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Abstract
Dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy and one of the most common causes of heart failure. It is characterized by left or biventricular dilation and a reduced systolic function. The causes are manifold and range from myocarditis to alcohol and other toxins, to rheumatological, endocrinological, and metabolic diseases. Peripartum cardiomyopathy is a special form that occurs at the end of or shortly after pregnancy. Genetic mutations can be detected in approximately 30-50% of DCM patients. Owing to the growing possibilities of genetic diagnostics, increasingly more triggering variants and hereditary mechanisms emerge. This is particularly important with regard to risk stratification for patients with variants with an increased risk of arrhythmias. Patient prognosis is determined by the occurrence of heart failure and arrhythmias. In addition to the treatment of the underlying disease or the elimination of triggering harmful toxins, therapy consists in guideline-directed heart failure treatment including drug and device therapy.
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Affiliation(s)
- A Hänselmann
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C Veltmann
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J Bauersachs
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Berliner
- Dept. of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Hagemus J, Sieweke JT, Biber S, Schallhorn S, Neuser J, Berliner D, Bauersachs J, Bavendiek U. 437 A score based on echocardiographic parameters highly predicts atrial fibrillation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.250] [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: 11/15/2022] Open
Abstract
Abstract
Background
Several scores indicating patients at high risk for atrial fibrillation (AF) have been developed. Early detection of AF supported by AF risk score is important to prevent embolic events such as ischemic stroke in these patients. However, specifity and sensitivity of AF risk scores available have to be improved. Echocardiographic parameters may significantly improve the diagnostic value of AF risk scores.
Purpose
To investigate whether a new AF risk score (LaHAsPa) including echocardiographic parameter of LA function and remodeling identifies patients with AF and is not inferior to other published AF risk scores (CHADS2-, ATLAS-, ARIC, simple CHARGE-AF-Score).
Methods
This monocentric, prospective, semi-blinded, controlled study screened 319 patients between 10/2017 and 04/2018 for eligibility. 290 patients were included after applying in- and exclusion criteria (Exclusion criteria: cardiac surgery in the past, highly graded valvular heart disease, pulmonary vein isolation or ablation of any other form of atrial arrhythmias in the past, myocardial ischemia in the recent past, class Ia antiarrhythmic therapy and AF during echocardiography). Standard parameters of heart function were determined by routine transthoracic echocardiography (TTE) as well as parameters indicating left atrial remodeling (Septal/lateral total atrial conduction time (s/l PA-TDI), left atrial volume index (LAVI)/a`). Two different investigators, blinded to each other and to AF status, determined the LaHAsPA-, CHADS2-, ATLAS-, ARIC, simple CHARGE-AF Score.
Results
Out of 290 patients (age 59.5 [45-71] yrs, female 121 (41.7%)) 66 patients had AF in the medical history. sPA-TDI and LAVI/a` are significantly altered in patients with AF compared to patients without of AF (sPA-TDI: 145 [117-158] vs. 111 [98-124], p < 0.001; LAVI/a`: 4.5 [3.7-6.9] vs. 3.1 [2.4-4.1]). Multivariate Cox regression proportionality analysis highlighted sPA-TDI, and LAVI/a` as markers for prediction of AF (sPA-TDI: HR 1.11, 95%CI 1.00-1.23, p < 0.04; LAVI/a`: HR 1.911, 95%CI 1.2-3.04). The LaHAsPA-Score, including hypertension, age, sPA-TDI and LAVI/a’, identified patients with AF with high specificity and sensitivity (area under the curve 0.993, 95%CI 0.99-1.0). Subsequently cut-off values determined for CHADS2-, ATLAS-, ARIC and simple CHARGE-AF Score, McNemar test for dichotomous distribution on dependent collectives highlighted the powerful predictive value of the LaHAsPA-risk Score.
Conclusion(s)
We demonstrate, that septal PA-TDI and LAVI/a` are highly predictive for AF presence. Our new AF score LaHAsPA consisting of variables easily to be determined in daily routine stratifies AF risk with high specificity and sensitivity. It might facilitate risk-dependent decision-making and potentially identifies patients with AF more precisely compared to commonly used AF scores. Additional prospective studies at greater scale are warranted to test this intriguing hypothesis.
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Affiliation(s)
- J Hagemus
- Hannover Medical School, Hannover, Germany
| | | | - S Biber
- Hannover Medical School, Hannover, Germany
| | | | - J Neuser
- Hannover Medical School, Hannover, Germany
| | - D Berliner
- Hannover Medical School, Hannover, Germany
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Boivin V, Zechmeister C, Schuetz C, Beyersdorf N, Berliner D, Bauer M, Stoerk S, Ertl G, Jahns R. P5452First data-analysis of the prospective ETiCS-study after study-end confirms acute (microbial-induced) inflammation as a key trigger for the development of cardiac GPCR-autoantibodies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Heart failure (HF) is the leading cause of mortality and morbidity in Western countries. In the past two decades, evidence for the clinical relevance of GPCR-autoimmunity in human HF has substantially increased. Stimulating autoantibodies targeting the second extracellular loop (ECII) of the cardiac beta1-adrenoceptor (beta1-aabs) have been claimed to be involved in the pathogenesis of HF and to increase the risk of cardiovascular death by three-fold. Still, the events triggering the formation of beta1-aabs and their impact on HF-progression are unknown.
Methods
In total 13 University Hospitals (12 German, 1 Serbian) prospectively recruited 226 patients (pts.) with a first acute myocardial infarction (FAMI), and 140 pts with acute (biopsy- or cMRI-proven) myocarditis (AMitis) into the Etiology, Titer-Course and effect on Survival of cardiac autoantibodies-study (ETiCS-study). This study aimed to investigate whether the presentation of cardiac membrane antigens (e.g., the beta1-adrenoceptor) following cardiac necrosis/inflammation triggers the formation of beta1-aabs. At baseline (BL) and three follow-ups (Fup1–3), blood was sampled to analyze the time-course of beta1-aabs. Beta1-aab titers were measured by FACS using Dyna-beads® M-270-Epoxy coated with increasing amounts of beta1-ECII-peptides (2.5–100 μg/ml), checked versus scrambled peptides (a mixture of same amino-acids). After reacting, the samples were measured by FACScan flow-cytometry; obtained data were analyzed with FlowJo (Treestar). When half-maximal binding was calculable the serum was classified beta1-aab-positive.
Results
From n=366 pts (226 FAMI/140 AMitis) recruited into the ETiCS-study 45 pts had to be excluded because of unperformed cMRI's; 46 pts stopped the study before Fup-1 (month 3). Only 180/226 FAMI- and 98/140 AMitis-pts had complete Fup1–3 (after 3, 6, and 12 months with clinical assessment, echocardiograms, and cMRI's at BL and Fup-3). In all valid ETiCS-pts (197 FAMI-/123 AMitis-pts) the titer-course of beta1-aabs was compared with the development of echo-LVEF. Relevant (high-affinity) beta1-aab-titers were detected in ∼31% (37/123) of the AMitis-pts compared to only ∼21% (42/197) of the FAMI-pts. In aab-positive AMitis-pts echo-LVEF did not recover and was always significantly inferior to aab-negative AMitis-pts (BL: 38 vs. 49% LVEF; Fup-3: 49 vs. 64% LVEF) whereas such a difference was not noted in FAMI-pts. In addition, aab-positive AMitis-pts had higher NT pro-BNP-, renin-, and aldosterone-levels than aab-negative AMitis-pts.
Conclusion
The first evaluation of the completed ETiCS-study clearly suggests that acute microbial-induced rather than post-infarction myocardial inflammation triggers the formation of clinically relevant beta1-aabs. AAb-positive AMitis-patients might profit from early intensification of standard HF-therapy (including early beta-blockade) and/or novel antibody-directed experimental therapies which are currently developed.
Acknowledgement/Funding
BMBF Grant FKZ 01ES0816
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Affiliation(s)
- V Boivin
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Zechmeister
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - C Schuetz
- Institute of Pharmacology and Toxicology, Wuerzburg, Germany
| | - N Beyersdorf
- University, Institute of Immunobiology and Virology, Wuerzburg, Germany
| | - D Berliner
- Hannover Medical School, Cardiology, Angiology and Pneumology, Hannover, Germany
| | - M Bauer
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - S Stoerk
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - G Ertl
- University Hospital, Comprehensive Heart Failure Center Wuerzburg, Wuerzburg, Germany
| | - R Jahns
- University and University Hospital, Interdisciplinary Bank of Biomaterials and Data Wuerzburg (ibdw), Wuerzburg, Germany
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Kittel-Schneider S, Kaspar M, Berliner D, Weber H, Deckert J, Ertl G, Störk S, Angermann C, Reif A. CRP genetic variants are associated with mortality and depressive symptoms in chronic heart failure patients. Brain Behav Immun 2018; 71:133-141. [PMID: 29627531 DOI: 10.1016/j.bbi.2018.04.002] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/07/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Heart failure (HF) is a complex medical condition with a multitude of genetic and other factors being involved in the pathogenesis. Emerging evidence points to an involvement of inflammatory mechanisms at least in subgroups of patients. The same is true for depression and depressive symptoms, which have a high prevalence in HF patients and are risk factors for the development and outcomes of cardiovascular disease. METHODS In 936 patients of the Interdisciplinary Network Heart Failure (INH) program, CRP and IL-6 protein blood levels were measured and genetic variants (single nucleotide polymorphisms) of the CRP and IL6 gene analyzed regarding their influence on mortality. RESULTS Less common recessive genotypes of two single nucleotide polymorphisms in the CRP gene (rs1800947 and rs11265263) were associated with significantly higher mortality risk (p < 0.006), higher CRP levels (p = 0.029, p = 0.006) and increased depressive symptoms in the PHQ-9 (p = 0.005, p = 0.003). Variants in the IL-6 gene were not associated with mortality. CONCLUSION Our results hint towards an association of less common CRP genetic variants with increased mortality risk, depressive symptoms and peripheral CRP levels in this population of HF patients thereby suggesting a possible role of the inflammatory system as link between poor prognosis in HF and depressive symptoms.
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Affiliation(s)
- S Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany.
| | - M Kaspar
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany
| | - D Berliner
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - H Weber
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - J Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
| | - G Ertl
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - S Störk
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - C Angermann
- Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - A Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, Würzburg, Germany
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Hohlfeld J, Vogel-Claussen J, Biller H, Berliner D, Berschneider K, Tillmann HC, Hiltl S, Bauersachs J, Welte T. Lungenentblähung mit Indacaterol/Glycopyrronium verbessert die kardiale Funktion bei COPD Patienten: Die CLAIM Studie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- J Hohlfeld
- Klinische Atemwegsforschung, Fraunhofer ITEM, Hannover
| | - J Vogel-Claussen
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover
| | - H Biller
- Klinische Atemwegsforschung, Fraunhofer ITEM, Hannover
| | - D Berliner
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
| | | | - HC Tillmann
- Novartis Institut für Biomedizinische Forschung, Basel
| | - S Hiltl
- Novartis Pharma GmbH, Nürnberg
| | - J Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
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Biber S, Sieweke JT, Grosse GM, Akin M, Berliner D, Zauner F, Bauersachs J, Weissenborn K, Bavendiek U. P4318Total atrial conduction time and left atrial strain highly predict occurrence of atrial fibrillation in patients with embolic stroke of unknown source (ESUS) during in-hospital stay. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4318] [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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Zauner F, Flierl U, Sieweke JT, Kruchten S, Tongers J, Napp L, Berliner D, Bauersachs J, Schaefer A. P2734Parameters indicative for prognostic and neurologic outcome: insights from the Hannover Hypothermia Registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2734] [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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Sieweke J, Berliner D, Zauner F, Flierl U, Kruchten S, Napp L, Tongers J, Bauersachs J, Schaefer A. P2779Left ventricular unloading with a microaxial flow-pump. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2779] [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: 11/15/2022] Open
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Feldmann C, Deniz E, Schmidt T, Hoffmann J, Hanke J, Rojas S, Dogan G, Berliner D, Bara C, Bara C, Warnecke G, Haverich A, Schmitto J, Reiss N. Telemonitoring in LVAD-Patients: Acceptance and Need. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.698] [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: 11/15/2022] Open
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Deniz E, Feldmann C, Schmidt T, Hoffmann J, Hanke J, Rojas-Hernandez S, Dogan G, Berliner D, Bara C, Warnecke G, Haverich A, Schmitto J, Reiss N. The Impact of Telemonitoring in Patients with Ventricular Assist Device. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E. Deniz
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - C. Feldmann
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T. Schmidt
- Schüchtermann Klinik, Bad Rothenfelde, Germany
| | | | - J. Hanke
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - S.V. Rojas-Hernandez
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - G. Dogan
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - D. Berliner
- Hannover Medical School, Cardiology and Angiology, Hannover, Germany
| | - C. Bara
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - G. Warnecke
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A. Haverich
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J.D. Schmitto
- Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - N. Reiss
- Schüchtermann Klinik, Bad Rothenfelde, Germany
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Schmitto J, Rojas S, Avsar M, Hanke J, Uribarri A, Burkhoff D, Tümler K, Ahrens P, Molitoris U, Martens A, Berliner D, Bauersachs J, Shrestha M, Cebotari S, Strueber M, Haverich A. Less-Invasive Left Ventricular Assist Device Implantations: Experience after More Than 100 Treated Patients. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.107] [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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Hohlfeld J, Biller H, Hagedorn I, Berliner D, Bauersachs J, Welte T, Vogel-Claussen J. Ein neuartiges Studiendesign mit Magnetresonanz-Bildgebungsverfahren zur Untersuchung des Effekts der Indacaterol/Glycopyrronium Fixdosiskombination auf die kardiale Funktion bei COPD Patienten: die CLAIM-Studie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572020] [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]
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Schmitto JD, Rojas SV, Avsar M, Hanke JS, Berliner D, Bara C, Bauersachs J, Haverich A. 023 * FIRST RESULTS OF 111 MINIMALLY-INVASIVE LEFT VENTRICULAR ASSIST DEVICE IMPLANTATIONS AT A SINGLE-CENTRE. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Guder G, Hammer F, Brenner S, Berliner D, Deutschbein T, Fassnacht M, Allolio A, Ertl G, Angermann CE, Stoerk S. Differential mortality risk prediction by aldosterone and cortisol in systolic heart failure with versus without mineralocorticoid receptor blockade. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1483] [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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Berliner D, Okun M, Peters RW, Carliner NH, Plotnick GD, Fisher ML. Transcutaneous temporary pacing in the operating room. JAMA 1985; 254:84-6. [PMID: 3999354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The safety and efficacy of transcutaneous temporary pacing were assessed in 21 patients undergoing elective surgical procedures under general anesthesia. Complete capture was achieved in all patients. The pacing threshold was 50 mamp in two patients, 100 mamp in nine, and 200 mamp in ten. The threshold was influenced by electrode position and also, possibly, by age, heart size, and chest size. No adverse effects of pacing were encountered. Transcutaneous pacing is a rapid, safe, and effective means of temporary pacing in the operating room.
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Piziak MV, Woodbury C, Berliner D, Takafuji E, Kirkpatrick J, Opal S, Tramont E. Resistance trends of Neisseria gonorrhoeae in the Republic of Korea. Antimicrob Agents Chemother 1984; 25:7-9. [PMID: 6230990 PMCID: PMC185423 DOI: 10.1128/aac.25.1.7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Penicillinase-producing Neisseria gonorrhoeae has increased in the Far East to the point that penicillin can no longer be recommended as the drug of choice, mandating a change to spectinomycin. As part of an ongoing surveillance of antibiotic susceptibilities, minimal inhibitory concentrations of penicillin, tetracycline, spectinomycin, trimethoprim-sulfamethoxazole, cefoxitin, ceftriaxone, cefotaxime, and moxalactam were determined. A disturbing, steady increase in resistance to spectinomycin was documented.
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