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Kaemmerer H, Diller GP, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Herberg U, Huntgeburth M, Kaemmerer AS, Kozlik-Feldmann R, Lammers A, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary arterial hypertension in congenital heart disease - Part I]. Pneumologie 2023; 77:956-961. [PMID: 37963485 DOI: 10.1055/a-2146-7434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The number of adults with congenital heart disease (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary arterial hypertension (PAH), which may develop early in untreated CHD. Despite timely treatment of CHD, PAH often persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart defects" is addressed only relatively superficially in these guidelines. Therefore, this article addresses the perspective of congenital cardiology in greater depth.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Institut für Humangenetik, Universität Heidelberg, INF 366, Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Ulrike Herberg
- Klinik für Kinderkardiologie und Angeborene Herzfehler, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenem Herzfehler, Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
| | - Christian Apitz
- Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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Diller GP, Benesch Vidal ML, Kempny A, Kubota K, Li W, Dimopoulos K, Arvanitaki A, Lammers AE, Wort SJ, Baumgartner H, Orwat S, Gatzoulis MA. A framework of deep learning networks provides expert-level accuracy for the detection and prognostication of pulmonary arterial hypertension. Eur Heart J Cardiovasc Imaging 2022; 23:1447-1456. [PMID: 35900292 DOI: 10.1093/ehjci/jeac147] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/15/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS To test the hypothesis that deep learning (DL) networks reliably detect pulmonary arterial hypertension (PAH) and provide prognostic information. METHODS AND RESULTS Consecutive patients with PAH, right ventricular (RV) dilation (without PAH), and normal controls were included. An ensemble of deep convolutional networks incorporating echocardiographic views and estimated RV systolic pressure (RVSP) was trained to detect (invasively confirmed) PAH. In addition, DL-networks were trained to segment cardiac chambers and extracted geometric information throughout the cardiac cycle. The ability of DL parameters to predict all-cause mortality was assessed using Cox-proportional hazard analyses. Overall, 450 PAH patients, 308 patients with RV dilatation (201 with tetralogy of Fallot and 107 with atrial septal defects) and 67 normal controls were included. The DL algorithm achieved an accuracy and sensitivity of detecting PAH on a per patient basis of 97.6 and 100%, respectively. On univariable analysis, automatically determined right atrial area, RV area, RV fractional area change, RV inflow diameter and left ventricular eccentricity index (P < 0.001 for all) were significantly related to mortality. On multivariable analysis DL-based RV fractional area change (P < 0.001) and right atrial area (P = 0.003) emerged as independent predictors of outcome. Statistically, DL parameters were non-inferior to measures obtained manually by expert echocardiographers in predicting prognosis. CONCLUSION The study highlights the utility of DL algorithms in detecting PAH on routine echocardiograms irrespective of RV dilatation. The algorithms outperform conventional echocardiographic evaluation and provide prognostic information at expert-level. Therefore, DL methods may allow for improved screening and optimized management of PAH.
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Affiliation(s)
- Gerhard Paul Diller
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Department of Cardiology III, Adult Congenital and Valvular Heart Disease University Hospital Muenster, Albert-Schweitzer Campus 1, Building A1, 48149 Münster, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany.,Kings College London, London WC2R 2LS, UK
| | - Maria Luisa Benesch Vidal
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Department of Cardiology III, Adult Congenital and Valvular Heart Disease University Hospital Muenster, Albert-Schweitzer Campus 1, Building A1, 48149 Münster, Germany
| | - Aleksander Kempny
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Imperial College for Science and Medicine, London SW3 6LY, UK
| | - Kana Kubota
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi 329-0498, Japan
| | - Wei Li
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Imperial College for Science and Medicine, London SW3 6LY, UK
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Imperial College for Science and Medicine, London SW3 6LY, UK
| | - Alexandra Arvanitaki
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Department of Cardiology III, Adult Congenital and Valvular Heart Disease University Hospital Muenster, Albert-Schweitzer Campus 1, Building A1, 48149 Münster, Germany
| | - Astrid E Lammers
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK
| | - Stephen J Wort
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Imperial College for Science and Medicine, London SW3 6LY, UK
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease University Hospital Muenster, Albert-Schweitzer Campus 1, Building A1, 48149 Münster, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Stefan Orwat
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease University Hospital Muenster, Albert-Schweitzer Campus 1, Building A1, 48149 Münster, Germany.,Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Disease and Pulmonary Hypertension, Royal Brompton Hospital, Guy's and St. Thomas' NHS Trust, Sydney Street, London SW3 6NP, UK.,Imperial College for Science and Medicine, London SW3 6LY, UK
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Spiesshoefer J, Regmi B, Orwat S, Kabitz HJ, Giannoni A, Dreher M, Boentert M, Diller GP. Response to: Low molecular weight guluronate: A potential therapies for inspiratory muscle dysfunction and restrictive lung function impairment in congenital heart disease by Guiyuan He, Ruiting Zhou, Tingyuan Huang, Fanjun Zeng. Int J Cardiol 2022; 363:40. [PMID: 35760159 DOI: 10.1016/j.ijcard.2022.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Jens Spiesshoefer
- Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Binaya Regmi
- Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Stefan Orwat
- Department of Cardiology III, University Hospital Muenster, Muenster, Germany
| | - Hans-Joachim Kabitz
- Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Boentert
- Department of Neurology with Institute for Translational Neurology, Muenster University Hospital, Muenster, Germany,; Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Gerhard Paul Diller
- Department of Cardiology III, University Hospital Muenster, Muenster, Germany
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Wegner F, Radke R, Ellermann C, Wolfes J, Fischer AJ, Baumgartner H, Eckardt L, Diller GP, Orwat S. Incidence and predictors of left atrial appendage thrombus on transoesophageal echocardiography before elective cardioversion. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Guidelines recommend transoesophageal echocardiography (TOE) before cardioversion in thrombogenic arrhythmias when the requirement of ≥3 weeks of anticoagulation is not met. Current data to support this approach, especially with direct oral anticoagulants (DOAC), are scarce.
Methods
We analysed consecutive elective pre-cardioversion TOE in a high-volume electrophysiology centre for the occurrence of LAA thrombi or reduced LAA flow velocity. Possible predictors were recorded and compared in a multivariate logistic regression analysis.
Results
Consecutive pre-cardioversion TOE in 512 patients (148 female, median age 69 years) were included. In all patients, indication for TOE was either intake of anticoagulation <3 weeks before cardioversion or uncertain adherence to the prescribed anticoagulation regimen. Of the 512 TOE, 19 (3.7%) depicted a LAA thrombus. An additional 41 patients (8.0%) showed either a reduced LAA flow velocity (≤20cm/s), LAA sludge, or both (see figure). In a multivariate logistic regression analysis, QRS width on admission 12-lead ECG emerged as a possible predictor of LAA thrombus and reduced LAA flow (p=0.008). Noteworthy, a high CHA2DS2-VaSc-Score was not associated with an increased risk of reduced LAA emptying velocity and LAA thrombi were even found in patients with a CHA2DS2-VaSc-Score of 0 (n=1) and 1 (n=1).
Conclusion
The presence of LAA thrombus before an elective cardioversion is a rare event in the age of direct oral anticoagulants. However, LAA thrombi occurred even in supposed low-risk individuals according to the CHA2DS2-VaSc score. QRS width may aid in identifying patients at a high risk of a reduced LAA flow velocity.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Representative images of a solid LAA thrombus (panel A), LAA sludge (panel B, not containing a solid thrombus on i.v. contrast imaging), and a LAA free of thrombus or sludge (panel C). Panel D shows the PW Doppler signal in a patient with LAA emptying velocity reduced ≤20cm/s while panel E shows a LAA with normal flow characteristics.
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Affiliation(s)
- F Wegner
- Muenster University Hospital, Department of Cardiology II – Electrophysiology, Muenster, Germany
| | - R Radke
- Muenster University Hospital, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - C Ellermann
- Muenster University Hospital, Department of Cardiology II – Electrophysiology, Muenster, Germany
| | - J Wolfes
- Muenster University Hospital, Department of Cardiology II – Electrophysiology, Muenster, Germany
| | - A J Fischer
- Muenster University Hospital, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - H Baumgartner
- Muenster University Hospital, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - L Eckardt
- Muenster University Hospital, Department of Cardiology II – Electrophysiology, Muenster, Germany
| | - G P Diller
- Muenster University Hospital, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - S Orwat
- Muenster University Hospital, Department of Cardiology III – Adult Congenital and Valvular Heart Disease, Muenster, Germany
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Gaur L, Cedars A, Diller GP, Kutty S, Orwat S. Management considerations in the adult with surgically modified d-transposition of the great arteries. Heart 2021; 107:1613-1619. [PMID: 33741578 DOI: 10.1136/heartjnl-2020-318833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/04/2022] Open
Abstract
Dextro-transposition of the great arteries (D-TGA) has undergone a significant evolution in surgical repair, leading to survivors with vastly different postsurgical anatomy which in turn guides their long-term cardiovascular morbidity and mortality. Atrial switch repair survivors are limited by a right ventricle in the systemic position, arrhythmia and atrial baffles prone to obstruction or leak. Functional assessment of the systemic right ventricle is complex, requiring multimodality imaging to include specialised echocardiography and cross-sectional imaging (MRI and CT). In the current era, most neonates undergo the arterial switch operation with increasing understanding of near-term and long-term outcomes specific to their cardiac anatomy. Long-term observations of the Lecompte manoeuvre or coronary stenoses following transfer continue, with evolving understanding to improve surveillance. Ultimately, an understanding of postsurgical anatomy, specialised imaging techniques and interventional and electrophysiological procedures is essential to comprehensive care of D-TGA survivors.
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Affiliation(s)
- Lasya Gaur
- Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ari Cedars
- Division of Adult Congenital Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerhard Paul Diller
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
| | - Shelby Kutty
- Pediatrics, Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Stefan Orwat
- Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany
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Spiesshoefer J, Henke C, Kabitz HJ, Bengel P, Schütt K, Nofer JR, Spieker M, Orwat S, Diller GP, Strecker JK, Giannoni A, Dreher M, Randerath WJ, Boentert M, Tuleta I. Heart Failure Results in Inspiratory Muscle Dysfunction Irrespective of Left Ventricular Ejection Fraction. Respiration 2020; 100:96-108. [PMID: 33171473 DOI: 10.1159/000509940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Exercise intolerance in heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF) results from both cardiac dysfunction and skeletal muscle weakness. Respiratory muscle dysfunction with restrictive ventilation disorder may be present irrespective of left ventricular ejection fraction and might be mediated by circulating pro-inflammatory cytokines. OBJECTIVE To determine lung and respiratory muscle function in patients with HFrEF/HFpEF and to determine its associations with exercise intolerance and markers of systemic inflammation. METHODS Adult patients with HFrEF (n = 22, 19 male, 61 ± 14 years) and HFpEF (n = 8, 7 male, 68 ± 8 years) and 19 matched healthy control subjects underwent spirometry, measurement of maximum mouth occlusion pressures, diaphragm ultrasound, and recording of transdiaphragmatic and gastric pressures following magnetic stimulation of the phrenic nerves and the lower thoracic nerve roots. New York Heart Association (NYHA) class and 6-min walking distance (6MWD) were used to quantify exercise intolerance. Levels of circulating interleukin 6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured using ELISAs. RESULTS Compared with controls, both patient groups showed lower forced vital capacity (FVC) (p < 0.05), maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) (p < 0.05), diaphragm thickening ratio (p = 0.01), and diaphragm strength (twitch transdiaphragmatic pressure in response to supramaximal cervical magnetic phrenic nerve stimulation) (p = 0.01). In patients with HFrEF, NYHA class and 6MWD were both inversely correlated with FVC, PImax, and PEmax. In those with HFpEF, there was an inverse correlation between amino terminal pro B-type natriuretic peptide levels and FVC (r = -0.77, p = 0.04). In all HF patients, IL-6 and TNF-α were statistically related to FVC. CONCLUSIONS Irrespective of left ventricular ejection fraction, HF is associated with respiratory muscle dysfunction, which is associated with increased levels of circulating IL-6 and TNF-α.
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Affiliation(s)
- Jens Spiesshoefer
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy, .,Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany, .,Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany,
| | - Carolin Henke
- Department of Neurology, Herz-Jesu-Krankenhaus Hiltrup, Muenster, Germany
| | - Hans Joachim Kabitz
- Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany
| | - Philipp Bengel
- Clinic for Cardiology and Pneumology/Heart Center, University Medical Center Goettingen, DZHK (German Centre for Cardiovascular Research), Goettingen, Germany
| | - Katharina Schütt
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jerzy-Roch Nofer
- Center for Laboratory Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Spieker
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan Orwat
- Department of Cardiology III, University Hospital Muenster, Muenster, Germany
| | - Gerhard Paul Diller
- Department of Cardiology III, University Hospital Muenster, Muenster, Germany
| | - Jan Kolia Strecker
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Winfried Johannes Randerath
- Institute for Pneumology at the University of Cologne, Solingen, Germany.,Bethanien Hospital gGmbH Solingen, Solingen, Germany
| | - Matthias Boentert
- Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany.,Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany
| | - Izabela Tuleta
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
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Barracano R, Brida M, Guarguagli S, Palmieri R, Diller GP, Gatzoulis MA, Wong T. Implantable cardiac electronic device therapy for patients with a systemic right ventricle. Heart 2020; 106:1052-1058. [PMID: 32269130 DOI: 10.1136/heartjnl-2019-316202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/12/2020] [Accepted: 03/15/2020] [Indexed: 11/04/2022] Open
Abstract
The systemic right ventricle (SRV), defined as the morphological right ventricle supporting the systemic circulation, is relatively common in congenital heart disease (CHD). Our review aimed at examining the current evidence, knowledge gaps and technical considerations regarding implantable cardiac electronic device therapy in patients with SRV. The risk of sinus node dysfunction (SND) after atrial switch repair and/or complete heart block in congenitally corrected transposition of great arteries requiring permanent pacing increases with age. Similar to acquired heart disease, indication for pacing includes symptomatic bradycardia, SND and high degree atrioventricular nodal block. Right ventricular dysfunction and heart failure also represent important complications in SRV patients. Cardiac resynchronisation therapy (CRT) has been proposed to improve systolic function in SRV patients, although indications for CRT are not well defined and its potential benefit remains uncertain. Amongst adult CHD, patients with SRV are at the highest risk for sudden cardiac death (SCD). Nevertheless, risk stratification for SCD is scarce in this cohort and implantable cardioverter-defibrillator indication is currently limited to secondary prevention. Vascular access and the incidence of device-related complications, such as infections, inappropriate shocks and device system failure, represent additional challenges to implantable cardiac electronic device therapy in patients with SRV. A multidisciplinary approach with tertiary expertise and future collaborative research are all paramount to further the care for this challenging nonetheless ever increasing cohort of patients.
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Affiliation(s)
- Rosaria Barracano
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Silvia Guarguagli
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | - Rosalinda Palmieri
- Division of Pediatric Cardiology, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital-IRCSS, Rome, Italy
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,Department of Cardiology and Angiology, Adult Congenital and Valvular Heart Disease Center, University Hospital Muenster, Muenster, Germany.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tom Wong
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
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Brida M, Diller GP, Nashat H, Barracano R, Kempny A, Uebing A, Rigby ML, Gatzoulis MA. Cardiac catheter intervention complexity and safety outcomes in adult congenital heart disease. Heart 2020; 106:1432-1437. [PMID: 32205313 DOI: 10.1136/heartjnl-2019-316148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the intervention spectrum, complexity, and safety outcomes of catheter-based interventions in a contemporary adult congenital heart disease (ACHD) tertiary cohort. METHODS All patients over 16 years who underwent a catheter-based intervention for ACHD in our centre between 2000 and 2016 were included. Baseline demographics, clinical characteristics, indications for and complexity of intervention, procedural complications and early and mid-term mortality were analysed. RESULTS Overall, 1644 catheter-based interventions were performed. Intervention complexity ranged from simple (67.5%) to intermediate (26.4%) and to high (6.1%). Commonly performed procedures were atrial septal defect (33.4%) and patent foramen ovale closure (26.1%) followed by coarctation of the aorta (11.1%) and pulmonary artery interventions (7.0%). Age at index intervention was 40±16 years, 758 (46.1%) patients were male, 73.2% in New York Heart Association (NYHA) class I, 20.2% in NYHA class II, whereas 6.6% in NYHA class III/IV. In-hospital mortality was 0.7%. Median postinterventional length of stay was 1 day. Complications occurred in 129 (7.9%) with major adverse events in 21 (1.3%). One-year postintervention survival rates were 98.7% (95% CI 98.2 to 99.2). Over the study period, there was a notable shift in intervention complexity, with a predominance of simple procedures performed in early years and more complex procedures in later years. Furthermore, the case mix during the study broadened (p<0.001) with new catheter-based interventions and a more individualised approach to therapy. CONCLUSION This study shows an increasing complexity and expanding variability of ACHD catheter-based interventions, associated with low major complications, short hospital stays and low early and mid-term mortality. Ongoing investment in ACHD catheter interventions is warranted.
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Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK .,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Heba Nashat
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Rosaria Barracano
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anselm Uebing
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael L Rigby
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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9
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Diller GP, Orwat S, Vahle J, Bauer UMM, Urban A, Sarikouch S, Berger F, Beerbaum P, Baumgartner H. Prediction of prognosis in patients with tetralogy of Fallot based on deep learning imaging analysis. Heart 2020; 106:1007-1014. [DOI: 10.1136/heartjnl-2019-315962] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
ObjectiveTo assess the utility of machine learning algorithms for automatically estimating prognosis in patients with repaired tetralogy of Fallot (ToF) using cardiac magnetic resonance (CMR).MethodsWe included 372 patients with ToF who had undergone CMR imaging as part of a nationwide prospective study. Cine loops were retrieved and subjected to automatic deep learning (DL)-based image analysis, trained on independent, local CMR data, to derive measures of cardiac dimensions and function. This information was combined with established clinical parameters and ECG markers of prognosis.ResultsOver a median follow-up period of 10 years, 23 patients experienced an endpoint of death/aborted cardiac arrest or documented ventricular tachycardia (defined as >3 documented consecutive ventricular beats). On univariate Cox analysis, various DL parameters, including right atrial median area (HR 1.11/cm², p=0.003) and right ventricular long-axis strain (HR 0.80/%, p=0.009) emerged as significant predictors of outcome. DL parameters were related to adverse outcome independently of left and right ventricular ejection fraction and peak oxygen uptake (p<0.05 for all). A composite score of enlarged right atrial area and depressed right ventricular longitudinal function identified a ToF subgroup at significantly increased risk of adverse outcome (HR 2.1/unit, p=0.007).ConclusionsWe present data on the utility of machine learning algorithms trained on external imaging datasets to automatically estimate prognosis in patients with ToF. Due to the automated analysis process these two-dimensional-based algorithms may serve as surrogates for labour-intensive manually attained imaging parameters in patients with ToF.
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10
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Diller GP, Helm P, Gundlach C, Baumgartner H, Bauer UMM. P2574Sexual activity and dysfunction in adult patients with congenital heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Although the number of adults with congenital heart disease (CHD) is increasing, there is little research into the impact of CHD on sexual activity and -dysfunction. Whether and to what extent sexual function is discussed with patients in clinical practice is also unknown.
Purpose
To study the current knowledge level, problems, wishes and fears of adult CHD patients regarding sexual activity.
Methods
Patients recruited via the German National Register for Congenital Heart Defects were invited to an online survey about sexual function. Overall, 4,484 patients (2,264 female) were invited to the survey and 873 patients (502 female) participated (19.5%). Patients were divided into four groups based on the underlying CHD severity classification: simple CHD (136 patients), moderate CHD (354 patients), complex CHD (340 patients).
Results
301 (35.6%) patients reported that they had very rarely or no sex at all in the six months preceding the survey (simple CHD: 25.7%, moderate CHD: 33.6%, complex CHD: 38.2%, other CHD: 39.5%). Based on the last six months, 71.2% of the surveyed male patients estimated the probability of having and maintaining an erection as high or very high (simple CHD: 85%, moderate CHD: 71.4%, complex CHD: 69.7%). In addition, 60.6% of the interviewed male patients reported to be almost always or always able to get a full erection sufficient for sexual intercourse. In contrast, 14.6% of the male patients already had erectile dysfunction, but did not discuss this issue with their physician. Overall, only 3.5% of the male patients stated that they were offered a consultation regarding erectile dysfunction by their treating physician. In contrast, 29.6% of the male patients would like to receive such counseling during routine medical examinations. In the last six months, 56.4% of the interviewed female patients, reported no difficulties with lubrication. 44% of the female patients already received advice from their physician on sexuality, contraception and pregnancy and 64.5% of the female patients would like to receive additional medical advice and information on sexuality, contraception and pregnancy in the context of routine medical check-ups.
Conclusions
This study reveals important issues regarding sexual function in male and female adult patients with CHD. The study reveals important gaps in counselling patients regarding sexual issues beyond contraception and pregnancy.
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Affiliation(s)
- G P Diller
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - P Helm
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - C Gundlach
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - H Baumgartner
- University Medical Center, Center for Adults with Congenital Heart Defects (EMAH-Center), Münster, Germany
| | - U M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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11
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Diller GP, Freisinger E, Bronstein L, Koeppe J, Gerss J, Bauer U, Reinecke H, Baumgartner H. P4697Complications and mortality related to non-cardiac surgery in adult congenital heart disease: Results of a nationwide study including 20,450 cases. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Adults with congenital heart disease (ACHD) represent a growing patient population with high morbidity and increasing health resource utilization. In addition to acute and chronic cardiac complications, these patients require numerous non-cardiac surgical procedures during their life-time. Limited data on the morbidity and mortality risk related to non-cardiac surgical procedures exist in contemporary CHD patients. The aim of this study was to analyse the frequency and outcome of non-cardiac surgical procedures in contemporary ACHD patients based on all hospital admissions in Germany between 2011 and 2016.
Methods
Based on the German diagnosis related groups data of patients treated between 2011 and 2016 we identified all ACHD patients treated surgically as inpatients for non-cardiac problems. The dataset contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was surgery related mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis or resuscitation).
Results
Overall, 48,872 ACHD cases were hospitalized during the study period. Of these, 20,450 (41.8%) were hospitalized for non-cardiac surgical procedures. The median age at surgery was 50.0 years and 62.9% of patients were male. The overall mortality rate following non-cardiac operations was 2.8% (95% CI 2.6–3.0%). The highest mortality rates were observed for procedure codes involving pharynx, larynx or trachea (27.2%; 95% CI: 22.3–32.1%) and lung surgery (15.4%; 95% CI: 13.3–17.8%). Abdominal surgery (9.2%; 95% CI: 7.7–10.9) and neurosurgical procedures (7.8%; 95% CI: 5.4–10.9) also had relative high mortality rates. The major adverse event rate overall was 12.7% (95% CI 11.7–12.7%). The highest major adverse event rates were observed for surgery of the airways (43.2%; 95% CI: 40.2%-46.4%).
Conclusions
Non-cardiac surgical procedures are common in ACHD patients and are associated with considerable mortality and morbidity in this cohort. Especially, surgical procedures involving the airways or neurosurgery emerged as risky procedures. However, even for routine abdominal or orthopaedic surgery considerable mortality and morbidity was observed. Overall, our data support careful pre-operative patient evaluation and concentration of surgical procedures at centres with extensive surgical and anaesthetic experience with ACHD patients.
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Affiliation(s)
| | | | | | - J Koeppe
- University Hospital, Muenster, Germany
| | - J Gerss
- University Hospital, Muenster, Germany
| | - U Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
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12
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Ghonim S, Gatzoulis MA, Smith GC, Heng E, Ernst S, Li W, Keegan J, Diller GP, Dimpoulos K, Moon JC, Pennell DJ, Babu-Narayan SV. 2395LGE CMR predicts sudden death and VT in adults with repaired tetralogy of Fallot - a prospective study with 3500 patient follow up years. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Adults with repaired tetralogy of Fallot (rtoF) are at risk of ventricular arrhythmia and sudden cardiac death (SCD). Cross-sectional data suggest association of late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) with adverse clinical risk factors
Purpose
We sought to determine prognosis related to LGE CMR.
Methods
In this prospective cohort study the primary composite outcome comprised the first of cardiovascular death (SCD or heart failure-related), aborted SCD (successfully resuscitated cardiac arrest or appropriate AICD shock for ventricular fibrillation), and clinical sustained ventricular tachycardia (VT>30 seconds duration).
Results
In 531 rtoF patients (median age 32; 23–42, 296 (56%) male, NYHA≥II 17%) followed up after LGE CMR for median 5 (1.7–8.9) years, there were 39 primary composite outcomes: 10 SCD, 11 heart failure related deaths (2 perioperative RV failure), 2 aborted SCD and 16 clinical sustained VT events. At study end, there were 28 ventricular arrhythmic events in 28 rtoF patients (10 SCD, 16 clinical sustained VT, 2 aborted VF) that were significantly predicted by RV LGE extent (HR 1.45 CI: 1.3–1.6; P<0.001).
Univariable predictors of the primary outcome were RV LGE score; HR: 1.44 (1.31–1.57; p<0.001), (Figure) together with older age; HR: 1.05 (1.02–1.07; P<0.001), late repair; HR: 1.04 (1.02–1.07; p<0.001), lower RV ejection fraction; HR: 0.92 (0.89–0.95; p<0.001), larger RVOT akinetic length; HR: 1.04 (1.02–1.06; p<0.001) larger right atrial area; HR: 1.2 (1.12–1.29; p<0.001); higher BNP levels; HR: 1.01 (1–1.02; p<0.001), lower peak VO2; HR: 0.89 (0.83–0.96; p=0.001), prior atrial arrhythmia; HR: 5.3 (2.8–10.07; p<0.001), and non-sustained VT; HR: 4.1 (2.1–7.7; p<0.001). Inducible VT did not predict the primary outcome; HR: 2.1 (0.57–8; p=0.25)
In multivariable analysis both RV LGE score and indexed right atrial area (RAAi) only, remained predictive of the primary outcome (HR 1.29 CI: 1.12–1.49; p<0.001 and HR 1.1 CI: 1.02–1.12; p=0.01, respectively). Patients could accordingly be stratified such that supramedian RV LGE score (≥5) and RAAi ≥16cm2/m2 had 5-year event free survival 84% vs 94% for supramedian RV LGE score (≥5) and RAAi <16cm2/m2 or 98% for inframedian RV LGE score with RAAI<16cm2/m2. Figure.
Conclusions
For every unit increase in CMR defined RV fibrosis score there is a 44% increased risk of sudden cardiac death and VT. LGE CMR and maximal right atrial area should therefore be incorporated into risk stratification for sudden death in adults with rTOF.
Acknowledgement/Funding
British heart foundation
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Affiliation(s)
- S Ghonim
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - M A Gatzoulis
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - G C Smith
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - E Heng
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - W Li
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - J Keegan
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - G P Diller
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - K Dimpoulos
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - J C Moon
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - D J Pennell
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
| | - S V Babu-Narayan
- Royal Brompton Hospital, Imperial College London, National Heart Lung Institute, London, United Kingdom
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13
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Diller GP, Freisinger E, Bronstein L, Koeppe J, Gerss J, Reinecke H, Baumgartner H. 77Infective endocarditis in patients with congenital heart disease: Results of a nationwide study including 1494 endocarditis cases. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany between 2011 and 2016.
Methods
Based on the German diagnosis related groups data of patients treated between 2011 and 2016, we identified all CHD patients with a diagnosis of IE. The data contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, resuscitation or intubation).
Results
Overall, 181,924 CHD patients were included in the analysis (55% male; 73% children, mean age 2.3 years; 27% adults, mean age 58.4 years; underlying heart defect of simple complexity 55%, moderate complexity 23% and complex heart defect 22%, respectively). During the study period 1494 cases were treated for IE corresponding to 0.82% of all inpatient treatment cases in CHD patients. Mortality rate was 6.6% (95% CI: 5.0–7.6%) with a major adverse events rate of 44.6% (95% CI: 41.3–48.2%). In total, 682 IE patients (45.7% CI: 42.3%-49–2%) required a surgical intervention. The relative risk of dying due to endocarditis in CHD patients was significantly lower compared to older IE patients without CHD (relative risk 0.39; 95% CI: 0.32–0.47).
Conclusions
Infective endocarditis accounts for a minority of CHD related hospitalizations but remains a deadly disease with a high proportion of patients requiring surgical intervention. In addition, major adverse events are common in this setting, with almost half of the IE population presenting with a major adverse event. Due to different demographic and comorbidity spectrum encountered in CHD patients, these younger patients tend to have significantly better survival prospects compared to non-CHD IE patients in the current era.
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Affiliation(s)
| | | | | | - J Koeppe
- University Hospital, Muenster, Germany
| | - J Gerss
- University Hospital, Muenster, Germany
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14
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Kempny A, Dimopoulos K, Fraisse AE, Diller GP, Price LC, Rafiq I, McCabe C, Wort SJ, Gatzoulis MA. 4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV).
Objectives
We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making.
Methods
We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method.
Results
We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2].
Adjustment of PVR required
Conclusions
We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.
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Affiliation(s)
- A Kempny
- Royal Brompton Hospital, London, United Kingdom
| | | | - A E Fraisse
- Royal Brompton Hospital, London, United Kingdom
| | - G P Diller
- Royal Brompton Hospital, London, United Kingdom
| | - L C Price
- Royal Brompton Hospital, London, United Kingdom
| | - I Rafiq
- Royal Brompton Hospital, London, United Kingdom
| | - C McCabe
- Royal Brompton Hospital, London, United Kingdom
| | - S J Wort
- Royal Brompton Hospital, London, United Kingdom
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15
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Spiesshoefer J, Becker S, Tuleta I, Mohr M, Diller GP, Emdin M, Florian AR, Yilmaz A, Boentert M, Giannoni A. Impact of Simulated Hyperventilation and Periodic Breathing on Sympatho-Vagal Balance and Hemodynamics in Patients with and without Heart Failure. Respiration 2019; 98:482-494. [PMID: 31461730 DOI: 10.1159/000502155] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The effects of hyperventilation and hyperventilation in the context of periodic breathing (PB) on sympatho-vagal balance (SVB) and hemodynamics in conditions of decreased cardiac output and feedback resetting, such as heart failure (HF) or pulmonary arterial hypertension (PAH), are not completely understood. OBJECTIVES To investigate the effects of voluntary hyperventilation and simulated PB on hemodynamics and SVB in healthy subjects, in patients with systolic HF and reduced or mid-range ejection fraction (HFrEF and HFmrEF) and in patients with PAH. METHODS Study participants (n = 20 per group) underwent non-invasive recording of diastolic blood pressure, heart rate variability (HRV), baroreceptor-reflex sensitivity (BRS), total peripheral resistance index (TPRI) and cardiac index (CI). All measurements were performed at baseline, during voluntary hyperventilation and during simulated PB with different length of the hyperventilation phase. RESULTS In healthy subjects, voluntary hyperventilation led to a 50% decrease in the mean BRS slope and a 29% increase in CI compared to baseline values (p < 0.01 and p < 0.05). Simulated PB did not alter TPRI or CI and showed heterogeneous effects on BRS, but analysis of dPBV revealed decreased sympathetic drive in healthy volunteers depending on PB cycle length (p < 0.05). In HF patients, hyperventilation did not affect BRS and TPRI but increased the CI by 10% (p < 0.05). In HF patients, simulated PB left all of these parameters unaffected. In PAH patients, voluntary hyperventilation led to a 15% decrease in the high-frequency component of HRV (p < 0.05) and a 5% increase in CI (p < 0.05). Simulated PB exerted neutral effects on both SVB and hemodynamic parameters. CONCLUSIONS Voluntary hyperventilation was associated with sympathetic predominance and CI increase in healthy volunteers, but only with minor hemodynamic and SVB effects in patients with HF and PAH. Simulated PB had positive effects on SVB in healthy volunteers but neutral effects on SVB and hemodynamics in patients with HF or PAH.
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Affiliation(s)
- Jens Spiesshoefer
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy, .,Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany,
| | - Sara Becker
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Izabela Tuleta
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Muenster, Muenster, Germany
| | - Gerhard Paul Diller
- Department of Cardiology III, University Hospital Muenster, Muenster, Germany
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
| | | | - Ali Yilmaz
- Department of Cardiology I, University Hospital Muenster, Muenster, Germany
| | - Matthias Boentert
- Respiratory Physiology Laboratory, Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
| | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
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16
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van Doren S, Brida M, Gatzoulis MA, Kempny A, Babu-Narayan SV, Bauer UMM, Baumgartner H, Diller GP. Sex differences in publication volume and quality in congenital heart disease: are women disadvantaged? Open Heart 2019; 6:e000882. [PMID: 31168370 PMCID: PMC6519433 DOI: 10.1136/openhrt-2018-000882] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/09/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Women are underrepresented in leading medical positions and academia. The gender-gap in authorship of congenital heart disease (CHD) publications remains unknown. As determinants of gender equity in this field are poorly characterised, we aimed to quantify and characterise publications in CHD and to assess factors associated with female representation in research. Methods and results We identified 35 118 CHD publications between 2006 and 2015 for which author gender could be ascertained. Overall, 25.0% of all authors were female. Women accounted for 30.2% and 20.8% of all first and senior authorship positions with great geographic heterogeneity. While globally female first and senior authorship increased by 0.8% and 0.6%/year, some geographic regions showed no improvement in gender representation. Significant predictors of female first authorship on logistic regression analysis were country gross domestic product, human development index, gender inequality index and a female senior author (p<0.0001 for all). Publications with a female lead author tended to be published in journals with a higher impact factor (IF) and to attract more citations compared with those with a male author. Mixed gender authorship was associated with higher IF and number of citations. Women were less disadvantaged when the analysis was confined to original research. Conclusions While modest improvement in female authorship over time was noted, women remain underrepresented in contemporary academic CHD. Manuscripts with mixed gender authorship had higher IF and more citations. The main predictor of female first authorship was a female senior author. These data should inform policy recommendations regarding gender parity.
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Affiliation(s)
- Sophie van Doren
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Margarita Brida
- Cardiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Michael A Gatzoulis
- Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | | | - Sonya V Babu-Narayan
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK
| | - Ulrike M M Bauer
- Competence Network for Congenital Heart Defects, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Helmut Baumgartner
- Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Gerhard Paul Diller
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
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Dimopoulos K, Muthiah K, Alonso-Gonzalez R, Banner NR, Wort SJ, Swan L, Constantine AH, Gatzoulis MA, Diller GP, Kempny A. Heart or heart-lung transplantation for patients with congenital heart disease in England. Heart 2019; 105:596-602. [DOI: 10.1136/heartjnl-2018-313984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/01/2018] [Accepted: 12/06/2018] [Indexed: 11/04/2022] Open
Abstract
BackgroundIncreased longevity in patients with congenital heart disease (CHD) is associated with late complications, mainly heart failure, which may not be amenable to redo surgery and become refractory to medical therapy and so, trigger referral for transplantation. We assessed the current role and future prospects of heart and heart-lung transplantation for patients with CHD in England.MethodsWe performed a retrospective analysis of hospital episodes for England for 1997–2015, identifying patients with a CHD code (ICD-10 ‘Q2xx.x’), who underwent heart or heart-lung transplantation.ResultsIn total, 469 transplants (82.2% heart and 17.8% heart-lung) were performed in 444 patients. Half of patients transplanted had mild or moderate CHD complexity, this percentage increased with time (p=0.001). While overall, more transplantations were performed over the years, the proportion of heart-lung transplants declined (p<0.0001), whereas the proportion of transplants performed in adults remained static. Mortality was high during the first year, especially after heart-lung transplantation, but remained relatively low thereafter. Older age and heart-lung transplantation were strong predictors of death. While an increase in CHD transplants is anticipated, actual numbers in England seem to lag behind the increase in CHD patients with advanced heart failure.ConclusionsThe current and future predicted increase in the numbers of CHD transplants does not appear to parallel the expansion of the CHD population, especially in adults. Further investment and changes in policy should be made to enhance the number of donors and increase CHD transplant capacity to address the increasing numbers of potential CHD recipients and optimise transplantation outcomes in this growing population.
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Diller GP, Helm P, Tutarel O, Bauer UMM, Baumgartner H. P5479Optimizing care for adults with congenital heart disease: results of a conjoint analysis based on a nationwide sample of patients included in the German National Register. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G P Diller
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
| | - P Helm
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - O Tutarel
- German Heart Center of Munich, Congenital Heart Disease, Munich, Germany
| | - U M M Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - H Baumgartner
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
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Diller GP, Bauer LJ, Bauer UM, Helm P, Abdul-Khaliq H, Baumgartner H. 2378Risk of pulmonary hypertension after shunt closure in patients with simple congenital heart defects. An analysis of the German national register for congenital heart defects. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G P Diller
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
| | - L J Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - U M Bauer
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - P Helm
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - H Abdul-Khaliq
- Saarland University Hospital, Paediatric Cardiology, Homburg, Germany
| | - H Baumgartner
- University Hospital of Munster, Division of Adult Congenital and Valvular Heart Disease, Dept. of Cardiovascular Medicine, Munster, Germany
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Beurtheret S, Tutarel O, Diller GP, West C, Ntalarizou E, Resseguier N, Papaioannou V, Jabbour R, Simpkin V, Bastin AJ, Babu-Narayan SV, Bonello B, Li W, Sethia B, Uemura H, Gatzoulis MA, Shore D. Contemporary cardiac surgery for adults with congenital heart disease. Heart 2017; 103:1194-1202. [PMID: 28270427 DOI: 10.1136/heartjnl-2016-310384] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Advances in early management of congenital heart disease (CHD) have led to an exponential growth in adults with CHD (ACHD). Many of these patients require cardiac surgery. This study sought to examine outcome and its predictors for ACHD cardiac surgery. METHODS This is an observational cohort study of prospectively collected data on 1090 consecutive adult patients with CHD, undergoing 1130 cardiac operations for CHD at the Royal Brompton Hospital between 2002 and 2011. Early mortality was the primary outcome measure. Midterm to longer-term survival, cumulative incidence of reoperation, other interventions and/or new-onset arrhythmia were secondary outcome measures. Predictors of early/total mortality were identified. RESULTS Age at surgery was 35±15 years, 53% male, 52.3% were in New York Heart Association (NYHA) class I, 37.2% in class II and 10.4% in class III/IV. Early mortality was 1.77% with independent predictors NYHA class ≥ III, tricuspid annular plane systolic excursion (TAPSE) <15 mm and female gender. Over a mean follow-up of 2.8±2.6 years, 46 patients died. Baseline predictors of total mortality were NYHA class ≥ III, TAPSE <15 mm and non-elective surgery. The number of sternotomies was not independently associated with neither early nor total mortality. At 10 years, probability of survival was 94%. NYHA class among survivors was significantly improved, compared with baseline. CONCLUSIONS Contemporary cardiac surgery for ACHD performed at a single, tertiary reference centre with a multidisciplinary approach is associated with low mortality and improved functional status. Also, our findings emphasise the point that surgery should not be delayed because of reluctance to reoperate only.
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Affiliation(s)
- Sylvain Beurtheret
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK.,Department of Adult Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Oktay Tutarel
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Gerhard Paul Diller
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Cathy West
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | | | - Noémie Resseguier
- Department of Biostatistic and Public Health, La Timone Hospital, Marseille, France
| | - Vasileios Papaioannou
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Richard Jabbour
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Victoria Simpkin
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Anthony J Bastin
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Sonya V Babu-Narayan
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Beatrice Bonello
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Wei Li
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Babulal Sethia
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Hideki Uemura
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Darryl Shore
- Department of Congenital Cardiac Surgery, Royal Brompton Hospital, London, UK
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Kaemmerer H, Apitz C, Brockmeier K, Eicken A, Gorenflo M, Hager A, deHaan F, Huntgeburth M, Kozlik-Feldmann R, Miera O, Diller GP. [Pulmonary hypertension in grown-ups with congenital heart disease: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S70-S79. [PMID: 27760453 DOI: 10.1055/s-0042-114530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for different forms of PH, and specifically address PH associated with congenital heart disease (CHD). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH in grown-ups with congenital heart disease (GUCH). This article summarizes the results and recommendations of this working group.
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Rosenkranz S, Lang IM, Blindt R, Bonderman D, Bruch L, Diller GP, Felgendreher R, Gerges C, Hohenforst-Schmidt W, Holt S, Jung C, Kindermann I, Kramer T, Kübler WM, Mitrovic V, Riedel A, Rieth A, Schmeisser A, Wachter R, Weil J, Opitz C. [Pulmonary hypertension associated with left heart disease: recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S48-S56. [PMID: 27760450 DOI: 10.1055/s-0042-114522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more common forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern because of limited ressources and the need to base treatments on scientific evidence. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, representing an unmet need of targeted PH therapies. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, several working groups were initiated, one of which was specifically dedicated to PH associated with left heart disease. This article summarizes the results and recommendations of this working group.
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De Torres-Alba F, Kaleschke G, Diller GP, Vormbrock J, Orwat S, Radke R, Reinke F, Fischer D, Reinecke H, Baumgartner H. Changes in the Pacemaker Rate After Transition From Edwards SAPIEN XT to SAPIEN 3 Transcatheter Aortic Valve Implantation. JACC Cardiovasc Interv 2016; 9:805-813. [DOI: 10.1016/j.jcin.2015.12.023] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 11/24/2022]
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Tutarel O, Röntgen P, Bode-Böger SM, Martens-Lobenhoffer J, Westhoff-Bleck M, Diller GP, Bauersachs J, Kielstein JT. Symmetrical Dimethylarginine Is a Better Biomarker for Systemic Ventricular Dysfunction in Adults after Atrial Repair for Transposition of the Great Arteries Than NT-proBNP. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Uebing A, Kempny A, Tutarel O, Gatzoulis MA, Diller GP. Einfluss des Interventionellen oder chirurgischen ASD-Verschlusses im Erwachsenenalter auf das Überleben. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0033-1354432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Radojevic J, Inuzuka R, Alonso-Gonzalez R, Borgia F, Giannakoulas G, Prapa M, Liodakis E, Li W, Swan L, Diller GP, Dimopoulos K, Gatzoulis MA. Peak oxygen uptake correlates with disease severity and predicts outcome in adult patients with Ebstein's anomaly of the tricuspid valve. Int J Cardiol 2013; 163:305-308. [DOI: 10.1016/j.ijcard.2011.06.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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Tay EL, Papaphylactou M, Diller GP, Alonso-Gonzalez R, Inuzuka R, Giannakoulas G, Harries C, Wort SJ, Swan L, Dimopoulos K, Gatzoulis MA. Quality of life and functional capacity can be improved in patients with Eisenmenger syndrome with oral sildenafil therapy. Int J Cardiol 2011; 149:372-6. [DOI: 10.1016/j.ijcard.2010.02.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 10/20/2009] [Accepted: 02/14/2010] [Indexed: 10/19/2022]
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Uebing A, Arvanitis P, Li W, Diller GP, Babu-Narayan SV, Okonko D, Koltsida E, Papadopoulos M, Johnson MR, Lupton MG, Yentis SM, Steer PJ, Gatzoulis MA. Effect of pregnancy on clinical status and ventricular function in women with heart disease. Int J Cardiol 2010; 139:50-9. [DOI: 10.1016/j.ijcard.2008.09.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Revised: 07/18/2008] [Accepted: 09/02/2008] [Indexed: 10/21/2022]
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