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Hildebrandt L, Fischer M, Klein O, Zimmermann T, Fensky F, Siems A, Zonderman A, Hengstmann E, Kirchgeorg T, Pröfrock D. An analytical strategy for challenging members of the microplastic family: Particles from anti-corrosion coatings. J Hazard Mater 2024; 470:134173. [PMID: 38603906 DOI: 10.1016/j.jhazmat.2024.134173] [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] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024]
Abstract
Potentially hazardous particles from paints and functional coatings are an overlooked fraction of microplastic (MP) pollution since their accurate identification and quantification in environmental samples remains difficult. We have applied the most relevant techniques from the field of microplastic analysis for their suitability to chemically characterize anti-corrosion coatings containing a variety of polymer binders (LDIR, Raman and FTIR spectroscopy, Py-GC/MS) and inorganic additives (ICP-MS/MS). We present the basis of a possible toolbox to study the release and fate of coating particles in the (marine) environment. Our results indicate that, due to material properties, spectroscopic methods alone appear to be unsuitable for quantification of coating/paint particles and underestimate their environmental abundance. ICP-MS/MS and an optimized Py-GC/MS approach in combination with multivariate statistics enables a straightforward comparison of the multi-elemental and organic additive fingerprints of paint particles. The approach can improve the identification of unknown particles in environmental samples by an assignment to different typically used coating types. In future, this approach may facilitate allocation of emission sources of different environmental paint/coating particles. Indeed, future work will be required to tackle various remaining analytical challenges, such as optimized particle extraction/separation of environmental coating particles.
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Affiliation(s)
- L Hildebrandt
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany
| | - M Fischer
- Federal Maritime and Hydrographic Agency (BSH), Marine Sciences Department, Wüstland 2, 22589 Hamburg, Germany
| | - O Klein
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany
| | - T Zimmermann
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany
| | - F Fensky
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany; Hochschule für Angewandte Wissenschaften Hamburg, Faculty of Life Sciences, Ulmenliet 20, 20099 Hamburg, Germany
| | - A Siems
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Institute for Inorganic and Applied Chemistry, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
| | - A Zonderman
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany; Universität Hamburg, Department of Biology, Marine Ecosystem and Fishery Science, Olbersweg 24, 22767 Hamburg, Germany
| | - E Hengstmann
- Federal Maritime and Hydrographic Agency (BSH), Marine Sciences Department, Wüstland 2, 22589 Hamburg, Germany
| | - T Kirchgeorg
- Federal Maritime and Hydrographic Agency (BSH), Marine Sciences Department, Wüstland 2, 22589 Hamburg, Germany
| | - D Pröfrock
- Department for Inorganic Environmental Chemistry, Helmholtz-Zentrum Hereon, Max-Planck-Straße 1, 21502 Geesthacht, Germany.
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Halicek MT, Scott C, Zimmermann T, Watson B. Primary Mucinous Carcinoma of the Thyroid: A Case Report, Literature Review, and Immunohistochemistry Summary. HCA Healthc J Med 2024; 5:39-43. [PMID: 38560396 PMCID: PMC10939087 DOI: 10.36518/2689-0216.1570] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Primary mucinous carcinoma of the thyroid is an exceedingly rare malignancy that is histologically similar to mucinous carcinoma of other sites. Accurate diagnosis is a challenging yet crucial component of clinical management for both patients and our understanding of this rare disease. Case Presentation We report the case of a 69-year-old male patient with primary mucinous carcinoma of the thyroid. Microscopic examination of a biopsy specimen showed fibrous tissue, which was extensively and irregularly infiltrated by a cytologically malignant epithelial neoplasm showing glandular differentiation with mucin production. Immunohistochemistry demonstrated that tumor cells were positive for TTF1, thyroglobulin, CK7, and PAX8. Co-expression of TTF1 and PAX8 is most commonly seen in thyroid tumors. These findings support our diagnosis of mucinous carcinoma of thyroid origin, which is rare and highly aggressive. Conclusion In this report, we present the only documented case of primary mucinous carcinoma of the thyroid reported in the United States in the last decade. The diagnosis of primary mucinous carcinoma of the thyroid can be challenging. Therefore, we discuss and detail the clinicopathologic tumor profile and provide more current, detailed histological criteria to assist in the diagnosis of this rare disease.
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Affiliation(s)
- Martin T Halicek
- Emory University Hospital, Atlanta, GA
- Grand Strand Medical Center, Myrtle Beach SC
| | - Caleb Scott
- Grand Strand Medical Center, Myrtle Beach SC
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Dreismann L, Wenzel M, Ginger V, Zimmermann T. OptiScreen – ein Schulungskonzept für Pflegekräfte zur Durchführung des psychosozialen Distress-Screenings. Onkologie 2023. [PMCID: PMC10144887 DOI: 10.1007/s00761-023-01343-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 06/10/2023]
Abstract
Hintergrund Eine angemessene, bedarfsgerechte psychoonkologische Versorgung reduziert Depressivität und Ängste von Krebserkrankten sowie ihren Angehörigen und erhöht die Lebensqualität. Psychisch belastete Krebserkrankte werden jedoch nicht flächendeckend identifiziert, um ihnen psychoonkologische Unterstützung anzubieten. Screeningfragebögen haben sich zur Identifikation bewährt, allerdings bestehen bei der Anwendung im klinischen Alltag Hürden. Pflegekräfte haben durch ihren kontinuierlichen Kontakt zu Patient_innen, die vielfältigen klinischen Eindrücke und ihre Verbindung zu anderen Berufsgruppen eine Schlüsselrolle. Ziele Die OptiScreen-Schulung soll Pflegekräfte in der Onkologie zur Durchführung des Distress-Screenings befähigen, entsprechendes Expert_innenwissen vermitteln und Hürden sowie Unsicherheiten im Screeningprozess abbauen, um somit belastete Erkrankte zielgerichtet identifizieren und einer psychoonkologischen Versorgung zuführen zu können. Das Training Die OptiScreen-Schulung gliedert sich in drei Module à 1,5–2 h zu den Themen psychische Störungen bei Krebs, psychoonkologische Versorgung, psychische Belastung, Distress-Screening, Kommunikation im Screeningprozess und Psychohygiene (vermittelt durch Vorträge, Videos, Rollenspiele, Übungen). Ergebnisse und Diskussion Erste praktische Erfahrungen weisen auf eine erfolgreiche Umsetzung des Schulungskonzepts hin. Weitere Ziele sind es, den Wissenszuwachs und die zunehmende Sicherheit der Pflegekräfte im Screeningprozess zu stärken sowie die Effekte langfristig aufrechtzuerhalten. Zusätzlich soll die Schulung in verschiedenen Settings etabliert und die Auswirkungen der Schulung in Bezug auf die Informiertheit und Zufriedenheit der Patient_innen mit dem Screeningprozess untersucht werden.
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Affiliation(s)
- L. Dreismann
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
| | - M. Wenzel
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
| | - V. Ginger
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
| | - T. Zimmermann
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Deutschland
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Salzmann S, Laferton J, Shedden-Mora M, Horn N, Gärtner L, Schröder L, Rau J, Schade-Brittinger C, Murmann K, Rastan A, Andrási T, Böning A, Salzmann-Djufri M, Löwe B, Brickwedel J, Albus C, Wahlers T, Hamm A, Hilker L, Albert W, Zimmermann T, Ismail I, Strauß B, Doenst T, Schedlowski M, Moosdorf R, Rief W. Pre-surgery Optimization of Patients’ Expectations to Improve Outcome in Heart Surgery: Study Protocol of the Randomized Controlled Multicenter PSY-HEART-II Trial. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761773] [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: 03/22/2023]
Affiliation(s)
- S. Salzmann
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Deutschland
| | - J. Laferton
- Department of Medicine, Health and Medical University, Potsdam, Deutschland
| | - M. Shedden-Mora
- Department of Psychology, Medical School Hamburg, Hamburg, Deutschland
| | - N. Horn
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Deutschland
| | - L. Gärtner
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Deutschland
| | - L. Schröder
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Deutschland
| | - J. Rau
- Coordination Center for Clinical Trials (KKS), University of Marburg, Marburg, Deutschland
| | - C. Schade-Brittinger
- Coordination Center for Clinical Trials (KKS), University of Marburg, Marburg, Deutschland
| | - K. Murmann
- Coordination Center for Clinical Trials (KKS), University of Marburg, Marburg, Deutschland
| | - A. Rastan
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Deutschland
| | - T. Andrási
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Deutschland
| | - A. Böning
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Deutschland
| | - M. Salzmann-Djufri
- Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Deutschland
| | - B. Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg, Hamburg, Deutschland
| | - J. Brickwedel
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - C. Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, Cologne, Deutschland
| | - T. Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Deutschland
| | - A. Hamm
- Department of Physiological and Clinical Psychology/ Psychotherapy, University of Greifswald, Greifswald, Deutschland
| | - L. Hilker
- Department of Cardiovascular Surgery, Clinic Karlsburg, Heart and Diabetes Center, Karlsburg, Deutschland
| | - W. Albert
- Psychosomatics, German Heart Center Berlin, Berlin, Deutschland
| | - T. Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Deutschland
| | - I. Ismail
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Deutschland
| | - B. Strauß
- Institute of Psychosocial Medicine, Psychotherapy, and Psychooncology, University Hospital Jena, Jena, Deutschland
| | - T. Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Deutschland
| | - M. Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Deutschland
| | - R. Moosdorf
- Department for Cardiovascular Surgery, Heart Center, Philipps University of Marburg, Marburg, Deutschland
| | - W. Rief
- Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Deutschland
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Toso A, Teixiera G, Zimmermann T, Schmitter D, Meyer M, Muller M, Mailly L, Baumert T, Iacone R. 193P CLAUDIN-1 targeting antibodies in solid tumors: From ALE.C04 to CLAUDIN-1 oncology platform. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zimmermann T, Koechlin L, Walter J, Kimenai D, Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Puelacher C, Gualandro D, Strebel I, Diebold M, Twerenbold R, Hammarsten O, Meex S, Mueller C. Differences in circulating cardiac troponin I and T in acute and chronic cardiac disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Clinical practice and guidelines assume that cardiac troponin I (cTnI) and cTnT are interchangeable, reflecting identical pathophysiological processes. However, it is unknown if cTnI and cTnT really are equivalent measures in different pathophysiological settings.
Purpose
To highlight potential differences in the release of cTnI and cTnT.
Methods
Large pooled cohort analysis including extensively characterized individuals, stratified into three groups: no cardiac disease (normal aging), chronic cardiac disease, and acute cardiac disease. Circulating cTnI and cTnT concentrations were measured blinded to clinical data using high-sensitivity assays (hs-cTnI-Architect, hs-cTnT-Elecsys) and their ratio calculated. Findings were validated using a second hs-cTnI assay (hs-cTnI-Clarity).
Results
Among 8719 individuals, 29% female, 10% had no known cardiac disease, 71% chronic cardiac disease, and 20% acute cardiac disease. Baseline characteristics including renal function were comparable between individuals with chronic and acute cardiac disease. Normal aging (without cardiac disease) was associated with a disproportional increase in cTnT versus cTnI (low cTnI/cTnT ratio, median 0.50, IQR 0.38–0.68). Although older, patients with chronic cardiac disease had a slightly higher cTnI/cTnT ratio (median 0.53, IQR 0.37–0.79, p<0.05). In contrast, in patients with acute cardiac disease, cTnI concentrations were disproportionally elevated compared to cTnT concentrations, resulting in a cTnI/cTnT ratio of 1.96 (IQR 0.93–4.73, p<0.001). Internal validation using a second hs-cTnI assay confirmed these findings.
Conclusion
These findings suggest relevant differences in the release of cTnI and cTnT with a greater release of cTnT versus cTnI in normal aging and a disproportional increase in cTnI versus cTnT in acute cardiac disease.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
| | - L Koechlin
- University Hospital Basel , Basel , Switzerland
| | - J Walter
- University Hospital Basel , Basel , Switzerland
| | - D Kimenai
- University of Edinburgh , Edinburgh , United Kingdom
| | | | | | | | - C Puelacher
- University Hospital Basel , Basel , Switzerland
| | - D Gualandro
- University Hospital Basel , Basel , Switzerland
| | - I Strebel
- University Hospital Basel , Basel , Switzerland
| | - M Diebold
- University Hospital Basel , Basel , Switzerland
| | - R Twerenbold
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - O Hammarsten
- Sahlgrenska University Hospital , Gothenburg , Sweden
| | - S Meex
- Cardiovascular Research Institute Maastricht (CARIM) , Maastricht , The Netherlands
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
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7
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Koechlin L, Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Miro O, Wussler D, Zimmermann T, Strebel I, Christ M, Wildi K, Rubini Gimenez M, Martin-Sanchez J, Keller D, Twerenbold R, Mueller C. Performance of high-sensitivity cardiac troponin T versus I for the early diagnosis of myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1339] [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
Clinical practice guidelines assume that both cardiac troponin (cTn) T and cTnI concentrations reflect identical pathophysiological processes and are equally effective in the detection of myocardial injury. However, there are differences between cTnT and cTnI that have been reported.
Purpose
The aim of this study was to directly compare the diagnostic performance of high-sensitivity cardiac troponin (hs-cTn) T versus hs-cTnI for the early diagnosis of acute myocardial infarction (MI).
Methods
In a prospective multicentre study, diagnostic and prognostic accuracies of hs-cTnT and I were analyzed in consecutive patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by two independent cardiologists using all information pertaining to the individual patient according to the fourth universal definition of MI. Adjudication of the final diagnoses was performed twice: once using serial measurements of hs-cTnT and once using hs-cTnI. Furthermore, the clinical performance of hs-cTnT/I when embedded in the European Society of Cardiology (ESC) 0/1h-algorithm was assessed.
Results
Among 5087 consecutive patients (median [Interquartile range, IQR] age 61 [49.0, 74.0] years, 33.2% female), 951 (18.7%) and 901 patients (17.7%) had an adjudicated final diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) when using serial measurements of hs-cTnT and hs-cTnI for adjudication, respectively. Diagnostic accuracy was very high for both hs-cTnT and hs-cTnI and comparable when using hs-cTnT for adjudication (hs-cTnT: area under the curve [AUC] 0.93 [95% CI 0.92–0.94] versus hs-cTnI AUC 0.93 [95% CI 0.92–0.94]; p=0.891). However, when using serial measurements of hs-cTnI for adjudication, diagnostic accuracy was significantly higher for hs-cTnI (AUC 0.93 [95% CI 0.92–0.94] versus AUC 0.94 [95% CI 0.94–0.95], p<0.001; Figure 1). This was confirmed in subgroup analyses including early presenter (≤3h), patients with renal failure, known coronary artery disease and elderly (≥70 years). However, both assays performed excellent with very high safety for rule-out and high accuracy for rule-in MI when embedded in the ESC 0/1h-algorithm. Prognostic accuracies for 730-day all-cause mortality and cardiovascular death were significantly higher for hs-cTnT compared to hs-cTnI (Figure 2).
Conclusions
While there seem to be differences between hs-cTnT and hs-cTnI in their diagnostic and prognostic performance, clinical relevance needs to be further evaluated since both assays performed excellent when embedded in their respective early triage algorithms.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Foundation, Swiss Heart Foundation
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Affiliation(s)
- L Koechlin
- University Hospital Basel , Basel , Switzerland
| | | | | | | | - O Miro
- Hospital Clinic de Barcelona , Barcelona , Spain
| | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | | | - I Strebel
- University Hospital Basel , Basel , Switzerland
| | - M Christ
- Kantonsspital Lucerne, Emergency Department , Lucerne , Switzerland
| | - K Wildi
- University Hospital Basel , Basel , Switzerland
| | - M Rubini Gimenez
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - J Martin-Sanchez
- Hospital Clinico San Carlos, Servicio de Urgencias , Madrid , Spain
| | - D Keller
- University Hospital Zurich, Emergency Department , Zurich , Switzerland
| | - R Twerenbold
- University Medical Center Hamburg Eppendorf, University Center of Cardiovascular Science & Department of Cardiology , Hamburg , Germany
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
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8
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Koechlin L, Boeddinghaus J, Lopez-Ayala P, Nestelberger T, Wussler D, Twerenbold R, Zimmermann T, Wildi K, Miro O, Martin-Sanchez J, Keller D, Christ M, Buser A, Rubini Gimenez M, Mueller C. 0/1h-algorithm using a new high-sensitivity cardiac troponin I assay for early diagnosis of myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1340] [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
The clinical performance of the novel high-sensitivity cardiac troponin I EXL (hs-cTnI-EXL) assay is unknown so far.
Purpose
We aimed to validate the clinical performance of the hs-cTnI-EXL assay and to derive and validate an hs-cTnI-EXL-specific 0/1h-algorithm for the early diagnosis of myocardial infarction (MI).
Methods
This multicenter study included patients presenting to the emergency department with symptoms suggestive of myocardial infarction. Central adjudication of final diagnoses was performed by two independent cardiologists using all clinical information including cardiac imaging twice: first, using serial hs-cTnI-Architect (primary analysis) and second, using serial hs-cTnT-Elecsys (secondary analysis) concentrations in addition to those clinically used (hs)-cTn. Hs-cTnI-EXL was measured at presentation and at 1h. The primary objective was to directly compare diagnostic accuracy quantified by the area under the receiver-operating-characteristic curve (AUC) of hs-cTnI-EXL, hs-cTnI-Architect and hs-cTnT-Elecsys. Secondary objectives included the derivation and validation of an hs-cTnI- EXL-specific 0/1h-algorithm.
Results
MI was the adjudicated final diagnosis in 204/1454 (14%) patients. At presentation, the AUC for hs-cTnI-EXL was 0.94 (95% CI, 0.93–0.96), being comparable to hs-cTnI-Architect (0.95; 95% CI, 0.93–0.96) and hs-cTnT-Elecsys (0.93; 95% CI, 0.91–0.95; Figure 1). In the derivation cohort (n=813), an optimal hs-cTnI-EXL-0/1h-algorithm was rule-out of MI with <9ng/L if onset of chest pain >3h or <9ng/L & 0h-1h-change <5ng/L, and rule-in with ≥160ng/L or 0h-1h-change ≥100ng/L. In the validation cohort (n=345), this hs-cTnI-EXL-0/1h-algorithm also performed well: rule-out in 56% of patients, negative predictive value 99.5% (95% CI, 97.1–99.9), sensitivity 97.8% (95% CI, 88.7–99.6), rule-in in 9% of patients, positive predictive value 83.3% (95% CI, 66.4–92.7), specificity 98.3% (95% CI, 96.1–99.3; Figure 2). Secondary analyses confirmed the findings using adjudication including serial measurements of hs-cTnT-Elecsys.
Conclusions
Hs-cTnI-EXL has comparable diagnostic performance to the currently best-validated hs-cTnT/I assays.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swiss National Foundation, Swiss Heart Foundation
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Affiliation(s)
- L Koechlin
- University Hospital Basel , Basel , Switzerland
| | | | | | | | - D Wussler
- University Hospital Basel , Basel , Switzerland
| | - R Twerenbold
- University Medical Center Hamburg Eppendorf, University Center of Cardiovascular Science & Department of Cardiology , Hamburg , Germany
| | | | - K Wildi
- University Hospital Basel , Basel , Switzerland
| | - O Miro
- Hospital Clinic de Barcelona , Barcelona , Spain
| | - J Martin-Sanchez
- Hospital Clinico San Carlos, Servicio de Urgencias , Madrid , Spain
| | - D Keller
- University Hospital Zurich, Emergency Department , Zurich , Switzerland
| | - M Christ
- Kantonsspital Lucerne, Emergency Department , Lucerne , Switzerland
| | - A Buser
- University Hospital Basel , Basel , Switzerland
| | - M Rubini Gimenez
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - C Mueller
- University Hospital Basel , Basel , Switzerland
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9
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Schaefer I, Lopez-Ayala P, Walter J, Rumora K, Amrein M, Zimmermann T, Boeddinghaus J, Koechlin L, Strebel I, Nestelberger T, Wussler D, Puelacher C, Kaiser C, Zellweger M, Mueller C. Using high-sensitivity cardiac troponin for the exclusion of inducible myocardial ischemia in patients without previously known coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The rapid and safe exclusion of functionally relevant coronary artery disease (CAD) is a crucial, yet unmet clinical need. High-sensitivity cardiac troponin (hs-cTn) may be an attractive strategy, particularly in patients without previously known CAD.
Purpose
To derive and internally validate optimal rule-out cutoffs for an early and safe exclusion of functionally relevant CAD in symptomatic patients without previously known CAD.
Methods
In an ongoing single-center, prospective, cohort study, we enrolled consecutive patients without previously known CAD that were referred with symptoms possibly related to functionally relevant CAD. Cardiac troponin concentrations were measured at presentation using two high-sensitivity assays (Elecsys hs-cTnT and Architect hs-cTnI). Presence of functionally relevant CAD was adjudicated by 2 independent cardiologists, blinded to hs-cTn measurements, using MPI-SPECT/CT in all patients, as well as coronary angiography and fractional flow reserve measurements, whenever available. The primary diagnostic outcome was safety for early rule-out of functionally relevant CAD, quantified by sensitivity and the negative predictive value (NPV). The co-primary prognostic outcomes were cumulative incidences of cardiovascular death and all-cause death after 5 years. A NPV ≥90% and sensitivity ≥90% were predefined as acceptable performance criteria. The derived cutoffs were further evaluated in pre-specified subgroups. Internal validity was assessed with a bootstrapping procedure for a realistic estimate in similar future patients. Cumulative incidence curves stratified by the presence of functionally relevant CAD and hs-cTn concentrations below and above the derived cutoffs were constructed.
Results
Among 2111 eligible patients, 498 (23.6%) had a final diagnosis of functionally relevant CAD. Median age was 68 years and 938 (44.4%) were female. For ruling out functionally relevant CAD, a hs-cTnT concentration <5 ng/L resulted in a sensitivity of 90.8% (95% CI: 87.9–93.0%) and a NPV of 90.2% (95% CI: 87.1–92.5), triaging 468 (22.2%) patients towards rule-out. Similarly, a hs-cTnI concentration <2 ng/L resulted in a sensitivity of 91.6% (95% CI: 88.8–93.7%) and a NPV of 90.0% (95% CI: 86.8–92.6), triaging 422 (20.0%) patients. Internal validation showed robustness of these findings. The diagnostic performance of the derived cutoffs did not significantly vary across the subgroups. Hs-cTn concentrations above the derived cutoffs were associated with a substantially higher cumulative event rate of cardiovascular death (hs-cTnT: 7.0% vs. 0.8%; hs-cTnI: 6.6% vs. 1.2%) and all-cause death (hs-cTnT: 14.3% vs. 2.4%; hs-cTnI: 13.1% vs. 4.4%) during 5-years follow-up (log rank p<0.001 for all).
Conclusion
In symptomatic patients without previously known CAD, very low hs-cTn concentrations may generally allow to safely and effectively exclude functionally relevant CAD.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science FoundationSwiss Heart Foundation
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Affiliation(s)
- I Schaefer
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - P Lopez-Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - J Walter
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - K Rumora
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - M Amrein
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - C Kaiser
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - M Zellweger
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel , Basel , Switzerland
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10
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Logemann A, Reininghaus M, Schmidt M, Ebeling A, Zimmermann T, Wolschke H, Friedrich J, Brockmeyer B, Pröfrock D, Witt G. Assessing the chemical anthropocene - Development of the legacy pollution fingerprint in the North Sea during the last century. Environ Pollut 2022; 302:119040. [PMID: 35202763 DOI: 10.1016/j.envpol.2022.119040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
The North Sea and its coastal zones are heavily impacted by anthropogenic activities, which has resulted in significant chemical pollution ever since the beginning of the industrialization in Europe during the 19th century. In order to assess the chemical Anthropocene, natural archives, such as sediment cores, can serve as a valuable data source to reconstruct historical emission trends and to verify the effectiveness of changing environmental legislation. In this study, we investigated 90 contaminants covering inorganic and organic pollutant groups analyzed in a set of sediment cores taken in the North Seas' main sedimentation area (Skagerrak). We thereby develop a chemical pollution fingerprint that records the constant input of pollutants over time and illustrates their continued great relevance for the present. Additionally, samples were radiometrically dated and PAH and PCB levels in porewater were determined using equilibrium passive sampling. Furthermore, we elucidated the origin of lead (Pb) contamination utilizing non-traditional stable isotopic analysis. Our results reveal three main findings: 1. for all organic contaminant groups covered (PAHs, OCPs, PCBs, PBDEs and PFASs) as well as the elements lead (Pb) and titanium (Ti), determined concentrations decreased towards more recent deposited sediment. These decreasing trends could be linked to the time of introductions of restrictions and bans and therefor our results confirm, amongst possible other factors, the effectiveness of environmental legislation by revealing a successive change in contamination levels over the decades. 2. concentration trends for ΣPAH and ΣPCB measured in porewater correspond well with the ones found in sediment which suggests that this method can be a useful expansion to traditional bulk sediment analysis to determine the biologically available pollutant fraction. 3. Arsenic (As) concentrations were higher in younger sediment layers, potentially caused by emissions of corroded warfare material disposed in the study area after WW II.
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Affiliation(s)
- A Logemann
- Federal Maritime and Hydrographic Agency (BSH), Bernhard-Nocht-Str. 78, 20359, Hamburg, Germany; Universität Hamburg, Department of Earth Sciences, Bundesstraße 55, 20146, Hamburg, Germany
| | - M Reininghaus
- Hamburg University of Applied Sciences, Department of Engineering, Ulmenliet 20, 21033, Hamburg, Germany; RWTH University Aachen, Department of Ecosystem Analysis (ESA), Worringer Weg 1, 52074, Aachen, Germany
| | - M Schmidt
- Universität Hamburg, Department of Earth Sciences, Bundesstraße 55, 20146, Hamburg, Germany; Helmholtz-Zentrum Hereon, Institute of Coastal Environmental Chemistry, Max-Planck Str. 1, 21502, Geesthacht, Germany
| | - A Ebeling
- Helmholtz-Zentrum Hereon, Institute of Coastal Environmental Chemistry, Max-Planck Str. 1, 21502, Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany
| | - T Zimmermann
- Helmholtz-Zentrum Hereon, Institute of Coastal Environmental Chemistry, Max-Planck Str. 1, 21502, Geesthacht, Germany
| | - H Wolschke
- Helmholtz-Zentrum Hereon, Institute of Coastal Environmental Chemistry, Max-Planck Str. 1, 21502, Geesthacht, Germany
| | - J Friedrich
- Helmholtz-Zentrum Hereon, Institute of Carbon Cycles, Max-Planck Str. 1, 21502, Geesthacht, Germany
| | - B Brockmeyer
- Federal Maritime and Hydrographic Agency (BSH), Bernhard-Nocht-Str. 78, 20359, Hamburg, Germany
| | - D Pröfrock
- Helmholtz-Zentrum Hereon, Institute of Coastal Environmental Chemistry, Max-Planck Str. 1, 21502, Geesthacht, Germany.
| | - G Witt
- Hamburg University of Applied Sciences, Department of Engineering, Ulmenliet 20, 21033, Hamburg, Germany
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11
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du Fay de Lavallaz J, Badertscher P, Zimmermann T, Nestelberger T, Walter J, Strebel I, Coelho C, Miró Ò, Salgado E, Christ M, Geigy N, Cullen L, Than M, Javier Martin-Sanchez F, Di Somma S, Frank Peacock W, Morawiec B, Wussler D, Keller DI, Gualandro D, Michou E, Kühne M, Lohrmann J, Reichlin T, Mueller C. Early standardized clinical judgement for syncope diagnosis in the emergency department. J Intern Med 2021; 290:728-739. [PMID: 33755279 DOI: 10.1111/joim.13269] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND The diagnosis of cardiac syncope remains a challenge in the emergency department (ED). OBJECTIVE Assessing the diagnostic accuracy of the early standardized clinical judgement (ESCJ) including a standardized syncope-specific case report form (CRF) in comparison with a recommended multivariable diagnostic score. METHODS In a prospective international observational multicentre study, diagnostic accuracy for cardiac syncope of ESCJ by the ED physician amongst patients ≥ 40 years presenting with syncope to the ED was directly compared with that of the Evaluation of Guidelines in Syncope Study (EGSYS) diagnostic score. Cardiac syncope was centrally adjudicated independently of the ESCJ or conducted workup by two ED specialists based on all information available up to 1-year follow-up. Secondary aims included direct comparison with high-sensitivity cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) concentrations and a Lasso regression to identify variables contributing most to ESCJ. RESULTS Cardiac syncope was adjudicated in 252/1494 patients (15.2%). The diagnostic accuracy of ESCJ for cardiac syncope as quantified by the area under the curve (AUC) was 0.87 (95% CI: 0.84-0.89), and higher compared with the EGSYS diagnostic score (0.73 (95% CI: 0.70-0.76)), hs-cTnI (0.77 (95% CI: 0.73-0.80)) and BNP (0.77 (95% CI: 0.74-0.80)), all P < 0.001. Both biomarkers (alone or in combination) on top of the ESCJ significantly improved diagnostic accuracy. CONCLUSION ESCJ including a standardized syncope-specific CRF has very high diagnostic accuracy and outperforms the EGSYS score, hs-cTnI and BNP.
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Affiliation(s)
- J du Fay de Lavallaz
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - P Badertscher
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - T Zimmermann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Nestelberger
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Walter
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - I Strebel
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - C Coelho
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - Ò Miró
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - E Salgado
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Hospital Clinic, Barcelona, Catalonia, Spain
| | - M Christ
- Department of Emergency Medicine, Kantonsspital, Luzern, Switzerland
| | - N Geigy
- Department of Emergency Medicine, Hospital of Liestal, Liestal, Switzerland
| | - L Cullen
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Royal Brisbane & Women's Hospital, Herston, Australia
| | - M Than
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Christchurch Hospital, Christchurch, New Zealand
| | - F Javier Martin-Sanchez
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
| | - S Di Somma
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - W Frank Peacock
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - B Morawiec
- GREAT - Global Research on Acute Conditions Team, Roma, Italy.,2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - D Wussler
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - D I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - D Gualandro
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - E Michou
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - M Kühne
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - J Lohrmann
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | - T Reichlin
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Cardiology, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - C Mueller
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,GREAT - Global Research on Acute Conditions Team, Roma, Italy
| | -
- From the, Department of Cardiology, Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
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12
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Kloppe T, Zimmermann T, Mews C, Tetzlaff B, Scherer M. Krank, arm, einsam und arbeitslos – Verbindung von hausärztlicher Praxis und sozialem Hilfesystem – ein Konzept für Aus- und Fortbildung. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T Kloppe
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin
| | - T Zimmermann
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin
| | - C Mews
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin
| | - B Tetzlaff
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin
| | - M Scherer
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin
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13
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Schettler V, Peter C, Zimmermann T, Julius U, Roeseler E, Schlieper G, Heigl F, Grützmacher P, Löhlein I, Klingel R, Hohenstein B, Vogt A. The German Lipoprotein Apheresis Registry (GLAR) – more than 7 years on. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Zimmermann T, Du Fay De Lavallaz J, Florez D, Widmer V, Freese M, Walter J, Lopez-Ayala P, Belkin M, Boeddinghaus J, Nestelberger T, Badertscher P, Lohrmann J, Twerenbold R, Kuehne M, Mueller C. Validation of the Canadian syncope risk score in a large prospective international multicenter study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Management and risk stratification of patients with syncope in the emergency department (ED) is often challenging. In an effort to support ED physicians in disposition decisions, the Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes.
Methods
The CSRS was developed in a Canadian multicenter study and contains nine predictors: predisposition to vasovagal syncope, heart disease, systolic pressure <90 or >180mmHg in the ED, troponin level >99th percentile, abnormal QRS axis, QRS duration >130ms, QTc interval >480ms and an ED diagnosis of vasovagal or cardiac syncope. Patients can achieve a CSRS score between −3 and +11 points. We validated the CSRS in a large prospective international multicenter study recruiting patients 40 years or older presenting to the ED with a syncopal event within the last 12 hours. Recruitment centers contained smaller provincial hospitals, as well as big University Hospitals in eight countries on three continents. Primary outcome measure were 30-day serious arrhythmic and non-arrhythmic adverse events, as defined by the authors of the original score.
Results
1581 patients were eligible for this analysis. The population in this validation cohort was older (mean age 68 vs 54 years) and had a considerably higher rate of serious outcomes compared to the derivation cohort (n=186 (11.8%) vs n=147 (3.6%)). The area under the receiver operating characteristic curve (AUC) for the CSRS was 0.88 (95% confidence interval (CI) 0.86–0.91) and significantly higher compared to the validated OESIL score (AUC 0.75, 95% CI 0.71–0.78, p<0.001). Calibration curve analysis showed an underestimation of risk in patients with a low CSRS and an overestimation in patients with a high CSRS. The rate of observed serious outcomes within 30d increased from 0.8% in the very low risk group (CSRS equal to or below −2) to 48% in the (very) high risk group (CSRS equal to or above 4, Hazard ratio 79.4, 95% CI 11.1–570.9). A Kaplan-Meier plot was used to visualize rates of serious outcomes in three different risk groups (Figure).
Conclusion
This is the first validation of the Canadian Syncope Risk Score in a large international syncope cohort. The prognostic discrimination of the CSRS for 30-day serious outcomes was very good in our validation cohort and comparable to that of the Canadian derivation study. Despite suboptimal calibration, prognostic analysis showed a high rate of serious outcomes in the CSRS (very) high risk group and a low rate of serious outcomes in the very low risk group. Allowing the clinical judgement of the ED physician in the form of suspected syncope etiology to be a part of the score seems to largely contribute to the high performance of the CSRS. Additional validation studies might be needed to further increase the accuracy of the CSRS in different patient populations with a different incidence of outcomes in settings outside of Canada.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation; Swiss Heart Foundation
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Affiliation(s)
| | | | - D Florez
- University Hospital Basel, Basel, Switzerland
| | - V Widmer
- University Hospital Basel, Basel, Switzerland
| | - M Freese
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | | | - M Belkin
- University Hospital Basel, Basel, Switzerland
| | | | | | | | - J Lohrmann
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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15
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Sarrazin C, Zimmermann T, Berg T, Hinrichsen H, Mauss S, Wedemeyer H, Zeuzem S. Prophylaxe, Diagnostik und Therapie der Hepatitis-C-Virus(HCV)-Infektion. Z Gastroenterol 2020; 58:1110-1131. [PMID: 33197953 DOI: 10.1055/a-1226-0241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C Sarrazin
- Medizinische Klinik II Gastroenterologie, Hepatologie, Infektiologie, Diabetologie, St. Josefs-Hospital, Wiesbaden, Deutschland.,Medizinische Klinik I Gastroenterologie, Hepatologie, Pneumologie, Endokrinologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - T Zimmermann
- Medizinische Klinik II, Klinikum Worms, Worms, Deutschland.,Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - T Berg
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | - S Mauss
- MVZ, Düsseldorf, Deutschland
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Zeuzem
- Medizinische Klinik I Gastroenterologie, Hepatologie, Pneumologie, Endokrinologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
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16
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Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Gualandro D, Strebel I, Lopez-Ayala P, Florez D, Koechlin L, Walter J, Diebold M, Wussler D, Belkin M, Kuehne M, Sun B, Mueller C. Development and validation of an ECG-based cardiac syncope risk calculator. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The early diagnosis of cardiac syncope is often challenging. We therefore developed an ECG-based risk calculator as an aid for rapid rule-out or rule-in of cardiac syncope and aimed to validate this decision tool.
Methods
In a prospective diagnostic international multicenter study (derivation cohort), 2007 patients, 40 years or older, presenting with syncope to the emergency department were recruited. The primary diagnostic outcome, cardiac syncope, was centrally adjudicated by two independent cardiologists using all clinical information obtained during syncope work-up including 12-month follow up. 12-lead ECG was recorded at presentation and read by residents blinded to clinical information. Significant ECG predictors of cardiac syncope were identified using penalized backward selection. Findings were validated in an independent US multicenter cohort with 2'269 syncope patients.
Results
In the derivation cohort (median age 71 years, 40% women), centrally adjudicated cardiac syncope was present in 267 patients (16%). Seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) were identified as significant predictors for cardiac syncope and combined into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy of ALERT-CS for cardiac syncope, as quantified by the area under the receiver-operating characteristics curve (AUC), was high (0.80, 95%-confidence interval (CI) 0.77–0.83) and significantly higher compared to the EGSYS score (0.73, 95% CI 0.70–0.76, p<0.001). In combination, ALERT-CS significantly increased the AUC of BNP (0.82, 95% CI 0.79–0.85 vs 0.77, 95% CI 0.74–0.81, p=0.003), hs-cTnT (0.84, 95% CI 0.0.81–0.87 vs 0.77, 95% CI 0.74–0.80, p<0.001) and integrated clinical judgment in the ED (0.90, 95% CI 0.89–0.92 vs 0.87, 95% CI 0.84–0.90, p<0.001).
A predicted probability for cardiac syncope below 5.5% by ALERT-CS identified 138 patients (8%) eligible for triage towards rapid rule-out of cardiac syncope with a sensitivity of 99%. A predicted probability above 37.5% identified 181 patients (11%) eligible for triage towards rapid rule-in of cardiac syncope with a specificity of 95%. Prognostic verification for 30-day major adverse cardiac events (MACE) showed a high rate of MACE in the rule-in group and a very low rate of MACE in the rule-out group (Figure).
External validation (median age 72 years, 48% women) showed similar diagnostic accuracy (AUC 0.76, 95% CI 0.73–0.79) and prognostic results.
Conclusion
Combining seven ECG criteria within the simple ALERT-CS may aid ED physicians in the early rule-out or rule-in of cardiac syncope.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
| | | | | | - D Gualandro
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | | | - D Florez
- University Hospital Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | - M Diebold
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - M Belkin
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - B Sun
- University of Pennsylvania, Department of Emergency Medicine, Philadelphia, United States of America
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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17
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Lopez Ayala P, Flores D, Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Strebel I, Gualandro D, Badertscher P, Miro O, Martin-Sanchez F, Geigy N, Christ M, Keller D, Than M, Mueller C. Incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac syncope has been shown to carry the highest hazard for all-cause death compared to other causes of syncope including vasovagal and orthostatic syncope. However, little is known about the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope.
Purpose
To evaluate the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope.
Methods
We enrolled patients presenting to the emergency department (ED) with syncope in a large prospective international multicentre study. The cause of syncope (cardiac vs non-cardiac) including the detailed cardiac aetiology (if cardiac) was centrally adjudicated by two independent cardiologists based on detailed in-hospital as well as outpatient cardiac work-up during 360 days following presentation. Cardiac syncope was classified into four groups: bradyarrhythmia, tachyarrhythmia, structural disease and other (cardiopulmonary and great vessels), as recommended in the ESC Syncope Guidelines. All-cause death during 2-years follow-up was the primary outcome.
Results
Among 2025 patients presenting with syncope to the ED, cardiac syncope was the final adjudicated diagnoses in 318 (15.7%) patients. The incidence rate of all-cause death among cardiac syncope patients was 103 cases per 1000 person-years. Bradyarrhythmia was the most frequent primary cause of cardiac syncope (n=146, 45.9%) followed by tachyarrhythmia (n=75, 23.6%), structural disease (n=64, 20.1%) and other cardiac (n=26, 8.2%). Patients were 37% female with a median age of 77 years (IQR 67–83) showing no statistically significant difference between subgroups. Clinical characteristics differed significantly among the four subgroups. E.g. syncope occurred during exercise in 12 patients (8.2%) with bradyarrhythmia, 10 patients (13.3%) with tachyarrhythmia, 16 patients (25%) with structural disease, and 5 patients (19%) with other cardiac (p<0.01). Likely of most importance, long-term mortality differed significantly among the four different cardiac subgroups. The multivariable-adjusted hazard ratios (HR) among patients with bradyarrhythmia, tachyarrhythmia, structural disease and other cardiac as compared to patients with vasovagal syncope, the HR were 1.3 (95% CI 0.7–2.5), 4.6 (95% CI 2.3–9.1), 3.1 (95% CI 1.5–6.4) and 5.9 (95% CI 2.3–15.2), respectively (Figure 1).
Conclusions
Bradyarrhythmia, tachyarrhythmia, and structural cardiac disease are the dominant causes of cardiac syncope. Interestingly, with the appropriate therapy initiated long-term mortality of bradyarrhythmia is comparable to that of vasovagal syncope, while long-term mortality of tachyarrhythmia and structural cardiac disease were substantially increased 3 to 5 fold.
Figure 1. Kaplan-Meier curve
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swiss National Science Foundation, the Swiss Heart Foundation, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel and the University Hospital Basel.
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Affiliation(s)
- P Lopez Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Flores
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D.M Gualandro
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - O Miro
- Barcelona Hospital Clinic, Emergency Department, Barcelona, Spain
| | | | - N Geigy
- University Hospital Liestal, Emergency Department, Liestal, Switzerland
| | - M Christ
- Kantonsspital Lucerne, Lucerne, Switzerland
| | - D Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - M Than
- Christchurch Hospital, Christchurch, New Zealand
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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18
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Boeddinghaus J, Meier M, Nestelberger T, Lopez-Ayala P, Ratmann P, Wussler D, Wildi K, Rubini Gimenez M, Zimmermann T, Miro O, Martin-Sanchez J, Keller D, Gualandro D, Twerenbold R, Mueller C. Clinical risk scores and integrated clinical judgment in patients with suspected acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1665] [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
Clinical risk scores are recommended for formal risk stratification in patients presenting with suspected acute coronary syndrome (ACS). It is unknown, whether these scores still provide additional value in the era of high-sensitivity cardiac troponin (hs-cTn) compared to simple integrated clinical judgment.
Purpose
To evaluate the diagnostic and prognostic performance of integrated clinical judgment compared to clinical risk scores.
Methods
We prospectively enrolled patients presenting to the emergency department with symptoms suggestive of ACS such as acute chest discomfort. The primary prognostic endpoint was the composite of 30-day major adverse cardiac events (MACE) including all-cause death, life-threatening arrhythmia, cardiogenic shock, acute myocardial infarction (AMI, including the index event), and urgent coronary revascularization and was adjudicated by two independent cardiologists. The performance of five well-established formal risk scores (T-MACS, HEART, GRACE, TIMI, and EDACS) for the prediction of 30-day MACE was directly compared with simple integrated clinical judgment for the ACS likelihood by the treating ED physician. Integrated clinical judgment was quantified using a visual analogue scale at 90 minutes after patient's presentation to the ED. The primary diagnostic endpoint was index AMI.
Results
Among 2031 patients, 417/2031 patients (20.5%) had at least one MACE within 30 days. Prognostic accuracy for 30-day MACE quantified by the area under the receiver-operating characteristics curve (AUC) was 0.87 (95% CI 0.85–0.89) for T-MACS, 0.87 (95% CI 0.85–0.89) for HEART, 0.84 (95% CI 0.82–0.86) for GRACE, 0.81 (95% CI 0.79–0.83) for TIMI, 0.75 (95% CI 0.73–0.78) for EDACS, versus 0.89 (95% CI 0.87–0.91) for simple integrated clinical judgment (p<0.01 versus GRACE, TIMI, and EDACS; Figure 1). Similarly, diagnostic accuracy was 0.92 (95% CI 0.90–0.94) for T-MACS, 0.89 (95% CI 0.87–0.90) for HEART, 0.88 (95% CI 0.86–0.89) for GRACE, 0.80 (95% CI 0.78–0.82) for TIMI, 0.74 (95% CI 0.72–0.77) for EDACS, versus 0.89 (95% CI 0.88–0.91) for simple integrated clinical judgment (p<0.01 versus GRACE, TIMI, and EDACS).
Conclusion
None of the formal clinical risk scores outperformed simple integrated clinical judgment for ACS in the prediction of 30-day MACE or the diagnosis of AMI. Therefore, in the era of hs-cTn testing as part of integrated clinical judgment, clinical risk scores seem to no longer provide incremental value.
Figure 1. Diagnostic accuracy for MACE at 30-days
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Meier
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P Lopez-Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P.D Ratmann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - K Wildi
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Rubini Gimenez
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | | | - D.I Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - D.M Gualandro
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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19
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Belkin M, Wussler D, Strebel I, Michou E, Kozhuharov N, Sabti Z, Nowak A, Flores D, Nestelberger T, Walter J, Boeddinghaus J, Zimmermann T, Koechlin L, Breidthardt T, Mueller C. Prognostic value of health-related quality of life in patients with acute dyspnea. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1186] [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
Previous studies have shown the prognostic value of health-related quality of life (HRQL) in stable and ambulatory chronic heart failure patients. However, it is unknown whether HRQL can predict all-cause mortality in patients presenting to the emergency department (ED) after acute onset of symptoms. In order to address this unmet need, the aim of this study was to assess the prognostic value of HRQL in patients with acute dyspnea caused by acute heart failure (AHF) and other dyspnea aetiologies for 360-day mortality.
Purpose
To assess prognostic value of HRQL using the generic EQ-5D and visual analogue scale (EQ VAS) in patients with acute dyspnea.
Methods
Basics in Acute Shortness of Breath EvaLuation (BASEL V) is a prospective, multicenter, diagnostic study enrolling adult patients presenting with acute dyspnea to the ED. For this analysis, only patients with a complete set of variables necessary for calculation of EQ-5D (range 0–10; with higher score indicating worse HRQL) and EQ VAS (range 0–100; with 100 being the best imaginable health state) at baseline were included. The endpoint was the prognostic value of EQ-5D and EQ VAS at 360 days of follow-up regarding all-cause death. Prognostic accuracy was calculated using c-statistics. In a cox regression analysis EQ-5D was treated as both, a continuous and categorical variable. Adjustments were made for clinically relevant covariates (age, sex, orthopnoea, edema, level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) at presentation, history of coronary artery disease and chronic obstructive pulmonary disease, diuretics, β-blockers and ACE-inhibitors at discharge).
Results
Among 2605 patients enrolled, 1141 (43,8%) had a complete set of variables allowing the calculation of EQ-5D and EQ VAS. Of these patients 594 (52.1%) had an adjudicated final diagnosis of AHF. 211 (18.5%) patients died within 360 days of follow-up. Median EQ-5D was 3 (interquartile range (IQR) 1.5–5) and median EQ VAS was 50 (IQR 40–70). The prognostic accuracy for 360-day mortality was 0.65 (95% confidence interval ((CI) 0.61–0.69) and 0.58 (95% CI 0.54–0.62) for EQ-5D and EQ VAS, respectively (p=0.002). After combining EQ-5D and EQ VAS in a logistic regression model c-statistics regarding all-cause mortality within 360 days did not improve. The prognostic accuracy of EQ-5D was comparable to that of NT-proBNP (c-statistics 0.69, p=0.385). In an adjusted cox regression analysis the hazard ratio for patients with EQ-5D >4 was 2.2 (95% CI 1.7–2.9; p<0.001).
Conclusions
In patients presenting with acute dyspnea HRQL is a strong prognostic instrument. Independently of the aetiology of the dyspnea the prognostic value of the generic EQ-5D for 360-day mortality is comparable to NT-proBNP. Patients with an EQ-5D >4 are at significantly higher risk for mortality within 360 days.
Figure 1. Prognostic value of HRQL
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
- M Belkin
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | - E Michou
- University Hospital Basel, Basel, Switzerland
| | | | - Z Sabti
- University Hospital Basel, Basel, Switzerland
| | - A Nowak
- University Hospital Basel, Basel, Switzerland
| | - D Flores
- University Hospital Basel, Basel, Switzerland
| | | | - J Walter
- University Hospital Basel, Basel, Switzerland
| | | | | | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | | | - C Mueller
- University Hospital Basel, Basel, Switzerland
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20
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Du Fay De Lavallaz J, Zimmermann T, Badertscher P, Flores D, Widmer V, Walter J, Belkin M, Boeddinghaus J, Nestelberger T, Reichlin T, Kuehne M, Christ M, Miro O, Martin-Sanchez J, Mueller C. Validation of the FAINT risk score in a large prospective international multicenter study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0699] [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
Risk stratification of older patients presenting to the Emergency Department (ED) with syncope remains an unmet clinical need. The FAINT Score was derived in a large American cohort in an attempt to predict 30-day serious cardiac outcomes in patients >60y.o. While a FAINT score of 0 showed high sensitivity to exclude death and serious outcomes at 30 days in the derivation cohort, it remains unvalidated.
Methods
We validated the FAINT score (History of heart failure, history of arrhythmia, initial ECG result abnormal, elevate NT-proBNP, elevated hs-troponin T) in a large prospective international multicenter study recruiting patients 40 years presenting to the ED with syncope within the last 12 hours in eight countries on three continents. Main outcome measure was 30-day serious cardiac events or mortality. We assessed the performance and calibration of the FAINT score for validation and compared it to the OESIL score (Age >64y, cardiovascular disease history, syncope without prodromes, abnormal ECG).
Results
1885 patients were eligible for this validation analysis. 169 (8.9%) patients experienced 30-day serious adverse events.
A FAINT score of 0 was present for 378 patients (20% of the cohort) and allowed for a sensitivity of 0.97 to rule out adverse events and death at 30-days. A FAINT score of 0 or 1 was present for 626 patients (33% of the cohort) and allowed for a sensitivity of 0.92.
The area under the receiver operating characteristic curve (AUC) for the FAINT score was 0.75 (95%, Confidence Interval (CI) 0.72–0.79), which was comparable to the performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) or high-sensitivity Troponin T (hs-cTnT) alone, which are two biomarkers used in the FAINT score. The score did not outperform the OESIL score.
A calibration curve showed that the score was extremely well calibrated for low-risk patients.
Conclusion
This is the first validation of the FAINT score in a large international syncope cohort. The safety of a FAINT score of 0 or 1 was good and comparable to the results obtained in the derivation cohort. While the score is suitable to highlight low-risk patients and calibrates well in an external cohort, its discrimination for higher risk patients is not better than biomarkers alone or an older, less complex risk score.
Figure 1. Area under the Receiver Operating Curve (ROC) for the FAINT score and for NT-proBNP and hs-cTnT as continuous markers as well as for the OESIL score. CI = Confidence Interval.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): University Hospital Basel, Switzerland
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Affiliation(s)
| | - T Zimmermann
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - P Badertscher
- Medical University of South Carolina, Electrophysiology, Charleston, United States of America
| | - D Flores
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - V Widmer
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - M Belkin
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Internal medicine, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - M Kuehne
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Christ
- Kantonsspital Lucerne, Lucerne, Switzerland
| | - O Miro
- Barcelona Hospital Clinic, Barcelona, Spain
| | | | - C Mueller
- University Hospital Basel, Cardiology, Basel, Switzerland
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21
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Boeddinghaus J, Nestelberger T, Lopez-Ayala P, Ratmann P, Wussler D, Zimmermann T, Wildi K, Rubini Gimenez M, Miro O, Martin-Sanchez F, Keller D, Kawecki D, Gualandro D, Twerenbold R, Mueller C. Early diagnosis of myocardial infarction in patients presenting late after chest pain onset. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The European Society of Cardiology (ESC) recommends the clinical use of the 0/1h-algorithms in patients with suspected acute coronary syndrome (ACS) to rule-out or rule-in non-ST elevation myocardial infarction (NSTEMI). However, the diagnostic performance of the ESC 0/1h-algorithms was only validated in patients presenting within 12 hours after chest pain onset (=early presenters) to the emergency department (ED). To this date, evidence regarding their performance in patients with chest pain onset >12h (=late presenters) is lacking.
Purpose
To evaluate the diagnostic performance of the ESC 0/1h-algorithms in late presenters.
Methods
We prospectively enrolled patients presenting to the ED with symptoms suggestive of ACS such as acute chest discomfort. Two independent cardiologists adjudicated the final diagnoses based on all available clinical information including serial hs-cTn concentrations, follow-up information and cardiac imaging. Hs-cTnT/I concentrations at 0h and 1h were measured in a blinded fashion. The primary diagnostic endpoint was the diagnostic performance of the hs-cTnT/I ESC 0/1h-algorithms in patients presenting late after chest pain onset compared to those presenting early. Diagnostic performance was quantified by safety of rule-out (sensitivity and negative predictive value), accuracy of rule-in (specificity and positive predictive value), and efficacy (proportion of patients) classified as rule-out or rule-in within 1 hour after presentation to the ED. The primary prognostic endpoint was all-cause mortality after 30-days and two-years in patients in whom NSTEMI was ruled-out by the ESC 0/1h-algorithms.
Results
Among 4733 patients, 308/4733 (7%) presented late to the ED. The ESC hs-cTnT 0/1h-algorithm ruled-out 185/308 (60%) of late presenters with a sensitivity of 100% (95% CI, 93.7–100) and a negative predictive value (NPV) of 100% (95% CI, 98.0–100). Sixty-one of 308 (20%) were ruled-in with a specificity of 95.2 (95% CI, 91.8–97.2) and a positive predictive value (PPV) of 80.3% (95% CI, 68.7–88.4). The remaining 62/308 (20%) were classified as observe with a NSTEMI prevalence of 13%. In comparison, 59% of early presenters were ruled-out (sensitivity 99.3% [95% CI, 98.4–99.7]; NPV 99.8 [99.5–99.9]), 17% were ruled-in (specificity 96.2 [95% CI, 95.5–96.8]; PPV 81.4 [95% CI, 78.4–84.0]), and 45% were classified as observe. Late presenters in whom NSTEMI was ruled-out had 30-day and two-year survival rates of 100% and 98.2%, respectively. Similar findings were made for the ESC hs-cTnI 0/1h-algorithm.
Conclusion
The ESC hs-cTnT/I algorithms also provide excellent diagnostic performance for early triage and specifically safe rule-out of NSTEMI in patients presenting late after chest pain onset to the ED.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation, Swiss National Science Foundation
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Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P Lopez-Ayala
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P.D Ratmann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - K Wildi
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Rubini Gimenez
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | | | - D.I Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - D Kawecki
- The Medical University of Silesia, Cardiology, Zabrze, Poland
| | - D.M Gualandro
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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22
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Zimmermann T, Du Fay De Lavallaz J, Nestelberger T, Gualandro D, Badertscher P, Lopez-Ayala P, Widmer V, Freese M, Twerenbold R, Wussler D, Koechlin L, Walter J, Kuehne M, Reichlin T, Mueller C. Incidence, characteristics, determinants and prognostic impact of recurrent syncope. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence, characteristics, determinants, and prognostic impact of recurrent syncope are largely unknown, causing uncertainty for both patients and physicians.
Methods
We characterized recurrent syncope including sex-specific aspects and its impact on death and major adverse cardiovascular events (MACE) in a large prospective international multicenter study enrolling patients ≥40 years presenting with syncope to the emergency department (ED). Syncope etiology was centrally adjudicated by two independent and blinded cardiologists using all information becoming available during syncope work-up and 12-month follow-up. MACE were defined as a composite of all-cause death, acute myocardial infarction, surgical or percutaneous coronary intervention, life-threatening arrhythmia including cardiac arrest, pacemaker or implantable cardioverter defibrillator implantation, valve intervention, heart-failure, gastrointestinal bleeding or other bleeding requiring transfusion, intracranial hemorrhage, ischemic stroke or transient ischemic attack, sepsis and pulmonary embolism.
Results
Incidence of recurrent syncope among 1790 patients was 20% (95%-confidence interval (CI) 18% to 22%) within 24 months. Patients with an adjudicated final diagnosis of cardiac syncope (hazard ratio (HR) 1.50, 95%-CI 1.11 to 2.01) or syncope of unknown etiology even after central adjudication (HR 2.11, 95%-CI 1.54 to 2.89) had an increased risk for syncope recurrence (Figure). LASSO regression fit on all patient information available early in the ED identified more than three previous episodes of syncope as the only independent predictor for recurrent syncope (HR 2.13, 95%-CI 1.64 to 2.75). Recurrent syncope within the first 12 months after the index event carried an increased risk for all-cause death (HR 1.59, 95%-CI 1.06 to 2.38) and MACE (HR 2.24, 95%-CI 1.67 to 3.01), whereas recurrences after 12 months did not have a significant impact on outcome measures.
Conclusion
Recurrence rates of syncope are substantial and vary depending on syncope etiology. There seem to be no reliable patient characteristics available early on the ED that allow for the prediction of recurrent syncope with only a history of more than three previous syncope being associated with a higher risk for future recurrences. Importantly, recurrent syncope within the first 12 months carries an increased risk for death and MACE.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation
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Affiliation(s)
| | | | | | - D Gualandro
- University Hospital Basel, Basel, Switzerland
| | | | | | - V Widmer
- University Hospital Basel, Basel, Switzerland
| | - M Freese
- University Hospital Basel, Basel, Switzerland
| | | | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Walter
- University Hospital Basel, Basel, Switzerland
| | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Inselspital, Department of Cardiology, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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23
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Zimmermann T, Mohamed AF, Reese A, Wieser ME, Kleeberg U, Pröfrock D, Irrgeher J. Zinc isotopic variation of water and surface sediments from the German Elbe River. Sci Total Environ 2020; 707:135219. [PMID: 31869611 DOI: 10.1016/j.scitotenv.2019.135219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
Recent studies suggested the use of the isotopic composition of Zn as a possible tracer for anthropogenic Zn emissions. Nevertheless, studies mainly focused on sampling areas of a few km2 with well-characterized anthropogenic Zn emissions. In contrast, this study focused on analyzing a large sample set of water and sediment samples taken throughout the course of the Elbe River, a large, anthropogenically impacted river system located in Central Europe. The primary objective was to evaluate the use of the isotopic composition of Zn to trace anthropogenic Zn emission on a large regional scale. In total 18 water and 26 surface sediment samples were investigated, covering the complete course of over 700 km of the German Elbe between the German/Czech border and the German North Sea, including six tributaries. Stable isotope abundance ratios of Zn were assessed by multi-collector inductively coupled plasma mass spectrometry (MC ICP-MS) in water filtrates (<0.45 µm) and total digests of the sieved surface sediment fraction (<63 µm) after analyte/matrix separation using Bio-Rad AG MP-1 resin via a micro-column approach and application of a 64Zn/67Zn double spike. Measured isotopic compositions of δ66Zn/64ZnIRMM-3702 ranged from -0.10 ‰ to 0.32 ‰ for sediment samples, and from -0.51 ‰ to 0.45 ‰ for water samples. In comparison to historical data some tributaries still feature high mass fractions of anthropogenic Zn (e.g. Mulde, Triebisch) combined with δ66Zn/64ZnIRMM-3702 values higher than the lithogenic background. The dissolved δ66Zn/64ZnIRMM-3702 values showed a potential correlation with pH. Our results indicate that biogeochemical processes like absorption may play a key role in natural Zn isotopic fractionation making it difficult to distinguish between natural and anthropogenic processes.
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Affiliation(s)
- T Zimmermann
- Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck Str. 1, 21502 Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
| | - A F Mohamed
- University of Calgary, Department of Physics and Astronomy, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - A Reese
- Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck Str. 1, 21502 Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
| | - M E Wieser
- University of Calgary, Department of Physics and Astronomy, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - U Kleeberg
- Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck Str. 1, 21502 Geesthacht, Germany
| | - D Pröfrock
- Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck Str. 1, 21502 Geesthacht, Germany.
| | - J Irrgeher
- Helmholtz-Zentrum Geesthacht, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck Str. 1, 21502 Geesthacht, Germany; University of Calgary, Department of Physics and Astronomy, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
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24
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Darstein F, Häuser F, Mittler J, Zimmermann A, Lautem A, Hoppe-Lotichius M, Otto G, Lang H, Galle PR, Zimmermann T. Hepatitis E Is a Rare Finding in Liver Transplant Patients With Chronic Elevated Liver Enzymes and Biopsy-Proven Acute Rejection. Transplant Proc 2020; 52:926-931. [PMID: 32139278 DOI: 10.1016/j.transproceed.2020.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/17/2019] [Accepted: 01/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In past decades, liver transplant (LT) patients were not routinely screened for hepatitis E virus (HEV) infection, and thus it might have been misdiagnosed as an acute rejection episode. Our aim was to analyze a real-world cohort of LT patients who presented with at least 1 episode of biopsy-proven acute rejection (BPAR) and suffered from persistent elevated transaminases, to evaluate the frequency of HEV infection misdiagnosed as a rejection episode. METHODS Data from 306 patients transplanted between 1997 and 2017, including 565 liver biopsies, were analyzed. Biopsies from patients suffering from hepatitis C (n = 79; 25.8%) and from patients who presented with a Rejection Activity Index <5 (n = 134; 43.8%) were excluded. A subgroup of 74 patients (with 134 BPAR) with persistently elevated liver enzymes was chosen for further HEV testing. RESULTS Positive HEV IgG was detectable in 18 of 73 patients (24.7%). Positive HEV RNA was diagnosed in 3 of 73 patients with BPAR (4.1%). Patients with HEV infection showed no difference in etiology of the liver disease, type of immunosuppression, or median Rejection Activity Index. CONCLUSION Few HEV infections were misdiagnosed as acute rejection episodes in this real-world cohort. Thus, HEV infection is an infrequent diagnosis in cases with persistent elevated liver enzymes and BPAR after LT.
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Affiliation(s)
- F Darstein
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany.
| | - F Häuser
- Institute for Clinical Chemistry and Laboratory Medicine, Universitätsmedizin Mainz, Mainz, Germany
| | - J Mittler
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - A Zimmermann
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany
| | - A Lautem
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - M Hoppe-Lotichius
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - G Otto
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - H Lang
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - P R Galle
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany
| | - T Zimmermann
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany
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25
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Graif A, Scott A, Zimmermann T, Kimbiris G, Grilli C, Putnam S, Paik H, Nwosu U, Leung D. 4:12 PM Abstract No. 263 Temporal analysis of heart rate during catheter-directed thrombolysis for acute pulmonary embolism. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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26
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Schettler VJJ, Neumann CL, Peter C, Zimmermann T, Julius U, Hohenstein B, Roeseler E, Heigl F, Grützmacher P, Blume H, Klingel R, Vogt A. Lipoprotein apheresis is an optimal therapeutic option to reduce increased Lp(a) levels. Clin Res Cardiol Suppl 2019; 14:33-38. [PMID: 30838552 DOI: 10.1007/s11789-019-00094-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease (CVD) and is associated with the induction and sustaining of atherosclerotic cardiovascular diseases (ASCVD). Since 2008 Lp(a) along with progressive CVD has been approved as an indication for regular lipoprotein apheresis (LA) in Germany. The German Lipoprotein Apheresis Registry (GLAR) has been initiated to provide statistical evidence for the assessment of extracorporeal procedures to treat dyslipidemia for both LDL-cholesterol (LDL-C) and Lp(a). The GLAR now allows prospective investigations over a 5-year period about annual incidence rates of cardiovascular events. Here Lp(a) patients (LDL-C < 100 mg/dl; Lp(a) > 60 mg/dl or >120 nmol/l) showed the same reduction of major coronary (83%) and non-coronary events (63%) as had been formerly shown in the Pro(a)LiFe study. However, Lp(a) is not only an apolipoprotein(a) (apo(a)) and LDL-C containing particle, which is covalently bound to a LDL-C core by a disulphide bridge. The composition of this particle, inter alia containing oxidized phospholipids, gives pro-atherosclerotic, pro-inflammatory, and pro-thrombotic properties, inducing atherosclerotic processes mainly in the arterial wall. However, recent investigations have shown that a reduction of inflammatory settings without LDL-C or Lp(a) reduction may reduce ASCVD events. Lipoprotein apheresis (LA) could not only reduce LDL-C and Lp(a) in parallel, but also different inflammatory and coagulation parameters. In summary lipoprotein apheresis is not only anti-atherosclerotic, but also anti-inflammatory and anti-thrombotic and therefore an ideal treatment option with respect to the shown reduction of major adverse coronary events (MACE) and major adverse non-coronary events (MANCE) by reducing Lp(a) levels.
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Affiliation(s)
- V J J Schettler
- Center of Nephrology Göttingen GbR, An der Lutter 24, 37075, Göttingen, Germany.
| | - C L Neumann
- BRAVE-Benefit for Research on Arterial Hypertension, Dyslipidemia and Vascular Risk and Education e. V, Göttingen, Germany
| | - C Peter
- BioArtProducts GmbH (B.A.P.), Rostock, Germany
| | | | - U Julius
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B Hohenstein
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - E Roeseler
- Center for Nephrology, Hypertension, and Metabolic Diseases, Hanover, Germany
| | - F Heigl
- Medical Care Centre Kempten-Allgäu, Kempten, Germany
| | - P Grützmacher
- Department of Medicine II for Nephrology, Hypertension and Vascular Risks, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - H Blume
- Scientific Institute for Nephrology (WiNe), Düsseldorf, Germany
| | - R Klingel
- Apheresis Research Institute, Stadtwaldgürtel 77, 50935, Cologne, Germany
| | - A Vogt
- Medizinische Klinik und Poliklinik 4, Universität München, Munich, Germany
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27
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Boeddinghaus J, Nestelberger T, Twerenbold R, Koechlin L, Wussler D, Badertscher P, Puelacher C, Du Fay De Lavallaz J, Rubini Gimenez M, Zimmermann T, Miro O, Martin-Sanchez FJ, Keller DI, Reichlin T, Mueller C. 3301A novel high-sensitivity cardiac troponin i assay for early diagnosis of acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lately, the novel high-sensitivity cardiac troponin I (hs-cTnI) Access assay was developed. Its clinical performance in patients presenting with chest pain to the emergency department (ED) is unknown.
Purpose
To clinically validate the novel hs-cTnI-Access assay and to derive and validate an assay specific 0/1h-algorithm accordingly to the European Society of Cardiology (ESC) recommendations.
Methods
In a prospective international multicentre study we enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by two independent cardiologists including all clinical information including cardiac imaging twice: first, using serial hs-cTnT (Elecsys, primary analysis) and second, using hs-cTnI (Architect, secondary analysis) measurements in addition to the clinically used (hs)-cTn. Hs-cTnI-Access was measured at presentation and at 1h. Primary objective was a direct comparison of diagnostic accuracy as quantified by the area under the receiver-operating-characteristic curve (AUC) of hs-cTnI-Access versus the two established hs-cTn assays (hs-cTnT-Elecsys, hs-cTnI-Architect). Secondary objectives included the derivation and internal validation of an hs-cTnI-Access specific 0/1h-algorithm.
Results
AMI was the adjudicated final diagnosis in 243/1579 (15.4%) patients. The AUC at presentation for hs-cTnI-Access was 0.95 (95% CI, 0.94–0.96), significantly higher as hs-cTnI-Architect (0.92 [95% CI, 0.91–0.94; p<0.001]), and comparable to hs-cTnT-Elecsys (0.94 [95% CI, 0.93–0.95; p=0.12]) Applying the derived hs-cTnI-Access 0/1h-algorithm (derivation cohort n=686) to the internal validation cohort (n=680), 60% of patients were ruled-out (sensitivity 98.9% [95% CI, 94.3–99.8]), and 15% of patients were ruled-in (specificity 95.9% [95% CI, 94.0–97.2]). Patients ruled-out by the 0/1h-algorithm had a survival rate of of 100% after 30-days and 98.4% after two years of follow up. Findings were confirmed in the secondary analyses using the adjudication including serial measurements of hs-cTnI (Architect).
Performance of the 0/1h-algorithm
Conclusions
Diagnostic accuracy of the novel hs-cTnI-Access assay is excellent and at least comparable to the two established hs-cTn assays. The assay-specific 0/1h-algorithm allows a safe rule-out and accurate rule-in of MI in about 75% of patients within 1-hour after presentation to the ED. Survival of patients ruled-out by the 0/1h-algorithm was very high.
Acknowledgement/Funding
Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union, the Stiftung für kardiovaskuläre Forschung Basel
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Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Rubini Gimenez
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | | | - D I Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - T Reichlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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28
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Youssef S, Bayan S, Ekbom D, Lohse C, Zimmermann T, Pittelko R, Orbelo DM. Breathiness and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) in Patients Undergoing Medialization Laryngoplasty With or Without Arytenoid Adduction. J Voice 2019; 35:312-316. [PMID: 31606224 DOI: 10.1016/j.jvoice.2019.08.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We hypothesized that, in patients with unilateral vocal fold paralysis (UVFP), the auditory-perception of breathiness measured with Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) would be higher preoperatively in patients who undergo medialization laryngoplasty (ML) with arytenoid adduction (AA) compared to ML alone. We further hypothesized that increased breathiness would correlate with increased glottal area at maximum glottal closure. STUDY DESIGN Retrospective chart review. METHODS CAPE-V recordings were rated by expert judges in 105 subjects with UVFP (47 ML+AA and 58 ML). Component scores of the CAPE-V prior to laryngeal framework surgery and those at 3 and/or 12 months postoperatively were compared. Assessment of glottal area width during maximum glottal closure was attempted. RESULTS Breathiness scores prior to laryngeal framework surgery were significantly greater in UVFP patients having ML+AA compared to ML only (P < 0.001). Roughness was greater for ML only (P = 0.003). At 3 months, adjusted for age and previous injection laryngoplasty, the ML+AA group showed greater improvement for breathiness (P <0.001), loudness (P < 0.001), strain (P = 0.037), and pitch (P = 0.039), while the ML only group showed greater improvement in roughness (P = 0.009). Results were similar at 12 months. Only 26% of glottal area widths were ratable using methods previously described; therefore, no further analysis was attempted. CONCLUSIONS In patients with UVFP baseline perception of breathiness is greater in those clinically selected for ML+AA compared to ML only. Glottal area measurements were not representative of the UVFP cohort and more stringent criteria are needed for valid and reliable glottal area assessment when using clinical flexible stroboscopic exams. Findings support the idea that surgeons may be making decisions about AA based, to at least some degree, on auditory perceptual evaluation of voice.
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Affiliation(s)
| | - Semirra Bayan
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Dale Ekbom
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota
| | - Christine Lohse
- Mayo Clinic Division of Biomedical Statistics and Informatics, Rochester, Minnesota
| | | | | | - Diana M Orbelo
- Mayo Clinic Department of Otolaryngology, Rochester, Minnesota.
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29
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Hildebrandt L, Voigt N, Zimmermann T, Reese A, Proefrock D. Evaluation of continuous flow centrifugation as an alternative technique to sample microplastic from water bodies. Mar Environ Res 2019; 151:104768. [PMID: 31519451 DOI: 10.1016/j.marenvres.2019.104768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
The scientific and public interest regarding environmental pollution with microplastic has considerably increased within the last 15 years. Nevertheless, up to now there is no widely applied standard operation procedure for microplastic sampling, resulting in a lack of inter-study comparability. In addition, many studies on microplastic occurrences do not indicate a sound methodological validation of the applied methods and procedures. This study presents an alternative volume-reduced sampling technique to sample the entire load of suspended particulate matter including microplastic particles in natural waters, based on continuous flow centrifugation. For the lab-scale validation of the proposed instrumental setup, six different microplastic types (PE, PET, PS, PVDC, EPS and PP) were used. The particles covered a size range from 1 μm to 1 mm and a density range from 0.94 g mL-1 to 1.63 g mL-1. Recoveries ranged from 95.0% ± 2.3% - 99.1% ± 0.3% for virgin powders and from 96.1% ± 0.6% - 99.4% ± 0.2% (1 SD, n = 2 - 3) for microplastic suspended in river water for 40 days. Gravimetric and microscopic analysis of the effluent indicates efficient removal of microplastic from the suspensions. Static light scattering analysis of the microplastic suspensions prior to and after centrifugation confirmed that no change of the particle size distribution has occurred - neither through aggregation nor through size-discrimination during centrifugation. Moreover, the system was tested in the field and used twice to sample suspended particulate matter from the Elbe estuary directly on site. Based on these first lab-scale experiments, continuous flow centrifugation proves a promising technique bearing potential to alleviate drawbacks such as contamination, filter clogging and particle size-discrimination of commonly used volume-reduced microplastic sampling approaches.
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Affiliation(s)
- L Hildebrandt
- Helmholtz-Zentrum Geesthacht, Centre for Materials and Coastal Research, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck-Str. 1, 21502, Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany
| | - N Voigt
- Helmholtz-Zentrum Geesthacht, Centre for Materials and Coastal Research, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck-Str. 1, 21502, Geesthacht, Germany
| | - T Zimmermann
- Helmholtz-Zentrum Geesthacht, Centre for Materials and Coastal Research, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck-Str. 1, 21502, Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany
| | - A Reese
- Helmholtz-Zentrum Geesthacht, Centre for Materials and Coastal Research, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck-Str. 1, 21502, Geesthacht, Germany; Universität Hamburg, Department of Chemistry, Inorganic and Applied Chemistry, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany
| | - D Proefrock
- Helmholtz-Zentrum Geesthacht, Centre for Materials and Coastal Research, Institute of Coastal Research, Marine Bioanalytical Chemistry, Max-Planck-Str. 1, 21502, Geesthacht, Germany.
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30
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Zimmermann T, Du Fay De Lavallaz J, Badertscher P, Puelacher C, Nestelberger T, Boeddinghaus J, Walter JE, Wussler D, Twerenbold R, Kuehne M, Reichlin T, Mueller C. P5673Combination of high-sensitivity cardiac troponin and B-Type natriuretic peptide (BNP) for diagnosis and risk-stratification of syncope. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0615] [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
While high-sensitivity cardiac troponin (hs-cTn) and B-Type natriuretic peptide (BNP) have been assessed separately for the diagnosis and risk-stratification of patients with syncope, their combined accuracy is unknown.
Methods
We assessed the diagnostic and prognostic accuracy of the combination of hs-cTnI and BNP in a prospective international multicenter study enrolling patients 40 years and older presenting with syncope to the emergency department (ED). Hs-cTnI (Architect) and BNP (Architect) concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by two independent physicians using all available clinical information including one year follow-up, was the diagnostic endpoint. MACE were defined as death, resuscitation, life-threatening arrhythmia, implantation of a pacemaker or implantable cardioverter defibrillator (ICD), acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack (TIA), intracranial bleeding or valvular intervention. Patients were classified in three risk groups (low (<10%), medium (10–30%), high (>30%)) for cardiac syncope based on hs-cTnI and BNP levels.
Results
Among 1533 patients, cardiac syncope was the adjudicated final diagnosis in 233 (15.2%). Hs-cTnI and BNP concentrations both remained independent predictors of cardiac syncope in multivariable models. The diagnostic accuracy of the combination hs-cTnI/BNP for cardiac syncope was good with an area under the curve (AUC) of 0.81 (95%-CI 0.78–0.84) and significantly better than each biomarker separately or a set of clinical variables (each p<0.001). The classification of patients in three risk groups, depending on the probability for cardiac syncope based on their hs-cTnI and BNP values, translated well in predictions for MACE (AUC 0.79, 95%-CI 0.77–0.82) and death (AUC 0.78, 95%-CI 0.74–0.82) at 2 years follow-up. Based on these results, we designed a visual tool allowing convenient patient-specific diagnostic and prognostic risk evaluation based solely on hs-cTnI and BNP concentrations (Figure).
Risk stratification based on hs-cTnI/BNP
Conclusion
The combination hs-cTnI/BNP may have clinical utility in patients presenting to the ED with syncope as it allows good diagnostic as well as prognostic discrimination.
Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel
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Affiliation(s)
| | | | | | - C Puelacher
- University Hospital Basel, Basel, Switzerland
| | | | | | - J E Walter
- University Hospital Basel, Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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31
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Walter JE, Amrein M, Koechlin L, Du Fay De Lavallaz J, Zimmermann T, Twerenbold R, Mueller C. P6436Soluble urokinase plasminogen activator receptor and functionally relevant coronary artery disease: a prospective cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1030] [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
The urokinase system is pivotal in the pathogenesis of atherosclerosis. Therefore, soluble urokinase plasminogen activator receptor (suPAR) concentrations may help in the detection of functionally relevant coronary artery disease (fCAD).
Purpose
To evaluate suPAR as diagnostic marker for fCAD.
Methods
Among consecutive patients with symptoms suggestive of fCAD, fCAD was adjudicated blinded to suPAR concentrations in two domains: first, diagnosis of fCAD according to myocardial perfusion single photon emission tomography (MPI-SPECT) and coronary angiography; second, fCAD according to cardiovascular death, non-fatal acute myocardial infarction (AMI) and all-cause death during 2-year follow-up.
Results
Among 968 patients, symptoms were adjudicated to be causally related to fCAD in 26% (255/968). SuPAR concentrations were higher in patients with fCAD as compared to those without (3.45 ng/mL versus 3.20 ng/mL, p=0.007), but overall had only low diagnostic accuracy (area under the curve [AUC]: 0.56, 95% CI 0.52–0.60) and were not independent predictors of fCAD after multivariable adjustment. Circulating suPAR concentrations were modestly correlated with high-sensitivity cardiac troponin (hs-cTn) T (Spearman's rho 0.393, p<0.001), NT-proBNP (Spearman's rho 0.327, p<0.001) and age (Spearman's rho 0.364, p<0.001), but only weakly correlated with the extent of coronary atherosclerosis as quantified by perfusion defects (Spearman's rho 0.123, p<0.001). Prognostically, suPAR concentrations had moderate-to-high accuracy in the prediction of cardiovascular death (AUC 0.72, 95% CI 0.62–0.81) and all-cause death (AUC 0.72, 95% CI 0.65–0.79) at 2-years, and remained a significant predictor for all-cause death after multivariable adjustment (p=0.001). SuPAR concentrations did not predict non-fatal AMI.
Conclusions
SuPAR is an independent predictor of death, but not helpful in the detection of fCAD.
Acknowledgement/Funding
European Union, Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel,
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Affiliation(s)
- J E Walter
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - M Amrein
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
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32
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Zimmermann T, Du Fay De Lavallaz J, Walter JE, Strebel I, Nestelberger T, Badertscher P, Boeddinghaus J, Twerenbold R, Koechlin L, Lohrmann J, Steude JS, Gualandro DM, Kuehne M, Reichlin T, Mueller C. 2409ALERT-CS - Development of an ECG-based cardiac syncope risk calculator. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Syncope is a common symptom with rising incidence, often leading to emergency department (ED) visits. Early determination of diagnosis is often difficult in patients with syncope and there is an unmet clinical need for tools that can support physicians in their decision making. We hypothesized that an electrocardiogram (ECG)-based cardiac syncope risk calculator might create a simple and attractive clinical decision tool for the diagnosis and risk stratification of patients with syncope.
Methods
Based on a large prospective diagnostic international multicenter study enrolling patients who presented to the ED with syncope, we derived a cardiac syncope risk calculator by penalized stepwise backward-selection and multivariable logistic regression utilizing predefined ECG criteria. Primary diagnostic endpoint was cardiac syncope, as adjudicated by two independent physicians taking into account all available information including cardiac work-up and 12-month follow-up. Major adverse cardiac events (MACE) including life-threatening arrhythmias, myocardial infarction, pulmonary embolism, stroke, transient ischemic attack, valvular surgery, and death within 30 days were the prognostic endpoint.
Results
Median age in our cohort was 71 years and 40% of patients were women. Of all 2007 patients enrolled, 1696 patients were eligible for the prognostic analysis and 1550 patients were eligible for the diagnostic analysis.
We identified seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) as significant predictors for cardiac syncope and combined them into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy for cardiac syncope, as quantified by the area under the receiver operating characteristic curve (AUC), was high (AUC 0.80, 95%-confidence interval (CI) 0.77 to 0.83), and significantly higher compared to that of the EGSYS score (AUC 0.73, 95%-CI 0.70 to 0.76, p<0.001). Prognostic verification of the ALERT-CS to predict 30-day overall MACE showed similar accuracy (AUC 0.75, 95%-CI 0.71 to 0.79).
Comparison of diagnostic discrimination
Conclusion
Combining seven ECG criteria within a simple risk calculator for cardiac syncope may aid physicians in the diagnosis and risk stratification of patients presenting to the ED with syncope.
Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel
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Affiliation(s)
| | | | - J E Walter
- University Hospital Basel, Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Basel, Switzerland
| | | | | | | | | | - L Koechlin
- University Hospital Basel, Basel, Switzerland
| | - J Lohrmann
- University Hospital Basel, Basel, Switzerland
| | - J S Steude
- University Hospital Basel, Basel, Switzerland
| | | | - M Kuehne
- University Hospital Basel, Basel, Switzerland
| | - T Reichlin
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - C Mueller
- University Hospital Basel, Basel, Switzerland
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Koechlin L, Strebel I, Boeddinghaus J, Nestelberger T, Wussler D, Walter J, Zimmermann T, Badertscher P, Wildi K, Puelacher C, Du Fay De Lavallaz J, Rubini Gimenez M, Reichlin T, Twerenbold R, Mueller C. P1765Hyperacute T-wave in the early diagnosis of acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The clinical significance of prominent T-waves, also referred as hyperacute T-waves, in the early diagnosis of acute myocardial infarction (AMI) is unknown.
Purpose
To evaluate the clinical utility of hyperacute T-waves in the early diagnosis of AMI.
Methods
In a prospective diagnostic study enrolling patients presenting to the emergency department (ED) with symptoms suggestive of AMI, final diagnoses were adjudicated by two independent cardiologists based on clinical information including cardiac imaging. Electronic electrocardiogram data were available in 2946 consecutive patients. Patients with left ventricular hypertrophy, complete left bundle branch block or pacemaker were excluded from further analysis. In the remaining 2382 patients, the T-wave amplitude was automatically derived from the standard 10 seconds 12-lead ECG recorded at presentation to the ED using an established algorithm.
Results
Median (IQR) time from chest pain onset (CPO) to ED presentation was 5 (IQR [2.5, 12.2]) hours. A total of 219 patients (9%) presented to the ED within 1h or less from CPO. AMI was the final diagnosis in 18% (NSTEMI in 15%, STEMI in 3%) of patients. High T-wave amplitude in leads AVF, III and V1 were associated with AMI. Optimal cut-offs were derived to achieve a predefined positive predictive value (PPV) of at least 75%. These criteria were 473mV, 357mV and 483mV for AVF, III and V1, respectively. With these cut-offs 1.4%, 4.2% and 0.9% of all patients with AMI were detected and specificity was 99.9% (95% CI [99.7%, 100%]), 99.7% (95% CI [99.4%, 99.9%]) and 99.9% (95% CI [99.8%, 100%]). However, majority of the patients with AMI correctly identified by the hyperacute T-wave had also significant ST-element elevations (AVF: 5 out of 6; [83.3%]; III: 10 out of 18 [56%]; V1:1 out of 4; [25%]).
Conclusion
In patients presenting to the ED with symptoms suggestive of AMI, only leads AVF, III and V1 showed hyperacute T-waves with high PPV. However, incidence of this finding is very low. In addition, majority of the cases correctly identified by hyperacute T-waves also had concomitant ST-segment elevations. Therefore, hyperacute T-waves have only very limited utility in the early diagnosis of AMI in the ED.
Acknowledgement/Funding
Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union,the Stiftung für kardiovaskuläre Forschung Basel
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Affiliation(s)
- L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - I Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Walter
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - P Badertscher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - K Wildi
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Rubini Gimenez
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Reichlin
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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34
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Boeddinghaus J, Twerenbold R, Nestelberger T, Koechlin L, Wussler D, Wildi K, Puelacher C, Du Fay De Lavallaz J, Rubini Gimenez M, Walter JE, Zimmermann T, Miro O, Martin-Sanchez FJ, Keller DI, Mueller C. 3305Validation of a novel high-sensitivity cardiac troponin i assay for early diagnosis of acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0069] [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
The novel high-sensitivity cardiac troponin I (hs-cTnI)-Vitros assay was developed recently. Before its possible implementation into routine clinical care for triage of chest pain patients, its performance needs clinical validation.
Purpose
To clinically validate hs-cTnI-Vitros and to derive and validate an assay-specific 0/1h-algorithm following the European Society of Cardiology (ESC) recommendations.
Methods
In a prospective international multicentre study (12 centres in 5 European countries) we enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI). Final diagnoses were centrally adjudicated by two independent cardiologists including all clinical information including cardiac imaging twice: first, using serial hs-cTnT (Elecsys, primary analysis) and second, using hs-cTnI (Architect, secondary analysis) measurements in addition to the clinically used (hs)-cTn. Hs-cTnI-Vitros was measured at presentation and at 1h in a blinded fashion. Primary objective was direct comparison of diagnostic accuracy as quantified by the area under the receiver-operating-characteristic curve (AUC) of hs-cTnI-Vitros versus the two established hs-cTn assays (hs-cTnT-Elecsys, hs-cTnI-Architect). Secondary objectives included the derivation and validation of a hs-cTnI-Vitros specific 0/1h-algorithm.
Results
AMI was the adjudicated final diagnosis in 158/1231 (13%) patients. The AUC at presentation for hs-cTnI-Vitros was 0.95 (95% CI, 0.93–0.96), and significantly higher as hs-cTnT-Elecsys (0.94 [95% CI, 0.92–0.95; p=0.01]) and hs-cTnI-Architect (0.92 [95% CI, 0.90–0.94; p<0.001]). Applying the derived hs-cTnI-Vitros 0/1h-algorithm (derivation cohort n=519) to the validation cohort (n=520), 53% of patients were ruled-out (sensitivity 100% [95% CI, 98.6–100]), and 14% of patients were ruled-in (specificity 95.6% [95% CI, 93.4–97.2]). Patients ruled-out by the 0/1h-algorithm had a survival rate of 99.8% at 30-days and 98.7% at 2-years. Findings were confirmed in the secondary analyses using the adjudication including serial measurements of hs-cTnI (Architect).
ROC Curves for the 3 hs-cTn assays at 0h
Conclusions
The novel hs-cTnI-Vitros assay has even higher diagnostic accuracy as the current gold-standards hs-cTnT and hs-cTnI. The hs-cTnI-Vitros specific 0/1h-algorithms allows a safe rule-out and accurate rule-in of AMI in about 70% of patients within 1h after presentation to the ED.
Acknowledgement/Funding
Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union, the Stiftung für kardiovaskuläre Forschung Basel
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Affiliation(s)
- J Boeddinghaus
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - R Twerenbold
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Nestelberger
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - L Koechlin
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - D Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - K Wildi
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - C Puelacher
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J Du Fay De Lavallaz
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - M Rubini Gimenez
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - J E Walter
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - T Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
| | - O Miro
- Hospital Clinic de Barcelona, Emergency Department, Barcelona, Spain
| | | | - D I Keller
- University Hospital Zurich, Emergency Department, Zurich, Switzerland
| | - C Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel (CRIB), Basel, Switzerland
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Sütel M, Schwitalla A, Zimmermann T, Müller WD. An innovative method for in-situ composition analysis of fixed metallic dental restorations. Dent Mater 2019; 35:709-712. [PMID: 30846373 DOI: 10.1016/j.dental.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/07/2019] [Indexed: 01/29/2023]
Abstract
Dental restorations made from alloys corrode during their service time. In cases of suspected toxic or allergic reactions to the corrosion products, the composition of the intraoral dental restorations has to be determined. The sample materials can be obtained intra-orally in a non-destructive manner using the chipping test. Metallic shavings are extracted with the aid of a dental stone and graphite carrier platelet, which is then transferred to an electron microscope for electro dispersive X-ray (EDX) analysis. The chipping test suffers from a rather complicated and error-prone procedure of obtaining and transferring the samples. OBJECTIVE The objective of the present study was the validation of a simplified method for non-destructive in-situ extraction of dental alloy samples, using a newly developed dental bur made from carbon fiber reinforced polyether ether ketone (PEEK), which at the same time serves as an electrically conductive sample carrier for EDX analysis. METHODS Fifteen burs for dental hand pieces were manufactured from carbon fiber reinforced PEEK, using two formulations. The burs were passed over precious and non-precious dental alloys with different rotation speeds. The alloy samples embedded in the burs were analyzed using EDX and compared to a control. RESULTS The burs manufactured from PEEK containing 30% short carbon fibers proved sufficiently robust for sample extraction even from the harder non-precious metals. The results of EDX analysis were in accordance with the control,no statistical significant differences, free of contamination, and were not affected by rotation speed,higher as 20%. SIGNIFICANCE The proposed method is valid, practical and constitutes an improvement over the traditional chipping test.
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Affiliation(s)
- M Sütel
- CharitéCenter 3 of Dental and Craniofacial Sciences (CC3), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauserstr. 4-6, 14197 Berlin
| | - A Schwitalla
- CharitéCenter 3 of Dental and Craniofacial Sciences (CC3), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauserstr. 4-6, 14197 Berlin
| | - T Zimmermann
- CharitéCenter 3 of Dental and Craniofacial Sciences (CC3), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauserstr. 4-6, 14197 Berlin
| | - W D Müller
- CharitéCenter 3 of Dental and Craniofacial Sciences (CC3), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauserstr. 4-6, 14197 Berlin.
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Riecke K, Chattopadhyay N, Ligges S, Zimmermann T, Kohnke A, Halabi A, Schultze-Mosgau M. Safety and pharmacokinetics (PK) of the progesterone receptor modulator vilaprisan in subjects with impaired liver function. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.401] [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: 11/26/2022]
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37
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Bogan R, Maas H, Zimmermann T. Chemical stability of reactive skin decontamination lotion (RSDL®). Toxicol Lett 2018; 293:264-268. [DOI: 10.1016/j.toxlet.2017.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/01/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
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38
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Labenz C, Baron JS, Toenges G, Schattenberg JM, Nagel M, Sprinzl MF, Nguyen-Tat M, Zimmermann T, Huber Y, Marquardt JU, Galle PR, Wörns MA. Prospective evaluation of the impact of covert hepatic encephalopathy on quality of life and sleep in cirrhotic patients. Aliment Pharmacol Ther 2018; 48:313-321. [PMID: 29863286 DOI: 10.1111/apt.14824] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 04/01/2018] [Revised: 04/23/2018] [Accepted: 05/07/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Minimal hepatic encephalopathy (HE) and HE grade 1 (HE1) according to the West Haven criteria have recently been grouped as one entity named-covert HE- (CHE). Data regarding the impact of CHE on health-related quality of life (HRQoL) and sleep quality are controversial. AIM First, to determine whether CHE affects HRQoL and sleep quality of cirrhotic patients and second, whether minimal HE (MHE) and HE1 affect HRQoL and sleep quality to a comparable extent. METHODS A total of 145 consecutive cirrhotic patients were enrolled. HE1 was diagnosed clinically according to the West Haven criteria. Critical flicker frequency and the Psychometric Hepatic Encephalopathy Score were used to detect MHE. Chronic Liver Disease Questionnaire (CLDQ) was used to assess HRQoL and Pittsburgh Sleep Quality Index (PSQI) was applied to assess sleep quality. RESULTS Covert HE was detected in 59 (40.7%) patients (MHE: n = 40; HE1: n = 19). Multivariate analysis identified CHE (P < 0.001) and female gender (P = 0.006) as independent predictors of reduced HRQoL (CLDQ total score). CHE (P = 0.021), low haemoglobin (P = 0.024) and female gender (P = 0.003) were identified as independent predictors of poor sleep quality (PSQI total score). Results of CLDQ and PSQI were comparable in patients with HE1 and MHE (CLDQ: 4.6 ± 0.9 vs 4.5 ± 1.2, P = 0.907; PSQI: 11.3 ± 3.8 vs 9.9 ± 5.0, P = 0.3). CONCLUSION Covert HE was associated with impaired HRQoL and sleep quality. MHE and HE1 affected both outcomes to a comparable extent supporting the use of CHE as a clinically useful term for patients with both entities of HE in clinical practice.
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Affiliation(s)
- C Labenz
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J S Baron
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - G Toenges
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J M Schattenberg
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Nagel
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M F Sprinzl
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M Nguyen-Tat
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - T Zimmermann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Y Huber
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - J U Marquardt
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - P R Galle
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - M-A Wörns
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.,Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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Haag P, Sharma H, Rauh M, Zimmermann T, Vuorinen T, Papadopoulos NG, Weiss ST, Finotto S. Soluble ST2 regulation by rhinovirus and 25(OH)-vitamin D3 in the blood of asthmatic children. Clin Exp Immunol 2018; 193:207-220. [PMID: 29645082 PMCID: PMC6046486 DOI: 10.1111/cei.13135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 12/27/2022] Open
Abstract
Paediatric asthma exacerbations are often caused by rhinovirus (RV). Moreover, 25(OH)-vitamin D3 (VitD3) deficiency during infancy was found associated with asthma. Here, we investigated the innate immune responses to RV and their possible modulation by 25(OH)-VitD3 serum levels in a preschool cohort of children with and without asthma. The innate lymphoid cell type 2 (ILC2)-associated marker, ST2, was found up-regulated in the blood cells of asthmatic children with low serum levels of 25(OH)-VitD3 in the absence of RV in their airways. Furthermore, in blood cells from control and asthmatic children with RV in their airways, soluble (s) ST2 (sST2) protein was found reduced. Asthmatic children with low 25(OH)-VitD3 in serum and with RV in vivo in their airways at the time of the analysis had the lowest sST2 protein levels in the peripheral blood compared to control children without RV and high levels of 25(OH)-VitD3. Amphiregulin (AREG), another ILC2-associated marker, was found induced in the control children with RV in their airways and low serum levels of 25(OH)-VitD3. In conclusion, the anti-inflammatory soluble form of ST2, also known as sST2, in serum correlated directly with interleukin (IL)-33 in the airways of asthmatic children. Furthermore, RV colonization in the airways and low serum levels of 25(OH)-VitD3 were found to be associated with down-regulation of sST2 in serum in paediatric asthma. These data indicate a counter-regulatory role of 25(OH)-VitD3 on RV-induced down-regulation of serum sST2 in paediatric asthma, which is relevant for the therapy of this disease.
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Affiliation(s)
- P. Haag
- Department of Molecular PneumologyFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum ErlangenErlangenGermany
| | - H. Sharma
- Translational Genomics Core, Partners Biobank, Partners HealthCare, Personalized MedicineCambridgeMAUSA
| | - M. Rauh
- Department of Allergy and Pneumology, Children's HospitalFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum ErlangenErlangenGermany
| | - T. Zimmermann
- Department of Allergy and Pneumology, Children's HospitalFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum ErlangenErlangenGermany
| | - T. Vuorinen
- Department of VirologyUniversity of TurkuTurkuFinland
| | - N. G. Papadopoulos
- Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and KapodistriaUniversity of AthensAthensGreece
| | - S. T. Weiss
- Translational Genomics Core, Partners Biobank, Partners HealthCare, Personalized MedicineCambridgeMAUSA
| | - S. Finotto
- Department of Molecular PneumologyFriedrich‐Alexander‐Universität (FAU) Erlangen‐Nürnberg, Universitätsklinikum ErlangenErlangenGermany
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Pohontsch NJ, Zimmermann T, Jonas C, Lehmann M, Löwe B, Scherer M. Coding of medically unexplained symptoms and somatoform disorders by general practitioners - an exploratory focus group study. BMC Fam Pract 2018; 19:129. [PMID: 30053834 PMCID: PMC6064152 DOI: 10.1186/s12875-018-0812-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/28/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) and somatoform disorders are common in general practices, but there is evidence that general practitioners (GPs) rarely use these codes. Assuming that correct classification and coding of symptoms and diseases are important for adequate management and treatment, insights into these processes could reveal problematic areas and possible solutions. Our study aims at exploring general practitioners' views on coding and reasons for not coding MUS/somatoform disorders. METHODS We invited GPs to participate in six focus groups (N = 42). Patient vignettes and a semi-structured guideline were used by two moderators to facilitate the discussions. Recordings were transcribed verbatim. Two researchers analyzed the data using structuring content analysis with deductive and inductive category building. RESULTS Three main categories turned out to be most relevant. For category a) "benefits of coding" GPs described that coding is seen as being done for reimbursement purposes and is not necessarily linked to the content of their reference files for a specific patient. Others reported to code specific diagnoses only if longer consultations to explore psychosomatic symptoms or psychotherapy are intended to be billed. Reasons for b) "restrained coding" were attempting to protect the patient from stigma through certain diagnoses and the preference for tentative diagnoses and functional coding. Some GPs admitted to c) "code inaccurately" attributing this to insufficient knowledge of ICD-10-criteria, time constraints or using "rules of thumb" for coding. CONCLUSIONS There seem to be challenges in the process of coding of MUS and somatoform disorders, but GPs appear not to contest the patients' suffering and accept uncertainty (about diagnoses) as an elementary part of their work. From GPs' points of view ICD-10-coding does not appear to be a necessary requirement for treating patients and coding might be avoided to protect the patients from stigma and other negative consequences. Our findings supply a possible explanation for the commonly seen difference between routine and epidemiological data. The recent developments in the DSM-5 and the upcoming ICD-11 will supposedly change acceptance and handling of these diagnoses for GPs and patients. Either way, consequences for GPs' diagnosing and coding behavior are not yet foreseeable.
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Affiliation(s)
- N. J. Pohontsch
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - T. Zimmermann
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - C. Jonas
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - M. Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - B. Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - M. Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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41
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Vos J, Cattaneo L, Patchkovskii S, Zimmermann T, Cirelli C, Lucchini M, Kheifets A, Landsman AS, Keller U. Orientation-dependent stereo Wigner time delay and electron localization in a small molecule. Science 2018; 360:1326-1330. [PMID: 29930132 DOI: 10.1126/science.aao4731] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 02/21/2018] [Accepted: 04/26/2018] [Indexed: 11/02/2022]
Abstract
Attosecond metrology of atoms has accessed the time scale of the most fundamental processes in quantum mechanics. Transferring the time-resolved photoelectric effect from atoms to molecules considerably increases experimental and theoretical challenges. Here we show that orientation- and energy-resolved measurements characterize the molecular stereo Wigner time delay. This observable provides direct information on the localization of the excited electron wave packet within the molecular potential. Furthermore, we demonstrate that photoelectrons resulting from the dissociative ionization process of the CO molecule are preferentially emitted from the carbon end for dissociative 2Σ states and from the center and oxygen end for the 2Π states of the molecular ion. Supported by comprehensive theoretical calculations, this work constitutes a complete spatially and temporally resolved reconstruction of the molecular photoelectric effect.
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Affiliation(s)
- J Vos
- Department of Physics, ETH Zurich, 8093 Zurich, Switzerland.
| | - L Cattaneo
- Department of Physics, ETH Zurich, 8093 Zurich, Switzerland
| | | | - T Zimmermann
- Max Planck Institute for the Physics of Complex Systems, D-01187 Dresden, Germany.,Max Planck Korea, Department of Physics, Postech, Pohang, Gyeongbuk 37673, Republic of Korea
| | - C Cirelli
- Department of Physics, ETH Zurich, 8093 Zurich, Switzerland.,Empa-Swiss Federal Laboratories for Materials Science & Technology, 8600 Dübendorf, Switzerland
| | - M Lucchini
- Department of Physics, ETH Zurich, 8093 Zurich, Switzerland
| | - A Kheifets
- Research School of Physics and Engineering, The Australian National University, Canberra ACT 0200, Australia
| | - A S Landsman
- Max Planck Institute for the Physics of Complex Systems, D-01187 Dresden, Germany.,Max Planck Korea, Department of Physics, Postech, Pohang, Gyeongbuk 37673, Republic of Korea
| | - U Keller
- Department of Physics, ETH Zurich, 8093 Zurich, Switzerland
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Darstein F, Hoppe-Lotichius M, Vollmar J, Weyer-Elberich V, Zimmermann A, Mittler J, Otto G, Lang H, Galle PR, Zimmermann T. Pretransplant coronary artery disease is a predictor for myocardial infarction and cardiac death after liver transplantation. Eur J Intern Med 2018; 51:41-45. [PMID: 29229303 DOI: 10.1016/j.ejim.2017.12.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiovascular disease is a serious problem of liver transplant (LT) recipients because of increased cardiovascular risk due to immunosuppressive therapy, higher age, intraoperative risk and comorbidities (such as diabetes and nicotine abuse). Reported frequency of cardiovascular events after LT shows a high variability between different LT cohorts. Our aim was to analyze a cohort of LT recipients from a single center in Germany to evaluate frequency of the cardiovascular endpoints (CVE) myocardial infarction and/or cardiac death after LT and to investigate correlations of CVE post LT with pretransplant patient characteristics. PATIENTS In total, data from 352 LT patients were analyzed. Patients were identified from an administrative transplant database, and all data were retrieved from patients' charts and reports. RESULTS During the median follow-up of 4.0 (0-13) years, 10 cases of CVE were documented (six myocardial infarctions and four coronary deaths). The frequency of CVE did not differ according to classic cardiovascular risk factors such as body mass index (p=0.071), total cholesterol (p=0.533), hypertension (p=0.747), smoking (p=1.000) and pretransplant diabetes mellitus (p=0.146). In patients with pretransplant coronary heart disease (n=24; 6.8%) CVE were found more frequently (p=0.024). CONCLUSION In summary, we found a rate of 2.8% CVE after LT in a German transplant cohort. Pretransplant CHD was the only risk factor for CVE, but showed no significant impact on overall survival.
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Affiliation(s)
- F Darstein
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany.
| | - M Hoppe-Lotichius
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - J Vollmar
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany
| | - V Weyer-Elberich
- Division of Biostatistics and Bioinformatics, Universitätsmedizin Mainz, Mainz, Germany
| | - A Zimmermann
- First Department of Internal Medicine, Endocrinology and Metabolic Diseases, Universitätsmedizin Mainz, Mainz, Germany
| | - J Mittler
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - G Otto
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - H Lang
- Department of Hepatobiliary and Transplantation Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - P R Galle
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany
| | - T Zimmermann
- First Department of Internal Medicine, Gastroenterology and Hepatology, Universitätsmedizin Mainz, Mainz, Germany.
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Schmidt U, Zimmermann T, Grabitz R, Haase R, Eisenmann S. EBUS in der Pädiatrie – Ein hilfreiches Zusatztool. Pneumologie 2018. [DOI: 10.1055/s-0037-1619229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- U Schmidt
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - T Zimmermann
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - R Grabitz
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - R Haase
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - S Eisenmann
- Klinik für Innere Medizin I, Universitätsklinik Halle
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Rimek D, Zimmermann T, Hartmann M, Prariyachatigul C, Kappe R. Disseminated Penicillium marneffei
infection in an HIV-positive female from Thailand in Germany. Mycoses 2017; 42 Suppl 2:25-28. [DOI: 10.1111/j.1439-0507.1999.tb00008.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/1999] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - M. Hartmann
- Department of Microbiology; Khon Kaen University; Thailand
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Welzel TM, Hinrichsen H, Sarrazin C, Buggisch P, Baumgarten A, Christensen S, Berg T, Mauss S, Teuber G, Stein K, Deterding K, van Bömmel F, Heyne R, John C, Zimmermann T, Lutz T, Schott E, Hettinger J, Kleine H, König B, Hüppe D, Wedemeyer H. Real-world experience with the all-oral, interferon-free regimen of ombitasvir/paritaprevir/ritonavir and dasabuvir for the treatment of chronic hepatitis C virus infection in the German Hepatitis C Registry. J Viral Hepat 2017; 24:840-849. [PMID: 28342229 DOI: 10.1111/jvh.12708] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 12/15/2016] [Accepted: 02/16/2017] [Indexed: 12/13/2022]
Abstract
Real-world studies are relevant to complement clinical trials on novel antiviral therapies against chronic hepatitis C; however, clinical practice data are currently limited. This study investigated effectiveness and safety of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r)±dasabuvir (DSV)±ribavirin (RBV) for treatment of HCV genotype (GT) 1 and GT4 infection in a large real-world cohort. The German Hepatitis C Registry is an observational cohort study prospectively collecting clinical practice data on direct-acting antiviral therapies. Patients with GT1/4 infection treated with OBV/PTV/r±DSV±RBV were analysed. Effectiveness was assessed by sustained virologic response in 558 patients who reached post-treatment week 12 (SVR12). Safety is reported in 1017 patients who initiated treatment. Of the patients, 892 (88%) had GT1 and 125 (12%) had GT4 infection. Prior treatment experience and cirrhosis were reported in 598 (59%) and 228 (22%) patients, respectively. Overall, SVR12 (mITT) was 96% (486/505) in GT1- and 100% (53/53) in GT4 patients. SVR12 rates were high across subgroups including patients with cirrhosis (95%, 123/129), patients with moderate to severe renal impairment (100%, 34/34), and subgroups excluded from registrational trials like patients ≥70 years (96%, 64/67) and failures to prior protease inhibitor treatment (96%, 46/48). Adverse events (AEs) and serious AEs were reported in 52% (525/1017) and 2% (21/1017) of patients, respectively, and led to treatment discontinuation in 1.5% (15/1017) of patients. OBV/PTV/r±DSV±RBV was effective and generally well tolerated for treatment of HCV infection in clinical practice.
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Affiliation(s)
- T M Welzel
- Department of Medicine 1, University Hospital, J.W. Goethe University, Frankfurt am Main, Germany
| | - H Hinrichsen
- Gastroenterology-Hepatology Center Kiel, Kiel, Germany
| | - C Sarrazin
- Department of Medicine 1, University Hospital, J.W. Goethe University, Frankfurt am Main, Germany.,Medical Department II, Gastroenterology, Hepatology, Infectiology, St. Josefs-Hospital, Wiesbaden, Germany
| | - P Buggisch
- Liver Unit, Asklepios Clinic St. Georg, IFI-Institute, Hamburg, Germany
| | | | - S Christensen
- Center for Interdisciplinary Medicine (CIM), Münster, Germany
| | - T Berg
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - S Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - G Teuber
- Private Practice, Frankfurt am Main, Germany
| | - K Stein
- Hepatologie - Magdeburg, Magdeburg, Germany
| | - K Deterding
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - F van Bömmel
- Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - R Heyne
- Leberzentrum am Checkpoint Berlin, Berlin, Germany
| | - C John
- Private Practice for Internal Medicine, Berlin, Germany
| | - T Zimmermann
- Department of Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - T Lutz
- Infektiologikum, Frankfurt am Main, Germany
| | - E Schott
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J Hettinger
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | - H Kleine
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | - B König
- AbbVie Deutschland GmbH & Co KG, Wiesbaden, Germany
| | - D Hüppe
- Center for Gastroenterology and Hepatology, Herne
| | - H Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Gillissen A, Paparoupa M, Zimmermann T. [Massive Morgagni Hernia as a Reason for Lung Function Impairment]. Pneumologie 2017; 72:309-312. [PMID: 28841740 DOI: 10.1055/s-0043-113976] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hernia of Morgagni is the most rare of the four types of congenital diaphragmatic hernia (2 % - 3 % of all cases). In adults, it commonly presents with non-specific symptoms. In severe cases patients complain about shortness of breath and in lung function analysis a restrictive pattern can be observed. This paper presents a rare case of a massive diaphragmatic hernia of the right thorax which remained undiagnosed over many years and gives an up-to-date overview of the literature. The transabdominal approach using laparoscopic repair is favored in adults especially in non-acute cases. In our patient, the lung expanded postoperatively in most parts resulting in improvement of lung function and blood gas analysis.
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Affiliation(s)
- A Gillissen
- Medizinische Klinik III, Ermstalklinik, Kreiskliniken Reutlingen, Reutlingen-Bad Urach
| | - M Paparoupa
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen
| | - T Zimmermann
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Kreiskliniken Reutlingen
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47
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Schmidt F, Wenz T, Schnorbus B, Galle P, Munzel T, Zimmermann T. P3469Treatment with direct-acting antivirals agents for Hepatitis C infection improves vascular function. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schettler VJJ, Neumann CL, Peter C, Zimmermann T, Julius U, Roeseler E, Heigl F, Grützmacher P, Blume H, Vogt A. Erratum to: The German Lipoprotein Apheresis Registry (GLAR) - almost 5 years on. Clin Res Cardiol Suppl 2017:10.1007/s11789-017-0092-1. [PMID: 28717887 DOI: 10.1007/s11789-017-0092-1] [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)
- V J J Schettler
- Center of Nephrology Göttingen GbR, An der Lutter 24, 37075, Göttingen, Germany.
| | - C L Neumann
- BRAVE e Benefit for Research on Arterial Hypertension, Dyslipidemia and Vascular Risk and Education e.V., Göttingen, Germany
| | - C Peter
- BioArtProducts GmbH (B.A.P.), Rostock, Germany
- Rostock Group (EXIM), Fraunhofer Institute for Cell Therapy and Immunology IZI, Rostock, Germany
| | | | - U Julius
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - E Roeseler
- Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
| | - F Heigl
- Medical Care Centre Kempten-Allgäu, Kempten, Germany
| | - P Grützmacher
- Department of Medicine II for Nephrology, Hypertension and Vascular Risks, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - H Blume
- Scientific Institute for Nephrology (WiNe), Düsseldorf, Germany
| | - A Vogt
- Medizinische Klinik und Poliklinik 4, Universität München, Munich, Germany
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Retzmann A, Zimmermann T, Pröfrock D, Prohaska T, Irrgeher J. A fully automated simultaneous single-stage separation of Sr, Pb, and Nd using DGA Resin for the isotopic analysis of marine sediments. Anal Bioanal Chem 2017; 409:5463-5480. [DOI: 10.1007/s00216-017-0468-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/02/2017] [Accepted: 06/13/2017] [Indexed: 02/04/2023]
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50
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Schettler VJJ, Neumann CL, Peter C, Zimmermann T, Julius U, Roeseler E, Heigl F, Grützmacher P, Blume H. Current insights into the German Lipoprotein Apheresis Registry (GLAR) - Almost 5 years on. ATHEROSCLEROSIS SUPP 2017; 30:50-55. [PMID: 29096861 DOI: 10.1016/j.atherosclerosissup.2017.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In recent years the Federal Joint Committee (G-BA), a paramount decision-making body of the German health care system required a reassessment of the approval of chronic lipoprotein apheresis therapy for regular reimbursement. Since 2005 an interdisciplinary German apheresis working group has been established by members of both German Societies of Nephrology. In 2009 the working group completed the indication for lipoprotein apheresis with respect to current cardiovascular guidelines and current scientific knowledge for the registry. In 2011 the German Lipoprotein Apheresis Registry (GLAR) was launched and data acquired over nearly 5 years can now be reported. METHODS AND RESULTS All data were collected and analyzed during the time period 2012-2015. Over this time interval, 68 German apheresis centers collected retrospective and prospective observational data of 1.283 patients undergoing lipoprotein apheresis (LA) treatment of high LDL-cholesterol (LDL-C) levels and/or high lipoprotein(a) (Lp(a)) levels suffering from progressive cardiovascular disease (CVD). A total of 15,167 documented LA treatments were investigated. All patients treated by LA exhibited a median LDL-C reduction rate of 68.6%, and a median Lp(a) reduction rate of 70.4%. Analogue to the Pro(a)LiFe pattern, patient data were analyzed and compared with respect to the incidence rate of coronary events (MACE) 1 and 2 years before the start of LA treatment (y-2 and y-1) and prospectively one year on LA treatment (y+1). During the first year of LA treatment a MACE reduction of 97% was be observed. In the years considered, LA treatment side effects occurred at a low rate (ca. 5%) and mainly comprised puncture problems. CONCLUSIONS For the first time data generated by the GLAR shows that LA lowers the incidence rate of cardiovascular events in patients with high LDL-C and/or high Lp(a) levels, progressive CVD and maximally tolerated lipid lowering medication. In addition LA treatments were found to be safe, exhibiting a low rate of side effects.
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Affiliation(s)
| | - C L Neumann
- BRAVE e Benefit for Research on Arterial Hypertension, Dyslipidemia and Vascular Risk and Education e.V., Göttingen, Germany
| | - C Peter
- BioArtProducts GmbH (B.A.P.), Rostock, Germany; Fraunhofer Institute for Cell Therapy and Immunology IZI, Rostock Group (EXIM), Germany
| | | | - U Julius
- Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - E Roeseler
- Center for Nephrology, Hypertension, and Metabolic Diseases, Hannover, Germany
| | - F Heigl
- Medical Care Centre Kempten-Allgäu, Kempten, Germany
| | - P Grützmacher
- Department of Medicine II for Nephrology, Hypertension and Vascular Risks, AGAPLESION Markus Hospital, Frankfurt, Germany
| | - H Blume
- Scientific Institute for Nephrology (WiNe), Düsseldorf, Germany
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