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Trum M, Riechel J, Schollmeier E, Lebek S, Hegner P, Reuthner K, Heers S, Keller K, Wester M, Klatt S, Hamdani N, Provaznik Z, Schmid C, Maier LS, Arzt M, Wagner S. Empagliflozin inhibits increased Na influx in atrial cardiomyocytes of patients with HFpEF. Cardiovasc Res 2024:cvae095. [PMID: 38728438 DOI: 10.1093/cvr/cvae095] [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] [Received: 12/08/2023] [Revised: 01/16/2024] [Accepted: 02/02/2024] [Indexed: 05/12/2024] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) causes substantial morbidity and mortality. Importantly, atrial remodeling and atrial fibrillation is frequently observed in HFpEF. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have recently been shown to improve clinical outcomes in HFpEF, and post-hoc analyses suggest atrial antiarrhythmic effects. We tested if isolated human atrial cardiomyocytes from patients with HFpEF exhibit an increased Na influx, which is known to cause atrial arrhythmias, and if that is responsive to treatment with the SGTL2i empagliflozin. METHODS AND RESULTS Cardiomyocytes were isolated from atrial biopsies of 124 patients (82 with HFpEF) undergoing elective cardiac surgery. Na influx was measured with the Na-dye Asante Natrium Green-2 AM (ANG-2). Compared to patients without heart failure (NF), Na influx was doubled in HFpEF patients (NF vs HFpEF: 0.21±0.02 vs 0.38±0.04 mmol/L/min (N=7 vs 18); p=0.0078). Moreover, late INa (measured via whole-cell patch clamp) was significantly increased in HFpEF compared to NF. Western blot and HDAC4 pulldown assay indicated a significant increase in CaMKII expression, CaMKII autophosphorylation, CaMKII activity, and CaMKII-dependent NaV1.5 phosphorylation in HFpEF compared to NF, whereas NaV1.5 protein and mRNA abundance remained unchanged. Consistently, increased Na influx was significantly reduced by treatment with the CaMKII inhibitor autocamtide-2 related inhibitory peptide (AIP), late INa inhibitor tetrodotoxin (TTX) but also with NHE1 inhibitor cariporide. Importantly, empagliflozin abolished both increased Na influx and late INa in HFpEF. Multivariate linear regression analysis, adjusting for important clinical confounders, revealed HFpEF to be an independent predictor for changes in Na handling in atrial cardiomyocytes. CONCLUSION We show for the first time increased Na influx in human atrial cardiomyocytes from HFpEF patients, partly due to increased late INa and enhanced NHE1-mediated Na influx. Empagliflozin inhibits Na influx and late INa, which could contribute to antiarrhythmic effects in patients with HFpEF.
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Affiliation(s)
- M Trum
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - J Riechel
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - E Schollmeier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - S Lebek
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - P Hegner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - K Reuthner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - S Heers
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - K Keller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - M Wester
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - S Klatt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - N Hamdani
- Department of Cellular and Translational Physiology, Ruhr-University Bochum, Bochum, Germany
| | - Z Provaznik
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - M Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - S Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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Göbel S, Braun AS, Hahad O, von Henning U, Brandt M, Keller K, Gaida MM, Gori T, Schultheiss HP, Escher F, Münzel T, Wenzel P. Etiologies and predictors of mortality in an all-comer population of patients with non-ischemic heart failure. Clin Res Cardiol 2024; 113:737-749. [PMID: 38224373 PMCID: PMC11026225 DOI: 10.1007/s00392-023-02354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Despite progress in diagnosis and therapy of heart failure (HF), etiology and risk stratification remain elusive in many patients. METHODS The My Biopsy HF Study (German clinical trials register number: DRKS22178) is a retrospective monocentric study investigating an all-comer population of patients with unexplained HF based on a thorough workup including endomyocardial biopsy (EMB). RESULTS 655 patients (70.9% men, median age 55 [45/66] years) with non-ischemic, non-valvular HF were included in the analyses. 489 patients were diagnosed with HF with reduced ejection fraction (HFrEF), 52 patients with HF with mildly reduced ejection fraction (HFmrEF) and 114 patients with HF with preserved ejection fraction (HFpEF). After a median follow-up of 4.6 (2.5/6.6) years, 94 deaths were enumerated (HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3% and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years, respectively. In EMB, we detected a variety of putative etiologies of HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate logistic regression analysis adjusting for age, sex and comorbidities only CA, age and NYHA functional class III + IV remained independently associated with all-cause mortality (CA: HRperui 3.13, 95% CI 1.5-6.51; p = 0.002). CONCLUSIONS In an all-comer population of patients presenting with HF of unknown etiology, incidental finding of CA stands out to be independently associated with all-cause mortality. Our findings suggest that prospective trials would be helpful to test the added value of a systematic and holistic work-up of HF of unknown etiology.
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Affiliation(s)
- S Göbel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - A S Braun
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - O Hahad
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U von Henning
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Brandt
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - K Keller
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
- TRON, Translational Oncology at the University Medical Center Mainz, Mainz, Germany
| | - T Gori
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - T Münzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - P Wenzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Ciampi E, Soler B, Uribe-San-Martin R, Jürgensen L, Guzman I, Keller K, Reyes A, Bravo-Grau S, Cruz JP, Cárcamo C. Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile. Mult Scler Relat Disord 2023; 78:104918. [PMID: 37562199 DOI: 10.1016/j.msard.2023.104918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. OBJECTIVE To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. METHODS Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. RESULTS We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). CONCLUSION MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.
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Affiliation(s)
- E Ciampi
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology Service, Hospital Sótero del Río, Santiago, Chile.
| | - B Soler
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology Service, Hospital Sótero del Río, Santiago, Chile
| | - R Uribe-San-Martin
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology Service, Hospital Sótero del Río, Santiago, Chile
| | - L Jürgensen
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - I Guzman
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - K Keller
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A Reyes
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Bravo-Grau
- Neurorradiology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J P Cruz
- Neurorradiology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Cárcamo
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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Keller K, Sivanathan V, Schmitt VH, Ostad MA, Munzel T, Espinola-Klein C, Hobohm L. Incidence and impact of venous thromboembolism in hospitalized patients with Crohn-disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2641] [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
Prevalence of Crohn's disease (CD) is high in North America and in Europe ranging between 100 and 350 patient-cases per 100,000 citizens. CD is characterized by chronic inflammation with a progressive course and is often associated with different intestinal as well as extra-intestinal complications. CD is associated with both, other inflammatory diseases such as ankylosing spondylitis and psoriasis as well as venous thromboembolism (VTE). CD causes an activation of coagulation system, which might be the main reason for an increased risk of thromboembolic complications. Beside previous study results regarding higher VTE risk of patients with CD in comparison to the general population, particularly, data on impact of VTE on survival and risk factors for the occurrence of VTE in CD are sparse.
Purpose
The objectives of our study were to provide evidence about the current and past prevalence of VTE events in hospitalized patients with CD and to investigate the impact of VTE on outcomes of CD patients.
Methods
The German nationwide inpatient sample was screened for patients admitted due to CD (ICD-code K50) (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, own calculations). CD hospitalizations were stratified for VTE and risk factors for VTE and impact of VTE on in-hospital case-fatality rate were investigated.
Results
Overall, 333,975 patients-cases with hospital admissions due to CD were counted in Germany (median age 38.0 [IQR 24.0–52.0] years, 56.0% females) during the observational period between 2005 and 2018. VTE rate increased slightly from 0.6% to 0.7% (β 0.000097 [95% CI 0.000027 to 0.000167], P=0.007) from 2005 to 2018 and with age-decade of life (β 0.0017 [95% CI 0.0016 to 0.0019], P<0.001). In total, 0.7% (n=2,295) of the CD inpatients had an event of VTE. Patients with VTE were in median 12 years older (49.0 [34.0–62.0] vs. 37.0 [24.0–52.0] years, P<0.001) and CD colon-manifestations were more prevalent in those patients (32.0% vs. 27.7%, P<0.001). Age ≥70 years, obesity, colon-involvement, cancer, surgery, thrombophilia, and heart failure were strongly associated with higher risk of VTE in CD patients.
In-hospital death occurred 15-times more often in CD with VTE than without (4.5% vs. 0.3%, P<0.001). VTE was independently associated with substantially increased in-hospital case-fatality rate (OR 9.31 [95% CI 7.54–11.50], P<0.001).
Conclusions
VTE is a life-threatening event in hospitalized CD patients associated with 9.3-fold increased case-fatality rate. Older age, obesity, colon involvement, cancer, surgery, thrombophilia and heart failure were strong risk factors for VTE in patients with CD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Keller
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - V Sivanathan
- University Medical Center of Mainz, Department of Gastroenterology , Mainz , Germany
| | - V H Schmitt
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - M A Ostad
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - C Espinola-Klein
- University Medical Center of Mainz, Department of Cardiology, Cardiology III , Mainz , Germany
| | - L Hobohm
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
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Trum M, Schollmeier E, Riechel J, Lebek S, Reuthner K, Keller K, Wester M, Provaznik Z, Schmid C, Maier L, Arzt M, Wagner S. Empagliflozin inhibits increased Na influx in HFpEF cardiomyocytes and reduces arrhythmic activity in human atrial trabeculae. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2948] [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
Heart failure with preserved ejection fraction (HFpEF) is a major health problem associated with substantial morbidity and mortality. However, the underlying pathophysiological mechanisms are poorly understood, and effective treatment strategies are scarce. Importantly, SGLT2i, which have been suggested to improve cellular Na and Ca homeostasis in HFrEF, have recently been shown to also improve clinical outcomes in patients with HFpEF. Interestingly, post-hoc analyses of clinical data suggest an involvement of anti-arrhythmic effects of SGLT2i.
Purpose
We tested, if isolated human atrial cardiomyocytes from patients with HFpEF exhibit an increased Na influx that is responsive to treatment with the SGLT2i empagliflozin (Empa) and if Empa has anti-arrhythmic properties in human atrial trabeculae.
Methods
Atrial biopsies were obtained from 101 patients undergoing elective cardiac surgery. Na influx was measured as increase in [Na]i during Na/K-ATPase inhibition in isolated cardiomyocytes loaded with the Na-sensitive fluorescence dye Asante Natrium Green–2 AM (ANG-2). Western Blot and HDAC4 pulldown assay were used to investigate NaV1.5 expression/phosphorylation as well as CaMKII expression/autophosphorylation and activity. Anti-arrhythmic effects of Empa were evaluated as the reduction in premature atrial complexes (PACs), which were induced in electrically field-stimulated (1Hz) human atrial trabeculae by superfusion with isoproterenol (100 nM) and high Ca (3.5 mM).
Results
Compared to patients without heart failure (NF), Na influx was almost doubled in HFpEF patients (NF vs HFpEF: 0.21±0.02 vs 0.38±0.04 mmol/L/min (N=7 vs 18); p=0.005) (Fig. 1D, E). CaMKII expression, CaMKII autophosphorylation, CaMKII activity, and CaMKII-dependent NaV1.5 phosphorylation were significantly increased in atrial biopsies of HFpEF patients, whereas NaV1.5 protein abundance remained unchanged (Fig. 1A–C). Consistent with these results, the increased Na influx was significantly reduced by treatment with the specific CaMKII inhibitor autocamtide-2 related inhibitory peptide (AIP) and the late INa inhibitor tetrodotoxin (TTX) (Fig. 1D, E). Importantly, Empa also abolished the increased Na influx in HFpEF cardiomyocytes (Fig. 1D, E). Multivariate linear regression analysis, adjusting for clinical co-variates, revealed HFpEF to be an independent predictor of cardiomyocyte Na handling. In line with Empa-mediated inhibition of Na influx, the frequency of PACs in human atrial trabeculae was significantly reduced by Empa (Fig. 1F, G).
Conclusion
This is the first study to demonstrate increased Na influx in human cardiomyocytes from HFpEF patients potentially by an increased CaMKII-dependent NaV1.5 phosphorylation. Excitingly, treatment with Empa decreases this Na influx in HFpEF cardiomyocytes and reduces isoproterenol-induced arrhythmic activity in human atrial trabeculae, which could contribute to the cardioprotective effects of this drug in patients with HFpEF.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Else Kröner-Fresenius-Stiftung,Deutsche Forschungsgemeinschaft
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Affiliation(s)
- M Trum
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - E Schollmeier
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - J Riechel
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - S Lebek
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - K Reuthner
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - K Keller
- Hospital Barmherzige Bruder , Regensburg , Germany
| | - M Wester
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - Z Provaznik
- University Hospital Regensburg, Cardiothoracic Surgery , Regensburg , Germany
| | - C Schmid
- University Hospital Regensburg, Cardiothoracic Surgery , Regensburg , Germany
| | - L Maier
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - M Arzt
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
| | - S Wagner
- University Hospital Regensburg, Internal Medicine II , Regensburg , Germany
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Farmakis I, Keller K, Scibior B, Mavromanoli AC, Sagoschen I, Munzel T, Ahrens I, Konstantinides S, Hobohm L. Pulmonary embolism response team implementation and its clinical value across countries: a scoping review and meta-analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1891] [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
Over the last years, the concept of multidisciplinary pulmonary embolism response teams (PERTs) has been developed to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE), but data on the use and the benefit of PERT are sparse.
Purpose
We aimed to systematically investigate the composition of PERT and its clinical value in clinical routine across different countries.
Methods
We searched PubMed, CENTRAL and Web of Science until January 2022 for full-text, prospective and retrospective observational studies, which included patients with acute PE who were evaluated by a PERT. Eligible articles were designed to either describe the structure and function of PERTs and/or to investigate outcomes related to the implementation of PERT. We performed a random-effects meta-analysis of controlled studies (PERT vs. pre-PERT era) to investigate the impact of PERTs on clinical outcomes and use of advanced therapies.
Results
We included 22 original studies and four surveys. Overall, 31.5% of patients with PE were evaluated by PERT referred mostly by emergency departments (59.4%). In total, PERT involved a median of 6 (range 2–10) specialties for guiding further diagnostic and treatment modalities. Patients evaluated by a PERT had a mean age of 60 years; of them, 48.7% were females, and 23.5% suffered from malignancy. Right ventricular dysfunction was present in 55% of the patients. In total, 74.5% were classified as intermediate-risk PE and 16% as high-risk PE. In eleven single-arm studies, 1,532 patients with intermediate- and high-risk PE were evaluated by PERT with a mortality rate of 10% and a bleeding rate of 9%. The mean length of stay was 7.3 days and the use of advanced therapy was reported in 30% of all cases. From these, catheter-directed treatment (CDT) was performed in 22% and inferior vena cava filter was inserted in 15%, while systemic thrombolysis was administered in only 6%, surgical thrombectomy in 2% and ECMO in 3% of all cases. When comparing PERT and pre-PERT era no difference in mortality (risk ratio [RR] 0.89, 95% confidence interval [CI] 0.67–1.19, I2=63%) was observed based on nine controlled studies, while mortality tended to be lower when including only intermediate and high-risk patients in the analysis (RR 0.71, 95% CI 045–1.12) (Figure 1). The use of advanced therapies was more common (RR 2.67, 95% CI 1.29–5.50) and the in-hospital stay as well as the duration of treatment in intensive care unit was shorter (mean difference −1.6 days and −1.8 days, respectively) in the PERT era.
Conclusion
PERT implementation tended to reduce the mortality rate in patients with intermediate- and high-risk PE and resulted in a shorter in-hospital stay. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Farmakis
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - K Keller
- University Medical Center Mainz, Department of Cardiology , Mainz , Germany
| | - B Scibior
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | | | - I Sagoschen
- University Medical Center Mainz, Department of Cardiology , Mainz , Germany
| | - T Munzel
- University Medical Center Mainz, Department of Cardiology , Mainz , Germany
| | - I Ahrens
- Hospital der Augustinerinnen, Department of Cardiology and Medical Intensive Care , Cologne , Germany
| | | | - L Hobohm
- Center for Thrombosis and Hemostasis , Mainz , Germany
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7
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Farmakis I, Valerio L, Mavromanoli AC, Bikdeli B, Connors JM, Giannakoulas G, Goldhaber SZ, Hobohm L, Hunt BJ, Keller K, Klok FA, Spyropoulos AC, Kucher N, Konstantinides S, Barco S. Mortality related to pulmonary embolism in the United States before and during the COVID-19 pandemic: an analysis of the CDC Multiple Cause of Death database. Eur Heart J 2022. [PMCID: PMC9619500 DOI: 10.1093/eurheartj/ehac544.1869] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The COVID-19 pandemic caused a large number of excess deaths. COVID-19 emerged as a prothrombotic disease often complicated by pulmonary embolism (PE). In light of this, we hypothesized that PE-related mortality rates (stable before the pandemic) would be characterized by an increasing trend following the COVID-19 outbreak. Purpose To investigate the mortality rates associated with PE among deaths with or without COVID-19 during the 2020 pandemic in the United States (US). Methods For this retrospective epidemiological study, we analyzed public medically certified vital registration data (death certificates encompassing underlying and multiple causes of death) from the Mortality Multiple Cause-of-Death database provided by the Division of Vital Statistics of the US Centers for Disease Control and Prevention (CDC; US, 2018–20). We investigated the time trends in monthly PE-related crude mortality rates for 2018–2019 and for 2020 (the latter associated vs. not associated with COVID-19), utilizing annual national population totals from the US Census Bureau. Second, we calculated the PE-related proportionate mortality among COVID-19 deaths (overall and limited to autopsy-based diagnosis). We performed subgroup analyses based on age groups, sex and race. Results During 2020, 49,423 deaths in association with PE were reported, vs. 39,450 in 2019 and 38,215 in 2018. The crude PE-related mortality rate without COVID-19 was 13.3 per 100,000 population in 2020 compared to 11.7 in 2018 and 12.0 in 2019 (Figure 1A). The PE-related mortality rate with COVID-19 was 1.6 per 100,000 population in 2020. Among non-COVID-19-related deaths, the crude PE-related mortality rate was higher in women; among COVID-19-related deaths, it was higher in men. PE-related mortality rates were approximately two-fold higher among black (vs. white) general population irrespective of COVID-19 status (Figures 1B and 1C). Among COVID-19 deaths, PE-related deaths corresponded to 1.4% of total; the value rose to 6.0% when an autopsy was performed. This figure was higher in men and its time evolution is depicted in Figure 2A. The proportionate mortality of PE in COVID-19 deaths was higher for younger age groups (15–44 years) compared to non-COVID-19-related deaths (Figure 2B). Conclusion In 2020, an overall 20%-increase in PE-related mortality was reported, not being limited to patients with COVID-19. Our findings could be interpreted in the context of undiagnosed COVID-19 cases, uncounted late sequelae, and possibly sedentary lifestyle and avoidance of healthcare facilities during the pandemic that may have prevented timely diagnosis and treatment of other diseases. Whether vaccination programs had an impact on PE-associated mortality in the year 2021, remains to be determined. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- I Farmakis
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - L Valerio
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | | | - B Bikdeli
- Brigham and Women's Hospital, Cardiovascular Medicine Division , Boston , United States of America
| | - J M Connors
- Brigham and Women's Hospital, Hematology Division , Boston , United States of America
| | - G Giannakoulas
- AHEPA University General Hospital, Department of Cardiology , Thessaloniki , Greece
| | - S Z Goldhaber
- Brigham and Women's Hospital, Cardiovascular Medicine Division , Boston , United States of America
| | - L Hobohm
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - B J Hunt
- Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital Thrombosis and Haemophilia Centre and Thrombosis and Vascular Biology Group , London , United Kingdom
| | - K Keller
- University Medical Center Mainz, Department of Cardiology , Mainz , Germany
| | - F A Klok
- Leiden University Medical Center, Department of Medicine - Thrombosis and Hemostasis , Leiden , The Netherlands
| | - A C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Hempstead , United States of America
| | - N Kucher
- University Hospital Zurich, Department of Angiology , Zurich , Switzerland
| | | | - S Barco
- University Hospital Zurich, Department of Angiology , Zurich , Switzerland
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8
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Schmitt V, Hobohm L, Vosseler M, Brochhausen C, Munzel T, Espinola-Klein C, Keller K. Temporal trends regarding clinical impact of diabetes mellitus on peripheral artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patients with peripheral artery disease (PAD) and Diabetes mellitus (DM) suffer from higher morbidity and mortality rates compared to non-diabetic PAD patients. Huge efforts are made to improve medical care of patients with DM including chronic disease programs.
Purpose
To investigate temporal trends of the clinical burden of DM on PAD patients between the years 2005 and 2019.
Methods
All patients hospitalized due to PAD between 2005 and 2019 in Germany based on the diagnosis related groups [DRG] system were stratified according to presence or absence of DM (source: Federal Statistical Offices of Germany, DRG statistics 2005–2019 and own calculations). Morbidity and mortality of both groups were compared in time trend.
Results
The number of hospitalisations due to PAD increased from 142,778 in the year 2005 to 190,135 in 2019 (β 3956 per year [95% CI 3034–4878], P<0.001). In the same period also the amount of PAD patients with additional diagnosis of DM inclined (2005: 41,609 patients corresponding 29.1% of all PAD patients vs. 2019: 65,302 patients corresponding 34.3% of all PAD patients; β 2019 per year [95% CI 1593–2446], P<0.001). While the portion of patients with type 1 DM decreased during the observational period (β −1.43 [95% CI −1.49 to −1.37]; P<0.001), type 2 DM was progressive (β 2.27 [95% CI 2.23–2.32]; P<0.001). PAD patients with DM suffered from lower rates of pulmonary embolism (β −0.64 [95% CI −0.89 to −0.40]; P<0.001) and intracerebral bleeding (β −0.45 [95% CI −0.94 to 0.04]; P=0.072) in the last years of the investigation period, whereas the amount of patient-cases with pneumonia (β 0.29 [95% CI 0.23–0.35]; P<0.001), shock (β 0.75 [95% CI 0.66–0.84]; P<0.001) and gastrointestinal bleeding (β 0.33 [95% CI 0.20–0.46]; P<0.001) increased. Fortunately, less amputations had to be performed in diabetics over time (amputations regardless of minor or major amputations: β −0.42 [95% CI −0.44 to −0.40]; P<0.001; minor amputations: β −0.03 [95% CI −0.06 to −0.01]; P=0.015; major amputations: β −1.24 [95% CI −1.28 to −11.20]; P<0.001) and in-hospital mortality decreased during the observational-time (2005: 4.7%, 2019: 2.8%; β −0.64 [95% CI −0.69 to −0.59]; P<0.001). Despite the improvement in morbidity and mortality within the investigated time period, diabetics with DM were still associated with increased risk for morbidity and mortality compared to PAD patients without DM.
Conclusions
We observed an improvement regarding morbidity and mortality in hospitalized PAD patients with DM in Germany within the investigation period between 2005 and 2019. However, DM remained to be associated with increased morbidity and mortality compared to non-diabetics. Hence, despite the achieved improvements within the period 2005 to 2019, DM still represents an outstanding risk factor for morbidity and mortality in patients with PAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - L Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - M Vosseler
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - C Brochhausen
- Institute of Pathology, University of Regensburg , Regensburg , Germany
| | - T Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - C Espinola-Klein
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - K Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
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9
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Hobohm L, Sagoschen I, Barco S, Farmakis I, Fedeli U, Koelmel S, Gori T, Espinola-Klein C, Munzel T, Konstantinides S, Keller K. COVID-19 infection and its impact on case-fatality in patients with pulmonary embolism. Eur Heart J 2022. [PMCID: PMC9619643 DOI: 10.1093/eurheartj/ehac544.1888] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Although a high prevalence of pulmonary embolism (PE) has been reported as a complication during severe COVID-19 infections in critical ill patients, nationwide data of hospitalized patients with COVID-19 with PE is still limited. Thus, we sought to analyze seasonal trends and predictors of in-hospital case-fatality in patients with COVID-19 and PE in Germany. Methods We used the German nationwide inpatient sample to analyze all data on hospitalizations for COVID-19 patients with and without PE in Germany during the year 2020 and to compare changes of PE prevalence to 2019. Results We analyzed data of 176,137 hospitalizations because of COVID-19 in 2020. Among those, PE was recorded in 1.9% (n=3,362) of discharge or death certificates. Almost one third of patients with COVID-19 and PE died during the in-hospital course (28.7%). The case-fatality rate increased with patients' age peaking in the 9th life-decade. Regardless of COVID-19, 196,203 inpatients were diagnosed with PE in Germany between 2019 and 2020. The number of PE hospitalizations were widely equally distributed between both years (98,485 vs. 97,718), while the case-fatality rate of all patients with PE was slightly lower in 2019 compared to 2020 (12.7% vs. 13.1%, P<0.001). In contrast, considerable differences in prevalence and case-fatality were demonstrated in 2020 regarding PE patients with and without COVID-19 infection (28.7% vs. 13.1%, P<0.001) (Figure 1). A COVID-19-infection was associated with a 2.8-fold increased risk of case-fatality in patients with PE (OR 2.81, 95% CI 1.66–2.12, P<0.001). Conclusions In Germany, the prevalence of PE events complicating hospitalizations was similar in 2019 and 2020. However, the fatality rate among patients with COVID-19-associated PE was substantially higher than that in those without either COVID-19 or PE, indicating an additive prognostic effect of these two conditions. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- L Hobohm
- University Medical Center of Mainz , Mainz , Germany
| | - I Sagoschen
- University Medical Center of Mainz , Mainz , Germany
| | - S Barco
- Universitätsspital Zürich, Angiology , Zürich , Switzerland
| | - I Farmakis
- University Medical Center of Mainz , Mainz , Germany
| | - U Fedeli
- University of Padua, Epidemiological Department , Padova , Italy
| | - S Koelmel
- Triemli Hospital, Department of Internal Medicine , Zurich , Switzerland
| | - T Gori
- University Medical Center of Mainz , Mainz , Germany
| | | | - T Munzel
- University Medical Center of Mainz , Mainz , Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH) , Mainz , Germany
| | - K Keller
- University Medical Center of Mainz , Mainz , Germany
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10
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Keller K, Sagoschen I, Barco S, Schmidtmann I, Espinola-Klein C, Konstantinides S, Munzel T, Hobohm L. Trends and risk factors of in-hospital mortality of patients with COVID-19 in Germany. Eur Heart J 2022. [PMCID: PMC9619601 DOI: 10.1093/eurheartj/ehac544.2232] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Unselected data of nationwide studies of hospitalized patients with COVID-19 is still sparse, but these data are of outstanding interest not to exceed hospital capacities and to avoid overloading of national health-care systems. Purpose Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality and mechanical ventilation (MV) in patients with COVID-19 in Germany. Methods We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID-19 diagnosis in Germany between January 1st and December 31st in 2020 (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2020, own calculations). Covid-19-inpatients with MV vs. without MV and survivors vs. non-survivors were compared. Logistic regression models were calculated to investigate associations between patients' characteristics as well as adverse events and i) necessity of MV and ii) in-hospital death. Results We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Cardiovascular comorbidities were common in hospitalized patients with confirmed COVID-19-infections: Overall, almost half of the patients (46.8%; n=82,480) had arterial hypertension and 25,574 (14.4%) had a diagnosis of coronary artery disease. In 60.7% (n=106,913) of the hospitalizations, pneumonia was reported, 8.6% (n=15,061) had an acute infection of the upper or lower airways other than pneumonia, and 6.6% (n=11,594) suffered from an acute respiratory distress syndrome (ARDS) during hospitalization Age ≥70 years (OR 5.91, 95% CI 5.70–6.13, P<0.001), pneumonia (OR 4.58, 95% CI 4.42–4.74, P<0.001) and acute respiratory distress syndrome (OR 8.51, 95% CI 8.12–8.92, P<0.001) were strong predictors of in-hospital death. Most COVID-19-patients were treated in hospitals in urban areas (n=92,971) associated with lowest case-fatality (17.5%) as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between 6th and 8th age-decade. In the first age-decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV and five of them died (0.3%). Conclusion The results of our study indicate seasonal and regional variations concerning number of COVID-19-patients, necessity of MV and case-fatality in Germany. These findings may help to ensure flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional health-care systems. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- K Keller
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - I Sagoschen
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - S Barco
- University Hospital Zurich, Department of Angiology , Zurich , Switzerland
| | - I Schmidtmann
- University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) , Mainz , Germany
| | - C Espinola-Klein
- University Medical Center of Mainz, Department of Cardiology, Cardiology III , Mainz , Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis , Mainz , Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
| | - L Hobohm
- University Medical Center of Mainz, Department of Cardiology, Cardiology I , Mainz , Germany
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11
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Schmitt V, Billaudelle AM, Schulz A, Keller K, Hahad O, Troebs SO, Koeck T, Michal M, Schuster AK, Toenges G, Lackner KJ, Prochaska JH, Munzel T, Wild PS. Impact of prediabetes and type 2 diabetes mellitus on cardiac function in the general population. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1060] [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
Introduction
Prediabetes and type 2 diabetes mellitus (T2DM) are risk factors for heart failure (HF). The association of prediabetes and T2DM to different forms of functional left ventricular impairment and their impact on clinical outcome in the general population needs to be further investigated. In this context, little is known about the prevalences of prediabetes and different HF subtypes in the general population, especially in Europe.
Purpose
To investigate the prevalence and clinical impact of prediabetes and type 2 diabetes mellitus (T2DM) on functional cardiac disorder (FCD).
Methods
The participants of the Gutenberg Health Study sample (15,010 subjects, 35–74 years) were stratified in individuals with euglycaemia, prediabetes and T2DM based on clinical information and HbA1c level. FCD included asymptomatic systolic and diastolic dysfunction, symptomatic systolic and diastolic heart failure, asymptomatic diastolic dysfunction and preserved left ventricular ejection fraction (EF), asymptomatic diastolic dysfunction and reduced EF, asymptomatic preserved diastole and reduced EF, symptomatic heart failure with preserved EF (HFpEF) and symptomatic heart failure with reduced EF HFrEF). Using structured follow-up clinical outcome was assessed.
Results
Overall, 14,870 individuals were included in the present analysis. Among them, 9,426 individuals were categorized in the euglycaemia group, 4,128 participants had prediabetes and in 1,316 individuals T2DM was present. Prevalence of FCD increased from euglycaemia (19.6%) over prediabetes (33.3%) to T2DM (46.8%, p<0.0001). Prevalence of symptomatic HF was increased in patients with T2DM (euglycaemia 2.8%, prediabetes 5.9%, T2DM 11.9%). T2DM was associated with reduced EF (β −0.63, 95% CI −0.99 to −0.26, P=0.00088) and elevated E/E' (β 0.08, 95% CI 0.06 to 0.10, P<0.0001), whereas prediabetes was associated to elevated E/E' (β 0.02, 95% CI 0.01 to 0.03, P=0.0029). Prediabetes and T2DM revealed increased prevalences of FCD (13%, 18%), asymptomatic diastolic dysfunction with preserved EF (prediabetes: 14%, T2DM: 11%), symptomatic heart failure (prediabetes: 46%, T2DM: 70%) and HFpEF (prediabetes: 49%, T2DM: 82%). With prediabetes and T2DM all-cause mortality was elevated in presence and absence of FCD, only T2DM was also a risk factor for cardiovascular mortality with and without FCD. Within a 5-years follow-up, T2DM was an independent risk factor for the development of FCD, asymptomatic diastolic dysfunction with reduced ejection fraction, symptomatic heart failure and HFrEF. Prediabetes was not an independent risk factor for FCD.
Conclusions
In the general population, a high prevalence of asymptomatic FCD is present. Coexisting FCD and prediabetes as well as T2DM result in increased mortality elucidating the need for early detection and prevention of DM development, especially with regard to numerous asymptomatic people concerned. T2DM, but not prediabetes, is a risk factor for incident FCD.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The Gutenberg Health Study is supported by the government of Rheinland-Pfalz (`Stiftung Rheinland-Pfalz für Innovation'), the research programmes `Wissen schafft Zukunft' and the Centre forTranslational Vascular Biology (CTVB) of the Johannes Gutenberg-University of Mainz, Germany, and its contract with Boehringer Ingelheim and Philips Medical Systems including an unrestricted grant forthe Gutenberg Health Study. P.S.W. and J.H.P. are funded by the Federal Ministry of Education and Research (BMBF 01EO1503). P.S.W. and T.M. are principal investigators of the German Center for Cardiovascular Research (DZHK). P.S.W. is principal investigator of the DIASyM research core (BMBF 161L0217A).
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Affiliation(s)
- V Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - A M Billaudelle
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
| | - A Schulz
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
| | - K Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - O Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - S O Troebs
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
| | - T Koeck
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
| | - M Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center , Mainz , Germany
| | - A K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - G Toenges
- Institute for Medical Biometrics, Epidemiology and Informatics (IMBEI), University Medical Center , Mainz , Germany
| | - K J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center , Mainz , Germany
| | - J H Prochaska
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
| | - T Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz , Mainz , Germany
| | - P S Wild
- Preventive Cardiology and Preventive Medicine, Department of Cardiology, University Medical Center , Mainz , Germany
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12
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Keller K, Rojas-Aedo R, Zhang H, Schweizer P, Allerbeck J, Brida D, Jariwala D, Maccaferri N. Ultrafast Thermionic Electron Injection Effects on Exciton Formation Dynamics at a van der Waals Semiconductor/Metal Interface. ACS Photonics 2022; 9:2683-2690. [PMID: 35996365 PMCID: PMC9389617 DOI: 10.1021/acsphotonics.2c00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Indexed: 06/15/2023]
Abstract
Inorganic van der Waals bonded semiconductors such as transition metal dichalcogenides are the subject of intense research due to their electronic and optical properties which are promising for next-generation optoelectronic devices. In this context, understanding the carrier dynamics, as well as charge and energy transfer at the interface between metallic contacts and semiconductors, is crucial and yet quite unexplored. Here, we present an experimental study to measure the effect of mutual interaction between thermionically injected and directly excited carriers on the exciton formation dynamics in bulk WS2. By employing a pump-push-probe scheme, where a pump pulse induces thermionic injection of electrons from a gold substrate into the conduction band of the semiconductor, and another delayed push pulse that excites direct transitions in the WS2, we can isolate the two processes experimentally and thus correlate the mutual interaction with its effect on the ultrafast dynamics in WS2. The fast decay time constants extracted from the experiments show a decrease with an increasing ratio between the injected and directly excited charge carriers, thus disclosing the impact of thermionic electron injection on the exciton formation dynamics. Our findings might offer a new vibrant direction for the integration of photonics and electronics, especially in active and photodetection devices, and, more in general, in upcoming all-optical nanotechnologies.
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Affiliation(s)
- Kilian
R. Keller
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Ricardo Rojas-Aedo
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Huiqin Zhang
- Department
of Electrical and Systems Engineering, University
of Pennsylvania, 19104 Philadelphia, Pennsylvania, United States
| | - Pirmin Schweizer
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Jonas Allerbeck
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
- Nanotech@Surfaces
Laboratory, EMPA, Ueberlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Daniele Brida
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
| | - Deep Jariwala
- Department
of Electrical and Systems Engineering, University
of Pennsylvania, 19104 Philadelphia, Pennsylvania, United States
| | - Nicolò Maccaferri
- Department
of Physics and Materials Science, University
of Luxembourg, 162a Avenue de la Faïencerie, L-1511 Luxembourg, Luxembourg
- Department
of Physics, Umeå University, Linnaeus väg 24, SE-90187 Umeå, Sweden
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13
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Klose-Jensen R, Therkildsen J, Blavnsfeldt AB, Langdahl B, Thygesen J, Keller K, Hauge EM. POS1380 AUTOANTIBODIES ARE ASSOCIATED WITH EROSIVE DAMAGE IN THE SECOND AND THIRD METACARPOPHALANGEAL JOINTS ASSESSED BY HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe presence of anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF) are prognostic for erosive severity by radiography in patients with rheumatoid arthritis (RA) [1]. However, others have shown that RF mainly acts as an enhancer for ACPAs mediated bone loss [2]. High-resolution peripheral quantitative computed tomography (HR-pQCT) has a very high resolution with a voxel size of 82 µm3, and has been proposed to monitor disease activity in patients with RA. In the current study, erosive damage was assessed by HR-pQCT according to the presence of autoantibodies. The hypothesis is that the presence of RF and especially ACPA is associated with erosive damage in two metacarpophalangeal (MCP) joints assessed by HR-pQCT; this has previously been shown using 44 joints assessment of both hands and feet by conventional radiography.ObjectivesThe objective was to investigate if the presence of the autoantibodies, RF and ACPAs, was associated with a higher erosive burden in two MCP joints assessed by HR-pQCT.MethodsPatients with RA and disease duration ≥ 5 years had their second and third MCP joints imaged by HR-pQCT. Age, sex, disease duration, ACPAs and RF status were acquired. From the Danish Clinical Quality Program – The Danish Rheumatologic Database (DANBIO) [3], the average 28-joint Disease Activity Score (DAS28-CRP) and Health Assessment Questionnaire (HAQ) from five years before inclusion were extracted. Statistical significance was investigated for the following groups, who were ordered according to the expected erosive burden: RF+/ACPA+ patients, RF-/ACPA+ patients, RF+/ACPA- patients, and autoantibodies negative patients. Analysis of variance was used to investigate the difference between the groups for age and sex. Cuzick’s Rank-sum test for trend of ordered groups was used to test for trend for disease duration, 5-year average HAQ, 5-year average DAS28, number of erosions, total erosive volume, and average erosion volume.ResultsA total number of 353 patients with RA were included in this study. 203 was RF+/ACPA+ positive, 52 was RF-/ACPA+ positive, 24 were RF+/ACPA- positives, and 74 were autoantibodies negative. The groups were comparable with respect to age, sex distribution, disease duration and mean disease activity during the last five years, according to mean DAS28-CRP and mean HAQ during the previous five years.There was a statistically significant test for trend for total erosive volume (p = 0.016) and average erosion volume (p = 0.043), but not for the number of erosions (p = 0.053) (Figure 1). A significant difference between the groups was only observed between double-positive patients and patients negative for autoantibodies.Figure 1.Scatterplot showing the number of erosions (A), total erosive volume (B) and the average volume of erosions (C) in the second and third MCP joint per patient according to the presence of the autoantibodies, ACPAs, as well as RF. Boxes denote the median and 25th and 75th percentile of the groups.ConclusionIn the current study, HR-pQCT scanning of only two MCP joints supports previous findings by radiography of both hands and feet, showing the accumulated erosive burden is higher in patients double-positive for RF and ACPA.References[1]Syversen SW, Gaarder PI, Goll GL, et al. High anti-cyclic citrullinated peptide levels and an algorithm of four variables predict radiographic progression in patients with rheumatoid arthritis: results from a 10-year longitudinal study. Ann Rheum Dis 2008;67:212–7. doi:10.1136/ARD.2006.068247[2]Hecht C, Englbrecht M, Rech J, et al. Additive effect of anti-citrullinated protein antibodies and rheumatoid factor on bone erosions in patients with RA. Ann Rheum Dis 2015;74:2151–6. doi:10.1136/annrheumdis-2014-205428[3]Ibfelt EH, Jensen DV, Hetland ML. The Danish nationwide clinical register for patients with rheumatoid arthritis: DANBIO. Clin Epidemiol 2016;8:737–42. doi:10.2147/CLEP.S99490Disclosure of InterestsRasmus Klose-Jensen: None declared, Josephine Therkildsen: None declared, Anne-Birgitte Blavnsfeldt: None declared, Bente Langdahl Speakers bureau: Amgen, UCB, Eli Lilly, Gedeon-Richter, Astellas, Consultant of: Amgen, UCB, Gedeon-Richter, Eli Lilly, Gedeon., Grant/research support from: Amgen, Novo Nordisk, Jesper Thygesen: None declared, Kresten Keller: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Research funding to Aarhus University Hospital from Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis.Travel expenses from Celgene, MSD, Pfizer, Roche, Sobi.
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Overgaard Donskov A, Mackie S, Hauge EM, Toro Gutiérrez C, Hansen I, Hemmig A, Van der Maas A, Gheita TA, Dalsgaard Nielsen B, Douglas K, Conway R, Rezus E, Dasgupta B, Monti S, Matteson E, Sattui SE, Matza M, Ocampo V, Bran A, Appenzeller S, Goecke A, Colman MC Leod N, Keen H, Kuwana M, Gupta L, Salim B, Harifi G, Erraoui M, Ziade N, Al-Ani NA, Ajibade A, Knitza J, Frølund L, Yates M, Pimentel-Quiroz V, Lyrio A, Sandovici M, Van der Geest K, Helliwell T, Brouwer E, Dejaco C, Keller K. AB0584 MANAGEMENT OF REFERRALS, TREATMENT STRATEGY, AND RESEARCH CHALLENGES IN POLYMYALGIA RHEUMATICA AMONGST RHEUMATOLOGISTS WORLDWIDE: A QUESTIONNAIRE BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) is diagnosed and treated by both general practitioners (GP) and rheumatologists. How rheumatologists around the world manage the referral process of patients with PMR from GP’s has not been described. EULAR/ACR guidelines recommend initial prednisolone doses between 12.5 and 25 mg, but it is unknown if guidelines are followed in daily clinical practice1. In addition, the understanding of challenges for recruitment to clinical trials in PMR is currently limited.ObjectivesThis study aims to describe the management of referrals, treatment strategy, and recruitment to clinical trials in PMR among rheumatologists worldwide.MethodsAn English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. Questions concerned: 1: respondent, 2: referrals, 3: prednisolone, and 4: barriers to research. Questionnaires were distributed to rheumatologists via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 2nd of November 2021 to 27th of January 2022. Countries were grouped by income and geographical region based on the World bank classifications. Data were weighted by number of inhabitants in a country, based on the United Nations age specific population count, divided by number of respondents in a country. Countries with more than 20 respondents were included.ResultsResults from 27 countries were analysed including 1000 responders in total (Figure 1). There was large variation in time from referral to first assessment, initial dose of prednisolone was high, duration of treatment was relatively short, and a large proportion of patients with newly diagnosed PMR received prednisolone prior to rheumatological evaluation (Table 1). Concerning the 15% of respondents who performed research in PMR, 52% had participated in clinical trials and 56% of the responders experienced difficulties with recruitment.Table 1.Characteristics of reponders, referrals, and treatment.Geographical regionIncomeThe worldEurope and Central AsiaNorth AmericaLatin AmericaEast Asia and PacificSouth AsiaMiddle East and AfricaHigh- income countriesLow- and middle- income countriesRespondersResponders (n), Completed questionnaire (total)875 (1000)294 (304)78 (81)136 (152)53 (53)53 (72)261 (338)446 (458)429 (542)Experience as rheumatologist (years)11 (6-20)12 (6-20)7 (4-20)11 (6-23)21 (10-30)7 (4-10)9 (5-18)11 (5-22)8 (5-12)ReferralsGP’s can discuss patients prior to referral, %647979575860677461Referred patients seen (%)100 (90-100)100 (90-100)100 (100-100)100 (100-100)100 (95-100)100 (100-100)100 (60-100)100 (100-100)100 (90-100)Evaluation > 2 weeks after referral, %26498060216185815PrednisoloneStarted prior to rheumatological evaluation (%)50 (20-50)60 (30-80)70 (50-80)50 (10-50)30 (20-50)50 (20-80)20 (0-50)50 (30-80)50 (10-70)Initial dose (mg)20 (15-40)20 (15-20)20 (15-20)20 (20-40)15 (15-15)20 (15-40)20 (15-40)15 (15-20)20 (15-40)Initial dose > 25 mg, %32964104143642Duration of treatment (months)12 (6-12)12 (12-18)12 (10-18)6 (3-12)18 (12-18)12 (6-12)6 (3-12)12 (12-18)9 (6-12)Data presented as weighted median (interquartile range) unless otherwise stated.GP: general practitionerConclusionThis is the first description of current practice in managing referrals and treatment of PMR by rheumatologists worldwide. In general, median treatment duration was according to EULAR/ACR guidelines, but initial dose of prednisolone was often higher than recommended in many parts of the world. PMR patients were often seen more than two weeks after referral, and treatment had started prior to first rheumatological evaluation.References[1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74(10): 1799-807.AcknowledgementsThis study was endorsed by the international PMR/GCA study group.Disclosure of InterestsAgnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis, Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Ib Hansen: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Tamer A Gheita: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Karen Douglas: None declared, Richard Conway Speakers bureau: Janssen, Roche, Sanofi, Abbvie,, Elena Rezus: None declared, Bhaskar Dasgupta: None declared, Sara Monti: None declared, Eric Matteson Consultant of: Boehringer-Ingelheim,, Grant/research support from: Boehringer Ingelheim,, Sebastian E. Sattui Grant/research support from: AstraZeneca, Mark Matza: None declared, Vanessa Ocampo Speakers bureau: Abbvie, Andrea Bran: None declared, Simone Appenzeller Grant/research support from: GSK, Annelise Goecke Speakers bureau: Abbvie, Boehringer Ingelheim, Recalcine. Consultant Abbvie, Boehringer Ingelheim, NELLY COLMAN MC LEOD Speakers bureau: Laboratorios FAPASA (Farmacéutica Paraguay), Helen Keen Speakers bureau: Roche, Abbvie, Masataka Kuwana: None declared, Latika Gupta: None declared, Babur Salim: None declared, Ghita Harifi Speakers bureau: Abvie, Johnson and johnson, Lilly, Novartis, Mariama Erraoui: None declared, Nelly Ziade Speakers bureau: Abbvie, Eli Lilly, Janssen, Pfizer, Pierre Fabre, Roche, Novartis, Sanofi-Aventis, Paid instructor for: Abbvie, Eli Lilly, Sanofi-Aventis, Pfizer, Janssen, Novartis., Consultant of: Abbvie, Eli Lilly, Janssen, Pfizer, Roche, Novartis, Sandoz, Grant/research support from: Abbvie, Celgene - Algorithm, Bristol-Myers Squibb - NewBridge, Pfizer, Nizar Abdulateef Al-Ani: None declared, Adeola Ajibade: None declared, Johannes Knitza: None declared, Line Frølund: None declared, Max Yates: None declared, Victor Pimentel-Quiroz: None declared, Andre Lyrio: None declared, Maria Sandovici: None declared, Kornelis van der Geest Speakers bureau: Roche, Toby Helliwell Grant/research support from: Valneva, Elisabeth Brouwer Speakers bureau: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared
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Overgaard Donskov A, Mackie S, Hauge EM, Toro Gutiérrez C, Hemmig A, Van der Maas A, Dalsgaard Nielsen B, Hansen I, Yates M, Frølund L, Douglas K, Van der Geest K, Rezus E, Monti S, Gromova M, Ocampo V, Appenzeller S, Erraoui M, Ajibade A, Marun Lyrio A, Grainger R, Sandovici M, Helliwell T, Brouwer E, Dejaco C, Keller K. AB0583 REFERRAL PATTERN AND TREATMENT OF POLYMYALGIA RHEUMATICA IN GENERAL PRACTICE: AN INTERNATIONAL QUESTIONNAIRE BASED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn most countries polymyalgia rheumatica (PMR) is diagnosed and managed by both general practitioners (GP) and rheumatologists. However, the referral pattern from GP’s to specialist around the world has not been described. The initial prednisolone dose recommended by EULAR/ACR is between 12.5 and 25 mg1, but little is known about whether these guidelines are followed everywhere by GP’s in clinical practice2.ObjectivesThis study aims to describe the refererral pattern and treatment strategy for PMR in general practice in several countries worldwide.MethodsAn English language questionnaire was drafted by a working group of rheumatologists and GP’s from 6 different countries. The questionnaire contained questions on: 1: Respondent, 2: Referral pattern and 3: Prednisolone. Questionnaires were distributed to GP’s via members of the International PMR/GCA study group. Answers were collected via an online survey tool (Redcap), from 3rd of November 2021 to 27th of January 2022. Countries with more than 15 responders to the questionnaire were included in the analysis.ResultsData from 11 countries were analysed. Referral patterns differed widely among countries (Table 1). Almost all patients initially seen by rheumatologists were returned to GP’s for treatment. In all countries a proportion of the GP’s prescribed higher initial prednisolone doses than recommended, with a large variation between countries (Table 1).Table 1.Characteristics of responders, referral pattern, and treatment strategyAustriaCanadaColombiaDenmarkItalyNether-landsNew ZealandRomaniaRussiaSwitzer-landUnited KingdomRespondersResponders (n), Completed questionnaire (total)26 (29)15 (15)17 (23)53 (53)36 (41)22 (22)17 (17)37 (43)42 (49)26 (26)34 (35)Experience (years)20 (12-34)8 (4-10)6 (4-9)12 (10-17)15 (5-27)23 (17-30)14 (9-27)21 (16-30)6 (5-9)26 (15-32)16 (11-24)Available PMR/GCA guideline, n (%)26 (100)15(100)17 (100)53 (100)36 (100)22 (100)17 (100)37 (100)42 (100)26 (100)34 (100)Adherence to guideline, n (%)21 (82)15 (100)17 (100)51 (97)34 (94)21 (95)17 (100)37 (100)42 (100)26 (100)34 (100)ReferralsNew PMR patients referred for diagnose (%)58 (10-100)50 (2-100)100 (13-100)50-(20-100)60 (28-100)20 (10-50)10 (10-20)60 (10-88)1 (1-2)28 (10-50)10 (1-25)Patients returned to GP for treatment (%)100 (50-100)50 (2-100)8 (0-50)85 (40-100)50 (0-100)50 (10-90)100 (90-100)80 (50-98)1 (1-1)80 (10-100)100 (100-100)Patients referred during treatment (%)50 (25-90)50 (10-100)100 (50-100)20 (10-33)50 (15-80)15 (10-30)20 (10-25)30 (10-80)1(1-1)20 (10-30)10 (10-20)PrednisoloneInitial dose (mg)38 (25-50)20 (20-50)20 (10-30)25 (15-40)25 (25-25)15 (15-15)20 (15-40)15 (12-20)15 (15-15)50 (25-50)15 (15-20)Initial dose > 25 mg, n (%)12 (47)4 (25)7 (40)14 (26)9 (25)1 (5)6 (38)7 (20)3 (8)22 (83)3 (9)Duration of treatment (months)9 (6-12)6 (2-9)6 (4-24)12 (8-18)5 (3-12)11 (6-12)12 (10-18)2 (2-5)6 (6-6)12 (12-14)15 (12-24)Data are presented as weighted median (interquartile range) unless otherwise stated. GP: general practitioner, PMR: polymyalgia rheumatica, GCA: great cell arteritis.ConclusionAlthough many patients were referred to the hospital for initial PMR diagnosis or during the disease course, a large proportion of patients received treatment in general practice worldwide. GPs frequently use a higher starting dose of prednisolone and shorter treatment duration than recommended by EULAR/ACR.References[1]Dejaco C, Singh YP, Perel P, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the rheumatic diseases 2015; 74(10): 1799-807.[2]Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. The British journal of general practice: the journal of the Royal College of General Practitioners 2013; 63(610): e361-6.AcknowledgementsThis study was endorsed by the international PMR/GCA study group.Disclosure of InterestsAgnete Overgaard Donskov: None declared, Sarah Mackie: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis,Celgene, MSD, Pfizer, Roche, Sobi, CARLOS TORO GUTIÉRREZ: None declared, Andrea Hemmig: None declared, Aatke van der Maas: None declared, Berit Dalsgaard NIelsen Paid instructor for: Roche, Ib Hansen: None declared, Max Yates: None declared, Line Frølund: None declared, Karen Douglas: None declared, Kornelis van der Geest Speakers bureau: Roche, Elena Rezus: None declared, Sara Monti: None declared, Margarita Gromova: None declared, Vanessa Ocampo Speakers bureau: Abvie, Simone Appenzeller Speakers bureau: Janssen, UCB, Lilly and Pfizer, Mariama Erraoui: None declared, Adeola Ajibade: None declared, Andre Marun Lyrio: None declared, Rebecca Grainger: None declared, Maria Sandovici: None declared, Toby Helliwell: None declared, Elisabeth Brouwer Speakers bureau: Roche, Consultant of: Roche, Christian Dejaco Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Abbvie, Eli Lilly, Janssen, Roche, Galapagos and Sanofi, Kresten Keller: None declared
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Blavnsfeldt ABG, Klose-Jensen R, Therkildsen J, Keller K, Hansen SG, Langdahl B, Hauge EM. POS0595 THE ASSOCIATION BETWEEN AXIAL AND PERIPHERAL BONE IN PATIENTS WITH RHEUMATOID ARTHRITIS, INCLUDING THE IMPACT OF EROSIVE DISEASE. A HR-pQCT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe severity of Rheumatoid Arthritis (RA) is associated with increased fracture risk (1). Areal bone mineral density (aBMD) by dual-energy absorptiometry (DXA) is the gold standard for diagnosis of osteoporosis as well as fracture risk assessment. High resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius yields volumetric BMD (vBMD) of trabecular and cortical bone compartments, as well as micro-architectural parameters and may prove useful for fracture risk prediction. The association between aBMD by DXA and HR-pQCT derived vBMD and microarchitecture have only been sparsely investigated in patients with RA, and it is not known if erosive disease, measured by the gold standard Heijde-modified Sharp Scores (HSS) (2) affects HR-pQCT derived parameters.ObjectivesTo assess the associations between aBMD by DXA and bone parameters of the distal radius by HR-pQCT, in both male and female patients with RA, and the impact of erosive disease on the bone parameters of the distal radius.MethodsWe measured aBMD by DXA of the lumbar spine and hip, HR-pQCT of the distal radius and assessed HSS in 162 patients with RA. Using multivariate linear regression models, we explored the association between HSS and HR-pQCT parameters, adjusted for sex and age. The associations between aBMD by DXA and vBMD and microarchitecture by HR-pQCT were assessed by Spearman correlation coefficients, interpreted as negligeable (0.00-0.10), weak (0.10-0.39), moderate (0.40-0.69), strong (0.70-0.89) or very strong (0.90-1.00).ResultsMean age for the included patients was 63 years, 75% were women and median disease duration was 18 years. Erosive disease (HSS) was negatively associated with trabecular number and density, but not with cortical bone parameters. This association was stronger for HSS of the wrist joints, than for HSS of the hands and total HSS (Table 1). Trabecular density of the distal radius correlated moderately with aBMD at the total hip, and weakly with aBMD at the lumbar spine. Trabecular numbers also correlated moderately with aBMD at the total hip. Cortical bone parameters at the distal radius correlated weakly with aBMD at the hip, but only among women.Table 1.Multivariate linear regression model exploring the effect of Heijde-modified Sharp Score on selected HR-pQCT (distal radius) parameters, adjusted for age and sex.R2Effectp-valueHSS total (n=146)Tt. BMD (mg HA/cm3)0.129-0.0520.519Ct. BMD (mg HA/cm3)0.1380.0600.642Ct. Th (mm)0.0960.0010.084Tb. BMD (mg HA/cm3)0.284-0.173<0.001Tb. N (1/mm)0.319-0.003<0.001HSS of the hands (n=145)Tt. BMD (mg HA/cm3)0.124-0.0730.522Ct. BMD (mg HA/cm3)0.1320.0460.801Ct. Th (mm)0.0870.0010.122Tb. BMD (mg HA/cm3)0.279-0.2420.001Tb. N (1/mm)0.324-0.005<0.001HSS of the wrists (n=146)Tt. BMD (mg HA/cm3)0.127-0.1210.614Ct. BMD (mg HA/cm3)0.136-0.0290.939Ct. Th (mm)0.0890.0010.158Tb. BMD (mg HA/cm3)0.273-0.4670.003Tb. N (1/mm)0.311-0.010<0.001HR-pQCT: high resolution peripheral quantitative computed tomography,HSS: Heijde-modified Sharp Score, Tt.: total, Ct.: cortical, Tb.: trabecular, BMD: bone mineral density, HA: hydroxyappatite, Th.: Thickness, N: numberConclusionAmong patients with RA, the correlation between axial and peripheral bone is strongest between trabecular bone parameters of the radius and aBMD at the hip, which suggests that prediction of hip fractures is maintained. However, the degree of erosive disease negatively impacts the trabecular bone parameters. This may potentially interfere with the hip fracture prediction abilities of HR-pQCT in patients with high degree of erosive disease.References[1]L. Dirven, M. van den Broek, J. H. van Groenendael et al. Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis. BMC Musculoskeletal Disorders 2012;13: 125.[2]van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. The Journal of rheumatology. 2000;27(1):261-3.Disclosure of InterestsAnne-Birgitte Garm Blavnsfeldt: None declared, Rasmus Klose-Jensen: None declared, Josephine Therkildsen: None declared, Kresten Keller: None declared, Stinus Gadegaard Hansen: None declared, Bente Langdahl Speakers bureau: Amgen, UCB, Eli Lilly, Gedeon-Richter, Astellas, Consultant of: Amgen, UCB, Eli Lilly, Gedeon-Richter, Astellas, Grant/research support from: Amgen, Novo Nordisk, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Novartis, Celgene, MSD, Pfizer, Roche, Sobi
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Nielsen BD, Therkildsen P, Keller K, Gormsen LC, Hansen I, Hauge EM. OP0186 SENSITIVITY TO CHANGE OF DIFFERENT ULTRASOUND SCORES IN A PROSPECTIVE FOLLOW-UP OF NEW-ONSET TREATMENT-NAÏVE GCA PATIENTS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe role of ultrasound (US) for monitoring giant cell arteritis (GCA) is not clarified. Follow-up assessment of number of halos (halo count) and different quantitative scores based on intima media complex (IMC) measurement of halos, have demonstrated potential to show sensitivity to change(STC)12. Including IMC of normalized arteries in such scores may reduce the risk of missing new arteritic lesions and assessment bias towards a response.We aimed to evaluate US scores based on halo features and scores based on IMT measurements of all assessed arteries.ObjectivesTo compare different US score’s 1) STC after institution of treatment and 2) correlation with disease activity.MethodsIn a prospective cohort of new-onset GCA patient, pre-treatment diagnostic evaluation including US and PET/CT and subsequently temporal artery biopsy (TAB) was performed per protocol. All patients were started on 60 mg of prednisolone and followed a routine tapering. Follow-up visits including clinical evaluation, blood tests, US, the physician’s and patient’s global NRS (0-10) were performed after 8 weeks, 24 weeks and in a subgroup (n=24) at 15 months. US of temporal, carotid and axillary arteries included assessment of halo and IMC measurement in all arteries.For each visit, max IMC, max halo IMC, sum IMC, sum halo IMC, mean IMC and halo count were calculated for all and for temporal (TA) and large vessels (LV) separately. Accordingly, halo IMC scores only included positive arteries whereas other IMC scores included all arteries assessed.The change from baseline was assessed by Student’s t-test. Standard response means (SRM=meanΔ(visit-baseline)/SEΔ) were computed for each timepoint as STC estimates. Correlation with disease activity markers was assessed by Spearman’s correlation. A p<0.05 was considered statistically significant.ResultsIn total 47 patients were included (60% women, mean (CI) age 67 (62-69) years, mean (CI) CRP 75 (63-89)). Baseline US was positive(+) in 94% (72% TA+, 72% LV+), PET/CT+ in 96% (77% cranial arteries, 85% large vessel vasculitis) and TAB+ in 72% of patients. All patients completed the per protocol planned follow-up visits. Two patients experienced a relapse at week 8 and 10 patients at week 24.All US outcomes improved during follow-up and was apparent by week 8 (Table 1) and forward. However, only scores including TA consistently showed statistically significant change from baseline to follow-up. In accordance the magnitude of change as expressed by SRM was large in TA, whereas SRM in LV was small (Figure 1).All TA based US scores showed significant moderate-strong correlation with disease activity markers (CRP, patient and physician global NRS). Some LV based US scored showed weak correlation with CRP but otherwise did not correlate with clinical disease activity.Figure 1.Table 1.US score changes during follow-upBaseline (IQR)Δw8 (SE)Δw24 (SE)Δm15 (SE)Halo countTA2 (0-4)-1.68 (.28)-1.70 (.30)-2.63 (.37)LV1 (0-2)-0.04 (.11)0.00 (.11)0.00 (.31)Total4 (2-6)-1.72 (.33)-1.70 (.34)-2.63 (.36)Sum IMCTA0.8 (0-1.8)-0.72 (.08)-0.69 (.11)-0.76 (.19)LV1.5 (0-2.8)-0.33 (.12)-0.13 (.11)-0.33 (.21)Total2.6 (1.6-4.4)-1.05 (.14)-0.81 (.15)-1.09 (.29)Sum halo IMCTA1.9 (1.6-2.5)-0.90 (.14)-0.90 (.17)-1.29 (.23)LV3.5 (2.8-4.0)-0.33 (.17)-0.15 (.14)-0.47 (.39)Total5.5 (4.6-6.3)-1.23 (.24)-1.04 (.24)-1.76 (.35)Max IMCTA0.5 (0.4-0.6)-0.17 (.03)-0.14 (.03)-0.17 (.05)LV1.2 (0.9-1.6)-0.16 (.06)-0.04 (.05)-0.20 (.09)Max halo IMCTA0.5 (0-0,6)-0.29 (.04)-0.26 (.05)-0.40 (.05)LV1.2 (0-1.6)-0.27 (.09)-0.09 (.08)-0.23 (.17)Mean IMCTA0.32 (0.27-0.43)-0.11 (.01)-0.10 (.02)-0.13 (.03)LV0.88 (0.7-1.03)-0.9 (0.3)-0.04 (.03)-0.10 (.05)Baseline medians, Δ mean difference from baseline. Bold indicates p<0.05.ConclusionSTC was maintained in US scores that included all assessed arteries hereby reducing potential assessment bias. These findings confirm US as a potential tool for monitoring treatment response.References[1]Ponte C, et al. Ann Rheum Dis 2021[2]Seitz L, et al. Rheumatology 2021AcknowledgementsThe authors would like to thank Morten Frydenberg for statistical support.Disclosure of InterestsBerit Dalsgaard Nielsen Speakers bureau: Roche, Paid instructor for: Roche, Consultant of: Sanofi, Philip Therkildsen: None declared, Kresten Keller: None declared, Lars Christian Gormsen: None declared, Ib Hansen: None declared, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: funding to Aarhus University Hospital from Roche, Novartis, Abbvie
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Meinhardsson J, Klose-Jensen R, Therkildsen J, Langdahl B, Hauge EM, Keller K. POS0133 HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY FOR THE EVALUATION OF BONE EROSIONS OF METATARSOPHALANGEAL JOINTS IN RHEUMATOID ARTHRITIS: A PILOT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundBone erosion in rheumatoid arthritis (RA) is most commonly detected in the wrist, metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints. High-resolution peripheral quantitative computed tomography (HR-pQCT) has successfully been used to quantify bone erosions in the wrist and MCP joints. A recent study highlights that HR-pQCT of only two MCP joints has equal accuracy to detect erosive disease in RA patients compared to conventional radiography (CR) of the hands, wrists, and feet (44 joints)1. However, no study has evaluated the MTP joints by HR-pQCT.ObjectivesTo characterize the localization, size and frequency of erosions in the 4th and 5th MTP joints. Furthermore, to evaluate the sensitivity for the detection of erosion in the 4th and 5th MTP joints by HR-pQCT, compared to CR.MethodsThis single-centre cross-sectional study included 42 patients with established RA (disease duration ≥ 5 years). The right foot was imaged by HR-pQCT in a 2.7 cm long region corresponding to the 4th and 5th MTP joint. Blinded to patient data, the number and volume of bone erosions by HR-pQCT were measured and scored according to the SPECTRA criteria2. CR of 44 joints was evaluated according to the Sharp/van der Heijde (SHS) method.ResultsThe patients (62% women) had a median disease duration of 12 years (interquartile range (IQR): 7 – 20). HR-pQCT of the 4th and 5th MTP joints identified erosions in 38 (90%) patients. The total erosion volume (Vtot) was 2610 mm3 in all quadrants of the 4th and 5th MTP joints. Erosions were most frequently found at the lateral aspect of the 5th metatarsal head (MH), including 1261 mm3 (48%) of Vtot (Figure 1). CR of 44 joints detected erosions in 30 (71%) patients with a median SHS erosion score of 9 (5 – 28). The sensitivity and specificity (95% CI) of classifying patients with erosive RA by HR-pQCT and CR is displayed in Table 1. McNemar’s χ2 test showed a significantly higher sensitivity of patients classified as having erosive RA by HR-pQCT of the 4th and 5th MTP joints than by CR of 44 joints (4.6, p = 0.03).Table 1.Comparing CR and HR-pQCT for classifying patients as having erosive RA, and for identifying erosions in the 4th and 5th MTP joints.Sensitivity & specificity of classifying patients with erosive RA by HR-pQCT when CR of the hands, wrist and feet was used as referenceCRHands, wrists, and feet Erosive RACRHands, wrists, and feetNon-erosive RATotalSensitivity (95% CI)HR-pQCT4th and 5th MTP jointsErosive RA27113890.0 (73.5 – 97.9)Specificity (95% CI)HR-pQCT 4th and 5th MTP joints Non-erosive RA3148.3 (0.2 – 38.5)Total301242Sensitivity & specificity of classifying patients with erosive RA by CR when HR-pQCT was used as referenceHR-pQCT4th and 5th MTP jointsErosive RAHR-pQCT4th and 5th MTP jointsNon-erosive RATotalSensitivity (95% CI)CRHands, wrists, and feetErosive RA2733071.0 (54.1 – 84.6)Specificity (95% CI)CRHands, wrists, and feetNon-erosive RA1111225.0 (0.6 – 80.6)Total38442Conventional Radiography (CR), High-resolution peripheral Quantitative Computed Tomography (HR-pQCT), Metatarsophalangeal (MTP), Rheumatoid Arthritis (RA), Confidence Interval (CI).ConclusionThis is the first study to evaluate erosions with HR-pQCT of the 4th and 5th MTP joints, including a comparison to CR. Erosions were frequent at the lateral aspect of the MTP joints, suggesting that mechanical and biomechanical demands may play a role in the development of erosions in the MTP joints. The superiority of HR-pQCT compared to CR for detecting erosions provide a basis for larger studies assessing bone changes in the MTP joints.References[1]Klose-Jensen, R., et al. Diagnostic accuracy of high-resolution peripheral quantitative computed tomography and X-ray for classifying erosive rheumatoid arthritis. Rheumatology (Oxford) (2021).[2]Barnabe, C., et al. Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement. J Rheumatol43, 1935-1940 (2016).Disclosure of InterestsJørgen Meinhardsson: None declared, Rasmus Klose-Jensen: None declared, Josephine Therkildsen: None declared, Bente Langdahl Speakers bureau: UCB, Amgen, Eli Lilly, Gedeon-Richter, Gilead, Astellas, Consultant of: UCB, Amgen, Eli Lilly, Gedeon-Richter, Gilead, Astellas, Grant/research support from: Amgen and Novo Nordisk, Ellen-Margrethe Hauge Speakers bureau: AbbVie, Sanofi, Sobi, MSD, UCB, Consultant of: AbbVie, Sanofi, Sobi, MSD, UCB, Grant/research support from: Novo Nordic Foundation, Danish Rheumatism Association, Danish Regions Medicine Grants, Roche, Novartis, Kresten Keller: None declared
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Therkildsen J, Klose-Jensen R, Blavnsfeldt AB, Langdahl B, Zejden A, Thygesen J, Keller K, Hauge EM. POS0526 HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY AND PREDICTION OF EROSIVE PROGRESSION AS ASSESSED BY THE GOLD STANDARD CONVENTIONAL RADIOGRAPHY IN ESTABLISHED RHEUMATOID ARTHRITIS: A 1-YEAR COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHigh-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) is a promising imaging technique for assessing erosive disease in rheumatoid arthritis (RA). We have shown that the diagnostic accuracy in detecting erosive disease of HR-pQCT of two joints corresponds to conventional radiography (CR) of 44 joints in established RA (1). No data assessing HR-pQCT as a tool for predicting erosive radiographic progression in a large cohort of established RA has been published.ObjectivesTo assess the association between erosive disease identified using either CR or HR-pQCT at baseline and erosive progression using CR during 1-year follow-up in established RA.MethodsThis observational cohort study included 220 patients with RA (disease duration ≥ 5 yrs) at the Department of Rheumatology, Aarhus University Hospital, between Mar. 2018 and Oct. 2020. All participants had demographic information collected, together with HR-pQCT at baseline and CR made at baseline and 1-year follow-up. Erosive assessment using HR-pQCT was performed at the second and third metacarpophalangeal (MCP) joint (2). The Sharp/van der Heijde score (SHS) method was used to assess erosive status and erosive progression using CR of hands, wrists and feet (3).ResultsIn total, 220 participants with RA (median age 66 yrs, interquartile range (IQR) 57-72; 71% women) were included and 212 completed their follow-up visit in Dec. 2021 (dropout n=8 (4 %)). During follow-up (median 1 yrs, range 0.7-1.4), erosive progression on CR was detected in 24 of 211 (11%) (missing baseline CR, n=1). Characteristics of the study population by erosive progression are shown in Table 1. In unadjusted regression analyses, number of erosions on HR-pQCT at baseline and erosion score (per 10) using CR at baseline were associated with erosive progression (yes/no) on CR at 1-year (Odds ratio (OR) 1.1; 95%CI 1.0-1.1; p<.05 and OR 1.1; 95%CI 1.0-1.2; p<.01). After adjusting for age and sex, erosion score remained associated with erosive progression (OR 1.1; 95%CI 1.1-1.2; p<.01), but number of erosions did not (OR 1.0; 95%CI 1.0-1.1; p=.07).Table 1.Demographics at baselineProgression on CRNo progression on CRP valueNo24/211 (11)187/211 (89)Age, yrs66 (57-73)66 (57-71).80Women15/24 (63)134/187 (72).35Disease Duration, yrs20 (8-28)15 (9-23).44DAS28-CRP1.7 (1.5-2.5)1.8 (1.5-2.5).53Erosive on CR24/24 (100)141/187 (75)< .01Erosive 2nd/3rdMCP on CR*17/23 (74)62/185 (34)< .001Erosive on HR-pQCT22/23 (96)153/185 (83).14Erosion score (per 10)4 (2-7)1 (0-3)< .0001Erosion number10 (5-17)3 (1-10)< .01Total erosion volume, mm3128 (19-201)26 (2-111)< .05Data are no. (%) or median with interquartile range. P-values: Mann-Whitney U or Fisher’s exact test. Missing HR-pQCT, n=3. CR = conventional radiography, DAS28-CRP = disease activity score of 28 joints based on C-reactive protein, HR-pQCT = high-resolution peripheral quantitative computed tomography* Same hand as HR-pQCT scannedConclusionIn established RA, baseline CR of 44 joints is superior to baseline HR-pQCT of two joints in identifying individuals at risk of erosive progression on CR. This underlines the need for a head-to-head comparison between progression identified by HR-pQCT and CR to fully assess the clinical utility of HR-pQCT in predicting erosive progression compared to CR.References[1]Klose-Jensen R, Therkildsen J, Blavnsfeldt AG, et al. Diagnostic accuracy of high-resolution peripheral quantitative computed tomography and X-ray for classifying erosive rheumatoid arthritis. Rheumatology (Oxford, England). 2021[2]Barnabe C, Feehan L. High-resolution peripheral quantitative computed tomography imaging protocol for metacarpophalangeal joints in inflammatory arthritis: the SPECTRA collaboration. The Journal of rheumatology. 2012;39(7):1494-5[3]van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. The Journal of rheumatology. 2000;27(1):261-3AcknowledgementsThe Danish Rheumatism Association (R179-A6365-B1668), The Health Research Foundation of Central Denmark Region (R64-A3145-B1504 and R49-A2254-B1504), The Novo Nordic Founda-tion, A.P. Møller Fonden, The Becket fund (20-2-5756), The Aase and Einar Danielsens fund (20-10-0254), The Family Hede Nielsens fund, The Grosserer L.F. Foghts fund and Aarhus University funded this project. The authors would like to thank all study participants and the clinical staff involved in this project.Disclosure of InterestsJosephine Therkildsen: None declared, Rasmus Klose-Jensen: None declared, Anne-Birgitte Blavnsfeldt: None declared, Bente Langdahl Speakers bureau: BLL has received honorariums from Amgen, UCB, Eli Lilly, Gedeon-Richter and Astellas., Consultant of: BLL has worked as a consultant for Amgen, UCB, Gedeon-Richter, Eli Lilly and Gedeon., Grant/research support from: BLL has received financial grants from Amgen and the Novo Nordic Foundation., Anna Zejden: None declared, Jesper Thygesen: None declared, Kresten Keller: None declared, Ellen-Margrethe Hauge Speakers bureau: EMH has received honorariums and/or consulting fees from AbbVie, Sanofi, Sobi, and SynACT Pharma., Grant/research support from: EMH has received research grants to Aarhus University Hospital from Danish Regions Medicine Grants, Roche, Novartis, and the Novo Nordic Foundation.
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Keller K, Hobohm L, Ostad MA, Karbach S, Espinola-Klein C, Munzel T, Gelfand J, Konstantinides S, Steinbrink K, Gori T. Psoriasis and its impact on the clinical outcome of patients with pulmonary embolism. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2406] [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
Venous thromboembolism (VTE) is common and associated with high morbidity and mortality. Although chronic inflammation was not categorized as a traditional risk factor for VTE, chronic inflammation might increase the risk to develop VTE events.
While studies confirmed an increased cardiovascular morbidity and mortality in psoriatic patients, data regarding the influence of psoriasis on patients' cardiovascular profile and on prognosis of patients with pulmonary embolism (PE) are sparse.
Purpose
We aimed to investigate the impact of psoriasis on prognosis of PE patients.
Methods
Hospitalized PE patients were stratified for psoriasis and the impact of psoriasis on outcome was investigated in the German nationwide inpatient sample of the years 2005–2017 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2017, own calculations).
Results
Overall, 1,076,384 hospitalizations of PE patients (53.7% females, median age 72.0 [60.0–80.0] years) were recorded in Germany 2005–2017. Among these, 3,145 patients were additionally coded with psoriasis (0.3%). Psoriatic PE patients were younger (68.0 [57.0–76.0] vs. 72.0 [60.0–80.0] years, P<0.001) and more often male (64.1% vs. 46.3%, P<0.001). The prevalence of VTE risk factors, traditional cardiovascular risk factors and cardiovascular comorbidities was higher in psoriatic than in non-psoriatic individuals: All investigated traditional cardiovascular risk factors such as essential arterial hypertension (49.8% vs. 43.1%, P<0.001), diabetes mellitus (24.4% vs. 18.7%, P<0.001), hyperlipidaemia (14.1% vs. 12.0%, P<0.001), as well as obesity (19.6% vs. 9.6%, P<0.001) and atherosclerotic comorbidities like coronary artery disease (15.2% vs. 13.8%, P=0.022) and peripheral artery disease (3.6% vs. 2.9%, P=0.010) were more prevalent in PE patients with psoriasis.
Psoriatic PE patients showed a lower in-hospital case-fatality rate (11.1% vs. 16.0%, P<0.001), confirmed by logistic regressions showing an independent association of psoriasis with reduced case-fatality rate (OR 0.73 [95% CI 0.65–0.82], P<0.001), despite higher prevalence of pneumonia (24.8% vs. 23.2%, P=0.029). Psoriasis was an independent predictor for gastro-intestinal bleeding (OR 1.35 [95% CI 1.04–1.75], P=0.023) and transfusion of blood constituents (OR 1.23 [95% CI 1.11–1.36], P<0.001).
Conclusions
Overall, only a minority (0.3%) of all PE cases were coded additionally with psoriasis. PE patients with psoriasis were hospitalized in median four years earlier than those without. Although psoriasis was associated with an unfavorable cardiovascular-risk and VTE-risk profile in PE patients, our data demonstrate a lower in-hospital mortality rate in psoriatic PE, which might be mainly driven by younger age. Our findings may improve the clinical management of these patients and contribute evidence for relevant systemic manifestation of psoriasis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Keller
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - L Hobohm
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - M A Ostad
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - S Karbach
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - C Espinola-Klein
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - J Gelfand
- University of Pennsylvania, Department of Dermatology, Philadelphia, United States of America
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - K Steinbrink
- University hospital Münster, Department of Dermatology, Muenster, Germany
| | - T Gori
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
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Geyer M, Schmitt VH, Keller K, Born S, Bachmann K, Schnitzler K, Hell MM, Tamm AR, Ruf TF, Kreidel F, Petrescu A, Da Rocha E Silva JG, Schulz E, Munzel T, Von Bardeleben RS. Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1640] [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
Introduction
Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse.
Purpose
To compare the outcome of patients with and without DM after TEER.
Methods
Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses.
Results
627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p<0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p<0.001), coronary artery disease (77.0% vs. 59.8%, p<0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p<0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110).
Conclusions
Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Geyer
- University Medical Center Mainz, Mainz, Germany
| | - V H Schmitt
- University Medical Center Mainz, Mainz, Germany
| | - K Keller
- University Medical Center Mainz, Mainz, Germany
| | - S Born
- University Medical Center Mainz, Mainz, Germany
| | - K Bachmann
- University Medical Center Mainz, Mainz, Germany
| | | | - M M Hell
- University Medical Center Mainz, Mainz, Germany
| | - A R Tamm
- University Medical Center Mainz, Mainz, Germany
| | - T F Ruf
- University Medical Center Mainz, Mainz, Germany
| | - F Kreidel
- University Medical Center Mainz, Mainz, Germany
| | - A Petrescu
- University Medical Center Mainz, Mainz, Germany
| | | | - E Schulz
- General Hospital of Celle, Celle, Germany
| | - T Munzel
- University Medical Center Mainz, Mainz, Germany
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Hobohm L, Schmitt VH, Munzel T, Konstantinides SV, Keller K. Case fatality rate and fatal bleeding complication in patients with pulmonary embolism and patent foramen ovale. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1900] [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
Objectives
In patients with acute pulmonary embolism (PE), right atrial pressure is elevated, which increases risk for right-to-left shunt when patent foramen ovale (PFO) is present and thus potentially increases risk for paradoxical embolism. Little is known about the clinical outcome of patients with PE and concomitant PFO.
Methods
We analysed data on patient characteristics, treatments and in-hospital outcomes for all PE patients (ICD-code I26) with concomitant presence of PFO in Germany 2005–2018 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, and own calculations).
Results
Between January 2005 and December 2018, 1,174,235 patients with acute PE (53.5% females) were included in this analysis; of those, 5,486 (0.5%) had a concomitant diagnosis of PFO. Trends analysis demonstrating an increasing frequency of diagnosed PE with additional PFO from 2005 (n=299) to 2018 (n=556; p<0.001). While patients with PE and PFO presented more often with signs of haemodynamic compromise such RV dysfunction (37.6% vs. 28.5%) or shock (7.1% vs. 3.9%) as well as paradox arterial emboli (47.8% vs. 3.2%) or intracerebral bleeding (3.3% vs. 0.6%), PE patients with PFO died less often compared to PE patients without PFO (11.1% vs. 15.8%). Patients with PE and PFO were younger (65 [IQR 52–75] vs. 72 [60–80]; P<0.001) and were more often treated invasively with a reperfusion treatment approach like embolectomy (10.2% vs. 4.2%) or systemic thrombolysis (5.0% vs 0.1%). A multivariate logistic regression analysis revealed a 27.6-fold increased risk for paradox arterial emboli (OR, 27.6 [95% CI 26.1–29.1]; p<0.001) and a 3.9-fold increased risk for intracerebral bleeding events (OR, 3.9 [95% CI 3.3–4.54]; p<0.001) for patients with PE and concomitant PFO. In normotensive patients with RVD and PFO, embolectomy were not associated to affect the rate of intracerebral bleeding events (OR, 0.8 [95% CI 0.2–2.6]; p=0.720) compared to conventional non-reperfusion treatment; instead of systemic thrombolysis, which is associated with a higher risk of intracerebral bleeding (OR, 3.5 [95% CI 1.8–6.59]; p<0.001) compared to conventional non-reperfusion treatment.
Conclusion
Patients with acute PE and the concomitant presence of PFO are associated with a high risk for paradox arterial emboli and intracranial bleeding events. Especially in normotensive patients, the use of systemic thrombolysis should be considered with cautious. Thus, our findings may improve the clinical management of patients with PE and PFO.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Hobohm
- University Medical Center of Mainz, Mainz, Germany
| | - V H Schmitt
- University Medical Center of Mainz, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Mainz, Germany
| | - S V Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Keller
- University Medical Center of Mainz, Mainz, Germany
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Goebel S, Hobohm L, Desuki A, Gori T, Muenzel T, Rapezzi C, Wenzel P, Keller K. Impact of cardiac amyloidosis on outcomes of patients hospitalized with heart failure in Germany. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1019] [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
Amyloidosis is a multi-systemic disease resulting from deposition of misfolded proteins as insoluble fibrils in the interstitium of affected organs including the heart, subsequently leading to organ failure. Cardiac involvement is predominantly observed in light chain (AL) amyloidosis and wild-type transthyretin (ATTRwt) amyloidosis.
Purpose
We aimed to investigate prevalence and prognostic implications of cardiac amyloidosis of any etiology on outcomes of hospitalized patients with heart failure (HF) in Germany.
Methods
We analyzed data of the German nationwide inpatient sample (2005–2018) of patients hospitalized for HF (including myocarditis with HF and heart transplantation with HF). HF patients with amyloidosis (defined as cardiac amyloidosis [CA]) were compared with those HF patients without amyloidosis and impact of CA on outcomes was assessed (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, and own calculations).
Results
During this fourteen-year observational period 5,478,835 hospitalizations of HF patients were analyzed. Amyloidosis was coded in 5,407 hospitalizations of HF patients (0.1%). Prevalence of CA was 1.87 hospitalizations per 100,000 German population. CA patients were younger (75.0 [IQR 67.0/80.0] vs. 79.0 [72.0–85.0] years, p<0.001), predominantly male (68.9%) and had a higher prevalence of cancer (14.8% vs. 3.6%, P<0.001) compared with HF without amyloidosis. Although patients without amyloidosis had a pronounced cardiovascular risk profile -especially arterial hypertension (45.4% vs. 35.6%; p<0.001) and diabetes mellitus (38.9% vs. 18.5%; p<0.001)- and a higher prevalence of concomitant coronary artery disease (40.5% vs. 34.5%; p<0.001) and chronic obstructive pulmonary disease (17.1% vs. 9.4%; p<0.001), adverse in-hospital events including necessity of transfusions of blood constituents (7.1% vs. 5.4%, p<0.001) and cardio-pulmonary resuscitation (CPR, 2.7% vs. 1.4%; p<0.001) were more frequent in CA. CA was independently associated with acute kidney failure (OR 1.40 [95% CI 1.28–1.52], p<0.001), CPR (OR 1.58 [95% CI 1.34–1.86], p<0.001), intracerebral bleeding (OR 3.13 [95% CI 1.68–5.83], p<0.001) and in-hospital mortality in the 6th and 8th decade of life (6thdecade: OR 1.40 [95% CI 1.01–1.94], p=0.042; 8thdecade: OR 1.18 [95% CI 1.03–1.35], p=0.02).
Conclusions
CA was identified as an independent risk factor for complications and in-hospital mortality in HF patients. Physicians should be aware of this issue concerning treatments and monitoring of CA-patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Goebel
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
| | - L Hobohm
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
| | - A Desuki
- University Cancer Center, Mainz, Germany
| | - T Gori
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
| | - T Muenzel
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
| | - C Rapezzi
- Cardiological Centre, University of Ferrara, Ferrara, Italy
| | - P Wenzel
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
| | - K Keller
- University Medical Center Mainz, Department of Cardiology, Mainz, Germany
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24
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Schwuchow-Thonke S, Göbel S, Emrich T, Schmitt VH, Fueting F, Klank C, Escher F, Schultheiss HP, Münzel T, Keller K, Wenzel P. Increased C reactive protein, cardiac troponin I and GLS are associated with myocardial inflammation in patients with non-ischemic heart failure. Sci Rep 2021; 11:3008. [PMID: 33542341 PMCID: PMC7862434 DOI: 10.1038/s41598-021-82592-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 [IQR 43/64], 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3+ lymphocytes/mm2 and/or ≥ 35.0 Mac1 macrophages/mm2 and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 [95%CI 1.160–3.397]; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 [1.215–7.464]; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 [0.873–3.757]; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74–0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
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Affiliation(s)
- S Schwuchow-Thonke
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - S Göbel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - T Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
| | - V H Schmitt
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Fueting
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Klank
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Escher
- Departement of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - H P Schultheiss
- Institut Kardiale Diagnostik Und Therapie (IKDT), Moltkestrasse 31, 12203, Berlin, Germany
| | - T Münzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - K Keller
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - P Wenzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany. .,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
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Goebel S, Hobohm L, Gori T, Ostad M, Muenzel T, Wenzel P, Keller K. Temporal trends, sex-differences and outcomes of patients hospitalized for heart failure in Germany. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0976] [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 remarkable improvements in treatment of cardiovascular disease, heart failure (HF) is still characterized by a high mortality rate. Sex-specific differences in HF have been described, but underlying reasons are widely unexplored. Thus, we aimed to investigate sex differences of patients hospitalized for HF in a nationwide cohort.
Methods
The nationwide German inpatient sample (2005–2016) was used for this sex-specific analyses. Temporal trends on hospitalizations, mortality, and treatments were analyzed and independent predictors of adverse outcomes identified.
Results
The present analysis comprises 4,538,977 hospitalizations due to HF (52.0%women) in Germany (2005–2016). Although women were older (median 82 (IQR75–87) vs. 76 (69–82), P<0.001), coronary artery disease (CAD, 50.3% vs. 30.7%, P<0.001) was more prevalent in men, who were more often treated with PCI (3.4% vs. 1.4%, P<0.001) and implantable cardioverter-defibrillator (2.2% vs. 0.5%, P<0.001). In-hospital mortality was significantly lower in men than in women (8.9% vs. 10.2, P=0.001) and was reduced in patients who received PCI or implantation of an ICD.
While total numbers of hospitalizations between 2005 and 2016 increased in both men (β-estimate 7185.71 (95% CI 6502.23 to 7869.18), P<0.001) and women (β-estimate 5297.60 (95% CI 4557.37 to 6037.83), P<0.001) as well as almost all comorbid co-conditions, in-hospital mortality rate decreased more distinctly in women (β-estimate −0.41 (95% CI: −0.42 to −0.39), P<0.001) compared to men (β-estimate −0.29 (95% CI: −0.30 to −0.27), P<0.001).
Conclusions
Interventional treatments of HF were associated with improved outcomes and equally beneficial for both sexes. However, they were more often used in male HF patients, in which CAD is significantly more frequent than in female HF patients. This may explain the higher case fatality rate of HF in females.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research (BMBF)
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Affiliation(s)
- S Goebel
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - L Hobohm
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - T Gori
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - M.A Ostad
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - T Muenzel
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - P Wenzel
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
| | - K Keller
- University Medical Center Mainz, Department of Cardiology and Angiology, Mainz, Germany
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Geyer M, Keller K, Ruf T, Kreidel F, Petrescu A, Tamm A, Born S, Bachmann K, Hahad O, Beiras-Fernandez A, Kornberger A, Schulz E, Munzel T, Von Bardeleben R. Impact of tricuspid valve regurgitation severity and its secondary reduction on long-term survival after transcatheter mitral valve edge-to-edge repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2634] [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
Mitral valve regurgitation (MR) is a frequent heart valve disorder affecting 1–2% of the humans in the general population and over 10% of the individuals older than 75 years. While a symptomatic and prognostic benefit of transcatheter edge-to-edge repair for MR (TMVR) was reported, data regarding long-term outcome as well as influence of concomitant tricuspid regurgitation (TR) are sparse.
Purpose
We aimed to investigate the impact of periinterventional development of TR on survival of patients undergoing interventional edge-to-edge repair for MR in a large retrospective monocentric study.
Methods
We retrospectively analyzed survival of patients successfully treated with isolated edge-to-edge repair for MR from 06/2010–03/2018 (exclusion of combined forms of TMVR) in our center. Baseline, periprocedural as well as follow-up data were gathered. Concomitant TR was evaluated at baseline and after 30 days and categorized from grades 0 (no TR) to grade III (severe TR). We analyzed the influence of severe vs. non-severe TR on 30-day, 1-year and long-term survival.
Results
Overall, 627 consecutive patients (47.0% female, 57.4% functional MR) were enrolled. Median follow-up time was 462 days [IQR 142–945]. Survival status was available in 96.7%. Survival rates were 97.6% at discharge, 75.7% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7 years.
TR at baseline (examination results were available in 92.3%) was categorized as severe TR in 25.6%, medium TR in 33.3%, mild TR in 35.1% and no TR in 6.0%. TR at 1 month (examination results were available in 81.1%) was severe in 16.7%, medium in 30.2%, mild in 45.6% and no TR was found in 7.4%; improvement by at least 1 TR-grade was documented in 33.6% of the patients.
While a severe (compared to non-severe) TR at baseline did not affect the 30-day mortality (7.4% vs. 5.2%, p=0.354), 1-year survival was substantially impaired in those patients (36.5% vs. 23.0%, p=0.012). Accordingly, severe TR was not associated with 30d-mortality (as evaluated by univariate Cox regression, p=0.340), but with 1-year survival (HR 1.78, 95% CI 1.19–2.65, p=0.005) and showed a trend towards impaired long-term survival (HR 1.30, 95% CI 0.96–1.76, p=0.089).
While residual severe TR at one month did not influence 1-year-mortality significantly (p=0.478), improvement of TR demonstrated a trend to better survival after the first year (86.9 vs. 81.0%, p=0.208) confirmed in the Cox regression analysis (HR 0.66, 95% CI 0.36–1.22, p=0.188).
Conclusions
In this large retrospective monocentric study with a long-term follow-up-period of >7 years after edge-to-edge therapy for MR, we demonstrated that severe TR at the time of the intervention had an impact on 1-year-survival. Furthermore, a missing periinterventional improvement of TR was shown to be unfavorable regarding the long-term survival of these patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Geyer
- University Medical Center Mainz, Mainz, Germany
| | - K Keller
- University Medical Center Mainz, Mainz, Germany
| | - T Ruf
- University Medical Center Mainz, Mainz, Germany
| | - F Kreidel
- University Medical Center Mainz, Mainz, Germany
| | - A Petrescu
- University Medical Center Mainz, Mainz, Germany
| | - A.R Tamm
- University Medical Center Mainz, Mainz, Germany
| | - S Born
- University Medical Center Mainz, Mainz, Germany
| | - K Bachmann
- University Medical Center Mainz, Mainz, Germany
| | - O Hahad
- University Medical Center Mainz, Mainz, Germany
| | | | | | - E Schulz
- General Hospital of Celle, Celle, Germany
| | - T Munzel
- University Medical Center Mainz, Mainz, Germany
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27
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Keller K, Hobohm L, Barco S, Schmidtmann I, Munzel T, Engelhardt M, Eckhard L, Konstantinides S, Drees P. Venous thromboembolism in patients hospitalized for knee and hip joint replacement surgery. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3567] [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
Venous thromboembolism (VTE) is a frequent acute cardiovascular disease, leading to significant morbidity and mortality worldwide. Major trauma, surgery, immobilisation and joint replacements are major provoking factors for VTE. In particular, patients undergoing knee and hip joint replacement surgery are at high risk of developing VTE perioperatively, even in the era of established pharmacological thromboprophylaxis. Without thromboprophylaxis, as many as 20–60% of patients may develop perioperative VTE.
Purpose
As recent studies indicate an increasing number of total knee and hip replacement surgeries in European countries and the United States, aims of our study were to investigate a) total burden and temporal trends of VTE complications following knee (KJR) and hip joint replacement (HJR) in Germany 2005–2016 and to identify b) predictors of VTE during hospitalization.
Methods
In an analysis of the nationwide German inpatient sample, we included all hospitalized patients with elective primary KJR and HJR in Germany between 2005 and 2016 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2016, own calculations). We analyzed temporal trends of surgical procedure, mortality, and VTE, and identified predictors of VTE.
Results
A total of 1,804,496 hospitalized patients underwent KJR (65.1% women, 53.4% aged ≥70 years) and 1,885,839 received HJR (59.1% women, 51.4% ≥70 years). VTE was documented in 23,297 (1.3% of total) KJR patients and in 11,554 HJR patients (0.6%).
The number of primary KJR (129,832 in 2005 to 167,881 in 2016 [β-(slope)-estimate 1978 per year; 95% CI 1951 to 2004, P<0.001]) and primary HJR (145,223 in 2005 to 171,421 in 2016 [β-estimate 1818 per year; 95% CI 1083 to 2553, P<0.001]) increased during this twelve-year period.
In-hospital VTE decreased from 1.9% to 0.9% (β-estimate −0.77 [95% CI: −0.81 to −0.72], P<0.001) after KJR and from 0.9% to 0.5% (β-estimate −0.71 (95% CI: −0.77 to −0.65), P<0.001) after HJR. In parallel, in-hospital death rate dropped from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate −0.44 [95% CI: −0.59 to −0.30], P<0.001) after KJR and from 0.33% to 0.29% (β-estimate −0.11 (95% CI: −0.20 to −0.02), P=0.018) after HJR.
Infections during hospitalization were associated with a higher VTE risk. VTE events were associated with in-hospital death in KJR (OR 20.86 [95% CI: 18.78–23.15], P<0.001) and HJR (OR 15.19 [95% CI: 14.19–16.86], P<0.001) independently from age, sex and comorbidities.
Conclusions
While total numbers of KJR and HJR interventions increased in Germany between 2005 and 2016, the rate of VTE decreased substantially. VTE complications were associated with 15-to 21-fold increase of in-hospital case-fatality rate. Perioperative infections increased the risk for VTE substantially.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503), institutional grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication.
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Affiliation(s)
- K Keller
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - L Hobohm
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - S Barco
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - I Schmidtmann
- University Medical Center of Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - M Engelhardt
- Klinikum Osnabrück, Department for Orthopaedics, Trauma Surgery and Hand Surgery, Osnabrück, Germany
| | - L Eckhard
- University Medical Center of Mainz, Department of Orthopaedics and Traumatology, Mainz, Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - P Drees
- University Medical Center of Mainz, Department of Orthopaedics and Traumatology, Mainz, Germany
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Hobohm L, Schmidt F, Gori T, Schmidtmann I, Barco S, Munzel T, Lankeit M, Konstantinides S, Keller K. In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2258] [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 and purpose
Catheter-directed treatment of acute pulmonary embolism (PE) is technically advancing. Recent guidelines acknowledge this treatment option for patients with overt or imminent haemodynamic decompensation, particularly when systemic thrombolysis is contraindicated or has failed. We investigated baseline characteristics and in-hospital outcomes of patients with PE who underwent catheter-directed thrombolysis (CDT) in the German nationwide inpatient cohort.
Methods
Data from hospitalizations with PE between 2005 and 2016 were collected by the Federal Office of Statistics (Statistisches Bundesamt) in Germany and included in this analysis. Patients with PE who underwent CDT were compared with patients receiving systemic thrombolysis, and those without thromboytic or other reperfusion treatment.
Results
We analyzed data from 978,094 hospitalized patients with PE. Of these, 41,903 (4.3%) patients received thrombolytic treatment (systemic thrombolysis in 4.2%, CDT in 0.1%). Among PE patients with shock, CDT was associated with lower in-hospital mortality compared to systemic thrombolysis (OR, 0.29, 95% CI 0.13–0.66, P=0.003). No intracranial bleeding occurred among PE patients with shock who received CDT. Among haemodynamically stable PE patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT also was associated with a lower risk of in-hospital mortality compared to systemic thrombolysis (OR, 0.52 [95% CI 0.38–0.70]; P<0.001) or no thrombolytic treatment (0.45 [95% CI 0.33–0.62]; P<0.001).
Conclusion
In the German nationwide inpatient cohort, CDT was associated with lower in-hospital mortality rates compared to systemic thrombolysis. Prospective controlled data are urgently needed to determine the true value of this treatment option in acute PE.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).
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Affiliation(s)
- L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - F Schmidt
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
| | - T Gori
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
| | - I Schmidtmann
- University Medical Center of Mainz, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - S Barco
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
| | - S.V Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Keller
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
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Hobohm L, Keller K, Munzel T, Konstantinides S, Lankeit M. Time trends of pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2265] [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 and purpose
Chronic thromboembolic pulmonary hypertension (CTEPH) is considered as a rare but severe complication after acute pulmonary embolism (PE) and is potentially curable by pulmonary endarterectomy (PEA). We aimed to evaluate, over an 11-year period, time trends of in-hospital outcomes of PEA in CTEPH patients in the German nationwide inpatient sample.
Methods and results
We analyzed data on the characteristics, comorbidities, treatments and in-hospital outcomes for all CTEPH patients treated with PEA in Germany between 2006 and 2016. Overall, 1,398 inpatients were included. The annual number of PEA increased from 67 in 2006 to 194 in 2016 (β 0.69 [95% CI 0.51 to 0.86]; p<0.001) in parallel with a significant decrease of in-hospital mortality (10.9% in 2008 to 1.5% in 2016; β −1.85 [95% CI: −2.46 to −1.24]; p<0.001). Patients' characteristics shifted slightly towards older age and higher prevalence of chronic renal insufficiency and obesity over time, whereas duration of hospital stay decreased over time. Independent predictors of in-hospital mortality were age and right heart failure, and in-hospital complications such as ischemic stroke and bleeding events.
Conclusions
The number of CTEPH patients treated with PEA increased markedly in Germany between 2006 and 2016, in parallel with a decrease of in-hospital mortality. Our findings may suggest that the perioperative management of PEA and the general patients' selection have improved over time and might draw more attention to predictors for in-hospital mortality for CTEPH patients hospitalized for PEA.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).
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Affiliation(s)
- L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Keller
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Center for Cardiology, Cardiology I, Mainz, Germany
| | - S.V Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
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Ebner M, Guddat N, Keller K, Merten M, Lerchbaumer M, Hasenfuss G, Konstantinides S, Lankeit M. Identification of the optimal hsTnI cut-off value for risk stratification of normotensive patients with pulmonary embolism. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2240] [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/Introduction
While numerous studies confirmed the prognostic role of high-sensitivity troponin T (hsTnT) in pulmonary embolism (PE), the prognostic relevance of high-sensitivity troponin I (hsTnI) is inappropriately studied and disease specific cut-off values remain undefined.
Purpose
To investigate the prognostic relevance of hsTnI in normotensive PE patients, establish the optimal cut-off value for risk stratification and compare the prognostic performances of hsTnI and hsTnT.
Methods
Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 04/2018 were studied. Using receiver operating curve analysis, an optimised hsTnI cut-off concentration was identified and the prognostic value for the prediction of in-hospital adverse outcomes (PE-related death, cardiopulmonary resuscitation or vasopressor treatment) and all-cause mortality analysed.
Results
We analysed data from 459 PE patients (age 69 [interquartile range (IQR) 57–77] years, 52% female). Patients who suffered an in-hospital adverse outcome (4.8%) had higher median hsTnI concentrations compared to those with a favorable clinical course (57 [IQR 22–197] vs. 15 [IQR 10–86] pg/ml, p=0.03). A hsTnI cut-off value of 16 ng/ml provided the best prognostic performance and predicted an in-hospital adverse outcome (Odds ratio [OR] 6.5, 95% confidence interval [CI] 1.9–22.4) and all-cause mortality (OR 3.7, 95% CI 1.0–13.3). Between female and male patients, no relevant differences in hsTnI concentrations (17 [IQR 10–97] vs. 17 [IQR 10–92] pg/ml, p=0.79) or optimized cut-off values (17 pg/ml and 19 pg/ml, respectively) were observed. Stratification of patients to risk classes according to the 2019 European Society of Cardiology (ESC) algorithm revealed no differences if calculated based on either hsTnI or hsTnT (Table).
Conclusions
Our findings confirm the prognostic relevance of hsTnI in normotensive PE. An optimal hsTnI cut-off value of 16 pg/ml predicted in-hospital adverse outcome and all-cause mortality. The use of sex specific cut-off values does not appear necessary. Importantly, our results suggest that hsTnI and hsTnT can be used interchangeably for risk stratification.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503). BRAHMS GmbH, part of Thermo Fisher Scientific, Hennigsdorf/Berlin, Germany provided financial support for biomarker measurements. The sponsor was neither involved in biomarker measurements, statistical analyses, writing of the abstract nor had any influence on the scientific contents.
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Affiliation(s)
- M Ebner
- Charite - Campus Mitte (CCM), Department of Cardiology and Angiology, Berlin, Germany
| | - N Guddat
- Georg-August University, Clinic of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - K Keller
- University Medical Center Mainz, Center for Cardiology, Mainz, Germany
| | - M.C Merten
- Georg-August University, Clinic of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - M.H Lerchbaumer
- Charite - Campus Mitte (CCM), Department of Radiology, Berlin, Germany
| | - G Hasenfuss
- Georg-August University, Clinic of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - S.V Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany
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Abstract
ZusammenfassungDie Verkehrsmedizin als Teil der Rechtsmedizin erfüllt in der Schweiz eine wichtige präventive Aufgabe in der Sicherung aller Verkehrsteilnehmer: Sie begutachtet die medizinisch basierte Fahrfähigkeit und Fahreignung. Als empirisch konsolidiertes Querschnittsfach hat sie Informationen aus einer Vielzahl von medizinischen Fachgebieten. Wie reagiert die Verkehrsmedizin aber auf den vermehrten Anspruch evidenzbasierter Gutachten und auf anstehende Herausforderungen?Über einen historischen Abriss motivierten wir die Vorteile und das Potential einer teilweise durch Fahrsimulation ergänzten Untersuchung und einer dediziert auf Fahrsimulation basierenden, klinisch-prospektiven Forschung.Neben vorhandener Literatur stützen sich historische Aspekte u.a. auf vorhandene Expertise. Die Bewertung der Fahrsimulation für die Verkehrs- bzw. Rechtsmedizin der Schweiz stützt sich auf die Diskussion selektierter Literatur.Auftrag und Anspruch der Verkehrsmedizin haben sich mehrfach verändert. Eine übersichtsartige Betrachtung existenter Literatur legt nahe, dass massgeschneiderte Fahrsimulatoren Teil einer modernisierten Verkehrsmedizin sein können, um anstehende Herausforderungen adäquat adressieren zu können. Bisher existiert kein derartiges dediziertes Forschungsinstrument in der Schweiz.Eine auf verkehrsmedizinische Fragestellungen massgeschneiderte, realitätsnahe und niedrigschwellige Fahrsimulation als Werkzeug für klinische Studien und Individualuntersuchungen verspricht neben einer wissenschaftlichen Produktivität einen umsetzbaren und vermittelbaren Mehrwert für das übergeordnete Ziel der Sicherheit aller Verkehrsteilnehmer.
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Mork C, Yde Matthiesen M, Callsen M, Keller K. FRI0527 THE EFFECT OF A NURSE-LED PREDNISOLONE TAPERING REGIME IN POLYMYALGIA RHEUMATICA: A RETROSPECTIVE COHORT STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The cornerstone treatment of polymyalgia rheumatic (PMR) is prednisolone, which has several side effects such as osteoporosis and type 2 diabetes [1]. Therefore, the duration of prednisolone treatment should be as short as possible. Previous studies indicate that only 10-30% has discontinued prednisolone after 1 year and approximately 50% after 2 years [2].Objectives:To investigate the efficacy of a nurse-led prednisolone tapering regime in patients with PMR compared to usual care.Methods:The study is a single center retrospective cohort study with a 2-year follow-up. Prednisolone dose was evaluated after 1 and 2 years.A nurse-led PMR clinic was introduced June 1st, 2015 and patients diagnosed until June 7th, 2017 were included. Patients were diagnosed by a physician, and subsequently managed by nurses according to a specific protocol, with prednisolone tapering from 15 mg to discontinuation after 52 weeks. Regularly blood tests and telephone interviews were performed and a rheumatologist was involved if deemed necessary.Patients diagnosed with PMR between June 1st, 2012 and June 1st, 2015 served as controls. They received standard care by a rheumatologist.The Danish guidelines for managing PMR remained unchanged throughout the study period.The study population was identified by searching the electronic patient journal for the PMR diagnosis. Data collection was performed by four experienced reumatologists. Data were obtained from the Electronic Patient Journal of Central Denmark Region and recorded in the RedCap database.Results:Five hundred and seventy patients were screened. Patients not diagnosed with PMR, with simultaneously giant cell arteritis, with relapse of known PMR, or prednisolone treatment for more than 4 weeks prior to the diagnosis were excluded. Sixty eight patients received standard care and 107 nurse-led care. There was no statistical difference between groups regarding reason for exclusion.At baseline there was no difference between patients receiving standard care and nurse-led care regarding gender, mean age (70.7 years vs. 72.2 years), clinical findings, symptoms, level of C-reactive protein (43.4 mg/L vs. 39.7 mg/L), anti-citrullinated protein antibody and reumatoid factor status. Median (IQR) prednisolone starting dose in the standard care group was 15 mg (15-25) vs. 15 mg (15-15) in the nurse-led care group (p=0.008).After 1 year 29.4% of patients receiving standard care had discontinued prednisolone vs. 35.5% receiving nurse-led care (p=0.403). Median (IQR) prednisolone dose after 1 year was 3.75 mg (0-5) in the standard care group and 1.25 mg (0-3.75) in nurse-led care group (p=0.004). After 2 years 60.3% of patients receiving standard had discontinued prednisolone vs. 82.2% receiving nurse-led care (p=0.001). Median (IQR) prednisolone dose after 2 years was 0 mg (0-2.5) in the standard care group and 0 mg (0-0) in the nurse-led care group (p=0.004). There was no difference between groups regarding relapse of PMR and initiation of MTX treatment in either year 1 or 2.Conclusion:A tight and systematic approach to prednisolone tapering in PMR is more effective than usual care. The results should be confirmed in a prospective setting.References:[1] Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum 1997; 40(10):1873-8.[2] Muratore F, Pipitone N, Hunder GG, Salvarani C. Discontinuation of therapies in polymyalgia rheumatica and giant cell arteritis. Clin Exp Rheumatol 2013; 31(4 Suppl 78):S86-92.Disclosure of Interests:None declared
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Keller K, Ritsch I, Hintz H, Hülsmann M, Qi M, Breitgoff FD, Klose D, Polyhach Y, Yulikov M, Godt A, Jeschke G. Accessing distributions of exchange and dipolar couplings in stiff molecular rulers with Cu(ii) centres. Phys Chem Chem Phys 2020; 22:21707-21730. [DOI: 10.1039/d0cp03105d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Novel approaches to quantitatively analyse distributed exchange couplings are described and tested on experimental data sets for stiff synthetic molecules.
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Abstract
Abstract
Background
Ischemic heart disease (IHD) is the most common cause of death with an increasing frequency worldwide. It accounts for approximately 20% of all deaths in Europe and the United States of America. Approximately 1/3 of the IHD patients present with sudden cardiac death. The acute presentation of IHD myocardial infarction (MI) is a life-threatening, serious health problem, which causes substantially morbidity and mortality. It is well established that the onset of MI follows a circadian and seasonal periodicity. Seasonal variation regarding the incidence and the short-term mortality of acute MI was frequently reported, but data about sex-specific differences are sparse.
Purpose
Thus, our objectives were to investigate seasonal variations of myocardial infarction.
Methods
We analyzed the impact of seasons on incidence and in-hospital mortality of patients with acute MI in Germany from 2005 to 2015. We included all MI patients (ICD code I21) with an acute MI (, but not those MI patients with a recurrent event in the first 28 days after a previous MI (ICD code I22)), who were hospitalized in Germany between 2005 and 2015, in this analysis (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2015, own calculations).
Results
The nationwide sample comprised 3,008,188 hospitalizations of patients with MI (2005–2015). The annual incidence was 334.7 per 100.000 population. Incidence inclined from 316.3 to 341.6 per 100.000 population per year (β 0.17 [0.10 to 0.24], P<0.001), while in-hospital mortality rate decreased from 14.1% to 11.3% (β −0.29 [−0.30 to −0.28, P<0.001). Overall, 377,028 (12.5%) patients died in-hospital.
Seasonal variation of both incidence and in-hospital mortality were of substantial magnitude. Seasonal incidence (86.1 vs. 79.0 per 100.000 population per year, P<0.001) and in-hospital mortality (13.2% vs. 12.1%, P<0.001) were higher in the winter than in the summer saeson. Risk to die in winter was elevated (OR 1.080 (95% CI 1.069–1.091), P<0.001) compared to summer season independently of sex, age and comorbidities. Reperfusion treatment with drug eluting stents and coronary artery bypass graft were more often used in summer.
We observed sex-specific differences regarding the seasonal variation of in-hospital mortality: males showed lowest mortality in summer, while females during fall. Low temperature dependency of mortality seems more pronounced in males.
Conclusions
Incidence of acute MI increased 2005–2015, while in-hospital mortality rate decreased. Seasonal variations of incidence and in-hospital mortality were of substantial magnitude with lowest incidence and lowest mortality in the summer season. Additionally, we observed sex-specific differences regarding the seasonal variation of the in-hospital mortality.
Acknowledgement/Funding
This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503)
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Affiliation(s)
- K Keller
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - M A Ostad
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
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Ebner M, Sentler C, Harjola VP, Bueno H, Keller K, Lerchbaumer M, Hobohm L, Hasenfuss G, Eckardt KU, Konstantinides S, Lankeit M. P5021Hypoperfusion markers identify patients with acute pulmonary embolism at highest risk for an adverse outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0199] [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/Introduction
According to the European Society of Cardiology (ESC) 2014 guideline, systemic hypotension (HT) is the critical variable defining high-risk in patients with pulmonary embolism (PE). However, signs of organ hypoperfusion might more adequately identify PE patients with cardiogenic shock due to right ventricular (RV) failure.
Purpose
We investigated whether hypoperfusion markers provide superior prognostic information for identifying PE patients at highest risk of early adverse outcomes.
Methods
Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 03/2018 were included. We analysed the predictive value of symptoms and findings suggesting hypoperfusion for in-hospital adverse outcome (catecholamine treatment, resuscitation or PE-related death) and in-hospital all-cause mortality.
Results
We analysed 814 patients, including 83 (10.2%) ESC 2014 high-risk patients. Patients presenting with cardiac arrest (CA, 4.5%) were a priori defined as high risk. Markers suggesting hypoperfusion of the brain (altered metal status, odds ratio [OR] 8.2 [95% CI, 4.2–16.0]), lung (respiratory insufficiency, 25.0 [9.4–66.7]) and tissue (venous lactate ≥2.2 mmol/l, 6.4 [3.2–12.9]) as well as HT (13.5 [6.7–27.2]) predicted an adverse outcome. The risk for an adverse outcome increased with the number of positive markers (AUC 0.86 [0.80–0.93]). Patients with ≥3 positive hypoperfusion markers had an OR of 42.9 (11.0–167.3) and patients defined as high-risk by the ESC 2014 an OR of 17.2 (8.8–33.3) with regard to an adverse outcome (Figure 1; Table 1).
A new definition of high-risk (CA or ≥3 hypoperfusion markers) was associated with an OR of 73.2 (31.3–171.1) for an in-hospital adverse outcome and 26.2 (12.1–56.7) for in-hospital mortality.
Table 1. Prognostic performance of hypoperfusion markers Adverse outcome (if negative) Adverse outcome (if positive) Sensitivity Specificity LR+ OR (95% CI) ≥1 hypoperfusion marker 1.1% 21.0% 91.9% 68.2% 2.9 24.4 (7.3–80.8) ≥2 hypoperfusion markers 4.7% 50.0% 48.6% 95.5% 10.9 20.3 (9.1–45.1) ≥3 hypoperfusion markers 6.5% 75.0% 24.3% 99.3% 32.7 42.9 (11.0–167.3) ESC 2014 high-risk 5.7% 51.1% 35.0% 96.9% 11.4 17.2 (8.8–33.3) Cardiac arrest 8.4% 86.5% 33.0% 99.3% 47.3 70.1 (26.4–186.1) Abbreviations: LR+, positive likelihood ratio; OR, odds ratio; CI, confidence interval.
Figure 1. Frequency of adverse outcome
Conclusions
Markers of organ hypoperfusion have high predictive value for early adverse outcomes in acute PE. Risk increases with the number of positive markers and is critically elevated in patients presenting with CA or ≥3 markers.
Acknowledgement/Funding
This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).
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Affiliation(s)
- M Ebner
- Charite University Hospital, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - C Sentler
- Georg-August University, Clinic of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - V P Harjola
- Helsinki University Central Hospital, Department of Emergency Medicine, Helsinki, Finland
| | - H Bueno
- University Hospital 12 de Octubre, Department of Cardiology, Madrid, Spain
| | - K Keller
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - M Lerchbaumer
- Charite - Campus Virchow-Klinikum (CVK), Department of Radiology, Berlin, Germany
| | - L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - G Hasenfuss
- Georg-August University, Clinic of Cardiology and Pneumology, Heart Center, Gottingen, Germany
| | - K U Eckardt
- Charite University Hospital, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany
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Keller K, Petzold A, Meisel C, Wimberger P. Fallbeispiel eines aggressiv wachsenden triplenegativen Mammakarzinoms. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692088] [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: 10/26/2022] Open
Affiliation(s)
- K Keller
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - A Petzold
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - C Meisel
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
| | - P Wimberger
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus, Dresden
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Keller K, Allsop Q, Brim Box J, Buckle D, Crook DA, Douglas MM, Jackson S, Kennard MJ, Luiz OJ, Pusey BJ, Townsend SA, King AJ. Dry season habitat use of fishes in an Australian tropical river. Sci Rep 2019. [PMID: 30952875 DOI: 10.1038/s41598-019-41387-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
The modification of river flow regimes poses a significant threat to the world's freshwater ecosystems. Northern Australia's freshwater resources, particularly dry season river flows, are being increasingly modified to support human development, potentially threatening aquatic ecosystems and biodiversity, including fish. More information is urgently needed on the ecology of fishes in this region, including their habitat requirements, to support water policy and management to ensure future sustainable development. This study used electrofishing and habitat survey methods to quantify the dry season habitat use of 20 common freshwater fish taxa in the Daly River in Australia's wet-dry tropics. Of twenty measured habitat variables, water depth and velocity were the two most important factors discriminating fish habitat use for the majority of taxa. Four distinct fish habitat guilds were identified, largely classified according to depth, velocity and structural complexity. Ontogenetic shifts in habitat use were also observed in three species. This study highlights the need to maintain dry season river flows that support a diversity of riverine mesohabitats for freshwater fishes. In particular, shallow fast-flowing areas provided critical nursery and refuge habitats for some species, but are vulnerable to water level reductions due to water extraction. By highlighting the importance of a diversity of habitats for fishes, this study assists water managers in future decision making on the ecological risks of water extractions from tropical rivers, and especially the need to maintain dry season low flows to protect the habitats of native fish.
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Affiliation(s)
- K Keller
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia.
| | - Q Allsop
- Department of Primary Industry and Resources, Berrimah Road, Berrimah, NT, 0828, Australia
| | - J Brim Box
- Department of Environment and Natural Resources, Alice Springs, NT, 0870, Australia
| | - D Buckle
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
| | - D A Crook
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
| | - M M Douglas
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
- School of Earth and Environment, University of Western Australia, Perth, WA, 6009, Australia
| | - S Jackson
- Australian Rivers Institute, Griffith University, Kessels Road, Nathan, QLD, 4111, Australia
| | - M J Kennard
- Australian Rivers Institute, Griffith University, Kessels Road, Nathan, QLD, 4111, Australia
| | - O J Luiz
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
| | - B J Pusey
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
- Australian Rivers Institute, Griffith University, Kessels Road, Nathan, QLD, 4111, Australia
| | - S A Townsend
- Water Resources Division, Department of Environment and Natural Resources, Palmerston, NT, 0830, Australia
| | - A J King
- Research Institute for the Environment and Livelihoods, Engineering Health Science & Environment, Charles Darwin University, Darwin, NT, 0909, Australia
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Affiliation(s)
- K. Keller
- Centrum Thrombosis and Haemostasis, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany
| | - M. Engelhardt
- Department for orthopedics, trauma surgery and hand surgery, Klinikum Osnabrück, Osnabrück, Germany
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Abstract
The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors. Individual therapeutic management strategies should consider the etiology of the tricuspid valve regurgitation, the degree of regurgitation, the valve pathology and the risk-to-benefit ratio of the envisaged therapeutic procedure. Medicinal treatment options for tricuspid valve regurgitation are limited and generalized recommendations cannot be provided due to the lack of conclusive clinical trials. Symptomatic therapeutic measures encompass especially (loop) diuretics for the reduction of preload and afterload of the right ventricle. Pharmaceutical reduction of the heart rate should be avoided in patients with right heart insufficiency. While symptomatic therapeutic measures are often associated with only moderate effects, the most effective therapy of tricuspid valve regurgitation consists in the treatment of underlying illnesses, in most cases pulmonary hypertension due to pulmonary arterial hypertension (PAH), left heart disease or acute pulmonary embolism. Based on a number of published clinical studies and licensing of new drugs, treatment options for patients with PAH and heart failure with reduced ejection fraction (HFrEF) have substantially improved during the past years allowing for a differentiated, individualized management.
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Affiliation(s)
- M Lankeit
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland. .,Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland. .,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.
| | - K Keller
- Centrum für Thrombose und Hämostase (CTH), Universitätsmedizin Mainz, Mainz, Deutschland
| | - C Tschöpe
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Berlin-Brandenburger Centrum für Regenerative Therapien (BCRT), Berlin, Deutschland
| | - B Pieske
- Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum (CVK), Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.,Standort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,Deutsches Herzzentrum Berlin (DHZB), Berlin, Deutschland
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Keller K, O’Grady J, Gordon B, Davis K. C - 18An Informal Intervention to Promote Social Engagement Using Communication Technologies with an Adult with Level 3 Autism Spectrum Disorder. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Krieg VJ, Hobohm L, Liebetrau C, Guth S, Koelmel S, Keller K, Kresoja KP, Konstantinides S, Mayer E, Wiedenroth CB, Lankeit M. P6342Risk assessment according to the 2015 ESC guidelines risk prediction model of patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6342] [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)
- V J Krieg
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - L Hobohm
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - C Liebetrau
- Kerckhoff Clinic, Department of Cardiology, Bad Nauheim, Germany
| | - S Guth
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - S Koelmel
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - K Keller
- Center for Thrombosis and Hemostasis, Mainz, Germany
| | - K P Kresoja
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
| | | | - E Mayer
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - C B Wiedenroth
- Kerckhoff Clinic, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
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42
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Hobohm L, Keller K, Pohl K, Kuhnert K, Sentler C, Hasenfuss G, Konstantinides S, Dellas C, Lankeit M. P2611Long-term outcome after acute pulmonary embolism - a single centre experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2611] [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: 11/12/2022] Open
Affiliation(s)
- L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Keller
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Pohl
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - K Kuhnert
- University Medical Center Gottingen (UMG), Clinic for Cardiology and Pulmonology, Heart Center, Gottingen, Germany
| | - C Sentler
- University Medical Center Gottingen (UMG), Clinic for Cardiology and Pulmonology, Heart Center, Gottingen, Germany
| | - G Hasenfuss
- University Medical Center Gottingen (UMG), Clinic for Cardiology and Pulmonology, Heart Center, Gottingen, Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostasis (CTH), Mainz, Germany
| | - C Dellas
- University Medical Center Gottingen (UMG), Department of Paediatric Cardiology and Intensive Care, GUCH Center, Gottingen, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
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43
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Keller K, Hobohm L, Munzel T, Konstantinides S, Lankeit M. P570Use of systemic thrombolysis in patients with acute pulmonary embolism in Germany. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p570] [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: 11/12/2022] Open
Affiliation(s)
- K Keller
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - M Lankeit
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine and Cardiology, Berlin, Germany
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44
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Keller K, Klein M. Mittendrin im Alter statt allein (MIASA) – Ein Projekt zur Verminderung der Einsamkeit älterer Menschen. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667706] [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: 10/28/2022]
Affiliation(s)
- K Keller
- Katholische Hochschule NRW, Abt. Köln, Deutsches Institut für Sucht- und Präventionsforschung, Köln, Deutschland
| | - M Klein
- Katholische Hochschule NRW, Abt. Köln, Deutsches Institut für Sucht- und Präventionsforschung, Köln, Deutschland
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45
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Keller K, Klein M. MIASA: Eine wirksame Intervention zur Reduzierung der Einsamkeit und Verbesserung des Wohlbefindens einsamer Älterer. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1668030] [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: 10/28/2022]
Affiliation(s)
- K Keller
- Katholische Hochschule NRW, Abt. Köln, Deutsches Institut für Sucht- und Präventionsforschung, Köln, Deutschland
| | - M Klein
- Katholische Hochschule NRW, Abt. Köln, Deutsches Institut für Sucht- und Präventionsforschung, Köln, Deutschland
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46
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Keller K, Hobohm L, Munzel T, Ostad MA, Espinola-Klein C, Lavie C, Konstantinides S, Lankeit M. P2539Obesity survival paradox in patients with acute pulmonary embolism. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2539] [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)
- K Keller
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - L Hobohm
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - T Munzel
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - M A Ostad
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - C Espinola-Klein
- University Medical Center of Mainz, Department of Cardiology, Cardiology I, Mainz, Germany
| | - C Lavie
- John Ochsner Heart & Vascular Institute, University of Queensland School of Medicine, Department of Cardiovascular Disease, New Orleans, United States of America
| | - S Konstantinides
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
| | - M Lankeit
- University Medical Center of Mainz, Center for Thrombosis and Hemostatsis, Mainz, Germany
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47
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Keller K, Meisel C, Petzold A, Wimberger P. Granulomatöse Mastitis – möglicher diagnostischer und therapeutischer Ablauf anhand von Fallbeispielen. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645912] [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: 10/27/2022] Open
Affiliation(s)
- K Keller
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Carl Gustav Carus Dresden
| | - C Meisel
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Carl Gustav Carus Dresden
| | - A Petzold
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Carl Gustav Carus Dresden
| | - P Wimberger
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe des Universitätsklinikums Carl Gustav Carus Dresden
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Keller K, Meisel C, Petzold A, Wimberger P, Kast K. Patient reported satisfaction after prophylactic operations of the breast. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1645911] [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: 10/27/2022] Open
Affiliation(s)
- K Keller
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Meisel
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - A Petzold
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - K Kast
- Department of Gynecology and Obstetrics, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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Ebner M, Kresoja K, Hellenkamp K, Hobohm L, Keller K, Hasenfuss G, Pieske B, Konstantinides S, Lankeit M. P3500Temporal trends in risk-adjusted management and outcome of patients with pulmonary embolism: a single centre experience. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3500] [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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50
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Hellenkamp K, Pruszczyk P, Jimenez D, Wyzgal A, Barrios D, Ciurzynski M, Morillo R, Hobohm L, Keller K, Kurnicka K, Kostrubiec M, Wachter R, Hasenfuss G, Konstantinides S, Lankeit M. P4922Validation of the prognostic impact of copeptin in normotensive pulmonary embolism in a European multicentre study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p4922] [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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