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Hanuna M, Herz G, Stanzl AL, Li Y, Mueller CS, Kamla CE, Scherer C, Wassilowsky D, Juchem G, Orban M, Peterss S, Hagl C, Joskowiak D. Mid-Term Outcome after Extracorporeal Life Support in Postcardiotomy Cardiogenic Shock: Recovery and Quality of Life. J Clin Med 2024; 13:2254. [PMID: 38673527 DOI: 10.3390/jcm13082254] [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: 02/27/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Extracorporeal life support (ECLS) therapy for refractory postcardiotomy cardiogenic shock (rPCS) is associated with high early mortality rates. This study aimed to identify negative predictors of mid-term survival and to assess health-related quality of life (HRQoL) and recovery of the survivors. Methods: Between 2017 and 2020, 142 consecutive patients received ECLS therapy following cardiac surgery. The median age was 66.0 [57.0-73.0] years, 67.6% were male and the median EuroSCORE II was 10.5% [4.2-21.3]. In 48 patients, HRQoL was examined using the 36-Item Short Form Survey (SF-36) and the modified Rankin-Scale (mRS) at a median follow-up time of 2.2 [1.9-3.2] years. Results: Estimated survival rates at 3, 12, 24 and 36 months were 47%, 46%, 43% and 43% (SE: 4%). Multivariable Cox Proportional Hazard regression analysis revealed preoperative EuroSCORE II (p = 0.013), impaired renal function (p = 0.010), cardiopulmonary bypass duration (p = 0.015) and pre-ECLS lactate levels (p = 0.004) as independent predictors of mid-term mortality. At the time of follow-up, 83.3% of the survivors were free of moderate to severe disability (mRS < 3). SF-36 analysis showed a physical component summary of 45.5 ± 10.2 and a mental component summary of 50.6 ± 12.5. Conclusions: Considering the disease to be treated, ECLS for rPCS is associated with acceptable mid-term survival, health-related quality of life and functional status. Preoperative EuroSCORE II, impaired renal function, cardiopulmonary bypass duration and lactate levels prior to ECLS implantation were identified as negative predictors and should be included in the decision-making process.
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Affiliation(s)
- Maja Hanuna
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - German Herz
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Andre L Stanzl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, NJ 08028, USA
| | - Christoph S Mueller
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christine E Kamla
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Clemens Scherer
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dietmar Wassilowsky
- Department of Anaesthesiology, LMU University Hospital, 81377 Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Martin Orban
- Department of Cardiology, LMU University Hospital, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, LMU University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
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Lüsebrink E, Gade N, Seifert P, Ceelen F, Veit T, Fohrer F, Hoffmann S, Höpler J, Binzenhöfer L, Roden D, Saleh I, Lanz H, Michel S, Schneider C, Irlbeck M, Tomasi R, Hatz R, Hausleiter J, Hagl C, Magnussen C, Meder B, Zimmer S, Luedike P, Schäfer A, Orban M, Milger K, Behr J, Massberg S, Kneidinger N. The role of coronary artery disease in lung transplantation: a propensity-matched analysis. Clin Res Cardiol 2024:10.1007/s00392-024-02445-y. [PMID: 38587564 DOI: 10.1007/s00392-024-02445-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS Candidate selection for lung transplantation (LuTx) is pivotal to ensure individual patient benefit as well as optimal donor organ allocation. The impact of coronary artery disease (CAD) on post-transplant outcomes remains controversial. We provide comprehensive data on the relevance of CAD for short- and long-term outcomes following LuTx and identify risk factors for mortality. METHODS We retrospectively analyzed all adult patients (≥ 18 years) undergoing primary and isolated LuTx between January 2000 and August 2021 at the LMU University Hospital transplant center. Using 1:1 propensity score matching, 98 corresponding pairs of LuTx patients with and without relevant CAD were identified. RESULTS Among 1,003 patients having undergone LuTx, 104 (10.4%) had relevant CAD at baseline. There were no significant differences in in-hospital mortality (8.2% vs. 8.2%, p > 0.999) as well as overall survival (HR 0.90, 95%CI [0.61, 1.32], p = 0.800) between matched CAD and non-CAD patients. Similarly, cardiovascular events such as myocardial infarction (7.1% CAD vs. 2.0% non-CAD, p = 0.170), revascularization by percutaneous coronary intervention (5.1% vs. 1.0%, p = 0.212), and stroke (2.0% vs. 6.1%, p = 0.279), did not differ statistically between both matched groups. 7.1% in the CAD group and 2.0% in the non-CAD group (p = 0.078) died from cardiovascular causes. Cox regression analysis identified age at transplantation (HR 1.02, 95%CI [1.01, 1.04], p < 0.001), elevated bilirubin (HR 1.33, 95%CI [1.15, 1.54], p < 0.001), obstructive lung disease (HR 1.43, 95%CI [1.01, 2.02], p = 0.041), decreased forced vital capacity (HR 0.99, 95%CI [0.99, 1.00], p = 0.042), necessity of reoperation (HR 3.51, 95%CI [2.97, 4.14], p < 0.001) and early transplantation time (HR 0.97, 95%CI [0.95, 0.99], p = 0.001) as risk factors for all-cause mortality, but not relevant CAD (HR 0.96, 95%CI [0.71, 1.29], p = 0.788). Double lung transplant was associated with lower all-cause mortality (HR 0.65, 95%CI [0.52, 0.80], p < 0.001), but higher in-hospital mortality (OR 2.04, 95%CI [1.04, 4.01], p = 0.039). CONCLUSION In this cohort, relevant CAD was not associated with worse outcomes and should therefore not be considered a contraindication for LuTx. Nonetheless, cardiovascular events in CAD patients highlight the necessity of control of cardiovascular risk factors and a structured cardiac follow-up.
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Affiliation(s)
- Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Nils Gade
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Paula Seifert
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Felix Ceelen
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Veit
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany
| | - Fabian Fohrer
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Höpler
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Leonhard Binzenhöfer
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Roden
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Inas Saleh
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Hugo Lanz
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sebastian Michel
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Schneider
- Division for Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Roland Tomasi
- Department of Anesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Rudolf Hatz
- Division for Thoracic Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Benjamin Meder
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, University Hospital Essen, University Duisburg-Essen, West German Heart- and Vascular Center, Essen, Germany
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Katrin Milger
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), LMU University Hospital, LMU Munich, Munich, Germany.
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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius-Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, Schrage B. Sex-related differences in patients presenting with heart failure-related cardiogenic shock. Clin Res Cardiol 2024; 113:612-625. [PMID: 38353681 PMCID: PMC10954943 DOI: 10.1007/s00392-024-02392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS. METHODS In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS. RESULTS N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75-1.19). CONCLUSIONS In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Düsseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, DHZC Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Norman Mangner
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, DHZC Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Anesthesia and Intensive Care, University of Pavia Italy, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Luca Villanova
- Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS Fondazione Don Gnocchi, ONLUS, Santa Maria Nascente, Milan, Italy
| | - Ephraim B Winzer
- Department for Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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4
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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Westenfeld R, Winzer EB, Westermann D, Schrage B. Association between left ventricular ejection fraction, mortality and use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Clin Res Cardiol 2024; 113:570-580. [PMID: 37982863 PMCID: PMC10954940 DOI: 10.1007/s00392-023-02332-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimise their expected benefit. METHODS Patients with non-ischaemic CS and available data on LVEF from 16 tertiary-care centres in five countries were analysed. Cox regression models were fitted to evaluate the association between LVEF and mortality, as well as the interaction between LVEF, MCS use and mortality. RESULTS N = 807 patients were analysed: mean age 63 [interquartile range (IQR) 51.5-72.0] years, 601 (74.5%) male, lactate 4.9 (IQR 2.6-8.5) mmol/l, LVEF 20 (IQR 15-30) %. Lower LVEF was more frequent amongst patients with more severe CS, and MCS was more likely used in patients with lower LVEF. There was no association between LVEF and 30-day mortality risk in the overall study cohort. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with LVEF ≤ 20% (hazard ratio 0.72, 95% confidence interval 0.51-1.02 for LVEF ≤ 20% vs. hazard ratio 1.31, 95% confidence interval 0.85-2.01 for LVEF > 20%, interaction-p = 0.017). CONCLUSION This retrospective study may indicate a lower mortality risk with MCS use only in patients with severely reduced LVEF. This may propose the inclusion of LVEF as an adjunctive parameter for MCS decision-making in non-ischaemic CS, aiming to optimise the benefit-risk ratio.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nuremberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luca Villanova
- Unità Di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Ephraim B Winzer
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20251, Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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5
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Lüsebrink E, Binzenhöfer L, Hering D, Villegas Sierra L, Schrage B, Scherer C, Speidl WS, Uribarri A, Sabate M, Noc M, Sandoval E, Erglis A, Pappalardo F, De Roeck F, Tavazzi G, Riera J, Roncon-Albuquerque R, Meder B, Luedike P, Rassaf T, Hausleiter J, Hagl C, Zimmer S, Westermann D, Combes A, Zeymer U, Massberg S, Schäfer A, Orban M, Thiele H. Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence? Circulation 2024; 149:1033-1052. [PMID: 38527130 DOI: 10.1161/circulationaha.123.067087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.
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Affiliation(s)
- Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Leonhard Binzenhöfer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Daniel Hering
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Laura Villegas Sierra
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany and DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany (B.S.)
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria (W.S.S.)
| | - Aitor Uribarri
- Cardiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. CIBER-CV (A.U.)
| | - Manel Sabate
- Interventional Cardiology Department, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (M.S.)
| | - Marko Noc
- Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia (M.N.)
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain (E.S.)
| | - Andrejs Erglis
- Latvian Centre of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia (A.E.)
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy (F.P.)
| | - Frederic De Roeck
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium (F.D.R.)
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia Intensive Care, Fondazione IRCCS Policlinico San Matteo, Italy (G.T.)
| | - Jordi Riera
- Intensive Care Department, Vall d'Hebron University Hospital, and SODIR, Vall d'Hebron Research Institute, Barcelona, Spain (J.R.)
| | - Roberto Roncon-Albuquerque
- Department of Intensive Care Medicine, São João University Hospital Center, UnIC@RISE and Department of Surgery and Physiology, Faculty of Medicine of Porto, Portugal (R.R.-A.)
| | - Benjamin Meder
- Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Germany (B.M.)
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen (P.L., T.R.)
| | - Jörg Hausleiter
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Germany (C.H.)
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, Germany (S.Z.)
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Germany (D.W.)
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France, and Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, Paris, France (A.C.)
| | - Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany (U.Z.)
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, Germany (A.S.)
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Germany and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (E.L., L.B., D.H., L.V.S., C.S., J.H., S.M., M.O.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Science, Germany (H.T.)
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6
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Kellnar A, Naumann D, Scherer C, Lüsebrink E, Joskowiak D, Peterß S, Hagl C, Massberg S, Orban M, Stremmel C. Aortic arch blood flow measurements as a predictor of successful ECMO weaning in cardiogenic shock. Heliyon 2024; 10:e26773. [PMID: 38444470 PMCID: PMC10912227 DOI: 10.1016/j.heliyon.2024.e26773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 12/08/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
Objective Acute cardiogenic shock is a life-threatening condition with mortality rates of up to 50%. If conventional therapy fails, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy has emerged to a promising alternative for temporary cardiac and respiratory support in specialized centers. However, it is only a bridge to recovery, final decision, heart transplantation or the permanent implantation of a left ventricular assist device. Therefore, the identification of the optimum weaning time point is challenging, and standardized weaning protocols are rare. Methods In this explorative pilot study, we evaluated the potential benefit of blood flow measurements in the aortic arch using an ultrasonic cardiac output monitor (USCOM) for the primary endpoint of successful VA-ECMO weaning. 12 patients under VA-ECMO therapy for acute cardiogenic shock and a hemodynamic condition which qualified for a stepwise weaning process were included in this study. Main exclusion criterion was the presence of additional venting therapy for left ventricular unloading, e.g. Impella. Statistical comparisons were performed using the Mann-Whitney test and corrected for multiple testing by the Holm-Sidak method. Results Peak velocity of flow in the aortic arch showed a positive correlation with weaning success independent of ECMO flow (weaning success vs. failure: 0.75 vs. 0.35 m/s (low ECMO support), p = 0.049), whereas we identified only a trend for mean pressure gradient, minute distance and stroke volume index. Conclusion We hypothesize, that USCOM might provide an additive benefit to conventional strategies in its ability to predict successful VA-ECMO weaning and prevent pulmonary congestion. Larger upcoming trials are required to address this relevant topic and provide standardized treatment protocols for optimized weaning in the future.
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Affiliation(s)
- Antonia Kellnar
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Dominik Naumann
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christopher Stremmel
- Medizinische Klinik und Poliklinik I, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
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7
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Vandenbriele C, M'Pembele R, Dannenberg L, Metzen D, Zako S, Helten C, Mourikis P, Ignatov D, Huhn R, Balthazar T, Adriaenssens T, Vanassche T, Meyns B, Panoulas V, Monteagudo-Vela M, Arachchillage D, Janssens S, Scherer C, Orban M, Petzold T, Horn P, Jung C, Zeus T, Price S, Westenfeld R, Kelm M, Polzin A. Heparin dosing in patients with Impella-supported cardiogenic shock. Int J Cardiol 2024; 399:131690. [PMID: 38160912 DOI: 10.1016/j.ijcard.2023.131690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS). OBJECTIVE Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings. METHODS This hypothesis-generating multi-center cohort study investigated 170 patients with left-Impella™ support. We (A) compared bleeding/thrombotic events in two centers with therapeutic range (TR-aPTT) activated partial thromboplastin time (60-80s) and (B) compared events of these centers with one center with intermediate range aPTT (40-60s). RESULTS After matching, there were no differences in patients' characteristics. In centers aiming at TR-aPTT, major bleeding was numerically lower with aPTT <60s within 48 h of left-Impella™ support, versus patients that achieved the aimed aPTT of ≥60s [aPTT ≥60s: 22 (37.3%) vs. aPTT<60s 14 (23.7%); Hazard ratio [HR], 0.62 (95%) CI, 0.28-1.38; p = 0.234]. Major cardiovascular and cerebrovascular adverse events (MACCE) did not differ between groups. In comparison of centers, TR-aPTT strategy showed higher major bleeding rates [TR: 8 (47.1%) vs. intermediate range: 1 (5.9%); HR, 0.06 (95%) CI, 0.01-0.45; p = 0.006]. MACCE were lower in the intermediate range aPTT group as well [TR 12 (70.6%) vs. intermediate range 5 (29.4%) HR, 0.32 (95%) CI, 0.11-0.92; p = 0.034]. CONCLUSION This pilot analysis showed that lowering UFH-targets in left-Impella™ supported CS patients seems to be a safe and promising strategy for reducing major bleedings without increasing MACCE. This needs to be validated in larger, randomized clinical trials.
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Affiliation(s)
| | - René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany
| | - Lisa Dannenberg
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Daniel Metzen
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Saif Zako
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Carolin Helten
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Philipp Mourikis
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Denis Ignatov
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany
| | - Tim Balthazar
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tom Adriaenssens
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of cardiac surgery, University Hospitals Leuven, Belgium
| | - Vasileios Panoulas
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Maria Monteagudo-Vela
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Deepa Arachchillage
- Centre for haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Stefan Janssens
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Clemens Scherer
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Martin Orban
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Tobias Petzold
- Intensive Care Unit and Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany
| | - Patrick Horn
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Christian Jung
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Tobias Zeus
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Susanna Price
- Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ralf Westenfeld
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Malte Kelm
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Amin Polzin
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
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8
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Beer BN, Kellner C, Goßling A, Sundermeyer J, Besch L, Dettling A, Kirchhof P, Blankenberg S, Bernhardt AM, Brunner S, Colson P, Eckner D, Frank D, Eitel I, Frey N, Eden M, Graf T, Kupka D, Landmesser U, Majunke N, Maniuc O, Möbius-Winkler S, Morrow DA, Mourad M, Noel C, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Reichenspurner H, Schulze PC, Schwinger RHG, Wechsler A, Skurk C, Thiele H, Varshney AS, Sag CM, Krais J, Westermann D, Schrage B. Complications in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy: distribution and relevance. Results from an international, multicentre cohort study. Eur Heart J Acute Cardiovasc Care 2024; 13:203-212. [PMID: 37875127 DOI: 10.1093/ehjacc/zuad129] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
AIMS Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications. This study aimed to quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (cerebral performance categories 1 + 2). METHODS AND RESULTS All-comer patients with CS treated with VA-ECMO were retrospectively enrolled from 16 centres in four countries (2005-2019). Neurological, bleeding, and ischaemic adverse events (AEs) were considered. From these, typical VA-ECMO complications were identified and analysed separately as device-related complications. n = 501. Overall, 118 were women (24%), median age was 56.0 years, median lactate was 8.1 mmol/L. Acute myocardial infarction caused CS in 289 patients (58%). Thirty-days mortality was 40% (198/501 patients). At least one device-related complication occurred in 252/486 (52%) patients, neurological AEs in 108/469 (23%), bleeding in 192/480 (40%), ischaemic AEs in 123/478 (26%). The 22% of patients with the most AEs accounted for 50% of all AEs. All types of AEs were associated with a worse prognosis. Aside from neurological ones, all AEs and device-related complications were more likely to occur in women; although prediction of AEs outside of neurological AEs was generally poor. CONCLUSION Therapy and device-related complications occur in half of all patients treated with VA-ECMO and are associated with a worse prognosis. They accumulate in some patients, especially in women. Aside from neurological events, identification of patients at risk is difficult, highlighting the need to establish additional quantitative markers of complication risk to guide VA-ECMO treatment in CS.
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Affiliation(s)
- Benedikt N Beer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Sundermeyer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Blankenberg
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Alexander M Bernhardt
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Brunner
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, Montpellier, France
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Derk Frank
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ingo Eitel
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Eden
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Graf
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Danny Kupka
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin/Institute of Health (BIH), Berlin, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würburg, Germany
| | | | - David A Morrow
- Cardiovascular Division, Brigham and Women's Hospital, Boston, USA
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, Montpellier, France
| | - Curt Noel
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würburg, Germany
| | - Martin Orban
- Department of Internal Medicine I, LMU University Hospital, Munich, Germany
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sandeep M Patel
- Department of Interventional Cardiology, St.Rita's Medical Center, Lima, USA
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Hermann Reichenspurner
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Antonia Wechsler
- Department of Internal Medicine II, Klinikum Weiden, Weiden, Germany
| | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin/Institute of Health (BIH), Berlin, Germany
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Anubodh S Varshney
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, USA
| | - Can Martin Sag
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Jannis Krais
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology I, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Hamburg/Lübeck/Kiel, Hamburg, Germany
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9
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Naumann D, Fischer J, Gmeiner J, Lüsebrink E, Beer BN, Grieger M, Giousouf A, Schrage B, Stremmel C, Massberg S, Orban M, Scherer C. The Association of Off-Hour vs. On-Hour ICU Admission Time with Mortality in Patients with Cardiogenic Shock - a Retrospective Multicenter Analysis. Eur Heart J Acute Cardiovasc Care 2024:zuae012. [PMID: 38306600 DOI: 10.1093/ehjacc/zuae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Studies have shown a so-called off-hour effect for many different diseases, but data are scarce concerning cardiogenic shock. We therefore assessed the association of off-hour vs. on-hour intensive care unit (ICU) admission with 30-day mortality in patients with cardiogenic shock. METHODS In total, 1720 cardiogenic shock patients (666 admitted during off-hours) from two large university hospitals in Germany were included in retrospect. RESULTS An admission during off-hours was associated with an increased 30-day mortality compared to an admission during on-hours (crude mortality 48% vs. 41%, HR 1.17 (1.03-1.33), p = 0.017). This effect remained significant after propensity score matching (p = 0.023). Neither patients with a combined SCAI stage D and E (p = 0.088) or C (p = 0.548) nor those requiring cardiopulmonary resuscitation (p = 0.114) had a higher mortality at off-hour admission. In contrast, those without veno-arterial extracorporeal membrane oxygenation (VA-ECMO) (HR 1.17 (1.00-1.36), p = 0.049), without acute myocardial infarction (HR 1.27 (1.02-1.56), p = 0.029) or a with combined SCAI stage A and B (HR 2.23 (1.08-4.57), p = 0.025) had an increased mortality at off-hour admission. CONCLUSION Our study showed an increased mortality in patients with cardiogenic shock admitted during off-hours especially in those with a milder onset of disease. This stresses the importance of a thorough workup of each patient especially at times of limited resources, the menace of underestimating the severity of cardiogenic shock and the need for an improved twenty-four seven available risk stratification.
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Affiliation(s)
- Dominik Naumann
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Julius Fischer
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jonas Gmeiner
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Maximilian Grieger
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Atakan Giousouf
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Lübeck/Kiel, Germany
| | | | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Munich Heart Alliance, Munich, Germany
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10
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Sundermeyer J, Kellner C, Beer BN, Besch L, Dettling A, Bertoldi LF, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Jozwiak-Nozdrzykowska J, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Majunke N, Mangner N, Maniuc O, Möbius Winkler S, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Winzer EB, Westermann D, Gustafsson F, Schrage B. Clinical presentation, shock severity and mortality in patients with de novo versus acute-on-chronic heart failure-related cardiogenic shock. Eur J Heart Fail 2024; 26:432-444. [PMID: 37940139 DOI: 10.1002/ejhf.3082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/22/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS Heart failure-related cardiogenic shock (HF-CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute-on-chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients with de novo and acute-on-chronic HF-CS. METHODS AND RESULTS In this international observational study, patients with HF-CS from 16 tertiary care centres in five countries were enrolled between 2010 and 2021. To investigate differences in clinical presentation and 30-day mortality, adjusted logistic/Cox regression models were fitted. Patients (n = 1030) with HF-CS were analysed, of whom 486 (47.2%) presented with de novo HF-CS and 544 (52.8%) with acute-on-chronic HF-CS. Traditional markers of CS severity (e.g. blood pressure, heart rate and lactate) as well as use of treatments were comparable between groups. However, patients with acute-on-chronic HF-CS were more likely to have a higher CS severity and also a higher mortality risk, after adjusting for relevant confounders (de novo HF 45.5%, acute-on-chronic HF 55.9%, adjusted hazard ratio 1.38, 95% confidence interval 1.10-1.72, p = 0.005). CONCLUSION In this large HF-CS cohort, acute-on-chronic HF-CS was associated with more severe CS and higher mortality risk compared to de novo HF-CS, although traditional markers of CS severity and use of treatments were comparable. These findings highlight the vast heterogeneity of patients with HF-CS, emphasize that HF chronicity is a relevant disease modifier in CS, and indicate that future clinical trials should account for this.
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Affiliation(s)
- Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt N Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Lisa Besch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Angela Dettling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Zouhir Dindane
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Joanna Jozwiak-Nozdrzykowska
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Linke
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Norman Mangner
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy
- Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, Leipzig, Germany
| | - Luca Villanova
- Intensive Cardiac Care Unit and De Gasperis Cardio-Center, Niguarda Hospital, Milan, Italy
| | - Nuccia Morici
- IRCCS S. Maria Nascente-Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
| | - Ephraim B Winzer
- Technische Universität Dresden, Heart Centre Dresden, University Hospital, Department for Internal Medicine and Cardiology, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Finn Gustafsson
- Rigshospitalet and Department of Clinical Medicine, University of Copenhagen Copenhagen, Copenhagen, Denmark
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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11
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Löw K, Steffen J, Lux M, Doldi PM, Haum M, Fischer J, Stolz L, Orban M, Stocker TJ, Rizas KD, Theiss H, Braun D, Massberg S, Hausleiter J, Deseive S. Atrial Functional Tricuspid Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:76-87. [PMID: 38199755 DOI: 10.1016/j.jcin.2023.10.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Knowledge about atrial functional tricuspid regurgitation (afTR) in transcatheter aortic valve replacement (TAVR) patients is scarce. OBJECTIVES The aim of the study was to analyze the association between the entity and the development of tricuspid regurgitation (TR) in patients undergoing TAVR for aortic stenosis and concomitant TR. METHODS We analyzed patients undergoing TAVR for severe aortic stenosis from January 2013 to December 2020 and concomitant at least moderate TR at baseline. afTR was defined as enlargement of the right atrium in relation to the right ventricle. TR development after TAVR and 3-year all-cause mortality were evaluated. RESULTS Out of 3,474 TAVR patients, we identified 420 patients with concomitant at least moderate TR. A total of 363 patients were included in the study, with 178 patients stratified in the afTR and 185 in the non-afTR group based on a receiver-operating characteristic curve cutoff of 1.132 of the right atrial/right ventricular area ratio. TR improvement after TAVR was observed in significantly less patients with afTR compared with non-afTR (31.1% vs 60.6%; P < 0.001). Multivariate regression analysis confirmed afTR as independent predictor for TR persistence (adjusted OR: 2.80; 95% CI: 1.66-4.76; P < 0.001). Moreover, afTR was associated with aggravation of TR after TAVR (17.0% vs 6.8%; P = 0.013). Three-year all-cause mortality was significantly higher in patients with persistence compared with patients with improvement of TR (P < 0.001). CONCLUSIONS In TAVR patients, afTR is an independent predictor for TR persistence. Moreover, TR persistence is associated with increased 3-year all-cause mortality.
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Affiliation(s)
- Kornelia Löw
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany; Munich Heart Alliance, Partner Site German Munich, Center for Cardiovascular Diseases, Munich, Germany
| | - Melanie Lux
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany; Munich Heart Alliance, Partner Site German Munich, Center for Cardiovascular Diseases, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | | | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Munich, Germany.
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12
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Fischer J, Steffen J, Arlart T, Haum M, Gschwendtner S, Doldi PM, Rizas K, Theiss H, Braun D, Orban M, Peterß S, Hausleiter J, Massberg S, Deseive S. Concomitant percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:186-193. [PMID: 38140761 DOI: 10.1002/ccd.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce. AIMS Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality. METHODS A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group). RESULTS Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84). CONCLUSIONS coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.
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Affiliation(s)
- Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Tobias Arlart
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sarah Gschwendtner
- Zentrale Notaufnahme und Aufnahmestation, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin, Berlin, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sven Peterß
- Department of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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13
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Stolz L, Kirchner M, Steffen J, Doldi PM, Braun D, Weckbach LT, Stocker TJ, Löw K, Fischer J, Haum M, Theiss HD, Rizas K, Orban M, Peterß S, Näbauer M, Massberg S, Hausleiter J, Deseive S. Cardio-hepatic syndrome in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2023; 112:1427-1435. [PMID: 37337011 PMCID: PMC10562337 DOI: 10.1007/s00392-023-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Cardiohepatic syndrome (CHS) has been identified as an important but underrecognized survival predictor in multiple cardiovascular disease entities. The objectives of this study were to evaluate the prevalence and prognostic value of CHS in patients undergoing TAVR for severe aortic stenosis (AS). METHODS The study included patients with available laboratory parameters of hepatic function who underwent TAVR from July 2013 until December 2019 at our center. CHS was defined as an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal (bilirubin, alkaline phosphatase, and gamma glutamyl transferase). Study endpoints were three-year survival, technical and device failure (VARC 3), as well as New York Heart Association (NYHA) functional class at follow-up. RESULTS Among a total of 953 analyzed patients (47.6% females, median age 80.0 [76.0-85.0] years) CHS was present in 212 patients (22.4%). In patients with vs. without CHS, rates of technical (6.1% vs. 8.4%, p = 0.29) and device failure (18.9% vs. 17.3%, p = 0.59) were comparable. NYHA functional class at baseline and follow-up was more severe in patients with CHS. Nevertheless, heart failure symptoms improved from baseline to follow-up irrespective of hepatic function. Three-year survival rates were significantly lower in patients with CHS (49.4 vs. 65.4%, p < 0.001). The predictive value of CHS persisted after adjustment in a multivariable analysis (hazard ratio 1.58, p < 0.01). CONCLUSION In patients undergoing TAVR, CHS is prevalent in 22% of patients and is associated with increased postinterventional mortality. Thus, CHS should be included in the decision-making process within the TAVR heart team. Cardiohepatic syndrome (CHS) as defined by an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal was prevalent in 22% of patients undergoing TAVR for severe AS. The presence of CHS was associated with more severe heart failure symptoms and worse three-year survival.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Kirchner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Hans D Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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14
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Gmeiner J, Bulach B, Lüsebrink E, Binzenhöfer L, Kupka D, Stocker T, Löw K, Weckbach L, Rudi WS, Petzold T, Kääb S, Hausleiter J, Hagl C, Massberg S, Orban M, Scherer C. Comparison of balanced and unbalanced crystalloids as resuscitation fluid in patients treated for cardiogenic shock. J Intensive Care 2023; 11:38. [PMID: 37674211 PMCID: PMC10481512 DOI: 10.1186/s40560-023-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The efficacy and safety of saline versus balanced crystalloid solutions in ICU-patients remains complicated by exceptionally heterogenous study population in past comparative studies. This study sought to compare saline and balanced crystalloids for fluid resuscitation in patients with cardiogenic shock with or without out-of-hospital cardiac arrest (OHCA). METHODS We retrospectively analyzed 1032 propensity score matched patients with cardiogenic shock from the Munich University Hospital from 2010 to 2022. In 2018, default resuscitation fluid was changed from 0.9% saline to balanced crystalloids. The primary endpoint was defined as 30-day mortality rate. RESULTS Patients in the saline group (n = 516) had a similar 30-day mortality rate as patients treated with balanced crystalloids (n = 516) (43.1% vs. 43.0%, p = 0.833), but a higher incidence of new onset renal replacement therapy (30.2% vs 22.7%, p = 0.007) and significantly higher doses of catecholamines. However, OHCA-patients with a lactate level higher than 7.4 mmol/L had a significantly lower 30-day mortality rate when treated with saline (58.6% vs. 79.3%, p = 0.013). In addition, use of balanced crystalloids was independently associated with a higher mortality in the multivariate cox regression analysis after OHCA (hazard ratio 1.43, confidence interval: 1.05-1.96, p = 0.024). CONCLUSIONS In patients with cardiogenic shock, use of balanced crystalloids was associated with a similar all-cause mortality at 30 days but a lower rate of new onset of renal replacement therapy. In the subgroup of patients after OHCA with severe shock, use of balanced crystalloids was associated with a higher mortality than saline. TRIAL REGISTRATION LMUshock registry (WHO International Clinical Trials Registry Platform Number DRKS00015860).
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Affiliation(s)
- Jonas Gmeiner
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Bernhardt Bulach
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Leonhard Binzenhöfer
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Danny Kupka
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Stocker
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Kornelia Löw
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ludwig Weckbach
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolf-Stephan Rudi
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Tobias Petzold
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Stefan Kääb
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Christian Hagl
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Martin Orban
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany.
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15
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Banning AS, Sabaté M, Orban M, Gracey J, López-Sobrino T, Massberg S, Kastrati A, Bogaerts K, Adriaenssens T, Berry C, Erglis A, Haine S, Myrmel T, Patel S, Buera I, Sionis A, Vilalta V, Yusuff H, Vrints C, Adlam D, Flather M, Gershlick AH. Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EUROINTERVENTION 2023; 19:482-492. [PMID: 37334659 PMCID: PMC10436068 DOI: 10.4244/eij-d-23-00204] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Cardiogenic shock (CGS) occurs in 10% of patients presenting with acute myocardial infarction (MI), with in-hospital mortality rates of 40-50% despite revascularisation. AIMS The EURO SHOCK trial aimed to determine if early use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) could improve outcomes in patients with persistent CGS following primary percutaneous coronary intervention (PPCI). METHODS This multicentre, pan-European trial randomised patients with persistent CGS 30 minutes after PPCI of the culprit lesion to receive either VA-ECMO or continue with standard therapy. The primary outcome measure was 30-day all-cause mortality in an intention-to-treat analysis. Secondary endpoints included 12-month all-cause mortality and 12-month composite of all-cause mortality or rehospitalisation due to heart failure. RESULTS Due to the impact of the COVID-19 pandemic, the trial was stopped before completion of recruitment, after randomisation of 35 patients (standard therapy n=18, VA-ECMO n=17). Thirty-day all-cause mortality occurred in 43.8% of patients randomised to VA-ECMO and in 61.1% of patients randomised to standard therapy (hazard ratio [HR] 0.56, 95% confidence interval [CI]: 0.21-1.45; p=0.22). One-year all-cause mortality was 51.8% in the VA-ECMO group and 81.5% in the standard therapy arm (HR 0.52, 95% CI: 0.21-1.26; p=0.14). Vascular and bleeding complications occurred more often in the VA-ECMO arm (21.4% vs 0% and 35.7% vs 5.6%, respectively). CONCLUSIONS Due to the limited number of patients recruited to the trial, no definite conclusions could be drawn from the available data. Our study demonstrates the feasibility of randomising patients with CGS complicating acute MI but also illustrates the challenges. We hope these data will inspire and inform the design of future large-scale trials.
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Affiliation(s)
- Amerjeet S Banning
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Manel Sabaté
- Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU University Hospital Munich, Munich, Germany
| | - Jay Gracey
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Teresa López-Sobrino
- Consorci Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, Barcelona, Spain
| | - Steffen Massberg
- Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum Muenchen, German Center for Cardiovascular Research (DZHK), Munich, Germany and Partner Site Munich Heart Alliance, Munich, Germany
| | - Kris Bogaerts
- Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium
| | - Tom Adriaenssens
- University Hospitals Leuven, Leuven, Belgium and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Colin Berry
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK and Robertson Centre for Biostatistics, Glasgow, UK
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, Riga, Latvia and the University of Latvia, Riga, Latvia
| | - Steven Haine
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - Truls Myrmel
- Universitetssykehuset Nord-Norge, Tromsø, Norway
| | - Sameer Patel
- King's College Hospital and Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Irene Buera
- Hospital Universitario Vall d'Hebron, VHIR, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Alessandro Sionis
- Cardiology Department, Intensive Cardiac Care Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain and Universitat Autònoma de Barcelona, Barcelona, Spain and Centro de Investigación Biomèdica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Vilalta
- Interventional Cardiology Unit, Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Hakeem Yusuff
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Christiaan Vrints
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium and Department of Cardiovascular Sciences, University of Antwerp, Antwerp, Belgium
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Marcus Flather
- University of East Anglia, Norwich, UK and Norfolk and Norwich University Hospitals, Norwich, UK
| | - Anthony H Gershlick
- Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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16
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Doldi PM, Steffen J, Stolz L, Fischer J, Stocker TJ, Orban M, Theiss H, Rizas K, Sadoni S, Hagl C, Massberg S, Hausleiter J, Braun D, Deseive S. Impact of mitral regurgitation aetiology on the outcomes of transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:526-536. [PMID: 37042426 PMCID: PMC10440686 DOI: 10.4244/eij-d-22-01062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/08/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Concomitant moderate/severe mitral regurgitation (MR) is observed in 17-35% of patients undergoing transcatheter aortic valve implantation (TAVI) and contributes to a worse prognosis. Studies analysing outcomes in patients undergoing TAVI with different MR aetiologies, including atrial functional MR (aFMR), are lacking. AIMS We aimed to analyse outcomes and changes in MR severity in patients with aFMR, ventricular functional (vFMR) and primary mitral regurgitation (PMR) following TAVI. METHODS We analysed all consecutive patients with at least moderate MR undergoing TAVI between January 2013 and December 2020 at the Munich University Hospital. Characterisation of MR aetiology was performed by detailed individual echocardiographic assessment. Three-year mortality, changes in MR severity and New York Heart Association (NYHA) Functional Class at follow-up were assessed. RESULTS Out of 3,474 patients undergoing TAVI, 631 patients showed MR ≥2+ (172 with aFMR, 296 with vFMR, 163 with PMR). Procedural characteristics and endpoints were comparable between groups. The rate of MR improvement was 80.2% in aFMR patients, which was significantly higher compared to both other groups (vFMR: 69.4%; p=0.03; PMR: 40.8%; p<0.001). The estimated 3-year survival rates did not differ between aetiologies (p=0.57). However, MR persistence at follow-up was associated with increased mortality (hazard ratio 1.49, 95% confidence interval: 1.04-2.11; p=0.027), mainly driven by the PMR subgroup of patients. NYHA Class improved significantly in all groups. In patients with baseline MR ≥3+, the PMR aetiology was associated with the lowest MR improvement, the lowest survival rates and least symptomatic improvement. CONCLUSIONS TAVI reduces MR severity and symptoms in patients with aFMR, vFMR and less-pronounced PMR. The presence of aFMR was associated with the greatest MR severity improvement.
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Affiliation(s)
- Philipp Maximilian Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
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17
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Thienel M, Müller-Reif JB, Zhang Z, Ehreiser V, Huth J, Shchurovska K, Kilani B, Schweizer L, Geyer PE, Zwiebel M, Novotny J, Lüsebrink E, Little G, Orban M, Nicolai L, El Nemr S, Titova A, Spannagl M, Kindberg J, Evans AL, Mach O, Vogel M, Tiedt S, Ormanns S, Kessler B, Dueck A, Friebe A, Jørgensen PG, Majzoub-Altweck M, Blutke A, Polzin A, Stark K, Kääb S, Maier D, Gibbins JM, Limper U, Frobert O, Mann M, Massberg S, Petzold T. Immobility-associated thromboprotection is conserved across mammalian species from bear to human. Science 2023; 380:178-187. [PMID: 37053338 DOI: 10.1126/science.abo5044] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/10/2023] [Indexed: 04/15/2023]
Abstract
Venous thromboembolism (VTE) comprising deep venous thrombosis and pulmonary embolism is a major cause of morbidity and mortality. Short-term immobility-related conditions are a major risk factor for the development of VTE. Paradoxically, long-term immobilized free-ranging hibernating brown bears and paralyzed spinal cord injury (SCI) patients are protected from VTE. We aimed to identify mechanisms of immobility-associated VTE protection in a cross-species approach. Mass spectrometry-based proteomics revealed an antithrombotic signature in platelets of hibernating brown bears with heat shock protein 47 (HSP47) as the most substantially reduced protein. HSP47 down-regulation or ablation attenuated immune cell activation and neutrophil extracellular trap formation, contributing to thromboprotection in bears, SCI patients, and mice. This cross-species conserved platelet signature may give rise to antithrombotic therapeutics and prognostic markers beyond immobility-associated VTE.
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Affiliation(s)
- Manuela Thienel
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Johannes B Müller-Reif
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
- Omicera Diagnostics, 82152 Martinsried, Germany
| | - Zhe Zhang
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Vincent Ehreiser
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Judith Huth
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Khrystyna Shchurovska
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Badr Kilani
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Lisa Schweizer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Philipp E Geyer
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
- Omicera Diagnostics, 82152 Martinsried, Germany
| | - Maximilian Zwiebel
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Julia Novotny
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Enzo Lüsebrink
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Gemma Little
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, Health and Life Sciences Building, University of Reading, RG6 6UR, UK
| | - Martin Orban
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Leo Nicolai
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Shaza El Nemr
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Anna Titova
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Michael Spannagl
- Anesthesiology and Transfusion Medicine, Cell Therapeutics and Hemostaseology, Ludwig-Maximilians-University Munich, 80336 Munich, Germany
| | - Jonas Kindberg
- Norwegian Institute for Nature Research, 7034 Trondheim, Norway
- Scandinavian Brown Bear Research Project, Tackåsen 2, SE-79498 Orsa, Sweden
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences, SE-90183 Umeå, Sweden
| | - Alina L Evans
- Department of Forestry and Wildlife Management, Faculty of Applied Ecology and Agricultural Sciences, Inland Norway University of Applied Sciences, 2480 Koppang, Norway
| | - Orpheus Mach
- Zentrum für Rückenmarkverletzte mit Neuro-Urologie, BG Unfallklinik Murnau, 82418 Murnau am Staffelsee, Germany
| | - Matthias Vogel
- Zentrum für Rückenmarkverletzte mit Neuro-Urologie, BG Unfallklinik Murnau, 82418 Murnau am Staffelsee, Germany
| | - Steffen Tiedt
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians- University Munich, 81377 Munich, Germany
| | - Steffen Ormanns
- Pathologisches Institut, Klinikum der Universität München, Ludwig-Maximilians- University Munich, 81377 Munich, Germany
| | - Barbara Kessler
- Gene Center, Ludwig-Maximilians-University Munich, 81377 Munich, Germany
| | - Anne Dueck
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
- Institute of Pharmacology and Toxicology, Technical University of Munich, 80802 Munich, Germany
| | - Andrea Friebe
- Norwegian Institute for Nature Research, 7034 Trondheim, Norway
- Scandinavian Brown Bear Research Project, Tackåsen 2, SE-79498 Orsa, Sweden
| | - Peter Godsk Jørgensen
- Herlev and Gentofte University Hospital, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Copenhagen, Denmark
| | - Monir Majzoub-Altweck
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany
| | - Andreas Blutke
- Institute of Veterinary Pathology, Center for Clinical Veterinary Medicine, LMU Munich, 80539 Munich, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, 40225 Dusseldorf, Germany
| | - Konstantin Stark
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Stefan Kääb
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Doris Maier
- Zentrum für Rückenmarkverletzte mit Neuro-Urologie, BG Unfallklinik Murnau, 82418 Murnau am Staffelsee, Germany
| | - Jonathan M Gibbins
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, Health and Life Sciences Building, University of Reading, RG6 6UR, UK
| | - Ulrich Limper
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany
- Department of Anesthesiology and Intensive Care Medicine, Merheim Medical Center, Hospitals of Cologne, University of Witten/Herdecke, 51109 Cologne, Germany
| | - Ole Frobert
- Faculty of Health, Department of Cardiology, Örebro University, 701 85 Örebro, Sweden
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, 8000 Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Matthias Mann
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, 82152 Martinsried, Germany
| | - Steffen Massberg
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - Tobias Petzold
- Department of Cardiology, University Hospital, LMU Munich, 81377 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, 80802 Munich, Germany
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Haum M, Humpfer F, Steffen J, Fischer J, Stocker TJ, Sadoni S, Theiss H, Braun D, Orban M, Rizas K, Massberg S, Hausleiter J, Deseive S. Quantification of physical activity with prospective activity tracking after transfemoral aortic valve replacement. Int J Cardiol 2023; 376:100-107. [PMID: 36758861 DOI: 10.1016/j.ijcard.2023.01.085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/11/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a well-established, safe and effective therapy for severe symptomatic aortic stenosis (AS). The aim of this study was to objectively quantify improvement of physical activity after TAVR, with consideration of different low-gradient AS subtypes. METHODS AND RESULTS All patients undergoing TAVR for severe AS were screened. Participants received a wearable activity tracker (Fitbit®) at hospital discharge following TAVR and 6 months thereafter. The difference of median daily steps was defined as surrogate outcome for physical activity. For analysis, patients were grouped into high-gradient (HG) AS (dPmean ≥40 mmHg), classical low-flow low-gradient (LFLG) AS (dPmean <40 mmHg, EF <50%), paradoxical LFLG-AS (dPmean <40 mmHg, EF ≥50%, SVi ≤35 ml/m2) and normal-flow low-gradient (NFLG) AS (dPmean <40 mmHg, EF ≥50%, SVi >35 ml/m2) according to mean transvalvular pressure gradient (dPmean), stroke volume index (SVi) and left-ventricular ejection fraction (LVEF). RESULTS AND CONCLUSIONS The analysis is based on 230 patients. The median daily step count was 4409 [IQR 2581-7487] after hospital discharge and 5326 [IQR 3045-8668] 6 months thereafter. Median difference of daily steps was ∆529 [IQR -702-2152]). Patients with HG-AS and paradoxical LFLG-AS showed a significant improvement of daily steps (∆951 [IQR -378-2323], p <0.001 and (∆1392 [IQR -609-4444], p = 0.02, respectively). Patients with classical LFLG-AS showed no statistically relevant improvement of daily steps (∆192 [IQR -687-770], p = 0.79). Patients with NFLG-AS showed a numerical decline in daily steps without statistical significance (∆-300 [IQR -1334-1406], p = 0.67). This first prospective study of this sample size shows significant improvement of physical activity after TAVR with an objective and reproducible method. This was mainly driven by an improvement in patients with HG-AS and paradoxical LFLG-AS.
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Affiliation(s)
- Magda Haum
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Fabian Humpfer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377 Munich, Germany.
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19
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Stolz L, Orban M, Karam N, Lubos E, Wild M, Weckbach L, Stocker TJ, Praz F, Braun D, Löw K, Hausleiter S, Stark K, Doldi P, Tence N, Orban M, Higuchi S, Haum M, Windecker S, Hagl C, Mayerle J, Näbauer M, Kalbacher D, Massberg S, Hausleiter J. Cardio-hepatic syndrome in patients undergoing transcatheter mitral valve edge-to-edge repair. Eur J Heart Fail 2023. [PMID: 36994662 DOI: 10.1002/ejhf.2842] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS The impact of the cardio-hepatic syndrome (CHS) on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for relevant mitral regurgitation (MR) is unknown. The objectives of this study were three-fold: (I) to characterize the pattern of hepatic impairment, (II) to investigate the prognostic value of CHS, and (III) to evaluate the changes in hepatic function after M-TEER. METHODS AND RESULTS Hepatic impairment was quantified by laboratory parameters of liver function. In accordance with existing literature, two types of CHS were distinguished: Ischemic type I CHS (elevation of both transaminases) and cholestatic type II CHS (elevation of two out of three parameters of hepatic cholestasis). The impact of CHS on two-year mortality was evaluated using a Cox model. The change in hepatic function after M-TEER was assessed by laboratory testing at follow-up. We analyzed 1083 patients who underwent M-TEER for relevant primary or secondary MR at four European centers between 2008 and 2019. Ischemic type I and cholestatic type II CHS were observed in 11.1% and 23.0% of patients, respectively. Predictors for two-year all-cause mortality differed by MR etiology. While in primary MR cholestatic type II CHS was independently associated with two-year mortality, ischemic CHS type I was an independent mortality predictor in SMR patients. At follow-up, patients with MR reduction ≤2+ (obtained in 90.7% of patients) presented with improved parameters of hepatic function (median reduction of 0.2mg/dl, 0.2U/l and 21U/l for bilirubin, ALT and GGT, respectively, p<0.01). CONCLUSIONS CHS is frequently observed in patients undergoing M-TEER and significantly impairs two-year survival. Successful M-TEER may have beneficial effects on CHS.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Edith Lubos
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Ludwig Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Sebastian Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Noemie Tence
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, Ludwig-Maximilians-Universität München, München, Bayern, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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20
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Schrage B, Sundermeyer J, Blankenberg S, Colson P, Eckner D, Eden M, Eitel I, Frank D, Frey N, Graf T, Kirchhof P, Kupka D, Landmesser U, Linke A, Majunke N, Mangner N, Maniuc O, Mierke J, Möbius-Winkler S, Morrow DA, Mourad M, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Radakovic D, Schulze PC, Scherer C, Schwinger RHG, Skurk C, Thiele H, Varshney A, Wechsler L, Westermann D. Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC Heart Fail 2023; 11:321-330. [PMID: 36724180 DOI: 10.1016/j.jchf.2022.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). OBJECTIVES This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS. METHODS Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation. RESULTS Overall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading. CONCLUSIONS This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
| | - Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Pascal Colson
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Matthias Eden
- Department of Internal Medicine III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Derk Frank
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; Department of Internal Medicine III-Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany; Institute of Cardiovascular Sciences, University of Birmingham and University Hospitals Birmingham and Sandwell and West Birmingham NHS Trusts, Birmingham, United Kingdom
| | - Danny Kupka
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Nicolas Majunke
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Mierke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marc Mourad
- Department of Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire Montpellier, University Montpellier, Montpellier, France
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Department of Cardiothoracic Anesthesia and Intensive Care, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sandeep M Patel
- Department of Interventional Cardiology, St. Rita's Medical Center, Lima, Ohio, USA
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Vittorio Pazzanese
- Advanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy; Intensive Cardiac Care Unit, San Raffaele Hospital, Milan, Italy
| | - Darko Radakovic
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | | | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | | | - Carsten Skurk
- Department of Cardiology, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany & German Center for Cardiovascular Research, Partner Site Berlin, Berlin, German
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Anubodh Varshney
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lukas Wechsler
- Medizinische Klinik II, Klinikum Weiden, Weiden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, University Freiburg, Freiburg, Germany.
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21
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Schrage B, Sundermeyer J, Beer BN, Bertoldi L, Bernhardt A, Blankenberg S, Dauw J, Dindane Z, Eckner D, Eitel I, Graf T, Horn P, Kirchhof P, Kluge S, Linke A, Landmesser U, Luedike P, Lüsebrink E, Mangner N, Maniuc O, Winkler SM, Nordbeck P, Orban M, Pappalardo F, Pauschinger M, Pazdernik M, Proudfoot A, Kelham M, Rassaf T, Reichenspurner H, Scherer C, Schulze PC, Schwinger RHG, Skurk C, Sramko M, Tavazzi G, Thiele H, Villanova L, Morici N, Wechsler A, Westenfeld R, Winzer E, Westermann D. Use of mechanical circulatory support in patients with non-ischaemic cardiogenic shock. Eur J Heart Fail 2023; 25:562-572. [PMID: 36781178 DOI: 10.1002/ejhf.2796] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
AIMS Despite its high incidence and mortality risk, there is no evidence-based treatment for non-ischaemic cardiogenic shock (CS). The aim of this study was to evaluate the use of mechanical circulatory support (MCS) for non-ischaemic CS treatment. METHODS AND RESULTS In this multicentre, international, retrospective study, data from 890 patients with non-ischaemic CS, defined as CS due to severe de-novo or acute-on-chronic heart failure with no need for urgent revascularization, treated with or without active MCS, were collected. The association between active MCS use and the primary endpoint of 30-day mortality was assessed in a 1:1 propensity-matched cohort. MCS was used in 386 (43%) patients. Patients treated with MCS presented with more severe CS (37% vs. 23% deteriorating CS, 30% vs. 25% in extremis CS) and had a lower left ventricular ejection fraction at baseline (21% vs. 25%). After matching, 267 patients treated with MCS were compared with 267 patients treated without MCS. In the matched cohort, MCS use was associated with a lower 30-day mortality (hazard ratio 0.76, 95% confidence interval 0.59-0.97). This finding was consistent through all tested subgroups except when CS severity was considered, indicating risk reduction especially in patients with deteriorating CS. However, complications occurred more frequently in patients with MCS; e.g. severe bleeding (16.5% vs. 6.4%) and access-site related ischaemia (6.7% vs. 0%). CONCLUSION In patients with non-ischaemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, but also with more complications. Randomized trials are needed to validate these findings.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jonas Sundermeyer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Norbert Beer
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Letizia Bertoldi
- Cardio Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Alexander Bernhardt
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Zouhir Dindane
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dennis Eckner
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | - Ingo Eitel
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tobias Graf
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Department of Intensive Care Medicine, Hamburg, Germany
| | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico Pappalardo
- Dept Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University Nürnberg, Nürnberg, Germany
| | | | - Alastair Proudfoot
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Matthew Kelham
- Department of Perioperative Medicine, St. Bartholomew's Hospital, London, UK
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Hermann Reichenspurner
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | | | | | - Carsten Skurk
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marek Sramko
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Guido Tavazzi
- Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.,Anesthesia and Intensive Care, Fondazione Policlinico San Matteo Hospital IRCCS, Pavia, Italy
| | - Holger Thiele
- Department of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Luca Villanova
- Unità di Cure Intensive Cardiologiche and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Nuccia Morici
- IRCCS Santa Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Antonia Wechsler
- Medizinische Klinik II, Kliniken Nordoberpfalz AG, Weiden, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ephraim Winzer
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center, Freiburg, Germany
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22
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Stolz L, Braun D, Higuchi S, Orban M, Doldi PM, Stocker TJ, Weckbach LT, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Transcatheter edge-to-edge mitral valve repair in mitral regurgitation: current status and future prospects. Expert Rev Med Devices 2023; 20:99-108. [PMID: 35791872 DOI: 10.1080/17434440.2022.2098013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Mitral regurgitation (MR) is associated with substantial morbidity and mortality. Within the past 15 years, mitral valve edge-to-edge repair (M-TEER) has developed from an experimental approach to a guideline-recommended, safe, and effective treatment option for patients with severe primary or secondary mitral regurgitation. AREAS COVERED This review covered relevant publications of M-TEER and summarizes the development of M-TEER devices within the last 15 years. It outlines anatomical challenges which drove the evolution of M-TEER devices, provides an overview about the current state of clinical application and research, and offers an outlook into the future of transcatheter mitral valve treatment. EXPERT OPINION The development and refinement of new M-TEER device generations offer the possibility to treat a wide range of mitral valve anatomies. Choosing the best device for the individual anatomic properties of the patients and considering comorbidities is the key to maximized MR reduction, minimalized complication rates, and thus optimized postinterventional prognosis. Independent from prognostic implications, quality of life has become an important patient-centered outcome that can be improved by M-TEER in virtually all patients treated.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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23
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Doldi PM, Stolz L, Buech J, Saha S, Weckbach L, Gmeiner J, Orban M, Braun D, Stocker TJ, Nabauer M, Lange CM, Massberg S, Hagl C, Hausleiter J. Indocyanine green clearance predicts outcome in patients undergoing transcatheter valve intervention for severe atrio-ventricular valve regurgitation. Interdiscip Cardiovasc Thorac Surg 2023; 36:7008333. [PMID: 36847676 PMCID: PMC9901415 DOI: 10.1093/icvts/ivad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Severe mitral regurgitation (MR) and tricuspid regurgitation (TR) aggravate haemodynamic stress leading to congestive heart failure with impaired hepatic function, also known as cardiohepatic syndrome (CHS). Current perioperative risk calculators do not sufficiently consider CHS and serum liver function parameters lack sensitivity to diagnose CHS. Indocyanine green and its elimination (measured by the LIMON® test) represent a dynamic and non-invasive test which correlates with the hepatic function. Nevertheless, its utility in the setting of transcatheter valve repair/replacement (TVR) to predict CHS and outcome remains unknown. METHODS We analysed liver function and outcomes of patients undergoing TVR for MR or TR between August 2020 and May 2021 at the Munich University Hospital. RESULTS Out of a total of 44 patients treated at the University Hospital of Munich, 21 (48%) were treated for severe MR, 20 (46%) for severe TR and 3 (7%) for both diseases. Procedural success defined as MR/TR ≤2+ was 94% among MR patients and 92% among TR patients. While classical serum liver function parameters did not change after TVR, there was a significant improvement in liver function as assessed by the LIMON® test (P ≤ 0.001). Patients with baseline indocyanine green plasma disappearance rate <12.95%/min showed significantly increased 1-year mortality (hazard ratio: 1.54, 95% confidence interval: 1.05-2.25, P = 0.027) and lower New York Hear Association class improvement (P = 0.05). CONCLUSIONS Especially in the context of the recently stressed importance of a careful patient selection prior to the interdisciplinary treatment of valvular heart disease, the LIMON® test may provide further real-time information on the patients' cardiohepatic injury and prognosis.
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Affiliation(s)
- Philipp Maximilian Doldi
- Corresponding author. Medizinische Klinik und Poliklinik I, Marchioninistr. 15, 81377 München, Germany. Tel: +49-89-4400-72361; fax: +49-89-4400-78870; e-mail: (P.M. Doldi)
| | - Lukas Stolz
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Joscha Buech
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Ludwig Weckbach
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jonas Gmeiner
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Nabauer
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian M Lange
- Department of Gastroenterology, Ludwig-Maximilians University Munich, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Munich, Germany
| | - Jörg Hausleiter
- Department of Cardiology, Ludwig-Maximilians University Munich, Munich, Germany,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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24
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Scherer C, Theiss H, Istrefi M, Binzenhöfer L, Kupka D, Stocker T, Lüsebrink E, Stambollxhiu E, Alemic A, Petzold T, Stark K, Deseive S, Braun D, Joskowiak D, Peterss S, Hausleiter J, Hagl C, Massberg S, Orban M. Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation-A retrospective observational study. Front Cardiovasc Med 2023; 10:1106114. [PMID: 36776253 PMCID: PMC9908581 DOI: 10.3389/fcvm.2023.1106114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. Therefore, the aim of this study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for VA-ECMO decannulation. Methods In this retrospective study, the procedural outcome of 33 patients with suture-based Perclose ProGlide closure devices was compared to 38 patients with MANTA plug-based closure devices. Results Rate of technically correct placement of closure devices was 88% in the suture-based group and 97% in the plug-based group (p = 0.27). There was a significant reduction of severe bleeding events during VA-ECMO decannulation in plug-based versus suture-based systems (3% vs. 21%, p = 0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device (p = 1.00). Pseudoaneurysm formation was detected in 3% in both groups (p = 1.00). No switch to vascular surgery due to bleeding after decannulation was necessary in both groups. Conclusion Based on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.
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Affiliation(s)
- Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany,*Correspondence: Clemens Scherer,
| | - Hans Theiss
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Mario Istrefi
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Leonhard Binzenhöfer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Danny Kupka
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Stocker
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Era Stambollxhiu
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Ahmed Alemic
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Petzold
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Konstantin Stark
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Simon Deseive
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany,Department of Cardiac Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany,German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
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25
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Löw K, Steffen J, Theiss H, Orban M, Rizas KD, Haum M, Doldi PM, Stolz L, Gmeiner J, Hagl C, Massberg S, Hausleiter J, Braun D, Deseive S. CTA-determined tricuspid annular dilatation is associated with persistence of tricuspid regurgitation after transcatheter aortic valve replacement. Clin Res Cardiol 2023; 112:645-655. [PMID: 36637479 PMCID: PMC10160207 DOI: 10.1007/s00392-023-02152-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
AIM The aim of this study was to analyse the predictive value of CTA-determined tricuspid annular dilatation (TAD) on the persistence of tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) and concomitant at least moderate TR. METHODS AND RESULTS 288 consecutive patients treated with TAVR due to severe AS and concomitant at least moderate TR at baseline were included in the analysis. As cutoff for TAD, the median value of the CTA-determined, to the body surface area-normalized tricuspid annulus diameter (25.2 mm/m2) was used. TAD had no impact on procedural characteristics or outcomes, including procedural death and technical or device failure according to the Valve Academic Research Consortium 3 criteria. However, the primary outcome of the study-TR persistence after TAVR was significantly more frequent in patients with compared to patients without TAD (odds ratio 2.60, 95% confidence interval 1.33-5.16, p < 0.01). Multivariable logistic regression analysis, adjusting for clinical and echocardiographic baseline characteristics, which are known to influence aetiology or severity of TR, confirmed TAD as an independent predictor of TR persistence after TAVR (adjusted odds ratio 2.30, 95% confidence interval 1.20-4.46, p = 0.01). Moreover, 2 year all-cause mortality was significantly higher in patients with persistence or without change of TR compared to patients with TR improvement (log-rank p < 0.01). CONCLUSION In patients undergoing TAVR for severe AS and concomitant at least moderate TR at baseline, TAD is a predictor of TR persistence, which is associated with increased 2-year all-cause mortality.
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Affiliation(s)
- Kornelia Löw
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany.,Center for Cardiovascular Diseases (DZHK), Munich Heart Alliance, Partner Site German Munich, Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany.,Center for Cardiovascular Diseases (DZHK), Munich Heart Alliance, Partner Site German Munich, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany.,Center for Cardiovascular Diseases (DZHK), Munich Heart Alliance, Partner Site German Munich, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Jonas Gmeiner
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU-Klinikum, Marchioninistr. 15, 81377, Munich, Germany.
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26
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Lüsebrink E, Scherer C, Binzenhöfer L, Hoffmann S, Höpler J, Kellnar A, Thienel M, Joskowiak D, Peterß S, Petzold T, Deseive S, Hein R, Brunner S, Kääb S, Braun D, Theiss H, Hausleiter J, Hagl C, Massberg S, Orban M. Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation. J Clin Med 2023; 12:jcm12010362. [PMID: 36615162 PMCID: PMC9821297 DOI: 10.3390/jcm12010362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated adverse drug reaction to unfractionated heparin (UFH) affecting also patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although the association between VA-ECMO support and the development of thrombocytopenia has long been known and discussed, HIT as one underlying cause is still insufficiently understood. Therefore, the purpose of this study was to further investigate the epidemiology, mortality, diagnosis, and clinical management of HIT occurring in VA-ECMO patients treated with UFH. Methods: We conducted a retrospective single-center study including adult patients (≥18 years) with VA-ECMO support in the cardiac intensive care unit (ICU) of the University Hospital of Munich (LMU) between January 2013 and May 2022, excluding patients with a known history of HIT upon admission. Differences in baseline characteristics and clinical outcome between excluded HIT (positive anti-platelet factor 4 (PF4)/heparin antibody test but negative functional assay) and confirmed HIT (positive anti-PF4/heparin antibody test and positive functional assay) VA-ECMO patients as well as diagnosis and clinical management of HIT were analysed. Results: Among the 373 patients included, anti-PF4/heparin antibodies were detected in 53/373 (14.2%) patients. Functional HIT testing confirmed HIT in 13 cases (3.5%) and excluded HIT in 40 cases (10.7%), corresponding to a prevalence of confirmed HIT of 13/373 (3.5%) [1.6, 5.3] and a positive predictive value (PPV) of 24.5% for the antibody screening test. The platelet course including platelet recovery following argatroban initiation was similar between all groups. One-month mortality in patients with excluded HIT was 14/40 (35%) and 3-month mortality 17/40 (43%), compared to 5/13 (38%) (p > 0.999), and 6/13 (46%) (p > 0.999) in patients with confirmed HIT. Neurological outcome in both groups measured by the cerebral performance category of survivors on hospital discharge was similar, as well as adverse events during VA-ECMO therapy. Conclusions: With a prevalence of 3.5%, HIT is a non-frequent complication in patients on VA-ECMO and was not associated with a higher mortality rate. HIT was ultimately excluded by functional essay in 75% of VA-ECMO patients with clinical suspicion of HIT and positive anti-PF4/heparin antibody test. Argatroban seems to be an appropriate and safe therapeutic option for confirmed HIT-positive patients on VA-ECMO support.
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Affiliation(s)
- Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
- Correspondence:
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Leonhard Binzenhöfer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Sabine Hoffmann
- Institut für Medizinische Informationsverarbeitung Biometrie und Epidemiologie, Klinikum der Universität München, 81377 Munich, Germany
| | - Julia Höpler
- Institut für Medizinische Informationsverarbeitung Biometrie und Epidemiologie, Klinikum der Universität München, 81377 Munich, Germany
| | - Antonia Kellnar
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Manuela Thienel
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Tobias Petzold
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Ralph Hein
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Stefan Brunner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Stefan Kääb
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany
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27
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Steffen J, Stocker A, Scherer C, Haum M, Fischer J, Doldi PM, Theiss H, Braun D, Rizas K, Peterß S, Hausleiter J, Massberg S, Orban M, Deseive S. Emergency transcatheter aortic valve implantation for acute heart failure due to severe aortic stenosis in critically ill patients with or without cardiogenic shock. Eur Heart J Acute Cardiovasc Care 2022; 11:877-886. [PMID: 36210517 DOI: 10.1093/ehjacc/zuac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/29/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
AIMS Severe aortic stenosis can cause acute heart failure and cardiogenic shock (CS). Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic stenosis in inoperable patients. However, its role in this setting is poorly evaluated. The study purpose was to explore clinical characteristics of these patients and to assess predictors of mortality. METHODS AND RESULTS All 2930 patients undergoing transfemoral TAVI at our centre between 2013 and 2019 were screened for critically ill patients, receiving intensive care therapy and emergency TAVI. Selected patients were subdivided into two groups, according to the presence or absence of CS. Remaining patients undergoing elective TAVI served as a comparison. Primary outcome was 90-day mortality. Out of 179 critically ill patients, 47 fulfilled criteria of CS (shock group) and 132 did not despite a severe decompensation (no shock group). Shock patients were more often male and had higher Society of Thoracic Surgeons scores [15.6, interquartile range (8.0-32.1) vs. 5.5 (3.9-8.5), P < 0.01] compared with severely decompensated patients. Ninety-day mortality was: shock group, 42.6%, vs. no shock group, 15.9%, vs. elective group, 5.3% (P < 0.01). A landmark analysis from day 90 showed similar mortality (P = 0.29). Compared with elective patients, 30-day composite endpoint device failure was higher in critically ill groups [shock group, odds ratio, 2.86 (1.43-5.36), no shock group, odds ratio, 1.74 (1.09-2.69)]. Multivariable regression revealed mechanical ventilation, haemofiltration, elevated C-reactive protein or bilirubin, and hypotension before TAVI as 90-day mortality predictors. CONCLUSION Ninety-day mortality after TAVI in critically ill patients is increased but survivors have similar outcomes as elective patients.
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Affiliation(s)
- Julius Steffen
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Angelika Stocker
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Clemens Scherer
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Magda Haum
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Julius Fischer
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Philipp M Doldi
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Daniel Braun
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Konstantinos Rizas
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Sven Peterß
- Departent of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Martin Orban
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Simon Deseive
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
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28
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Gmeiner JMD, Linnemann M, Steffen J, Scherer C, Orban M, Theiss H, Mehilli J, Sadoni S, Peterß S, Joskowiak D, Hagl C, Tsilimparis N, Curta A, Maurus S, Doldi PM, Löw K, Haum M, Roden D, Hausleiter J, Massberg S, Rizas K, Deseive S, Braun D. Dual ProGlide versus ProGlide and FemoSeal for vascular access haemostasis after transcatheter aortic valve implantation. EUROINTERVENTION 2022; 18:812-819. [PMID: 35903846 PMCID: PMC9724847 DOI: 10.4244/eij-d-22-00311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Large-bore arteriotomy for transcatheter aortic valve implantation (TAVI) requires percutaneous vascular closure devices, but real-world data comparing different closure strategies are limited. AIMS We sought to compare a dual ProGlide strategy vs a combination of one ProGlide and one FemoSeal for vascular closure after TAVI. METHODS We retrospectively analysed 874 propensity score-matched patients undergoing TAVI at the Munich University Hospital from August 2018 to October 2020. From August 2018 to August 2019, a dual ProGlide strategy was used for vascular closure. From October 2019 to October 2020, a combination of one ProGlide and one FemoSeal was used. The primary endpoint was defined as access-related major vascular complications or bleeding ≥Type 2 according to Valve Academic Research Consortium 3 criteria. RESULTS Patients in the dual ProGlide group (n=437) had a higher incidence of the primary endpoint than patients treated with one ProGlide and one FemoSeal (n=437; 11.4% vs 3.0%; p<0.001). Furthermore, they had a higher rate of closure device failure (2.7% vs 0.9%; p=0.044) and more often required unplanned surgery or endovascular treatment (3.9% vs 0.9%; p=0.004). The incidence of death did not differ significantly between groups (3.4% vs 1.6%; p=0.08). CONCLUSIONS A combined ProGlide and FemoSeal strategy might have the potential to reduce access-related vascular complications following TAVI.
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Affiliation(s)
- Jonas M D Gmeiner
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Marie Linnemann
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Julinda Mehilli
- Medizinische Klinik I, Krankenhaus Landshut Achdorf, Landshut, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum München, Munich, Germany
| | - Sven Peterß
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum München, Munich, Germany
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum München, Munich, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum München, Munich, Germany
| | | | - Adrian Curta
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Munich, Germany
| | - Stefan Maurus
- Klinik und Poliklinik für Radiologie, LMU Klinikum München, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Daniel Roden
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
- Munich Heart Alliance, German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum München, Munich, Germany
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29
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Lüsebrink E, Binzenhöfer L, Kellnar A, Scherer C, Schier J, Kleeberger J, Stocker TJ, Peterss S, Hagl C, Stark K, Petzold T, Fichtner S, Braun D, Kääb S, Brunner S, Theiss H, Hausleiter J, Massberg S, Orban M. Targeted Temperature Management in Postresuscitation Care After Incorporating Results of the TTM2 Trial. J Am Heart Assoc 2022; 11:e026539. [DOI: 10.1161/jaha.122.026539] [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: 11/16/2022]
Abstract
Cardiac arrest still accounts for a substantial proportion of cardiovascular related deaths and is associated with a tremendous risk of neurological injury and, among the few survivors, poor quality of life. Critical determinants of survival and long‐term functional status after cardiac arrest are timely initiation of cardiopulmonary resuscitation and use of an external defibrillator for patients with a shockable rhythm. Outcomes are still far from satisfactory, despite ongoing efforts to improve cardiac arrest response systems, as well as elaborate postresuscitation algorithms. Targeted temperature management at the wide range between 32 °C and 36 °C has been one of the main therapeutic strategies to improve neurological outcome in postresuscitation care. This recommendation has been mainly based on 2 small randomized trials that were published 20 years ago. Most recent data derived from the TTM2 (Targeted Hypothermia Versus Targeted Normothermia After Out‐of‐Hospital Cardiac Arrest) trial, which included 1861 patients, challenge this strategy. It showed no benefit of targeted hypothermia at 33 °C over normothermia at 36 °C to 37.5 °C with fever prevention. Because temperature management at lower temperatures also correlated with an increased risk of side effects without any benefit in the TTM2 trial, a modification of the guidelines with harmonizing temperature management to normothermia might be necessary.
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Affiliation(s)
- Enzo Lüsebrink
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Leonhard Binzenhöfer
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Antonia Kellnar
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Clemens Scherer
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Johannes Schier
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Jan Kleeberger
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Thomas J. Stocker
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik Klinikum der Universität München Munich Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik Klinikum der Universität München Munich Germany
| | - Konstantin Stark
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Tobias Petzold
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Stephanie Fichtner
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Daniel Braun
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Stefan Kääb
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Stefan Brunner
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Hans Theiss
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Jörg Hausleiter
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Steffen Massberg
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
| | - Martin Orban
- Cardiac Intensive Care Unit Medizinische Klinik und Poliklinik I, Klinikum der Universität München Munich Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance Munich Germany
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30
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Stolz L, Doldi PM, Weckbach LT, Stocker TJ, Braun D, Orban M, Wild MG, Hagl C, Massberg S, Näbauer M, Hausleiter J, Orban M. Right ventricular function in transcatheter mitral and tricuspid valve edge-to-edge repair. Front Cardiovasc Med 2022; 9:993618. [PMID: 36312295 PMCID: PMC9596758 DOI: 10.3389/fcvm.2022.993618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Since transcatheter edge-to-edge repair (TEER) has become a valuable therapy in the treatment of both, mitral (MR) and tricuspid regurgitation (TR), the question of optimized patient selection has gained growing importance. After years of attributing rather little attention to the right ventricle (RV) and its function in the setting of valvular heart failure, this neglect has recently changed. The present review sought to summarize anatomy and function of the RV in a clinical context and aimed at presenting the current knowledge on how the RV influences outcomes after TEER for atrioventricular regurgitation. The anatomy of the RV is determined by its unique shape, which necessitates to use three-dimensional imaging methods for detailed and comprehensive characterization. Complex parameters such as RV to pulmonary artery coupling (RVPAc) have been developed to combine information of RV function and afterload which is primary determined by the pulmonary vasculature and LV filling pressure. Beyond that, TR, which is closely related to RV function also plays an important role in the setting of TEER. While mitral valve transcatheter edge-to-edge repair (M-TEER) leads to reduction of concomitant TR in some patients, the prognostic value of TR in the setting of M-TEER remains unclear. Overall, this review summarizes the current state of knowledge of the outstanding role of RV function and associated TR in the setting of TEER and outlines the unsolved questions associated with right-sided heart failure.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,*Correspondence: Lukas Stolz,
| | - Philipp M. Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ludwig T. Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mirjam G. Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Christian Hagl
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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31
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Scherer C, Endres S, Orban M, Kaeaeb S, Massberg S, Winter A, Loebe M. Implementation of a clinical trial recruitment support system based on fast healthcare interoperability resources (FHIR) in a cardiology department. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2795] [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
Clinical Trial Recruitment Support Systems can booster patient inclusion of clinical trials by automatically analyzing eligibility criteria based on electronic health records. However, missing interoperability has hindered introduction of those systems on a broader scale.
Purpose
Our aim was to develop a recruitment support system based on FHIR R4 and evaluate its usage and features in a cardiology department.
Methods/Implementation
Clinical conditions, anamnesis, examinations, allergies, medication, laboratory data and echocardiography results were imported as FHIR resources. Trial study nurses and physicians were enabled to add new and edit trial information and input inclusion and exclusion criteria using a web-browser user interface in the hospital intranet. All information were recorded on the server side as the FHIR resources “ResearchStudy” and “Group”. Eligibility criteria linked by the logical operation “OR” were represented by using multiple FHIR Group resources for enrollment. On the client side, eligibility criteria were transformed to a tree-like structure (see Figure 1). Upon user demand, all hospitalized and ambulatory patients in the cardiology department were instantly screened for trial eligibility using the FHIR eligibility criteria on the existing patients' FHIR resources. Furthermore, study personal was able to manually edit trial status (i.e. ineligible, on-study, ...) of patients, which was implemented using the FHIR resource “ResearchSubject”.
Results
This implementation of a CTRSS based on FHIR R4 was evaluated in clinical practice: Beginning from 1st April 2021 the application was used as an additional patient screening tool for the four trials CLOSURE-AF, FAIR-HF2, SPRIRIT-HF and TORCH-PLUS of the German Centre for Cardiovascular Research. As the COVID-19 pandemic is prohibiting any proper comparison of patient inclusion rates, efficacy of the recruitment support system was tested by comparing the numbers of patients identified by the recruitment support system and enrolled in a trial to the actual number of enrolled patients irrespective of the screening method from 1st April 2021 to 23rd November 2021. The system was able to identify 52 of 55 patients included in those four clinical trials.
Conclusion
Use of FHIR for defining eligibility criteria of clinical trials may facilitate interoperability and allow automatic screening for eligible patients at multiple sites of different healthcare providers in the future. Upcoming changes in FHIR should allow easier description of “OR”-linked eligibility criteria.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
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Affiliation(s)
- C Scherer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Endres
- Ludwig-Maximilians University , Munich , Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Kaeaeb
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - A Winter
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology , Leipzig , Germany
| | - M Loebe
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
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Loew K, Steffen J, Theiss H, Orban M, Rizas K, Hagl C, Massberg S, Hausleiter J, Braun D, Deseive S. CT-determined tricuspid annular dilatation is associated with persistence of tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1652] [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
Moderate or severe tricuspid regurgitation (TR) can be observed in 11% to 27% of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Even though in most patients an improvement of TR can be achieved after TAVR, the persistence of severe or massive TR after the procedure is associated with increased all-cause mortality.
Purpose
The aim of this study was to investigate if tricuspid annular dilatation (TAD) measured in pre-procedural CT among TAVR patients who had at least moderate TR at baseline could serve as a predictor for the persistence of TR. Moreover, the predictive value of TR persistence on the composite of 2-year mortality or tricuspid valve intervention was analysed.
Methods
We examined 151 patients with severe AS and at least moderate concomitant TR at baseline, who were treated with TAVR from April 2013 to December 2019. TR persistence was defined as the same or a higher grade of TR in the follow-up echocardiography at least 30 days after the procedure compared to preprocedural TR grade. To identify patients with TAD, the maximum septolateral diameter of the tricuspid annulus was measured in pre-procedural cardiac computed tomography images and normalized to the body surface area.
Results
The median value of 25.5 mm/m2 was determined as cut-off value for TAD. Out of 151 patients with moderate or more TR before TAVR, 75 patients (49.7%) were above the threshold of 25.5 mm/m2. Improvement of TR after TAVR of at least one grade was significantly more frequent in patients without TAD than with TAD (59% vs. 32%, corresponding odds ratio for persistence of TR: 3.06, 95% confidence interval: 1.50–6.35, p=0.001) (Figure 1A). Multivariable logistic regression analysis with adjustment for baseline TR severity confirmed that the predictive value of TAD for TR persistence after TAVR was irrespective of baseline TR (adjusted odds ratio: 2.79, 95% confidence interval: 1.42–5.59, p=0.003). Tricuspid valve intervention was conducted in 11 patients with TAD after TAVR (14.6%) and in no patients without TAD. Accordingly, at 2-years, tricuspid valve intervention-free survival was lowest among patients with TAD and persistent TR (Figure 1B).
Conclusion
Our analysis demonstrates for the first time that in patients undergoing TAVR for severe AS and at least moderate concomitant TR, CT-derived TAD is associated with persistence of TR after the procedure. Furthermore, TR persistence is associated with an adverse outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Loew
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - J Steffen
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - H Theiss
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - M Orban
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - K Rizas
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - C Hagl
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - S Massberg
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - J Hausleiter
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - D Braun
- Clinic of the University of Munich Grosshadern , Munich , Germany
| | - S Deseive
- Clinic of the University of Munich Grosshadern , Munich , Germany
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Scherer C, Theiss H, Istrefi M, Stocker TJ, Kupka D, Luesebrink E, Hausleiter J, Hagl C, Massberg S, Orban M. Suture-based vs. pure plug-based vascular closure devices for VA-ECMO decannulation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1502] [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
VA-ECMO is a valuable treatment option for patients in cardiogenic shock, but complications during decannulation may worsen the overall outcome. To date, no larger study has ever compared suture-based to pure plug-based vessel closure devices for VA-ECMO decannulation.
Purpose
The aim of the study was to compare the efficacy and safety of suture-based to pure plug-based vascular closure devices for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation for patients with cardiogenic shock.
Methods
In this retrospective study, the outcome of 33 patients with suture-based closure devices implanted between 02/2019 to 05/2020 were compared to 38 patients with plug-based closured device implanted between 06/2020 to 11/2021.
Results
Closure device success rate was 88% in the suture-based group versus 97% in the plug-based group (Figure 1, p=0.27). Median number of devices used was two for patients with suture-based closure device and 1 for patients with plug-based closure device (p<0.01). Severe bleeding was more frequent in the suture-based (21%) compared to the plug-based group (3%) (Figure 2, p=0.04). Ischemic complications occurred in 6% with suture-based and 5% with plug-based device (p=1.00). Pseudoaneurysm formation was detected in 3% in both groups (p=1.00). Application of the femoral compression system was required in 27% of patient with suture-based closure device and 11% of patients with plug-based closure device (p=0.13). No switch to open vascular surgery due to closure device failure occurred in both groups.
Conclusions
Based on our retrospective analysis, we propose that plug-based vascular closure should be the preferred option for VA-ECMO decannulation. This hypothesis should be further tested in a randomized trial.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
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Affiliation(s)
- C Scherer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - H Theiss
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - M Istrefi
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - T J Stocker
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - D Kupka
- University Hospital Zurich, Department of Medical Oncology and Hematology , Zurich , Switzerland
| | - E Luesebrink
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - C Hagl
- Ludwig-Maximilians University, Department of Cardiac Surgery , Munich , Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
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Schrage B, Sundermeyer J, Blankenberg S, Eitel I, Kirchhof P, Mangner N, Moebius-Winkler S, Orban M, Thiele H, Morrow DA, Schulze PC, Westermann D. Timing of active left ventricular unloading in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aim
To evaluate the impact of timing of active left ventricular (LV) unloading in relation to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation on outcomes of patients with cardiogenic shock (CS).
Methods and results
Data from 421 patients with CS treated with active LV unloading on top of VA-ECMO at 18 tertiary-care centers in 4 countries were collected. Only patients in whom both devices were implanted within 24 hours of each other were considered and patients were stratified by timing of device implantation in early vs. delayed active LV unloading (e.g. active LV unloading before vs. after VA-ECMO). Cox and logistic regression models (adjusted for age, sex, lactate, cardiopulmonary resuscitation (CPR), VA-ECMO assisted CPR and enrollment center) were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as several safety outcomes.
Overall, 310 (73.6%) patients were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (hazard ratio 0.63, 95% confidence interval 0.46–0.87) and a higher likelihood of weaning from mechanical ventilation (odds ratio 1.25, 95% confidence interval 1.03–1.52), but not with more complications. Importantly, postponing active LV unloading in these patients was associated with higher mortality risk (Figure 1), and lower likelihood of successful weaning from mechanical ventilation.
Conclusion
This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO as a primary treatment strategy, as opposed to a bail-out approach.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Unrestricted research grant from Abiomed
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Affiliation(s)
- B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - I Eitel
- University Heart Center , Luebeck , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | | | - M Orban
- University Hospital of Munich , Munich , Germany
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D A Morrow
- Brigham and Women's Hospital , Boston , United States of America
| | | | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
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Stolz L, Weckbach L, Doldi P, Orban M, Braun D, Stocker T, Higuchi S, Orban M, Wild M, Massberg S, Hagl C, Naebauer M, Hausleiter J. Right ventricular reverse remodeling after mitral valve transcatheter edge-to-edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2119] [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
Right ventricular dysfunction (RVD) is an important predictor for outcome in patients undergoing transcatheter mitral or tricuspid valve edge-to-edge repair (M/T-TEER). Due to the unique anatomy and contraction pattern of the RV, three-dimensional echocardiography (3DE) has emerged as a valuable tool in the assessment of RV function. While 3DE data showed RV reverse remodeling (RVRR) following T-TEER, respective data are absent in the setting of M-TEER.
Purpose
We sought to assess RVRR after M-TEER using 3DE comparing baseline and follow-up RV measurements.
Methods
Patients undergoing M-TEER treatment for relevant MR between August 2016 and February 2021 with eligible transthoracic 3DE of the RV at baseline and follow-up were included in the study. 3DE comprised RV end-diastolic and end-systolic volumes (RVEDV3D, RVESV3D), total RV stroke volume (RVSV3D) and RV ejection fraction (RVEF3D). Further, RV length (RVL3D) as well as RV basal (RVbase3D) and mid-ventricular diameters (RVmid3D) were derived from 3DE. RVRR was assessed as change in the respective 3DE parameters of RV dimensions between baseline and follow-up.
Results
A total of 66 patients (45.5% female; age 78.5±8.2 years; EuroScore II 4.6±3.6%) were included in the study. From baseline to latest available follow-up (median interval 364 days, interquartile range 180–728 days), a significant reduction of RVEDV3D and RVESV3D was observed (RVEDV3D 140.2±50.2 ml to 128.1±46.1 ml, p<0.01 and RVESV3D 93.1±37.8ml to 87.1±34.7ml, p=0.04). The decrease in 3D-derived linear RV dimensions primarily occurred in the septolateral direction, while RV length did not change significantly. The observed RVRR was associated with significant reduction of TR severity. Of note, patients with RVRR showed also left ventricular reverse remodeling (LVRR).
Conclusion
M-TEER is an effective treatment option for patients with MR which leads to LVRR and RVRR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - L Weckbach
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - P Doldi
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - M Orban
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - D Braun
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - T Stocker
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - S Higuchi
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - M Orban
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - M Wild
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - C Hagl
- Clinic of the University of Munich Großhadern, Herzchirurgische Klinik und Poliklinik , Munich , Germany
| | - M Naebauer
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
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Schrage B, Sundermeyer J, Blankenberg S, Graf T, Kirchhof P, Luedike P, Nordbeck P, Proudfoot A, Orban M, Skurk C, Tavazzi G, Thiele H, Winzer EB, Westenfeld R, Westermann D. Use of mechanical circulatory support in patients with non-ischemic cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The aim of this study was to evaluate mechanical circulatory support (MCS) for the treatment of non-ischemic cardiogenic shock (CS).
Methods
Data from 1,030 consecutive patients with non-ischemic CS treated with or without MCS at 16 tertiary-care centers were retrospectively collected. The association between MCS and 30-day mortality was assessed in a 1:1 propensity score matched cohort.
Results
MCS was used in 406 (39%) patients. MCS treated patients presented with more severe CS (lactate 5.4 vs. 4.1 mmol/l, systolic blood pressure 80 vs. 83 mmHg, higher SCAI class) and with more disease modifiers (prior cardiac arrest 42.4 vs. 36.1%, mechanical ventilation 78.4 vs. 56.5%). After matching, 272 patients treated with were compared vs. 272 patients treated without MCS. MCS was associated with a lower 30-day mortality (hazard ratio 0.77, 95% confidence interval 0.60–0.98, Figure 1). This finding was consistent through all tested sub-groups except when ejection fraction was considered, indicating an association especially in patients with an ejection fraction ≤20%. Complications occurred more frequently in patients with MCS; e.g. severe bleedings (21.8 vs. 9.2%) and access-site related ischemia (6.6 vs. 0%).
Conclusion
In patients with non-ischemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, particularly in patients with a lower ejection fraction. This provides rationale for randomized trials to validate these findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Schrage
- University Heart Centre Hamburg , Hamburg , Germany
| | | | | | - T Graf
- Schleswig-Holstein University Clinic, Lubeck Campus , Luebeck , Germany
| | - P Kirchhof
- University Heart Centre Hamburg , Hamburg , Germany
| | - P Luedike
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - P Nordbeck
- University Hospital of Wurzburg , Würzburg , Germany
| | - A Proudfoot
- Barts Heart Centre , London , United Kingdom
| | - M Orban
- University Hospital of Munich , Munich , Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin , Berlin , Germany
| | | | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - E B Winzer
- Dresden University Heart Center , Dresden , Germany
| | - R Westenfeld
- Heinrich Heine University , Duesseldorf , Germany
| | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
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Scherer C, Kleeberger J, Kellnar A, Binzenhoefer L, Luesebrink E, Stocker TJ, Thienel M, Deseive S, Braun D, Petzold T, Brunner S, Hagl C, Hausleiter J, Massberg S, Orban M. Propofol versus midazolam sedation in patients with cardiogenic shock – an observational propensity-matched study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1498] [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
Benzodiazepines are recommended as first line sedative agent in ventilated cardiogenic shock patients, although data regarding the optimal sedation strategy are sparse. On our cardiac ICU, midazolam was used as first line sedation until 2016, whereas soybean oil formulated propofol was used preferentially since 2017.
Purpose
The aim of this study was to investigate the hemodynamic effects of propofol versus midazolam sedation in our cardiogenic shock registry.
Methods
Mechanically ventilated patients suffering from cardiogenic shock were retrospectively enrolled from a cardiogenic shock registry. 174 patients treated predominantly with propofol were matched by propensity-score to 174 patients treated predominantly with midazolam.
Results
Catecholamine doses were similar on admission but significantly lower in the propofol group on days 1–4 of ICU stay (Figure 1). Mortality rate was 38% in the propofol and 52% in the midazolam group after 30 days (p=0.002, Figure 2). Rate of ≥BARC3 bleeding was significantly lower in the propofol group compared to the midazolam group (p=0.008). Age, gender, first lactate measured on ICU, first GFR measured on ICU, cardiac arrest, coaxial left ventricular assist device and sedation with midazolam were significantly associated with ICU mortality.
Conclusion
In this observational cohort study, sedation with propofol in comparison to midazolam was linked to a reduced dose of catecholamines, decreased mortality and bleeding rates for patients with cardiogenic shock. Based on this study and in contrast to current recommendations, propofol should be given consideration for sedation in cardiogenic shock patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft
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Affiliation(s)
- C Scherer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - J Kleeberger
- University Hospital Zurich, Department of Internal Medicine , Zurich , Switzerland
| | - A Kellnar
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - L Binzenhoefer
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - E Luesebrink
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - T J Stocker
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - M Thienel
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Deseive
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - D Braun
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - T Petzold
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Brunner
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - C Hagl
- Ludwig-Maximilians University, Department of Cardiac Surgery , Munich , Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Cardiology , Munich , Germany
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Sundermeyer J, Beer BN, Blankenberg S, Kirchhof P, Luedike P, Mangner N, Nordbeck P, Orban M, Pazdernik M, Proudfoot A, Schulze PC, Tavazzi G, Thiele H, Westermann D, Schrage B. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1013] [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
Evidence in non-ischaemic cardiogenic shock (CS), especially regarding prognostic markers and use of mechanical circulatory support (MCS), is scarce.
Aim
The aim of this study was to evaluate left ventricular ejection fraction (LVEF) as a prognostic marker as well as a factor to guide the use of MCS in non-ischaemic CS.
Methods
In this international observational study, patients with non-ischaemic CS (e.g. caused by severe de-novo or acute on chronic heart failure; but not by acute myocardial infarction) treated with or without MCS from 18 tertiary-care centers in five countries were enrolled. Cox regression models adjusted for age, sex, SCAI class, lactate, prior resuscitation, mechanical ventilation and pH were fitted to evaluate the association between LVEF and 30-day mortality as well as the interaction between MCS use, LVEF and 30-day mortality.
Results
A total of 807 patients were enrolled, of whom 387 (47,9%) were treated with and 418 (52.1%) without MCS; mean age was 63 [interquartile range (IQR) 51.5–72) years, 601 (74.5%) were male, 486 (60.2%) had acute on chronic heart failure, 221 (32.7%) had an ischaemic cardiomyopathy and 277 (34.5%) had prior cardiac arrest. The baseline LVEF was 20 (IQR 15–30) % and baseline lactate was 4.9 (IQR 2.6–8.5) mmol/l.
There was no significant association between LVEF and 30-day mortality risk [hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.74–1.22 if LVEF was considered as a continuous variable; HR 1.09, 95% CI 0.83–1.44 if LVEF was considered as a categorical variable with ≤20% vs. >20%]. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with a depressed LVEF (HR 0.74, 95% CI 0.52–1.05, interaction-p = 0.04).
Conclusion
In this retrospective, multicenter, international study of patients with non-ischaemic CS, LVEF was not a predictor of 30-day mortality risk. However, we observed a significant interaction between MCS use and LVEF, indicating a lower morality risk with MCS use only in patients with a depressed LVEF. This provides rationale to use LVEF as a parameter to guide MCS therapy in non-ischaemic CS, and calls for a randomized trial on this topic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - B N Beer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Luedike
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | - P Nordbeck
- University Hospital of Wurzburg, Department of Internal Medicine I, , Würzburg , Germany
| | - M Orban
- University Hospital of Munich , Munich , Germany
| | - M Pazdernik
- Institute for Clinical and Experimental Medicine , Prague , Czechia
| | - A Proudfoot
- St Bartholomew's Hospital , London , United Kingdom
| | | | - G Tavazzi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
| | - B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
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Steffen J, Andreae D, Haum M, Fischer J, Doldi P, Peterss S, Hausleiter J, Rizas K, Braun D, Orban M, Nabauer M, Massberg S, Deseive S. Characteristics and outcomes of normal-flow low-gradient aortic stenosis patients compared to high-gradient aortic stenosis patients undergoing TAVI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1559] [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
Guidelines recommend aortic valve replacement for aortic stenosis (AS) depending on mean pressure gradients (dPmean) and flow status. It is indicated when dPmean is ≥40 mmHg (high-gradient, HG) or when patients have low-flow low-gradient AS. Normal-flow (stroke volume index, SVi >35 ml/m2) low-gradient (dPmean <40 mmHg) (NFLG) AS is subject of scientific debate and severe AS is considered unlikely in current European guidelines.
Purpose
We hypothesized that NFLG patients are heterogenous, containing a subgroup similar to HG patients in terms of characteristics and outcomes. The purpose of this study was to identify and assess this subgroup by dividing NFLG patients by dPmean.
Methods
All patients undergoing transcatheter aortic valve implantation (TAVI) at our centre between 2013 and 2019 were analysed and categorised into groups according to dPmean, left-ventricular ejection fraction, and SVi. Among 2,326 patients analysed, 386 patients fulfilled criteria for NFLG AS (dPmean <40 mmHg, LV-EF ≥50%, SVi >35 ml/m2). They were further subdivided into two groups according to the median dPmean and were compared to 956 HG AS patients (dPmean ≥40 mmHg). Groups were compared for baseline characteristics, mortality, and outcomes according to Valve Academic Research Consortium (VARC) 3 definitions.
Results
Median dPmean was 33 mmHg in NFLG patients. Accordingly, they were split into two groups, with 204 patients above (higher gradient NFLG) and 182 patients below (lower gradient NFLG) this value. Characteristics of lower gradient NFLG patients differed from HG patients in many aspects while they were similar between higher gradient NFLG and HG patients. This was underscored by higher Society of Thoracic Surgeons (STS) scores in lower gradient NFLG compared to the other two groups (Table).
Procedural and short-term clinical complications were similar between groups. The VARC-3 composite endpoint of technical failure occurred in 42 HG (4.4%), 12 higher gradient NFLG (5.9%), and 5 lower gradient NFLG patients (2.7%, p=0.32). The rates of the VARC-3 composite endpoint of device failure at 30 days were 108 patients (11.3%), 21 patients (10.3%), and 17 patients (9.3%), respectively (p=0.71). At follow-up, symptoms of patients from all three groups improved equally by at least one New York Heart Association class (p=0.47). Hazard ratio (HR) for 3-year mortality for all NFLG patients vs. HG patients was 1.4 [95% confidence interval, CI, 1.1–1.8]. Estimated 3-year all-cause mortality was significantly higher in lower gradient NFLG compared to HG patients, whereas mortality rate of higher gradient NFLG was similar to HG (Figure).
Conclusions
The data show that a large subgroup of NFLG patients has characteristics similar to those of HG patients, with similar clinical and procedural outcomes and comparable mortality rates. If severe AS was identified as the main clinical problem in this subgroup, aortic valve replacement can be justified.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Steffen
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - D Andreae
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - M Haum
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - J Fischer
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - P Doldi
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - S Peterss
- Ludwig-Maximilians University, Department of Heart Surgery , Munich , Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - K Rizas
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - D Braun
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - M Orban
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - M Nabauer
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - S Massberg
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
| | - S Deseive
- Ludwig-Maximilians University, Department of Medicine I , Munich , Germany
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Orban M, Kuehl A, Dischl D, Müller C, Ulrich S, Petzold T, Rizas KD, Orban M, Braun D, Hausleiter J, Hagl C, Mehilli J, Massberg S. Fibrotic plaques in heart transplanted patients and their association with insulin resistance syndrome and Lp(a). Int J Cardiol 2022; 363:218-224. [PMID: 35772579 DOI: 10.1016/j.ijcard.2022.06.062] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Angiographic evidence of cardiac allograft vasculopathy (CAVangio) is a major limiting factor to survival after heart transplantation (HTx). Prevention of CAVangio is therefore most relevant. Whether modifiable risk factors could be targeted for the prevention of fibrotic plaques, that are common and related to CAVangio, is not clear. METHODS AND RESULTS In a cohort of 74 consecutive HTx patients (median post-transplant interval 9.2 [4.1-15.5] years), we used the high resolution of optical coherence tomography (OCT) to quantify angulation parameters (maximal and mean arc) and plaque load (mean arc*relative plaque length) of fibrotic plaques. Mean arc was defined as the mean value of all angulation measurements per patient. We assessed the association between cardiovascular risk factors and OCT findings. Linear regression analysis showed a significant association of TG/HDL-c with mean fibrotic arc (12.7 [3.9-21.5], p = 0.006) and fibrotic plaque load (2298 [617-3979], p = 0.009) after adjustment for recipient age and sex. We used the median value of fibrotic plaque load to define high fibrotic plaque load. In binary logistic regression analysis, TG/HDL-c (odds ratio [OR] 1.81 with 95% CI [1.09-3.03], p = 0.02) and Lp(a) (OR 1.02 [1.00-1.05], p = 0.02) were associated with high fibrotic plaque load. Multivariable logistic regression analysis confirmed Lp(a) as significant predictor of high fibrotic plaque load (OR 1.03 [1.01-1.05], p = 0.02). CONCLUSION TG/HDL-c ratio, a surrogate of insulin resistance syndrome, and Lp(a) were significantly associated with fibrotic plaque in HTx patients. Insulin resistance syndrome and Lp(a) might therefore represent additional targets for CAV prevention.
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Affiliation(s)
- Madeleine Orban
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany.
| | - Anne Kuehl
- Department of Medicine I, University Hospital, LMU Munich, Germany
| | - Dominic Dischl
- Department of Medicine I, University Hospital, LMU Munich, Germany
| | - Christoph Müller
- Department of Heart Surgery, University Hospital, LMU Munich, Germany
| | - Sarah Ulrich
- Department of Paediatric Cardiology and Intensive Care Medicine, University Hospital, LMU Munich, Germany
| | - Tobias Petzold
- Department of Medicine I, University Hospital, LMU Munich, Germany
| | - Konstantinos D Rizas
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Germany
| | - Daniel Braun
- Department of Medicine I, University Hospital, LMU Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Christian Hagl
- Department of Heart Surgery, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Julinda Mehilli
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany
| | - Steffen Massberg
- Department of Medicine I, University Hospital, LMU Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Berlin, Germany
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41
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Lüsebrink E, Binzenhöfer L, Kellnar A, Müller C, Scherer C, Schrage B, Joskowiak D, Petzold T, Braun D, Brunner S, Peterss S, Hausleiter J, Zimmer S, Born F, Westermann D, Thiele H, Schäfer A, Hagl C, Massberg S, Orban M. Venting during venoarterial extracorporeal membrane oxygenation. Clin Res Cardiol 2022; 112:464-505. [PMID: 35986750 PMCID: PMC10050067 DOI: 10.1007/s00392-022-02069-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/12/2022] [Indexed: 11/03/2022]
Abstract
AbstractCardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics—possibly with concomitant pulmonary congestion and even lung failure—and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option.
Graphical abstract
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Pöss J, Sinning C, Schreiner I, Apfelbacher C, Drewitz KP, Hösler N, Schneider S, Pieske B, Böttiger BW, Ewen S, Wienbergen H, Kelm M, Bock D, Graf T, Adler C, Dutzmann J, Knie W, Orban M, Zeymer U, Michels G, Thiele H. German Cardiac Arrest Registry: rationale and design of G-CAR. Clin Res Cardiol 2022; 112:455-463. [PMID: 35729429 PMCID: PMC10050030 DOI: 10.1007/s00392-022-02044-9] [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: 04/10/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Germany, 70,000-100,000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquisition of the treatment course and of the outcome of OHCA patients is warranted. STUDY DESIGN The German Cardiac Arrest Registry (G-CAR) is an observational, prospective, multicentre registry. It will determine the characteristics, initial treatment strategies, invasive procedures, revascularisation therapies and the use of mechanical circulatory support devices with a focus on extracorporeal cardiopulmonary resuscitation. A special feature is the prospective 12-month follow-up evaluating mortality, neurological outcomes and several patient-reported outcomes in the psychosocial domain (health-related quality of life, cognitive impairment, depression/anxiety, post-traumatic stress disorder and social reintegration). In a pilot phase of 24 months, 15 centres will include approximately 400 consecutive OHCA patients ≥ 18 years. Parallel to and after the pilot phase, scaling up of G-CAR to a national level is envisaged. CONCLUSION G-CAR is the first national registry including a long-term follow-up for adult OHCA patients. Primary aim is a better understanding of the determinants of acute and long-term outcomes with the perspective of an optimised treatment. TRIAL REGISTRY NCT05142124. German Cardiac Arrest Registry (G-CAR).
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Affiliation(s)
- Janine Pöss
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany.
| | | | - Isabelle Schreiner
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany
| | | | | | | | | | - Burkert Pieske
- Charité University Medicine, Campus Virchow Klinikum and German Heart Center and Berlin Brandenburger Center for Regenerative Therapies (BCRT) of the Berlin Institute of Health (BIH), Berlin, Germany
| | - Bernd W Böttiger
- Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | | | - Malte Kelm
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Daniel Bock
- Klinikum Frankfurt Höchst GmbH, Frankfurt am Main, Germany
| | - Tobias Graf
- University Heart Center Lübeck, Lübeck, Germany
| | - Christoph Adler
- Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Wulf Knie
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Martin Orban
- Klinikum der Universität München and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Uwe Zeymer
- Institut Für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | | | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Strümpellstr. 39, 04289, Leipzig, Germany
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Doldi P, Steffen J, Orban M, Theiss H, Sadoni S, Hagl C, Massberg S, Hausleiter J, Deseive S, Braun D. Clinical Outcome Following Transcatheter Aortic Valve Implantation in Patients With Chronic Obstructive Pulmonary Disease. JACC Cardiovasc Interv 2022; 15:1188-1190. [PMID: 35680203 DOI: 10.1016/j.jcin.2022.03.017] [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] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
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Lüsebrink E, Zimmer S, Schrage B, Dabboura S, Majunke N, Scherer C, Aksoy A, Krogmann A, Hoffmann S, Szczanowicz L, Binzenhöfer L, Peterss S, Kühn C, Hagl C, Massberg S, Schäfer A, Thiele H, Westermann D, Orban M. Intracranial haemorrhage in adult patients on venoarterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care 2022; 11:303-311. [PMID: 35213724 DOI: 10.1093/ehjacc/zuac018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/15/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
AIMS Intracranial haemorrhage (ICH) is one of the most serious complications of adult patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with increased morbidity and mortality. However, the prevalence and risk factors of ICH in this cohort are still insufficiently understood. We hypothesized that a considerable proportion of patients undergoing VA-ECMO support suffer from ICH and that specific risk factors are associated with the occurrence of ICH. Therefore, the purpose of this study was to further investigate the prevalence and associated mortality as well as to identify risk factors for ICH in VA-ECMO patients. METHODS AND RESULTS We conducted a retrospective multicentre study including adult patients (≥18 years) treated with VA-ECMO in cardiac intensive care units (ICUs) at five German clinical sites between January 2016 and March 2020, excluding patients with ICH upon admission. Differences in baseline characteristics and clinical outcome between VA-ECMO patients with and without ICH were analysed and risk factors for ICH were identified. Among the 598 patients included, 70/598 (12%) developed ICH during VA-ECMO treatment. In-hospital mortality in patients with ICH was 57/70 (81%) and 1-month mortality 60/70 (86%), compared to 332/528 (63%) (P = 0.002) and 340/528 (64%) (P < 0.001), respectively, in patients without ICH. Intracranial haemorrhage was positively associated with diabetes mellitus [odds ratio (OR) 2, 95% confidence interval (CI) 1.11-3.56; P = 0.020] and lactate (per mmol/L) (OR 1.06, 95% CI 1.01-1.11; P = 0.020), and negatively associated with platelet count (per 100 G/L) (OR 0.32, 95% CI 0.15-0.59; P = 0.001) and fibrinogen (per 100 mg/dL) (OR 0.64, 95% CI 0.49-0.83; P < 0.001). CONCLUSION Intracranial haemorrhage was associated with a significantly higher mortality rate. Diabetes mellitus and lactate were positively, platelet count, and fibrinogen level negatively associated with the occurrence of ICH. Thus, platelet count and fibrinogen level were revealed as potentially modifiable, independent risk factors for ICH. The findings address an area with limited data, provide information about risk factors and the epidemiology of ICH, and may be a starting point for further investigations to develop effective strategies to prevent and treat ICH.
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Affiliation(s)
- Enzo Lüsebrink
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Salim Dabboura
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nicolas Majunke
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Clemens Scherer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Adem Aksoy
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexander Krogmann
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilians Universität München, Munich, Germany
| | - Lukasz Szczanowicz
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Leonhard Binzenhöfer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Christian Kühn
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinischen Hochschule Hannover, Hannover, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
| | - Andreas Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Martin Orban
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistraße 15, 81377 Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart Alliance, Munich, Germany
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Scherer C, Endres S, Orban M, Kääb S, Massberg S, Winter A, Löbe M. Implementation of a Clinical Trial Recruitment Support System Based on Fast Healthcare Interoperability Resources (FHIR) in a Cardiology Department. Stud Health Technol Inform 2022; 294:440-444. [PMID: 35612118 DOI: 10.3233/shti220497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Clinical Trial Recruitment Support Systems can booster patient inclusion of clinical trials by automatically analyzing eligibility criteria based on electronic health records. However, missing interoperability has hindered introduction of those systems on a broader scale. Therefore, our aim was to develop a recruitment support system based on FHIR R4 and evaluate its usage and features in a cardiology department. Clinical conditions, anamnesis, examinations, allergies, medication, laboratory data and echocardiography results were imported as FHIR resources. Clinical trial information, eligibility criteria and recruitment status were recorded using the appropriate FHIR resources without extensions. Eligibility criteria linked by the logical operation "OR" were represented by using multiple FHIR Group resources for enrollment. The system was able to identify 52 of 55 patients included in four clinical trials. In conclusion, use of FHIR for defining eligibility criteria of clinical trials may facilitate interoperability and allow automatic screening for eligible patients at multiple sites of different healthcare providers in the future. Upcoming changes in FHIR should allow easier description of "OR"-linked eligibility criteria.
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Affiliation(s)
- Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Department of Medicine I, University Hospital, LMU Munich
| | - Stephan Endres
- Medical Technology and IT (MIT), University Hospital, LMU Munich, Munich, Germany
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Department of Medicine I, University Hospital, LMU Munich
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Department of Medicine I, University Hospital, LMU Munich
| | - Steffen Massberg
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Department of Medicine I, University Hospital, LMU Munich
| | - Alfred Winter
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Matthias Löbe
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
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Scherer C, Lüsebrink E, Binzenhöfer L, Stocker TJ, Kupka D, Chung HP, Stambollxhiu E, Alemic A, Kellnar A, Deseive S, Stark K, Petzold T, Hagl C, Hausleiter J, Massberg S, Orban M. Incidence and Outcome of Patients with Cardiogenic Shock and Detection of Herpes Simplex Virus in the Lower Respiratory Tract. J Clin Med 2022; 11:jcm11092351. [PMID: 35566477 PMCID: PMC9105969 DOI: 10.3390/jcm11092351] [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] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
(1) Herpes simplex virus (HSV) reactivation in critically ill patients can cause infection in the lower respiratory tract, prolonging mechanical ventilation. However, the association of HSV reactivation with cardiogenic shock (CS) is unclear. As CS is often accompanied by pulmonary congestion and reduced immune system activity, the aim of our study was to determine the incidence and outcome of HSV reactivation in these patients. (2) In this retrospective, single-center study, bronchial lavage (BL) was performed on 181 out of 837 CS patients with mechanical ventilation. (3) In 44 of those patients, HSV was detected with a median time interval of 11 days since intubation. The occurrence of HSV was associated with an increase in C-reactive protein and the fraction of inspired oxygen at the time of HSV detection. Arterial hypertension, bilirubin on ICU admission, the duration of mechanical ventilation and out-of-hospital cardiac arrest were associated with HSV reactivation. (4) HSV reactivation could be detected in 24.3% of patients with CS on whom BL was performed, and its occurrence should be considered in patients with prolonged mechanical ventilation. Due to the limited current evidence, the initiation of treatment for these patients remains an individual choice. Dedicated randomized studies are necessary to investigate the efficacy of antiviral therapy.
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Affiliation(s)
- Clemens Scherer
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Enzo Lüsebrink
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Leonhard Binzenhöfer
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Thomas J. Stocker
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Danny Kupka
- Department of Medical Oncology and Hematology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Hieu Phan Chung
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
| | - Era Stambollxhiu
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
| | - Ahmed Alemic
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
| | - Antonia Kellnar
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Simon Deseive
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Konstantin Stark
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Tobias Petzold
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Christian Hagl
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
- Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Jörg Hausleiter
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Steffen Massberg
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
| | - Martin Orban
- Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (E.L.); (L.B.); (T.J.S.); (H.P.C.); (E.S.); (A.A.); (A.K.); (S.D.); (K.S.); (T.P.); (J.H.); (S.M.)
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany;
- Correspondence: ; Tel.: +49-89-4400-0
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Lüsebrink E, Kellnar A, Krieg K, Binzenhöfer L, Scherer C, Zimmer S, Schrage B, Fichtner S, Petzold T, Braun D, Peterss S, Brunner S, Hagl C, Westermann D, Hausleiter J, Massberg S, Thiele H, Schäfer A, Orban M. Percutaneous Transvalvular Microaxial Flow Pump Support in Cardiology. Circulation 2022; 145:1254-1284. [PMID: 35436135 DOI: 10.1161/circulationaha.121.058229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Impella device (Impella, Abiomed, Danvers, MA) is a percutaneous transvalvular microaxial flow pump that is currently used for (1) cardiogenic shock, (2) left ventricular unloading (combination of venoarterial extracorporeal membrane oxygenation and Impella concept), (3) high-risk percutaneous coronary interventions, (4) ablation of ventricular tachycardia, and (5) treatment of right ventricular failure. Impella-assisted forward blood flow increased mean arterial pressure and cardiac output, peripheral tissue perfusion, and coronary blood flow in observational studies and some randomized trials. However, because of the need for large-bore femoral access (14 F for the commonly used Impella CP device) and anticoagulation, the incidences of bleeding and ischemic complications are as much as 44% and 18%, respectively. Hemolysis is reported in as many as 32% of patients and stroke in as many as 13%. Despite the rapidly growing use of the Impella device, there are still insufficient data on its effect on outcome and complications on the basis of large, adequately powered randomized controlled trials. The only 2 small and also underpowered randomized controlled trials in cardiogenic shock comparing Impella versus intra-aortic balloon pump did not show improved mortality. Several larger randomized controlled trials are currently recruiting patients or are in preparation in cardiogenic shock (DanGer Shock [Danish-German Cardiogenic Shock Trial; NCT01633502]), left ventricular unloading (DTU-STEMI [Door-To-Unload in ST-Segment-Elevation Myocardial Infarction; NCT03947619], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO], and REVERSE [A Prospective Randomised Trial of Early LV Venting Using Impella CP for Recovery in Patients With Cardiogenic Shock Managed With VA ECMO; NCT03431467]) and high-risk percutaneous coronary intervention (PROTECT IV [Impella-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function; NCT04763200]).
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Affiliation(s)
- Enzo Lüsebrink
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Antonia Kellnar
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Kathrin Krieg
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Leonhard Binzenhöfer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Clemens Scherer
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Germany (S.Z.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, and German Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck (B.S.)
| | - Stephanie Fichtner
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Tobias Petzold
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Daniel Braun
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik (S.P., C.H.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Stefan Brunner
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik (S.P., C.H.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg, Germany (D.W.)
| | - Jörg Hausleiter
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Steffen Massberg
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Germany (H.T.)
| | - Andreas Schäfer
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Germany (A.S.)
| | - Martin Orban
- Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I (E.L., A.K., K.K., L.B., C.S., S.F., T.P., D.B., S.B., J.H., S.M., M.O.), Klinikum der Universität München, and German Center for Cardiovascular Research, partner site Munich Heart Alliance
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Orban M, Dietl M, Dischl D, von Samson-Himmelstjerna P, Neubarth-Mayer J, Strüven A, Tengler A, Jakob A, Fischer M, Rizas K, Petzold T, Orban M, Braun D, Hausleiter J, Hagl C, Haas NA, Mehilli J, Pozza RD, Massberg S, Ulrich S. Assessment of sex- and age-dependency of risk factors for intimal hyperplasia in heart transplant patients using the high resolution of optical coherence tomography. Int J Cardiol 2022; 358:17-24. [DOI: 10.1016/j.ijcard.2022.04.042] [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] [Received: 12/02/2021] [Revised: 02/26/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
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Steffen J, Reißig N, Andreae D, Beckmann M, Haum M, Fischer J, Theiss H, Braun D, Orban M, Rizas K, Sadoni S, Näbauer M, Peterss S, Hausleiter J, Massberg S, Deseive S. TAVI in patients with low-flow low-gradient aortic stenosis-short-term and long-term outcomes. Clin Res Cardiol 2022; 111:1325-1335. [PMID: 35320407 DOI: 10.1007/s00392-022-02011-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The study objective was to characterize different groups of low-flow low-gradient (LFLG) aortic stenosis (AS) and determine short-term outcomes and long-term mortality according to Valve Academic Research Consortium-3 (VARC-3) endpoint definitions. BACKGROUND Characteristics and outcomes of patients with LFLG AS undergoing transcatheter aortic valve implantation (TAVI) are poorly understood. METHODS All patients undergoing TAVI at our center between 2013 and 2019 were screened. Patients were divided into three groups according to mean pressure gradient (dPmean), ejection fraction (LVEF), and stroke volume index (SVi): high gradient (HG) AS (dPmean ≥ 40 mmHg), classical LFLG (cLFLG) AS (dPmean < 40 mmHg, LVEF < 50%), and paradoxical LFLG (pLFLG) AS (dPmean < 40 mmHg, LVEF ≥ 50%, SVi ≤ 35 ml/m2). RESULTS We included 1776 patients (956 HG, 447 cLFLG, and 373 pLFLG patients). Most baseline characteristics differed significantly. Median Society of Thoracic Surgeons (STS) score was highest in cLFLG, followed by pLFLG and HG patients (5.0, 3.9 and 3.0, respectively, p < 0.01). Compared to HG patients, odds ratios for the short-term VARC-3 composite endpoints, technical failure (cLFLG, 0.76 [95% confidence interval, 0.40-1.36], pLFLG, 1.37 [0.79-2.31]) and device failure (cLFLG, 1.06 [0.74-1.49], pLFLG, 0.97 [0.66-1.41]) were similar, without relevant differences within LFLG patients. NYHA classes improved equally in all groups. Compared to HG, LFLG patients had a higher 3-year all-cause mortality (STS score-adjusted hazard ratios, cLFLG 2.16 [1.77-2.64], pLFLG 1.53 [1.22-193]), as well as cardiovascular mortality (cLFLG, 2.88 [2.15-3.84], pLFLG, 2.08 [1.50-2.87]). CONCLUSIONS While 3-year mortality remains high after TAVI in LFLG compared to HG patients, symptoms improve in all subsets after TAVI.
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Affiliation(s)
- Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Nikolas Reißig
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - David Andreae
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Markus Beckmann
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.
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50
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Doldi PM, Stolz L, Escher F, Steffen J, Gmeiner J, Roden D, Linnemann M, Löw K, Deseive S, Stocker TJ, Orban M, Theiss H, Rizas K, Curta A, Sadoni S, Buech J, Joskowiak D, Peterss S, Hagl C, Massberg S, Hausleiter J, Braun D. Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View. J Clin Med 2022; 11:jcm11061561. [PMID: 35329887 PMCID: PMC8953752 DOI: 10.3390/jcm11061561] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/20/2021] [Revised: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 01/27/2023] Open
Abstract
Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.
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Affiliation(s)
- Philipp Maximilian Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
- Correspondence:
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Felix Escher
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, 81377 Munich, Germany; (F.E.); (A.C.)
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Jonas Gmeiner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Daniel Roden
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Marie Linnemann
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Thomas J. Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Adrian Curta
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, 81377 Munich, Germany; (F.E.); (A.C.)
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Joscha Buech
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Dominik Joskowiak
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, 81377 Munich, Germany; (S.S.); (J.B.); (D.J.); (S.P.); (C.H.)
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, 81377 Munich, Germany; (L.S.); (J.S.); (J.G.); (D.R.); (M.L.); (K.L.); (S.D.); (T.J.S.); (M.O.); (H.T.); (K.R.); (S.M.); (J.H.); (D.B.)
- German Center for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
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