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Schach C, Reitschuster R, Benedikt D, Füssl E, Debl K, Maier LS, Luchner A. Less major bleeding and higher hemoglobin after left atrial appendage closure in high-risk patients: Data from a long-term, longitudinal, two-center observational study. Clin Cardiol 2023; 46:1337-1344. [PMID: 37573576 PMCID: PMC10642336 DOI: 10.1002/clc.24123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Left atrial appendage closure (LAAC) is a mechanical alternative for stroke prevention in patients at risk who cannot tolerate oral anticoagulation (OAC). HYPOTHESIS Our hypothesis was that the reduction of anticoagulation following LAAC results in a decrease of bleeding events and a rise in serum hemoglobin in a high-risk collective of patients with atrial fibrillation (AF). METHODS Bleeding events, use of erythrocyte concentrates, anticoagulation, embolic events, and serum hemoglobin levels before and following LAAC were compared over more than 4 years. RESULTS Seventy-five patients (CHA₂DS₂-VASc score 4.4 ± 1.7, HAS-BLED score 4.6 ± 1.1) were analyzed. Before LAAC (observation period 1.8 ± 1.8 years), 67 patients experienced 1.8 ± 1.4 bleeding events (0.9 ± 1.3 major) per year resulting in 0.7 ± 1.3 transfusions per year. After LAAC (2.6 ± 2.0 years), 26 patients (p < .0001 vs. before) had 0.6 ± 2.1 bleeding events (p < .0001), 0.2 ± 0.6 major bleedings (p < .0001) and received 0.6 ± 1.9 transfusions per year (p = .671). Fourteen patients had stroke before and 3 after LAAC (p = .008). Serum hemoglobin increased from initially 9.9 ± 3.0 to 11.9 ± 2.3 g/dL until the end of follow-up (p = .0005). Adverse embolic events did not differ before and after LAAC in our collective. CONCLUSION In this clinical relevant cohort of AF patients with high risk for stroke and intolerance to OAC, we show that LAAC was able to reduce the rate of stroke and bleeding events, which translated into a rising serum hemoglobin concentration.
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Affiliation(s)
- Christian Schach
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Raphael Reitschuster
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Dennis Benedikt
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Elias Füssl
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Kurt Debl
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Lars S. Maier
- Department for Internal Medicine IIUniversity Heart Center RegensburgRegensburgGermany
| | - Andreas Luchner
- Department for CardiologyHospital Barmherzige Brüder RegensburgRegensburgGermany
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Wester M, Koll F, Luedde M, Langer C, Resch M, Luchner A, Müller K, Zeman F, Koller M, Maier LS, Sossalla S. Effects of percutaneous coronary intervention on dyspnea in stable coronary artery disease. Clin Res Cardiol 2023; 112:1194-1203. [PMID: 36100700 PMCID: PMC10449717 DOI: 10.1007/s00392-022-02107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/06/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dyspnea is a frequent symptom in patients with stable coronary artery disease (CAD) and is recognized as a possible angina equivalent. OBJECTIVES This study was to assess the impact of percutaneous coronary intervention (PCI) on dyspnea, quality of life, and angina pectoris in patients with stable CAD. METHODS The prospective, multi-center PLA-pCi-EBO-pilot trial included 144 patients with symptomatic stable CAD and successful PCI. The prespecified endpoints angina pectoris (Seattle Angina Questionnaire-SAQ) and dyspnea (NYHA scale) were assessed 6 months after PCI. Predictors for symptomatic improvement were assessed with uni- and multivariable logistic regression analyses. RESULTS Patients with concomitant dyspnea had worse SAQ physical limitation scores at baseline (49.5 ± 21.0 vs 58.9 ± 22.0, p = 0.013) but showed no difference for angina frequency or quality of life. Overall, symptomatic burden of angina pectoris and dyspnea was alleviated by PCI. However, patients with concomitant dyspnea had markedly worse scores for physical limitation (78.9 ± 25.0 vs 94.3 ± 10.6, p < 0.001), angina frequency (77.9 ± 22.8 vs 91.1 ± 12.4, p < 0.001), and quality of life (69.4 ± 24.1 vs 82.5 ± 14.4, p < 0.001) after PCI. The prevalence of dyspnea (NYHA class ≥ 2) declined from 73% before PCI to 54%. Of 95 initially dyspneic patients, 57 (60%) improved at least one NYHA class 6 months after PCI. In a multivariable logistic regression analysis, "atypical angina pectoris" was associated with improved NYHA class, whereas "diabetes mellitus" had a negative association. CONCLUSION PCI effectively reduced dyspnea, which is a frequent and demanding symptom in patients with CAD. The German Clinical Trials Register registration number is DRKS0001752 ( www.drks.de ).
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Affiliation(s)
- Michael Wester
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Franziska Koll
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Mark Luedde
- Kardiologische Gemeinschaftspraxis Bremerhaven, Bremerhaven, Germany
| | - Christoph Langer
- Kardiologisch-Angiologische Praxis, Heart Centre Bremen, Bremen, Germany
| | - Markus Resch
- Department of Internal Medicine I, St. Josef Hospital, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Karolina Müller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Michael Koller
- Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Samuel Sossalla
- Department of Internal Medicine II, University Heart Centre Regensburg, University Medical Center Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Allgaier R, Strack C, Wallner S, Hubauer U, Uecer E, Lehn P, Keyser A, Luchner A, Maier L, Jungbauer C. NAG: potential cardiorenal biomarker indicates progression of chronic kidney disease in implantable cardioverter defibrillator patients, contrary to KIM-1. Biomark Med 2022; 16:265-275. [PMID: 35176879 DOI: 10.2217/bmm-2021-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: NAG and KIM-1 as markers of tubular damage are suggested as potential biomarkers for the cardiorenal syndrome. Aim of the study was to assess the prognostic capability of NAG and KIM-1 regarding progression of chronic kidney disease (CKD) in patients with implantable cardioverter defibrillator (ICD). Materials & methods: We included 313 patients with an ICD and collected plasma and urine samples. Follow-up was performed after 51 months (interquartile range [IQR]: 25-55). Outcome of interest was continuous CKD progression defined as persistent decline in estimated glomerular filtration rate category accompanied by a ≥25% drop of baseline estimated glomerular filtration rate. Results: Average four (IQR: 2-6) follow-up values of serum creatinine per patient were obtained. During follow-up 29 patients (9%) developed a continuous CKD progression. NAG was shown as independent predictor for continuous CKD progression (p = 0.01), opposite to KIM-1 (p = n.s.). Conclusion: NAG was shown as predictor for a progressive and real deterioration of kidney function in patients with ICD.
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Affiliation(s)
- Raphael Allgaier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christina Strack
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry & Laboratory Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Ekrem Uecer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry & Laboratory Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lars Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
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Wester M, Koll F, Lüdde M, Langer C, Resch M, Luchner A, Frey N, Müller K, Zeman F, Koller M, Maier LS, Sossalla S. Effects of Visualization of Revascularization on Symptomatic Outcomes in Patients With Chronic Coronary Syndrome. JACC Cardiovasc Interv 2021; 14:2525-2527. [PMID: 34794658 DOI: 10.1016/j.jcin.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 12/16/2022]
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Bauer S, Strack C, Ücer E, Wallner S, Hubauer U, Luchner A, Maier LS, Jungbauer C. Evaluation of a multimarker panel in chronic heart failure: a 10-year follow-up. Biomark Med 2021; 15:1709-1719. [PMID: 34783584 DOI: 10.2217/bmm-2020-0722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We assessed the 10-year prognostic role of 11 biomarkers with different pathophysiological backgrounds. Materials & methods/results: Blood samples from 144 patients with heart failure were analyzed. After 10 years of follow-up (median follow-up was 104 months), data regarding all-cause mortality were acquired. Regarding Kaplan-Meier analysis, all markers, except TIMP-1 and GDF-15, were significant predictors for all-cause mortality. We created a multimarker model with nt-proBNP, hs-TnT and IGF-BP7 and found that patients in whom all three markers were elevated had a significantly worse long-time prognosis than patients without elevated markers. Conclusion: In a 10-year follow-up, a combination of three biomarkers (NT-proBNP, hs-TnT, IGF-BP7) identified patients with a high risk of mortality.
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Affiliation(s)
- Susanne Bauer
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Christina Strack
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Ekrem Ücer
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Stefan Wallner
- University Hospital Regensburg, Department for Clinical Chemistry and Laboratory Medicine, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Ute Hubauer
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Andreas Luchner
- Hospital Barmherzige Brüder, Department for Cardiology, Prüfeninger Straße 86, Regensburg, 93049, Germany
| | - Lars Siegfried Maier
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
| | - Carsten Jungbauer
- University Hospital Regensburg, Department for Cardiology, Franz-Josef-Strauss Allee 11, Regensburg, 93053, Germany
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Dietl A, Zimmermann ME, Brandl C, Wallner S, Burkhardt R, Maier LS, Luchner A, Heid IM, Stark KJ. Distribution and specificity of high-sensitivity cardiac troponin T in older adults without acute cardiac conditions: cross-sectional results from the population-based AugUR study. BMJ Open 2021; 11:e052004. [PMID: 34728452 PMCID: PMC8565570 DOI: 10.1136/bmjopen-2021-052004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE European guidelines recommended a uniform upper reference limit of high-sensitivity cardiac troponin T (hsTnT) to rule out non-ST segment elevation myocardial infarction. Our study aimed to provide a hsTnT reference distribution and to assess the specificity of the 14 ng/L cut-off value in the mobile population ≥70 years of age. DESIGN A cross-sectional analysis was performed in the German AugUR study (Altersbezogene Untersuchungen zur Gesundheit der University of Regensburg). SETTING Study population was the mobile population aged 70+ years living in the city and county of Regensburg, Germany. PARTICIPANTS A random sample was derived from the local population registries of residence. Of the 5644 individuals invited, 1133 participated (response ratio=20.1%). All participants came to the study centre and were mentally and physically mobile to conduct the protocol (face-to-face interview, blood draw and standardised transthoracic echocardiography). None of the participants was in an acute state of myocardial infarction. RESULTS Among the 1129 individuals with hsTnT measurements (overall median=10.0 ng/L(25th, 75th percentile)=(7.0, 15.0 ng/L)), hsTnT was higher among the older individuals and higher among men (men 70-74 years median=9.6 ng/L (7.2, 13.1 ng/L); men 90-95 years median=21.2 ng/L (14.6, 26.0 ng/L); women 70-74 years median=6.3 ng/L (4.7, 8.7 ng/L); and women 90-95 years median=18.0 ng/L (11.0, 21.0 ng/L)). In participants with impaired kidney function (eGFRcrea <60 mL/min/1.73 m2), hsTnT was elevated (median=13.6 ng/L (9.4, 20.6 ng/L)).Specificity of recommended upper reference limit, 14 ng/L, is 68%. Most false positives were among men aged >79 years (specificity=34%). In a healthy subgroup (n=96, none of the following: overt heart disease, impaired renal function, blood pressure >160/100 mm Hg, left ventricular hypertrophy and diastolic/systolic dysfunction), specificity was 90%. CONCLUSION In the elderly population without acute myocardial infarction, hsTnT further increases with age showing different levels for men and women. The specificity of the 14 ng/L cut-off is considerably lower than 99%, even in healthy subjects.
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Affiliation(s)
- Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Krankenhaus Barmherzige Brueder Regensburg, Regensburg, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
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7
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Günther F, Straub RH, Hartung W, Luchner A, Fleck M, Ehrenstein B. Increased Serum Levels of soluble ST2 as a Predictor of Disease Progression in Systemic Sclerosis. Scand J Rheumatol 2021; 51:315-322. [PMID: 34474647 DOI: 10.1080/03009742.2021.1929457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Interleukin-33 (IL-33) has been investigated as a mediator in the pathogenesis of fibrosis in lung, liver, and heart. There is accumulating evidence for the involvement of the IL-33/IL-33 receptor ST2L signalling pathway in systemic sclerosis (SSc). Little is known about the role of serum sST2 in SSc, which is the subject of the present investigation. METHOD Serum levels of sST2 were measured in 49 patients with SSc, recruited prospectively between November 2017 and March 2019. Patients were divided into those with progressive and those with stable disease. Receiver operating characteristics (ROC) curve analysis was applied to study sST2 as a marker for identifying patients with progressive disease. We used multivariate logistic regression analysis to evaluate the predictive value of sST2 for progressive disease after adjustment for potential confounding factors. RESULTS Serum sST2 levels in patients with progressive disease were significantly elevated compared with patients with stable disease (mean ± sem: 50.4 ± 4.7 ng/mL vs 29.2 ± 2.97 ng/mL, p < 0.001). ROC curve analysis identified an sST2 cut-off value of 37.8 ng/mL as optimal for discriminating patients with progressive disease from those with stable disease (sensitivity 80.0%, specificity 79.3%, area under the curve 0.80). After controlling for potential confounding factors (age, gender, C-reactive protein, pro-brain natriuretic peptide, and sum of internal medicine comorbidities), sST2 remained predictive of progressive disease (odds ratio 1.070, 95% confidence interval 1.017-1.126, p < 0.009). CONCLUSION In the present study, sST2 serum levels were predictive of disease progression in patients with SSc.
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Affiliation(s)
- F Günther
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - R H Straub
- Department of Internal Medicine I, University Medical Center, Regensburg, Germany
| | - W Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - A Luchner
- Department of Cardiology, Barmherzige Brüder Hospital, Regensburg, Germany
| | - M Fleck
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany.,Department of Internal Medicine I, University Medical Center, Regensburg, Germany
| | - B Ehrenstein
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany.,Department of Internal Medicine I, University Medical Center, Regensburg, Germany
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Strack C, Bauer S, Hubauer U, Ücer E, Birner C, Luchner A, Maier L, Jungbauer C. N-acetyl-ß-D-glucosaminidase is predictive of mortality in chronic heart failure: a 10-year follow-up. Biomark Med 2021; 15:1143-1153. [PMID: 34397265 DOI: 10.2217/bmm-2020-0366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The study focused on biomarkers of kidney injury as predictors of mortality in patients with chronic heart failure (CHF) in a long-term follow-up (median 104 months). Methods/results: KIM-1, NAG and NGAL were assessed from urine, NT-proBNP from blood samples. 149 patients (age 62 ± 12 years) with CHF (mean EF 30% [IQR 24-40%]) were enrolled. 79 (53%) patients died. Cox regression analysis revealed Log2NAG (HR: 1.46, CI: 1.12-1.89), Log2KIM-1 (HR: 1.23, CI: 1.02-1.49) and Log2NT-proBNP (HR: 1.50, CI: 1.32-1.72) as significant predictors of all-cause mortality as opposed to Log2NGAL (HR: 1.04, CI: 0.90-1.20). Log2NAG remained a significant predictor of all-cause mortality in a multivariate Cox regression model but lost its predictive value in combination with Log2NT-proBNP. Conclusion: The 10-year follow-up suggests NAG as a predictive tubular marker in CHF patients.
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Affiliation(s)
- Christina Strack
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Susanne Bauer
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Ute Hubauer
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Ekrem Ücer
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christoph Birner
- Clinic of Internal Medicine I, Klinikum St. Marien, Amberg, Mariahilfbergweg 7, 92224, Amberg, Germany
| | - Andreas Luchner
- Clinic of Internal Medicine III, Clinic of Cardiology, Krankenhaus Barmherzige Brüder, Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - Lars Maier
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Carsten Jungbauer
- Clinic of Internal Medicine II, University Hospital of Regensburg, Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Reynen S, Schlossbauer M, Hubauer U, Hupf J, Mohr A, Orso E, Zimmermann M, Luchner A, Maier LS, Wallner S, Jungbauer CG. Urinary N-terminal pro-brain natriuretic peptide: prognostic value in patients with acute chest pain. ESC Heart Fail 2021; 8:2293-2305. [PMID: 33822463 PMCID: PMC8120380 DOI: 10.1002/ehf2.13332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS The objective of this study was to investigate the prognostic value of urinary N-terminal pro-brain natriuretic peptide (NT-proBNP) compared with plasma NT-proBNP in patients presenting with acute chest pain in the emergency department. METHODS AND RESULTS We measured simultaneously plasma and urinary NT-proBNP at admission in 301 patients with acute chest pain. In our cohort, 174 patients suffered from acute coronary syndrome (ACS). A follow-up (median of 55 months) was performed regarding the endpoints all-cause mortality and major adverse cardiac events (mortality, congestive heart failure, ACS with the necessity of a coronary intervention, and stroke). Fifty-four patients died during follow-up; 98 suffered from the combined endpoint. A significant and positive correlation of urinary and plasma NT-proBNP was found (r = 0.87, P < 0.05). Patients with troponin positive ACS had significantly elevated levels of plasma and urinary NT-proBNP compared with those with unstable angina pectoris or chest wall syndrome (each P < 0.05). The highest levels of both biomarkers were found in patients with congestive heart failure (each P < 0.05). According to Kaplan-Meier analysis, plasma and urinary NT-proBNP were significant predictors for mortality and the combined endpoint in the whole study cohort and in the subgroup of patients with ACS (each P < 0.05). Regarding Cox regression analysis, plasma and urinary NT-proBNP were independent predictors for mortality and the combined endpoint (each P < 0.05). CONCLUSIONS Urinary NT-proBNP seems to provide a significant predictive value regarding the endpoints all-cause mortality and major adverse cardiac events in patients with acute chest pain and those with ACS.
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Affiliation(s)
- Stefanie Reynen
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Michael Schlossbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Anesthesiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Julian Hupf
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Arno Mohr
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany.,Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Evelyn Orso
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Department of Internal Medicine II (Cardiology), University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany
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Messmann R, Dietl A, Wagner S, Domenig O, Jungbauer C, Luchner A, Maier LS, Schopka S, Hirt S, Schmid C, Birner C. Alterations of the renin angiotensin system in human end-stage heart failure before and after mechanical cardiac unloading by LVAD support. Mol Cell Biochem 2020; 472:79-94. [PMID: 32564294 PMCID: PMC7431447 DOI: 10.1007/s11010-020-03787-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 06/11/2020] [Indexed: 01/06/2023]
Abstract
Heart transplantation is often an unrealizable therapeutic option for end-stage heart failure, which is why mechanical left ventricular assist devices (LVADs) become an increasingly important therapeutic alternative. Currently, there is a lack of information about molecular mechanisms which are influenced by LVADs, particularly regarding the pathophysiologically critical renin angiotensin system (RAS). We, therefore, determined regulation patterns of key components of the RAS and the β-arrestin signaling pathways in left ventricular (LV) tissue specimens from 8 patients with end-stage ischemic cardiomyopathy (ICM) and 12 patients with terminal dilated cardiomyopathy (DCM) before and after LVAD implantation and compared them with non-failing (NF) left ventricular tissue samples: AT1R, AT2R, ACE, ACE2, MasR, and ADAM17 were analyzed by polymerase chain reaction. ERK, phosphorylated ERK, p38, phosphorylated p38, JNK, phosphorylated JNK, GRK2, β-arrestin 2, PI3K, Akt, and phosphorylated Akt were determined by Western blot analysis. Angiotensin I and Angiotensin II were quantified by mass spectrometry. Patients were predominantly middle-aged (53 ± 10 years) men with severely impaired LV function (LVEF 19 ± 8%), when receiving LVAD therapy for a mean duration of 331 ± 317 days. Baseline characteristics did not differ significantly between ICM and DCM patients. By comparing failing with non-failing left ventricles, i.e., before LVAD implantation, a downregulation of AT1R, AT2R, and MasR and an upregulation of ACE, ACE2, GRK, β-arrestin, ERK, PI3K, and Akt were seen. Following LVAD support, then angiotensin I, ACE2, GRK, and β-arrestin were downregulated and AT2R, JNK, and p38 were upregulated. ACE, angiotensin II, AT1R, ADAM17, MasR, ERK, PI3K, and Akt remained unchanged. Some regulation patterns were influenced by the underlying etiology of heart failure, the severity of LV dysfunction at baseline, and the duration of LVAD therapy. Key components of the RAS and β-arrestin signaling pathways were divergently altered in failing left ventricles both before and after LVAD implantation, whereas a remarkable fraction remained unchanged. This indicates a rather incomplete molecular reverse remodeling, whose functional relevance has to be further evaluated.
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Affiliation(s)
- Rebecca Messmann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Clinic Barmherzige Brüder, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Simon Schopka
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany.
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11
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Allgaier R, Strack C, Wallner S, Hubauer U, Uecer E, Lehn P, Keyser A, Luchner A, Maier L, Jungbauer C. N-acetyl-b-D-glucosaminidase: A potential cardiorenal biomarker with a relevant impact on ICD shock therapies and mortality. Nephrology (Carlton) 2020; 25:888-896. [PMID: 32841436 DOI: 10.1111/nep.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/05/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
AIMS Chronic heart failure may lead to chronic kidney disease. Previous studies suggest tubular markers N-acetyl-b-D-glucosaminidase (NAG) and Kidney-injury-molecule-1 (KIM-1) as potential markers for the cardiorenal syndrome (CRS). The prognostic value of NAG and KIM-1 regarding implantable cardioverter defibrillator (ICD) shock therapies is unknown. METHODS We included 314 patients with an ICD and collected plasma and urine samples. Urine-values of NAG and KIM-1 got related to urinary creatinine. Outcomes of interest were sustained adequate shock therapies and a combined endpoint of all-cause mortality, rehospitalisation due to congestive heart failure and adequate shock therapies. Follow up time was 32 months (IQR 6-35 months). RESULTS KIM-1 and NAG were positively correlated with NT-proBNP (KIM-1: r = .34, P < .001; NAG: r = .47, P < .001). NAG was significantly elevated in patients with primary prevention compared with secondary prevention ICD indication (P = .003). According to Kaplan Meier analysis, NAG as well as NT-proBNP were significant predictors for adequate ICD shock therapies and for the combined endpoint (each P < .001). Elevated KIM-1 showed no significant differences (each P = n.s.). In multivariate cox regression analysis, NAG as well as NT-proBNP were both independent predictors for adequate ICD shock therapies as well as the combined endpoint, beside ejection fraction <35% (each P < .05). Diabetes, primary prevention ICD indication, coronary artery disease, eGFR and age were no significant predictors for both endpoints (each P = n.s.). CONCLUSION Similar to NT-proBNP, NAG showed promising value for overall prognostication in ICD patients. Especially, NAG seems to incorporate an additional prognostic value regarding occurrence of ICD shock therapies.
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Affiliation(s)
- Raphael Allgaier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christina Strack
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Wallner
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Ekrem Uecer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Petra Lehn
- Department of Clinical Chemistry and Laboratory Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Keyser
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Lars Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
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12
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Kaufmann M, Schlossbauer M, Hubauer U, Stadler S, Fischer M, Wallner S, Hupf J, Zimmermann M, Orso E, Zeman F, Luchner A, Maier L, Jungbauer C. N-acety-b-D-glucosaminidase: A potential biomarker for early detection of acute kidney injury in acute chest pain. Nephrology (Carlton) 2019; 25:135-143. [PMID: 31568610 DOI: 10.1111/nep.13664] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/16/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
AIM Acute kidney injury (AKI) is often underdiagnosed due to several limitations of the renal marker creatinine. Tubular urinary biomarkers may substantially contribute to diagnose AKI early. For early detection of AKI, we evaluated for the first time N-acetyl-β-d-glucosaminidase (NAG), Kidney-injury-molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in acute chest pain. METHODS We included 402 chest pain patients aged 18 to 95 years seen in the emergency department. From 311 subjects, blood and urine samples were collected. RESULTS Thirty-three patients developed an AKI and showed a significant increase in all three tubular markers compared to patients without AKI (each P < .001). According to receiver operating characteristic (ROC) analysis, combining NAG and creatinine showed a significantly increased area under the curve (AUC) compared to creatinine alone (AUC: 0.75 vs 0.87; P < .001). KIM-1, NGAL and cystatin C showed no significant differences in AUC compared to creatinine. In 120 individuals with blood and urine sampling before contrast media exposure, ROC analysis showed a significantly improved diagnostic performance for the combination of both (AUC: 0.83 vs creatinine AUC: 0.66; P = .004). AKI occurrence showed no dependency from CM volume. NAG presented as an independent AKI predictor beside creatinine, age, the diagnosis of myocardial infarction and mean arterial pressure. Regarding the prognostic value for renal replacement therapy, the combination of NAG and creatinine showed a significantly lager AUC than creatinine (AUC: 0.95 vs AUC: 0.85; P < .001). CONCLUSION NAG presented as a promising marker of impending AKI and the necessity of renal replacement therapy.
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Affiliation(s)
| | | | - Ute Hubauer
- University Hospital Regensburg, Regensburg, Germany
| | | | | | | | - Julian Hupf
- University Hospital Regensburg, Regensburg, Germany
| | | | - Evelyn Orso
- University Hospital Regensburg, Regensburg, Germany
| | | | | | - Lars Maier
- University Hospital Regensburg, Regensburg, Germany
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13
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Schober AD, Strack C, Bauer S, Hubauer U, Schober AL, Uecer E, Maier LS, Luchner A, Jungbauer CG. P5453Cardiorenal biomarker N-acteyl-beta-D-glucosaminidase (NAG) potentially predicts mortality in chronic heart failure - A 10 year follow up. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0409] [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 strong relation between chronic heart failure (CHF) and chronic kidney disease (CKD) is well known as cardiorenal syndrome (CRS). The current study focused on the impact of novel markers of kidney injury next to the established cardiac marker NT-proBNP as predictors for mortality in patients with CHF in a long term follow up.
Methods
We conducted a prospective longitudinal study. The novel renal biomarkers kidney injury molecule-1 (KIM-1), N-acteyl-β-D-glucosaminidase (NAG) and Neutrophil Gelatinase-Associated Lipocalin (NGAL) were assessed from urine samples. Additionally, blood levels of NT-proBNP were determined. The primary endpoint all-cause mortality was evaluated after a median follow-up of 104 months (interquartile range 42–117 months).
Results
149 adolescents (mean age 62±12 years) with CHF (mean ejection fraction 32±9%) were enrolled. 79 (53%) patients died. The secondary endpoint was reached by 104 patients (70%).
The renal marker NAG (HR 1.02, p=0.002) was a significant and independent predictor for all-cause mortality next to the established cardiac biomarker NTproBNP (HR 1.0, p<0,001) using Cox regression analysis, opposite to KIM-1 as well as NGAL (each p=n.s.). Similar results were obtained for the combined endpoint of all-cause mortality and hospitalization for heart failure.
In a multivariate analysis model with biomarkers and clinical parameters NAG (HR 1.02, p=0.036) remained a significant predictor for all-cause mortality next to NT-proBNP (HR 1.0, p=0.027, older age (HR 1.04, p=0.004), the lack of diabetes mellitus (HR 0.39, p<0.001), reduced EF (HR 0.97, p=0.034) and creatinine (HR 1.45, p=0.026). Again similar results were obtained for the secondary endpoint.
Patients were stratified into groups with markers above and below Youden Index to calculate Kaplan-Meier analysis. A combined analysis of NT-proBNP (< and ≥1906 pg/mL) and NAG (< and ≥10 U/gUCr) revealed an increase of the predictive value of each marker: patients with all three markers above Youden index had the highest mortality rate (79%) compared to patients with one (43%) or none (26%) marker above Youden Index.
All-cause Mortality
Conclusion
The current 10-years long-term follow-up suggests that the tubular biomarker NAG as cardiorenal biomarker in combination with NT-proBNP may allow to discriminate a high-risk collective of chronic heart failure patients. These findings emphasize the close relationship of kidney injury and renal function in patients with CHF.
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Affiliation(s)
- A D Schober
- University Hospital Regensburg, Regensburg, Germany
| | - C Strack
- University Hospital Regensburg, Regensburg, Germany
| | - S Bauer
- University Hospital Regensburg, Regensburg, Germany
| | - U Hubauer
- University Hospital Regensburg, Regensburg, Germany
| | - A L Schober
- University Hospital Regensburg, Regensburg, Germany
| | - E Uecer
- University Hospital Regensburg, Regensburg, Germany
| | - L S Maier
- University Hospital Regensburg, Regensburg, Germany
| | - A Luchner
- Hospital Barmherzige Bruder, Cardiology, Regensburg, Germany
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14
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Schlossbauer MH, Hubauer U, Stadler S, Hupf J, Sag S, Birner C, Zimmermann M, Orso E, Fischer M, Luchner A, Maier LS, Jungbauer CG. The role of the tubular biomarkers NAG, kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin in patients with chest pain before contrast media exposition. Biomark Med 2019; 13:379-392. [PMID: 30920848 DOI: 10.2217/bmm-2018-0275] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: We evaluated the role of the tubular biomarkers N-acetyl-ß-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in patients with chest pain. Methods: Serum and urine samples were collected of 223 patients and 47 healthy controls. None of them was exposed to contrast media. Results: NAG showed among others significant correlation with N-terminal pro brain natriuretic peptide (NTproBNP), troponin I and creatinine. KIM-1 and NGAL showed weaker correlations. NAG was significantly elevated in all subgroups of acute coronary syndrome (ACS) compared with chest wall syndrome and controls. NAG was an independent predictor for the diagnosis of myocardial infarction. Conclusion: NAG may demonstrate the presence of acute tubular injury due to cardiac impairment already in the emergency department. NAG should be evaluated as marker of acute cardiorenal syndrome in patients with chest pain.
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Affiliation(s)
- Michael H Schlossbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Julian Hupf
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Sabine Sag
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Zimmermann
- Interdisziplinäre Notaufnahme Universitätsklinikum Regensburg, Regensburg, Germany
| | - Evelyn Orso
- Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lars S Maier
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Carsten G Jungbauer
- Abteilung für Kardiologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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15
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Persoon S, Paulus M, Hirt S, Jungbauer C, Dietl A, Luchner A, Schmid C, Maier LS, Birner C. Cardiac unloading by LVAD support differentially influences components of the cGMP-PKG signaling pathway in ischemic and dilated cardiomyopathy. Heart Vessels 2018; 33:948-957. [PMID: 29546540 DOI: 10.1007/s00380-018-1149-x] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/09/2018] [Indexed: 12/11/2022]
Abstract
Implantation of left ventricular assist devices (LVADs) as bridge to transplant in end-stage heart failure allows for analyzing reverse remodeling processes of the supported heart. Whether this therapy influences the cGMP-PKG signaling pathway, which is currently under thorough investigation for developing new heart failure therapeutics, is unknown. In fourteen end-stage heart failure patients (8 with dilated cardiomyopathy, DCM; 6 with ischemic cardiomyopathy, ICM) tissue specimens of left ventricles were collected at LVAD implantation and afterwards at receiver heart explantation, respectively. Then the expressions of key components of the cGMP-PKG signaling pathway were determined by polymerase chain reaction (ANP; BNP; natriuretic peptide receptor A, NPR-A; natriuretic peptide receptor C, NPR-C; neprilysin; NOS3; soluble guanylyl cyclase, sGC; PDE5; cGMP-dependent protein kinase G, PKG) and enzyme-linked immunosorbent assay (cGMP), respectively. Patients were predominantly male, 52 ± 10 years old, were receiving recommended heart failure therapy, and had their donor organ implanted after 351 ± 317 days of LVAD support. Except for more DCM patients with ICD therapy, no significant differences were detected between ICM and DCM, which also applies to the expression of cGMP-PKG pathway components at baseline. After LVAD support, ANP, NPR-C, and cGMP were significantly down-regulated and neprilysin, PDE5, and PKG I expressions were reduced with borderline significance in DCM, but not in ICM patients. Multiple significant correlations were found for expression differences (i.e., expression at LVAD implantation minus expression at heart transplantation) both in DCM and ICM, even though there was a closer connection between the NO and NP side of the cGMP-PKG pathway in DCM patients. Furthermore, duration of LVAD support negatively correlated with expression differences of PKG I, PDE5, and sGC in ICM, but not in DCM. Originating from the same activation level at LVAD implantation, cardiac unloading significantly alters key components of the cGMP-PKG pathway in DCM, but not in ICM patients. This etiology-specific regulation should be considered when analyzing therapeutic interventions with effects on this signaling pathway.
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Affiliation(s)
- Sven Persoon
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stephan Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Christof Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
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16
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Dietl A, Prieschenk C, Eckert F, Birner C, Luchner A, Maier LS, Buchner S. 3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information. Cardiovasc Ultrasound 2018; 16:1. [PMID: 29310672 PMCID: PMC5759791 DOI: 10.1186/s12947-017-0120-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). METHODS Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D-colour-Doppler datasets were available before, during and 4 weeks after PMVR. RESULTS Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9% NYHA III/IV) and severe degenerative (34%) or functional (66%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm2 vs. 0.22 ± 0.15 cm2, p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR. CONCLUSIONS VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients' physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.
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Affiliation(s)
- Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany. .,Comprehensive Heart Failure Center Würzburg, University Hospital and University of Würzburg, Würzburg, Germany.
| | - Christine Prieschenk
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Franziska Eckert
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine II, Sana Kliniken Cham, Cham, Germany
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17
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Sterz U, Buchner S, Hetzenecker A, Satzl A, Debl K, Luchner A, Husser O, Hamer OW, Fellner C, Zeman F, Maier LS, Arzt M. Erratum to: Resolution of ST deviation after myocardial infarction in patients with and without sleep-disordered breathing. Somnologie (Berl) 2018; 22:130. [PMID: 31187786 PMCID: PMC5992229 DOI: 10.1007/s11818-018-0165-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ulrich Sterz
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Stefan Buchner
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Andrea Hetzenecker
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Anna Satzl
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Kurt Debl
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | | | - Oliver Husser
- 3Deutsches Herzzentrum München, Klinik a.d. Technischen Universität München, Munich, Germany
| | - Okka W Hamer
- 4Institut für Röntgendiagnostik, UniversitätsklinikumRegensburg, Regensburg, Germany
| | - Claudia Fellner
- 4Institut für Röntgendiagnostik, UniversitätsklinikumRegensburg, Regensburg, Germany
| | - Florian Zeman
- 5Zentrum für klinische Studien, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lars S Maier
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Michael Arzt
- 1Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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18
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Tschöpe C, Birner C, Böhm M, Bruder O, Frantz S, Luchner A, Maier L, Störk S, Kherad B, Laufs U. Heart failure with preserved ejection fraction: current management and future strategies : Expert opinion on the behalf of the Nucleus of the "Heart Failure Working Group" of the German Society of Cardiology (DKG). Clin Res Cardiol 2017; 107:1-19. [PMID: 29018938 DOI: 10.1007/s00392-017-1170-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022]
Abstract
About 50% of all patients suffering from heart failure (HF) exhibit a reduced ejection fraction (EF ≤ 40%), termed HFrEF. The others may be classified into HF with midrange EF (HFmrEF 40-50%) or preserved ejection fraction (HFpEF, EF ≥ 50%). Presentation and pathophysiology of HFpEF is heterogeneous and its management remains a challenge since evidence of therapeutic benefits on outcome is scarce. Up to now, there are no therapies improving survival in patients with HFpEF. Thus, the treatment targets symptom relief, quality of life and reduction of cardiac decompensations by controlling fluid retention and managing risk factors and comorbidities. As such, renin-angiotensin-aldosterone inhibitors, diuretics, calcium channel blockers (CBB) and beta-blockers, diet and exercise recommendations are still important in HFpEF, although these interventions are not proven to reduce mortality in large randomized controlled trials. Recently, numerous new treatment targets have been identified, which are further investigated in studies using, e.g. soluble guanylate cyclase stimulators, inorganic nitrates, the angiotensin receptor neprilysin inhibitor LCZ 696, and SGLT2 inhibitors. In addition, several devices such as the CardioMEMS, interatrial septal devices (IASD), cardiac contractility modulation (CCM), renal denervation, and baroreflex activation therapy (BAT) were investigated in different forms of HFpEF populations and some of them have the potency to offer new hopes for patients suffering from HFpEF. On the basic research field side, lot of new disease-modifying strategies are under development including anti-inflammatory drugs, mitochondrial-targeted antioxidants, new anti-fibrotic and microRNA-guided interventions are under investigation and showed already promising results. This review addresses available data of current best clinical practice and management approaches based on expert experiences and summarizes novel approaches towards HFpEF.
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Affiliation(s)
- Carsten Tschöpe
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany. .,Berliner Zentrum für Regenerative Therapien (BCRT), Charite, Campus Virchow Clinic (CVK), Berlin, Germany. .,Deutsches Zentrum für Herz Kreislaufforschung (DZHK), Standort Berlin/Charité, Berlin, Germany.
| | - Christoph Birner
- Germany Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Böhm
- Innere Medizin III-Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
| | - Stefan Frantz
- Department of Internal Medicine III, University Halle, Halle, Germany
| | - Andreas Luchner
- Department of Internal Medicine I, Clinic St. Marien, Amberg, Germany
| | - Lars Maier
- Germany Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Störk
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum und Universität Würzburg, Würzburg, Germany
| | - Behrouz Kherad
- Department of Cardiology, Universitätsmedizin Berlin, Charite, Campus Rudolf Virchow Clinic (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.,Privatpraxis Dr. Kherad, Berlin, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie im Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
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19
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Fisser C, Marcinek A, Hetzenecker A, Debl K, Luchner A, Sterz U, Priefert J, Zeman F, Kohler M, Maier LS, Buchner S, Arzt M. Association of sleep-disordered breathing and disturbed cardiac repolarization in patients with ST-segment elevation myocardial infarction. Sleep Med 2017; 33:61-67. [DOI: 10.1016/j.sleep.2017.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
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20
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Luchner A, von Haehling S, Holubarsch C, Keller T, Knebel F, Zugck C, Laufs U. Einsatzgebiete und praktischer Nutzen der kardialen Marker BNP und NT-proBNP. Dtsch Med Wochenschr 2017; 142:346-355. [DOI: 10.1055/s-0042-117368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andreas Luchner
- Klinik für Innere Medizin I (Kardiologie, Angiologie, Nephrologie, Pneumologie, Internistische Intensivmedizin), Klinikum St. Marien, Amberg
| | - Stephan von Haehling
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen
| | | | - Till Keller
- Goethe University Frankfurt, Department of Internal Medicine III, Division of Cardiology, Frankfurt am Main
| | - Fabian Knebel
- Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Mitte, Charité – Universitätsmedizin Berlin
| | | | - Ulrich Laufs
- Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg
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21
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Husser O, Núñez J, Burgdorf C, Holzamer A, Templin C, Kessler T, Bodi V, Sanchis J, Pellegrini C, Luchner A, Maier LS, Schmid C, Lüscher TF, Schunkert H, Kastrati A, Hilker M, Hengstenberg C. Mejora en la estratificación del riesgo tras el implante percutáneo de válvula aórtica mediante una combinación de marcador tumoral CA125 y EuroSCORE logístico. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Jungbauer CG, Uecer E, Stadler S, Birner C, Buchner S, Maier LS, Luchner A. N-acteyl-ß-D-glucosaminidase and kidney injury molecule-1: New predictors for long-term progression of chronic kidney disease in patients with heart failure. Nephrology (Carlton) 2017; 21:490-8. [PMID: 26422793 DOI: 10.1111/nep.12632] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 07/26/2015] [Revised: 09/21/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022]
Abstract
AIM Patients with chronic heart failure (CHF) are often characterized by the cardiorenal syndrome (CRS). The aim of the present study was to assess whether novel markers of kidney injury are able to predict progression of chronic kidney disease (CKD) in patients with CHF. METHODS New renal biomarkers, N-acteyl-ß-D-glucosaminidase (NAG), kidney injury molecule-1 (KIM-1) and Neutrophil Gelatinase-Associated Lipocalin (NGAL), were assessed from urine samples of 149 patients with chronic heart failure. During a 5-year-follow-up, renal function was assessed by creatinine and estimated glomerular filtration rate (eGFR CKD EPI) and was available for 138 patients. Further, data regarding all-cause mortality was obtained. RESULTS Twenty-six patients (18.8%) developed a progression of CKD during the follow-up period, as defined by decline in eGFR category accompanied by a ≥25% drop in eGFR form baseline. No difference regarding age, sex, body mass index, hypertension, diabetes or EF was present between patients with and without CKD progression (each P = n.s.). At baseline, creatinine concentrations and eGFR were significantly different between both groups (sCr: 1.50 ± 0.67 vs 1.04 ± 0.37, P = < 0.001; eGFR: 47.8 ± 12.3 vs. 77.3 ± 23.5 mL/min per 1.73m(2) , each P < 0.001). In a Kaplan-Meier-analysis, KIM-1 and NAG were significant predictors for CKD progression (both P < 0.05). In Cox regression analysis, NAG > median (OR 3.25,P = 0.013), initial eGFR (OR 0.94, P < 0.001) and diuretic use (OR 3.92, P = 0.001) were independent predictors of CKD progression. Further, KIM-1 and NAG were also independent predictors of a combined endpoint of CKD progression and all-cause mortality by Cox regression analysis (each P < 0.05). The combination of both markers showed additive value regarding both endpoints. NGAL showed no association with CKD progression. CONCLUSIONS During long-term follow-up chronic heart failure patients with CKD show a relevant disease progression. The current study emphasizes a strong association of the tubular biomarkers NAG and KIM-1 with CKD progression in chronic heart failure and suggests their usefulness as cardiorenal markers.
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Affiliation(s)
- Carsten G Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Ekrem Uecer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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23
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Altmann U, Böger CA, Farkas S, Mack M, Luchner A, Hamer OW, Zeman F, Debl K, Fellner C, Jungbauer C, Banas B, Buchner S. Effects of Reduced Kidney Function Because of Living Kidney Donation on Left Ventricular Mass. Hypertension 2017; 69:297-303. [DOI: 10.1161/hypertensionaha.116.08175] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 07/29/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
Living kidney donation is associated with a small but significant increase in cardiovascular mortality. In addition, mildly decreased kidney function is associated with an increase of left ventricular mass and with cardiovascular disease in patients with chronic kidney disease. To investigate this association, we evaluated the impact of mildly decreased kidney function after living kidney donation on subclinical cardiac structural and functional changes. In this prospective cohort study, cardiac and renal magnetic resonance imaging and laboratory analyses were performed in 23 living kidney donors (mean age 54±10 years, 52% male) before donation and at 4 and 12 months after nephrectomy. Mean estimated glomerular filtration rate was 102±15 mL min
−1
1.73 m
−2
before donation and 70±13 mL min
−1
1.73 m
−2
at 12 months (
P
<0.001). Left ventricular mass increased from 112±22 to 115±23 g (
P
<0.001). In addition, heart rate was significantly increased (65±7 to 74±14;
P
=0.04). Concurrently, kidney and adrenal gland volume increased from 163±33 to 195±34 mL (
P
<0.001) and from 7.6±2.2 to 8.4±2.4 mL (
P
=0.032), respectively, as did procollagen type III (Δ0.11 ng/mL,
P
<0.001) and not N-terminal probrain natriuretic peptide (Δ14 pg/mL,
P
=0.25). The mild decrease in kidney function after living kidney donation leads to a significant but clinically negligible increase in left ventricular mass 12 months after living kidney donation. This study of a longitudinal analysis of living kidney donors provides direct evidence of a kidney–heart link.
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Affiliation(s)
- Ursula Altmann
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Carsten A. Böger
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Stefan Farkas
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Matthias Mack
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Andreas Luchner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Okka W. Hamer
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Florian Zeman
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Kurt Debl
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Claudia Fellner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Carsten Jungbauer
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Bernhard Banas
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
| | - Stefan Buchner
- From the Klinik und Poliklinik für Innere Medizin II (U.A., A.L., K.D., C.J., S.B.), Abteilung für Nephrologie (C.A.B., M.M., B.B.), Klinik und Poliklinik für Chirurgie (S.F.), Institut für Röntgendiagnostik (O.W.H., C.F.), and Zentrum für klinische Studien, Biostatistics (F.Z.), Universitätsklinikum Regensburg, Germany
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Grois L, Hupf J, Reinders J, Schröder J, Dietl A, Schmid PM, Jungbauer C, Resch M, Maier LS, Luchner A, Birner C. Combined Inhibition of the Renin-Angiotensin System and Neprilysin Positively Influences Complex Mitochondrial Adaptations in Progressive Experimental Heart Failure. PLoS One 2017; 12:e0169743. [PMID: 28076404 PMCID: PMC5226780 DOI: 10.1371/journal.pone.0169743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 12/21/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Inhibitors of the renin angiotensin system and neprilysin (RAS-/NEP-inhibitors) proved to be extraordinarily beneficial in systolic heart failure. Furthermore, compelling evidence exists that impaired mitochondrial pathways are causatively involved in progressive left ventricular (LV) dysfunction. Consequently, we aimed to assess whether RAS-/NEP-inhibition can attenuate mitochondrial adaptations in experimental heart failure (HF). METHODS AND RESULTS By progressive right ventricular pacing, distinct HF stages were induced in 15 rabbits, and 6 animals served as controls (CTRL). Six animals with manifest HF (CHF) were treated with the RAS-/NEP-inhibitor omapatrilat. Echocardiographic studies and invasive blood pressure measurements were undertaken during HF progression. Mitochondria were isolated from LV tissue, respectively, and further worked up for proteomic analysis using the SWATH technique. Enzymatic activities of citrate synthase and the electron transfer chain (ETC) complexes I, II, and IV were assessed. Ultrastructural analyses were performed by transmission electron microscopy. During progression to overt HF, intricate expression changes were mainly detected for proteins belonging to the tricarboxylic acid cycle, glucose and fat metabolism, and the ETC complexes, even though ETC complex I, II, or IV enzymatic activities were not significantly influenced. Treatment with a RAS-/NEP-inhibitor then reversed some maladaptive metabolic adaptations, positively influenced the decline of citrate synthase activity, and altered the composition of each respiratory chain complex, even though this was again not accompanied by altered ETC complex enzymatic activities. Finally, ultrastructural evidence pointed to a reduction of autophagolytic and degenerative processes with omapatrilat-treatment. CONCLUSIONS This study describes complex adaptations of the mitochondrial proteome in experimental tachycardia-induced heart failure and shows that a combined RAS-/NEP-inhibition can beneficially influence mitochondrial key pathways.
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Affiliation(s)
- Laura Grois
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Julian Hupf
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jörg Reinders
- Institute of Functional Genomics, University Regensburg, Regensburg, Germany
| | - Josef Schröder
- Electron Microscopy Core Facility, Institute for Pathology, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Peter M. Schmid
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Carsten Jungbauer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Markus Resch
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine I, Clinic St. Marien, Amberg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
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25
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Dietl A, Stark K, Zimmermann ME, Meisinger C, Schunkert H, Birner C, Maier LS, Peters A, Heid IM, Luchner A. NT-proBNP Predicts Cardiovascular Death in the General Population Independent of Left Ventricular Mass and Function: Insights from a Large Population-Based Study with Long-Term Follow-Up. PLoS One 2016; 11:e0164060. [PMID: 27711172 PMCID: PMC5053441 DOI: 10.1371/journal.pone.0164060] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 09/19/2016] [Indexed: 12/28/2022] Open
Abstract
Aims B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) predict cardiovascular endpoints in patients and all-cause death in the general population. This was assigned to their association with clinical cardiac remodelling defined as changes in size, shape and function of the heart. The aim of this study was to evaluate whether NT-proBNP and BNP were associated with cardiovascular and overall death independent of clinical cardiac remodelling measured by echocardiography as left ventricular hypertrophy (LVH), diastolic dysfunction and left ventricular ejection fraction (EF). Methods and Results In a general population-based cohort study from Germany (KORA-S3) with subjects’ baseline age ranging from 25 to 74 years, cardiac morphology and function were assessed as left ventricular mass (LVM), diastolic dysfunction and EF by echocardiography and circulating NT-proBNP and BNP were measured at baseline. In 1,223 subjects with mortality follow-up information, we examined the association of baseline NT-proBNP and BNP with cardiovascular mortality (number of deaths = 52, median follow-up time = 12.9years) using Cox regression without and with adjustment for cardiovascular risk factors, LVM, diastolic dysfunction and EF. The risk of cardiovascular mortality increased with higher NT-proBNP levels measured at baseline (hazard ratio HR = 1.67 per unit increment in logNT-proBNP, p = 2.78*10−4, adjusted for age and sex). This increased risk persisted after adjustment for cardiovascular risk factors, LVM, diastolic dysfunction and EF (HR = 1.73; p = 0.047). When excluding subjects with relevant LVH (LVM to body surface area > 149g/m2 in men / 122g/m2 in women), the NT-proBNP association with mortality was still significant (n = 1,138; number of deaths = 35; HR = 1.48; p = 0.04). We found similar results for BNP. Conclusion Our data confirms NT-proBNP and BNP as predictor of cardiovascular mortality in a large general population-based study with long-term follow-up. Our study extends previously published population-based studies to younger and potentially healthier individuals without relevant LVH, diastolic dysfunction or LVD.
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Affiliation(s)
- Alexander Dietl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Klaus Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | | | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum Muenchen, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, and DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum Muenchen, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Iris M. Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- * E-mail:
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Klinikum Amberg, Amberg, Germany
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26
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Resch M, Ostheim P, Endemann DH, Debl K, Buchner S, Birner C, Maier LS, Kerber S, Luchner A, Griese DP. Drug Coated Balloon Is Less Effective for Treatment of DES In-Stent Restenosis Both in Native Coronary Arteries and Saphenous Vein Grafts: Results From a Bicenter Registry. J Interv Cardiol 2016; 29:461-468. [PMID: 27477024 DOI: 10.1111/joic.12324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The paclitaxel drug coated balloon (DCB) is an established treatment for bare metal stent (BMS) in-stent restenosis (ISR) in native coronary arteries. The evidence of DCB-application for drug eluting stent (DES) ISR both in native coronaries and saphenous vein grafts (SVG) is limited. Aim of our study was to compare the differential efficacy of DCB for treatment of BMS- and DES-ISR in native coronary vessels and SVGs. METHODS AND RESULTS N = 135 DCB-treated patients with available follow up (FU) angiography were included in this retrospective study. Patients received treatment between April 2009 and March 2013 at 2 tertiary care hospitals in Germany. DCB was applied in BMS-ISR (n = 65; 48%) and DES-ISR (n = 70; 52%). DCB-treated lesions were located in native coronary arteries (n = 110; 81%; BMS-ISR: n = 58; 53%; DES-ISR: n = 52; 47%) and SVGs (n = 25; 19%; BMS-ISR: n = 7, 28%; DES-ISR: n = 18, 72%). Median FU was 12 months. Endpoints were binary restenosis and target lesion revascularization (TLR). Binary restenosis (29% vs. 57%; P < 0.01) and TLR (18% vs. 46%; P < 0.01) were significantly more frequent in DES-ISR versus BMS-ISR. In SVGs, TLR was required in 72% (DES-ISR) versus 14% (BMS-ISR); P = 0.02. In the Kaplan-Meier-analysis freedom from both endpoints was significantly decreased in the DES-lesions both in the total population (binary restenosis P < 0.01; TLR P < 0.01) and native coronaries (binary restenosis P = 0.02; TLR P = 0.04). CONCLUSIONS DCB treatment is less effective in DES-ISR than in BMS-ISR. The diminished efficacy of DCB treatment is even more pronounced in DES-ISR located within degenerated SVGs.
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Affiliation(s)
- Markus Resch
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Patrick Ostheim
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dierk H Endemann
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Daniel P Griese
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
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Miller WL, Borgeson DD, Grantham JA, Luchner A, Redfield MM, Burnett JC. Dietary sodium modulation of aldosterone activation and renal function during the progression of experimental heart failure. Eur J Heart Fail 2015; 17:144-50. [PMID: 25823360 DOI: 10.1002/ejhf.212] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Aldosterone activation is central to the sodium–fluid retention that marks the progression of heart failure (HF). The actions of dietary sodium restriction, a mainstay in HF management, on cardiorenal and neuroendocrine adaptations during the progression of HF are poorly understood. The study aim was to assess the role of dietary sodium during the progression of experimental HF. METHODS AND RESULTS Experimental HF was produced in a canine model by rapid right ventricular pacing which evolves from early mild HF to overt, severe HF. Dogs were fed one of three diets: (i) high sodium [250 mEq (5.8 g) per day, n =6]; (ii) standard sodium [58 mEq (1.3 g) per day, n =6]; and (iii) sodium restriction [11 mEq (0.25 g) per day, n =6]. During the 38-day study, haemodynamics, renal function, plasma renin activity (PRA), and aldosterone were measured. Changes in haemodynamics at 38 days were similar in all three groups, as were changes in renal function. Aldosterone activation was demonstrated in all three groups; however, dietary sodium restriction, in contrast to high sodium, resulted in early (10 days) activation of PRA and aldosterone. High sodium demonstrated significant suppression of aldosterone activation over the course of HF progression. CONCLUSIONS Excessive dietary sodium restriction particularly in early stage HF results in early aldosterone activation, while normal and excess sodium intake are associated with delayed or suppressed activation. These findings warrant evaluation in humans to determine if dietary sodium manipulation, particularly during early stage HF, may have a significant impact on neuroendocrine disease progression.
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Brand M, Schwiede M, Trappe HJ, Christ M, Maier L, Luchner A, Jungbauer CG. Established renal markers for diagnosis and prognosis in acutely decompensated heart failure. Intensive Care Med Exp 2015. [PMCID: PMC4797905 DOI: 10.1186/2197-425x-3-s1-a259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Stark K, Olden M, Brandl C, Dietl A, Zimmermann ME, Schelter SC, Loss J, Leitzmann MF, Böger CA, Luchner A, Kronenberg F, Helbig H, Weber BHF, Heid IM. The German AugUR study: study protocol of a prospective study to investigate chronic diseases in the elderly. BMC Geriatr 2015; 15:130. [PMID: 26489512 PMCID: PMC4617905 DOI: 10.1186/s12877-015-0122-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/07/2015] [Indexed: 12/18/2022] Open
Abstract
Background The majority of patients suffering from chronic health disabilities is beyond 70 years of age. Typical late-onset chronic diseases include those affecting the heart, the kidney, cancer, and conditions of the eye such as age-related macular degeneration. These diseases disable patients for many years and largely compromise autonomy in daily life. Due to challenges in recruiting the elderly, the collection of population-based epidemiological data as a prerequisite to understand associated risk factors and mechanisms is commonly done in the general population within an age-range of 20 to 70 years. Methods/Design We establish the German AugUR study (Age-related diseases: understanding genetic and non-genetic influences - a study at the University of Regensburg), a prospective study in the mobile elderly general population in and around Regensburg in eastern Bavaria. In the long term, we aim to recruit 3,000 persons of Caucasian ethnicity with at least 70 years of age via residents’ registration offices and conduct 3-year follow-ups. The study protocol includes a standardized interview regarding social and life-style factors, medication history, quality-of-life, and existing diagnoses of common diseases. The participants undergo medical examinations for ophthalmological, cardiovascular or diabetes-related conditions, and general measurements of body shape and fitness. The program is particularly tailored for the elderly. Biobanking of whole blood, serum, plasma, and urine is conducted and standard laboratory measurements are performed in fresh samples. Discussion AugUR is specifically designed as a research platform to host studies of late onset diseases. Consequently, this platform will help (1) to unravel the genetic and non-genetic etiology of disease development and progression, (2) to serve as control group of elderly individuals for comparisons with various patient groups, (3) to derive prevalence and incidence data on chronic diseases, and (4) to provide clinical reference parameters for the elderly mobile general population. This data will foster our understanding of disease mechanisms, which may ultimately help to improve prevention, diagnosis, and therapy for frequent chronic diseases. Here we present the baseline study protocol of AugUR.
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Affiliation(s)
- Klaus Stark
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Matthias Olden
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Caroline Brandl
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany. .,Institute of Human Genetics, University Regensburg, Regensburg, Germany.
| | - Alexander Dietl
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Sabine C Schelter
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
| | - Julika Loss
- Department of Epidemiology and Preventive Medicine, University Regensburg, Regensburg, Germany.
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University Regensburg, Regensburg, Germany.
| | - Carsten A Böger
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany.
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Horst Helbig
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany.
| | - Bernhard H F Weber
- Institute of Human Genetics, University Regensburg, Regensburg, Germany.
| | - Iris M Heid
- Department of Genetic Epidemiology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Buchner S, Dreher A, Resch M, Schach C, Birner C, Luchner A. Simplified Method for Insertion of Steerable Guide into the Left Atrium Using a Pigtail Guide Wire During the MitraClip(®) Procedure: A Technical Tip. J Interv Cardiol 2015; 28:472-8. [PMID: 26346179 DOI: 10.1111/joic.12224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To assess whether a new floppy pigtail guidewire provides sufficient support for introduction of the 22F-steerable guide catheter (SG) into the left atrium and is less time-consuming during the MitraClip(®) -procedure without necessity of probing and inserting a stiff wire into the pulmonary vein. METHODS In group 1, traditional probing of the left upper pulmonary vein and insertion of a standard stiff wire was used. In group 2, direct insertion of the floppy pigtail guidewire directly after transseptal puncture was used. RESULTS Patients in group 1 (n = 18) and group 2 (n = 21) did not differ significantly with respect to mitral regurgitation severity (3.2 ± 0.4 vs 3.2 ± 0.4; P = 0.814) and etiology (functional 78% vs 71%, P = 0.651). Comparing both methods, a significant reduction in time-to-SG was observed in group 2 versus group 1 (17 ± 7 minutes vs 30 ± 11 minutes; P = 0.001). The rate of crossing failures was 0% with use of the floppy pigtail guidewire as well as with the traditional technique. No complications were observed with use of the floppy pigtail guidewire. CONCLUSIONS Utilization of a thin, floppy pigtail guidewire for left atrium access is safe and markedly accelerates insertion of the SG for the MitraClip(®) -procedure without crossing failures of the atrial septum.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
| | - Ansgar Dreher
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
| | - Markus Resch
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
| | - Christian Schach
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
| | - Christoph Birner
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Universit, ä, tsklinikum Regensburg, Regensburg
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Buchner S, Debl K, Schmid FX, Luchner A, Djavidani B. Cardiovascular magnetic resonance assessment of the aortic valve stenosis: an in vivo and ex vivo study. BMC Med Imaging 2015; 15:34. [PMID: 26306577 PMCID: PMC4548454 DOI: 10.1186/s12880-015-0076-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/11/2015] [Indexed: 11/25/2022] Open
Abstract
Background Aortic valve area (AVA) estimation in patients with aortic stenosis may be obtained using several methods. This study was undertaken to verify the cardiovascular magnetic resonance (CMR) planimetry of aortic stenosis by comparing the findings with invasive catheterization, transthoracic (TTE) as well as tranesophageal echocardiography (TEE) and anatomic CMR examination of autopsy specimens. Methods Our study was performed in eight patients with aortic valve stenosis. Aortic stenosis was determined by TTE and TEE as well as catheterization and CMR. Especially, after aortic valve replacement, the explanted aortic valves were examined again with CMR ex vivo model. Results The mean AVA determined in vivo by CMR was 0.75 ± 0.09 cm2 and ex vivo by CMR was 0.65 ± 0.09 cm2 and was closely correlated (r = 0.91, p < 0.001). The mean absolute difference between AVA derived by CMR ex vivo and in vivo was −0.10 ± 0.04 cm2. The mean AVA using TTE was 0.69 ± 0.07 with a significant correlation between CMR ex vivo (r = 0.85, p < 0.007) and CMR in vivo (r = 0.86, p < 0.008). CMR ex vivo and in vivo had no significant correlation with AVA using Gorlin formula by invasive catheterization or using planimetry by TEE. Conclusion In this small study using an ex vivo aortic valve stenosis model, the aortic valve area can be reliably planimetered by CMR in vivo and ex vivo with a well correlation between geometric AVA by CMR and the effective AVA calculated by TTE.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Kurt Debl
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Franz-Xaver Schmid
- Klinik und Poliklinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany.
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany.
| | - Behrus Djavidani
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany.
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Buchner S, Eglseer M, Debl K, Hetzenecker A, Luchner A, Husser O, Stroszczynski C, Hamer OW, Fellner C, Zeman F, Pfeifer M, Arzt M. Sleep disordered breathing and enlargement of the right heart after myocardial infarction. Eur Respir J 2014; 45:680-90. [DOI: 10.1183/09031936.00057014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3–5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea–hypopnoea index of ≥15 events·h−1.12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27)versusthose without (n=25) (mean±sd14±23%versus0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea–hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013–0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm2versus1.0±2.4 cm2, p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI.
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Dietl A, Winkel I, Deutzmann R, Hupf J, Riegger G, Luchner A, Birner C. P654Left and right atria show different basal expression patterns of metabolic enzymes in a proteomic-based gene ontology representation study. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dietl A, Winkel I, Deutzmann R, Schröder J, Hupf J, Riegger G, Luchner A, Birner C. Interatrial differences of basal molecular set-up and changes in tachycardia-induced heart failure-a proteomic profiling study. Eur J Heart Fail 2014; 16:835-45. [PMID: 25045083 DOI: 10.1002/ejhf.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/06/2014] [Accepted: 05/23/2014] [Indexed: 01/09/2023] Open
Abstract
AIMS Left and right atria show compelling differences regarding organogenesis and specific clinical diseases. In congestive heart failure (CHF), remodelling of the atria occurs leading to increased arrhythmogenic susceptibility and deterioration of clinical symptoms. We aimed to assess the basal left and right atrial molecular set-up and different chamber-specific atrial changes in heart failure. METHODS AND RESULTS We combined an animal model of rapid ventricular pacing induced heart failure in the rabbit and a gel-based proteomic screening of left and right atrial specimen. A gene ontology over-representation analysis was performed for biological function. Ultrastructural adaptations were evaluated using transmission electron microscopy. Comparing left and right atria of healthy control animals (CTRL), 39 proteins displayed significant expression differences involving various biological functions. Upon further statistical analyses, four pathways of energy metabolism were confirmed to be significantly over-represented beneath the other biological processes. Rapid ventricular pacing induced severe left ventricular systolic dysfunction, symptomatic heart failure and a macroscopic atrial remodelling. In CHF versus CTRL, metabolic and antioxidative enzymes were differentially expressed and showed chamber-specific bidirectional alterations. Transmission electron microscopy visualized a remarkable and again chamber-specific ultrastructural disturbance of mitochondrial morphology. CONCLUSIONS Our data indicate a diverging basal left and right atrial molecular set-up in the adult healthy heart. In addition, metabolic and antioxidative enzymes are profoundly and chamber-specifically altered during atrial remodelling in progressive heart failure.
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Affiliation(s)
- Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg; Department of Genetic Epidemiology, University of Regensburg
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Jungbauer CG, Riedlinger J, Block D, Stadler S, Birner C, Buesing M, König W, Riegger G, Maier L, Luchner A. Panel of emerging cardiac biomarkers contributes for prognosis rather than diagnosis in chronic heart failure. Biomark Med 2014; 8:777-89. [DOI: 10.2217/bmm.14.31] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: As complex disease, heart failure is associated with various pathophysiological and biochemical disorders. No single biomarker is able to display all these characteristics. Therefore, we evaluated a multimarker panel together with the biochemical gold-standard NT-proBNP. Part of the panel are markers for angiogenesis (Endostatin, IBP-4, IBP-7, sFlt-1 as antiangiogenetic factors and PLGF as angiogenectic factor), myocyte stress (GDF-15), extracellular matrix remodelling (galectin-3, mimecan and TIMP-1), inflammation (galectin-3) and myocyte injury (hs-TnT). Methods: All markers (Roche Diagnostics, Penzberg, Germany) were assessed in a cohort of 149 patients with chronic heart failure and 84 healthy controls. Results: All markers were positively correlated with ln NT-proBNP (each p < 0.05). Furthermore, they were significantly elevated in patients with chronic heart failure (each p < 0.05). All markers increased significantly with severity of LV dysfunction and severity of New York Heart Association class (each p < 0.05), except for PLGF and Mimecan (each p = NS). With the exception of endostatin, mimecan and PLGF, all other markers were further significant predictors for all-cause mortality in a 3-year follow-up. In a multimarker approach of the five biomarkers with the best performance (NT-proBNP, hs-TnT, TIMP-1, GDF-15 and IBP-4), the event rate was superior to NT-proBNP alone and increased significantly and progressively with the number of elevated biomarkers. Conclusion: All emerging markers increased stepwise with the severity of symptoms and LV dysfunction and offer important prognostic information in chronic heart failure, except for PLGF and mimecan. Five biomarkers with different pathophysiological background incorporated additive prognostic value in heart failure. Prognostication in heart failure may be further improved through a multimarker approach.
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Affiliation(s)
- Carsten G Jungbauer
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | - Stefan Stadler
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Monika Buesing
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Wolfgang König
- Department of Cardiology, Klinik fuer Innere Medizin II, Universitätsklinikum Ulm, Ulm, Germany
| | - Günter Riegger
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Lars Maier
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Klinik & Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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Birner C, Hierl S, Dietl A, Hupf J, Jungbauer C, Schmid PM, Rümmele P, Deutzmann R, Riegger G, Luchner A. Experimental heart failure induces alterations of the lung proteome--insight into molecular mechanisms. Cell Physiol Biochem 2014; 33:692-704. [PMID: 24643085 DOI: 10.1159/000358645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Heart failure (CHF) is characterized by dyspnea and pulmonary changes. The underlying molecular adaptations are unclear, but might provide targets for therapeutic interventions. We therefore conceived a study to determine molecular changes of early pulmonary stress failure in a model of tachycardia-induced heart failure. METHODS CHF was induced in rabbits by progessive right ventricular pacing (n=6). Invasive blood pressure measurements and echocardiography were repeatedly performed. Untreated animals served as controls (n=6). Pulmonary tissue specimens were subjected to two-dimensional gel electrophoresis, and differentially expressed proteins were identified by mass spectrometry. Selected proteins were validated by Western Blot analysis and localized by immunohistochemical staining. RESULTS CHF animals were characterized by significantly altered functional, morphological, and hemodynamic parameters. Upon proteomic profiling, a total of 33 proteins was found to be differentially expressed in pulmonary tissue of CHF animals (18 up-regulated, and 15 down-regulated) belonging to 4 functional groups: 1. proteins involved in maintaining cytoarchitectural integrity, 2. plasma proteins indicating impaired alveolar-capillary permeability, 3. proteins with antioxidative properties, and 4. proteins participating in the metabolism of selenium compounds CONCLUSION Experimental heart failure profoundly alters the pulmonary proteome. Our results supplement the current knowledge of pulmonary stress failure by specifying its molecular fundament.
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Affiliation(s)
- Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Jungbauer CG, Birner C, Jung B, Buchner S, Lubnow M, von Bary C, Endemann D, Banas B, Mack M, Böger CA, Riegger G, Luchner A. Kidney injury molecule-1 and N
-acetyl-ß-d
-glucosaminidase in chronic heart failure: possible biomarkers of cardiorenal syndrome. Eur J Heart Fail 2014; 13:1104-10. [DOI: 10.1093/eurjhf/hfr102] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carsten G. Jungbauer
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Christoph Birner
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Bettina Jung
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Stefan Buchner
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Matthias Lubnow
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Christian von Bary
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Dierk Endemann
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Bernhard Banas
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Matthias Mack
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Carsten A. Böger
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Günter Riegger
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
| | - Andreas Luchner
- Departments of Cardiology and Nephrology, Klinik und Poliklinik fuer Innere Medizin II; Universitätsklinikum Regensburg; Regensburg Germany
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Husser O, Núñez J, Núñez E, Holzamer A, Camboni D, Luchner A, Sanchis J, Bodi V, Riegger GAJ, Schmid C, Hilker M, Hengstenberg C. Tumor marker carbohydrate antigen 125 predicts adverse outcome after transcatheter aortic valve implantation. JACC Cardiovasc Interv 2014; 6:487-96. [PMID: 23702013 DOI: 10.1016/j.jcin.2013.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/02/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to predict the value of tumor marker carbohydrate antigen 125 (CA125) before and after transcatheter aortic valve implantation (TAVI) for all-cause death and a composite endpoint of death, admission for heart failure, myocardial infarction, and stroke (major adverse cardiac events [MACE]). BACKGROUND Risk stratification after TAVI remains challenging. The use of biomarkers in this setting represents an unmet need. METHODS CA125 was measured in 228 patients before and after TAVI. The association with outcomes was assessed using parametric Cox regression and joint modeling for baseline and longitudinal analyses, respectively. CA125 was evaluated as logarithm transformation and dichotomized by its median value (M1 ≤15.7 U/ml vs. M2 >15.7 U/ml). RESULTS At a median follow-up of 183 days (interquartile range: 63 to 365) and 144 days (interquartile range: 56 to 365), 50 patients (22%) died and 75 patients (33%) experienced MACE. A 3-fold increase in the rates for death and MACE was observed in patients above the median (M2 vs. M1) of CA125 (5.2 vs. 1.6 per 10 person-years and 8.3 vs. 3.3 per 10 person-years, respectively; p for both <0.001). In a multivariable analysis adjusted for logistic EuroSCORE, New York Heart Association functional class III/IV, and device success, baseline values of CA125 (M2 vs. M1) independently predicted death (hazard ratio [HR]: 2.18; 95% confidence interval [CI]: 1.11 to 4.26; p = 0.023) and MACE (HR: 1.77; 95% CI: 1.05 to 2.98; p = 0.031). In the longitudinal analysis, lnCA125 as a time-varying exposure, was highly associated with both endpoints: HR: 1.47; 95% CI: 1.01 to 2.14; p = 0.043 and HR: 2.26; 95% CI: 1.28 to 3.98; p = 0.005, for death and MACE, respectively. CONCLUSIONS Serum levels of CA125 before and after TAVI independently predict death and MACE.
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Affiliation(s)
- Oliver Husser
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
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Weisz G, Smilowitz NR, Moses JW, Rabbani LE, Collins MB, Herscovici A, Jeron A, Leon MB, Luchner A. Magnetic positioning system in coronary angiography and percutaneous intervention: a feasibility and safety study. Catheter Cardiovasc Interv 2013; 82:1084-90. [PMID: 23592312 DOI: 10.1002/ccd.24946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 02/28/2013] [Accepted: 04/07/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study sought to evaluate the safety and feasibility of a magnetic medical positioning system (MPS) to determine the three-dimensional (3D) position and orientation of intracoronary wires and catheters and to guide angiography and percutaneous coronary intervention (PCI). BACKGROUND Coronary angiography relies on fluoroscopy for catheter navigation and often fails to accurately portray vessel tortuosity, overlap, and length because of complex anatomy and foreshortening of curved coronary segments. METHODS Forty adult participants underwent coronary angiography and/or PCI with MPS guidance. Two interventional cardiologists independently scored (1-5) the accuracy of MPS catheter tracking projected on live fluoroscopy, recorded cine loops, and 3D vessel reconstructions. Measurements from MPS reconstructions were compared to conventional two-dimensional (2D) quantitative coronary angiography (QCA) measurements. Device procedural success was defined as the ability of the MPS-enabled catheter to reach the target vessel, perform the intended operations, and be retrieved without major adverse cardiac events. RESULTS Diagnostic coronary angiography was performed in 19 (47.5%) and PCI in 21 patients (52.5%). MPS procedural success was achieved in 36 (90%) of the cases. MPS accuracy was highest with the MPS superimposed on live fluoroscopy (4.9 ± 0.2/5) and the 3D vessel reconstruction (4.7 ± 0.5/5). MPS length measurements were more accurate than conventional QCA. CONCLUSIONS This study demonstrates the feasibility and safety of magnetic catheter tracking with 3D positional data during diagnostic angiography and PCI. Catheter position was accurately projected on real-time fluoroscopy, recorded cine loops, and 3D reconstructions. An MPS may serve as a platform for device navigation and positioning during PCI.
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Affiliation(s)
- Giora Weisz
- Center for Interventional Vascular Therapy, NewYork Presbyterian Hospital, Columbia University Medical Center, New York, NY
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Buchner S, Fischer M, Fellner C, Hamer OW, Luchner A. Non-invasive mapping of organ perfusion and blood flow by CT and MRI highlighted by a case of pulmonary artery stenosis. Eur Heart J Cardiovasc Imaging 2013; 15:595. [PMID: 24212933 DOI: 10.1093/ehjci/jet200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
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Buchner S, Satzl A, Debl K, Hetzenecker A, Luchner A, Husser O, Hamer OW, Poschenrieder F, Fellner C, Zeman F, Riegger GAJ, Pfeifer M, Arzt M. Impact of sleep-disordered breathing on myocardial salvage and infarct size in patients with acute myocardial infarction. Eur Heart J 2013; 35:192-9. [DOI: 10.1093/eurheartj/eht450] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Hetzenecker A, Buchner S, Greimel T, Satzl A, Luchner A, Debl K, Husser O, Hamer OW, Fellner C, Riegger GAJ, Pfeifer M, Arzt M. Cardiac workload in patients with sleep-disordered breathing early after acute myocardial infarction. Chest 2013; 143:1294-1301. [PMID: 23715560 DOI: 10.1378/chest.12-1930] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) may promote an increase in cardiac workload early after acute myocardial infarction (AMI). We tested the hypothesis that in the early phase after AMI, SDB is associated with increased 24-h arterial BP, heart rate (HR), and, thus, cardiac workload. METHODS In this prospective study, 55 consecutive patients with AMI and subsequent percutaneous coronary intervention (78% men; mean age, 54 ± 10 y; mean BMI, 28.3 ± 3.6 kg/m²; mean left ventricular ejection fraction [LVEF], 47% ± 8%) underwent polysomnography and 24-h ambulatory BP and heart rate monitoring within 5 days after MI. Cardiac workload was calculated as systolic BP multiplied by HR. The presence of SDB was defined as ≥ 10 apneas and hypopneas per hour of sleep. RESULTS Fifty-five percent of the patients had SDB, of which 40% was predominantly central in nature. Patients with SDB had higher 24-h HR and systolic and diastolic BP compared with those without SDB (115 vs 108 mm Hg, P = .029; 71 vs 67 mm Hg, P = .034; 69 vs 64 beats/min, P = .050, respectively). Use of antihypertensive medication and β-receptor blockers was similar in both groups. In a multivariate linear regression analysis, SDB was significantly associated with an increased 24-h cardiac workload (β-coefficient, 0.364; 95% CI, 0.071-0.657; P = .016), independently of age, sex, BMI, LVEF, and antihypertensive medication. CONCLUSION Patients with AMI and SDB have significantly increased 24-h BP, HR, and cardiac workload. Treatment of SDB may be a valuable nonpharmacologic approach to lower cardiac workload in these patients.
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Affiliation(s)
| | - Stefan Buchner
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Tanja Greimel
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Anna Satzl
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Oliver Husser
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Okka W Hamer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Günter A J Riegger
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Pfeifer
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany; Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany.
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Ücer E, Fredersdorf S, Jungbauer C, Debl K, Philipp A, Amann M, Holzamer A, Keyser A, Hilker M, Luchner A, Schmid C, Riegger G, Endemann D. A unique access for the ablation catheter to treat electrical storm in a patient with extracorporeal life support. Europace 2013; 16:299-302. [PMID: 23816515 DOI: 10.1093/europace/eut165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Extracorporeal membrane oxygenation (ECMO) is a very effective bridging therapy in patients with cardiogenic shock. To perform coronary angiography in these patients our group developed an unique system to get urgent vascular access with minimal additional vascular complication risk. The 6 Fr coronary catheters are introduced through a standard Y-connector, which is inserted into the arterial cannula of the ECMO-line close to the patient, the blind end of which is then equipped with a haemostatic valve (Check-Flo Performer accessory adapter, Cook Medical, USA). To the best of our knowledge, we here present the first patient, in whom this system had been used to insert an 8 Fr radiofrequency ablation catheter to treat incessant ventricular fibrillation. METHODS AND RESULTS A 66-year-old patient had been transferred with electrical storm 5 days after an acute MI. After failed interventional and medical therapies an ECMO system had been inserted (right femoral artery cannula 15 Fr, left femoral vein cannula 21 Fr) and an electrophysiological study had been performed because of incessant ventricular fibrillation episodes, which always were induced by the same ventricular premature beat (VPB). During this first EP study over the left femoral artery the VPB could be targeted and successfully ablated. Unfortunately the VPB recovered again after some days so a second EP study had to be performed. This time the left femoral artery could not be used because of a postinterventional complication so we used the arterial cannula of the ECMO system as the access for the ablation catheter using a Y-connector. Using this way again a successful ablation procedure could be performed, after getting familiar with manipulation the ablation catheter over the ECMO cannula and with the help of different curved ablation catheters. The issue of compromising of the effective lumen of the arterial cannula by the ablation catheter`s cross sectional area could be overcome with increasing the rotational speed of the V-A ECMO. CONCLUSION Ablation of ventricular arrhythmias using a Y-connector to insert the ablation catheter into the arterial cannula is feasible in patients with a V-A ECMO system avoiding additional arterial puncture with potentially major vascular complications in critically ill patients. Manipulation of the catheter is not as easy as using a standard sheath but can well be performed after a short habituation.
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Affiliation(s)
- Ekrem Ücer
- Department of Internal Medicine II Cardiology, University Hospital Regensburg, 93053 Regensburg, Germany
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Weber M, Luchner A, Seeberger M, Mueller C, Liebetrau C, Schlitt A, Apostolovic S, Jankovic R, Bankovic D, Jovic M, Mitrovic V, Nef H, Mollmann H, Hamm CW. Corrigendum to: ‘Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery’ [Eur Heart J 2013;34(11): 853-862, doi:10.1093/eurheartj/ehs445]. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Husser O, Holzamer A, Resch M, Endemann DH, Nunez J, Bodi V, Schmid C, Riegger GAJ, Gössmann H, Hamer O, Stroszczynski C, Luchner A, Hilker M, Hengstenberg C. Prosthesis sizing for transcatheter aortic valve implantation--comparison of three dimensional transesophageal echocardiography with multislice computed tomography. Int J Cardiol 2013; 168:3431-8. [PMID: 23688431 DOI: 10.1016/j.ijcard.2013.04.182] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [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: 04/05/2012] [Revised: 04/13/2013] [Accepted: 04/19/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The complex anatomy of the aortic annulus warrants the use of three dimensional (3D) modalities for prosthesis sizing in transcatheter aortic valve implantation (TAVI). Multislice computed tomography (MSCT) has been used for this purpose, but its use may be restricted because of contrast administration. 3D transesophageal echocardiography (3D-TEE) lacks this limitation and data on comparison with MSCT is scarce. We compared 3D-TEE with MSCT for prosthesis sizing in TAVI. METHODS Aortic annulus diameters in the sagittal and coronal plane and annulus areas in 3D-TEE and MSCT were compared in 57 patients undergoing TAVI. Final prosthesis size was left at the operator's discretion and the agreement with 3D-TEE and MSCT was calculated. RESULTS Sagittal diameters on 3D-TEE and MSCT correlated well (r=.754, p<.0001) and means were comparable (22.3±2.1 vs. 22.5±2.3 mm; p=0.2; mean difference: -0.3 mm [-3.3-2.8]). On 3D-TEE, coronal diameter and annulus area were significantly smaller (p<.0001 for both) with moderate correlation (r=0.454 and r=0.592). Interobserver variability was comparable for both modalities. TAVI was successful in all patients with no severe post-procedural insufficiency. Final prosthesis size was best predicted by sagittal annulus diameters in 84% and 79% by 3D-TEE and MSCT, respectively. Agreement between both modalities was 77%. CONCLUSIONS Annulus diameters and areas for pre-procedural TAVI assessment by 3D-TEE are significantly smaller than MSCT with exception of sagittal diameters. Using sagittal diameters, both modalities predicted well final prosthesis size and excellent procedural results were obtained. 3D-TEE can thus be a useful alternative in patients with contraindications to MSCT.
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Affiliation(s)
- Oliver Husser
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany.
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Husser O, Holzamer A, Philipp A, Nunez J, Bodi V, Müller T, Lubnow M, Luchner A, Lunz D, Riegger GAJ, Schmid C, Hengstenberg C, Hilker M. Emergency and prophylactic use of miniaturized veno-arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2013; 82:E542-51. [PMID: 23554044 DOI: 10.1002/ccd.24806] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 12/06/2012] [Accepted: 01/01/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To report our center's experience using veno-arterial extracorporeal membrane oxygenation (vaECMO) in transcatheter aortic valve implantation (TAVI). BACKGROUND In TAVI, short-term mortality closely relates to life threatening procedural complications. VaECMO can be used to stabilize the patient in emergency situations. However, for the prophylactic use of vaECMO in very high-risk patients undergoing TAVI there is no experience. METHODS From January 2009 to August 2011, we performed 131 TAVI. Emergency vaECMO was required in 8 cases (7%): ventricular perforation (n = 3), hemodynamic instability/cardiogenic shock (n = 4), hemodynamic deterioration due to ventricular tachycardia (n = 1). Since August 2011, during 83 procedures, prophylactic vaECMO was systematically used in very high-risk patients (n = 9, 11%) and emergency ECMO in one case (1%) due to ventricular perforation. RESULTS Median logistic EuroScore in prophylactic vaECMO patients was considerably higher as compared to the remaining TAVI population (30% vs. 15%, P = 0.0003) while in patients with emergency vaECMO it was comparable (18% vs. 15%, P = 0.08). Comparing prophylactic to emergency vaECMO, procedural success and 30-day mortality were 100% vs. 44% (P = 0.03) and 0% vs. 44% (P = 0.02), respectively. Major vascular complications and rate of life threatening bleeding did not differ between both groups (11% vs. 11%, P = 0.99 and 11% vs. 33%, P = 0.3) and were not vaECMO-related. CONCLUSIONS Life-threatening complications during TAVI can be managed using emergency vaECMO but mortality remains high. The use of prophylactic vaECMO in very high-risk patients is safe and may be advocated in selected cases.
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Affiliation(s)
- Oliver Husser
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg Medical Center, Regensburg, Germany
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Luchner A, Behrens G, Stritzke J, Markus M, Stark K, Peters A, Meisinger C, Leitzmann M, Hense HW, Schunkert H, Heid IM. Long-term pattern of brain natriuretic peptide and N-terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors. Eur J Heart Fail 2013; 15:859-67. [PMID: 23568644 DOI: 10.1093/eurjhf/hft048] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [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] [Indexed: 11/14/2022] Open
Abstract
AIMS The natriuretic peptides BNP and NT-proBNP are potent cardiac markers, but knowledge of long-term changes is sparse. We thus quantified determinants of change in BNP and NT-proBNP in a study of south German residents (KORA). METHODS AND RESULTS A total of 1005 men and women (age 25-74 years, mean 48 years) underwent physical examination and echocardiography at baseline and at follow-up after 10 years. The current analysis comprised 877 subjects with dual measurements of BNP and NT-proBNP. Both markers increased in both sexes (P < 0.001) during the 10-year follow-up, and higher levels in women persisted across time (P for sex difference <0.001). Among baseline covariates, predictors for 10-year change of NT-proBNP, BNP, or both were age, sex, diabetes status, and heart rate (multivariable regression analysis, each P < 0.05). However, changes of covariates over the 10-year follow-up were much stronger determinants. Specifically, incident myocardial infarction, new beta-blocker medication, and increased cardiac parameters (left atrial diameter, LV end-diastolic diameter, and LV mass index) were associated with increasing BNP, NT-proBNP, or both, whereas increased heart rate, haematocrit, and body mass index (BMI) were associated with decreasing BNP and NT-proBNP (all P < 0.05). CONCLUSION Next to ageing and sex, a variety of changes in covariates reflecting the sequelae of cardiac remodelling as well as myocardial infarction and diabetes influence long-term changes of BNP and NT-proBNP. Of note, diabetes and increased BMI exert opposite effects. For interpretation of individual marker concentrations, a host of covariates needs to be considered, especially in subjects without prevalent or incident cardiac disease.
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Affiliation(s)
- Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Regensburg, Germany.
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Schmid PM, Resch M, Schach C, Birner C, Riegger GA, Luchner A, Endemann DH. Antidiabetic treatment restores adiponectin serum levels and APPL1 expression, but does not improve adiponectin-induced vasodilation and endothelial dysfunction in Zucker diabetic fatty rats. Cardiovasc Diabetol 2013; 12:46. [PMID: 23497197 PMCID: PMC3606629 DOI: 10.1186/1475-2840-12-46] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/12/2013] [Indexed: 01/21/2023] Open
Abstract
Background Adiponectin is able to induce NO-dependent vasodilation in Zucker lean (ZL) rats, but this effect is clearly alleviated in their diabetic littermates, the Zucker diabetic fatty (ZDF) rats. ZDF rats also exhibit hypoadiponectinemia and a suppressed expression of APPL1, an adaptor protein of the adiponectin receptors, in mesenteric resistance arteries. Whether an antidiabetic treatment can restore the vasodilatory effect of adiponectin and improve endothelial function in diabetes mellitus type 2 is not known. Methods During our animal experiment from week 11 to 22 in each case seven ZDF rats received an antidiabetic treatment with either insulin (ZDF+I) or metformin (ZDF+M). Six normoglycemic ZL and six untreated ZDF rats served as controls. Blood glucose was measured at least weekly and serum adiponectin levels were quantified via ELISA in week 11 and 22. The direct vasodilatory response of their isolated mesenteric resistance arteries to adiponectin as well as the endothelium-dependent and -independent function was evaluated in a small vessel myograph. Additionally, the expression of different components of the adiponectin signaling pathway in the resistance arteries was quantified by real-time RT-PCR. Results In ZDF rats a sufficient blood glucose control could only be reached by treatment with insulin, but both treatments restored the serum levels of adiponectin and the expression of APPL1 in small resistance arteries. Nevertheless, both therapies were not able to improve the vasodilatory response to adiponectin as well as endothelial function in ZDF rats. Concurrently, a downregulation of the adiponectin receptors 1 and 2 as well as endothelial NO-synthase expression was detected in insulin-treated ZDF rats. Metformin-treated ZDF rats showed a reduced expression of adiponectin receptor 2. Conclusions An antidiabetic treatment with either insulin or metformin in ZDF rats inhibits the development of hypoadiponectinemia and downregulation of APPL1 in mesenteric resistance arteries, but is not able to improve adiponectin induced vasodilation and endothelial dysfunction. This is possibly due to alterations in the expression of adiponectin receptors and eNOS.
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Affiliation(s)
- Peter M Schmid
- Klinik und Poliklinik für Innere Medizin 2, Franz-Josef-Strauss Allee 11, University of Regensburg, Regensburg, 93042, Germany.
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Rupprecht L, Philipp A, Camboni D, Müller T, Bein T, Luchner A, Lunz D, Hilker M, Schmid C. ECMO transport of critically ill patients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332307] [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: 10/27/2022]
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Weber M, Luchner A, Manfred S, Mueller C, Liebetrau C, Schlitt A, Apostolovic S, Jankovic R, Bankovic D, Jovic M, Mitrovic V, Nef H, Mollmann H, Hamm CW. Incremental value of high-sensitive troponin T in addition to the revised cardiac index for peri-operative risk stratification in non-cardiac surgery. Eur Heart J 2012; 34:853-62. [DOI: 10.1093/eurheartj/ehs445] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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