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Zenker S, Strech D, Jahns R, Müller G, Prasser F, Schickhardt C, Schmidt G, Semler SC, Winkler E, Drepper J. [Nationally standardized broad consent in practice: initial experiences, current developments, and critical assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03878-6. [PMID: 38639817 DOI: 10.1007/s00103-024-03878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The digitalization in the healthcare sector promises a secondary use of patient data in the sense of a learning healthcare system. For this, the Medical Informatics Initiative's (MII) Consent Working Group has created an ethical and legal basis with standardized consent documents. This paper describes the systematically monitored introduction of these documents at the MII sites. METHODS The monitoring of the introduction included regular online surveys, an in-depth analysis of the introduction processes at selected sites, and an assessment of the documents in use. In addition, inquiries and feedback from a large number of stakeholders were evaluated. RESULTS The online surveys showed that 27 of the 32 sites have gradually introduced the consent documents productively, with a current total of 173,289 consents. The analysis of the implementation procedures revealed heterogeneous organizational conditions at the sites. The requirements of various stakeholders were met by developing and providing supplementary versions of the consent documents and additional information materials. DISCUSSION The introduction of the MII consent documents at the university hospitals creates a uniform legal basis for the secondary use of patient data. However, the comprehensive implementation within the sites remains challenging. Therefore, minimum requirements for patient information and supplementary recommendations for best practice must be developed. The further development of the national legal framework for research will not render the participation and transparency mechanisms developed here obsolete.
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Affiliation(s)
- Sven Zenker
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek), Kaufmännische Direktion, Universitätsklinikum Bonn, Bonn, Deutschland.
- AG Angewandte Medizininformatik (AMI), Institut für Medizinische Biometrie, Informatik und Epidemiologie (IMBIE), Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland.
- AG Angewandte Mathematische Physiologie (AMP), Klinik & Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
- Stabsstelle Medizinisch-Wissenschaftliche Technologieentwicklung und -koordination (MWTek) Kaufmännische Direktion, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Daniel Strech
- QUEST Center for Responsible Research, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Roland Jahns
- Interdisziplinäre Biomaterial- und Datenbank Würzburg (ibdw), Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Müller
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - Fabian Prasser
- Center for Health Data Science, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Schickhardt
- Sektion Translationale Medizinethik, KKE Angewandte Tumor-Immunität, Nationales Centrum für Tumorerkrankungen (NCT), Deutsches Krebsforschungszentrum (DKFZ) Heidelberg und Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I. Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Sebastian C Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
| | - Eva Winkler
- Sektion Translationale Medizinethik, Abteilung Medizinische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg und Universität Heidelberg, Heidelberg, Deutschland
| | - Johannes Drepper
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin, Deutschland
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Martens E, Haase HU, Mastella G, Henkel A, Spinner C, Hahn F, Zou C, Fava Sanches A, Allescher J, Heid D, Strauss E, Maier MM, Lachmann M, Schmidt G, Westphal D, Haufe T, Federle D, Rueckert D, Boeker M, Becker M, Laugwitz KL, Steger A, Müller A. Smart hospital: achieving interoperability and raw data collection from medical devices in clinical routine. Front Digit Health 2024; 6:1341475. [PMID: 38510279 PMCID: PMC10951085 DOI: 10.3389/fdgth.2024.1341475] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Today, modern technology is used to diagnose and treat cardiovascular disease. These medical devices provide exact measures and raw data such as imaging data or biosignals. So far, the Broad Integration of These Health Data into Hospital Information Technology Structures-Especially in Germany-is Lacking, and if data integration takes place, only non-Evaluable Findings are Usually Integrated into the Hospital Information Technology Structures. A Comprehensive Integration of raw Data and Structured Medical Information has not yet Been Established. The aim of this project was to design and implement an interoperable database (cardio-vascular-information-system, CVIS) for the automated integration of al medical device data (parameters and raw data) in cardio-vascular medicine. Methods The CVIS serves as a data integration and preparation system at the interface between the various devices and the hospital IT infrastructure. In our project, we were able to establish a database with integration of proprietary device interfaces, which could be integrated into the electronic health record (EHR) with various HL7 and web interfaces. Results In the period between 1.7.2020 and 30.6.2022, the data integrated into this database were evaluated. During this time, 114,858 patients were automatically included in the database and medical data of 50,295 of them were entered. For technical examinations, more than 4.5 million readings (an average of 28.5 per examination) and 684,696 image data and raw signals (28,935 ECG files, 655,761 structured reports, 91,113 x-ray objects, 559,648 ultrasound objects in 54 different examination types, 5,000 endoscopy objects) were integrated into the database. Over 10.2 million bidirectional HL7 messages (approximately 14,000/day) were successfully processed. 98,458 documents were transferred to the central document management system, 55,154 materials (average 7.77 per order) were recorded and stored in the database, 21,196 diagnoses and 50,353 services/OPS were recorded and transferred. On average, 3.3 examinations per patient were recorded; in addition, there are an average of 13 laboratory examinations. Discussion Fully automated data integration from medical devices including the raw data is feasible and already creates a comprehensive database for multimodal modern analysis approaches in a short time. This is the basis for national and international projects by extracting research data using FHIR.
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Affiliation(s)
- Eimo Martens
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- European Reference Network Guard Heart, European Union, Amsterdam, Netherlands
| | - Hans-Ulrich Haase
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Giulio Mastella
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Andreas Henkel
- TUM School of Medicine and Health, Department of Clinical Medicine—Department of Information Technology, University Medical Center, Technical University of Munich, Munich, Germany
- IHE Deutschland e.V, Berlin, Germany
| | - Christoph Spinner
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Franziska Hahn
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Congyu Zou
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Augusto Fava Sanches
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Julia Allescher
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Daniel Heid
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Elena Strauss
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Melanie-Maria Maier
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Mark Lachmann
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- Working Group of Medical Ethics Committees in the Federal Republic of Germany e.V., Berlin, Germany
- TUM School of Medicine and Health, Department of Clinical Medicine—Ethics Committee, University Medical Center, Technical University of Munich, Munich, Germany
| | - Dominik Westphal
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Human Genetics, University Medical Center, Technical University of Munich, Munich, Germany
| | - Tobias Haufe
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - David Federle
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- TUM School of Medicine and Health, Center for Digital Health & Technology—Institute for Artificial Intelligence and Informatics in Medicine, University Medical Center, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, United Kingdom
| | - Martin Boeker
- TUM School of Medicine and Health, Center for Digital Health & Technology—Institute for Artificial Intelligence and Informatics in Medicine, University Medical Center, Technical University of Munich, Munich, Germany
| | - Matthias Becker
- Development Department, Fleischhacker GmbH & Co, Schwerte, Germany
| | - Karl-Ludwig Laugwitz
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Alexander Steger
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Alexander Müller
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
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Nikolaev KO, Lake SR, Schmidt G, Demokritov SO, Demidov VE. Resonant generation of propagating second-harmonic spin waves in nano-waveguides. Nat Commun 2024; 15:1827. [PMID: 38418458 PMCID: PMC10902293 DOI: 10.1038/s41467-024-46108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 02/14/2024] [Indexed: 03/01/2024] Open
Abstract
Generation of second-harmonic waves is one of the universal nonlinear phenomena that have found numerous technical applications in many modern technologies, in particular, in photonics. This phenomenon also has great potential in the field of magnonics, which considers the use of spin waves in magnetic nanostructures to implement wave-based signal processing and computing. However, due to the strong frequency dependence of the phase velocity of spin waves, resonant phase-matched generation of second-harmonic spin waves has not yet been achieved in practice. Here, we show experimentally that such a process can be realized using a combination of different modes of nano-sized spin-wave waveguides based on low-damping magnetic insulators. We demonstrate that our approach enables efficient spatially-extended energy transfer between interacting waves, which can be controlled by the intensity of the initial wave and the static magnetic field.
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Affiliation(s)
- K O Nikolaev
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany
| | - S R Lake
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
| | - G Schmidt
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
- Interdisziplinäres Zentrum für Materialwissenschaften, Martin-Luther-Universität Halle-Wittenberg, 06120, Halle, Germany
| | - S O Demokritov
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany.
| | - V E Demidov
- Institute of Applied Physics, University of Muenster, 48149, Muenster, Germany
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Hnatkova K, Andršová I, Novotný T, Vanderberk B, Sprenkeler D, Junttila J, Reichlin T, Schlögl S, Vos MA, Friede T, Bauer A, Huikuri HV, Willems R, Schmidt G, Sticherling C, Zabel M, Malik M. QRS complex and T wave planarity for the efficacy prediction of automatic implantable defibrillators. Heart 2024; 110:178-187. [PMID: 37714697 PMCID: PMC10850677 DOI: 10.1136/heartjnl-2023-322878] [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: 05/16/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To test the hypothesis that in recipients of primary prophylactic implantable cardioverter-defibrillators (ICDs), the non-planarity of ECG vector loops predicts (a) deaths despite ICD protection and (b) appropriate ICD shocks. METHODS Digital pre-implant ECGs were collected in 1948 ICD recipients: 21.4% females, median age 65 years, 61.5% ischaemic heart disease (IHD). QRS and T wave three-dimensional loops were constructed using singular value decomposition that allowed to measure the vector loop planarity. The non-planarity, that is, the twist of the three-dimensional loops out of a single plane, was related to all-cause mortality (n=294; 15.3% females; 68.7% IHD) and appropriate ICD shocks (n=162; 10.5% females; 87.7% IHD) during 5-year follow-up after device implantation. Using multivariable Cox regression, the predictive power of QRS and T wave non-planarity was compared with that of age, heart rate, left ventricular ejection fraction, QRS duration, spatial QRS-T angle, QTc interval and T-peak to T-end interval. RESULTS QRS non-planarity was significantly (p<0.001) associated with follow-up deaths despite ICD protection with HR of 1.339 (95% CI 1.165 to 1.540) but was only univariably associated with appropriate ICD shocks. Non-planarity of the T wave loop was the only ECG-derived index significantly (p<0.001) associated with appropriate ICD shocks with multivariable Cox regression HR of 1.364 (1.180 to 1.576) but was not associated with follow-up mortality. CONCLUSIONS The analysed data suggest that QRS and T wave non-planarity might offer distinction between patients who are at greater risk of death despite ICD protection and those who are likely to use the defibrillator protection.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Bert Vanderberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juhani Junttila
- MRC Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Schlögl
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Gottingen, Germany
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Friede
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Heikki V Huikuri
- University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Rik Willems
- Division of Experimental Cardiology, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
- Division of Clinical Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Georg Schmidt
- Medizinische Klinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Markus Zabel
- German Center of Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cardiology and Pneumology, Heart Center, University Hospital Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
- Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Schmidt G, Mayo T, Paepke S, Kiechle M, Müller D. Microsurgical training curriculum in a gynecological breast cancer center: a benefit for patients and surgeons? Arch Gynecol Obstet 2024; 309:281-286. [PMID: 37644236 PMCID: PMC10770192 DOI: 10.1007/s00404-023-07198-z] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Autologous breast reconstruction improves patient satisfaction and quality of life after mastectomy. In Germany, free flap surgery and implant-based reconstruction is usually separate between reconstructive surgery and gynecology. Cooperation between the specialist disciplines and implementation of microsurgery into breast surgeon training could enhance surgical treatment for breast cancer patients. This evaluation is intended to demonstrate the learning progress within a microsurgical training program and the complication rate in relation to microsurgical experience. METHODS At the breast cancer center at Klinikum rechts der Isar, TU Munich, a three-stage training program for autologous breast reconstruction and microsurgery for gynecological breast surgeons was developed. Between 2019 and 2022, 74 women received autologous free flap breast reconstruction by a consistent team consisting of a gynecological surgeon in training and an expert microsurgeon. Peri- and postoperative data were collected to analyze the feasibility and safety of a microsurgical training in gynecology. RESULTS Within the training, operative steps of free autologous breast reconstruction were increasingly taken over by the gynecological surgeon in training. The analysis showed a decrease in operating times with consistently low complication rates during the training. CONCLUSION This study demonstrated that a training in free autologous breast reconstruction for gynecological surgeons is safely feasible through close cooperation between gynecological and reconstructive surgery.
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Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany.
| | - Theresa Mayo
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany
| | - Stefan Paepke
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany
| | - Daniel Müller
- Department of Gynecology and Obstetrics, Klinikum Rechts Der Isar and Comprehensive Cancer Center (CCCTUM), Technical University Munich, Munich, Germany
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Allescher J, Sinnecker D, von Goeldel B, Barthel P, Müller A, Hapfelmeier A, Martens E, Laugwitz K, Schmidt G, Steger A. QRS fragmentation does not predict mortality in survivors of acute myocardial infarction. Clin Cardiol 2024; 47:e24218. [PMID: 38269630 PMCID: PMC10797824 DOI: 10.1002/clc.24218] [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: 10/21/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Despite advances in coronary revascularization and in heart failure management, myocardial infarction survivors remain at substantially increased mortality risk. Precise risk assessment and risk-adapted follow-up care are crucial to improve their outcomes. Recently, the fragmented QRS complex, i.e. the presence of additional spikes within the QRS complexes on a 12-lead electrocardiogram, has been discussed as a potential non-invasive risk predictor in cardiac patients. HYPOTHESIS The aim of this study was to evaluate the prognostic meaning of the fragmented QRS complex in myocardial infarction survivors. METHODS 609 patients with narrow QRS complexes <120 ms were included in a prospective cohort study while hospitalized for myocardial infarction and followed for 5 years. RESULTS The prevalence of the fragmented QRS complex in these patients amounted to 46.8% (285 patients). These patients had no increased hazard of all-cause death (HR 0.84, 95%-CI 0.45-1.57, p = 0.582) with a mortality rate of 6.0% compared to 7.1% in patients without QRS fragmentations. Furthermore, the risks of cardiac death (HR 1.28, 95%-CI 0.49-3.31, p = 0.613) and of non-cardiac death (HR 0.6, 95%-CI 0.26-1.43, p = 0.25) were not significantly different in patients with QRS fragmentations. However, patients with QRS fragmentations had increased serum creatine kinase concentrations (1438U/l vs. 1160U/l, p = 0.039) and reduced left ventricular ejection fractions (52% vs. 54%, p = 0.011). CONCLUSIONS The hypothesis that QRS fragmentation might be a prognostic parameter in survivors of myocardial infarction was not confirmed. But those with QRS fragmentation had larger myocardial infarctions, as measured by creatine kinase and left ventricular ejection fraction.
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Affiliation(s)
- Julia Allescher
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Daniel Sinnecker
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
- Medizinisches Versorgungszentrum (MVZ) HarzGoslarGermany
| | - Bernhard von Goeldel
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Petra Barthel
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Alexander Müller
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Alexander Hapfelmeier
- School of Medicine, Institute of AI and Informatics in MedicineTechnical University of MunichMunichGermany
- School of Medicine, Institute of General Practice and Health Services ResearchTechnical University of MunichMunichGermany
| | - Eimo Martens
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Karl‐Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
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Judge PK, Staplin N, Mayne KJ, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Ng SYA, Roddick AJ, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Massey D, Landray MJ, Baigent C, Haynes R, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Zhang SC, Schmidt G, Paquette RL, Hakimian B, Ballas LK. Real World Utilization of Cranial or Craniospinal Radiation in Adult Acute Lymphoid Leukemia Patients: Data from the Center for International Blood and Marrow Transplant Research. Int J Radiat Oncol Biol Phys 2023; 117:e496-e497. [PMID: 37785563 DOI: 10.1016/j.ijrobp.2023.06.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Though CNS involvement at diagnosis in adult acute lymphoid leukemia (ALL) is relatively rare (3-7%), >50 % of patients will develop CNS relapse without CNS-directed therapy. Radiation therapy is commonly used as part of stem cell transplant (SCT) conditioning. Historically, a cranial boost was given to reduce risk of CNS relapse. While a CNS boost is not a universal part of prophylaxis, CNS directed RT is used in patients at highest risk for CNS relapse following transplantation, typically those with CNS disease at diagnosis or after induction. There is little data on real world utilization of CNS directed radiation as part of SCT for adult ALL patients. MATERIALS/METHODS The Center for International Blood and Marrow Transplant Research (CIBMTR) database was queried for adult ALL patients undergoing SCT between 2013 - 2019 who received TBI as part of their regimen where data was available on CNS directed RT. Patient demographics, pre-transplant response to induction, CNS status pre/post-transplant, and overall survival information were collected. Results were stratified by cranial irradiation (CNS-RT), craniospinal irradiation (CSI), or no cranial RT (nCRT). Radiation dose is not collected by the CIBMTR. The data presented here are preliminary and were obtained from the Statistical Center of the Center for International Blood and Marrow Transplant Research. The analysis has not been reviewed or approved by the Advisory or Scientific Committees of the CIBMTR. RESULTS A total of 1240 patients were identified, of which 59 (5%) received CNS-RT, 2 (0.2%) received CSI, 989 (80%) received nCRT, and 190 (15%) had unknown CNS RT status. Median age was younger in patients receiving CNS-RT (26y, range 19-66y) or CSI (34y, 22-46y) compared to patients receiving nCRT (42y, 18-79y). Patients receiving CNS radiation had more advanced disease at time of transplant (17% requiring 3+ lines of induction before CR vs 50% vs 5%, respectively). 24% of CNS-RT patients and 50% of CSI patients had CNS disease at diagnosis compared to 7% of nCRT patients. 37% of CNS-RT patients and 100% of CSI patients had CNS disease prior to transplant compared to 11% of nCRT patients. Overall survival at 1-5 years was numerically higher with CNS-RT compared to no RT, though 95% confidence intervals overlapped at each follow up point. CONCLUSION Data from the CIBMTR on real world utilization of CNS-RT or CSI in adult ALL patients suggest inconsistent practice patterns with 11% of patients without any cranial RT having CNS disease prior to transplant and 57% of CNS-RT patients having no CNS disease prior to transplant. These data offer an interesting analysis of current CNS radiation practice patterns in the past 10 years for adult ALL patients, though interpretation is limited by the retrospective nature of the study and by significant limitations of available data.
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Affiliation(s)
- S C Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - G Schmidt
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - R L Paquette
- Blood and Marrow Transplant Program, Cedars-Sinai Medical Center, Los Angeles, CA
| | - B Hakimian
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - L K Ballas
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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10
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Nikolaev KO, Lake SR, Schmidt G, Demokritov SO, Demidov VE. Zero-Field Spin Waves in YIG Nanowaveguides. Nano Lett 2023; 23:8719-8724. [PMID: 37691265 DOI: 10.1021/acs.nanolett.3c02725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Spin-wave-based transmission and processing of information is a promising emerging nanotechnology that can help overcome limitations of traditional electronics based on the transfer of electrical charge. Among the most important challenges for this technology is the implementation of spin-wave devices that can operate without the need for an external bias magnetic field. Here we experimentally demonstrate that this can be achieved using submicrometer wide spin-wave waveguides fabricated from ultrathin films of a low-loss magnetic insulator, yttrium iron garnet (YIG). We show that these waveguides exhibit a highly stable single-domain static magnetic configuration at zero field and support long-range propagation of spin waves with gigahertz frequencies. The experimental results are supported by micromagnetic simulations, which additionally provide information for the optimization of zero-field guiding structures. Our findings create the basis for the development of energy-efficient zero-field spin-wave devices and circuits.
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Affiliation(s)
- Kirill O Nikolaev
- Institute of Applied Physics, University of Muenster, 48149 Muenster, Germany
| | - Stephanie R Lake
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
| | - Georg Schmidt
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
- Interdisziplinäres Zentrum für Materialwissenschaften, Martin-Luther-Universität Halle-Wittenberg, 06120 Halle, Germany
| | - Sergej O Demokritov
- Institute of Applied Physics, University of Muenster, 48149 Muenster, Germany
| | - Vladislav E Demidov
- Institute of Applied Physics, University of Muenster, 48149 Muenster, Germany
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Balalaikins M, Schmidt G, Aksjuta K, Hendrich L, Kairišs K, Sokolovskis K, Valainis U, Zolovs M, Nitcis M. The first comprehensive population size estimations for the highly endangered largest diving beetle Dytiscus latissimus in Europe. Sci Rep 2023; 13:9715. [PMID: 37322014 PMCID: PMC10272167 DOI: 10.1038/s41598-023-36242-w] [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] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Dytiscus latissimus (Coleoptera Dytiscidae) is an endangered diving beetle throughout its range. It is one of the two species of Dytiscidae listed in Annex II of the Habitats Directive, IUCN red list and in many national level legislations and therefore strictly protected. The conservation of endangered species first of all requires an assessment of their population size. Until now, a method has not been developed for estimating the size of D. latissimus populations. The article summarizes the results of two studies carried out independently in Germany and Latvia. Both studies were carried out in one water body used recapture method but with a different spatial placement of traps, which, according to our data, is an important factor in population estimation. We evaluated Jolly-Seber and Schnabel approaches of estimating aquatic beetle's populations and found that confidence intervals obtained by different methods in our research do not differ significantly, but combination of both models provide the most accurate estimates of population dynamics. As part of the study, we concluded that the populations of Dytiscus latissimus are relatively closed, so we accept that the Schnabel estimate shows more accurate data. By fixing the places of capture of each individual, it was found that females live mainly locally, and males actively move within the water body. This aspect indicates the advantage of the spatial placement of traps compared to the use of transects. The results of our study show a significantly higher number of both captured and recaptured males Such a sex ratio may indicate both a greater activity of males and differences in the sex ratio in the population. The study confirmed that environmental changes, such as the water level in a water body, can also significantly affect the result of a population assessment. In the frame of D. latissimus monitoring, to obtain an objective estimation of the species population size we recommend using four traps for each 100 m of water body shoreline with 4-8 censuses, dependently on the recapture rate.
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Affiliation(s)
- M Balalaikins
- DU Nature Studies and Environmental Education Centre, Vienības Str. 13, Daugavpils, 5401, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - G Schmidt
- Independent researcher, Heidelberg, Germany
| | - K Aksjuta
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - L Hendrich
- Department of Entomology, SNSB-Zoologische Staatssammlung München, München, Germany
| | - K Kairišs
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - K Sokolovskis
- Department of Biology, Lund University, Sölvegatan 37, 223 62, Lund, Sweden
| | - U Valainis
- DU Nature Studies and Environmental Education Centre, Vienības Str. 13, Daugavpils, 5401, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
| | - M Zolovs
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia.
- Riga Stradins University, Statistics Unit, Balozu Str. 14, Rīga, 1048, LV, Latvia.
| | - M Nitcis
- Institute of Life Sciences and Technology, Daugavpils University, Coleopterological Research Center, Parades Str. 1a, Daugavpils, 5401, Latvia
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Anyfantis DI, Ballani C, Kanistras N, Barnasas A, Tsiaoussis I, Schmidt G, Papaioannou ET, Poulopoulos P. Magnetic Anisotropies and Exchange Bias of Co/CoO Multilayers with Intermediate Ultrathin Pt Layers. Materials (Basel) 2023; 16:1378. [PMID: 36837008 PMCID: PMC9963626 DOI: 10.3390/ma16041378] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Co/CoO multilayers are fabricated by means of radio-frequency magnetron sputtering. For the formation of each multilayer period, a Co layer is initially produced followed by natural oxidation. Platinum is used not only as buffer and capping layers, but also in the form of intermediate ultrathin layers to enhance perpendicular magnetic anisotropy. Three samples are compared with respect to the magnetic anisotropies and exchange bias between 4-300 K based on superconducting quantum interference device magnetometry measurements. Two of the multilayers are identical Co/CoO/Pt ones; one of them, however, is grown on a Co/Pt "magnetic substrate" to induce perpendicular magnetic anisotropy via exchange coupling through an ultrathin Pt intermediate layer. The third multilayer is of the form Co/CoO/Co/Pt. The use of a "magnetic substrate" results in the observation of loops with large remanence when the field applies perpendicular to the film plane. The CoO/Co interfaces lead to a significant exchange bias at low temperatures after field cooling. The largest exchange bias was observed in the film with double Co/CoO/Co interfaces. Consequently, significant perpendicular anisotropy coexists with large exchange bias, especially at low temperatures. Such samples can be potentially useful for applications related to spintronics and magnetic storage.
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Affiliation(s)
- Dimitrios I. Anyfantis
- Department of Materials Science, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | - Camillo Ballani
- Institut für Physik, Martin-Luther Universität Halle Wittenberg, Von-Danckelmann-Platz 3, 06120 Halle, Germany
| | - Nikos Kanistras
- Department of Materials Science, School of Natural Sciences, University of Patras, 26504 Patras, Greece
- Institut für Physik, Martin-Luther Universität Halle Wittenberg, Von-Danckelmann-Platz 3, 06120 Halle, Germany
| | - Alexandros Barnasas
- Department of Materials Science, School of Natural Sciences, University of Patras, 26504 Patras, Greece
| | - Ioannis Tsiaoussis
- Department of Physics, School of Natural Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georg Schmidt
- Institut für Physik, Martin-Luther Universität Halle Wittenberg, Von-Danckelmann-Platz 3, 06120 Halle, Germany
- Interdisziplinäres Zentrum für Materialwissenschaften, Nanotechnikum Weinberg, Martin-Luther University Halle-Wittenberg, 06120 Halle, Germany
| | - Evangelos Th. Papaioannou
- Institut für Physik, Martin-Luther Universität Halle Wittenberg, Von-Danckelmann-Platz 3, 06120 Halle, Germany
| | - Panagiotis Poulopoulos
- Department of Materials Science, School of Natural Sciences, University of Patras, 26504 Patras, Greece
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Hnatkova K, Andršová I, Novotný T, Britton A, Shipley M, Vandenberk B, Sprenkeler DJ, Junttila J, Reichlin T, Schlögl S, Vos MA, Friede T, Bauer A, Huikuri HV, Willems R, Schmidt G, Franz MR, Sticherling C, Zabel M, Malik M. QRS micro-fragmentation as a mortality predictor. Eur Heart J 2022; 43:4177-4191. [PMID: 35187560 PMCID: PMC9584751 DOI: 10.1093/eurheartj/ehac085] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 08/27/2021] [Revised: 01/05/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Fragmented QRS complex with visible notching on standard 12-lead electrocardiogram (ECG) is understood to represent depolarization abnormalities and to signify risk of cardiac events. Depolarization abnormalities with similar prognostic implications likely exist beyond visual recognition but no technology is presently suitable for quantification of such invisible ECG abnormalities. We present such a technology. METHODS AND RESULTS A signal processing method projects all ECG leads of the QRS complex into optimized three perpendicular dimensions, reconstructs the ECG back from this three-dimensional projection, and quantifies the difference (QRS 'micro'-fragmentation, QRS-μf) between the original and reconstructed signals. QRS 'micro'-fragmentation was assessed in three different populations: cardiac patients with automatic implantable cardioverter-defibrillators, cardiac patients with severe abnormalities, and general public. The predictive value of QRS-μf for mortality was investigated both univariably and in multivariable comparisons with other risk factors including visible QRS 'macro'-fragmentation, QRS-Mf. The analysis was made in a total of 7779 subjects of whom 504 have not survived the first 5 years of follow-up. In all three populations, QRS-μf was strongly predictive of survival (P < 0.001 univariably, and P < 0.001 to P = 0.024 in multivariable regression analyses). A similar strong association with outcome was found when dichotomizing QRS-μf prospectively at 3.5%. When QRS-μf was used in multivariable analyses, QRS-Mf and QRS duration lost their predictive value. CONCLUSION In three populations with different clinical characteristics, QRS-μf was a powerful mortality risk factor independent of several previously established risk indices. Electrophysiologic abnormalities that contribute to increased QRS-μf values are likely responsible for the predictive power of visible QRS-Mf.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W12 0NN, UK
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
| | - Annie Britton
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Martin Shipley
- Research Department of Epidemiology and Public Health, University College London, UK
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - David J Sprenkeler
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Juhani Junttila
- Medical Research Center Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon Schlögl
- Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim Friede
- German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Heikki V Huikuri
- Medical Research Center Oulu, University Central Hospital of Oulu and University of Oulu, Oulu, Finland
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Georg Schmidt
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,German Center for Cardiovascular Research Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael R Franz
- Veteran Affairs and Georgetown University Medical Centers, Washington, DC, USA
| | | | - Markus Zabel
- Department of Cardiology and Pneumology, University Medical Center, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W12 0NN, UK.,Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czech Republic
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14
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Andršová I, Hnatkova K, Toman O, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Intra-subject stability of different expressions of spatial QRS-T angle and their relationship to heart rate. Front Physiol 2022; 13:939633. [DOI: 10.3389/fphys.2022.939633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Three-dimensional angle between the QRS complex and T wave vectors is a known powerful cardiovascular risk predictor. Nevertheless, several physiological properties of the angle are unknown or poorly understood. These include, among others, intra-subject profiles and stability of the angle relationship to heart rate, characteristics of angle/heart-rate hysteresis, and the changes of these characteristics with different modes of QRS-T angle calculation. These characteristics were investigated in long-term 12-lead Holter recordings of 523 healthy volunteers (259 females). Three different algorithmic methods for the angle computation were based on maximal vector magnitude of QRS and T wave loops, areas under the QRS complex and T wave curvatures in orthogonal leads, and weighted integration of all QRS and T wave vectors moving around the respective 3-dimensional loops. These methods were applied to orthogonal leads derived either by a uniform conversion matrix or by singular value decomposition (SVD) of the original 12-lead ECG, giving 6 possible ways of expressing the angle. Heart rate hysteresis was assessed using the exponential decay models. All these methods were used to measure the angle in 659,313 representative waveforms of individual 10-s ECG samples and in 7,350,733 individual beats contained in the same 10-s samples. With all measurement methods, the measured angles fitted second-degree polynomial regressions to the underlying heart rate. Independent of the measurement method, the angles were found significantly narrower in females (p < 0.00001) with the differences to males between 10o and 20o, suggesting that in future risk-assessment studies, different angle dichotomies are needed for both sexes. The integrative method combined with SVD leads showed the highest intra-subject reproducibility (p < 0.00001). No reproducible delay between heart rate changes and QRS-T angle changes was found. This was interpreted as a suggestion that the measurement of QRS-T angle might offer direct assessment of cardiac autonomic responsiveness at the ventricular level.
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Zenker S, Strech D, Ihrig K, Jahns R, Müller G, Schickhardt C, Schmidt G, Speer R, Winkler E, von Kielmansegg SG, Drepper J. Data protection-compliant broad consent for secondary use of health care data and human biosamples for (bio)medical research: Towards a new German national standard. J Biomed Inform 2022; 131:104096. [PMID: 35643273 DOI: 10.1016/j.jbi.2022.104096] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/05/2022] [Accepted: 05/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The secondary use of deidentified but not anonymized patient data is a promising approach for enabling precision medicine and learning health care systems. In most national jurisdictions (e.g., in Europe), this type of secondary use requires patient consent. While various ethical, legal, and technical analyses have stressed the opportunities and challenges for different types of consent over the past decade, no country has yet established a national consent standard accepted by the relevant authorities. METHODS A working group of the national Medical Informatics Initiative in Germany conducted a requirements analysis and developed a GDPR-compliant broad consent standard. The development included consensus procedures within the Medical Informatics Initiative, a documented consultation process with all relevant stakeholder groups and authorities, and the ultimate submission for approval via the national data protection authorities. RESULTS This paper presents the broad consent text together with a guidance document on mandatory safeguards for broad consent implementation. The mandatory safeguards comprise i) independent review of individual research projects, ii) organizational measures to protect patients from involuntary disclosure of protected information, and iii) comprehensive information for patients and public transparency. This paper further describes the key issues discussed with the relevant authorities, especially the position on additional or alternative consent approaches such as dynamic consent. DISCUSSION Both the resulting broad consent text and the national consensus process are relevant for similar activities internationally. A key challenge of aligning consent documents with the various stakeholders was explaining and justifying the decision to use broad consent and the decision against using alternative models such as dynamic consent. Public transparency for all secondary use projects and their results emerged as a key factor in this justification. While currently largely limited to academic medicine in Germany, the first steps for extending this broad consent approach to wider areas of application, including smaller institutions and medical practices, are currently under consideration.
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Affiliation(s)
- Sven Zenker
- Staff Unit for Scientific & Medical Technology Development & Coordination (MWTek), Commercial Directorate, Institute for Medical Biometry, Informatics & Epidemiology, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusbergcampus 1, 53127 Bonn, Germany.
| | - Daniel Strech
- QUEST Center, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Kristina Ihrig
- Department of Medicine, Hematology/Oncology, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Roland Jahns
- Interdisciplinary Bank of Biomaterials and Data Würzburg (ibdw), University and University Hospital of Würzburg, Building A8/A9, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Gabriele Müller
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Christoph Schickhardt
- Section of Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center, Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
| | - Georg Schmidt
- Department of Internal Medicine 1, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, German Centre for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
| | - Ronald Speer
- LIFE - Leipzig Research Center for Civilization Diseases, Medical Faculty, Leipzig University, Philipp-Rosenthal-Straße 27, 04103 Leipzig, Germany
| | - Eva Winkler
- Section for Translational Medical Ethics, Dept Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, INF 460, 69121 Heidelberg
| | | | - Johannes Drepper
- TMF - Technology, Methods, and Infrastructure for Networked Medical Research, Charlottenstrasse 42, 10117 Berlin, Germany
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16
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Bengel PRF, Kessel B, Schloegl S, Bauer A, Junttila J, Lubinski A, Malik M, Merkely B, Schmidt G, Svendsen JH, Vos MA, Willems R, Sticherling C, Friede T, Zabel M. QRS duration as an independent risk factor for appropriate shocks and mortality in patients with prophylactic implantable cardioverter-defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Community’s 7th Framework Programme FP7/2007-2013
Background
The implantable cardioverter defibrillator (ICD) is an established therapy for the prevention of sudden cardiac death (SCD) in high-risk heart failure patients. However, improvements in risk stratification are necessary to increase the efficiency of ICD use. We performed an analysis of the retrospective EU-CERT-ICD registry with respect to QRS duration and effects of cardiac resynchronisation therapy (CRT) on outcomes.
Methods/Results
A total of 5033 patients (81% males) from 14 European centres had an ICD implanted for primary prophylaxis. Mean age at the time of ICD implantation was 64±11 years and ischemic cardiomyopathy was the underlying pathology in 65% of patients. CRT was used in 43% of the patients. The median follow-up was 2.7 years (IQR 1.4-4.6 years). Predefined primary endpoints were all-cause mortality, first appropriate and first inappropriate shocks. The effect of covariates on the cumulative primary endpoints were assessed through hazard ratios in the Fine and Gray subdistributional hazard models (accounting for the competing risks) stratified by centres.
Because of resynchronization by the device, the analysis considered a different influence of QRS on outcomes in the CRT-D and the ICD groups. We observed an increase in the cumulative incidence of the first appropriate shock with increasing QRS values for patients implanted with only an ICD (HR 1.12 per 10ms increase, p<0.001). In patients with CRT-D, increasing QRS values related to a (statistically non-significant) decrease in the cumulative incidence of the first appropriate shocks (HR 0.96 per 10ms, p=0.299).
Since a wide QRS is an indication for CRT-D therapy, high QRS values cluster among those patients with implanted CRT-D, while among patients with QRS under 130ms standard ICD implantations are more frequent. This can explain the observed increase in the cumulative incidence of the first appropriate shocks for increasing QRS values up to 130ms in the ICD-group and its decrease for increasing QRS values over 130ms in the CRT-D group.
Regarding all-cause mortality, hazard ratios for age, LVEF, NYHA, ICM, AF, diabetes and sex category agreed with the results obtained in previously published meta-analyses.
Increased QRS values are associated with higher mortality in the ICD group (HR 1.09 per 10ms increase, p<0.001), but not in the CRT-D group (HR 0.99 per 10ms increase, p=0.695).
Conclusion
In our study, we confirmed QRS duration as an independent risk factor for appropriate ICD shocks and all-cause mortality in patients with ICD for primary prophylaxis. However, this was only observed in patients with single- or dual-chamber ICD, while there was no correlation in CRT-D patients. The findings suggest that CRT-D exerts a protective effect regarding the occurrence of first appropriate shock and all-cause mortality for patients with QRS values higher than 130 ms and indication for resynchronization.
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Affiliation(s)
- PRF Bengel
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
| | - B Kessel
- Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S Schloegl
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
| | - A Bauer
- Medical University of Innsbruck, Dept. of Cardiology, Innsbruck, Austria
| | - J Junttila
- Medical Research Center Oulu, Oulu, Finland
| | - A Lubinski
- Medical University of Lodz, Dept. of Cardiology, Lodz, Poland
| | - M Malik
- Imperial College London, National Heart and Lung Institute, London, United Kingdom of Great Britain & Northern Ireland
| | - B Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - G Schmidt
- Technical University of Munich, Med. Klinik und Poliklinik I, Klinikum rechts der Isar, Munich, Germany
| | - JH Svendsen
- Rigshospitalet - Copenhagen University Hospital, Dept. of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - MA Vos
- University Medical Center Utrecht, Dept. of Medical Physiology, Utrecht, Netherlands (The)
| | - R Willems
- University Hospitals Leuven, Leuven, Belgium
| | - C Sticherling
- University Hospital Basel, Department of Cardiology, Basel, Switzerland
| | - T Friede
- University Medical Center of Gottingen (UMG), Department of Medical Statistics, Goettingen, Germany
| | - M Zabel
- University Medical Center Gottingen (UMG), Department for Cardiology and Pneumology, Gottingen, Germany
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17
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Toman O, Hnatkova K, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Andršová I, Schmidt G, Malik M. Short-Term Beat-to-Beat QT Variability Appears Influenced More Strongly by Recording Quality Than by Beat-to-Beat RR Variability. Front Physiol 2022; 13:863873. [PMID: 35431991 PMCID: PMC9011003 DOI: 10.3389/fphys.2022.863873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
Increases in beat-to-beat variability of electrocardiographic QT interval duration have repeatedly been associated with increased risk of cardiovascular events and complications. The measurements of QT variability are frequently normalized for the underlying RR interval variability. Such normalization supports the concept of the so-called immediate RR effect which relates each QT interval to the preceding RR interval. The validity of this concept was investigated in the present study together with the analysis of the influence of electrocardiographic morphological stability on QT variability measurements. The analyses involved QT and RR measurements in 6,114,562 individual beats of 642,708 separate 10-s ECG samples recorded in 523 healthy volunteers (259 females). Only beats with high morphology correlation (r > 0.99) with representative waveforms of the 10-s ECG samples were analyzed, assuring that only good quality recordings were included. In addition to these high correlations, SDs of the ECG signal difference between representative waveforms and individual beats expressed morphological instability and ECG noise. In the intra-subject analyses of both individual beats and of 10-s averages, QT interval variability was substantially more strongly related to the ECG noise than to the underlying RR variability. In approximately one-third of the analyzed ECG beats, the prolongation or shortening of the preceding RR interval was followed by the opposite change of the QT interval. In linear regression analyses, underlying RR variability within each 10-s ECG sample explained only 5.7 and 11.1% of QT interval variability in females and males, respectively. On the contrary, the underlying ECG noise contents of the 10-s samples explained 56.5 and 60.1% of the QT interval variability in females and males, respectively. The study concludes that the concept of stable and uniform immediate RR interval effect on the duration of subsequent QT interval duration is highly questionable. Even if only stable beat-to-beat measurements of QT interval are used, the QT interval variability is still substantially influenced by morphological variability and noise pollution of the source ECG recordings. Even when good quality recordings are used, noise contents of the electrocardiograms should be objectively examined in future studies of QT interval variability.
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Affiliation(s)
- Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czechia
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czechia
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | | | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czechia
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czechia
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
- *Correspondence: Irena Andršová
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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18
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Sex and Rate Change Differences in QT/RR Hysteresis in Healthy Subjects. Front Physiol 2022; 12:814542. [PMID: 35197861 PMCID: PMC8859307 DOI: 10.3389/fphys.2021.814542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
While it is now well-understood that the extent of QT interval changes due to underlying heart rate differences (i.e., the QT/RR adaptation) needs to be distinguished from the speed with which the QT interval reacts to heart rate changes (i.e., the so-called QT/RR hysteresis), gaps still exist in the physiologic understanding of QT/RR hysteresis processes. This study was designed to address the questions of whether the speed of QT adaptation to heart rate changes is driven by time or by number of cardiac cycles; whether QT interval adaptation speed is the same when heart rate accelerates and decelerates; and whether the characteristics of QT/RR hysteresis are related to age and sex. The study evaluated 897,570 measurements of QT intervals together with their 5-min histories of preceding RR intervals, all recorded in 751 healthy volunteers (336 females) aged 34.3 ± 9.5 years. Three different QT/RR adaptation models were combined with exponential decay models that distinguished time-based and interval-based QT/RR hysteresis. In each subject and for each modelling combination, a best-fit combination of modelling parameters was obtained by seeking minimal regression residuals. The results showed that the response of QT/RR hysteresis appears to be driven by absolute time rather than by the number of cardiac cycles. The speed of QT/RR hysteresis was found decreasing with increasing age whilst the duration of individually rate corrected QTc interval was found increasing with increasing age. Contrary to the longer QTc intervals, QT/RR hysteresis speed was faster in females. QT/RR hysteresis differences between heart rate acceleration and deceleration were not found to be physiologically systematic (i.e., they differed among different healthy subjects), but on average, QT/RR hysteresis speed was found slower after heart rate acceleration than after rate deceleration.
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Affiliation(s)
- Irena Andršová
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Martina Šišáková
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Ondřej Toman
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | | | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tomáš Novotný
- Faculty of Medicine, Department of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czechia
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Faculty of Medicine, Department of Internal Medicine and Cardiology, Masaryk University, Brno, Czechia
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19
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Grünwald V, Bethge W, Blohmer JU, Burkhardt B, Dirksen U, Ebert M, Gschwend J, Gutzmer R, Henn D, Hermann K, Isbary G, Klußmann JP, Knauf W, Krause M, Luntz S, Paradies K, Piso P, Ryll B, Schmidt G, Sinn M, Stintzing S, Wedding U, Wesselmann S, Reinacher-Schick A. Situation klinischer Studien in Deutschland – ein interdisziplinäres Positionspapier. Onkologe 2022; 28:19-22. [PMID: 35106031 PMCID: PMC8796186 DOI: 10.1007/s00761-022-01106-x] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Viktor Grünwald
- Westdeutsches Tumorzentrum Essen, Innere Klinik (Tumorforschung) und Klinik für Urologie, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147 Essen, Deutschland
- Arbeitsgemeinschaft Internistische Onkologie (AIO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Wolfgang Bethge
- Zentrum für Klinische Studien ZKS Tübingen, Tübingen, Deutschland
| | - Jens-Uwe Blohmer
- Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Birgit Burkhardt
- Arbeitsgemeinschaft Pädiatrische Onkologie (APO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Uta Dirksen
- Arbeitsgemeinschaft Pädiatrische Onkologie (APO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Matthias Ebert
- Arbeitsgemeinschaft Internistische Onkologie (AIO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Jürgen Gschwend
- Arbeitsgemeinschaft Urologische Onkologie (AUO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Ralf Gutzmer
- Arbeitsgemeinschaft Dermatologische Onkologie (ADO), Deutsche Krebsgesellschaft e. V., Hannover, Deutschland
| | - Doris Henn
- Industrie, AstraZeneca, Wedel, Deutschland
| | - Ken Hermann
- Arbeitsgemeinschaft Bildgebung in der Onkologie (ABO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | | | - Jens Peter Klußmann
- Arbeitsgemeinschaft Hals-Nasen-Ohren-Heilkunde, Mund-Kiefer-Gesichtschirurgische Onkologie (AHMO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Wolfgang Knauf
- Berufsverband der Niedergelassenen Hämatologen & Onkologen in Deutschland e. V., Köln, Deutschland
| | - Mechthild Krause
- Arbeitsgemeinschaft Radiologische Onkologie (ARO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Steffen Luntz
- Koordinierungszentrum für Klinische Studien KKS Heidelberg, Heidelberg, Deutschland
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege (KOK), Deutsche Krebsgesellschaft e. V., Hamburg, Deutschland
| | - Pompiliu Piso
- Assoziation Chirurgische Onkologie (ACO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Bettina Ryll
- Melanoma Patient Network Europe, Upsala, Schweden
| | - Georg Schmidt
- Arbeitskreis Medizinischer Ethik-Kommissionen, Berlin, Deutschland
| | - Marianne Sinn
- Arbeitsgemeinschaft Internistische Onkologie (AIO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Sebastian Stintzing
- Arbeitsgemeinschaft Internistische Onkologie (AIO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Ulrich Wedding
- Arbeitsgemeinschaft Palliativmedizin (APM), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | | | - Anke Reinacher-Schick
- Arbeitsgemeinschaft Internistische Onkologie (AIO), Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
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20
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Braunisch MC, Mayer CC, Werfel S, Bauer A, Haller B, Lorenz G, Günthner R, Matschkal J, Bachmann Q, Thunich S, Schlegl M, Ludwig M, Holzmann-Littig C, Assali T, Pachmann M, Küchle C, Renders L, Wassertheurer S, Müller A, Schmidt G, Heemann U, Malik M, Schmaderer C. U-Shaped Association of the Heart Rate Variability Triangular Index and Mortality in Hemodialysis Patients With Atrial Fibrillation. Front Cardiovasc Med 2021; 8:751052. [PMID: 34912859 PMCID: PMC8667023 DOI: 10.3389/fcvm.2021.751052] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Atrial fibrillation (AF) is common in hemodialysis patients and contributes to increased mortality. We aimed to examine heart rate variability triangular index (HRVI) in hemodialysis patients with AF as it has recently been reported to predict mortality in AF patients without kidney disease. Methods: A total of 88 patients on hemodialysis with a medical history of AF or newly diagnosed AF underwent 24-h electrocardiography recordings. The primary endpoint of cardiovascular mortality was recorded during a median follow up of 3.0 years. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results: Median age was 76 years, median dialysis vintage was 27 months. Altogether, 22 and 44 patients died due to cardiovascular and non-cardiovascular causes. In 55% of patients AF was present during the recording. Kaplan-Meier plots of HRVI quartiles suggested a non-linear association between HRVI, cardiovascular, and all-cause mortality which was confirmed in non-linear Cox regression analysis. Adjusted linear Cox regression revealed a hazard ratio of 6.2 (95% CI: 2.1–17.7, p = 0.001) and 2.2 (95% CI: 1.3–3.8, p = 0.002) for the outer quartiles (combined first and fourth quartile) for cardiovascular and all-cause mortality, respectively. Patients in the first quartile were more likely to have sinus rhythm whereas patients in the fourth quartile were more likely to have AF. Conclusions: We found a U-shaped association between HRVI and mortality in hemodialysis AF patients. The results might contribute to risk stratification independent of known risk scores in hemodialysis AF patients.
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Affiliation(s)
- Matthias C Braunisch
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher C Mayer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Stanislas Werfel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.,Department of Cardiology, Munich University Clinic, DZHK (German Centre for Cardiovascular Research), Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,School of Medicine, Klinikum Rechts der Isar, Institute of Medical Informatics, Statistics and Epidemiology (IMedIS), Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Matschkal
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Quirin Bachmann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Thunich
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,School of Medicine, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Michaela Schlegl
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maximilian Ludwig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tarek Assali
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Claudius Küchle
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Alexander Müller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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21
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Wacker-Gussmann A, Schopen J, Engelhard J, Sitzberger C, Lienert N, Ewert P, Müller A, Schmidt G, Oberhoffer-Fritz R, Lobmaier SM. The Impact of Gestational Diabetes in Pregnancy on the Cardiovascular System of Children at One Year of Age. J Clin Med 2021; 10:jcm10245839. [PMID: 34945134 PMCID: PMC8707570 DOI: 10.3390/jcm10245839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/17/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common complication in pregnancy. The effect of GDM on the cardiovascular system after birth is still unclear. Between August 2015 and December 2018, 205 pregnant women were included in the prospective controlled observational study. Patients with GDM were assigned to the study group (n = 99), whereas (n = 107) healthy women served as controls. Postnatal follow up of their offspring was performed at 12 months of age. All included children (n = 125) underwent a specific standardized protocol including anthropometric data, such as weight, height, body mass index (BMI), blood pressure (BP) recordings and ultrasound measurements of the abdominal aortic intima-media-thickness (IMT). Furthermore, at least 10 min 3-channel electrocardiogram recording was done to evaluate the autonomic nervous system (ANS) by phase rectified signal averaging. There were no significant differences in anthropometric data between the groups, neither in the blood pressure nor in the intima-media-thickness of the aorta abdominals. However, in the study group, significantly lower average acceleration capacity (AAC) (study group −20.10 ± 3.04 ms, control group −18.87 ± 4.00 ms, p = 0.02) was found, indicating ANS activation at one year of age. Further studies are required to determine if these results are persistent and if these findings have long-term effects.
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Affiliation(s)
- Annette Wacker-Gussmann
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
- Correspondence:
| | - Judith Schopen
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
| | - Jana Engelhard
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Christina Sitzberger
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Nadine Lienert
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Peter Ewert
- German Heart Center, Department of Congenital Heart Disease and Pediatric Cardiology, 80663 Munich, Germany; (J.S.); (P.E.)
| | - Alexander Müller
- Department of Adult Cardiology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.M.); (G.S.)
| | - Georg Schmidt
- Department of Adult Cardiology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (A.M.); (G.S.)
| | - Renate Oberhoffer-Fritz
- Institute of Preventive Pediatrics, Faculty of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany; (J.E.); (C.S.); (N.L.); (R.O.-F.)
| | - Silvia Maria Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
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22
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Müller A, Haneke H, Kirchberger V, Mastella G, Dommasch M, Merle U, Heinze O, Siegmann A, Spinner C, Buiatti A, Laugwitz KL, Schmidt G, Martens E. Integration of mobile sensors in a telemedicine hospital system: remote-monitoring in COVID-19 patients. Z Gesundh Wiss 2021; 30:93-97. [PMID: 34667714 PMCID: PMC8518886 DOI: 10.1007/s10389-021-01655-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/20/2021] [Indexed: 01/01/2023]
Abstract
Aim The goal is to design and, in a next step, establish a scalable, multi-center telemonitoring platform based on existing systems for monitoring COVID-19 patients in home quarantine. In particular, the focus will be on raw data acquisition, integration of sensor data into the hospital system, structured data storage, and interoperability. Subject and methods Data necessary for monitoring, otherwise provided in various portals, will be continuously queried and integrated into the hospital system via a new interface in this proof-of-concept work. Results Based on extensive preliminary work at Klinikum rechts der Isar with a structured clinical database, we extend our system's integration of raw data and visualization in dashboards, as well as scientific provision of data from mobile sensors for monitoring patients in home quarantine. Conclusion Based on existing integrated telemonitoring systems supporting semantic and syntactic interoperability, short-term provision of scientific databases is possible. The integration of different mobile sensors into a clinical system for remote monitoring of patients around the clock is still new and to our knowledge unique.
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Affiliation(s)
- Alexander Müller
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannah Haneke
- Board of Healthcare Management, Department Value-Based Healthcare, Charité - University Medicine, Berlin, Germany
| | - Valerie Kirchberger
- Board of Healthcare Management, Department Value-Based Healthcare, Charité - University Medicine, Berlin, Germany
| | - Giulio Mastella
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Michael Dommasch
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Heinze
- Department Medical Information Systems, University Hospital Heidelberg, Heidelberg, Germany
| | - Adonia Siegmann
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christoph Spinner
- Department of Information Technology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Clinic for Gastroenterology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Alessandra Buiatti
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Karl-Ludwig Laugwitz
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Georg Schmidt
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Eimo Martens
- Clinic for Cardiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675 Munich, Germany
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23
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Wurzer D, Spielhagen P, Siegmann A, Gercekcioglu A, Gorgass J, Henze S, Kolar Y, Koneberg F, Kukkonen S, McGowan H, Schmid-Eisinger S, Steger A, Dommasch M, Haase HU, Müller A, Martens E, Haller B, Huster KM, Schmidt G. Remote monitoring of COVID-19 positive high-risk patients in domestic isolation: A feasibility study. PLoS One 2021; 16:e0257095. [PMID: 34559832 PMCID: PMC8462738 DOI: 10.1371/journal.pone.0257095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/24/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background If a COVID-19 patient develops a so-called severe course, he or she must be taken to hospital as soon as possible. This proves difficult in domestic isolation, as patients are not continuously monitored. The aim of our study was to establish a telemonitoring system in this setting. Methods Oxygen saturation, respiratory rate, heart rate and temperature were measured every 15 minutes using an in-ear device. The data was transmitted to the Telecovid Centre via mobile network or internet and monitored 24/7 by a trained team. The data were supplemented by daily telephone calls. The patients´ individual risk was assessed using a modified National Early Warning Score. In case of a deterioration, a physician initiated the appropriate measures. Covid-19 Patients were included if they were older than 60 years or fulfilled at least one of the following conditions: pre-existing disease (cardiovascular, pulmonary, immunologic), obesity (BMI >35), diabetes mellitus, hypertension, active malignancy, or pregnancy. Findings 153 patients (median age 59 years, 77 female) were included. Patients were monitored for 9 days (median, IQR 6–13 days) with a daily monitoring time of 13.3 hours (median, IQR 9.4–17.0 hours). 20 patients were referred to the clinic by the Telecovid team. 3 of these required intensive care without invasive ventilation, 4 with invasive ventilation, 1 of the latter died. All patients agreed that the device was easy to use. About 90% of hospitalised patients indicated that they would have delayed hospitalisation further if they had not been part of the study. Interpretation Our study demonstrates the successful implementation of a remote monitoring system in a pandemic situation. All clinically necessary information was obtained and adequate measures were derived from it without delay.
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Affiliation(s)
- David Wurzer
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul Spielhagen
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Adonia Siegmann
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ayca Gercekcioglu
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Judith Gorgass
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Simone Henze
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Yuron Kolar
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Sari Kukkonen
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hannah McGowan
- Telecovid Centre, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Alexander Steger
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dommasch
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Ulrich Haase
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Müller
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Eimo Martens
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Katharina M. Huster
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- Department of Internal Medicine I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- * E-mail:
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24
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Steger A, Dommasch M, Müller A, Sinnecker D, Huster KM, Gotzler T, Gotzler O, Hapfelmeier A, Ulm K, Barthel P, Hnatkova K, Laugwitz KL, Malik M, Schmidt G. Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study. Europace 2021; 23:789-796. [PMID: 33276379 PMCID: PMC8139819 DOI: 10.1093/europace/euaa359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/09/2020] [Indexed: 11/14/2022] Open
Abstract
Aims Present society is constantly ageing and elderly frequently suffer from conditions that are difficult and/or costly to treat if detected late. Effective screening of the elderly is therefore needed so that those requiring detailed clinical work-up are identified early. We present a prospective validation of a screening strategy based on a Polyscore of seven predominantly autonomic, non-invasive risk markers. Methods and results Within a population-based survey in Germany (INVADE study), participants aged ≥60 years were enrolled between August 2013 and February 2015. Seven prospectively defined Polyscore components were obtained during 30-min continuous recordings of electrocardiogram, blood pressure, and respiration. Out of 1956 subjects, 168 were excluded due to atrial fibrillation, implanted pacemaker, or unsuitable recordings. All-cause mortality over a median 4-year follow-up was prospectively defined as the primary endpoint. The Polyscore divided the investigated population (n = 1788, median age: 72 years, females: 58%) into three predefined groups with low (n = 1405, 78.6%), intermediate (n = 326, 18.2%), and high risk (n = 57, 3.2%). During the follow-up, 82 (4.6%) participants died. Mortality in the Polyscore-defined risk groups was 3.4%, 7.4%, and 17.5%, respectively (P < 0.0001). The Polyscore-based mortality prediction was independent of Framingham score, diabetes, chronic kidney disease, and major stroke and/or myocardial infarction history. It was particularly effective in those aged <75 years (n = 1145). Conclusion The Polyscore-based mortality risk assessment from short-term non-invasive recordings is effective in the elderly general population, especially those aged 60–74 years. Implementation of a comprehensive Polyscore screening of this age group is proposed to advance preventive medical care.
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Affiliation(s)
- Alexander Steger
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Michael Dommasch
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Müller
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Daniel Sinnecker
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katharina M Huster
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Teresa Gotzler
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Othmar Gotzler
- INVADE Study Group, Karl-Böhm-Str. 32, 85598 Baldham, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Grillparzerstr. 18, 81675 Munich, Germany
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, Grillparzerstr. 18, 81675 Munich, Germany
| | - Petra Barthel
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W120NN, UK
| | - Karl-Ludwig Laugwitz
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Road, Shepherd's Bush, London W120NN, UK.,Department of Internal Cardiology Medicine, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic
| | - Georg Schmidt
- Klinik für Innere Medizin I, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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25
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26
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Willems D, Bak M, Tan H, Lindinger G, Kocar A, Seperhi Shamloo A, Schmidt G, Hindricks G, Dagres N. Ethical issues in two parallel trials of personalised criteria for implantation of implantable cardioverter defibrillators for primary prevention: the PROFID project-a position paper. Open Heart 2021; 8:openhrt-2021-001686. [PMID: 34261778 PMCID: PMC8280899 DOI: 10.1136/openhrt-2021-001686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/26/2022] Open
Abstract
Aim To discuss ethical issues related to a complex study (PROFID) involving the development of a new, partly artificial intelligence-based, prediction model to enable personalised decision-making about the implantation of an implantable cardioverter defibrillator (ICD) in postmyocardial infarction patients, and a parallel non-inferiority and superiority trial to test decision-making informed by that model. Method The position expressed in this paper is based on an analysis of the PROFID trials using concepts from high-profile publications in the ethical literature. Results We identify ethical issues related to the testing of the model in the treatment setting, and to both the superiority and the non-inferiority trial. We underline the need for ethical-empirical studies about these issues, also among patients, as a parallel to the actual trials. The number of ethics committees involved is an organisational, but also an ethical challenge. Conclusion The PROFID trials, and probably other studies of similar scale and complexity, raise questions that deserve dedicated parallel ethics and social science research, but do not constitute a generic obstacle. A harmonisation procedure, comparable to the Voluntary Harmonization Procedure (VHP) for medication trials, could be needed for this type of trials.
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Affiliation(s)
- Dick Willems
- Ethics, Law, and Humanities, Amsterdam Public Health, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Marieke Bak
- Ethics, Law, and Humanities, Amsterdam Public Health, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Hanno Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Georg Lindinger
- Institute for Health Care Management and Health Sciences, University of Bayreuth, Bayreuth, Bayern, Germany
| | - Ayca Kocar
- Institute for Health Care Management and Health Sciences, University of Bayreuth, Bayreuth, Bayern, Germany
| | | | - Georg Schmidt
- Medizinische Klinik und Poliklinik, Technische Universität München, München, Bayern, Germany
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27
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Influence of heart rate correction formulas on QTc interval stability. Sci Rep 2021; 11:14269. [PMID: 34253795 PMCID: PMC8275798 DOI: 10.1038/s41598-021-93774-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/12/2021] [Accepted: 06/30/2021] [Indexed: 12/12/2022] Open
Abstract
Monitoring of QTc interval is mandated in different clinical conditions. Nevertheless, intra-subject variability of QTc intervals reduces the clinical utility of QTc monitoring strategies. Since this variability is partly related to QT heart rate correction, 10 different heart rate corrections (Bazett, Fridericia, Dmitrienko, Framingham, Schlamowitz, Hodges, Ashman, Rautaharju, Sarma, and Rabkin) were applied to 452,440 ECG measurements made in 539 healthy volunteers (259 females, mean age 33.3 ± 8.4 years). For each correction formula, the short term (5-min time-points) and long-term (day-time hours) variability of rate corrected QT values (QTc) was investigated together with the comparisons of the QTc values with individually corrected QTcI values obtained by subject-specific modelling of the QT/RR relationship and hysteresis. The results showed that (a) both in terms of short-term and long-term QTc variability, Bazett correction led to QTc values that were more variable than the results of other corrections (p < 0.00001 for all), (b) the QTc variability by Fridericia and Framingham corrections were not systematically different from each other but were lower than the results of other corrections (p-value between 0.033 and < 0.00001), and (c) on average, Bazett QTc values departed from QTcI intervals more than the QTc values of other corrections. The study concludes that (a) previous suggestions that Bazett correction should no longer be used in clinical practice are fully justified, (b) replacing Bazett correction with Fridericia and/or Framingham corrections would improve clinical QTc monitoring, (c) heart rate stability is needed for valid QTc assessment, and (d) development of further QTc corrections for day-to-day use is not warranted.
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Affiliation(s)
- Irena Andršová
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England, UK
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, Faculty of Medicine, University Hospital Brno, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, ICTEM, Hammersmith Campus, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England, UK. .,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic.
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28
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Braunisch MC, Gundel P, Werfel S, Mayer CC, Bauer A, Haller B, Günthner R, Lorenz G, Angermann S, Matschkal J, Schaller C, Holzmann-Littig C, Kemmner S, Mann J, Krieter A, Renders L, Wassertheurer S, Schmidt G, Heemann U, Malik M, Schmaderer C. Electrocardiographic parameters of left ventricular hypertrophy and prediction of mortality in hemodialysis patients. J Nephrol 2021; 35:233-244. [PMID: 34014512 PMCID: PMC8803820 DOI: 10.1007/s40620-021-01068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/09/2021] [Indexed: 11/09/2022]
Abstract
Background In hemodialysis patients, left ventricular hypertrophy (LVH) contributes to high cardiovascular mortality. We examined cardiovascular mortality prediction by the recently proposed Peguero-Lo Presti voltage since it identifies more patients with electrocardiographic (ECG) LVH than Cornell or Sokolow-Lyon voltages. Methods A total of 308 patients on hemodialysis underwent 24 h ECG recordings. LVH parameters were measured before and after dialysis. The primary endpoint of cardiovascular mortality was recorded during a median 3-year follow up. Risk prediction was assessed by Cox regression, both unadjusted and adjusted for the Charlson Comorbidity Index and the Cardiovascular Mortality Risk Score. Results The Peguero-Lo Presti voltage identified with 21% the most patients with positive LVH criteria. All voltages significantly increased during dialysis. Factors such as ultrafiltration rate, Kt/V, body mass index, sex, and phosphate were the most relevant for these changes. During follow-up, 26 cardiovascular deaths occurred. Post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages were independently associated with cardiovascular mortality in unadjusted and adjusted analysis. The Sokolow-Lyon voltage was not significantly associated with mortality. An optimal cut-off for the prediction of cardiovascular mortality was estimated at 1.38 mV for the Peguero-Lo Presti. Conclusions The post-dialysis Peguero-Lo Presti cut-off as well as the Peguero-Lo Presti and Cornell voltages allowed independent risk prediction of cardiovascular mortality in hemodialysis patients. Measuring the ECG LVH parameters after dialysis might allow a standardized interpretation as dialysis-specific factors influence the voltages. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01068-0.
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Affiliation(s)
- Matthias C Braunisch
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Peter Gundel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Klinik für Innere Medizin 4, Schwerpunkt Nephrologie und Hypertensiologie, Klinikum Nürnberg, Nuremberg, Germany
| | - Stanislas Werfel
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher C Mayer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Axel Bauer
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.,Department of Cardiology, Munich University Clinic, DZHK (German Centre for Cardiovascular Research), Ludwig-Maximilians University, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology (IMedIS), School of Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Roman Günthner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Lorenz
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Susanne Angermann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julia Matschkal
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Schaller
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christopher Holzmann-Littig
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,TUM Medical Education Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Kemmner
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Transplant Center, University Hospital Munich, Ludwig-Maximillians University (LMU), Munich, Germany
| | - Johannes Mann
- Department of Nephrology, University of Erlangen-Nürnberg, Erlangen, Germany.,KfH Kidney Center Munich, Isoldenstraße 15, Munich, Germany
| | - Axel Krieter
- Nephrocare München-Ost, Rosenkavalierplatz 5, Munich, Germany
| | - Lutz Renders
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health and Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Georg Schmidt
- School of Medicine, Klinik für Innere Medizin I, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe Heemann
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Christoph Schmaderer
- Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
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29
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Zabel M, Willems R, Lubinski A, Bauer A, Brugada J, Conen D, Flevari P, Hasenfuß G, Svetlosak M, Huikuri HV, Malik M, Pavlović N, Schmidt G, Sritharan R, Schlögl S, Szavits-Nossan J, Traykov V, Tuinenburg AE, Willich SN, Harden M, Friede T, Svendsen JH, Sticherling C, Merkely B. Clinical effectiveness of primary prevention implantable cardioverter-defibrillators: results of the EU-CERT-ICD controlled multicentre cohort study. Eur Heart J 2021; 41:3437-3447. [PMID: 32372094 PMCID: PMC7550196 DOI: 10.1093/eurheartj/ehaa226] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/19/2019] [Accepted: 03/17/2020] [Indexed: 12/25/2022] Open
Abstract
Aims The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter-Defibrillators (EU-CERT-ICD), a prospective investigator-initiated, controlled cohort study, was conducted in 44 centres and 15 European countries. It aimed to assess current clinical effectiveness of primary prevention ICD therapy. Methods and results We recruited 2327 patients with ischaemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and guideline indications for prophylactic ICD implantation. Primary endpoint was all-cause mortality. Clinical characteristics, medications, resting, and 12-lead Holter electrocardiograms (ECGs) were documented at enrolment baseline. Baseline and follow-up (FU) data from 2247 patients were analysable, 1516 patients before first ICD implantation (ICD group) and 731 patients without ICD serving as controls. Multivariable models and propensity scoring for adjustment were used to compare the two groups for mortality. During mean FU of 2.4 ± 1.1 years, 342 deaths occurred (6.3%/years annualized mortality, 5.6%/years in the ICD group vs. 9.2%/years in controls), favouring ICD treatment [unadjusted hazard ratio (HR) 0.682, 95% confidence interval (CI) 0.537–0.865, P = 0.0016]. Multivariable mortality predictors included age, left ventricular ejection fraction (LVEF), New York Heart Association class <III, and chronic obstructive pulmonary disease. Adjusted mortality associated with ICD vs. control was 27% lower (HR 0.731, 95% CI 0.569–0.938, P = 0.0140). Subgroup analyses indicated no ICD benefit in diabetics (adjusted HR = 0.945, P = 0.7797, P for interaction = 0.0887) or those aged ≥75 years (adjusted HR 1.063, P = 0.8206, P for interaction = 0.0902). Conclusion In contemporary ICM/DCM patients (LVEF ≤35%, narrow QRS), primary prophylactic ICD treatment was associated with a 27% lower mortality after adjustment. There appear to be patients with less survival advantage, such as older patients or diabetics. ![]()
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Affiliation(s)
- Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Rik Willems
- Department of Cardiovascular Sciences, University Hospitals of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Andrzej Lubinski
- Department of Cardiology, Medical University of Lodz (MUL) WAM Hospital, ul. Żeromskiego 113, 90-549 Lodz, Poland
| | - Axel Bauer
- Department of Cardiology, Ludwig-Maximilians-Universität Munich, Klinikum Großhadern, Marchioninistr. 19, 81377 München, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80802 München, Germany.,Department of Cardiology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Josep Brugada
- Department of Cardiology, IDIBAPS, Hospital Clinic Barcelona, Carrer de Villaroel, 08036 Barcelona, Spain
| | - David Conen
- Department of Cardiology, University Hospital Basel, University of Basel, Spitalstr. 21, 4031 Basel, Switzerland.,Department of Medicine, Population Health Research Institute, McMaster University, 237 Barton Street East, Hamilton, ON LBL 2X2, Canada
| | - Panagiota Flevari
- 2nd Department of Cardiology, Attikon University Hospital, Rimini 1, Chaidari, 12462 Athens, Greece
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Heart Center, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Martin Svetlosak
- Department of Cardiology and Angiology, Slovak Medical University NUSCH, Pod Krasnou horkou 7185, 83101 Nove Mesto, Bratislava, Slovakia
| | - Heikki V Huikuri
- Department of Internal Medicine, Medical Research Center, Oulu University Hospital, University of Oulu, PO Box 8000, 90570 Oulu, Finland
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW36LY, UK
| | - Nikola Pavlović
- Department of Cardiology, KBC Sestre Milosrdnice, Vinogradska Cesta 29, 10000 Zagreb, Croatia
| | - Georg Schmidt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Biedersteiner Str. 29, 80802 München, Germany.,Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München, Germany
| | - Rajevaa Sritharan
- Department of Cardiology and Pneumology, Heart Center, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany
| | - Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Janko Szavits-Nossan
- Department of Cardiology, Magdalena Klinika, Ul. Ljudevita Gaja 9, 49217 Krapinske Toplice, Croatia
| | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, bul. "Nikola Y. Vaptsarov" 51Б, 1407 Sofia, Bulgaria
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, Netherlands
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Schumannstr. 20/21, 10117 Berlin, Germany
| | - Markus Harden
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073 Göttingen, Germany
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Copenhagen, Denmark
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Spitalstr. 21, 4031 Basel, Switzerland
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University Heart Center, Gaál József út 9, 1122 Budapest, Hungary
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Schmidt G, Gerlinger C, Endrikat J, Gabriel L, Müller C, Baus S, Volk T, Findeklee S, Solomayer EF, Hamza A, Ströder R. Teaching breast ultrasound skills including core-needle biopsies on a phantom enhances undergraduate student's knowledge and learning satisfaction. Arch Gynecol Obstet 2021; 304:197-202. [PMID: 33728537 PMCID: PMC8164585 DOI: 10.1007/s00404-021-06016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Purpose To investigate whether a training program on breast ultrasound skills including core-needle biopsies to undergraduate students can improve medical knowledge and learning satisfaction. Methods Medical students attending mandatory classes at the Medical School of the University of Saarland received a supplemental theoretical and hands-on training program on ultrasound (US) breast screening and on US-guided core-needle biopsy using an agar–agar phantom. Experienced breast specialists and ultrasound examiners served as trainers applying Peyton’s 4-step training approach. The students’ theoretical knowledge and hands-on skills were tested before and after the training program, using a multiple-choice questionnaire (MCQ), the Objective Structured Clinical Examination (OSCE) and a student curriculum evaluation. Results The MCQ results showed a significant increase of the student’s theoretical knowledge (50.2–75.2%, p < 0.001). After the course, the OSCE showed a mean total of 17.3/20 points (86.5%), confirming the practical implementation of the new skills. The student curriculum evaluation in general was very positive. A total of 16/20 questions were rated between 1.2 and 1.7 (very good) and 3 questions were rated as 2.1 (good). Conclusion Undergraduate student’s medical education can be enhanced by teaching breast US skills.
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Affiliation(s)
- G Schmidt
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany.
| | - C Gerlinger
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - J Endrikat
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - L Gabriel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - C Müller
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - S Baus
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - T Volk
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - Sebastian Findeklee
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- MVZ Fertility Center Hamburg, 20095, Hamburg, Germany
| | - E F Solomayer
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
| | - A Hamza
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
- Department of Gynecology, Obstetrics, Kantonsspital Baden AG, 5404, Baden, Switzerland
| | - R Ströder
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Kirrberger Straße, 66421, HomburgSaar, Germany
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Haragan A, Nekolla K, Kapil A, Brieu N, Widmaier M, Budco A, Kanchev I, Testori M, Chan J, Schneider K, Hidalgo Sastre A, Baehner M, Schmidt G, Field J, Davies M, Gosney J. FP07.02 Deep Learning Based Analysis of Multiplex IHC Accurately Interprets PD-L1 and Provides Prognostic Information in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kessler AL, Pham MH, Ikenberg B, Wiestler B, Haber G, Wunderlich S, Seifert C, Mueller A, Schmidt G. Abstract P705: Lesion Symptom Mapping of Cardiac Autonomic Dysfunction in Patients With Acute Ischaemic Stroke: A Prospective Cohort Study. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
About 15% of patients with stroke show elevated Troponin T levels without presenting an acute coronary syndrome. Dysbalance in the autonomous nervous system is discussed as a possible reason. However, it remains unknown which brain regions affect specific autonomous biosignals.
Methods:
Prospectively from July 2018 to May 2019 we performed simultaneous non-invasive 30-min recordings of autonomous biosignals with all patients at our centre suffering from an ischaemic stroke within the last 7 days. Previously described autonomous risk factors were investigated and a lesion symptom mapping based on MRI was done.
Results:
In total, 100 patients with ischaemic stroke were measured. Subsequently 10 patients had to be excluded because of atrial fibrillation during recording, resulting in a study population of 90 patients. Mean age was 64.9 years, 38 patients (42.2%) were female. Mean NIHSS-Score at first admission was 3.7 points.
The five parameters baroreflex sensitivity (BRS), deceleration capacity of the heart rate, expiration-triggered sinus arrhythmia, mean heart rate and average respiration rate were analysed for their association with ischaemic lesion location. Using established dichotomy limits in the lesion symptom mapping we could find risk factor related overlaps in different brain regions, such as an association of disturbed BRS with pontine strokes.
Conclusion:
Previous studies show that patients with abnormalities in autonomous parameters have higher cardiovascular risk. Identifying brain regions that affect the cardiac autonomous system is relevant for better understanding the underlying pathophysiology as well as early identification of these patients at risk. It is interesting to speculate if patients with lesions in these brain regions could benefit from early cardiologic surveillance. We are currently validating our findings with a higher sample size and follow up data.
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Affiliation(s)
| | | | | | | | - Georg Haber
- Technische Universität München, Munich, Germany
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Rutckaia V, Heyroth F, Schmidt G, Novikov A, Shaleev M, Savelev RS, Schilling J, Petrov M. Coupling of Germanium Quantum Dots with Collective Sub-radiant Modes of Silicon Nanopillar Arrays. ACS Photonics 2021; 8:209-217. [PMID: 37362546 PMCID: PMC10286553 DOI: 10.1021/acsphotonics.0c01319] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
In this paper, we demonstrate the infrared photoluminescence emission from Ge(Si) quantum dots coupled with collective Mie modes of silicon nanopillars. We show that the excitation of band edge dipolar modes of a linear nanopillar array results in strong reshaping of the photoluminescence spectra. Among other collective modes, the magnetic dipolar mode with the polarization along the array axis contributes the most to the emission spectrum, exhibiting an experimentally measured Q-factor of around 500 for an array of 11 pillars. The results belong to the first experimental evidence of light emission enhancement of quantum emitters applying collective Mie resonances in finite nanoresonators and therefore represent an important contribution to the new field of active all-dielectric meta-optics.
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Affiliation(s)
- Viktoriia Rutckaia
- Centre
for Innovation Competence SiLi-nano, Martin-Luther-University
Halle-Wittenberg, Karl-Freiherr-von-Fritsch-Strasse 3, 06120 Halle (Saale), Germany
| | - Frank Heyroth
- Interdisciplinary
center of material science, Martin-Luther-University
Halle-Wittenberg, Heinrich-Damerow-Strasse 4, 06120 Halle (Saale), Germany
| | - Georg Schmidt
- Institute
of Physics, Martin-Luther-University Halle-Wittenberg, von-Danckelmann-Platz 3, 06120 Halle (Saale), Germany
| | - Alexey Novikov
- Institute
for Physics of Microstructures of the Russian Academy of Sciences, Academicheskaya Str. 7, Nizhny Novgorod 603950, Russia
- Lobachevsky
University, Gagarin av. 23, Nizhny Novgorod 603950, Russia
| | - Mikhail Shaleev
- Institute
for Physics of Microstructures of the Russian Academy of Sciences, Academicheskaya Str. 7, Nizhny Novgorod 603950, Russia
| | - Roman S. Savelev
- Department
of Physics and Engineering, ITMO University, St. Petersburg 197101, Russia
| | - Joerg Schilling
- Centre
for Innovation Competence SiLi-nano, Martin-Luther-University
Halle-Wittenberg, Karl-Freiherr-von-Fritsch-Strasse 3, 06120 Halle (Saale), Germany
| | - Mihail Petrov
- Department
of Physics and Engineering, ITMO University, St. Petersburg 197101, Russia
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Heart Rate Dependency and Inter-Lead Variability of the T Peak - T End Intervals. Front Physiol 2021; 11:595815. [PMID: 33384609 PMCID: PMC7769826 DOI: 10.3389/fphys.2020.595815] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
The electrocardiographic (ECG) assessment of the T peak–T end (Tpe) intervals has been used in many clinical studies, but several related physiological aspects have not been reported. Specifically, the sources of the Tpe differences between different ECG leads have not been systematically researched, the relationship of Tpe duration to underlying heart rate has not been firmly established, and little is known about the mutual correspondence of Tpe intervals measured in different ECG leads. This study evaluated 796,620 10-s 12-lead ECGs obtained from long-term Holters recorded in 639 healthy subjects (311 female) aged 33.8 ± 9.4 years. For each ECG, transformation to orthogonal XYZ lead was used to measure Tpe in the orthogonal vector magnitude (used as a reference for lead-to-lead comparisons) and to construct a three-dimensional T wave loop. The loop roundness was expressed by a ratio between its circumference and length. These ratios were significantly related to the standard deviation of Tpe durations in different ECG leads. At the underlying heart rate of 60 beats per minute, Tpe intervals were shorter in female than in male individuals (82.5 ± 5.6 vs 90.0 ± 6.5 ms, p < 0.0001). When studying linear slopes between Tpe intervals measured in different leads and the underlying heart rate, we found only minimal heart rate dependency, which was not systematic across the ECG leads and/or across the population. For any ECG lead, positive Tpe/RR slope was found in some subjects (e.g., 79 and 25% of subjects for V2 and V4 measurements, respectively) and a negative Tpe/RR slope in other subjects (e.g., 40 and 65% for V6 and V5, respectively). The steepest positive and negative Tpe/RR slopes were found for measurements in lead V2 and V4, respectively. In all leads, the Tpe/RR slope values were close to zero, indicating, on average, Tpe changes well below 2 ms for RR interval changes of 100 ms. On average, longest Tpe intervals were measured in lead V2, the shortest in lead III. The study concludes that the Tpe intervals measured in different leads cannot be combined. Irrespective of the measured ECG lead, the Tpe interval is not systematically heart rate dependent, and no heart rate correction should be used in clinical Tpe investigations.
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Affiliation(s)
- Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Dommasch M, Steger A, Barthel P, Huster KM, Müller A, Sinnecker D, Laugwitz KL, Penzel T, Lubinski A, Flevari P, Harden M, Friede T, Kääb S, Merkely B, Sticherling C, Willems R, Huikuri HV, Bauer A, Malik M, Zabel M, Schmidt G. Nocturnal respiratory rate predicts ICD benefit: A prospective, controlled, multicentre cohort study. EClinicalMedicine 2021; 31:100695. [PMID: 33554086 PMCID: PMC7846675 DOI: 10.1016/j.eclinm.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. ICD implantation decisions are currently based on reduced left ventricular ejection fraction (LVEF≤35%). However, in some patients, the non-arrhythmic death risk predominates thus diminishing ICD-therapy benefits. Based on previous observations, we tested the hypothesis that compared to the others, patients with nocturnal respiratory rate (NRR) ≥18 breaths per minute (brpm) benefit less from prophylactic ICD implantations. METHODS This prospective cohort study was a pre-defined sub-study of EU-CERT-ICD trial conducted at 44 centers in 15 EU countries between May 12, 2014, and September 6, 2018. Patients with ischaemic or non-ischaemic cardiomyopathy were included if meeting primary prophylactic ICD implantation criteria. The primary endpoint was all-cause mortality. NRR was assessed blindly from pre-implantation 24-hour Holters. Multivariable models and propensity stratification evaluated the interaction between NRR and the ICD mortality effect. This study is registered with ClinicalTrials.gov (NCT0206419). FINDINGS Of the 2,247 EU-CERT-ICD patients, this sub-study included 1,971 with complete records. In 1,363 patients (61.7 (12) years; 244 women) an ICD was implanted; 608 patients (63.2 (12) years; 108 women) were treated conservatively. During a median 2.5-year follow-up, 202 (14.8%) and 95 (15.6%) patients died in the ICD and control groups, respectively. NRR statistically significantly interacted with the ICD mortality effect (p = 0.0070). While the 1,316 patients with NRR<18 brpm showed a marked ICD benefit on mortality (adjusted HR 0.529 (95% CI 0.376-0.746); p = 0.0003), no treatment effect was demonstrated in 655 patients with NRR≥18 brpm (adjusted HR 0.981 (95% CI 0.669-1.438); p = 0.9202). INTERPRETATION In the EU-CERT-ICD trial, patients with NRR≥18 brpm showed limited benefit from primary prophylactic ICD implantation. Those with NRR<18 brpm benefitted substantially. FUNDING European Community's 7th Framework Programme FP7/2007-2013 (602299).
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Affiliation(s)
- Michael Dommasch
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Alexander Steger
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Katharina M Huster
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Alexander Müller
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Daniel Sinnecker
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité Universitätsmedizin Berlin, Germany
| | - Andrzej Lubinski
- Department of Cardiology, Medical University of Lodz Hospital, Lodz, Poland
| | - Panagiota Flevari
- Second Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Markus Harden
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, Heart Center University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Kääb
- German Center for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany
| | - Bela Merkely
- Department of Cardiology, Semmelweis University Heart Center, Budapest, Hungary
| | | | - Rik Willems
- University Hospitals of Leuven, Leuven, Belgium
| | - Heikki V. Huikuri
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Axel Bauer
- German Center for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Munich University Clinic, Munich, Germany
- University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Marek Malik
- Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Internal Medicine and Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Markus Zabel
- Department of Cardiology and Pneumology, Heart Center University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Georg Schmidt
- Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research partner site Munich Heart Alliance, Munich, Germany
- Corresponding author at: Klinikum rechts der Isar, Medizinische Klinik und Poliklinik I, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
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Andršová I, Hnatkova K, Šišáková M, Toman O, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Heart Rate Influence on the QT Variability Risk Factors. Diagnostics (Basel) 2020; 10:diagnostics10121096. [PMID: 33339231 PMCID: PMC7767205 DOI: 10.3390/diagnostics10121096] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/05/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
QT interval variability, mostly expressed by QT variability index (QTVi), has repeatedly been used in risk diagnostics. Physiologic correlates of QT variability expressions have been little researched especially when measured in short 10-second electrocardiograms (ECGs). This study investigated different QT variability indices, including QTVi and the standard deviation of QT interval durations (SDQT) in 657,287 10-second ECGs recorded in 523 healthy subjects (259 females). The indices were related to the underlying heart rate and to the 10-second standard deviation of RR intervals (SDRR). The analyses showed that both QTVi and SDQT (as well as other QT variability indices) were highly statistically significantly (p < 0.00001) influenced by heart rate and that QTVi showed poor intra-subject reproducibility (coefficient of variance approaching 200%). Furthermore, sequential analysis of regression variance showed that SDQT was more strongly related to the underlying heart rate than to SDRR, and that QTVi was influenced by the underlying heart rate and SDRR more strongly than by SDQT (p < 0.00001 for these comparisons of regression dependency). The study concludes that instead of QTVi, simpler expressions of QT interval variability, such as SDQT, appear preferable for future applications especially if multivariable combination with the underlying heart rate is used.
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Affiliation(s)
- Irena Andršová
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; (I.A.); (M.Š.); (O.T.); (T.N.)
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd’s Bush, London W12 0NN, UK;
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; (I.A.); (M.Š.); (O.T.); (T.N.)
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; (I.A.); (M.Š.); (O.T.); (T.N.)
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160 Vienna, Austria;
| | - Katharina M. Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 Munich, Germany; (K.M.H.); (P.B.); (G.S.)
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 Munich, Germany; (K.M.H.); (P.B.); (G.S.)
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic; (I.A.); (M.Š.); (O.T.); (T.N.)
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675 Munich, Germany; (K.M.H.); (P.B.); (G.S.)
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd’s Bush, London W12 0NN, UK;
- Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00 Brno, Czech Republic
- Correspondence:
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El-Hamad FJ, Bonabi SY, Müller A, Steger A, Schmidt G, Baumert M. Augmented Oscillations in QT Interval Duration Predict Mortality Post Myocardial Infarction Independent of Heart Rate. Front Physiol 2020; 11:578173. [PMID: 33240101 PMCID: PMC7680963 DOI: 10.3389/fphys.2020.578173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
Objective This study seeks to decompose QT variability (QTV) into physiological sources and assess their role for risk stratification in patients post myocardial infarction (MI). We hypothesize that the magnitude of QTV that cannot be explained by heart rate or respiration carries important prognostic information. Background Elevated beat-to-beat QTV is predictive of cardiac mortality, but the underlying mechanisms, and hence its interpretation, remain opaque. Methods We decomposed the QTV of 895 patients post MI into contributions by heart rate, respiration, and unexplained sources. Results Cox proportional hazard analysis demonstrates that augmented oscillations in QTV and their level of dissociation from heart rate are associated with a higher 5-year mortality rate (18.4% vs. 4.7%, p < 0.0001). In patients with left ventricular ejection fraction (LVEF) > 35%, a higher QTV risk score was associated with a significantly higher 5-year mortality rate (16% vs. 4%, p < 0.0001). In patients with a GRACE score ≥ 120, a higher QTV risk score was associated with a significantly higher 5-year mortality (25% vs. 11%, p < 0.001). Conclusion Augmented oscillations in QTV and discordance from heart rate, possibly indicative of excessive sympathetic outflow to the ventricular myocardium, predict high risk in patients post MI independent from established risk markers. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT00196274.
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Affiliation(s)
- Fatima J El-Hamad
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Safa Y Bonabi
- School of Electronic and Telecommunications Engineering, RMIT University, Melbourne, VIC, Australia
| | - Alexander Müller
- Internal Medicine I Department, Technical University of Munich, Munich, Germany
| | - Alexander Steger
- Internal Medicine I Department, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- Internal Medicine I Department, Technical University of Munich, Munich, Germany
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
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Smoczyńska A, Loen V, Sprenkeler DJ, Tuinenburg AE, Ritsema van Eck HJ, Malik M, Schmidt G, Meine M, Vos MA. Short-Term Variability of the QT Interval Can be Used for the Prediction of Imminent Ventricular Arrhythmias in Patients With Primary Prophylactic Implantable Cardioverter Defibrillators. J Am Heart Assoc 2020; 9:e018133. [PMID: 33215550 PMCID: PMC7763775 DOI: 10.1161/jaha.120.018133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Short‐term variability of the QT interval (STVQT) has been proposed as a novel electrophysiological marker for the prediction of imminent ventricular arrhythmias in animal models. Our aim is to study whether STVQT can predict imminent ventricular arrhythmias in patients. Methods and Results In 2331 patients with primary prophylactic implantable cardioverter defibrillators, 24‐hour ECG Holter recordings were obtained as part of the EU‐CERT‐ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter Defibrillators) study. ECG Holter recordings showing ventricular arrhythmias of >4 consecutive complexes were selected for the arrhythmic groups (n=170), whereas a control group was randomly selected from the remaining Holter recordings (n=37). STVQT was determined from 31 beats with fiducial segment averaging and calculated as ∑Dn+1‐Dn/30×2, where Dn represents the QT interval. STVQT was determined before the ventricular arrhythmia or 8:00 am in the control group and between 1:30 and 4:30 am as baseline. STVQT at baseline was 0.84±0.47 ms and increased to 1.18±0.74 ms (P<0.05) before the ventricular arrhythmia, whereas the STVQT in the control group remained unchanged. The arrhythmic patients were divided into three groups based on the severity of the arrhythmia: (1) nonsustained ventricular arrhythmia (n=32), (2) nonsustained ventricular tachycardia (n=134), (3) sustained ventricular tachycardia (n=4). STVQT increased before nonsustained ventricular arrhythmia, nonsustained ventricular tachycardia, and sustained ventricular tachycardia from 0.80±0.43 ms to 1.18±0.78 ms (P<0.05), from 0.90±0.49 ms to 1.14±0.70 ms (P<0.05), and from 1.05±0.22 ms to 2.33±1.25 ms (P<0.05). This rise in STVQT was significantly higher in sustained ventricular tachycardia compared with nonsustained ventricular arrhythmia (+1.28±1.05 ms versus +0.24±0.57 ms [P<0.05]) and compared with nonsustained ventricular arrhythmia (+0.34±0.87 ms [P<0.05]). Conclusions STVQT increases before imminent ventricular arrhythmias in patients, and the extent of the increase is associated with the severity of the ventricular arrhythmia.
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Affiliation(s)
- Agnieszka Smoczyńska
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - Vera Loen
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - David J Sprenkeler
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
| | - Anton E Tuinenburg
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Henk J Ritsema van Eck
- Department of Medical Informatics Erasmus University Medical Center Rotterdam The Netherlands
| | - Marek Malik
- National Heart and Lung InstituteImperial College London London United Kingdom
| | - Georg Schmidt
- Medical Klinik und Poliklinik I Technische Universität MünchenKlinikum rechts der Isar Münich Germany
| | - Mathias Meine
- Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
| | - Marc A Vos
- Department of Medical Physiology University Medical Center Utrecht Utrecht The Netherlands
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Müller C, Schmidt G, Juhasz-Böss S, Solomayer EF, Juhasz-Böss I. Neoadjuvant behandelte Brustkrebspatientinnen: Einflussfaktoren auf die pathologische Komplettremission. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- C Müller
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - G Schmidt
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - S Juhasz-Böss
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - EF Solomayer
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
| | - I Juhasz-Böss
- Universitätsklinikum des Saarlandes, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
- Universitätsklinikum Freiburg, Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin
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Paepke S, Kiechle M, Karsten M, Blohmer J, Schmidt G, Stassek J, Kühn T, Thill M. SPIO-guided Sentinel Lymph Node Biopsy (SLNB) in early Breast Cancer – first monoinstitutional data and perspectives. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schmidt G, Mathes S, Klein E, Kiechle M, Paepke D. Evaluation of an Expert Guided Integrative Therapy Concept in Patients With Breast or Gynecological Cancer During Systemic Therapy. J Evid Based Integr Med 2020; 25:2515690X20949444. [PMID: 32808558 PMCID: PMC7436788 DOI: 10.1177/2515690x20949444] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose. Breast and gynecological cancer patients undergoing systemic therapy frequently request integrative therapy concepts. The potential of integrative therapy (IM) lies in minimizing side effects of conventional cancer treatments and therefore decreasing treatment delays. IM can help to improve patients’ physical and emotional well-being, optimizing health and quality of life as IM involves patients in their own treatment. A counseling service for integrative medicine concepts as an outpatient program was implemented in our cancer center in 2013. Methods. In 2016 and 2017 144 breast and gynecological cancer patients were included into our specific IM program. The program comprises biological based complementary and alternative medicines (BB-CAM), a structured exercise therapy, manipulative and body-based practices, nutritional counseling, psycho-oncological and relaxing therapies. Therapists with additional specialization for IM, guide the treatment units. The program was evaluated via self-administered questionnaire. Results. 78% of the participating patients noticed an improvement by using BB-CAMs. 86% stated to feel better through participation in the structured exercise program. 74% profited from nutritional counseling and 91% from manual therapy. 93% of the patients treated with body compresses considered the application as soothing. The Bio-Frequency Sound Color Bed led to a relaxation in 96%. Psychological therapy improved coping with the disease in 70% of the patients. Conclusion. Integrative oncology combines the best practices of conventional and complementary therapy, uniting them in a holistic concept. Data show that our integrative therapy concept is well accepted by the patients and that therapy- and disease-related side effects can be reduced.
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Affiliation(s)
- Georg Schmidt
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Sofia Mathes
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Evelyn Klein
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Marion Kiechle
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
| | - Daniela Paepke
- Department of Gynecology and Obstetrics, Klinikum rechts der Isar and Comprehensive Cancer Center (CCCTUM), TU Munich, Germany
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Pekolj J, Clariá Sánchez R, Salceda J, Maurette RJ, Schelotto PB, Pierini L, Cánepa E, Moro M, Stork G, Resio N, Neffa J, Mc Cormack L, Quiñonez E, Raffin G, Obeide L, Fernández D, Pfaffen G, Salas C, Linzey M, Schmidt G, Ruiz S, Alvarez F, Buffaliza J, Maroni R, Campi O, Bertona C, de Santibañes M, Mazza O, Belotto de Oliveira M, Diniz AL, Enne de Oliveira M, Machado MA, Kalil AN, Pinto RD, Rezende AP, Ramos EJB, Talvane T Oliveira A, Torres OJM, Jarufe Cassis N, Buckel E, Quevedo Torres R, Chapochnick J, Sanhueza Garcia M, Muñoz C, Castro G, Losada H, Vergara Suárez F, Guevara O, Dávila D, Palacios O, Jimenez A, Poggi L, Torres V, Fonseca GM, Kruger JAP, Coelho FF, Russo L, Herman P. Laparoscopic Liver Resection: A South American Experience with 2887 Cases. World J Surg 2020; 44:3868-3874. [PMID: 32591841 DOI: 10.1007/s00268-020-05646-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Affiliation(s)
- J Pekolj
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Clariá Sánchez
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Salceda
- Hospital Ramón Santamarina, Tandil, Argentina
| | | | | | - L Pierini
- Clínica Nefrología, Clínica Uruguay, Hospital Iturraspe, Santa Fe, Argentina
| | - E Cánepa
- Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - M Moro
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - G Stork
- Hospital Italiano - Regional Sur, Bahía Blanca, Argentina
| | - N Resio
- Unidad HPB Sur, General Roca, Argentina
| | - J Neffa
- Hospital Italiano de Mendoza, Mendoza, Argentina
| | | | - E Quiñonez
- Hospital El Cruce, Buenos Aires, Argentina
| | - G Raffin
- Hospital Argerich, Buenos Aires, Argentina
| | - L Obeide
- Hospital Universitario Privado, Córdoba, Argentina
| | - D Fernández
- Clínica Pueyrredón, Mar del Plata, Argentina
| | - G Pfaffen
- Sanatorio Güemes, Buenos Aires, Argentina
| | - C Salas
- Sanatorio 9 de Julio, Santiago del Estero, Argentina, Hospital Centro de Salud, San Miguel de Tucumán, Argentina
| | - M Linzey
- Hospital Angel C. Padilla, San Miguel de Tucumán, Argentina
| | - G Schmidt
- Hospital Escuela Gral, Corrientes, Argentina
| | - S Ruiz
- Clínica Colón, Mar del Plata, Argentina
| | - F Alvarez
- Clínica Reina Fabiola, Hospital Italiano, Córdoba, Argentina
| | | | - R Maroni
- Hospital Papa Francisco, Salta, Argentina
| | - O Campi
- Clínica Regional General Pico, Santa Rosa, Argentina
| | - C Bertona
- Hospital Español, Mendoza, Argentina
| | - M de Santibañes
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - O Mazza
- HPB Surgery Section, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - A L Diniz
- A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - A N Kalil
- Santa Casa de Porto Alegre, Universidade Federal de Ciências da Saúde, Porto Alegre, Brazil
| | - R D Pinto
- Hospital Santa Catarina de Blumenau, Blumenau, Brazil
| | | | - E J B Ramos
- Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | - O J M Torres
- Hospital Universitario HUUFMA, Hospital São Domingos, UDI Hospital, Fortaleza, Brazil
| | | | - E Buckel
- Clínica Las Condes, Santiago, Chile
| | | | | | | | - C Muñoz
- Hospital de Talca, Talca, Chile
| | | | - H Losada
- Hospital de Temuco, Temuco, Chile
| | - F Vergara Suárez
- Clínica Vida - Fundación Colombiana de Cancerología, Medellin, Colombia
| | - O Guevara
- Instituto Nacional de Cancerologia, Bogotá, Colombia
| | | | | | - A Jimenez
- Hospital Clínicas, Asunción, Paraguay
| | - L Poggi
- Clínica Anglo Americana, Lima, Peru
| | - V Torres
- Hospital Guillermo Almenara ESSALUD, Lima, Peru
| | - G M Fonseca
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - J A P Kruger
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - F F Coelho
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil
| | - L Russo
- Hospital Maciel, Casmu, Montevideo, Uruguay
| | - P Herman
- Hospital das Clínicas - University of São Paulo School of Medicine, São Paulo, Brazil.
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DiGuardo M, Krull A, Dietz A, Soiney K, Chicos A, Wayne J, Skaer C, Wadewitz M, Bowler C, Schmidt G, Stubbs J, Jacob E. The Mayo Clinic Cellular Therapy Fellowship: Training the Next Generation of Cellular Therapy Leaders. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toman O, Hnatkova K, Smetana P, Huster KM, Šišáková M, Barthel P, Novotný T, Schmidt G, Malik M. Physiologic heart rate dependency of the PQ interval and its sex differences. Sci Rep 2020; 10:2551. [PMID: 32054960 PMCID: PMC7018842 DOI: 10.1038/s41598-020-59480-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 10/15/2019] [Accepted: 01/29/2020] [Indexed: 12/29/2022] Open
Abstract
On standard electrocardiogram (ECG) PQ interval is known to be moderately heart rate dependent, but no physiologic details of this dependency have been established. At the same time, PQ dynamics is a clear candidate for non-invasive assessment of atrial abnormalities including the risk of atrial fibrillation. We studied PQ heart rate dependency in 599 healthy subjects (aged 33.5 ± 9.3 years, 288 females) in whom drug-free day-time 12-lead ECG Holters were available. Of these, 752,517 ECG samples were selected (1256 ± 244 per subject) to measure PQ and QT intervals and P wave durations. For each measured ECG sample, 5-minute history of preceding cardiac cycles was also obtained. Although less rate dependent than the QT intervals (36 ± 19% of linear slopes), PQ intervals were found to be dependent on underlying cycle length in a highly curvilinear fashion with the dependency significantly more curved in females compared to males. The PQ interval also responded to the heart rate changes with a delay which was highly sex dependent (95% adaptation in females and males after 114.9 ± 81.1 vs 65.4 ± 64.3 seconds, respectively, p < 0.00001). P wave duration was even less rate dependent than the PQ interval (9 ± 10% of linear QT/RR slopes). Rate corrected P wave duration was marginally but significantly shorter in females than in males (106.8 ± 8.4 vs 110.2 ± 7.9 ms, p < 0.00001). In addition to establishing physiologic standards, the study suggests that the curvatures and adaptation delay of the PQ/cycle-length dependency should be included in future non-invasive studies of atrial depolarizations.
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Affiliation(s)
- Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, 72 Du Cane Rd, Shepherd's Bush, London, W12 0NN, England.
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Braunisch MC, Mayer CC, Bauer A, Lorenz G, Haller B, Rizas KD, Hagmair S, von Stülpnagel L, Hamm W, Günthner R, Angermann S, Matschkal J, Kemmner S, Hasenau AL, Zöllinger I, Steubl D, Mann JF, Lehnert T, Scherf J, Braun JR, Moog P, Küchle C, Renders L, Malik M, Schmidt G, Wassertheurer S, Heemann U, Schmaderer C. Cardiovascular Mortality Can Be Predicted by Heart Rate Turbulence in Hemodialysis Patients. Front Physiol 2020; 11:77. [PMID: 32116784 PMCID: PMC7027389 DOI: 10.3389/fphys.2020.00077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background Excess mortality in hemodialysis patients is mostly of cardiovascular origin. We examined the association of heart rate turbulence (HRT), a marker of baroreflex sensitivity, with cardiovascular mortality in hemodialysis patients. Methods A population of 290 prevalent hemodialysis patients was followed up for a median of 3 years. HRT categories 0 (both turbulence onset [TO] and slope [TS] normal), 1 (TO or TS abnormal), and 2 (both TO and TS abnormal) were obtained from 24 h Holter recordings. The primary end-point was cardiovascular mortality. Associations of HRT categories with the endpoints were analyzed by multivariable Cox regression models including HRT, age, albumin, and the improved Charlson Comorbidity Index for hemodialysis patients. Multivariable linear regression analysis identified factors associated with TO and TS. Results During the follow-up period, 20 patients died from cardiovascular causes. In patients with HRT categories 0, 1 and 2, cardiovascular mortality was 1, 10, and 22%, respectively. HRT category 2 showed the strongest independent association with cardiovascular mortality with a hazard ratio of 19.3 (95% confidence interval: 3.69-92.03; P < 0.001). Age, calcium phosphate product, and smoking status were associated with TO and TS. Diabetes mellitus and diastolic blood pressure were only associated with TS. Conclusion Independent of known risk factors, HRT assessment allows identification of hemodialysis patients with low, intermediate, and high risk of cardiovascular mortality. Future prospective studies are needed to translate risk prediction into risk reduction in hemodialysis patients.
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Affiliation(s)
- Matthias C Braunisch
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Christopher C Mayer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Axel Bauer
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany.,University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Lorenz
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Konstantinos D Rizas
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Stefan Hagmair
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Lukas von Stülpnagel
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany.,University Hospital for Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Hamm
- Department of Cardiology, Munich University Clinic, German Centre for Cardiovascular Research, Ludwig Maximilian University of Munich, Munich, Germany
| | - Roman Günthner
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Susanne Angermann
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Julia Matschkal
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Stephan Kemmner
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Anna-Lena Hasenau
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Isabel Zöllinger
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Dominik Steubl
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Johannes F Mann
- Department of Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany.,KfH Kidney Center, Munich, Germany
| | | | | | | | - Philipp Moog
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Claudius Küchle
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Lutz Renders
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Georg Schmidt
- Klinik für Innere Medizin I, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Siegfried Wassertheurer
- Center for Health & Bioresources, Biomedical Systems, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Uwe Heemann
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
| | - Christoph Schmaderer
- Abteilung für Nephrologie, Klinikum Rechts der Isar, Fakultät für Medizin, Technische Universität München, Munich, Germany
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Cao X, Müller A, Dirschinger RJ, Dommasch M, Steger A, Barthel P, Laugwitz KL, Schmidt G, Sinnecker D. Risk Prediction After Myocardial Infarction by Cyclic Variation of Heart Rate, a Surrogate of Sleep-Disordered Breathing Assessed From Holter ECGs. Front Physiol 2020; 10:1570. [PMID: 32009979 PMCID: PMC6974555 DOI: 10.3389/fphys.2019.01570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/13/2019] [Indexed: 11/17/2022] Open
Abstract
Aims Sleep-disordered breathing (SDB) is common among cardiac patients, but its role as an independent risk predictor after myocardial infarction (MI) is unclear. SDB causes cyclic variation of heart rate (CVHR). The aim of this study was to score Holter ECGs of a large cohort of MI survivors for SDB-related CVHR to investigate its value for mortality prediction. Methods A total of 1590 survivors of acute MI in sinus rhythm were prospectively enrolled and followed for 5-year all-cause mortality. Heart rate (HR) tachograms were generated from nocturnal (00:00–06.00 am) segments of Holter ECGs, and the minutes with CVHR were quantified by a previously developed algorithm. According to a pre-specified cutpoint, SDB was assumed if CVHR was present during ≥72 min. Results Seventy-seven patients (4.8%) had flat HR tachograms which prohibited analysis for SDB. Of the remaining 1513 patients, 584 (38.6%) were classified as having SDB. Mortality rates in groups stratified according to ECG-derived SDB did not differ significantly. Taken as a continuous variable, low CVHR duration was associated with increased mortality. The mortality of patients with flat HR tachograms was significantly increased, even after adjustment for age, sex, LVEF, GRACE score and diabetes mellitus. Mortality prediction by a flat HR tachogram was also independent of heart rate variability (HRV), heart rate turbulence (HRT), and deceleration capacity (DC). Conclusion In Holter ECG recordings of survivors of acute MI, signs suggestive of SDB were frequently present, but not associated with mortality. A flat nocturnal HR tachogram was a strong, independent predictor of 5-year all-cause mortality.
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Affiliation(s)
- Xu Cao
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Müller
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ralf J Dirschinger
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Dommasch
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Petra Barthel
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Sinnecker
- Klinik und Poliklinik für Innere Medizin I, University Hospital Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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47
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Junttila MJ, Pelli A, Kenttä TV, Friede T, Willems R, Bergau L, Malik M, Vandenberk B, Vos MA, Schmidt G, Merkely B, Lubinski A, Svetlosak M, Braunschweig F, Harden M, Zabel M, Huikuri HV, Sticherling C. Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators. Diabetes Care 2020; 43:196-200. [PMID: 31645407 DOI: 10.2337/dc19-1014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/10/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62-0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P = 0.001). CONCLUSIONS All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.
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Affiliation(s)
- M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ari Pelli
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, Division of Cardiology, University Medical Center Göttingen, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, U.K
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Marc A Vos
- Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Georg Schmidt
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bela Merkely
- Semmelweis University Heart Center, Budapest, Hungary
| | | | - Martin Svetlosak
- Slovak Medical University and Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | - Markus Harden
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Zabel
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Department of Cardiology and Pneumology, Heart Center, Division of Cardiology, University Medical Center Göttingen, Göttingen, Germany
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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48
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Lombardi F, Vicenzi M, Hnatkova K, Schmidt G, Malik M. The search for non-invasive markers of cardiac diseases comes back to the 12-lead electrocardiogram. Int J Cardiol 2020; 298:55-56. [DOI: 10.1016/j.ijcard.2019.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/26/2022]
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49
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Weyrich J, Ortiz JU, Müller A, Schmidt G, Brambs CE, Graupner O, Kuschel B, Lobmaier SM. Intrapartum PRSA: a new method to predict fetal acidosis?-a case-control study. Arch Gynecol Obstet 2019; 301:137-142. [PMID: 31883047 DOI: 10.1007/s00404-019-05419-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 12/13/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Phase-rectified signal averaging method (PRSA) represents an analysis method which applied on fetal cardiotocography (CTG) allows the quantification of the speed of fetal heart rate changes. By calculating the average deceleration capacity (ADC) an assessment of the fetal autonomic nervous system (ANS) is possible. The objective of this study was to test its ability to predict perinatal acidosis. METHODS A case-control study was performed at a University Hospital in Munich. All intrapartum CTG heart rate tracings saved during a 7-year period were considered for analysis. All neonates born with an umbilical arterial blood pH ≤ 7.10 were considered as cases. Controls were defined as healthy fetuses born with a pH ≥ 7.25. The main matching criteria were gestational age at delivery, parity, birth mode, and birth weight percentile. Exclusion criteria were a planned caesarean section, fetal malformations, and multiple pregnancies. ADC and STV were then calculated during the last 60, the last 45, and the last 30 min intervals prior to delivery. RESULTS Of all stored birth CTG recordings, 227 cases met the inclusion criteria and were studied. ADC was significantly higher in fetuses born with acidemia (4.85 bpm ± 3.0) compared to controls (3.36 bpm ± 2.2). The area under ROC curve was 0.659 (95% CI 0.608-0.710) for ADC and 0.566 (0.512-0.620) for STV (p = 0.013). CONCLUSIONS This study confirms that the assessment of ADC using PRSA represents a good additional tool for the prediction of acute fetal acidosis during delivery.
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Affiliation(s)
- Joy Weyrich
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany.
| | - Javier U Ortiz
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany
| | - Alexander Müller
- Department of Internal Medicine I - Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- Department of Internal Medicine I - Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Christine E Brambs
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany
| | - Oliver Graupner
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany
| | - Bettina Kuschel
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Straße 22, E81675, Munich, Germany
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50
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Hnatkova K, Toman O, Šišáková M, Smetana P, Huster KM, Barthel P, Novotný T, Schmidt G, Malik M. Sex and race differences in J-Tend, J-Tpeak, and Tpeak-Tend intervals. Sci Rep 2019; 9:19880. [PMID: 31882660 PMCID: PMC6934529 DOI: 10.1038/s41598-019-56328-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022] Open
Abstract
To facilitate the precision of clinical electrocardiographic studies of J-to-Tpeak (JTp) and Tpeak-to-Tend (Tpe) intervals, the study investigated their differences between healthy females and males, and between subjects of African and Caucasian origin. In 523 healthy subjects (254 females; 236 subjects of African origin), repeated Holter recordings were used to measure QT, JT, JTp, and Tpe intervals preceded by both stable and variable heart rates. Subject-specific curvilinear regression models were used to obtain individual QTc, JTc, JTpc and Tpec intervals. Rate hysteresis, i.e., the speed with which the intervals adapted after heart rate changes, was also investigated. In all sex-race groups, Tpe intervals were not systematically heart rate dependent. Similar to QTc intervals, women had JTc, and JTpc intervals longer than males (difference 20–30 ms, p < 0.001). However, women had Tpec intervals (and rate uncorrected Tpe intervals) shorter by approximately 10 ms compared to males (p < 0.001). Subjects of African origin had significantly shorter QTc intervals than Caucasians (p < 0.001). Gradually diminishing race-difference was found for JTc, JTpc and Tpec intervals. JTc and JTpc were moderately increasing with age but Tpe/Tpec were not. Rate hysteresis of JTp was approximately 10% longer compared to that of JT (p < 0.001). In future clinical studies, Tpe interval should not be systematically corrected for heart rate and similar to the QT interval, the differences in JT, JTp and Tpe intervals should be corrected for sex. The differences in QT and JT, and JTp intervals should also be corrected for race.
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Affiliation(s)
- Katerina Hnatkova
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd's Bush, London, W12 0NN, England
| | - Ondřej Toman
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Martina Šišáková
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Peter Smetana
- Wilhelminenspital der Stadt Wien, Montleartstraße 37, 1160, Vienna, Austria
| | - Katharina M Huster
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Petra Barthel
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Tomáš Novotný
- Department of Internal Medicine and Cardiology, University Hospital Brno, Faculty of Medicine, Masaryk University, Jihlavská 20, 625 00, Brno, Czech Republic
| | - Georg Schmidt
- Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, Munich, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, 72 Du Cane Road, Shepherd's Bush, London, W12 0NN, England.
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