Surg 2018; 27:921-930. [DOI: 10.1093/icvts/ivy282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/24/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Julian G Westphal
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Tarek Bekfani
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Paul Christian Schulze
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
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25
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Bekfani T, Bekhite Elsaied M, Derlien S, Hamadanchi A, Froeb E, Nisser J, Kretzschmar T, Haase D, Smolenski UC, Lehmann G, Wolf G, Moebius-Winkler S, Schulze PC. P4733Growth factors and atrophy-related genes are highly expressed in patients with HFpEF and are associated with elevated BNP and reduced exercise capacity and quality of life. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Bekfani
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - M Bekhite Elsaied
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - S Derlien
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - A Hamadanchi
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - E Froeb
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - J Nisser
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - T Kretzschmar
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - D Haase
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - U C Smolenski
- University Hospital of Jena, Institute of Physiotherapy, Jena, Germany
| | - G Lehmann
- University Hospital of Jena, Department of Endocrinology, Nephrology and Rheumatology, Jena, Germany
| | - G Wolf
- University Hospital of Jena, Department of Endocrinology, Nephrology and Rheumatology, Jena, Germany
| | - S Moebius-Winkler
- University Hospital of Jena, Department of Cardiology, Jena, Germany
| | - P C Schulze
- University Hospital of Jena, Department of Cardiology, Jena, Germany
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26
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Bekfani T, Pellicori P, Morris D, Ebner N, Valentova M, Sandek A, Doehner W, Cleland JG, Lainscak M, Schulze PC, Anker SD, von Haehling S. Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 2018; 108:203-211. [PMID: 30051186 DOI: 10.1007/s00392-018-1344-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of iron deficiency (ID) in outpatients with heart failure with preserved ejection fraction (HFpEF) and its relation to exercise capacity and quality of life (QoL) is unknown. METHODS 190 symptomatic outpatients with HFpEF (LVEF 58 ± 7%; age 71 ± 9 years; NYHA 2.4 ± 0.5; BMI 31 ± 6 kg/m2) were enrolled as part of SICA-HF in Germany, England and Slovenia. ID was defined as ferritin < 100 or 100-299 µg/L with transferrin saturation (TSAT) < 20%. Anemia was defined as Hb < 13 g/dL in men, < 12 g/dL in women. Low ferritin-ID was defined as ferritin < 100 µg/L. Patients were divided into 3 groups according to E/e' at echocardiography: E/e' ≤ 8; E/e' 9-14; E/e' ≥ 15. All patients underwent echocardiography, cardiopulmonary exercise test (CPX), 6-min walk test (6-MWT), and QoL assessment using the EQ5D questionnaire. RESULTS Overall, 111 patients (58.4%) showed ID with 89 having low ferritin-ID (46.84%). 78 (41.1%) patients had isolated ID without anemia and 54 patients showed anemia (28.4%). ID was more prevalent in patients with more severe diastolic dysfunction: E/e' ≤ 8: 44.8% vs. E/e': 9-14: 53.2% vs. E/e' ≥ 15: 86.5% (p = 0.0004). Patients with ID performed worse during the 6MWT (420 ± 137 vs. 344 ± 124 m; p = 0.008) and had worse exercise time in CPX (645 ± 168 vs. 538 ± 178 s, p = 0.03). Patients with low ferritin-ID had lower QoL compared to those without ID (p = 0.03). CONCLUSION ID is a frequent co-morbidity in HFpEF and is associated with reduced exercise capacity and QoL. Its prevalence increases with increasing severity of diastolic dysfunction.
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Affiliation(s)
- Tarek Bekfani
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany.
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel Morris
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Wolfram Doehner
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | | | - Mitja Lainscak
- Department of Cardiology, Golnik University, Golnik, Slovenia
| | - P Christian Schulze
- Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany
| | - Stefan D Anker
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Medical School Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
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Affiliation(s)
- Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Florian Westphal
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Saitoh M, Dos Santos MR, Emami A, Ishida J, Ebner N, Valentova M, Bekfani T, Sandek A, Lainscak M, Doehner W, Anker SD, von Haehling S. Anorexia, functional capacity, and clinical outcome in patients with chronic heart failure: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). ESC Heart Fail 2017; 4:448-457. [PMID: 28960880 PMCID: PMC5695184 DOI: 10.1002/ehf2.12209] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/24/2022] Open
Abstract
Aims We aimed to assess determinants of anorexia, that is loss of appetite in patients with heart failure (HF) and aimed to further elucidate the association between anorexia, functional capacity, and outcomes in affected patients. Methods and results We assessed anorexia status among 166 patients with HF (25 female, 66 ± 12 years) who participated in the Studies Investigating Co‐morbidities Aggravating HF. Anorexia was assessed by a 6‐point Likert scale (ranging from 0 to 5), wherein values ≥1 indicate anorexia. Functional capacity was assessed as peak oxygen uptake (peak VO2), 6 min walk test, and short physical performance battery test. A total of 57 patients (34%) reported any anorexia, and these patients showed lower values of peak VO2, 6 min walk distance, and short physical performance battery score (all P < 0.05). Using multivariate analysis adjusting for clinically important factors, only high‐sensitivity C‐reactive protein [odds ratio (OR) 1.24, P = 0.04], use of loop diuretics (OR 5.76, P = 0.03), and the presence of cachexia (OR 2.53, P = 0.04) remained independent predictors of anorexia. A total of 22 patients (13%) died during a mean follow‐up of 22.5 ± 5.1 months. Kaplan‐Meier curves for cumulative survival showed that those patients with anorexia presented higher mortality (Log‐rank test P = 0.03). Conclusions Inflammation, use of loop diuretics, and cachexia are associated with an increased likelihood of anorexia in patients with HF, and patients with anorexia showed impaired functional capacity and poor outcomes.
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Affiliation(s)
- Masakazu Saitoh
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Marcelo R Dos Santos
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany.,Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Amir Emami
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Junichi Ishida
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Tarek Bekfani
- Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
| | - Mitja Lainscak
- Faculty of Medicine, Ljubljana, Slovenia; Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
| | - Wolfram Doehner
- Centre for Stroke Research Berlin and Department of Cardiology, Virchow Klinikum, Charité-Universitätsmedizin, Berlin, Germany
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany.,Division of Cardiology and Metabolism - Heart Failure, Cachexia and Sarcopenia; Department of Internal Medicine and Cardiology, Berlin-Brandenburg Center for Regenerative Therapies (BCRT) at Charité University Medicine, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen and DZHK (German Center for Cardiovascular Research), Göttingen, Germany
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Bekfani T, Schoebel C, Pietrock C, Valentova M, Ebner N, Elsner S, Sandek A, Doehner W, Noutsias M, Schulze P, Anker S, Von Haehling S. P4386Sleep disordered breathing (SDB) increases the risk of heart failure decompensation: clinical factors and bioelectrical impedance analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hamadanchi A, Moradi B, Bekfani T, Franz M, Otto S, Poerner T, Schulze P, Goebel B. P2399Applying 3D echocardiography derived stroke volume for quantification of aortic valve area in low-flow aortic stenosis: The superiority of a hybrid approach. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2399] [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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Westphal J, Schlattmann P, Lutschinger L, Konstas C, Aftanski P, Bekfani T, Schulze P, Noutsias M. P6298Meta-analysis for the value of colchicine for the therapy and prevention of recurrence of pericarditis, and for rehospitalization for pericarditis and postpericardiotomy syndrome. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bekfani T, Pellicori P, Morris DA, Ebner N, Valentova M, Steinbeck L, Wachter R, Elsner S, Sliziuk V, Schefold JC, Sandek A, Doehner W, Cleland JG, Lainscak M, Anker SD, von Haehling S. Sarcopenia in patients with heart failure with preserved ejection fraction: Impact on muscle strength, exercise capacity and quality of life. Int J Cardiol 2016; 222:41-46. [PMID: 27454614 DOI: 10.1016/j.ijcard.2016.07.135] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND To describe the prevalence of sarcopenia in ambulatory patients with heart failure with preserved ejection fraction (HFpEF) and its relation to reduced exercise capacity, muscle strength, and quality of life (QoL). METHODS AND RESULTS A total of 117 symptomatic outpatients with HFpEF were prospectively enrolled in Germany, England, and Slovenia as part of the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Appendicular skeletal muscle (ASM) mass (the sum of muscle mass in both arms and legs) was assessed by DEXA. Echocardiography, 6-minute walk testing (6-MWT), muscle strength assessment, spiroergometry and QoL evaluation using EQ-5D Questionnaire were performed. Sarcopenia was defined as ASM 2 standard deviations below the mean of a healthy reference group aged 18-40years. Patients were divided into 3 groups according to the E/e' value: ≤8, 9-14, and ≥15. Sarcopenia was detected in 19.7% of all patients. These patients performed worse during 6-MWT (404±116 vs. 307±145m, p=0.003) and showed lower absolute peak oxygen consumption (1579±474 vs. 1211±442mL/min, p<0.05). Both ASM and muscle strength were lowest in patients with E/e' >15 (p<0.05). Higher values of muscle strength/ASM were associated with a better QoL (r=0.5, p<0.0005). Logistic regression showed ASM to be independently associated with reduced distance walked during the 6-MWT adjusted for NYHA, height, left atrium diameter, ferritin and forced expiratory volume in 1s (FEV1) (odds ratio 1.2, p=0.02). CONCLUSION Sarcopenia affects a clinically relevant proportion of patients with HFpEF. Low ASM is strongly linked to reduced muscle strength, exercise capacity and QoL in these patients.
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Affiliation(s)
- Tarek Bekfani
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Friedrich-Schiller-University, Jena, Germany.
| | | | - Daniel A Morris
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Nicole Ebner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Miroslava Valentova
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany; Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic.
| | - Lisa Steinbeck
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Rolf Wachter
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Sebastian Elsner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Veronika Sliziuk
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland.
| | - Anja Sandek
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Wolfram Doehner
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
| | - John G Cleland
- University of Hull, Department of Cardiology, Hull, United Kingdom.
| | - Mitja Lainscak
- Golnik University, Department of Cardiology, Golnik, Slovenia.
| | - Stefan D Anker
- University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
| | - Stephan von Haehling
- Charité Medical School, Campus Virchow-Klinikum, Department of Cardiology, Berlin, Germany; University of Göttingen Medical School, Department of Cardiology and Pneumology, Göttingen, Germany.
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Valentova M, von Haehling S, Bauditz J, Doehner W, Ebner N, Bekfani T, Elsner S, Sliziuk V, Scherbakov N, Murín J, Anker SD, Sandek A. Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure. Eur Heart J 2016. [PMID: 26865478 DOI: 10.1093/eurheartj/ehw008.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia. METHODS AND RESULTS Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment. CONCLUSION Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship.
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Affiliation(s)
- Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Juergen Bauditz
- Department of Gastroenterology, Charité Medical School, Campus Mitte, Berlin, Germany Center for Internal Medicine, Helios Clinic Zerbst/Anhalt, Zerbst, Germany
| | - Wolfram Doehner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Tarek Bekfani
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Sebastian Elsner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Veronika Sliziuk
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Nadja Scherbakov
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Ján Murín
- First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
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Bekfani T, Abraham WT. Current and future developments in the field of central sleep apnoea. Europace 2016; 18:1123-34. [DOI: 10.1093/europace/euv435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
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Valentova M, von Haehling S, Bauditz J, Doehner W, Ebner N, Bekfani T, Elsner S, Sliziuk V, Scherbakov N, Murín J, Anker SD, Sandek A. Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure. Eur Heart J 2016; 37:1684-91. [PMID: 26865478 DOI: 10.1093/eurheartj/ehw008] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/07/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Miroslava Valentova
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Juergen Bauditz
- Department of Gastroenterology, Charité Medical School, Campus Mitte, Berlin, Germany Center for Internal Medicine, Helios Clinic Zerbst/Anhalt, Zerbst, Germany
| | - Wolfram Doehner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Tarek Bekfani
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Sebastian Elsner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Veronika Sliziuk
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Nadja Scherbakov
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Ján Murín
- First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Stefan D Anker
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany
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Ebner N, Jankowska EA, Ponikowski P, Lainscak M, Elsner S, Sliziuk V, Steinbeck L, Kube J, Bekfani T, Scherbakov N, Valentova M, Sandek A, Doehner W, Springer J, Anker SD, von Haehling S. The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure. Int J Cardiol 2015; 205:6-12. [PMID: 26705670 DOI: 10.1016/j.ijcard.2015.11.178] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 01/27/2023]
Abstract
UNLABELLED Anaemia and iron deficiency (ID) are important co-morbidities in patients with chronic heart failure (HF) and both may lead to reduced exercise capacity. METHODS We enrolled 331 out-patients with stable chronic HF (mean age: 64 ± 11 years, 17% female, left ventricular ejection fraction [LVEF] 35 ± 13%, body mass index [BMI] 28.5 ± 5.2 kg/m(2), New York Heart Association [NYHA] class 2.2 ± 0.7, chronic kidney disease 35%, glomerular filtration rate 61.7 ± 20.1 mL/min). Anaemia was defined according to World Health Organization criteria (haemoglobin [Hb] < 13 g/dL in men, < 12 g/dL in women). ID was defined as serum ferritin < 100 μg/L or ferritin < 300 μg/L with transferrin saturation (TSAT) < 20%. Exercise capacity was assessed as peak oxygen consumption (peak VO2) by spiroergometry and 6-minute walk test (6MWT). RESULTS A total of 91 (27%) patients died from any cause during a mean follow-up of 18 months. At baseline, 98 (30%) patients presented with anaemia and 149 (45%) patients presented with ID. We observed a significant reduction in exercise capacity in parallel to decreasing Hb levels (r = 0.24, p < 0.001). In patients with anaemia and ID (n = 63, 19%), exercise capacity was significantly lower than in patients with ID or anaemia only. Cox regression analysis showed that after adjusting for NYHA, age, hsCRP and creatinine anaemia is an independent predictor of mortality in patients with HF (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.33-0.97, p = 0.04). CONCLUSION The impact of anaemia on reduced exercise capacity and on mortality is stronger than that of ID. Anaemia remained an independent predictor of death after adjusting for clinically relevant variables.
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Affiliation(s)
- Nicole Ebner
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland
| | - Piotr Ponikowski
- Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland
| | - Mitja Lainscak
- Department of Cardiology, General Hospital Celje, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sebastian Elsner
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Veronika Sliziuk
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Lisa Steinbeck
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Jennifer Kube
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Tarek Bekfani
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Nadja Scherbakov
- Center for Stroke Research Berlin, Charite University Medical School, Germany
| | - Miroslava Valentova
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; 1st Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic
| | - Anja Sandek
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Wolfram Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
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Steinbeck L, Ebner N, Valentova M, Bekfani T, Elsner S, Dahinden P, Hettwer S, Scherbakov N, Schefold JC, Sandek A, Springer J, Doehner W, Anker SD, von Haehling S. Detection of muscle wasting in patients with chronic heart failure using C-terminal agrin fragment: results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Eur J Heart Fail 2015; 17:1283-93. [PMID: 26449626 DOI: 10.1002/ejhf.400] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 12/29/2022] Open
Abstract
AIMS Skeletal muscle wasting affects 20% of patients with chronic heart failure and has serious implications for their activities of daily living. Assessment of muscle wasting is technically challenging. C-terminal agrin-fragment (CAF), a breakdown product of the synaptically located protein agrin, has shown early promise as biomarker of muscle wasting. We sought to investigate the diagnostic properties of CAF in muscle wasting among patients with heart failure. METHODS AND RESULTS We assessed serum CAF levels in 196 patients who participated in the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). Muscle wasting was identified using dual-energy X-ray absorptiometry (DEXA) in 38 patients (19.4%). Patients with muscle wasting demonstrated higher CAF values than those without (125.1 ± 59.5 pmol/L vs. 103.8 ± 42.9 pmol/L, P = 0.01). Using receiver operating characteristics (ROC), we calculated the optimal CAF value to identify patients with muscle wasting as >87.5 pmol/L, which had a sensitivity of 78.9% and a specificity of 43.7%. The area under the ROC curve was 0.63 (95% confidence interval 0.56-0.70). Using simple regression, we found that serum CAF was associated with handgrip (R = - 0.17, P = 0.03) and quadriceps strength (R = - 0.31, P < 0.0001), peak oxygen consumption (R = - 0.5, P < 0.0001), 6-min walk distance (R = - 0.32, P < 0.0001), and gait speed (R = - 0.2, P = 0.001), as well as with parameters of kidney and liver function, iron metabolism and storage. CONCLUSION CAF shows good sensitivity for the detection of skeletal muscle wasting in patients with heart failure. Its assessment may be useful to identify patients who should undergo additional testing, such as detailed body composition analysis. As no other biomarker is currently available, further investigation is warranted.
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Affiliation(s)
- Lisa Steinbeck
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Nicole Ebner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Miroslava Valentova
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Tarek Bekfani
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Sebastian Elsner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | | | | | - Nadja Scherbakov
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Centre for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Jörg C Schefold
- Department of Nephrology and Intensive Care, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany
| | - Anja Sandek
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - Jochen Springer
- Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Wolfram Doehner
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Centre for Stroke Research Berlin, Charité Medical School, Berlin, Germany
| | - Stefan D Anker
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
| | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany
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38
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Morris DA, Takeuchi M, Krisper M, Köhncke C, Bekfani T, Carstensen T, Hassfeld S, Dorenkamp M, Otani K, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Osmanoglou E, Kühnle Y, Düngen HD, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH. Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 2014; 16:364-72. [PMID: 25368210 DOI: 10.1093/ehjci/jeu219] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this multicentre study was to determine the normal range and the clinical relevance of the myocardial function of the left atrium (LA) analysed by 2D speckle-tracking echocardiography (2DSTE). METHODS AND RESULTS We analysed 329 healthy adult subjects prospectively included in 10 centres and a validation group of 377 patients with left ventricular diastolic dysfunction (LVDD). LA myocardial function was analysed by LA strain rate peak during LA contraction (LA-SRa) and LA strain peak during LA relaxation (LA-Strain). The range of values of LA myocardial function in healthy subjects was LA-SRa -2.11 ± 0.61 s(-1) and LA-Strain 45.5 ± 11.4%, and the lowest expected values of these LA analyses (calculated as -1.96 SD from the mean of healthy subjects) were LA-SRa -0.91 s(-1) and LA-Strain 23.1%. Concerning the clinical relevance of these LA myocardial analyses, LA-SRa and LA-Strain detected subtle LA dysfunction in patients with LVDD, even though LA volumetric measurements were normal. In addition, in these patients we found that the functional class (dyspnoea-NYHA classification) was inversely related to both LA-Strain and LA-SRa. CONCLUSION In the present multicentre study analysing a large cohort of healthy subjects and patients with LVDD, the normal range and the clinical relevance of the myocardial function of the LA using 2DSTE have been determined.
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Affiliation(s)
- Daniel A Morris
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Masaaki Takeuchi
- School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Maximilian Krisper
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Clemens Köhncke
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tarek Bekfani
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Tim Carstensen
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sabine Hassfeld
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marc Dorenkamp
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Kyoko Otani
- School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Satoshi Yuda
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Nobuyuki Ohte
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | - York Kühnle
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | | | - Yutaka Otsuji
- School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wilhelm Haverkamp
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Leif-Hendrik Boldt
- Department of Cardiology, Charité University Hospital (Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin), Augustenburger Platz 1, 13353 Berlin, Germany
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39
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Bekfani T, Pellicori P, Ebner N, Valentova M, Sandek A, Doehner W, Cleland J, Anker S, von Haehling S. Muscle Wasting in Patients with Heart Failure with Preserved Ejection Fraction and Its Impact on Muscle Strength and Functional Capacity during Exercise. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.013] [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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40
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Ebner N, Bekfani T, Steinbeck L, Elsner S, Sliziuk V, Valentova M, Sandek A, Doehner W, Anker SD, von Haehling S. Predictors of Anaemia-Development in Patients with Chronic Heart Failure: Results from the Studies Investigating Co-Morbidities Aggravating Heart Failure (SICA-HF). J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.110] [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: 10/25/2022]
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41
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Ebner N, Elsner S, Steinbeck L, Bekfani T, Valentova M, Sliziuk V, Kube J, Sandek A, Doehner W, Anker SD, von Haehling S. Risk Factors of Anaemia-Development in Patients with Chronic Heart Failure: Results from the Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF). J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.111] [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: 11/25/2022]
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42
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Morris DA, Otani K, Bekfani T, Takigiku K, Izumi C, Yuda S, Sakata K, Ohte N, Tanabe K, Friedrich K, Kühnle Y, Nakatani S, Otsuji Y, Haverkamp W, Boldt LH, Takeuchi M. Multidirectional Global Left Ventricular Systolic Function in Normal Subjects and Patients with Hypertension: Multicenter Evaluation. J Am Soc Echocardiogr 2014; 27:493-500. [DOI: 10.1016/j.echo.2014.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Indexed: 01/07/2023]
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43
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Bekfani T, Valentova M, Ebner N, Sandek A, Anker SD, Doehner W, Von Haehling S. Body composition in patients with diastolic dysfunction and heart failure with preserved ejection fraction and its effect on muscle strength and exercise capacity. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2441] [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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Valentova M, Sandek A, Bekfani T, Steinbeck L, Ebner N, Murin J, Doehner W, Anker SD, Von Haehling S. Prevalence and clinical implications of liver dysfunction in chronic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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Steinbeck L, Ebner N, Valentova M, Sandek A, Bekfani T, Doehner W, Anker SD, Von Haehling S. C-terminal agrin-fragment as a novel diagnostic marker for muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Morris DA, Parwani A, Huemer M, Wutzler A, Bekfani T, Attanasio P, Friedrich K, Kühnle Y, Haverkamp W, Boldt LH. Clinical significance of the assessment of the systolic and diastolic myocardial function of the left atrium in patients with paroxysmal atrial fibrillation and low CHADS(2) index treated with catheter ablation therapy. Am J Cardiol 2013; 111:1002-11. [PMID: 23337834 DOI: 10.1016/j.amjcard.2012.12.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 12/12/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to determine the clinical significance of the assessment of the diastolic and systolic myocardial function of the left atrium in patients with paroxysmal atrial fibrillation (AF) and low CHADS(2) scores treated with catheter ablation therapy. In a cohort of 84 symptomatic patients with paroxysmal AF and low CHADS(2) scores (≤1), the clinical significance of the systolic and diastolic myocardial function of the left atrium (assessed using 2-dimensional speckle-tracking echocardiography) were studied to predict the risk for recurrence of AF after catheter ablation therapy in the course of a follow-up period of ≥1 year. During a mean follow-up period of 19.2 ± 5.4 months, patients with left atrial (LA) myocardial diastolic dysfunction (LA strain <18.8%) had a significantly higher rate of recurrence of AF (42.4% vs 9.8%, p <0.05) compared to those without LA diastolic dysfunction. In line with this finding, patients with impaired LA myocardial systolic function (LA strain rate >-0.85 s(-1)) had worse outcomes after catheter ablation therapy than those with normal LA systolic function (rate of recurrence of AF 42.9% vs 12.5%, respectively, p <0.05). In relation to these results, in a logistic regression analysis including co-morbidities, left ventricular dysfunction, LA enlargement, and LA myocardial alterations, diastolic and systolic LA myocardial dysfunction were the principal variable associated with the recurrence of AF (odds ratios 6.8 and 5.2, respectively). In conclusion, in symptomatic patients with paroxysmal AF and low CHADS(2) scores, these findings suggest that the assessment of diastolic and systolic LA myocardial function using 2-dimensional speckle-tracking echocardiography could be of great utility to distinguish those patients with high or low risk for recurrence of AF after catheter ablation therapy.
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