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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius-Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, Schrage B. Sex-related differences in patients presenting with heart failure-related cardiogenic shock. Clin Res Cardiol 2024; 113:612-625. [PMID: 38353681 PMCID: PMC10954943 DOI: 10.1007/s00392-024-02392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS. METHODS In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS. RESULTS N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75-1.19). CONCLUSIONS In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Düsseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, DHZC Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Norman Mangner
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, DHZC Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Anesthesia and Intensive Care, University of Pavia Italy, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Luca Villanova
- Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS Fondazione Don Gnocchi, ONLUS, Santa Maria Nascente, Milan, Italy
| | - Ephraim B Winzer
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Westenfeld R, Winzer EB, Westermann D, Schrage B. Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Clin Res Cardiol 2024; 113:570-580. [PMID: 37982863 PMCID: PMC10954940 DOI: 10.1007/s00392-023-02332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit. METHODS Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality. RESULTS N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017). CONCLUSION This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luca Villanova
- Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Ephraim B Winzer
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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3
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Beer BN, Kellner C, Goßling A, Sundermeyer J, Besch L, Dettling A, Kirchhof P, Blankenberg S, Bernhardt AM, Brunner S, Colson P, Eckner D, Frank D, Eitel I, Frey N, Eden M, Graf T, Kupka D, Landmesser U, Majunke N, Maniuc O, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Reichenspurner H, Schulze PC, Schwinger RHG, Wechsler A, Skurk C, Thiele H, Varshney AS, Sag CM, Krais J, Westermann D, Schrage B. Complications in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy: distribution and relevance. Results from an international, multicentre cohort study. Eur Heart J Acute Cardiovasc Care 2024; 13:203-212. [PMID: 37875127 DOI: 10.1093/ehjacc/zuad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
AIMS Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications. This study aimed to quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (cerebral performance categories 1 + 2). METHODS AND RESULTS All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in four countries (2005-2019). Neurological, bleeding, and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications. n = 501. Overall, 118 were women (24%), median age was 56.0 years, median lactate was 8.1 mmol/L. Acute myocardial infarction caused CS in 289 patients (58%). Thirty-days mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor. CONCLUSION Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
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Affiliation(s)
- Benedikt N Beer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Sundermeyer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Blankenberg
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Alexander M Bernhardt
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Brunner
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, Montpellier, France
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Derk Frank
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingo Eitel
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Eden
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Graf
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Danny Kupka
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin/Institute of Health (BIH), Berlin, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würburg, Germany
| | | | - David A Morrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, Montpellier, France
| | - Curt Noel
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würburg, Germany
| | - Martin Orban
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sandeep M Patel
- Department of Interventional Cardiology, St.Rita's Medical Center, Lima, USA
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Hermann Reichenspurner
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Antonia Wechsler
- Department of Internal Medicine II, Klinikum Weiden, Weiden, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin/Institute of Health (BIH), Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Anubodh S Varshney
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, USA
| | - Can Martin Sag
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jannis Krais
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
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4
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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, Gustafsson F, Schrage B. Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock. Eur J Heart Fail 2024; 26:432-444. [PMID: 37940139 DOI: 10.1002/ejhf.3082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute-on-chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients with de novo and acute-on-chronic HF-CS. METHODS AND RESULTS In this international observational study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation and 30-day mortality, adjusted logistic/Cox regression models were fitted. Patients (n = 1030) with HF-CS were analysed, of whom 486 (47.2%) presented with de novo HF-CS and 544 (52.8%) with acute-on-chronic HF-CS. Traditional markers of CS severity (e.g. blood pressure, heart rate and lactate) as well as use of treatments were comparable between groups. However, patients with acute-on-chronic HF-CS were more likely to have a higher CS severity and also a higher mortality risk, after adjusting for relevant confounders (de novo HF 45.5%, acute-on-chronic HF 55.9%, adjusted hazard ratio 1.38, 95% confidence interval 1.10-1.72, p = 0.005). CONCLUSION In this large HF-CS cohort, acute-on-chronic HF-CS was associated with more severe CS and higher mortality risk compared to de novo HF-CS, although traditional markers of CS severity and use of treatments were comparable. These findings highlight the vast heterogeneity of patients with HF-CS, emphasize that HF chronicity is a relevant disease modifier in CS, and indicate that future clinical trials should account for this.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Norman Mangner
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Luca Villanova
- Intensive Cardiac Care Unit and De Gasperis Cardio-Center, Niguarda Hospital, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
| | - Ephraim B Winzer
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Finn Gustafsson
- Rigshospitalet and Department of Clinical Medicine, University of Copenhagen Copenhagen, Copenhagen, Denmark
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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5
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Pollari F, Hitzl W, Rottmann M, Vogt F, Ledwon M, Langhammer C, Eckner D, Jessl J, Bertsch T, Pauschinger M, Fischlein T. A Machine Learning Model for the Accurate Prediction of 1-Year Survival in TAVI Patients: A Retrospective Observational Cohort Study. J Clin Med 2023; 12:5481. [PMID: 37685547 PMCID: PMC10488486 DOI: 10.3390/jcm12175481] [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: 07/11/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND predicting the 1-year survival of patients undergoing transcatheter aortic valve implantation (TAVI) is indispensable for managing safe early discharge strategies and resource optimization. METHODS Routinely acquired data (134 variables) were used from 629 patients, who underwent transfemoral TAVI from 2012 up to 2018. Support vector machines, neuronal networks, random forests, nearest neighbour and Bayes models were used with new, previously unseen patients to predict 1-year mortality in TAVI patients. A genetic variable selection algorithm identified a set of predictor variables with high predictive power. RESULTS Univariate analyses revealed 19 variables (clinical, laboratory, echocardiographic, computed tomographic and ECG) that significantly influence 1-year survival. Before applying the reject option, the model performances in terms of negative predictive value (NPV) and positive predictive value (PPV) were similar between all models. After applying the reject option, the random forest model identified a subcohort showing a negative predictive value of 96% (positive predictive value = 92%, accuracy = 96%). CONCLUSIONS Our model can predict the 1-year survival with very high negative and sufficiently high positive predictive value, with very high accuracy. The "reject option" allows a high performance and harmonic integration of machine learning in the clinical decision process.
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Affiliation(s)
- Francesco Pollari
- Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90471 Nuremberg, Germany; (M.R.); (F.V.); (M.L.); (T.F.)
| | - Wolfgang Hitzl
- Research and Innovation Management (RIM), Team Biostatistics and Publication of Clinical Trial Studies, Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Ophthalmology and Optometry, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Magnus Rottmann
- Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90471 Nuremberg, Germany; (M.R.); (F.V.); (M.L.); (T.F.)
| | - Ferdinand Vogt
- Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90471 Nuremberg, Germany; (M.R.); (F.V.); (M.L.); (T.F.)
| | - Miroslaw Ledwon
- Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90471 Nuremberg, Germany; (M.R.); (F.V.); (M.L.); (T.F.)
| | - Christian Langhammer
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, 90471 Nuremberg, Germany; (C.L.); (T.B.)
| | - Dennis Eckner
- Cardiology, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90419 Nuremberg, Germany; (D.E.); (J.J.); (M.P.)
| | - Jürgen Jessl
- Cardiology, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90419 Nuremberg, Germany; (D.E.); (J.J.); (M.P.)
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, 90471 Nuremberg, Germany; (C.L.); (T.B.)
| | - Matthias Pauschinger
- Cardiology, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90419 Nuremberg, Germany; (D.E.); (J.J.); (M.P.)
| | - Theodor Fischlein
- Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University-Klinikum Nuremberg, 90471 Nuremberg, Germany; (M.R.); (F.V.); (M.L.); (T.F.)
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6
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Vogt F, Eckner D, Pollari F, Santarpino G. Vascular complications in patients undergoing percutaneous transfemoral aortic valve implantations. Eur J Cardiothorac Surg 2023; 64:ezad279. [PMID: 37584695 DOI: 10.1093/ejcts/ezad279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
- Department of Cardiac Surgery, Artemed Clinic Munich South, Munich, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Francesco Pollari
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Giuseppe Santarpino
- Cardiac Surgery Unit, Department of Experimental and Clinical Science, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
- Paracelsus Medical University, Nuremberg, Germany
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7
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Schrage B, Sundermeyer J, Blankenberg S, Colson P, Eckner D, Eden M, Eitel I, Frank D, Frey N, Graf T, Kirchhof P, Kupka D, Landmesser U, Linke A, Majunke N, Mangner N, Maniuc O, Mierke J, Möbius-Winkler S, Morrow DA, Mourad M, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Radakovic D, Schulze PC, Scherer C, Schwinger RHG, Skurk C, Thiele H, Varshney A, Wechsler L, Westermann D. Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC Heart Fail 2023; 11:321-330. [PMID: 36724180 DOI: 10.1016/j.jchf.2022.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). OBJECTIVES This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS. METHODS Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation. RESULTS Overall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading. CONCLUSIONS This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
| | - Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Matthias Eden
- Department of Internal Medicine III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Derk Frank
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; Department of Internal Medicine III-Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham NHS Trusts, Birmingham, United Kingdom
| | - Danny Kupka
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Mierke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Department of Cardiothoracic Anesthesia and Intensive Care, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sandeep M Patel
- Department of Interventional Cardiology, St. Rita's Medical Center, Lima, Ohio, USA
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Vittorio Pazzanese
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Intensive Cardiac Care Unit, San Raffaele Hospital, Milan, Italy
| | - Darko Radakovic
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | | | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | | | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Anubodh Varshney
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lukas Wechsler
- Medizinische Klinik II, Klinikum Weiden, Weiden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany.
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8
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Schrage B, Sundermeyer J, Beer BN, Bertoldi L, Bernhardt A, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Wechsler A, Westenfeld R, Winzer E, Westermann D. Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Eur J Heart Fail 2023; 25:562-572. [PMID: 36781178 DOI: 10.1002/ejhf.2796] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
AIMS Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment. METHODS AND RESULTS In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%). CONCLUSION In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Norbert Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Letizia Bertoldi
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Alexander Bernhardt
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Zouhir Dindane
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luca Villanova
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS Santa Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Antonia Wechsler
- Medizinische Klinik II, Kliniken Nordoberpfalz AG, Weiden, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ephraim Winzer
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, Freiburg, Germany
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9
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Vogt F, Santarpino G, Fujita B, Frerker C, Bauer T, Bekeredjian R, Bleiziffer S, Beckmann A, Möllmann H, Walther T, Beyersdorf F, Hamm C, Böning A, Baldus S, Ensminger S, Fischlein T, Eckner D. Surgical Aortic Valve Replacement in Patients Aged 50 to 69 Years: Insights from the German Aortic Valve Registry (GARY). Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742941] [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: 10/19/2022]
Affiliation(s)
- F. Vogt
- Department of Cardiac Surgery, Nürnberg, Deutschland
| | - G. Santarpino
- Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecche, Italy
| | - B. Fujita
- Department of Thoracic and Cardiaovascular Surgery, Lübeck, Deutschland
| | - C. Frerker
- Department of Cardiology, Ratzeburger Allee 160, Lübeck, Deutschland
| | - T. Bauer
- Department of Cardiology, Offenbach, Deutschland
| | | | - S. Bleiziffer
- Department of Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Deutschland
| | - A. Beckmann
- Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie e.V., Berlin, Deutschland
| | - H. Möllmann
- Department of Internal Medicine, Dortmund, Deutschland
| | - T. Walther
- Department of Cardiac, Thoracic and Thoracic Vascular Surgery, Frankfurt, Deutschland
| | - F. Beyersdorf
- Department of Cardiovascular Surgery, Freiburg, Deutschland
| | - C. Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Deutschland
| | - A. Böning
- Department of Cardiothoracic Surgery, Gießen, Deutschland
| | - S. Baldus
- Department of Internal Medicine III, Heart Center Cologne, Köln, Deutschland
| | - S. Ensminger
- Clinic for Heart and Thoracic Vessel Surgery, Lübeck, Deutschland
| | - T. Fischlein
- Department of Cardiac Surgery, Nürnberg, Deutschland
| | - D. Eckner
- Department of Cardiology, Nürnberg, Deutschland
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10
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Eckner D, Hofmann EM, Ademaj F, Martinovic K, Vogt F, Becher PM, Schrage B, Westermann D, Pauschinger M. Differences in the Treatment of Acute Coronary Syndrome in the Pre-COVID and COVID Era: An Analysis from Two German High-Volume Centers. J Cardiovasc Dev Dis 2021; 8:145. [PMID: 34821698 PMCID: PMC8625826 DOI: 10.3390/jcdd8110145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/23/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic is placing a heavy burden on healthcare systems worldwide with the risk that acute cardiovascular diseases are treated too late. The present study aims to analyze patients with acute coronary syndrome in the current pandemic. A total of 966 patients (2019 n = 463, 2020 n = 503) can be evaluated. A comparison of patient care during and before the COVID-19 pandemic was made in terms of patient characteristics and pre- and in-hospital processes. Another aim is to show how many patients seek clinical care at a late stage of the disease. After Lockdown in Germany at week 12, 2020, there was a significant decrease in patients with an acute coronary syndrome (ACS), significant for STEMI cases in the first weeks after Lockdown (calendar week 13-16 2019 n = 43, 2020 n = 30; p = 0.02). The time from pain to first medical contact (time to FMC) is significantly extended during Lockdown, while internal clinical processes are unchanged. The rate of subacute myocardial infarction is numerically, but not significantly increased in calendar weeks 15, 2020 (p = 0.40) and 16 (p = 0,19). In addition, elderly patients avoid treatment for multifactorial reasons, and the longer overall pain to FMC may impact long-term mortality.
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Affiliation(s)
- Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Eva M. Hofmann
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Fadil Ademaj
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Kristinko Martinovic
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany;
- Department of Cardiac Surgery, Artemed Clinic Munich South, 81379 Munich, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Centre, 20251 Hamburg, Germany; (P.M.B.); (B.S.); (D.W.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University, 90471 Nuremberg, Germany; (E.M.H.); (F.A.); (K.M.); (M.P.)
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11
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Schrage B, Becher PM, Bernhardt A, Bezerra H, Blankenberg S, Brunner S, Colson P, Cudemus Deseda G, Dabboura S, Eckner D, Eden M, Eitel I, Frank D, Frey N, Funamoto M, Goßling A, Graf T, Hagl C, Kirchhof P, Kupka D, Landmesser U, Lipinski J, Lopes M, Majunke N, Maniuc O, McGrath D, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Reichenspurner H, Sandri M, Schulze PC, H G Schwinger R, Sinning JM, Aksoy A, Skurk C, Szczanowicz L, Thiele H, Tietz F, Varshney A, Wechsler L, Westermann D. Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study. Circulation 2020; 142:2095-2106. [PMID: 33032450 PMCID: PMC7688081 DOI: 10.1161/circulationaha.120.048792] [Citation(s) in RCA: 243] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality. METHODS Data from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort. RESULTS Left ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98]; P=0.03) without differences in various subgroups. Complications occurred more frequently in patients with left ventricular unloading: severe bleeding in 98 (38.4%) versus 45 (17.9%), access site-related ischemia in 55 (21.6%) versus 31 (12.3%), abdominal compartment in 23 (9.4%) versus 9 (3.7%), and renal replacement therapy in 148 (58.5%) versus 99 (39.1%). CONCLUSIONS In this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
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Affiliation(s)
- Benedikt Schrage
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Peter Moritz Becher
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Alexander Bernhardt
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Hiram Bezerra
- Tampa General Hospital, University of South Florida (H.B.)
| | - Stefan Blankenberg
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Gaston Cudemus Deseda
- Division of Anesthesia, Critical Care and Pain Medicine (G.C.D.), Massachusetts General Hospital, Boston
| | - Salim Dabboura
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Matthias Eden
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Derk Frank
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Norbert Frey
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Masaki Funamoto
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Alina Goßling
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Germany (I.E., T.G.)
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik (C.H.), LMU Klinikum, Munich, Germany
| | - Paulus Kirchhof
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham National Health ServiceTrusts, United Kingdom (P.K.)
| | - Danny Kupka
- Departments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.,Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Jerry Lipinski
- Department of Internal Medicine, University of California, San Diego (J.L.)
| | - Mathew Lopes
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Octavian Maniuc
- Medizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | - Daniel McGrath
- Division of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.)
| | - Curt Noel
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).,Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany(M.E., D.F., N.F., C.N.)
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.)
| | | | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).,Department of Anesthesia and Intensive Care, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) ISMETT (Istituto Mediterraneo trapianti e terapie avanzate), UPMC (University of Pittsburgh Medical Center)Italy, Palermo, Italy (F.P.)
| | - Sandeep M Patel
- Department of Interventional Cardiology, St. Rita's Medical Center, Lima, OH (S.M.P.)
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.)
| | - Vittorio Pazzanese
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.)
| | - Hermann Reichenspurner
- Cardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany
| | - Marcus Sandri
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - P Christian Schulze
- Department of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.)
| | | | - Jan-Malte Sinning
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Adem Aksoy
- University Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.)
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).,Franklin/German Centre for Cardiovascular Research (DZHK), partner site Berlin/Institute of Health (BIH), Germany (U.L., C.S.)
| | - Lukasz Szczanowicz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Franziska Tietz
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.)
| | - Anubodh Varshney
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.)
| | - Lukas Wechsler
- Medizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.)
| | - Dirk Westermann
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.)
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12
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Vogt F, Marianowicz J, Jessl J, Eckner D, Fischlein T. Balloon Transcatheter Aortic Valve Replacement After Aortic Valve Repair With HAART 300 Device. Ann Thorac Surg 2020; 110:e375-e376. [PMID: 32376351 DOI: 10.1016/j.athoracsur.2020.03.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
The HAART 300 (BioStable Science and Engineering, Austin, TX) is a rigid, elliptical device introduced to facilitate aortic valve repair providing annular stabilization in the setting of aortic regurgitation. Percutaneous strategies have been described for patients with dysfunctional biological prostheses or recurrence insufficiency after mitral ring annuloplasty. This report shows the feasibility of aortic valve-in-ring transcatheter aortic valve replacement (TAVR). The sufficient ring stability to support the implanted TAVR-prosthesis and the fact that the elliptical shape of the HAART-ring did not result in a problem concerning paravalvular leakage were important for the success of this procedure.
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Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
| | - Jill Marianowicz
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Jürgen Jessl
- Department of Cardiology, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Nuremberg, Germany
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13
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Vogt F, Moscarelli M, Pollari F, Kalisnik JM, Pfeiffer S, Fittkau M, Sirch J, Pförringer D, Jessl J, Eckner D, Ademaj F, Bertsch T, Langhammer C, Fischlein T, Santarpino G. Two approaches-one phenomenon-thrombocytopenia after surgical and transcatheter aortic valve replacement. J Card Surg 2020; 35:1186-1194. [PMID: 32349178 DOI: 10.1111/jocs.14547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROPUND AND AIM Postoperative thrombocytopenia after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) and aggravating causes were the aim of this retrospective study. METHODS Data of all patients treated with SAVR (n = 1068) and TAVR (n = 816) due to severe aortic valve stenosis was collected at our center from 2010 to 2017. Preprocedural and postprocedural values were collected from electronic patient records. RESULTS There was a significant drop in platelets in both groups, the TAVR group showed overall superior platelet preservation compared to the AVR group (P < .001). In the SAVR subgroup analysis, a significant difference in platelet preservation was observed between the valve types (P < .001), particularly with the Freedom SOLO valve. In the TAVR subgroup analysis, the valve type did not influence platelet count (PLT) reduction (P = .13). In the SAVR subgroup analyses, PLT was found to be worsened with cardiopulmonary bypass (CPB) duration. CONCLUSION Thrombocytopenia frequently occurs after implantation of a biological heart valve prosthesis, with a higher frequency observed in patients after cardiac surgery rather than TAVR. Although some surgical bioprosthetic models are more susceptible to this phenomenon, CPB duration seems to be a major determinant for the development of postoperative thrombocytopenia.
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Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Francesco Pollari
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Jurij M Kalisnik
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Steffen Pfeiffer
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Matthias Fittkau
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Joachim Sirch
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jürgen Jessl
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Fadil Ademaj
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Christian Langhammer
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Giuseppe Santarpino
- Cardiac Surgery Unit, Department of Experimental and Clinical Science, Magna Graecia, University of Catanzaro, Catanzaro, Italy.,Paracelsus Medical University, Nuremberg, Germany
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Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F, Pieri M, Skurk C, Lauten A, Landmesser U, Westenfeld R, Horn P, Pauschinger M, Eckner D, Twerenbold R, Nordbeck P, Salinger T, Abel P, Empen K, Busch MC, Felix SB, Sieweke JT, Møller JE, Pareek N, Hill J, MacCarthy P, Bergmann MW, Henriques JP, Möbius-Winkler S, Schulze PC, Ouarrak T, Zeymer U, Schneider S, Blankenberg S, Thiele H, Schäfer A, Westermann D. Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock. Circulation 2019; 139:1249-1258. [DOI: 10.1161/circulationaha.118.036614] [Citation(s) in RCA: 263] [Impact Index Per Article: 52.6] [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]
Affiliation(s)
- Benedikt Schrage
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
| | - Karim Ibrahim
- University Heart Centre Dresden, Department of Cardiology and Intensive Care, Germany (K.I., T.L.)
| | - Tobias Loehn
- University Heart Centre Dresden, Department of Cardiology and Intensive Care, Germany (K.I., T.L.)
| | - Nikos Werner
- University Heart Centre Bonn, Department of Cardiology, Germany (N.W., J-M.S.)
| | - Jan-Malte Sinning
- University Heart Centre Bonn, Department of Cardiology, Germany (N.W., J-M.S.)
| | - Federico Pappalardo
- San Raffaele Scientific Institute Milan, Anaesthesia and Intensive Care Department, Italy (F.P., M.P.)
| | - Marina Pieri
- San Raffaele Scientific Institute Milan, Anaesthesia and Intensive Care Department, Italy (F.P., M.P.)
| | - Carsten Skurk
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Alexander Lauten
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Ulf Landmesser
- Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Cardiology, Germany (C.S., A.L., U.L.)
| | - Ralf Westenfeld
- Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Germany (R.W., P.H.)
| | - Patrick Horn
- Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology and Vascular Medicine, Germany (R.W., P.H.)
| | - Matthias Pauschinger
- Paracelsus Medical University Nürnberg, Department of Cardiology, Germany (M.P., D.E.)
| | - Dennis Eckner
- Paracelsus Medical University Nürnberg, Department of Cardiology, Germany (M.P., D.E.)
| | - Raphael Twerenbold
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (R.T.)
| | - Peter Nordbeck
- University Hospital Würzburg, Department of Internal Medicine I, Germany (P.N., T.S.)
| | - Tim Salinger
- University Hospital Würzburg, Department of Internal Medicine I, Germany (P.N., T.S.)
| | - Peter Abel
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Klaus Empen
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Mathias C. Busch
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Stephan B. Felix
- German Centre for Cardiovascular Research, Partner Site Greifswald (P.A., K.E., M.C.B., S.B.F.)
- University Medicine Greifswald, Department of Internal Medicine B, Division of Cardiology, Germany (P.A., K.E., M.C.B., S.B.F.)
| | - Jan-Thorben Sieweke
- Hannover Medical School, Department of Cardiology and Angiology, Germany (J.T.S., A.S.)
| | | | - Nilesh Pareek
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | - Jonathan Hill
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | - Philip MacCarthy
- King’s College Hospital National Health Service Foundation Trust, London, United Kingdom (N.P., J.H., P.M.)
| | | | - José P.S. Henriques
- Academic Medical Centre Heart Centre, Academic Medical Centre–University of Amsterdam, the Netherlands (J.P.S.H.)
| | - Sven Möbius-Winkler
- University Hospital Jena, Department of Internal Medicine I, Germany (S.M-W., P.C.S.)
| | - P. Christian Schulze
- University Hospital Jena, Department of Internal Medicine I, Germany (S.M-W., P.C.S.)
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
| | - Uwe Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
- Klinikum der Stadt Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany (U.Z.)
| | - Steffen Schneider
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany (T.O., U.Z., S.S.)
| | - Stefan Blankenberg
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany (S.B., D.W.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Germany (H.T.)
| | - Andreas Schäfer
- Hannover Medical School, Department of Cardiology and Angiology, Germany (J.T.S., A.S.)
| | - Dirk Westermann
- University Heart Centre Hamburg, Department of General and Interventional Cardiology, Germany (B.S., R.T., S.B., D.W.)
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany (S.B., D.W.)
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Pollari F, Cuomo M, Vogt F, Kalisnik J, Söhn C, Eckner D, Fischlein T, Pfeiffer S. RF35 CALCIUM LOADING AS RISK FACTOR FOR CLINICAL MAJOR COMPLICATIONS AND SURVIVAL FOLLOWING TAVI PROCEDURES. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549975.21153.3e] [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: 11/05/2022]
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16
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Eckner D, Popp S, Wicklein S, Pauschinger M. [Acute coronary syndrome in older people]. Z Gerontol Geriatr 2018; 51:461-475. [PMID: 29846808 DOI: 10.1007/s00391-018-1411-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022]
Abstract
The acute coronary syndrome (ACS) is subdivided into ST segment elevation myocardial infarction (STEMI), non-ST segment elevation acute coronary syndrome (NSTE-ACS) and unstable angina pectoris. It poses a particular challenge in terms of diagnostics and treatment, especially in the elderly. Starting with the possibly difficult anamnesis, through the laboratory chemical findings up to special features in the electrocardiogram (ECG), echocardiography and angiography, these patients should be considered in some ways different to the younger population. Because of the mortality and morbidity after ACS, especially in old age, it is important to adhere to evident strategies in diagnostics and treatment and to employ specially trained personnel for people with acute chest pain in order to improve the prognosis and quality of life. A first important step is to provide certified chest pain units which ensure smooth diagnostics and treatment and thus positively influence the clinical decision-making processes.
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Affiliation(s)
- D Eckner
- Kardiologie, Klinikum Nürnberg Süd, Paracelsus Medizinische Privatuniversität, Breslauer Str. 201, 90471, Nürnberg, Deutschland.
| | - S Popp
- Kardiologie, Klinikum Nürnberg Süd, Paracelsus Medizinische Privatuniversität, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - S Wicklein
- Geriatrie, Klinikum Nürnberg Nord, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - M Pauschinger
- Kardiologie, Klinikum Nürnberg Süd, Paracelsus Medizinische Privatuniversität, Breslauer Str. 201, 90471, Nürnberg, Deutschland
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17
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Vogt F, Wicklein S, Gosch M, Jessl J, Hitzl W, Fischlein T, Pauschinger M, Pfeiffer S, Eckner D. Functionality and Outcome in Older Patients with Severe Aortic Stenosis (FOOPAS): an interdisciplinary study concept for a prospective trial. Clin Interv Aging 2018; 13:185-193. [PMID: 29440878 PMCID: PMC5798545 DOI: 10.2147/cia.s154234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Frailty is a geriatric syndrome that can influence mortality and functional recovery after treatment of severe aortic stenosis (AS). The integration of standardized geriatric assessment (GA) in clinical practice is limited by a lack of consensus on how to measure it. Objectives This study aims to compare the incremental predictive value of different frailty scales to predict the outcomes following surgical aortic valve replacement, transcatheter aortic valve implantation, and conservative treatment of severe AS. Methods A prospective cohort of 300 older adults with severe AS will be assembled after standard clinical examinations and a comprehensive GA, including 18 different tests and values. Primary outcome parameters are overall mortality, cardiovascular mortality, quality of life, and functionality. Secondary parameters are overall complications, cardiovascular complications, and costs. Results Expected results will contribute to the growing body of evidence on frailty based on parameters that influence clinical and functional outcome in elderly patients independent of the method of treatment. The pre-procedural assessment is expected to be valuable in discriminating new post-procedural complications from simple exacerbations of pre-existing conditions. Therefore, a new frailty test which is simple and feasible for application in a clinical routine by most medical professionals, may help in identifying patients for whom further GA should be considered. Finally, such a frailty score could support heart teams to find the right treatment for patients suffering from AS. Conclusion Comparison of different frailty scales has not only the goal of finding a predictive value of mortality but also to bring in a meaningful improvement for each individual patient and to avoid disability or fatal outcomes.
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Affiliation(s)
- Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Susanne Wicklein
- Department of Geriatric Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Markus Gosch
- Department of Geriatric Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Jürgen Jessl
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research Office - Biostatistics, Paracelsus Medical University, Salzburg, Austria
| | - Theodor Fischlein
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | | | - Steffen Pfeiffer
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University, Nuremberg, Germany
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18
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Eggebrecht H, Vaquerizo B, Moris C, Bossone E, Lämmer J, Czerny M, Zierer A, Schröfel H, Kim WK, Walther T, Scholtz S, Rudolph T, Hengstenberg C, Kempfert J, Spaziano M, Lefevre T, Bleiziffer S, Schofer J, Mehilli J, Seiffert M, Naber C, Biancari F, Eckner D, Cornet C, Lhermusier T, Philippart R, Siljander A, Giuseppe Cerillo A, Blackman D, Chieffo A, Kahlert P, Czerwinska-Jelonkiewicz K, Szymanski P, Landes U, Kornowski R, D’Onofrio A, Kaulfersch C, Søndergaard L, Mylotte D, Mehta RH, De Backer O. Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J 2017; 39:676-684. [DOI: 10.1093/eurheartj/ehx713] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
- Department of Cardiology, Herz- Thorax- Zentrum, Klinikum Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Beatriz Vaquerizo
- Unidad de Cardiología Intervencionista, Departamento de Cardiología, Hospital del Mar, Passeig Marítim 25/29, 08003 Barcelona, Spain
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Roma s/n, 33011 Oviedo, Asturias, Spain
| | - Eduardo Bossone
- Cardiology Division “Cava de'Tirreni and Amalfi Coast” Heart Department, University Hospital, Via de Marinis 4, 84013 Cava de'Tirreni, Italy
| | - Johannes Lämmer
- Department of Cardiology, Cardioangiologisches Centrum Bethanien (CCB) at the AGAPLESION Bethanien Hospital, Im Prüfling 21-25, 60389 Frankfurt, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Kepler University Hospital, Krankenhausstr. 9, 4021 Linz, Austria
| | - Holger Schröfel
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Walther
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Tanja Rudolph
- Department of Cardiology, Heart Center, University of Cologne, Medizinische Klinik III, Kerpener Str. 3, 50937 Cologne, Germany
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jörg Kempfert
- Department of Cardiac Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Marco Spaziano
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Thierry Lefevre
- Department of Cardiology, Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Privé Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Lazarettstr. 36, 80636 Munich, Germany
| | - Joachim Schofer
- Medicare Center and Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Wördemannsweg 25-27, 22527 Hamburg, Germany
| | - Julinda Mehilli
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University Munich and German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
| | - Christoph Naber
- Department of Cardiology, Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45134 Essen, Germany
| | - Fausto Biancari
- Department of Cardiology, University of Oulu and Heart Center, University of Turku, Hämeentie 11 P.O. Box 52, 20521 Turku, Finland
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nuernberg, General Hospital Nuernberg, Medizinische Klinik 8, Breslauer Str. 201, 90471 Nürnberg, Germany
| | - Charles Cornet
- Cardiology Department. Interventional Cardiology Unit. University Hospital of Angers, 4 rue Larry, 49000 Angers, France
| | - Thibault Lhermusier
- Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, 1, Professeur Jean Poulhes Avenue, 31059 Toulouse, France
| | - Raphael Philippart
- Groupe Cardio-Vasculaire Interventionnel Clinique Pasteur, 45 avenue de Lombez BP 27617, 31076 Toulouse, France
| | - Antti Siljander
- Department of Cardiology, Kuopio University Hospital Heart Center, PL 100, 70029 KYS Kuopio, Finland
| | - Alfredo Giuseppe Cerillo
- UO Cardiochirurgia Ospedale del Cuore G. Pasquinucci Fondazione Toscana Gabriele Monasterio, Via Aurelia Sud, 54100 Mass, Italy
| | - Daniel Blackman
- Department of Cardiology, Leeds Teaching Hospitals, LS23 6AL Leeds, UK
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Hospital, Olgettina Street 60, 20132 Milan, Italy
| | - Philipp Kahlert
- Department of Cardiology, West German Heart and Vascular Center, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
| | | | - Piotr Szymanski
- Valvular Heart Disease Department, National Institute of Cardiology, Alpejske 42, 06-628 Warsaw, Poland
| | - Uri Landes
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and the “Sackler” Faculty of Medicine, Tel-Aviv University, Jabotinski St. 29, 39100 Petah-Tikva, Israel
| | - Augusto D’Onofrio
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, Azienda Ospedaliera-University of Padova, 2 Via Nicolò Giustiniani, 35128 Padova, Italy
| | - Carl Kaulfersch
- Department of Cardiology, Klinikum Klagenfurt, Sankt Veiter Straβe 47, Klagenfurt am Wörthersee, Austria
| | - Lars Søndergaard
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Rajendra H Mehta
- Department of Internal Medicine Division of Cardiology Duke University Medical Center and Duke Clinical Research Institute, 2400 Pratt Street Durham NC 27715, Durham, NC, USA
| | - Ole De Backer
- The Heart Center, Department of Cardiology Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2200 Copenhagen, Denmark
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