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Schuermann H, von Rennenberg R, Riegler C, Rangus I, Litmeier S, Scheitz JF, Doehner W, Audebert H, Braemswig TB, Nolte CH. Characteristics associated with occurrence of stroke in patients with infective endocarditis - a retrospective cohort study. Neurol Res Pract 2024; 6:22. [PMID: 38600573 PMCID: PMC11007977 DOI: 10.1186/s42466-024-00317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Stroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms. METHODS All patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité - Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke. RESULTS The study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35-4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06-6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21-8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04-0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14-0.72). CONCLUSIONS Stroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.
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Affiliation(s)
- H Schuermann
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- Paracelsus Medical University Salzburg, Salzburg, Austria.
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - R von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Riegler
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - I Rangus
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Litmeier
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
- German Heart Center of the Charite, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health-Center or Regenerative Therapies, Universitätsmedizin Berlin, Berlin, Germany
| | - H Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T B Braemswig
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
| | - C H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
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Scherbakov N, Pietrock C, Sandek A, Ebner N, Valentova M, Fiebach JB, Schefold JC, Von Haehling S, Anker SD, Norman K, Haeusler KG, Doehner W. 1200Body weight changes and incidence of cachexia after stroke. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Scherbakov
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - C Pietrock
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - A Sandek
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - N Ebner
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - M Valentova
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - J B Fiebach
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - J C Schefold
- Bern University Hospital, Department of Intensive Care Medicine, Inselspital, Bern, Bern, Switzerland
| | - S Von Haehling
- University Medical Centre Göttingen, Innovative Clinical Trials, Department of Cardiology and Pneumology, Göttingen, Germany
| | - S D Anker
- German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - K Norman
- Charité - Universitätsmedizin Berlin, Research Group on Geriatrics, Berlin, Germany
| | - K G Haeusler
- Center for Stroke Research CSB, Charite University Medical School, Berlin, Germany
| | - W Doehner
- Center for Stroke Research CSB, Charite University Medical School, Berlin, 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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Laag V, Maier B, Behrens S, Schoeller R, Schuehlen H, Theres H, Doehner W. P4632Impact of body mass index on hospital mortality in acute myocardial infarction over 15 years: Findings from 27,607 patients of a local myocardial infarction registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V. Laag
- Berlin Myocardial Infarction Registry at TU Berlin, Berlin, Germany
| | - B. Maier
- Berlin Myocardial Infarction Registry at TU Berlin, Berlin, Germany
| | - S. Behrens
- Vivantes Humboldt Klinikum, Berlin, Germany
| | | | - H. Schuehlen
- Vivantes Auguste-Viktoria Klinikum, Berlin, Germany
| | - H. Theres
- Charite - Campus Mitte (CCM), Berlin, Germany
| | - W. Doehner
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
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Palus S, Springer J, Doehner W, von Haehling S, Anker M, Anker S, Springer J. Models of sarcopenia: Short review. Int J Cardiol 2017; 238:19-21. [DOI: 10.1016/j.ijcard.2017.03.152] [Citation(s) in RCA: 25] [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: 08/31/2016] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
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Loncar G, Bozic B, Cvetinovic N, Dungen HD, Lainscak M, von Haehling S, Doehner W, Radojicic Z, Putnikovic B, Trippel T, Popovic V. Secondary hyperparathyroidism prevalence and prognostic role in elderly males with heart failure. J Endocrinol Invest 2017; 40:297-304. [PMID: 27738907 DOI: 10.1007/s40618-016-0561-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 08/01/2016] [Accepted: 10/05/2016] [Indexed: 01/06/2023]
Abstract
AIM Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). METHODS Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. RESULTS SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p < 0.0001), left ventricular ejection fraction (27 ± 8 vs. 31 ± 7 %, p = 0.019), and NT-proBNP [2452 (3399) vs. 918 (1372) pg/ml, p < 0.0001]. No differences in age, vitamin D status, and renal function were noted between studied groups. A total of 41 (56 %) patients died within 6 years of follow-up. Kaplan-Meier survival analysis showed impaired long-term survival in patients with SHPT versus patients with normal PTH (p = 0.009). The rate of death was highest (75 %) in the group of patients with SHPT and NT-proBNP levels above median value (p = 0.003). Cox regression analysis demonstrated that NT-proBNP was the single independent predictor of all-cause mortality at 6-year follow-up [HR 3.698 (1.927-7.095), p < 0.0001]. CONCLUSION SHPT was highly prevalent in elderly males with HF and was associated with impaired survival. HF patients with SHPT had more severe disease compared to the patients with normal serum PTH. Determination of serum PTH levels provided additional value to NT-proBNP for risk stratification in these patients.
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Affiliation(s)
- G Loncar
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - B Bozic
- Institute for Medical Research, Military Medical Academy, Belgrade, Serbia
- Institute for Physiology and Biochemistry, University of Belgrade, Belgrade, Serbia
| | - N Cvetinovic
- Cardiology Department, Clinical Hospital Zvezdara, Dimitrija Tucovica 161, Belgrade, 11 000, Serbia
| | - H-D Dungen
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Lainscak
- Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Göttingen, Germany
- Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charite University Medical School, Berlin, Germany
| | - Z Radojicic
- Institute for Statistics, Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia
| | - B Putnikovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Department, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - T Trippel
- Department of Cardiology, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - V Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Endocrinology, Clinical Center of Serbia, Belgrade, Serbia
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7
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Pschowski R, Briegel S, Von Haehling S, Doehner W, Bender TO, Pape UF, Hasper D, Jörress A, Schefold JC. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure. Anaesth Intensive Care 2016; 43:764-70. [PMID: 26603802 DOI: 10.1177/0310057x1504300615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P <0.001). Overall, transfusion rates did not differ between the study groups. In patients with sepsis, transfusion rates of all blood products were significantly higher when compared to cardiogenic shock (all P <0.01) or other conditions. In conclusion, procedural and non-procedural blood loss may often be observed in critically ill patients on RRT. In CVVH-treated patients, procedural blood loss was increased but overall transfusion rates remained unchanged. Our data show that IHD and CVVH may be regarded as equivalent approaches in critically ill patients with dialysis-dependent acute renal failure in this regard.
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Affiliation(s)
- R Pschowski
- Department of Nephrology and Intensive Care Medicine and Department of Hepatology and Gastroenterology, Charite Universitatsmedizin, Berlin, Germany
| | - S Briegel
- Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany
| | - S Von Haehling
- Department of Clinical Cardiology and Department of Cardiology and Center for Innovative Trials, Charite Universitatsmedizin, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charite Universitatsmedizin, Berlin, Germany
| | - T O Bender
- Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany
| | - U F Pape
- Department of Hepatology and Gastroenterology, Charite Universitatsmedizin, Berlin, Germany
| | - D Hasper
- Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany
| | - A Jörress
- Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany
| | - J C Schefold
- Department of Nephrology and Intensive Care Medicine, Charite Universitatsmedizin, Berlin, Germany
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Fearon K, Argiles JM, Baracos VE, Bernabei R, Coats A, Crawford J, Deutz NE, Doehner W, Evans WJ, Ferrucci L, Garcia JM, Gralla RJ, Jatoi A, Kalantar-Zadeh K, Lainscak M, Morley JE, Muscaritoli M, Polkey MI, Rosano G, Rossi-Fanelli F, Schols AM, Strasser F, Vellas B, von Haehling S, Anker SD. Request for regulatory guidance for cancer cachexia intervention trials. J Cachexia Sarcopenia Muscle 2015; 6:272-4. [PMID: 26675232 PMCID: PMC4670733 DOI: 10.1002/jcsm.12083] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 12/27/2022] Open
Affiliation(s)
- Kch Fearon
- Clinical and Surgical Sciences, School of Clinical Sciences and Community Health, Royal Infirmary, University of Edinburgh Edinburgh, UK
| | - J M Argiles
- Biochemistry and Molecular Biology of Cancer, Faculty of Biology, University of Barcelona Barcelona, Spain
| | - V E Baracos
- Department of Oncology, University of Alberta Edmonton, Alberta, Canada
| | - R Bernabei
- Department of Geriatrics, Neurosciences, and Orthopedics, Catholic University of the Sacred Heart Roma, Italy
| | - Ajs Coats
- Monash University Australia ; University of Warwick UK
| | | | - N E Deutz
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University College Station, TX, 77843, USA
| | - W Doehner
- Center for Stroke Research CSB, Charité - Universitätsmedizin Berlin Germany
| | - W J Evans
- KineMed, Inc. Emeryville, CA, 94608, USA ; Division of Geriatrics, Duke Medical Center Durham, NC, 27710, USA
| | - L Ferrucci
- Intramural Research Program, National Institute on Aging, NIH Baltimore, MD, 20892, USA
| | - J M Garcia
- Division of Endocrinology, Diabetes and Metabolism, Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine Houston, TX, 77030, USA
| | - R J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center Bronx, NY, 10461, USA
| | - A Jatoi
- Department of Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - K Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center Orange, CA, 92868, USA
| | - M Lainscak
- Department of Cardiology and Department of Research and Education, General Hospital Celje Celje, Slovenia
| | - J E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine St Louis, MO, 63103, USA
| | - M Muscaritoli
- Department of Clinical Medicine, Sapienza University Rome, Italy
| | - M I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and NHS Foundation Trust and Imperial College London, UK
| | - G Rosano
- Department of Medical Sciences, IRCCS San Raffaele Roma. Nutramed Consortium Italy
| | - F Rossi-Fanelli
- Department of Clinical Medicine, Sapienza University Rome, Italy
| | - A M Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Department of Respiratory Medicine, Maastricht University Medical Centre Maastricht, The Netherlands
| | - F Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department Internal Medicine and Palliative Centre, Cantonal Hospital St.Gallen Switzerland
| | - B Vellas
- Department of Geriatrics, CHU Toulouse Toulouse, France
| | - S von Haehling
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
| | - S D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG) Göttingen, Germany
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Tahirović E, Lashki DJ, Trippel TD, Tscholl V, Fritschka M, Musial-Bright L, Busjahn A, Kolip P, Störk S, Rauchfuß M, Inkrot S, Lainscak M, Apostolović S, Vesković J, Lončar G, Doehner W, Zelenak C, Düngen HD. Validation of the FEW16 questionnaire for the assessment of physical well-being in patients with heart failure with reduced ejection fraction: results from the CIBIS-ELD study. ESC Heart Fail 2015; 2:194-203. [PMID: 27708856 PMCID: PMC5034814 DOI: 10.1002/ehf2.12045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022] Open
Abstract
Aims Patients with heart failure (HF) commonly suffer from severe impairment of quality of life (QoL). One main goal of HF treatment is improvement of QoL. Physical well‐being is an essential component of QoL. To enable assessment of physical well‐being in HF patients, we validated the FEW16 questionnaire in a prospective study with patients from the Cardiac Insufficiency Bisoprolol Study in ELDerly. Methods and results In 127 HF patients (age 73 ± 5.5 years, 72% male, 60% New York Heart Association class II, left ventricular ejection fraction 37 ± 8.5%), we measured physical well‐being (FEW16), QoL [36‐Item Short‐Form Health Survey (SF36)], and depressive symptoms [PRIME MD Patient Health Questionnaire German short version for depression (PHQ‐D)] at baseline and two follow‐up visits, and correlated FEW16 scores with QoL data and clinical parameters. FEW16 mean scores are 3.04 ± 1.04 at baseline, 3.19 ± 0.94 after 3 months, and 2.77 ± 0.94 after 2–4 years. We assessed data quality, scale assumptions, and construct validity and reliability. Cronbach's alpha for subscales resilience: 0.84; ability to enjoy: 0.80; vitality: 0.88; inner peace: 0.87; total score: 0.95. Intraclass correlation coefficient (ICC) is 0.87 (95% CI 0.84–0.89, ICC (1.4). Pearson's correlations of FEW16 with SF36 and PHQ‐D were significant. Six minutes walking distance and heart rate correlated significantly with the FEW16 total score. Conclusions The FEW16 showed good reliability, internal consistency, and intraclass correlation. FEW16 scores correlated well with psychological and physical well‐being (SF36) and clinical markers of exercise tolerance (6 min walk test and heart rate). Our results indicate a strong correlation of self‐reported physical well‐being with psychological factors. FEW16 values at baseline predicted the development of several aspects of QoL during beta‐blocker up‐titration.
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Affiliation(s)
- E Tahirović
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - D J Lashki
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - T D Trippel
- Department of Internal Medicine - CardiologyCharité University Medicine BerlinGermany; German Center for Cardiovascular Research (DZHK)Site BerlinGermany
| | - V Tscholl
- Medical Clinic for Cardiology and Pulmonology, Campus Benjamin Franklin Charité University Medicine Berlin Germany
| | - M Fritschka
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - L Musial-Bright
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | | | - P Kolip
- Department of Prevention and Health Promotion, School of Public Health Bielefeld University Bielefeld Germany
| | - S Störk
- Comprehensive Heart Failure Center University of Würzburg Germany
| | - M Rauchfuß
- Centre of Internal Medicine and Dermatology, Clinic for Internal Medicine and Psychosomatics Charité University Medicine Berlin Germany
| | - S Inkrot
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - M Lainscak
- Department of Cardiology and Department of Research and EducationGeneral Hospital Celje, Slovenia and Faculty of Medicine, University of LjubljanaCeljeSlovenia; Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - S Apostolović
- Clinical Center Niš, Department of Internal Medicine University of Niš Serbia
| | - J Vesković
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - G Lončar
- Cardiology Department Zvezdara University Medical Center Belgrade Serbia
| | - W Doehner
- Center for Stroke Research Charité University Medicine Berlin Germany
| | - C Zelenak
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
| | - H D Düngen
- Department of Internal Medicine - Cardiology Charité University Medicine Berlin Germany
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Scherbakov N, Doehner W. I. Peripheral endothelial dysfunction after subarachnoid haemorrhage: what the fingertips can tell us. Br J Anaesth 2014; 112:205-6. [DOI: 10.1093/bja/aet443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Doehner W. A direct link between haemodynamic failure and inflammatory activation in heart failure: the simplified approach to heart failure and to creation of life. Eur Heart J 2014; 35:413-5. [DOI: 10.1093/eurheartj/eht562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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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Szabó T, Scherbakov N, Sandek A, Kung T, von Haehling S, Lainscak M, Jankowska EA, Rudovich N, Anker SD, Frystyk J, Flyvbjerg A, Pfeiffer AFH, Doehner W. Plasma adiponectin in heart failure with and without cachexia: catabolic signal linking catabolism, symptomatic status, and prognosis. Nutr Metab Cardiovasc Dis 2014; 24:50-56. [PMID: 23791298 DOI: 10.1016/j.numecd.2013.04.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 12/21/2012] [Revised: 03/05/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Adiponectin (ADPN) as an adipose tissue hormone contributes to regulation of energy metabolism and body composition and is associated with cardiovascular risk profile parameters. Cardiac cachexia may develop as a result of severe catabolic derangement in chronic heart failure (CHF). We aimed to determinate an abnormal ADPN regulation as a link between catabolic signalling, symptomatic deterioration and poor prognosis. METHODS AND RESULTS We measured plasma ADPN in 111 CHF patients (age 65 ± 11, 90% male, left ventricular ejection fraction (LVEF) 36 ± 11%, peak oxygen consumption (peakVO2) 18.1 ± 5.7 l/kg*min, body mass index (BMI) 27 ± 4 kg/m(2), all mean ± standard deviation) and 36 healthy controls of similar age and BMI. Body composition was assessed by dual energy X-ray absorptiometry, insulin sensitivity was evaluated by homoeostasis model assessment, exercise capacity by spiroergometry. Plasma ADPN did not differ between CHF vs. controls (13.5 ± 11.0 vs. 10.5 ± 5.3 mg/l, p > 0.4), but increased stepwise with NYHA functional class (I/II/III: 5.7 ± 1.4/10.7 ± 8.3/19.2 ± 14.0 mg/l, ANOVA p < 0.01). Furthermore, ADPN correlated with VO2 at anaerobic threshold (r = -0.34, p < 0.05). ADPN was highest in cachectic patients (cCHF, 16%) vs. non-cachectic (ncCHF) (18.7 ± 15.0 vs. 12.5 ± 9.9 mg/l; p < 0.05). ADPN indicated mortality risk independently of established prognosticators (HR: 1.04 95% CI: 1.02-1.07; p < 0.0001). ADPN above the mean (13.5 mg/l) was associated with a 3.4 times higher mortality risk in CHF vs. patients with ADPN levels below the mean. CONCLUSION Circulating ADPN is abnormally regulated in CHF. ADPN may be involved in impaired metabolic signalling linking disease progression, tissue wasting, and poor outcome in CHF.
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Affiliation(s)
- T Szabó
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - N Scherbakov
- Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany
| | - A Sandek
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - T Kung
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - S von Haehling
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - M Lainscak
- Division of Cardiology, University Clinic, Golnik, Slovenia
| | - E A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - N Rudovich
- Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany
| | - S D Anker
- Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - J Frystyk
- Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Flyvbjerg
- Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A F H Pfeiffer
- Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany
| | - W Doehner
- Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany; Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany.
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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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14
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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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15
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Tkaczyszyn M, Nega K, Lopuszanska M, Szklarska A, Von Haehling S, Doehner W, Banasiak W, Anker SD, Ponikowski P, Jankowska EA. Symptoms associated with male aging in men with systolic heart failure. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5733] [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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16
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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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Rudovich N, Sparwasser A, Pivovarova O, Bergmann A, Weickert MO, Doehner W, Anker S, Pfeiffer AFH. Metabolic regulation of adrenomedullin, a novel marker of metabolic syndrome and type 2 diabetes, in subjects with different stages of glucose tolerance. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Fulster S, Tacke M, Sandek A, Ebner N, Tschope C, Doehner W, Anker SD, von Haehling S. Muscle wasting in patients with chronic heart failure: results from the studies investigating co-morbidities aggravating heart failure (SICA-HF). Eur Heart J 2012. [DOI: 10.1093/eurheartj/ehs381] [Citation(s) in RCA: 381] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Doehner W, Schenkel J, Anker SD, Springer J, Audebert HJ. Overweight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J 2012; 34:268-77. [DOI: 10.1093/eurheartj/ehs340] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [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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20
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Ebner N, Werner CG, Doehner W, Anker SD, von Haehling S. Erratum to: Recent developments in the treatment of cachexia: highlights from the 6th Cachexia Conference. J Cachexia Sarcopenia Muscle 2012; 3:143. [PMID: 22614821 PMCID: PMC3374016 DOI: 10.1007/s13539-012-0070-x] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- N Ebner
- Department of Cardiology, Applied Cachexia Research, Charité Medical School, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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Liman TG, Neeb L, Rosinski J, Wellwood I, Reuter U, Doehner W, Heuschmann PU, Endres M. Peripheral endothelial function and arterial stiffness in women with migraine with aura: a case-control study. Cephalalgia 2012; 32:459-66. [PMID: 22523187 DOI: 10.1177/0333102412444014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular dysfunction may be involved in migraine pathophysiology and contribute to the increased risk of ischemic stroke in migraine, particularly in women with migraine with aura (MA). However, data on endothelial function in MA are controversial. Here, we investigated whether systemic endothelial function and arterial stiffness are altered in women with MA, using a novel peripheral arterial tonometry device for the first time. METHODS Twenty-nine female MA patients without comorbidities and 30 healthy women were included, and carotid intima-media thickness was assessed by a standardized procedure. Endothelial function was assessed using peripheral arterial tonometry. Reactive hyperaemic response of digital pulse amplitude was measured following 5 minutes of forearm occlusion of the brachial artery. Arterial stiffness was assessed by fingertip tonometry derived and heart-rate-adjusted augmentation index. RESULTS No differences were found in peripheral arterial tonometry ratio (2.3 ± 0.6 vs 2.2 ± 0.8; p = 0.58) and left carotid intima-media thickness (in µm: 484 ± 119 vs 508 ± 60; p = 0.37). Women with MA had higher heart-rate-averaged augmentation index [median (interquartile range, IQR) of 5 (IQR 0.5 to 18) vs -5 (IQR -16.8 to 8.3), p = 0.005] and heart-rate-adjusted augmentation index [1 (IQR -6 to 12.5) vs -8 (IQR -20.3 to 2.5), p = 0.008] than healthy controls. CONCLUSION Peripheral endothelial function is not impaired in women with MA, but they have greater arterial stiffness. This may contribute to the increased stroke risk in women with MA.
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Affiliation(s)
- T G Liman
- Charité-Universitätsmedizin Berlin, Germany.
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22
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Von Haehling S, Schefold JC, Jankowska EA, Springer J, Vazir A, Kalra PR, Sandek A, Fauler G, Stojakovic T, Trauner M, Ponikowski P, Volk HD, Doehner W, Coats AJS, Poole-Wilson PA, Anker SD. URSODEOXYCHOLIC ACID IN PATIENTS WITH CHRONIC HEART FAILURE. A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED, CROSSOVER TRIAL. Racionalʹnaâ farmakoterapiâ v kardiologii 2012. [DOI: 10.20996/1819-6446-2012-8-1-110-117] [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: 11/22/2022] Open
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23
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von Haehling S, Bode-Böger SM, Martens-Lobenhoffer J, Rauchhaus M, Schefold JC, Genth-Zotz S, Karhausen T, Cicoira M, Anker SD, Doehner W. Elevated levels of asymmetric dimethylarginine in chronic heart failure: a pathophysiologic link between oxygen radical load and impaired vasodilator capacity and the therapeutic effect of allopurinol. Clin Pharmacol Ther 2010; 88:506-12. [PMID: 20827268 DOI: 10.1038/clpt.2010.116] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide-dependent vasodilation. In 113 patients with chronic heart failure (CHF) and 26 controls, ADMA level was studied in relation to peripheral blood flow and vasodilator capacity. Further, the effects of allopurinol on concentrations of reactive oxygen species (ROS) and ADMA and peripheral vasodilator capacity were tested in a double-blind design. ADMA level was found to be elevated in CHF patients as compared with controls and increased in parallel with New York Heart Association (NYHA) class and exercise capacity (all P < 0.0001). The level of ADMA predicted resting blood flow (P < 0.05) and postischemic vasodilator capacity (P < 0.001). Sixty eight patients died during the follow-up period. The level of ADMA predicted survival after multivariable adjustment (P = 0.04). Allopurinol reduced uric acid (UA) concentration (P < 0.001) and decreased ROS concentration (allantoin, P < 0.01). Allopurinol lowered ADMA concentration (P = 0.02); postischemic vasodilation as well as endothelium-dependent vasodilation (both P < 0.05) improved. ADMA may be a pathophysiologic factor that is modulated by ROS accumulation and contributes to impaired vascular regulation in CHF.
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Affiliation(s)
- S von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
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Baid-Agrawal S, Frei U, Reinke P, Schindler R, Kopp MA, Martus P, Berg T, Juergensen JS, Anker SD, Doehner W. Impaired insulin sensitivity as an underlying mechanism linking hepatitis C and posttransplant diabetes mellitus in kidney recipients. Am J Transplant 2009; 9:2777-84. [PMID: 19845589 DOI: 10.1111/j.1600-6143.2009.02843.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aim of this study was to investigate the mechanism/s associating hepatitis C virus (HCV) infection and posttransplant diabetes mellitus in kidney recipients. Twenty HCV-positive and 22 HCV-negative kidney recipients, 14 HCV-positive nontransplant patients and 24 HCV-negative nontransplant (healthy) subjects were analyzed. A 3-h intravenous glucose tolerance test was performed; peripheral insulin sensitivity was assessed by minimal modeling. Pancreatic insulin secretion, hepatic insulin uptake, pancreatic antibodies and proinflammatory cytokines in serum (tumor necrosis factor-alpha, intereukin-6, high-sensitive C-reactive protein) were also assessed. HCV-positive recipients showed a significantly lower insulin sensitivity as compared to HCV-negative recipients (3.0 +/- 2.1 vs. 4.9 +/- 3.0 min(-1).microU.mL(- 1).10(4), p = 0.02), however, insulin secretion and hepatic insulin uptake were not significantly different. Pancreatic antibodies were negative in all. HCV status was an independent predictor of impaired insulin sensitivity (multivariate analysis, p = 0.008). The decrease of insulin sensitivity due to HCV was comparable for transplant and non-transplant subjects. No significant correlation was found between any of the cytokines and insulin sensitivity. Our results suggest that impaired peripheral insulin sensitivity is associated with HCV infection irrespective of the transplant status, and is the most likely pathogenic mechanism involved in the development of type 2 diabetes mellitus associated with HCV infection.
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Affiliation(s)
- S Baid-Agrawal
- Division of Nephrology and Medical Intensive Care, Department of Medicine, Berlin, Germany.
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25
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Barnett JC, Toluie K, Sterns D, Chandiramani S, Jetton E, Oza A, Pezzali N, Metra M, Covolo L, Curnis A, Gelatti U, Donato F, Dei Cas L, Charlton TA, Mcgrew FA, Johnson EJ, Coppess MA, Hamilton B, Charlton S, Sims JJ, Diaz Escofet M, Arbelo Lainez E, Moreno Djadou B, Garcia Quintana A, Caballero Dorta E, Rios Diaz C, Missorici Corso M, Medina Fernandez-Aceytuno A, Stockburger M, Fateh-Moghadam S, Karhausen T, Doehner W, Nitardy A, Anker SD, Celebi O, Dietz R, Kronborg MB, Nielsen JC, Albertsen AE, Mortensen PT. Abstracts: Cardiac resynchronisation therapy: results and mechanisms. Europace 2009. [DOI: 10.1093/europace/euq246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heinz C, Mori Y, Karhausen T, Stieler J, Doehner W, Oettle H, Dietz R, Anker S, Rauchhaus M. 3528 POSTER Fatigue in pancreatic cancer: the potential link between exertional dyspnea, exercise limitation, skeletal musculature and neurohormonal activation. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71031-5] [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: 10/22/2022] Open
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28
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von Haehling S, Doehner W, Anker SD. The roles of immunity and autoimmunity in chronic heart failure. Ernst Schering Res Found Workshop 2005:155-68. [PMID: 16329662 DOI: 10.1007/3-540-30822-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Chronic heart failure (CHF) represents a major public health burden in developed countries. The introduction of new treatments has helped to improve its prognosis in recent years. However, it is still not possible to directly target the immunological aspects of the disease. In fact, chronic immune activation with the up-regulation of pro-inflammatory substances in the plasma remains an important feature of the disease, independently of its aetiology. Autoimmune mechanisms play a significant role in a subgroup of patients with dilated cardiomyopathy. The interplay between the two systems has not been established so far. This review briefly summarizes immune and autoimmune mechanisms in CHF.
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Affiliation(s)
- S von Haehling
- Department of Clinical Cardiology, Imperial College School of Medicine, National Heart & Lung Institute, London, UK.
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29
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Abstract
Anemia is a common finding in chronic heart failure (CHF). Anemia develops due to CHF, but is also known to cause heart failure. Patients with CHF are limited by exercise capacity and fatigue. Low hemoglobin concentration can account for both and may substantially contribute to the symptoms of CHF. Increasing severity of CHF is associated with a higher frequency of anemia, which also becomes clinically more relevant. Anemia has been shown to predict impaired survival in CHF, independent of established prognostic markers. There are many potential reasons for development of anemia in CHF, such as bone marrow depression, reduced intestinal iron uptake and hemodilution as a consequence of sodium and water retention. In most cases, however, anemia in CHF should be viewed as "anemia of chronic illness", being the result of a combination of many factors related to the disease, particularly chronic inflammation. The option of therapeutically targeting anemia in CHF is an intriguing novel approach to improve morbidity and potentially mortality in these patients.
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Affiliation(s)
- T Karhausen
- Div. of Applied Cachexia Research, Dept. of Cardiology, Charité, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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Abstract
A substantial body of evidence has accumulated to suggest a role for the xanthine oxidase metabolic pathway in the pathophysiology of chronic heart failure and other cardiovascular diseases.
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Abstract
BACKGROUND Minimal model analysis of the intravenous glucose tolerance test (IVGTT) has been used successfully to demonstrate that patients with chronic heart failure (CHF) are insulin-resistant. Continuing experience in minimal model methodology has raised questions about how best to assign basal glucose concentrations during such analyses. METHODS AND RESULTS IVGTT data from randomly selected patients with CHF (n = 15) and controls (n = 15) were analysed using the minimal model, with the basal glucose concentration (G (b)) assigned the value of fasting plasma glucose concentration (G (fast)), or the value of plasma glucose concentration 180 minutes after the start of the IVGTT (G (180)). Insulin sensitivity (S (I)) was significantly higher with G (b) = G (fast), than with G (b) = G (180) (controls: 5.60 +/- 0.78 vs. 3.36 +/- 0.25/min/muU/ml x 10 (4), p = 0.0017; patients 4.19 +/- 0.54 vs. 2.36 +/- 0.15/min/microU/ml x 10 (4), p = 0.0004). At G (b) = G (fast), CHF patients showed a non-significant 25 % reduction in S (I) in comparison to controls (p = 0.15). In contrast, at G (b) = G (180), CHF patients showed a significant 30 % reduction of S (I) in comparison to controls (p = 0.0018). S (I) estimates derived at G (b) = G (fast) exhibited twice the variability of those estimated using G (b) = G (180) (coefficients of variation of S (I) in patients with CHF were 50.0 % and 24.8 %, respectively). CONCLUSION In studies of patients with CHF, greater precision and discriminatory power of insulin sensitivity estimates is obtained when the basal glucose concentration is taken as the plasma glucose concentration 180 minutes after the start of the IVGTT.
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Affiliation(s)
- W Doehner
- Applied Cachexia Research, Dept of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany.
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Rauchhaus M, Schmidt H, Doehner W, Francis D, Davies C, Kemp M, Anker S, Müller-Werdan U, Coats A. Changes in metabolic and cytokine kinetics during strenuous exercise in patients with chronic heart failure. Eur J Heart Fail 2004. [DOI: 10.1016/s1388-9842(00)80243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/24/2022] Open
Affiliation(s)
- M. Rauchhaus
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | - H.B. Schmidt
- Cardiology, Martin Luther University; Halle Germany
| | - W. Doehner
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | - D.P. Francis
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | - C. Davies
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | - M. Kemp
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | - S.D. Anker
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
| | | | - A.J.S. Coats
- Clinical Cardiology; National Heart and Lung Institute; London United Kingdom
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Steinborn W, Doehner W, Anker SD. Anemia in chronic heart failure--frequency and prognostic impact. Clin Nephrol 2003; 60 Suppl 1:S103-7. [PMID: 12940540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Chronic heart failure (CHF) is an important public health care problem and a leading cause of morbidity and mortality world wide. Anemia is a common finding in CHF and known to cause heart failure. Patients with CHF are limited by exercise capacity and fatigue. A low hemoglobin concentration leads to impairment of both. With increasing severity of heart failure, anemia also becomes more frequent and clinically more relevant. There are many potential reasons for development of anemia in chronic heart failure like bone marrow depression, reduced intestinal iron uptake, and the dilution in consequence of sodium and water retention. However, the anemia seen in CHF is generally an "anemia of chronic illness". Furthermore, it has been shown that hemoglobin levels independently predict increased mortality in CHF.
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Affiliation(s)
- W Steinborn
- Imperial College, NHLI, Department of Clinical Cardiology, London, UK
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Doehner W, Pflaum CD, Rauchhaus M, Godsland IF, Egerer K, Cicoira M, Florea VG, Sharma R, Bolger AP, Coats AJ, Anker SD, Strasburger CJ. Leptin, insulin sensitivity and growth hormone binding protein in chronic heart failure with and without cardiac cachexia. Eur J Endocrinol 2001; 145:727-35. [PMID: 11720897 DOI: 10.1530/eje.0.1450727] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Regulation of growth hormone (GH) receptor expression and hence tissue GH sensitivity may be important for the conflicting results found in treatment studies with recombinant growth hormone in chronic heart failure (CHF). Growth hormone-binding protein (GHBP) corresponds to the extracellular domain of the GH receptor and is closely related to measures of body composition and, specifically, to size of visceral fat tissue. Leptin, the adipocyte specific (ob) gene product, has been proposed as the signal linking adipose tissue and GHBP/GH-receptor expression. CHF has recently been shown to be a hyperleptinaemic and insulin-resistant state regardless of aetiology. This study aimed to examine the influence of leptin on GHBP in CHF patients with and without cardiac cachexia compared with healthy control subjects. METHODS We studied 47 male patients with CHF (mean age 61+/-2 years, New York Heart Association (NYHA)-class 2.7+/-0.1, left ventricular ejection fraction (LVEF) 28+/-2%, peak oxygen consumption 16.8+/-0.9 ml/kg/min) and 21 male healthy controls of similar age. Of the CHF patients, 19 were cachectic (cCHF; non-oedematous weight loss >7.5% over at least 6 months) and 28 non-cachectic (ncCHF; similar for age and LVEF). Insulin sensitivity was assessed by an intravenous glucose tolerance test using the minimal model approach. RESULTS Compared with healthy controls, patients had elevated levels of leptin (7.6+/-0.7 vs 4.8+/-0.7 ng/ml, P<0.05), insulin (76.2+/-8.9 vs 41.4+/-6.0 pmol/l, P<0.01), and reduced insulin sensitivity (2.43+/-0.2 vs 3.48+/-0.3 min(-1).microU.ml(-1).10(4), P<0.005) but similar GHBP levels (901+/-73 vs 903+/-95 pmol/l). Leptin levels were increased in ncCHF (9.11+/-1.0 ng/ml, P=0.001) but were not different from normal in cCHF (5.32+/-0.7 ng/ml, P>0.5). After correction for total body fat mass, both ncCHF and cCHF were hyperleptinaemic (41.8+/-3.8 and 37.9+/-0.38 vs 24.4+/-2.1 ng/ml/100 g, ANOVA P=0.001). In both patients and controls there was a direct correlation between leptin levels and GHBP (r=0.70 and r=0.71 respectively, both P<0.0001). This relationship was stronger than between GHBP and several parameters of body composition (body mass index (BMI), total and regional body fat mass or % body fat) and held true when sub-groups were tested individually (ncCHF r=0.62, P<0.001; cCHF r=0.79, P<0.0001). In multivariate regression analysis in all CHF patients, serum leptin levels emerged as the strongest predictor of GHBP, independent of age, BMI, total and regional fat mass or % body fat, fasting insulin level and insulin sensitivity. CONCLUSION Fat mass corrected leptin levels are elevated in CHF patients with and without cachexia. Reduced total fat mass may account for lower leptin levels in cachectic CHF patients compared with non cachectic patients. Leptin strongly predicts GHBP levels in CHF regardless of its hyperleptinaemic state or severely altered body composition as in cardiac cachexia. Leptin could be the signalling link between adipose tissue and GHBP/GH receptor expression in CHF.
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Affiliation(s)
- W Doehner
- Department of Clinical Cardiology, NHLI, Imperial College School of Medicine, London, UK.
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Sharma R, Florea VG, Bolger AP, Doehner W, Florea ND, Coats AJ, Hodson ME, Anker SD, Henein MY. Wasting as an independent predictor of mortality in patients with cystic fibrosis. Thorax 2001; 56:746-50. [PMID: 11562511 PMCID: PMC1745930 DOI: 10.1136/thorax.56.10.746] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is the most common life threatening autosomal recessive disorder in the white population. Wasting has long been recognised as a poor prognostic marker in CF. Whether it predicts survival independently of lung function and arterial blood gas tensions has not previously been reported. METHODS 584 patients with CF (261 women) of mean (SD) age 21 (7) years were studied between 1985 and 1996, all of whom were being followed up in a tertiary referral centre. Lung function tests, body weight, arterial blood oxygen (PaO(2)) and carbon dioxide (PaCO(2)) tensions were measured. The weight was calculated as a percentage of the ideal body weight for age, height, and sex. RESULTS Forced expiratory volume in one second (FEV(1)) recorded at the start of the study was 1.8 (1.0) l (52 (26)% predicted FEV(1)), PaO(2) 9.8 (1.9) kPa, PaCO(2) 5.0 (0.9) kPa, and % ideal weight 92 (18)%. During the follow up period (45 (27) months) 137 patients died (5 year survival 72%, 95% CI 67 to 73). FEV(1), % predicted FEV(1), PaO(2), % ideal weight (all p<0.0001), and PaCO(2) (p=0.04) predicted survival. In multivariate analysis, % predicted FEV(1) (p<0.0001), % ideal weight (p=0.004), and PaCO(2) (p=0.02) were independent predictors of outcome. Patients with >85% ideal body weight had a better prognosis at 5 years (cumulative survival 84%, 95% CI 79 to 89) than those with < or =85% ideal weight (survival 53%, 95% CI 45 to 62), p<0.0001. Percentage predicted FEV(1) (area under curve 0.83; 95% CI 0.78 to 0.87) and % ideal weight (area under curve 0.74; 95% CI 0.68 to 0.79) were accurate predictors of survival at 5 years follow up (receiver-operating characteristic analysis). CONCLUSIONS Body wasting is a significant predictor of survival in patients with CF independent of lung function, arterial blood oxygen and carbon dioxide tensions.
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Affiliation(s)
- R Sharma
- Department of Clinical Cardiology, National Heart & Lung Institute, Imperial College School of Medicine, London SW3 6LY, UK
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Anker SD, Volterrani M, Pflaum CD, Strasburger CJ, Osterziel KJ, Doehner W, Ranke MB, Poole-Wilson PA, Giustina A, Dietz R, Coats AJ. Acquired growth hormone resistance in patients with chronic heart failure: implications for therapy with growth hormone. J Am Coll Cardiol 2001; 38:443-52. [PMID: 11499736 DOI: 10.1016/s0735-1097(01)01385-7] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We aimed to determine whether growth hormone (GH) resistance is present in patients with chronic heart failure (CHF) and whether it may be linked to the biochemical response to GH treatment. BACKGROUND Acquired GH resistance is a feature of severe illness, in particular, cachexia. In patients with CHF, the response to GH therapy appears to be variable. METHODS Biochemical markers of the GH-insulin-like growth factor-I (IGF-I) axis were compared in 21 cachectic patients with CHF, 51 noncachectic patients and 26 healthy control subjects. In separate studies, the predictive value of baseline biochemical variables for the IGF-I response to GH treatment was analyzed. RESULTS Cachectic patients showed an increase of total GH and immunologically intact GH (p < or = 0.0002) and a decrease of GH-binding protein (BP) (p = 0.005), IGF-BP3 (p = 0.01) and IGF-I (p = 0.06), compared with noncachectic patients. Similar changes were found when the cachectic group was compared with the control group. No differences were found between noncachectic patients and control subjects. Levels of GH-BP correlated with the IGF-I/GH ratio in all subgroups (all p < or = 0.002). Baseline GH-BP levels were related to the increase of IGF-I levels in response to GH treatment in patients with CHF after 24 h (r = 0.83, p = 0.005; n = 9; study 2), 44 days (r = 0.52, p = 0.007; n = 25; study 3) and 96 days (r = 0.54, p = 0.006; n = 24; study 3). CONCLUSIONS Most cachectic and some noncachectic patients with CHF show features of acquired GH resistance. The principal predictors of the biochemical features of GH resistance and of the poor biochemical response to short-term and longer-term GH treatment are GH-BP plasma levels. The presence of GH resistance is potentially a major factor determining the response to GH therapy in patients with CHF.
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Affiliation(s)
- S D Anker
- Franz-Volhard-Klinik, Max Delbrück Centrum for Molecular Medicine, Charité, Berlin, Germany.
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Ponikowski P, Chua TP, Anker SD, Francis DP, Doehner W, Banasiak W, Poole-Wilson PA, Piepoli MF, Coats AJ. Peripheral chemoreceptor hypersensitivity: an ominous sign in patients with chronic heart failure. Circulation 2001; 104:544-9. [PMID: 11479251 DOI: 10.1161/hc3101.093699] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peripheral chemoreceptor hypersensitivity is a feature of abnormal cardiorespiratory reflex control in chronic heart failure (CHF) and may contribute to sympathetic overactivity, attenuated baroreflex sensitivity (BRS), and excessive ventilation during exercise. We studied whether augmented peripheral chemosensitivity carries independent prognostic significance. METHODS AND RESULTS We assessed peripheral chemosensitivity (ventilatory response to hypoxia using transient inhalation of pure nitrogen) and BRS (phenylephrine and spectral methods) in 80 consecutive CHF patients (age 58+/-9 years; left ventricular ejection fraction [LVEF] 24+/-12%; peak oxygen consumption [peak VO(2)] 18+/-7 mL(-1). min(-1)). CHF patients demonstrated augmented peripheral chemosensitivity and decreased BRS (all P<0.01 versus reference values). During follow-up (median 41 months, >3 years in all survivors), 37 patients died. High peripheral chemosensitivity (>0.72 L. min(-1). %SaO(2)(-1)) predicted impaired survival (hazard ratio 3.2, 95% CI 1.6 to 6.0, P=0.0006). In the 27 patients (34%) with high peripheral chemosensitivity, 3-year survival was 41% (95% CI 22% to 60%) compared with 77% (66% to 89%) in 53 patients with normal chemosensitivity (P=0.0002). In multivariate analyses, augmented chemosensitivity independently predicted death (hazard ratio 2.8, 95% CI 1.5 to 5.5, adjusted for age, peak VO(2), and VE/VCO(2) [P=0.002]; hazard ratio 2.6, 95% CI 1.3 to 5.1, adjusted for age, LVEF, and peak VO(2) [P=0.008]). Depressed BRS was related to unfavorable prognosis in univariate analysis (P=0.05) but not in multivariate analyses. CONCLUSIONS Hypersensitivity of the peripheral chemoreceptors independently predicts adverse prognosis in ambulatory patients with CHF. This hyperactive excitatory reflex, through its inhibitory effect on the baroreflex, may be the reason for the previously observed prognostic association of the latter.
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Cicoira M, Bolger AP, Doehner W, Rauchhaus M, Davos C, Sharma R, Al-Nasser FO, Coats AJ, Anker SD. High tumour necrosis factor-alpha levels are associated with exercise intolerance and neurohormonal activation in chronic heart failure patients. Cytokine 2001; 15:80-6. [PMID: 11500083 DOI: 10.1006/cyto.2001.0918] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immune activation plays an important role in the progression of chronic heart failure (CHF). We sought to investigate whether different degrees of tumor necrosis factor-alpha (TNF-alpha) activation are associated with exercise intolerance, neurohormonal activation and alterations in muscle mass and function in patients with CHF without cardiac cachexia. Patients were divided into quartiles according to their TNF levels (first quartile: 0.98-4.90 pg/ml, second quartile: 5.00-6.60 pg/ml; third quartile 6.80-9.00 pg/ml; fourth quartile 9.80-32.00 pg/ml). Patients underwent cardiopulmonary exercise testing, quadriceps muscle strength test, quadriceps fatigue test, and assessment of thigh muscle and fat cross-sectional area (CSA) by computerized tomography scanning. Patients in the highest TNF quartile had the lowest peak oxygen consumption [13.1 (+/-4.1) ml/kg/min vs 18.1 (+/-5.3), 18.8 (+/-4.8) and 18.7 (+/-5.6) ml/kg/min, P<0.01] the greatest relation of ventilation and dioxide production (VE/VCO(2)) slope (P<0.05) and the most elevated catecholamine levels (P<0.05) compared to patients in the first three quartiles. Patients with the lowest TNF levels had preserved thigh muscle size and quadriceps strength. Strength/muscle CSA was similar in the four groups. Muscle strength during fatigue testing was significantly lower in the fourth quartile (P=0.01) compared with the other three groups. In CHF patients only the highest levels of TNF are associated with poor functional status and neurohormonal activation. This group of patients may represent the appropriate target population for TNF antagonism.
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Affiliation(s)
- M Cicoira
- Department of Cardiac Medicine, National Heart & Lung Institute, London, UK.
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Cicoira M, Davos CH, Florea V, Shamim W, Doehner W, Coats AJ, Anker SD. Chronic heart failure in the very elderly: clinical status, survival, and prognostic factors in 188 patients more than 70 years old. Am Heart J 2001; 142:174-80. [PMID: 11431675 DOI: 10.1067/mhj.2001.115796] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is a frequent disease with a dismal prognosis, but little is known about survival in the very elderly. There are no data on the prognostic value of cardiopulmonary exercise testing in this population. We aimed to assess exercise capacity, survival, and prognostic parameters in elderly patients with CHF. METHODS We evaluated 188 patients with CHF >70 years old (mean 77 +/- 4 years, range 70-94 years) seen at our heart failure clinic between March 1992 and June 1998. A cardiopulmonary exercise test was performed in 102 patients (peak VO2 15.3 +/- 4.7, VE/VCO2 slope 39.6 +/- 15.01). All patients were followed up for at least 12 months. The prognostic end point of the study was all-cause mortality. RESULTS At the end of follow-up (16 +/- 10 mo, range 12-41 mo), 67 patients (35.6%) had died (1-year mortality rate 26% [95% confidence interval 20-32]). In univariate analysis New York Heart Association class (NYHA) (relative risk [RR] = 2.56, P <.0001), VE/VCO2 (RR = 1.041, P <.0001), peak VO2 (RR = 0.87, P =.0007), and fractional shortening (RR = 0.95, P <.0001) predicted mortality. Peak VO2 predicted mortality independently of age, NYHA class, and left ventricular ejection fraction. A subgroup of 12 patients with dynamic left ventricular outflow tract obstruction during stress had an excellent outcome, with a 100% survival at the end of follow-up (mean 16 +/- 7 mo, range 12-39 mo). CONCLUSIONS The prognosis in elderly patients with CHF is poor. Valid exercise testing results can be obtained in more than 50% of elderly patients with CHF. NYHA class and peak VO2 are the strongest prognostic factors in this population.
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Affiliation(s)
- M Cicoira
- Department of Cardiac Medicine, National Heart and Lung Institute, London, United Kingdom.
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Doehner W, Rauchhaus M, Florea VG, Sharma R, Bolger AP, Davos CH, Coats AJ, Anker SD. Uric acid in cachectic and noncachectic patients with chronic heart failure: relationship to leg vascular resistance. Am Heart J 2001; 141:792-9. [PMID: 11320368 DOI: 10.1067/mhj.2001.114367] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic heart failure (CHF) is a hyperuricemic state, and capillary endothelium is the predominant site of xanthine oxidase in the vasculature. Upregulated xanthine oxidase activity (through production of toxic free radicals) may contribute to impaired regulation of vascular tone in CHF. We aimed to study the relationship between serum uric acid levels and leg vascular resistance in patients with CHF with and without cachexia and in healthy control subjects. METHODS In 23 cachectic and 44 noncachectic patients with CHF (age, 62 +/- 1 years, mean +/- SEM) and 10 healthy control subjects (age, 68 +/- 1 years), we assessed leg resting and postischemic peak vascular resistance (calculated from mean blood pressure and leg blood flow by venous occlusion plethysmography). RESULTS Cachectic patients, compared with noncachectic patients and control subjects, had the highest uric acid levels (612 +/- 36 vs 459 +/- 18 and 346 +/- 21 micromol/L, respectively, both P <.0001) and the lowest peak leg blood flow and vascular reactivity (reduction of leg vascular resistance from resting to postischemic conditions: 83% vs 88% and 90%, both P <.005). In all patients, postischemic vascular resistance correlated significantly and independently of age with uric acid (r = 0.61), creatinine (r = 0.47, both P <.0001), peak VO2 (r = 0.34), and New York Heart Association class (r = 0.33, both P <.01). This correlation was not present in healthy control subjects (r = -0.04, P =.9). In multivariate and stepwise regression analyses, serum uric acid emerged as the strongest predictor of peak leg vascular resistance (standardized coefficient = 0.61, P <.0001) independent of age, peak VO2, creatinine, New York Heart Association class, and diuretic dose. CONCLUSIONS Hyperuricemia and postischemic leg vascular resistance are highest in cachectic patients with CHF, and both are directly related independent of diuretic dose and kidney function. The xanthine oxidase metabolic pathway may contribute to impaired vasodilator capacity in CHF.
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Affiliation(s)
- W Doehner
- Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
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Bolger A, Doehner W, Anker SD. Insulin-like growth factor-I can be helpful towards end of life. BMJ 2001; 322:674-5. [PMID: 11291651 PMCID: PMC1119861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Doehner W, Godsland IF, Anker SD. Vascular effect of insulin in endothelial dysfunction. J Am Coll Cardiol 2001; 37:689. [PMID: 11216999 DOI: 10.1016/s0735-1097(00)01151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rauchhaus M, Doehner W, Francis DP, Davos C, Kemp M, Liebenthal C, Niebauer J, Hooper J, Volk HD, Coats AJ, Anker SD. Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation 2000; 102:3060-7. [PMID: 11120695 DOI: 10.1161/01.cir.102.25.3060] [Citation(s) in RCA: 556] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammatory immune activation is an important feature in chronic heart failure (CHF). Little is known about the prognostic importance of tumor necrosis factor-alpha (TNF-alpha), soluble TNF-receptor 1 and 2 (sTNF-R1/sTNF-R2), interleukin-6 (IL-6), and soluble CD14 receptors (sCD14) in CHF patients. METHODS AND RESULTS In 152 CHF patients (age 61+/-1 years, New York Heart Association [NYHA] class 2.6+/-0.1, peak VO(2) 17.3+/-0.6 mL. kg(-1). min(-1), mean+/-SEM) plasma concentrations of immune variables were prospectively assessed. During a mean follow-up of 34 months (>12 months in all patients), 62 patients (41%) died. Cumulative mortality was 28% at 24 months. In univariate analyses, increased total and trimeric TNF-alpha, sTNF-R1, and sTNF-R2 (all P</=0.0001), sCD14 (P=0.0007), and IL-6 (P=0.005) predicted 24-month mortality. With multivariate analysis and receiver operating characteristics, sTNF-R1 emerged among all cytokine parameters as the strongest and most accurate prognosticator in this CHF population, regardless of follow-up duration and independently of NYHA class, peak VO(2), VE/VCO(2) slope, left ventricular ejection fraction, and wasting (P<0.001). The receiver operating characteristic area under the curve for sTNF-R1 was greater than for sTNF-R2 at 6, 12, and 18 months (all P<0.05). CONCLUSIONS sTNF-R1 was the strongest and most accurate prognosticator, independent of established markers of CHF severity. Assessment of sTNF-R1 may be useful in identifying patients who are at high risk of death and in monitoring patients undergoing anti-TNF-alpha treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Analysis of Variance
- Antigens, CD/blood
- Biomarkers/blood
- Cardiac Output, Low/blood
- Cardiac Output, Low/immunology
- Cardiac Output, Low/mortality
- Chronic Disease
- Cytokines/blood
- Female
- Humans
- Immunoassay
- Interleukin-6/blood
- Lipopolysaccharide Receptors/blood
- Male
- Middle Aged
- Prognosis
- ROC Curve
- Receptors, Tumor Necrosis Factor/blood
- Receptors, Tumor Necrosis Factor, Type I
- Receptors, Tumor Necrosis Factor, Type II
- Solubility
- Survival Analysis
- Tumor Necrosis Factor-alpha/metabolism
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Affiliation(s)
- M Rauchhaus
- Clinical Cardiology, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
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Affiliation(s)
- W Doehner
- Department of Cardiac Medicine, National Heart and Lung Institute, London, UK
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Florea VG, Henein MY, Cicoira M, Anker SD, Doehner W, Ponikowski P, Francis DP, Gibson DG, Coats AJ. Echocardiographic determinants of mortality in patients >67 years of age with chronic heart failure. Am J Cardiol 2000; 86:158-61. [PMID: 10913476 DOI: 10.1016/s0002-9149(00)00853-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study sought to assess the prognostic significance of echocardiographic measurements of left and right ventricular dimensions and function in patients >67 years of age with chronic congestive heart failure (CHF). This is a retrospective follow-up of elderly patients who underwent an echocardiography in the tertiary cardiac center. A total of 185 patients (131 men) aged >/=68 years (mean +/- SD 75 +/- 5) with CHF were enrolled into the study. After undergoing a detailed echocardiographic examination, all patients were followed-up for a median of 20 months (interquartile range 9 to 36). During the follow-up period 54 patients (29%) died. Left ventricular (LV) M-mode isovolumic relaxation time (IVRT), end-diastolic and end-systolic diameters, fractional shortening and mass, transmitral E:A ratio, and left atrial dimension, as well as New York Heart Association class and the age were found by Cox proportional-hazards univariate analyses to predict the outcome in these patients (all p <0.05). In multivariate analyses including these measurements, LV IVRT (p <0.04), age (p <0.03), and New York Heart Association class (p <0.001) were found to be the independent predictors of outcome. In the Kaplan-Meier analysis, patients with LV IVRT >30 ms had a better prognosis at 3 years (cumulative survival 78% [95% confidence interval 65% to 91%]) than those with LV IVRT </=30 ms (survival 52% [95% confidence interval 37% to 68%]). Measurements of LV performance, especially those obtained during diastole, are significantly related to prognosis in patients >67 years of age with CHF. LV M-mode IVRT is among the most important independent predictors of outcome in this population.
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Affiliation(s)
- V G Florea
- Department of Cardiac Medicine, National Heart and Lung Institute, London, United Kingdom
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Davos C, Doehner W, Rauchhaus M, Cicoira M, Francis D, Coats A, Anker S. The impact of obesity on survival in chronic heart failure patients. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80099-9] [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: 10/27/2022] Open
Affiliation(s)
- C.H. Davos
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - W. Doehner
- Cardiac Medicine; National Heart and Lung Institute; London United Kingdom
| | - M. Rauchhaus
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - M. Cicoira
- Cardiac Medicine; National Heart and Lung Institute; London United Kingdom
| | - D. Francis
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - A.J.S. Coats
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - S.D. Anker
- Franz-Volhard-Klinik at MDC; Charité Berlin Germany
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Doehner W, Davos C, Rauchhaus M, Sharma R, Bolger A, Florea V, Anker S. Serum uric acid (UA) in cachectic and non-cachectic chronic heart failure (CHF) patients - Relation to peripheral vascular resistance (PVR). Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80234-2] [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: 11/15/2022] Open
Affiliation(s)
- W. Doehner
- Cardiac Medicine; National Heart and Lung Institute; London United Kingdom
| | - C.H. Davos
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - M. Rauchhaus
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - R. Sharma
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - A. Bolger
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - V.G. Florea
- Dept. of Cardiology; National Heart & Lung Institute; London United Kingdom
| | - S.D. Anker
- Franz-Volhard-Klinik at MDC Charité; Berlin Germany
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Rauchhaus M, Doehner W, Koloczek V, Kemp M, Volk HD, Coats A, Anker S. Cytokines and cytokine receptors are predictive for increased mortality in chronic heart failure. Eur J Heart Fail 2000. [DOI: 10.1016/s1388-9842(00)80365-7] [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: 11/16/2022] Open
Affiliation(s)
- M. Rauchhaus
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
| | - W. Doehner
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
| | - V. Koloczek
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
| | - M. Kemp
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
| | - H.-D Volk
- Medical Immunology, Charite; Berlin United Kingdom
| | - A.J.S. Coats
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
| | - S.D. Anker
- Clinical Cardiology, National Heart and Lung Institute; London United Kingdom
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Doehner W, Anker SD. TNF-alpha system in CHF. Eur Heart J 2000; 21:782-3. [PMID: 10739736 DOI: 10.1053/euhj.1999.1817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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