1
|
Schäfer A, Westenfeld R, Sieweke JT, Zietzer A, Wiora J, Masiero G, Sanchez Martinez C, Tarantini G, Werner N. Complete Revascularisation in Impella-Supported Infarct-Related Cardiogenic Shock Patients Is Associated With Improved Mortality. Front Cardiovasc Med 2021; 8:678748. [PMID: 34307495 PMCID: PMC8299360 DOI: 10.3389/fcvm.2021.678748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Acute myocardial infarction-related cardiogenic shock (AMI-CS) still has high likelihood of in-hospital mortality. The only trial evidence currently available for the intra-aortic balloon pump showed no benefit of its routine use in AMI-CS. While a potential benefit of complete revascularisation has been suggested in urgent revascularisation, the CULPRIT-SHOCK trial demonstrated no benefit of multivessel compared to culprit-lesion only revascularisation in AMI-CS. However, mechanical circulatory support was only used in a minority of patients. Objectives: We hypothesised that more complete revascularisation facilitated by Impella support is related to lower mortality in AMI-CS patients. Methods: We analysed data from 202 consecutive Impella-treated AMI-CS patients at four European high-volume shock centres (age 66 ± 11 years, 83% male). Forty-seven percentage (n = 94) had cardiac arrest before Impella implantation. Revascularisation was categorised as incomplete if residual SYNTAX-score (rS) was >8. Results: Overall 30-day mortality was 47%. Mortality was higher when Impella was implanted post-PCI (Impella-post-PCI: 57%, Impella-pre-PCI: 38%, p = 0.0053) and if revascularisation was incomplete (rS ≤ 8: 37%, rS > 8: 56%, p = 0.0099). Patients with both pre-PCI Impella implantation and complete revascularisation had significantly lower mortality (33%) than those with incomplete revascularisation and implantation post PCI (72%, p < 0.001). Conclusions: Our retrospective analysis suggests that complete revascularisation supported by an Impella microaxial pump implanted prior to PCI is associated with lower mortality than incomplete revascularisation in patients with AMI-CS.
Collapse
Affiliation(s)
- Andreas Schäfer
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Cardiac Arrest Center, Heinrich Heine University, Düsseldorf, Germany
| | - Jan-Thorben Sieweke
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | - Andreas Zietzer
- Department of Cardiology, University Heart Center, Bonn, Germany
| | - Julian Wiora
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Cardiac Arrest Center, Heinrich Heine University, Düsseldorf, Germany
| | - Giulia Masiero
- Department of Cardiology, University of Padua, Padua, Italy
| | - Carolina Sanchez Martinez
- Department of Cardiology and Angiology, Cardiac Arrest Center, Hannover Medical School, Hanover, Germany
| | | | - Nikos Werner
- Department of Cardiology, University Heart Center, Bonn, Germany.,Department of Cardiology, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Trier, Germany
| |
Collapse
|
2
|
Abstract
BACKGROUND Iodinated contrast is essential for diagnosis and treatment in contemporary interventional cardiology. An important complication of percutaneous intervention is contrast-induced nephropathy, which is associated with increased morbidity and mortality, while prolonged hospitalization is responsible for economic consequences. OBJECTIVES This article reviews the definition of contrast-induced nephropathy, the role of biomarkers in early diagnosis to identify high-risk patients and potential therapeutic options for preventing acute nephropathy. CURRENT DATA The optimization of patients' circulating volume remains the main aspect for preventing contrast-induced nephropathy, as recent studies confirm. Several medications are known to be nephrotoxic, whereas several are nephroprotective and the subject of recent research. CONCLUSION Interventions to improve outcomes of established acute kidney injury have not been developed as yet. Prevention and early diagnosis are relevant factors in clinical management. It is important to identify patients at risk and to treat them preemptively.
Collapse
Affiliation(s)
- J Wiora
- Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - R Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| |
Collapse
|
3
|
Chandrasekaran U, Burkhoff D, Ishikawa K, Swain L, Sunagawa K, Møller J, Santos-Gallego C, Annamalai S, Udelson J, Westenfeld R, Kapur N, Qiao X, Wiora J, Schäfer A, Bernhardt A, Kochar A, Kloner R, Faraz H. Proceedings of the 3rd annual Acute Cardiac Unloading and REcovery (A-CURE) symposium. BMC Cardiovasc Disord 2019; 19:27. [PMID: 30732562 PMCID: PMC6366036 DOI: 10.1186/s12872-019-1000-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Daniel Burkhoff
- Cardiovascular Research Foundation and Columbia University, New York City, NY, USA
| | | | | | | | | | | | | | | | | | | | | | - Julian Wiora
- University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | - Ajar Kochar
- Duke Clinical Research Institute, Durham, NC, USA
| | - Robert Kloner
- Huntington Medical Research Institute & University of South California, Pasadena, CA, USA
| | - Haroon Faraz
- Hackensack University Medical Center, Hackensack, NJ, USA
| |
Collapse
|
4
|
Spieker M, Hellhammer K, Wiora J, Klose S, Zeus T, Jung C, Saeed D, Horn P, Kelm M, Westenfeld R. Prognostic value of impaired hepato‐renal function assessed by the MELD‐XI score in patients undergoing percutaneous mitral valve repair. Catheter Cardiovasc Interv 2018; 93:699-706. [DOI: 10.1002/ccd.27906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Maximilian Spieker
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Katharina Hellhammer
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Julian Wiora
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Simon Klose
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Tobias Zeus
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Christian Jung
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Diyar Saeed
- Division of Cardiovascular SurgeryMedical Faculty, Heinrich‐Heine University Düsseldorf Germany
| | - Patrick Horn
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| | - Malte Kelm
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
- CARID (Cardiovascular Research Institute Düsseldorf) Germany
| | - Ralf Westenfeld
- Division of CardiologyPulmonology and Vascular Medicine, Heinrich‐Heine University, Düsseldorf, Medical Faculty Germany
| |
Collapse
|
5
|
Uwarow A, Büter S, Wiora J, Haurand J, Jung C, Westenfeld R, Horn P. TCT-649 Ventricular unloading by Impella® support reduces pulmonary congestion in patients with cardiogenic shock. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.1076] [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: 10/18/2022]
|
6
|
Trippel TD, Holzendorf V, Halle M, Gelbrich G, Nolte K, Duvinage A, Schwarz S, Rutscher T, Wiora J, Wachter R, Herrmann-Lingen C, Duengen HD, Hasenfuß G, Pieske B, Edelmann F. Ghrelin and hormonal markers under exercise training in patients with heart failure with preserved ejection fraction: results from the Ex-DHF pilot study. ESC Heart Fail 2016; 4:56-65. [PMID: 28217313 PMCID: PMC5292632 DOI: 10.1002/ehf2.12109] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Over 50% of patients with symptomatic heart failure (HF) experience HF with preserved ejection fraction (HFpEF). Exercise training (ET) is effective in improving cardiorespiratory fitness and dimensions of quality of life in patients with HFpEF. A systemic pro-inflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations has been proposed in HFpEF. ET modifies myocardial structure and has been related to inflammatory state. We investigated Ghrelin, related adipokines, markers of inflammation, and neuro-hormonal activation in patients undergoing a structured ET vs. usual care are with HFpEF. METHODS AND RESULTS Ex-DHF-P was a prospective, controlled, randomized multi-centre trial on structured and supervised ET in patients with HFpEF. We performed a post hoc analysis in 62 patients from Ex-DHF-P. Ghrelin, adiponectin, leptin, IL-1ß, IL-6, IL-10, tumour necrosis factor-alpha, MR-proANP, MR-proADM, CT-proET1, and CT-proAVP were assessed to seize the impact of ET on these markers in patients with HFpEF. Thirty-six (58%) patients were female, mean age was 64 years, and median ghrelin was 928 pg/mL (interquartile range 755-1156). When stratified for high versus low ghrelin, groups significantly differed at baseline in presence obesity, waist circumference, and adiponectin levels (P < 0.05, respectively). Overall, ghrelin levels rose significantly to 1013 pg/mL (interquartile range 813-1182) (P < 0.001). Analysis of covariance modelling for change in ghrelin identified ET (P = 0.013) and higher baseline adiponectin levels (P = 0.035) as influencing factors. CONCLUSIONS Exercise training tended to increase ghrelin levels in Ex-DHF-P. This increase was especially pronounced in patients with higher baseline adiponectin levels. Future trials are needed to investigate the effect of ET on endogenous ghrelin levels in regard to interactions with cardiac structure and clinically meaningful surrogate parameters.
Collapse
Affiliation(s)
- Tobias Daniel Trippel
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Volker Holzendorf
- ZKS Leipzig (Clinical Trial Centre Leipzig) University of Leipzig Leipzig Germany
| | - Martin Halle
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and BiometryUniversity of WürzburgWürzburgGermany; Clinical Trial CentreUniversity Hospital WürzburgWürzburgGermany
| | - Kathleen Nolte
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Andre Duvinage
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Silja Schwarz
- DZHK (German Centre for Cardiovascular Research), Partner Site MunichMunich Heart AllianceMunichGermany; Else Kröner-Fresenius-Zentrum, Klinikum rechts der IsarTechnical University MunichMunichGermany
| | - Tinka Rutscher
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Julian Wiora
- Department of Internal Medicine - Cardiology Charité - Universitaetsmedizin Berlin, Campus Virchow Klinikum Berlin Germany
| | - Rolf Wachter
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany; Department for Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Hans-Dirk Duengen
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Gerd Hasenfuß
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany; DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Burkert Pieske
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Frank Edelmann
- Department of Internal Medicine - CardiologyCharité - Universitaetsmedizin Berlin, Campus Virchow KlinikumBerlinGermany; DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany; Department of Cardiology and PneumologyUniversity of Göttingen Medical CentreGöttingenGermany
| |
Collapse
|
7
|
Ansorg R, Müller KD, Wiora J. Comparison of inhibitory and bactericidal activity of antipseudomonal antibiotics against Pseudomonas aeruginosa isolates from cystic fibrosis patients. Chemotherapy 1990; 36:222-9. [PMID: 2110878 DOI: 10.1159/000238770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Using a broth microtiter dilution method, the minimum inhibitory (MIC) and minimum bactericidal concentrations (MBC) of so-called antipseudomonal antibiotics were determined against 79 Pseudomonas aeruginosa isolates from cystic fibrosis patients. On the basis of the MIC values and using DIN breakpoints, the percentual susceptibilities led to the following rank order: imipenem (91%), ciprofloxacin (90%), tobramycin (87%), amikacin (87%), ceftazidime (82%), cefsulodin (76%), piperacillin (71%), azlocillin (62%), followed by gentamicin, ceftriaxone, mezlocillin, netilmicin, and cefotaxime (less than 50%). However, evaluating MBC values according to DIN breakpoints, only ciprofloxacin (82%), tobramycin (77%), amikacin (58%), and imipenem (57%) showed a pronounced antipseudomonal effectiveness. The data indicate that MBC determinations are necessary to evaluate the antibiotic susceptibility of P. aeruginosa rather than MIC determinations, at least in patients with impaired defence mechanisms which require bactericidal therapy.
Collapse
Affiliation(s)
- R Ansorg
- Institut für Medizinische Mikrobiologie, Universität (GHS) Essen, FRG
| | | | | |
Collapse
|