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Paulus MG, Liedtke T, Hamerle M, Schach C, Maier LS, Stadler S, Birner C, Debl K, Arzt M, Unsöld B, Meindl C. Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea. Clin Res Cardiol 2022; 112:594-604. [PMID: 36507943 PMCID: PMC10160214 DOI: 10.1007/s00392-022-02139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Aims
Sleep-disordered breathing (SDB) and its subtype central sleep apnoea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Whereas pharmacological therapy of heart failure has been shown to ameliorate CSA, results from previous studies on the effect of mitral regurgitation therapy on SDB are contradicting. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of CSA.
Methods and results
We enrolled 47 patients undergoing TEER for symptomatic mitral regurgitation in a prospective study. Secondary mitral regurgitation and left ventricular ejection fraction < 50% were present in 79% and 68% of patients, respectively. Respiratory polygraphy was performed before TEER in a compensated condition and four weeks after the procedure. 34 patients completed the follow-up. At baseline, 19 (56%) patients showed moderate-to-severe SDB, of whom 13 (68%) were classified as CSA. Both apnoea-hypopnoea index and percentage of recorded time spent in Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7–30] vs. 7 [4–15] /h, p = 0.007; 6 [0–34] vs. 0 [0–8] %, p = 0.008). Median relative reduction of central apnoea index was 75% (p = 0.023), while obstructive apnoea index did not change significantly. Increase in stroke volume after TEER and high systolic pulmonary artery pressure at baseline predicted a > 50% reduction of both Apnoea-hypopnoea index and Cheyne-Stokes respiration.
Conclusion
TEER is associated with a significant short-term reduction of CSA and Cheyne-Stokes respiration in high-risk patients, strengthening its value as an effective treatment option for advanced heart failure.
Graphical abstract
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Affiliation(s)
- Michael G Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Tobias Liedtke
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Paulus MG, Meindl C, Hamerle M, Schach C, Maier LS, Debl K, Birner C, Unsöld B. Reduction of radiation exposure during transcatheter edge-to-edge mitral valve repair. Catheter Cardiovasc Interv 2022; 99:1259-1267. [PMID: 35084083 DOI: 10.1002/ccd.30046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair is an increasingly used therapy for mitral regurgitation which requires fluoroscopic guidance. Limiting radiation exposure during lengthy procedures is important for both patient and operator safety. This study aimed to investigate radiation dose during contemporary use of MitraClip implantation and the effects of a dose reduction program. METHODS A total of 115 patients who underwent MitraClip implantation were prospectively enrolled in a single-center observational study. During the inclusion period, our institution adopted a radiation dose reduction program, comprising lowering of fluoroscopy pulse rate and image target dose. The first 58 patients were treated with conventional fluoroscopy settings, while the following 57 patients underwent the procedure with the newly implemented low dose protocol. RESULTS Radiation dose area product significantly decreased after introduction of the low dose protocol (693 [366-1231] vs. 2265 [1517-3914] cGy·cm2 , p < 0.001). After correcting for fluoroscopy time, gender and body mass index, the low dose protocol emerged as a strong negative predictor of radiation dose (p < 0.001), reducing dose area product by 64% (95% confidence interval [57-70]). Device time, device success, and procedural safety did not differ between the normal dose and low dose group. Furthermore, the low dose protocol was not associated with an increased incidence of a combined endpoint consisting of death, repeat intervention, or heart surgery during 12 months follow-up. CONCLUSION Reduction of radiation exposure during transcatheter mitral valve repair by 64% is feasible without affecting procedural success or safety.
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Affiliation(s)
- Michael G Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Meindl C, Paulus M, Koller T, Rogalski D, Hamerle M, Schach C, Buchner S, Zeman F, Maier LS, Debl K, Unsöld B, Birner C. Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair. Clin Cardiol 2020; 44:261-266. [PMID: 33372698 PMCID: PMC7852171 DOI: 10.1002/clc.23538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/05/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023] Open
Abstract
Background and Hypothesis The acquired von Willebrand syndrome (AvWS), which predisposes to bleeding events, is often related to valvular heart diseases. We investigated possible implications of AvWS and factor VIII levels in patients with moderate to severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR). Methods and Results 123 patients with moderate to severe MR were prospectively enrolled. Complete measurements of von Willebrand Factor activity (vWFAct), von Willebrand Factor antigen (vWFAg), and factor VIII expression before and 4 weeks after TMVR were available in 85 patients. At baseline, seven patients had a history of gastrointestinal bleeding, two patients suffered bleeding events during their hospital stay, and one patient had a bleeding 4 weeks after TMVR. Even though vWFAct, vWFAct/vWFAg ratio and vWFAg values did not change after TMVR, we observed a significantly lower vWFAct/vWFAg ratio in patients with primary MR as compared to patients with secondary MR both at baseline (p = 0.022) and 4 weeks following the TMVR procedure (p = 0.003). Additionally, patients with a mean mitral valve gradient ≥4 mmHg after TMVR had significantly lower vWFAct/vWFAg ratios as compared to patients with a mean mitral valve gradient <4 mmHg (p = 0.001). Conclusions MR of primary etiology was associated with lower vWFAct/vWFAg ratio, hinting toward HMWM loss due to shear stress caused by eccentric regurgitation jets. In addition, morphological changes leading to postprocedural transmitral gradients ≥4 mmHg were related to lower vWFAct/vWFAg ratio 4 weeks after the procedure. Alterations of the vWFAct/vWFAg ratio in turn did not translate into a greater risk for bleeding events.
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Affiliation(s)
- Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Theresia Koller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dominik Rogalski
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, Sana Hospital Cham, Cham, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Department of Internal Medicine I, St. Marien Hospital Amberg, Amberg, Germany
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Abstract
Abstract
Background
Chronic subclinical intravascular hemolysis is a common complication after valve replacement associated with worse prognosis, occurring in up to 80% of patients after mitral valve surgery. While serious intravascular hemolysis after MitraClip implantation has been reported anecdotally, data on the impact of transcatheter mitral valve repair on the prevalence of subclinical hemolysis are lacking.
Methods and results
From August 2017 to November 2019, 77 patients with high perioperative risk and moderate-to-severe or severe mitral regurgitation were prospectively enrolled in a single-center trial. All participants were treated with transcatheter edge-to-edge mitral valve repair using the MitraClip NT, NTR or XTR system. Before and three months after the procedure, all patients underwent comprehensive clinical assessment including laboratory measurement of hemoglobin, haptoglobin and lactic acid dehydrogenase in venous blood samples. Presence of subclinical intravascular hemolysis was defined as hemoglobin <13.8 g/dl for males or <12.4 g/dl for females, haptoglobin <65 mg/dl and lactic acid dehydrogenase >250 U/l. Levels of the hemolysis marker haptoglobin significantly decreased three months after the intervention (127±71 mg/dl at three months vs. 158±73 mg/dl at baseline, p<0.001), accompanied by an increase in lactic acid dehydrogenase (251±88 U/l vs. 222±55 U/l, p<0.01), implying the induction of intravascular hemolysis by transcatheter mitral valve repair. Higher residual mitral regurgitation was associated with lower haptoglobin levels three months after mitral valve repair (p<0.05), hinting that shear stress caused by regurgitation flow is the primary mechanism for hemolysis after MitraClip implantation. Concurrently, we observed a trend towards an increase in the presence of subclinical intravascular hemolysis (9.1% at three months vs. 3.9% at baseline, p=0.289). Hemoglobin levels remained unchanged (12.1±1.5 g/dl at three months vs 12.3±1.8 g/dl at baseline, p=0.107). No patient needed treatment for intravascular hemolysis.
Conclusion
Transcatheter edge-to-edge mitral valve repair in a high-risk collective is associated with the induction of hemolysis. Yet, prevalence of subclinical intravascular hemolysis is low when compared to mitral valve surgery, emphasizing the good safety profile of minimal-invasive mitral valve therapy.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ReForM-B research grant, University of Regensburg
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Affiliation(s)
- M Paulus
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - C Meindl
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - M Hamerle
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - C Schach
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - L.S Maier
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - C Birner
- Klinikum St. Marien, Department of Internal Medicine I, Amberg, Germany
| | - K Debl
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - B Unsoeld
- University hospital Regensburg, Department of Internal Medicine II, Regensburg, Germany
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Paulus MG, Meindl C, Böhm L, Holzapfel M, Hamerle M, Schach C, Maier LS, Debl K, Unsöld B, Birner C. Predictors of functional improvement in the short term after MitraClip implantation in patients with secondary mitral regurgitation. PLoS One 2020; 15:e0232817. [PMID: 32463820 PMCID: PMC7255600 DOI: 10.1371/journal.pone.0232817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/22/2020] [Indexed: 01/11/2023] Open
Abstract
Background and objectives MitraClip implantation is an established therapy for secondary mitral regurgitation (MR) in high-risk patients and has shown to improve several important outcome parameters such as functional capacity. Patient selection is both challenging and crucial for achieving therapeutic success. This study investigated baseline predictors of functional improvement as it was quantified by the six-minute walk distance (6MWD) after transcatheter mitral valve repair. Methods and results We retrospectively analyzed 79 patients with secondary MR treated with MitraClip implantation at an academic tertiary care center. Before and four weeks after the procedure, all patients underwent comprehensive clinical assessment, six-minute walk tests and echocardiography. 6MWD significantly improved after MitraClip therapy (295 m vs. 265 m, p < 0.001). A linear regression model including seven clinical baseline variables significantly predicted the change in 6MWD (p = 0.002, R2 = 0.387). Female gender, diabetes mellitus and arterial hypertension were found to be significant negative predictors of 6MWD improvement. At baseline, female patients had significant higher left ventricular ejection fraction (49% vs. 42%, p = 0.019) and lower 6MWD (240 m vs. 288 m, p = 0.034) than male patients. Conclusion MitraClip implantation in secondary MR significantly improves functional capacity in high-risk patients even in the short term of four weeks after the procedure. Female gender, diabetes mellitus and arterial hypertension are baseline predictors of a less favourable functional outcome. While further validation in a larger cohort is recommended, these parameters may improve patient selection for MitraClip therapy.
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Affiliation(s)
- Michael G. Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Böhm
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Magdalena Holzapfel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
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Meindl C, Hamerle M, Rogalski D, Paulus M, Schach C, Maier L, Debl K, Birner C, Unsoeld B. P5571MitraClip implantation impairs functional echocardiographic parameters of the left atrium in patients with moderate to severe mitral regurgitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
MitraClip implantation induces hemodynamic unloading and reverse remodeling of the left atrium (LA) and the left ventricle (LV). However little data exist concerning the effects of MitraClip implantation on LA and LV strain reflecting LA and LV function.
Methods and results
From August 2017 to September 2018 62 patients with moderate to severe mitral regurgitation were prospectively enrolled in our single-center RETORT-MR trial (Regensburg Trial on TMVR Techniques in Mitral Regurgitation). All included patients were treated using the MitraClip procedure. Two dimensional speckle tracking echocardiography (2DSTE) of the LA as well as of the LV could be performed in 35 patients with follow-up 2DSTE at four weeks and/or three months after MitraClip implantation. In 25.7% of patients primary mitral regurgitation was present (n=9) and in 74.3% of subjects a secondary entity of mitral regurgitation had been diagnosed (n=26). 57.1% of patients (n=20) suffered from heart failure with preserved ejection fraction (HFpEF) and 42.9% of patients (n=15) had heart failure with reduced ejection fraction (HFrEF). Global longitudinal strain (GLS) was reduced at baseline (−15.3%), at four-week (−14.5%, n=27) and at three-month follow-up (−13.9%, n=28) with no statistically significant differences indicating a sustained mechanical impairment of LV. In contrast significant deterioration was observed in the peak atrial longitudinal strain (PALS) representing LA reservoir function (15.3% at baseline vs. 11.8% at four-week follow-up, n=25, p=0.015 and 16.0% at baseline vs. 13.2% at three-month follow-up, n=25, p=0.03). Similarly to LA reservoir function LA booster function indicating left atrial active contraction was significantly reduced after MitraClip implantation (12.5% at baseline vs. 8.0% at four-week follow-up, n=10, p=0.028). Contrary to LA functional parameters LA size did not change significantly after MitraClip implantation (LA volume index at baseline 74.5 ml/m2 vs. 70.1 ml/m2 at four-week follow-up, n=27, p=0.489).
Conclusion
The present study revealed a deterioration of LA functional parameters (LA reservoir and LA booster function) after MitraClip insertion. It is known that severe mitral regurgitation can cause structural changes of the LA such as fibrosis. MitraClip insertion leads to a significant reduction of regurgitant volumes but structural changes of the LA may not be reversible. In addition MitraClip implantation increases afterload in the LA potentially explaining the observed deterioration of LA functional parameters.
Acknowledgement/Funding
None
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Affiliation(s)
- C Meindl
- University Hospital Regensburg, Regensburg, Germany
| | - M Hamerle
- University Hospital Regensburg, Regensburg, Germany
| | - D Rogalski
- University Hospital Regensburg, Regensburg, Germany
| | - M Paulus
- University Hospital Regensburg, Regensburg, Germany
| | - C Schach
- University Hospital Regensburg, Regensburg, Germany
| | - L Maier
- University Hospital Regensburg, Regensburg, Germany
| | - K Debl
- University Hospital Regensburg, Regensburg, Germany
| | - C Birner
- St. Marien Hospital, Amberg, Germany
| | - B Unsoeld
- University Hospital Regensburg, Regensburg, Germany
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Hamerle M, Ghaeni L, Kowski A, Weissinger F, Holtkamp M. Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy. Front Neurol 2018; 9:401. [PMID: 29922217 PMCID: PMC5996121 DOI: 10.3389/fneur.2018.00401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/13/2018] [Accepted: 05/15/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose: This study aimed to assess alcohol consumption and the occurrence of alcohol-related seizures in patients with epilepsy within the last 12 months. Methods: In an epilepsy outpatient clinic, a standardized questionnaire was used to collect data retrospectively from consecutive adult epilepsy patients who had been suffering from the disease for at least 1 year. Logistic regression analyses were performed to identify independent predictors. Results: A total of 310 patients with epilepsy were included. Of these, 204 subjects (65.8%) consumed alcohol within the last 12 months. Independent predictors for alcohol use were antiepileptic drug monotherapy (OR 1.901) and physicians' advice that a light alcohol intake is harmless (OR 4.102). Seizure worsening related to alcohol consumption was reported by 37 of the 204 patients (18.1%) who had used alcohol. All 37 subjects had consumed large quantities of alcohol prior to the occurrence of alcohol-related seizures regardless of their usual alcohol-drinking behavior. The amount of alcohol intake prior to alcohol-related seizures was at least 7 standard drinks, which is equivalent to 1.4 L of beer or 0.7 L of wine. In 95% of cases, alcohol-related seizures occurred within 12 h after cessation of alcohol intake. Independent predictors for alcohol-related seizures were generalized genetic epilepsy (OR 5.792) and chronic heavier alcohol use (OR 8.955). Conclusions: Two-thirds of interviewed subjects had consumed alcohol within the last 12 months. This finding may be an underestimate due to patients' self-reporting and recall error. In all cases, the occurrence of alcohol related-seizures was associated with timely consumption of considerably large amounts of alcohol. Thus, a responsible alcohol intake seems to be safe for most patients with epilepsy. However, subjects with epilepsy and especially those with generalized genetic epilepsy should be made aware of an increased risk for seizures related to heavy alcohol consumption. Factors accompanying acute heavy alcohol intake such as altered sleep architecture, impaired adherence to antiepileptic medication, and metabolic disturbances may further facilitate the occurrence of seizures.
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Affiliation(s)
- Michael Hamerle
- Department of Cardiology, University Hospital Regensburg, Regensburg, Germany.,Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leyli Ghaeni
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Kowski
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Weissinger
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Holtkamp
- Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Herkenrath S, Pepin J, Treml M, Arzt M, Zeman F, Penzel T, Schöbel C, Fietze I, Sert Kuniyoshi F, Lotz G, Weissmueller V, Hamerle M, Randerath W. 0898 Elevated Total Lung Capacity Attenuates Sleep-related Breathing Disorders In Chronic Obstructive Pulmonary Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.897] [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: 11/13/2022] Open
Affiliation(s)
| | - J Pepin
- University Grenoble Alps, Grenoble, FRANCE
| | - M Treml
- Bethanien Hospital, Soligen, GERMANY
| | - M Arzt
- University of Regensburg, Regensburg, GERMANY
| | - F Zeman
- University of Regensburg, Regensburg, GERMANY
| | - T Penzel
- Advanced Sleep Research GmbH, Berlin, GERMANY
| | - C Schöbel
- Advanced Sleep Research GmbH, Berlin, GERMANY
| | - I Fietze
- Advanced Sleep Research GmbH, Berlin, GERMANY
| | | | - G Lotz
- Philips Respironics, Murrysville, PA
| | | | - M Hamerle
- University of Regensburg, Regensburg, GERMANY
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Abstract
INTRODUCTION Second-generation antipsychotics (SGAs) are widely used in several psychiatric disease entities and exert to a different extent a risk for antipsychotic-induced weight gain (AIWG). As AIWG is associated with an increase in metabolic syndrome or cardiovascular events, knowledge of these risks is crucial for further monitoring and the initiation of counteractive measures. AREAS COVERED We searched PubMed and Web of Sciences for randomized-controlled trials and naturalistic observational studies published between 2010 and 2014 with sample sizes exceeding 100, including all marketed SGAs apart from zotepine, and providing data on weight increase. We also summarized relevant systematic reviews and meta-analyses of head-to-head comparisons. EXPERT OPINION Recently published data still support the hierarchical ranking of SGAs already proposed in previous reviews ranking clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone and sertindole in the middle, and aripiprazole, lurasidone and ziprasidone with the lowest risk. Number needed to harm varied considerably in our meta-analysis. Younger patients and patients with a lower baseline body mass index are most vulnerable. The greatest amount of weight gain occurs within the first weeks of treatment. AIWG occurs in all diagnostic groups and is also common in treatment with first-generation antipsychotics; therefore, awareness of this adverse event is essential for anyone prescribing antipsychotics.
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Affiliation(s)
- Richard Musil
- Ludwig-Maximilians-University Munich, Department of Psychiatry and Psychotherapy , Nussbaumstraße 7, 80336 Munich , Germany +1 0049 89 4400 55888 ; +1 0049 89 4400 55188 ;
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Haeckert J, Bunse T, Wirth S, Hamerle M, Falkai P, Hasan A. Massive, previously undetected cancer metastasis revealed by application of a depot antipsychotic: a case report. J Clin Psychiatry 2014; 75:e705-6. [PMID: 25093486 DOI: 10.4088/jcp.14cr09021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | | | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Nussbaumstreet 7, Munich, Bavaria 80366, Germany
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Hamerle M, Ghaeni L, Kowski A, Weissinger F, Holtkamp M. Cannabis and other illicit drug use in epilepsy patients. Eur J Neurol 2013; 21:167-70. [DOI: 10.1111/ene.12081] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/21/2012] [Indexed: 11/27/2022]
Affiliation(s)
- M. Hamerle
- Department of Neurology; Charité-University Hospital Berlin; Berlin Germany
| | - L. Ghaeni
- Department of Neurology; Charité-University Hospital Berlin; Berlin Germany
| | - A. Kowski
- Department of Neurology; Charité-University Hospital Berlin; Berlin Germany
| | - F. Weissinger
- Department of Neurology; Charité-University Hospital Berlin; Berlin Germany
| | - M. Holtkamp
- Department of Neurology; Charité-University Hospital Berlin; Berlin Germany
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