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Makhmudova U, Schatz U, Perakakis N, Kassner U, Schumann F, Axthelm C, Stürzebecher P, Sinning DL, Doevelaar A, Rohn B, Westhoff T, Vogt A, Scholl M, Kästner U, Geiling JA, Stach K, Mensch J, Lorenz E, Paitazoglou C, Eitel I, Baessler A, Steinhagen-Thiessen E, Koenig W, Schulze PC, Landmesser U, Laufs U, Weingärtner O. High interindividual variability in LDL-cholesterol reductions after inclisiran administration in a real-world multicenter setting in Germany. Clin Res Cardiol 2023; 112:1639-1649. [PMID: 37422840 PMCID: PMC10584696 DOI: 10.1007/s00392-023-02247-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/29/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND AIMS Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the treatment of hypercholesterolemia. Small interfering RNA (siRNA) inclisiran is a new drug, which targets PCSK9 mRNA in the liver, reducing concentrations of circulating LDL-C. In randomized trials, inclisiran demonstrated a substantial reduction in LDL-C. The German Inclisiran Network (GIN) aims to evaluate LDL-C reductions in a real-world cohort of patients treated with inclisiran in Germany. METHODS Patients who received inclisiran in 14 lipid clinics in Germany for elevated LDL-C levels between February 2021 and July 2022 were included in this analysis. We described baseline characteristics, individual LDL-C changes (%) and side effects in 153 patients 3 months (n = 153) and 9 months (n = 79) after inclisiran administration. RESULTS Since all patients were referred to specialized lipid clinics, only one-third were on statin therapy due to statin intolerance. The median LDL-C reduction was 35.5% at 3 months and 26.5% at 9 months. In patients previously treated with PCSK9 antibody (PCSK9-mAb), LDL-C reductions were less effective than in PCSK9-mAb-naïve patients (23.6% vs. 41.1% at 3 months). Concomitant statin treatment was associated with more effective LDL-C lowering. There was a high interindividual variability in LDL-C changes from baseline. Altogether, inclisiran was well-tolerated, and side effects were rare (5.9%). CONCLUSION In this real-world patient population referred to German lipid clinics for elevated LDL-C levels, inclisiran demonstrated a high interindividual variability in LDL-C reductions. Further research is warranted to elucidate reasons for the interindividual variability in drug efficacy.
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Affiliation(s)
- U Makhmudova
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Friedrich-Schiller-University, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center at Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Berlin, Germany
| | - U Schatz
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - N Perakakis
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
- Paul Langerhans Institute Dresden (PLID), Helmholtz Center Munich, University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD E.V.), Neuherberg, Germany
| | - U Kassner
- Clinic for Endocrinology and Metabolic Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - F Schumann
- Clinic for Endocrinology and Metabolic Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - C Axthelm
- Cardiologicum Dresden and Pirna, Dresden, Germany
| | - P Stürzebecher
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - D L Sinning
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Berlin, Germany
| | - A Doevelaar
- Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Herne, Germany
| | - B Rohn
- Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Herne, Germany
| | - T Westhoff
- Medical Clinic I, Marien Hospital Herne, University Hospital of the Ruhr-University of Bochum, Herne, Germany
| | - A Vogt
- Department of Internal Medicine IV, University Hospital Munich, Munich, Germany
| | - M Scholl
- Medical Care Centre, Nephrocare Mühlhausen GmbH, Mühlhausen/Thuringia, Germany
| | - U Kästner
- Medical Care Centre, Nephrocare Mühlhausen GmbH, Mühlhausen/Thuringia, Germany
| | - J-A Geiling
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Friedrich-Schiller-University, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - K Stach
- Department of Internal Medicine V, University Hospital Mannheim, Mannheim, Germany
| | - J Mensch
- Institute for Clinical Chemistry, University Medicine Rostock, Rostock, Germany
| | - E Lorenz
- Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - C Paitazoglou
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - I Eitel
- Department of Internal Medicine II, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - A Baessler
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - E Steinhagen-Thiessen
- Clinic for Endocrinology and Metabolic Medicine, Charité-University Medicine Berlin, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center at Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Chemistry, University Medicine Rostock, Rostock, Germany
| | - W Koenig
- Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - P C Schulze
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Friedrich-Schiller-University, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - U Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
- Friede Springer Cardiovascular Prevention Center at Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Berlin, Germany
| | - U Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Oliver Weingärtner
- Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, Friedrich-Schiller-University, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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2
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Schrage B, Sundermeyer J, Blankenberg S, Eitel I, Kirchhof P, Mangner N, Moebius-Winkler S, Orban M, Thiele H, Morrow DA, Schulze PC, Westermann D. Timing of active left ventricular unloading in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1504] [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
Aim
To evaluate the impact of timing of active left ventricular (LV) unloading in relation to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation on outcomes of patients with cardiogenic shock (CS).
Methods and results
Data from 421 patients with CS treated with active LV unloading on top of VA-ECMO at 18 tertiary-care centers in 4 countries were collected. Only patients in whom both devices were implanted within 24 hours of each other were considered and patients were stratified by timing of device implantation in early vs. delayed active LV unloading (e.g. active LV unloading before vs. after VA-ECMO). Cox and logistic regression models (adjusted for age, sex, lactate, cardiopulmonary resuscitation (CPR), VA-ECMO assisted CPR and enrollment center) were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as several safety outcomes.
Overall, 310 (73.6%) patients were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (hazard ratio 0.63, 95% confidence interval 0.46–0.87) and a higher likelihood of weaning from mechanical ventilation (odds ratio 1.25, 95% confidence interval 1.03–1.52), but not with more complications. Importantly, postponing active LV unloading in these patients was associated with higher mortality risk (Figure 1), and lower likelihood of successful weaning from mechanical ventilation.
Conclusion
This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO as a primary treatment strategy, as opposed to a bail-out approach.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Unrestricted research grant from Abiomed
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Affiliation(s)
- B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - I Eitel
- University Heart Center , Luebeck , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | | | - M Orban
- University Hospital of Munich , Munich , Germany
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D A Morrow
- Brigham and Women's Hospital , Boston , United States of America
| | | | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
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Lange T, Stiermaier T, Backhaus SJ, Boom P, Kowallick JT, Lotz J, Kutty S, Bigalke B, Gutberlet M, De Waha-Thiele S, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. Fully automated artificial intelligence-based myocardial scar quantification for diagnostic and prognostic stratification in patients following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background Myocardial infarct size (IS) remains one of the strongest predictors of adverse cardiac events following acute myocardial infarction (AMI). Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can precisely quantify the extent of injury but requires manual post-processing. Whether novel user-independent artificial intelligence (AI) based fully-automated analyses may facilitate clinical workflow and deliver similar information for risk stratification is unknown.
Methods 913 AMI patients from two multi-center trials (AIDA-STEMI n = 704 with ST-elevation myocardial infarction [STEMI] and TATORT-NSTEMI n = 245 with non-ST-elevation-infarction [NSTEMI]) were included in this sub-study. IS was quantified manually using conventional software (Medis, Leiden Netherlands) and fully automated AI-based software (NeoSoft). All automatically detected IS were evaluated visually and corrected if necessary. Analyzed data were tested for agreement and prediction of major adverse clinical events (MACE) within one year after AMI.
Results Automated and manual IS were similarly associated with outcome in cox regression analyses (HR 1.05 [95% CI 1-02-1.07] p < 0.001 for automated IS and HR 1.04 [95% CI 1.02-1.06]; p < 0.001 for manual IS). Comparison of C-statistics derived area under the curve (AUC) resulted in equivalent MACE prediction (AUC 0.65 for automated vs. AUC 0.66 for manual, p = 0.53). Manual correction of the automated scar detection did not lead to an improved risk prediction of MACE (AUC 0.65 to 0.66, p = 0.43). There was good agreement of automated and manually derived IS (intraclass correlation coefficient [ICC] 0.75 [0.07-0.89]) which was further improved after manual correction of the underlying contours (ICC 0.98 [0.97-0.98]).
Conclusion AI-based software enables automated scar quantification with similar prognostic value compared to conventional methods in patients following AMI.
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Affiliation(s)
- T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Lotz
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology , Berlin, Germany
| | - M Gutberlet
- University of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - S De Waha-Thiele
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
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4
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Boom P, Matz J, Kowallick JT, Steinmetz M, Kutty S, Bigalke B, Desch S, Hasenfuss G, Thiele H, Stiermaier T, Eitel I. Fully automated cardiac assessment for diagnostic and prognostic stratification following myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.260] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular magnetic resonance (CMR) imaging is considered the reference methodology for cardiac morphology and function but requires manual post-processing. Whether novel artificial intelligence (AI) -based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of AI-based analyses.
Methods
CMR data (n = 1017 patients) from two myocardial infarction multi-center trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and AI-based software. Obtained parameters entered regression analyses for prediction of major adverse clinical events (MACE) defined as death, reinfarction or congestive heart failure within one-year after the acute event.
Results
Both manual and uncorrected automated volumetric assessments showed similar impact on outcome on univariate (LVEF HR 0.93, [95% CI 0.91-0.95]; p < 0.001 for manual and HR 0.94 [0.92-0.96]; p < 0.001 for automated) and multivariable analyses (LVEF HR 0.95, [0.92-0.98]; p = 0.001 for manual and HR 0.95 [CI 0.92-0.98]; p = 0.001 for automated). Manual correction of the automated contours did not lead to improved risk prediction (LVEF AUC 0.67 automated vs. 0.68 automated corrected, p = 0.49). There was acceptable agreement (bias: 2.6%, 95% limits of agreement [LOA] -9.1-14.2%, intraclass correlation coefficient [ICC] 0.88 [0.77-0.93] for LVEF) of manual and automated volumetric assessments.
Conclusions
User independent volumetric analyses performed by fully automated software are feasible and results are equally predictive of MACE compared with conventional analyses in patients following myocardial infarction.
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Affiliation(s)
- A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - C Strohmeyer
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Matz
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - M Steinmetz
- University Medical Center of Gottingen (UMG), Department of Pediatric Cardiology, Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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5
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Lange T, Stiermaier T, Backhaus SJ, Boom P, Kowallick JT, De Waha-Thiele S, Lotz J, Kutty S, Bigalke B, Gutberlet M, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. CMR feature tracking remote myocardial strain analyses for optimized risk prediction following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.267] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac magnetic resonance myocardial feature tracking (CMR-FT) derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown.
Methods
1052 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as scar size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint.
Results
Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cut-off value for RM CS of -25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07-1.14, p = 0.003). RM CS provided further risk stratification amongst patients considered at risk according to established CMR parameters for 1.) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35 % (p = 0.002 on log-rank testing), 2.) patients with reduced global circumferential strain (GCS) > -18,3 % (p = 0.015 on log-rank testing), and 3.) patients with large microvascular obstruction ≥ 1.46 % (p = 0.038 on log-rank testing).
Conclusion
CMR-FT derived RM CS is a useful parameter to characterize the response of RM and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients.
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Affiliation(s)
- T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S De Waha-Thiele
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - J Lotz
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology , Berlin, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
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6
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Feistritzer H, Desch S, Freund A, Poess J, Zeymer U, Ouarrak T, Schneider S, De Waha-Thiele S, Fuernau G, Eitel I, Noc M, Stepinska J, Huber K, Thiele H. Prognostic impact of active mechanical circulatory support in cardiogenic shock complicating acute myocardial infarction: results from the CULPRIT-SHOCK trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1787] [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
Active mechanical circulatory support (MCS) devices are increasingly used in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). However, data derived from randomized controlled trials on the efficacy and safety of these devices are still limited.
Purpose
To analyze the prognostic impact of active MCS devices in a large prospective contemporary cohort of patients with CS complicating AMI.
Methods
This is a predefined subanalysis of the Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups; (1) use of at least one active MCS device, vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or need of renal replacement therapy at 30 days.
Results
Two hundred of 1055 (19%) patients received at least one active MCS device (n=112 Impella®; n=95 extracorporeal membrane oxygenation [ECMO]; n=6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared to those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p<0.001). All-cause mortality at 30 days and 1 year as well as bleeding rates were significantly higher in the active MCS group (all p<0.001). After multivariable adjustment the use of active MCS was significantly associated with the primary endpoint (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.7–5.9; p<0.001).
Conclusion
In the CULPRIT-SHOCK randomized trial and prospective registry approximately one fifth of patients was treated with active MCS devices. Compared to patients without active MCS, patients treated with active MCS devices showed worse outcome at 30 days and 1 year.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Supported by a grant (FP7/2007-2013) from the European Union 7th Framework Program and by the German Heart Research Foundation and the German Cardiac Society.
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Affiliation(s)
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | - J Poess
- Heart Center of Leipzig, Leipzig, Germany
| | - U Zeymer
- Stiftung Institut, Ludwigshafen, Germany
| | - T Ouarrak
- Stiftung Institut, Ludwigshafen, Germany
| | | | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - G Fuernau
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - M Noc
- University Medical Centre Ljubljana, Cardiology, Ljubljana, Slovenia
| | - J Stepinska
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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7
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Stiermaier T, Schaefer P, Saad M, Meyer-Saraei R, De Waha-Thiele S, Fuernau G, Langer H, Barkhausen J, Desch S, Thiele H, Eitel I. Impact of morphine treatment with and without metoclopramide co-administration on myocardial and microvascular injury in acute myocardial infarction: insights from a randomized trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1726] [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
Intravenous morphine administration in patients with acute myocardial infarction (AMI) can adversely affect platelet inhibition induced by P2Y12 receptor antagonists, potentially resulting in an increased risk of adverse clinical events. In contrast, some evidence suggests that opioid agonists may have cardioprotective effects on the myocardium. Currently available data in this regard are, however, sparse, inconsistent, and methodologically limited.
Purpose
The aim of this study was to investigate the impact of morphine with or without metoclopramide (MCP) co-administration on myocardial and microvascular injury after AMI assessed by cardiac magnetic resonance (CMR).
Methods
This prospective, randomized, single-center study assigned 138 patients with AMI in a 1:1:1 ratio to (a) ticagrelor 180 mg plus intravenous morphine 5 mg (morphine group); (b) ticagrelor 180 mg plus intravenous morphine 5 mg and MCP 10 mg (morphine + MCP group); or (c) ticagrelor 180 mg plus intravenous placebo (control group). Study drugs were administered before primary percutaneous coronary intervention. CMR was performed in 101 patients on day 1–4 after the index event to assess infarct size, microvascular obstruction, and left ventricular ejection fraction.
Results
Infarct size was significantly smaller in the morphine only group as compared to controls (15.5%LV [IQR 5.0 to 21.4%LV] vs. 17.9%LV [IQR 12.3 to 32.9%LV]; p=0.047). Furthermore, the number of patients with microvascular obstruction was significantly lower after morphine administration (10/36 [28%] versus 21/39 [54%]; p=0.022) and the extent of microvascular obstruction was smaller (0%LV [0 to 1.40%LV] versus 0.74%LV [0 to 3.10%LV]; p=0.037). In multivariable regression analysis, morphine administration was independently associated with a reduced risk for the occurrence of microvascular obstruction (odds ratio 0.37; 95% confidence interval 0.14 to 0.93; p=0.035). Left ventricular ejection fraction did not differ significantly between the morphine and the control group (p=0.970) and there was no significant difference in left ventricular ejection fraction (p=0.790), infarct size (p=0.491), and extent (p=0.753) or presence (p=0.914) of microvascular obstruction when comparing the morphine + MCP group to the control group.
Conclusions
In this randomized study, intravenous administration of morphine prior to primary percutaneous coronary intervention resulted in a significant reduction of myocardial and microvascular damage following AMI. This potential cardioprotective effect of morphine requires further evaluation in well-designed future trials with clinical endpoints.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Stiermaier
- University Heart Center Luebeck, Luebeck, Germany
| | - P Schaefer
- University Heart Center Luebeck, Luebeck, Germany
| | - M Saad
- University Heart Center Luebeck, Luebeck, Germany
| | | | | | - G Fuernau
- University Heart Center Luebeck, Luebeck, Germany
| | - H Langer
- University Heart Center Luebeck, Luebeck, Germany
| | - J Barkhausen
- University hospital Schleswig-Holstein Campus Lübeck, Luebeck, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center Luebeck, Luebeck, Germany
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Fuernau G, Lehrke M, Jung C, Kahles F, Lebherz C, Eitel I, Thelemann N, Desch S, Werdan K, Zeymer U, Adams V, Marx N, Thiele H. GLP-1 is an independent predictor of long-term mortality in patients with myocardial infarction complicated by cardiogenic shock – a substudy of the IABP-SHOCK II trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The incretin hormone Glucagon-like-peptide 1 (GLP-1) is a major stimulus for glucose dependent insulin secretion and holds cardioprotective efficacy. This has made the GLP-1 system a preferred target for diabetes therapy. Secretion of GLP-1 happens in response to nutritional but also inflammatory stimuli. Consequently, marked elevation of circulating GLP-1 levels were found in critically ill patients featuring marked association to markers of inflammation.
Purpose
Our study sought to investigate GLP-1 levels in patients with cardiogenic shock (CS) complicating myocardial infarction and a possible prognostic correlation to short- and long-term outcome.
Methods
We serially assessed circulating GLP-1 levels in a prospectively planned biomarker substudy in the IABP-SHOCK II trial. Blood samples were drawn during index PCI and at day 2. The blood was centrifuged immediately, and serum was frozen at −87°C. GLP-1 was measured with a standard ELISA-kit. All-cause mortality at short- (30 days), intermediate- (1 year) and long-term (6 years) follow-up was used for outcome assessment.
Results
In this study we found circulating GLP-1 to be markedly elevated in patients with myocardial infarction complicated by CS (n=172) at time of index PCI. Patients with fatal short-term outcome (n=70) exhibited higher GLP-1 levels (86 [45–130] pM) at ICU admission in comparison to patients with 30-day survival (48 [33–78] pM; p<0.001) (n=102). In repeated measures ANOVA the course of GLP-1 levels between baseline and day 2 showed a significant interaction between survivors and non-survivors (p=0.04). By univariate Cox-regression analysis GLP-1 levels >median were predictive of short- (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.50–3.94; p<0.001), intermediate- (HR 2.46; 95% CI 1.62–3.76; p<0.001) and long-term (HR 2.12; 95% CI 1.44–3.11; p<0.001) outcome. This association remained after multivariable correction (HR 2.01; 95% CI 1.37–3.07; p<0.001). In a landmark analysis we found a significant higher mortality in patients with GLP-1 levels >median from day 30 to 1 year (HR 2.56; 95% CI 1.08–6.09; p=0.03). In contrast, beyond 1 year up to 6 years no difference has been observed anymore (HR 1.02; 95% CI 0.41–2.58; p=0.96).
Conclusions
Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS at short-, intermediate and long-term follow-up. In a landmark analysis this prognostic effect is sustained up to 1 year. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG), German Heart Research Foundation
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Affiliation(s)
- G Fuernau
- University Heart Center, Luebeck, Germany
| | - M Lehrke
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - F Kahles
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Lebherz
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - I Eitel
- University Heart Center, Luebeck, Germany
| | | | - S Desch
- University of Leipzig, Heart Center, Leipzig, Germany
| | - K Werdan
- University Clinic Halle (Saale), Halle, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - V Adams
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - N Marx
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - H Thiele
- University of Leipzig, Heart Center, Leipzig, Germany
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Stiermaier T, Backhaus S, Matz J, Koschalka A, Kowallick J, De Waha-Thiele S, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking.
Purpose
To assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI.
Methods
Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (STEMI: n=795; NSTEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (edema representing reversible ischemia, irreversible infarction, microvascular obstruction [MVO]) and functional (ejection fraction, global longitudinal strain [GLS]) RV alterations. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE).
Results
RV ischemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischemia was associated with a significantly increased risk of MACE (10.1% versus 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% versus 3.8%; p<0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (hazard ratio 1.05, 95% confidence interval 1.00–1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020), and left ventricular GLS (p=0.001), while RV ischemia was not independently associated with outcome.
Conclusions
RV GLS is a predictor of post-infarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Stiermaier
- University Heart Center Luebeck, Luebeck, Germany
| | - S.J Backhaus
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - J Matz
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - A Koschalka
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - J.T Kowallick
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | | | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center Luebeck, Luebeck, Germany
| | - A Schuster
- University Heart Center Luebeck, Luebeck, Germany
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Feistritzer H, Jobs A, De Waha-Thiele S, Eitel I, Freund A, Abdel-Wahab M, Desch S, Thiele H. Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1458] [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
Previous randomized controlled trials (RCTs) indicated a benefit of multivessel percutaneous coronary intervention (PCI) compared to culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) without cardiogenic shock.
Purpose
To perform a pairwise meta-analysis of RCTs, already including the recently published COMPLETE (The Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI) trial, comparing multivessel PCI and culprit vessel-only PCI in STEMI patients without cardiogenic shock.
Methods
We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.
Results
Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6,314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p=0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p=0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p=0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p=0.09) was observed.
Conclusion
In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Jobs
- Heart Center of Leipzig, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | | | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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11
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Sano M, Fink T, Sciacca V, Vogler J, Saad M, Joost A, Heeger CH, Eitel C, Keelani A, Langer H, Eitel I, Tilz R. P1438Predictors and clinical impact of bleeding events after left atrial appendage closure in patients with high risk or a history of bleeding. Europace 2020. [DOI: 10.1093/europace/euaa162.095] [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: 11/12/2022] Open
Abstract
Abstract
Background
Left atrial appendage closure (LAAC) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation and may be especially attractive in patients with high risk or a history of bleeding. However, data of clinical benefit and incidence of post-procedural bleeding in patients with both high risk of bleeding and ischemic cerebral stroke after LAAC are lacking.
Objectives
This study sought to identify predictors and the prognostic impact of post-LAAC bleeding in patients at high risk and/or history of bleeding in the direct oral anticoagulant therapy (DOAC) era.
Methods and results
We retrospectively enrolled a total of 195 patients (75 ± 8.7 years, 38% female, 47% with previous major bleeding, mean CHA2DS2-VASc score 4.3 ± 1.6 and mean HAS-BLED score 2.7 ± 1.1) undergoing endocardial (91%) or epicardial (9%) LAAC during a mean follow-up of 339 ± 319 days. Twenty-three (11.9%) patients developed procedure-unrelated bleeding events after a median of 147 (43, 362) days after LAAC, in 12/23 (52%) patients under single antiplatelet therapy (SAPT), 6/23 (26%) dual antiplatelet therapy (DAPT), 1/23 (4%) DOAC, 1/23 (4%) VKA, 2/23 (9%) dual therapy (SAPT and DOAC/VKA) and 1/23 (4%) triple therapy (DAPT and DOAC/VKA). (Figure) Diabetes mellitus and previous major bleeding were identified as the independent predictors of post-LAAC bleeding (Odds ratio 2.65 [95% CI:1.04-6.73], p = 0.041, and 5.50 [95% confidence interval:1.72-17.5], p = 0.004). Post-LAAC bleeding was associated with all-cause death (9/23 [39%] vs 18/171 [11%], p = 0.001), but not ischemic stroke/TIA (1/23 [4%] vs 6/171 [4%], p = 0.593) nor device thrombus (2/23 [9%] vs 3/171 [2%], p = 0.108). Kaplan-Meier curve estimated that patients with post-LAAC bleeding had a worse mortality than those without post-LAAC bleeding (3-year mortality; 35.6% [95%CI; 11.6-61.0%] vs 68.7% [45.0-83.8], p = 0.029)
Conclusions
In AF patients with high bleeding risk or history of bleeding undergoing LAAC, bleeding events are common and may occur even after long-term duration after LAAC. Previous major bleeding history strongly predicts subsequent bleeding events following LAAC and is associated with unfavorable mortality. Further investigations are required to identify optimal post-procedural antithrombotic strategies for patients undergoing LAAC with previous major bleeding.
Abstract Figure. The association between time to bleeding
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Affiliation(s)
- M Sano
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - T Fink
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - V Sciacca
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - J Vogler
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - M Saad
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - A Joost
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - C-H Heeger
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - C Eitel
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - A Keelani
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
| | - H Langer
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - I Eitel
- University hospital Schleswig-Holstein Campus Lübeck, Department of Cardiology, Luebeck, Germany
| | - R Tilz
- University Hospital Schleswig-Holstein, Department of electrophysiology, University Heart Center Lübeck, Lübeck, Germany
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12
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Kowallick JT, Backhaus SJ, Stiermaier T, Lange T, Navarra JL, Koschalka A, Rommel KP, Lotz J, Gutberlet M, Kutty S, Hasenfus G, Thiele H, Eitel I, Schuster A. 564 Cardiac magnetic resonance myocardial feature tracking for optimized risk assessment after acute myocardial infarction in patients with type 2 diabetes. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.294] [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
Objective
Type 2 diabetes mellitus (T2DM) associates with worse cardiovascular outcome following acute myocardial infarction (AMI) as compared to non-diabetic patients. Since the mechanisms behind these observations are not fully understood we aimed to quantify the underlying pathophysiology on ventricular and atrial levels and study their prognostic implications using cardiovascular magnetic resonance (CMR) quantitative feature-tracking (FT) and tissue characterization.
Research Design and Methods:
A total of 1147 consecutive patients with AMI (n = 265 with diabetes; n = 882 without diabetes) undergoing cardiac magnetic resonance (CMR) imaging in median 3 days after AMI were included in this multicenter study. Left ventricular (LV) function and volumetry included LV ejection fraction (LV-EF), global longitudinal (GLS), radial (GRS) and circumferential strain (GCS) as well as left atrial (LA) strain and strain rate parameters of LA reservoir, conduit and booster pump function. LV damage assessment included infarct size (IS), edema and microvascular obstruction (MO). The clinical study endpoint was the rate of major adverse cardiovascular events (MACE) at 12 months.
Results
T2DM patients had impaired LA reservoir (19.8 vs. 21.2%, p < 0.01) and conduit strains 7.6 vs. 9.0%, p < 0.01) but no differences in ventricular function or myocardial damage. They were at higher risk of MACE than non-diabetic patients (10.2% vs. 5.8%, p < 0.01) with the majority of MACE occurring in patients with LVEF ≥ 35%. Whilst LVEF was an independent predictor of adverse events in non-diabetic patients (p = 0.04 on multivariable analysis), LV GLS as well as LA strain emerged as independent predictors of poor prognosis in patients with diabetes (p < 0.02 on multivariable analysis). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with higher 12-month event rates.
Conclusions
In patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above LVEF.
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Affiliation(s)
- J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - T Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - K P Rommel
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Department of Radiology, Leipzig, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, United States of America
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
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Schuster A, Backhaus SJ, Navarra JL, Stiermaier T, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Bigalke B, Kutty S, Gutberlet M, Hasenfus G, Thiele H, Eitel I. 565 Impact of right atrial physiology on heart failure and adverse events after myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.295] [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
Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion needs further evaluation.
Methods
1235 MI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation MI and 440 with non ST-elevation MI). Right atrial (RA) performance was evaluated using cardiac magnetic resonance myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa) and associated strain rates (SR) in a blinded core-laboratory. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post MI.
Results
RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with clinical onset of heart failure and MACE independently of RV systolic function (multi-variable analysis HR 0.95, 95% CI 0.91-0.99, p = 0.006) while RV systolic function was no independent prognosticator (HR 0.98, 95% CI 0.96-1.00, p = 0.055). Furthermore, RA conduit strain identified low- and high-risk groups within patients with relatively preserved and reduced RV and LV systolic functions (p < 0.019 on log rank testing).
Conclusions
Right atrial impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT derived quantification of RA strain.
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Affiliation(s)
- A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - K P Rommel
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology and Pneumology, Berlin, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, United States of America
| | - M Gutberlet
- Heart Center of Leipzig, Department of Radiology, Leipzig, Germany
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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14
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Fujita B, Bozkurt K, Saad M, Emmel E, Eitel I, Aboud A, Langer H, Ensminger S, Kurz T. Surgical versus Transcatheter Aortic Valve Replacement for Treatment of Bicuspid Aortic Valve Stenosis. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705303] [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: 10/24/2022]
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15
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Feistritzer HJ, Hasenfus G, Thiele H, Eitel I, Schuster A. 567 Interplay of infarct territory related myocardial mechanics and prognostic implications following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.297] [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
Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct related artery (IRA) subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA associated pathophysiological consequences using cardiac magnetic resonance (CMR).
Methods
1235 AMI patients (n = 795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction.
Results
LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular (LV ejection fraction (EF) 47.4%, GLS -13.2%, GCS -20.8%) and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS -17.4%, GCS -25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS -19.1%, GCS -26.6%, εs 21.7%). In AUC analyses εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC > 0.69). Multivariate analyses identified εs (p = 0.017) in LAD and GLS (p = 0.034) in LCx infarcts as independent predictors of MACE.
Conclusions
CMR allows IRA specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct specific prognostic implications and may represent novel diagnostic and therapeutic targets following AMI.
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Affiliation(s)
- S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Luebeck, Germany
| | - T Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology , Berlin, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - H J Feistritzer
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Luebeck, Germany
| | - A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
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16
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Stiermaier T, Backhaus SJ, Lange T, Koschalka A, Navarra JL, Boom P, Lamata P, Kowallick JT, Lotz J, Hasenfus G, Gutberlet M, Thiele H, Eitel I, Schuster A. 566 Myocardial left ventricular mechanical uniformity and adverse cardiac events following myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.296] [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
Despite limitations as a standalone parameter, left ventricular ejection fraction (LVEF) is the preferred measure of myocardial function and marker for post-infarction risk stratification. LV myocardial uniformity may provide superior prognostic information after acute myocardial infarction (AMI), which was subject of this study.
Methods and Results:
Consecutive patients with AMI (n = 1082; median age 63 years; 75% male) undergoing cardiac magnetic resonance (CMR) in median 3 days after infarction were included in this multicenter, observational study. Circumferential and radial uniformity ratio estimates (CURE and RURE) were derived from CMR feature-tracking as markers of mechanical uniformity (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE), consisting of all-cause death, re-infarction, and new congestive heart failure.
Patients with MACE (n = 73) had significantly impaired CURE [0.76 (IQR 0.67-0.86) versus 0.84 (IQR 0.76-0.89); p < 0.001] and RURE [0.69 (IQR 0.60-0.79) versus 0.76 (IQR 0.67-0.83); p < 0.001] compared to patients without events. While uniformity estimates did not provide independent prognostic information in the overall cohort, CURE below the median of 0.84 emerged as an independent predictor of outcome in post-infarction patients with LVEF >35% (n = 959) even after adjustment for established prognostic markers (hazard ratio 1.99; 95% confidence interval 1.06-3.74; p = 0.033 in stepwise multivariable Cox regression analysis). In contrast, LVEF was not associated with adverse events in this subgroup of AMI patients.
Conclusions
CMR-derived estimates of mechanical uniformity are novel markers for risk assessment after AMI and CURE provides independent prognostic information in patients with preserved or only moderately reduced LVEF.
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Affiliation(s)
- T Stiermaier
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - P Boom
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - P Lamata
- King"s College London, Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - M Gutberlet
- University of Leipzig, Heart Center Leipzig, Department of Radiology, Leipzig, Germany
| | - H Thiele
- University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Luebeck, Germany
| | - A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
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17
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Jobs A, De Waha-Thiele S, Ledwoch J, Sievert H, Rassaf T, Luedike P, Kelm M, Hellhammer K, Horn P, Westenfeld R, Patzelt J, Langer HF, Desch S, Eitel I, Thiele H. P4714Individual patient data meta-analysis comparing general anesthesia and deep sedation on safety and length of intensive care unit stay in patients undergoing percutaneous mitral valve repair. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1094] [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
Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as a treatment option for patients with severe mitral regurgitation not considered suitable candidates for surgery. The procedure can be performed in general anesthesia (GA) or deep sedation (DS) without mechanical ventilation. However, debate remains about the optimal approach.
Purpose
To compare the impact of the anesthetic method on efficacy, safety, and length of intensive care stay.
Methods
We identified studies comparing GA versus DS in patients undergoing PMVR by searching PubMed and CENTRAL. We included studies for which investigators agreed to provide individual patient data. Analyzed outcomes were a composite safety endpoint comprising all-cause death, stroke, pneumonia, and major to life-threating bleeding as well as length of intensive care unit stay. We performed an one-stage and two-stage meta-analysis on each outcome after multiple imputation of missing data. For two-stage meta-analysis, between-study heterogeneity was estimated according to Paule-Mandel and confidence intervals were derived using the method proposed by Hartung and Knapp.
Results
We included five observational studies (n=647 patients). Procedural success was achieved in 618 of 647 (95.5%) patients. The composite safety endpoint occurred in 92 of 647 (14.2%) patients with no difference between patients treated with GA or DS. In this regard, risk ratio was 0.78 (95% confidence interval, 0.53 to 1.14; P=0.20) following the one-stage approach and 0.73 (95% confidence interval, 0.30 to 1.80; P=0.39) following the two-stage approach. Length of intensive care stay was longer after GA as compared to DS (adjusted mixed linear regression model, 1.94 days, 95% confidence interval, 1.29 to 2.59 days, P<0.001; random effects model pooling study-specific estimates from adjusted linear models 1.40 days, 95% confidence interval, 0.54 to 2.22 days, P=0.0104).
Conclusion
Both, DS and GA offer good procedural success rates and a similar safety profile. However, length of intensive care stay is shorter after DS.
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Affiliation(s)
- A Jobs
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck, Germany
| | - J Ledwoch
- Klinikum rechts der Isar, Technical University of Munich, Division of Cardiology, Munich, Germany
| | - H Sievert
- Sankt Katharinen Hospital, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - T Rassaf
- University Hospital of Essen (Ruhr), Department of Cardiology and Vascular Medicine, Essen, Germany
| | - P Luedike
- University Hospital of Essen (Ruhr), Department of Cardiology and Vascular Medicine, Essen, Germany
| | - M Kelm
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - K Hellhammer
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - P Horn
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - R Westenfeld
- Medical Faculty of the Heinrich Heine University Düsseldorf, Department of Cardiology, Pulmonology, and Vascular Medicine, Düsseldorf, Germany
| | - J Patzelt
- University Hospital, Eberhard Karls University, Department of Cardiology and Cardiovascular Medicine, Tübingen, Germany
| | - H F Langer
- University Hospital, Eberhard Karls University, Department of Cardiology and Cardiovascular Medicine, Tübingen, Germany
| | - S Desch
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck, Germany
| | - H Thiele
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
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18
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Schrage B, Dabboura S, Bezerra H, Sinning JM, Thiele H, Pauschinger M, Frank D, Schulze PC, Pappalardo F, Morrow D, Li Y, Eitel I, Nordbeck P, Skurk C, Westermann D. P5738Multicenter analysis of left ventricular unloading on top of VA-ECMO for treatment of cardiogenic shock. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0678] [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
Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) is increasingly used for treatment of severe cardiogenic shock, although it causes an increase in left ventricular (LV) afterload and might therefore hamper myocardial recovery. Recently, the addition of catheter-based left ventricular assist device (cLVAD) on top of VA-ECMO has been used to unload the LV and to improve outcome measures. However, there is limited data on predictors of outcome in this high-risk population.
Aim
The aim of this study was to evaluate predictors of 30-day survival in a multicentre cohort of severe cardiogenic shock patients treated with cLVADon top of VA-ECMO.
Material and methods
We report on consecutive patients from six tertiary care centers being treated with cLVAD in addition to VA-ECMO for treatment of cardiogenic shock. The primary endpoint is 30-day all-cause mortality. To identify predictors of the primary endpoint, multivariate analysis using an “elastic net” variable selection algorithm was done after imputation of missing variables.
Results
A total of 220 patients treated with cLVAD on top of VA-ECMO were included in the analysis. Of these, 79.1% were male with a median age of 55.5 (25thpercentile 48.0, 75thpercentile 65.6) years. In 60.5% of the patients, acute myocardial infarction was the underlying cause of cardiogenic shock and in 44.6% VA-ECMO was used for refractory cardiac arrest (eCPR). In the multivariable analysis, the following baseline parameters were significantly associated with the primary endpoint: Age (odds ratio of 1.68 per standard deviation), duration of cardiopulmonary resuscitation (OR 2.08 per SD), lactate (OR 1.04 per SD) and time from onset of shock to VA-ECMO (OR 1.30 per SD).
Conclusion and outlook
In this large-scale multicentre analysis of severe cardiogenic shock patients treated with VA-ECMO plus additional cLVAD unloading, age, duration of cardiopulmonary resuscitation, lactate and time from onset of shock to VA-ECMO were significantly associated with 30-day all-cause mortality.
To further investigate this topic, we will evaluate predictors of outcome in distinct patient populations such as acute myocardial infarction vs. acute heart failure and patients without vs. patients with prior cardiopulmonary association.
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Affiliation(s)
- B Schrage
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
| | - S Dabboura
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
| | - H Bezerra
- University Hospitals Case Medical Center, Cleveland, United States of America
| | | | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | | | - D Frank
- University Medical Center of Schleswig-Holstein, Kiel, Germany
| | | | | | - D Morrow
- Harvard Medical School, Boston, United States of America
| | - Y Li
- First Affiliated Hospital of Lanzhou University, Lanzhou, China
| | - I Eitel
- Medical University, Luebeck, Germany
| | - P Nordbeck
- University Hospital Würzburg, Würzburg, Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - D Westermann
- University Heart Center Hamburg, Department for General and Interventional Cardiology, Hamburg, Germany
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19
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Patzelt J, Zhang W, Sauter R, Mezger M, Nording H, Becker AS, Rudolph V, Saad M, Eitel I, Schlensak C, Gawaz M, Boekstegers P, Schreieck J, Seizer P, Langer HF. P4724Elevated mitral valve pressure gradient is predictive for long-term outcome after percutaneous edge-to-edge mitral valve repair (PMVR) in patients with degenerative MR, but not in functional MR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1101] [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
To analyze the effects of residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MVPG) after percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip-system on long term outcome.
Methods and results
Two hundred fifty-five patients who underwent PMVR were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical endpoint (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used.
After PMVR, mean MVPG increased from 1.6±1.0 mmHg to 3.1±1.5 mmHg (p<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive for the combined endpoint while elevated MVPG >4.4 mmHg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities.In the cohort with degenerative MR, elevated MVPG was associated with increased occurrence of the primary endpoint, whereas this was not observed in the cohort with functional MR.
Conclusions
MVPG >4.4 mmHg after MitraClip-implantation was predictive for clinical outcome in the patient cohort with degenerative MR. In the patient cohort with functional MR, MVPG >4.4 mmHg was not associated with increased clinical events.
Acknowledgement/Funding
This study was supported by grants from the German Research Foundation (KFO 274), the Volkswagen Foundation (Lichtenberg Program) and the German Heart
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Affiliation(s)
- J Patzelt
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - W Zhang
- The Affiliated Hospital of Medical College Qingdao University, Department of Cardiology, Angiology, and Intensive Care Medicine, Qingdao, China
| | - R Sauter
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - M Mezger
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - H Nording
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - A S Becker
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - V Rudolph
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - M Saad
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - I Eitel
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
| | - C Schlensak
- University Hospital, Department of Cardiovascular Surgery, Tuebingen, Germany
| | - M Gawaz
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | | | - J Schreieck
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - P Seizer
- University Hospital, Department of Cardiology and Cardiovascular Medicine, Tuebingen, Germany
| | - H F Langer
- UKSH, Department of Cardiology, Angiology, and Intensive Care Medicine, Luebeck, Germany
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20
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Feistritzer HJ, Eitel I, Jobs A, De Waha-Thiele S, Meyer-Saraei R, Freund A, Stiermaier T, Abdel-Wahab M, Lurz P, Reinstadler SJ, Reindl M, Klug G, Metzler B, Desch S, Thiele H. P1697Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in Non-ST-Elevation Myocardial Infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The prognostic significance of cardiac magnetic resonance (CMR) derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients.
Purpose
To investigate determinants and the long-term prognostic impact of CMR imaging derived infarct characteristics in patients with NSTEMI.
Methods
Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction (MVO) were assessed using CMR imaging in 311 consecutive NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centers. CMR imaging was performed 3 [interquartile range (IQR) 2–4] days after admission. The clinical endpoint was defined as major adverse cardiac events (MACE) during a median follow-up of 4.4 (IQR 3.6–4.9) years.
Results
Median IS was 7.0% (IQR 2.3–13.5) of LV myocardial mass (%LV) and MSI was 65.2 (IQR 36.7–82.9). Age (p=0.003), heart rate (p=0.002) and TIMI flow grade before PCI (p<0.001) were independent predictors of IS. Independent predictors of the MSI were age (p=0.001), heart rate (p=0.01), the number of diseased coronary arteries (p=0.001) and the TIMI flow grade before PCI (p<0.001). MACE occurred in 75 (24.1%) patients. CMR-derived infarct characteristics had no additional prognostic value over and above LV ejection fraction in multivariable analysis.
Conclusions
In this prospective, multicenter NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics above and beyond traditional risk markers.
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Affiliation(s)
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Jobs
- Heart Center of Leipzig, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - R Meyer-Saraei
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | - T Stiermaier
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | | | - P Lurz
- Heart Center of Leipzig, Leipzig, Germany
| | | | - M Reindl
- Innsbruck Medical University, Innsbruck, Austria
| | - G Klug
- Innsbruck Medical University, Innsbruck, Austria
| | - B Metzler
- Innsbruck Medical University, Innsbruck, Austria
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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21
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Feistritzer HJ, Hasenfuss G, Thiele H, Eitel I, Schuster A. P5255Culprit vessel related myocardial mechanics and prognostic implications following acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0226] [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
Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct related artery (IRA) subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA associated pathophysiological consequences using cardiac magnetic resonance (CMR).
Methods
1235 AMI patients (n=795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction.
Results
LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular (LV ejection fraction (EF) 47.4%, GLS −13.2%, GCS −20.8%) and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS −17.4%, GCS −25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS −19.1%, GCS −26.6%, εs 21.7%). In AUC analyses εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC>0.69). Multivariate analyses identified εs (p=0.017) in LAD and GLS (p=0.034) in LCx infarcts as independent predictors of MACE.
Conclusions
CMR allows IRA specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct specific prognostic implications and may represent novel diagnostic and therapeutic targets following AMI.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - T Lange
- Heart Centre Goettingen, Goettingen, Germany
| | - A Koschalka
- Heart Centre Goettingen, Goettingen, Germany
| | - J L Navarra
- Heart Centre Goettingen, Goettingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | | | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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22
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Hasenfuss G, Thiele H, Eitel I, Schuster A. P3097Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0173] [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
Data on sex-specific outcomes following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse clinical events (MACE). Since underlying mechanisms remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.
Methods
Amongst 8 centres across Germany, 795 ST-elevation MI (STEMI) patients underwent post-interventional CMR imaging. CMR feature-tracking (FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster pump function (εa). Tissue characterisation included infarct size (IS), microvascular obstruction (MO), area at risk and myocardial salvage index (MSI). Primary endpoint was the occurrence of major adverse clinical events (MACE) within 1 year.
Results
Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13–3.42, p=0.017) but not independently of baseline confounders (p=0.526) with women being older, more often diabetic and hypertensive (p<0.001) and of higher Killip-class (p=0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p=0.011, εe p<0.001) but increased systolic ventricular mechanics (GLS p=0.001, LVEF p=0.048). Ventricular strain was associated with MACE irrespective of all univariate significant baseline characteristics (GLS HR 1.08, 95% CI 1.01–1.16, p=0.036 and GCS HR 1.07, 95% CI 1.00–1.14, p=0.040).
Conclusion
Atrial function is reduced in women following STEMI, while ventricular systolic function is increased. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE and may add to sex-specific prognosis evaluation.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - T Lange
- Heart Centre Goettingen, Goettingen, Germany
| | - A Koschalka
- Heart Centre Goettingen, Goettingen, Germany
| | - J L Navarra
- Heart Centre Goettingen, Goettingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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Santoro F, Nunez-Gil IJ, Stiermaier T, El-Battrawy I, Guerra F, Arcari L, Musumeci B, Novo G, Cannone M, Almendro M, Sionis A, Akin I, Thiele H, Eitel I, Brunetti ND. P3691Intra-aortic balloon counterpulsation in takotsubo syndrome complicated by cardiogenic shock: short- and long-term results from a cohort of 2250 patients of the German-Italian-Spanish registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Takotsubo syndrome (TTS) is featured by an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock. Intra-aortic balloon pumping (IABP) use in this setting is controversial, and few data are available from large populations. Aim of this study was therefore to evaluate short- and long-term impact of IABP on mortality in TTS complicated by cardiogenic shock.
Methods
The GEIST registry is a multicenter, international registry on TTS involving 38 centers from Germany, Italy and Spain. Between 2006 and 2017, 2250 consecutive patients with TTS were enrolled.
Results
Of the 2250 patients, 211 (9%) experienced cardiogenic shock during hospitalization for TTS. Admission left ventricular ejection fraction (LVEF) was 30±15% and systolic blood pressure was 90±35 mmHg. Apical ballooning pattern was found in 77%, mid-ventricular/basal pattern in 11%, and 2% of the patients, respectively.
Forty-two patients out of 211 (19%) received IABP after coronary angiography. Patients receiving IABP compared to standard medical therapy did not differ in terms of age, gender, cardiovascular risk factors and admission LVEF.
No differences were found in term of in-hospital mortality (9.5% vs 17% p=0.35), length of hospitalization (19.3 vs 16.3 days p=0.34), need of invasive ventilation (35% vs 41% p=0.60), stroke (4.7% vs 11% p=0.17) and LV thrombus (0.5% vs 1.7%, p=0.98).
At long-term follow-up, with a median of 2 years, overall mortality in patients with cardiogenic shock and TTS was 34.1%. Mortality was not different between the IABP and the control group (33.7% vs 35.0%; p=0.85).
Conclusions
In this large multicenter observational registry, the use of IABP has no impact on mortality at short and long-term follow-up. Further studies are needed to evaluate the best therapeutic strategy in TTS complicated by cardiogenic shock.
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Affiliation(s)
- F Santoro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | | | - T Stiermaier
- University Medical Center of Schleswig-Holstein, Luebeck, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, Mannheim, Germany
| | - F Guerra
- University Hospital Riuniti of Ancona, Ancona, Italy
| | - L Arcari
- Sapienza University of Rome, Rome, Italy
| | - B Musumeci
- Sapienza University of Rome, Rome, Italy
| | - G Novo
- University of Palermo, Palermo, Italy
| | - M Cannone
- Bonomo Hospital, Department of Cardiology, Andria, Italy
| | - M Almendro
- University Hospital Virgen de Valme, Seville, Spain
| | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, Luebeck, Germany
| | - N D Brunetti
- University of Foggia, Department of Cardiology, Foggia, Italy
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Feistritzer HJ, Eitel I, Jobs A, De Waha-Thiele S, Meyer-Saraei R, Freund A, Stiermaier T, Abdel-Wahab M, Lurz P, Reinstadler SJ, Reindl M, Klug G, Metzler B, Desch S, Thiele H. 550Determinants and prognostic value of cardiac magnetic resonance imaging derived infarct characteristics in non-ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez125.001] [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)
- H-J Feistritzer
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Jobs
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - R Meyer-Saraei
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Freund
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - T Stiermaier
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - M Abdel-Wahab
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - P Lurz
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - S J Reinstadler
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - M Reindl
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - G Klug
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - B Metzler
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
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Feistritzer HJ, Eitel I, Jobs A, De Waha-Thiele S, Stiermaier T, Abdel-Wahab M, Lurz P, Reinstadler SJ, Reindl M, Klug G, Metzler B, Desch S, Thiele H. 53Impact of smoking on cardiac magnetic resonance infarct characteristics and clinical outcome in patients with non-ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez112.008] [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)
- H-J Feistritzer
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Jobs
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - T Stiermaier
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - M Abdel-Wahab
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - P Lurz
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - S J Reinstadler
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - M Reindl
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - G Klug
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - B Metzler
- Innsbruck Medical University, University Clinic of Internal Medicine III, Innsbruck, Austria
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Heart Center Leipzig - University Hospital, Leipzig, Germany
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von Knobelsdorff-Brenkenhoff F, Bauer WR, Deneke T, Fleck E, Rolf A, Schulz-Menger J, Sommer P, Tillmanns C, Eitel I. Empfehlungen zu kardialen MRT-Untersuchungen bei Patienten mit Herzschrittmachern und implantierbaren Kardioverter-Defibrillatoren. Kardiologe 2019. [DOI: 10.1007/s12181-019-0301-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Schuster A, Backhaus SJ, Stiermaier T, Navarra JL, Uhlig J, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Bigalke B, Kutty S, Hasenfus G, Eitel I. P3695Quantitative left atrial function allows optimized prediction of cardiovascular events following myocardial infarction: a cardiovascular magnetic resonance imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Affiliation(s)
- A Schuster
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - S J Backhaus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - J L Navarra
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - J Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - K P Rommel
- Heart Center of Leipzig, Leipzig, Germany
| | - A Koschalka
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, United States of America
| | - G Hasenfus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Uhlig J, Kowallick JT, Gertz R, Bigalke B, Villa A, Lotz J, Hasenfus G, Thiele H, Eitel I, Schuster A. P4685Prognostic implications of atrial mechanics in ventricular takotsubo syndrome: insights from cardiovascular magnetic resonance imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4685] [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)
- S J Backhaus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - T Lange
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - A Chiribiri
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - R Gertz
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology and Pneumology, Berlin, Germany
| | - A Villa
- King's College London, Division of Imaging Sciences and Biomedical Engineering, London, United Kingdom
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - G Hasenfus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Schuster
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
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30
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Reinstadler S, Stiermaier T, Stiermaier T, Eitel C, Eitel C, Fuernau G, Fuernau G, Saad M, Saad M, Poess J, Poess J, De Waha S, De Waha S, Desch S, Desch S, Metzler B, Metzler B, Thiele H, Thiele H, Eitel I, Eitel I. P1493Impact of atrial fibrillation during ST-elevation myocardial infarction on infarct characteristics and prognosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1493] [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)
- S Reinstadler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - T Stiermaier
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - T Stiermaier
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - C Eitel
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - C Eitel
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - G Fuernau
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - G Fuernau
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - M Saad
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - M Saad
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - J Poess
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - J Poess
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - S De Waha
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - S De Waha
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - B Metzler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - B Metzler
- Innsbruck Medical University, Department of Internal Medicine III, Cardiology, Innsbruck, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
| | - I Eitel
- Medical University, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive, Lübeck, Germany
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31
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Fuernau G, Stiermaier T, Saad M, Poess J, Thiele H, Eitel I. P5561Obesity paradox and myocardial injury by cardiac magnetic resonance imaging in ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5561] [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 Fuernau
- University Hospital of Schleswig-Holstein, Universitäres Herzzentrum, Lubeck, Germany
| | - T Stiermaier
- University Hospital of Schleswig-Holstein, Universitäres Herzzentrum, Lubeck, Germany
| | - M Saad
- University Hospital of Schleswig-Holstein, Universitäres Herzzentrum, Lubeck, Germany
| | - J Poess
- University Hospital of Schleswig-Holstein, Universitäres Herzzentrum, Lubeck, Germany
| | - H Thiele
- University of Leipzig, Heart Center, Leipzig, Germany
| | - I Eitel
- University Hospital of Schleswig-Holstein, Universitäres Herzzentrum, Lubeck, Germany
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32
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Saad M, Stiermaier T, Fuernau G, Poess J, Desch S, Thiele H, Eitel I. P815Impact of chronic total occlusion in a non-infarct-related coronary artery on myocardial injury assessed by cardiac magnetic resonance imaging and prognosis in ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p815] [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)
- M Saad
- University Heart Center - Lübeck, Cardiology, Lübeck, Germany
| | - T Stiermaier
- University Heart Center - Lübeck, Cardiology, Lübeck, Germany
| | - G Fuernau
- University Heart Center - Lübeck, Cardiology, Lübeck, Germany
| | - J Poess
- University Heart Center - Lübeck, Cardiology, Lübeck, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center - Lübeck, Cardiology, Lübeck, Germany
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33
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Santoro F, Stiermaier T, El-Battrawy I, Guastafierro F, Guerra F, Novo G, Mariano E, Montisci R, Tarantino N, Caldarola P, Cannone M, Bahlmann E, Akin I, Eitel I, Brunetti ND. P4391In-hospital complications in patients with takotsubo syndrome: a novel score from a cohort of 1002 patients from the multi-center international GEIST registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4391] [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)
- F Santoro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - T Stiermaier
- University Hospital of Schleswig-Holstein, Department of Cardiology, Lubeck, Germany
| | - I El-Battrawy
- University Medical Centre of Mannheim, Department of Medicine, Mannheim, Germany
| | - F Guastafierro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - F Guerra
- University Hospital Riuniti of Ancona, Cardiology and Arrhythmology Clinic, Ancona, Italy
| | - G Novo
- University Hospital Paolo Giaccone, Department of Internal Medicine and Specialties (DIBIMIS), Chair of Cardiology, Palermo, Italy
| | - E Mariano
- University Hospital Policlinico Tor Vergata, Department of Cardiology, Rome, Italy
| | - R Montisci
- University of Cagliari, Department of Cardiology, Cagliari, Italy
| | - N Tarantino
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - P Caldarola
- San Paolo Hospital, Department of Cardiology, Bari, Italy
| | - M Cannone
- Bonomo Hospital, Cardiology Department, Andria, Italy
| | - E Bahlmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - I Akin
- University Medical Centre of Mannheim, Department of Medicine, Mannheim, Germany
| | - I Eitel
- University Hospital of Schleswig-Holstein, Department of Cardiology, Lubeck, Germany
| | - N D Brunetti
- University of Foggia, Department of Cardiology, Foggia, Italy
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Yalin K, Lyan E, Abdin A, Sawan N, Eitel C, Thiele H, Eitel I, Tilz R. P1109Safety and efficacy of persistent atrial fibrillation ablation using the second generation cryoballoon. Europace 2018. [DOI: 10.1093/europace/euy015.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - H Thiele
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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Abdin A, Sieg HJ, Eitel C, Eitel I, Tilz R. P377Incidence and predictors for left atrial appendage thrombus in patients with left atrial arrhythmia. Europace 2018. [DOI: 10.1093/europace/euy015.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Abdin
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - H J Sieg
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - C Eitel
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - I Eitel
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
| | - R Tilz
- University Hospital of Schleswig-Holstein , Heart Center Lubeck, Lubeck, Germany
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36
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Lyan E, Yalin K, Abdin A, Sawan N, Eitel C, Eitel I, Tilz R. P753Mechanism of atrial tachycardia following atrial fibrillation ablation using the second generation cryoballoon. Europace 2018. [DOI: 10.1093/europace/euy015.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II, Lübeck, Germany
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Yalin K, Lyan E, Abdin A, Sawan N, Eitel C, Thiele H, Eitel I, Tilz R. P1099Safety, acute efficacy, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with pulmonary vein abnormality. Europace 2018. [DOI: 10.1093/europace/euy015.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Yalin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - E Lyan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Abdin
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - N Sawan
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - C Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - H Thiele
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - I Eitel
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - R Tilz
- Medical University, Lübeck Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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38
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Santoro F, Stiermaier T, Tarantino N, Guastafierro F, Di Martino LFM, Di Biase M, Eitel I, Brunetti ND. 114Impact of persistent ST elevation on outcome in patients with Takotsubo syndrome. Results from the GErman Italian STress Cardiomyopathy (GEIST) registry. Europace 2018. [DOI: 10.1093/europace/euy015.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Santoro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - T Stiermaier
- University Hospital of Schleswig-Holstein , Department of Cardiology, Lubeck, Germany
| | - N Tarantino
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - F Guastafierro
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - LFM Di Martino
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - M Di Biase
- University of Foggia, Department of Cardiology, Foggia, Italy
| | - I Eitel
- University Hospital of Schleswig-Holstein , Department of Cardiology, Lubeck, Germany
| | - N D Brunetti
- University of Foggia, Department of Cardiology, Foggia, Italy
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Jobs A, Stiermaier T, Klotz S, Eitel I. [Antiplatelet or anticoagulative strategies after surgical/interventional valve treatment]. Herz 2017; 43:26-33. [PMID: 29147971 DOI: 10.1007/s00059-017-4646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
At the end of August 2017 the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) published new joint guidelines for the treatment of valvular heart disease. These guidelines incorporate the scientific progress since the last version of the guidelines published in 2012. This article reviews current guideline recommendations for antiplatelet and anticoagulative therapy after surgical/interventional treatment of the aortic and mitral valves and discusses the underlying scientific evidence.
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Affiliation(s)
- A Jobs
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - T Stiermaier
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - S Klotz
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - I Eitel
- Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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de Waha S, Desch S, Fuernau G, Pöss J, Ledwoch J, Jobs A, Eitel I, Thiele H. Interventional therapies in acute myocardial infarction complicated by cardiogenic shock. Herz 2017; 42:11-17. [PMID: 27909767 DOI: 10.1007/s00059-016-4511-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiogenic shock remains the most common cause of death in patients with acute myocardial infarction. Early revascularization of the infarct-related artery has been shown to reduce mortality and is the therapeutic cornerstone. The optimal revascularization strategy of additional non-culprit lesions remains yet to be determined. Further, uncertainties exist with respect to access site choice, antiplatelet regimen as well as mechanical support devices. This review outlines current evidence on the interventional management of cardiogenic shock complicating acute myocardial infarction.
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Affiliation(s)
- S de Waha
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany. .,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany.
| | - S Desch
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - G Fuernau
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - J Pöss
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - J Ledwoch
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - A Jobs
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - I Eitel
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
| | - H Thiele
- University Heart Center Luebeck, Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Luebeck, Germany
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De Waha S, Jobs A, Ouweneel D, Henriques J, Seyfarth M, Poess J, Fuernau G, Eitel I, Desch S, Thiele H. P1500Percutaneous short-term active mechanical support devices in cardiogenic shock: a collaborative meta-analysis of randomised trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reinstadler S, Stiermaier T, Liebetrau J, Fuernau G, Eitel C, De Waha S, Desch S, Reil J, Poess J, Metzler B, Luecke C, Gutberlet M, Schuler G, Thiele H, Eitel I. P1070Prognostic significance of remote myocardium alterations assessed by quantitative non-contrast T1 mapping in ST-elevation myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Waha S, Jobs A, Eitel I, Poess J, Stiermaier T, Fuernau G, Zeymer U, Desch S, Thiele H. P3402Multivessel versus culprit lesion only percutaneous coronary intervention in cardiogenic shock complicating acute myocardial infarction: a meta-analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Redfors B, Furer A, Selker H, Thiele H, Patel M, Udelson J, Ohman E, Eitel I, Granger C, Maehara A, Kirtane A, Genereux P, Ben-Yehuda O, Stone G. P4667Relationships between cigarette smoking, infarct size, and clinical outcomes in patients undergoing primary PCI For STEMI: a patient-level pooled analysis of 10 randomized trials. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Santoro F, Stiermaier T, Tarantino N, De Gennaro L, Moeller C, Guastafierro F, Marchetti M, Montisci R, Graft T, Caldarola P, Thiele H, Di Biase M, Brunetti N, Eitel I. P4516Left ventricular thrombi in Takotsubo syndrome: incidence, predictors and management. Results from the German Italian stress cardiomyopathy (GEIST) registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lange T, Stiermaier T, Lamata P, Raaz U, Kowallick J, Lotz J, Hasenfuss G, Thiele H, Eitel I, Schuster A. P5223The cure: demonstrating temporal resolution of mechanical dyssynchrony in patients with takotsubo syndrome using cardiovascular magnetic resonance myocardial feature-tracking. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eitel I, Stiermaier T, Lange T, Chiribiri A, Moeller C, Graf T, Raaz U, Kowallick J, Lotz J, Hasenfuss G, Thiele H, Schuster A. P5301Comprehensive assessment of left ventricular myocardial deformation in takotsubo syndrome using cardiovascular magnetic resonance myocardial feature tracking. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Teren A, Kirsten H, Beutner F, Scholz M, Holdt LM, Teupser D, Gutberlet M, Thiery J, Schuler G, Eitel I. Alteration of Multiple Leukocyte Gene Expression Networks is Linked with Magnetic Resonance Markers of Prognosis After Acute ST-Elevation Myocardial Infarction. Sci Rep 2017; 7:41705. [PMID: 28155873 PMCID: PMC5290530 DOI: 10.1038/srep41705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 08/09/2016] [Accepted: 12/21/2016] [Indexed: 02/02/2023] Open
Abstract
Prognostic relevant pathways of leukocyte involvement in human myocardial ischemic-reperfusion injury are largely unknown. We enrolled 136 patients with ST-elevation myocardial infarction (STEMI) after primary angioplasty within 12 h after onset of symptoms. Following reperfusion, whole blood was collected within a median time interval of 20 h (interquartile range: 15-25 h) for genome-wide gene expression analysis. Subsequent CMR scans were performed using a standard protocol to determine infarct size (IS), area at risk (AAR), myocardial salvage index (MSI) and the extent of late microvascular obstruction (lateMO). We found 398 genes associated with lateMO and two genes with IS. Neither AAR, nor MSI showed significant correlations with gene expression. Genes correlating with lateMO were strongly related to several canonical pathways, including positive regulation of T-cell activation (p = 3.44 × 10-5), and regulation of inflammatory response (p = 1.86 × 10-3). Network analysis of multiple gene expression alterations associated with larger lateMO identified the following functional consequences: facilitated utilisation and decreased concentration of free fatty acid, repressed cell differentiation, enhanced phagocyte movement, increased cell death, vascular disease and compensatory vasculogenesis. In conclusion, the extent of lateMO after acute, reperfused STEMI correlated with altered activation of multiple genes related to fatty acid utilisation, lymphocyte differentiation, phagocyte mobilisation, cell survival, and vascular dysfunction.
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Affiliation(s)
- A Teren
- Department of Cardiology/Internal Medicine, Heart Center, University of Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany
| | - H Kirsten
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, Germany.,IZI, Fraunhofer Institute for Cell Therapy and Immunology IZI, Leipzig, Germany
| | - F Beutner
- Department of Cardiology/Internal Medicine, Heart Center, University of Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany
| | - M Scholz
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Medical Informatics, Statistic and Epidemiology, University of Leipzig, Germany
| | - L M Holdt
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Laboratory Medicine, University Hospital Munich (LMU) and Ludwig-Maximilian- University Munich, Germany
| | - D Teupser
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Laboratory Medicine, University Hospital Munich (LMU) and Ludwig-Maximilian- University Munich, Germany
| | - M Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center, University of Leipzig, Germany
| | - J Thiery
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Germany
| | - G Schuler
- Department of Cardiology/Internal Medicine, Heart Center, University of Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany
| | - I Eitel
- University Heart Center Lübeck, University of Lübeck, Medical Clinic II (Cardiology, Angiology and Intensive Care Medicine), Lübeck, Germany
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Lücke C, Rutschke W, Lurz P, Pershina E, Grothoff M, Stiermaier T, Foldyna B, Schuler G, Lehmkuhl L, Eitel I, Gutberlet M. Diagnostischer Wert von T1- und T2-Mapping zur Differenzialdiagnose bei akutem Koronarsyndrom. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581378] [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: 10/22/2022]
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Stiermaier T, de Waha S, Fürnau G, Eitel I, Thiele H, Desch S. Thrombusaspiration bei Patienten mit akutem Myokardinfarkt. Herz 2016; 41:591-598. [DOI: 10.1007/s00059-016-4412-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
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